This is the final article I wrote about Afganistan, also intended for publication in the newspaper. This is not for the kiddos.
The alarm clock begins beeping, signaling the start of another day. It’s only been a few hours since he closed his eyes, but for Capt. Robert Austin of the U.S. Air Force, there is no sleeping in, no matter how tired he is. “Service Before Self” is one of the three key tenets of the Air Force, and this deployment has provided an exceptional opportunity to live that tenet.
Austin, a Nurse Anesthetist deployed from Travis Air Force Base in Northern California is a Nurse Anesthetist with the 455th Expeditionary Medical Group at Craig Joint Theater Hospital, Bagram Air Base, Afghanistan.
He says, “On paper, we only work 8 hour shifts. I’m usually at the hospital 12-14 hours a day, minimum. So many of our patients require so much that we often have 2 providers in the room, or we are busy enough that we end up staying over to help cover the cases.” He is referring to the nearly 300 anesthetics he has provided or helped with in the past 6 months.
“My last day off was the day I got here, December 21st,” He smiles and jokes, “My next will be the day I go home.”
The hospital cares for a large majority of the American troops wounded in theater, as well as Afghan National Police, Afghan military, and local nationals. He explains, “Bagram is the primary hub for evacuation to Germany. No matter where in country you are injured, you will most likely come through this facility on your way out.”
Accurate numbers were not available, but Austin estimates that the facility averages 10 surgeries a day, ranging from laparoscopic appendectomies and gall bladder extractions to multi-specialty, multi-hour cases. "We have specialties here that you’ll only find at large hospitals stateside. Neurosurgical services, pediatric orthopedics, vascular surgeons, ophthalmological surgeons. We have it all. Often we’ll have one surgery with 4 or 5 services scrubbed in. It can be very hectic."
One of the surgeries that stands out in his mind is a Polish patient early in the deployment. “I started his case one evening and took it back over and finished it the next day. He was in surgery for over 18 hours. He had Ortho, General Surgery, Neuro, and I believe, Urology, all working on him.”
Such extensive surgeries are the exception, not the rule, fortunately. Unfortunately, the signature injury of the war, amputation of both lower extremities and one hand with or without groin injury are seen almost daily, and are increasing in frequency. “These patients are the hardest,” says Austin. “Usually we are not the first to see them. By the time they get to us, they have already sustained not only their original injury, but the first of what will be multiple surgeries. They are the recipients of massive transfusions.”
‘Massive transfusion’ refers to when a patient receives more than 10 units of blood products. The average circulating volume of the human body is 5 liters. 10 units of blood products comes close to completely replacing that volume.
“We recently had a patient who had received 70 units of packed red blood cells (pRBCs), 64 units of Fresh Frozen Plasma (FFP), 21 units of whole blood, 4 10-packs of cryoprecipitate and 5 6-packs of platelets before he got to us. He had the equivalent of 14 people’s entire blood volumes for one surgery. We took him back to surgery, gave him another 8 units of whole blood, 8 pRBCs, 13 FFP, 3 10-packs of cryoprecipitate and 5 more 6 packs of platelets, or about another 4 blood volumes, just for the revision and washout of his injuries. He’s facing probably another 20 or more surgeries over the next few months, and then years worth of recovery and physical therapy.”
Austin says he wonders about how well these patients will do. “We’ll never see these guys again. I have no idea if they will recover and adjust to life without three limbs, or if they will die of infection, or what. It’s hard.”
Some patients exhibit a spirit that reassures him. “We had one guy who had lost a leg. He had to go back to surgery for a washout of his injury. After surgery he was in a lot of pain, both physically and emotionally. He was really struggling with accepting his injury. One of the ICU nurses told me the next day he was gonna be ok. I asked her how she knew and she shared a joke with me that he had told her that night.
‘Where does a man with only one leg go for breakfast? IHOP!’ If you can joke about it, you’re probably going to be all right.”
There are other patients that Austin will never forget either, the ones who didn’t survive. Speaking of the first patient who died while in the operating room under his care, Austin says, “I carry a lot of guilt,” he says. “They died under my care. While I can know that I did everything right, that we all did, it doesn’t change the fact that we lost him. We tried until it was apparent that he wasn’t going to make it, and then we kept trying. There were four anesthesia providers working on him and six surgeons. At one point there were over 20 people in the room, all contributing to try and keep this soldier alive. He had the best of the best giving it their best, and it wasn’t enough.”
Austin says he is glad he’s going home soon. “I have been privileged to care for our troops, but it’s someone else’s turn. The cost is of caring for these boys is high, mentally and emotionally, not just for me, but for my family as well. I’m looking forward to being reunited with them, and to my upcoming PCS.” Austin will be moving to Elmendorf AFB in Anchorage later this summer.
No comments:
Post a Comment
Feel free to comment as you wish. Remember that my kids will read these too, and conduct yourself appropriately. Thanks.