Sunday, October 27, 2013

12-Hour Challenge 10/27/2013

The prompt was to imagine a dream job - one you want, or one you see someone in and think, "Man. They've got it made!" Imagine that job, and then imagine a bad day at that job.

There's a part of me that has been wishing and wishing that instead of getting some liberal arts degree and remaining comfortably lodged in my government career, that I had gotten out of the Navy and gone to medical school. I'd be in Syria now, patching people up. Being under constant strain. Missing the crap out of my family, but making sure someone else's family members would make it.

It wasn't hard to imagine the bad day - there were so many options to choose from.



I was halfway through my 12-hour shift. It had been the normal things; what you expect in a situation like this: lots of gunshot wounds, no shrapnel unless there’s an explosion. Today it was thighs, and I was grateful and angry, but mostly grateful. So long as they missed the femoral artery and the femur itself wasn't too badly splintered, these guys were mostly going to make it. Guys, Jesus. Kids. Women. Children. And guys. But mostly not. I had talked to my colleagues, and it wasn't just my imagination: those bastards are targeting civilians, and they're playing a game: throats one day, thighs the next. Three days ago it was shoulders.

Good days are few and far between. I had a good day a couple of weeks ago. Everyone I saw, I had the supplies I needed to treat them. No one came in that unexpectedly didn't make it. Only two were too far gone to save (one kid had died on his way here). More folks walked out of here than walked in, freeing desperately needed beds. All the needs are desperate. Not enough beds. Not enough medicine. Not enough people. Never enough people. It just never quits.

Yesterday wasn't too terrible, but it wasn't a good day. No big explosions, but also no miraculous cures. We got supplies in two days ago, so nothing was too short… it’s just, like I said, yesterday it was throats. Lots of sewing esophagi back together, and more blood transfusions than I can count. Remove foreign bodies. Stitch lacerations. Close wounds. Scrub. Throats bleed a lot, even if the bullet manages to miss the major arteries. One was a little kid. The guy who brought her in said she had been trying to get to school. Her dad didn't make it; she’s still here. Such a tiny little throat, and so much damage.

Normally, I work at an inner-city hospital as an emergency surgeon. I'm a general surgeon, so, I have to be ready to do surgery on anything. It’s not like my college friends, who specialized in orthopedic surgery – they get to work 9-5, weekends and holidays off most of the time, they rarely see anything too terrible, or something that can't be fixed.

“Hey, Doc.” It’s Ziyad, one of the nationals working with us as a nurse. He had joined up about a month ago.
“Another arrival? I swear I'm almost done…” I had been plowing through the plate of whatever that I was given in the cafeteria tent. It’s usually rice with some chicken or beef or something and some lettuce and tomatoes. I'm pretty laid back most of the time, but I’m hard and fast about my eating. I need the nutrients to keep going, to keep saving life after life, so I insist on meal breaks when needed.
“Naw – it’s still quiet. Just hoping you had a cigarette?”

I passed him one. I don't smoke in the states. Shifts in my ER are 12 hours on and 12 hours off, and after three shifts on, you get some days off. There’s usually a good bit of down-time during a shift. There’s never the kind of carnage there is out here. And back in the states… People look at you funny, if you smoke wearing scrubs. Here, everyone smokes, and they smoke all the time.

One of the guys I was in med school with was from Sudan. His parents moved to Chicago when he was in high school. They got into an accident in their first week in the states, and were astonished at the quality of the hospitals here. He kept saying how much he wished they had that level of care back home. We found out about Doctors Without Borders and I just knew we had to sign up. We come out for 6 months, and go home for 6. He and I happen to be off-set – Idris left last month and was replaced with Eric.

I put my Styrofoam plate in the trash bag tied to the tent-pole, drained my water-bottle, grabbed another one and headed outside. May as well smoke while there’s time.

The suddenness of the explosion made me stumble. Yup. Exactly enough time for a cigarette and a scrub-down. Eric ran past me, yelling something about scrubbing. He'd get used to it, eventually. Hopefully, sooner rather than later – his high-strung jumpiness was wearing on my patience, and I worried about his ability to focus during surgery. You have to find your Zen place. The place where nothing else matters besides fixing the brokenness in front of you as fast as you can.

I finished scrubbing up just as the victims started coming in. The nurses that were working with us may have started off lacking some training, but nothing will get you up to speed like disaster. After two years, we had the routine down. Eric and I would move from bed to bed at the direction of the nurses – mostly nationals – who would have triaged the victims. I took a steadying breath, found my Zen place. Remove foreign bodies. Stitch lacerations. Close wounds. Scrub.

Remove foreign bodies. Stitch lacerations. Close wounds. Scrub. At some point, I realized there were more of us. The other two surgeons must have woken up because of the blast and come in. Anything big like that, and it’s not like you'd be sleeping anyway. Remove foreign bodies. Stitch lacerations. Close wounds. Scrub. Extra-long days for everyone.

Ziyad, the guy who had bummed a cigarette earlier, started walking me to the next victim.

“Allah al-musti’an,” he muttered as we passed the still-long line of victims waiting to be triaged. God help us indeed. “We are drowning in these Shi’a,” he lamented as we prepared for the next surgery. I shot him a sharp look – bringing sectarian bias into the environment was strictly forbidden – but the look was all there was time for. Remove foreign bodies. Stitch lacerations. Close wounds. Scrub.

I passed Eric, working furiously on an abdomen. Had he found his Zen place? He looked pale and scared. So did the surgeon from the other shift working on an arm across from him. Did I look like that, too? Remove foreign bodies. Stitch lacerations. Close wounds. Scrub.

I glanced at the clock, but it didn’t make sense. The numbers couldn’t mean anything. Remove foreign bodies. Stitch lacerations. Close wounds. Scrub.

The next victim just had a little shrapnel in his lower legs. The nurses probably could have handled this. Remove foreign bodies. Stitch lacerations. Close wounds. Scrub. And then it was over. The remaining victims all had very minor injuries that the nurses were wrapping up.

I went out for a cigarette with Ziyad and Eric and a couple of others and tried to make sense of my watch. It took a few drags, but I figured it out. I had been on shift for almost 16 hours. I had eight hours to get home, shower, and sleep before the start of my next shift. I left Eric and Ziyad, and dragged myself to my near-by apartment.

Something was niggling at me, but I was too tired to put a finger on it.

My eyes had only been closed a moment when my alarm went off, followed by the call of the muezzin. Dawn already. I grabbed an energy shot from my stash, and put another two into my pockets. I got to the hospital and started checking up on the folks who had stayed overnight. Everyone was doing well, but this environment wasn't nearly as sterile as it should be – they'd need to be watched closely for signs of infection.

“Hey, Eric.” I greeted my shift-mate. He looked even more tired than I felt. I considered what he'd be like, wound as tight as he already is, with an energy shot piled on top, and tossed him one anyway. “Crazy day, huh?”
“Yeah.” Eric looked thoughtful, for once more concerned than panicked. “All these attacks… You think all these folks are shi’ites? I mean, it seems like in Iraq, it’s all divided by neighborhood. Do you think it’s like that here?”
“I don't know.” I hadn't been keeping up with the news as well as I should have been. “This area? I don’t think so. Maybe it’s getting that way? But I'm pretty sure not all of these victims are Shi’ites. Why?” That niggling feeling was back. Something was off.
“Oh. Something someone said yesterday.”
“Jeeze. You remember yesterday? It’s still all such a blur. What do you think today will be?”
Eric looked unhappy. Maybe a poor choice of small-talk on my part. “I guess we'll find out.” He downed the last of his energy shot and I took a last drag as a car sped into the lot nearest the hospital. It looked like arms, maybe hands. It’d be a lot of work, but fewer casualties, I hoped.

Ziyad wasn't around, which was too bad. I was actually starting to warm up to the guy. His attitude wasn't the greatest, but he really busted and got a lot done. Being a local resident, he got weekends. For me, it’s 6 months of hell. When I get home, I'll take a couple weeks off, then get back to my job. For these guys… I mean, they live here, you know?

The next victim came in, helped by someone else, but walking. He had been on his way to work. Yup. It was hands. Remove foreign bodies. Stitch lacerations. Close wounds. Scrub. Smoke. Eat some breakfast (some kind of bean dish and eggs). Another car pulled up and another victim jumped out. I was scrubbing up when I heard the explosion. Two days in a row. This isn't good. At least it’s earlier in my shift. Maybe I can go home on time today.

It seemed like fewer victims this time, but it still seemed like a never-ending stream. Remove foreign bodies. Stitch lacerations. Close wounds. Scrub. I grabbed coffee, food, and energy drinks where I could. Remove foreign bodies. Stitch lacerations. Close wounds. Scrub. I went home only an hour late, feeling bad for the guys on the other shift. They had come in after only three hours’ sleep. It all balances in the end, though. Or it doesn’t. Keeping score is too hard, and we'd be trading shifts in another 2 weeks, anyway.

The next day, Ziyad wasn't in again. I asked Eric about it.

He looked uncomfortable. Ziyad had been killed in the explosion, he told me. The only one who had died in that explosion. Then it made sense, kind of. Maybe helping all those other victims was his way of making up for what he knew he'd do, just a little bit. I wondered about the other nurses, the Syrians we were working with.

Doctors Without Borders. We're not supposed to be political – we just go in and do what we can to put people back together. But how can we stay neutral in an area where everything – your neighborhood, your faith, even your name – is political? And how long before the hospital full of wounded Shi’ites and the doctors trying to save them is itself a target? 

Hopefully, it never will. In the meantime, I've still got two more months. Remove foreign bodies. Stitch lacerations. Close wounds. Scrub.

Thursday, October 10, 2013

My Dream is an Allegory

We went to Chesapeake Bay. It looked a lot like Monterey Bay, but grayer. It was the Navy base there, right on the water. It was like a Navy recreation area. On the left side were kayaks, and then paddle boats, and then the swimming area, where we were, roped off for safety.

We swam out into the deep water because it was. Because it was warm. Because the sun was shining. Because fish. Because we could. But then, the sky darkened, and all the people went away, and the swells grew. Beautiful swells, like chutes and ladders, like water slides, like rolling hills you take at a dead run because you have legs. We were way past the ropes.

"What about rip tides?!" He shouted at me. "WHAT?" I yelled, looking over my shoulder as I swam. I checked on my daughter, and my son, and looked back to the front. There it was, nestled between swells, like a snake, silvery and smooth. "RIP TIDE!!!" We were being swept out to the sea, but we knew what to do. "We have to swim ACROSS it!" I yelled back to my daughter, my son, my husband. "WHAT?" "Swim - ACROSS - it!!!"

So we swam and swam. The water was cooling down, churning, graying, and we were getting tired. I looked back, over my shoulder, checked on my daughter, my son, my husband. My son was flagging. So tired. I could feel the adrenaline starting to fight through the cold water and exhaustion. And then I saw his head. It popped out of the water, laughing and winking, and dove beneath the surface. He swam fast, like a dolphin, and caught up. So tired. We kept swimming.

We finally got to the floating dock where the water was all plants at the bottom and the kayaks were tied up, by the shore where it was calm, and the sand was topped with some cement embankment under the water. To stop erosion? Maybe.

Two cars were parked there. Sedans. They were visiting sailors on the base and  didn't realize about the tide, that it goes out, and comes back in. In one of the cars, a couple had fallen asleep after making out. They had jumped out of the car when the cold water on their legs woke them up. The cars were ruined. Insurance wouldn't cover that.

Here we were on the dock, floating, with its little floating empty office. How to get to our car? It was so far away, and we were so tired. We could walk, but we couldn't get there from here, and it was so far. We could swim, but my arms were like jelly. My whole body rebelled at the thought of more swimming.