Monday, August 21, 2006

Beach to beach, cont'd


I figured out right away what had happened: a rocket had, by pure chance, hit my barracks -- slammed into the revetment protecting the bottom floor of the two-story building. It turns out there was far less damage than you'd conclude from the crash and the subsequent chaotic yelling. My mental inventory made note of a pretty painful shoulder, and some blood dripping into my right eye. Dripping, not flowing: I was ok. I got up and out, checked the hall and, seeing no obvious carnage, headed downstairs. The building was dark, and it was nighttime outside. In front of the door lay a guy familiar to me but unknown by name. He was rocking slowly and moaning. "Get a flashlight!" I said to an onlooker. "Get an ambulance here!" I said to another. Meantime, I could see blood on the man's shirt, by his left shoulder. Tearing open his shirt by the neck, I saw that part of his shoulder was missing; when the flashlight arrived, it was apparent that it was bleeding pretty briskly. I took off my shirt and shoved it into the wound, applying firm pressure. That was it. Nothing more I could do until the ambulance showed up, which it did in a few more minutes. I rode with the man to the clinic, helped unload him and get him inside. After clamping and ligating a couple of vessels, and exchanging my shirt for some disinfectant-soaked gauze, I wrapped the shoulder as tightly as possible while a medic got a couple of IVs in. Meanwhile, someone was calling for a chopper. A quick check-over revealed a few more shrapnel wounds, on his buttock and belly. Given our lack of facilities, and his stability at this point, I just documented what I found for the docs at the evac hospital and sent him on his way.

There were a few other casualties; wounds needing cleansing and suturing, taking up a couple of hours. Finally, as the dust was fully settled, I began to pay attention to the fact that my own shoulder hurt like hell. Broken clavicle, as it turned out. Poor timing, given that in a few days I was scheduled for a week's leave in Hong Kong, with my wife scheduled to meet me there. Well, where there's a will, as they say, there's a way...

I called the Army hospital next day to find out how the man was doing. The news shocked me: he'd died in surgery to repair internal abdominal injuries from the shrapnel. I wasn't able to track down the surgeon; the nurse with whom I spoke didn't know the whole story. Even now, I can't imagine what it could have been, given how stable he'd been while at our base. As I said in the previous post, I had it better than most in Vietnam, and didn't handle many major injuries, at least not initially (I was in charge of the medevac flights to Japan, and saw lots of injured in that role, but they'd been stabilized enough to make the flight.) So that man's death bothered me a lot; and again when I saw his name on the subsequent casualty list. And today, miles and years away, I can't remember his name at all.

I only had one GI die in front of me, and I can't remember his name either. It was toward the end of my tour of duty. Because the US was bugging out, we'd had to leave Danang in rather a hurry, as the North Vietnamese made their way relentlessly south, though our base and not long thereafter, to Saigon. We ended up in Thailand, at a hastily re-opened air base in a little town called Takhli, the downtown of which went from one or two bars to fifty literally overnight. With that, of course, came rampant venereal disease. We'd arrived at the base before much in the way of equipment (can you believe it? The military sending undersupplied soldiers to a place?) so we set up shop using cots for exam tables, empty boxes for chairs and desks. We had plenty of penicillin, a few other drugs, virtually no machinery. So when a poor soul developed anaphylaxis (severe allergic reaction, prominent in which is airway constriction), we (and he) were up a creek. We did have a laryngoscope (for passing a breathing tube into the airway) and I managed to intubate his trachea and start squeezing oxygen into him, but it was increasingly difficult as his bronchioles (the smallest airway branches) shut down one by one. Ten by ten. Thousand by thousand. Epinephrine was given to open the airways; at some point I stabbed it directly into his heart (like in Pulp Fiction). But he clearly wasn't responding. We had no heart monitor, no defibrillator, but it became obvious that he was heading toward cardiac arrest. I looked around the empty and echoing room, and in desperation grabbed a lamp and ripped out the electrical cord. Not being much of an electrophysiologist, thinking maybe it would give his heart a jolt, I peeled the wires, plugged in the plug, and touched the raw ends to opposite sides of his left chest. Made his pectoral muscle jump, not much else. And then it was over. How, I wondered as I looked at him lying there, his underwear showing the green stain of his gonorrheal discharge, would we inform his family back in the world?

At this point, I feel I should say something: I think my beach-blogging isn't up to whatever standards I might have had, blogging from home. I don't want to wear out my wifi welcome by taking the time to provide links to words or ideas; so I'm saving the "deeper" posts for later. My war stories aren't as glamorous as some, but I have a few more that might be instructive. Hope you'll understand. And keep coming back anyway; it'll get better, at least in my view, after I return home.

7 comments:

Jordan said...

Thailand huh? you and my father might have crossed paths.

Bryan said...

Wow! Every day I check your blog hoping for another installment of your writing. I'm going to HAVE to get your book! I love the tales of surgery (particularly the trauma a SICU). But there is something that sets you apart from a lot of bloggers - medical and otherwise. You can WRITE. Not just the ability to puts words into sentences and tell a story, but the art of stringing words and phrases together into art. Beautiful descriptions that transport me away from my pc and stir my emotions! Wonderful!

Ali said...

I disagree with you - I think these last entries have been interesting and stirring. Thanks for sharing.

Intelinurse2B said...

I have really enjoyed you last few posts. I agree w/ Bryan, your gift for storytelling via the written word is quite good. I often am halfway down the page, engrossed in a scene, before I realize how much I have read.

Moof said...

Dr. Schwab, I don't see a problem with these last posts. I'm really enjoying them! I hope you'll keep them coming!

And Bryan ... definitely get the book! It's more than worth it!

Good Guy said...

Good info

http://drugs-about.com/ing/epinephrine.html

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Regards,

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