Army Dentistry

This post was written almost a year ago and describes 3 of the most emotionally difficult days of my deployment.  I waited for the right time to post this, but the time never came. I guess now is as good a time as ever. These events are how I recall them and were written immediately after they took place:

The other night at 0130 I was awakened to the loudspeaker announcement “ATTENTION ON THE FOB: ALL B POSITIVE BLOOD DONORS REPORT TO THE AID STATION IMMEDIATELY.”  Disoriented,  I sat up and waited to hear it again, as I couldn’t quite make out what the voice said. Sure enough, they wanted all B + personnel down there ASAP. I jumped out of bed, grabbed my weapon, and beat feet the 100 meters or so to the aid station not knowing what I was going to walk into.

There was already a handful of half-dressed, sleepy-eyed soldiers and contractors waiting. People were running around, clearing chairs, scurrying about. I asked someone what was going on: “IED, sir. 5 casualties. Three are heading to the OR right now.”  They needed five units of B positive apparently.

Within five minutes I was laying on a table with a garden hose in my arm draining me of my precious B+. I hoped that my blood would somehow work miracles on whoever it was that was so in desperate need of it not 20 feet away. A few minutes later we were done, a lab tech came and grabbed the bag and ran a couple of quick tests and took that tomato colored juice bag of blood next door to the operating room.

“First guys dead.” I heard a SGT say. “They’re prepping the next guy for surgery.”

I didn’t know whether my blood made it into the first or the second guy, but I like to think my hemoglobin carried some oxygen to another man’s tissues. I hoped my blood gave at least one of them a fighting chance.

For those who don’t know me, I don’t usually give blood. I am not opposed, I just don’t tolerate it well. Every time I donate blood I experience orthostatic hypotension when I stand up and if no one is around, I hit the floor. Hard. I guess that is something you don’t grow out of.

As expected, I got very pale apparently. Someone got me a chair and some water. I downed the water and grabbed some Ho-ho’s I had stashed in the fridge. I sat in the hall for a good five to ten minutes waiting to absorb some of the fluid I just drank. I watched as they wheeled the second guy into the OR. In my head I wished them the best. I wanted to stand up and help, but I knew I would pass out if I did.

0630 came a lot faster than I had hoped. I was exhausted. I had not gotten back to bed until after 0230. I made it to the clinic around 0750 and inquired about the patients from last night. Two out of three didn’t make it through surgery. The third survived and was in our ICU recovering.

This is the third or fourth time this has happened since I have been here. I was honored to be able to help by giving blood that went straight into the operating room but I wish there was no need for the blood.  Sadly though, this is becoming my world. This is where I live. This is the crap that goes down in my neighborhood.

PART II: The following evening I was waiting in my office for a friend. We were heading up to the roof to smoke some cigars. Out of nowhere one of the surgeons from the Forward Surgical Team pops her head in and says “Im glad I found you! We have a guy coming in with a gunshot wound to the jaw. Would you mind helping us out?”

I spent three hours that night in the operating room assisting a neck dissection on a young man who took several rounds to the head and neck region. One of these bullets went in through his left parotid gland and came out on his neck about three inches below his left ear. Another bullet appeared to enter just anterior to the sternocleidomastoid and exited the back of his neck. This is the luckiest man in the world as not one of those bullets hit an artery, nerve, or vein. Just muscle. We dissected all the way down past the carotid to the esophagus and trachea. Everything was intact.

I wasn’t used to standing for so long. I hadn’t eaten much that day and at one point the pulsing carotid  became too much for me. Beads of sweat starting forming on my forehead and I felt my face tingling. I knew I was about to pass out or vomit or both. So instead of hitting the floor in the OR I excused myself. One of the nurses gave me a soda and let me relax for a few minutes before scrubbing back in.

I helped close up his neck and I closed up his facial wound myself. He is going to need some grafting to replace this half-dollar size chunk of face that was gone, but other than that he will probably be fine. I never thought my life as a general dentist would take me into the operating room to help handle gunshot wounds. I guess I was wrong.

Part III: How much trauma is going to happen while I’m writing this post? It was 2400 last night. Almost exactly midnight by my watch. I heard the door to my hut fly open and our brigade nurse speaking firmly, yet seeming to try and be quiet at the same time. I couldn’t make out what she was saying.

“Whats going on?” I asked, disoriented.

“A Chinook just crashed with 24 people on board. We need everyone down at the aid station. Right now.”

“Are you f*cking kidding me?” I replied. I hoped this was another MASCAL drill.

“No. I’m not kidding. We need everyone down there right now.”

My heart just dropped. I felt sick to my stomach. I could not even imagine what this could mean.

I was still waking up and getting oriented as I ran down to the aid station. People were running around all over the place. The Forward Surgical Team was up and their doors were propped open so I knew this was no drill (as they don’t usually participate in our midnight training exercises).  I tried to get some info from our platoon sergeant. All I was able to determine was that a CH-47 Chinook helicopter had gone down with 24 soldiers on board. No status as to any survivors, but we were preparing to receive 24 casualties.

In the middle of the night we executed our plan for a Mass-Casualty Event (MASCAL) flawlessly. I was really impressed at how everyone came together. We had over 30 litter-bearers show up just to help carry people. During a MASCAL my job is to triage the patients as they bring them to us. For an hour I waited out front trying not to vomit thinking about the horror that could be dropped at my feet any moment. Thankfully at 0100 we sent everyone packing. The had taken the critically wounded to a closer surgical team and we would not be receiving any of the urgent or surgical patients. We received several of the crash victims throughout the night, but they were stabilized and not surgical patients. Thankfully, not a single person was killed in the crash, though there were some very serious injuries.

That all happened in the last 72 hours. I spent most of Sunday sleeping. I was just physically exhausted.