BeeGees and Eyebrow Hair

Hi everyone.
I’m ready to come home. Just in case you wondered.
This letter was going to be a catharsis. I had a bad day yesterday, and I was going to unload by writing you. E-mailing you guys and this subsequent Blog have been a way to pass the time and get out my missives to the huge list of people that I need to correspond with while I’m here. I don’t have the time or the speed to type out letters to everyone so this seemed to be the best way to accomplish that task.

But as I sit here now I’m having second thoughts about spilling my feelings all over the page for you. I hope that you all read what I send, but I suspect that mostly I’m sending my thoughts out into the electronic ether, to be casually glanced at as proof that I’m still alive; which is fine. But, in the interest of keeping the meager audience I may have I’m going to spare you the emotions and stick to the story.

My patient yesterday was a ten-year-old boy. I guess ten because a lot of Iraqis don’t know their ages. They don’t know their weight either. Weight and age are unimportant to them as far as I have seen. You are alive or dead, old or young, fat or skinny. Maybe you are thirty, which can be old or young depending on the amount of wear on your tires. But he was young, pre-pubescent and dying.

We were told he was coming from Baghdad after an unfortunate encounter between a brick and his head. The Army’s 207th Head and Neck Team are posted with us in Balad. So we get the every neuro trauma from the entire theater. The neuro team is really fantastic. Some of the lazier people here don’t like their presence, because it means we get all of the severely head injured patients. Severely head injured patients are a lot of work, both intra-op and post op, but I don’t care. It’s become the most high profile thing we do. Without them here the suspicion is that the Army in Baghdad would only send us the cruddy cases they didn’t want.
But back to the kid. . .

His head was swollen and purple. He had a massive sub-cutaneous hematoma throughout his scalp. Giving him the appearance of a hydrocephalic. His pupils were fixed and dilated, a really bad sign. I placed a subclavian central line in him while the rest of the team prepped and assisted with the surgical setup. Craniectomies bleed a lot. So we spent a bit of time preparing to combat that before the start of the actual surgery. (Incidentally, he had blood products administered upon his arrival in the ED, which was due to the blood policy I spearheaded.)
Then the surgeons began their task. I continued a full-bore resuscitation with blood, plasma and fluid. 700ml of blood were lost in his scalp prior to his arrival. Maybe one liter was oozing out onto the field. The neurosurgeon had told me right at the beginning that he though the kid was too far gone but of course we were going to try anyway, which I agreed to. Things proceeded well for a few minutes. But by the time a quarter hour had passed, he was dwindling. I asked for, and got help from an operating room RN, Emma Piehl and my boss Lt. Col. Schank. We needed three people just to keep up with the blood loss, ventilatory efforts and pharmaceutical interventions. Trauma surgeries were proceeding in every room so there were few personnel to spare. Brett Schlifka, the surgeon, called over to me and said that he was sure that the brain was dead. The tissue was white, secondary to the swelling that had starved it of blood and nutrients. My team were maxing out an epinephrine (adrenaline) drip and trying to keep him well ventilated despite the fluid that was shifting into his lungs.

This child was dead, but his heart didn’t know that yet. Dr. Schlifka suggested that we cease giving blood, as it was futile. I kept him alive long enough to get him to the ICU where his heart exhausted its last beats about thirty minutes later. I had never been so depressed over a patient’s death, before I encountered this child. As an RN I didn’t have the responsibility for my patients’ lives that I currently do. It weighs so much heavier upon me now.

Now, for the really depressing news. I went to get my hair cut today. Going to the barber here is an experience. The barbers are I believe, Indian (dot, not feather). There are so many Asiatic third country nationals here: Philippinos, Nepalese, Pakis, Malays etc. It’s hard to keep them straight. I think these dudes are Indian, however.
Anyway, the barber is cutting my hair and in the background they have a stereo blaring pre-disco Bee-Gees. The kind of BeeGee's you hear on AM. My barber, I believe in an effort to add to the surrealism of the scene, is whistling along to “Lights go Down in Massachusetts”. I’ve got an Indian, entranced by the musical stylings of the Australian Brothers Gibb, who are singing a song about a NewEngland state, as I sit in Iraq. I don't think this is what people expect from the new globalism but this is the strange reality of it.
and just then , he does it. . .

He takes the scissors and cuts my EYEBROW HAIR!
Aw shit! I have wild old-man eyebrows?! Why didn’t anyone tell me? Now it’s shit like that; that can make you really depressed.