Got my Birthday Cards!

Another day down! Tuesdays and Thursdays are mail days. It is always fun to see if I got anything. Today I got some Birthday cards from my wife and kids. That was awesome Madeline and Carter! Thank you Stacy for the gift and card! Those were fun to read (and listen to!). Thanks to everyone who has sent me stuff! The food and snacks all go to my FST members (after I screen it for the stuff I really want) to share and they all really appreciate it. Greg mentioned to me the other day that we are coming up on the halfway point of our deployment in a couple of weeks. It's hard to beleive it. We had two patients yesterday that were local nationals that were involved in a truck rollover. One sustained a significant closed head injury, but we could not fly him out to Bagram due to weather problems. If we can't fly, ground transport really is not an option unless you want to get shot or killed. So, we kept them overnight and treated him the best we could. Since we don't have any imaging capability other than plain film X-ray, we have to depend on clinical diagnosis to guide treatment. His GCS (Glascow Coma Scale) was 12 on admit, deteriorated to 6-8 over the next hour or so. We established an airway, got central venous access, and an a-line. Then, started the closed head injury protocol with hypertonic saline. That's about all we could do without any other information. We really needed to fly him to a facility with a CT scanner to get a definitive diagnosis to guide his treatment. Our trauma surgeon (Greg) thought about opening his head to decompress the brain (his clinical S&S suggested increased ICP, again, we don't have things like ICP bolts), but after talking to the surgeons at BAF (Bagram Air Field, Craig Joint Theater Hospital) we decided that the surgery would be too risky at this point (he was a 70 year old man, the average life expectancy of a typical Afghan male is 44 years). So, we monitored him all night. This morning, no improvement and the weather was still an issue. We were running low on O2 cylinders and weren't sure when we would get resupplied. So, we transferred him to Ghazni City Hospital where they have no ventilators. He will most likely die soon. The Afghan medical system is basically non-existant by our standards. Its hard to make patient care decisions based on utilization of resources at hand and planning for future possibilities. These are things we don't even have to think about back home in the U.S. Our patient with the pelvic fracture died in Bagram yesterday. If you are interested, you can view MAJ Greg Watson's blog at: http://pittsburghistan.blogspot.com/. He has some good pictures of some of the cases we have done and the X-rays of the pelvis fractures. If you had been reading my previous posts, you would recognize him as the trauma surgeon that is working here with me. It was really something that we were able to keep him alive like we did. Our patient with the IED injuries to all four extremities is alive and well. He was able to keep his left leg. Our little 2 year old is still with us and doing well. He actually started smiling at us yesterday. I think it was probably the drugs that we were giving him. Everyone smiles when the get Versed. I thought I would post a picture of the boy, his dad and I after the dressing change. Also, I will post pictures of my room with all of the cards on the back wall (this picture was taken before today, so there are alot more cards on there now! Thanks!). I believe I mentioned before that the barracks and FST are in an old Taliban training complex. We have put up some plywood and sliding doors to kindof give the illusion that we have our own rooms, but it is still open air style. My room is about 8 X 6 feet, so it is tight. I am not complaining because I have lived in alot worse! Anyway, thats about all for today, so enjoy the pictures of where I live.