Photo by James Nachtwey, war photographerThis photograph hangs on the wall of my clinic in Afghanistan.
It reminds me daily of why I work here.
The first time I saw this picture, in Life Magazine, my eyes began to blur. Partially from tears. Partially from a chemical reaction. I was sitting in the office of an ophthalmologist, having my eyes dilated as part of a pre-deployment physical. In preparation for a retinal scan. Earlier in the day, I'd had a panoramic dental x-ray, and a DNA test. Independent biological identifiers. Required for deployment into a warzone.
I remember staring into the eyes of this young man, as mine lost their ability to focus. Such eyes.
How would you define his emotion? His clenched brow. His distant stare. The tear in the corner of his eye. The clenched right hand. Is this pain? Is this fear? Is this devastation? What you do not know, when you first look at this photograph, is that this young solder has just had both of his legs blown off in an IED explosion. Minutes prior.
I hate this picture. For the invasion of this man's privacy, in this perhaps most intimate moment of his life. And yet, I am so very grateful for this glimpse. For this reminder of an event that happens here in Afghanistan...nearly every single day. Sometimes to soldiers, sometimes to local Afghani citizens, just trying to go about living their lives in the middle of an incessant warzone.
IED -- improvised explosive device -- injuries are generally devastating. The force of the explosion, frequently experienced from below, by a person in the front seat of a vehicle driving over an explosive, causes massive blast injury. Bilateral lower extremity amputation is common. As are pelvic injuries, genitalia injuries, and massive internal injuries. Every soldier wears a tourniquet on the shoulder of his or her uniform -- in the event of such an encounter. They are taught how to apply these devices to themselves. Because the military has studied the causes of death in soldiers in Iraq and Afghanistan in the past decade, and have determined that death from exsanguination from blast injuries is the most common preventable death...if dealt with immediately...with a tourniquet.
When I went through my predeployment training, I was taught how to put on a tourniquet. I am an emergency medicine provider. I know how to put on a tourniquet. And in my 13 year career, I have had to to this only once. Most injuries will stop bleeding with direct pressure and elevation. But, not blast injuries like these, in which the anatomy becomes a tangled mess of barely identifiable flesh. These injuries are, at times, inconceivable.
Five days ago, 25 miles north of my clinic, a young soldier on a night patrol, stepped on an IED. He was a 15 minute helicopter flight from our airbase. Fifteen minutes from a trauma surgeon. An imbedded journalist reported on the events. In confusion in the night, he'd stepped off a path that had been cleared by the company's bomb sniffing German Shephard. Moments later, an explosion. A buried IED. The young solder sustained devastating injuries. In the millisecond which was the explosion, he lost both legs and one arm. Instantaneously.
His fellow soldiers acted immediately, applying tourniquets to his extremities. The injured solder, incredibly, remained alert and oriented. He complained that the tourniquets were too tight. He continued to speak to his comrades as they carried him to an improvised landing zone, and called for a medevac helicopter.
And so begins the Golden Hour of trauma. The hour in which one has to get to a surgeon, to stabilize life threatening injuries, before one bleeds to death.
It is likely a blast, that is so forceful it tears your limbs from your body, has devastated more than your limbs. Pneumatic injury to air filled organs -- lungs, intestines, ears -- can lead to their rupture. Blast injury to solid organs -- liver and spleen -- can cause them to bleed uncontrollably. And, in this war, we have discovered, the force of the blast on the brain leads to axonal disruption, in which the very cells that make up the brain are shifted and sheared -- leading to closed head injury and possible lifelong neurological compromise.
If you look back at the photograph that hangs on my wall, you will see the medic with one hand on the young man's chest, and one on his wrist. In the back of a medevac helicopter, finding a shallow pulse, and distinguishing it from the pounding of the chopper's rotor blades, is a true challenge. A too- fast beating heart, palpable in the medic's palm, is a sign of impending death in the race against time. An absent pulse in the wrist serves as a second warning sign -- that the body has chosen to conserve its remaining blood for the vital organs, and no longer perfuse the extremities. You might even see the medic raise his fingers to his own neck...to determine if the racing pulse he feels is his patient's, or that of his own antagonized heart.
I think back to the tourniqueted soldier, lying in the field five nights ago, 25 miles from me. His fellow solders kneeling beside him, in desparation, awaiting a medevac. He is talking. What does he say? What do his fellow soldiers reply? Are they 18, 19 years old? Twenty? How have they been prepared for this day? For this conversation?
There was a delay in the helicopter dispatch on that day, because an armed escort chopper needed to be located before the medical crew deployed. It took 60 minutes to get to the soldier. The golden hour expired. And, tragically, so did he.
When I walk home to my bunk at night, sometimes the flag has been lowered to half mast. It was, that night. It sits in quiet communication that another American soldier has died today in Afghanistan.
Yesterday, on the runway here, I spotted a C17 cargo plane from McChord airforce base, with a big green Shamrock on the tail. I know this plane. It is the very one that used to carry me from Antarctica to New Zealand, when I used to fly medevacs out of McMurdo station. It is the plane that was diverted from the Iraq military theatre 6 years ago, when we had a mid-winter medical emergency on the Ice requiring an emergency medevac. It took them nearly a week to get to us, due to weather conditions. I remember, after sitting desperately with that patient for nearly a week, the miraculous, beautiful site of this very C17, cutting through the Antarctic sky, and swooping down to our blue ice runway. Like a gigantic grey angel dropping down from heaven. I remember the back cargo door opening, and a medevac flight crew disembarking, wandering across the snow to our ambulance, to accept our patient. Our patient's salvation.
I stared at the familiar grey plane. Surreal. What are the chances of us meeting here, I asked it silently? What are you doing here today?
As I watched, its back cargo door dropped open once again. This time, soldiers slowly marched in unison towards the opening. They formed a line on each side, and then stood at attention. A sand colored military vehicle then slowly appeared from off the side of the airfield. It was intercepted by a group of soldiers in dress uniform. As the vehicle turned slightly, the situation was revealed. A coffin, draped in an American flag, was now visible on the bed of the vehicle. Six soldiers slowly lowered the coffin onto their shoulders. And, in unison, turned and quietly marched their precious cargo into the belly of the C17. The two lines of soldiers paralleling the plane's cargo door slowly raised their right arms in salute as the casket was carried past. From my vantage point on the side of the runway, the sound of taps could be heard wafting past softly in the warm desert breeze.
A dignified transfer.
What is in their minds, these men and women, as they bear this weight, this flag, upon their shoulders? What is in their minds, as they steady their guns back on their shoulders, and slowly march away. I stare at their young faces.
My eyes begin to blur again.
Please, look into the eyes of the young soldier in my photograph. See his pain. His fear. His desperation. His sacrifice.
And remember him.
Did you remember, when you awoke today, that our country is fighting a war in Afghanistan?
Please don't forget.
Please work for peace.
Please pray for peace.
صلح
I remember staring into the eyes of this young man, as mine lost their ability to focus. Such eyes.
How would you define his emotion? His clenched brow. His distant stare. The tear in the corner of his eye. The clenched right hand. Is this pain? Is this fear? Is this devastation? What you do not know, when you first look at this photograph, is that this young solder has just had both of his legs blown off in an IED explosion. Minutes prior.
I hate this picture. For the invasion of this man's privacy, in this perhaps most intimate moment of his life. And yet, I am so very grateful for this glimpse. For this reminder of an event that happens here in Afghanistan...nearly every single day. Sometimes to soldiers, sometimes to local Afghani citizens, just trying to go about living their lives in the middle of an incessant warzone.
IED -- improvised explosive device -- injuries are generally devastating. The force of the explosion, frequently experienced from below, by a person in the front seat of a vehicle driving over an explosive, causes massive blast injury. Bilateral lower extremity amputation is common. As are pelvic injuries, genitalia injuries, and massive internal injuries. Every soldier wears a tourniquet on the shoulder of his or her uniform -- in the event of such an encounter. They are taught how to apply these devices to themselves. Because the military has studied the causes of death in soldiers in Iraq and Afghanistan in the past decade, and have determined that death from exsanguination from blast injuries is the most common preventable death...if dealt with immediately...with a tourniquet.
When I went through my predeployment training, I was taught how to put on a tourniquet. I am an emergency medicine provider. I know how to put on a tourniquet. And in my 13 year career, I have had to to this only once. Most injuries will stop bleeding with direct pressure and elevation. But, not blast injuries like these, in which the anatomy becomes a tangled mess of barely identifiable flesh. These injuries are, at times, inconceivable.
Five days ago, 25 miles north of my clinic, a young soldier on a night patrol, stepped on an IED. He was a 15 minute helicopter flight from our airbase. Fifteen minutes from a trauma surgeon. An imbedded journalist reported on the events. In confusion in the night, he'd stepped off a path that had been cleared by the company's bomb sniffing German Shephard. Moments later, an explosion. A buried IED. The young solder sustained devastating injuries. In the millisecond which was the explosion, he lost both legs and one arm. Instantaneously.
His fellow soldiers acted immediately, applying tourniquets to his extremities. The injured solder, incredibly, remained alert and oriented. He complained that the tourniquets were too tight. He continued to speak to his comrades as they carried him to an improvised landing zone, and called for a medevac helicopter.
And so begins the Golden Hour of trauma. The hour in which one has to get to a surgeon, to stabilize life threatening injuries, before one bleeds to death.
It is likely a blast, that is so forceful it tears your limbs from your body, has devastated more than your limbs. Pneumatic injury to air filled organs -- lungs, intestines, ears -- can lead to their rupture. Blast injury to solid organs -- liver and spleen -- can cause them to bleed uncontrollably. And, in this war, we have discovered, the force of the blast on the brain leads to axonal disruption, in which the very cells that make up the brain are shifted and sheared -- leading to closed head injury and possible lifelong neurological compromise.
If you look back at the photograph that hangs on my wall, you will see the medic with one hand on the young man's chest, and one on his wrist. In the back of a medevac helicopter, finding a shallow pulse, and distinguishing it from the pounding of the chopper's rotor blades, is a true challenge. A too- fast beating heart, palpable in the medic's palm, is a sign of impending death in the race against time. An absent pulse in the wrist serves as a second warning sign -- that the body has chosen to conserve its remaining blood for the vital organs, and no longer perfuse the extremities. You might even see the medic raise his fingers to his own neck...to determine if the racing pulse he feels is his patient's, or that of his own antagonized heart.
I think back to the tourniqueted soldier, lying in the field five nights ago, 25 miles from me. His fellow solders kneeling beside him, in desparation, awaiting a medevac. He is talking. What does he say? What do his fellow soldiers reply? Are they 18, 19 years old? Twenty? How have they been prepared for this day? For this conversation?
There was a delay in the helicopter dispatch on that day, because an armed escort chopper needed to be located before the medical crew deployed. It took 60 minutes to get to the soldier. The golden hour expired. And, tragically, so did he.
When I walk home to my bunk at night, sometimes the flag has been lowered to half mast. It was, that night. It sits in quiet communication that another American soldier has died today in Afghanistan.
Yesterday, on the runway here, I spotted a C17 cargo plane from McChord airforce base, with a big green Shamrock on the tail. I know this plane. It is the very one that used to carry me from Antarctica to New Zealand, when I used to fly medevacs out of McMurdo station. It is the plane that was diverted from the Iraq military theatre 6 years ago, when we had a mid-winter medical emergency on the Ice requiring an emergency medevac. It took them nearly a week to get to us, due to weather conditions. I remember, after sitting desperately with that patient for nearly a week, the miraculous, beautiful site of this very C17, cutting through the Antarctic sky, and swooping down to our blue ice runway. Like a gigantic grey angel dropping down from heaven. I remember the back cargo door opening, and a medevac flight crew disembarking, wandering across the snow to our ambulance, to accept our patient. Our patient's salvation.
I stared at the familiar grey plane. Surreal. What are the chances of us meeting here, I asked it silently? What are you doing here today?
As I watched, its back cargo door dropped open once again. This time, soldiers slowly marched in unison towards the opening. They formed a line on each side, and then stood at attention. A sand colored military vehicle then slowly appeared from off the side of the airfield. It was intercepted by a group of soldiers in dress uniform. As the vehicle turned slightly, the situation was revealed. A coffin, draped in an American flag, was now visible on the bed of the vehicle. Six soldiers slowly lowered the coffin onto their shoulders. And, in unison, turned and quietly marched their precious cargo into the belly of the C17. The two lines of soldiers paralleling the plane's cargo door slowly raised their right arms in salute as the casket was carried past. From my vantage point on the side of the runway, the sound of taps could be heard wafting past softly in the warm desert breeze.
A dignified transfer.
What is in their minds, these men and women, as they bear this weight, this flag, upon their shoulders? What is in their minds, as they steady their guns back on their shoulders, and slowly march away. I stare at their young faces.
My eyes begin to blur again.
Please, look into the eyes of the young soldier in my photograph. See his pain. His fear. His desperation. His sacrifice.
And remember him.
Did you remember, when you awoke today, that our country is fighting a war in Afghanistan?
Please don't forget.
Please work for peace.
Please pray for peace.
صلح
What beautiful writing Barbi - sounds like life off the ice continues to hold many adventures for you. I left Pole 3 years ago, got married, moved to NY, worked as an ortho PA and now am running a restaurant with my husband in Boquete, Panama. I'll miss being a PA and going down to Antarctica but life just keeps evolving and getting better...
ReplyDeleteStay safe and give my thanks to all the brave folks over there.
Heidi Lim Rehm