Another day — night — at office, eh Doc? Keesler physician shares experience in Afghanistan

Published June 26, 2007
By Capt. (Dr.) Andrew Allen
81st Surgical Operations Squadron

BAGRAM AIR BASE, Afghanistan -- Editor's note: Capt. (Dr.) Andrew Allen, an 81st Surgical Operations Squadron obstetrician/gynecologist and a new flight physician, is deployed to Bagram Air Base, Afghanistan. This is an excerpt from his journal.

Today actually started last night.

I stopped working on the obstetrics statistics around 7 p.m., went to have dinner (Cornish hen and baked fish with a side of green beans), then made it back to my shack to get cleaned up. I decided to come back to the hospital around 9 and tried to call home, but Kathy was taking care of some utilities for the neighborhood. So I went to my office to catch up on some things.

I had just about finished my journal entry when the medevac people called. They initially called the wrong flight doctor by mistake (they called the aerovac phone), who then ran over to the hospital from her hut to see if I was around. Luckily, she found me. I already had my new flight suit on so I grabbed my helmet, body armor, M-9 pistol and medical bag and ran out to the hangar.

Going, not going, going ...

Upon arrival, we were told to stand by because there were a couple of conflicting missions and they also needed final approval to fly. After several rounds of hearing that we're going, then we're not going, then we're going, we finally boarded the helicopter.

The ride didn't make me as nervous this time, mostly because I had done it before and also because I knew the flight medic had a lot of experience -- I knew he could teach me some things. This mission was also different because it was nighttime. I could see lights on the ground, from houses and cars, but nothing like I could see during daylight.
After about an hour or so, we arrived at a forward operating base. I got off the helicopter to stretch while they refueled and was struck by the remoteness of my surroundings.

This was obviously a heliport. I could make out the shadows of some tents nearby, but there were no lights on. The helicopters were dark, the tents were dark and if it wasn't for the rising moon, I probably wouldn't have been able to see the tents.

Starstruck awaiting incoming flight

The stars were just amazing. I could recognize several constellations: Big Dipper, Cassiopeia, Scorpius -- all amidst a vast array of stars in the Milky Way. It was one of those times when you feel so small in the vastness of creation.

Once they finished refueling, I hopped back onto the helicopter and waited for the incoming flight. I could see the shadowy images of the other two helicopters coming in with the rising moon behind them. It was rather surreal to watch them as they crept through the dark sky, hovering over the airfield. The medic ran out to greet them and after a few minutes returned with a stretcher laden with a casualty, accompanied by two soldiers.

He was shot in three places and didn't have much for treatment other than a tourniquet on his leg and a bandage on his thigh. As we were flying back, we started the ABC survey -- Airway is OK; Breathing is OK -- he was trying to talk to us -- Circulation not OK. No IV access. His prior IVs had blown so I put in an intra-osseus catheter. That just uses a sharp instrument to puncture his sternum and insert tubing you can use to give fluids. Then we checked his wounds for bleeding -- released the tourniquet on the leg, but it started to bleed again so we re-applied. I put on a splint (the leg was partially amputated) and bandaged his abdomen.

In the meantime, we were also working to start oxygen, get blood pressure, pulse oximetry, keep him warm, etc. I gave him some fentanyl for pain, tried to rapidly infuse fluids to keep his blood pressure up (70/39) and eventually started a dopamine drip to boost his blood pressure. With all the work, the flight back didn't seem to take quite as long as the flight out. The whole time the lights are dimmed inside the helicopter. There were vibrations -- it's a cramped space and difficult to move in body armor.

When we landed just outside the emergency room, the medics were waiting with a stretcher carrier and brought him in. We gave the report to the emergency room doc and trauma surgeon. After being stabilized, he was brought back to the operating room where his amputation was completed and his belly was explored and repaired.

I didn't stay for the surgery (it was about 1 a.m. at this point). Instead, I went with the group of American soldiers out to the flight line to get them loaded on the plane for their aerovac mission to Germany. We took them out on ambulances, loaded the stretchers onto the plane while the others walked on, sat in their seats and away they went.

I didn't get back to my bed until about 3 a.m. I was able to sleep until about 6:30. After morning report, I went to the operating room with the orthopedic surgeon and helped him put a plate onto some guy's fractured tibial plateau. It's always interesting to watch these guys work with their power tools, scraping and snipping off broken bone fragments and trying to put things back together.

As I'm writing this, I hear the medevac phone going off again -- the next one up is already going out and she's only had the phone for 12 hours. I had to carry that thing around for about a week, which really limits extra activities. You have to be able to get on the helicopter within just a few minutes of being called.