Portal de Periódicos da CAPES

Fifteen Minutes Inside the Baghdad ER

2011; Lippincott Williams & Wilkins; Volume: 33; Linguagem: Inglês

10.1097/01.eem.0000398183.50014.72

1552-3624

Todd Baker,

Health and Conflict Studies

ImageBOOM! BOOM! The building shook by two hits nearby, and we all looked at each other, thinking, “Here we go again.” I was off shift by this point, so I rushed to the ER, and joined the crew of the night shift preparing for the next wave of victims. A few moments later, two local Iraqis were brought in, one with significant flank trauma and another with superficial injuries. While our team was working on them, I once again waited in the front for more casualties to arrive from the rockets, but none came. However, a patient came in twenty minutes later who will haunt me forever. Jason, the ER doc on shift, was in the back working on the victims hit by the rocket fire, so when the burned solider from an IED blast came in, I was waiting for him in the trauma room. We had prepared by calling down our burn surgeon, Dr. King, and Marti joined us to assist with the resuscitation. When the patient was brought into the trauma room, it was a replay of the incredibly burned soldier I treated just two days before. Once he was placed in bed one, I immediately leaned down to his face, inches from mine, and looked into his eyes. I will never forget him looking straight back at me. His eyelids were missing; he had no hair, eyebrows, or eyelashes left. His skin was charred black and brown from the flame and heat, and the rest of his body was covered in third- and fourth-degree burns. His fingers were blackened, shriveled, and mostly amputated from the heat. But his wedding ring was somehow still in place. It was carefully removed, and while the other physicians worked feverishly to get central access on his groins, our medics tried their best to stick a vein in his arms, going right through the charred skin. I never pulled away from his face. I held a bag-valve oxygen mask over his nose and mouth, and each time he would take a breath, I would help him. I suctioned out his mouth to try to remove anything that could be impeding his airway. His eyes burned into me; they burned into my soul. He was fully conscious; he knew everything that was going on. What could I do? What could I say? I asked him if he had any allergies, to which he weakly shook his head no. He could not speak due to the extensive burns to his mouth and airway. I explained to him that after we got an IV placed, I would put him to sleep and relieve his pain. I said, “Just hang in there. They are putting IVs into your groin and your arms. You are doing great. We're going to take care of you.” I would assist a breath for him. “Do you need me to suction you again?” He nodded yes. “Hang in there, you are doing so well. You are doing great. I'm going to take away your pain, buddy. I won't leave you.” His eyes continued to stare into mine; he had no ability to blink. I just kept looking into his eyes, keeping my face close to his, and I kept trying to comfort him. “We're going to take care of you, you're going to be okay.” He stared back at me, saying with his eyes, “I trust you to take care of me. Don't let me down.” It was one of the hardest moments of my life. I have never connected with a patient like I did this hero. I did not know his name, but it did not matter. I was not about to pull away from his face; I would never leave his side. I decided I would never abandon him in this time of need. Three physicians and multiple nurses and medics were attempting to gain IV access through his burned skin, and I could have tried an IV in his subclavian vein just below his clavicle, but once again, standing at the head of the bed, with his eyes locked on mine, I would not leave him. If he died right there, I was determined that he would not die alone. I was with him, and at the moment, that was the only thing I could control. His beautiful, white, and untraumatized eyes were locked on mine, and I continued to help him get air, and tell him how I would take the pain away momentarily. Jason successfully placed a central line, and I told the soldier, “We are going to take five deep breaths together.” He nodded. I wanted to get his lungs as full of oxygen as possible, in anticipation of a difficult, swollen, burned, and charred airway. “One.” He took a huge breath, and I squeezed the bag pushing oxygen into his chest. “Two.” The same. He followed all of my directions until the sedating medication was pushed at “Four.” By the time he took the fifth deep breath, he was unconscious from the medication. We paralyzed him, and I quickly went into his mouth with the laryngoscope blade. His airway was swollen and beefy red, but by the grace of God I was able to visualize his cords and get him intubated successfully.” Dr. Baker is the author of Baghdad ER: Fifteen Minutes, a chronicle of the 15 months he served as the chief emergency physician of the U.S. Army's combat support hospital in the Green Zone in Baghdad, Iraq. The book starts with the day he left his family and follows him until he returned home. Baghdad ER: Fifteen Minutes is available for $18.50 on his website, www.BaghdadER.com. Ten percent of proceeds go to the Wounded Warrior Project.