Monday, October 19, 2009

Battle Scars

My heart broke for this poor kid.

A 23 year-old male – a veteran of Operation Iraqi Freedom. A cavalry scout. Wounded by an IED that had more than just shrapnel in it. The device was also loaded with toxic chemicals which, when it detonated, let loose all over the vehicle he was in. Worse, the whole mess caught fire, severely burning him and ultimately wreaking havoc on his body in other ways that didn’t catch up with him until later.

We were dispatched to the VA Medical Center in Bedford to pick this young man up and take him to the Beth Israel’s Emergency Room because of a recurrence of problems that he was having. As to why we were sent, we had just finished up a call in Cambridge and we were the closest unit available out of both Somerville and Boston. So we owned it. If you’re not familiar with Bedford, the trip from downtown Cambridge to the Bedford VA is approximately 20 miles long. And there is no easy way to get there. I won’t describe the route in detail, but suffice it to say that I was able to make decent time out to Bedford.

We located where the patient was in Urgent Care which, to our surprise, was open and he was the only patient. Just driving onto the grounds was sort of creepy as the buildings all have that institutional, old-school sort of look. Sort of like this:

This is the main building during the day. Just imagine what it looks like after dark.

Anyway, we got to the room he was in and the nurse who was taking care of him gave us a report filling us in on his condition and issues that he was dealing with. He’d apparently been at their facility for detox; one of the other problems a lot of these folks have been reported to have are issues with substance abuse to deal with the aftermath of their experiences, both physical and otherwise. This patient was no different. But while he was there he’d started having episodes of swelling to his hands and face as well as intractable pain all over. In addition, he was running a low grade fever, right around 100.5-101.0 degrees F. Immediately I wondered if he’s dealing with an opportunistic infection of some sort, but I have no way of knowing that. And since I didn’t have patient care I didn’t look at the records to see what any labs might have looked like. But I really didn’t have to once I got a look at this patient.

He was awake, alert, and oriented appropriately. He was incredibly photophobic; any amount of light made him scream with pain. In fact, just about anything made him scream with pain. Taking a blood pressure was excruciating for him, not so much because of the inflation of the cuff, but the act of simply getting it around his bicep made him cry out. His face and hands were swollen; it almost looked like anaphylaxis because the swelling was accompanied with flushing. He also had sores everywhere; his torso, extremities, face, in his mouth and up in his sinuses, even under his eyelids.

I have never seen anything like it. and I’m not at all surprised by how much pain he was in.

We packed him up for transport as gently as we could. And that just didn’t matter because the movement made him go into spasms. He was given both pain medication (Dilaudid) and something to help him settle down (Ativan) about 15-20 minutes before we arrived, but it didn’t seem to help him very much. By the time we got to the BI, about 25 minutes after we left, he was just as restless as when we left. To her credit, my partner did a superb job keeping him calm during the trip. And I was thankful for her efforts.

It makes me angry that veterans of the current wars or conflicts or whatever you want to call them are being given such short shrift. After seeing this poor guy and thinking back onto so many other cases like this I’d heard about but had never seen, I can’t help but think the people who are in charge and make the decisions continue to keep their heads in the sand with respect to dealing with all of the people who’ve been there and are sick from situations similar to his. And I feel guilty because I’m selfishly glad I didn’t re-enlist.

Kinda sucks, doesn’t it?

1 comment:

Karen Brook Westhaver said...

Just read your post about this poor guy...and realizing there are far too many more like him out there. While I am not at ALL minimizing the outrageousness of what's going on over there in Iraq and Afghanistan and the extraordinary sacrifices being made by those who're there (& their families back home), you have NOTHING to be selfish about in not re-inlisting. In a different way, by the work you do, you HAVE re-inlisted in a broader/different scale. Your compassion, skill and dedication to this service are a blessing for which there are not adequate words. Your previous experience in the "service" has given you more depth (if that's possible) and understanding to consistently push the envelope of excellence and all your patients (and their families)are the beneficiaries of this.