Jet Fuel

When Jessica and I were children, I remember how she always loved the smell of fuel—logging trucks, snowplows, airplanes. Anytime we were around anything that gave off the smell of diesel fuel or jet fuel, she would take a deep breath in and say how much she loved that smell! Well, Jess, you would have loved the experience I had this morning, but let me start at the beginning.

I spent last night caring for two Afghan boys, one was ten years old and the other was twelve. The 10 year old was in a motor vehicle accident and suffered a skull fracture. He definitely acted like a patient suffering from a neurological injury because he would open his eyes, but would never really focus on you. Every time I tried to do anything with him, he would try to kick me away with his feet. He would also grind his teeth and spit up all his oral secretions. He was very restless and would frequently put his legs over the bed rail or he would flip his whole body around, his head facing down at the foot of the bed and his feet at the head of the bed. He was pretty cute, though, so I couldn’t get too frustrated with him. Besides, the Afghan children are much smaller for their age than American children. He was about the size of a 6 or 7 year old, so I was able to reposition him back up in bed easily.

The 12 year old boy was with us because he had gotten his shemagh, a scarf worn by Afghan men either around their neck or around their head, caught in a grain mill. In order to keep from getting sucked into the mill, the boy had to rip his head out of the scarf as it tightened around his throat. This resulted in multiple fractures of his jaw bones, several layers of skin getting ripped off, and two large cuts into his lips. These injuries lead to the swelling of his tongue and airways. When I had him two nights ago, he had to have a breathing tube, called an endotracheal tube, down his nose into his lungs so that he could breath. Tonight, he was breathing on his own, but his mouth and tongue were still extremely swollen so he wasn’t able to swallow his saliva or talk. I had to continuously suction his mouth and, even with the interpreter at the bedside, it was difficult to communicate because the boy would just point and we would have to guess what it was that he needed.

If this child had not been brought in to us, he would have died because his airway would have eventually closed off from the swelling of the injury. But, now, with the help of intravenous steroids and a mechanical form of ventilation, he will be fine. In addition, he would have been extremely disfigured in his face if it were not for the amazing work that our Ear, Nose and Throat surgeon does here. I told this doctor that he should consider going into plastic surgery when he gets back because he does wonderful work!

The two kids actually came from a different area of the country and, now that they were stable, it was time to send them back to the medical facility at the Forward Operating Base in the region where their families live. This would allow for the patients to be closer to their relatives and then be easily discharged back into their community. However, in order to get them back, they had to be packaged up and flown by fixed-wing aircraft.

Normally, a team of U.S. Air Force personnel come and pack up the patients by hooking them up to transport monitors and other equipment and then loading them onto gurneys. This morning, however, no one arrived to start prepping the patients, and when we called to find out if anyone was coming, we were told that there had been a miscommunication and, thus, no one was coming. This meant that we were going to be responsible for getting the patients all ready for the flight and that we would also need to make arrangements with our own ambulance to get the patients out onto the flight line. And oh, by the way, the plane is scheduled for departure at 06:15. It was 5:30 when we were told all of this.

Well, this began a whirlwind of activity. This was a job that was normally the responsibility of a specially designated team that is deployed here specifically to do this part for us. The packaging, the transporting, and the loading of the patients onto to the aircraft was not something I had ever been trained to do. Our Respiratory Therapist tracked down the portable monitors and equipment we needed to monitor the patients during transport. The Officer of the Day, who should have been manning the Quarter Deck (front office) of the hospital, went and brought us gurneys, while the other ICU nurses helped me load my patients onto the gurneys.

The 12 year old boy had not spoken since he had the endotracheal tube removed the previous morning, despite frequent encouragement do so, until we were just about to roll him out the door. He suddenly became wide-eyed and franticly tried to spurt out something that sounded very slurred, as his tongue remained pretty swollen. His family member, probably his grandfather, leaned close over him in an attempt to hear him better. He finally blurted out one clear word and the old man smiled. I had tucked a stuffed bunny rabbit that we had given the boy earlier in the night, down near his feet under the strap that was securing his legs to the gurney. The old man pulled it out and held it up to the boy’s face so he could see. Out of all the things to say at that moment, the boy just wanted to make sure the rabbit was going with him!

Meanwhile, the lead officer from the Tactical Operations Center for the hospital gathered up a group of Corpsmen from the Hospital Ward to drive the ambulance and help load and unload the patients. We wheeled the patients out to the ambulance, hoisted the gurneys up into the back, placing the 12 year old up on the designated gurney shelf in the back of the ambulance and the 10 year was placed on the floor of the ambulance, because normally this ambulance is meant to carry only one patient. These are not ambulances like the nice fancy ones back home. These are military vehicles that have been converted into make-shift ambulances.

I climbed up into the back of the ambulance with the patients and waited while one of the Corpsmen brought me a portable suction machine so that I could ensure the two kids wouldn’t drown in their secretions on the ride out to aircraft. Several people kept yelling that we had to go because the aircraft was running behind schedule. I yelled back that we couldn’t drive off until I had the right equipment to ensure the safety of my patients. Meanwhile, someone threw me a pair of goggles and told me to put them on when I got out to the flight-line, otherwise the jet fuel would burn my eyes. I was handed the suction machine and then the heavy ambulance doors were slammed shut, leaving me in the back of the ambulance, very dimly lit only by the daylight shining through the two small windows in the back. There was no interior lighting like in modern, American ambulances.

The ride out to the aircraft was somewhat bumpy and I was glad to have the suction machine because the younger boy required it’s use a couple of times. After a few minutes, I felt the vehicle change direction and then begin to move backwards until I heard someone yell, “That’s good. That’s good!” It seemed as if the double doors blew open on their own as I suddenly felt something burning my eyes. I remembered the goggles from earlier; they were still on top of head. I quickly pulled them over my eyes just as they were starting to water. Then as I climbed out of the ambulance, the smell hit me hard, that smell that reminded me of my sister’s obsession—jet fuel. Boy would she have loved to just stand out there on that runway this morning and taken in the fumes of the majestic C130!

Then back to reality as several people quickly pulled the two patients out of the ambulance and ran them up the ramp into the bowels of the aircraft. I walked up the ramp, hoping it would be quieter inside than it was outside, but was sadly disappointed. I had to yell my report to the medic who was taking over care of the boys and hope that he at least heard the most important parts. I then knelt down next to the 12 year old and boy, touched his head and smiled at him, hoping to make him feel more comfortable about the trip he was about to take. He seemed to understand everything that was going on and, once the Air Force personnel were done frisking his family member, as he slid in behind me and smiled at the boy, the boy finally smiled back.