Rough Night In The ICU

Well, over the past couple weeks all we have had to complain about is all the mud we have been tracking into our rooms and the hospital due to the several days of rain around here. Now when it rains in Kandahar, it’s not like Seattle where it rains sometimes for days with no break in precipitation. Here it just drizzles for a short time and then stays gray for the rest of the day, then may drizzle again later on. However, because the ground is so hard packed here, the water is not absorbed and, instead lies on top of surface, causing large puddles and even flooding in some areas. The mud that forms from the rain mixing with the “sand” (more like fine, powdery dirt) becomes pasty and loves to cling to tread on the bottom of our boots. The hallways of our NATO housing are scattered with clumps of dirt as well as the hallways of the hospital. Housekeeping sweeps and buffs the floors every night, but as soon as the day shift crew walks through the doors, the shiny linoleum quickly becomes tarnished with dirt.

I will warn you that this blog entry may be disturbing to some. I wasn’t sure if I should write about my experience at work last night, but I think my friends and family should know what a night in the ICU here can be like. It is not all about Bazaars and birthday parties here. We are fighting a war over here. So here it is . . .

Last night, I was just about to head out the DFAC to grab something to eat for dinner when my phone rang. It was the ICU charge nurse requesting me and my room-mate to please come in as soon as possible because they were getting several patients from the OR. Several Army personnel were injured by an IED. When we arrived, there were so many people running around that it took several minutes for someone to even take notice of our presence. We asked people if they needed help, but everyone kept referring us to the charge nurse to receive our assignment. Eventually, I was assigned to a 25-year-old Army soldier named Patrick, due to come out of the OR at any time. All I knew was that he had multiple blast injuries, including major head trauma.

As soon as I saw the OR team rolling my patient through the door that separates the ICU from the OR suites, I grabbed the foot of the bed to help direct it to the right bay. The anesthesiologist, an older bald man with a slightly eccentric, grey mustache, asked me to get the ICU doctor. I found our intensivist and informed him that the patient had just arrived. Once at the bedside, the anesthesiologist told him everything that was done in the OR, but despite their efforts, he did not feel that the patient would survive very long. The patient was currently on the maximum dose of vasopressors (drugs used to improve contraction of the heart as well as blood pressure) and had already received over 30 units of blood products.

Once we got the monitor hooked up, his blood pressure was reading only 50/30. Essentially there was nothing else that could be done. He was bleeding out from multiple injuries, including his head, and not even surgery was able to stop it at this point. When I looked at his eyes, his pupils were fixed and dilated, a strong indication for brain death. When I lifted his head to reposition some tubing that had been caught under his neck, I could actually feel my hand mush into his skull. He was bleeding from his nose, his mouth and his ears. His left arm and both legs were wrapped tight with ace wrap bandages, but I could see large amounts of blood already oozing through.

When the anesthesiologist finished giving report to the ICU intensivist, they made a collaborative decision to withdraw support. I received orders to give morphine “to keep the patient comfortable.” Giving morphine to patients prior to withdrawing support is often a palliative measure that benefits the caregivers and family/friends of the patients more than it does the already-brain-dead patient. I administered the morphine and then, along with an Air Force medical technician who was helping us out, the two of us cleaned up Patrick’s face, chest and hands so that he looked more presentable. I knew there were several of his buddies anxiously waiting to come see him.

Because it had been so busy with so many casualties, the ICU doctor had not had a chance to inform Patrick’s Unit Liaison that we were withdrawing care. Luckily, his Chaplain walked in and I informed him of the fact that there was nothing else that we could do for him. He went out to the hallway where Patrick’s Unit members were waiting and notified them that this would be good bye. I was also told, by the Chaplain, that an Army General would be arriving in about 30 minutes to perform a Purple Heart Ceremony. I immediately informed the ICU doctor that I wanted to do whatever it took to maintain his blood pressure long enough so that he would still be alive for the ceremony. The doctor gave me permission to continue resuscitative measures using the vasopressive drips, as well as fluid boluses, to keep him alive just a little bit longer.

In the meantime, a female soldier who had been shielded by this hero during the blast, and thus only suffered a few minor injuries, was brought by wheelchair to his side to say goodbye. She immediately broke down in tears and starting screaming, “Fucking Taliban.” Through her sobs she spoke of her regrets that she wasn’t able to somehow stop this tragedy from happening. A wonderful female Medical Liaison for the Army personnel, stood next to her, explaining everything that we were doing to keep him comfortable. She consoled her, telling her that there was nothing she could have done. I had to grit my teeth as tears welled up in my eyes. “I must maintain my composure,” I reminded myself.

After she was wheeled back out of the ICU, I let the other member’s of Patrick’s Unit come in, four at a time, to say good bye. Some only stayed for less than a minute, then quickly retreated, while others lingered for longer periods of time, whispering words into Patrick’s ear. The Chaplain stood at the bedside, offering support and condolences. I continued to adjust the drips and hang more bags of fluid while I watched his blood pressure drift down to 35/20. I anxiously eyed the clock every few minutes, hoping for the General to arrive sooner rather than later because I wasn’t sure how much longer Patrick would live.

Finally the General walked in and stood next to me while an entourage of people, including a photographer snapping photos, filed into the bay. While the General waited for everyone to squeeze into the small space, he turned to me and shook my hand, saying, “Thank you for your service and providing such excellent care to our soldiers.” I replied with, “You are welcome, Sir and thank you for your service as well.” He then stepped up next to the patient and someone called the group to attention. The General presented Patrick with the Purple Heart Medal by placing it over his heart. The photographer snapped a few pictures. The award was then removed and placed into a protective case. And as quickly as they arrived, the General and his entourage were gone.

A few of Patrick’s buddies lingered, just standing with heads hanging low and hands behind their backs, probably feeling a lot like I did just before my mom died, hoping that suddenly the vital signs will reverse and go back up, proving us all wrong. But eventually, the drugs and the fluid boluses couldn’t keep up and I lost his peripheral pulses. I told the Chaplin that it was time to turn everything off and remove the breathing tube. I informed Patrick’s friends that they were welcome to stay, but if they wanted to step out, now was the time. My respiratory therapist then removed the tape holding his breathing tube in place and pulled it out as I turned off all the IV pumps. Within five minutes a flatline appeared on the monitor and I said, to the people who were gathered at Patrick’s side during his last minutes of life, “He’s gone,” and turned off the monitor. Shortly after that, the ICU doctor came and officially pronounced the time of death.

After allowing Patrick’s “family away from home” to sit with him for a while, another Corpsman and I bathed him and removed all other tubes and lines. Two Army men arrived from the Mortuary and we helped place Patrick’s body into a rather fancy black bag. I then placed a U.S. flag over the body and informed as many people as possible that we would be having a ramp ceremony. Approximately twenty people lined the hallway near the exit out to the loading ramp. We all stood at attention and then saluted Patrick as he passed by, providing him with one last honor before he departed the Role 3 hospital. It was a sad night for us as it had been a while since we had experienced the death of a U.S. soldier.

As I sit here in my bed, listening to the artillery fire somewhere off in the distance and feeling the building shake from bombs being detonated, I think about how complacent we have become over the colder winter months. But now, as the weather is beginning to warm up, rocket attacks are occurring more frequently and casualties among the coalition forces are increasing. We have mostly had local nationals as patients with injuries from things like falling off donkeys and burns from oil lamps or infections. Now, after almost three months of very few coalition force casualties, I was reminded last night that we are still in a war zone.

12 comments on “Rough Night In The ICU

  1. Tom Penn says:

    Krista, thank you for sharing; I am so sorry.

    Please know that I love you soo much; your words made me break down and cry. I just want to tell you I am here for you – I am waiting for your return…and although nothing I can say can make it better , know that I am here by your side. God speed you home soon.

    Thomas

  2. Jessica says:

    Krista,

    Thank you for writing this. There are no words. Thank you to Patrick for his service to this country and for helping to save the lives of others, and thank you for doing the same.

    Jessica

  3. Marita Zieger says:

    Krista, No words can express the sadness and the sorrow I feel for this young man and all of you caregivers who take such good care of the wounded and the dying. I wish I could do something to make this all better. I can only pray for the soldiers, their families and their caregivers. Be strong and stay safe! God speed for coming home.

  4. Jessica Titus says:

    Krista,

    I have tears in my eyes after reading this. You have so much courage performing duties that surround so much tradjedy. You have also reminded us that there is war and death, and to be thankful for each day that we have with our loved ones. I am certainly thankful for you and that you are safe and healthy. A part of Patrick and his heroism lives on in your words. Your patients are lucky to have such a caring and genuine care-giver such as yourself! You truely are amazing. I hope you give yourself time to grieve (or will) for these losses . . afterall you are human, and what you are dealing with is something no one could ever imagine unless in your position. Take care and be strong. I love you!

  5. Dad says:

    I, too, don’t know what to do or what to say in response. There is so much hate and division in this world that, it seems, no human mind (certainly not mine) can quite comprehend the “why” of it all. What drives me to tears, and deep anger, is that a young man like Patrick, who has had little to nothing to do with conjuring up all this division and hate, receives the brunt of it all. And I weep as much for his family, too, who now have to live the rest of their haunted lives without him. And, of course, those of you who gave him care and had to be the ones to “put him to rest” will have to live with your own hauntings and will have to find a way to release all your grieve as well. It is all so totally unimaginable and insane — and yet — if I were Patrick, or any other soldier over there doing my duty in the midst of all that insanity, there’s no one I’d rather see hover over me than my daughter and her well-trained compatriots. Thank you, Krista for being there as a healing angel. I hope I get to see that daughter again soon; that’ll be a wonderful moment. Until then — stay safe, keep being a human being in the middle of all that inhumaneness, thank all your co-workers for doing just that, and send my best wishes to all your soldier friends. Looking forward to seeing you soon. No “fair winds and following seas” tonight; it just doesn’t seem appropriate. Hugs — that will have to suffice.

  6. Tom Sheridan says:

    Krista,

    Thank you so much for your detailed writings. I know I’m not alone in saying that your writings have brought the story home to us in a way the media has generally overlooked.

    Patrick lost his life as a hero. Unfortunately, that will still leave so much emptiness in his family and friends’ lives as they move on without him. Words cannot ever bring solace to those whom he touched; time is the only true healer.

    I pray for all of our troops and caregivers stationed in harm’s way and that God, in His infinite wisdom and power, protects all of you from further harm and heartache.

  7. Baerbel says:

    Saddened, touched, humbled, angered— but most of all, grateful to all of you including of course, Patrick.

  8. Maureen says:

    Thank you for writing this. We all need to know what a night in the ICU is about….what a night in the field for one of our soldiers is like……what it is like to be subjected to IEDs……We cannot make sense of the hatred that spawns such things but we must be aware of it and its consequences…..and people like you and Patrick sacrifice to make the lives of others better….to try and contain the hatred and protect those who find themselves in the middle of it day in and day out…I cannot imagine what it is like to be an ordinary citizen there.

    Maureen

  9. Kevin, Susan, Scott, & Halle says:

    Krista,

    Halle and I were walking the dog last weekend and asked me why all the neighbors had yellow ribbons around their trees. I explained that they were there to remind us of your service and would remain until your safe return home. The very next day I arrived home from work to find a ribbon tied to one of our trees on the front yard.

    I walk by your house every morning and twice on the weekends. We think about you and Tom every day and what you sacrifice to keep us free. THANK YOU!

    Stay safe, return soon,

    the Hansens

  10. lynne says:

    krista, as per usual, i was in tears before i finished your entry. I continue to be impressed with your professional attutude, your compassion and empathy, your respect for patients and your amazing writing ability. You are such a credit to nursing. PS if you want to know latest on CRU group, email me

  11. Margaret says:

    Forgive others for they know not what they do. Spiritual growth often comes to us in ways that we don’t expect. Trust that your inner guide is leading you and guiding you in ways that are best for you and everyone around you. Stay strong and know that you are protected in love.

    Margaret, RN, CRU

  12. Commander, USN (RET) says:

    Krista, your father-in-law sent this to a friend of mine who once served under his command. Please know that we will try to give your blog the widest possible exposure. So many persons know little of what is taking place in Afghanistan and your voice needs to be heard far and wide.

    Thank you so much for caring, sharing and yes, loving.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s