Unintended consequences.

The unintended consequences of war. Local national driving his car, hits an IED. Brought to our hospital in bad, bad shape. The list of injuries: intracranial bleeding, broken jaw, skull base fracture, broken scapulae, broken left arm, left pneumothorax, splenic injury, pelvic fracture with significant internal bleeding, shattered left femur, left below knee amputation, penetrating injury to the right leg with no pulse.

He receives the full court press. Intubation, left chest tube, multiple catheters to deliver fluids and blood products. Full body CT scan and then rushed to the OR because we're losing the battle.

Try to visualize the activity level in a small OR with this patient. Two anesthesiologists, two general surgeons, two orthopedic surgeons, one interventional radiologist and one general radiologist, one OR nurse, two OR techs, one radiology tech, all engaged in a battle against time. The anesthesiologists are keeping the patient breathing and pumping blood products into him as fast as they can. The general surgeons are opening his abdomen to look for the source of bleeding. The orthopedic surgeon is completing the amputation to his lower leg and trying to stop the bleeding from that side. As they are doing this, I'm putting a catheter into his femoral artery to evaluate his arteries in his right leg and then look at the arteries in his pelvis to potentially stop internal bleeding.

In the best of situations, all of these individual pieces of this operation are complex and deserving of special focus and attention. This is not the best of situations. We're trying to do this simultaneously in a small OR on a critically injured patient. In this patient's case, this was the proverbial dance with death. Death won.

This is not the kind of work that I did in residency and fellowship. It's hard to train for this kind of trauma because we don't see this kind of trauma in the U.S. That being said, I love what we're doing here.

I fully expect that as the surge happens this kind of trauma will happen more frequently. It's a rather simple concept, put more people into harm's way, more will get injured. Funny thing, most people agree that putting more troops into the fight is the right thing to do. If that's the case, then why is it that fewer than 1% of all Americans are involved in this war?

“It must be laid down as a primary position and the basis of our system, that every citizen who enjoys the protection of a free government owes not only a proportion of his property, but even his personal service to the defense of it.” George Washington, in a letter to Alexander Hamilton, 2 May 1783.