The Longest Day

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By that time, we’d been there for months. Jay, Gino and I, along with the rest of the team, except that coward Helton, he was never coming back, we just didn’t know it yet. Afghanistan smelled like diesel exhaust and pot, with a little burning garbage thrown in for flavor. We could taste the remoteness of our location in the dust. It was everywhere and got into everything. By October we were pros at treating people on the battle field, we had grown used to the burned and bloody, to dirty people who just needed a good scrubbing and some morphine.

The day started like most others, another groundhog day just like the day before. Casualties to this point had been sporadic, with most of our time spent on sick call for GI’s with the Salerno Crud and Afghan civilians with every problem under the sun from kidney stones to cataracts. We treated just enough local nationals to keep busy. Boredom was a constant enemy that could sap our strength, our morale and sanity if we didn’t act to prevent it. We saw its power work on the unit we replaced, worn out after 6 months only seeing a few hundred patients.

Sarvar was his name; he was evacuated to us from Orgun-e the previous week. Shot in the back. He came with his father; it was rare to get a local national without a family member, because in a country with no nurses, your family played that role. On its surface his wound looked catastrophic, a bullet hole in the middle of his back around T-11. He could move his toes, which kind of surprised us, and he could kind of breathe so all hope wasn’t lost. His x-ray revealed that he was one of the luckiest guys in Khowst province because his spinal cord and vertebrae were intact, the bullet skimming along his rib cage and collapsing his left lung, he would live to walk another day if we could re-inflate his lung.

Sarvar and was my only patient for five days, is chest tube with a constant air leak that just wouldn’t go away. He spoke no English of course Pashto was all he and his father knew. The interpreter or ” Terp” was always around to get the message across. Sarvar, while now a civilian drive by victim, had been part of the AMF or Afghan militia, who helped the US throw out the Taliban. We had by now learned that sometimes local nationals had a flair for exaggeration and half-truths to shore up their position when dealing with us. Sarvar told a tail of working with the Americans at Orgun-e and distinguishing himself against the enemy in support of coalition forces and shaking hands with General Franks. Of course, of course was my first thought, they were all on our side helping us to find Osama Bin Laden. My skepticism faded quickly when his father produced the pentagon shaped coin the general presented him. He also had the ID card and paper laminated Combat Infantry Badge the Special Forces gave him. He was on our side after all and this seemed to make the days go quicker caring for him. Turns out they both had a keen interest in watching DVD’s with me to pass the time.

Following the war day to day on the computer did two things: If you were like me, and obsessed with what was going on, it passed the time nicely. It also told us when things were happening. There was a TIC or army speak for troops in contact, a battle, a firefight. The Medevac’s parked on the field just over the wall spooled up their rotors to fly to our south, the AMF had made contact with the enemy and people were hurt. This gave us some time to get ready. Years’ worth of training was called to action; there would be more than a few casualties. We were a small unit of 20 on paper. Howard was in Bahgram managing our supplies, and the Med Group had taken one of our surgeons due to a lack in volume. We had a few medics from the infantry battalion, but they mostly just watched when these things happened or deferred to the Doctors and nurses present. 17 total to man 4 trauma beds, 2 OR tables and post-op with 4 ICU beds and 4 Med/Surg. I was the ICU/Med-Surg head nurse. I was supposed to supervise 3 LPN’s, one per shift but Allen had been taken to the Trauma section to shore up their clinical skills and Helton had gone home to a Red Cross Emergency 10 days after we got here. That left me and Jay, an RN in civilian life, with tons of experience to staff 12 on and 12 off.

We received 11 traumas from the battle between Afghan National Army soldiers led by American Special forces and insurgents. They came in two helicopters; we had planned for four, because that’s what they told us on the MIRC. The flight medics were good about getting us the sickest first. A gunshot wound to the liver, the other 10 with blast injuries and gunshot wounds in various extremities, all of them frozen from fighting in the mountains, all of them covered with blood and dirt. Doctors argued over whether the liver was worth the effort, while layer after layer of clothing was cut off, and wound after wound was cleaned out and prepped for the OR. We all worked in the trauma room, then the OR as patients made their way through our little system. Once they were sorted and stable, I stepped over to the ICU tent to prep for post-ops. Sarvar and his dad were still there, his chest tube having been taken out that very morning.

What started as a busy day just after lunch with a magnificent sky had turned to darkness without anyone really noticing. As the patients started arriving from the OR, they began to stack up in my tent, newly expanded with addition of a few cots from 8 beds to 10. My efforts were focused on the liver, who survived surgery to make to the ICU. He had gotten 8 units of blood, but as fast as I could put it in, it drained out of his chest tube. His criticality was enough to hold peoples interest but as soon as he was gone, things began to calm. Being busy caring for people at first I didn’t even notice. One by one my help was fading away, 12 hours into this operation it was no wonder. I was alone in the tent with all 11.

Unfortunately for me, every one of the soldiers who got anesthesia decided to start throwing up at the same moment. I started at one end holding basins, giving Zofran. How the hell was this ever going to work? This day already sucked and I’d seen enough awfulness to last me a long while. Now the puke-a-thon! I looked up and saw something that touched me and changed my outlook on this dirty country and its mercenary people. At the other end of the tent was Sarvar, basin in hand helping one of his countrymen throw up, at the bed opposite him his father was doing exactly the same with another soldier. I was truly touched witnessing this level of caring for total strangers. It was like these two men through their selfless acts had erased a day’s worth of awfulness and given me hope that maybe this country would not always be at war with itself or anyone else.

About the Author: Joe Bick Served as a Captain in the Army Reserves 691st Forward Surgical Team at Forward Operating Base Salerno, Afghanistan in 2003-2004.