Beneath the Surface

Up until today I have been writing about happy times in my blog. You see, I enjoy writing, and keeping this blog going has been something I’ve enjoyed doing. It does make me feel less alone when people post comments and it’s nice to know people out there are keeping track of what’s happening here. But here’s the caveat, my blog hasn’t been a completely accurate description of ALL of my thoughts on a day to day basis. It, for the most part, has left out my political opinions, my deep thoughts and my concerns. Instead it talks about such comical things as mouse traps and personal lubricant. I’ve done this because I know my mom has given this blog address to many of her friends and family, close and distant, and up until recently I’ve felt that it was pointless to worry everyone or talk about my darker thoughts. Yesterday, one of my friends called me out on this. He said that he didn’t enjoy reading my blog because it didn’t talk about any of my personal thoughts and instead he thought it was a popularity website, that I needed validation for what I’m doing. Well, here’s what I have to say to that.

Has anyone ever seen what a leg that’s been blown apart looks like up close? …A leg that sustained a blast injury to the thigh so severe that it was attached only by a few layers of skin? In the very recent past (I can’t disclose date for security reasons) the base wide announcement system came on in the middle of the afternoon “Attention Al Asad, Attention Al Asad, all trained medical personnel are to report to the Army Hospital immediately”. So without hesitation, I grabbed my gear, took my corpsmen and we were off. On the way to the hospital I asked myself what might be going on – a Mass Casualty? An accident on base? A drill? I also went over some emergency procedures in my head as it’s been a while since I was involved in a trauma scene and I was afraid of my personal inadequacies.

We arrived at the hospital to a mob scene. It was chaos. I identified one of the ER employees I knew amidst the crowd of docs, surgeons, nurses and corpsmen that were crowded into this relatively small Emergency Room. He said that a Mass Casualty Event occurred and we would be receiving casualties momentarily. I looked around to see who might be in charge of this scene and identified the charge nurse. I identified myself as a Physician and she said “Follow me.” She directed me towards bed 8. She said, “Ok, you’ll be in charge of this bed. Standby to receive a casualty”. I was like, “Holy Shit! I went from an innocent bystander to being in charge of someone’s life in the blink of an eye.” (Mind you, I'm in charge of the lives of all of my squadron, but usually they're not slipping away in front of me.) I tried to stay calm and I began to go over my emergency procedures in my head as I introduced myself to the other nurses that were at my bed looking to me for guidance. I made sure we all had a position / task to do to ensure there wasn’t any panic when the person arrived. This may seem a bit de-humanizing, but saving someone’s life when they’re slipping away before you takes focus and requires a calm, organized procedure. I was ready as my heart was pounding, and so was my team.

(I need to remain somewhat vague about the following details for security reasons, but if you have a weak stomach, please don’t read any further.)
Several soldiers came in (I can’t disclose their nationality), but because the casualties we received never made it to 8, my bed never got filled. I decided to offer my help in one of the trauma bays. I approached this unconscious male whose left leg was all but blown off. His Femur (thigh bone) was broke off just a few inches below his pelvis and his muscle and tissue were hanging on the gurney. Blood vessels were spurting blood out of this poor man as the surgeons raced to clamp each one. I started to let it all in – what this guy was going through - Was he a father? A husband? Was he in the wrong place at the wrong time? Why are we fighting this war anyway? But I quickly caught myself and tried to remain focused. Things were very chaotic (another trauma victim was being taken care of just 5 feet away from me). The nurse doing CPR was getting tired, so I offered to step in and take over. The ER doc in charge of this man knew he was slipping away. His blood pressure was falling and something needed to be done. So he decided to crack open his chest, exposing his heart and lungs, which he felt for any damage. He took a clamp and clamped the soldier’s aorta (a large blood vessel leaving the heart) to help support his blood pressure. It worked! Now that he was stable, within seconds, the next group of people stepped in – the Radiologists, the Surgeons, the nurses. It was all happening so fast. There were so many thoughts going through my head: “This poor guy might die right now…No one even knows who he is...I can’t believe the ER doc saved his life…How cool is it that we have such knowledge of medicine that because of our efforts (and God’s will), he made it. How else can I help? What should I do?” Focus RJ, Focus!

Within 5 minutes all of the soldiers were rushed off to surgery as quickly as they came in. One of them sustained a blast injury to his lower back and buttock, which was completely unrecognizable. The IED blew apart that entire section of his body and just left a hole where his rectum should have been. This made the room smell like smoke and stool. (A smell which pretty much tells you something terrible has happened) The others I never got to see. And I left, not knowing anyone’s name. We were told to clear out and we walked out of the hospital, with only our prayers to the soldiers that were hurt…

Everyday I wake up to the comfort of my Jersey cotton sheets. They provide me with comfort at the end of every day, but its false comfort really. As I start my day and walk out into the hot desert sun I look up and see several helicopters leaving the base perimeter to go on their mission. I think about the war, and why we’re here. I often wonder if one day the people of this planet will be able to all get along, despite their differences in culture, language and belief structures. I try to remember my sense of purpose and I think about God and how he has a plan for every one of us.

Every night, when I get off the bus and walk home in the dark under a beautiful starry sky, I think about my presence here, and if it’s legit. I have to trust that despite the opinions of those who may or may not believe in our President, someone is making the decisions that need to be made and he or she is doing the best possible job that they can do, based on what they know and with God looking down on them. You see, if I don’t believe in our cause, how can I possible motivate my Marines and Sailors everyday to do their job?

My mission is to take care of the men and women in my squadron, in addition to those I see in the hospital, and I’m doing just that. I was born an American, and despite everything that has occurred in my country’s history, both good and bad, I can only affect the here and now – today. I can only do my best to take care of everyone that’s out here – as a Doctor, and as a friend. This makes me proud. I do feel proud to be helping in this way. I am an American who knows that he can’t change the past, but one who also knows that my actions here are a reflection on my country, and I’d like to think that they reflect positively – especially to those who have any beefs against America or our presence here.

Now as I continue with my blog entries about Girl Scout cookies and water gun fights, remember - that's only half of RJ, only half of what he thinks and feels every day. Please don't assume that because I choose to write about happier moments that I am ignorant or that I don't think about the global picture. Trust me, I do.