166 Days: My Journey Through The Darkness (15 page)

13 August 2008

With every day I spent in Afghanistan, and the more war I saw, the more I longed to be home. Two days before, the team had a mission to go into a very hostile area where the majority of the people were members of the Taliban or their supporters. They were expecting to get into a firefight, which of course was worrisome for me; every time they went out we worried one of them wouldn’t come back.

Naturally as the guys left, Becky and I took our second job of manning the radios. Throughout the day we listened in horror as they got ambushed several times by the Taliban. It was the worst feeling, hearing the gunfire in the background as they requested Close Air Support (CAS). Back at the firebase, two of the team guys stayed with us and were hanging [shooting] mortar rounds as requested by the team commander to help with defense of their position. As previously planned, CAS targeted several pre-determined locations in effort to draw the Taliban out. One particular compound, that was said to be a safe zone for some high ranking Taliban, was demolished with a 2,000 lb. bomb. Unfortunately the Taliban had time to flee the compound before the explosion, and before they left, they forced eleven civilians to remain in the targeted compound. Eight innocent lives were lost and three people were wounded. After the blast, the team had the task of digging the bodies out of the rubble. I couldn’t imagine how this must have felt. Hal told me later they were buried holding each other; women holding babies, men holding women, it was awful.

The three injured civilians were evacuated and brought back to the clinic where we treated their wounds. While we cared for them, some of the guys questioned them and discovered one of the survivors, a man, was a facilitator for the Taliban. He was paralyzed from the waist down. His wife had minor injuries, and thankfully their baby only suffered minor injuries as well. The rest of their family had perished in the explosion. I couldn’t imagine how it must have felt for them to have their lives completely flipped upside down and lose the majority of their family, not to mention being cared for by the people who were responsible. War is a horrible thing.

Along with the surviving family came a little boy with his five-year-old sister, who was not in the same compound but one nearby that was hit by a mortar round. The little girl’s nose was cut badly and appeared to be broken. The whole time I was treating her, she kept crying, “I am only hurt a little, I am strong! I am ok!”

“Tell her she is so strong….she is so brave!” I pleaded with the Terp, holding back my own tears. I wanted so badly to take her into my arms and hold her. I wanted to make all of the terrible things that happened there go away, but I couldn’t. All I could do was suture up her wounds and treat her pain.

Luckily, our guys fared much better through the whole ordeal. Two of the ANA soldiers were wounded, one was shot in the back, and thankfully the round did not penetrate his body armor. The other soldier was shot in the hand and we later air evacuated him to TK. The incident made national news and I can’t describe how it felt reading about myself, and the people I was with, on the internet. The whole thing got to me; it was horrible to see what happened to innocent people who did nothing more than frequent the wrong place at the wrong time.

The next morning I woke up, well-rested and in a somewhat better state of mind. I went to the clinic and saw yet another child on the verge of death due to severe dehydration and malnutrition. At least with this little one her father agreed to take her to a bigger facility to get more definitive treatment; this certainly was not the norm. Death was an everyday circumstance to these people, it was like the majority of them seemed numb to it. Later in the morning I saw a sixteen-year-old boy who had crashed his motorcycle three days before. He was the nephew of an ANP soldier I had treated throughout the month of July for a gunshot wound to the leg. He’d come to see me every day for dressing changes for almost a month after returning from the FST. He thought highly enough of me that he brought his entire family for care several days before he brought in his nephew; I was grateful and happy to help in whatever ways I could.

When I saw the boy I knew the situation was not a good one. He was originally treated by the bazaar doctor nearby. As I lifted the boy’s pant leg, I could see what this “treatment” consisted of. He had a “splint” made of four small twigs, about the diameter of pencils and blue cloth. While this was certainly not the standard of care in the US, I had no idea what I was in for just beneath this configuration. As I cut away the cloth, I saw a large glob of hair that was soaked in egg. Apparently it was thought that this combination had some healing benefits. The odor took my breath away and the idea of touching the hair and egg was almost too much. I felt my stomach turn with nausea.

I put on another pair of gloves and took a deep breath and began to cut it away from his skin. After quite an ordeal of cutting, I was finally able to get the hair and egg off and performed an x-ray which unfortunately revealed a serious injury. He had a comminuted (broken in multiple places), displaced tibia fracture with a segment of bone millimeters away from puncturing his skin. His fibula was also fractured. This was, without a question, a case for an orthopedic surgeon. He would need the kind of intervention that I could not provide, and of course his family was unable to take him to TK because his father had no money and feared if he made the journey the Taliban would kill him and his son. I called and spoke with the orthopedic surgeon, who recommended external fixation, which I did not have the equipment for, so he talked me through how to reduce the fracture and we came up with a make-shift treatment plan together. I splinted him in a long-leg cast for four weeks. Then he was to return, and I would place him in a short-leg cast for four more weeks, and there could be absolutely no weight bearing on the leg for the entire eight weeks. I explained to the boy and his father he would likely lose some function of the leg, but he should still be able to walk. I sent them away with my new calendar system of hash marks feeling I did the best thing for him, given the circumstances I had to deal with.

After clinic I went up to my room and shopped online for Griffen, my stepson. He was coming to live with us in Florida and would be there when I got home. This was a huge step for us as a family and I wanted to send him a little “Welcome Home” gift from me since I couldn’t be there to greet him in person. After an extensive search I found him a little bouquet made of candy that was placed in a neat little ceramic shoe. Perfect. I couldn’t wait to see my little guy…and Greg. It put a smile on my face thinking about my boys and my life away from this place.

And, just when my spirits were up again, there was a knock on the door. “Jenn! Becky! We need you down at the clinic, there’s a little girl who got blown up and she lost her thumb and part of her hand!” Hal yelled.

“Oh my God! How awful, we’re right behind you,” I said and quickly gathered my things. When I got down to the clinic I saw a beautiful little girl who was covered in blood and had shrapnel wounds to her entire abdomen, face and arms. She had nothing but mangled remains of what used to be her right hand.

“What happened to her?” Becky asked the father.

“She was outside playing and the next thing she knew her hand was blown up!” the father explained and IG translated. As we stabilized her, and made her comfortable with pain medication, I noticed how distraught her father was. He appeared genuinely concerned for his daughter; a rare sight in my experience with Afghanistan.

I put my hand on his shoulder and told the interpreter, “Tell this man we will do everything we can to help his daughter.”

“Thank you,” he said.

“You have a beautiful daughter,” I replied.

He looked at me and began to cry as he said, “Yes, but they ruined her! Her hand!” I looked at IG who could tell I didn’t fully understand what the father meant.

“In Afghan tradition, a woman with a mangled hand is undesirable and will never marry, except to a man that is much older,” he explained. She was fourteen. My heart sank.

We worked to get her air evacuated out, but the weather was far from favorable for the flight. The visibility was significantly decreased and given the hostile area we were in, which prevented any movement until it cleared. We would have to keep her overnight and keep her stable until we could get her out to TK. Hal, Becky, Kyle and I agreed to take shifts throughout the night with her. I wrote out the schedule of times she would need repeat doses of her antibiotics and pain medicine and we started our shifts. The night was long, but thankfully with the hard work of our team, she remained stable and comfortable throughout. My shift was scheduled at 0200 hours and as I sat in silence with the poor little girl and her father I cried for her. She would likely lose her hand and had already lost her potential for love; she was so young and innocent of all that was happening around her. Her father was sitting next to his child rubbing her hair softly with a broken heart and crying sincere tears of sadness for his only daughter.

14-18 August 2008

The next morning we were able to get the little girl on a helicopter back to TK for further care at the FST. While the night was relatively uneventful, as she remained stable, it was such a relief to get her to the surgeons who would do the best they could for her hand. I called later that night and was informed they were able to salvage part of her thumb and fingers. They had a good prognosis for her and stated they would continue to follow her progress there.

Two days after this news I was in the clinic and I looked outside and saw the girl and her father walking up to the door. “What are you doing here?” I asked the father.

“We have been released and they told me to take her to you to change her bandages,” he answered. I found this to be odd, considering I had just spoken with her surgeon who told me a different story. As I took off her dressing, I saw that this was certainly not what was recommended. She still had pins in her fingers and her thumb was turning black; a sign that the tissue was dying.

I called the FST and was told the rest of the story. The orthopedic surgeon didn’t want to discharge her yet, but the father insisted on going home to check on his family, but promised to be back in three days for continued treatment. The surgeon was equally concerned about the status of her thumb. I went back to the clinic and spoke with the father, “Sir, you have to go back to TK, her thumb needs immediate treatment.”

He saw my concern and agreed to return. “Yes Doctor,” he said, “I will get her back tonight.” I changed her dressing and sent them on their way.

Two days later the father showed up at the gate. “Please help me! I was given a letter at my shop in the bazaar that said they would kill me if I continue to come to you,” he pleaded with the guard. “I’m scared to travel to TK and I need help.”

“Go home, get your daughter and the letter and come back and we will help you,” Kyle instructed. Luckily there was a flight coming in later that day from TK we could put them on. Several hours later he showed up empty handed and told the guards he couldn’t leave that night and requested to speak with me the next morning. He left before I could speak to him. The next morning I was told he showed up several hours before the clinic opened and was told to come back but never did. I never saw him again.

Several days later I called the FST to see if they heard anything about the girl and her father and fortunately they managed to make it back on their own for further treatment of her hand. The surgeon had to go back into surgery and debride (cut away) the dead tissue of what remained of her thumb, but she did well. I prayed they were safe and she recovered well; however, I never found out, because that was the last update I received.

19 August 2008

I woke up to the sound of gunfire and explosions. I had become somewhat used to the sound, as we got attacked more and more frequently due to the time of the year. I thought initially it was the guys doing routine test fires, yet when we got a knock on the door from Kyle, telling us the base was being mortared, the reality of the situation became obvious. We were under fire all morning, receiving a total of fifteen attempted rockets, luckily for us, their aim was way off. Clinic of course was cancelled, so Becky and I spent the day on the radios.

After our daily afternoon meeting, I went to my room and not five minutes later there was a knock on the door. It was one of the guys telling me there was an emergency patient down at the clinic. I grabbed my things and ran down to the clinic to find a twenty-two year old girl with a gunshot wound to the head. I was told that it happened around 0800 hours, during the time our base was being attacked. I looked at my watch and noted it was 1700 hours.

She was covered in a blanket and when I unwrapped her head I couldn’t believe what was in front of me. Her wound was mortal; she had extensive amounts of brain matter protruding from her head and her pupils were fixed and dilated. Her condition was imminent and I knew there was nothing I could do to help her. She was already brain dead and basically, her vital functioning was keeping her body alive.

As we worked on her, I watched her father who was sitting at her side. I was taken aback by the coldness and lack of emotion in the behavior he displayed. He didn’t even request to be near her. Eventually I became very angry at this display of what was to me a total lack of humanity. After we finished bandaging her wounds I couldn’t stand it anymore. “Hanifi, tell him to sit down by her, hold her hand and at
least
console his dying daughter,” I said angrily. I explained everything that was happening to him and then asked if he had any questions.

“Yes, I have one. Is she going to be ok? Her husband is upset,” he answered coldly. I couldn’t believe a father had such disregard for his own child.

“Sir, do you understand the extent and seriousness of her injury? She is dying. Her body will keep her alive for a short time before infection and her organs will start shutting down,” I explained.

He shrugged his shoulders and replied, “Ok. If she dies, then she dies.”

I was disgusted by him, and the more I sat there, the more upset I became. Hanifi must have sensed my anger. He put his hand on my shoulder and said, “My sister, this is my country.”

I looked at him with tears in my eyes and replied, “It’s awful.”

He nodded and went on, “My two brothers were killed by the Taliban as well.”

“Hanifi! Are you serious?” I gasped in disbelief.

“Yes. They were ambushed and both shot in the head. Jennifer, I watched them both die just like this poor girl.”

“I’m so sorry Hanifi,” I replied. It took everything I had to keep myself together and not break down into tears. I couldn’t understand how these people had come to live so complacently with this horrible reality.

The team conducted their standard interviews with the husband and the father. I looked closely at the husband, trying to discern if he expressed any grief, but he appeared to be handling the news just fine. I noticed his right shirt pocket was overflowing with cash. This was customary when there was a loss of a wife or child to give the husband money to help him move on. We eventually released the girl back to them and said there was nothing more we could do. Even if we could medevac her, there wasn’t anything further that could be done for her at this point; she had been in her current state for over eight hours. We instructed the men on ways to keep her comfortable in her final hours and sent them home.

As I walked back up to my room I reflected on the innocent young Physician Assistant I was before I came here. I had minimal exposure to anything
significant
as a provider; my biggest struggles were dealing with uncontrolled Diabetes and Hypertension, or perhaps the occasional strange psychological patient. I never thought this type of scenario would be something
I
would encounter. I couldn’t help but wonder if I would ever be able to get these countless
significant
medical encounters out of my head when I returned to my world of “normalcy and safety”.