Could you describe a shift in the Baghdad ER, describing one or two cases and how you managed them? [The following description is excerpted from Dr. Baker's book, "Baghdad ER."]
It was 5:55 a.m. on Easter Sunday, and the insurgents were giving us a wake-up call by firing rockets at us. I was just climbing out of the shower, preparing to go on shift at 7:00 after stopping by Chaplain Sermon's outdoor Easter sunrise service at 6:30. I quickly got dressed, and headed down to the ER to check the damage. A Nepalese security guard came in about 6:35 with a large cut to his leg from shrapnel, but that was the only injury we received from the 22 rockets that landed in the International Zone that morning, as they all landed in uninhabited areas. An hour later, we were given a 1-minute heads-up that a Blackhawk helicopter headed to the neurosurgeons in Balad was diverting to us because their patient, a U.S. soldier with a massive open head injury, was becoming unstable and the flight medic did not think he would survive the extra 30 minutes to Balad. Once in the trauma room, I quickly noticed him to be unresponsive and intubated him, followed by venous and arterial line placements.
A patient came in 20 minutes later who will haunt me forever. When he was brought into the trauma room, it was a replay of an incredibly burned soldier I treated just 2 days before. Once he was placed in bed one, I immediately leaned down to his face, inches from mine, and looked into his eyes. I will never forget him looking straight back at me. His eyelids were missing; he had no hair, eyebrows, or eyelashes left. His skin was charred black and brown from the flame and heat, and the rest of his body was covered in third- and fourth-degree burns. His fingers were blackened, shriveled, and mostly amputated from the heat. But his wedding ring was somehow still in place. It was carefully removed, and while the other physicians worked feverishly to get central access on his groins, our medics tried their best to stick a vein in his arms, going right through the charred skin. I never pulled away from his face. I held a bag-valve oxygen mask over his nose and mouth, and each time he would take a breath, I would help him.
His eyes continued to stare into mine; he had no ability to blink. I just kept looking into his eyes, keeping my face close to his, and I kept trying to comfort him. "We're going to take care of you; you're going to be okay." He stared back at me, saying with his eyes, "I trust you to take care of me. Don't let me down." It was one of the hardest moments of my life. I have never connected with a patient like I did this hero.
What did you and your team do to stay as safe and calm as possible, and to manage stress?
We exercised, read books, played video games, and smoked cigars to pass the time. Occasionally, an emergency physician from another unit would come to the hospital and relieve us, and we took every chance we could get to fly to another base or just get off the compound. When I had an opportunity, I would go over to another compound in the Green Zone and fish in one of Saddam's ponds. Staying safe was not hard - the rocket either hit you or it didn't. There was not much we could do about it, so we just continued to do our jobs and let them land where they fell. The ER was evacuated down to "essential personnel only" on more than one occasion, because we were the most vulnerable area of the hospital to indirect fire, and we spent a lot of time caring for patients while wearing our body armor. One wounded soldier even told me after we sustained a near-miss, "I want to go back out to my [forward operating base]; you guys are the ones they are shooting at!"
What specialized equipment did you have that was most helpful to saving lives in a combat setting?
One of the most instrumental items was the SonoSite MicroMaxx Ultrasound. I could tell within seconds if there was bleeding into the abdomen, and it helped determine immediate disposition of patients. It also assisted in central lines, peripheral IV access, and arterial line access. We also used the GlideScope to intubate patients with LeFort II and III facial injuries, and it provided a lifesaving airway that I could not get with direct laryngoscopy on more than one occasion.