Doctor- husband gets news in war zone

Posted: April 10, 2013

The new novel from Inquirer columnist Lisa Scottoline, "Don't Go" (St. Martin's Press), is in bookstores now. Excerpts continue Wednesday in Style & Soul.

Chapter Two

Mike raised the scalpel, about to make the first incision. He always said a prayer before he cut, though his wife Chloe was the religious one. She'd given him a silver crucifix before his deployment, and he kept it in his ACU pocket with a picture of their baby Emily. He was about to send up his homemade prayer when he noticed Joe Segundo, their administrative medical service officer, looking at him funny from across the OR.

Mike returned his focus to his case, telescoping the task at hand and ignoring the anguished moans of the wounded, the constant talk of the docs and nurses, the whop whop whop of the Chinook outside, and the crack pop of ordnance in the distance. The 556th FST, or Forward Surgical Team, was only three to five miles behind the offensive, but Mike didn't think about that when he operated, staying in the silence of his own mind, his fingers working on muscle memory, a result of the on-the-job training from hell, in hell.

The 556th was a twenty-person surgical team assigned to an Army combat brigade, traveling with three tents that took only an hour to assemble into a surgical facility complete with triage, OR, and recovery bays, as well as medical supplies and materiel to last seventy-two hours, including generators to power the fluorescent lights that shone overhead. The OR reeked of sickly-sweet blood and medicinal iodine wash, and the air was freezing. One of the nurses had decorated an IV stalk with homemade tinsel, but it wasn't easy to make carnage cheery.

Mike was the only orthopedist/podiatrist of the 556th, and the three other docs were general trauma surgeons, now bent so far over their patients that they looked almost headless from behind. There was Phil DeMaria from Providence, chubby enough to be called Phat Phil, and Adam Goldstein, who was in his mid-forties, so they called him Oldstein. Their FST commander was Stephen Chatham, a hotshot from Darien who never shut up in the OR. Mike called him Chatty Kathy, but he called himself Batman. Everybody loved Chatty, especially the nurses, who made him a Batman cape out of a body bag, which he never took off.

Mike never felt like a superhero, and podiatry was far from a prestigious branch of medicine, which was why his nickname was Dr. Scholl's. Ironically, blast injuries to the extremities were the signature wound of Operation Enduring Freedom, due to the overwhelming number of IEDs, so Mike was the busiest doc in the 556th.

Supporting the team were three nurses, two nurse anesthetists, three medics, three surgical technicians, and Joe Segundo, who kept track of them and the paperwork the Army loved so much.

Mike focused his attention on his case, Nestor Salinas. Salinas was twenty-one, and his right calf and ankle were riddled with AK-47 fire that had shredded his gastrocnemius, the large calf muscle, and the smaller soleus, underneath. Salinas must've sprinted in high school track, his calves were so well-developed, but Mike didn't have time to think about that. The FST docs limited their surgeries to an hour or two, then evacuated the case to a Combat Support Hospital, or CSH, out of the battle zone, similar to the old-school MASH units.

Salinas would end up in CSH Bagram, but the more severely wounded were flown from Bagram to Landstuhl Regional Medical Center in Germany.

Salinas was already being transfused, and Mike needed to salvage as much tissue as he could from the lower leg. His goal was to control any hemorrhage and clean, debride, irrigate, and pack the wounds, emplace a cast or external fixation if necessary and get Salinas onto a transport. Each minute counted and the FST was in constant motion, but Mike had learned to slow time down while he operated, all the while assessing the variables that meant life or death in combat theatre.

Mike cut around the first wound, a glistening cavern of blown away flesh, nine centimeters long. The bullets had shredded, burned, and shattered everything in their path, including the tibia and fibula, embedding bone fragments in the remaining tissue. Still it was only a GSW, a gunshot wound, and Mike had gotten used to the idea that a soldier who merely got shot was lucky.

He felt eyes on him as he worked and looked up to see Joe Segundo talking with Oldstein. It wasn't Mike's concern, and he made the cuts he needed, excising the purplish tissue and salvaging the healthy red and pink. The wound didn't smell bad and wasn't that filthy; in contrast, homemade IEDs were stuffed with trash, so when they blew up, they caused bizarrely dirty wounds, embedded with pens, rocks, pins, nails, and even kids' toys.

Mike tied off the veins, noting that the wound was remarkably clear of blood flow, thanks to a battlefield tourniquet by a combat medic, the medically trained infantrymen, the 68W who acted as first responders. Medics were able to stabilize a wounded soldier in fifteen minutes, and the one who had treated Salinas had written on his bare chest in purple marker, per procedure, so that the soldier was traveling with his medical records:

GSW

R LEG

4 HOLES

3 ENTRANCE

1 EXIT

tourniquet 3:15 a.m.

Mike felt as if he were being watched again and glanced up to see Joe Segundo, now talking to Chatty. He wondered what was going on, momentarily distracted. He'd heard that the 556th might get reassigned up north, which would be a problem because they weren't ready to roll out yet. When they had to go, Chatty would tell them the way he always did - to the Batmobile!

Mike accepted a roll of Kerlix bandages from his nurse, Linda, and began to pack the wound, which stopped the bleeding by pinching off leaky vessels and pressing them into soft tissue. The technique was called tamponade, from the French, which also gave rise to the word tampon. Mike loved knowing stuff like that and he loved being a podiatrist, though they all kidded him because he worked in silence. His nurse, Linda, liked to joke around with Chatty, who was singing, I'm too sexy for my cape, and Linda sang back, I'm too sexy for my gloves, then Chatty sang, Who needs latex, it gets in the way, and the OR erupted in laughter.

Mike kept his hands in Salinas, who would become The Kid With The Lucky GSW. He remembered his soldiers by names he gave them, like The Kid With The Big Freckles, The Kid With The Lazy Eye, and The Virgin. He would never forget The Girl With Hair Like Chloe's, because he had to amputate her left foot after an IED blast. Her injuries scored nine on the Mangled Extremity Scoring System, the tactlessly-named MESS scale, when anything over seven was predictive of amputation. He still replayed that procedure in his mind when he couldn't sleep, thinking of Chloe.

He tried not to think of his wife now, but he wasn't succeeding.

He loved his wife and he hated not to be home on their baby's first Christmas. His only consolation was that his tour ended in a month, and he was counting the days. Emily was only a newborn, a month old, when he deployed, and the photos Chloe e-mailed him showed how much she was growing. They e-mailed and Skyped when the 556th returned to base to resupply, but the contact only intensified his longing for her, the baby, his home, his practice, his very country. It was all too much, and afterward, he would block it out, mentally.

If Mike was a superhero of anything, it was that. He was the Batman of Compartmentalizing.

Joe Segundo walked to Mike's table, his dark eyes concerned over his surgical mask, which cut into his fleshy cheeks. He was a short and blocky Texan, whose jarhead haircut fit perfectly under his scrub cap. He frowned when he saw Salinas' wound, up-close.

"Bone salad, yo," he said, with a touch of a Tex-Mex accent.

Mike glanced up. "What's going on?"

"When will you be finished?"

"Me? My tour is up in one month." Mike was joking, but he could tell by Joe's eyes that he didn't smile under his mask, which was strange. "Joe, what's up? Something on your mind?"

"Can we talk when you get a break in the action?"

Mike thought it was an odd request. "No, I gotta finish this kid, then I got another GSW. Why, are we rolling out?"

"The other GSW isn't an urgent. Oldstein will take him. Come find me when you're done, okay?"

"Okay." Mike let it go, figuring that it was about the FST or Army politics, as usual. Army MEDCOM was always on their case about one thing or another, and Joe loved to vent to Mike, whose oddman-out status made him like Switzerland. It was probably nothing.

But later, when they told him that Chloe was dead, Mike remembered one thing:

I forgot to say my prayer.


Wednesday in Style & Soul: Chapter Three.

Write to Lisa Scottoline at lisa@scottoline.com.

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