It seems that over the last two weeks we’ve had somewhat of a reprieve from the traumatic injuries that we have been treating. It has been somewhat of a welcome break to not have multiple people with severe wounds entering our EMT. At the end of last week we began treating a local man who drove a supply truck from town to one of the surrounding bases. His vehicle was involved in an IED blast (picture # 1). As you can imagine, the majority of his injuries occurred to his left side; a partial traumatic amputation of his left arm, a collapsed left lung, a ruptured spleen (it’s also on the left), perforated bowel, and a broken left femur. He was critically ill upon presentation. After resuscitation was initiated, that included the need for a massive blood transfusion, he was taken to the OR. There we finished removing his severely damaged arm, removed his injured spleen and bowel, and splinted his broken leg. He was taken back to the ICU in critical condition. Over the course of the next few days he would return to the OR several times. He slowly stabilized and began showing signs of improvement, except for his kidneys. Due to the seriousness of his injuries as well as requiring massive amounts of blood products he went into kidney failure. In the states this is treated by a phone call to a nephrologist (kidney doctor) who would initiate dialysis. This isn’t available here at FOB Salerno or in the cities and provinces around us. Miraculously, Dr. R, a hospital interpreter, found a doctor in Kabul who would accept the patient and initiate renal replacement therapy. The hospital commander was able to find a humanitarian flight for the patient and an escort to Kabul. He left this morning. My hope is that because he is young, with some time his kidney function will return and he will make a full recovery. We learned that he was married only a few months ago. This will be a real hardship on his young family.
We’ve started another week of the spleen. It was initiated on whom we affectionately refer to as the “spleen brothers” (picture # 2). These boys are 3 and 5 years of age, both with Beta-Thalassemia major. They require blood transfusions about every other week. They had their spleens removed on the same day. The following day, we found them recovering together in the same bed. In the upcoming week we will remove the largest spleen I have ever seen in an adult with the same blood disorder. There will be more to come on that case in the next blog. Take care.