Monday, December 13, 2010

The Irony Of Success

Last week, an army special forces warrant officer was in an IED blast.  Given his job, this was not his first deployment of the wars, but it was to be his last before retirement.  In this mission he was sitting in the troop commander seat, meaning the front passenger.  This seat is perhaps the most dangerous seats in a vehicle because it is the first to pass through the kill zone and is closest to the side of the road where the explosive typically is planted.  His vehicle was the sixth in the convoy.  The first five vehicles either missed the pressure switch or failed to activate it, but his was not so lucky.

His unit was not taking the incident well.  The warrant was well-liked and respected.  They had set out to find the perpetrator but had had little success.  Instead they might find only the impotent rage that comes after an enemy attack without an enemy to fight.

Body armor, no laughing matter.

He arrived awake, with a single iv, and with tourniquets on three of his four limbs.  He had the injury that has come to define the Iraq and Afghanistan wars: multiple limb amputations but no abdominal, thoracic or head injuries.  In his case his legs were amputated at the knees and his right arm was fractured, dislocated and torn open.  His body armor saved his life but not his limbs.  We make much about the success of medical care in the current war but the jury is still out on whether it is our practices or the body armor that has improved survival rates. 

In surgery, the immediately agreed upon priority was to try to preserve his right arm.  Paul and Kat washed, revised, and packed the leg stumps while Dave and Ted worked on the right arm.  They washed the wound, cleaning out gross dirt and debris, identified vital structures including the vessels, the nerves and the muscle tendons, and stabilized the fracture with a frame.  Aric and I transfused more the 30 units of blood product. To what effect, we do not know.  This soldier is now a double amputee and is at significant risk of becoming a triple amputee.  If his arm does not succumb to infection, it has a chance to regain some function.  He faces dozens more surgeries and years of rehabilitation.  He was doing okay the next day at the hospital at KAF.  We do not have word beyond that. 

One of the phenomena of the current war is the survival of quadruple amputees.  It is not an exaggeration to claim that never, in the history of war, have quadruple amputees survived the battlefield.  Before I deployed, I remember reading about Spec Brendan Marrocco, the first quad to survive, and marveling at his resilience.  There are now three living quad's among about 1100 amputees from the Iraq and Afghanistan wars.  One of the three, Marine CPL Todd Nicely, is from my home town, St. Louis.  I am heartened to hear about their successes as they persevere through the ordeal of rehabilitation.  Still, the devastation of the body that remains means that we might be able to save their life but not the life they had.  That is the irony of success.

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