~~Editor’s Note: Battlefields have provided medical advances for centuries. Our combat units in Afghanistan have close medical support from military physicians and surgeons. Dr. Jason Oberste, of Tallahassee Orthopedic Clinic, tells his story in this brief article about one of the surgical teams that deployed with US ground forces in Afghanistan. Operating on casualties essentially on the front lines of combat is fraught with hazard, and the tension is made even worse when the team is striving to save its own members.
By Jason Oberste, M.D.
Afghanistan, Winter 2009
I sat half asleep with a radio in my lap…waiting.
It was like many other nights that we had an “alert.” Earlier this night, we had sat outside staring at a comet that was lighting up a perfectly clear Afghan sky, overlooking the mountains, with many more stars than were ever visible in the half illuminated skies back home. No lights allowed here. We called it “light discipline.” No need to give the enemy any lit up targets to shoot.
There were usually thirty of us on this base: special operators and our medical team. We spent our days preparing, practicing, and planning out missions. We also played cards, swapped music, watched movies, shot weapons, grilled crappy food, and discussed home together.
We were family. Our lifeline to the world was a dirt airstrip and a satellite link.
Tonight, all that was left on the base was the surgical team.
We were a special operations surgical team, SOST. Our mission was to be embedded with small covert teams in “destinations unknown” throughout the worst places in the world.
We were all highly trained in our medical specialties. Our team consisted of 2 surgeons (Orthopedics and General Surgery), an Emergency Medicine physician, a Nurse Anesthetist, and a surgical technician. We were all aware of the risks that this team would face. We were all volunteers and had been selected.
The team was also highly trained in the requirements of special operations. This included: weapons training, air commando school, survival/evasion/resistance/escape, international terrorism, as well as months of field training.
In four years, I had spent over 16 months deployed, and at least another 8 months in military training. All while practicing as a military physician stateside.
We were there as a safety net, in case our operators were injured.
This was my fourth overseas tour with this team…
Our operators had NEVER been injured.
At this point, only the 5 surgical members were left behind to guard the base. The gates were closed. The lights were off. The weapons were loaded. The operators were on a mission.
The transport team had been activated to pick up casualties from “troops in contact.”
I was manning the radio, but there was little chatter. We had done this many times. It was becoming somewhat routine.
Usually, we would bring in Taliban or civilian casualties, occasionally a coalition soldier from another country. We would patch them up and obtain information that may be useful in future mission planning.
We had not heard from our transport team since they had left in the Blackhawk helicopter.
I could hear the helicopter returning. This is a rhythm that will be forever etched into my memory. Even today, when I hear a helicopter at the hospital, my adrenal glands squeeze and my heart quickens.
The door to our makeshift trauma bay moves with the draft from the chopper.
The trauma bay/operating room is a shack. We have stocked it with cinder block and wooden shelves. We have a spartan array of medical equipment. Essentially enough to stabilize a small mass casualty without resupply. We had headlamps, minor surgical sets, some hand tools for fracture repair, and very simple anesthesia equipment for airway management.
We were trained to be dropped from a helicopter with our 5 bags and to be ready for surgery within 15 minutes.
In 4 deployments, I had done about 50 surgeries. Mostly minor gunshot wounds, shrapnel injuries, some amputations. I had also done over 100 small surgical procedures as a gesture of goodwill in small villages and rural communities throughout the world. These included dental extractions, mole removal, cyst excision, even circumcisions.
I never would have envisioned this when I signed up to join the military at the age of 21. I had joined the Air Force on a HPSP (Health Professions Scholarship Program) contract. In return for full tuition, books, and a living allowance during medical school, I owed four years of obligation after training. After medical school, I was selected for a military orthopedic residency in San Antonio. When all of my training was complete, my wife and I had been in the US military for nine years.
For my 4 years of obligation, I applied for the Special Operations position at Air Force Special Operations Command (AFSOC) at Hurlburt Field in Fort Walton Beach, Florida. I was selected and trained for this mission.
This was my last deployment. I had been to El Salvador, Qatar, Southeast Asia, Philippines, and now Afghanistan.
Afghanistan is the end of the earth. Don’t ever go there.
The swing doors burst open!
My critical care nurse, Ricky, the transport commander, stumbles through the entry. His body armor is half fastened. His beard is full of the gray dust that is a constant nuisance. Typically a stoic, calming presence on our team; he looks rattled. His pupils are dilated and his eyebrows are raised…
“It’s our guys!”
Stretcher after stretcher burst through the doors with my operators/friends lying with ripped uniforms, bloodstained bandages, and tired eyes.
The surgical team immediately responds to triage and address each of our injured comrades.
Following the stretchers, my anesthesiologist, a Westpoint and Harvard Med grad and collegiate swimmer, limps into the trauma bay. He was with our operators on this mission as close medical support. His eyes are swollen shut, his hair is singed, and he bumps into me at the door. He has obviously sustained a massive facial injury.
“Where do you need me Obi?”
“Eric, I need you to just sit down.”
We laid him on a stretcher, placed an IV, and immediately intubated our anesthesiologist.
We triaged and operated on six of OUR team members that morning. Not Taliban. Not foreign coalition soldiers. Not civilians.
Their Humvee had rolled over an IED that was made of 2 antitank mines and a 40 mm mortar. The vehicle had been blown into the air and onto a mud hut. All 6 men were in that Humvee. Two other vehicles in the convoy were not destroyed and called in medical support and secured the area.
Injuries included: open abdominal shrapnel wound, bilateral ankle/talus fractures, open acetabular fracture, closed humerus fracture, open scrotum, open pelvis fracture, and knee dislocation.
Our anesthesiologist sustained a C3 spinal burst fracture, maxilla fracture and closed head injury. Our CRNA performed all anesthesia that morning.
Each of our teammates were stabilized and loaded on a C-130 transport plane that arrived at 0900. They each were reassessed in Bagram, Afghanistan that afternoon, then transported to Germany the following day. Later that week they were at Bethesda Naval Hospital in Maryland.
I stood alone and watched the C-130 take off and disappear over the mountains.
I slowly walked to our chow hall and sat down alone…and cried.
4 years of college…4 years of medical school…5 years of residency…4 years of deployment…
Every minute of those years for this moment.
About the Tallahassee Orthopedic Clinic and its Foundation
For over 35 years, TOC has provided the highest quality orthopedic and sports medicine care in North Florida and South Georgia. TOC staff include 22 physicians with more than 200 employees, including PA’s, ARNP’s, RN’s, Certified Athletic Trainers, Certified Orthotics and an extensive support team of medical and technical assistants. TOC provides a comprehensive Sports Medicine Program, a Regional Concussion Center, MRI services, an Orthotics and Prosthetics Division, Physical Therapy and an Outpatient Surgery Center.
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