We packaged the child for the mother to mourn.

Warning: Discussion of treating a suspected rape survivor at the end of this post.

Glossary:

ISOF:  Iraqi Special Operations Forces
TSP: Trauma Stabilization Point
MSF: Doctors without Borders
VBIED: Vehicle Borne IED
Daesh: Arabic name for IS/ISIS/ISIL, possibly derogatory, largely interchangeable with IS/ISIS/ISIL. There’s more to it than that, but can we just generally agree, fuck those guys?

 

Walked in to the TSP as a humvee was driving up with a guy standing on it shooting his rifle. Multiple casualties. Soldiers. Chest and arm wound, but stable. We did a good job controlling bleeding and pain. I transported to the coalition hospital. Great to see those guys again.

It feels odd to write, but I honestly don’t remember this patient. I remember the humvee with the guy on it however the patients that come from it are lost to me. I think that says something about the number of casualties we saw.

In the previous entry, I talked about the coalition hospital and the outstanding staff there. I really hope I cross paths with some of those folks again.

This is what I would consider an ISOF Humvee in good condition. I saw a few that had little to no signs of damage (repaired before returning to action),  but most looked like this one or a lot worse. Notice the windows… those are roughly 2″ thick bullet and blast resistant glass. This vehicle was heading back to fight. I think the crew stopped to chat with some of the ISOF guys at the TSP when I took this picture.

Mother brought in a limp child, no obvious trauma, not obviously dead, textbook PALS resuscitation run, I called the code. We packaged the child for the mother to mourn. I nearly cried as I called it. I needed to take 10 minutes on my own, after checking that the other side was clear of patients.

This one I definitely remember. A few things really stand out. First, there was a surreal moment during the resuscitation where  everyone was calm and I remember thinking that this was the smoothest, calmest resuscitation I had ever been part of. I think we all had some sense that this might be unsuccessful but we needed to try both for our sakes as well as the child and their mother.

Despite us being in a trauma stabilization point in the middle of a war zone we did a totally textbook Pediatric Advanced Life Support resuscitation including appropriate fluid and medication dosages.

To my memory this was the first time I really deeply felt the pain around me. It was likely a culmination of the week as well as what I had just done. I contained my emotions until the resuscitation was concluded, the mother was notified, and I had confirmed we didn’t have patients waiting. Once all that was done I walked past the TSP to where one of our trucks was parked and just leaned against it. I cried some and focused on my breathing. In that moment I realized that I had gotten good at using a space blanket to create a pediatric body bag.

Had a 16 F brought in unconscious but seemingly stable. Did some oral glucose in the gums and IV of D4.5 and 0.48%. She perked up eventually.

We didn’t have a glucometer, but in the absence of other findings and knowing that many of the civilians we received had been severely calorically restricted we were routinely giving glucose orally or dextrose IV to many of them. This patient responded well initially confirming our suspicion that she was hypoglycemic.

Later on an Iraqi solider was talking to her and she seemed to be triggered.

I was in the same general area but caring for another patient when this happened. I had left her with her mother and an IV drip plus some food. The plan was to allow her to rest for a bit until she was able to walk and then we could transfer her to an IDP camp. Suddenly I heard her screaming and a man yelling in Arabic. By the time I could get to her several of the Iraqi soldiers were involved. She was screaming and crying. She looked extremely scared. I was able to find out from one of the Iraqi officers that a solider had been talking to her and the she suddenly started screaming. Several of the men were essentially yelling at her to calm down. I’m certainly no expert in middle eastern culture, but I’ve treated a few upset people before and yelling at them rarely improves the situation. She seemed especially afraid of the Iraqi solider who had been in there with her and her mother. My best guess was that he resembled someone who had hurt her. Regardless of the specifics his presence as well as that of the other Iraqis was only making things worse.

An Iraqi Officer wanted to sedate her.

He had actually drawn up a sedative and was at her side getting ready to administer it. As tactfully as I could I asked him if I could handle that as I had been treating her before. I had no interest in sedating her at that point. She wasn’t a threat to herself or others and I hoped that if I could de-escalate the situation it wouldn’t be necessary to administer the sedative.

I held off, kicked out the soldiers, let her mother sit with us. I had Hasan talk to her a little then I just sat and held her hand for 30 min. Nearly cried while doing so.

Hasan did an awesome job. He was able to help me get rid of the soldiers and say some comforting words to the patient. Between the girl and the mother Hassan was able to find out that the girl had been “married” to an older man, likely a Daesh fighter. The Iraqi soldier didn’t do anything to her as far as we could ascertain, but did remind her of someone, possibly the “husband”. She was wearing an abaya and hijab as was her mother so I knew they were somewhat conservative Muslims. Some of the women I had treated previously in similar attire wouldn’t allow themselves to be touched at all by a man so I wasn’t sure if I could hold her hand or not. The patient and her mother had allowed me to treat her earlier but I realized this might be different. Fortunately the TSP was a little slow at this point. I ended up holding her hand without touching her in any other way and just sat with her and her mother. I told her my name in Arabic and asked what her name was. That was the extent of my Arabic and Hasan was needed elsewhere.

Seeing so much fear from someone so young was tough. Additionally, I assumed that she had been raped at least once if not more than that by the “husband.” People I love are survivors of rape and I could see some of their pain in her. It was a concerned effort to not allow myself to cry there. She eventually calmed down and fortunately after 30 or so minutes she ended up falling asleep and I left her with her mother.

She is one of the patients that I know we helped physically, but I worry for. So many Iraqis survived horrors and in some cases committed horrors to survive, but I don’t think there is an adequate amount of counseling and psychological care available to help process those experiences.

This all transpired before 2 or 3pm that day. Normal day in the TSP.

On a lighter note, here’s Hasan and I at the TSP. He was a major asset. He is an ISOF Soldier, translator, fixer, and friend. He and his family live in Mosul so this was a deeply personal operation. His brothers were killed by Daesh plus the countless friends he lost along the way.

 

This was my last day in Mosul. I’ll write about leaving and coming home in another post, but suffice it to say I wasn’t eager to go.

After an uneventful drive out of Mosul we spent several hours working our way to Erbil. We passed through multiple check points without incident and returned to the GRM house. Although just a few hours from Mosul, Erbil might as well be in another middle eastern country. There’s hardly any military presence and since Daesh never made it there there’s no evidence of war.

The western toilet and shower as well as the air conditioning felt incredibly luxurious.

Within a few hours of getting to Erbil we were cleaned up and heading out to a nice dinner. We celebrated Kyirsty’s birthday as well as the last night the team would be together.

My dinner was excellent. Part of what may have made it taste so good was the contrast between it and what I had been eating for dinner for the last week (instant noodles), but I also think it was damn good food. This evening contained some of the surreal moments I experienced after leaving Mosul.

It was very strange to spend just a few hours traveling and suddenly be somewhere so seemingly untouched by war. My feelings would be magnified the next day when I took a short flight to Vienna and had a 12 hour layover there.