The tap

Sunday 7 February 2010

It’s about 8 pm and I just walked through the ICU to check on a patient that I operated on Saturday. He’s an ANA soldier who had been injured by an IED. He had a tissue defect just above his right ankle, essentially a 6x 5 inch hole with damaged tendons. On Saturday, an orthopedic surgeon repaired his tendons while I harvested a flap of tissue from his forearm for use in reconstructing the defect. My team sewed an artery and two veins from his leg to an artery and veins from this harvested tissue in order to give it a living blood supply. We did this under a microscope with 9-0 suture that is much finer than a human hair. The closest place to Bagram where you could get this kind of surgery is probably in India, two countries away.

I stood over the patient with my plastic surgeon partner and we congratulated ourselves on our success. We listened to a Doppler device which documents blood flow through the flap and fist-bumped each other in toast. Suddenly, I felt a tap on my shoulder and looked up to see two older Afghan men in traditional Afghan garb pointing to the patient’s head, which I hadn’t noticed. As I walked around the bed, I saw that they were pointing at the rivulet of saliva which was draining from their brother’s mouth in a slow but steady trickle. I had forgotten that the patient also had a head injury from the concussion of the blast. I put on a glove and wiped it away, chiding myself for the descent into myopic vanity. The dark eyes and gentle tap of the Afghan villager who spoke no English provided a crystal-clear reminder that I was apparently in need of.