He'd gotten blown up. Sustained burns to the face and hands and suffered blast inhalation. Breathing in superheated air is not good for the bronchial tubes and lungs. He’s being mechanically ventilated.
I watch him struggle even when completely sedated, but some patients have a real rough patch before extubation. To make sure a patient can breathe on his own, first the docs need to dial back on the meds.
This is called "waking him up".
Still out of it, he gradually becomes more and more aware of his pain and the discomfort of the breathing tube. He feels like he's choking. Constantly. And he's too out of it to understand why.
His hands are restrained so he can't pull the tube out. But he keeps lifting them, trying. His legs squirm. He lifts and turns his head.
Then the RT (respiratory therapy) guy comes in and tells the patient he’s turning off the ventilator as a test, and if it goes well, the tube can be removed. He now has to breathe on his own, sucking in air through the narrow tube. He must be scared to death wondering why he can hardly breathe.
"You probably feel like you're breathing through a straw, right?"
The patient nods. He looks unconscious but he's tracking everything.
The RT encourages him, "This is all you, man... you're doing great. Keep going!"
After 5 minutes the RT deflates the outside of the tube so the patient can now breathe around it as well as through it, which is better, but as he slowly comes around the agony of the tube becomes unbearable.
He has to breathe like that for 20 minutes.
I keep telling him, "You're in the Army hospital in Germany. You have a tube down your throat... don’t fight the tube… try to relax!" He does... but he’s so dopey that he forgets after like 30 seconds and starts struggling again.
It’s time. A small group of nurses and docs gather outside his door. You hear them say, "Ok, we gonna do this guy now?"
They flow into the room, tell him they're pulling the tube, and that he should try to cough when they say ‘go’.
"Ok, here we go... COUGHCOUGHCOUGHCOUGHCOUGH!!!!"
When it's out they place an oxygen mask over his face and he gags and chokes and gasps for air and coughs up huge globs of junk which they suck out with a suction tube.
He finally lays back, exhausted. People slowly leave. But his nurse stays - as always - hovering, watching his vitals, carefully checking all of his many lines and the machines connected to them.
I move back to his side and he tries to say something, but his throat's raw and he can't talk. I lean in, apologizing because I can't understand.
"How much... how much... longer?"
I know these guys. He wants to know how much longer he has to stay here before he can go back downrange.
Exchanging glances with his nurse, and deliberately misunderstanding, I tell him he'll be out of the Intensive Care Unit in a couple of days. Even in his sedated state he knows exactly what I've done and gives me the dirtiest look imaginable.
Then, "fffff.... mmmm fffff.... "
He's saying, "Friends... my friends... "
I tell him everybody from the truck's ok. He did good, everybody's ok.
His face screws up like a child's as he breaks down and cries with relief.
I watch the tears roll down over the ointment covering his face, over the seared redness of his skin, over the blisters on his nose and lips.
It's hard for people on the outside to understand. They always seem to focus only on the "terrible things" that we see. But we also have the honor to see something else: The true heart of the American Soldier.