Operation Damage Control

Doctors David Zonies (standing, center) and Dr. Jeff Marchessault and surgical tech Ashley Knezevich (R) take a moment for sustenance at 1:00 a.m. between surgeries at Role 3 Craig Joint-Theatre Hospital at Bagram Airfield in Bagram, Afghanistan on October 23, 2010. After doing a surge of amputee patients they will move on to less critical surgeries waiting for them. Its a typical day and night for medical staff at Role 3 hospitals in Afghanistan before patients are moved on to Germany the next day. Photo: Linda Davidson / The Washington Post.

The surgeons here have a fierce dedication to saving every life. Only in mass casualty events must some patients be put aside and treated "expectantly," the euphemism for the assumption they will die. Even getting someone alive to Landstuhl, where their family can see them before they die, counts as a victory.

"We try not to withdraw care here in theater," Eastridge said.

But every once in a while it happens. It's usually someone with brain injuries so severe they're likely to die during transport. They're allowed to die here, with troops at the bedside. "That just affords them that last little bit of dignity," he said.

He stopped, and his eyes filled with tears.

Reporters of the Washington Post recently spent time with a DUSTOFF crew and with the staff of Role 3 Craig Joint-Theatre Hospital at Bagram Airfield, Afghanistan.

In this segment, the reporters cover the weekly teleconference between doctors, nurses and medics at military hospitals in Afghanistan, Germany, and the US.

The week, the assembled group of over 80 people review the cases of the 13 critical patients treated the prior week. Nine of the patients will have permanent disabilities: Two lost one leg; two lost a leg and a foot; two lost both legs; two lost both legs and a hand; and one was paralyzed from the waist down.

The conference is run by Col. Brian Eastridge, a 47-year-old trauma surgeon with 23 years in the Army. He grew up in Damascus, Md., graduated from Virginia Tech and the University of Maryland School of Medicine. He now heads the Joint Theater Trauma System, which organizes trauma care in both wars.

Over five deployments, Eastridge has seen the entire arc of worsening wounds and increasing survival that has marked trauma care during the Iraq and Afghan wars.

Dressed in brown camouflage battle dress, he sits halfway around a large U made of wooden tables. Around him on the walls are idealized scenes of Afghan life painted by a local artist - a girl leading a caravan of camels, children being taught arithmetic at the base of a tree, kids flying kites.

Eastridge runs the conference with somber efficiency, offers comments sparingly and addresses his listeners mostly by location-"Kandahar," "Landstuhl," "Walter Reed."

The rapid-fire reports are dense with medical jargon and anatomical description. It's a narration of one disaster after another, and of how things were kept from getting worse, and made better, by skill, speed and attention. It's the aural equivalent of watching a dozen high-wire acts in which some people are rescued mid-fall.

Here's just one.

"Dismounted IED" injury is jargon for wounds caused by a bomb or mine that are suffered outside a vehicle. The soldier had tourniquets placed for partial amputation of both legs. One liter of a special IV fluid was given in the helicopter, and the patient arrived at the Kandahar hospital in and out of consciousness and in shock.

In the operating room, surgeons temporarily tied off the arteries going to the legs and repaired a tear in a major vein. There was massive damage to the area between the legs. One leg was amputated at the knee. In a second operation the next day his wounds were rewashed and a finger, broken in the explosion, was fixed with external hardware.

That same day the soldier was evacuated to Bagram, where his wounds were washed out and the pelvic region was re-explored. A "foreign body"- the speaker didn't say whether it was dirt, metal or something else - not seen in the first operation was removed. He suffered a collapsed lung after surgery, which was fixed.

He stayed there two days before flying by critical care air transport to Landstuhl.

Seven days after suffering his wounds the soldier arrived at a hospital in the United States. He had another collapsed lung, and pneumonia. His right foot, initially thought to be salvageable, wasn't healing and the surgeons planned to amputate it at the ankle. He had further surgery to his abdomen and numerous operations to start repairing the missing floor of his pelvis.

"This was one of the biggest pelvic injuries I've ever seen," said one of the surgeons in the United States. Eastridge later said he hears that a lot from surgeons in the United States who haven't been deployed yet.

This was not an uncommon case.

Make sure to view the accompanying photo gallery and see these dedicated professionals at work.