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Another consult this morning: a routine request from a surgeon on another service to see one of his patients. This happens almost daily, and it always involves bullets, or other explosive detritus. Today it was a 32 year-old soldier shot through the bladder by a bullet that of course injured other pelvic structures along the way. He had intractible bladder pain, and the strangury -- a painful colic of the bladder musculature -- was not controlled by the usual narcotics. I added four new medications to his regimen in an effort to alleviate the pain. Yesterday, it was a call to one of the Operating Rooms to check on the status of a testis that had been cut in half by the same IED blast that removed one leg at the knee and the other at the hip. That patient was so similar to the two before him that I temporarily (but understandably) am confused about his particulars, and have to refer to the medical narrative in the chart that follows each of these soldiers around, as they progress from one medical facility to another, achieving at each new venue a higher level of surgical expertise and comprehensiveness. (That does not imply a lack of expertise at any lower level facility, especially the Combat Support Hospitals in Iraq. It merely means that here, at Landstuhl, the full panoply of surgical services, along with all the support services, is offered for the first time.) I don't only treat Americans, either. Last week brought a young Canadian soldier from Khandahar with kidney stones, and before him was a French contractor sans leg. What a way to see the world. Gotta go. |