Sunday, January 25, 2015

Corpsman Chronicles III : Circles and Layers

I've been messing around with this post trying to get it just right. Well, that's not gonna happen.

A long time ago, and then some...

North Atlantic. 1986. Late summer.

Longer ago even than that...

Roll the clock back 21 more years and check in at the EJE Ranch on August 21, 1965.

I got up early that morning, a little before 5 a.m. It was early for me but my dad was already up and around as usual. I walked into the living room, dimly lit by the soft pre-dawn glow, and switched on the old Zenith black and white television. Which at the time was neither old nor remarkable.


Wikimedia Commons.
I stood there as the tubes warmed up and the screen began to glow, feeling quite grown up. I was a NASA kid you see, and soaked up everything I could about the space program. This morning I was on a mission.

Last night Walter Cronkite had told me that he’d be carrying live coverage of the Gemini V splashdown in the morning, starting at 7 a.m.


As a NASA kid, this was something I was obviously required to watch. I did a quick time zone conversion (NASA kids ate that time zone sh.., er, stuff, with a spoon), ran it by Mom for a giggle test, and scrambled off to set my alarm clock. A first for me. Four-forty-five a.m.

That morning I watched events unfold on the television with rapt attention. Walter was great. He could do the big picture and the little details, and Vulcan mind meld them directly into the info sponge between my ears. There was a delay in the recovery when the Gemini capsule splashed down off target, landing about 600 miles east of Jacksonville. It wasn't long, though, before the television showed an image of the stubby craft bobbing gently in the swells. A big green monster of a helicopter circled the spacecraft several times, then made a very low, very slow pass.

I watched in amazement as a wetsuit-clad fellow (a "frogman" according to Walter) jumped into the sea next to the bobbing capsule. That guy had to have the the best and coolest job in the world.
Astronaut L. Gordon Cooper Jr. is hoisted up to a Navy helicopter during recovery operations in the Atlantic Ocean of the Gemini-5 spacecraft. NASA, in the public domain.

Gordon Cooper, Command Pilot of the Gemini V spacecraft is hoisted into a recovery helicopter after the Gemini 5 eight day mission. NASA, in the public domain.
A U.S. Navy Sikorsky SH-3A Sea King dropping rescue swimmers around a Mercury space capsule mock-up during recovery practice. NASA, in the public domain.
And that was the moment when I knew. When my navy future became pretty much a certainty. By the time I took my place as a crewman on the mighty Sea King, space capsule recoveries were a thing of the past. Which was good, because what we did was even better.

Flash forward to 1986...

Mid-August. The Nimitz Battle Group was underway as a player in Northern Wedding. It was a huge exercise, both at sea and in Europe. Ashore, simulated red hordes of soviets were charging deep into Germany. At sea, simulated (and some not so simulated) red hordes of the soviet navy surged into the Atlantic to disrupt NATO resupply efforts.

Underway! Sailors belong on ships, and ships belong at sea. My extended tour with the squadron was coming to a close, and this was my last hurrah before shore duty.

My time with the squadron had been a long, hard slog. Four major deployment cycles. Hard, yes, but I lived for this stuff. I'd grown tremendously. A snot-nosed kid at the beginning, now I was a paramedic, an aircrewman, and a swimmer. Nowhere else in the world could I practice these skills at this level and in this kind of arena. Operationally, I was at the top of my game.

The non-operational part of my life was a bit shaky. I was clueless when it came to striking a healthy balance. I was also hard-headed enough to try to impose my will on the world.

Behind me on the beach was a home and mortgage shared with a girlfriend. She was in the navy too, and in the age old story of the naval service, we had different dreams and goals and spent most of our time talking around reality.

I wasn't looking forward to shore duty. The best uncle bupers could do was a berth at the medical clinic at USNA. Dress Blues or Dress Whites. Every day. Doing flight physicals. Gag. All pain, no gain. Purgatory.

This last float provided some temporary avoidance of "things which must be dealt with," but the clock was ticking and they were ever close at hand. And though I didn't realize it at the time, I really needed to decompress. I was wound tighter than an eight day clock. I'd had a magnificent run with the squadron, but it had taken a toll.

As day four began there was a medevac in the works. A young Fireman (E-3/FN) in one of our escorts had been severely steam scalded in an engineering mishap. He was being flown to the battleship USS Iowa (BB-61), the closest major medical department within range of the frigate's SH-2 Seasprite helo. We needed to get him to Gander, Newfoundland, for a rapid transfer the Army Burn Center in San Antonio. Our Sea King helos had the range for the mission, but only just. Iowa had turned around and was charging toward Gander at 34 knots to close the range. We'd fly to Iowa, refuel while we took on the patient, fly to Gander and drop him off, then retrace our path.


A Kaman SH-2G Seasprite. Wikimedia Commons
USS Iowa, BB-61, 1986. Wikimedia Commons.
Knox Class Frigate USS Moinester, FF-1097, 1986. Wikimedia Commons.
An SH-3H Sea King lands on Iowa. Wikimedia Commons
As I grabbed supplies and shoved them in my medevac bag, I did a quick mental review. Burns are terrible injuries, and according to the casualty message, the injured sailor had suffered second degree burns over 100 percent of his body. Burns cause severe loss of fluid as the damaged skin weeps in response to the injury, and that fluid would need to be replaced intravenouslyWith 100 percent of the skin involved, starting and keeping IV's in place would a major challenge. The weeping, damaged skin would also allow bacteria to get in. This patient was already infected. He was going to become very, very ill. There was also a good chance that his airway had been burned, damaging the lining of the trachea and bronchus. Such injuries can flare up hours or even days after the injury, abruptly and unexpectedly closing the airway.

My medevac bag contained IV fluids and sets, A cutdown tray in case I had to surgically acquire a vein. A Laryngoscope, endotracheal tubes and a tracheotomy kit in case we lost the airway. A Lifepak heart monitor and defibrillator. Morphine for pain control.

The Iowa medical department would have the patient stabilized and prepared for medevac. He'd have an IV going and his airway would be stable. His burns would be dressed and he'd have pain medicine on board. He'd be wrapped and secured correctly in a transfer litter. If all went well, I'd only have to monitor his IV, airway, vital signs, and level of pain. I'd be ready to handle complications, but with a little luck, my most skilled services wouldn't be required.

I slung my bag and headed for the paraloft to suit up. It was the middle of summer, but summer is often less than balmy up north. The air/water temp matrix said I had to wear a wetsuit or a dry suit. I chose the wet, because it afforded more freedom of movement and I might be scrambling around quite a bit. The downside to wearing a wet suit in the back of a helo in cool conditions is that it's even more uncomfortable than the dry suit. It gets cold and clammy, and wearing one for hours can be a miserable experience.

Over the wet suit I wore a green nomex flight suit and summer weight flight jacket. On my feet were woolen socks and scuffed flight boots. I shrugged into an LPA/SV2, a combined life preserver, torso harness, and survival vest. A flight helmet finished the ensemble.

I rolled into the brief in time to hear all the bad stuff. We were going to be very tight on fuel on two of the four legs, and the weather was turning dogshit. Visibility at Gander would be at or near minimums. We had zip for fuel reserves and no divert options. If we'd been a civilian flight crew we couldn't have legally flown the mission. But we weren't civilians. One part of my mind was very concerned with the risks, but the dominant part of my mind was zeroed in on executing the mission.

"How bad is he burned, Doc?"

A rule of thumb for estimating mortality in burn cases was to add the age of the patient to the total percentage of skin burned. If the number reached 70, the mortality rate was 90 percent. If the number equaled or exceeded 90, the mortality rate was 100 percent. This young sailor was 20. Do the math.

"He's probably going to die. His only chance is to get him to a burn center in the next 12 hours."

And so we launched.

We ground our way west and south under a solid overcast. Below us the sea was dark gray and choppy, broken by millions of foaming, white backed waves. From 2,500 feet above the restless Atlantic, the horizon was a distinct line where dark gray met light gray.

The first leg of the flight went quickly, and before long Iowa came into view, charging toward Gander with a bone in her teeth. We set up a normal approach for landing on her helo deck aft. I'd landed on plenty of destroyers, and from a distance a destroyer and a battleship bear a superficial resemblance, so the approach seemed pretty normal at first. Until the battleship started getting bigger and bigger. And bigger. And bigger still. As we hovered over our landing spot, Iowa's helo deck seemed to rival the size of the carrier's flight deck.

From this point I'm left more with impressions than distinct memories. I followed the Iowa corpsman who'd been sent to guide me. I recall dark and narrow passageways, and the massive thickness of of main deck hatch, hanging counterbalanced over the ladder leading down to the second deck.

I followed the corpsman into sickbay, around a corner and through a hatch, and then into the treatment room. I remember the smell of that room, the smell of silvadine burn cream, sterilized gauze, sweat, pain, misery, despair. I remember that the burned sailor was in a lot of pain, moaning with it, slowly writhing in an attempt to find a more comfortable position. I remember that his face was pale beneath the redness of fairly mild burns, but that the rest of him was swathed in acres of freshly changed gauze, much of it already becoming sodden with weeping fluids.

I must have done a detailed turnover with the ship's doctors, but I don't remember any of that. I checked the IV site where someone had done a serviceable job on a cutdown. I checked the security of the foley catheter, and felt a slight boost of hope when I saw that the burned sailor was still making urine.

The helo was full of gas by the time we got the patient loaded and situated. We didn't waste any time.


The next four hours were extremely busy. There were so many things that could go wrong so quickly. The major needs were to keep the airway open, keep the IV going, and keep the analgesia adjusted.

If the airway had been injured it could, without warning, swell shut in a minute or less. If that happened the patient would quickly suffocate unless I performed a field tracheotomy. I knew the procedure cold but had never actually done one. I watched that airway like a hawk.

The IV was vital. Losing it could also be lethal, though not as quickly as a closed airway. It was sutured directly into the great saphenous vein on the patient's left foot. His skin was so damaged elsewhere that the surgical cutdown had been the best option and the only way to get and keep access to a vein. But any IV can fail, and if this one went south I'd have to do a cutdown on the other foot. I'd done cutdowns before, but never in the back of a helo.

I administered analgesia through the IV. The young man's body was in terrible pain. The morphine I gave didn't stop the pain, rather, it blocked the pain receptors in his brain. In addition to blocking pain receptors, it caused opiate euphoria, a kind of altered consciousness and relaxation. Morphine is a great pain medicine, but it's potentially deadly as well. With such severe pain, the line between adequate analgesia and overdose is very thin indeed. The first sign of overdose would be slowed respiration, so I watched the patient's breathing closely.

Managing all that was a full time job, but all the usual "bad deal" thoughts were bouncing around inside my skull. This wasn't the first badly burned patient I'd treated. It wasn't the first losing battle I'd fought.

The losing fight

It seems almost strange in retrospect that the hardest battles trauma corpsmen fought ended so very often in defeat. When our best skills were most needed, the outcome was generally predetermined.

The life force and physiology of the young human being is remarkably powerful and self healing. In the vast majority of injuries we dealt with, our services weren't really required. The trauma was either immediately fatal or the patient would pretty much heal themselves. We provided good and useful support in the latter case, but it was rarely directly life saving. In the former case, of course, we packaged the remains for shipping.

The paradoxical realities for trauma corpsmen of my era were stark. Badly injured borderline cases were too often not going to survive. We had no choice but to fight the battle though. Our responsibility was to maintain life, and every single scrap of skill and energy we had was expended in the execution of that responsibility. It was never negotiable. But the outcome, success or failure, life or death, depended almost entirely on factors beyond the control of mere mortals. We had mad skills and they could make a difference. But not always.

In the naval service in the 1980's death was far from uncommon. We all lost shipmates. Each loss was a tragedy and a blow. For most sailors, as painful as the blow could be, it was quick and clean. For the trauma teams, though, sometimes it wasn't.

As we approached Gander the weather was awful. I was focused on my patient, but I heard concern leaking through the calm and collected voices on the ICS, and part of me was quite unhappy about the thumps and bumps and unusual attitudes. We landed near a turning Air Force Starlifter that represented the final leg of a tragic journey. Our helo was mobbed by a green-clad crowd, and strong hands whisked the sailor and stretcher across the ramp and into the belly of the big green bird.

I did my turnover thing and headed back toward the helo as the jet taxied away. I stopped in the lee of the refueling truck emblazoned with bilingual no-smoking signs, and sparked a Camel to life. I was joined by a fellow in a funny looking flight suit, a paramedic from the local Canadian SAR unit. We had a nice chat as fuel flowed into the helo's nearly dry bag. Then it was time to go.

The return trip is a blank to me now. I remember that I was shiveringly cold and spent. I also remember feeling a great wash of sorrow for the young man who was going to die, and for a family who had surely by now had the dreaded visit. They would be traveling to Texas, most likely. I prayed that they would make it in time and that God would hold them close in their time of tragedy.

Postscript

After a good sleep I was back up and in battery. The rest of the deployment went well, for the most part, though there was more tragedy and loss of life. The medevac had been a tipping point though, and I decided not to reenlist.

I drove away from Oceana in early spring, headed for the ranch with vague plans of going to medical school. I helped with calving and healed and decompressed. My grandfather, the son of our ranching patriarch, a great and humble man who had taught me uncountable important lessons, died suddenly in the summer. I was blessed to have spent time with him in his final weeks. He seemed impressed with some of the stories I shared and bragged on me to his friends.

As the days marched toward late summer, I began to realize that I wanted to get back into the fight. I'd left too much on the table. I made my way to the local recruiting office, and by the time September rolled around I was back at sea with a different squadron and airwing on a different carrier. I'd found the perfect way to circumvent crappy shore duty orders. I had many more adventures.

And yet another postscript

A couple of years ago I stumbled across a social media page belonging to the ship the burned sailor had been assigned to. I discretely reached out to some folks and found to my delight that the sailor had not in fact died. He had survived. He'd had, and continues to have, a life.

My part in his survival was vanishingly small. The corpsmen on the ship, the medical department on Iowa, the burn center in Texas, and the young man's own stout constitution and will to live were the deciding factors.

When I learned the happy news, I went to the attic and dug a small golden pin from a pouch, the tarnished, "Winged S" of a Sikorsky Award. It sits on my desk today, with a couple of mates and alongside other shiny bits of career detritus. It's perhaps my favorite relic, because it reminds me that where there's life there's hope, that the losing fight is always worth fighting, and that sometimes we win.



6 comments:

  1. Awfully dusty in here today. In a good way.

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  2. Agreed. Well Done, Shaun. You may not be able to win them all, but to that young man, you won the one that mattered to him.

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  3. Great post, and the last paragraph says it all.

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  4. August 21, 1965. The day I turned 4!

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  5. You truly are a Man who has fully justified his existence. Well Done.

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  6. You truly are a Man who has fully justified his existence. Well Done.

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