Maj. (Dr.) Steve Barnes (left) works with vascular surgeon Maj. (Dr.) Cabot Murdock to repair blood vessels in the thigh of a wounded insurgent Aug. 7 at the Air Force Theater Hospital at Balad Air Base, Iraq. Located about 42 miles north of Baghdad, the forward-based hospital is the military medical hub for all of Iraq and admits about 700 patients a month. (U.S. Air Force photo/Lt. Col. Bob Thompson)
Maj. (Dr.) Steve Barnes (left) works with vascular surgeon Maj. (Dr.) Cabot Murdock to remove shrapnel from a U.S. Soldier at the Air Force Theater Hospital at Balad Air Base, Iraq, Aug. 7. Severely wounded by a roadside bomb, the Soldier's life hung in the balance until the surgeons found and extracted fragments of metal and bone from the Soldier's iliac veins deep in his pelvis. (U.S. Air Force photo/Lt. Col. Bob Thompson)
by Lt. Col. Bob Thompson & Lt. Lisa Kostellic
332nd Air Expeditionary Wing Public Affairs
8/11/2006 - BALAD AIR BASE, Iraq -- During a 24-hour shift that began at 7 a.m. on Aug. 7, an Air Force surgeon treated 18 patients with injuries that varied from a crushed foot and multiple improvised explosive device penetrations to gunshot wounds through the thigh and head.
For Air Force Maj. (Dr.) Steve Barnes, the surgeon of the day, this meant nine operations, five of which were performed on Americans, three on Iraqis and one insurgent.
"I volunteered to come to Balad for both personal and professional reasons," said the trauma surgeon instructor based at Cincinnati's University Hospital in Ohio. "I needed to be here out of a sense of service. I think I am good at what I do, and I could help make a difference. As for the professional experience -- you don't see wounds like this at home."
The Air Force Theater Hospital here treats about 700 patients a month. About 50 percent are medical admissions and the other 50 percent are trauma cases.
According to hospital records, if a trauma patient arrives at the hospital with a pulse, the patient has a 97-percent chance of recovering and moving on to the next stage of care. This is the best rate for trauma patients in military medical history.
"You don't see stuff like this in the states," Major Barnes said. "They don't have IEDs in Cincinnati."
The surgeons are equipped to handle any injury just short of performing heart transplant operations. However, the most common trauma injuries they see are from IED blasts.
Located about 42 miles north of Baghdad, the forward-based hospital is the military medical hub for the whole country. Representing nearly every specialty, the surgeons work to stabilize patients for aeromedical evacuation to the Landstuhl Regional Medical Center in Germany. Every six days, they pull an around-the-clock shift as the surgeon of the day.
"We're feeling like big studs right now," said Major Barnes as he operated on an IED victim. "We found pieces of shrapnel and bone in this guy's iliac veins deep in his pelvis, that's the worse place it could be."
Together with vascular surgeon Maj. (Dr.) Cabot Murdock, Major Barnes extracted a piece of shrapnel the size of a quarter from inside a U.S. Soldier.
"He probably would have started bleeding internally on the plane," Major Murdock said.
During the five-hour flight to Germany, that kind of internal bleeding would have been fatal, the major said.
With the aid of the hospital's X-ray and imaging capability, the two surgeons found the elusive but deadly metal fragment.
"Trust no one, believe nothing," Major Barnes said. "Pop the hood and look inside for yourself to find out what's going on."
After they vacuum sealed the Soldiers abdomen closed, they explored and irrigated the wounds on his backside and legs.
"We see this here all the time," Major Barnes said. "The IED blast hit him while he was sitting down in his vehicle. See how the blast went up his pelvis and into the abdominal cavity? You don't see this in civilian trauma."
"See that, that's energized pieces of Iraq," Maj Murdock said. "Debris, little rocks. These are in every wound on this guy's body."
Tonight, the pace is steady, Maj Barnes said as the sound of incoming medevac helicopters fills the air. This time the arrival is a single patient, an Iraqi soldier with a gunshot wound in the back of his head. The surgeon holds up to the overhead light an X-ray with the bullet clearly defined just inside the patient's forehead.
"It doesn't take a doctor to tell you that there's something wrong with this picture," he said.
Later, he checks in on fellow surgeon U.S. Army Maj. (Dr.) Hans Bakken, who performs a craniotomy, or removal of the skull cap. This is the second brain surgery in less than four hours.
Before his 24-hour shift comes to close at 7:30 a.m., Major Barnes responds to his fifth American patient for the night. Though exhausted, the University of Alabama in Birmingham graduate always tries to give a warm greeting to his patients and take their mind off of what they're going through.
"It's good to talk to them," he said. "I ask them 'where are you from?' and I tell them 'we're going to take good care of you.'"
