Although the air was warm that night, as I stepped off the helicopter in a country thousands of miles from home, I was shivering. I was covered in blood that was not my own and I was physically and emotionally drained. Pushed beyond my limits, I had been forced to dig down deep within myself. As my teammate was fighting for his life in the surgical room where I had left him I was fighting to hold back my emotions wondering if I had known enough and if I had done enough. Our lives can often be mentally segregated into fragments by series of defining events. There are the things that happened before these events, the events themselves, and then life after the event. Each phase has a present, a now. I had just transitioned into the post event now.
This wasn’t my first combat trauma. In the now of my pre-event life I had finished the special operations combat medic course and spent time at a level one trauma center. After which, my first deployment was to Iraq and on my first operation one of our Kurdish counterparts was shot through the shoulder and the bullet exited his chest. It was my first trauma patient and the first time I was solely in charge of someone’s care. The pressure was on me and everyone was looking to me for answers. I just hoped I had the right ones. This patient though was admittedly simple. He needed an occlusive chest seal and a needle decompression for a tension pneumothorax. Later in the deployment I was privileged to provide care as part of a forward surgical team to Iraqi kids and other civilian casualties. It was a tremendously emotional experience but helped to bolster my confidence. However, none of these patients were my teammates and I had not known any of them personally.
By my second deployment to Iraq I felt like I could handle any trauma thrown my way. I believed it to be confidence, but perhaps it was hubris. Whenever I wasn't out on operations I found myself in the casualty collection point. All my free time was spent trying to learn from the surgeons attached to us or working on combat casualties. While there were many American servicemember casualties, still none of them were my teammates, a fact that I took for granted.
That night during the now of this life-altering event, however; was different. I had already lost one friend on this mission and was forced to care for another. He had been shot in the face and the force of the round had knocked him unconscious and also blew a massive hole in his face and neck. As far as I could tell no major arteries had been severed but there was a lot of work to be done. This time it was personal. This was a friend, a teammate, a patient with a family I knew. My heart rate spiked, my pupils dilated, I began to shake. I found myself in that altered universe of time that exists solely in one’s own mind wherein seconds feel like hours. I questioned myself. How hard did I study in my medic course? How much reading had I done? Had I trained enough? Was I truly prepared for this? The answers would have to wait, but it was too late at this point anyway. I did my best in that cold, loud helicopter in the dead of night.
Finally, we had reached the spot where I would turn him over to the surgeons on the larger helicopter. It pains me to admit that I was relieved to no longer be responsible for my friend’s care and move into the post-event phase. The only problem was that the surgeon’s helicopter had just crashed. Now it was up to me to treat the injured surgical team and keep my friend alive until we could reach a surgical table. My medical skills were pushed to the limit and as I left my teammate there in the operating room I was scared. I was scared that I wasn't good enough, I didn't know enough, and I hadn't done enough.
Standing there in the post event now, I was completely oblivious to the helicopter behind me or anything else in the world for that matter. I realized that what I had learned, how hard I studied, and how much effort I had put into my training had real consequences. Consequences for my future, but more importantly, for my patient’s future. It meant the difference between telling my friend’s family that I just could not save their husband/father versus sitting down to a meal with my friend and his family as he recovered from his injuries. In this moment I understood that my personal decisions and my efforts or lack there-of would make a substantial difference to my patients. I was ashamed that it took a casualty that was my companion to bring me to this realization. All my patients deserved better. The cold hard truth is that the now matters, especially in so much as it pertains to the future. When the now of the present calls one to perform, the now of the past will be the only thing one can rely on to determine the now of the future.