Calif. surgeon reflects on downrange surgeries in Afghanistan
By Josh Dulaney | San Bernardino County Sun, Calif. | Published: November 25, 2012
COLTON - Here's the bullet. You're good to go.
American troops wounded in war likely have heard words to that effect after emerging from trauma surgery on the battlefield.
Just ask John Culhane, a 45-year-old trauma surgeon and critical care specialist at Arrowhead Regional Medical Center in Colton who recently returned from a four-month deployment to Afghanistan as an Army reservist.
Wounded warriors keep deadly tokens.
"They always want the bullet," Culhane said Wednesday during a break in another busy shift at the San Bernardino County-run hospital.
Culhane has served on staff since 2005. His experience handling between 10 and 20 surgeries a week was valuable on the battlefield, where he had
the same work load.
But nothing can prepare a surgeon for working while hearing the terrifying sound of bullets and bombs. Culhane served at a forward operating base near Kabul.
Once he was operating on a wounded soldier when he heard machine guns and explosions outside. His base was under attack.
He quickly put in a shunt, packed the wound and evacuated the soldier in a helicopter.
"It's different because you see things you don't see over here," Culhane said.
He routinely wore full body armor during surgery because of the dangerous conditions.
Culhane also served on deployments to Iraq in 2007 and 2009.
But it was during his time in Afghanistan that he honed his diagnostic skills.
The base didn't have CT scans, leaving surgeons to work with ultrasound and plain X-rays.
"It helps you rely more on your hands, eyes and ears to make a diagnosis rather than being dependent on technology," Culhane said.
It also meant surgeons turned into artists, improvising with lives on the line.
He once operated with the only light from flashlights after the power went out in the hospital.
Then there was the time he created a colostomy bag for a soldier by suturing a freezer bag.
"We're at the end of a long supply chain that's (depleted) so we were out of things a lot," Culhane said.
He saw his fair share of unusual cases that provided some comic relief during Afghanistan's notorious fighting season.
One soldier had a shrapnel injury to the bowel. When Culhane operated, he found that a piece of shrapnel had severed both the soldier's bowel and a foot-long intestinal worm.
The running joke between patient and staff, according to Culhane: "We should get two purple hearts - one for the soldier, one for the worm."
He said the medical environment on the battlefield is like the TV series "M-A-S-H" except "nobody is clowning around."
It's that kind of matter-of-fact professionalism that Culhane is known for at Arrowhead Regional.
Dev Gnanadev, medical director and chairman of the surgery department, said the hospital is proud of Culhane's service to the country.
"He's actually really quiet but very hardworking and very dedicated to his patients," Gnanadev said. "John is not the kind who would just try to talk about himself. He does things rather than talk."
Culhane started as a paramedic. The experience sparked a desire to become a doctor and surgeon in order to provide regular medical as well as surgical care.
He attended the College of Medicine at the University of Illinois at Urbana-Champaign, and did his residency work at Loma Linda University Medical Center.
Now a seasoned surgeon, Culhane described the heartbreak and the glory of life as a doctor on the battlefield.
In one instance, two soldiers arrived at the base after getting hit by a roadside bomb. One was already dead from the crushing weight of an 800-pound door landing on his chest.
The other was alive but couldn't breathe because of a severe throat injury. Culhane and staff saved him but couldn't revive his comrade, "which was a very different emotional experience at the same time."
He recalled the playing of Taps while dead soldiers were taken away by helicopter.
"That's a very emotional experience when you see the person you couldn't save and everybody is honoring their fallen comrade," Culhane said.
But for those brought to the base alive, Culhane and staff made a promise.
"Every soldier that comes in with a pulse leaves with a pulse," he said. "That's what we said and that's what we did when I was there."
And healing soldiers apparently sounds a lot like healing civilians.
"One thing I heard them say," Culhane said, "was it makes their experience easier if they know someone has their backs."