Mideast edition, Saturday, May 5, 2007

BAGHDAD — The wound was deceptively small.

Pfc. Dustin Fritschel, 20, of Lockport, Ill., had a small puncture in his back. He looked fine as he lay in his bed at Ibn Sina Hospital, run by the 28th Combat Support Hospital. He described a mortar going off, he and his buddies running into a building, a medic checking him over.

But CT scans detected what the eye could not: A piece of shrapnel had made its way into Fritschel’s body and appear to be embedded in one of his organs.

Surgeons opened him up and found his spleen was nicked. Since the body doesn’t need the organ, it was removed.

In a war whose signature weapon is explosives, combat medical staff in Iraq spend much of their time searching for foreign objects in people’s bodies that could become a problem.

They’ll see whether a patient is pale, a possible sign of internal bleeding. At Ibn Sina, ultrasound, X-rays and CT scans — a sophisticated form of X-ray — are enlisted to take a look inside.

“The chance for missed injuries is very high,” said Maj. Melissa Givens, 37, of Laumore, N.D., an emergency-room physician at Ibn Sina. So her staff works to make sure that doesn’t happen.

Sometimes an explosive’s effects are only too obvious, and combat doctors see patients with mangled flesh and torn-off limbs.

An Iraqi dental student was wheeled into the emergency room with the top part of his left foot torn off.

A big ball of bandages wrapping up his foot was carefully cut off, revealing that the big toe was intact but the other toes were gone. Some of the bones in the foot were exposed.

Lt. Col. Kenneth Taylor, an orthopedic surgeon, painstakingly removed dirt and bone fragments from the wound. He searched for dead tissue, cutting it off and cauterizing as he went along.

Healthy tissue looks red; unhealthy, purple and black. Healthy tissue is tough and elastic; dead tissue is mushy and gelatinous.

“I make no promises at the the beginning,” said Taylor, 41, of West Milford, N.J. “I tell the patient the primary goal today is to prevent infection. What we can save, we will.

“If we’re convinced there’s a nice bed of tissue, we can think of reconstructing.”

The man’s big toe was salvageable, although the nail was ripped up. “We’ll repair that,” Taylor said, smiling behind his surgical mask. “I’ll make it look pretty.”

Surgeons at Ibn Sina see many gunshot and shrapnel wounds, injuries they don’t see that often in the States, said Lt. Col. Robert Stewart, chief of surgery, who worked as a cardiac surgeon in U.S. hospitals.

Many of the patients have multiple injuries. It’s actually unusual to see them with single injuries, said Stewart, 58, of Washington, D.C.

Life-threatening wounds are treated first, including breathing difficulties and bleeding in the chest and abdomen. Then other wounds are looked at. Most patients with head injuries and cases needing neurosurgery are flown to the combat support hospital in Balad.

Surgeons at Ibn Sina get a tremendous amount of experience handling many types of injures. They operate virtually seven days a week, whereas in the States, they might get in two days a week, according to Maj. John Sloboda, an orthopedic surgeon.

One day, 14 people were admitted to the hospital, said Sloboda, 38, of Marion, Ohio. “Most needed surgery.”

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