Nurses' training overrode fear in Iraq
He was a little boy of about 3, around 40 pounds, and dying. No one knew what he looked like.
Someone, it appeared, had put a gun under the 3-year-old’s chin and pulled the trigger. The bullet’s force flayed the small face apart from chin to forehead, shattering bones and displacing skin and muscle until there wasn’t a face there at all anymore. “I never saw nothing like that before,” said Lt. Shynell Bennett. “I couldn’t look at him.”
But Lt. Chuck Dickerson could.
The only nurse on duty with pediatric experience at the Navy’s first-ever combat hospital, Fleet Hospital 3 in southern Iraq, Dickerson looked at the small Iraqi boy brought in by U.S. Marines in the early days of the Iraq war, and thought how to save him.
“I just calmed myself and told myself if I panic, this boy’s going to die,” Dickerson said Wednesday from the U.S. Naval Hospital at Yokosuka Naval Base, Japan, where he and Bennett have been assigned since late last year. “I said, ‘Remember your training. Keep your goal in mind. And don’t give in to fear.
“What we did is not a medically approved procedure in the U.S. by any means,” Dickerson said. “However, it was necessary to keep the boy alive.”
Dickerson’s actions to save the boy, including devising an innovative drug cocktail, were recognized Wednesday at a surprise party at the hospital, where Dickerson learned he’d won a national nursing award sponsored by a nursing-uniform manufacturer.
The award, the Cherokee Inspired Comfort Award, was bestowed on nine U.S. nurses, from more than 1,600 who were nominated by colleagues, and includes an engraved stethoscope and a paid trip to the winners’ 2005 medical conference of choice.
Dickerson’s colleagues at the hospital, primarily intensive care unit nurses so experienced and proficient that they’re “floaters” who can work in all hospital units, said his award was well-deserved. “To him, work is play,” said Lt. Robert Reyna.
“They were real creative,” Bennett said of Dickerson and the doctors and respiratory therapist who cared for the boy for more than eight hours before he was flown by helicopter to a Kuwait pediatric hospital.
The boy’s injury was the most “dramatic” Dickerson and Bennett said they saw during their three months at the 116-bed hospital — a big, vinyl tent that looked “just like ‘M*A*S*H,’ ” Bennett said, and opened its doors April 1, 2003.
The hospital drew staff from naval hospitals in Pensacola, Fla., and Portsmouth, Va., among other places; places where most patients were sick or having surgery.
So no one was emotionally prepared for the trauma injuries — almost all of them suffered by Iraqis — that started coming through the doors.
“We were all eager, pumped and ready to go, and then, when the casualties started coming in, there was this moment of shock,” Bennett said. Bennett, who said she had refused to talk about her experiences in Iraq until this spring, recalled one woman whose jaw was blown off when her small son brought a hand-grenade into the house. The little boy was killed in the explosion.
At that point in the war, members of the 1st Marine Expeditionary Force, which the fleet hospital was supporting, came in most often for gastrointestinal illness, Bennett and Dickerson said, and occasional accidents.
The Iraqi patients, though, had shrapnel wounds and blast wounds and gunshot wounds. And some of them said they’d been shot, or their wives and children had been shot, by other Iraqis for refusing to fight for Saddam Hussein.
The little boy Dickerson helped save was one of those, the hospital staff was told. According to the story, men had barged into his home and tried to press his father to fight for the Iraqi army; they held a gun under the boy’s chin and fired it when the father did not cooperate.
The family had handed the gravely wounded boy over to the Marines for help, and he initially was treated by what Dickerson said must have been a highly skilled doctor in the field who managed to intubate the boy and attach him to a ventilator.
But the ventilators were not as sophisticated as those in the United States, Dickerson and Bennett said, and, along with the dust and often compromised lung condition of the Iraqi population, caused problems in patient care.
“A lot of things we normally counted on having, we didn’t have,” Bennett said. “We jerry-rigged a lot of things.”
Dickerson saw that the boy’s condition was deteriorating because he wasn’t responding well to the ventilator, and, within minutes likely would suffer lung damage, then cardiac arrest. Looking at the small boy lying there, his head wrapped in saline-soaked gauze to help preserve the detached facial skin, Dickerson came up with a plan:
“Because we couldn’t change the ventilator, we changed him,” Dickerson said.
Dickerson, with a background in critical-care nursing and a knowledge of how both drugs and ventilators worked, suggested the boy be given a three-drug mixture to paralyze and sedate him and block his pain, all at once.
“The idea just jumped out at me,” Dickerson said. “Here — here’s a solution. And the doctors liked it.”
In theory, the drugs would allow the boy’s lungs to relax and expand more, and keep him oxygenated, without damage to his lungs. It was a tricky thing to pull off — too much of one drug and the boy would not have been able to breathe on his own, too little and the desired result wouldn’t happen — in the best of circumstances. “I didn’t know it would work for sure,” Dickerson said.
For eight hours, as they waited for a helicopter to take the boy, whose name Dickerson has forgotten, to the Kuwaiti hospital, Dickerson continued the meds, administered with a syringe because there was no tubing to hook up an intravenous drip.
And lastly, he made up a batch of the syringes, carefully labeled and made “doctor-proof,” for the doctor and respiratory therapist who accompanied the boy to the hospital. The Kuwaiti hospital would not allow the boy’s parents to accompany him, Dickerson said.
Last he heard, the boy had lived, lost an eye and undergone facial reconstructive surgery, Dickerson said.
Dickerson was nominated for the Cherokee award by his former boss, Cmdr. Janet Hughen, who, both he and Bennett said, always was trying to recognize the good things her nurses did. She has since rotated out.
Bennett might have been nominated, too, for some of the heroic things she did at the fleet hospital, but, she said, she didn’t want to bring any of those memories to the front of her mind.
“I just totally put it out of the way,” she said. “The sounds, the smells … I’m not going to ever forget.”