Ive been told sometimes I jump to conclusions, fly off the handle, think with my heart and not my brain.  Concerned only with how I feel and not what I know is the obvious and right course of action.

I remember one time in particular that proves most of that all at once.

It was a cool Autumn (or the Iraq equivalent) in Baghdad, and it had rained earlier that afternoon.  The mud had caked to the bottom of my boots and I could stell smell that fresh rain smell.  Everything took on a different hue after the rain had swept away the dust, revealing the true colors of our surroundings.

We were patrolling, dismounted, through the winding alleys and garbage ridden streets of a largely Sunni neighborhood, which meant there were a lot of people that didnt think very well of us.  Even knowing that it had been a pretty quiet night and we were in high spirits.  The guys were joking and laughing quietly to some jokes and comments I made when it happened.

Our point man, a cuban kid from florida named Hernandez, stepped into an empty town square that was used as a market during the day.  A single shot rang out and he crumpled over into a heap on the dirt road.  I could see a black puddle forming through my NVG's and knew he was going to bleed out and die if something wasnt done, and done fast.

I yelled to our platoon sergeant that I needed to get him and started running.  He grabbed me as I ran past and pulled me to the ground, saying that he couldnt afford me going down too, and we would have to wait for Bravo to move around and secure the perimeter.  The thing he wouldnt say would that it would take at least 45 minutes, but I knew that, and he knew that I knew that.

I cussed him out and told thim that I was going to get Hernandez and he could take my rank when we got back to base.  I ran as fast as I could back to my aid bag and grabbed a 300 foot rope from the truck, a caribeaner, gauze, a pressure dressing and a tourniquet just in case.  I ran the rope through my D ring, just in case, and ran back up the road towards the square.  I told the Sergeant that he could either cover me or shoot me, I was going out to get Hernandez.

I took off into the square as seven men started firing all they had into the abandoned buildings around me, hoping I would make it.  It was a 200 foot dead sprint with all my gear and a weapon in my hands, but it seemed like a damned 10k run.  As fast and hard as I ran, as much as my chest was on fire and my legs felt like jello it seemed like I was going nowhere.  I dont know if I heard the shot first or saw it smash into the ground in front of me first, but thats when I started to think this was a bad idea.  He was only two feet off.  If he was any good at what he did he would most likely hit me with the second shot. 

Im going to assume the squad reacted and adjusted fire when the second shot rang out, because it bought me the twenty seconds I needed to to jump on top of hernandez and snap the rope and ring to the casualty strap on his vest. As soon as I moved a bullet smashed into the ground right where I was kneeling.  I ran faster than I ever thought I could.  I think that I even forgot to breath, thats how much my adrenaline was pumping.

I made it back to the cover of the alley and grabbed the ass end of the rope and started pulling hernandez in by myself.  not three seconds later the rest of the squad was in on it and Hernandez was in my hands.  He took one in the thigh and it knicked his femoral.  His body did what it had to do to keep himself alive.  His Rectus Femorus, Bicep Femors, and Medial and Vastus Medialus and Lateralus all tightened, constricting and pinching off the femoral artery before it had time to snap and retract into his abdominal cavity.  I strapped a tourniquet on and started an IV of hextend.  The Hetastarch compound began pumping through his veins.  Using the large protein, and Sugar molecules to osmotically pull fluids into his half empty veins from the interstitial and cellular space, replacing that life giving blood that he left on the streets of baghdad that night.

The bleeding was stopped, colloids were pumping through his veins, so I called the nine line medevac.  A bird was dispatched.  I checked his radial pulse and it was present, meaning the colloids did their job and put enough fluids into his vasculature to bring his BP enough to perfuse out to his peripheral extremities.  If those are gettin blood, everything is.  He came back around just in time to fly out on a UH-64A Blackhawk.

I never saw Hernandez again.  I heard he got an office job back in the rear at hood, and was going to physical therapy.  And thats about it.

After that I decided that I wasnt going to do the mission thing anymore.  Its gotten to the point where I just throw myself in without thinking or caring, and I have too many people that love me back home to do that.  It may have been a shitty week, and I may have heard somethings I didnt want to hear, but things will work out, Im pretty sure of this. 

I just need to keep reminding myself that things are difficult because she cares about me, and I care about her.  If it would be easy it would be because one of us doesnt matter.  And now that Ive sat down and thought things out, came to this realization, I feel alot better about everything.

So if youre out there just know I love you, and its gonna be ok.

You can run on for a long time, sooner or later god will cut you down...

1)Tension pneumothorax with jugular vein distension, penetrating trauma  at the fourth intercostal space mid clavicular R side. 4 percent BSA third degree burn. 2)Flail chest with agonal respirations and penetrating trauma to the head3)Partial amputation L arm distal elbow, complete amputation at the R knee.  Tension hemo-pneumothorax.  blunt trauma to the chest.4)Cerebral spinal fluid oozing from the ears and nose.  crepitus present at the base of the skull. 5)evisceration.

what do you do??  Which two do you try and save?  All the injuries are life threatening.  The casualties are loosing blood and body heat quickly.  Their peripheral veins are beginning to constrict, shunting the blood flow to their arms and legs, trying desperately to preserve their vital organs.  Which ones get the ivs?  Do you use a colloid to pull water from the interstitial space via osmotic pressure?  be careful, you might just end up dilluting his hemoglobin to the point where coagulation and hemostasis is impossible.  you might put so much in that his blood pressure shoots up, blows out his clots and he bleeds to death.

You do what you need to do.  Thats what.  You ignore the screams of your friends and start doing what they trained you to do.  Triage and treat.five critical casualtiesOne medic.enough resources to treat three.

Number 3- Hes bleeding out, and fast. Kneel over him and dig one of your knees into the pit of his groin on the right side, cutting off the flow of his femoral artery while you slap a combat tourniquet onto his left arm.  without releasing pressure pivot around and slap another on his leg.  Rip his shirt off quickly and jab a 14 gauge catheter into his chest, midclavicular at the 4th intercostal space to relieve the build up of pressure in his lungs, allowing them to reinflate.  lay him on his side, start pushing fluids, 500ml Hextend to replace the volume in his veins from the massive hemorrhaging.  You remember how he used to tell you how much fun he had playing football with his son. 

Number 1- 14 gauge catheter mid clavicular at the 4th intercostal.  release the pressure.  whip out a large sheet of plastic and secure it over the chest wound with a shit load of duct tape.  it keeps the air that hes breathing in from escaping out immediately and allows his punctured lung to reinflate.  wrap his burns with dry gauze and start pushing fluids.  lactated ringers, to replace all the vital nutrients lost through his burns.

Number 5- dont let him try and push his intestines back inside.  get a large abominal dressing, soak it in water and secure it over the wound and intestines.  make sure to keep them moist.  start an iv, normal saline.

number 4- Nothing much to do.  Put him in a cervical collar and pray. 

number 2- Expectant. you pass him by  Hes dying and you cannot afford to waste your time or supplies on him.  You wont be playing spades with him anymore in the middle of the night when neither of you can sleep.

you wait impatiently, jumping from patient to patient monitoring and tryin to reassure them.  number two dies after only a few minutes.  i have yet to hear anything that shakes your soul like the sounds a man who was shot in the head makes.

number four is suffering.  screaming in pain.  his brain is bleeding, building massive amounts of pressure, and slowly cutting off its own source of oxygen.  blood begins to pour from his ears and nose.  you give him 30 mg of morphine, he passes out and dies silently in several minutes.Five is doing good.  it takes a long time to die of an abdominal wound.  you keep him warm, and keep his intestinal wrapping moist.

Number one is able to breath now that the pressure has been released.  hes still in massive pain, but you cannot give him morphine because of his injuries. 

number three is unconcious.  you finish off the hextend and hook up some normal saline and run it slowly to keep him hydrated and prevent from busting out his blood clots.  his pulse is strong.