All Quiet

When you work in an ER for a living you know that one thing almost always holds true. It’s quiet until it’s not. When it’s not, there is usually a co-worker to blame. Someone who casually, without thinking, utters the simple and seemingly innocent phrase, “It’s really slow in here right now.” The obligatory, “Why would you say that,” is then directed at the person, and usually within minutes the calm is replaced by a maelstrom of chest pain, vomiting, and shortness of breath as patients begin to file into the ER.


This happened to me recently during a shift that I was working. It was a Monday, known throughout the ER world as consistently the busiest day to work. For whatever reason, the ER is always busy on a Monday. It is interesting to me that the trend continues during a deployment because there is nothing to set a Monday apart from any other day of the week. There are no long weekends here and everyone pretty much works seven days a week. I suppose our bodies are hard-wired to hate Mondays based on principle, and so patients feel their worst and decide to pay the ER a visit.

So I sat in my office listening to the Beatles, waiting for the jinx to provide me with patients up to my head. For five minutes nothing happened. Another five minutes and still nothing. “I guess the jinx doesn’t work in Iraq,” I thought to myself. Then, an innocent enough appearing man, a contractor, poked his head though the door and asked if someone would take a look at his boss who was having chest pain. Here we go, although I remember being strangely comforted by the fact that the jinx still worked so far from home.

A word first about contractors. For those that don’t know, and I certainly didn’t, this whole deployment thing couldn’t happen without them. The military just doesn’t have enough bodies to keep the bases up and running on their own without sending every service member over. Think about it, who sets up the internet, runs the cafeteria, works in the PX, translates, or works as the plumber, electrician or handy man – it’s the contractor. Initially, the military could perform all these functions, but as the forces over here number in the tens of thousands, and the bases become little cities unto themselves, it’s impossible for the military to do it on its own.

The contractors, just like their job titles, come in all shapes and sizes, but in general those sizes are a variation on large. Before we left for Iraq we lived among the contractors that would be coming over here with us. We would joke amongst ourselves as the overweight and out of shape man would walk by, that we will be seeing them in our ER in Iraq. They come here for the opportunity to make six figures doing a job that wouldn’t make them half of that at home in the US, but I don’t think there’s a price you could quote me to come here on my own free will. They are hard workers to boot, and I guess the biggest compliment I could pay them is to say that you hardly even notice them. Which is to say that everything here runs pretty smoothly.



After we told the man that yes, we could take a look at his boss, I peered into the hallway and looked at his boss sitting on the bench. He may have been one of the guys we said we would see when we got over here, and if there is a picture in the dictionary of a heart attack about to happen it was him. The medics helped the man into the bed and got him hooked up to the monitors. As the nurse placed an IV he complained of severe chest pain and trouble breathing. Sweat poured from every pore, it looked as though he had been hosed down prior to arrival. Then he vomited. Classic presentation for a MI, I thought to myself.

However, EKG number one was normal, and so was number two. His pain was getting better with aspirin and nitroglycerin, and it looked as though my clinical acumen had come up a little short. A moment later, the pain was back and I got one more EKG just to be sure I wasn’t missing anything and there it was – the stereotypical overweight contractor with the stereotypical presentation for a heart attack, now had the stereotypical I’m going to die unless something is done soon EKG.

All of a sudden I was transported back to Newark, to my residency, and the rush that I get when taking care of someone really sick. It’s what I had been trained to do except for one thing, I was in Iraq, and there was no cardiac catheterization lab waiting for the patient to open up his blocked artery with a balloon. In all my years of training I’ve never had to deal with this set of circumstances, and I didn’t have too much time to play with, this guy looked like hell and was getting worse. So, for the first time in my career I pushed lytics (medications that break down clots) for an MI, hoping to avoid some of the dreaded (and deadly) side effects such as bleeding in the brain or gastrointestinal tract.

It had been a total of perhaps five minutes between the “I’m going to die” EKG and the administration of the lytics and now we waited and watched for improvement. If this didn’t work we were out of options and this guy was out of luck. Almost instantly his pain subsided and a repeat EKG showed no sign of abnormality at all. Like nothing had ever happened.

Arrangements were made, and a few hours later he was on an Air Force C-130 on his way to Landstuhl, Germany, which was the closest catheterization lab to us in Baghdad. He stayed there a couple of days, and the cardiologist told me that he had been a very lucky patient – there was no evidence, not in subsequent EKG’s or lab tests, that would indicate that this guy had ever had a heart attack thanks to the treatment he received in Baghdad. He made it back to the US a few days later. Right place, right time.

It’s interesting that the first real “save” over here is from a contractor having a heart attack and not a soldier getting shot up. I guess it says a lot about where we are in this war. I think it’s a good thing, at least for now.