A Silent Killer

The Invisible Enemy in Iraq
By Steve Silberman
02:00 AM Jan, 22, 2007

A homemade bomb exploded under a Humvee in Anbar province, Iraq, on August 21, 2004. The blast flipped the vehicle into the air, killing two US marines and wounding another – a soft-spoken 20-year-old named Jonathan Gadsden who was near the end of his second tour of duty. In previous wars, he would have died within hours. His skull and ribs were fractured, his neck was broken, his back was badly burned, and his stomach had been perforated by shrapnel and debris.

Gadsden got out of the war zone alive because of the Department of Defense’s network of frontline trauma care and rapid air transport known as the evacuation chain. Minutes after the attack, a helicopter touched down in the desert. Combat medics stanched the marine’s bleeding, inflated his collapsed lung, and eased his pain. He was airlifted to the 31st Combat Support Hospital in Baghdad, located in an old health care facility called the Ibn Sina, which had formerly catered to the Baathist elite. Army surgeons there repaired Gadsden’s cranium, removed his injured spleen, and pumped him full of broad-spectrum antibiotics to ward off infection.

Three days later, he was flown to the Landstuhl Regional Medical Center in Germany, the largest American military hospital in Europe. He was treated for his burns, and his spine was stabilized for the 18-hour flight to the US. Just a week after nearly dying in the desert, Gadsden was recuperating at the National Naval Medical Center in Bethesda, Maryland, with his mother, Zeada, at his bedside.

The surgeons, nurses, medics, and pilots of the evacuation chain have saved thousands of lives. Soldiers wounded in Vietnam were six weeks of transit time away from US hospitals, and one out of every four of them died. By contrast, a soldier’s odds of surviving battle injuries in Iraq are nine out of 10. Unfortunately, this remarkable advance in battlefield logistics has also resulted in an increase in the number of traumatically injured patients who are particularly susceptible to infections during their recovery. In Gadsden’s case, from the moment he was carried into the Ibn Sina, the injured marine was in the crosshairs of an enemy he didn’t even know was there.

At first, he did quite well. By early September, Gadsden was weaned off his ventilator and breathing on his own. For weeks he gradually improved. His buddies took him to a Washington Redskins game in his wheelchair, and the next day he navigated 50 feet with a walker. Soon Gadsden was transferred to a veterans’ hospital in Florida called the James A. Haley Medical Center, where he offered to serve as the eyes of a fellow marine blinded in an ambush. The doctors told Zeada that her son might be able to go home by the end of October.

But he still had mysterious symptoms that he couldn’t shake, like headaches, rashes, and intermittent fevers. His doctors gave him CT scans, laxatives, methadone, beta-blockers, Xanax, more surgery, and more antibiotics. An accurate evaluation of his case was difficult, however, because portions of his medical records never arrived from Bethesda. If they had, they would have shown a positive test for a kind of bacteria called Acinetobacter baumannii.

In the taxonomy of bad bugs, acinetobacter is classified as an opportunistic pathogen. Healthy people can carry the bacteria on their skin with no ill effects – a process known as colonization. But in newborns, the elderly, burn victims, patients with depressed immune systems, and those on ventilators, acinetobacter infections can kill. The removal of Gadsden’s spleen and the traumatic nature of his wounds made him a prime target.

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