Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

A physician anesthesiologist reports in from Afghanistan

Jesse M. Ehrenfeld, MD, MPH
Physician
May 4, 2015
384 Shares
Share
Tweet
Share

shutterstock_156842612

american society of anesthesiologistsA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

As a physician, you never quite get used to being paged in the middle of the night. The shrill tones emitted via a radio frequency device that seems squarely stuck in the 1980s are almost always the first sign of something gone wrong, especially when serving as a military physician.

That was the case mid-way through my recent eight-month deployment at Kandahar Airfield in Southern Afghanistan, where I was staffing one of the world’s busiest combat trauma hospitals — the NATO Role 3 Multinational Medical Unit. Four Alphas, three Bravos. That’s all I knew. Alphas were our code for the most badly injured, with Bravos often not being that far behind. Our pagers never went off for Charlies, or the walking wounded.

I grabbed my surgical cap and stethoscope, and headed for the trauma bay. As a physician anesthesiologist, my role was to work with our trauma team to evaluate the most badly injured, administer blood products, manage the patient’s airway, breathing and circulation, and if needed, bring the patient safely through surgical procedures in the operating room (OR).

The first patient rolled in, carried on a blood-soaked stretcher by two hospital corpsmen, with a flight medic close behind. He had taken small arms fire, with several high-velocity rounds piercing his shoulder, legs, and abdomen. He would need to go to the OR, once we had evaluated the extent of his injuries.

“Where are you from?” I asked the young soldier as he looked up at me. “Arizona,” he responded, and then quickly followed with, “How is everyone else? Are they all OK?” With little concern about his own injuries, and in spite of his obvious discomfort, this soldier, like so many others I have met, was more concerned about his comrades and his mission. After stabilizing his immediate injuries and normalizing his blood pressure, we were off to the OR.

The rest of that night is a blur. Patient after patient arrived. We worked all night, taking the most critically injured to the OR in order of severity. Worried if we would have enough blood to go around, we considered initiating the walking blood bank — taking from pre-screened soldiers and administering directly to wounded personnel. Fortunately, it never came to that.

In those moments, my colleagues and I were presented with extraordinary challenges: limited resources; critical injuries; lives on the line — not to mention the ever-present threats against our own lives. Meeting the needs of my patients and my comrades was only possible because of effective teamwork, clear standards, and high-quality communication.

Teamwork. It doesn’t matter whether I am seeing patients in my home practice at Vanderbilt University in Nashville or as a military physician overseas in Afghanistan. Only when we provide patient-centered, physician-led care can we ensure efficient, high-quality, cost-effective care. It has been demonstrated over and over that when physicians and patients are removed from the care delivery process, either because of opaque cost-management practices like pre-authorizations, or the unsupervised practice of underqualified health care workers, costs go up, quality goes down, and patients stop receiving the care they would otherwise choose for themselves. Teamwork is essential to ensuring our patients, our families, our veterans and all Americans receive the care they deserve.

Standards. Our standards define how we function and who we are. Knowing what to expect at any point in the care delivery process is essential to success. Meeting and exceeding standards ensures that everyone is on the same page, and no one is surprised by how decisions are made. While some denounce care standards, pathways and care protocols as “cookbook medicine,” adhering to standards is the only way to ensure that we can execute processes in a reliable fashion without having to make it up as we go along. Standards and reliability remove uncertainty and enable teams to perform effectively under the most difficult circumstances.

Communication. High-quality, two-way, closed-loop communication is an equally essential ingredient for success in health care, but often challenging to both establish and maintain. I have witnessed and been a part of teams that practiced both good and poor communication. Good communication has helped me and my teammates stop errors from happening. Poor communication has enabled the opposite effect: causing direct harm to patients and worsening outcomes. I have witnessed medication errors, diagnostic and other types of errors that were clearly and unequivocally the result of poor communication. Ensuring that all parties — our patients first and foremost — understand, acknowledge and respond to us when we are working together toward a common goal is critically important.

During my overseas tour, the dust never quite settled. Along with a thin, grimy film of sand, I was always encased with the uncertainty of when my pager would go off next, when the latest round of casualties would arrive, and when just a few minutes could mean the difference between life and death. As a physician anesthesiologist, I have a comprehensive knowledge of the body and all its systems, and the expertise to know how to react in an emergency and diagnose unexpected complications. My ten years of education and training as a physician anesthesiologist prepared me to serve as both a physician and a service member.

The views expressed in this article do not represent the views of the Department of Defense or the U.S. Navy. They are the personal opinion of Dr. Ehrenfeld.

Jesse M. Ehrenfeld is an anesthesiologist.

Image credit: Shutterstock.com

Prev

Dear drunk driver: From your trauma surgeon

May 4, 2015 Kevin 2
…
Next

A surgeon who wasn't God in the OR after all

May 4, 2015 Kevin 2
…

Tagged as: Surgery

Post navigation

< Previous Post
Dear drunk driver: From your trauma surgeon
Next Post >
A surgeon who wasn't God in the OR after all

More in Physician

  • The shifting landscape of gastroenterology manpower and compensation

    Brian Hudes, MD
  • Surgical procedures for inpatients: Addressing socioeconomic urgencies

    Deepak Gupta, MD
  • I’m a doctor, and I almost died during childbirth

    Bayo Curry-Winchell, MD
  • A message of hope for physicians

    Kim Downey, PT
  • From aversion to office politics to embracing independence

    Osmund Agbo, MD
  • Navigating medical decision-making: Embracing limits and growth

    Benjamin Wade Frush, MD
  • Most Popular

  • Past Week

    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
    • Unveiling excessive medical billing and greed

      Amol Saxena, DPM, MPH | Policy
    • Bitcoin’s role in diversified portfolios [PODCAST]

      The Podcast by KevinMD | Podcast
    • Dying is a selfish business

      Nancie Wiseman Attwater | Conditions
    • Navigating medical decision-making: Embracing limits and growth

      Benjamin Wade Frush, MD | Physician
    • Empathy and compassion in palliative care [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Navigating the broken medical system: challenges faced by foreign medical graduates

      Anonymous | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
    • The essence of medicine: genuine connections in practice

      Jennifer Tillman, MD | Physician
  • Recent Posts

    • Bitcoin’s role in diversified portfolios [PODCAST]

      The Podcast by KevinMD | Podcast
    • 1 in 5 doctors will become disabled. Are you prepared?

      Amarish Dave, DO | Finance
    • The pros and cons of whole life insurance for high-income earners

      Shane Tenny, CFP | Finance
    • Family support is pivotal in the treatment of schizophrenia

      Frank Chen, MD | Conditions
    • Is emergency medicine your calling? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Exploring disfigurement and self-worth

      Kathleen Watt | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • CDC Advisors Endorse Maternal RSV Vax to Protect Newborns
  • Amoxicillin Alone for Acute Sinusitis Holds Up Against Broad-Spectrum Cousin
  • Despite Taboo, Med Students, Doctors Use Substances Too
  • White House Opens Gun Violence Prevention Office
  • Nurses Step Up to Bat on Educating Patients About Climate Change

Meeting Coverage

  • Loneliness Needs to Be Treated Like Any Other Health Condition, Researcher Suggests
  • Stopping Medical Misinformation Requires Early Detection
  • AI Has an Image Problem in Healthcare, Expert Says
  • Want Better Health Outcomes? Check Out What Other Countries Do
  • ERS Roundup: Cell Transplant Boosts Lung Function in COPD Patients
  • Most Popular

  • Past Week

    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
    • Unveiling excessive medical billing and greed

      Amol Saxena, DPM, MPH | Policy
    • Bitcoin’s role in diversified portfolios [PODCAST]

      The Podcast by KevinMD | Podcast
    • Dying is a selfish business

      Nancie Wiseman Attwater | Conditions
    • Navigating medical decision-making: Embracing limits and growth

      Benjamin Wade Frush, MD | Physician
    • Empathy and compassion in palliative care [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Navigating the broken medical system: challenges faced by foreign medical graduates

      Anonymous | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
    • The essence of medicine: genuine connections in practice

      Jennifer Tillman, MD | Physician
  • Recent Posts

    • Bitcoin’s role in diversified portfolios [PODCAST]

      The Podcast by KevinMD | Podcast
    • 1 in 5 doctors will become disabled. Are you prepared?

      Amarish Dave, DO | Finance
    • The pros and cons of whole life insurance for high-income earners

      Shane Tenny, CFP | Finance
    • Family support is pivotal in the treatment of schizophrenia

      Frank Chen, MD | Conditions
    • Is emergency medicine your calling? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Exploring disfigurement and self-worth

      Kathleen Watt | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...