Posts Tagged surgery
Title: Coppola: A Pediatric Surgeon in Iraq
Author: Christopher Coppola, M.D., LTC, USAF
Publisher: NTI Upstream (February 1, 2010)
Review source: Library Thing Early Reviewers
There is no one around and the housing compound is silent. The oscillating razor feels warm against my forehead as I slide the stainless steel blade across the crown. I suppose shaving my head is a kind of acceptance of the rotten situation of having to be here. I feel a lot of things-loneliness, fear, concern for my family back in Texas. As the last vestiges of my stateside life pile in black-gray clumps on the wet earth, I take a full breath. No longer is there any doubt my part in this war is real. Until now, the war has been something I have critiqued from afar as a mistake, a missed opportunity to deal with the stability of Iraq as a world community. But now I am in the middle of it and it is personal.
Coppola: A Pediatric Surgeon in Iraq reads a bit like M*A*S*H in the Middle East. There are some funny times, poignant moments, absurdities and plenty of new friendships spawned during Dr. Chris Coppola’s two four month tours. To pay for medical school, Coppola agreed to service with the USAF and earned two tours of duty in Iraq. He received his medical degree from Yale University School of Medicine and trained in surgery at Yale University. He completed pediatric surgery training at the Children’s National Medical Center in Washington, D.C.
When Dr. Coppola arrives in Iraq, his twelve surgeon team of general surgeons and specialists—orthopedic, urology, neurosurgery, pediatrics, ophthalmology, maxillofacial—replaces the team that has been there for the past four months. Most of his team are from Wilford Hall Medical Center in San Antonio but others are reservists that have been called up for duty or from smaller Air Force Hospitals. So at least Dr. Coppola recognizes some familiar faces.
During his tour of duty, he faces some tough cases, professionally and personally. His writing style is not overly sentimental or too detached. He’s right there in the mix of it all– with the destruction of families and lives. Of Americans and Iraqis. Although by the second tour of duty, Dr. Coppola’s narratives read a bit more jaded, tired and matter-of-fact.
On Election Day, a 7-year-old boy got struck in the head with a piece of shrapnel during a bombing. An insurgent bleeds out after pre-maturely detonating an IED. [“The patient is a mess. His entire body looks like it was run through a meat grinder.] An Iraqi man brings in his son with a problem. His son has an intersex anomaly—he has been born with some female and some male parts. He has female reproductive organs that need to be removed so he can live his life as a regular boy. But the father is adamant that nothing is wrong. Dr. Coppola worries that the boy will not receive the care he require: the surgery or hormone therapy. After taking care of a two-year-old girl with severe burns for a month, the girl, Leila, died. It deeply affected Coppola. [“But tonight I am broken.”] He had completed several arduous skin graft surgeries on her which at first seemed promising.
Coppola: A Pediatric Surgeon in Iraq is quite enlightening in that it shows the destruction and cost of life and health of a war from the viewpoint of a surgeon, someone who takes care of both the “enemy” and the allies. Dr. Coppola has quite the memory for detail as he wrote the entire time he spent in Iraq. The book is filled with these details whether gory or touching [his dinner at an interpreter’s home before his return to America] or frustrating. If you are at all interested in the human loss during war, Coppola: a Pediatric Surgeon in Iraq is well worth the read.
** Coppola: A Pediatric Surgeon in Iraq is currently available on the website. On February 1 it will be available through online and other booksellers. A partnership has been created with the not-for-profit organization War Kids Relief. NTI Upstream, will donate 10% of book sales to the Helmand Children’s Medical Fund (HCMF).
Money raised will provide medical aid to children living in Kabul’s largest internally displaced person camp. In the U.S. led effort to hunt down Taliban, many civilians have lost their homes due to bombing and violence. Thousands of families have fled Helmand Province and are currently living in makeshift camps on the outskirts of Kabul, where open defecation, lack of toilets, and poor sanitation, have accelerated the spread of disease. Currently, more than 70% of the 2,000 children living there have pneumonia.
This review is part of the Coppola: A Pediatric Surgeon in Iraq virtual book tour.
Book received as part of LibraryThing Early Reviewers.
Guest Post by Dr. Christopher Coppola
Author: Coppola: Pediatric Surgeon in Iraq
It is difficult to select the most memorable operation from my time in Iraq, for several reasons. On the one hand, so many of the operations have blurred together in my mind. Night after night we were treating so many people who had been seriously injured in explosions. It seemed like I was endlessly scrubbing burned flesh, digging out hundreds of embedded fragments of shrapnel, and cutting away more and more dead tissue. There were also so many striking operations — things I had never done before, like removing destroyed eyes, bizarre pieces of shrapnel, six-foot lengths of rebar or shards of human bone; simply horrifying combinations of injuries.
But the operation that is most memorable from both of my deployments was barely an operation at all. One afternoon, we received several victims from a shooting. Insurgents had opened fire on a busload of women going to worship. One of the victims was a woman who was eight months pregnant. She had been shot through the right hip, and one of the bullets had pierced her uterus near her unborn baby’s head. The mother was bleeding internally and slowly dying. None of us were obstetricians, and we were quite nervous about taking care of her. We called a few friends at home for some quick advice, and called on the help of one of our ICU nurses who was an OB nurse back home. In the OR, we had her anesthetized and her abdomen prepped with iodine liquid. I cut across her lower abdomen and found several liters of blood in her belly. Her uterus was stretched thin over her baby’s body, and there were tattered edges where the bullet had torn the muscle. I opened the uterus, and reached in to feel the baby’s head. The cord was wrapped around his neck, so I carefully worked my fingers under it and pulled the cord up over his head. I delivered the baby boy, clamped and cut the cord, and quickly carried him over to the infant warmer. My friend stayed with the injured woman to control her bleeding and get her safely to the ICU. On the warmer, I suctioned the child’s mouth and nose, gave him a flow of oxygen across his face, and listened to his breathing. He coughed twice, took a deep breath, and let out a loud healthy cry. I am pleased to report that both mother and child left our hospital in excellent health.
The most difficult operation I performed in Iraq was not for trauma at all. Even though I am a pediatric surgeon, I was deployed to Iraq as a general trauma surgeon. After I had been at the hospital in Balad for a while, word got out that there was a pediatric surgeon available, and I started to get consultations from the surrounding cities and other military bases. A surgeon in Tikrit sent a child and her parents to see me. She was a one-and-a-half-year-old who had a congenital illness of her liver called biliary atresia in which the liver becomes scarred and cannot pass bile into the intestine. It is a rare illness, and I had only treated a few cases in the United States — but I was honestly the only pediatric surgeon the family had available to them. It was unfortunate that she was as old as she was, because the best chance for these children to survive long term is if they get the operation before they are two months old.
It took some convincing to get our OR nurses and anesthesiologists to participate in the operation. The only way I was able to get them on board was to find a pediatric anesthesiologist who happened to be stationed at a nearby base and convince him to fly in. Over the next six hours, we worked as a team to carefully bypass the scarred tissue at the base of her liver with a healthy length of intestine. It was difficult, especially in a hospital designed for combat support, but we were able to get her through her recovery. It is a sad ending to her story, she died a year later; but I try to take some comfort from the fact that her parents told me they appreciated having another year with her before she passed away.
I think the child with whom I developed the greatest bond was a two- year-old girl named Leila. She was the daughter of a local commander in the Iraqi National Guard. One of the insurgents in our city threw an incendiary device like a Molotov cocktail through the window of their home and burned the man’s wife and two daughters. For a month I worked so hard to get Leila through her burns. I operated on her nearly every other day, and even got skin grafts to grow over a portion of the burns on her legs. Every day I would speak with her parents and discuss her progress. I could see the anguish in their eyes as they watched their daughter cry out in pain as I changed her dressings. At first she showed some hints of promise that she might pull through, but in the end she succumbed to an overwhelming infection. I had become so attached to her and so hopeful she would make it that her death was just a terrible blow. I still think of her often and wish I could have found some way to get her through.
–Christopher Coppola, M.D.
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On February 1, 2009 Coppola: A Pediatric Surgeon in Iraq is available at online and other booksellers.
COPPOLA: A PEDIATRIC SURGEON IN IRAQ HAS CREATED A PARTNERSHIP WITH THE NOT-FOR-PROFIT ORGANIZATION WAR KIDS RELIEF. NTI UPSTREAM, WILL DONATE 10% OF BOOK SALES MADE TO THE HELMAND CHILDREN’S MEDICAL FUND (HCMF).
MONEY RAISED WILL PROVIDE MEDICAL AID TO CHILDREN LIVING IN KABUL’S LARGEST INTERNALLY DISPLACED PERSON CAMP. IN THE U.S. LED EFFORT TO HUNT DOWN TALIBAN, MANY CIVILIANS HAVE LOST THEIR HOMES DUE TO BOMBING AND VIOLENCE. THOUSANDS OF FAMILIES HAVE FLED HELMAND PROVINCE AND ARE CURRENTLY LIVING IN MAKESHIFT CAMPS ON THE OUTSKIRTS OF KABUL, WHERE OPEN DEFECATION, LACK OF TOILETS, AND POOR SANITATION, HAVE ACCELERATED THE SPREAD OF DISEASE. CURRENTLY, MORE THAN 70% OF THE 2,000 CHILDREN LIVING THERE HAVE PNEUMONIA.