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.