Videos

"Mag Sulfate" Mystery!

Magnesium Sulfate is often quite effective in slowing contractions. I was informed this young female, who was 23 weeks gravid, was on a "Mag" drip. The Premature Contraction protocol was visible on the nursing station wall when we arrived. She was in no distress and waiting to be transferred to UMC in Fresno, California. After receiving a turnover from the patient's nurse, I and my partner Paul, went over to her bedside to transfer her onto our gurney. As I did a quick physical assessment, I also checked what solutions she had in her IV; Normal Saline, as well as wait, what, Potassium Chloride (K+Cl‾)?! I went back over to the protocol on the wall to confirm the medication, "Magnesium Sulfate" was listed. I bee-lined over to the patient's nurse and told her of the discrepancy. After a silent expletive came from her lips, without saying a word, she jumped up and hurried to the patient's bedside, confirmed my findings, stopped and disconnected the (K+Cl‾), went over the closet, pulled out a Magnesium Sulfate piggyback, returned to the patient, plugged it in, reset and restarted the pump. She sincerely thanked me. Paul and I then continued our transfer.

https://youtu.be/qj0iwOtdKqMsi=ew4uSuYF0QJFCSRU&t=140

Forward Operating Base, Hit, Iraq, August 29, 2004

FOB "HEET"

0200 FOB Hit, Iraq January 9, 2005 - Charlie Company's 3rd Platoon rolled out of the Forward Operating Base to patrol within the city, gather intel and locate troubled spots. I was there, sitting among the fifteen or so Marines on the freezing cold metal floor of the seven-ton's bed, to fill a manpower shortage and to provide medical support as one of their Line Corpsman that early thirty-four-degree morning in FOB Hit (pronounced "Heet"), Iraq. I'll have to admit, being a Battle Aid Station Corpsman was like living in the Hilton compared to what the Line Corpsman and Marines put up with nearly every day out there either on foot, or on the road patrolling in Iraq. These guys are tough. They don't ask questions, nor are they always in a position to do so. They have a job to do so they just pile in to whatever vehicle they are assigned to and put up with whatever punishment is thrown at them. Speaking of punishment, I can't forget to mention the potholes that the seven-ton driver hits, which at times seem purposeful! They have a tendency to jar your spine right up your back and out the top of your head! Damn, that hurts! What can you do but suck it up and curse the driver one more time!

Through the advice of another Corpsman, that had "been there, done that," I chose to pack light and leave my cold weather gear behind, for "The hump will warm you up soon after you get going," so he says. Well, I forgot to mention that the wind-chill, which bit through every exposed body surface while traveling forty-five miles per hour down that desert highway, dropped the temperature down to twelve degrees Fahrenheit! I only had a lightweight polypropylene liner on under my uniform blouse and flak jacket. I figured I'd have to tough it out like the rest of the hard Marines I was with. I friggin' froze during that near hour trip to our insertion point! Who was I to whine? The young devil-dog next to me proceeded to show me, by ripping open the Velcro of his flak jacket and lifting up his blouse, that he didn't have anything on under his gear and then smiled as if he was proud that he'd one-upped me!

We finally reach our insertion point, the seven-ton coming to a relieving stop as we quietly dismount into the dark morning with zero percent illumination.  A hasty perimeter is set up as I struggle to focus out into the near complete darkness in front of me. After about ten minutes of observing and letting our eyes adjust, we fan out into a wedge formation and step out into the void. Sarge, the squad leader, is wearing his VOX headset and microphone with the radioman at his side. I am positioned a few meters behind them in the middle of the formation. The dispersion is fairly close, for if you get separated more than a few meters you lose the guy in front of you. Only a select few have NVG's and GPS' and they are literally our guide dogs!

There is only a short hump to gain the city proper. The desert floor is dry with a few rocky outcrops and undulations to navigate around. We cross a set of railroad tracks then proceed gently downhill into the amber glow of city lights. Not too bad so far. What is soon apparent is the night vision we had gained earlier was gone now due to the city lights ahead which were blinding us, NVG's were virtually useless now! I look behind me and see the fifty or so troops scattered about like an army of ants crawling across a brightly lit stage! So much for a stealth approach!

A strong odor of sulfur starts to fill the air as I observe a light fog sitting atop the desert floor. The ground is becoming moist and mud starts to build up on the soles of my boots. Puddles of water become visible all around us and trying to avoid them is now useless. We push on into the wetlands as the mud and water grows deeper, almost over the top of my boots now. My body is warming up just as I was instructed it would...this is a good thing! Corporal Linan, the point man, with a GPS in hand, continues to beeline towards the city lights. The water isn't letting up, becoming deeper and deeper, almost over my knees now. Everyone is following the point-man, and it is starting to look like the pied piper is leading the mice into their watery graves (I learned later that the squad leader was ordering the point man to "push on" through his earpiece)! The sulfuric odor is stronger now and it resembles more of a stench than anything. I stop and sniff the air again.

"What is that?" I quizzically ask myself.

I can't quite place my finger on its identity. A group of buildings resembling a factory is off to my left in the distance. "I wonder if the water we are standing in is originating from that plant," I ask myself. I look around me once again, and then the light bulb goes on! "We must be standing in the middle of an evaporation field for sewage treatment, not good!" I exclaim to myself. I have to get word to Cpl. Linan  to stop, for the situation is getting worse! We are getting into, "deep sh*t" literally! I push myself to the front and in the loudest "Pssst!" I can muster, I get the point man's attention.

"You need to stop! We need to get to shallow water, everyone is following you into this crap! Do you realize what were standing in Corporal?"

"What do you mean Doc?" Linan asks innocently.

"This is sewage water!" I say with my best disgusting facial grimace.

"Holy sh*t Doc, are you serious?!" A grin starts to form on my face, but I quickly regain my composure and remember that we are to locate a bridge to gain access to the city.

"What happened to the bridge we are supposed to cross?" I ask Linan.

"I don't know Doc, but I think you're right. Follow me!" Linan instructs, as he turns south relaying his plan to Sarge, continuing his pied piper march.

The previous day, back at the FOB, we rehearsed securing a bridge that apparently crossed into the city. We spent a better part of the afternoon practicing that drill, for it was a possible choke point into the city. Rehearsals were made to avoid an ambush or compromise to the platoon.

The water eventually retreats back to ankle depth. I meet up with Corporal Linan on point;

"What do you think Doc? Do you think I can cross here?" His outstretched arm pointing, contemplating fording the moat that was formed along the edge of the field. I struggle to focus in the dark, to look at the situation, and see about a five-meter gap of dark black water.

"No way Corporal, it looks way too far and who knows how deep it is!" I whisper back to him. Before I could say another word the Marine walks to the moats edge, losses his balance and slips, nearly disappearing under the muck!

"Help me!" he grunts with the water at his neckline and his arms above water.

"Get yourself out!" yells another Marine.

"I can't, I'mmmmm stuck!" Linan's voice trembles from the cold sewage soaking through his gear.

At this point everything starts to move in slow motion. A Marine is being pulled under by the weight of his flak jacket, Kevlar and combat load, helplessly sinking to his inevitable death. I picture other Marines frantically jumping in to help, succumbing to the same nightmare! The situation was getting worse fast...was I about to witness a horrible tragedy?! 

The drowning Marine's face disappears with only his helmet seeming to float on top of the water, his right arm outstretched into the air like someone being buried alive in a horror movie!







I desperately want to do something, but I can't react, standing there frozen in my boots and unable to think. Suddenly, off to my left, the barrel of an M-16 is shoved into the drowning Marine's hand!  Cpl. Linan cinches tightly onto this life saving oar, his head and face re-surfacing, his lungs heaving and coughing violently.

"Pull me out, pull me out!" his voice taking on a primal plea for life. I grab hold of the Marine holding the M-16, as other Marines grab me in succession. It is like pulling dead weight out of cement! We pull him clear of the moat's edge while he remains on all fours coughing and vomiting up fluid that he swallowed. "I'm ok, I'm alright," Linan says, trying to catch his breath.

For now, the emergency is over, but the Marine is soaked from head to foot and with the wind-chill, the temperature is below freezing. I know that hypothermia will eventually set in unless I remove his wet clothes and get him into a dry set. Unfortunately, this is not an option, for no one has an extra set of cammies with them. We only prepared for a six-hour operation from start to finish and our load is minimal. All I can do is keep him moving, have someone keep an eye on him, and hope he doesn't get worse.

We eventually find where the moat narrows to a point where a thirty-six-inch drainage pipe is laid, and dirt is filled in over it creating a speed bump of sort. It turns out to be only wide enough for a single Humvee to cross so, although it is not the "bridge" that we rehearsed for, it is still a potential chokepoint where problems can develop when three platoons and vehicles gather in one place.

Dog's barking seems to be the normal greeting for patrols along the streets of Iraq. It isn't any different this cold morning in the city of Hit. If the insurgents weren't alerted to our arrival, they were now by these annoying canines! We patrol in a file formation, one on each side of the street, our eyes scanning the alleys, rooftops and windows for suspicious activity. 

Our Iraqi interpreter, Safwan, quietly mingles among us, dressed in his leather flight jacket, digital desert cammies, and his traditional AK-47 slung over his shoulder. A low, distant rumble breaks the morning silence. It seems to be getting closer...

Safwan is a Colonel and former pilot in the Iraqi Air Force. He stands a good six feet one inch in height with his dark eyebrows and grey flaked mustache giving him a Tom Sellick-like appearance. His casual demeanor and well-kept standards forgive any faults he may display. He has a love for women that can be immediately noticed when you walk into his bedroom and witness the collage of pictures he wallpapers his room with. The odor of his favorite cologne surrounds him. Although he is of the Muslim faith he has a fascination with Christmas and all that it stands for. His birthday falls on December 25th as well! Ever since his childhood, he anticipates the arrival of this Christian holiday and puts together his own Christmas tree which he adorns with lights and ornaments, he tells me. He collects the songs and carols that are heard during this festive season and loves other classic American songs such as John Denver's, "Country Road".
"This is what I dream of when I imagine America," he tells me. Safwan carries his maticulously kept Kalashnikov with him on all his assignments. He occupies a room back at the FOB, upstairs, with his roommate and fellow interpreter Ali. I visit to have tea and coffee with them nearly every evening. Safwan and Ali are invaluable assets to the U.S. forces.

...It was on top of us in an instant! An incredible crack in the air and quaking above forces us to our stomachs! My eyes peer past the lip of my helmet skyward into the pitch-black darkness to see four orange star bursts illuminating the night sky. A ghost like silhouette screams past us at rooftop level into the distance. My guess is that it must be a "fast mover" making a low-level pass over us releasing one of its defensive countermeasures. Within a microsecond following its high-speed maneuver an even larger explosion comes from the west, this time with the familiar barometric pressure change in the air! With our senses overwhelmed, we are pushed back down into the prone position, our teeth clenched down and our eyes forced shut as the ground shakes underneath us!

A Navy Corpsman, who was fortunate to have survived nine IED detonations, was heard to say, "If you hear the explosion, you are halfway there." 

"Crap, what was that?!" I struggle a whisper, staring eyes wide open at Safwan. All I could think of was that we were being rocked by bombs! It was too coincidental for the rumble, the low-level pass, the orange, star like bursts and the explosion that followed in that succession for it to be anything else. Maybe ordinance was released by the fast mover? I asked if anyone was hurt, but was interrupted by Sarge with a "Let's go Doc, lets go!" We picked up our pace trying to keep in tune to our surroundings yet now realizing how vulnerable we really were! We doubled timed it down the empty residential street constantly looking back so not to miss any hand signals that were being passed. 

"What are we doing here?!" I fearfully ask.

"We're here to draw out the bad guys, Doc. That way the reinforcements in the rear will be able to take them out with the big guns," explains one Marine.

Great, we're sitting ducks in other words! A constant churning of nerves fill my gut while outside the wire. Not knowing what will be thrown at you next takes a toll on you mentally and physically. How much safer, as their medical support, am I than the Marine next to me? What good am I if I get hit and am unable to provide care? I have a Beretta M-9 on my left hip. Even if I carried an M-16, how am I going to manage it and take care of my patient at the same time? The only logical thing I could think of is to make sure it's reasonably safe before I begin providing care, surround myself with Marines so they can lay down rounds to protect me and the injured, and then take cover inside a building or behind a structure in order to put something between me and the chaos while I begin treatment. Plans like this are constantly rehearsed in my head.

We continue our march as sweat drips down my face and the middle of my back even though the temperature is still in the thirties. My medical load is trivial compared to the weapon and combat loads the Marines are carrying! Most of the guys are of Hispanic origin from south Texas and average around 5'6" tall, but what they lack in height they make up for with thier strength and stamina! They definitely have my respect!

The streets are still barren, and businesses are yet to open. With speakers positioned throughout the neighborhoods the constant drone of Islamic prayers emanating from the Muslim mosques, fills the air five times a day. Dogs continue to bark and yelp at our passing. The rare presence of a vehicle early in the morning only heightens our posture for you never know what it contains, what its purpose is for, or what is going to pop out of it! Vehicles are randomly loaded with high explosives and used as weapons, deadly effective weapons! VBIED's are everyone's dreaded fear!

My squad turns the corner heading south along a four-lane business district road. I am walking along the right side of the street passing wrought iron security gates that protect the front of the buildings. Downed electrical wire hang from rooftops and telephone poles. The familiar third world smell of burning trash is constant (I have done some world travel in my life and the presence of poverty, disorganization and a more primitive society isn't new. I try to take in as much as I can, sometimes pretending I am on a vacation of sort, but knowing that I am in a war-torn country brings me quickly back to reality.

A loud burst of gunfire erupts from behind us! Yelling follows in the distance and I can hear Sarge's earpiece come alive. We all run for cover. I inadvertently separate from my radioman and squad leader and head for a brick wall that I had eyed earlier. My eyes scan frantically as I kneel in the hard dirt, wondering if I am safe.

"Doc, get over here!" the radioman yells.

I quickly scan my surroundings and bee-line back across to the other street corner to join back up with my team. I learn that the platoon behind us opened up on a vehicle that apparently headed towards them without an apparent intention to stop.

Earlier, a group of four or five local males were seen getting into a car in a dark back alley. This same vehicle, with headlights beaming, accelerated directly at the platoon which prompted the Marine's deadly reactions. The vehicle came to a quick stop, backed away from the scene and disappeared without further incident.

My platoon gets a quick head count, and we continue the last leg of our egress out of the city. We are to meet up with the QRF, load back up into the seven ton from which we came in and return to the base. There is only about four hundred meters to go, and the pace quickens.

BOOM! Another crack in the air breaks the silence. Damn, the word must be out that we're here! Thank God it wasn't close to us, but you have to wonder who WAS close by and if anyone was injured. We turn the last corner and catch a glimpse of our extract. Almost there! Legs are starting to cramp, and lungs are starting to burn as we push the last bit.

"MacKay, MacKay!" A voice calling my name echo's from off to my right in the shadows.

"I need some help. Give me a hand!" HM2 shouts as he emerges half carrying an injured Marine. "1st Sergeant's been hit. Help me get him to the truck."

Without saying another word, we work in unison assisting 1st Sgt. the last 500 yds and lift him up into the back of the seven ton. Automatic weapons start to erupt again, this time from just behind us. Laying low on the trucks floor, turning on my red tinted lensed head lamp atop my helmet, I break out the bandages to begin my treatment. A quick exam reveals a venous bleed seeping from just above the ankle. There is some swelling, but the bone appears to be intact. The other Corpsman has more serious wounds consisting of deep, full thickness lacerations to the upper left arm and shoulder. The bleeding is managed with direct pressure bandages without complications.

1st Sarge is laying up against the sidewall of the cold, metal bed, his helmet askew on his head shadowing his right eye. His Wiley-X eye protection and soft yellow ear plugs are still in place. A facial grimace is apparent, his breathing is unlabored yet rapid, a response from the catecholamine release after the "fight or flight" response. Fellow Marines kneeling nearby get tunnel vision with their eyes fixated on 1st Sergeant's injuries,

"WHAT ARE YOU GUYS LOOKING AT?" 1st Sarge yells with a still commanding presence. "GET YOUR GUNS DOWN RANGE AND SHOOT THE F'ERS!" Without hesitation the young devil dogs swing their weapons around and join in on the sporadic firing.

Soon, after the rest of the squad fills the empty spaces, the truck begins to accelerate away from the scene at a blistering pace. I'm amazed at how quick seven tons can move! The rest of the convoy, with their troops onboard, follow suit behind by leaving a cloud of dirt in the rising dawn sunlight. The wind is cold, biting to be more precise. I see 1st Sergeant starting to slump down, his chin touching his chest.

"You okay 1st Sarge?" I ask.

"Yeah, I'mmm ok," his voice starting to tremble.

I sense Sarge is getting cold (the bodies reaction to adrenaline is to shut down peripherally, shunting the blood to the vital organs, i.e.; head, chest and abdomen), so I bear-hug him, using my body to provide extra warmth for him as well as for myself.

"Hey Doc, you won't say anything about this to my wife, will ya?" 1st Sergeant asks with a smile, referring to my close proximity to him. I can't help but to smile back and shake my head.

"No, not if you won't tell mine!" I chuckle back. "You a little bit warmer now 1st Sarge?" I raise my head up and ask.

"Yes, I am, thanks Doc," he replies.

At the first safe opportunity, the convoy comes to a stop to get a head count. I hear my name being yelled out again but this time it's because I'm not in the truck that I originally came in on. After assisting with the transfer of 1st Sergeant to a warmer Humvee, where he'd receive further care and pain control, I climb back into the truck with my platoon to complete the count. We resume our return to the FOB. Apparently, 1st Sarge was hit by shrapnel that came from a mortar, a rocket or an IED that detonated nearby. Either way, it could have been worse.

"Hey Doc, I think Corporal Linan is cold!" a fellow Marine advises me above the drone of the engine and wind.

"Crap, Linan, I almost forgot about him!" I think out loud as a sense of urgency kicks me.

I turn to find the Corporal with his arms crossed, his knees drawn up to his chest, his eyes like a deer in headlights. I can see that Linan is shivering and barely able to speak when I question him. Frost has actually begun to form on the still damp surface of his blouse and BDU's. I stand up, controlling my balance in the moving truck, and knock on the sliding back windows of the cab. The driver reaches back and opens them, his head straining back to hear me over the roar of the engine and road noise;

"You've got to stop and get this guy up front!" I yell as clear as I can.

The driver acknowledges me with a raise of his chin and a thumbs up, communicates the emergency over his VOX and stops the vehicle, the rest of the convoy behind stops like a giant caterpillar recoiling itself. Linan is assisted down from the back of the truck, by three others, to the heated cab up front. I instruct them to get his clothes off down to his PT shorts and Under Armour T-shirt and crank up the heater. They find an olive drab blanket to wrap him in as well.

"Good, another fire put out," I say to myself. Once again, we continue our return...the ride is still a cold one, a really cold one!

"Argh!" I grunt out loud, trying to do anything to keep my mind off of the hurt.

"You ok Doc?" a Marine beside me asks with concern.

"MAN, this is cold!" I belt out with pressured speech.

"Check this out!" The Marine proceeds to show his hands by holding them up for me to see. His fingers appear an ashen blue gray and frozen in an unnatural position. He readjusts his M-16 between his legs by using his two wrists. He obviously has little mobility left in his hands and fingers.

"It's this way every morning Doc, you'll get used to it", he confidently replies. "I don't know if I WANT to get used to it!" I think to myself.

We get back to the FOB without further incident. I further assess Corporal Linan back at the BAS and he eventually returns to duty. 1st Sergeant Hoover gets medevac'd in a HH60 Blackhawk helicopter for advanced level care and treatment...

Blackhawk Evac...

I'd have to say that my experience in Iraq could have been a LOT worse. Compared to the stories I've heard and watched from those that were there in the "suck" of this war, what I experienced during those seven months was trivial. My compassion goes out to them. 

War is not a perfect game nor are you always able to define its purpose, but I CAN tell you this...

These guys and gals VOLUNTEERED there services in the armed forces with their signature on the dotted line. POTUS may or may not always be correct in deploying his troops, but we signed up to be a part of that. Therefore, we are putting our lives on the line to accomplish a job, a job that we extensively trained for, and most importantly, to make it home alive...these two things I DO know!

The United States is the "Land of the Free" because of a Democracy that was drafted and put into place by a select few genius, God fearing immigrants that had a vision beyond anything that exists to this day. This Democracy is looked upon by many as the model government for this planet Earth and is persecuted by others who do not enjoy the freedoms that some of us take for granted. No, it's not a perfect government but it is the BEST Democracy in the world! Freedom comes with boundaries. You only give up boundaries for bondage.

Therefore, to those of you citizens of the USA, reflect on this the next time you say anything about the country that you live in or about the people with whom you share your country with. Pause a second and take a look around you. Realize that there is life outside of the United States of America and that you are VERY fortunate to have what you have! No, I'm not saying that you can't express your opinions, but you have to be smarter than that. Educate yourself if you haven't already, and accept that GOD is the ONLY reason you have that right! When you Truly understand, you'll be free FOREVER.

Nevertheless, I still can't help but to remember Jack Nicholson's famous lines while being questioned in the court room in the Hollywood movie A Few Good Men:

"I have neither the time nor the inclination to explain myself to a man (mankind) who rises and sleeps under the blanket of the very freedom I provide, then questions the manner in which I provide it. I'd prefer you just said, "Thank you!" and went on your way. Otherwise, I suggest you pick up a weapon and stand a post."

Support our troops and welcome them home when they return!

Respectfully,

HM2 "Doc" McCay, Gary E., (U.S.N.R), Pt. Mugu, NAS, 1999 - 2007

1/23 Marines, FOB Hit, Iraq, 2004 - 2005

After Action

Doc Found A Mine!

0800 October 2004, Hit, Iraq - The platoon left the J.C.C. early in the morning, proceeding east along a well traveled dirt road outside the wire towards the Euphrates River. We were in a file formation, one on each side of the road, in a standard tactical dispersion. I was on a "familiarization" patrol to learn the ropes and eventually replace their Corpsman as he was being utilized elsewhere in the Battalion.

The morning was cool this time of the year and the wind was calm. It was a beautiful day with clear skies and an occasional turkey buzzard soaring high in the thermals above. The landscape was monotonous, looking towards the palm groves that blanketed the edge of the Euphrates river. Villagers could be seen stooped over in the distance harvesting their last crops in preparation for the change of seasons. The Marines were habitually going through their motions keeping about ten meters between themselves while keeping alert and watching for hand signals. All I knew was that our destination was a firing range that the Iraqi National Guardsmen used for weapons practice.

"Hey Sarge, what are we doing out here anyway?" I quizzically ask as Sarge turns around while continuing to walk backwards. "Nobody told you Doc? We're out here to look for mines!" he replies with a maniacal look on his face and animated tone in his voice. My stomach about ends up in my throat, my face probably turning white looking like I just saw a ghost! "How the heck do you do that? I honestly question him back. "You just look for anything out of the ordinary and stay in the steps of the guy in front of you Doc," Sarge confidently answers as the other Marines echo almost in unison back to me with just as fearless of a look on their faces. Now I may be dumb but I'm not stupid! But, then again, I know nothing about finding land mines out in the monotone deserts of Iraq! I've never even seen a land mine except for what most of us picture one to look like from the books we've read and television programs we may have watched! Doesn't EOD take care of situations like these? Aren't they the ones that are trained in these things and don't they have those high speed detectors at their disposal? My level of anxiety jumped to another level after hearing this news! I later find out that this patrol was put together in response to an incident where a Humvee drove over a vehicle mine near the same firing range. A Marine officer, who was walking behind the Humvee, was injured after taking shrapnel from the explosion. The vehicle caught fire and burned to the ground leaving the charred chassis laying in the dirt.

The walk down to the range was uneventful ending conveniently next to the burnt remains of the Humvee. We turned right, up and over a small dirt burm that separated the dirt road from the range. Looking down at the boot prints in front of me, about to place my left foot into the fresh print just stamped in the dirt, over what looked like one of those pop-up sprinkler heads, I stop and kneel down to verify my find. A half moon portion of tan plastic is uncovered by the wind swept sand. I stand up, look around for the nearest water source, pause for a second and then remind myself that I'm in the middle of an Iraqi desert! A surge of adrenaline overwhelmes my senses, the hair on the back of my neck standing straight up! Holding up a closed fist, I bring the patrol to a stop. "What'd ya find Doc?" the Marine behind me yells out. I shrug my shoulders and continue to look at the ground below while two Marines merge in on my position. "I think you found a mine Doc!" the Marine exclaims as he gently uncovers the rest of the "sprinkler head" and probes the dirt with his K-Bar   while kneeling on one knee. Without a word and remaining in the boot prints ahead of me I cautiously, yet hastily, egress away from the immediate area until I feel I am safe! "Okay, you guys can play with that thing as much as you want now," I shout to them from about two hundred meters away. Either those guys know what their doing or it's their curiosity that's keeping them there! After excavating around the mine, exposing it and posing for pictures, including myself (I guess that makes me the hypocrite now), EOD is contacted. After about a two hour wait EOD arrives with their high tech equipment, sweep the area for any additional mines (none found), disassemble the mine and detonate the explosive charge without incident.

On my walk back to the FOB I meet up with the EOD 1st Sergeant: "Hey Doc, a mine is a beautiful thing to waste," he chuckles with a smile on his face. I shake my head and wave back in acknowledgement. "Sick bastard," I think to myself, continuing my walk to the BAS.

=========================== ===========================

Operation Iraqi Freedom / Enduring Freedom

Operation Iraqi Freedom /
Enduring Freedom
Al Anbar Province, Iraq
1st Battalion 23rd Marines
Navy Corpsman
HM2 McCay



==============================================================

I, now sixty-two years of age, was raised in the civilian world until the age of thirty-six, two month's before my thirty seventh birthday, the cut-off age for the military then. This is when I stepped into a Navy recruiter's office and offered my services as a civilian Paramedic.

Since the age of seventeen, when my high school football field was invaded by all the branches of the armed forces, each branch having set up their own recruitment tent, my thought of becoming a Navy SEAL had surfaced. I never took the bait back then but the desire to "do my part" in the United States Armed Services followed me. I wanted to be able to say, "I know where you're coming from" when in conversation with another service member. I was in a bit of need for a job and support at that time in my life and word had it that civilian experience could be incorporated into the military.

One morning, while having breakfast with a Navy recruiter, who was nearly half my age, I was offered a part-time enlisted position as a Navy Corpsman in the Ready Reserves which I accepted with a signature on the dotted line. The next day I was officially sworn in down at the 32nd Street Naval Air Station, San Diego, California. Yes, it was a crash course into the Navy but in the eight years that I served I learned quite a bit more about the services that protect my country.

Professor Keith Brueckner's 1987 Mt. Woodson Guide

Andy McKee

Tomb of the Unknown Soldier

"When *#%!

Hits the Fan!"

"Unit 12 your location?" the mobile 800 megahertz radio interrupts the drone inside the ambulance cab.

"Unit 12, west bound 26, approaching Cedar Hills," I respond from the navigators seat.

"Unit 12, respond to 2346 Barnes Road, apartment #206 for a GSW (gun shot wound). The scene is secure per Washington County SO (Sheriff Officer) on scene."

" Unit 12, copy, GSW at 2346 Barnes Road, apartment #206, responding," I reply back.

My partner Don reaches his right hand up to flip on the master switch to the emergency lights. A glow of red, blue and white lights reflect off of the highway around us and the nearby cars. It has begun to rain with small droplets now appearing on the windshield. Don slows to change lanes to the right for our exit is approaching ahead.

"Clear on the right," I inform Don after I make a head check out my window. I reach back to the laminated city map behind the center console, flip on the map light and confirm the location given to me.

"You know where you're going Don? I ask.

"Yeah, I know RIGHT where it is," he emphatically replies. As we approach the stop sign at the end of the exit ramp, Don activates the siren to warn oncoming vehicles. The simultaneous wail and yelp of the siren echoes into the night. It is about eight o'clock on a Friday evening. Vehicles slow and attempt to pull to the right and stop. After a bit of confusion and chaos the intersection is clear and safe to proceed into.

Don makes a right turn onto Cedar Hills Boulevard and accelerates into the left lane. Barnes Road is ahead about an eighth of a mile. Another right turn puts us less than a minute out from the scene. The flashing of other emergency vehicles can be seen ahead on the right in an apartment complex parking lot.

"There it is, on the right," I inform Don.

"Yeah, I see it" he confirms back to me. Don slows to turn into the driveway and proceeds slowly over the speed bumps in the road ahead. He positions the ambulance next to the curb on the left ahead of the police and sheriff vehicles already on scene. A simultaneous scene survey reveals crime scene tape already cordoning off the steps heading up to the second floor. Sheriff and police officers are positioned at the base of the staircase as well as at the top.

"Medcom, Unit 12 has arrived on scene." I inform the dispatch center.

"Copy Unit 12, on scene." The dispatcher replies. I grab my portable radio, glance out the window for traffic then open the door. I step out on to the wet pavement shutting the door behind me. I pull out the airway bag and drug kit from the side compartment. Don continues to the rear of the ambulance and opens the back doors to gain access to the gurney. The gurney lock is pushed as an audible "POP" is heard to signify it's release. The EKG monitor is already strapped to the mattress with the patient seat belts. I meet up with Don at the rear doors and swing my bags onto the top of the gurney. Don takes a position at the foot as I push from the head. After a quick lift over the curb we meet the officers at the bottom of the stairs.

"They're up in room #206, up and to the right guys" an officer informs us.

"Thanks, appreciate it." Don acknowledges. The gurney is secured down at the base of the steps as we retrieve our equipment and begin the walk up to the second deck. I am ahead of Don with the airway bag. Don is behind with the drug kit and EKG monitor. As we reach the top of the stairs the officers continue to guide us to the correct apartment.

The front door is open. It is dimly lit inside. I step onto a dark green, carpeted, unlit living room. The kitchen light is on with an officer visible, standing in the middle of it, listening to a distraught, crying female.

"In the bedroom guys," the same officer, who's holding a pen and notepad, raises his arm and points to his right while making eye contact with me. I turn and see a bedroom lit up with an incandescent light and two officers crowding the doorway. I can hear a muffled, inspiratory groan coming from inside the bedroom. As I part the two officers at the doorway I find two more officers, one standing at the foot of the bed, another at the near side and a plain clothed male on his knees at the end of the bed as well. His arms are up on the comforter, his bloodied head is between his arms and his face turned to the left. His respiratory rate is somewhat rapid and his groan almost sounds purposeful.

"What happened?" I ask a general question to the officers present.

"It appears that this guy shot himself after an argument with his girlfriend who's out in the kitchen," an officer replies.

"What did he shoot himself with and where?" I ask.

"Where not sure but..." The officer interrupts his sentence by moving his right hand up to his mouth, his hand taking on the form of holding a weapon, then pulling the imaginary trigger.

"Where's the weapon?" I ask with concern.

At that moment, I witness the officers start to look at each other with a "I don't know, do you?" look on their faces.

"We haven't found it yet" one officer finally admits. At this point I really don't care who didn't do what. All I know is that we're not going to do anything else until someone finds a weapon! Don and I step back and remain outside as the officers begin a careful search inside the room.

"Here it is, I've found it!" an officer finally belts out standing beside the far side of the bed. "The slide is open, it looks like a .38 caliber. I'll secure it if you guys want to go ahead and do your thing," he instructs us as he stands, straddling the weapon on the floor next to the night stand, electing to leave the weapon in situ.

We leave our equipment outside the bedroom door. Don proceeds to the patients head and starts looking for the source of the bleeding. His gloved hands quickly become bloodied as he runs his fingers through the victims hair.

"I've found the bubbling brew!" Don exclaims, smiling with morbid sarcasm in his voice. I bend over with a facial grimace to take a look at his finger pointing at his find. I continue the exam by cutting the back of his shirt open. His back is clear, revealing no additional trauma.

"Hey, can you hear me?" I ask him with a loud voice, my hand on his shoulder giving him a firm shake. The patient continues to groan without an appropriate response.

"Lean him back for a sec Don. Let me look in his mouth." I request, taking my mini-mag light out of it's holster on my right hip. I twist the lens to turn it on and pull the patients chin down. I can see a lot of blood pooling in the patients mouth and I see what appears to be a round entry wound at the top of his palate. I check a radial pulse at his wrist and find it to be rapid, regular and strong.

"Gary, what do you want to do with this guy? Don asks.

"There's a lot of room out in the living room, let's move him out there and work on him. What do you think?" I inquire.

"Sounds good," Don concurs.

The apartment appears fairly empty. It's hard to tell if these people are just moving in or if they are on their way out. Either way, they're making it pretty easy for us to find a work space (space is always a necessary commodity when working on a patient and more often than not, hard to come by. The lighting isn't good and this is going to be an issue as we progress with the call).

I take the lead and lean the patient back so I can place my arms under his armpits from behind. Bending down, I reach through and grab each of his wrists in my opposing hands (this gives me better support and leverage and helps keep his arms from inverting up over his head. A flaccid body with no muscle tone is very heavy and difficult to manage). In tandem, Don and I pivot the guys body around so Don can manage his legs. I lift his body up off of his knee's as Don pulls his legs out from underneath him. I lose my balance and sit back on the edge of the bed.

"You okay?" Don asks with concern.

"Yeah, I'm good." I reply. "You see anything on his chest or belly?" I ask trying to avoid missing anything.

"No, nothing," Don responds after lifting up his half cut shirt. I can see silhouettes moving out in the living room now. Tan overpants with suspenders and a blue t-shirt soon become apparent as I recognize the arrival of the local firefighters. One in particular, Mark, appears in the doorway first.

"You guys need a hand?" Mark asks with a motivational look on his face.

"We're moving this guy out into the living room. Can you guide Don out? I request.

"Got it," Mark replies.

"Ready? One, two, three!" I count out loud as we both stand in unison. Don walks backward out the bedroom door as Mark guides him with a hand on Don's belt.

"Where you guys putting him?" Mark asks.

"In the middle of the living room is good." I grunt with my arms full. Don lays the patients feet down on the carpet as another officer spots me as I lay his torso down.

"What happened to this guy?" Mark inquires.

"He put a gun in his mouth and shot himself. He's got an entry wound inside his mouth and an exit wound out the top of his head. The weapon is secure in the bedroom with the officer. He says it looks like a .38 caliber. As you can see, he's breathing on his own and he has a strong radial pulse." I respond trying to give Mark as pertinent and detailed of a turnover as I can (Mark is a Paramedic as well and can assist us in advanced life support if needed).

"Let me know what I can do for you guys and I'll give you a hand," Mark offers.

"Can you put my airway bag over here next to me Mark?" I request pointing back next to the bedroom doorway. "And, do you guys have some suction?" I ask referring to a portable suction device that is commonly carried by first responders.

"Portable suction!" Mark barks out to his fellow firefighters. My airway bag and a battery operated suction machine appear quickly and are placed beside me within easy reach.

Now that I have the patient laying supine on his back his airway is quickly becoming compromised from the copious amount of blood that is pooling in his mouth. I suction this thick serous fluid with a rigid plastic catheter that is attached to flexible tubing coming from the suction machine. The cyclic groan emanating from the suction machine produces a syncopated cadence along with the moan coming from the patient! Thick clots are now becoming apparent and starting to plug the end of the suction catheter causing the groan of the machine to take on a higher octave (a pretty morbid, harmonized symphony if you ask me)! Don and Mark simultaneously begin to place the patient on the EKG monitor, obtain vital signs and prepare to obtain intravenous (IV) access in the event the patient needs fluids or medications.

My job is quickly getting nowhere fast! Blood clots the size of toothpaste coming from the tube are starting to come out of the patients nostrils! The patient is starting to clench his teeth down now making it next to impossible to suction through his mouth (when a person's brain is starved of oxygen, one response to this "hypoxia" is for the muscles of the jaw to tighten)! Blood is everywhere...pooling in his eyes, dripping down his face and out from between his clenched teeth! And, to add to this deteriorating mess, the battery to the suction machine starts to lose it's power taking on the growl of a slowing record on a turntable!

"I'll go get another battery," a firefighter initiates as he starts the trip downstairs to his truck.

"Give me a towel or something! I ask in frustration as an officer finds a kitchen towel and hands it to me. I wipe the mess away the best I can when without notice...the patient coughs forcefully!

"Argh!" I yell out. "You've got to be kidding me!" rocking back onto my heels. My glasses are covered with blood now dripping off of them. My face feels wet as well. Another towel is handed to me as I take my glasses off to wipe away the mess.

"This guy needs to be paralyzed so I can intubate him!" I inform Don and Mark with an obvious rise in my inflection.

"We ain't going to be able to do anything if we don't get an IV on this guy!" Mark looks up at me with wide eyes obviously referring to their difficulties (paralytic agents are used to paralyze the vocal chords and relax a persons muscle tone, in this case, to facilitate the passing of an ET tube. The IV route is the preferred route of drug administration)."Try to ventilate him!" Mark suggests trying to come up with a temporary solution for me.

Don gets up and runs down to the ambulance, passing the firefighter who's running upstairs with the fresh battery, to where we keep the Rapid Sequence Induction (RSI) kit (a kit containing the medications necessary to paralyze in a rapid and sequential manner). Another firefighter breaks out the bag valve mask (BVM) and attaches it to a bottle of oxygen so I can attempt to oxygenate the patient. I do my best in obtaining a tight seal around the guys mouth and nose with the resuscitation mask while I squeeze the bellows of the BVM. This soon becomes futile as well for I am blowing blood everywhere (it is next to impossible to pass anything around or through a patients clenched teeth or through an obstructed nose)! Don returns with the RSI kit and continues with their difficult task.

"We've got one!" Mark exclaims as he and Don finally find an IV site and secure it to the patients arm. Don and Mark quickly crunch numbers as they come up with the proper dosage's for the medications that they are about to administer to the patient. They draw up Succinylcholine into a syringe and pull out the Lidocaine. I've transferred my responsibility to a nearby firefighter as I prepare my equipment in anticipation of intubating the patient.

"You ready?" Don looks up at me with one syringe in hand, the other in Mark's, waiting for my acknowledgement. I finish up my preparation.

"Yep, go for it." I knod, giving Don the go ahead. The two medications are carefully administered. The room becomes silent as we wait for the drugs to take affect (the paralyzing agent, Succinylcholine, usually has a quick onset of action. The muscles will fasciculate or start to tremor as the drug takes affect. The patient will stop breathing and the muscles will become flaccid as the medication reaches it's full potential).

After recognizing the signs I was anticipating I proceed with the intubation of the patient. Lying myself prone on the floor, I gently insert the laryngoscope blade (a wide, curved or straight, metal blade attached to a handle held in the left hand) into the patients mouth, lifting and sweeping the tongue up and to the left so I can visualize the patients vocal chords, a landmark in order to help successfully intubate a patient. I quickly realize that suctioning is required  for the patients mouth is again full of blood. The fresh batteries of the suction machine groan like a champ as I clear the patients mouth the best I can. I can see the vocal chords easily and look to pick up the ET tube with my right hand. Grasping the curved, thirty centimeter tube with my thumb, first and second fingers I begin to insert it into the patients mouth towards it's critical destination when, POP!...my left hand shoots towards the ceiling as the tension of my hand, holding the weight of the patients head off the floor, releases! The head hits the carpet with a dull THUMP! ! I look down in the dim light.

"Please, give me some light!" I plead as an officer quickly shines his flashlight at my hands. I find the detached laryngoscope blade still in the patients mouth, the handle in my left hand!

"What in the world?!" I explode out loud. I quickly remove the blood coated blade from the patients mouth attempting to reattach it to the handle when I feel someone tapping me on the back. I turn and look over my right shoulder, the flashlight beam following my every move.

"Gary, the weld broke!" Don exclaims, his face lit up by the bright flashlight circle shown in his face. "Look!" he points with his finger. I look back down at the two pieces, one in each of my hands.

"How did that happen?!" I ask myself looking at the top of the laryngoscope handle (I can't lie but right now I'm drawing a blank as to what to do next!).

"We've got a disposable laryngoscope down in the truck!" Mark reports out loud. "It's in the side panel next to..." Mark continues to give instructions as Don, again, hightails it downstairs to the fire truck.

"Ventilate the guy!" Mark instructs. I reach over and pick up the BVM. The bellows and mask is sticky with drying blood. The patients mouth has filled up again so I suction the dark red fluid, watching it travel through the tubing as it adds to the filling reservoir. I squeeze the BVM with every breath I take.

Time seems to be moving so slowly as we wait for Don to return with the extra equipment.

"Where the heck is he!" I exclaim to myself looking back to the front door. Just then I hear the crackling of plastic in front of me. I turn back around to see Mark reaching into a bag, pulling out a plastic package which I soon recognize to be that of a tracheotomy kit (it is taught to keep this device readily available in case, "*#%! hit's the fan!" during an RSI procedure). My level of anxiety drops and my excitement rises to another level as I realize what is about to transpire!

"Great idea Mark!" I quietly exclaim. Mark continues to open the package as I instruct a fireman to continue to suction and ventilate the patient the best he can. I don sterile gloves and begin to prepare the patients neck, sterilizing it with alcohol and betadine swabs first.

I raise my head and note that a sheriff officer with a white, handlebar mustache is standing at the foot of the patient with a camera hanging from a strap around his neck. I quickly deduce that he is the crime scene photographer and get a fantastic idea in my head.

"Excuse me!," I raise my voice trying to get his attention. "Would you be able to get pictures of this for us?" I ask with intentions of documenting this rarely performed field procedure and use it for future educational purposes. Without answering, the officer grasps the camera in his hands and begins to make adjustments. He holds the camera up to his eye when brilliant flashes of white light start to illuminate the room while clicking of shutters adds to the cacophany of noises already present.

Getting back to my task at hand I locate the cricothyroid membrane [a physical landmark on the front of the neck, the insertion site below the larynx (voice box)] with my right forefinger. Pinching the skin over the site between my left fingers, I take a surgical blade in my right hand and make a horizontal incision through the skin and fatty tissue. There is minimal bleeding. I take my right forefinger and place it into the incision, resting it against the membrane.

"I'm ready when you are Mark." I anxiously wait keeping my finger in place.

There is jingling at the front door. We turn to see Don arrive from his wild goose chase.

"I couldn't find the darn thing!" Don exclaims a bit out of breath. "Oh, that'll work too!" he continues, seeing the change of treatment plan already in progress. With the tracheotomy kit readied Mark replaces my finger with his and begins the procedure (a large gauge, break-away needle is used to penetrate the crichothyroid membrane. This enables the insertion of a plastic catheter which in turn faciltates the introduction of the tracheostomy device itself).

"Help me out Gary." Mark asks, his hands starting to shake uncontrollably.

"No problem Mark, I've got ya." I respond, placing my hands on his, helping to guide the catheter in place (the plastic catheter graduates in size and increases the diameter of the insertion site as it is advanced and Mark is having considerable difficulty inserting the last of the device).

"Stand up, you have to sit on it!" I exagerate. Mark stands to straddle the patient and applying firm, controlled pressure with both hands, seats the device into place against the patients neck. After assisting with securing the device, the BVM is attached and I resume ventilations without difficulty. Finally the patients airway is secure and blood is prevented from entering his airway!

The patient is evenually packaged and moved downstairs to the awaiting gurney by the firefighters then transfered to the ambulance. A fireman drives the ambulance while Don and I both ride in the back with the patient while further care and treatment is given enroute to the trauma center.

"Phew!" I exhale with relief.