The Universal Language of Parenthood

I'm pleased to welcome back Dr. David Carnahan as he writes about a personal experience caring for an Iraqi youngster during his military service.

Welcome back, David.

It was easy to hate the people who had produced the martyrs of 9/11. Maybe hate was too strong a word, but I certainly had no compassion for them, even though I’d taken an oath to do so. That was until one night in Iraq, when the squawk box relayed a trauma on its way in.

“Trauma call, Trauma call, Trauma call, times one, pediatric,” a voice cried over the hospital speakers. A collective moan echoed in the emergency room as physicians, nurses, and technicians streamed in to take their positions.

The squawk box sounded again in staccato sentences. “Vitals stable. Patient fell off roof. Fall distance: twenty feet. Seven year old boy trying to fly his kite. Significant head injuries. Would call the Neurosurgeon. Over.”

Trauma Tahoe arrived listless and unresponsive with a bluish hue. Orders reverberated off the walls as the Trauma Czar, Dr. Garrett, directed Tahoe’s initial resuscitation, stabilizing him for his eventual surgical care. Within an hour, he was taken to surgery and  then placed in the Intensive Care Unit on the ventilator.

The next morning I got up early to check on him. His physical examination had degenerated, and now showed signs of herniation, a condition incompatible with life. The ominous signs on the initial CT scan suggested that Tahoe had suffered severe damage akin to having major strokes on both sides of the brain, and had little chance of recovery, but we all were praying he would be the outlier. The neurosurgeon leaned against the door of the “doc box,” the room where the doctors stay overnight to care for the ICU patients. “There’s nothing more we can do,” he said. All gazes cast downward, and the room remained quiet. We had all arrived at the same conclusion, but saying it had cast the reality into the universe with finality.

The pediatrician, ICU director, neurosurgeon and I walked into the room, and looked at the silent, unconscious patient. His head was wrapped in white bandages. His long, dark eyelashes curled up hinting of his former handsome features, but his swollen face now cast a shadow over his angelic appearance. The ICU staff worked all around me as I watched them perform as professionals: removing tubes, shutting down machines, gradually causing the room to grow still. Dr. Williams, the pediatrician, asked the nurse to bring in the nicest blanket we had. She returned with a hand-quilted blanket sent from a family in Wisconsin.

The beautiful design contrasted against the hideousness of the moment. Then, we waited. The little boy’s father approached the door, his face somber and eyes heavy. The mother was close behind. She was dressed in a black robed dress, shawl and shoes. She held a handkerchief to her face as the tears streamed down her face. Her voice filled the room with an Arabic phrase uttered repetitiously and mournfully. I imagined what I would say, how I would react, and my mind began to whirl as I pictured my own seven-year old daughter in the bed. The father pulled the blanket off and leaned over the bed to kiss his boy’s feet. His tears washed his son’s toes as he slumped over his feet, rocking back and forth in grief.

His mother kissed his lips, brooded over him as she continued to chant the doleful phrase trying to bring her boy back to her. Then as if she suddenly realized we were in the room, she looked up at Dr. Williams and with begging eyes asked him the question in Arabic. The translator in the room knew that he need not explain, Dr. Williams had been asked the question that all doctors despise, the question that raises the issue of the limitations of medicine and the injustice of harm that befalls innocent children. He shook his head and said, “I’m sorry, there’s nothing we can do.”

In that moment, I stood with tear-brimmed eyes, struggling with the sorrow and grief that losing a child will bring.

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Dr. David Carnahan is a Board Certified Internist, who fell in love with writing while getting his Masters Degree in Epidemiology at the University of Pennsylvania. He has served in the Air Force for the past 14 years as an academic clinician/educator and now works in the area of Healthcare Informatics. He has a wonderful wife and two beautiful daughters, and invites you to read about his life (www.dhcarnahan.blogspot.com), and weekly installments of his current work in progress, The Perfect Flaw (www.theperfectflaw.com).

A Miracle in the Desert

Today, Dr. David Carnahan concludes his series on the widow maker and finishes up with his first hand experience of a patient surviving this usually fatal heart attack. The first part can be found here.

Now, David....

Then, their expressions dropped.

“I’m sorry I don’t have better news.” I paused, letting the words sink in and waited for their questions to bubble up to the surface.

“Does this mean you aren’t going to do anything else for him?”

“No. We’re going to continue to do everything we can to keep him alive. I just wanted you to know how grave the situation is.”

An hour later, the team stood at the bedside, waiting for another round of electrical shocks and epinephrine to urge his body to fight through the blockage in his heart.

I walked up next to Dr. Winfield again. “He still the same?”

“Pretty much. I think we are at the decision point now.”

“Yeah?”

“He’s on eleven drips.”

Most patients in the ICU are on a couple of drips: antibiotics, sedation, pain meds, but eleven is an unusually high number.

“I’m worried he’s not going to get his brain function back,” Winfield said.

I envisioned him at the end-state: awake, alive but functioning at a third grade level or worse, non-communicative. Are we doing this guy any favors by bringing him back? I rubbed my forehead with my right hand and then scratched the top of my head as I thought again about the consequences of our decision. “I think the next time he codes, you should code him. But, if he doesn’t come right back, then just call it.”

As I finished my sentence the announcement was made again, “He’s in V tach.”

I watched as they pushed on his chest, the patient’s ribs flopped up and down. Dr. Winfield looked over at me and I knew what he was thinking because I was thinking it as well: we’re torturing this poor man.

I walked over to the crowd of co-workers who’d assembled for the impromptu vigil. “Mr. Williams, I’m worried he’s not going to regain his mental abilities. We’re at a point where I feel the best thing to do is to let him go.” They looked at me apparently expecting this because they all held their expressions with little reaction. “I know this is tough, but I think the right thing to do is to let him pass when he codes next.”

“Can our chaplain say a prayer over him?”

“Of course.”

The look of relief on the faces of Drs. Winfield and Bauer told me I’d made the right decision, but I still wondered.

The chaplain stood beside the patient’s bed and the onlookers formed a semi-circle around him as well. “I would like to start by saying, on behalf of his co-workers and his family, that we appreciate the heroic measures you all have taken to preserve his life.” He grabbed the black skinned book in both hands and dipped his head. “Richard loved to laugh. He’s a good man and well liked. I know he will be missed greatly.” He paused, closed his eyes and said, “Will you join me in prayer.”

Several weeks later, I sat at my desk, working on a presentation that I would give to the medical staff of the hospital. I did this every month to relay the outcomes of the patients we sent to a hospital in Germany. I paused on the slide that represented Mr. Hall; the man I predicted would never make it to Germany alive. Tears rolled down my cheeks as I smiled in remembrance.

After the chaplain’s brief prayer, Mr. Hall, who coded almost ten times during the first four hours in the ICU, went the next fourteen without so much as a blip on the telemetry monitor. He then made it to the next hospital while being managed in a plane on a ventilator and eleven drips for eight hours. But most importantly, I later learned that he woke up and began following commands – a sign his brain had made it through the whole ordeal.

To this day, I am humbled at how close we came to “calling the code,” and thankful that God hears the cries of his people. Most of all, I was honored to watch God’s handiwork on yet another Sunday.


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Dr. David Carnahan is a Board Certified Internist, who fell in love with writing while getting his Masters Degree in Epidemiology at the University of Pennsylvania. He has served in the Air Force for the past 14 years as an academic clinician/educator and now works in the area of Healthcare Informatics. He has a wonderful wife and two beautiful daughters, and invites you to read about his life (www.dhcarnahan.blogspot.com), and weekly installments of his current work in progress, The Perfect Flaw (www.theperfectflaw.com).

A Miracle in the Desert

I'm so pleased to host Dr. David Carnahan who will be blogging every month or so here at Redwood's. To introduce him, he's doing a three-part series on the Widow Maker--- and I'm not talking black spiders...

Part I about why this medical condition is so deadly can be found here.

Welcome back, David!

“I need to make you aware of a situation.” The Intensive Care Unit Director, Dr. Thomas Winfield, said as he entered my office. “We have an American contractor in the ICU who is having a large anterior wall MI.”

I heard the words “widow maker” in the back of my mind because those were the words used when I learned an anterior wall myocardial infarction was the worst kind to have. “What’s his name?”

“Richard Hall. He showed up at the clinic and collapsed. The ambulance got him to the ER and they started coding him there. We don’t know how long he was down, but we’ve coded him four times since he’s been in the ICU.”

It was here that the ICU director and I were thinking the same thoughts. Will he be a vegetable when he wakes up? If, he wakes up. We could save the heart, but lose the mind.

“Have you called about a special mission?”

He anticipated my question and before I finished it, he said. “They can’t make it until after midnight.”

I shook my head. In the Iraqi desert, all we could do was give him medicine to bust the clot up and wait for transportation to fly him to Germany, but in the states we would send this man to the Cardiac Cath Lab where he would get a state-of-the-art stent.

“I don’t think he’ll make it twelve hours and if he does ….”

I nodded. “It’s too early to call it.”

“We’ll keep coding him.”

Dr. Winfield and I returned to the ICU and saw Dr. Baur running through the advanced cardiac life support (ACLS) algorithms. The team was tense, but composed. When the patient recovered, Dr. Bauer put her card in her pocket. “Great job everybody.” She gave us a weary look as we approached her.

“What was he in?” Winfield asked.

“V tach.” Ventricular Tachycardia is when the bottom two chambers of the heart start going faster than usual and if prolonged is incompatible with life.

“How many times have you coded him?” I asked.

“I’m losing count. He seems to be coding about every twenty minutes.”

“Have you talked with his friends? Does he have family?”

Dr. Bauer looked to Dr. Winfield, who said, “I’ve told his coworkers he’s probably not going to make it. They told me he has a brother who they’re trying to reach.”

“Dr. Bauer,” a strained voice from the patient’s bed called out. “He’s coding again.”

The ACLS dance began again. I turned to the group waiting outside the ICU. I needed to have a discussion with them myself. As I approached, the expressions on their faces said everything. He was more than a co-worker; he was a brother. Thousands of miles from home, tons of sand and the threats of a combat zone will do that.

“I’m Dr. Carnahan. Who’s Mr. Hall’s supervisor?”

“I am,” said a stocky man with a mustache and goatee. He extended his right hand. “Tim Williams.”

“Mr. Williams,” I said as I lowered my voice to a respectful hush, “it doesn’t look good.” He nodded as did the others crowding around him. “We’ve coded him about five or six times in the short time we’ve had him.”

“Doc, we appreciate everything you’re doing.”

I met his eyes. “I just want you to know that the next plane to Germany probably won’t be able to get here for another twelve hours.” They looked at me, trying to find the meaning in this kernel of information. “I don’t think he'll make it that long.”

Then, their expressions dropped.

Stay tuned... the remainder will post Friday.


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Dr. David Carnahan is a Board Certified Internist, who fell in love with writing while getting his Masters Degree in Epidemiology at the University of Pennsylvania. He has served in the Air Force for the past 14 years as an academic clinician/educator and now works in the area of Healthcare Informatics. He has a wonderful wife and two beautiful daughters, and invites you to read about his life (www.dhcarnahan.blogspot.com), and weekly installments of his current work in progress, The Perfect Flaw (www.theperfectflaw.com).