The patient arrived in critical condition last month at the Bagram Air Base hospital in Afghanistan, with what American military doctors at first thought was an all too typical war injury: metal shrapnel from an improvised bomb lodged in his head.
A CAT scan showed that the piece of metal, about two and a half inches long, was probably a cartridge fragment — again, not at all unusual.
But as the patient, an Afghan soldier in his 20s, was prepared for surgery, the chief radiologist, Lt. Col. Anthony Terreri, took a closer look at the CAT scan. Stunned, he realized the object was an explosive round, primed to go off.
“It looks like we have a problem here,” he announced.
To the other, how would you like to be Major Jeffrey Rengel, USAF, the anesthesiologist who, after the evacuation of the operating room, was left to tend to the patient until the bomb squad arrived?
The surgical team recounted the episode for Elisabeth Bumiller of The New York Times.
The surrounding hallways were secured, and a bomb disposal team was urgently summoned. All electrical monitoring devices in the operating room were turned off for fear of detonating the round. To keep track of the patient’s vital signs, doctors turned to manual blood pressure cuffs and a battery-operated heart monitor, and they began counting drips per minute to estimate the amount of the intravenous anesthesia they were giving the patient. “It was taking anesthesia back about 30 years,” Dr. Rengel said.
Within a half-hour, the bomb disposal team arrived and confirmed, based on the CAT scan, that the patient indeed had unexploded ordnance in his head.
“They said, the way these things are set up, this type of round has an impact detonator on the front of the charge,” Dr. Bini said. “They just said, ‘Don’t drop it.'”
With that for reassurance Dr. Bini put on body armor as well, and he began the process of surgically removing the round from the patient’s head, joined in the operating room only by Dr. Rengel and a member of the bomb team. He cut through scalp tissue and made a large incision encircling the round, which was lodged under a piece of skull bone and jutted down the right side of the patient’s head. Within 10 minutes, he pulled out the live round. With care, he handed it to the bomb technician, who put it in a bag and left.
Did Dr. Bini breathe a sigh of relief before handing off to a neurosurgeon?
“I didn’t even think about breathing a sigh of relief,” Dr. Bini said. “Technically, it wasn’t a very complicated procedure, and I had the confidence that I wasn’t going to drop it on the floor. This is something we train for — although it’s a very uncommon event.”
In all the ways it was the patient’s lucky day, count among them that Major John Bini, USAF, has actually instructed students at Wilford Hall Medical Center, at Lackland Air Force Base in Texas, on the removal of live ordnance from wounded patients.
But war is hell, as the saying goes; the patient apparently did suffer some brain injuries from bone fragments, but Dr. Bini said the soldier is able to walk, communicate, and eat on his own. I suppose all we can do is send our best wishes from half a world away. And, of course, take a moment to admire the skill of our military doctors abroad. Because, really, that’s just so … damn … cool. And any good news coming out of that war is welcome.