Today's Reading

The anesthesiologist took a quick blood sample and put it through our very basic hemoglobinometer, a device which measures the red cell count in blood. It confirmed that she had a hemoglobin of 4 grams per liter (the normal amount of hemoglobin—the stuff that carries oxygen in the blood—is between 12 and 15g/L). It was clear she had lost a great deal of blood. He quickly established her blood group and then went to get a pint of fresh blood of the right type from our dwindling supplies. Then, on the other arm, he set up a saline drip to replace some of the fluid that she had lost.

All this happened on the operating table in the dining room. The nurse in charge set up the gurney with sterile drapes and instruments as the patient was given general anesthesia. It was impossible to assess the wound properly as there was arterial bleeding, most likely from the superficial femoral artery in the leg. There was a large dressing on the top, which was acting as a local compression. I scrubbed up and prepared to operate.

One of the Syrian assistants, who didn't speak much English, was helping to lift the leg. As I prepped the limb with iodine, I asked the helper to take off the pressure dressing. The bleeding by this time had stopped, and there was a large clot overlying the wound. With the patient now draped and prepped, I started the procedure by making an incision below the tourniquet, high on the leg, so that I could get a clamp on the artery before exploring the wound. After gaining proximal control of the blood vessel I then went down to have a proper look. I tentatively put my finger into a large hole just above her knee joint and felt an object in there which I assumed was a piece of metal—a fragment from the bomb, or maybe a bit of her house.

In this kind of scenario it is always important to go very carefully, putting your finger into the wound slowly and cautiously because there may be fractured bone, which can be as sharp as shards of glass—the last thing you want is a needlestick injury without knowing the blood status of the patient. In this environment there was perhaps less concern about HIV or hepatitis, but it is a common mistake not to assume the worst.

Probing gently with my finger, it didn't appear to be the usual jagged piece of metal or fragment but a smooth, cylindrical object. Very carefully I grabbed it with my fingers and pulled it out. I held it up to examine it, and the Syrian helper who was with me took one look and went pale. He obviously knew what I was holding and blurted out, "Mufajir!" before turning tail and leaving the room.

The anesthesiologist and I looked at each other. Was I holding some sort of bomb? In that instant, I froze as I wondered what on earth I should do next. It became extremely quiet—all I could hear was the soft hiss of the ventilator pumping oxygen into the patient's lungs. The anesthesiologist shuffled away, moving across to the corner of the room behind one of the cabinets. By now my hands were shaking, I was in danger of dropping whatever it was, and I realized I had to do something. I decided to take a deep breath and walk out of the operating room as carefully and slowly as I could. I needed the anesthesiologist to open the door for me and jerked my head in its direction to show him what I wanted, hardly daring to speak. He said to wait, as he was sure somebody was going to come very shortly— thankfully he was right, and as I deliberated for a few more seconds the door opened and in came the Syrian helper with a bucket of water. He put the bucket on the floor next to me and he and the anesthesiologist ran to the safety of the next room. With my heart pounding, I carefully put the object into the bottom of the bucket, feeling the cold water seeping into the sleeve of my green scrubs, and very gingerly took it outside.

Mufajir means "detonator." It was hard to tell if it was live or not. I was told later that it probably would not have killed me, but it would most likely have blown off my hand—not the end of my life, maybe, but certainly the end of my career, and at the time the two were much the same thing.

It wasn't the last time I had a run-in with homespun explosives. Most of the fragmentation wounds from bombs that we were receiving were from the effects of amateur bomb-makers. Several times throughout the mission, we would receive young girls and boys at the hospital who had lost one or both of their hands. Some had severe facial injuries as well, and, even more pitifully, some had dreadful eye damage that rendered them blind. Many times I would go to the ward and hear the sobbing of parents holding their five- or six-year-old, who would never see them again or touch them with their fingers. It was utterly heartbreaking.

This excerpt is from the hardcover edition.

Monday we begin the book The Founding Fortunes by Tom Shachtman.

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