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Friday, July 24, 2009

The Surgeon General of Midway - Part 4 - Stamping Out Disease and Pestilence

Well, it's been a while since I visited Midway Island on the blog so it's time I got back to work. I wanted to make some comments and tell some stories as a medical doctor with the navy there on the island.

If you have not read my previous Midway posts it might be helpful to go back and read them first:
Click below:
Introduction
Part 1
Part 2
Part 3

As I stated in a previous post, sick call began at 0900 during the week and ended about 1100. I had the weekend "off" but was actually on call all the time for any emergency that might appear.

Clinic

The clinic was a fairly nice facility. It has been a while so I do not remember exactly what it looked like inside, but there was basically a large reception area in the center where the sailors and marines would come and wait for sick call. Off of the large center room were several smaller exam rooms, a couple of rooms with beds where we could actually keep inpatients, an xray room, a lab, and a dental area which could also be used as an operating room. There were other areas for storage and central supply area with an autoclave and a secure area for drugs.

We could do a very few plain xray films and as I recall we could do a complete blood count, a basic blood chemistry, and a urinalysis. That was about it. In this setting you learn to rely on your skill and your intuition and a whole lot less on lab and xray.

I was the only doctor on the island except for flight surgeons who never came to the clinic but always stayed with their squadrons. We had one nurse, Becky, who was also the senior officer. She was a lieutenant commander. There was also an administrative office who was a lieutenant like me. I don't recall his name. We also had a dental officer there as well. The interesting thing about the dentist was that he had had some kind of special training in the administration of anesthesia and in an emergency, he could actually put someone to sleep and I could do "meatball" surgery on them. Fortunately, this never happened and would have been a rarity since we had fairly frequent flights off the island back to Hickam AFB in Hawaii.

We also had several enlisted crew. I don't remember exactly how many, but they were all corpsmen of various ranks. A couple of the more senior corpsmen were what they called "independent duty". These folks were quite valuable in that they had received a lot of specialized training. They were able to function independently on smaller ships such as light cruisers and destroyers where there was no doctor. Many of them were also attached to the marines and were extensively trained in battlefield medicine. One of the best things about the navy was the corpsmen. In fact, they handled about 80 percent of the sick call. All I had to do was review their work and sign off the charts. In fact, some of them became downright indignant if the doctors tried to assume too much of their responsibility.

On Midway, there were no families, rather all active duty folks. Also on Midway, all female enlisted personnel were REQUIRED to take birth control pills without exception. All females were under orders not to become pregnant. There was no place for pregnancy on the island, and since the few female sailors were isolated there for long periods of time along with a bunch of horny male sailors, the likelihood of sexual activity was high. Any female who became pregnant on Midway would be transferred off the island and to my understanding would be administratively discharged (I don't guess they thought much about the swab that made her that way). One of my duties as medical officer was to perform, "contraception exams". This was one activity not done by corpsmen and they were glad not to do it. We usually had no more than a couple of these exams per day and sometimes none, but it would consist mainly of a pap smear, a physical, some baseline lab work, and a prescription for birth control pills. Sick call was more or less routine and monotonous.

A big problem on Midway from a health perspective was alcohol consumption and I remember several sailors and marines were sent back to Hawaii for alcohol problems. When I left Midway, I had the opportunity to "escort" a sailor who was under arrest for "drunk and disorderly conduct" and "striking an officer". I'm going to save the details of this for a later post.

On several nights the commanding officer invited all the other officers over to his quarters for drinks and social hour. I never have been much on drinking and would rather have been working ham radio, but when the CO invites you over, you go. The CO, a bird captain as I recall, could hold his liquor with the best of them. I had the obligatory rum and coke and let that be it……after all, I was ON CALL! A few of the other officers were feeling no pain.

I also remember seeing a lot of psych problems, lots of depression, lots of bawling and squalling. You have to understand that many of these junior enlisted were 18 or 19 year old kids and they were suddenly plunged onto this isolated rock in the middle of nowhere for months at a time. Many of these kids were ill prepared for this endeavor. Nurse Becky and I understood their plight, as did most of the corpsmen. Unfortunately, many of the line officers and NCO's in charge of these folks were not as understanding.

One day we got a report that a Japanese fishing boat out in the north Pacific had run into a storm and there were injuries aboard. There was a report of a fisherman with a near amputated arm and another with a fractured leg. There were some other more minor injuries. Apparently a hatch had slammed shut on the arm of the most seriously injured person. CINCPACFLT (Commander in Chief Pacific Fleet) hatched a plan, and the plan was going to involve ME! Japan was our ally and it was our job to help them out.

The air force was going to fly out a C-130 transport plane to Midway with a couple of special operations guys known as PJ's (Air Force Pararescue Men). These guys are really special; they are parachute jumpers tasked with recovery and medical treatment in humanitarian and combat environments. Many of these men have been decorated with awards as high as the Air Force Cross.

In the meantime, a Coast Guard cutter had already joined with the fishing boat, transferred the injured crew, and was heading at flank speed toward Midway.

I was ordered to accompany the PJ's on a flight out to the location of the cutter (which was still a couple of days away from Midway), drop the PJ's onto the ship, and circle the area as the PJ's evaluated the injured parties. I was then supposed to further advise the PJ's (like they really needed my advice) on any further required treatment and then return to base. The cutter would then continue its high-speed dash to our harbor with its cargo of injured fishermen and PJ's.

Lockheed C-130 Hercules

We saddled up and climbed aboard the C-130 and headed out over the north Pacific. This was the second and last time I ever got to ride a C-130. My first C-130 ride was my initial flight to Midway. What a great airplane! We flew for several hours seeing nothing but clouds and ocean. I had some fun talking to the PJ's. They said they had an extra parachute and asked me if I wanted to jump out with them. I smiled politely and declined. When we finally got to the drop area, the weather was terrible, with rainsqualls, high winds, and high seas. It was decided that the weather was too bad to drop the men and much to the disappointment of all aboard, the mission was scrubbed, so back to base we went. Oh well, it was a nice C-130 ride although the plane was getting knocked around pretty good near the drop zone. The Coast Guard cutter continued on without the assistance of the PJ's. We even gave the cutter a ham radio frequency on which they could call me back at Midway for advice, although they never called, or if they did, I did not hear them.

Coast Guard Cutter

The cutter arrived at Midway a couple of days later and they could not have come at a worse time. As the big ship pulled into the lagoon, the winds were gusting between 40 and 50 knots, so hard that it was difficult to stand up straight on the pier. The wind was so powerful that the cutter was actually listing noticeably as the wind hit it broadside and after several futile attempts, the skipper decided even with the help of a couple of tugs (the wind was that strong) that he could not safely bring the ship in without risking crashing into the pier.

Midway Tugs

Finally, the cutter was taken out into the center of the lagoon and as we all held our breath, with some fancy rope work and a little hocus pocus the injured men were eventually transferred to the tugboats. At long last the tugs tied up to the pier and the weary victims were delivered into the waiting arms of our corpsmen. In fact we were all weary that day.

The Corpsmen wait for the wounded

The injured were hastily driven back to the clinic. The victims were pretty weak but were basically stable. Both men had IV's already and were hydrated well. One man's left arm was a lost cause. It was pretty much amputated just below the shoulder. The only thing holding it on was the humerus (arm bone). All the flesh was gone and the arm was black and gangrenous and smelled like dead fish. Fortunately, the dead arm was isolated from the rest of the body, as the hatch had destroyed all arterial and venous connections. The other fisherman obviously had a fractured left leg, but it was closed and that appeared to be his only significant injury.


Removing the wounded from a tug

We put both of these poor souls to bed, filled them with morphine, gave amputation man lots of antibiotics, and splinted leg man's leg. We wrapped the gangrenous arm in some gauze and sealed it in a plastic bag to cut down some of the smell. Neither one of these guys spoke any English so communication was difficult, but they seemed appreciative of our efforts. We did have someone on the island, I don't remember who, that could speak a little Japanese, so in a pinch we could get some translation. I went by the clinic late that night and spoke with the corpsman on watch and visited our patients. I was satisfied to see that both of the fishermen rested well that first night. They both had been through quite an ordeal.

There was some talk about me completing the amputation in our "operating room", but after a discussion with an orthopedic surgeon in Hawaii we decided against it. The man was not septic (blood stream infection) and he was stable and we also got news that we should have a flight back to Hawaii either tomorrow or the next day. I was relieved.

Sure enough, we loaded the injured aboard a flight the next day and sent them off on the final leg of their journey. I have to say that I was never more proud of the Navy, the Coast Guard, and the Air Force and their combined efforts of saving these two men. We got word later on that both men made uneventful recoveries, one man without a left arm.

Japanese Fishing Boat

About 2 or 3 days after this, the Japanese fishing boat finally limped into our lagoon. The wind had subsided by then and they were able to tie up to the pier without incident. There were 3 or 4 more men with minor injuries, mostly contusions and lacerations. These were handled in short order. Japanese fishermen had a nasty habit of sewing up their own lacerations with fishing line. These would invariably become infected, so we'd have to re-open them, wash them out, and fill them with antibiotics. No amount of education or persuasion seemed to prevent them from doing this. The Midway crew told me they had seen this type of thing time and again.

The captain of the fishing boat and a couple of his crew came to visit us at the clinic. He brought me a carton of Japanese cigarettes as a reward. These fellows were smiling, bowing, grabbing our hands and forearms and holding on. They were obviously grateful for the service we had given them. In politeness to the captain I smoked one of the cigarettes and I must say it was one of the most awful things I had ever tasted, but I did not let on. I smiled and shook hands with the crew and we went to the pier to see them off. It was hard for me to imagine that just 40 years before this we were trying to kill these people. My how things change in such a short time. Finally the weary fisherman left our island bound for Hawaii.

Man, I'm tired from just writing this. Hope all of you have enjoyed listening to some of my tales as the Surgeon General of Midway. Next I'll tell you a little about working ham radio and finally my flight home.

2 comments:

  1. Great story. Keep it up.....

    ReplyDelete
  2. I remember you bringing the carton of cigarettes back home with you. I never remember you telling me exactly how or why you got them. I do remember the story about the injured men, wow what an ordeal for them, especially the man with the injured arm.

    Deborah F. Hamilton
    Right Truth
    http://www.righttruth.typepad.com

    ReplyDelete