On Being a Doctor |

Inshala FREE

CPT Charles Broy, MD
[+] Article, Author, and Disclosure Information

From Blanchfield Army Community Hospital, Fort Campbell, KY 42223.

Requests for Single Reprints: CPT Charles Broy, MD, 115 South Cedar Avenue, Wood Dale, IL 60191.

Disclaimer: The opinions or assertions contained herein are the views of the author and are not to be construed as official or reflecting the views of the Army Medical Department, Department of the Army, or the Department of Defense.

Ann Intern Med. 2009;150(8):565. doi:10.7326/0003-4819-150-8-200904210-00013
Text Size: A A A

It was my first day in the Iraqi pediatric burn clinic, and the experience had been exhausting. The medics called me over to the newly burned 12-year-old girl who was in respiratory distress. She was burned from head to toe, and the smell was overpowering. While I repositioned her head, she stopped breathing. I didn't have a crash cart, suction, or even a bag valve mask. Her carotid pulse was gone when I checked it. Her fixed and dilated pupils regarded me in glassy peace. I reassured myself that a person with a burn over 40% of the body surface area is likely to die.

I am an internal medicine physician in the U.S. Army completing a 15-month rotation in Iraq. I have no training in burn treatment, and I have never treated a child. Along with the health of my soldiers, I am the officer in charge of the local pediatric burn clinic. We see approximately 35 patients per day with burns ranging from mild to very severe. The makeshift treatment area consists of 2 welded shipping containers. This provides a 20 × 16–foot area out of the elements to treat patients with more serious conditions. Those with less-extensive injuries are treated in the shaded, outdoor waiting area. We are an all-volunteer, all-donation clinic that does the best it can with what it has to help local children. Iraqi hospitals admit and retain patients on the basis of their ability to pay. Parents come to me in desperation from halfway across the country.

On my first day, I also meet Haseed. He is an 8-year-old boy with burns over 85% of his body. He is lying in the litter next to the 12-year-old dead child. His face is a mass of burn, puffy and grotesque. His penis has a first-degree burn from the tip to the base. His body is covered in leather-like, dead skin. Most of his pelvis and the back of his left leg are all that remain unscathed. He is passive, lethargic on his cot. The burned flesh causes a nauseating reek around his entire body. I feel completely unprepared and unable to properly care for this child. Although painful and difficult, I dutifully tell his parents that he is going to die just like his neighbor. You can see the desperation in their eyes, but they say, “Inshala”—if it is God's will. They have faith in my ability to heal their child.

Our time and supplies are limited, but we need to manage his pain. Acetaminophen, NSAIDs, and toradol are the only pain relief at my disposal, and I use them all. I emotionally compartmentalize him as already dead and move on to 1 of the other 32 people treated that day. Much to my surprise, he returns the next clinic day and we treat him, although we expected him to die of renal failure or infection. He returns again, and again. Despite my better judgment, I start debriding his dead tissue and using our precious medication, medical-grade honey, over his entire body. His mood and activity slowly improve; his ability to cry out from our second-rate pain management is a good sign. His parents are ecstatic about the slow change in their son. Three times a week for many months, we spend countless hours and limited resources on his treatment. In many ways, he reminds me of my own sons. He asks me if I have children, and then he asks for my family picture to put on the wall of his bedroom. Against my better judgment, I start to hope.

As of today, his face and chest no longer require treatment. His arms are 80% better, but his legs are still badly burned. He continues to have a poor prognosis, but his improvement is remarkable. Sometimes when we are tasked with the impossible, faith and hope are all we have.

I have recently seen another 15-year-old girl with burns over 80% of her body. She has just recovered from having blood in her vomit, feces, and urine. She has started eating and drinking well. Inshala.

CPT Charles Broy, MD

Blanchfield Army Community Hospital

Fort Campbell, KY 42223





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment
Posted on April 28, 2009
Khalid L. Rehman
No Affiliation
Conflict of Interest: None Declared

Dear Sir: The article titled "Inshala" under the section "On Being a Doctor" published in the 21 April 2009 issue of the Annals requires a minor corrcction. The word sounds like" Inshala" but in fact the correct Arabic word is" Insha Allah". "Insha" meaning the will of and "Allah" referring to God in the Arabic language. It is customary in the Muslim world to utter this word for future events. It is based on the Muslim belief that in spite of the best efforts by man, things happen or do not happen based on the Will of God. Such a belief offers consolation and patience in the case of adversity and allows the faithf to accept the outcome as a matter of divine writ.

Conflict of Interest:

None declared

"Insha Allah"
Posted on April 30, 2009
Ahmad Kaako
University of Tennessee, College of Medicine, Chattanooga
Conflict of Interest: None Declared

From a human perspective, when I read this article I had mixed feelings about the situation. The author did paint the picture well and we were able to imagine and feel the suffering of these children who were victims of the "correctional mission" of the army.

Sadness, compassion, guilt and embarrassment were amongst the feelings that predominate when thinking about these victims of the war. On the other hand, it is striking how those people, amid all this chaos, fear and difficult circumstances, still have that impressive hope. I would guess this is probably because this is the only good thing left for them in this life to experience.

I believe that the "Insha Allah" word from the parents was not merely a word they used to utter frequently, rather it was coming out of the bottom of the heart stating that whatever happened is a test in this life to know whether we did well or not and " Insha Allah" ( i.e. if Allah will) after hardship will always come with ease!

As doctors, when we take away the hope from people, we almost blow out this little candle that provides some light amid the scary darkness.

Conflict of Interest:

None declared

Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Want to Subscribe?

Learn more about subscription options

Topic Collections
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.