Sabir, Patient 4914

“Shukren le linqathi.”

“He says, ‘Thanks for saving me,’” explains the interpreter as we approach the bedside of patient 4914. His name, which we usually remember to use, is Sabir. Sabir, the Iraqi policeman who has been with us longer than any other patient in the short history of our facility, is the last patient to be seen on ICU rounds in the Air Force Theater Hospital at Balad Airbase, Iraq. He received a gunshot wound to the abdomen and currently suffers from “abdominal catastrophe,” an uncomplicated term to describe a complicated medical and surgical course that has resulted in an open abdomen, limited enteral function, and a dependence on parenteral nutrition. Bed-bound and weighing about 100 pounds, he is not nearly the man he was when he arrived here.

With an awkward feeling of undeserved praise, I ask the interpreter to tell Sabir, “You are welcome,” and looking at my notes, begin Sabir's daily presentation to the other physicians of the ICU team. “No significant events in the past 24 hours. Vitals stable. Exam unchanged.” I don't have a chance to get to the rest of my brief presentation before an approaching helicopter, its conversation-deafening and air-reverberating presence easily drowning me out through the tent walls of our hospital, signifies the arrival of yet another trauma victim. We finish rounds on Sabir quickly, examine his abdominal tubes and dressing, write a few orders, and prepare for the arrival of the next patient.

I am a military internist deployed to an expeditionary hospital that cares for injured American and Iraqi military and police members. Most patients here have suffered some combination of burn, …