Had a brief and entertaining Tactical Medicine lecture this morning. There are some significant differences in how you treat trauma victims in civilian life and on the battlefield. Definitely less to remember:


Civilian life:

A-Airway
B-Breathing
C-Circulation
D-Disability
E-Exposure
F-F.A.S.T. exam


Military:

R-Return Fire
T-Tourniquet


All kidding aside, there are actually pretty good statistics backing this methodology up gleaned from studies of the Vietnam war. Focusing on reversible causes of mortality with very limited time and resources - exanguination is far and away the leading treatable cause of mortality in the battlefield, with pneumothorax/hemothorax trailing a distant second.

Comixed

Assasinations and Bombings in the Pelican State

The hospital I work at in Baton Rouge is named after the younger brother of famed politician and former governor Huey P. Long - "The Kingfish."

Huey Long was a tyrant, probably manic, a heavy drinker, he ruined the lives of many of his competitors through political subversion, he was adored by the underprivileged and minorities in Louisiana, and he built the beautiful state capitol building here and Baton Rouge. He was shot inside of it, just after getting off of his personal elevator, and bullet holes still scar the marble walls 75 years later.




Long was allegedly shot inside of his new building by physician Carl Weiss, M.D. Dr. Weiss was the son of a judge in Opelousas whom Long despised. Long had been unable to unseat the judge, so he introduced a bill to divide up voting districts in his area to force him out of office.

Statue of the Kingfish, facing the state capitol.

According to some theories, Dr. Weiss a well respected physician, confronted the governor who was with his heavily armed entourage. There is a debate as to whether Weiss had a weapon, or simply punched the governor in the mouth as he exited his elevator. What ever the case - Dr. Weiss was shot 32 times in the hallway of the capitol, and the governor died in a local hospital 2 days later from a gunshot wound that may have been ricochet from his own guards.

Dr. Weiss' body lying in the capitol hallway after the assassination.

I was prompted to write this, and to post pictures from my visit to the capitol by an NPR special for the 75th anniversary of Huey Long's death. At the state capital next weekend, Dr. Weiss' son (now himself a surgeon) will be speaking publicly for the first time on the event. After the assassination, his mother was mistreated by the local community in Baton Rouge, and they were forced to move to France, where he grew up. There will also be a play, based on the assassination, in which members of the audience will be chosen as jurors. The jurors will decide the final scene, whether Dr. Weiss indeed murdered Governor Long, or if the Kingfish was inadvertently killed by his own men.

Another interesting bit of history that is not readily apparent to all visitors of the state capitol is the evidence of a bomb blast that shook the state senate chamber in the 1970's. Luckily the bomb, hidden under the front podium, exploded at the wrong time when the senate was out of session. Shards of wood are still embedded in the plaster and in the ceiling, and the marble columns are fractured behind the speaker's podium.

Wood shard embedded in the column.

Fissure in the marble column behind the speaker's podium.
Small wood shard embedded in the ceiling.

"My walk has become rather sillier lately."

Everyone has encountered these types of steps at some point in their lives. They are too wide to take just one foot per step, but just too narrow to take two full strides - so inevitably you end up taking a full stride to advance, and a half step just to position yourself to go up to the next level. To bystanders I likely look like a 4 year old, or a retarded cat.

Yes. Because what says 'Spanish,' more than burritos, margaritas, and a sombrero with a couple of maracas.

Celebrity look-alike day in Ortho clinic, posted on our exam room doors.

Thank God, someone painted arrows on the floor to let me know where the nearest wall is.

The Author's guide to The Hospital's fantastic elevators.

Time

The top photo is a picture of the Bristol suspension bridge. Normally when you snap a picture with your camera, the shutter opens for a fraction of a second allowing light to hit the film. In this photo, light was allowed to hit the film for half a year. The streaks you see are the path of the sun as it passed overhead 180 times. The bottom photo is of MoMA as it went up over the course of a year.

More here.

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Inside a dead skyscraper.


When the windows were broken, the air turned to poison

So time was frozen, and time was frozen

There were inches of dust on mahogany tables

Where the footprints of rats raced across the asbestos

And the children in the pictures taped up on the cubicle walls

There is sometimes a strange feeling subsequent to a disaster that develops in stages after the initial concussive force. In some rare instances, you can see tragedy coexisting with what once was normal. You get an opportunity to see just how thin the veneer of your comfortable life really is - and with any luck, it makes you thankful.

I noticed this when I had to evacuate for hurricane Rita and left my rent house for six weeks. The night before, the hurricane it was projected to miss us by a very wide margin. We all went out and had a great time as we would any other night. But when the National Weather Service issued it's 5 a.m. update the storm had made a dramatic, unpredicted turn off-shore, and was now heading right for us.

I woke up to a quiet and sunny morning with several voicemails and texts from family and friends, telling me to get out as soon as possible. Every channel on the television was giving stern warnings for everyone to leave. They were showing maps with cones and storm surge probabilities - it was a grim, ominous feeling.

I decided to go to Wal-mart and stock up on batteries and dog food, "just in case." When I got there, I had the store to myself. Within about 2o minutes, the isles were flooded with panicked throngs, blindly dumping bottled water and batteries into their carts. They had apparently received their voicemails and turned on their televisions at about the same time as I had.

I had just enough time to block off my bedroom window with my closet door that I had pulled off the hinges, pack up the dog, and hit the road. We left everything else - the playing cards on the coffee table, the half empty red plastic Solo cups on the kitchen cabinet, the food in the freezer.

The interstate was clogged with SUV's, most with gas cans tied down to their roof racks with bungee cords, there were people desperately driving through the median and on the break-down lanes trying to get ahead. It took me (and my dog Amos sitting on the front seat) nearly 4 hours just to make it 10 miles.

When they finally took away the road blocks entering the area 6 weeks later, they allowed people in only during daylight hours to assess property damage. It was like a ghost town. No businesses were open, traffic lights didn't work, all of the bank signs that normally tell you the time and temperature were either splintered or dead, people were burying and burning garbage in their front yards, windows were taped and broken, trees and bits of peoples' roofs lined every path you took.

When I first went back to our house, entering it after 6 weeks of absence, it was alien. While there was a 70 year old elm tree lying over our house - the normal things were what really shocked me.

I had forgotten about the playing cards, and the red plastic cups, and my closet door bravely defending my desk against an attack from a wayward tree, the now bloated and rotting bag of green beans in the freezer, my unmade bed - still with the impression of where I was laying 45 days ago, reading text messages about a storm.

It was almost voyeuristic, the way I felt looking around my own house through a different pair of eyes, seeing the contrast of normal life juxtaposed with desolation and emptiness. It was like it was some other person's living room. Someone I had met before but only had the vaguest recollection of.

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Jesse Stiles was a musician who had just graduated college when the WTC came down. After the disaster, he and some friends moved to New York to help clean up the nearly collapsed buildings that surrounded the site, and few years later, he put what he saw inside the building into song. That song was then made into concept-art in the form of a 'game,' called Inside a dead skyscraper.

Said one blogger: "it’s creepy, but the mixture of the music and the content makes it oddly compelling and kind of beautiful."

Be sure to fly around a bit...