This unfortunate gentleman was involved in a diesel tanker fire. He and his friend were brought in late in the afternoon a few days ago. His friend had 75% of his body burned, but he only had about 25-30%. They both came in intubated, but only his friend was on a ventilator. I insisted several times they put him on a ventilator, but they stated, "he is breathing fine on his own, see." I could not believe it. If I had my camera, I would have taken a picture because it is so unbelievable. The one gentleman died early that morning, which I was not surprised, he was in very bad shape. But the tube was out the next morning on this gentleman. When I asked what happened, they stated he pulled it out in the middle of the night. I thought about giving them a straw to breath through and ask how it feels, but I didn't have one on hand. This pic is of them doing dressing changes. He is actually doing good, eating on his own, drinking ensure through a plastic tube because he can't open his mouth very much. I tried to give them praise by saying good job on intubating any and every patient with facial burns, but then STRESSED that they also need to sedate and ventilate the pt. Not sure how much got through as, I also stressed that they needed frequent lab draws that first night they came in, but there were no labs until midmorning the next day. There is no reprecussion for being lazy here. People frequently do not show up for work without any negative effects.

On a good note though, we are continuing the M&M conference and it will be run by Afghan doctors. The next one will be this Sunday on the burn patient that died. I am to review the chart with two doctors tomorrow morning to see what could have been done better. Although I could name 5 things at first glance, we will probably only focus on one, maybe two. Another good note, I have got them to do a system that now has the lab and nurses reporting abnormal lab values in less than an hour!!! Instead of the next day if anyone even cared to look at the labs. It may not seem like much, but that is a huge victory. Praise God!!