DPC

Historical fiction is often the most gripping witness to war. My recent favorite is Kristin Hannah's The Women, which takes me to the Vietnam War around 1967.

One of the women in this fiction is a twenty-year-old nurse Frances McGrath who joined the Army Nurse Corps. Let us not forget, indeed, that women can be heroes. 

The story of this green nurse Frances McGrath in Vietnam is all blood and sweats. Her workplace was an operating table on wheels, and she lived in the middle of nowhere. There were bits of shrapnel embedded everywhere, cyring casualties, moaning and shouting medics. Frances had never performed a tracheotomy before, but she'd watched and assisted on dozens within one year of joining the hospital. One day, she was facing a dying soldier who could barely breathe. He looked sucked dry, hollowed-out, with sunken eyes and sunken cheeks characteristic of the prisoners of war. The gasping soldier struggled and probably couldn't make it. Frag wounds had torn up his arms and neck, and there was probably something swollen or lodged in his airway. 

"What are you doing, McGrath?" the doctor asked.

"Letting him say goodbye to his friends and die in peace." 

"Be quick. I've got a sucking chest wound that needed you ten minutes ago."

Frances McGrath felt sad, and decided to change into clean gloves and wiped the soldier's neck with antiseptic solution. Holding her scalpel, she took a breath to steady herself, then made a cut between the thyroid and cricoid cartilage.

The dying man took a deep, wheezing breath, with relief coming into his eyes. Frances took hold of his hand, held it in hers, and leaned close, whispering, "You must be a good man. Your friends are here."

The soldier took his last breath, and went still.

That was her way of facing a never-ending fight of wartime Whac-A-Mole. Once a wounded soldier was settled (or sent to morgue), another would be brought in. That was a fact of life.

During the Vietnam War, Frances McGrath saw everything from amputations to rat bites to what's left of a soldier after a land mine (many of which were planted with sharpened sticks and coated with human feces to assure both deep wound and infection when stepped on). Most wounds require delayed primary closure – DPC – which means the medic clear and debride wounds but don't close. The wait – at least four to five days – before wound closure offers time for the human host defense system to decrease the bacterial load. On the other hand, I don’t think there’s anything, be they words or healing sessions, that could bring closure to the wound suffered by Frances McGrath.