A Liberating Breath

Abstract

28 Narrative Inquiry in Bioethics • Volume 13 • Number 3 • Winter 2023 York Times Magazine, 18 May 2012). This particular NGO refused to accept any patient who had received surgery at a NATO facility, with one of its leaders saying, “It’s better to let (a patient) die than to suffer while going from one hospital to another.” The article stung. We did care about those patients whom we sent to Mirwais and KRMH. We wanted to give them the best possible chance at recovery. We tried to send them along with enough information for their new caregivers to manage them, with enough supplies to make it work. Perhaps we would have had more success if we had a way to build professional connections with our counterparts at Mirwais, but security concerns made that nearly impossible. “Greenon -blue” attacks were common in 2012, when individual ANSF personnel would attack coalition personnel, and Mirwais Hospital had been attacked by militants more than once. Transitions of care, when a patient is transferred from the care of one team to another, are risky times even when they occur within a single hospital in the U.S. The risk is magnified when that transition occurs between two hospitals in an active war zone who speak different languages with widely divergent capabilities. The article did sting, but there was truth to it. We were failing these patients, or at least some of them. Over 16,000 civilian trauma victims received care at U.S. military hospitals during the wars in Afghanistan and Iraq. Over 90% of them survived their initial hospitalizations, although an unknown (to me, anyways) number succumbed to injury and infection later. All of our patients received the same standard of care at the time of presentation; it was the follow-up that diverged. I had no solution for this at the time, and I do not have a good one now. When you look at the spectrum of resources utilized across our patient groups (i.e., airborne ECMO for NATO forces versus ground transfer to an ICRC hospital for an Afghan villager), it troubled me that the wounded civilians seemed to come up last. So what are the limits of our obligations in war? NATO policy stated that our obligation was for emergency care only; we were not equipped to manage these patients for the long term. We did the best we could with the tools we had and hopefully gave them better odds than a local hospital. In other conflicts, NGOs might have been able to fill the void, but many of these groups prize their neutrality and are understandably reluctant to coordinate with the U.S. military. The deliberate targeting of medical facilities in war has also made their work increasingly hazardous, both for local caregivers or NGOs. While undoubtedly courageous people, I do question the morality of the NGO that refused to care for any patient we had touched before. I will not defend the wisdom of our discharge policies, but punishing these patients for our failures is also hard for me to defend. Before I went home, I updated our turnover guide for the new rotation who would be assuming responsibility for the Role 3. Writing about detainees , I said: “Try not to jump to too many conclusions about these guys and be 100% positive that you are providing the same level of care to them as you would to any other patient. We are not cops, we are not judges, and we are not prison guards. Be always mindful of safety and security, but don’t do anything that will bring discredit on the Navy or that you will regret.” Looking back, I hope this was good advice. I also hope that I remembered to take my own advice. B A Liberating Breath Elizabeth Dotsenko T he war in Ukraine started not in 2022, but in 2014. Some of my relatives have been living under occupation for the past nine years. After a year of occupation, parts of Ukrainian society stopped paying attention. But on February 24th 2022, that changed. The whole country was awakened by missile attacks in almost every region. Kyiv, the capital, was heavily shelled...