James A. Blair, MD, FAAOS, FACS

January 2007 I had been in Afghanistan for about 3 or 4 days when we received this 17 year old Pakistani kid who had both his legs blown off above the knee, one arm amputated at the elbow and most of his hand blown off on the other arm. Now the kicker was that he was a “bad guy” that is to say he was an enemy combatant that our troops brought to us for medical care. Believe it or not he got blown up while trying to set up an IED (aka roadside bomb) to blow our guys up. He accidentally blew himself up and now it was our job to provide him medical care. Now you might be saying why not just let him die as he was an enemy. Well the reality is that as a physician it is not your job to judge people it is to treat them and do the best job that you possibly can. I was taught this while in my surgical residency, as we often took care of TDC (Texas department of corrections) inmates while I was at Galveston. It was not uncommon that we’d do surgery on murderers, rapists and even death row inmates. Anyway, this kid was in pretty bad shape and we took him to the OR about 10 times over a 6 week period to wash out his wounds, revise his amputations and get him healed up. Blast wounds are notoriously difficult to deal with as shrapnel, dirt and bacteria are often forced way deep into the tissue and multiple surgeries are often needed to get all of the infection producing material out. It was this kid that caused myself and the other orthopedic surgeon Dr. via Tom Large to adopt a rule that no one gets their wound closed up after a blast injury until they’ve had at least three wound washouts. Anyway, we nicknamed him “stumpy”, I know offensive. But let me tell you when you are in this type of situation, gallows humor helps to keep you sane. The reality is a high percentage of our patients were both Afghan civilians and Afghan army so they often all had very similar sounding names. It was hard to remember who was who so most of our patients got nicknames associated with their particular injuries. For example, a guy with a big liver laceration we dubbed “hepatocrackadullah”. Stumpy was later renamed RXL4 which was considered somewhat more politically correct as the medical command staff didn’t like Stumpy- RXL4 stood for “Residual limb x 4” -the more official title for a stump is residual limb. Enemy combatants were always brought in to the medical facility blind folded with earphones on so that they could not see or hear anything that might be used to cause us harm. It was alway kind of bizarre seeing a kid with effectively no arms and legs blind folded with earphones on, but it was what it was. Even though the guy was an enemy the hospital staff provided him the best care that we could and after a few weeks he would actually smile and converse with the staff via the translators. Remember he’s a 17 year old kid, no doubt subject to all kinds of propaganda and may have even been forced to fight. War is a very crazy, hellish nightmare and honestly no one wants to be there, but it is what it is, and once you are there you do what you gotta do! So after 6 weeks or so we get Stumpy all healed up and at that point we turn him over to the Afghan army. The next day we found out that as soon as the Afghan army got him they took him outside and shot him in the head and disposed of his body! I had mixed feelings about this. One it was basically a tragedy all around from every aspect of it. What the fuck were we even doing, why spend all that time effort and resource if this was going to be the result. But realistically what kind of future would he have, even if the war ended and he somehow got home. Poor country, minimal resources, likely a social pariah, no chance to work or have a life, probably better off dead. I remember a few months later we had an army surgeon that was attached to a Special