'Don't Let Me Die'

Military surgeons make heroic efforts to save soldiers bleeding from major injuries, but a drug they use is suspected as a cause of fatal clots

November 20, 2006|By Robert Little | Robert Little,SUN REPORTER

BAGHDAD, Iraq -- Pfc. Caleb A. Lufkin landed on the helipad at about 12:30 p.m., screaming at the sky as a small all-terrain vehicle carried him past the palm trees and concrete bunkers to the emergency room. Doctors inside cut off his blood-covered boots and prepared to sedate him and insert a breathing tube, and he pleaded with them to keep him alive.

"Don't let me die," he said.

"I won't let you die," answered Capt. David Steinbruner, an Army doctor. "I promise. I give you my word."

Lufkin was bleeding from multiple blast injuries and compound fractures, so the medical team at the 10th Combat Support Hospital gave him red blood cells to replace his lost blood and plasma to help him clot. But they quickly concluded that he was on a perilous course toward a massive transfusion and that his odds of survival were decreasing with each minute that he continued to bleed.

At 12:41, without waiting to see if surgery or more transfusions would be enough to stop the bleeding, they ordered a 7.2 milligram dose of Recombinant Activated Factor VII.

When Lufkin arrived at the Army's combat hospital in Baghdad on May 4, he was the first of three American soldiers brought in over a 24-hour period, each with injuries severe enough to require blood transfusions and emergency surgery. Like more than 1,000 of the war's seriously wounded troops, each was treated with Factor VII, a powerful and largely untested blood-coagulating drug that the Army considers a wonder of modern trauma care, but which researchers have linked to deadly blood clots that lodge in the heart, lungs and brain.

All three soldiers left Baghdad alive, their doctors anticipating full recovery. One experienced no problems and later said he was grateful for whatever steps were taken to save his life. But two later suffered unexplained blood clots and died from subsequent complications.

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Some doctors worry that the Army, in its effort to push the limits of modern trauma medicine, is going too far with its enthusiasm for Factor VII, that giving it to the war's casualties could be doing more harm than good. But the physicians in Baghdad say that a war is no time to be cautious and that they'll consider any new advancement or technique that might save lives.

"All we can do is give these guys the best chance we can, with the best equipment and training we have," said Lt. Col. Bob Mazur, who served as the chief emergency room doctor in Baghdad that day. "This is war, and bad stuff happens."

Private Lufkin's injuries

Lufkin, 24, was wounded just before noon on a busy street in downtown Baghdad. He had joined the Army a year earlier after trying odd jobs that all seemed to be dead ends. He hoped that military service on his resume would help him land a job as a professional firefighter, but mostly he just wanted his life to go somewhere.

He still lived in his hometown of Knoxville, Ill., in the flatlands near the Iowa line, and he had a reputation for always smiling, even at odd times. In his yearbook from basic training he's the only soldier without a frozen scowl. He loved his friends and fishing and playing the banjo, his relatives say. And he hated Iraq.

"He believed in what he was doing, but he couldn't understand how some of the people in Iraq loved them and how some hated them," said Pat Houston, Lufkin's grandmother. "The hate bothered him a lot."

Lufkin's unit, the 5th Engineer Battalion out of Fort Leonard Wood, Mo., had one of the most dangerous jobs of the war: driving around Baghdad at 5 mph in search of roadside bombs. But he told his mother not to worry, that the oversized armored truck he rode in - a fortified mine-clearing vehicle called an RG-31 - could withstand anything, particularly an improvised explosive device.

"He said, `Mom, I'm telling you, these things are built to survive the blast,'" said Lufkin's mother, Marcy Gorsline. "He'd been hit by IEDs I don't know how many times before and said it'd always just blow out a tire."

The one that hit him May 4 wasn't a typical IED, but a military-style bomb designed to pierce armor and inflict maximum damage.

The blast injured one soldier only slightly, but killed two others and left Lufkin bleeding so badly that he was certain to die without prompt medical care. With the vehicle still burning, Lufkin's platoon leader dragged him out through the gunner's hatch, medics quickly placed tourniquets on his arms and legs, and a helicopter lifted him out minutes later.

The Army's hospital in Baghdad is inside a former Baath Party medical center, down the street from the main palace in a section of the city that American officials call the International Zone but which nearly everyone else calls the Green Zone. Many of the signs are still in Arabic, but otherwise it looks much like any small hospital in the United States, right down to the harsh lights and the green tile.

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