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Chapter One: The Fatal Bullet

Whatever limits us, we call Fate.

Ralph Waldo Emerson

My son Nazar was working with a small American military unit in Baghdad as a contractor after the 2003 war in Iraq, he was always very friendly and greatly respected by his employers, but on the morning of the 29th of March, 2004, he was mistakenly shot by an American soldier from the unit he was working with, the bullet he received caused multiple injuries to various structures in his left loin including his kidney, he was operated in a make shift hospital in the camp where his employers were deployed. It was an extremely inadequate surgery because few hours later he had a massive bleeding from  the badly damaged kidney, he was transferred from the camp’s hospital during the night  to the American military hospital in the green zone the Combat Support Hospital [31st CSH] , he was operated there as an emergency which was a long and very complicated surgery  which lasted  seven hours and required twenty eight bottles of blood  from which he was recovering very nicely , but at the end of the first post-operative week his right kidney started to fail which required  kidney dialysis which was done in a nearby Iraqi hospital which was a  great failure, a disaster which  was followed by a heart attack which lasted for 14 minutes which was too long for the brain to withstand and left him in a

33 Chapter One

brain damaged condition which is called a vegetative state. He was discharged from the American hospital after six weeks still in an extremely serious condition when we took him home and started the very complex 24 hours a day care his condition required ourselves all the time waiting for a miracle. But there was miracle and after a nightmare which lasted more than 8 years my son died in Michigan few days before the last Christmas.

Nazar was born in Baghdad on the 9th of January 1967, my wife became pregnant shortly after we were married on the 25th of November 1965, it was a very normal pregnancy without much problems or complications, I was working at that time in the Kurdish city of Sulaymaniah in the north of the country, but by December 1966 the pregnancy was very so we returned to Baghdad to celebrate Christmas with our families and await the big event. The delivery was not easy, there were lots of problems which threatened the life of the embryo so it was ended by a cesarean section which brought a very healthy and robust boy. After few weeks with our families we returned back to the north and started the fairly uneasy job of raising a first born by a newlywed couple without the support of our families, but we managed, we had very good friends and an extremely  capable pediatrician who was always around when the boy had some medical problems and life went on reasonably satisfactorily and then at the end of 1968  I returned with my family to a new job as an eye specialist  in one of the major hospitals in the capital.

Life in Iraq during the seventies was excellent, it was a period of great improvements and reconstruction, the country’s earnings from oil [its main commodity] were tremendous and it was spent reasonably sensibly and for let

 

34 The Fatal Bullet

good projects but things started to deteriorate with Saddam’s first adventure, his war with next door Iran which started on September 1080 and lasted for eight years, but during those terrible years the western powers, the united states and its allies were helping him with military soft hardware and logistics which allowed him to continue the bloodshed but we were lucky, we were not affected directly by the massacre, our son escaped the hazards of the war, he was in Baghdad’s university studying economics from which he graduated in 1986 with a bachelor degree in statistics. He started working with one of my brothers in Baghdad who was selling building materials which were in great demand. We were reasonably happy but our luck did not last long because Saddam Hussein started his second adventure, he invaded and occupied our southern neighbor, the small sheikhdom of Kuwait.

Saddam’s occupation of Kuwait created an immensely furious reaction from the western world which under the leadership of the United States President George H. W. Bush assembled a coalition of more than thirty counties which after six months succeeded in  expelling him from Kuwait in a fairly short military operation [operation desert storm] In a very humiliating  and demeaning  way but  during that tragic episode Nazar once again escaped the hazards of the war ,he was working in an office which served the military but was not involved in actual fighting. But the whole country paid an exorbitant price for Saddam’s folly to make things even worse the war was followed by very harsh united nations sanctions which were supposed to contain Saddam but in fact it was the Iraqi people who suffered and very severely and because of that the next decade was terrible, the local currency lost its value and what we were earning was not enough, but I was lucky I got a job an invitation to work in Yemen in 1995 as an eye specialist which was a god sent chance so I

35 Chapter One

took and went to work there for a year which earned me a little more than 5.000 US$ which was a fortune at that time which sustained us very nicely for the next few years, and during my year in Yemen Nazar was with me there trying to immigrate to the united states but he was not successful so we both returned to Baghdad in January 1996. I went back to my old practice there and he to a small shop which belonged to his uncle who was now living in Michigan, he was married on the 28th of April 2000, he was surviving but when the Americans arrived in Baghdad he found a job with a small military unit with which he was very happy until fait struck us with a very hash blow when Nazar was shot by a young soldier from the unit he was working with.

It was about 2.30 PM, I entered my house in Baghdad and the phone was ringing, a young man said he was a translator to the military unit my son Nazar was working with, he told me that Nazar had fallen from a ladder when he was doing some minor repair to the ceiling of one of the rooms of the complex his unit was occupying, he said Nazar has injured his ankle  when he fell down but it was a minor problem and nothing to worry about and that I could go and see him if I wanted to. I took a small bite of food and ran the fifteen minutes distance to my daughter’s house picked up my son in law and started the one hour journey to where my son was working. The area was called  al-Rustamia, it was located in a south-easterly  part of the  city, it was home during the days of Saddam to one of his largest military compounds, there was an officers college a staff college and a huge hospital which served the air force personnel and their families, the area also housed a large number of military units and their equipment plus residential areas for the officers and the enlisted, it was a small city which was now home for a large contingent from the occupying forces and my son’s unit occupied a very small niche of it, the camp was now

36 The Fatal Bullet

encompassed inside a ten feet high wall which was made of huge blocks of reinforced concrete sealing the camp inside it, the wall sealing the camp waspunctuated by several entry points which were called check points, these were heavily guarded posts making entry to the camp a very difficult and a very frustrating and time consuming undertaking. I arrived at the camp with my son in-law about 4.0 PM hoping that we are going to be able to see my son fairly quickly, but we were asked to wait with a lot of people, mainly Iraqis who were also waiting to get inside.

We were kept there for more than an hour, the soldiers who were controlling the movements across the check point were young, they didn’t speak our language and they were evidently under very strict orders to be alert to anything suspicious because by that time the situation in the country was extremely poisoned and the relations between the Americans and the Iraqis were very tense to say the least. We were asked a lot of questions, we and a small bag we were carrying were searched and in the meantime they were talking to people inside the camp, which I presumed were my son’s employers and almost certainly the security office of the camp. Finally a young American in military gear came towards me and said his name was Gandhi, he was a  sergeant in my son’s unit he was a friend of Nazar and he had come to take us to the hospital were my son was staying. He told me during our walk from the check point that my son’s problem was not falling from a ladder but the boy was shot by one of his colleagues, an American soldier, he said my son was operated in the hospital here and he was recovering nicely, but when we arrived at the so called hospital I almost fainted, what they showed me was anything but a hospital, it was a small piece the remaining of the kitchen of the old hospital which has evidently received very severe pounding during the

37 Chapter One

early days of the recent war. It was very clear that the whole setup was established in a hurry without even the basic requirements of a hospital, but I did not worry about that at that time, I was in a great hurry to see my son and find out what had actually happened to him.  We entered through an entrance whose doors were about to fall on our heads, We came into a long narrow corridor to the left of which was a fairly large room which they said was the operating room, next to it was  another narrow area about 3 meters by 6 which they said was the ICU which again did not look like an ICU at all, there were only very few things there, there was an old stretcher on which my son was lying and next to him was seated a young medic  who told me that  he was watching my son’s recovering from last night’s . When I entered the ICU my son was lying on the stretcher still not fully recovered from the anesthetic he received during the operation, he recognized me but was unable to respond to my questions. The medic was very kind and polite, he was trying to comfort me and said that my son was recovering nicely and I needn’t worry, he was taking care of him and suggested that I better leave, I could come and see him tomorrow.

When we left the ICU!!! We came back to the same area we entered on arrival into the Hospital!!! , There were a lot of people there, there was a fairly young man, who was very strangely dressed with a funny band on his forehead and was behaving even more strangely and bizarrely, he told me that he was the surgeon who had operated on my son, everything was perfect and that I should leave the facility, I was becoming a distraction but he didn’t look to me like a good surgeon. In that limited space there was also a group of six army personnel one of them was big and heavy who was carrying few papers who looked like the leader of the group, he was asking questions and giving orders,

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sergeant Gandhi told me that the big man was an officer who was investigating the shooting of my son, I asked the big man a question or two about the incident but he did not even bother to answer me and went on with his investigation, someone from his group told me that I had to wait until the investigation is completed after which I would be told about what had actually happened which was after six months.

I went outside and sat on a bench near the entry to the facility, few minutes later Sergeant Gandhi came to me and said your son’s condition seems to be stable the medic who is keeping an eye on him is reliable and competent you have been through a lot today, go home take some rest come back tomorrow at 8 AM and I will meet you at the same check point to take inside. Next day I was at the check point at exactly 8 am expecting to be able to see my son without yesterday’s hassle but there was no sergeant Gandhi, there was a new batch of soldiers who knew nothing about what had happened to my son and I had to go into the same rigmarole like yesterday’s, they were talking into the phone, they again asked me dozens of questions, I was searched twice and was kept waiting a gain for more than an hour when finally a soldier came from inside the camp and told me that my son had a major  surgical complication last night, he had a very severe bleeding resulting from the surgery , he was sent in a helicopter as an emergency to the  31st Combat Support Hospital , the American facility  in the green zone, go you can see him there.

When I was told next morning that my son was sent to the American hospital I was greatly worried about what was going on, but I never imagined that it was the start of the incredible journey which we would ultimately travel, which would last more than 8 years of pain and appalling tensions, and would finally

39 Chapter One

end in death but then and in spite of my worries I was still not beyond hope. When I reached the green zone I found that like the camp were my son was hospitalized earlier was also surrounded by a similarly high wall of enforced concrete which was even more imposing and the entry into it was much better safeguarded with more check points which were secured by more soldiers and fortified by huge blocks of concrete and barbed wire, there were also in addition to the soldiers a number of Iraqi civilians who were acting as translators. It was now a bit later than 10AM and one of the translators an old acquaintance of mine who was previously an English language teacher in one of the best high schools in the city told me that visitors to patients in the hospital are allowed to enter only at 9AM, he also told me that next door in what was an excellent conference hall in the old days there was an Iraqi assistance center which is staffed by Iraqis helping the lots of Iraqis who had grievances and problems which resulted from the breakdown of the Iraqi state after the invasion, my friend the translator suggested it might useful as long I was near there to go and see them and I went there and was received  by a very young Iraqi woman, a university graduate who was working there as a secretary, I told her my story and then she asked me to sit in a nearby waiting area, she left me and came back twenty minutes later and said that my son was in fact in the hospital and confirmed what the translator had told me, it is only possible to get inside the zone after 9AM, we cannot do anything about it now, go home and come back tomorrow.

Next day, my wife, my daughter and myself were at the check point before 9 when at exactly 9 a big car arrived from the hospital from which emerged three American soldiers one of them was carrying a piece of paper with the names of the patients who were in the hospital, my son’s name was there so we were

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allowed to enter. it was a twenty minutes’ walk from the check point to the hospital and when we reached there we entered into a fairly spacious hall, which was well furnished in its center was a small desk behind which sat a young girl in a military attire who after few questions and making sure of our identity told us that our son was in the ICU on the second floor you can go there to see him. The American 31st Combat Support Hospital in the green zone was before the invasion was  singular hospital, a two story building, a forty bed structure which served only Saddam Hussein , his immediate family and the small circle of his nearest relatives, the most senior party members and ministers, and his most trusted  assistants. Because of its proximity to Saddam’s presidential palace which was now at the heart of the occupation authority it was taken over by the Americans and was used as a surgical emergency center for their injured personnel and some of their Iraqi employers. It was very clean and staffed by American physicians and assistants with an extremely good Intensive care unit, during Saddam it was very well equipped with very modern technology to which the Americans added a lot but not a kidney dialysis unit a fact which would have a disastrous influence on what would happen to my son later. There was an ICU unit on the second floor a four rooms area with a smaller one between two of the big ones were the staff could sit and relax for few minutes during their shifts, this small room would become home to my daughter who stayed with him until he was sent home six weeks later.

When we got into the ICU my son was lying on a bed in a corner of one of the rooms, there were many iv lines attached to him with wires connected to two or three monitors, he was still drowsy but he recognized us, there were a lot of people in the room one of them was a young African American woman who

 

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said that she was the surgeon who had operated on the boy, she said that it was a fairly long and difficult surgery which required 28 bottles of blood and entailed the removal of the damaged left kidney and the spleen and the repair and suturing of some damage to the diaphragm and esophagus , it was impossible to remove the bullet because it was now lying in his back behind the pancreas, she said that at the end of the very complicated operation the skin was so swollen it was impossible to close the wound because the sutures were not holding because of the fragility of the skin so they had to place a surgical mesh to hold the intra-abdominal structures and strengthening the wall.

Surgical mesh is a woven fabric used for reconstruction of abdominal walls after injury or surgery by providing support for the internal organs. The fabric is usually made of Gore-Tex, Teflon, polypropylene or some other polymer, but the insertion of the mesh, which was absolutely necessary in our son’s case, did not deal with the gaping wound, a very dangerous situation which was solved by using a Montgomery strap.

A Montgomery strap is a piece of adhesive the upper part of which is made of cloth which has few holes in its upper edge, one sheet of this thing is placed on each side of the gaping wound, a strong lace is entered into the holes of the two pieces and tightened slightly which results in a slight approximation of the wound edges, this procedure was repeated daily for two years until the two edges came together.

The surgeon said that he was recovering nicely we can see him for few minutes but try not to disturb him; she was extremely nice and evidently very capable and experienced, Dr. Jimmie Owsley. We stayed there for few minutes and then my wife and I left the hospital. We went back the next day, he was

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looking much better and my daughter who has remained at his bedside all night said that he was reasonably comfortable he slept well a view which was confirmed by Dr. Owsley who came to see him when we were there, we went back the day after and the day after for the whole week during which he was recovering very nicely, some of the tubes and monitors have been removed and he was ready for discharge but on the morning of the seventh post-operative day the male nurse who was in charge said that he [our son] was in a very good condition, he is no more an ICU case and he is going to be taken to a regular ward for few days to be discharged and to be sent home in a few days’ time. A bit later the nurse and myself were moving him from the bed to a nearby wheel chair when he said he was having chest pain so we returned him to the bed and within two or three minutes there was at least half a dozen ICU workers and others on him injecting attaching IV lines and wires to different monitors to him, we were asked to leave and wait outside the ICU greatly  worried and terribly concerned, half an  hour later one of the nurses came out and said he’d had a pulmonary embolism but they are working on him.

A pulmonary embolism (PE) is a blockage of the main artery of the lung or one of its branches by a substance that has traveled from elsewhere in the body through the bloodstream (embolism). PE most commonly results from deep vein thrombosis (a blood clot in the deep veins of the legs or pelvis) that breaks off and migrates to the lung, a process termed venous thromboembolism. A small proportion of cases are due to the embolization of air, fat, talc in drugs of intravenous drug abusers or amniotic fluid. The obstruction of the blood flow through the lungs and the resultant pressure on the right ventricle of the heart lead to the symptoms and signs of PE.  Mortality from untreated PE is very high. Prognosis depends on the amount of lung that is affected, the embolus

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must be resolved somehow if the patient is to survive. They were working on the boy for two hours at the end of which the same nurse came and said that your son’s embolic problem has been fixed you can go and see him now. We went to see him and went back every day the next week, he was getting better but not as good as he was before the embolic attack. What was really amazing about the pulmonary embolic attack of our son was that it was totally unexpected, he was on a very powerful blood thinner [Coumadin] and was receiving a very aggressive massage to his legs because he was totally bedridden and these measures should have protected him but they did not. At the end of the week doctor Owsley came to see us and said that his right kidney, the only one he was left with was failing and he needs kidney dialysis but we don’t have the equipment take him to a hospital in the city where it can be done. We took him to a nearby hospital, one of the main city’s medical centers, a teaching hospital which had before the war a very advanced nephrology dept. which has performed thousands of the procedure, but now a year into the war it has fallen into a terrible disarray, most of its senior staff the highly qualified doctors who were trained in the best centers in the united kingdom and the united states had either fled the country or were murdered, the buildings were pretty decrepit, but the most important problem was that the young doctors who were now in charge were badly trained and not very interested. When our son was sent from the American hospital he was very well prepared for the procedure including a very advanced ventilator, he was provided with a very detailed report about his condition and what he needs doing. But the doctors who were supposed to perform the dialysis were very clearly not to the required standard, the man in charge did not understand the report so he arrogantly threw it away and dislodged the ventilator and started the procedure providing the necessary oxygen with a small plastic bag which is

 

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called ambo which was not supplying the high levels of oxygen a dialysis needs, my son was in a terrible shape, very tense and straining and in distress so they aborted the procedure and sent in a hurry to the green zone ,but before he arrived there and because there  was no oxygen in the ambulance which was carrying him back , he had a heart attack,   he was taken to the cardiac resuscitation unit was very well staffed with a highly  qualified team who were able to reverse the cardiac arrest , his heart started to beat again but his brain has already been severely damaged from the lack of oxygen which left him in a vegetative state, his brain has been denied oxygen for 14 minutes which was too long.

A Persistent vegetative state is a disorder of consciousness in which patients with severe brain damage are in a state of partial arousal rather than true awareness. It is a diagnosis of some uncertainty in that it deals with a syndrome. A persistent vegetative state is a coma like state characterized by open eyes and the appearance of wakefulness. The vegetative state is a very strange and unusual medical condition, a patient in a vegetative state is not dead but he is also not alive in the usual sense of the word, he has lost his higher order cortical brain functions like speech and movement but the mid brain’s automatic ones like breathing and heart beat are normal.

The successful reversal of the heart attack which my son has suffered which nevertheless left him in a vegetative state necessitated the insertion of a Naso-Gastric [NG] tube to help with his feeding and hydration and the delivery of his medication and a tracheostomy to help with his breathing.

Naso gastric intubation is a medical process involving the insertion of a plastic tube through the nose past the throat and down into the stomach. The first nasogastric tubes were made of soft rubber. Recently, tubes have been made

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of slapstick and polyethylene compounds which are much easier to insert and create fewer problems for the patient.  A nasogastric tube is used for feeding and administering drugs and other oral agents. For drugs and for minimal quantities of liquid a syringe is used for injection into the tube. For continuous feeding, a gravity based system is employed, with the solution placed higher than the patient's stomach. If accrued supervision is required for the feeding the tube is often connected to an electronic pump which can control and measure the patient's intake and signal any interruption in the feeding.

It was also necessary to help with his increasing difficulties with breathing which has resulted from the damage to his brain has sustained, so they also performed a tracheostomy.

A tracheostomy is the surgical creation of a hole in the front of the neck and through the trachea. A tube is usually placed in the opening. The tube provides  in airway and access to remove lung secretions and excess mucus. Once the tube is in place the patient will breathe through the tube instead of the nose or mouth. A tracheostomy can be temporary or permanent, depending on the condition for which it is needed. A tracheostomy is a common but major surgery with significant risks and potential complications it is recommended for the following conditions:

A blocked airway and in Long-term coma.

Tracheostomy tubes are available in several sizes and materials including semi-flexible plastic, rigid plastic or metal. The tubes are disposable or reusable.

They may have an inner cannula that is either disposable or reusable. The tracheostomy tube may or may not have a cuff. Cuffed trach tubes are generally used for patients who have swallowing difficulties or who are

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receiving mechanical ventilation. Non-cuffed trach tubes are used to maintain the patient’s airway when a ventilator is not needed. The choice of tube is based on the patient’s condition, neck shape and size and purpose of the tracheostomy.

In our case and after six weeks in the hospital nothing changed and we were told that they can do nothing for him so  you can either take him home and do what he needs yourselves which might be for months or years or otherwise let us stop his life saving devices and allow  him to go which was never an option to us, so we took him home and began the  very long  and extremely difficult journey which has already started in Baghdad and lasted for two years and then to Amman in next door Jordan for another two years and finally to Michigan in the United States which would last for more than four years at the of which  nothing got better in  fact during the last months of his struggle his condition started to deteriorate pretty rapidly when the end came before last  Christmas.

 
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