Date: August 2nd, 2015
Location: Landstuhl Hospital, Germany
Time: 1415

I pushed open the door with my back done scrubbing my arms and shook my hands a resident nurse handing me a pair of gloves and another tying the surgical blue robe pinning it.

"Thank you", I said snapping on the white latex gloves.

I headed over to the patient. "Anesthesia seems to be working", I muttered snapping over the face mask. This patient was a talker, it was interesting to see her finally quiet. Normally all bubbly and bright. I enjoyed her conversations. Another surgeon came in through the door getting his gloves strapped on and he smiled.

"We ready to get going?", he asked.

"The longer you talk the longer I have to wait", I said turning on my light from my glasses and moved the lamp over the arm. The second surgeon was Doctor Cade. He came over on the other side getting things ready.

"So, an Ulnar Nerve Decompression surgery", said Doctor Cade.

"Yes", I replied getting a marker drawing a line.

I handed it to the waiting assistant. She handed me the next instrument. Dr. Cade came over taking his small tweezers as I cut the four incision is along the elbow in between the two bony prominences that are on the same side of the arm as the thumb. The incision was deep enough to visualize the ulnar nerve.

The nerve itself travels into the upper arm to the point that is passes through the triceps muscle. It continues in the forearm until it passes through a muscle in the forearm. I began to explore these primary sites and released any compressive forces on the ulnar nerve. Once the entire nerve was completed thoroughly it seemed to be well decompressed. Dr. Cade observed as well aiding in the process. He began to stitch the cut the with the overlying connective tissue and skin are closed. I pulled carefully and looped it through in the tweezers.

"So, how's your day?", asked Dr. Cade.

"Fine, and your's?", I inquired politely.

"Good, rather long", he said.

"Won't get any shorter", I said.

"Maybe the paper work will", laughed Dr. Cade.

"I wish", I replied.

"I'm assuming you have a more than me today", said Dr. Cade.

"I always have paperwork to fill out. I'd much rather be doing things like this than paper work and signing documents", I said.

"I'd be happy to do a bit for you", said Dr. Cade smiling.

I shook my head smiling, "I appreciate the offer, but it's my responsibility, you have enough to deal with", I said cleaning the excess blood and cleaned the wound. Once finished I took off the gloves tossing them in the trash and took off the coat tossing it in the hamper. I scrubbed my hands with the soap. I wiped my hands dry turning to exit when my pager went off beeping.

I took it. "New Cases on your desk meet in the conference room", I muttered. I groaned the nurse at the desk was terrible at communicating. Beginner intern. I tucked the pager back into my pocket.

"You seem on agitated", said Dr. Cade. "Front desk?", he asked.

"I'm going to snap at the intern", I sighed.

This was the third time. I sighed shaking my head, "Good day Dr. Cade", I said.

"See you around Dr. King! Pleasure doing the surgery with you", said Dr. Cade.

I nodded smiling, "Pleasure working with you as well Dr. Cade", I replied cleaning the water droplets off my glasses and set the navy blue rimmed nerd glasses on. I put on my white coat pushing open the door heading down the hall.

I traversed up taking the elevator and went down to my glass office and popped in snatching the files off my desk. I left flipping the first one open. I began to read. Eyes flicking back and forth. Head trauma, possible nerve damage within the vertebrae. I shut the first file knowing that the team would get me up to speed with the new cases they had received and discuss the status of the patients being transported to Landstuhl Hospital within the next forty eight hours.

I knocked on the door before entering. I stepped inside closing the door behind me to find the usual group sitting at a long table. Dr. Reinhard smiled. He was head physician and had been working at Landstuhl for many years. A highly acclaimed trauma physician.

"Good afternoon King", said Dr. Reinhard.

"Good afternoon Reinhard, I'm sorry for the delay", I replied.

"No need to worry, I know this was last minute on my part", He motioned for me to have a seat wanting to continue. Dr. Reinhard was a man who got things done but he would be sure to get me filled in quickly. There was also Dr. Helen who was our nutritionist. Officially we couldn't fully make an assumption until our diagnostic team had officially made their full analysis. At the moment we only had the information coming from the emergencies medics in Afghanistan.

However, it's an important aspect for us to get to know our patients before they arrive so we can treat them within an average of three weeks and then decide if they are able to return to service or to be flown to Washington for further intensive care.

"So, we have fifteen who are scheduled to arrive by Sunday, August fourth at around 1345. We have eight men and seven women. Three of which have developed intensive fever, two developed food poisoning, seven have suffered bullet wounds, and three others were injured at the explosion of an mine", said Dr. Reinhard.

I sat with crossed legs with my pen shaking it from side to side between my fingers as I read the information and medical history of the patients one by one looking at their profile pictures. The locations of their wounds and the notes of the other doctors and combat medics. I would most likely be require for ten of these patients.

"What do you make of this King?", asked Dr. Reinhard.

I tilted my head and then raised it speaking, "From the injuries it's highly likely Craniotomy will be required for a few of them. The swelling may have been reduced but with the change in elevation further operation on brain may be required...", I paused and went to the final file in the stack and opened it.

I raised my eyebrows seeing the file of an Italian soldier. It was uncommon since the majority who came here were American service members but in truth we took any injured or ill patient. I continued to read the file.

Sergeant Bryan Bernardi, "This one will likely need Lumbar surgery. No, correction will require it", I said lifting my head.

"I'll start forming a meal plan for these individuals and will deliver it to each of you, by when do you believe the Lumbar surgery should be done?", asked Dr. Helen.

"I need to evaluate the patient first before proceeding. However, the Craniotomy prosecute should be done as quickly as possible to avoid further damage and injury", I replied.

There was further discussion as to what was to be done. Such as their location, the requirements of the room and the items needed to accommodate each patient to suffice their needs and bring them to good health. Officially Dr. Reinhard would be the first to see them. I would only see them after diagnosis. The neurologist would give me the report of their conditions and confirm the need for surgery along with the diagnostic team.

I walked down the halls. For now I had other patients to check on.