I taught the medics that with head and neck or facial traumas, when in doubt, first secure the airway, and then pack any bleeding wounds. —Philip Zapanta, MD
Explore This IssueJune 2020
SR: So, your first tour of duty was in Oklahoma?
PZ: Yes, and it was actually really fun. Fort Sill houses a big Army field artillery school. It was my first time working on a military post, and it was invigorating to interact with the soldiers’ families, who remained on base while the soldiers were deployed.
That was a big eye-opener for me. Their sacrifices were palpable. Their loved ones were somewhere else, possibly in harm’s way. I wanted to give them the best care, because that’s what I would want for my family.
SR: What was your role as a doctor on the base?
PZ: I was the only otolaryngologist, so I was busy treating soldiers’ families as well as a big veteran community. I worked in the clinic four days a week and in the OR one day a week, seeing 20 to 25 patients a day. I worked with a surgical tech who had been a medic in the military. He pretty much functioned like a chief resident; I would leave him in the OR to close at the end of my cases while I ran back to the clinic to see patients. We were a small, efficient team.
SR: How did you mentally prepare for your deployment to Iraq, halfway across the world?
PZ: Overall, I was excited, but my biggest concern before leaving was making sure my family was taken care of—so long as that happened, I would be fine. I had already accepted whatever might happen to me. I was concerned about being unable to help them with any issues that might arise, so I got everything inspected in our house, and I took each of our cars to be serviced.
SR: As a back-fill, you basically practiced on your own. Did you also work independently in Iraq?
PZ: In Iraq, I was part of a head and neck augmentation unit, meaning we would augment a hospital. Our unit included me, an anesthesiologist or nurse anesthetist, a neurosurgeon, and an ophthalmologist, plus the OR techs and other integral OR support staff. In theory we were supposed to be mobile, but for our mission they had us stay at one main hospital where we functioned like a level-one trauma center, receiving all the combat injuries. I was the otolaryngologist on call 24/7 for all of Iraq, Syria, and Jordan. I could either be really busy or have an easy day, depending on what was happening in the region.
SR: What did your work environment look like?
PZ: Our hospital was a large tent, just like what you would see on M*A*S*H. It could probably take two hits by rocket-propelled grenades before collapsing. I knew doctors in Afghanistan who worked on dirt floors, but we had some sort of hard, synthetic wood flooring. We had two operating rooms. The larger OR, the better of the two, was in a self-contained module that could be packed up and transported anywhere—it unfolded like a Transformer toy into a functional structure. The M*A*S*H surgeons had better lighting than my OR, though. I operated with an REI headlight and a lamp with a 60-watt bulb. It was difficult to see sometimes!
SR: Your description puts into perspective 19th century paintings depicting laryngologists, holding a candle to a laryngoscope while operating.
PZ: Exactly! That’s not far off from what I had to do. I don’t know how they even saw anything, much less well enough to do a good job.
SR: Is there a case that you remember most vividly from your deployment?
PZ: The biggest case I had was a soldier who was shot in the face by a high-velocity round, probably from an AK-47. Ninety percent of his maxilla was shattered, and of course all the structures behind it were traumatized. He had a temporal bone fracture, a sphenoid sinus fracture, a cerebrospinal fluid leak, and a subcondylar mandible fracture. The bullet had pierced him through-and-through, so he didn’t have significant loss of skin, but his skin was fileted open. I was able to repair the cutaneous defects primarily, but only because he had no maxilla.
The medics who saw him in the field did a great job. I had previously done some head and neck teaching through teleconference at the main Iraq site. Medics at various locations had been sent my slides ahead of time, so they could see remotely what I was talking about. I had reinforced with them how to manage penetrating head and neck trauma, which was important since I’m frequently not there with them at the point of injury. I taught the medics that with head and neck or facial traumas, when in doubt, first secure the airway, and then pack any bleeding wounds. That’s exactly what they did with this soldier.
He had lost so much blood in the field that they activated the “walking blood bank.” In a combat zone, if there’s a trauma that requires more blood than is available to transfuse, the medics put a call out to any soldiers who have signed up to donate their own blood on the spot. It’s such a different system from anything else I had seen, and very effective in the field.
SR: Was there a big mental adjustment returning to GW after deployment?
PZ: Yes. Routine issues no longer carried the same sense of urgency for me. For the first several weeks after I returned home, I never felt like I was in a rush. Something that might have burdened me before, like being asked to refill Flonase prescriptions when my to-do list was already so long, wouldn’t bother me in quite the same way.
SR: How do the experiences you’ve had impact how you mentor your residents?
PZ: It’s a privilege to be in a collegial community where you can ask questions and teach one another. Sometimes when you’re in practice, there’s no one questioning you but yourself. Learning to question is important, and if someone doesn’t push you to do it, you might not. I try to instill that in my residents and medical students: Always ask questions.