The Art of War

by Zach Read –

Tim Weiner, MD, pediatric surgeon at N.C. Children’s Hospital, could see the dusty structure rising from the hill less than a mile away from base, near the village of Qalat, Afghanistan.

“They call it Alexander’s Castle – or The Castle,” says Weiner. “It was built by Alexander the Great 2,000 years ago. He garrisoned troops there. It’s probably as far southeast as he ever got.”

The building, located in Zabul Province in the southeastern part of the country, has been a strategic military asset ever since its construction. Most recently, the British, Russians, the Taliban, and Americans have occupied it. For a history buff like Weiner, who served an 8-month Navy deployment in Qalat in 2012, being stationed so close to an ancient historic site that has proven pivotal in battles spanning millennia was thrilling – but it was also excruciatingly frustrating.

“I couldn’t even go a quarter-mile down the road to see it,” he recalls, laughing. “The command would never allow one of their surgeons on such tourist trip. It was driving me nuts. So, I just painted it as they’d done back in the 1840s.”

Weiner’s deployment to Afghanistan two years ago came as he was turning 50, an unlikely age for a person to join the military. Half-jokingly, he refers to his decision as his midlife crisis.

“It’s cliché, but at some point, especially when you’ve reached my age, you want to be part of something bigger than yourself,” he says. “Joining the Navy was my crazy way of doing it. It was my midlife crisis.”

For most of his life, Weiner had never felt a call to serve. In fact, he had always felt removed from the military. His father, a pediatrician in a small western Pennsylvania town, served in the Marine Corp after the Korean War, but Weiner didn’t hear many stories about his father’s experiences. As a young teenager, during the tail end of the Vietnam War, Weiner watched as the military became increasingly unpopular in communities across America, including his own. He knew kids who joined because they couldn’t find decent jobs after high school. But his plans were to attend college, and he landed at Oberlin College, where he majored in Biology and Theater.

“I was pretty much a hippie at one of the hippiest schools around,” he says. “The idea that I’d ever serve overseas would have been unimaginable to everyone who knew me then, including me.”

For Weiner, the evolution of his views on the military began after he arrived at N.C. Children’s Hospital in 1997. He remembers a family scheduled for a prenatal consult at his affiliated practice in Wilmington, North Carolina. The mother was set to deliver conjoined twins. When Weiner heard she was part of a military family, he made assumptions about them: they would be young, perhaps not well educated, and it would be difficult to communicate the challenges of the surgery to them. After meeting them, however, he quickly realized that his understanding of military families was inaccurate. The family, like many of the military men and women who he would continue to meet, were dedicated, professional, and smart people who took tremendous pride in their families, their country, and their service. The husband, in fact, was an officer in the Marine Corp and the mother-to-be had been an English major with a keen observer’s eye and an interest in writing.

“They were as poised, bright, and insightful as any of my families,” he recalls. “I went into that consult with a bias about the military. Meeting them opened my eyes to how diverse and intelligent our military population is. We have been great friends ever since.”

Today, the Eskelund Award for Service and Teamwork in the Division of General Pediatric Surgery at UNC is named after the family.

Weiner estimates that military families make up roughly a quarter of his practice. Working with them is one of the greatest satisfactions of his career now and his experiences with military families while at UNC have played an important role in his decision to serve in Afghanistan.

“There were many reasons I got the urge to serve,” says Weiner. “But perhaps an important one was that I wanted to gain a better understanding of these patients. I wanted them to know that I had a small sense of who they are and what it is they go through.”

A Huge Save

In March 2012, Weiner was deployed to Qalat as a general surgeon with the 4509th Forward Surgical Team (FST). He estimates that roughly 80 percent of the patients his team cared for were Afghan soldiers, civilians, or police; the remaining 20 percent were coalition forces.

“We’d go through a run of caring for 8 to 16 severely injured patients over 36 hours, then for three days we wouldn’t see anything other than minor bumps and bruises,” he recalls.

Because so many of the civilian injured were children, the rest of the FST was relieved to have a pediatric specialist with them.

“In my experience, I’ve seen that it’s even more upsetting to caregivers when children are injured,” he says. “I was glad that the team was able to feel more comfortable knowing that I was there with them.”

He describes his FST’s work as “damage control surgery” – nothing fancy: stabilize the patient, stop the bleeding, and move them on to the next level of care. One particular patient, a 40-year-old Romanian soldier, presented perhaps the biggest challenge for the group. The soldier was walking the point, leading the patrol along a narrow dirt path, when he was blown up by an IED. The typical IED injury during the wars in Iraq and Afghanistan, Weiner explains, included amputations of both legs, the arm supporting the weapon barrel, and often loss of genitals. In this case, in addition to those injuries, the soldier’s abdominal wall had been sheared off.

“His guts had spilled into the dust,” remembers Weiner. “The dust in this part of Afghanistan, which is a dry region, is like talcum powder. He comes in with all this dust everywhere, all over him, and half the job is trying to clean up the wounds.”

The FST applied tourniquets and the soldier had to be amputated bilaterally. Urgent “completion” amputations of his mangled legs and left arm were necessary to control the bleeding and infection. Regarding the soldier’s bowel evisceration, Weiner had been through similar situations in his civilian practice. As a pediatric surgeon, he had experience with gastroschisis, a not uncommon condition in which babies are born with their intestines sticking out.

“The poor guy is dying in front of us and I thought, ‘Here I am – I see this all the time and I can deal with this,’” he says.

As they wheeled the soldier into the operating room, Weiner reached inside the main opening of the soldier’s wound, moved his hands through the open abdomen, and temporarily clamped the aorta by hand so that the heart would fill and blood would continue to flow to the brain.

That was the first step in trying to save him. The amount of blood he was losing would require a massive blood transfusion, but supplies were being drained. The team put out a call to the base – they needed volunteers for more blood. Within minutes, the receiving room in the OR filled with soldiers who wanted to donate.

“Oddly, that kind of event can be a morale builder,” says Weiner. “You want to help your buddies or anyone you know – even those you don’t know. So, everyone started lining up to give blood.”

The FST quickly realized that the soldier’s blood type was B-negative – a rare type – and saving him would require finding donations from outside the base, particularly from his countrymen and women. As Romanian soldiers on base heard about the soldier and the blood type needed to save his life, groups of them hopped into their armored vehicles to track down other Romanians at nearby bases.

“As he was starting to fall apart in the OR, blood began arriving from the receiving area from these guys who left base to find it,” says Weiner. “We started giving it to him. It’s warm blood, it has all the coagulation factors, it was type-specific, and he started clotting. It helped save his life and was a remarkable community effort.”

After they stopped the loss of blood, the team was able to send the soldier to Kandahar for the next level of care. They’d saved his life. He would later be sent to Walter Reed National Army Medical Center in Bethesda, Maryland, where he remained for a year. While at Walter Reed, he received a visit from the president of the United States, and when returned to Romania, he was greeted as a hero.

“It was a huge save,” says Weiner. “It was incredible to be a part of it.”

Coming Home

When Weiner reflects on his 8-month deployment, he’s filled with gratitude for the assistance he received from so many, including the university and his division partners in the Children’s Hospital.

“We live in such a military-friendly state,” he says. “The support filters down from the legislature to Chapel Hill and the Medical Center, where we see so many military-related patients and have so many employees who have military connections or have served….UNC Medical Center is a user-friendly place for the military and everyone here honors the sacrifices they’ve made.”

Although he never felt he was in any danger on the base – mortar and rocket attacks were infrequent and inaccurate – he believes that his experiences overseas have helped him better serve his patients by giving him an appreciation of what it must be like for young soldiers to return home from conflict. He has made it a part of his educational mission to teach residents that the families they care for in the Division of Pediatric Surgery are battling stresses that residents cannot fully understand.

“There was an adjustment period for me coming home,” he admits. “I had insomnia for months even though I never actually went out on missions. But I’m fortunate in that I have age and experience and a strong support system to be able to get through it. It helps me understand a little bit better what these young military families must go through and how difficult it must be for them.”

Weiner remains committed to these families in North Carolina and beyond, and he knows he may be deployed again. Among his goals moving forward, he hopes to highlight the lengths to which UNC Medical Center and the UNC School of Medicine go to assist military families.

“It’s a new mission of mine to make sure that the story of our good work gets told.”

Dr. Weiner took many photographs while in Afghanistan and with the help of Corpsman Joe Henry compiled them into this video of the 4509th Forward Surgical Team at work during OEF, 2012.