By Sarah Elizabeth Brown - The Chronicle Journal

Monday, October 8, 2007

Dr. David Puskas uses a drill to alter a pediatric femur nail — a man-made bone to replace a child‘s broken femur — so it will fit in a Taliban soldier‘s broken arm. Faced with a Taliban soldier‘s injured upper arm, but lacking the appropriate-sized titanium rod to stabilize the shattered bone, Dr. David Puskas made his own. Taking a power drill to a child‘s femoral “nail,” as the metal rods are called, Puskas made new holes for screws, polished the piece and inserted it into the soldier‘s arm.

Metres away from the “plywood box” of a military hospital at Kandahar Airfield Base is the airstrip. “If a fighter jet took off, it really did sound like it was going in one ear and out the other,” said Puskas. Cargo planes taking off shook the hospital. “That kind of environment breeds ingenuity,” said Puskas, 44. “You have to do what you have to do.”

The Thunder Bay orthopedic surgeon of 11 years returned in August from a two-month stint reassembling soldiers and police officers from Afghanistan, Canada and other coalition countries. Occasionally, he was called on to patch up Taliban soldiers and Afghan civilians. In those two months at Kandahar base hospita,l Puskas did several hundred operations. On one occasion, 11 casualties arrived and went through the two operating rooms in nine hours.

Sixty per cent of his cases in Afghanistan were things he‘d never seen or read about before. He learned terms like “biologic shrapnel” as he picked bits of one person‘s body out of another‘s. In two months, he attended ramp ceremonies for nine fallen Canadian soldiers.

Besides serving his country, Puskas found the level of “medical altruism” of the people he worked with gratifying. “You have an opportunity to work with people who are willing to extend themselves . . . to do things that aren‘t a normal part of their comfort zone, and it‘s very hard not to find that to be an intoxicating medical experience,” Puskas said in an interview.

It‘s a special environment, with no families, soccer practice, meetings or paperwork to distract from fixing broken bodies. “There was an enormous degree of collegiality and co-operation – general surgeons working hand-in-hand with orthopedic surgeons, the maxillofacial surgeon. Quite different from normal civilian practice, where in many ways we compete for access to resources for our patients.”

Knowing the military had downsized its medical staff in recent decades and hearing of the need for civilian specialists in Afghanistan at various medical meetings, he spent six months screwing up the courage to talk to his wife about going. His wife is also an orthopedic surgeon, and the two have sons ages 6, 8 and 10. The family mulled it over for a few months, and then it took another six months for Puskas to find a slot.

Wearing the requisite short hair and muscles, standing more than six feet tall, Puskas looks like a military man. Swears like one too. He looked at deploying as a member of the Canadian Forces, but it would have meant leaving his civilian practice for a long period.

Though there were two surgical teams who worked 24 hours in, 24 hours off, the doctors worked when there was work to be done, Puskas said. It was brutally hot, emotionally exhausting and seeing gun racks everywhere took getting used to, but Puskas brushes that off as nothing compared to combat soldiers who risk their lives daily.

“You don‘t have to believe in what we‘re doing over there,” said Puskas. “I personally do. I think it‘s a very good mission, I think it‘s the right level of our commitment. But you can‘t be there for more than 10 minutes and not see the incredible focus and the attention of the (military personnel) there.”