‘It’s never too late for anything, everything is salvageable’: A medic tells a story of 2,820 breaths and a man injured in the battle against Daesh

Jonathan Rieth started working as a medic in 2016 with the Kurdish Peshmerga. Then as the war against Islamic State entered the battle for Mosul he continued volunteering to provide medical aid with the Iraq Golden Division during the liberation of Mosul. “I now recently found myself back again after a roughly 16 hiatus while attending paramedic school. I honestly never thought I’d find myself back here, especially in Rojava.”

He recently wrote a recollection of a moving experience that he has given us permission to share.

[As a personal note I met Rieth in Bashiqa overlooking the front line, where I spoke to him about his experiences. Later I saw him again during the first days of the Mosul offensive in Nawaran. I saw his post below on Facebook  – Seth J. Frantzman]

By JONATHAN RIETH 

3 hours, 8 minutes 2,820 breaths.

That’s roughly the number of times I breathed for a person.

It all started back at Green Village just outside Hajin at our CCP. Daesh was pushed out of Deir Ezzor, through Hajin and now occupy a few small towns and villages but are putting up one hell of a defense. They have even been launching some fierce attacks. I was transferring video from my GoPro to my computer and backup drive. Our commander enters the room and waves frantically.

“Nahoosh” I ask.

“yes!” He says.

I head out front and I hear someone say, he was shot near the heart and is going straight to the Americans. I see a young man on the stretcher outside the ambulance with several people around him. I take charge and push people out of the way, I feel like a jerk but times like this you need to take charge, be the boss, even at the risk of upsetting people. I yell for a chest seal. No one knows what I’m talking about. I run to grab my Go bag. I rifle through it looking for the chest seal then I remember the only chest seal I have is in my IFAK (Individual First Aid Kit). I can’t see the wound, but there is a lot of blood, so I really have no idea what I’m about to find.

This kid has on the most ridiculous number of layers. I tell the Kurds I am going with him because I know seconds will count here, because I’ve yet to find the injury. We get him in the ambulance and I start cutting clothing. A winter jacket, a military uniform, then at least 5-6 shirts. I recall asking him if he was trying to be like Ralphie’s little brother in the movie A Christmas Story. I think “bro can you even put your arms down?” I have to watch my Go Pro video, I’m pretty sure I actually ask him that.

I bought a pair of Leatherman Raptor shears for this trip, best thing I’ve ever bought. There is no way I could have cut through that much clothing that fast with regular trauma shears. After I cut through everything I find the wound. He had a gun shot wound to the upper left chest. I put on a chest seal and cut the rest of the shirts off and roll him over looking for an exit wound. I find it and put on a second chest seal.
I cut off his pants, shoes and socks. He has two additional wounds to his feet but not my main concern right now. The guy is almost trauma naked when we pull into the American base. I give a give update on what I’ve done and they bring him in.

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“This is from the actual ride” (Jonathan Rieth)

I hang out in the ambulance, I try to stay out of the way and not bother the high speed Army medics. Some of them think it’s cool I’m here and some don’t. I’m not looking to piss anyone off. We sit outside for 15-20min when I’m asked to come inside. I think to myself, I’m going to get a nasty talking to for being out here, just the opposite. We walk into one of the medic bays and I see they have an intubated patient. They said he needs to go to Hasakah and can’t be transported by air. I then realize I was just volunteered. I go on the offensive and say “I’ll do what ever is needed here.”

If I didn’t ride over with that kid I wouldn’t be here to help now, things happen for a reason. I can tell they appreciate someone with my skill and someone they can explain directions to without an interpreter. The instructions are easy. Breathe for the guy once every 3-5 seconds. Give 1ml of Vecuronium every 15min. 1ml of Propofol/Ketamine blend every 15min. As we start to leave with the patient I hear Shoop by Salt-N-Pepa playing in the med bay. This song is my jam to say the least so I kinda sing along quietly and a few others join in. A last bit of fun before shit gets real.

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The road to Hasakah is around a 200 km drive 

Normally a patient like this would be transported with a ventilator, cardiac monitor, a respiratory therapist and a critical care nurse in the very least. Over smooth roads with all the comforts of an ICU. But today they get me, the guy that failed his state paramedic test by one point. They get a guy with no monitoring equipment, an ambulance with nothing in it and driver that I need to yell every 30min to not smoke with a patient in the back.

So they pass me the medications and I confirm my instructions and we load the patient into the ambulance. I do some rough math and realize I will need more medication for the long drive. I ask for more and they gave me what I asked for. They hand me more medication, saline flushes and a additional bag of fluid.

The Kurds are taking their sweet time. A couple American medics come out and talk to me, ask for a selfie with me. I think they are going to send the picture somewhere to see if I’m a wanted man or something. One asks if I was part of a “team” and if it’s ok to take my picture. I find it funny, I’m just guy out here trying to help. Plus I heard I would win a date with Jennifer Lawrence if I came here but I think I was lied to.

Once we start out the safety net comes off. It’s me and the patient. I don’t know his name. He will never no mine. I’ll probably always remember his face, of course he will never know what I look like. His life is 100% in my hands, I have one job, breathe. I keep telling myself that. Breathe…breathe. I pray that I do this job correctly. I set an alarm on my phone for every 15min. At the 15min mark I breathe with one hand and get the 1st medication ready to push. I push the medication between breaths, I need two hands for that. I give a couple breaths and let the medication work through the line. Then I give the second medication. I repeat this process for 3 hours.

Maybe a voice, even a voice he doesn’t know, in a langue he can’t understand will help keep him on our side.

Three hours is a long time to do anything repetitive. But this is more than just a repetitive process. I’m watching every detail, are his eye fluttering, is he trying to breathe over my breaths. How is his pulse, has it been constant? I could kill him with the medications I’m pushing. If I breathe to slow he could suffer from hypoxia, causing brain damage and an acid build up in his system. If I breathe too fast and hard I could push air into his stomach and he could vomit. I don’t have suction to fix that problem so he could die choking on his own vomit, and I could do nothing about it, just watch him die. Everything I do has a sweet spot and I need to keep my mind in that zone at all times.

I find my mind drifting from that sweet spot from time to time. I keep thinking about her, those thoughts consume me. I can’t do that, not right now, not right here. I reflect on my mentor Chris, amazing paramedic, not just because of his skills and knowledge but how he treats people, his empathy. What would Chris do right now I ask myself. Chris is a Christian and I’m certain he would pray. As a terrible example of a Christian myself, I pray for the patient and for my ability to stay the course and manage the situation correctly. I also begin to talk to him. I tell him about home, my family, I just talked. Maybe a voice, even a voice he doesn’t know, in a langue he can’t understand will help keep him on our side.

Breathe…I start to think about two years ago, before paramedic school. This situation would have scared the living hell out of me, not understanding the drugs or how to manage the situation if things get sideways. This transport scares me now, but I know I can handle it. One of my other mentors Heather has always told me to have a backup plan, and when that fails, have another. In my Go bag I have an advanced airway kit, not as good as the ET tube but it’s a backup. The roads are so bad that there is a very real chance the ET tube can become dislodged. At that point I’d have to switch to the Advanced airway. If that should fail I have a surgical airway kit.

It’s never too late for anything, everything is salvageable.

Breathe…just breathe… it’s all I tell myself. It’s horribly uncomfortable in the tiny ambulance. My legs keep going numb from the awkward way I have to sit. My hands getting a bit sore from squeezing the bag. How dare I complain, there is literally a life on the line and my small discomfort pales in comparison to what he is going through.
I realize as I keep telling myself to breathe for my patient I am also giving myself some good advice, or maybe he is, maybe that’s why I’m here, now, for this moment. My breakup earlier in the year has devastated me, left my very soul sore and worn out. Maybe what I ned to do myself is to slowdown and breathe. Lots of emotions on this long trip but I keep them in check the best I can. Life is fragile and short, tell the people you love that you love them daily, even if it sounds routine, tell them. Don’t sweat the small stuff, it’s all small stuff. It’s never too late for anything, everything is salvageable.

If I lose it, if I get out of sync, he dies. No mistakes here, it’s not allowed. People forget that about EMT’s and Paramedics, we don’t get to make mistakes, we don’t get do overs. We go from relaxing, drinking tea, goofing off to 100% mental and physical focus in sometimes a fraction of a second. It’s a lot on the mind and body. We are not super human, just the opposite, we break down, just usually not in front of anyone. No one here wants to see the medic on his hands and knees at 4:00am in the morning crying to the point of vomiting. Sometimes it just gets ugly, I found a spot in one of the abandoned buildings to be ugly.

Thank you for reminding me…to just breathe.

The other element I have to consider is Daesh [ISIS] has been launching a lot of small attacks from motorcycles and placing IEDs to take out the military units and even the ambulances. We are going through those very villages where over 20 have died in the past 24 or more hours in such attacks, I know because the I’ve treated the injured and put the dead in bodybags. I don’t think Toyota built this ambulance for a war zone. I think my old bicycle was tougher than this thing. I was in a rush and didn’t bring my body armor. So if we are attacked there is no defense, nothing.

We thankfully arrive at the hospital in Hasakah safely. We go straight to their ICU. Doctors swarm, I hand off ventilations to a nurse and slowly back out of the room, I’ve done all I can, he no longer needs me. I’m no longer the captain, they are the captains now. I walk back to the ambulance and listen to Amber Run while I wait for the driver. It’s an attempt to mentally disappear for a few seconds.

To the man I breathed with and not for. To the man that almost died fighting the very demons of hell so the rest of us didn’t have to face them. I will always remember your face. You humbled me, I enjoyed our talk, thank you for reminding me…to just breathe.

3 hours, 8 minutes 2820 breaths.

I’m sharing this story because it rocked me to my core. It isn’t about bravery, being a hero or anything of the sort. It’s about learning, growing, building, loving and being scared. It’s about slowing down to breathe. No matter how bad things are, with all the cards stacked against you, someone will always have enough love left to help you breathe.

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