Riyam explained how her cousin had been trying to close a heavy, metal door in front of her aunt's house when the door became unhinged and crashed down upon her body. Her skull was crushed. Bruises on her brain caused swelling and internal bleeding, which increased the pressure in her skull, causing further damage to the brain. Surgeons were forced to remove a part of the bone to relieve the pressure. Cmdr. Theodore D. Edson, a general surgeon with Taqaddum Surgical, 1st Marine Logistics Group (Forward) and an team of surgeons assembled to receive and treat the girl, including Edson, 39 from Lexington, Mass. and Lt. Cmdr. Pamela C. Harvey, 39 from Muscatine, Iowa.
When the girl arrived with her father, she was delirious and disoriented, said Edson.
"She was hostile in a way that didn't make sense," said Harvey. She said the translator reported the girl was speaking gibberish.
"These are all signs of brain injury," said Edson.
The surgeons struggled to treat the girl, to stabilize her, but it soon became clear that she needed a higher level of care. A call went out for a helicopter to medically evacuate the girl to a better equipped hospital.
"As our evaluation continued, she deteriorated right in front of us, and our worst fears came true," said Harvey.
Surgeons and corpsmen "launched into action," said Harvey. They quickly medicated the girl intravenously and inserted a breathing tube. But because of the injury to her brain, she lost her ability to clot blood.
If the girl did not get blood soon, she would die.
A 'walk-in' blood bank message was sent out on Camp Taqaddum. The camp responded immediately with almost two dozen donors offering aid.
The girl got her blood. But stormy weather blocked flights from leaving Camp Taqaddum. With no specialized neurosurgeons in TQ Surgical, it appeared hope was lost.
"Back in the states, with an injury like this, the patient would be operated on within forty-five minutes," said Edson.
Two hours passed. Then three. Then four. Outside the storm raged, and inside anxiety peaked. The staff was beginning to consider opening her up here despite lack of resources and experience. At some points "you could barely see your hand in front of your face," said 31-year-old Marine Capt. Justin J. Hall, a pilot for air refueling transport squadron 352, Marine Air Group 16, 3rd Marine Air Wing (Forward).
Then they received a call from Taqaddum to do a casualty evacuation. Since helicopters usually do most "casevacs," the crew knew this had to be important.
"I knew that it was a head injury... (on a) 9-year-old Iraqi girl," said Hall, "that kind of brought it home for me." Hall has two children of his own.
The old mission was scrubbed, and feelings of urgency filled the crew. The determined Marines sat on the runway with the engines running, waiting for visibility to clear up.
"If there was any way we could get (the mission) done, we were going to get it done," said Hall.
They got it done, eventually delivering an unconscious Riyam to neurosurgeons in time for surgery.
"I just hoped she was all right," said Hall.
"Even when the Marines took off, we weren't sure if she would make it," said Cmdr. Tracy R. Bilski, a trauma surgeon with TQ Surgical. The injury was so bad that doctors and corpsmen doubted whether she would survive the operation, much less walk and talk again. So when Riyam, patient number 1267, walked back into TQ Surgical a month later and asked for strawberry bubble gum, the staff was amazed.
"The surgeons all ran in different directions to find her some strawberry bubble gum," said her 36-year-old father, Younis Aved Shihan, a taxi-driver who became an Iraqi Policeman because he wanted to help prevent insurgents from taking over his town.
"The Iraqi people of Habbaniyah hear what the coalition forces have done to save my grand daughter, and they cry. They are very grateful and you have gained them to your side," said Riyam's grandfather, 70-year-old Aved Shihan Ghathaib. After Riyam's operation, coalition forces learned that Ghathaib was a sheik, or tribal leader, in the town of Habbaniyah.
"It's because we were there, advising the Iraqi people, that we had the opportunity to save this girl," said McCarthy.
Riyam's uncle, 41-year-old Capt. Hameed Aftat Shihan, a chief security officer said this humanitarian effort has far reaching affects in the Iraqi community. Police Transition Teams in the area are now revered by the people. They meet with smiles, waves and friendly greetings almost every where they go. Some of the team members said that saving the girl has made more progress toward stability in the region a few weeks than is usually made in a few months.
"(The sheik) is in charge of 6,000 people, and all of them know this story, and soon all of their friends will know this story," said Hameed.
Riyam's grandfather has also informed many other sheiks, who will probably inform their people, he added. The effects of saving this one little girl have reached far beyond just those involved. The relationship between the Iraqi Police, the Police Transition Team, and the local population has changed for the better. The citizens of Habbaniyah have a new-found respect for the work of the Americans, who strive not only to improve the quality of the Iraqi Police, but also the lives of the Iraqi people.
"Saving this girl's life," said Hameed while in Habbaniyah PTT Headquarters, "was like saving all of Iraq."
But Riyam's fight for life is far from over. With a piece of her skull incubating inside her stomach, Riyam currently lives with only soft tissue to protect that part of her brain. Riyam is forced to wear a helmet now when she plays with her friends.
Another problem is that Riyam is still growing. Without her skull intact during her growth, she could face problems associated with irregular brain growth, such as a decrease in motor function capability and speech.
Within the next six months, she will need a follow up operation to replace the missing piece of her skull. It is a delicate operation that, due to the rebuilding of Iraq's infrastructure, will be almost impossible to provide in her home nation.
The efforts of coalition forces have bought her more time, but without this operation, Riyam's future still remains stormy. |
Commanders Susan P. McKeefrey, a nurse with Taqaddum Surgical and Pamela C. Harvey, a doctor with Taqaddum Surgical, got to see recovering patient Riyam Shihan again during an arranged meeting in Habbaniyah.
