After the PHCP has stabilized his patient and there is a respite from the battlefield, the focus of patient care must shift to a period of convalescence. Convalescence is an integral step in the progression toward total patient recovery. Of course the care of the wounded is modified by conditions and circumstances that govern the tactical situation at hand. A fluid tactical situation inevitably leads to a patient convalescing in an expedient base camp that is often primitive at best (Photo 86). Given such a backdrop, the PHCP’s convalescent care of his patient may be limited to nutritional and emotional support.
NUTRITION
As the body begins to lay down a new framework of capillaries and tissue in the wound, it must be able to draw nutrients from the body. There is a direct correlation between the body’s nutritional state and its ability to fight infection and generate new tissue. Troops in the field frequently consume insufficient calories, which, compounded by stress, has a detrimental impact on the body’s regenerative powers (Photo 87). 1 If more than 2 percent of body weight is lost simply to sweat, both performance and recovery from physical activity can be affected.2
Photo 86: This temporary base camp depicts the environment in which the PHCP must be prepared to work. (Photo courtesy of D.E. Rossey.)
Photo 87: Joint American/MISURA team members just arriving back in Honduras after two weeks of operations inside Nicaragua. The emaciated, exhausted state of these troops is the result of extremely limited food rations during the offensive. Should these soldiers have suffered wounds, their normal healing powers would have been hampered. (Photo courtesy of D.E. Rossey.)
The PHCP must be diligent to maintain a balanced nutritional supply to the patient, whether this is via an oral or IV route. It may be necessary to add vitamins to the IV solution or feed a patient by a nasogastric tube. Patients should be encouraged to drink plenty of fluids (dependent upon their wounds), as studies have found that, when fluid intake is limited, field personnel will reduce food intake voluntarily.3
EMOTIONAL SUPPORT
Extreme behavioral and emotional reactions to the stress of battle have been recorded for as long as men have fought with one another. For the wounded soldier, stress mixed with despair can destroy his will to survive or alter his behavior so that he is unable to respond to the medical support given him (Photo 88).
Photo 88: American team member after having participated in extended operations inside Nicaragua. He is showing signs of physical fatigue, mental stress, and a lack of ability to function on the “local diet.” (Photo courtesy of D.E. Rossey.)
To be of aid, the PHCP must establish communication with his patient, give an honest ap - praisal of the boundar ies of help available, convey a sense that he is well in control, and, most importantly, generate the hope that there is a way out of this circumstance with confidence to know it can be done. Truth on the part of the PHCP is a defense against anxiety. There is no quicker way to set a patient emotionally adrift than for two separate PHCPs to answer a patient’s questions with completely different responses.
The PHCP should remember that distraught patients can be left feeling very embarrassed after “unloading.” The PHCP must at this time reinstill self-worth. Allowing the patient to participate in the decisions affecting him is a remedy for a tarnished self-image. This gives the patient a feeling of participation and an ability to cope.
Providing emotional support to a patient is probably more draining for the PHCP than the actual “blood up to the elbows” trauma case. The PHCP usually would much rather deal with the tangible aspects of emergency patient care. With continued exposure to trauma, the PHCP is capable of carrying out objective emergency patient care tasks in an automaton fashion. At the same time, he can relegate a potentially counterproductive emotional response to some little understood repository deep in the brain.
It is a special PHCP that can provide emotional strength and courage for both himself and his patients. It has been said that courage can be a consumable resource. If this is so, the combat-weary PHCP must learn to use his resources judiciously, as so many look to him for courage amongst the carnage of war.
NOTES
1 John S.A. Edwards and Donald E. Rober ts, “The Influence of a Calorie Supplement on the Consumption of the Meal, Ready-to-Eat in a Cold Environment,” Military Medicine, 1991, p. 466.
2 Madeleine S. Rose, Patr icia C. Szlyk, Ralph P. Francesconi, Laur ie S. Lester, and Rober t Whang, “Acceptability and Effect of Carbohydrate Electrolyte Solutions on Electrolyte Homeostasis During Field Training,” Military Medicine, 1991, p. 494.
3 John S.A. Edwards and Donald E. Rober ts, “The Influence of a Calorie Supplement on the Consumption of the Meal, Ready-to-Eat in a Cold Environment,” Military Medicine, 1991, p. 470.
