Homecoming

By the skin of our noses, both Dr. R and I were able to get onto a plane late night June 1st. We travelled to Germany, Iceland, then Baltimore. Luckily, I arrived early enough at BWI that I was able to catch a flight to San Antonio through Atlanta. After almost 31 hours of straight travel I arrived home. I was greeted by the beautiful sight of my family. It was so great to be home.

Several weeks have passed and I am now busy being back at work; Afghanistan, and FOB Salerno seem so far away. However, I can truly say that there isn't a day that goes by that I don't thing about my time there, the people I met, the experiences we shared, and those that are still over there. I pray that they will remain safe in this very dangerous time. I hope that what I did over there, however small it may have been, will somehow contribute to the stability of such a wild and chaotic country. Take care.

Lost in Transportation

(Which way?)

I was really hoping that this weeks blog would be of my homecoming, however, military transportation isn't exactly non-stop. Dr. R and I left FOB Salerno early Tuesday morning. We flew on a "puddle hopper," a small two propeller, 8 seat cargo plane. It had brought mail to Salerno. We actually helped empty the plane's contents, then got on board. What a ride. It went through the mountain passes and was rather bumpy. Some of the mountain sides were just a stone's throw away. Now I understand why some of our patient' couldn't be transferred to Bargram due to weather conditions. When we reached the hospital in Bagram, of course no one knew we were coming hadn't book us a flight out of Manas, as they had told us. I was a little ticked off. We hurried and did the required paperwork and left to find our own way home.

(Al Udeid AFB, Qatar)

At the PAX terminal (Airport) there happened to be a flight to Al Udeid AFB in Qatar (picture # 2) leaving within a few hours. We were able to catch this flight. It was on a C-130, a four propeller cargo plane. We rode with a country band that was touring Afghanistan, Matt Poss and Rolling Thunder. We were delayed and waited on the tarmac for about an hour and a half. During this time, the band sang some of their songs, pretty cool. They performed at Al Udeid the next day. Again, it was good to hear live music. They did a shout out for us while on stage and we took pictures with them after the show. I really appreciate their time and effort to come and entertain the troops stuck in the sand. The plane ride was just over 5 hours and we arrived around 11 PM, too late to catch the flight to Baltimore (BWI) leaving the next day. When we checked in, we were informed that we were booked for a flight to BWI on June 3rd. Huh?

(The Bra, the tent at the center of the base)

The last 5 days have been filled with excitement: sleep, eat, watch movies, eat, sleep, swim at the pool, eat, sleep, read, eat, surf the internet, sleep, walk around, eat...you get the picture. All in all, it's not a bad base to travel through. Notice I said travel through. As a surgeon, I wouldn't want to be deployed here. Among the many different missions of this base, one is to house and entertain troops to and from their area of responsibility (AOR). It is also a place for troops who are deployed for more than 6 months to come and enjoy some rest and relaxation (R&R). Therefore, there are more amenities here that help accomplish this mission. For example, picture # 3 shows what is referred to as "the Bra." It is a tarp in the middle of the coalition camp, where the majority of the troops stay. Wireless internet is available, and different activities occur here throughout the week. Additionally, 3 drinks containing alcohol can be purchased every 24 hours for those that want it (picture # 4).

(Indoor air conditioned mall)

Because so many of the troops here are "in transit," there are many rows of tents that serve as temporary barracks (picture #6). They contain 22 pairs of bunk beds. Much better than a cot, but after the last 4 months, it will be nice to have my own room! The base also contains multiple base exchanges (BX), one of which is indoors, like an indoor mall. It contains a food court, movie theater, wireless internet, barber shop, store, post office and large TV and game room (picture # 5). The best part is that it is air conditioned. This is greatly appreciated in 120 degree, 80% humidity weather. The base also contains a swimming pool (picture # 7). Part of my day has been spent laying by the pool , reading, and taking a dip to cool off. I will probably still come home without a tan. While walking through the base I came across picture # 1. I always loved the sign like this on the TV show MASH. Just a few more days and this adventure will be over. Take care.

(The pool)

Parting...

Today we discharged the patient with the heart injury. It’s amazing what the body is able to go through and recover from. He is doing very well. I took this picture with him this morning (picture # 1).

He was a friendly guy who would smile and wave to us on the ward. I couldn’t get him to smile for the camera. I’m not sure why he has such a horrifying look on his face. It turns out that he is the sole bread winner for his family. I’m glad that we were able to help him. My replacement arrived here yesterday. I will be leaving Afghanistan this week. The fact that as I get older time seems to accelerate continues to amaze me. Although over 4 months has passed since I left the United States, it has come and gone in a blink of an eye. I really believe that this has been a wonderful experience for me, both personally and professionally. Although being away from my family has been difficult, I feel closer to them now than I did before. They have been so strong and have flown through this like champs. I look forward to seeing them shortly.

I will miss the people I have met over here. I have worked with people from all of the services from all over the United States. I can truly say that they are a wonderful group of individuals that are sacrificing much in the service of their country. I couldn’t have asked for a better group. In this blog I have included pictures of many, but not all, of them. I’ve enjoyed their hard work and support in the trauma bay, their countless hours within the operating room, and their care of our patients in the ICU and ward. I commend them in the highest and would gladly have them take care of me if I were injured. I’m also grateful for the time we have spent together eating hundreds of meals, watching hundreds of movies, and also playing hundreds of games of Call of Duty. Thank you for all you have done. You as well as your family should be proud of your service. Keep up the good work. I will pray every day that God will watch over and protect you. Take care.

This is B, one of the army special forces guys out of Ohio.

This is a picture Dr. D and I took earlier with H, one of the “dustoff” flight medics.

This picture is of DP, a flight medic, and myself the day before I left.

This is a mix of nurses from the ward as well as the OR: F, R, M, L.

M is a CRNA. He is actually from Provo, UT. Funny enough, he deployed earlier to Iraq with one of my surgery attendings, John Sorenson, from the University of Utah. Small world.

L is a scrub tech from Florida and K is a scrub tech from Las Vegas. They did a great job.

W, me, B, and G in front of a Blackhawk.

Dr. R is an orthopedic surgeon in Maryland. She has also completed her deployment and will be leaving. Dr. G is an anesthesiologist who lives in England. He has just over a month to go.

This picture is of the surgeons and OR staff. We’ve worked together almost everyday for the last 4 months.

This picture is of the entire crew that works in the hospital. Most will complete their deployment in July.

Hearts and Minds

(Khost)

***WARNING: This blog entry contains some graphic surgical images that may be inappropriate for some viewers. Please proceed at your own risk.***

(Mosque, Khost)

The pictures of areas off base were given to me by Jeff, a special forces medic. I don't get off the base, so I really have no clue as to what my surroundings look like. He graciously gave me these photos.

As we work day in and day out we realize that as medical care providers we are not on the front lines of this conflict. Our primary mission is to provide medical support and care to those troops that are, both US and US coalition. Our secondary mission is to provide medical care, as resources allow, to locals. As I mentioned before, we actually have a "local national" clinic that runs 5 days a week and allows us to see a variety of patients. In this blog I have already talked about several different disease processes that we have taken care of since my arrival in January. We are also very active in treating civilians who are injured in the conflict. We hope that in addition to other humanitarian efforts that are on going, this secondary mission will help win the "Hearts and Minds" of the people. This week it's meaning became a little more literal.

(Men in a field...I think it looks like a postcard)

This week began as any other. We were anticipating several elective cases during the week. However our plans were dramatically changed when armed men (Taliban) attacked the Governor's palace as well as stormed the municipal building in downtown Khost (picture # 5, see New York Times). There were about 30 men in all, several of which were suicide bombers wearing explosive vests. A firefight ensued between US special forces along side of Afghan commandos and the Taliban. Many were injured both military and civilian. We received and treated many of the wounded. It seemed to be a never ending stream of injured patients. In the blink of an eye our hospital was full, but more was to come.

The following day a Vehicle Based Explosive Device (VBED) went off at the gate of our base (picture # 6, see New York Times). It occurred in the morning when many of the locals who work on base line up for entry. 7 local people were killed. Minutes after the explosion, injured individuals drenched in blood began entering the EMT doors. We went into action. A triage area was established outside the hospital doors where several doctors initially evaluated the injured. Those that had expired were taken to the morgue. The more critical patients were brought to the EMT and treated by trauma teams. Patients with minimal injuries were treated in the clinic area, then released. We ended up treating 29 patients in all, 7 of which required an operation. Our hospital that only holds 8 patients was full with 5 ICU patients and 6 Ward patients. Amid the controlled chaos of the trauma bay, everyone present did an outstanding job in taking care of the injured. It was an amazing thing to witness and be a part of.

(Open wide)

One of the patients we treated was found by Jeff who went with his team to the gate to assist the wounded. There, he found a young man that was underneath several other bodies. At first they thought he was dead, but on further evaluation, he was alive. His only wound was a small penetrating wound to his right chest. He was rushed to the hospital and brought into the EMT. As we began to evaluate him, we could see that he was really sick. We quickly put him on a ventilator and placed a large IV and began giving him IV fluids and blood which seemed to help him come back to life. A tube was then placed in both sides of his chest with a fair amount of blood coming out of the right tube. An x-ray demonstrated a moderate amount of fluid still within his right chest and a piece of shrapnel in his heart. He was taken to the OR where we performed a right thoracotomy to evaluate his right chest. In addition to finding some injuries to his right lung, a small hole was seen in the sac around the heart that was draining blood. We opened the rest of his chest, called a clamshell thoracotomy, because it basically opens the chest like a clam (picture # 7). We then opened up the cover around his heart and found a hole in the atrium squirting out blood. A urinary catheter was placed in the hole to control the bleeding and the hole was closed with suture (picture # 8). As you can see it left a pretty big scar (picture # 9). He is stable and recovering well.

(All the way across)

Friday night, which is the equivalent of the Sabbath for Muslims, a suicide bomber entered a mosque just outside of Khost. I don't know if it was the mosque pictured above. Eight people were killed and eight others wounded. Because our hospital was already running over capacity, we did not see or treat any of the wounded. As I sit here and reflect on this past week I just can't help but feel overwhelmed by these events. Not because I feel that my life is in danger, but because of the precarious situation that Afghanistan is in. The US news is replete with the atrocities of Afghan civilians killed by US forces. I do not condone these occurrences at all. But after being here 4 months it is obvious that many more Afghan civilians are killed by their own countrymen, without regard for race, religion, tribe, sex, or age.

The US and US coalition forces should do everything in it's power to minimize civilian casualties, but the people we are at war against have no obvious regard for human life. With much planning and thought they go into towns and shoot their neighbors and blow up their municipal buildings. On sacred days they walk into their own mosques killing people of their own religion. They willingly drive a car loaded with ball-bearings and explosives to a gate surrounded by their own countrymen and then detonate it. How can we possibly win this war unless the people themselves want to change? I don't think it is the majority of Afghans themselves that are resistant. For the most part, they are a poor and humble people. Those with whom I have come in contact seem to be good natured and genuine. I'm not trying to stand on a soap box because I don't know what the answer is; the Roman empire, and the Russians (and now the US) both lacked it as well. I do think that providing proper education for these people as put by Greg Mortensen in his book "Three Cups of Tea" is the best solution I have heard. As long as these people have no real outlet and hope to better themselves I believe that their involvement in the drug trade and their pursuit of radical fundamentalism will continue. Take care.

Cinco de Mayo

(Garcia and Danielson)

Another week has passed. First we need to say goodbye to Capt. Garcia, a CRNA, and Dr. Danielson, a Pediatric surgeon (picture # 1). They completed their deployment and flew out at the end of the week for home. I have heard that they are already stateside and should be home to their families later this week. They did a great job and were great to work with. We will miss them. Next, the little boy with beta-thalassemia that had his spleen removed and was treated for parasites returned to clinic this week with his father and sister. He looked great and was all smiles (picture # 2).

(First Seargent)

This week was Cinco de Mayo and we didn't want to miss out on it's celebration. Dr. D. put it best when he said, "it's funny that we are celebrating a Mexican holiday while on an American army base in Afghanistan." True, but let the celebrations begin. Because the 5th landed on a Tuesday, we actually celebrated this event on Saturday May 9th. The hospital had a picnic, complete with typical picnic games; pin the tail on the donkey (picture # 3), fill the urinal relay (picture # 4), wrap the mummy race (picture # 5), and a relay bag race (picture # 5). Please consider that all of these activities were done while completely sober as alcohol is strictly forbidden by General Order # 1.

(Mummy wrap)

(Bag race)

The picnic also included a wheelchair race (picture # 6) and the hitting of a pinata. At the end we had a bar-b-que with hamburgers, hot dogs, steak and all the trimmings. All in all it was a great time to relax and be with each other outside the hospital. I think everyone was grateful for this little diversion. The picnic concluded with the throwing of shaving cream pies. Everyone seemed to get a little shaving cream on them, some more than others (picture # 7). The middle of May is approaching, which means the end is even closer. Take care.

(First Seargent)

Toby Keith

(Toby Keith)

Although my greater family (parents, brothers, and sisters) has always listened to country music, I haven't really been a big fan of it for many years. This week I gained a new respect for one of it's top singers. Toby Keith is currently on his seventh tour with the USO. During this tour he will visit both Iraq and Afghanistan. Last Sunday he came to little old FOB Salerno and put on a show with his band. It was held in the Fire Department tent (picture # 1). I didn't really know any of his songs, but it was fun to hear live music. The concert he provided was the 12th in 4 days. It was a whirlwind visit all over Afghanistan. He even went to many of the very small bases way out on the front called COBs (Combat Operation Bases). The music was great and the troops really appreciated his time and support. I now consider myself one of his fans and plan to buy his greatest hits album when I get back (the internet is too slow to download it here).

(Apache Pilot?)

This week was much like the others; working in the hospital, taking care of patients. We had a busy week and had to postpone most of our elective surgeries on local nationals due to a significant amount of trauma care. On Saturday we found time to go to the flight line and get a closer look at some of the helicopters here on base. I tried on one of the helmets in a Blackhawk (picture # 2) that is used to transport patients to and from the hospital. I also was able to sit in the cockpit of an Apache helicopter (pictures # 3 & 4). Pretty cool. At one point, for a very brief time growing up, I thought about becoming a pilot, but eventually decided on medicine instead. The technology these things have is pretty amazing. I guess I'll just have to settle for a PS3 game. At least I won't have to worry about hard landings.

(Goiter)

This week we were able to squeeze in one elective case before it got too busy. As you can see, this lady had a very large thyroid goiter (picture # 5). It presented us with a nice challenge. The operation went fine and her neck looked almost as good as new, with a sizable scar at it's base (picture # 6). Life continues to go by at FOB Salerno. May is here. Take care.

Salerno Dynamite

It continues to amaze me how fast the weeks pass. This week was much like the last. We spent much of it in the hospital taking care of our patients. Our free time was spent reading, watching, movies, working out, or napping. Dr. D’s office sent him a Napoleon Dynamite wig. We each took turns wearing it (picture # 1). Gosh…. As I have mentioned before, the base has several training facilities. We have used the “trauma” mannequins to help teach resuscitation to our medics. There is also a “combat” facility. There they have weapons that are connected to a computer. One shots at a different targets on a screen. The weapon feels and handles like a real one. Some of us from the hospital went and learned techniques to improve our 9mm skills (picture # 2). It’s within a nice air conditioned building. We are hoping to have a tournament within the next couple of weeks. Picture # 3 depicts one of the vehicles that are used off base. As you can see, it was involved in an IED blast. Luckily, no one on board was seriously injured.

(MRAP)

As I mentioned in my last blog, this was to be another “week of the spleen.” We originally had 5 patients scheduled for splenectomy, but only 4 kept their appointment. One of them was a 25 year-old male with the biggest spleen I have ever seen. He has had this for several years. It appears that he has beta-thalassemia intermedia. It’s not the most serious form of the disease, but has still resulted in splenomegally (enlargement of the spleen). He went to the OR (picture # 4) for splenectomy. As you can see, it was a pretty large specimen (picture # 5). Needless to say, his abdomen was a lot smaller after it was removed. He left the hospital 2 days later feeling much better.

(Monster Spleen)

The week ended busier than it began. We received multiple mass casualties with critically injured patients. This kept us busy in the OR (picture # 6). One patient was a local man who works here on base. He was shot with an AK-47 more than 5 times. He was brought to the hospital in critical condition on the verge of death. We began treating him in the ER and rushed him to surgery within minutes of his arrival. He was found to have injuries to his right arm, right lung, liver, more than 15 injuries to his small bowel, and a hole in the inferior vena cava (IVC, picture #7). This is a large vein that carries the blood from the lower half of the body to the heart. Gratefully, we were able to control the bleeding and repair it. He went back to the OR the next day where we put his bowel back together and repaired his broken arm. He remains critically ill, but is stable and is recovering. Because most of our patients arrive to the hospital cold, the OR temperature is usually turned up to the max. This day it was about 90 degrees. After the case, Dr. D. and I were drenched from our “work-out” (picture # 8).

(Sweat Hogs)

Finally, we say hello and goodbye to Dr I (picture #9). He is an orthopedic surgeon originally from Malad, Idaho. He came to help Dr. R with the orthopedic trauma that we receive. We anticipated him staying for a month before going to another FOB for the remainder of his deployment. We found out that he will leave this week. We’ve enjoyed having him around and wish him the best on the rest of his tour. Take care.

(Dr. I off to another FOB)