M5

(Does the 'stach make us look tough?)

This month was officially identified as “Mega Medical Mustache Madness March,” or M5 for short. Any male (or female) in the hospital who wanted to participate simply stopped saving their mustache. This is permitted as part of the uniform in the military. Picture # 1 includes all of those who participated. We had to take a picture at the half way point, as several were going on leave and would not be present for a final picture. Many decided to shave after the picture, I have decided to keep mine until 1 April. Since everyone wears a uniform, it’s the only way to be a little different.

This week the people of Afghanistan celebrate Nowruz, which is the beginning of the New Year. The whole week was considered a holiday. The base was put on heightened security to be prepared for the worst. We did experience an increase in injured civilians. The Taliban detonated several bombs in the area, one of which was in Khost (See article in New York Times). The two survivors we took care of were gravely injured civilians that required the amputation of booth lower legs (picture # 2, to be uploaded tomorrow). They are recovering and will survive. I spoke with one of the Afghanistan physicians that works at the hospital about the current situation. He told me that the people who are from Afghanistan love the Americans and want peace. It’s the “others,” mainly Taliban and those from Pakistan that continue to wage this war. This has been my experience. The local national people we treat are really a delightful people who live in the poorest conditions. A great majority of the “bad guys” we have cared for are not original to Afghanistan. It’s unfortunate that the fate of this country is being determined by radicals who don’t even live here. We decided to celebrate Nowruz by having (virgin) Pina Coladas. Picture # 3 shows Capt G serving us this treat during movie night.

(Capt G. serving Pina Coladas during the movie)

The week was pretty busy. We mainly took care of local nationals. In addition to the elective cases, there were several emergencies we treated, mainly; gun shot wounds, burns, and blast injuries. The New Year didn’t start out so well for many of the locals. In clinic, the father of one of my patients brought in a parasite that the little child expelled after receiving some medication (picture # 4). Ascaris lumbricoides, also known as roundworm, occurs in humans when an ingested egg releases a worm that penetrates the wall of the small intestine and enters the bloodstream. It is then carried through the liver and heart to enter the pulmonary circulation where it grows and molts. In 3 weeks, the larvae are then coughed up respiratory system and swallowed returning it to the small intestine. Here they mature into adult male and female worms. Fertilization can now occur and the female produces as many as 200,000 eggs per day for a year. These fertilized eggs become infectious after 2 weeks in soil and can persist in soil for 10 years or more. It’s life cycle can be seen in picture # 5 which was taken from http://www.dpc.cdc.gov/cdc.gov. We tend to feel a lot of these parasites within the bowel of the patients that we treat. I decided to try one for a treat (picture # 6).

(I got worms)

Each week we participate in a conference call that includes medical teams all over Iraq and Afghanistan, Germany, and the United States (Walter Reid Medical Center, Brook Army Medical Center, Wilford Hall Medical Center, as well as Cincinnati and San Diego). We discuss American soldiers that have been treated during the previous weeks. It allows us to get feed back on their current condition, as well as discuss possible areas where care could improve. It’s a great way to learn from other surgeons treating the same types of injuries. The trauma director in charge of keeping track of these patients as well as the overall trauma care in both theatres of war paid us a visit over the weekend. It was a pleasure having Dr. B around and to get to know him better (picture #7). Take care.

(Back row: Me, Dr. P, Dr B, Front row: Dr R, Col O)