A clean perspective

Wednesday 30 September 2009

Dark and thin and young and lovely,

The girl from Ipanema goes walking..

And when she passes, he smiles,

But she doesn’t see…she just doesn’t see.

- The Girl from Ipanema

Not being dark, thin, young, or lovely does have its advantages, one of them being that I do tend to notice things, especially over here. I’ve come to realize that comfort and privilege can warp your perspective, opacifying the lens through which you perceive the world around you and even interfering with the formation of fundamental values. At home, I live a life blessed with every possible creature comfort, many of which I just take for granted. Being in a place with, shall we say, diminished comforts and somewhat minimal privileges can be enlightening. It is amazing to me how one’s perceptions of pleasure and comfort can change so rapidly. Small, seemingly insignificant or irrelevant things are capable of providing great happiness in the right situation.

I’ve been traveling some with a full Colonel, and we have been searching forward operating bases throughout the theatre for a bar of soap. For some reason, you can’t buy a regular bar of soap at Bagram, right now. There is plenty of the gel and soft stuff, but this gentleman is kind of an effete New Englander and prefers an old-fashioned bar of soap. I can appreciate the old-school tendencies. Anyway, we finally found some at a FOB, recently, and beside himself with glee, he bought 5 bars- one for each of the next five months. I couldn’t surgically remove the smile off of this guy’s face, and despite a night spent listening to an artillery battery firing illumination rounds over the wire, he recounts that trip as the best one of our deployment. Now, I’m sure that three months ago, a trip to the drugstore to buy soap would have been an afterthought at best, a nuisance at worst. Here, it has been a highlight of the past month for him. The pleasure that he receives from that soap is now sincere, real.

I recently acquired a small rug to put on the floor between my bed and locker. I can’t tell you how many times it has crossed my mind as I get out of my rack that it is so nice to have a piece of carpet to step on. Would that ever occur to me at home?

I am thankful for this experience in many ways. Perhaps that most important of these is that I will return home with a much greater appreciation for the wonderful family, friends, and incredible life with which I’ve been blessed.

Confidence

I can't take a picture worth a damn, but if I could, this one would be impressive. We're scooting along in a chinook helicopter at an altitude of several hundred feet. The tailgunner plopped down on the tailgate of the helicopter for the 40 minute ride, his legs dangling out the back. He would nonchalantly reach over and fiddle with the ammunition box of his 50 cal every once in a while, apparently a tad bored. I just can't believe that this is how this guy spends his days, and probably many nights.

From the air, this is a typical Afghan house/compound. It has mud walls and turrets in the corners. We took this picture over Jalalabad, the most lush view that we've found in Afghanistan. It is actually pretty atypical.

The flock

Sunday 27 September 2009

I have spent the bulk of the last week out of Bagram and I’m pretty dogged. Nevertheless, I decided to go to mass last night at 1945. It seems that I am most at peace here during my times in church or in the operating room, and I pondered why that might be. At first glance, the two seem strikingly different. As I sat through the mass, though, it occurred to me that the two have some similarities- not because of the surgeon worship that some of us long for, but in the familiar rhythms that both provide. As a lifelong Roman Catholic, the familiarity and predictable rhythm of much of the mass provides kind of a sense of comfort. The practiced responses allow you to float back, reflect, and sometimes transcend on to other thoughts or places. The rhythms of the operating room are likewise predictable and comforting. The usual dance with the nurses and techs as you move around the patient, preparing and positioning him as you have done for thousands of cases; the obligatory banter with anesthesia and the scrub techs, teasing one, waiting for a witty reply; the familiar touch and feel of the instruments, the rituals of scrubbing, gowning, and gloving, all put you into a state of preparedness for what is about to occur.

I thought, though, that the rhythm of the mass isn’t what necessarily defines a good church experience. It can, certainly. Sometimes just the aura of the mass is enough to smooth out a long week. But I think the value lies in what comes after the familiarity relaxes and prepares you. You are slowed enough to think about the homily, reflect on the week you’ve had and plan for the one you hope to have. You can think about what you did, and what you wish you might have done. In a lot of ways, being in the operating room prepares and recharges me for the rest of my job here. I am most comfortable with the surgeon part of my job. It’s what I do full time at home. But I think that this clinical work has provided enough confidence for me to tackle the other aspects of my job, with which I’m not as comfortable. As an aspiring surgeon, scholar, and soldier, I strive to attain some sort of balance between the three. The scholar part of the job requires me to search for answers to questions that will improve the care of our injured warriors, and to do it the way I think it needs to be done requires the courage of a soldier to leave this base and search for those answers. If not now, when? If not me, who?

The priest reported last night that he had spent the previous night out on a foot patrol outside of the wire at Bagram with an infantry unit. He rode out in an MRAP, then dismounted and conducted a recon patrol with them. He was without night vision and, I’m sure, unarmed. Having the courage to literally and truly walk with his flock is incredibly inspiring. But he’s not the outlier in this place. While one might assume that war highlights the inhumanity of man, and while there is unbelievable suffering and tragedy, I’ve also found the opposite, here. I have also had the privilege of seeing the very best of humanity, courage and compassion, displayed over and over, again.

Horton's photo

My photo of the Kandahar franchise of Tim Horton's didn't load last time, apparently. Here it is, dedicated to Tim Horton's fans the world over.

Getting shanked

23 September 2009

“The nation that will insist on drawing a broad line of demarcation between the fighting man and the thinking man is liable to find its fighting done by fools and its thinking done by cowards.”

-Sir William Francis Butler

I’m waiting at the flightline for a lift out to FOB Shank as the flight is delayed for a few hours. We lost a bird yesterday, and the flight crews are scrambling to get people out to the various FOB’s. It’s interesting how the meaning of words can change based on context. To be lost here doesn’t imply misplaced.

I’m sitting on my IOTV, surrounded by soldiers, contemplating the quote by Sir William Francis Butler and reflecting on the education of our warriors. Two of my classmates are battalion commanders at the FOB to which I’m heading, and I’m thinking about how our paths have differed and converged. Based on my experiences at West Point, I know that it was important to our educators to make us “Renaissance men,” in the fashion of Sir Walter Raleigh- The Fox. They knew that to be a successful fighting man, you have to be a thinking man. It is the officer’s job to think his way out of, or to victory in, a fight. Advanced thinking and degrees were stressed. General Petraeus, a USMA grad, has a masters or PhD from Princeton. It was expected that warrior-leaders pursue academics as well as military training.

I’m not sure that the converse is true. That is, I think that the elite and more highly educated slices of our society may have lost touch with the military, thus hampering their decision making. A survey at Harvard in 1956 showed that roughly 50% of the class had military experience. Today, that percentage would be less than 1%, I’m sure. It is well publicized that Harvard banned ROTC from its campus. What is the message of that ban- that it’s not important to educate an officer or that somehow the presence of someone committed to military service would taint the environment and education of the others? Is that diversity?

I am certainly not implying that everyone should serve in the military, and I don’t think that a draft is the answer. Frankly, I don’t have the time or energy to really study the matter and come to some thoughtful conclusion. I just think that the creation of a separate, “warrior class” of people that do the bulk of the military service and fighting, generation after generation, is unfortunate and less than ideal. It is the mingling of different perspectives, backgrounds, experiences, and insight that makes for creative achievement.

I hope to find my friends and hear what their journey has entailed for last 19 years. I don’t know where they’ve been or where we’re heading, but I know where we are now. I wonder if our civilian leaders do.

24 Sept 09 posto-script:

Kevin, not much has changed from your description of Shank, and your 15 alarm-clock gig, set to go off every hour after your departure from the O-4 hooch, is the stuff of legend in 3^rd Brigade. I’ll pass on their message to you in another, more appropriate, format.

O, Canada

Canadians being, well, Canadians, the second thing that they built after Tim Horton's was a hockey rink. There is no ice, of course, since the temperature is over 100 degrees F, but this apparently doesn't dampen their spirits or desire to throw a good body check.

Tim Horton's

Tuesday 22 September 2009

I’ve been a bit busy with some travels recently, so I haven’t been able to put my thoughts in writing. It’s frustrating to have all these mundane reflections flitting around my brain, powerless to vomit them up onto the computer screen or a piece of paper. At any rate, I had the opportunity to pass through Kandahar on a recent return trip. I’ve heard Beirut described as the Paris of the Middle East. Well, Kandahar Air Field is kind of like the Paris of wartorn Afghanistan. There are soldiers and airmen from an entire parade of nations- France, Belgium, Canada, and some nations I didn’t even know had a military. Honestly, I’m still not sure they do. Anyway, Kandahar is famous throughout the theatre for a Canadian donut shop called Tim Horton’s. I had never heard of the shop prior to this deployment, but one frequently hears tales of their baking exploits spoken in hushed, reverent tones. The Kandahar franchise is located in a pretty non-descript trailor in the middle of the base. If you ask for directions, passers-by will just tell you to look for the crowd. While I’m a pretty avowed Krispy Kreme fan after growing up in Tennessee, I have been converted to a lifelong devotee of Tim Horton’s. I should point out that I haven’t tasted anything freshly baked in over a month. Likewise, all vegetables and fruit are frozen, here, and many goods are pre-packaged or vacuum-packed. Not a complaint, as I know I have it far better than many in Afghanistan. I know of a FOB here that just converted from MRE’s 2 weeks ago. A friend of mine posted there celebrated by eating the first meal cooked in their “chuck-wagon kitchen.” After two days, he begged for an MRE to help stop up the….well, you know.

Back to the donut. Or the 7 I ate. They were the most delicious things I can ever recall tasting. My favorite was the custard-filled, maple dipped donut. The maple was rich and earthy, with the creamy custard just the right temperature and degree of sweetness. The Boston Cremes ran a close second. I guess the Canadians would know their maple. I hope I can remember to enjoy and savor the pleasure of things after I get home as much as I did those donuts. I think there’s a lesson hidden inside the custard.

My flight back to Bagram was actually pretty amazing. I hooked up with some Texas Air National Guard guys and they gave me a ride back to BAF in the cockpit of a C-130. I know this Texas homage thing is getting out of hand on this blog, but the flight was an absolute blast. Airplane takeoffs and landings in theatre are called “combat” takeoffs and landings, and they are fast, steep, and unpredictable (by design). I can tell you that they are a lot more fun in the cockpit than in the back with the grunts. The rate of at least one person vomiting in the back of the plane is nearly 100%, according to the loadmaster experts. I did have one close call. Sitting in the cockpit and watching the long line of grunts in body armor and rucks loading the plane, I couldn’t help but notice a blonde, female Belgian medic at the back of the line. The scene wasn’t lost on anyone else, either, because the pilot came over the headset and announced that my cockpit seat was actually taken. I told him that possession was 9/10 of the law, and besides, I’m armed. He responded that she was, too. The loadmasters in the back ended up begging for a bone, so the pilot let her sit in the back. The pilot, by the way, is a Southwest Airlines pilot in the real world. I am also, now, a lifelong devotee to SWA.

Leathernecks

18 September 2009

As part of my duties on the combat casualty research team, we were recently presented with an interesting, and quite serious, issue. Apparently, the concern exists that the combat tourniquets that the Marines are using may become somewhat weathered as combat tours wear on, potentially degrading their functionality. The Marines tend to wear them on the outside of their body armor, which makes sense, the tourniquets need to be readily accessible. The tourniquets have been working extremely well, likely saving many lives and limbs that would have been lost without this equipment and training. At this point, I should mention that I have the utmost respect and regard for United States Marines. After living in Hawaii in close proximity to the K-bay Marines and befriending many leathernecks, I firmly believe that they are dedicated, motivated, and effective. They also have a somewhat unique thought process. Unfortunately, I can’t describe their initial proposal to address the issue at this point. It would certainly have worked, and quickly, but in a uniquely Marine fashion. When I get back home next spring, please remind me to describe the proposal. I’ll buy the beer, and I promise it will make for a good night.

Everyone should be comforted to know that all parties ultimately arrived at a great solution. The right thing is being done and our warriors are being cared for in the best possible way.

Milan and Dave, I have a new insight into you guys.

God Bless the United States Marine Corps.

Deep in the heart.....of Afghanistan

For my Texas relatives.

You can take the boy out of Texas, ....

What's mined is yours

15 September 2009

Have you ever been this close to a minefield? I hope and suspect not. I can think of two reasons why you might not have experienced this pleasure. First, minefields are fairly uncommon in the U.S. Second, who in their right mind would get this close to a minefield with a non-telephoto lens in hand?

Well, if you happen to walk out of the North chow hall at Bagram and decide to meander north along Disney drive (the main road in Bagram), perhaps contemplating the mysteries and contradictions of the ancient Greeks or debating the profound question of whether the stuff you just ate for lunch was chicken or tuna salad, you would immediately see dozens of signs just like this one on your right side. In fact, there are active minefields all over Bagram, inside the wire, left courtesy of the last tenants of our real estate, the Russians. The EOD (explosive ordinance detachments) are actively trying to demine the base, but the work is a tall order. I understand there is a new movie out about the EOD. I would love to see how Hollywood portrays these guys.

By the way, Disney Drive is named after Specialist Disney, KIA in Afghanistan, not Walt Disney. Most streets on Army bases have been named for people killed in combat. While I’m sure it would be quite exciting to have a civilian street named after you, if you are the namesake of a street on a military base, odds are you won’t be attending the dedication ceremony.

Reflections of Leonidas

Sunday 13 September 2009

My very bright cousin from Austin posed an intriguing question after seeing the Leonidas sign posted over the door to the North chow hall, one that occurred to me when I first saw it.

“My recollection is that the day didn’t end so well for the Spartans…”

Well, yes…and no. Leonidas led an allied force of Greeks, maybe 7,000, against a huge Persian army led by Xerxes, perhaps numbering up to a million men from the various Persian tribes and lands that they had conquered. One is reminded of the UN forces aligned against the various elements of the Taliban, Al Qaeda, and paid insurgents- generally funded by Iranians, sons of the ancient Persians.

Leonidas actually sent away the bulk of the Greek forces, choosing 300 of his Spartan hoplites to remain for the fight. For the site of the battle, he chose a narrow pass in which to face his overwhelming enemy. Bagram happens to be located in a valley, surrounded on all sides by nearly impassable mountains, except on the narrow south side- the road to Kabul. Interestingly, Leonidas only chose Spartan warriors who had young sons. Why was it important to him to choose men with sons? First, he ensured that they had a reason to fight to the death. What father wouldn’t sacrifice all for the safety of his child? Second, he ensured that his brave warriors had passed on their “warrior spirit” to the next generation of Spartans. At church last night, the priest asked, “How many of you have children at home? More than 90% raised their hand.

Interestingly, General McChrystal (commander of all forces in Afghanistan) has recently decided to DECREASE the number of support troops in Afghanistan. He wants more warfighters, but a much smaller support group. I can’t announce the percentage of the cut, but it is significant. Medical forces, by the way, are not being reduced. Is General McChrystal picking his 300?

As the two sides squared off in the narrow pass, the first 10,000 of the Persian troops that the Spartans faced were the “immortals,” or most elite and lethal of the Persians. Xerxes threatened that he would “launch so many arrows against the Spartans as to block out the sun.” One of Leonidas’ warriors replied bravely, “All the better! Then we shall fight in the dark!” You see, Spartan boys were taught and trained from a young age to fight at night. In that manner, they maintained the element of surprise and denied the enemy knowledge of their true number. U.S. ground forces also now train constantly, and prefer, to fight at night, utilizing some of the same advantages. The contemporary motto of our more elite forces is “we own the night.”

Leonidas and his 300 Spartans held off the tens (or hundreds) of thousands of Persians for three days, ultimately being defeated only after being betrayed by an ally, who showed Persian forces a way to flank the Spartans.

What had Leonidas’ sacrifice accomplished? He saved the bulk of the Greek army to fight another day. Within the next three years, the Greeks had effectively driven the Persians out of Europe and the Mediterranean. The sacrifice of the few had united the many, ultimately leading to victory.

Was this the intended message of the artist who put that sticker above the chow hall entrance? I don’t know. I don’t think the final battle will be fought at Bagram, though it certainly was for the burnt Russians hanging in the dustoff hangar for so many years.

Anyway, Granger, this is what the art says to me.

King Leonidas

This is for Barbara, MSW.

This sticker is posted on the door of the North DFAC (dining facility, aka chow hall) at Bagram.

For those unfamiliar with the legend of King Leonidas of Sparta or the Battle of Thermopylae, I refer you to the 2007 movie "300."

9/11

Friday 11 September 2009

Today is 9/11- the reason we’re all here, I suppose. Hard to believe the real 9/11 was 8 years ago. My baby girl turns 6 today, and she was born 2 years after the attacks.

I’m walking to the gym at 0500. There’s a 9/11 run/walk this morning. It’s a 9.11 km race around the perimeter of the base. I’ll bet a commander’s aide gets an award out of that one. About 1,500 people are participating. Some of them are wearing the free race t-shirt that the USO gave out with a flag on the front. My friend and I are walking upstream against the racers like salmon on our way to the gym. Up ahead, I see a small line of infantrymen walking in their combat gear in our direction and loading up on their MRAPs (mine resistant armored personnel carriers) for a patrol. I comment to my friend that they’re doing the real 9/11 walk. He grunts assent. Our room ran out of coffee yesterday. There’s a band playing outside the gym at the start line. They’re singing something about ‘knowing your enemy.’ I’m not sure if they wrote it or if it’s a contemporary rock song. I’m a bit out of touch with pop culture. (You’re a man of the ‘90’s, Joe……the 1890’s.)

Inside the gym, the Steelers are playing the Titans on one TV. There’s no sound. On the other TV, some VH-1 reality show is playing. Apparently, some ex-strippers have to get an over-the-hill rocker to pick them so they can win a date with a set of transvestite twins. I don’t know- there’s no sound. Just glad to be a part of the great gift of American culture.

This afternoon, I’m standing in the trauma room waiting for a Medevac. The dry-erase board on the wall says USSM x 3 (US Service members)__ MRAP vs IED. Sounds like an unfair fight to me. I wonder if they were the other salmon I saw this morning. The surgeons and ER docs waiting for the doors to open blink through tired eyes. They did 7 cases last night. That was 9/10.

The Olde Course

While the Air Force gets the lion's share of the credit in the Department of Defense for beautiful Officers' clubs and golf courses, the Army is not to be outdone. It is a little known fact that the Army has installed lush golf courses at all of its forward operating bases in Afghanistan. This is a view of the famous 18th hole of The Olde Course at scenic FOB ___. It is a 9-yard, dogleg right, 4 par. The hole is known, of course, for the signature ammunition case hazard along the left fairway.

I have omitted the name of the FOB for national security reasons and to prevent over-play by non-members.

Lawn Dart

Wednesday 9 September 2009

I’ve spent the past 2 days at a FOB (forward operating base) in far eastern Afghanistan. The flight over was one of the most interesting parts. We actually flew a small, fixed-wing aircraft, which is unusual for this theatre. I should have expected a bit of drama when the goateed, t-shirt wearing Blackwater pilots chuckled as we boarded. Immediately after finding a seat, which was not difficult on this small plane, a bald, 60-year old man with a beard stood in the aisle and said, “Welcome aboard, gentlemen. I’m you’re lovely flight attendant for this hop. It’s taken years of therapy for me to be able to admit that, but I’m finally making the money to pay for the sessions. Buckle up. If I come running down the aisle with what little hair I have on fire and my arms flailing above my head with a panicked look on my face, you two in the back grab the fire extinguisher. I spent 14 years in the Air Force as a loadmaster on a Special Ops C-130 Talon, so I can sure as shit handle this.” He then sat down in the front row and yelled up at the pilots, “Hey, kick it.” They had clearly anticipated the command because the plane was already moving. I had been aboard less than 90 seconds.

After taking off, it occurred to me that the makeshift seatpockets in front of me were filled with barf bags rather than in-flight magazines. The inspiration for the substitution became immediately clear as we bucked and rocked off of the Bagram runway. The arid, dustbowl of a canyon that we occupy became evident, with the square, mud-walled compounds of Afghan houses with their corner turrets visible just outside of the limits of BAF. The scenery looks directly transported out of the 10^th century. Only occasional dots of green were evident against the endless, tan landscape. Up ahead, the jagged, brown cliffs of the Hindu Kush reached nearly vertically. Before long, we were bouncing between and around the cliffs, but not above them. It became a little difficult to breathe, and I realized we were not in a pressurized cabin and were probably at about 15,000 feet. The mountains are laced with small trails and dry riverbeds, or wadis. Small, mud-hutted villages are occasionally nestled in the valleys and along the lower faces of the mountains. All of these are connected with steep, narrow, dirt trails. I understand that there is only 1 paved road in Afghanistan, Route 1, which runs from Kabul to Kandahar. It was built by Americans a few years back and is now a flashpoint in the fight against the Taliban.

We landed about 30 minutes and two lifetimes later with the trajectory of a lawn dart. Looking at the mountains of Pakistan from the FOB runway with the sound of the Muslim call to prayer floating over the wire from the nearby village was only strange in that it didn’t really feel strange at all. The sight, sound, and feel of Afghanistan is starting to seem normal. I listened to the thump of nearby helo blades and tried hard to remember the sound of crashing ocean waves.

Up until 45 days ago, this FOB was attacked nearly daily with mortars and rockets. After a U.S. soldier was “kidnapped” by the Taliban, however, command directives changed and the U.S. forces adopted a much more aggressive posture, sending out many more patrols and active hunts for the bad guys. The gloves came off and everyone now feels a bit better. There hasn’t been a rocket attack in 45 days. The E-7 who recounted these sentiments then found a piece of wood to knock on. I also heard an interesting story about the soldier who is missing. The feeling here is that the whole truth hasn’t yet been revealed. I’ll be interested to follow the news on this one.

The funny thing is that the quality of life here is actually better than I have at BAF. The housing is nicer, the latrines are cleaner, and the pace is much slower. BAF is kind of like New York meets Afghanistan Road Warrior. Aircraft, vehicles, and a kaleidoscope of people are moving around 24/7. The sound of helicopter blades and jet aircraft is a constant backdrop. Most noticeably, the ubiquitous dust is absent from this FOB. At BAF, you constantly breathe, swallow, and snort the dust. It covers every surface, fills every crevice, and invades every accessible orifice. Even your teeth feel gritty. I think I’ve swallowed my body weight in Afghan dust over the past few weeks. I could actually see the stars last night at the FOB, a rare treat. The view was helped by the fact that this is a “dark” FOB with no lights allowed at night. Once the sun goes down, the only visible lights are the occasional bobbing red headlight, marking someone’s nighttime trek to the latrine trailors.

The trip back to BAF was much less eventful, although the same lovely flight attendant was again present. Without the thermals rocking us around, I could see that the mountains were stunningly beautiful shades of red and brown, sprinkled with sparse evergreens. Landing back at BAF, I reminded myself what an improvement this was from Kuwait. Life is good.

Diplomacy stinks

Sunday 6 September 2009

As I was walking through the hospital this morning, the very pungent odor of our host nation brethren struck me, almost literally. It made me ponder the various smells of the numerous “outdoorsy” men that I have encountered from around the world. I have had the good fortune of traveling fairly extensively, and it occurs to me that the smell of the natural state of man varies from country to country and region to region. I should begin by acknowledging that I, personally, have an immense capacity to stink. The stench of my blue and white checkered Vans from seventh grade is still deeply embossed on my olfactory cortex. It was a sort of thick, vinegar smell that really sticks with you and generally precludes me from going sockless to this day.

Back to Afghanistan. I find that the smell of the local men is unique, sort of an old cloth smell with a dirt-tinged musk. This is much different from the odors that I encountered when stranded for five hours on a runway in Bangkok on an Air India flight. That was much more, well, predictable and bourgeois. These differences lead me to ruminate on the etiology of the different scents of people from around the world. My first theory is the most scientific, and postulates that bacteria from the local flora and fauna, after simmering in sweat, play a profound role in the way people smell. This might explain why the local Afghanis smell differently than naturalists in Palau or Thailand. The ubiquitous dirt and dust here seems regionally unique.

My second theory is that perhaps the food that we eat may play a role. This one is less convincing since it would lead one to hypothesize that a good working smell in Hawaii would be somewhat sweet, from all of the fruits and fish in the diet. I have personally disproved this theory on numerous occasions.

I do feel that I could sit in a hospital waiting room in up to 5 different countries with my eyes closed and make a pretty good guess as to my location. I’m not sure that’s a marketable skill, but it does help to occupy the mind, and it must be some soft of marker of international sensitivity.

cigars

Last night, for the first time in a month, I was able to smoke a cigar with some friends. It is probably evident from the goofy look on my face that it was a rare treat and enjoyable experience. There is a little shack on top of the hospital in which cigar smokers gather most evenings. It overlooks the runway with a spectacular night-time view of all sorts of aircraft coming and going with a backdrop of a full moon highlighting the snow-capped Hindu Kush mountains. I'll try to get a picture of the view, but nighttime flashes tend to gather attention, here.

For those interested, I smoked a La Gloria Cubana Corona Especial. The other guy in the picture is an Otolaryngologist friend of mine who is here involved with some community outreach. He mentioned that his beard was embarasingly mangy, so he has opted for the wizened, fu manchu moustache look.

Bags

Saturday 5 September 2009

I just drank a “Rip it!” energy drink, so I’m typing pretty quickly. I hope you can keep up.

I’ve always had kind of a hard time deciding exactly what I wanted to do or be. I have lots of interests. At various times, I’ve wanted to be an athlete, a scholar, a doctor, a soldier, a writer, or some combination of the above. I prefer to think of myself as diversified rather than schizophrenic. My father would say that I always try to fit two pounds of manure in a one pound bag. He doesn’t use those exact words, but that’s the message. Here in Afghanistan, I have similar issues. My job is neat in that I am a part time clinician, part time researcher (trying to find optimal ways of caring for the wounded), and I have an opportunity to be in situations that can best be categorized as a direct patient care setting. The only problem is that when I’m playing one role, another duty always seems to be screaming at me for attention. I suppose we’re all constantly searching for the right balance in our lives. I can hear my father say, “it’s not about your destination, it’s the journey that defines you.”

I suppose there’s not only one thing that any of us is meant to do. When Joey asks me what he should be when he grows up, I think I’ll tell him that he should do something that interests him, that enables him to help others, then convince himself that it is that profession that makes him happy. I do know that for me, the roles of husband, father, brother, and son provide the most satisfaction. Those seem to be my bag. Until I get to play those roles again, however, I’ll carry a different kind of bag on my back and try to find the balance that does the most good. I guess that’s all any of us can do.

Dustoff Hangar

This is the hangar for the Medevac (dustoff) team. The Russians had their last stand in this hangar when fighting the Taliban in the 1980's. When the U.S. Army took over this hangar in the early 2000's, they found the burned bodies of Russian Spetznatz officers hanging from the rafters. The enlisted guys had been taken outside and disposed of less gloriously. Mortar holes pockmark the runway and bullet holes remain in the walls of the hangar. Inside the hangar, some of the most heroic and competent people I've ever met prepare to do their business.

Medevac

This is one of the Medevac (dustoff) helicopters at BAF. When under fire, they will just scoop up patients, put them in the back, and take off. They also have the ability to transport critically ill patients with nearly all of the medical monitoring and equipment of a world-class intensive care unit.

Dustoff

3 September 2009

In the field of medicine, being a surgeon is pretty much the coolest thing going. Now, I am obviously a bit biased, but objectively speaking, the job rocks. You get to take care of profound problems in a systematic way, in a finite time period, and you get immediate feedback. You get to control your little fiefdom (the operating room), and people generally listen to you. And the cool thing is, most non-surgeons in medicine are a little afraid of you, because you can’t be quite right in the head to have survived a surgical residency. Here in Afghanistan, though, the surgeons aren’t the biggest heroes. The real rock stars out here are the guys on the Medevac team. The Army calls it “dustoff” because of the image of helicopters filled with injured soldiers taking off rapidly from a hot landing zone in a cloud of dust. In fact, the Army really invented the whole helicopter “lifeflight” concept in Korea and honed it during the Vietnam War. Here in Afghanistan, the dustoff team has taken things to an entirely new level and they are amazing. They often pick up critically injured soldiers, Marines, and civilians directly from the battlefied, often under fire, and transport them safely to our health care teams. They also transport unbelievably sick and injured patients from our forward medical sites to our bigger hospitals for complex surgery. They do this at well over 10,000 feet, at altitudes and temperatures that are supposed to be incompatible with helicopter flight. Their office is cold, jolting around at 200 knots, generally completely dark, and did I mention that they’re often being shot at?

The current Medevac team is a national guard unit from California and they are absolutely the best. They are all paramedics, as opposed to just emergency medical technicians, which is the Army standard. They do procedures every day in an environment that would make nearly any surgical intern squirm. I would credit these guys for saving more lives than just about any facet of our trauma care system. Here at Bagram, Dustoff is pretty much the coolest thing going.

Standards

Wednesday 2 September 2009

Sometimes you can outsmart the big green machine, but sooner or later, the administrative whip of the U.S. Army always catches up with you. I have successfully avoided a series of administrative, in-processing lectures for over a week through a combination of guile and misdirection. I have claimed to be too busy “transitioning” to make the uplifting lectures on suicide prevention, why we fight, and the grooming and uniform standards of BAF (Bagram Air Field). Alas, today was the day I paid my administrative dues. Fortunately, the keynote address on uniform and grooming standards was delivered by the Sergeant Major who runs every morning with his henchmen, as I previously described. I had been looking forward to meeting him. If you have ever seen “Generation Kill,” you have seen this Sergeant Major, although the BAF version is slightly more Army than the Marine SGM in “Gen Kill.” He’s a bit softer, but equally as unintelligible.

“The grooming and uniform standards must be maintained in the war zone. These standards exist in order to maintain standards and guarantee your safety.”

Wearing sunglasses prior to 0700 is apparently a clear invitation to the Taliban to do something horrific to you, which I hadn’t realized. Pretty standard.

Ricochet

Tuesday 1 September 2009

There appears to be some concern that this blog is being authored by a shadow writer since I have only mentioned food once. In order to allay any fears of my autheniticity, I may add that I have now eaten two consecutive meals (and 3 of the last 5) at the meat shack, which is, of course, a misnomer, since it is actually a tent. At any rate, I’m well on my way to achieving “Norm” status at this establishment of haute cuisine. Nothing like sitting down to a chicken, chili, and pork chop dinner with 30 armed Texans. Maybe it is a little like the Salt Lick. No offense to my Texas relatives intended.

After breakfast, I got issued a field radio and had to take a one-hour class from a Private First Class on the function, care, and maintenance of the device. I found this intriguing, if not engaging, since the radio really only has two buttons- an on/volume switch and the “talk” button. The PFC is accurately nicknamed “Ricochet” due to his hyperactivity and clear ADD tendencies. Ricochet showed up 10 minutes late to give me the class, so he was forced to endure a pre-course, motivational, public tongue-lashing from his Master Sergeant.

“Ricochet, you orange-julius drinking desk jockey. Where the hell you been?”

“In the hospital, Master Sergeant. I had to get orthotics- my feet are killing me from walking on the rocks, here.”

Expletives and verbiage are removed since this is a family channel. Suffice it to say that the Master Sergeant’s prescription was for Ricochet to get to the gym, which would clearly cure his “powderpuff, x-box loving” feet of the plantar fasciitis.

I left Ricochet’s class one hour later, comfortable that I could operate, service, and maintain both buttons on my new radio.