Truth told in joust

The resiliency and sense of humor of deployed soldiers never ceases to amaze me. OK, Marines are funny, too…they’re just different. A soldier can be faced with an uncomfortable, maybe even miserable, situation and respond with a cursed complaint issued through a wry smile, immediately followed by an attempt to make a buddy laugh. It may take the form of a resurrected form of ancient combat, inspired by an all-night viewing of A Knight’s Tale and adapted to available equipment, or the feigned assurance that this plague of biblical proportions really will impart the ability to fly.

I didn’t take these pictures and I’m not even sure where they’re from- they were forwarded to me by a friend- but I’ve seen an incredible spectrum of these forms of amusement. And they work.

Trauma OR #3

Monday 26 October 2009

I don’t usually post much about the specifics of my job on this blog for several reasons. The most important reason is to maintain operational security, the second is that I sometimes prefer to keep my thoughts and feelings private until I have a chance to ruminate over them for a while. Tonight I can’t help myself.

It was reported in the news that there were three helicopter crashes in Afghanistan, today, with 14 US service members killed. Late this afternoon, 13 casualties from the crashes arrived in the trauma room (emergency room) at Bagram, simultaneously. I had the privilege of operating on two of them tonight. Prior to the first patient being taken back to the OR, one of the other patients came up to him and hugged him, as best you can hug someone who is laying on a gurney with his face encrusted with dried blood. Apparently, the patient on the gurney was a medic and had pulled six people out of a burning helicopter before it was engulfted in flames. He didn’t remember doing it, but his friend informed him that he had saved six lives today.

While I miss my wife and children with a passion and intensity that no words can describe, there is no place on this earth that I would rather have been, tonight, than in trauma OR #3, helping to care for this soldier. I am thankful to my family for being strong and supportive enough to allow me to be here. Thank you, Barbara.

Wanderlust

Due to my frequent flyer status on C-130 Theatre Airways, I managed to consistently secure an upgrade to business class on all of my intra-theatre flights. The first photo was taken in the luxurious first class cabin on a C-130 en route to Balad. While the comfortable, 180 degree reclining seats are evident in the picture, the lovely and pleasant in-flight service and entertainment were really the highlight of the travel experience.

During the past 9 days, I traveled from Bagram to Quatar, Tikrit (Iraq), Kirkuk, Baghdad, and Balad. The flight time from Bagram to Quatar was 5 hours, Quatar to Tikrit 4 hours... you get the point. Fortunately, the meetings and various work enterprises made the trip worthwhile. The persistence paid off.

Within roughly 16 hours of returning to Bagram, I ran the Army 10-miler race. I did secure a personal best time, though I feel obligated to admit that any time would have been a PB since I had never run 10 miles before. Two of my roommates are in the post-race picture- Bill Latzka (Boston) and Mike LaGiglia (Chicago/Salt Lake).

Persistence

Friday 23 October 2009

One of my first surf-partners, Mike Broderick, was once sitting in a lineup with the famous surfer Peter Cole and asked him the key to becoming a good surfer. The aging legend said, “Persistence, man, persistence.” He then took off on a killer wave. Interestingly, my top four most consistent surfing partners have all been named Mike and have all possessed an incredible stoke for the sport. Their judgement occasionally seemed to be inversely related to the stoke, but their passion has proven to be incredibly contagious. Honestly, I can’t recall which of the four Mike’s recounted that story, but I know it was one of them. Aloha to them all. I can’t wait to get in the water with you, again.

I think about that quote often out here, as it seems as applicable in the mountains and desert as it is in the ocean. Persistence is the single attribute that I have found to be most critical during my deployment. Whether in attempting to travel throughout the theatre, fighting for personnel actions, or just mustering the energy to pack my ruck one more time in the middle of the night, persistence has been the key to meeting my goals. Maybe it will even help my surfing.

Orwell

"All animals are equal. But some are more equal than others."

-George Orwell, Animal Farm

Here is a juxtaposition of two different deployment perspectives. One pool is located at the Air Force Base, Quatar. The other is a tongue-in-cheek jab at the former, located at an Army Base outside of Baghdad. Can you tell the difference?

Dinner jackets

Tuesday 20 October 2009

“There are dinner jackets, then there are dinner jackets.

That…. is a dinner jacket.”

-Vesper, Casino Royale

I used to think that a deployment was pretty much a deployment. I saw them as a binary thing; either you had been deployed, or you hadn’t. I now see that there is an infinite variety of deployments. Your experience depends on where you are, what your job is, the timing of the deployment, and multiple other variables. The experience of my colleagues here at Balad is really in no way similar to that of my colleagues at Bagram. Both, honestly, are valuable, life-altering experiences, but in incredibly different ways. I couldn’t comprehend that variability before this deployment, and the unique opportunity to travel extensively throughout Afghanistan and fairly widely in the Iraq theatre has been an insightful experience.

I smoked a cigar up on the roof of the Balad Hospital last night with a group of friends. I’ve done this throughout Afghanistan and Iraq, and the “smoke shacks” on top of the various hospitals are as diverse as the deployment experiences, themselves. All have been both unique and enjoyable. The Balad smoke shack is nicknamed “OR-5” (the hospital actually has 4 OR’s) and is probably the most famous of the cigar smoking areas in theatre, having been featured in an Article in Men’s Health. It is sort of a deployed surgeons’ tradition to gather for a cigar in the evening after surgical cases. Balad’s smoke shack is actually more of an attractive lanai than a shack, with a well-built deck, walls, and chairs. It accurately mirrors the mature nature of the hospital. Bagram’s smoke shack is just that, some rough lumber that has been nailed together and covered with camoflauged netting. Again, appropriate for its environment. Balad’s lanai was largely built, incidentally, by a general surgeon who is now stationed at Bagram. What a great legacy he left behind here at Balad. I’m sure it is just one of many.

By the way, while my perfect day generally involves one in which I never have to don a shirt, I kind of miss the dinner jacket. It is appropriate attire for a dinner with Vesper.

Baghdad (k)nights

Sunday 18 October 2009

I’m sitting in the laundry trailer at Camp Sather, Baghdad, Iraq attempting to remove some of the travel filth from my clothes. Don’t worry, Barbara, I’m sure that this skill, along with the ability to set an alarm clock and determine the directionality of artillery/mortar fire, will dissipate soon after my return. This has been a pretty outstanding trip, so far. I’m here to essentially close down the medical research efforts in Iraq as the medical system redeploys out of this war zone. The plans are already in motion for the redeployment of our medical forces, down to the single man level of detail, but I don’t want to get ahead of myself. Redeploy, by the way, is army-speak for deployment in reverse, ie- getting out of the country. Kind of like ‘retrograde attack’ means retreat. Not sure why we talk this way.

It took us two days to get out of Bagram/Afghanistan. It’s hard to really put that into perspective for you. Rather than spending time on the phone with a travel agent trying to arrange the perfect flight, this means humping your body armor, ruck, helmet, weapon, and whatever you might need for a two week trip to Iraq about a mile to the PAX (travel) terminal for every possible flight, three hours in advance of every flight time, which isn’t released until 2300 the night before. We did this 5 times on the first day, to no avail. Finally on the second day, we were able to catch a flight to Al Udeid, Quatar. I should mention that I am traveling with an O-6, which is usually the equivalent of a wartime, golden hall pass. An O-6 can pretty much get whatever he wants in theatre, and whatever he says usually goes. Except for travel out of country. R&R and combat missions take priority, and both happen to be quite in vogue in Afghanistan, right now.

We landed at Al Udeid about midnight and found our tents. Since it is an Air Force base, they have an O-6 tent, then an everybody-else tent. I think the U.S. Air Force is the last vestige of communism. Anyway, I of course managed to sneak my way into the O-6 tent for the night, which was a great upgrade. Heck, it's not that much of a stretch, I figure I’ll be one, someday. Ooh, inspiration for another fieldcraft piece. I’m not actually sure that the folks at Al Udeid know that there is a war going on, but it was amazing- everything is clean, there is wi-fi internet, they even took away our weapons, which was disconcerting. I haven’t walked around without one for over two months. I found myself constantly checking my hip with my hand as I used to do with my pager in a former life. I got a good 4 hours of sleep, then loaded up for the flight to Iraq.

This being the deployed environment, if not a war zone, our plane malfunctioned while on the runway and we got to sit in a sweltering C-17 for about two hours while they worked on it. Pretty standard, combat zone stuff. Of course we are in Quatar, which is in the Middle East, which is hot. Squiggly vision, Koran chants echoing from the top of minarets, hot. The problem was that they couldn’t get their power to work while on the ground. If the engines were running, there wasn’t a problem. The challenge would come, of course, when they had to stop the engines and drop off their cargo in Tikrit, Iraq before heading on to Baghdad (my destination). How would they get the engines restarted? The answer seemed fairly obvious- keep the engines running while you offload the equipment. It wouldn’t have been so dramatic, but the cargo happened to be a full fuel truck and two full, 5000 lb liquid oxygen containers. No problem, they decided to drive on. Apparently, you can’t smoke a cigarette within 50 feet of either a fuel truck or an O2 container, but 4 jet engines in direct proximity to the flammables don’t pose much of a risk. Got it- I’m ok with that. Besides, I need to get to Baghad. By the way, it worked.

Landing in Baghdad, I was once again amongst my Army brethren. Our camp consists of tents with the requisite amount of dust/dirt and eau de port-a-potty. Perfect. I’m back home. I spent the morning at the 10^th Combat Support Hospital, where I ran into a bunch of friends from Tripler. Dwight Kellicut, a vascular surgeon from TAMC, is here. He’s lost 49 pounds during this deployment, so far. Our CT surgeon from TAMC is also here along with an OB/GYN from Tripler. They’re doing well. Iraq is incredibly quiet. No real American traumas, thank God. Everyone is spending their time planning the draw-down and listening to the reports from Afghanistan. I wish I could describe the looks I get when they hear I’m at Bagram. Priceless- I actually love it. I’ll self-analyze my reaction at some point in the future. We’re quite close to Baghdad Int’l Airport, by the way, which was well depicted in a battle scene in the HBO mini-series “Generation Kill.”

I spent the afternoon at Al Faw palace, one of Sadam’s former homes. It is quite stunning and is now Multi-National Corps- Iraq HQ. I had to meet with the top Army medical staff in Iraq to discuss the drawdown plans for medicine and research in Iraq. The MNC-I surgeon (top doc in theatre) is Dallas Homas, a former colleague from Tripler, and his deputy is Wilma Larsen, former Dept Chair of Ob/Gyn at Tripler. I think we’re supporting this war out of the Pink Palace, sometimes. Either that, or I’m just getting older and have been around for too long. The meetings lasted for a few hours and went great, we’re all on the same page with our plans. I am very impressed with the medical war plans that I hear about. These people are on it. Mostly, I’m glad that there is essentially no trauma in Iraq and we are really winding down in this theatre.

I head up to Balad tonight to finish up business, here. I hear Balad has a pool and is no longer deserving of the title “Mortaritaville.” Excellent. I’ve kind of felt like I’m on R&R in Iraq. How strange to write that sentence. I think my stuff is ready for the dryer.

18 October 2009, cont.- PAX terminal, Baghdad

I was on a bus last night from Al Faw Palace back to Sather and had the joy of eavesdropping on the philosophical contemplations of some young soldiers. These were the same guys that I listened to on the airplane to Kuwait, except that they were different people. The bus was dark, about half-full, and idling at the stop, waiting for departure. The dust is slowly swirling in the dark outside the curtained windows. It’s still about 96 degrees outside, and the hum of the air conditioner is lulling us all to sleep.

“Belks, your ever heard of that saying, ‘money can’t buy happiness.”

“Of course, dumb shit, I’m not stupid.”

“Well, that’s bullshit.”

This is a verbatim transcript of the conversation to the best of my recollection. I wanted to write it down to guarantee accuracy, but it was too dark to see. While these were different people from the plane flight pair, young soldiers are apparently at that age where they are testing and defining the boundaries and truths of their universe.

“Man, I’m tired…I don’t want no theory, right now.”

“Seriously, I mean, whenever I’ve got money, I’m happy as hell. What kind of dumbass would have money and not be happy?”

Maybe these guys are smarter than I realized.

Sunday 11 October 2009

Winston Churchill tops my all-time favorite list of writers, wordsmiths, and politician/orators. He was a connoisseur of cigars, scotch, and sarcasm; man, I would have loved to sit out on my back lanai and share a stogie and finger of single malt with him. I think he was such an effective leader of his nation during WW II because he had known personal defeat and he had experienced war as a young officer during WW I. He realized the price of victory in war as well as the cost of not achieving it. His writing and spontaneous quotations, however, are my favorite part of his legacy. Apparently, he had a famous hate/hate relationship with Lady Astor, and during a dinner party at which they were seated alongside one another, and during which he had consumed a healthy quantity of scotch, she apparently told him, “Sir Winston, if I were your wife, I would put arsenic in your tea.” He calmly and dispassionately responded, “Lady Astor, if I were your husband, I would drink it.” Well played.

I recently came across another somewhat jaded quotation of his with which I had not been familiar.

“Men occasionally stumble over the truth, but most of them pick themselves up and hurry off as if nothing happened.”

I think he was talking about me. I often stumble across a truth or opportunity, and only later does the importance or profundity of the moment strike me. Such has been the case with my job. I knew upon receiving the assignment that it would potentially offer a nice balance of clinical medicine and academic challenge. I recently stumbled across an opportunity with our team, however, that I hadn’t envisioned, but seems so incredible, in retrospect. Late last week, while I was performing an administrative dance with some CENTCOM leaders, which did offer a fair share of staring, blinking, and entertaining gut checks, my team was doing something far more important. They met with a provincial reconstruction team that is attempting to grow a crop in Afghanistan that would potentially become a foodsource that could address much of the malnutrition in this country, the most significant enedemic health care crisis in Afghanistan. I didn’t realize it until I was safely away from the opportunity to make any impact whatsoever, but the concept is brilliant. It addresses the three most fundamental needs in this nation, to my simple mind. You grow a crop, creating an indiginous agricultural economy. The product alleviates malnutrition, the greatest health care concern in country, and at the same time provides an alternative to poppy/opium production, depriving the Taliban of their source of income. Brilliant. It is a cool opportunity to make a difference, but even more importantly, it allows the Afghanis to help themselves.

By the way, credits to John Cusack in Hi Fidelity for perfecting the all-time greatest, all-time greatest lists.

Ascension

Saturday 10 October 2009

“The superior man…stands erect by bending above the fallen. He rises by lifting others.”

Robert Green Ingersoll

Ingersoll was a famous 18^th century orator and lawyer, but beside that, he seems to have been a pretty good guy. I think he was an agnostic, and I wonder if his experiences as a soldier during the Civil War had any impact on his thoughts and values. I imagine that seeing numerous, shattered young men inspired his words, in both the literal and figurative sense. In my experience in Afghanistan, I continue to be impressed with the skill and compassion of those people who spend their days and nights bending above the fallen. I see the very best of humanity and compassion on display every day. It’s hard for me to place the health care debate ongoing in our nation into perspective over here…budgets, tort reform, partisan politics. The care here is sincere, unadulterated, risen to its purest form. I’m fortunate to see it and be a small part of work that is healing for both patient and provider.

I think Ingersoll was right in the figurative sense, as well. I have had the recent opportunity to meet with some of my senior leaders, and it has led me to reflect on what makes (some of) them effective. Actually, I’ve been thinking how to manipulate those in my direct chain of command in order to achieve my team goals, but that’s beside the point.

When I think back on the leaders that I respect the most, they always seemed to be more concerned about the welfare of those around them than on personal gain or advancement. They never tried to rise by pushing down on others. They would certainly shine, probably all the more from the reflection of those shining around them. I’m convinced that you do rise best and furthest by elevating and celebrating those who surround you.

Saw an interesting quote in the laundry tent, yesterday. Yes, inspiration comes from the most unlikely sources.

“The world is a dangerous place, not because of those who do evil, but because of those who look on and do nothing.”

-Albert Einstein

The bomb

Tuesday 6 October 2009

One thing that has really surprised me about this deployment is that people are actually nicer to each other here than back “in the world.” Internists and surgeons practice together peaceably, nurses rarely seem to complain, and even administrators appear to grasp the big picture. It’s kind of a strange “cats and dogs living together in harmony” sort of thing. Given my suspicious nature, I assumed it must be just an introductory phenomenon, but it actually seems genuine.

I experienced another example of an unnecessary and undeserved act of kindness, today. My team was taken on a tour of the flight line, highlighting the Air Force jets. There are a number of cool jets and fighters, here. While my more jaded side wonders if they might be more valuable if the Taliban actually had an Air Force, I realize that they do fill an important strategic role. I won’t go into the lecture I received from my well-intentioned, but exasperated, USAF tour guide after I questioned the potency of Al Qaeda air-power. Despite the wide-eyed stare, I realized we were still friends when I was offered the opportunity to help the weapons section assemble a bomb. With a half-smile, I flashed back to the Oath of Hippocrates I had muttered so many years ago, “First, do no (bomb?)”

Sure, friend, why not? Then, again, is that a favor or an answer to my question?

The gator

Fieldcraft lesson #2: Never walk when you can ride.

On average, we probably walk at least 4-5 miles per day on this FOB. While I realize that in the life of an infantryman, four miles is nothing, the art of fieldcraft demands that a soldier constantly strive to improve his quality of life. Being fully committed to this endeavor, one of my deployment goals has been to acquire the use of a "gator-" a 4-wheeled, offroad vehicle.

One of my partners in Hawaii recently asked if I've had my name stenciled on the side of a helicopter, yet. While I have ridden more than my share of helicopters over here, they are accessible to the masses, and therefore I deem this goal not fit to earn the title of "fieldcraft."

Now acquiring a gator, there's a challenge. They are incredibly hard to find and possess in this theatre. This past weekend, I succeeded in securing the services of a sweet gator, red cross and all. My friend Bill and I took the "long way" to deliver a package and loved every minute of it. It's probably the most fun I have had in the past two months, as you can probably see from Bill's smile (behind the wheel) and my filthy face. While I enjoy nearly anything that makes me dirty, this was absolutely smashing. Much better than walking.

Fieldcraft

Saturday 3 October 2009

Soldiers have a slang term for the little skills, or tricks of the trade, that help you to survive life “out in the field” or in a deployed environment. This art is called “fieldcraft,” and it has existed and been passed down to young warriors as a sacred religion since the first soldier walked out of his garrison. The lessons may be as profound as how to best avoid an IED or as mundane as the adage to change your socks regularly. I have decided to pass on some of this ancient wisdom to which I have become privy over the past few months. I will start with the first, and most important, tenet of fieldcraft:

LESSON #1- How to choose a toilet.

You approach a line of port-a-potties, field toilets, toilet trailors, whatever. It doesn’t matter. The lesson will still apply. You are suffused with a mixture of trepidation, hostile intent, and silent relief. The DFAC food hasn’t exactly been racing through your digestive tract, so you have some time to pick your target- probably about 10-15 seconds before the guy behind you starts to get jumpy. He may have been a “healthy eater” who stuck to the frozen vegetables. Anyway, you have a decision to make. Before you decide to engage your other senses in order to identify your victim, use your eyes. Look at the magazines on the ground in and around the port-a-potty or toilet. You will inevitably see a Maxim outside at least one of them. These should be avoided at all costs. The generation of over-caffeinated, Rip-it infused Maxim readers is not known for their fastidiousness in toilet etiquette and cleanliness. This one(s) will also have been the most used, by far. While you may be sorely tempted to peruse the article on calf-muscle exercises, step quickly away. Look, instead, for the toilet with a Car and Driver or Popular Mechanics on the ground. The gear-head, engineer types are much more considerate with their toilet-care, and they are far fewer in number.

I hope this provides some insight into the thought processes of the reflective soldier. More to follow. Cheers.