RIP-TOA

Sunday 22 November 2009

It’s kind of a dusty and dreary Sunday here in Bagram. Or “Runday” as my roommate refers to it, since we usually run our 8 mile loop around the perimeter of the base on Sunday mornings. The air is so full of dust and pollution, today, that the mountains are not visible at all. During the run, somewhere in the midst of a skeptical diatribe that I was delivering and both of us were largely ignoring, my roommate commented that in 20 years, people will be skiing in those mountains. I wittily replied, “What mountains?” Well, it seemed funnier at the time since we were both pretty high from the carbon monoxide being spewed in the exhaust fumes of the jingo trucks passing us on the dusty road.

We had a large turnover of the surgeons last week. The Army calls it a RIP-TOA, for relief in place/transfer of authority. The old crew of surgeons redeployed and the new group just arrived. Being slightly more than half way through my deployment afforded me a somewhat objective perspective to the experience. The guys leaving tried hard (some harder than others) not to gloat or expose their glee at heading home. The new guys were pretty bleary-eyed from the jetlag and bothered by the incessant hacks emanating from their still healthy lungs and airways, not yet compensated to the filth in the air here. Their first real day on the job, we had 13 casualties arrive simultaneously. Welcome to Bagram. The Taliban shot RPG’s and rifles into a bazaar not far from Bagram that happened to be crowded with children at the time. Four of the victims were under ten, and there were several teenagers, as well. While you tend to adapt to anything, even war casualties, seeing children that have been victimized by war wounds is unnatural and haunting. Their little bodies in our trauma room and ICU beds is a sight that I won’t soon forget.

The new team did well and provided great care. One week later, the glazed looks of trepidation are gone, the coughs are resolving, and they appear to have settled into the rhythm of life here. The witty comments and bits of laughter have even returned to rounds, an excellent sign. Like their upper airways, they're adjusting to the grit of deployment. Hard to believe that in about three months, it will be time for my RIP/TOA. I’ll have to remember not to appear gleeful.

Good news- the inauguration went off a few days ago without any major violence or incidents. Everyone was pretty anxious about what would happen. Good cause for Thanksgiving.