From the Beach to Bagram

Bagram to beach

2010-02-27T06:58:00.002+04:30

Well, I have made it back home. It is surreal, strange, and amazing. I am thankful for the experience, even more thankful to be back home, and most thankful for my amazing wife and children. We went straight to Lanikai beach from the airport to wash away some of Afghanistan- the perfect homecoming. I hope to be in touch with friends and family as the next few weeks roll along.

Thank you for tolerating my ramblings.

Warmest Aloha,

Joe

Purgatory

2010-02-19T11:56:00.001+04:30

Thursday 18 February 2010

I am currently in Kuwait, laying in my cot and listening to the sandy wind blow the tent flaps after making the overnight, 5 hour flight from Afghanistan in a C-17. I must admit that the sand of Kuwait looks a lot more inviting to me while traveling in this direction. I’ll be here for 4 or 5 days before going to Ft Benning, GA to complete the redeployment process.

The feeling is kind of surreal. I can feel my body unwinding, my pulse slowing, a kind of deep fatigue possessing me. I see it in the other redeploying guys, as well. Not as much banter among the guys returning from Afghanistan as one might expect. It seems like guys are sleeping 14 or 16 hours at a stretch.

I watched some news on a TV in the gym tent and am filled with mixed emotions. I am ecstatic to be heading home, but strangely, a little guilty to have left while my friends are there doing important things. I can hear the EOD guys blowing some ordinance in the background. Not sure why they are having controlled detonations in Kuwait.

I am actually thankful to have this temporary stop on the way home. It has been a good chance to unwind and slow down, let the caffeine wear off. I am jaded enough to know that this stop is unlikely intentional on the part of the “system,” but it is worthwhile nonetheless- sort of a soft transition back to our other lives.

You can’t always get what you want,

But if you try, sometimes, you just might find,

You get what you need.

-Rolling Stones

medics

2010-02-14T15:52:00.003+04:30

Sunday 14 February 2010

Until I just wrote today’s date, I had once again forgotten that it’s Valentine’s Day. Being here, my hope is that this transgression will be overlooked (right, B?)

While much about the Army frustrates me beyond words, I don’t think I have ever been prouder to be in the Army than I am today. I just came from an awards ceremony for the 8^th Forward Surgical Team, recognizing the work of their medics, in particular. I am extremely flattered to have been asked to present the awards to their medics since I’m not assigned to the unit and I’m not in their chain of command. I have, however, been to their forward operating base several times and have worked closely with their team. It’s also special to me that that the unit happens to be based out of Hawaii.

Their forward surgical team has been the busiest in Afghanistan. So much so, that they were highlighted in an MSNBC piece that I mentioned on this blog several months ago. Their successes have been phenomenal and they have paid a high price- they have had to experience the tragedy of their own medics being severely injured in combat. Beside my clinical ties with this unit, I have worked with their medics and trauma nurses on what has become a very high-profile project to improve the life-saving interventions performed by combat medics. They have been the best in every respect.

I have never before been choked up at a formal military awards ceremony. I wish I could capture that moment and the looks in their young eyes, standing in their worn and faded uniforms, waiting to board their flight to Kyrgyzstan, Europe, then home to Hawaii. I wish I could turn my appreciation, my admiration, my affection for these young people into something tangible. My words seemed so impotent, unworthy of their deeds. I hope to remember their laughter, their sarcasm, the smell of the broken wooden crate bonfire in front of their medical tent, the sight of the stars flying over their dark FOB, my own comical fear that I might have flinched at an outgoing artillery round or flare, belying my nonchalant facade.

Now they head back to their motor pools, medical supply offices, and Tripler clinics where they work. Back to their car payments and pau hanas (happy hours). At the end of the ceremony, their First Sergeant went medic by medic, pointing out their dreams, aspirations, career hopes. Meanwhile, the assault on Marjah progresses as I head up to the smoke shack for a cigar, wondering what the night will bring. I think I’ll have a good one, tonight.

The tap

2010-02-07T20:41:00.002+04:30

Sunday 7 February 2010

It’s about 8 pm and I just walked through the ICU to check on a patient that I operated on Saturday. He’s an ANA soldier who had been injured by an IED. He had a tissue defect just above his right ankle, essentially a 6x 5 inch hole with damaged tendons. On Saturday, an orthopedic surgeon repaired his tendons while I harvested a flap of tissue from his forearm for use in reconstructing the defect. My team sewed an artery and two veins from his leg to an artery and veins from this harvested tissue in order to give it a living blood supply. We did this under a microscope with 9-0 suture that is much finer than a human hair. The closest place to Bagram where you could get this kind of surgery is probably in India, two countries away.

I stood over the patient with my plastic surgeon partner and we congratulated ourselves on our success. We listened to a Doppler device which documents blood flow through the flap and fist-bumped each other in toast. Suddenly, I felt a tap on my shoulder and looked up to see two older Afghan men in traditional Afghan garb pointing to the patient’s head, which I hadn’t noticed. As I walked around the bed, I saw that they were pointing at the rivulet of saliva which was draining from their brother’s mouth in a slow but steady trickle. I had forgotten that the patient also had a head injury from the concussion of the blast. I put on a glove and wiped it away, chiding myself for the descent into myopic vanity. The dark eyes and gentle tap of the Afghan villager who spoke no English provided a crystal-clear reminder that I was apparently in need of.

The goat

2010-01-31T15:20:00.004+04:30

Sunday 31 January 2010

I suppose I should provide some follow-up on the surgeon/patient. He ended up recovering quite nicely at BAF for 2 days, without surgery. He has been sent to Germany for a few weeks of observation to ensure that he doesn’t develop any delayed complications as he is posted in a location where it would take a while for him to reach medical care. Outside of his own, that is. I fully expect that he will be assertive enough to play salmon, swimming upstream against the normal patient flow and make it back to theater.

Yesterday at about 3:30, as I was dutifully and happily working on the transition brief for my replacement, my vascular surgeon friend walked in and told me that a patient had arrived with a gunshot would to the back of the neck and that the bullet was lodged in the soft tissues of his neck. He told me not to worry, though, that they could handle it.

“You just like to turn the bovie (electrocautery) up really high and dig right down to it, right? I mean, it’s just the neck- there’s nothing to hurt in there.”

My keen sense of observation and his half-smirk told me he was just getting my goat, but I was surprised at how quickly he was able to find the soft spots. I guess I’m not as subtle and mysterious as I had hoped. As he walked to the OR, I chased him down the hallway muttering profound things like, “Come on, I mean… no…you can’t…you have to approach…fine.”

The case was actually fun and not very technically demanding. I was able to dig the fragment out from the deep neck musculature quite easily and nothing important had been injured. The whole thing only took about 15 minutes, including my running commentary to the anesthesia team about the incredible degree of difficulty of this case and that only 3 surgeons in the world could pull this off. All of which was totally untrue, as confirmed when the anesthesiologist said that he had seen zits that were more difficult to get out. I think this is a conspiracy.

After the case, I walked into OR #2, where my buddy was doing an intricate vascular repair with a graft to the posterior tibial artery on a patient who had been shot through the lower leg. He had also, incidentally, been shot through the back and stomach, so the general surgeons were doing a laparotomy at the same time.

I asked him if he needed any help as I had recently read that the leg bone is indeed connected to the foot bone and I’d be happy to talk him through it. It’s just the leg, after all, there’s nothing important in there, right? He asked me how my zit went.

Something

2010-01-23T17:40:00.001+04:30

Saturday 23 January 2010

I ran into one of my favorite people yesterday in the smoke shack on the roof, an Air Force vascular surgeon who was intently examining his cigar and immediately said to me in an exasperated tone as I entered our little Shangri La, “You Army guys are something.” I could sense that he wasn’t exactly complimenting me, so I inquired as to the inspiration for this sudden realization. He told me that one of our FOB’s was rocketed yesterday, injuring several medical personnel. One of the casualties was a general surgeon, who was then flown here on a medevac flight for treatment. The surgeon actually walked off of the helicopter and into the trauma room, saying loudly “Where’s the latrine?” As he walked out of the bathroom, he then exclaimed, ”There. Now there’s no need for a foley (catheter).”

After agreeing to finally lay down and get examined, the “patient” said “I’ve already explored the wound- there’s no intraperitoneal injury.” My friend inquired how the surgeon had managed to explore his own wound, upon which he replied, “With my finger.” Some eyebrows were raised, but the patient did agree to undergo imaging (x-ray and CT) studies, which actually showed that he had free air in his belly. This finding indicated that he did indeed have some shrapnel that entered his abdominal cavity, necessitating a laparotomy- a surgery to explore the abdomen and remove the shrapnel. After my friend reviewed the films with him and briefly discussed the procedure, with which both surgeons were of course familiar and which was completely necessary, the patient said, “No.”

“No?”

The patient said that he had no fevers and didn’t want to have surgery or be air-evacuated to Germany. He wanted to be observed for 48 hours, and if he didn’t develop peritonitis (an infected abdomen), he wanted to go back to his FOB and get back to work.

Funny enough, noone has ever said “no” here before. I won’t go into the medical details of the situation, but the request was risky, unusual, and caused a bit of head-scratching on the part of my friend and our entire medical command structure.

I’ll let you know how it turns out.

The arena

2010-01-20T17:46:00.001+04:30

Tuesday 20 January 2010

I am back at BAF and ran into some of my surgeon friends who were stationed at FOB Ghazni and FOB Salerno (Khost Province). They’re on their way back home and fly out tomorrow. Both groups mentioned that in a strange way, they are kind of disappointed and a bit sad to be leaving. After referring them for immediate cognitive testing and a neuropsych evaluation, I found out that they had been happy with their deployments and universally had very rewarding experiences. One of the surgeons, interestingly, reportedly left FOB Salerno in tears. Part of their melancholy is no doubt associated with the fact that they’re actually on the way home. I still have about 6 weeks left to go and am trying to just keep up the pace and finish strong. Once I let myself really start thinking about home, I’m afraid that time will start to slow. I’m not quite ready to reflect back just yet- there are too many hours and miles between me and Kailua.

While I have very little access or time for media, even I have heard about the recent tragedy in Haiti. I’ve also heard about some of the frustration with the slowness of relief efforts. I am acutely aware of the challenges of providing humanitarian relief in austere environments and was at first frustrated by the critical nature of some reports. Then I thought, how American of us to just assume that of course we would come to the aid of another country and that of course we should be rapid and effective. What other nation expects and demands such perfectly executed compassion? Ultimately, that is likely a good thing and I guess that’s why we are who we are. Before I came to that realization, however, one of my favorite quotes regarding the difference between doers and critics came to mind:

"It is not the critic who counts: not the man who points out how the strong man stumbles or where the doer of deeds could have done better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood, who strives valiantly, who errs and comes up short again and again, because there is no effort without error or shortcoming, but who knows the great enthusiasms, the great devotions, who spends himself for a worthy cause; who, at the best, knows, in the end, the triumph of high achievement, and who, at the worst, if he fails, at least he fails while daring greatly, so that his place shall never be with those cold and timid souls who knew neither victory nor defeat."

-Teddy Roosevelt

I suspect that my departing friends must be feeling the satisfaction of leaving the arena with their heads held high.

tulips

2010-01-19T20:18:00.002+04:30

Sunday 17 January 2010

I’m currently at Kandahar Air Field (KAF), which is a NATO base in Southern Afghanistan. The weather has been warm (in the 60’s during the day), a blessed relief from the cold of northern and eastern Afghanistan. Since it’s a NATO base, the majority of people at Kandahar are actually not from the U.S., which is also an interesting distraction. Aside from the Tim Horton’s donut shop (which I will not discuss as I’ve just barely come to terms with my gluttony-inspired self-loathing), the most amazing thing about KAF is the NATO gym. It’s run by a civilian company from Amsterdam, and it is the cleanest place I’ve been in 5 months. It very much resembles a health club back home with music playing and weight machines- strikingly different form the Army gym tent at Bagram. I had previously heard that you actually have to change into clean shoes when you get into the gym, which is a problem for me, because I just don’t have anything clean. As I approached the European front desk worker/receptionist, he looked down his nose at me with a pinched expression, as if he had just discovered a worm in one of the tulips in his windmill garden. I can understand Serge’s shock (I’m assuming his name is Serge, though it could just as easily have been Tomas or Sven) at my appearance. I was wearing my stretched, stained workout uniform and shorts with my combat boots, since I don’t have one clean pair of running shoes let alone two that would allow a change. I’m fairly sure that he gagged when he saw my running shoes. I hadn’t noticed until then that my formerly grey New Balance 990’s are now black, cracked, and surrounded by a Pigpen-like cloud/aura/entitiy that is part dust, part stench.

He felt compelled at that point to state, “Ze purpose of ze shoo shange policy ees to shange from derty to clean, not derty to dertier.”

Got it, Sven, it is what it is. I’ll try not to touch anything and I won’t even comment on the Enya CD you just put in. Deal?

He let me in and dove straight for the hand gel. Anyway, they had soccer playing on the TV’s, though thankfully the sound didn’t quite overpower the Enya. Ugh. I did notice a short piece on BBC about Prince William. He was standing in a Royal Air Force uniform along with his father, who was in his Royal Navy uniform. I’m assuming Prince William must have completed some sort of military training. I recall vaguely that his little brother is doing something with the Royal Marines. Though I suspect that neither of them will be dropping 20 pounds with their brethren in Helmand Province or nearly freezing to death along the border of Pakistan, I think it’s neat that they get a little taste of military life.

I will admit to watching a bit of the soccer, since they weren’t showing the NFL playoff games. I know that I am shallow, biased, and woefully underexposed, but I can’t help myself- I just don’t understand the attraction to soccer. I mean, when the players get blazing mad at one another, they run up and kick each other, much like the young girls did on my schoolhouse playground. While I can shamefully admit that those kicks did actually sometimes hurt, I just don’t get it. We were taught as youngsters playing baseball that if you get hit by a pitch, jog nonchalantly to first base as if nothing happened, though it may feel like you just ruptured your spleen. Your teammates would be yelling “Don’t rub it” as you trotted down the first base line. In football, you’re taught to “play through the pain,” or “grin and bear it.” Soccer players, however, seem to suffer an epileptic fit when another player actually happens to graze them, flopping on the ground like a dying fish.

I am happy to report, though, that Chelsea beat Ulster (or Unger or something like that) 7-1. Tomas was ecstatic.

Resolution

2010-01-03T15:03:00.003+04:30

Sunday 3 January 2010

New Year’s Eve and Day came and went with barely a notice. Christmas was recognizable because of the holiday lights hanging inside b-huts, barracks, and in the hospital- the multi-colored kind we keep strung up all year in Hawaii. Christmas trees of different sizes were visible here and there, mostly small ones shipped from home with a handful of token ornaments, infinitely more poignant and profound in their sincerity and simplicity. New Year’s, however, was pretty much ignored. I spent the morning of New Year’s Day with the smell of my daughter’s hair, the squeeze of my son’s tight hug, the feeling of a tender kiss on New Year’s eve somewhere in the back of my mind. The rest of me spent the morning of New Year’s Day in OR #3, operating on a 13 year-old Afghan child that I had seen out in a village when I was on a medical outreach mission. He had a tumor working its way out through the skin of his face, so I did a parotidectomy and neck dissection to remove the tumor. It was nice to be doing head and neck surgery again, rather than trauma surgery or combat trauma research work. Mostly, I guess I was relieved by how much I enjoyed the case. I see it as proof that I will eventually be able to return home to my normal life, finding it fulfilling and well, normal. I’ve only been gone for five months, but it seems strange to imagine a world without the constant sound of helicopters, the smell of outdoor toiletry, the vista of haze and opacity that lurks and obscures.

The real heroes of that case were the guys who went back out to the village to find the child and bring him in. Their daily courage is awe-inspiring. Maybe even more than them, though, I admire the boy. He is a 13 year-old villager who showed up at the hospital to see me with no escort outside of a commando that he didn’t know. I can’t imagine what he must have been thinking and feeling as we walked to the CT scanner, not understanding the language of anyone around him, in an environment that must seem so utterly incomprehensible. Through an interpreter, I explained the scan and the upcoming surgery, and he neither blinked nor flinched. An impassive nod was his sign of assent. One of the commandos was able to track down an older brother who serves as his guardian and has stayed with him since the surgery.

I just checked on him this afternoon and he is doing fine. I have always enjoyed rounding on my patients alone. The patients tend to be more relaxed, I’m less rushed and distracted, and it allows for real communication, even when we don’t speak the same language. When I’m alone, I can sometimes hear my former patients that I carry around with me- the successes and the failures. They remind me of my strengths, my weaknesses. They sometimes scold, sometimes applaud, often remind me of things that I should have remembered but seem to have forgotten, and constantly point out that they will always be there, patiently waiting for me to be quiet and wise enough to listen.

Team Taliban

2009-12-27T08:42:00.002+04:30

Sunday 27 December 2009

This has been a fairly atypical Christmas Day, which I suppose is pretty typical for a war zone.

A few weeks back, one of my team members had a syncopal episode, losing consciousness in the hospital and suffering a pretty good head bonk upon floor impact. The end result was an impressive pool of blood on the floor, some of which managed to trickle under a nearby Christmas tree in the small "dining area" of the hospital, followed by a few staples in the scalp laceration. Today, in the spirit of celebration, another friend of mine performed a song during our team meeting that was written and inspired by the event. The song was entitled "Blood under the Christmas tree" and was a smashing success. I'm not sure that it will replace "Silent Night" as a Christmas classic, but it has a pretty catchy tune, great lyrics, and is certainly original.

Here’s another Christmas story, albeit one you won’t likely want to share with the children fireside. During a village medical outreach mission about a month ago, intelligence came in that the Taliban was going to attack the team. As the security team spread out to the perimeter in order to form a hasty defense, the group of female Afghan interpreters, joined by my female team member, barricaded themselves into the place where they were staying and immediately starting dressing up and putting on make-up. I should add that having a female health care provider in that environment is critical, since Afghan women in most villages will only consent to be seen and treated by women. At any rate, when my female team member inquired as to why they were getting dressed up for the attack, they recounted that their survival strategy was to get dolled up so that if they were captured, they could become hookers for the Taliban. They were very pleased as my team member, who has a light complexion, began to get cleaned and dressed up as well, and they would now be able to offer the Taliban a variety of skin tones from which to choose.

A photo was taken of the potential Taliban hooker team, and my friend actually forwarded it to her husband back home. He then sent it to her father, not recounting the story for the inspiration of the photo. The proud father now displays the photo on his fireplace. The perfect gift for my team member this Christmas, of course, was make-up.

Christmas

2009-12-25T01:31:00.002+04:30

For every boot that tramped in battle,

every cloak rolled in blood,

will be burned as fuel for flames.

For a child is born to us, a son is given us;

upon his shoulder dominion rests.

They name him Wonder-Counselor, God-Hero,

Father-Forever, Prince of Peace.

- Isaiah 9, 4-5

Merry Christmas.

The potency of medicine

2009-12-23T19:33:00.005+04:30

The first photo shows the face of Afghanistan, at least one of them. The second shows one of my team members during a village medical outreach mission. She is literally reaching out to an Afghan child. The mother's crinkled eyes show that she is smiling under the veil. Even a burka can't hide that.

Logar Province.

2009-12-17T21:31:00.005+04:30

This is a photo of Logar Province that I took the day after spending my night of penance for poor judgement. Highway 1, the aorta of Afghanistan, is in the foreground. You can see typical walled-off Afghan compounds on the plain.

Distinctions

2009-12-17T07:17:00.003+04:30

Wednesday 16 December 2009

Fieldcraft tip #3: When moving around a combat zone, always travel light. Except during winter in Afghanistan.

I remain humbled at the incredible number of lessons that I continue to learn and relearn as time and life passes. That’s a polite way of saying that I’m amazed at what a dumbass I can occasionally be. One important truism of life in a deployed environment is that it is critical to travel light, since whether you are an E-3 or an O-6, you will eventually be carrying whatever you decide to bring with you on your back. In general, it’s easier to suffer a little bit from the absence of something than it is to consistently carry too much stuff. This has been reinforced through my experiences time and again as I have traveled throughout the combat zone. One critical exception, however, applies when the equipment is necessary to keep you alive. That’s where I made my mistake.

I recently traveled to a forward operating base that is located at over 6,500 feet. I knew that the temperatures at night would hover around 10 degrees F and that I would be staying in a tent, but I figured that since I would be one of the three highest ranking officers on the FOB, the tent would be a “VIP” tent, and certainly heated. I had experienced nights at higher altitudes and colder temperatures in the recent past and been just fine. (Sidenote- if you ever hear an explanation of someone’s reasoning that is this long, it is a guaranteed admission of guilt.) Accordingly, I brought my lighter sleeping bag, a Snugpak Jungle Pack. It is compact, light, sturdy, and totally appropriate for, well… a jungle. Surviving through the night during an Afghan winter, not so much.

That, of course, was exactly the issue. The heater in the tent failed to work, and it seemed that the tent miraculously managed to actually lower the inside temperature below that of the ambient temperature outside. After nightfall, as I transitioned through the uncomfortable phase, passed through misery, and stumbled upon desperation, I finally admitted to myself that an intervention was necessary. I picked up my sleeping bag, which was easy with it being so light and all, and trudged down to an E-6 tent, which had more people, so I figured it would be warm enough to let me survive the night. Fortunately, the soldiers took pity on, or at least indifference to, the idiot officer with a sleeping bag that had mosquito netting sewn around the head end.

I obviously survived the night and am now left to ponder the fact that good rules are only good until they’re not. More importantly, I will now remember to contemplate the often subtle distinction between being savvy and being lazy when making a decision.

The enemy within

2009-12-15T13:37:00.001+04:30

Sunday 13 December 2009

Thankfully, the clinical pace at the hospital has slowed down quite a bit. There are, however, quite a few “enemies of peace” that are being cared for in our medical facility. “Enemies of peace” is the new, politically correct term for the forces that fight against the Afghan government and Coalition Forces. Personally, I consider constipation to be an “enemy of peace.” These guys are something different. It is interesting to look into their eyes and know that prior to receiving world class medical care in our hospital, they were trying to kill our friends and peers. Most people, fortunately, rarely get to see that look. Well, except maybe for the resident a few years back who claimed during a quarterly review session that I sometimes “looked like I wanted to kill the residents.” Totally untrue. Maybe just hurt them a little. If any residents or members of the Residency Review Committee are reading this, that was totally a joke- an effort to instill comic relief into a piece that I should probably not have posted.

It’s no secret that we provide medical care not only to our friends and allies, but also to enemy forces that are injured in combat. It is, however, an incredible thing that our medical personnel really do deliver the same quality of care to our enemies that we do to our own forces, without hesitation or resentment. I was recently up on the roof of the hospital discussing the matter with a trauma surgeon and he mentioned that he had just finished a pretty amazing and complex surgery on an injured “enemy of peace.” He said, “It’s funny, I’ve done some of my best work on these guys.” At least that’s what I think he said, since we were conversing through gaps between our neck gators and fleece caps that were exactly the diameter of a cigar. The truth is, they really do get our very best.

Pressure

2009-12-10T17:28:00.002+04:30

Thursday 10 December 2009

We had our first snow today here at Bagram. Actually, it was a slushy, icy, 33 degree F, muddifying, Afghanistan version of snow, not the beautifying mountain kind of snow. It was sort of the weather equivalent of learning to snow ski at West Point. That place could even suck the joy out of something as fun as skiing. I still have an image of a heap of bodies (most of them from Southern states) piled at the exit of the ski lift at the top of the ski slope at West Point.

“You bunch of monkeys look like a goddamn Rossignol yard sale!” That comment from the compassionate instructor assigned to the Department of Physical Education would have been funnier had I known at the time that Rossignol was a brand of ski equipment. The fact that his boss was officially titled “The Master of the Sword” should tell you something. It was a fairly accurate portrayal of the situation, however, given the tangle of skis, poles, and various items of inappropriate clothing that lay strewn about. At the time, we had to wear cotton sweat pants and our felt jackets as the uniform for ski class. That, too, is funnier in retrospect because we must have looked like a bunch of snowballs as we caromed down what we considered our “ski mountain.” You can probably imagine the end result of setting loose a bunch of cooped up, late teen/early-20’s adrenaline junkies who have no idea that snow + gravity = danger onto an icy mountain in New York state.

Truthfully, any kind of change is a welcome distraction here and I haven’t heard a “this sucks” in over 2 days. There’s kind of a feeling of anticipation in the air, most likely due to the expectation of more troops arriving and the predictions about whether the optempo will actually slow down this winter, as it has during past winters in this country. The consensus is that it will not, especially given GEN McChrystal’s recent testimony that “victory will result from the prolonged application of pressure.” I guess that’s us.

Other side of the world

2009-12-01T18:44:00.003+04:30

"Remember those times on the telephone line,

trying to break through to you.

I'm on the other side of this world,

I wish I was there with you.

All these days and all these nights,

thinking about you my friend,

I can't wait to get back home..."

- Donavon Frankenreiter, So Far Away

Until I do get back home, I will do my best to record and share some of my experiences on this journey. I have recently returned from a trip that I will remember for a lifetime. I spent some time at the old Taliban barracks in the picture, above, which is now a coalition medical facility. The operating room is the first door to the right, the trauma room is the first door on the left. This is one of the two or three busiest trauma stabilization sites in Afghanistan. The site is guarded by some Hazaris (like in Kite Runner), which is a good thing because they really hate the Taliban and seem to have an uncanny ability to sniff them out.

My interactions with the Polish Army at this site were moving and memorable. I know that I am completely biased, but I am left with an incredible fondness for the people with whom I worked and interacted. I am fortunate to have worked with some fantastic people, both Polish and American, and I take away memories of laughter echoing off of walls that formerly encompassed scenes of tragedy and terror. I will also remember the sound and feeling of the mournful hymns of a Polish Sunday mass, filled with words that I couldn't understand but a message that was clear.

During the trip, I spent a good deal of time with two American surgeons, a trauma surgeon from the University of Pittsburgh and an orthopod from east Tennessee, about 30 miles from where I grew up. What a small world it is here on the other side of the world.

Paddling in

2009-11-26T18:34:00.002+04:30

Thursday 26 November 2009

It has been a nice Thanksgiving here in Afghanistan, cool and blessedly clear. The snow line is moving down the mountains and I suspect will hit us any day now. People here have two main ways of dealing with holidays. Some prefer to pretend that the holiday doesn’t exist. “Just 1 out of 180, man” is what many say, meaning that it’s just another day of deployment and one more closer to going home. I’ve opted to try to make the best of it, ate some turkey in the chow hall, and my team took turns talking about their favorite Thanksgiving traditions. I detailed how excellent the waves have been on the Windward side of Oahu on every Thanksgiving weekend for the past 8 years and how nice it is to paddle out from my neighborhood into clean, peeling, reef-break waves. After recounting this story, though, I suddenly realized that the best part was actually paddling in, knowing what and who was waiting for me on shore. That’s what I’m really thankful for.

I am going to spend some time with a Polish military unit in the near future. That’s kind of exciting for me, given my Polish heritage. My great-grandfather was apparently in the Polish cavalry, so it’s kind of neat for there to be another Sniezek working with the Polish Army again, 100 years later. I’ve actually been thinking of my Polish roots, lately, hoping that somewhere buried in my genetic code lies an improved tolerance of this cold weather. After all, my name means "snow" in Polish. Eight years in Hawaii has made me pretty soft.

Happy Thanksgiving to my family and friends. You don’t know it, but you just spent a Thanksgiving with me in Afghanistan.

RIP-TOA

2009-11-22T17:36:00.002+04:30

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.

Ashtrays and mice

2009-11-11T19:22:00.002+04:30

Wednesday 11 November 2009

Unfortunately, there was an accident yesterday just outside of the wire at the 8^th FST involving some ANA (Afghan National Army) soldiers. The details of the story were recounted to me last night by the FST Commander. The ANA is actually very well respected by coalition troops. They form the lead and tail elements of many patrols and we treat more ANA casualties than Americans or NATO forces. They are a tough lot with their own idiosyncracies, like everyone else. At any rate, five ANA soldiers were apparently in a bunker when one of them threw a cigarette butt down and ignited a fire, cooking off an RPG, which ignited several other RPG’s, injuring all five. There is certainly no humor in that, but after operating on the guys, the surgeons starting passing around a hat for the “ANA ashtray fund.” Pretty good stuff.

I had the pleasure last week of eating an Afghan meal prepared and served by some of the Afghani interpreters who accompany the local outreach efforts. It was certainly the best meal I have had in many months and amazingly, all courses were prepared over one small field stove. There were several curries with potatoes, a long grain rice, and local bread. They also served a tabouli-like salad with spicy peppers. The food was excellent, but the company was even better. I really like the Afghan people who I have met. I suppose I expected most Afghanis to be stoic and stolid, similar to the folks I’ve interacted with in Ladakh and Kashmir, but the Afghanis are more apt to smile, laugh, tease, and joke. Granted, the sample is a bit skewed because these interpreters have a fair amount of interaction with Americans, so they tend to adopt some of our habits and mannerisms, but they have an innate happiness that pleasantly surprised me. Rather than being destroyed by the centuries of war and suffering experienced by their nation, most are generally upbeat, generous, and gracious. The Afghanis who work in the laundry tent are equally as pleasant. About once per week or so, they hide a rubber mouse between the pages of the sign-in book and laugh hysterically when I, or anyone else, looks shocked as it is discovered. Kind of like playing 'pull my finger', the joke just never seems to get old. People are resilient.

Bagram skyline

2009-11-09T19:52:00.004+04:30

Here's the Bagram skyline. It's not Manhattan, but I think the backdrop of the Hindu Kush mountains edges out the East River. Cold winds blew in from the North today and cleared the air. I hadn't realized that the mountains are snow-covered until I walked out of my barracks this morning. We've been blanketed in dust for the past three months. It's getting down to 18 degrees tonight. Winter is finally here. Also, for those who haven't seen one, that's an MRAP (mine resistant armored personnel carrier) on the right. My prediction is that we're going to start hearing a lot about these vehicles in about 12 months or so. If you double click on the photo, you can get a better sense of just how stunning the mountains are. Who knew?

Any Given Sunday

2009-11-08T15:56:00.003+04:30

Sunday 8 November 2009

It is a beautiful Sunday morning here at Bagram with a cool breeze and light, sprinkling rain. This is only our third rain in the past three months and it is certainly welcome. When I walked out of the hospital last night, a general surgeon I passed saw the rain and said, “Wow, isn’t it beautiful.” It was dark and all you could really see were little muddy puddles, but I know what he meant. The rain helps to clean the dust out of the air. Soon after it stopped raining this morning, however, the passing MRAP’s stirred up clouds of dust that returned me to the atmospheric reality of life at Bagram. Despite three semesters of college physics, I’m not exactly sure how a road can be muddy and dusty at the same time. This is a miraculous place.

Instead of operating this morning, I was “excused” out of the OR by the other Head & Neck Surgeon here at Bagram. We did a pretty challenging mandibular and facial reconstruction yesterday on an ANA patient who had been shot in the jaw. It was the third patient we had treated with a similar injury in the past three days, so he told me to take off and do something “Sunday-like.” Besides, the case was “only” a tracheotomy, maxillary-mandibuar fixation, and repair of a facial Leforte I fracture. Rather commonplace in these environs, and he could certainly handle it without me. So, instead of operating, I went on an 8 mile, muddy, grunge-run. If you would have told me 5 months ago that I would elect to go on an 8-mile run as a form of relaxation, I would never have believed you.

I have posted a link to a series of pictures compiled by CNBC. The pictures show trauma patients being treated at the 8^th FST (forward surgical team). The 8^th FST is based out of Hawaii and is comprised of nurses and techs stationed at either Schofield Barracks or Tripler. I have had the fortune to spend some time with this unit at their FOB (forward operating base) and it was memorable. The pictures portray some of the feelings, emotions, intensity, and blessing of spending time in our medical units here in Afghanistan far better than words ever could. They also show one of the most intense experiences encountered by the health care providers at the 8^th. They were forced to treat one of their own medics who suffered an IED blast while riding in an MRAP on a mission outside the wire. This would be akin to treating one of your own family members, as the bonds that are formed in this environment are often stronger than a traditional co-worker relationship. I should also mention that the two surgeons mentioned in the article have since redeployed, and the senior surgeon at the FST is now a recently-graduated, former general surgery resident from Tripler. Those of you at Tripler who know him should be proud- he has done some amazing work.

One of my favorite memories of this deployment is sitting next to a bonfire comprised of burning wooden pallets, smoking a cigar with the nurses and surgeons of the 8^th right in front of the hospital tent shown in one of the pictures. As we smoked, UAV’s and helicopters buzzed overhead and 155 mm howitzers would occasionally be fired from the artillery battery not far from the tents. I asked one of the surgeons if it was wise to light a bonfire at night since no other lights were allowed at night at the FOB due to Taliban activity in the region. He responded that “sitting next to a target is the safest place to be. Their aim sucks.”

http://www.msnbc.msn.com/id/33305590/ns/news-picture_stories/displaymode/1247/?beginSlide=1

Bagram is kind of a-flutter today because the FOX Sunday NFL pre-game show is being televised from here this evening. Terry Bradshaw, Howie Long, Jimmy Johnson, and crew are roaming around, signing autographs, and taking pictures. Actually, they’re not roaming around, but they’re here, and I'm glad. It provides a welcome distraction, if even for a little while, and it’s just nice to know that this place will be remembered by some of the millions of Americans sitting on their couches, watching Sunday football. As they should. That’s why we’re here.

All in

2009-11-03T20:21:00.007+04:30

Tuesday 3 November 2009

Since I’ve been deployed for roughly three months, now, and had the opportunity to watch and read some of the media coverage about Afghanistan during my recent trip to Iraq (I frankly haven’t had adequate time or internet access to follow the news prior to that trip), I feel as though I should share some thoughts on the reality of the situation here in Afghanistan with my family and friends.

My thoughts and opinions are based on personal observations, military briefs to which I have had access (though I obviously won’t discuss secret or classified information), and reading some insightful comments from people such as David Brooks of the New York Times. I am a physician, not a politician, so my interests are more aligned toward the delivery of health care than the trend of politics. I will also try to distinguish between facts and my perceptions. My intent is to share these perceptions, not initiate a political debate.

Who are the bad guys?

The enemies of peace in Afghanistan consist of a loose and fluid group comprised of the Taliban (religious extremists from Afghanistan and/or Pakistan), members of Al Qaeda from nations such as Chechnya, various tribes who are paid or incentivized to attack the Coalition or Afghan government, and individuals who are coerced or paid to perform violent acts. The numbers and allegiances are constantly changing, which is why it’s impossible to distinguish, separate, or even quantify this group at any point in time. There is no underlying or unifying philosophy or mantra of this disparate group, and their goals are not always aligned. The one thing that they have in common is a willingness to randomly attack the Afghan govt, coalition forces, or their own people in order to preclude a representative government and personal freedoms such as the education of women or religious tolerance.

Who are the good guys?

The Afghan National Army (ANA), Afghan National Police (ANP), and Coalition Forces (68k or so US forces and various NATO troops). Only about 20% of US forces are actual combat soldiers, the rest are support troops. After the US, the largest percentage is from the UK and Poland. I believe that there are approximately 30+k NATO/UN troops. Afghanistan is roughly the size of Texas.

What is GEN McChrystal’s plan?

GEN McChrystal’s military career has predominately been spent with Special Operations and covert military units. Interestingly, he feels that success in Afghanistan cannot be achieved solely with military technology such as unmanned drones or special ops forces. He feels that a successful counter-insurgency strategy needs to focus on the protection of the majority of the populus rather than focusing on killing the bad guys. In fact, he has forbidden the use of large bombs that may be effective but have an increased likelihood of inflicting collateral casualties. That is logical and easy to digest from a couch back in the States, but the decision to place your soldiers, your brothers, at higher risk of injury or death in order to prevent theoretical collateral damage is brave and profound.

Essentially, the GEN sees a race or competition between the govt/coalition and the bad guys. The coalition is trying to build infrastructure and essential services that will potentially allow a representative government and society to be established, while the bad guys are trying to destroy infrastructure, government, and commerce. It’s always easier to destroy than to build, so the race is actually defined by which side can win the faith and commitment of the majority of the population. This is the essence of a successful counter-insurgency strategy. Unfortunately, protecting all major population centers, roads (there is only one main road in the country, but it is extremely long), and infrastructure requires a lot of soldiers and skill. There currently aren’t enough ANA, ANP, or coalition forces to adequately protect the important stuff, when the bad guys have the advantage of attacking anywhere, at any time, and having any violence reported in the media as a failure of governance.

What do I think we should do?

The previous discussion is fact rather than opinion. Here is my opinion. While I generally support compromise and it is my instinct to build a consensus when resolving a conflict, this is one case where only the extremes offer an adequate solution. I think that we either need to fully commit to a comprehensive counter-insurgency strategy that will require tens of thousands more American soldiers, trainers, aggressive civil infrastructure efforts, and years of commitment, or we need to totally pull out. There is no adequate compromise or middle path. I wish there were. That’s what we’re doing now, merely treading water. Everyone over here is just desperate for a decision, and all are hedging their bets- the Afghan govt, the populus, and the US military. We all need to know what the stakes are, and I believe all is depending on the level of commitment that President Obama is willing to make. Locals, and some allies, are not willing to fully commit until they confirm the level of US commitment.

Honestly, I don’t feel passionately about which path is chosen, though I do feel that more troops are required if it is our goal to provide enough security for a more representative and stable government and society to be established, with the marginalization of the violent and extremist minority. That is how I would define success, and NATO, the UN, and most Afghanis agree. The most important thing, though, is just that A decision is made, one that is definitive and unequivocal. This is not a time or situation where half-measures are adequate.

Truth told in joust

2009-10-29T18:53:00.001+04:30

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

2009-10-26T20:18:00.001+04:30

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

2009-10-25T16:41:00.004+04:30

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

2009-10-23T16:34:00.002+04:30

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

2009-10-22T11:40:00.005+04:30

"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

2009-10-21T14:26:00.003+04:30

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

2009-10-18T18:14:00.006+04:30

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.

2009-10-13T22:05:00.002+04:30

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

2009-10-10T17:54:00.006+04:30

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

2009-10-06T20:25:00.002+04:30

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

2009-10-05T18:50:00.002+04:30

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

2009-10-03T18:29:00.002+04:30

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.

A clean perspective

2009-09-30T16:28:00.003+04:30

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

2009-09-29T20:38:00.005+04:30

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

2009-09-27T14:44:00.004+04:30

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

2009-09-24T18:35:00.003+04:30

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

2009-09-24T17:23:00.003+04:30

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

2009-09-22T20:33:00.011+04:30

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

2009-09-22T20:27:00.004+04:30

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

2009-09-18T16:43:00.003+04:30

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

2009-09-17T19:53:00.004+04:30

For my Texas relatives.

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

What's mined is yours

2009-09-15T17:36:00.005+04:30

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

2009-09-13T10:34:00.003+04:30

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

2009-09-12T16:39:00.005+04:30

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

2009-09-11T20:41:00.002+04:30

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

2009-09-10T17:30:00.004+04:30

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

2009-09-10T08:30:00.002+04:30

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

2009-09-06T15:49:00.003+04:30

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

2009-09-06T10:33:00.006+04:30

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

2009-09-05T20:49:00.003+04:30

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

2009-09-03T20:54:00.003+04:30

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

2009-09-03T20:44:00.004+04:30

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

2009-09-03T20:43:00.002+04:30

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

2009-09-02T19:06:00.002+04:30

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

2009-09-01T21:06:00.002+04:30

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.

2009-08-31T21:04:00.002+04:30

Monday 31 August 2009

I suppose that the reason I’m writing this is so that my family and friends can share the feelings, smells, and tastes of being here. Hopefully, many years from now, I’ll also be able to reread this and remember things that I had forgotten.

Because of the constant dust, I always have kind of a dry, chalky taste in my mouth and nose. There isn’t enough water to wash it away and it covers everything, imparting a dull, opaqueness to the buildings, tents, and horizon. The soundtrack to this place, though, is what will stick with me. It is the sound of laughter. Despite the obvious challenges of being here, you hear laughter nearly everywhere you go. People laugh at themselves, at each other, at the discomfort, at ridiculousness, at situations they might never have imagined. They laugh at the Sergeant Major who runs down the main drag every morning from 0500-0700 flanked by two henchmen in complementary t-shirt colors, sending them out on missions to correct errant runners who may have committed the cardinal sins of wearing their reflective belts too loosely around their waists, or God forbid, their sunglasses prior to 0730 (when sunglasses are authorized). Anyone sporting a beard, of course, is immune from prosecution. They chuckle at the young priest with the flattop, who looks as capable of removing someone from this world as he is of preparing them for the next. Then, they’re moved to laughing tears as he tells the story of missing his younger brother with Down’s Syndrome, because he is a better person when his brother is around. The brother isn’t jealous, or boastful, or vindictive. He does, however, apparently have a slight stealing issue.

Hindu Kush Mountains

2009-08-31T20:04:00.004+04:30

Bagram is surrounded on the west, north, and east sides by the Hindu Kush Mountains in a sort of horseshoe shape. Kabul lies about 20 km to the south. Due to the constant dust in the valley from the vehicles, aircraft, and personnel, it's been difficult to see the mountains clearly. I understand that soon the mountains will become snow-covered and much more clear.

The dust picks up in the afternoons along with the winds. A dry, chalky smell and taste is ever-present.

2009-08-31T19:50:00.004+04:30

I've posted a picture of "The meat shack," the most famous of the dining options here at Bagram. They actually serve barbecue ribs, burgers, and pretty good grilled chicken. The tent has picnic tables and pies for dessert. It's not the Salt Lick outside of Austin, but it sure is a nice change of pace. You can almost convince yourself that you're back in the States, except for all of the weapons inside, of course. I think they won an honorable mention for landscaping from the Garden Club of Afghanistan.

2009-08-30T10:24:00.002+04:30

Sunday 30 August 2009

Sunday morning, Groundhog Day. Sunday is Tuesday is Friday. I went to the gym early this morning and watched the potpourri of soldiers, contractors and “shadow warriors” in their beards and ballcaps. Disclaimer- I have the utmost respect for our nation’s secret warriors- Special Forces, CIA, etc. It does however, intrigue me to see the legions of white guys with short hair, full beards, and UT Longhorn baseball caps trucking around in Land Cruisers, looking a bit like rogue Amish Dutch. Now in 2001, that was probably a pretty good disguise. I mean, people probably bought that they were a University of Oregon student on a walkabout for some good hash who just happened to be carrying several automatic weapons. In 2009, not so muich. By the way, yes, Mom, I’m going to mass.

2009-08-29T20:27:00.001+04:30

29 August 2009

I have had to think carefully about my feelings before I write today’s entry, which is unusual for me. I spent the first half of the day in the hospital. Bagram hospital is currently the busiest trauma center in the world with patient acuity (severity of injury) unparalleled in the civilian trauma literature. Rather than a fleet of university physicians to shoulder the burden, however, Bagram’s surgical staff consists of—well, I shouldn’t really say because of operational security. Suffice it to say, however, that the few surgeons here work 7 days a week, night and day. Their courage is only matched by that of the soldiers and marines who go out to do their duty every single day, facing incredible danger and discomfort. Most soldiers now wear their blood type stenciled onto their helmets. It’s a functional, yet eerie sight to behold. It really highlights the acceptance of risk that these young men display every day when they pull on their dusty boots. Although I work in an amazing facility at home surrounded by excellent physicians and people, I stood today in the ICU, choked up with awe at the heroes laying before me and bustling around this strange place.

2009-08-28T17:40:00.001+04:30

2009-08-28T17:05:00.002+04:30

2009-08-28T16:54:00.002+04:30

22 August 2009 0709 Shannon, Ireland

I’ve just experienced another first on my Grand Tour of the Middle East and Southwest Asia. I am currently in the airport in Shannon, Ireland, having flown directly from Atlanta on an Omni International Airlines flight. I assume that Omni is some sort of charter/government contractor airlines. I’ve elected not to apply for their frequent flyer program. We are expecting a 6 hour layover here prior to departing for Kuwait International Airport. Speaking of waiting, I was reminded early this morning of critical Army lessons that I had apparently forgotten. I failed to recall the golden military axiom of “never volunteer for anything.” (see photo of end result) I was informed yesterday that anyone volunteering for the baggage detail would be bumped up to first class on today’s flight. In retrospect, I can see two fundamental flaws in my decision to volunteer for this duty. First, the words ‘baggage detail’ should have leapt out at me. Our “baggage”consists of 100 lb ruck sacks full of body armor, Kevlar helmets, entrenching tools, etc. 800 of them on this flight. Despite the intimation that the baggage detail wouldn’t have to actually lift the baggage, the team was aptly named. Second, the assumption that “first class” would exist on this flight was a tad naive. At any rate, I got a good early morning workout and provided much entertainment to the E3-6 weapons guards who stood and ogled the LTC lifting all of the duffels (picture 19 y/o soldier with M-16 standing “guard” over me and offering words of helpful encouragement while I helped the others and civilian KBR (Kellog-Brown-Root) contractors move their duffels about 50 yards in the South Georgia early morning swelter. Although the first class section ended up as a bit of a sequestered quarantine for the ripe-scented, post-workout officers dull enough to volunteer for an additional duty, the flight was actually pleasant- isle seat in row 4 with, strangely, noone beside me.

I should describe the rather unique flight attendant’s pre-flight brief, delivered with quite a pleasant smile. “This aircraft has 4 exits, two located over the wings and one each at the fore and aft of the plane. Please place all carry-on items safely in the overhead storage compartments. Place your weapons on the ground at your feet with the butt-stocks facing the aisles and all magazines removed. Should the aircraft experience a temporary loss in cabin pressure, oxygen masks will drop from overhead and oxygen will flow freely through the mask. Thank you for flying Omni International.” I wonder what else she learned in flight attendant training.

Forgot to mention that today was my 41^st birthday. After unloading all 800 duffel bags from the belly of the airplane on the Kuwait City Airport at 2300 (temperature 96 degrees, 100% humidity), my buddy Chuck (the SF type) led a rousing chorus of ‘happy birthday’ for me on the runway, culminating in my blowing out my birthday candle (a bottle cap placed upside down on the empty water bottle.) Pretty surreal experience on the runway of Kuwait city International airport at 11:30 pm.

On the bus from the airport to Ali Al Salem staging area, had some interesting conversations behind me. Classic Army conspiracy theory. MP E-6 to his neighbor, “Did you hear that bullshit about Pluto?”

“What bullshit?”

“It ain’t even a planet!”

“What the hell is it, then?”

“I don’t know- cloud or some shit.”

“That’s bullshit. I lived 23 years thinking that Pluto was a planet, now I find out they were bullshitting me all along. You don’t do that to people.”

26 August 2009

I’ve spent the past 5 days at the garden spot of Camp Buehring, Kuwait. High temps during the day is 126 degrees with near 100% humidity. I’m not exactly sure how you can have humidity here since there isn’t a living thing in sight and the place seems incompatible with life. Did a bunch of pretty interesting Army training- practicing rollovers in HumV’s and armored vehicles, classes on IED’s and convoy tactics, etc. I had a computer class with 12 docs and it turns out that 6 of them were West Point grads, ranging from the Class of ’85 to 2000. Since the class was boring, one ’92 grad spent a good deal of time hazing the 2000 grad under his breath for the entertainment of the rest.

“Hey Travis, are you wearing the pink underwear they issued you in Beast? Did they give you a pink or yellow striped towel? You did have Beast, right? Hey, you better drink water, Travis. You look like you’re going to fall out. If you’re not drinking water, you’re wrong, Travis.” Travis, by the way, is a 6’4” 225 lb orthopedic surgeon stud who played along and took it all in good humor. We all got some good laughs. In retrospect, a large portion of the baggage detail was made up of these guys. Laughter, by the way, is the perfect tonic for misery. At times it felt so hot and miserable that I just had to laugh at the ridiculousness of it all.

One profound thought. We have sophisticated, satellite-guided weapons, IT jamming devices, and high tech infrared scanning that is used medically to diagnose internal injuries, but the US Army can’t install a functional flush toilet at Camp Buehring. We’ve occupied the area since 1991 and still live in tents and use port-a-potties.

What has struck me so far about the deployment is how simplified life becomes and how the mundane issues suddenly rise to the forefront of importance. I will actually ponder and pick which set of port-a-potties I use based on the whether I have to go #1 or #2. If I’m going to do the serious business, I’ll walk far away to less used port-a-potties for a more palatable experience. I will not forget the burning feeling of the hot port-a-potty seat at nearly any time of day or night (recall 126 degrees). The highlight of the day becomes mealtime. Not that the food is that good, but it signifies the concrete passing of time and the next scheduled goal.

The equipment that we’re issued is really pretty amazing. The body armor, helmets, new combat shirts, hiking boots, are all fantastic. I’m also impressed with the morale of the combat soldiers. They remain upbeat (but of course classically skeptical in the soldier’s way) and take their 2^nd, 3^rd, or 4^th deployment in stride. They talk about their experience with IED’s casually and slowly prepare to be reinserted into Iraq or Afghanistan. I’m not sure what inspires them, I suspect it’s a mixture of things, but it is incredible to see. The sacrifice and suffering they so nonchalantly endure is diminished by their attitudes.

0048 hours (after midnight)

I’m sitting back at Ali Al Salem airfield waiting for the flight to Afghanistan. We do everything at night (we own the night…) I’m really looking forward to Afghanistan. Only Camp Buehring could result in Afghanistan being an improvement in quality of life. I am not sure whether I’m more excited about the neat job at Bagram or just getting the hell out of Kuwait.

0400 27 August 2009

I’m sitting in a big black leather chair awaiting my flight. The chairs kind of remind me of the pilots’ pre-flight chairs on an aircraft carrier, although in true Army fashion, it appears that my mission is to wait.

28 August 2009

Finally made it to Bagram, Afghanistan. It is no garden spot, but certainly an improvement over Kuwait. The hospital is fantastic and really state-of-the art. Very busy place with some amazing medical research ongoing. Most of the LTC’s and COL’s stay in plywood buildings called B-huts, but I’ve elected to stay, for now, in a hardened building next door. I walked through an Afghani bazaar that happens at Bagram on Fridays. It’s exactly what you would imagine- tents with scarves, old guns and knives, and pottery for sale. Everyone sweating and bargaining in a dusty melee.

2009-08-26T13:36:00.000+04:30

It's Monday afternoon here at Camp Buehring, Kuwait. Temperature is 126 degrees. I wish I could describe what that feels like. It's so hot it's funny. I'm doing well and in great spirits. Had a training class with 12 physicians this morning, and 6 of the 12 were West Pointers. There was one guy class of 86, me, some 92'ers, and one 2000. Needless to say, the guy from 2000 spent 4 hours being hazed about the "new corps" and the likelihood that he was wearing pink underwear. He's 6'2", 220 lbs. I didn't realize it, but I worked with most of them on the baggage detail Saturday night (my birthday), unloading the airplane of the 800 duffels. I should have recognized the affect when one big guy (Muggs Malinowski from Cleveland) was yelling in the cargo hold of the airplane that he needed more bags- the ones he was lifting were too light.