Monday, January 31, 2011

Life After Afghanistan - PTSD

I have been conflicted a bit about my blog ever since I returned home. Part of me thought that it should end right after I got home. After all, I was home and everything was okay, right? Not the case. Life after Afghanistan has challenges as well. I have written a few entries in the past few months. I seem to be gaining some inspiration to write again. Today I was reminded vividly of a very important condition - Post Traumatic Stress Disorder (PTSD).

In the Charleston Air Force Base Clinic today, I saw a patient who was at Bagram Air Field on 19 May 2010. It was the night we were attacked by the Taliban. It was a complex attack at 3 in the morning that sent the base into chaos. I remember it vividly and probably will for the rest of my life. My patient from today is a member of security forces, a military cop essentially. He was in the middle of the firefight that night! 8 months later he has issues consistent with PTSD. This is not surprising in the least. But, he can and will get better. I assured him of that. How can I be confident of this? Well, it is because I also have PTSD.

PTSD has one major requirement. The person must have been involved in something outside of the normal human experience. Examples are a disfiguring accident, a motor vehicle crash, and rape. These are not normal events, and they should not be wished upon anyone. Of course, war is definitely outside the normal human experience! It is messed up to say the least. That is why it leads to a large amount of PTSD cases. There are 2 condtions which have become the signature medical problems of Iraq and Afghanistan - Traumatic Brain Injury from explosions and also PTSD from the insanity of war. Without a doubt, PTSD has been present in all wars from the beginning of time. It was previously called "shell shocked" or "combat stress". To have the "thousand yard stare" was definitely taboo. Heck, General Patton did notbelieve in it which is why he slapped a hospitalized soldier right in the face! He lost a star for that. Good riddance. The bottom line is that in the 21st century we have a much better understanding of PTSD, thus we can recognize and treat it.

PTSD is characterized by a number of symptoms. Flashbacks to the traumatic event are common. These flashbacks become intrusive. The person has difficulty functioning in normal society. Poor sleep, anger, poor concentration, irritability, substance abuse, depressed mood, and low energy are all symptoms of PTSD. Many other physical things can happen as well such as back pain, muscle aches, and gastrointestinal distress. In general, these people are a mess! One of my PTSD patients here in Charleston was at home taking care of his young kids. His wife was gone. He began thinking about his war experience as he did constantly. He then got in the car and drove down the street. At a traffic light, he realized that he was supposed to be at home taking care of his young kids. He turned around and went home. The kids were okay. Nothing bad happened. Nevertheless, these incidents are scary for everyone involved. He essentially was in a completely different world for about 10 minutes.

In my first three months back from Afghanistan in 2010, I noticed a lot of the symptoms listed above in myself. My sleep was quite poor. It just seemed like I could not sleep through the night. The silence here was deafening to me after sleeping through explosions all the time in Afghanistan. I kept thinking about certain incidents over and over trying to make sense of them which I never could. One day I left the gym after a workout and began thinking about one of my patients in Afghanistan. I opened the hatch to my Saturn VUE. I got in the car and drove 3 miles down a busy road at 50 mph with the hatch wide open. I pulled over and closed the hatch. No big deal, right? Nope! I could no longer deny that I did in fact have PTSD. I needed help before things worsened.

To be continued...

Sunday, January 9, 2011

Life After Afghanistan - A Long Haul

Today I realized that is has been exactly 3 years since my life as I knew it changed drastically. It was an ordinary Monday morning the second week of January 2008 when I received the news that I would be deploying to Afghanistan. The details were sketchy at that point. I was surprised because it had appeared that I would not deploy during that rotation cycle. I came to find out later that I was needed to replace a doctor who broke his leg during pre-deployment training. Regardless, it was an anxious time. I did not know what to expect and there were not many people to give me any definitive information. I remember being relieved to certain extent knowing that I would be going to Afghanistan and not Iraq. It seemed that Afghanistan was a "just war" given that Al Queda lived and trained there. We were going after the people that attacked us on 9/11 which seemed like a noble cause to me. I was naive at that point, but to this day I still believe that some good is being done in Afghanistan.

2008 was a long year for me. The first part was spent mentally preparing to go into a war zone. I was going to a dangerous place with a real possibility of a bad outcome like coming home in a body bag. I filled out my will and gave copies to my family. It was sobering. I thought about how I would like to be remembered. Crazy. Who thinks about these things at the age of 32? I then went to "Combat Skills Training" for 2 months at an Army base. I was no longer a doctor. Instead I was a member of the U.S. military making me a target at all times in Afghanistan. While deployed, I went on my fair share of trips off base in armored vehicles heavily armed. It was surreal. My mission there was to train Afghan doctors and medics which I did to the best of my ability. There was danger every day. I never was shot at and my life was never in imminent danger. I was lucky. On October 31st of 2008, I left Camp Alamo for a long convoy to Bagram Air Field. I remember arriving at Bagram and feeling like the weight of the world was lifted off my shoulders. Bagram is a heavily fortified base. I felt safe again. Safety is a good thing.

I returned to the United States a different person because I had seen a third world, war torn nation up close. The hypervigilance that you have in a dangerous place wore off in a few weeks. I was able to breathe a sigh of relief for a while. It was nice to see people and relate my experiences. I was proud of my service. Then, thoughts of another deployment came into focus. Notification came that I would be on the list to deploy in just 6 months. How could this be? For several weeks over the holidays I contemplated another deployment. But, this notification was a mistake, an apparent "clerical error". I was angry that such a mistake could be made, but it did not matter because I had been bitten by the deployment bug. Now I actually wanted to go back! Deep down I felt that going to Afghanistan one time was not enough. So many others had done more. I could do more. Specifically, I wanted to take care of the wounded. A call was made to higher headquarters. I volunteered to be sent to the hospital at Bagram during the next cycle. The Air Force was happy to grant me my wish.

So, it was July 2009 and I was facing another deployment. When a deployment is on the horizon, no matter how far away it is, your life basically goes on hold. Everything you do is in the context of this impending trip overseas. There was more training to attend this go round. But, it was purely medical training this time which was both exciting and nerve wracking. Little did I know that nothing could really prepare me for the experience at Bagram. I arrived on Christmas Eve 2009. On Christmas Day I had a knot in my stomach all day because I knew that this was going to be the hardest work of my career. The next 6 months were exhausting. The blog tells the story.

When I arrived home in early July, it was apparent to many that I had "been through the ringer". The second deployment was actually harder than the first. In fact, I hope it is the most difficult thing I ever have to do in my professional career. I have been adjusting back to life at home ever since. It seems like a never ending process. I think about my deployments every single day. The images seem to be fading, but the lessons learned are deeply engrained in my mind. As I reflect on all that has happened in the past 3 years, it is a bit overwhelming. It tugs at my emotions. One thing is undeniable. It has been a long haul.

Monday, October 18, 2010

Life After Afghanistan - My Dog Maddy!

We have now been at war in Afghanistan for over 9 years. It is officially the longest war in our history. Vietnam clearly was longer and bloodier, but it was not always called a war for whatever reason. So, what affect does war have on a country? Thousands of miles away from the bombs and the blasts, there are profound consequences here in America. When even one service member deploys, it touches so many people. Entire communities pray every day for safe and speedy returns. The families go through a range of emotions. It puts tremendous strain on our military back home. I see spouses and kids every day in our clinic who have a range of issues that are undoubtedly related to the war. There are kids acting out, spouses who cannot sleep, and extramarital affairs. It is not pretty. We have programs in place to help. But, many times really nothing can help. And, when the deployer returns things will never quite be the same. In my own life I have experienced this in a way that I did not anticipate at all. Enter my dog Maddy. Let me explain.

In August of 2009 I adopted Maddy. She was a rescue dog that I met at a charity event. She came right up to me with a friendly greeting and the rest is history. Maddy is a yellow labrador retriever who has been through a lot. Apparently she was rescued some time ago when she was quite emaciated. In fact, Maddy had delievered a litter of puppies and was found laying down with all her puppies surrounding her. Her left side was literally stuck to sizzling hot black asphault. She was peeled off the ground and taken in for treatment. This left her with a permanent spot on her left side that will never grow fur completely. All of her puppies died. She spent the next 6 months living in various households as the rescue organization attempted to find a suitable owner. Her health was in peril. Maddy had heartworms which left untreated can be fatal. It is an expensive and long treatment to eradicate the heartworms. This was left for the new owner which of course is me.

The very first night that Maddy stayed at my home it was apparent that she had major issues. She began scratching herself vigorously. It was out of control. I attempted to console her to no avail. She actually scratched so much that a nipple bled. Wow. I took Maddy to the vet a few days later. The intitial bill was $500 and she came home on 6 medications. Her skin was in horrible shape. She needed heartworm treatment ASAP. Nevertheless, we bonded quickly. It is hard not to love Maddy. She is great around people. She comes right up to you and puts her face in your lap. Then she lays down on her back begging for a belly rub. She has an almost insatiable need for affection. Eventually Maddy began the extensive heartworm eradication. She had a section of her fur shaved off and was injected with powerful medications once a month for several months. Over the course of about 6 months the worms were slowly eliminated.

In December 2009 I deployed to Afghanistan. Maddy once again had to adapt to a new caregiver. I had made arrangements for a live in pet sitter so that she could stay in the same home. I thought this would make it a lot easier for her but that was not the case. Maddy's caregiver Jessica told me little about what was going on back in Charleston. That was a blessing because I needed to be focused 100% on my work at Bagram. My sister Annie took care of Maddy a lot as well. She also kept any details about Maddy to herself. Fast forward to July 2010 . I was home and at first everything seemed okay with Maddy. Then, the attacks started. She would go into attack mode anytime another dog was spotted. There are tons of dogs in the neighborhood. It made walks with her absolutely miserable. She would be bucking like a bronco, barking up a storm, and foaming at the mouth. It was embarrassing. Then one day it really got out of hand. Maddy spotted a golden retriever, got off the leash, and made a bee line for the other dog. She attacked the other dog. I actually had to run over and tackle Maddy to get her away. This was BAD!

So, I hired a dog trainer. Over the course of the next 2 months, I learned a lot about handling dogs. Maddy is in fact trainable. We went to public areas and attempted to socialize her. It was often painful. Progress was slow. Maddy would show glimpses of good behavior, then revert back to the bucking bronco on the next walk. It was frustrating. I actually thought about not only getting rid of her, but having her put to sleep. You would understand if you saw these outbursts. After several months, Maddy graduated from dog training school. Her prize was a small stuffed goat to chew. Graduation did not in any way mean that she was all better. In fact, it is still a struggle today. Every day I have to walk her with caution. I give her positive feedback as much as possible. Spending a lot of time with her seems to help. Exercising her for about an hour a day is key. When she gets excited, then we run which seems to calm her fairly well. Maddy has a lot of room for improvement. Progress is slow, but there is hope. If I can get her to get along well with other dogs it will be one of my biggest accomplishments in life. No kidding.

I did not in any way anticipate that my deployment would affect my dog as much as much as it did. Unbelievable. Maddy is a great dog overall. She has so much to offer. I look forward to seeing her every time I come home. Yep, that's corny but true. You would understand if you met her. She is very lovable. But, this whole thing has been harder than I ever expected. I guess even our pets have a hard time with deployments!

Sunday, October 3, 2010

Life After Afghanistan - America is Beautiful!

Yes, THE BLOG IS BACK! Why? Simply stated, the deployment experience lives on... even after you are back home safely... sleeping in your own bed again... reunited with your dog... on vacation in great places... laughing with friends and family... swimming in the ocean... or just back in normal routine of everyday life.

It has been 3 months since I arrived back on American soil the evening of July 2nd. It was an amazing feeling to be home again after a long, tough deployment. The ephoria of being home wore off in three or four weeks. I was then left to process all that happened in Afghanistan. As much as I would like to forget about it all, that's impossible. My two deployments are now a part of me forever. As I write this, not even one fiber of my being wants to return to Afghanistan in this lifetime. Who want want to go back to that war torn country when you live in America?

In the last few months I have been able to see and do a lot. It has solidified the fact that we live in an amazing country. In July I took a trip to San Francisco. Wow, what a fabulous city! I met up with my friend Mona there. She is a dynamic person that I met while living in Nebraska. We had an absolute blast touring and experiencing all that San Fran has to offer. The scenery along the coast really is "breathtaking". That's the first time I've ever used that word to describe something! Of course, I ran the San Francisco Half Marathon for fun. It actually went over The Golden Gate Bridge. Not your average Sunday morning run for sure! Perhaps the best experience in San Francisco was something completely random. Mona and I were walking back to our hotel when we came upon a crowd. There was music blasting. People were dancing. Essentially, it was a spontaneous dance party right in front of city hall. It was the most eclectic group of people I have ever seen all having a blast right in the middle of the city. Nobody cared. It was just pure fun. The cops drove by and told everyone to have a good time. So, here was a group of total strangers from all walks of life who were able to spontaneously come together. I was astounded. None of the people wanted to kill anyone. There was no hatred. Politics did not matter. It was just pure fun. The war seemed a million miles away for me.

In September I was able to take another cool trip, this time to Seattle. I went with my good friend Jeremy from Charleston. We went there to experience the northwest, to take in the sights, and to get away from our busy lives. It was an action packed vacation. We started by going to the top of the Space Needle. We finished by taking in a college football game between my team Nebraska and the University of Washington. In between we went kayacking on Lake Union with the Seattle skyline at our backs, travelled up to see the surprisingly cosmepolitan metropolis of Vancouver, and did white water rafting in the mountains. Mostly though we explored the interesting city of Seattle. The neighborhoods have so much character. The layout of the city is unique with Elliot Bay, Puget Sound, and 3 lakes dividing up the city. The air is fresh and cool. On a sunny day, it is definitely one of the most beautiful places in the USA. The sun was shining at Husky Stadium as we watched my Nebraska Cornhuskers pile on the touchdowns against the University of Washington. The only thing that reminded me of the war that day was the fly over of fighter jets, and those thoughts were fleeting. I was in heaven that day.

On top of these vacations, I get to live in the crown jewel of the south. Living in Charleston is a little slice of paradise. I never get tired of strolling through the historic district. The ocean is always refreshing here. The people are friendly. I live in Mount Pleasant which often is called Mount Perfect. Need I say more? My summer in Charleston was filled with family visits and reconnecting with friends here. My parents both came for nice visits. And, over Labor day weekend we were able to have 5 of the 6 Hayes siblings and 9 of the 12 nieces and nephews all here for the weekend. We had a blast together. There were Hayes kids running all over the beach. We all visited my sister Annie at her art booth in the Charleston market one night. My 12 year old nephew Joe got to meet his first ever bachelorette party while we were downtown that night. The photo of that is priceless and is currently displayed on my refrigerator. Good times.

After 6 months in a dusty, smelly, dry, nasty place... well, anything would seem better than Afghanistan. Americans often overlook the fact that we live in a vast country with so many interesting things to see and do. I hope to never take our country for granted again. After all, America is Beautiful!

Monday, July 12, 2010

Never Forget

After working harder than I ever have for six months in Afghanistan, I am now enjoying some much needed vacation time. Home feels the same in many ways. My dog still loves me. The ocean is still refreshing. Charleston is still a fabulous place to live. Nevertheless, everything seems different as well. I am enjoying the little things in life a lot more. Things like a hot shower, quiet nights, and a comfortable bed are more appreciated now. I am more grateful for our country. We truly have more blessings than most of us can imagine. I am also trying to live in the moment. However, more often than not my time in Afghanistan is on my mind. It was an unforgettable, life changing experience for many reasons.

Who could forget the 19th of May? At 3 in the morning I was sleeping in the on call room when I was awakened by BOOM, BOOM, BOOM. We were told to get our weapons and stay put in our duty sections. As we huddled together in the hospital, the fighting seemed like it was just outside the door. Apache helicoptors were hovering above us and were raining rounds down on the base perimeter. The army took position with their armored vehicles and quickly gained firepower superiory. The firefight lasted maybe an hour although it seemed much longer. 20 terrorists attacked our base that night with a myriad of weapons. None of them survived. They managed to kill one person and wound 5 others. Their actions put our base into lockdown for several days. Security was increased. Several of my colleagues were shaken by this experience and would not sleep well for the remainder of the deployment.

Who could forget our six year old patient with brain trauma? Modaser sustained an injury to the right side of his head. He was a victim of war related violence. He was also one of the cutest and most entertaining kids you ever want to meet. His hospital course was complicated by an infection that required long term antibiotics. He actually had a wound vacuum on his head. Modaser also had neurological damage which caused his right leg to not work properly. No problem. His solution was to simply walk more. Modaser did countless laps around the hospital. His walking improved greatly over weeks. His infection eventually was eradicated. He was quiet at first, but then he came out of his shell big time. Modaser had the great gift of gab. He would talk practically non-stop in his native tongue. Then, he would smile and laugh. Modaser single handedly raised the morale of our staff every day. I hope that he is safe in his village right now and that he is able to help his country become a better place.

Who could forget the baby faced marine with the leg amputation and the open abdomen? He spent several weeks guarding a prisoner who was hospitalized. His unit had captured the suspected terrorist. He was a nice kid that was well liked by everyone. Eventually, the prisoner left the hospital and the baby faced marine returned to Helmand Province. This is one of the most dangerous places on earth right now. Shortly after leaving us, he returned as a critical trauma patient. It was so difficult for us to see someone we actually knew get torn up by yet another IED blast. It was hard to stomach even looking at him as he lay motionless on a ventilator in the ICU. He was stabilized and sent on to Germany. His wounds will likely heal, but he will never be the same.

Who could forget working with extraordinary people? Dr. Mike Greene became my closest friend in Afghanistan. We both did our residency in Family Medicine at the University of Nebraska and Offutt Air Force Base. Mike was two years behind me in his training. He was an intern when I was the chief resident of the program. We barely knew each other then. But now we have shared a difficult experience together. Mike is very dedicated to his work. He showed up every day to see his patients at oh dark zero. I would make it in at oh dark thirty. He always went the extra mile even when the sheer number of patients was practically unmanageable. We often needed time away from the hospital just to talk about the insanity of it all. We leaned on one another to make it through the deployment. His work ethic, patience, and integrity inspired me every day to be a better doctor.

There are certain experiences in life that shape us. Some even change us for the better. Many of the events of the past 6 months are burned into my brain. My world view has changed. The little things in life are more important now. The small stuff is not as stressful now. I feel very grateful for my many blessings. Friends and family matter more than ever before. I am more connected with my spiritual side. I want these feelings to stay with me indefinitely. Without a doubt, life goes on after Afghanistan. It is important to compartmentalize the memories in order to move forward. But, I hope to never forget all that happened. I hope to never forget how it felt to take care of the wounded. I hope to never forget all the people that prayed for us. I hope to never forget those that were severely injured. I hope to never forget the hard work of the troops. I hope to never forget those that paid the ultimate sacrifice. I hope to never forget those that are serving our country at home and abroad. I hope to never forget all the difficult lessons that I learned serving our country.

Wednesday, July 7, 2010

Coming Home

Military travel is almost always long and arduous. The trip home from Afghanistan certainly qualified as such. I spent 3 relatively peaceful days in Kyrgystan at Manas Air Base. It was absolutely necessary to have some down time before the long trip home. To the credit of the military, they have built in this time at Manas as part of the deployment. I felt a lot of the deployment tension easing over those 72 hours. It was fun to shoot the breeze with people and have some laughs. I was able to hang out with my good friend Geoff Cooper. He is a family doctor I know from residency who was deployed to Manas. His time there was very different than mine at Bagram. Horseback riding and kayaking are just a few of the things the folks at Manas are able to do in their time there. Now that is what I call a good deployment! Before leaving Manas, I was able to get a fabulous back massage from a local lady named Lena. It cost me $10 for 30 minutes. I tipped her $15 which apparently is a lot of money there. Lena gave me a kiss on the cheek. Oh Lena! I felt the best I had in probably a year.

The trip home began abruptly. We had a show time at the terminal of approximately 0500. But, 130 marines had a different agenda. A small group of us Air Force guys were sharing a tent with these fine gentlemen. At 0230 their sergeants began screaming at the top of their lungs. The lights were turned on and chaos ensued. Apparently, it was important for them to act like they were in Times Square at this crazy hour. There was no reason for this at all because they were not getting on the same plane as us and to my knowledge there were no other planes taking off that morning. Oh well. I thought about pulling rank on one of their sergeants. But, the fact that they had a plethora of semi automatic weapons readily available was the deciding factor. I kept my mouth shut up, packed up, and left with the rest of the Air Force guys.

Our first stop on the way home was in Turkey at Incirlik Air Base. We were there for a few hours refueling and picking up more passengers. The summer is a busy time for moving in the military. Various families joined us on the way to the states. We were able to eat some turkish food there which was nice. My belly was full as we headed off to Germany. The flight across Europe was pretty easy. I could not help but notice green trees as far as the eye could see as we descended into Ramstein Air Base. This is something none of us had seen for months. The stay at Ramstein was a bit odd. We were allowed to stroll through the terminal for about 10 minutes. Then we had to hurry up and get back in line. It was yet another security screening. Our identification was checked about a half dozen times. The German security agent took away my deoderant because it was 4 ounces. It was the only way for me to control the overwhelming body odor that happens on a transcontinental flight. Too bad for the passenger next to me! We were then quarantined like animals in a large room for 2 hours which is standard procedure for some reason. A large amount of families also joined us for this flight. Screaming babies were abundant.

The flight across the Atlantic was smooth. However, about 5 hours into the trip I noticed a woman in distress at the front of the plane. I approached her and immediately noticed her gravid uterus. She stated calmly that she was contracting every 2 minutes! What? Excuse me? Holy -----!!!!! This is not a trauma patient I told myself as I tried to remember what to do with a contracting 34 week pregnant lady. After all, it had been over 3 years since I delivered a baby. 6 months of shattered bones, amputated limbs, and open abdomens had not prepared me for this. I asked her a few questions. Luckily, she did not have any major abnormalities that were red flags for disaster. The head flight attendant then asked me point blank if we needed to divert the aircraft to Nova Scotia. After all, we were still over the Atlantic! 250 people wanted to get home that day. I was not about to stop this unless absolutely necessary. My answer was no. We had several other family doctors on the plane to help with this crazy situation. Also, we had a labor and delivery nurse named Lieutenant D whom I worked with for the past 6 months at Bagram. She had not dealt with a pregnant patient in a long time. Now was her chance.

Lieutenant D had the patient lay down and drink lots of water. She was able to calm the patient in a way that I could not. 30 minutes later the patient was still contracting every 2 minutes. I suggested checking her cervix for dilation. Lieutenant D talked me out of it. Her instincts told her that this would pass. She was 100% correct. As we descended into Baltimore, the contractions slowed down to every 5 minutes. Our 34 week pregnant patient was feeling good. There would be no delivery at 30,000 feet! Crisis averted. The plane landed. The paramedics came to the gate. The patient was immediately taken to the hospital. I proceeded to baggage claim thanking the good lord the entire way.

Arriving back in the United States of America after a deployment is an amazing feeling. Euphoria is the best word to describe it. I had to stay the night in Baltimore which was fine by me. I took multiple showers in my sparkling bathroom, had a belgium waffle for breakfast, and went for a jog through a suburb of Baltimore. It was relaxing. By mid morning I was ready to continue on to my home in Charleston. I could not help but notice the busy people at the airport talking on their cell phones and rushing through the day. They were all blistfully unaware that I was on my way home from the most difficult experience of my professional life. After the plane landed in Charleston, I walked slowly through the terminal. My knees were weak as I hugged my sister Annie. There was a group of my friends and colleagues there to welcome me home. It was emotional. It felt great to be home again after this long deployment. I felt immensely grateful. Coming home after a long deployment is like nothing else.

Wednesday, June 30, 2010


Making it out of Afghanistan is a great feeling. Most people feel very relieved to be leaving a war zone. It does not matter that the military flights are always uncomfortable. We are packed in there like sardines. Wearing body armor makes it worse. Some people even have to fly back with caskets of fallen service members on the same plane. That's sobering to say the least. But, it is worth it to leave a war torn country. Our first stop out of Afghanistan is in another one of the "Stans"- Kygystan to be exact. This is a former soviet republic that is now an independent country. It has been in the news for several months due to civil unrest. It's unstable, but for now we have a base here that serves as the transit center to and from Afghanistan.

When the relief of leaving Bagram wears off, people generally have a lot of different emotions. For me, it is simply mental exhaustion. I just want to vegetate watching movies and doing other mindless things. There is a certain amount of hypervigilance about safety that goes along with being deployed. Even at a large base like Bagram, you have to be on guard. You learn to sleep with F-16's roaring through the sky and explosions off in the distance. Now, we understand the phrase that the "silence is deafening". It is strange to have pure silence although those moments are few here given that I am sleeping in a tent with 130 marines. We all need time to process everything that happened on our deployments. This will take weeks. For some it will take months. For others they may never reconcile what happened. My 130 marine roommates definitely had a very different experience than me. It all needs to be compartmentalized to a degree to return to normalcy.

Enough with the psycho babble... LET'S PARTY!!! That is exactly what is happening here in Kygystan. This base has all sorts of amenities to keep us occupied. The average stay here is about 72 hours. Having a little fun is important. There is a cool hangout here called "Pete's Place". It is located in the middle of the base. It has a large deck, pool tables, a stage for entertainment, and of course a bar. Everyone is allowed 2 alcoholic beverages a day. People let loose. The young nurses from Bagram have been severely tipsy on 2 beers. Nice. Karaoke was the center attraction one night. I thought about singing a Neil Diamond song, then thought the better of it. Last night there was music provided by the local Kygystans. It was really entertaining. They played some interesting instruments which rang out some American songs for everyone to sing along. The ladies had elaborate costumes for some exotic dancing which was quite a sight for many sore eyes. A good time was had by all.

In the next 48-72 hours I will be back in my close to the beach condo in Charleston. There will be a reunion with my dog Maddy. I cannot wait to jump in the ocean. Taking a nap on the sofa sounds fabulous. Lounging at the pool while catching some strong South Carolina sun is a must. Seeing friends and family again will be a lot of fun. When the dust settles, another deployment will be in the books. Then, the process will continue on with some serious decompression.