Holy Cow, it was a long week of working nights. I was at the hospital this past week something like 100 hours. I am not exaggerating. We were very busy. Last night I admitted 9 patients to the ward. Anyone in medicine knows that's a lot. Then, I had to turn around and see them all in the morning again. It's all kind of all a blur. The bottom line is that another week is done here. I'd rather write about something other than medicine.
So, let's talk about government contractors. Yep, you've heard of this. Does Blackwater or Halliburton ring a bell? I have always been intrigued by these government contractors. What motivates someone to voluntarily come to a combat zone without any means of self defense? Just like many things in life the answer is simple - MONEY!
Tonight I sat and ate dinner with a contractor. He was one of the biggest characters that I have met in a long time. His name is Zaki. Picture an Indian guy with long hair and a goatee. That's Zaki. Are you having a hard time picturing this guy??? Yeah, I would have to send you a picture of him. He's short, stocky, and has glasses too. Most importantly, Zaki is a talker. He's a virtual chatter box. He struck up a conversation out of left field when I met him 2 weeks ago. Tonight myself and my friend Mike Greene ran into him for a second time at the pizza parlor. Zaki was in rare form again. Actually, I think his borderline manic behavior, which includes making sound effects to excentuate his stories, is probably his baseline normal self. In short, the guy is hilarious. Zaki is well travelled having been raised in India and then subsequently living in places like Kuwait and the windy city of Chicago. Most recently he has lived in Afghanistan for 3 years working for company called KBR. He is in charge of public works here at Bagram. He finds the work interesting. Mostly though, he loves the money. Yeap, without a doubt it is all about the money. Government contractors often make 3 times what they would make in the same job in the states or on active duty in the military. Zaki is probably making 150K per year easy. He's actually getting rich off the U.S. government.
There are tons of people just like him. They come from all over the world. They are of all ages and races. They walk around our military bases in the middle of war zone in jeans and North Face jackets. Some work in food service. Others are doing construction. Some are doing the exact job they used to do in the military, but now they are wearing civilian clothes and are making 3 times that. It's big business to say the least.
Bagram Air Field is loaded with contractors. The price tag is huge. Tonight Zaki confirmed for me what drives all of this, the almighty dollar.
Sunday, January 31, 2010
Thursday, January 28, 2010
Rainy Days in Afghanistan
Hello from rainy Bagram Air Field, Afghanistan! Rain here is rare, however, it has been raining for 2 consecutive days now. This is the first rain since I arrived on Christmas Eve. It feels like a nasty November day in my hometown of Cleveland - cold, wet, and dark. The sun shines brightly on most days here. This is a dry climate to say the least. On my last deployment in 2008 to Camp Alamo in Kabul, it rained 4 times in 6 months. Bagram Air Field is about a 45 minute convoy from Camp Alamo. So, to have 2 consecutive days of precipitation is very out of the ordinary. I mention this so that you can get a visual of this place. Bagram is basically a dust bowl. We are surrounded by mountains that are maybe a dozen clicks (km) away. The climate is extremely dry as previously stated. Thus, dust is everywhere. You cannot escape it. It gets all over your shoes, your pants and your skin. The air quality is poor. Pollution is completely unregulated. Garbage here is burned no matter what it is, even plastic. There is no recycling. Afghanistan is an environmentalists's worst nightmare. Almost nothing is being done here to save our planet. I am told it is too expensive for coalition forces to do anything about this. What are we gonna do... fly our recyclables and our garbage back to the U.S.? So, this dusty, dry, and smelly place has been rained on for 2 days turning it into a GIANT MUD PIT!!!
Iam holed up in my B-Hut today after catching 4 hours of sleep following an uneventful night shift. It is one of those days when you just want to stay home, so here I am in my 7 x 6 foot space that I now call home. I do have internet access here through a wireless server. It's a nice luxury. If only I had some hot chocolate, then I would be set.
More about this country... Afghanistan is a land locked country approximately the size of Texas. The population is approximately 30 million people. The largest city is Kabul which has about half a million residents. Kabul is the most advanced city in this country and yet it is considered a luxury to have electricity in your home for 6 hours a day. The average life expectancy is somewhere in the mid 40's. Yes, that is right people typically live only until what we consider middle age here. The reasons for that are pretty simple - malnourishment, lack of medical care, and war. Travelling here is a nightmare. It was only recently that roads were built connecting the major cities. This affects even my job as a doctor at an American base. Just yesterday, we attempted to send one of our patients home after a 2 month stay. The child lives just 50 miles away. This requires a plane trip. His parents just can't "swing by" and pick him up as if he just completed summer band camp. The bottom line is that the plane could not land in Jalalabad yesterday. I don't know why. Another patient of mine is stuck in the hospital until cab fare can be found for him. He lives somewhere in the mountains in north Afghanistan. It seems odd that thousands of American taxpayer money was used to fix this guy's blown up arm, but we are having problems getting him home.
Well, I think that is enough for today's lesson on Afghanistan. Khuda Hafiz! (Good Bye in Dari)
Iam holed up in my B-Hut today after catching 4 hours of sleep following an uneventful night shift. It is one of those days when you just want to stay home, so here I am in my 7 x 6 foot space that I now call home. I do have internet access here through a wireless server. It's a nice luxury. If only I had some hot chocolate, then I would be set.
More about this country... Afghanistan is a land locked country approximately the size of Texas. The population is approximately 30 million people. The largest city is Kabul which has about half a million residents. Kabul is the most advanced city in this country and yet it is considered a luxury to have electricity in your home for 6 hours a day. The average life expectancy is somewhere in the mid 40's. Yes, that is right people typically live only until what we consider middle age here. The reasons for that are pretty simple - malnourishment, lack of medical care, and war. Travelling here is a nightmare. It was only recently that roads were built connecting the major cities. This affects even my job as a doctor at an American base. Just yesterday, we attempted to send one of our patients home after a 2 month stay. The child lives just 50 miles away. This requires a plane trip. His parents just can't "swing by" and pick him up as if he just completed summer band camp. The bottom line is that the plane could not land in Jalalabad yesterday. I don't know why. Another patient of mine is stuck in the hospital until cab fare can be found for him. He lives somewhere in the mountains in north Afghanistan. It seems odd that thousands of American taxpayer money was used to fix this guy's blown up arm, but we are having problems getting him home.
Well, I think that is enough for today's lesson on Afghanistan. Khuda Hafiz! (Good Bye in Dari)
Sunday, January 24, 2010
A Little Rest for the Weary
Happy Monday! For me it is a tired monday morning. I finished a long, very busy night shift. Now I'm fixin' to get myself some shut eye! How does that sound, ya'll? The good news is that another week is down - 5 down, 22 to go until I am back in the beautiful southern city of Charleston. The better news is the all of my patients from last night are doing fine. We had a couple guys banged up pretty good, but all will be okay.
Mental fatigue is setting in for me. Everyone at the hospital is working more than at home. Most people are working quite a bit more including myself. Gone are the days of carefree weekends. There are no weekends here. The casualties keep coming. There are no days off. I'm not exaggerating. Most of us do not have any days off for 6 monhts. We have to be ready 24/7. That's exhausting to think about.
My challenge is the daily early wake up call. I am at the hospital no later than 6 seeing my patients. Or, if I am working nights I will start a new day around 0530. I have to be ready to have a plan for all my patients by 0630 when the entire professional staff gets together for rounds. It's hard to be coherent at that hour much less have a game face on ready to go. It has to be this way so that the surgeons can get started early on their surgeries. This is how the surgery world works. I prefer a kinder, gentler work schedule but that will not happen here. It is what it is.
There are people that have a more challenging workload than me. We have only one eye surgeon, thus, he is on call 24/7 for 6 months in a row. That's painful to think about to say the least. We have just 2 radiologists, therefore, they each work 12 hours a day every day. Our chief of the medical staff makes the call on what patients we will take at our hospital from outside places. Thus, he is busy almost all of the time. I could go on and on with examples. The bottom line is that we are working as hard as we can. We have to do it because our troops need us.
Lights out for me...
Mental fatigue is setting in for me. Everyone at the hospital is working more than at home. Most people are working quite a bit more including myself. Gone are the days of carefree weekends. There are no weekends here. The casualties keep coming. There are no days off. I'm not exaggerating. Most of us do not have any days off for 6 monhts. We have to be ready 24/7. That's exhausting to think about.
My challenge is the daily early wake up call. I am at the hospital no later than 6 seeing my patients. Or, if I am working nights I will start a new day around 0530. I have to be ready to have a plan for all my patients by 0630 when the entire professional staff gets together for rounds. It's hard to be coherent at that hour much less have a game face on ready to go. It has to be this way so that the surgeons can get started early on their surgeries. This is how the surgery world works. I prefer a kinder, gentler work schedule but that will not happen here. It is what it is.
There are people that have a more challenging workload than me. We have only one eye surgeon, thus, he is on call 24/7 for 6 months in a row. That's painful to think about to say the least. We have just 2 radiologists, therefore, they each work 12 hours a day every day. Our chief of the medical staff makes the call on what patients we will take at our hospital from outside places. Thus, he is busy almost all of the time. I could go on and on with examples. The bottom line is that we are working as hard as we can. We have to do it because our troops need us.
Lights out for me...
Thursday, January 21, 2010
Enemy of Peace (EOP's)
One of the many challenges we face here at Bagram is the treatment of patients designated as an "Enemy of Peace" (EOP). This is the latest politically correct way to say "bad guy". These patients come to us along with the coalition troops who captured them. They are required to be guarded 24 hours a day. We have to take off any identifying information such as hospital badges when seeing the EOP's. The EOP must be blindfolded if they leave their room. The interpreters stay behind a curtain when communicating with them because they do not want to be seen by a "bad guy". It takes a while to get used to this as you might imagine.
The EOP's come to us with horrific injuries just like any other casualty of war. We are required to give them the exact same treatment as we would any other patient. We are told, "A patient is a patient is a patient, no matter what." They get a full resuscitation in the trauma bay, get a plethora of radiologic studies, undergo many operations, are monitored closely in the Intensive Care Unit (ICU), and eventually will make it to the ward where I will get to care for them. We tap into our extensive resources to treat them. One of my EOP patients has had brain surgery, eye surgery, and extensive orthopedic surgery on broken bones all while spending a week in the ICU. When these patients are ready to leave the hospital, they are discharged back to the soldiers that captured them. This is often a complicated process.
The Geneva Convention is often referred to when we talk about "rules of war". Because of the Geneva Convention, all prisoners of war are entitled to medical care. It seems crazy that a soldier is supposed to shoot the enemy and then do what they can to save that person's life. I don't understand how a soldier can do that. It's out of the realm of normal human experience to say the least. And, what we do here in treating the EOP's is also out of the ordinary. But, a patient is a patient is a patient, right?
Not exactly. We all do the best we can to separate it all out and provide good care. But, I think it is natural to wonder what the EOP's are thinking. Do they hate me because I am an American? Do they think that we hate them? I don't know. I do know that it is a daily struggle to provide medical care for EOP's. We have a young physical therapy assistant who is tasked each day to get our hospital patients up and moving. Here is this airmen in his early 20's helping a severely injured EOP walk again. That is a very tall order! We are asking a lot of him and all of our medical staff to treat these patients. Honestly, I am still not totally sure how I feel about it all.
By the way, the subject of my last post "A Dying Man" left our hospital. He's an Afghan and it was not right for him to spend his remaining days in an American military hospital. I watched him get loaded into the ambulance to take him away. I hope he dies with dignity.
The EOP's come to us with horrific injuries just like any other casualty of war. We are required to give them the exact same treatment as we would any other patient. We are told, "A patient is a patient is a patient, no matter what." They get a full resuscitation in the trauma bay, get a plethora of radiologic studies, undergo many operations, are monitored closely in the Intensive Care Unit (ICU), and eventually will make it to the ward where I will get to care for them. We tap into our extensive resources to treat them. One of my EOP patients has had brain surgery, eye surgery, and extensive orthopedic surgery on broken bones all while spending a week in the ICU. When these patients are ready to leave the hospital, they are discharged back to the soldiers that captured them. This is often a complicated process.
The Geneva Convention is often referred to when we talk about "rules of war". Because of the Geneva Convention, all prisoners of war are entitled to medical care. It seems crazy that a soldier is supposed to shoot the enemy and then do what they can to save that person's life. I don't understand how a soldier can do that. It's out of the realm of normal human experience to say the least. And, what we do here in treating the EOP's is also out of the ordinary. But, a patient is a patient is a patient, right?
Not exactly. We all do the best we can to separate it all out and provide good care. But, I think it is natural to wonder what the EOP's are thinking. Do they hate me because I am an American? Do they think that we hate them? I don't know. I do know that it is a daily struggle to provide medical care for EOP's. We have a young physical therapy assistant who is tasked each day to get our hospital patients up and moving. Here is this airmen in his early 20's helping a severely injured EOP walk again. That is a very tall order! We are asking a lot of him and all of our medical staff to treat these patients. Honestly, I am still not totally sure how I feel about it all.
By the way, the subject of my last post "A Dying Man" left our hospital. He's an Afghan and it was not right for him to spend his remaining days in an American military hospital. I watched him get loaded into the ambulance to take him away. I hope he dies with dignity.
Sunday, January 17, 2010
A Dying Man
The last 2 weeks or so I have been taking care of a dying man. He's an Afghan who came here after an IED attack like many of our patients. The main difference is that he is an old man in this society. He is somewhere around 50 years old. The Afghans do not keep track of birthdays, so you never know exacatly how old they are. 50 here is like 80 in the western world. So, imagine your grandfather getting blown up by an IED, then you can picture this frail old man. But, he was not a frail old man before the attack. He was a very important person actually as we came to find out. For security reasons, I won't elaborate.
The dying man did well in his first 24 hours at Bagram. He had multiple complicated fractures which our Orthopedic surgeons worked very hard to fix. He was on the road to recovery. He was talking. He was articulate. Then, things took a major turn for the worse. He reportedly had a heart conditiion that would drive his heart rate up from time to time. That's all we knew. He had some medication called propranolol for this to slow down his heart. Every once in a while he would take it at home. Well, his heart began to race one night. Our on call doctor ordered some medication to slow his heart. We think that his son having good intentions also gave him medication that was brought from home. The result was a precipitous drop in heart rate and blood pressure. We need a certain pressure to "nourish the squash" as one of my mentors used to say. The blood flow to his brain was not adequate for some period of time, probably a few hours. He essentially had a stroke from low blood pressure. The patient was never the same. He began to die.
His "mental status" as we call it changed rapidly then began to decline gradually over the next 1-2 weeks. It was hard to watch. This was an important man. This was a strong man. First he could not speak. Then he would not move. I would give him a vigorous sternal rub and there would be nothing day after day. It was disheartening to say the least. Even harder was trying to explain this all to his son. Each day he would ask me if the dying man would get better. I tried to be as honest as possible. We all knew he would not get better. His son was like most family in a situation like this. It just takes a long time for it all to sink in because it is such a difficult message to digest. I try to be compassionate but it is hard to do that through a translator. I wish it could all be different.
It's been a while since I have taken care of dying patients. Most of my patients are young and healthy at Charleston Air Force Base. End of life care is not a typical issue for them. Because of this, I think this has all hit me a little harder. The dying man will be in a better place soon.
The dying man did well in his first 24 hours at Bagram. He had multiple complicated fractures which our Orthopedic surgeons worked very hard to fix. He was on the road to recovery. He was talking. He was articulate. Then, things took a major turn for the worse. He reportedly had a heart conditiion that would drive his heart rate up from time to time. That's all we knew. He had some medication called propranolol for this to slow down his heart. Every once in a while he would take it at home. Well, his heart began to race one night. Our on call doctor ordered some medication to slow his heart. We think that his son having good intentions also gave him medication that was brought from home. The result was a precipitous drop in heart rate and blood pressure. We need a certain pressure to "nourish the squash" as one of my mentors used to say. The blood flow to his brain was not adequate for some period of time, probably a few hours. He essentially had a stroke from low blood pressure. The patient was never the same. He began to die.
His "mental status" as we call it changed rapidly then began to decline gradually over the next 1-2 weeks. It was hard to watch. This was an important man. This was a strong man. First he could not speak. Then he would not move. I would give him a vigorous sternal rub and there would be nothing day after day. It was disheartening to say the least. Even harder was trying to explain this all to his son. Each day he would ask me if the dying man would get better. I tried to be as honest as possible. We all knew he would not get better. His son was like most family in a situation like this. It just takes a long time for it all to sink in because it is such a difficult message to digest. I try to be compassionate but it is hard to do that through a translator. I wish it could all be different.
It's been a while since I have taken care of dying patients. Most of my patients are young and healthy at Charleston Air Force Base. End of life care is not a typical issue for them. Because of this, I think this has all hit me a little harder. The dying man will be in a better place soon.
Friday, January 15, 2010
Taking Care of the Locals
Right now 80-90% of our patients in the hospital are Afghans. Most of them are trauma patients. They can be members of the Afghan National Army (ANA), Afghan National Police (ANP), or just civilian local nationals (LN). Some of the patients are sent to us for humanitarian reasons. Our ENT surgeon does cleft lip/palate repairs and has done 3 or 4 of them since I have been here. Most of the patients are sent here because they would not survive their injuries if they were treated at Afghan hospitals. Their injuries are complicated. Their stays at our hospital are long because we do not have anywhere to send them that give them what they need. We can't just send them to Germany then Walter Reed like we do with our Americans.
One of my Afghan patients injured his small intestines in a car crash and needed 85 cm of small intestine to be removed surgically. Wow. He's doing fine overall two and a half weeks later. Another Afghan was hit by an IED, lost one eye, has a broken jaw, and had an injury to his carotid artery (the big artery in your neck) which has been repaired. The other patient I have been seeing every day for the last 10 days has 2 broken legs, 2 broken heels, and unfortunately had stroke of some sort in the hospital leaving him in a vegetative state. All 3 of these patients are located within just a few feet of one another in our ward. We do not have private hospital rooms. It's a big open ward like what they had on the TV show "MASH".
So, I have been struggling a bit to make sense of all this. What am I doing here in Afghanistan caring for the locals who have been blown up, were on death's door, and now face long recoveries if they will recover at all? Well, the best I can come up with is that our Afghan patients deserve our best just like anyone else. I do not control who comes to our hospital. We are all here to treat patients. The war rages on. The injured come here and we do what we can to make them better. Most of our patients will never be the same. My job is to look at them as a whole person and treat them with dignity. Our surgeons will fix what they can. Once their work is done, I need to be there to direct the care of these patients. I need to lead our nurses and our technicians to provide excellent care. That's my job as a family doctor - see the whole picture, be an advocate for the patient, and be a leader.
One of my Afghan patients injured his small intestines in a car crash and needed 85 cm of small intestine to be removed surgically. Wow. He's doing fine overall two and a half weeks later. Another Afghan was hit by an IED, lost one eye, has a broken jaw, and had an injury to his carotid artery (the big artery in your neck) which has been repaired. The other patient I have been seeing every day for the last 10 days has 2 broken legs, 2 broken heels, and unfortunately had stroke of some sort in the hospital leaving him in a vegetative state. All 3 of these patients are located within just a few feet of one another in our ward. We do not have private hospital rooms. It's a big open ward like what they had on the TV show "MASH".
So, I have been struggling a bit to make sense of all this. What am I doing here in Afghanistan caring for the locals who have been blown up, were on death's door, and now face long recoveries if they will recover at all? Well, the best I can come up with is that our Afghan patients deserve our best just like anyone else. I do not control who comes to our hospital. We are all here to treat patients. The war rages on. The injured come here and we do what we can to make them better. Most of our patients will never be the same. My job is to look at them as a whole person and treat them with dignity. Our surgeons will fix what they can. Once their work is done, I need to be there to direct the care of these patients. I need to lead our nurses and our technicians to provide excellent care. That's my job as a family doctor - see the whole picture, be an advocate for the patient, and be a leader.
Wednesday, January 13, 2010
Just Doing My Duty
The last few days at the hospital have been pretty quiet overall. That's a good thing. So, no intense stories for you today. I'll get philosophical instead!
In the last few days I received a couple interesting emails. One was from a reporter in Charleston where I am stationed. He wants to put a link to my blog on the Charleston Post and Courier websit. I said no problem. In addition, two Viet Nam veterans emailed me. Both are friends with my uncles. One is a retired Navy Captain which means he did a career in the Navy. The other gentlemen has worked a lot on behalf of Viet Nam Veterans. (interestingly, both vets spelled it Viet Nam not Vietnam... I wonder why) At any rate, the common theme in all these emails was a deep sense of appreciation for our military. They all had kind words to say and thanked me pretty profusely for my service.
It is great to receive messages like this from strangers. It's also important to know that America is behind our military, despite what one's views are regarding this war. Any student of American history knows that it is not always been that way. I cannot imagine what it would be like to not have the support of the American people. When I got off the plane in Baltimore from my last deployment, there was a group of veterans/supporters at the airport thanking us. Awesome. When we left the U.S. this time around, there was also a group there in Banger, Maine to send us off warmly. Nice touch. In short, the support is fabulous. I know so many of my friends and family are praying for me. There is no doubt that it helps. THANK YOU!
The truth of the matter for me is that it's my duty to be here. I really believe that. Ten years ago I joined the Air Force. They gave me a full ride for medical school. The American taxpayers shelled out tens of thousands of dollars for my education. I am now paying it back. It's that simple. Nevertheless, if you would have told me in the year 2000 that I would be deployed to Afghanistan not once but twice in my career, I would not have believed you. I am not sure that I would have raised my right hand to take that oath... "I vow to defend the constitution against all enemies both foreign and domestic". That's being honest. But, 9/11 happened and the world changed. The military has been asked to do a lot. So many service members have sacrificed a great deal. Too many have paid the ultimate sacrifice. For me, I am just doing my duty.
In the last few days I received a couple interesting emails. One was from a reporter in Charleston where I am stationed. He wants to put a link to my blog on the Charleston Post and Courier websit. I said no problem. In addition, two Viet Nam veterans emailed me. Both are friends with my uncles. One is a retired Navy Captain which means he did a career in the Navy. The other gentlemen has worked a lot on behalf of Viet Nam Veterans. (interestingly, both vets spelled it Viet Nam not Vietnam... I wonder why) At any rate, the common theme in all these emails was a deep sense of appreciation for our military. They all had kind words to say and thanked me pretty profusely for my service.
It is great to receive messages like this from strangers. It's also important to know that America is behind our military, despite what one's views are regarding this war. Any student of American history knows that it is not always been that way. I cannot imagine what it would be like to not have the support of the American people. When I got off the plane in Baltimore from my last deployment, there was a group of veterans/supporters at the airport thanking us. Awesome. When we left the U.S. this time around, there was also a group there in Banger, Maine to send us off warmly. Nice touch. In short, the support is fabulous. I know so many of my friends and family are praying for me. There is no doubt that it helps. THANK YOU!
The truth of the matter for me is that it's my duty to be here. I really believe that. Ten years ago I joined the Air Force. They gave me a full ride for medical school. The American taxpayers shelled out tens of thousands of dollars for my education. I am now paying it back. It's that simple. Nevertheless, if you would have told me in the year 2000 that I would be deployed to Afghanistan not once but twice in my career, I would not have believed you. I am not sure that I would have raised my right hand to take that oath... "I vow to defend the constitution against all enemies both foreign and domestic". That's being honest. But, 9/11 happened and the world changed. The military has been asked to do a lot. So many service members have sacrificed a great deal. Too many have paid the ultimate sacrifice. For me, I am just doing my duty.
Monday, January 11, 2010
Maxim Magazine
My last entry was a bit intense. But, not everything that goes on here at Bagram in the middle of a combat zone is so serious. We have to find the humor in things as well. Yesterday was a good example.
We have several Afghan kids in the hospital right now in long term recovery. One is a 12 year old with the initials of A.M. He's a pretty happy kid and all. He's been through a lot, but things are looking up for him. A.M. should leave the hospital in a few weeks and have a full recovery. His biggest challege right now is boredom. He is constantly looking for things to do. I'll get back to A.M. in a minute.
Right around the corner from A.M.'s room are some "Enemies of Peace", aka bad guys being treated by us. They are guarded by the Army guys who captured them. It's a bit surreal to have guys with guns outside the patient rooms. Anyway, the Army guys also deal with a lot of boredom. The other day I noticed one of them reading Maxim Magazine. If you are not familiar with it, basically it is like soft core pornography with lots of pictures of scantilly clad super models. It also has all kinds of ridiculous articles trying to help guys get chicks in bed. That's basically it. Not exactly quality reading for our soldiers and perhaps not appropriate while on guard duty!
So, I decided to intervene. A copy of "The Five Love Languages" was sitting at the nurses station for some reason. I decided to pull rank here. As a Captain in the U.S. Air Force, I jokingly ordered the Army private to put down that Maxim Magazine and pick up "The Five Love Languages". The lad followed my order... so I thought.
Not long thereafter, as I was walking through the ward I noticed the aforementioned Afghan kid with the initials A.M. sitting in the hallway. He had a big grin on his face and seemed mesmorized by something. Well... HE WAS READING MAXIM MAGAZINE!
Yeah, the private followed my order only to hand over the Maxim to a 12 year old Afghan boy. Tomfoolery, I tell ya, Tomfoolery!
We have several Afghan kids in the hospital right now in long term recovery. One is a 12 year old with the initials of A.M. He's a pretty happy kid and all. He's been through a lot, but things are looking up for him. A.M. should leave the hospital in a few weeks and have a full recovery. His biggest challege right now is boredom. He is constantly looking for things to do. I'll get back to A.M. in a minute.
Right around the corner from A.M.'s room are some "Enemies of Peace", aka bad guys being treated by us. They are guarded by the Army guys who captured them. It's a bit surreal to have guys with guns outside the patient rooms. Anyway, the Army guys also deal with a lot of boredom. The other day I noticed one of them reading Maxim Magazine. If you are not familiar with it, basically it is like soft core pornography with lots of pictures of scantilly clad super models. It also has all kinds of ridiculous articles trying to help guys get chicks in bed. That's basically it. Not exactly quality reading for our soldiers and perhaps not appropriate while on guard duty!
So, I decided to intervene. A copy of "The Five Love Languages" was sitting at the nurses station for some reason. I decided to pull rank here. As a Captain in the U.S. Air Force, I jokingly ordered the Army private to put down that Maxim Magazine and pick up "The Five Love Languages". The lad followed my order... so I thought.
Not long thereafter, as I was walking through the ward I noticed the aforementioned Afghan kid with the initials A.M. sitting in the hallway. He had a big grin on his face and seemed mesmorized by something. Well... HE WAS READING MAXIM MAGAZINE!
Yeah, the private followed my order only to hand over the Maxim to a 12 year old Afghan boy. Tomfoolery, I tell ya, Tomfoolery!
Saturday, January 9, 2010
Power of Prayer
There is a lot of evil in this world. All you have to do is read the paper or watch the news. The doom and gloom can be overwhelming. I do think it is important to follow current events, but we must filter that information. Otherwise, we run the risk of thinking that very little good is going on in this world. In this blog, I plan to report my experiences only. I do not want to get political in any way. I do not want to prostelytize. More than anything else, this blog is therapeutic for me. Plus, I can type out a story or my thoughts only ONE TIME instead of sending 18 emails saying the same thing!
With this in mind, I must tell you about one patient that really hit me hard. 2 nights ago the hospital was a madhouse. We were feeling the effects of what is called an "SVBID" or suicide vehicle born improvised device. In other words, a terrorist loads up a car with a bomb and drives that thing into a target. It's similar to "kamakazee" missions of previous wars.
We received 3 patients from an SVBID attack. I began to evaluate one of them in the ER. He was a First Lieutenant. He began describing the event. He was quite lucid upon arrival. A nurse gave him pain medicine ordered by me. Within what seemed like seconds, he began to "crash". He became pale and stopped talking. The evaluation continued. More help arrived. It was needed. Soon 4 physicians more experienced that me were now at the bedside doing everything possible to stabilize him. Time seemed to stand still. His leg was badly broken and bleeding. A surgeon put a large IV into his chest. He received 2 units of blood in less than 5 minutes. An emergency room doctor put a breathing tube down. I stood by trying to help in any way that I could. His leg was unwrapped revealing the badly broken lower left leg. Clearly this was the cause of his massive blood loss. The patient was taken from the ER for a fast CT Scan and then to the Operating Room. I returned to the hospital floor. It was a humbling experience to say the least. At the end of my shift the patient was out of the OR and now into the ICU. I was able to visit him there. He was stable. What a relief!
I spent much of yesterday praying. A night filled with the arrival of 5 critical patients including the first lieutenant with the badly broken leg had affected me. I prayed that my next shift would be quieter. I prayed for our patients. I prayed for peace. I arrived for work last night and my colleague gave me the report on our patients. The first lieutenant was now out of the ICU and was in a regular hospital bed. He was talking. He was eating. This is how I like my patients to be! A nurse conducted a test of his memory and cognition at the bedside as I watched. The first lieutenant was now remembering the horrors of the previous day. But, he was strong. He was determined. He was on his way to recovery. And now, he is well on his way back to his home in Utah. He will be okay. I will be okay.
With this in mind, I must tell you about one patient that really hit me hard. 2 nights ago the hospital was a madhouse. We were feeling the effects of what is called an "SVBID" or suicide vehicle born improvised device. In other words, a terrorist loads up a car with a bomb and drives that thing into a target. It's similar to "kamakazee" missions of previous wars.
We received 3 patients from an SVBID attack. I began to evaluate one of them in the ER. He was a First Lieutenant. He began describing the event. He was quite lucid upon arrival. A nurse gave him pain medicine ordered by me. Within what seemed like seconds, he began to "crash". He became pale and stopped talking. The evaluation continued. More help arrived. It was needed. Soon 4 physicians more experienced that me were now at the bedside doing everything possible to stabilize him. Time seemed to stand still. His leg was badly broken and bleeding. A surgeon put a large IV into his chest. He received 2 units of blood in less than 5 minutes. An emergency room doctor put a breathing tube down. I stood by trying to help in any way that I could. His leg was unwrapped revealing the badly broken lower left leg. Clearly this was the cause of his massive blood loss. The patient was taken from the ER for a fast CT Scan and then to the Operating Room. I returned to the hospital floor. It was a humbling experience to say the least. At the end of my shift the patient was out of the OR and now into the ICU. I was able to visit him there. He was stable. What a relief!
I spent much of yesterday praying. A night filled with the arrival of 5 critical patients including the first lieutenant with the badly broken leg had affected me. I prayed that my next shift would be quieter. I prayed for our patients. I prayed for peace. I arrived for work last night and my colleague gave me the report on our patients. The first lieutenant was now out of the ICU and was in a regular hospital bed. He was talking. He was eating. This is how I like my patients to be! A nurse conducted a test of his memory and cognition at the bedside as I watched. The first lieutenant was now remembering the horrors of the previous day. But, he was strong. He was determined. He was on his way to recovery. And now, he is well on his way back to his home in Utah. He will be okay. I will be okay.
Thursday, January 7, 2010
Better Lucky Than Good
We had three trauma patients come in during my last shift. All three were IED victims. Again, this is the terrorist weapon of choice.
My first patient was just 6 feet away from a blast. He sustained injuries to his face, right hand, and left thigh. Amazingly, the worst of his injuries was a broken finger. He has shrapnel in his chin and his left thigh. He did not need to go to the Operating Room for any of it. Instead, we sent him back to his FOB (forward operating base). Later on I wondered to myselft if that was the right thing to do. After all, the guy just went through some really traumatic stuff. He was air evacuated here to Bagram. Most trauma patients are brought here that way. That's not your typical day for an airmen like this guy. Regardless, he is now back in the fight.
This morning at 0600 two Norwegian casualties came our way. They were hit by an IED after responding to help out after a different explosion. Both patients had serious eye injuries. We called our eye surgeon STAT. He came and did a full exam on my patient right there in the ER. It was awesome to have an Ophthalmologist there in no time. After all, he is the ONLY eye surgeon in all of Afghanistan! That includes the civilian sector as well. This is a third world country. There medical system is probably 50-100 years behind the western world. But I digress. Our eye surgeon was able to take both patients to the operating room this morning. Both Norwegians had their eye sight saved!!!
So, it was a good night overall. In this war as in life, it's always a must to be "Better Lucky Than Good".
My first patient was just 6 feet away from a blast. He sustained injuries to his face, right hand, and left thigh. Amazingly, the worst of his injuries was a broken finger. He has shrapnel in his chin and his left thigh. He did not need to go to the Operating Room for any of it. Instead, we sent him back to his FOB (forward operating base). Later on I wondered to myselft if that was the right thing to do. After all, the guy just went through some really traumatic stuff. He was air evacuated here to Bagram. Most trauma patients are brought here that way. That's not your typical day for an airmen like this guy. Regardless, he is now back in the fight.
This morning at 0600 two Norwegian casualties came our way. They were hit by an IED after responding to help out after a different explosion. Both patients had serious eye injuries. We called our eye surgeon STAT. He came and did a full exam on my patient right there in the ER. It was awesome to have an Ophthalmologist there in no time. After all, he is the ONLY eye surgeon in all of Afghanistan! That includes the civilian sector as well. This is a third world country. There medical system is probably 50-100 years behind the western world. But I digress. Our eye surgeon was able to take both patients to the operating room this morning. Both Norwegians had their eye sight saved!!!
So, it was a good night overall. In this war as in life, it's always a must to be "Better Lucky Than Good".
Tuesday, January 5, 2010
Working Nights
Well, I have officially started working nights now. Last night was my first night on and I worked about 15 hours. We did some shifting of personnel and this is how it all ended up. It will take a little getting used to of course, but it should be fine. I am now assigned to the Intermediate Care Ward (ICW) instead of the Intensive Care Unit (ICU). That's fine by me, probably a little less stress this way although I will probably be asked to handle some critical patients when we are really busy.
We were busy last night with several patients aerovaced to Bagram from various places in Afghanistan. One will not make it unfortunately. The other ones will make it to Germany for further treatment and should be okay. What I am noticing the most right now is that we are not taking care of many Americans in the hospital right now. Only about 25% of our hospital patients are Americans. I guess that is a good thing in many ways. The bad guys tend to hole up in their caves for the winter here. Thus, we see less wounded soldiers, marines, airmen, and sailors (yes, we have Navy personnel on the ground here too in certain career fields). But, the violence goes on and on. It's the civilian contractors and the locals that are taking the hits right now. We even have some "Enemies of Peace" (EOP) at our facility. That's the latest designation for bad guys. It's pretty strange to treat a known or suspected terrorist. One EOP that I dealt with last night just looked like a bad guy. Treating him is that much more challenging. It's something we all have to get used to doing here.
Off to bed now than back at it tonight. At least working nights I will be able to make a few more calls home when things are slow at night and it is daytime back in the U.S. I miss the good old U.S.A.!!!
We were busy last night with several patients aerovaced to Bagram from various places in Afghanistan. One will not make it unfortunately. The other ones will make it to Germany for further treatment and should be okay. What I am noticing the most right now is that we are not taking care of many Americans in the hospital right now. Only about 25% of our hospital patients are Americans. I guess that is a good thing in many ways. The bad guys tend to hole up in their caves for the winter here. Thus, we see less wounded soldiers, marines, airmen, and sailors (yes, we have Navy personnel on the ground here too in certain career fields). But, the violence goes on and on. It's the civilian contractors and the locals that are taking the hits right now. We even have some "Enemies of Peace" (EOP) at our facility. That's the latest designation for bad guys. It's pretty strange to treat a known or suspected terrorist. One EOP that I dealt with last night just looked like a bad guy. Treating him is that much more challenging. It's something we all have to get used to doing here.
Off to bed now than back at it tonight. At least working nights I will be able to make a few more calls home when things are slow at night and it is daytime back in the U.S. I miss the good old U.S.A.!!!
Sunday, January 3, 2010
Deployment Life
There are a lot of things about life on deployment at Bagram that are so much different than life at home in the U.S. I guess that kind of goes without saying. Some things here are good, some not so good. Let me start with the good things. We have laundry service here. It's nice to not have to do laundry for 6 months! I'll take that. We have good food and lots of it. There are 3 cafeterias otherwise known as DFAC's (dining facilities) here within a 5 minute walk of where I live and work. As in America, food is in abundance. Since I am at a large base, we actually have a pizza place and a coffee shop here as well. Also, the United Arab Emirates has a great DFAC (there are lots of nationalities here at Bagram). I actually got to have some fabulous hummus there last week. So, I am not kidding when I say that sending food or sweets is unnecessary. We have food everywhere! One other great thing here is the workout facilities. We have 2 gyms just down the road. One is called "the clamshell" because the structure of it resembles a clam. That's where all the muscleheads work out. Basically, it's a lot of Army guys in there pumping iron in their uniforms. The other gym is called "The Rock" although I am not exactly sure why. It has more machines and cardio equipment, thus more Air Force people! There are also exercise classes there every day. Last night I went to a yoga class. Yep, that's right yoga in a combat zone! Do not knock it until you try it. I took a friend with me who had never done yoga. He was sweating like a pig in there and enjoyed the heck out of it. I came out of there feeling the best I have in a few weeks. I'll definitely be back for that, maybe to stretch out after pumping some iron with the army dudes at the clamshell!
As for the not so good stuff on deployment, I'll keep it brief. Lack of space and indoor plumbing is the main issue here. Some people live in hardened facilities that do have indoor plumbing, but they do not have much personal space there. They have to share bunk beds. I live in a B Hut where I have 6 x 7 feet of space that I can call my own. But, I have to walk 175 paces outside (I've counted it!) to get to a decent shower.
So, in the end life on deployment at a big base like Bagram is very manageable, one day at a time of course!
As for the not so good stuff on deployment, I'll keep it brief. Lack of space and indoor plumbing is the main issue here. Some people live in hardened facilities that do have indoor plumbing, but they do not have much personal space there. They have to share bunk beds. I live in a B Hut where I have 6 x 7 feet of space that I can call my own. But, I have to walk 175 paces outside (I've counted it!) to get to a decent shower.
So, in the end life on deployment at a big base like Bagram is very manageable, one day at a time of course!
Friday, January 1, 2010
IED's
The last few days I have seen directly the devastating injuries from IED's, the infamous improvised explosive devices that have become the face of this war. Two government workers, one Canadian and one American, sustained some very serious injuries from IED blasts while working in Afghanistan. It's terrible. We are doing everything we can to help them. One is well on his way home and the other patient hopefully will follow soon. It's humbling to help treat them in the ICU.
It just blows my mind that people can be so evil. It is such a cowardly act to plant a bomb. I don't think I will ever understand it. It's sickening.
I know that over the next 6 months we will see countless patients who have been injured by an IED. It's not easy taking care of these patients, but we must do it. What else can I say?
It just blows my mind that people can be so evil. It is such a cowardly act to plant a bomb. I don't think I will ever understand it. It's sickening.
I know that over the next 6 months we will see countless patients who have been injured by an IED. It's not easy taking care of these patients, but we must do it. What else can I say?
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