Change

I have worked 149 consecutive days on this deployment. I will not have a day off until I leave Bagram. God willing that will be around the end of June. This is just the way it is. There is nothing I can do about it except press on until the end. We all have become quite comfortable with our jobs here despite the human carnage surrounding us. Routine has kept us all sane. We work. We eat. We exercise. We sleep. There is little else to do. It has become predictable which is important when you are in the middle of an unpredictable war zone. However, in the last week or so most of the surgeons and all of the emergency room doctors have been replaced. We are all trying to put names to faces now. More importantly, we are all scrambling trying to deal with all the CHANGE that has been thrust upon us with this new wave of doctors. It has been painful to say the least. Our routine has been turned upside down.

For the last 5 months, the hospital has functioned based on an early rounding time of 0630. I would see my patients on my own from 0530 to 0630. Then, the professional staff would meet to see all the patients together and come up with comprehensive care plans. The surgeons would start operating around 0800. It was not easy to be coherent at that early hour, but after a while everyone became accustomed to it. One week ago all of this changed. The new boss (aka trauma czar) decided that starting things later would be better. We are now meeting at 0800 or 0830. The intention is to make things a little easier on us. It seems like a good idea. The problem is that routines have been established and many of us are not happy to have it all changed when the end of our deployment is in sight. Oh well, we will get over it.

Another issue is that there is a lot of confusion over who is responsible for what. Our roles were clearly delineated with the previous group. Everyone knew what they were supposed to do and where they needed to be even if you did not like it. In a crazy place like our hospital, it really helped us all stay focused on providing excellent care to our patients. That is what truly matters. In my first 5 months here, only 2 injuries were missed on our entire populatione of trauma patients. We had over 600 trauma patients admitted to the hospital. That's an amazing record. It is a tribute to the organization and the redundancy of the system. A systematic approach is absolutely essential in trauma patients. It is even more important in our patients because they sustain all kinds of atypical injuries from these powerful blasts. In the last week or so, there have been several near misses. The problems were corrected before they could lead to any adverse outcomes. But, the potential is there for patient care to suffer. It has been difficult for us all who have been here since December to see all this happening.

Change in life is inevitable. The previous group of surgeons and ER doctors had to leave. Their work here was complete. People are always coming and going whether that be here at a busy military trauma hospital or back home in any workplace. An important principle for new leaders to understand is that too much change is not good. There needs to be a balance. Right now we are slowly finding that balance again after some drastic changes. We will all get through it. I just wish it did not have to be this way. Nevertheless, embracing the change going forward is probably the best solution.