Ramp Ceremony

Kandahar, Afghanistan

Solemn was the only thought I could muster.  I watched the ramp ceremony from behind a chain link fence topped with concertina wire.  I had been told the ceremony started at 11pm, but it had really begun a few minutes before.  I was not able to muster up with the rest of the uniformed folks.

A ramp ceremony is an event which memorializes one of our fallen.  We line up in columns, arranged by our constituent countries.  The casket is slowly carried into the bowels of the awaiting plane after a brief ceremony.  We show our support for our comrade who gave her life.

This night we gathered in particular to remember one close to us, a young woman who worked as a medic at the ROLE-1.  I had seen her at the barbeque not two nights before.  I remembered her as a lively, vivacious person, full of energy at that gathering.  I did not know her, but it didn't matter at this moment.  She was one of us.

The day after the barbeque she was transiting to a nearby forward operating base by vehicle.  They struck an IED and the vehicle was devastated, killing all aboard.   So just like that, she went from vivacious young woman enjoying herself with her friends, to being loaded up into the back of a plane less than 48 hours later.

It was quiet despite the fact that we were on the flightline.  Two Stryker vehicles, large green trucks that look like giant multi-antennaed insects rolled towards the plane, then past it.  There was a full moon overhead - a poppy-harvest moon?  C-130s took off in the distance, oblivious to what was going on in front of me.  The Canadians began marching in their unique, animated tin soldier like way.  Someone played Amazing Grace on the bagpipes, perhaps the saddest version of the song I have ever heard.  The coalition country's version of Taps was then played by a bugler.  The casket was loaded slowly into the gaping black hole in the rear of the plane.  And just like that, it was over.  Surreal.

That's Entertainment!

Kandahar, Afghanistan

Somewhere between rocket attacks and trauma victims landing in our trauma bay, one must find time to distract oneself.  Failing to do so can be dangerous to one's mental health.

It can be a bit schizophrenic around here sometimes.  Virtually every day one has the opportunity to see the violence of war and its tragic consequences.  In spite of that, or perhaps because of it, there is an air of silliness, giddiness, or at least attempts at such, to fill the gaps between the badness.  Don't get me wrong, there is no laugh track here, no Hotlips Hoolihan, no Hawkeye Pierces or gin stills.  At least none that I am aware of.  But we do find - or invent - opportunities to blow off steam, or at least temporarily forget what came into the trauma bay, the OR, or the ICU an hour ago.

                  Survivor: Kandahar Edition

Last week we experienced one of our more creative diversions - a pool party put together by one of our senior surgeons.  He supplied the blow up pool and the precious water to put inside of it (under the auspices of "training" - specifically on how to decontaminate a chemical warfare victim).  Everyone else just ran with it.  There were Polynesian grass skirts, coconut bikini tops which thankfully no-one put on, Hawaiian leis, and so forth.  There was the obligatory "baptism" of some allegedly surprised victims.  And of course more NA beer than you could ever hope to drink.

The day before that we had a huge cookout commemorating the Navy Hospital Corpsman birthday.  A photographer representing the Getty Collection or something similarly named was there to cover the event, and his photos were published online.  Anytime you can eat something barbequed, even a military issue hotdog whose juices could be used for embalming purposes, it's OK.  Drink an NA beer, close your eyes for a brief second and pretend you're 8000 miles away at a beach party.



A birthday I will not soon forget - with my colleagues at Mamma Mia's

I celebrated a birthday nearly two weeks ago.  I was feted by my ICU and surgery colleagues at the local pizza joint, Mama Mia's.  Never mind that Mama's is about 80 yards away from where a set of rockets landed a few weeks ago.  Fo'gedabout it.  It is pizza.  And even if it challenges the notion that there is no such thing as bad sex or bad pizza, it's OK.  Just close your eyes for a brief second... I'll say this about my Kandahar birthday - it's not one I will soon forget.  Can you remember your last birthday?

Sharing some yuks at the Canadian BBQ

Last Thursday we were invited to the Canadian monthly barbeque.  This was special in that not only was the food pretty good, but we even got to watch people drink beer or wine, like voyeurs.  The Canadians are allowed two beers or a half bottle of wine per month.  I even smelled a real beer and it was heavenly.  We toasted several people and organizations and one clever fellow managed to toast the Taliban - for not rocketing us tonight so we can enjoy our beer in peace!  Not 30 minutes later I was chewing dust under the picnic table with 60 of my new best friends thanks to that evening's rocket attack.  That's entertainment!

Again, Precious

Kandahar, Afghanistan

I was a little surprised to see our new baby "Jane" out of bed, but I was truly arrested at the tender scene that met me when I walked into the ICU for rounds.  One of our nurses embraced this new Jane, calming her into a dream-like state while her analgesics coursed through her.  She is burned over her chest and arms, having been run over by a bus.  This is not a child of war, but a bit player in the survival-of-the-fittest play known as "growing up in Afghanistan."  In addition to her burns she has multiple fractures and has lost her left leg below the knee, but for this briefest of moments she is a picture of bandaged serenity.

Fallen Angel

Kandahar, Afghanistan

I got the cryptic text message on my pager at about 4:20 this morning: Fallen angel, ETA 20 min.  I was dead to the world at 4:20, but I was pretty sure what fallen angel meant - a KIA was inbound.  Why were they texting me about this?  I rolled over, feeling pretty confident that I didn't need to go in for that:  I get all the pages that the folks on call get, so I know that if there are too many Alphas coming in for one ICU doc to handle, I can go in to lend a hand.  One person could handle a fallen angel, although I still found it curious that the Tactical Operations Center felt compelled to page about this.

I never got back to sleep.  At about 4:30 I got another text about the fallen angel, and that 13 were inbound.  I apparently did not know what fallen angel meant and if we had 13 inbound, that was a mass casualty.  I got up quickly this time and threw my uniform on.  This was going to be a long day, I knew it.  I had to at least find a clean pair of socks.

I ran into my colleague Corey and his roommate Joe.  None of us knew what was going on but we knew we needed to go in.  Maybe fallen angel was the name of a plane or helo squadron I thought to myself.  Maybe a small plane was shot down.

It is still murky to me what exactly fell out of the sky - I know now that it was a helo, but what kind?  We got to the trauma bay in minutes, thanks to the duty driver who picked us up.  The bay was packed.  I could here moaning and some patients yelling out.  I quickly surveyed the bays.  All of them were full - we have at least 13 bays, perhaps 14.  Generally traumas come in in 2's and 3's at most.  X-ray techs were wheeling their machines methodically into bays.  I snaked past the radiologist who was holding a probe covered in goo, heading for the next patient's abdomen, to see if it contained blood.  Breathing tubes were being placed into the trachea's of our crash victims, one, then two, perhaps five total.  I assessed a few patients and helped out where I could.  In no time one was rolled into the OR for surgery, then two more followed him.  A curtain to one trauma bay was closed and there was no noise coming out of that bay, no X-ray tech going in.

Full ICU Status Board

I and my ICU colleagues made it back to the ICU to help flush out whatever patients could go to the wards.  The new patients were already being filed in, one by one on their rickshaw gurneys.  Many would go to the OR later as they were presently mostly stable.  We were getting more news about what happened: a helicopter carrying at least 13 fell from about 200 feet.  No word about a rocket or gun shots - mechanical failure seemed to be the reason for this tragedy.



My prediction that it would be a long day - not a huge stretch of the imagination - was correct.  The fact that I was unshaven, hadn't brushed my teeth, and essentially was wearing the same thing I had started wearing on my call day 48 hours prior didn't help.  

The surgeons at the end of the day

By 4:30 that afternoon it was quiet enough for Jon and I to leave the mostly cleaned up mess for the on-call guy, Corey.  Poor Jon was worse off than myself - he had started his day at 3:30 am the previous day when a young child was medevac'd in - and really hadn't slept during that whole time.   We passed a handful of surgeons who were sticking around and nearly giddy that they had at least two more surgeries to go -- two more traumas had arrived, amputations, about 15 minutes before.  Welcome to the trauma bay that never sleeps.

A Day in the Life

Kandahar, Afghanistan

It occurs to me that among those living outside of Kandahar there is probably a very distorted view of what our lives our like here.  The news is very skewed towards headline-grabbing events (rocket attacks and helicopter crashes), which doesn't accurately portray an average day.

I had a busy day yesterday, perhaps busier than most.  But it represents.

Out of bed by 5:15, it's broad daylight but relatively cool.  I go for a 30 minute run outside, marvelling at the blue sky and sharp, craggy line of the mountain range in Taliban country out there.  The wind is blowing from a different direction and the dust seems to be gone here at 5:45 am - it's crystal out there.  It's only 70 degrees or so at this point, about 45 degrees less than it would be at noon.

I stop at Tim Horton's Canadian donut shack to pick up a dozen for the ICU staff.  I'm on call today and these folks work hard.  Some of them have occasionally unpleasant jobs, cleaning sh*t or other bodily fluids off of patients backsides, rolling heavy torsos and legs for better positioning, and watching patients die before their eyes sometimes.  It's a satisfying job too - many "saves," feeling honored to serve those who have served and have given limbs or eyesight in service to their country.  But it is hard no matter how you slice it, and the least that they deserve is a Timmy Ho's donut to start the day.  Maple is the best.

After morning report we sat down for a talk by one of our surgeons on burn care.  He is a burn specialist on loan here in Kandahar as part of his fellowship.  It's an excellent talk despite the fact that I can barely stomach burn care, but we are interrupted ten minutes into the talk by multitudes of pagers announcing that we have 4 Alphas inbound and multiple Bravos.  All GSWs - gun shot wounds.  A firefight?  We ambulate with purpose toward the trauma bay.

Before noon we have managed over 9 Alpha's and untold number of Bravos.  Apparently a coalition unit arrived in a Taliban-held town and all hell broke loose.  Those that were shot were all locals, seemingly innocents including one child, who all seemed to have been struck by Taliban bullets (that's what they looked like when they were removed).  We rarely get the real story initially as it needs to get pieced together later.

Busy day in the trauma bays

It was a busy morning in the trauma bay, with bays being quickly mopped up of their blood and medical detritus, only to have another trauma come through the bay doors to fill it up again.  It was like a rolling mass casualty without the histrionics that generally comes with that.  I put in a few central lines and moved from one bay to the next, line kits propped under my elbow, sterile gloves in pocket.

Despite the madness, and probably because of our familiarity at this point with groups of casualties, I managed to break away for lunch with some colleagues.  We typically go to the "European" dining facility (DFAC) Luxembourg - the closest to the hospital, but this day we went to the North American one, Niagra.  The highlights to the NBA finals, which had come on at 5:30am, were playing.  Had to see that, a small slice of what was happening at home, 8000 miles away.


Waiting outside the DFAC known as "Southpark"

I went back to the ICU as I my call was beginning - we go noon to noon, 24 hour coverage.  The ICU was getting business coming out of the OR from the morning's events.  I stayed busy fairly continuously through about 7pm, grabbed a quick bite from the food brought in from one of the DFAC's which by this time was cold and fairly gross.

Around 8pm we get a surprise patient who ended up in the trauma bay without warning.  He was a local national, hopelessly mangled in his lower extremities and torso.  By the time I made it from the ICU to the trauma bay, his chest had already been "cracked," in order to clamp the descending aorta and put epinephrine directly into the heart.  It was futile and when all parties agreed, the resuscitation was "called."  

Back to the ICU where I soon found out that an enroute care (ERC) mission was being spun up.  I was on call to cover that mission.  By 8:30 I was getting into my flak jacket and helmet, and having medications drawn up.  In the trauma bay the patient whose chest I had stared directly into before he officially died was now laying in a body bag on a gurney, awaiting mortuary affairs.  I headed out to the flightline alone.

While waiting for the helicopter to pick me up I was able to see two UK jets light up the night sky with their afterburners as they took off.  Several Unmanned Aerial Vehicles (UAVs) flew by, heading to missions unknown.  A half dozen other fixed wing planes took off without navigation lighting, climbing like dark ghosts into the crescent-mooned sky.  Shortly before 9p two helo's touched down on the flightline in front of me.  I climbed into the lead helo and we lifted off into the dark sky.  I was able to listen in on the comms of the pilots, as I had a set of headphones on this mission.  They seemed like two friends navigating their way through the NJ Turnpike.   I could see the Milky Way on the horizon, it was so clear and dark outside.  I was trying to be oblivious to the potential badness below me.

It's in the open press now that one of the local squadrons had a helo shot down recently by the bad guys. I certainly hadn't forgotten this.  As we descended toward the forward operating base (FOB) that was caring for our transport patient I realized I was saying to myself, between Hail Marys,  I hope these guys know what the f*k they are doing.  The holy and profane in one breath.  I amused myself, but was not really amused.

We picked up our patient, myself and the Army medic, who thankfully was very calm and knowledgeable.  Our patient was a local national who had been shot at the jaw.  The bullet went through his oral cavity and out the other side.  He had a lot of dried blood on his face and a breathing tube in his mouth.  He was sedated and paralyzed, lying on a stretcher.  After doing the requisite turnover and patient inspection, we loaded the patient onto an ambulance and then onto the awaiting helo.  Forty five minutes later I was back in the trauma bay, safe.  It was 11p by this time.   I relieved my colleague, Jon, who had to mind the ICU while I was gone.

The ICU Team on rounds

I managed to tuck the jaw-gunshot patient into the ICU by 1am.  I had promised to myself to do some training to the night shift nursing staff - they are often neglected from the teaching angle, so I gave  prepared lecture via laptop to them on an ICU topic that might come in handy in the care of their patients.  By about 2am I was at least supine on my makeshift bed, uniform still on, in case we got another ERC call.  I pinned my pager to my front pocket.  The first time I got an ERC call I only had 5 minutes to get ready.  I clearly couldn't sleep through this and had to be up and ready in minutes if need be.

I manage to get a couple of hours of interrupted sleep: the nurses inevitably have "issues" with their patients, or labs that don't make sense.  It's part of my job to answer these questions, of course.  I stroll through the ICU usually a few times overnight.  The nurses try to save a few of the less critical questions for these stroll-throughs.  I wake up to the same watch alarm that I awoke to 24 hours prior, when I was then thinking about running.  This morning I am thinking about going home, after noon, to try to catch a nap. Instead, I sit here, writing this post.

Not Your Typical ICU

Kandahar, Afghanistan


As you can see from the diagnoses posted on our white "status board," this is not your typical ICU.  We admitted a "GSW to the head" last week - a gun shot wound, allegedly.  Our neurosurgeon, Steve, was certain that it wasn't a GSW, but rather, an axe, machete, or other similar object that caused the skull-crushing damage to this local Afghani's head.  When you see macabre injuries, you deal with it by developing a macabre sense of humor.  Our patient, another Doe, soon became "the Axeman."  Today Axeman left for a local Afghani hospital.  He was quickly replaced in the trauma bay with a patient who had a  "knife to the head."  Knifeman?

We have seen other bizarre injuries.  The photo below shows my colleagues, Oscar and Corey, removing a ball bearing from an IED which had traveled from one temple, through the frontal lobe, to end up in the soft tissue beneath the opposite temple.  Ball Bearing Man fared much better than Axeman, as I expect he will walk out of the hospital with minimal deficits.

We have also seen weird animal-related injuries:  I have written about the young boy with the viper bite to the face, who fared well - and became famous via the front page of the NY Times.  As we were arriving in March a young boy was being discharged who had been picked up by his head - by a camel!  You can't find much in medical textbooks about camel bites to the head.  This only confirmed my suspicions about camels - that they are mean SOB's that are to be avoided.  We also recently had a young boy who was in some ways assaulted by a mule.  We never did figure out how that happened, but that mule must have been a real terror.

There are precious few weeks around here where someone doesn't say 'you'll never see that again.'

The Plankowner Crew

Kandahar, Afghanistan








The quarterdeck to the new ROLE-3

I miss the old ROLE-3 hospital.  I am not alone.

One of the 'tent wards' of the old ROLE-3

We moved into our new building on May 23rd.  It has taken awhile to adjust.  Last night was the first time I managed to get real sleep in my makeshift bed in the new ROLE-3 while on call.  I woke up in the early morning, realizing I had actually made it into a pair of scrubs.  If I sleep at all on call it is usually with my camouflage uniform and boots on.   In the old ROLE-3 I generally crashed on a couch that would have been rejected by most college fraternities for whatever minutes (or rarely hours) I could snag between admissions or emergencies.

Chris, one of our surgeons, and I on moving day - the morning after the big rocket attack on KAF

It occurred to me as I rushed to the trauma bay to greet the three new "Alpha's" that this mad rush would have taken all of 5 seconds in the old, M*A*S*H-style ROLE-3, whereas now I run down the 100 yard hallway to the vast and impersonal trauma bay.  Sometimes I don't get a page and may find out that we have an ICU-inbound trauma patient only when they are halfway through their damage control surgery.



This would not have happened at the old ROLE-3.  When traumas arrived, virtually the entire hospital knew about it.  The ICU was all of 10 yards from the heart of the trauma bay.  The OR's were adjacent to the trauma bays.  Now one has to trek through a maze of automatic doors that may or may not open when you hit the silver button, dogleg left, right, left again to get to the well-hidden OR.  Impersonal.

I used to follow the patients into the OR to lend a hand when necessary, or just to learn what I could from the surgeons.  Rarely is that the case now, as I generally only don scrubs when I am on call.  You can't go into the new OR without scrubs, as it ought to be.

Jon moves central line kits to the new ROLE-3

I feel petulant complaining about moving into a shiny new hospital with its new paint, its fly-free interior, its waxy-shiny floors, its cavernous rooms.  We are Plankowners - a Navy tradition and honor which is bestowed only on the first crew to inhabit a ship, or in this case, a hospital.  In the old wooden ship Navy the crew which inhabited a ship at its commissioning would feel entitled to own a plank from the main deck, as they helped to "bring the ship alive," hence the designation "plankowner."

The old ICU now lies empty

We certainly put some blood, sweat, and tears in bringing this "ship" alive.  Although we didn't labor with bricks and mortar, we did put in dozens of hours into building and stocking shelves, operationally testing equipment, configuring operating rooms and hospital wards into working units, and so forth.  Many drills were conducted.  The night before we were to move in we endured a rocket attack on the base, about which I have written in detail.  We awoke the next morning, a few hours later, to begin moving a hospital filled from the night before's activities into the new and sterile ROLE-3.

It is a better facility, no doubt.  But it lacks character, charm, and the cohesiveness of the old ROLE-3.  Being that we were "crammed" into a makeshift facility of tents, plywood shacks, and CONEX boxes, we were much physically closer together, and figuratively closer as well.  I see my surgery colleagues a lot less these days, the hospital ward folks even less.

Plankowner certificate - easier to provide than the plank of a ship

As we become tighter as an ICU, we become more like acquaintances with the rest of the hospital.  We are the plankowners of a steel cargo ship, not a salty ship of the line with torn sails who has sailed the seven seas.

Dusty Roads

Kandahar, Afghanistan

The marathon started at 4 am.  I just couldn't bring myself to do it.  I may have been able to finish, but then again, I may have really hurt myself.  I've run a handful of marathons in my day, but the last time I ran more than ten miles was in the NYC marathon last November.  I briefly considered how ridiculous it would be if I ended up in my own ICU with hyponatremia (low sodium) from sweating in the Kandahar heat.  I'm sure the command would not have laughed.

So instead I woke up at 5am last Sunday to get in line to pay for the half-marathon, which started at 5:30.  A surprising number of people had shown up, perhaps 200, for this Tour de Kandahar.  Races here aren't like other road races.  They don't play the national anthem I realized.  Probably because it would take 30 minutes or more, given that there were probably ten different countries represented on this NATO compound.

The safety briefer made sure we knew that in case of a rocket attack we should seek cover and the race would be canceled.  Also - "the porto-potties are next to the guard towers, " and "follow the guy in front of you, but if you've gone two miles without a water stop, turn around!"  OK then, let's go!

We trekked out to the perimeter road, sucking in dust in the early morning light.  The race was a figure 8 which concluded with the route around the flightline.  As I crossed the leeward side of the flightline, a gunsmoke grey mysterious-looking passenger plane flew just overhead, maybe one hundred feet above, landing gear down.  At one point, about 8 miles into the race, I was stuck behind a column of brightly painted South Asian trucks.  One had eyes painted like a Hindu goddess that kept staring at me.  I kept pace with it for a half mile, feeling delirious and strangely mesmerized by the goddess eyes.  I repeated to myself, your forearms are pistons, your biceps are crankshafts, you legs are the wheels.  Keep rolling, it's almost over, I lied to myself.

I finished the thirteen miles in one hour, forty-five minutes.  Not bad for an old man.  Once showered I plodded back to work to see what surprises lay in store.

The Reunion

Kanadahar, Afghanistan

Thursday was busy.  In addition to the visit by the Secretary of the Navy, three rocket attacks, and steady stream of trauma patients, we received a special visitor.  Jane's father had finally arrived.

He was escorted into the ICU by a small cadre of Army soldiers in their field cammies.  One carried a large SLR camera.  Apparently their unit was as anxious to record this reunion as we were.

Oddly, little Jane didn't jump up and down and yell "Daddy" in Pashto.  She seemed confused.  Dad was speechless, but began wiping tears on the tail of his flowing turban.  For a moment I wondered if we had found the "wrong" father or that he was acting real well, based on the reaction of little Jane.  This is not out of the realm of possibility as we have had alleged "fathers" here for days visiting patients' bedsides, and later it was determined that they were actually uncles or other relatives.  But it became clear soon enough that this was her father, as she opened up and began speaking to him, telling him of her crazy, crazy new life at the ROLE-3.

Jane with her father and Joe, her orthopedic surgeon

Later when we discussed the unusual first moments of their reunion we came to the conclusion that there were some cultural issues at hand at which we could only speculate.  Maybe seeing her father crying stunned her.  Maybe father usually interacted only with her five male siblings, leaving the other four girls to be attended to by her mother.  Who could say?

In addition to learning about the composition of her family, we learned that no-one in her family had been killed - fortunately.  She had been out playing with her friends and siblings when a rocket hit her village compound.  Dad had heard that although Jane's arm was hurt, it was intact: he was a bit stunned to see her tiny left arm stump.  Who wouldn't be?

Jane showed dad all her toy she had amassed during her week with us.  He told her to pick out some for her siblings - smart, as I would have done the same thing.  As radically different as our cultures are, I supposed there are some universal thoughts about parenting.  He asked that she put on a special red dress for the trip home.  She put on her tiara and was led by her remaining hand down the hallway by one of the nurses, to the awaiting van.  I could barely suppress a tear as the sliding door of the van shut.  The dirty white van carried our princess to the plane which would take her back to her mud hut, her siblings, and her mother.  Now that is a reunion I would pay to see.

Big Ray of Sunshine

Kandahar, Afghanistan

There is nothing like hitting the deck on the tarmac during a rocket attack and finding yourself face to prone face with the Secretary of the Navy.  That was me last night.

If you aren't in the military you probably have no idea what a big deal it is to have some face time with your Presidentially-appointed "big boss."  It's big, trust me.

A friend of mine from my Tulane days, Elizabeth, is the sister-in-law to Secretary Ray Mabus.  I found this out a year ago at an impromptu mini-reunion of Tulane friends.  "We'll have to arrange a meeting someday," said Elizabeth, long before I had orders to come here.

A couple of weeks ago, having forgotten this statement she made, I began to get cryptic e-mails from Elizabeth: "Where exactly are you in Kandahar?"  "What is your local cell number?"  I figured that maybe she had a friend stationed here - it's a large base.  As it turns out, she was arranging a care package delivery by none other than the Secretary of the Navy.  Ultimately the secret could not be sustained and I found out that the "Big Ray of Sunshine," as Elizabeth calls him affectionately, was arriving Wed night.

Of course I couldn't keep that a secret and told some colleagues about the mystery package and the visit. My fellow intensivist, Jon, was supposed to be promoted on Wed night to Captain - "Do you think he'd pin on my eagles?," Jon inquired.  I had no idea but I suggested we try, given he could only say no.

We arrived at the appointed time and place and saw a plane that must have been his, which rolled 200 yards down the tarmac from the place I was told to wait.  The much anticipated meeting was not to be.  The next day I found out that the package had been brought to the hospital by a smartly-dressed Marine who would only surrender it to CDR Quast.  The mystery behind the package now began to gain steam as much of the hospital now knew that the Secretary of the Navy had schlepped this box from halfway around the world to give it to me.  Was there a piece of the Arc of the Covenant in there?  The Holy Grail?  What is the deal with this package?

The package turned up late yesterday.  It was awesome, filled with Mississippi-themed treasures - pecans, Mississippi blues on cd, a Mississippi shaped chocolate, and much more... Elizabeth, who hails from Mississippi, had put a lot of thought and care into it.  And it was brought to this dusty place by none other than the former governor of Mississippi and current Secretary of the Navy, Ray Mabus.  Better than the Holy Grail.

I was still getting "feelers" on Thursday from Secretary Mabus' assistant that perhaps a return trip rendezvous was possible.  They had gone ahead to a FOB further downrange to visit Marines and Sailors and were coming through Kandahar on their way home.  I got the instructions on where to meet and when, and Jon and I waited again - Jon once again carrying his new blouse with the eagles on his collar.

We saw a plane land and an SUV picking up an important-looking group.  We hustled down the tarmac to intercept what we thought was the SECNAV's party.  As soon as he got out of the SUV we heard two rockets explode on base.  I hit the deck, looked up and saw... the big man himself, lying prone right in front of me.  When we got up, I introduced myself on our way to the closest bunker.

I could tell immediately how he got the "Big Ray of Sunshine" monniker - he was instantly engaging and genuine. One of the first things he said was "Don't you have a friend that needs to be promoted?"  So within a few minutes we were standing in a bunker, sirens going off in the background, as Jon raised his right hand and had a truly memorable promotion ceremony.

We spent about 30 minutes with Secretary Mabus.  It was like talking to an uncle or old friend.  Jon was beaming in his new blouse.  After the "ALL CLEAR" was given, the Secretary was herded onto his waiting plane and Jon and I went back to the hospital.  I was assigned to a trauma bay upon our arrival as we had seven new casualties to take care of from this latest rocket attack.  It's a rocket attack I won't soon forget.

Princess Postscript

Kandahar, Afghanistan

The princess is still with us.  The good news is that we think we have located her dad, and it's taken awhile to get him to Kandahar.  In the meantime, Jane has taken a liking to the ICU.  She is our starlet and gets lots of attention.  Before I had wondered aloud whether she would ever smile again.  She has made it to that point and then some.  She likes to bounce "volleyballs" made of blown up rubber gloves, take walks around the hospital and to the flightline, and has developed a sweet tooth for cookies.  She is a Stranger in a Strange Land, for sure.  I imagine what she is experiencing is analogous to an American being abducted by benevolent aliens.

What will she tell her friends and siblings when she gets back home to her mud hut?  What will she discuss with her father? (who, by the way, looks a lot more like Osama bin Laden than Hamid Karzai... We have a picture of him that we have shown her: he has a long black beard with streaks of grey, a less than full complement of teeth, and stands in front of some decrepit mud huts).

This morning one of my colleagues brought her to morning report to give a first hand report on her excellent condition.  She seemed to enjoy the attention.  Dad arrives Thursday and we anxiously await that reunion.

Sidebar:  I had spoken of a child I admitted on my last night of call who had been bitten in the face by a viper.  I was able to extubate him the next morning (remove the breathing tube).  He did quite well and has since been discharged.  The morning after my call I was informed that the story of his air evacuation was covered in the NY Times.  Catch it here:  http://www.nytimes.com/2010/05/29/world/asia/29viper.html