Chilling on the Flightline

01 Aug 2010

Kandahar, Afghanistan

I am post-call now, 30-odd hours of start-and-stop, hiccup, run-and-go.   I try to recall what happened over the last 30 or so hours - my mind's eye is distorted right now, as if on some of the hypnotic drugs I have prescribed during this time.  And an odd 30 hours they were, but not atypical for what has gone on around here lately.

I began the day sitting on the flightline, watching the to and fro of Davids and Goliaths taking off every five minutes or so.  I am on Enroute Care Call which means I am tied to the hospital, donned in my FRACUs (fire retardant army camouflage uniforms), awaiting a mission to be spun up.  I have the reputation of always getting a mission when I am on call.

I am reading a biography of Alexander, who died not far from here, and who also had an outpost that I can make out in the craggy mountains across the flightline - if you believe that rumor.  I look up from my book and see a true Goliath landing about 200 meters away - a Russian IL-76, which has hunched-up shoulder-like wings which makes it look like a hawk descending on its prey.  It is clearly the loudest plane ever built.  I make a mental note that the Russians might have been landing IL-76s here 30 years ago, for supply runs to their soldiers who were then fighting the mujahedin.  The more things change...


Kandahar Int'l Airport

I see another Goliath, a C-17, flat grey, taking off steeply.  It might be my ticket out of here in a few weeks.  A David takes off - a small unmanned aerial vehicle (UAV), being driven by some guy either here or God knows where, remotely.  I have heard these UAV video game players get hazardous duty pay.  It must be a joke, but one can never be sure what to believe around here.  We see UAVs buzzing around here all the time, like annoying flies.  But I am sure they are invaluable to our protection so we welcome them.  In the next 15 minutes I see pairs of jets taking off and landing - A-10s, F-18s, French Mirages, Belgian F-16s.  Always in pairs, like Noah's Ark.  Where are they going?  There is no air threat here.  Are they dropping bombs on Taliban out there?  I can only speculate.

I take over my ICU watch at noon.  It is moderately busy with several patients coming out of the OR from a recent busy spell we have been having.  I have managed to read through charts of at least 8 patients, listen to lungs, palpate abdomens, and examine wounds when I get the call for an enroute care mission.  I now languidly throw on my flak, get two additional magazines for my M-9, and pick up my bag of tricks - medications, syringes, saline flushes and so on, which may be needed to keep someone alive for 45 minutes or so.  Back to the flightline.

I see a white 747 at the end of this busy runway as I wait for our two helos.  This is the busiest one runway airport in the world if you believe that particular rumor.  I believe it.

I am in the chase helo now for some reason.  I see the actual medical helo, with its red on white cross, out the open window to my left as we travel close to the earth.  To my right I see a herd of camels running somewhere pretty fast.  I curse because I can't get my camera out quickly enough.  We are traveling low because of poor visibility due to a sand-fog that has enveloped us for a couple of days.  I remember something that allegedly came out from the Wikileaks scandal recently - that the Taliban have gotten their hands on surface to air missiles.  I wonder to myself if our traveling at low altitudes puts us at a higher risk for these missiles.  I urge myself to think about camels instead.

We pick up our patient who is remarkably stable for one who has an open abdomen: he took some fragments from an IED in the hip, nicked some of his small bowel and then landed adjacent to his navel, his umbilicus.  The flight home is notable only for the eery sunset through the sand mist sky.

When I arrive back at the ICU I am now four hours behind in my work - getting labs and data from the patients in the ICU.  I had barely gotten to know them before I left on my mission.  While I was gone my colleague, Jon, had to re-intubate a small boy who had been shot through his frontal lobe.  He was back on the breathing machine and Jon and I performed a bronchoscopy, me still sweaty from the hot helo ride back.

I play catch-up all night and manage to hold the fort down until about 7:30 am, thirty minutes before morning report.  Feeling smug that I might have salvaged an otherwise challenging evening, I then get a page that 5 Alphas are inbound, many children.  One of the nurses I had worked closely with all night asked, "Dr. Q, when is this going to end?"  It was a rhetorical question with no good answer.  When we get on that C-17, I thought to myself.