Kandahar, Afghanistan
The USO tour brought us James Gandolfini (Tony Soprano) and Tony Sirico (Paulie Walnuts) this week. Yesterday I waited for Tony to arrive at the USO stage -- they were supposed to arrive at 7p but were fashionably late. I got called back to the hospital and as I climbed onto the boardwalk I nearly ran Tony over. He was being incognito as long as he could, sneaking up behind people and snapping photos over people's shoulders at the crowd that had gathered. The line for autographs snaked almost entirely around the boardwalk, and as I am not an "autograph guy" I bailed early.
This morning I was working on my ICU notes when my surgeon buddy Joe motioned for me to come quickly to the trauma bay. Tony and Paulie were there, mobbed by our staff. I wasn't quick enough on the draw to get my photo with da' guys, but I got to shake Paulie's hand and thank him for coming to support us. I always liked Paulie's character the best.
It was really good for morale, you could feel it most of the day.
One request though guys: Like my friend Roy said, next time bring Meadow along, will ya!
Tuesday, March 30, 2010
Sunday, March 28, 2010
CPR in Progress
Kandahar, Afghanistan
Kandahar ROLE 3 Surgeons
It was probably appropriate that the first day the new crew had the hospital to ourselves we'd get a group of casualties like we did yesterday. The old crew, who in reality had handed us the reigns almost two weeks ago, had officially departed yesterday morning at 5:30 am for Kuwait.
By about 10am we received a "9-line" - the message telling us there are incoming casualties. The 9 lines have critical information, type and mechanism of injury, nationality, and so on, but the most important piece of information is the degree of injury and number wounded. An "Alpha" is worst - life, limb, or eyesight is at risk. "Bravo"and"Charlie" - of course important - don't merit as much sphincter tone. "Alpha" gets everyone to their stations right quick.
Stretchers - we use a lot of them - drying after being cleaned
We had three Alphas inbound, one with CPR in progress. That's not good, obviously. Another IED blast, by now sounding like a broken record. If CPR is in progress, the casualty likely becomes a "right turn." That means as soon as the injured person gets offloaded from the ambulance and enters the trauma bay, the gurney takes an immediate right turn into the first operating room. Crazy stuff then happens. The chest usually gets "cracked" (officially an 'open thoracotomy') so that open cardiac massage can be performed. For those unfamiliar with medicine, you may recall that Princess Diana had open cardiac massage, performed by a French surgeon after her fateful car crash. Like Princess Di, cardiac massage means the person is as close to death as he or she can be, necessitating this last ditch effort to perfuse vital organs like the brain and heart itself.
Our first Alpha made a right turn and I made my way into the OR. I had been told that I might be able to put central lines into these critical patients if the surgeons were busy doing their miracle work. This day I could get no closer than about 3 feet. The first thing I noticed was that I had a bird's eye view of the patient's heart unnaturally open to the atmosphere, pumping away like mad. A clamp had been placed on the aorta just downstream of the heart. I noticed what was left of the patient's legs - bone and flesh in an unnatural order, all blood, dirt and mess. A boot, foot still inside it, hung awkwardly off the OR table. I noticed that one of the surgeons had managed to place a central line. I was no longer needed in this room. I went back into the trauma bay to find the other two Alphas.
The surgeons ultimately succeeded in resuscitating the patient whose heart I had been fixated on. He made it to my ICU after about 3 hours, got more blood, and departed for higher echelons of care via C-130 by 6:30pm that day.
First day by ourselves... many more to follow.
ROLE 3 entrance at sunset - not where the traumas come in
Kandahar ROLE 3 Surgeons
It was probably appropriate that the first day the new crew had the hospital to ourselves we'd get a group of casualties like we did yesterday. The old crew, who in reality had handed us the reigns almost two weeks ago, had officially departed yesterday morning at 5:30 am for Kuwait.
By about 10am we received a "9-line" - the message telling us there are incoming casualties. The 9 lines have critical information, type and mechanism of injury, nationality, and so on, but the most important piece of information is the degree of injury and number wounded. An "Alpha" is worst - life, limb, or eyesight is at risk. "Bravo"and"Charlie" - of course important - don't merit as much sphincter tone. "Alpha" gets everyone to their stations right quick.
Stretchers - we use a lot of them - drying after being cleaned
We had three Alphas inbound, one with CPR in progress. That's not good, obviously. Another IED blast, by now sounding like a broken record. If CPR is in progress, the casualty likely becomes a "right turn." That means as soon as the injured person gets offloaded from the ambulance and enters the trauma bay, the gurney takes an immediate right turn into the first operating room. Crazy stuff then happens. The chest usually gets "cracked" (officially an 'open thoracotomy') so that open cardiac massage can be performed. For those unfamiliar with medicine, you may recall that Princess Diana had open cardiac massage, performed by a French surgeon after her fateful car crash. Like Princess Di, cardiac massage means the person is as close to death as he or she can be, necessitating this last ditch effort to perfuse vital organs like the brain and heart itself.
Our first Alpha made a right turn and I made my way into the OR. I had been told that I might be able to put central lines into these critical patients if the surgeons were busy doing their miracle work. This day I could get no closer than about 3 feet. The first thing I noticed was that I had a bird's eye view of the patient's heart unnaturally open to the atmosphere, pumping away like mad. A clamp had been placed on the aorta just downstream of the heart. I noticed what was left of the patient's legs - bone and flesh in an unnatural order, all blood, dirt and mess. A boot, foot still inside it, hung awkwardly off the OR table. I noticed that one of the surgeons had managed to place a central line. I was no longer needed in this room. I went back into the trauma bay to find the other two Alphas.
The surgeons ultimately succeeded in resuscitating the patient whose heart I had been fixated on. He made it to my ICU after about 3 hours, got more blood, and departed for higher echelons of care via C-130 by 6:30pm that day.
First day by ourselves... many more to follow.
ROLE 3 entrance at sunset - not where the traumas come in
Friday, March 26, 2010
Oh! Canada
Kandahar, Afghanistan
There is a large Canadian contingency here in Kandahar. If you didn't know better, you'd think they are the largest by far (the US is), based on the number of Canadian flags, the Tim Horton's on the boardwalk, and lately the cavalcade of Canadian icons and activities that have been coming our way. A group of Canadian NHL all stars have been visiting and playing the various club teams here on base, on the no-ice hockey rink. We had a contingent of Canadian Olympiads come through the hospital last week, followed by a brief visit by the Stanley Cup. The XO, who is Canadian, commented that he found it ironic that the Taliban would get closer to the Stanley Cup than the Toronto Maple Leafs ever would.
There still is a "feel good" vibe that the Canadians have in the wake of the Olympics. I can appreciate that. From what I read they put on a great show in Vancouver. After the gold medal win in hockey, there apparently was a huge parade here in Kandahar; this happened before I got here.
A few nights ago some Canadian big hair 80s bands did a decent job covering the classic rock spectrum out on the boardwalk.
I had lunch with a group of Canadians yesterday - very interesting to get their take on health care and such. We mutually agreed that each of our systems have significant flaws, though it is a fact that Canada has better health care outcomes as of 2010 (infant mortality, life expectancy, etc). Funniest comment by their group: "Is Fox News a real news organization?" Hmmmm.
Also, I have recently learned that when the Canadian docs come to the end of their 2 months in-theater deployment (ours is 6 months), they go to Cyprus or Dubai to decompress, receiving a small stipend to go to a spa or what-have-you. Wow. We go back to Kuwait where the promise of a clean outdoor pool awaits us (and a Starbucks).
One of the reasons the Canadians have a big entertainment footprint here is that Kandahar is their one true big base, whereas the US has several. We do get USO tours every now and then, but it seems as though this has tailed off as the war has drawn on. Think about it, we've been here nearly 9 years, twice as long as our involvement in WWII. Nonetheless, we are getting a USO visit this week - Tony Soprano and Paulie Walnuts. It's not the Dallas Cowboy cheerleaders or Chris Rock, but we'll take it. Paulie was always my favorite Soprano character.
There is a large Canadian contingency here in Kandahar. If you didn't know better, you'd think they are the largest by far (the US is), based on the number of Canadian flags, the Tim Horton's on the boardwalk, and lately the cavalcade of Canadian icons and activities that have been coming our way. A group of Canadian NHL all stars have been visiting and playing the various club teams here on base, on the no-ice hockey rink. We had a contingent of Canadian Olympiads come through the hospital last week, followed by a brief visit by the Stanley Cup. The XO, who is Canadian, commented that he found it ironic that the Taliban would get closer to the Stanley Cup than the Toronto Maple Leafs ever would.
There still is a "feel good" vibe that the Canadians have in the wake of the Olympics. I can appreciate that. From what I read they put on a great show in Vancouver. After the gold medal win in hockey, there apparently was a huge parade here in Kandahar; this happened before I got here.
A few nights ago some Canadian big hair 80s bands did a decent job covering the classic rock spectrum out on the boardwalk.
I had lunch with a group of Canadians yesterday - very interesting to get their take on health care and such. We mutually agreed that each of our systems have significant flaws, though it is a fact that Canada has better health care outcomes as of 2010 (infant mortality, life expectancy, etc). Funniest comment by their group: "Is Fox News a real news organization?" Hmmmm.
Also, I have recently learned that when the Canadian docs come to the end of their 2 months in-theater deployment (ours is 6 months), they go to Cyprus or Dubai to decompress, receiving a small stipend to go to a spa or what-have-you. Wow. We go back to Kuwait where the promise of a clean outdoor pool awaits us (and a Starbucks).
One of the reasons the Canadians have a big entertainment footprint here is that Kandahar is their one true big base, whereas the US has several. We do get USO tours every now and then, but it seems as though this has tailed off as the war has drawn on. Think about it, we've been here nearly 9 years, twice as long as our involvement in WWII. Nonetheless, we are getting a USO visit this week - Tony Soprano and Paulie Walnuts. It's not the Dallas Cowboy cheerleaders or Chris Rock, but we'll take it. Paulie was always my favorite Soprano character.
Wednesday, March 24, 2010
Monday, March 22, 2010
"Best Care Anywhere"
Kandahar, Afghanistan
"Best Care Anywhere" is the motto here at ROLE 3 Kandahar. I know this to be true because it is on our patch that we are supposed to wear on our Army camouflage uniform.
Yesterday two of our patients, both Afghani nationals, died of their wounds. The first was a 16 year old boy who had a head-on collision while driving a motorcycle, unhelmeted of course. I had to declare him dead, something I would not wish on anyone. Prior to his passing we rotated his bed so that he was facing Mecca, as is customary. Our translator chanted verses from the Koran.
The second Afghani was a soldier who was hit by a rocket propelled grenade. He was declared dead on arrival. I have so much respect for the Afghani soldiers - they suffer much, and one does not read about this. There are many Afghanis fighting side by side with us and our NATO colleagues. I find comfort in this, knowing that someday they will be able to defend their own country.
Today has been better than yesterday - so far. About 2 hours ago we received four casualties in the trauma bay. Another MRAP hit by an IED, only this time the vehicle behind the MRAP was struck - a fuel carrying vehicle. The trauma bay reeked of fuel as they were wheeled in. I took my position with Corey, my running mate, between the two primary trauma bays. As our predecessors told us, we are "line b*tches:" we put central lines into the trauma victims between primary and secondary trauma surveys, a half centimeter diameter straw into the femoral vein in the groin. We will also put in chest tubes and intubate (place a breathing tube) into these patients when needed, although this is generally done by the surgeons or anesthesiologists. Everyone has their role in the trauma bay by design. I don't mind being a line b*tch. Today the victims were lucky, only suffering fairly minor orthopedic injuries.
When trauma victims reach the ward or ICU they receive a hand sewn wounded soldier's quilt. These have been made lovingly by women from the heartland of the USA, having taken dozens of hours each I am sure. Keep it up ladies, they are appreciated!
"Best Care Anywhere" is the motto here at ROLE 3 Kandahar. I know this to be true because it is on our patch that we are supposed to wear on our Army camouflage uniform.
Yesterday two of our patients, both Afghani nationals, died of their wounds. The first was a 16 year old boy who had a head-on collision while driving a motorcycle, unhelmeted of course. I had to declare him dead, something I would not wish on anyone. Prior to his passing we rotated his bed so that he was facing Mecca, as is customary. Our translator chanted verses from the Koran.
The second Afghani was a soldier who was hit by a rocket propelled grenade. He was declared dead on arrival. I have so much respect for the Afghani soldiers - they suffer much, and one does not read about this. There are many Afghanis fighting side by side with us and our NATO colleagues. I find comfort in this, knowing that someday they will be able to defend their own country.
Today has been better than yesterday - so far. About 2 hours ago we received four casualties in the trauma bay. Another MRAP hit by an IED, only this time the vehicle behind the MRAP was struck - a fuel carrying vehicle. The trauma bay reeked of fuel as they were wheeled in. I took my position with Corey, my running mate, between the two primary trauma bays. As our predecessors told us, we are "line b*tches:" we put central lines into the trauma victims between primary and secondary trauma surveys, a half centimeter diameter straw into the femoral vein in the groin. We will also put in chest tubes and intubate (place a breathing tube) into these patients when needed, although this is generally done by the surgeons or anesthesiologists. Everyone has their role in the trauma bay by design. I don't mind being a line b*tch. Today the victims were lucky, only suffering fairly minor orthopedic injuries.
When trauma victims reach the ward or ICU they receive a hand sewn wounded soldier's quilt. These have been made lovingly by women from the heartland of the USA, having taken dozens of hours each I am sure. Keep it up ladies, they are appreciated!
Sunday, March 21, 2010
Inshallah
Kandahar, Afghanistan
Peace Garden (my term) in front of the hospital:
The color green is virtually nonexistent here...
Inshallah means "If God wills it." It is a commonly used phrase in these parts, perhaps reflecting the capriciousness of fate that local people feel in these parts. Or as Edward Gibbon might say, "the vicissitudes of fortune," and around here there is not much "fortune." I am sure thirty years of war interlaced with rule by the Taliban can make one say "Inshallah" quite a bit.
We see many local Afghanis in our hospital, to include children. They are usually flown in from the Forward Operating Bases in southern Afghanistan. In my week here we have had four children, only one the victim of trauma - a five year old boy hit by a car in a local city with multiple fractures to the skull. We had a particularly sad case of a 7 year old girl who was transported here after having a surgical repair to her bowel. Her small intestines were filled with worms and could no longer pass stool. The local surgeons attempted surgical repair but the wounds became infected and she developed septic shock, at which time she was transported to our hospital. Here she received state of the art care, had 3 revision surgeries, and had been resuscitated appropriately, surviving her sepsis. She needed a skin graft, which is exceedingly difficult to do. Through much effort we had engaged a Kabul-based French hospital, secured funds for treatment and transfer, and were awaiting word of acceptance. The girl's grandfather, who was her spokesman, finally tired of the waiting, and refused to wait any longer on word from the French hospital. Inshallah. If she dies, I want her near her parents, he said through an interpreter.
The base chapel, behind barricades and the ubiquitous water bottle boxes
Inshallah indeed. We all felt she could survive, and we found out shortly after she left that the French hospital had finally accepted her. There were many difficult-to-suppress emotions circulating through the ICU - anger, sadness, and a bit of Inshallah on our parts as well. We all are aware that life is difficult here to say the least. It's probably no exaggeration to state that a child born in Afghanistan has a slightly better than a coin-flip's chance of reaching adulthood. This 7 year old was about the size of my youngest daughter at 2 and half. Once one makes it to adulthood, life continues to be tough. One of the departing ICU docs told me that when they are young, they look about half their age whereas once they get to their 20s they look double or triple their age. The girl's grandfather, who may have been in his late 40s or early 50s looked like a wizened 75 year old.
As the young girl was being gurneyed to the medevac helicopter I caught a glimpse of her as I was putting in a central venous catheter into our newest patient, the 5 year old boy struck by the car.
Inshallah.
Peace Garden (my term) in front of the hospital:
The color green is virtually nonexistent here...
Inshallah means "If God wills it." It is a commonly used phrase in these parts, perhaps reflecting the capriciousness of fate that local people feel in these parts. Or as Edward Gibbon might say, "the vicissitudes of fortune," and around here there is not much "fortune." I am sure thirty years of war interlaced with rule by the Taliban can make one say "Inshallah" quite a bit.
We see many local Afghanis in our hospital, to include children. They are usually flown in from the Forward Operating Bases in southern Afghanistan. In my week here we have had four children, only one the victim of trauma - a five year old boy hit by a car in a local city with multiple fractures to the skull. We had a particularly sad case of a 7 year old girl who was transported here after having a surgical repair to her bowel. Her small intestines were filled with worms and could no longer pass stool. The local surgeons attempted surgical repair but the wounds became infected and she developed septic shock, at which time she was transported to our hospital. Here she received state of the art care, had 3 revision surgeries, and had been resuscitated appropriately, surviving her sepsis. She needed a skin graft, which is exceedingly difficult to do. Through much effort we had engaged a Kabul-based French hospital, secured funds for treatment and transfer, and were awaiting word of acceptance. The girl's grandfather, who was her spokesman, finally tired of the waiting, and refused to wait any longer on word from the French hospital. Inshallah. If she dies, I want her near her parents, he said through an interpreter.
The base chapel, behind barricades and the ubiquitous water bottle boxes
Inshallah indeed. We all felt she could survive, and we found out shortly after she left that the French hospital had finally accepted her. There were many difficult-to-suppress emotions circulating through the ICU - anger, sadness, and a bit of Inshallah on our parts as well. We all are aware that life is difficult here to say the least. It's probably no exaggeration to state that a child born in Afghanistan has a slightly better than a coin-flip's chance of reaching adulthood. This 7 year old was about the size of my youngest daughter at 2 and half. Once one makes it to adulthood, life continues to be tough. One of the departing ICU docs told me that when they are young, they look about half their age whereas once they get to their 20s they look double or triple their age. The girl's grandfather, who may have been in his late 40s or early 50s looked like a wizened 75 year old.
As the young girl was being gurneyed to the medevac helicopter I caught a glimpse of her as I was putting in a central venous catheter into our newest patient, the 5 year old boy struck by the car.
Inshallah.
Saturday, March 20, 2010
We Embrace Our NATO Colleagues
Kandahar, Afghanistan
Feting one of our Dutch NATO colleagues on his birthday
Or perhaps it is a mutual embrace? We are a team after all, but the US Navy is technically running the show here at ROLE 3, after taking over from the Canadians last October.
Nowhere is it more obvious that we are a multinational organization than at "morning report." At 0815 every day, all the physicians and chief nurses collect in the admin room, where the list of all ROLE 3's patients are on a white board. I scanned the room this morning and noted physicians from the UK, the Netherlands, Canada, nurses from Denmark, and of course the US. We run through every patient fairly quickly so everyone has "situational awareness." Various accents take their turns, giving a three sentence run-down. The surgeons and the trauma team then goes from bed to bed throughout our humble but important trauma hospital.
The XO is an affable, leprechaun-like man who always gets the last word at morning report, and he always comes armed with a joke. He is Canadian and has a slight brogue, so the delivery is usually as entertaining to me as the joke itself. Here was yesterday morning's joke:
"Three men living in the old folks' home had a heated discussion. The first one said, 'I'm 70 years old, wake up every morning at 7am and go to the toilet to urinate. It takes me 30 minutes to develop a stream! The second man said, 'Ya think that's bad - I'm 80 years old, wake up at 8am every morning and go to the loo where it takes me 60 minutes to have a bowel movement! The third man said 'I've got you all beat. I'm 90 years old, urinate at 7am, then have a BM at 8am.' The other two said 'What's yer problem then?' 'I wake up at 9am!' he said. OK, guess you had to be there and hear it in brogue.
The new ROLE 3
Yesterday we got to tour the new and improved ROLE 3. Exciting tour - the place sparkles. There is a notable absence of equipment though. Hard to believe we take the keys sometime next month. Still, the chrome, mint green paint, flat surfaces without dust on them - the whole place has an "Aaaaah" feeling to it, especially when you've just walked out of the humble, old ROLE 3. That humble place has saved many lives though.
The new ICU - love it.
Wednesday, March 17, 2010
St Patrick's Day in Kandahar
Kandahar, Afghanistan
Pepperoni pizza, "Kandahar Style"
To celebrate St. Patrick's day, a large group of us splurged on pizza and beer. That's NA beer, natch! The next beer I have will be many moons from now. But in a pinch, an ice cold Beck's NA and a good imagination can get you close.
Pizzeria Mamma Mia is one of the restaurants on the boardwalk. Wow, reading the words "restaurant" and "boardwalk" in the same sentence makes it seem like we're in Cape May, NJ or something. It's not that good, trust me, but it is amazing that there is a pizza joint and a TGIF (motto on the door - "Where every day is Friday." Had to chuckle at that - every day is "a day.") within 200 yards from our barracks.
Hockey rink on the boardwalk
Enclosed within the boardwalk, which is arranged as a big square, is a non-ice hockey rink, basketball courts, and a dusty "quad" good for rugby or soccer. At night it is a hub. Twice I have seen two men fighting with what looks like a dungeons and dragon sword and mace set. If they wind up in our hospital ER I will not be amused. But it does give the whole boardwalk area a festive appearance and you can almost imagine you are not in a war zone. Until you pinch yourself and realize everyone is in cammies and is carrying weapons.
Trauma bay at ROLE 3
We are in the last stages of getting our turnovers from the folks that will soon be leaving. The ones leaving are truly giddy, most of them. They begin shipping out this weekend. I start my first "call" tomorrow, in the ICU. I will be "Q2" or in Navy-speak, "port-starboard." That means I am in the ICU 24 hours, do turnover in the morning with Corey, my running mate from Norfolk, then I take the reins 24 hours later. We are supposed to get another intensivist in late April at which point we can go to Q3. If nothing else, Q2 will make time go by quicker I believe, though it will add to the "groundhog day" mentality.
Hang Ten! (?)
Pepperoni pizza, "Kandahar Style"
To celebrate St. Patrick's day, a large group of us splurged on pizza and beer. That's NA beer, natch! The next beer I have will be many moons from now. But in a pinch, an ice cold Beck's NA and a good imagination can get you close.
Pizzeria Mamma Mia is one of the restaurants on the boardwalk. Wow, reading the words "restaurant" and "boardwalk" in the same sentence makes it seem like we're in Cape May, NJ or something. It's not that good, trust me, but it is amazing that there is a pizza joint and a TGIF (motto on the door - "Where every day is Friday." Had to chuckle at that - every day is "a day.") within 200 yards from our barracks.
Hockey rink on the boardwalk
Enclosed within the boardwalk, which is arranged as a big square, is a non-ice hockey rink, basketball courts, and a dusty "quad" good for rugby or soccer. At night it is a hub. Twice I have seen two men fighting with what looks like a dungeons and dragon sword and mace set. If they wind up in our hospital ER I will not be amused. But it does give the whole boardwalk area a festive appearance and you can almost imagine you are not in a war zone. Until you pinch yourself and realize everyone is in cammies and is carrying weapons.
Trauma bay at ROLE 3
We are in the last stages of getting our turnovers from the folks that will soon be leaving. The ones leaving are truly giddy, most of them. They begin shipping out this weekend. I start my first "call" tomorrow, in the ICU. I will be "Q2" or in Navy-speak, "port-starboard." That means I am in the ICU 24 hours, do turnover in the morning with Corey, my running mate from Norfolk, then I take the reins 24 hours later. We are supposed to get another intensivist in late April at which point we can go to Q3. If nothing else, Q2 will make time go by quicker I believe, though it will add to the "groundhog day" mentality.
Hang Ten! (?)
Tuesday, March 16, 2010
ROLE 3 Welcomes Us
Kandahar, Afghanistan
The Master Chief, our senior enlisted, welcomed us last week with the following profound statement: "You're still in a shithole, but it's the best shithole in all of Afghanistan!" Another boast we can make is that we clearly will be working in the best hospital in all Afghanistan, but not yet.
The medical detachment is called ROLE 3. It is a NATO establishment run by the US Navy. Bagram AFB is north of us by about an hour by air, with very robust medical capabilities as well. Camp Bastion is our cousin to the west, with similar capabilities, but we are technically more capable than Bastion, based on subspecialties present here. Trauma is our business, all of us.
MRAPs
There are other smaller bases, called Forward Operating Bases, to which a casualty can be medevacced for damage control surgery. From the FOB, once the casualty was stabilized, the wounded soldier (or local national) would be transported to us, or one of the other two "big boys."
One would imagine that these state of the art trauma facilities would be bright and shiny, with all the bells and whistles needed to stabilize these often very mangled wounded men and women. I was a bit surprised to see the half-cylinder tents that contained the trauma bays and operating rooms. Inside these canvas "walls" there is also an ER, a small medicine ward, a dental clinic, a radiology "suite", and a detainee holding area for sick or wounded detainees. Before I came out here they were described to me as "ghetto." That's fair. We get the job done, though, as I saw first hand today.
In about a month we will move into the best hospital in all Afghanistan. The Germans are building the new NATO ROLE 3. It's going to be quite an improvement, a brick and mortar two storied structure that looks more impressive than many tertiary care facilities I've seen in the US.
Today we had a continuation of an orientation scheduled - a mock mass casualty in which we - the FNG's ("f*kg new guys") - would run a trauma from offloading at the ambulance drop-off point, until the patient went to the OR. We ran one reasonably chaotic scenario. Before we could run the second of four scenarios, 4 actual casualties came barreling in, some very sick folks. Suicide bomber. We had had about a 15 minute heads up, during which time the actual trauma teams assembled. The FNG's got to watch the organized chaos of airway-breathing-circulation, ripping off of clothes, chest tubes, central lines, intubations of airways... I was tapped to put in a central line into one of the casualties, a straw sized catheter into the femoral vein. However, the casualties already had good IV access, but my "sweat pumps" were running on high.
It was exciting to watch, and we were impressed that the organized chaos produced rapid results. Within minutes the casualties were in the OR getting their initial surgeries. Soon we won't be observers, we'll be "do-ers," and hopefully we'll be able to the chaotic ballet that we were able to observe. We will.
Kandahar Marathon - you've got to be kidding, right? (nope). Missed it...
The Master Chief, our senior enlisted, welcomed us last week with the following profound statement: "You're still in a shithole, but it's the best shithole in all of Afghanistan!" Another boast we can make is that we clearly will be working in the best hospital in all Afghanistan, but not yet.
The medical detachment is called ROLE 3. It is a NATO establishment run by the US Navy. Bagram AFB is north of us by about an hour by air, with very robust medical capabilities as well. Camp Bastion is our cousin to the west, with similar capabilities, but we are technically more capable than Bastion, based on subspecialties present here. Trauma is our business, all of us.
MRAPs
There are other smaller bases, called Forward Operating Bases, to which a casualty can be medevacced for damage control surgery. From the FOB, once the casualty was stabilized, the wounded soldier (or local national) would be transported to us, or one of the other two "big boys."
One would imagine that these state of the art trauma facilities would be bright and shiny, with all the bells and whistles needed to stabilize these often very mangled wounded men and women. I was a bit surprised to see the half-cylinder tents that contained the trauma bays and operating rooms. Inside these canvas "walls" there is also an ER, a small medicine ward, a dental clinic, a radiology "suite", and a detainee holding area for sick or wounded detainees. Before I came out here they were described to me as "ghetto." That's fair. We get the job done, though, as I saw first hand today.
In about a month we will move into the best hospital in all Afghanistan. The Germans are building the new NATO ROLE 3. It's going to be quite an improvement, a brick and mortar two storied structure that looks more impressive than many tertiary care facilities I've seen in the US.
Today we had a continuation of an orientation scheduled - a mock mass casualty in which we - the FNG's ("f*kg new guys") - would run a trauma from offloading at the ambulance drop-off point, until the patient went to the OR. We ran one reasonably chaotic scenario. Before we could run the second of four scenarios, 4 actual casualties came barreling in, some very sick folks. Suicide bomber. We had had about a 15 minute heads up, during which time the actual trauma teams assembled. The FNG's got to watch the organized chaos of airway-breathing-circulation, ripping off of clothes, chest tubes, central lines, intubations of airways... I was tapped to put in a central line into one of the casualties, a straw sized catheter into the femoral vein. However, the casualties already had good IV access, but my "sweat pumps" were running on high.
It was exciting to watch, and we were impressed that the organized chaos produced rapid results. Within minutes the casualties were in the OR getting their initial surgeries. Soon we won't be observers, we'll be "do-ers," and hopefully we'll be able to the chaotic ballet that we were able to observe. We will.
Kandahar Marathon - you've got to be kidding, right? (nope). Missed it...
Saturday, March 13, 2010
Wild, Wild West
Kandahar, Afghanistan
Not a NATO vehicle!
Been here three days here in Kandahar. As I walk the dusty roads, becoming more familiar with my new home, I am reminded that Alexander himself rode the streets of Kandahar on his horse Bucephalus 24 centuries ago, choking on the same dust that I have been choking on. Kandahar in fact means Alexandria in Afghan Pashtun, in honor of Alexander the Great. Alexander probably could never imagine seeing what I am seeing now though.
This is the NATO "Wild, Wild West." Everyone carries a weapon, everyone is dressed for "the fight," in their various cammies, flak jackets, and occasionally, helmets. The streets beg for a roadside saloon. A duel could be imagined, although it would probably take place on the hockey rink (no ice) or rugby pitch we have here.
I have spent parts of the past three days exploring this expansive base: we haven't begun clinical duties or turnover with the offgoing crew just yet. In fact, parts of our posse are still arriving from Kuwait - I had to welcome aboard 28 newbies this morning between the hours of midnight and 4am.
The streets are clogged with coalition force vehicles of every make and model, most enormous pachyderms with a yellow-ochre hue designed to mask them. They belch out diesel and stir up the lunar dust on the unpaved streets, which are narrow. There are pedestrians walking astride these dangerous roads, wearing a veritable palette of camouflage with flags and patches that could fill an encyclopedia. So far I have seen Bulgarian, Romanian, French, Canadian, UK, Dutch, German, Australian, and more. The Aussies, God love them, have the most unusual cammies (you could say funny looking, but that would be mean, and I like the Aussies) - yellow with brown spots. They look like giraffes (sorry mates!).
Not a NATO vehicle!
Been here three days here in Kandahar. As I walk the dusty roads, becoming more familiar with my new home, I am reminded that Alexander himself rode the streets of Kandahar on his horse Bucephalus 24 centuries ago, choking on the same dust that I have been choking on. Kandahar in fact means Alexandria in Afghan Pashtun, in honor of Alexander the Great. Alexander probably could never imagine seeing what I am seeing now though.
This is the NATO "Wild, Wild West." Everyone carries a weapon, everyone is dressed for "the fight," in their various cammies, flak jackets, and occasionally, helmets. The streets beg for a roadside saloon. A duel could be imagined, although it would probably take place on the hockey rink (no ice) or rugby pitch we have here.
I have spent parts of the past three days exploring this expansive base: we haven't begun clinical duties or turnover with the offgoing crew just yet. In fact, parts of our posse are still arriving from Kuwait - I had to welcome aboard 28 newbies this morning between the hours of midnight and 4am.
The streets are clogged with coalition force vehicles of every make and model, most enormous pachyderms with a yellow-ochre hue designed to mask them. They belch out diesel and stir up the lunar dust on the unpaved streets, which are narrow. There are pedestrians walking astride these dangerous roads, wearing a veritable palette of camouflage with flags and patches that could fill an encyclopedia. So far I have seen Bulgarian, Romanian, French, Canadian, UK, Dutch, German, Australian, and more. The Aussies, God love them, have the most unusual cammies (you could say funny looking, but that would be mean, and I like the Aussies) - yellow with brown spots. They look like giraffes (sorry mates!).
There are a few old structures, such as the Soviet built airport terminal, but most buildings are built for expediency, temporary shelters and tents, boxy prefab shelters, and so on. The airport terminal is interesting - all archways and a thick outer shell. On the inside are the scars of war: apparently 100 Taliban were holed up in there when we arrived shortly after 9/11. They didn't fare so well. You can see the evidence of bunker-busting bombs on the inside.
Today we walked to the bazaar on the far end of the base. It was a packed area filled with local Afghanis and coalition forces. The wares included rugs, hookahs, toys, jewelry, and a variety of dubious looking DVDs. I didn't buy anything today as I am presently broke. It is hard to get cash here: the last time the ATM was down it lasted 3 weeks - it's down now. Most places on base take a debit card called the Eagle Cash Card, which is tied to ones bank account. We have heard that the base officials like to limit circulating cash as this somehow trickles to ne'er-do-wells who can use the hard currency for their less than noble purposes.
I have visited three different DFACs (dining facilities for those just joining). There are different "themes" with different names for each DFAC. Luxembourg is the European DFAC, Niagra is the mostly American (heavily Canadian though), Cambridge is UK (great curry!). There is also "South Park", which one has to walk past the "poo pond," a human waste treatment plant. It's run by KBR, which is the Halliburton follow-on project. I may boycott this one, though the thought of walking past the poo-pond mentally causes me to lose my appetite. There is also the "Asian DFAC" which has been universally chastised. It's weird, there are no Asian forces here that I have seen. I may have to check that one out. The UK DFAC was playing cricket on the telly at lunch today. Niagra mostly plays hockey or US basketball. I can't remember what Luxembourg was playing.
Meredith, whom I dined with at Cambridge today, reminded me that the World's Cup is this July. Can't wait for that!
Our barracks are awesome. We are in NATO barracks, built by the Danish I believe. They are simple, clean, and comfortable. I already have internet access in my own room. Not cheap at $100 per month, worth every penny though. I think the relatively ascetic accommodations of the past 30+ days allow us to truly appreciate these barracks. Two nights ago I put my head on a pillow for the first time in over a month (minus our one weekend off). Unbelievable.
More on Kandahar later, it's still so new to me that I will most certainly notice something weird every day.
I believe this is the Dutch side of base, whadya' think!? The Dutch Kaafi Haus is supposed to be the best, although there is always a long line out the Tim Horton's (Canadian Coffee/Donuts).
I believe this is the Dutch side of base, whadya' think!? The Dutch Kaafi Haus is supposed to be the best, although there is always a long line out the Tim Horton's (Canadian Coffee/Donuts).
Thursday, March 11, 2010
Advance Party to Kandahar - here at last!
Kandahar, Afghanistan
As the chief petty officer I was traveling with in our 3-man group said, "this isn't so 'advance' and it sure ain't a party." Well said chief, but we are here, and I am not complaining.
About two days ago I was informed that I was selected to be part of a team to go to Kandahar ahead of our group of what is now about 130 people: our counterparts from Ft Dix, NJ had recently arrived at Camp Virginia, Kuwait and were doing their MRAP rollover training and admin check-in. The three of us we sent ahead to get answers to some nagging questions such as who might have their orders changed to stay in Kandahar versus continuing on to a Forward Operating Base in western Afghanistan. We've gotten many rumors about what might happen once we are in theater -- the Navy runs on diesel fuel, paper, and rumors the old saying goes. We were sent to get these answers and also to serve as liaisons to the folks who are soon to arrive.
We departed for the Kuwait airport at 3am two days ago. We were lucky to get on a C-17, which is like a smaller version of a 747, but for cargo. The alternative was a prop-plane C-130 which is noisy and far more uncomfortable. We flew with a couple of MRAPs and a HUMVEE to Qatar -- wrong direction by the way, but it's a middle eastern military hub.
Although to the best of my knowledge Qatar is a "friendly," we performed a tactical landing as we descended. My understanding of a tactical landing is that the pilot performs a corkscrew type of maneuver as he or she lands, making the plane a more difficult target to acquire for AAA guns or missiles. All I know is that we pulled several G-forces and the chains holding the 37000 lb MRAPs looked pretty stressed out as the MRAP "leaned" into the rolls. No one "gruggled" as my daughters like to say (i.e. puked).
When we arrived we learned that we had to haul our 17 total (heavy!) bags through customs after leaving our weapons in an armory, then wait 18 hours for the next plane to Kandahar.
We spent the day wandering around the hot and dusty Qatar base, killing time. As always, "it could be worse" - we weren't getting shot at, and it was steak night at the DFAC. However, going with the regular non-advance party was looking like a better deal at this point.
We finally got aboard our next C-17, with another MRAP and some cargo. It's loud and not especially comfortable in the C-17. We were told that once we took off we could lie down on the floor and sleep, which we did. We were all pretty tired by this point.
We arrived in Kandahar yesterday morning - got to see the craggy mountain ranges circling the base. I am very happy to finally be in this town, a NATO wild, wild west from the looks of it yesterday. Home at last (at least for now)!
As the chief petty officer I was traveling with in our 3-man group said, "this isn't so 'advance' and it sure ain't a party." Well said chief, but we are here, and I am not complaining.
About two days ago I was informed that I was selected to be part of a team to go to Kandahar ahead of our group of what is now about 130 people: our counterparts from Ft Dix, NJ had recently arrived at Camp Virginia, Kuwait and were doing their MRAP rollover training and admin check-in. The three of us we sent ahead to get answers to some nagging questions such as who might have their orders changed to stay in Kandahar versus continuing on to a Forward Operating Base in western Afghanistan. We've gotten many rumors about what might happen once we are in theater -- the Navy runs on diesel fuel, paper, and rumors the old saying goes. We were sent to get these answers and also to serve as liaisons to the folks who are soon to arrive.
We departed for the Kuwait airport at 3am two days ago. We were lucky to get on a C-17, which is like a smaller version of a 747, but for cargo. The alternative was a prop-plane C-130 which is noisy and far more uncomfortable. We flew with a couple of MRAPs and a HUMVEE to Qatar -- wrong direction by the way, but it's a middle eastern military hub.
Although to the best of my knowledge Qatar is a "friendly," we performed a tactical landing as we descended. My understanding of a tactical landing is that the pilot performs a corkscrew type of maneuver as he or she lands, making the plane a more difficult target to acquire for AAA guns or missiles. All I know is that we pulled several G-forces and the chains holding the 37000 lb MRAPs looked pretty stressed out as the MRAP "leaned" into the rolls. No one "gruggled" as my daughters like to say (i.e. puked).
When we arrived we learned that we had to haul our 17 total (heavy!) bags through customs after leaving our weapons in an armory, then wait 18 hours for the next plane to Kandahar.
We spent the day wandering around the hot and dusty Qatar base, killing time. As always, "it could be worse" - we weren't getting shot at, and it was steak night at the DFAC. However, going with the regular non-advance party was looking like a better deal at this point.
We finally got aboard our next C-17, with another MRAP and some cargo. It's loud and not especially comfortable in the C-17. We were told that once we took off we could lie down on the floor and sleep, which we did. We were all pretty tired by this point.
We arrived in Kandahar yesterday morning - got to see the craggy mountain ranges circling the base. I am very happy to finally be in this town, a NATO wild, wild west from the looks of it yesterday. Home at last (at least for now)!
Sunday, March 7, 2010
Boots on Ground
Camp Virginia, Kuwait
Shhh... I am trying to spot an Ewak. Clearly I have been transported to the planet Tatooine, where Luke Skywalker hails from.
I'm really in the desert at Camp Virginia, the embark-debark location for troops headed to Afghanistan and Iraq. We arrived here two days ago, at 4am, after a 30 hour trip which began at McCord Air Force Base in Washington and went via Topeka and Leipzig, former East Germany. We had beautiful views of Mt Rainier as we left our Ft Lewis home of one month, more meals and movies than I can count, AND many of us got to sit in first class - a first for me.
The plane was a civilian charter plane on North America Airways. Don't try to find them on Travelocity, it doesn't really exist, at least not for non-military folks. The military charters these 767s and 747s to transport their troops to various spots throughout the world. Other than the fact that everyone was carrying an unloaded weapon (with firing pin removed, rendering it unusable), and that we were all in camouflage gear, it was just like a regular flight.
We arrived in Kuwait International in the pitch black with a waxing gibbous moon, dry air, temperature of about 60 degrees, and humidity at 5%. By the time we unloaded the plane (that was different than the regular airlines - we had a 40 person working party to do that) and made the 45 minute bus ride to Camp Virginia, it was light, and clear that we had arrived at a place 180 degrees out from the wet, mountainous, and mossy Ft Lewis where we had just come from. Flat as a laser, a dusty layer of talc-like brown powder filled the lower atmosphere, and nary a tree to be seen. We spotted a few camels but that was about it for life forms. Lots of Toyota pick-ups with turbined locals. No Ewaks.
Camp Virginia is an expansive piece of this drab territory filled with quonset huts as far as the eye can see. It is hemmed in by 6 to 8 foot tall New Jersey barriers (they are either Alaska or Texas barriers - true - but I don't know the difference between the two. They're big, that's all.) We have a small slice of Americana here: a Starbucks (I am sitting there now, using the Wifi at 2:42 in the morning - my circadian rhythm is non-existent at this point), a Taco Bell in a hut, a USO in a quonset hut filled with video game stations, TVs, and free phones (15 min limit) from which you can call the states, and of course, a MacDonalds.
We now eat in a DFAC designed to hold 1050 persons. It's massive, and it has Baskin-Robbins, a sandwich station, the usual salad bar, cafeteria food, a so on. You could get real fat here. Plus it has TV on where you can watch the 9pm EDT basketball game at breakfast time. We are 8 hours ahead of EDT here.
Why are we here? Well, we are now officially "Boots on the Ground" (BOG) which means that we have to get administratively in-processed to the theater. Our "ticker" has begun, which means our roughly 6 months in-theater time starts now. That's big. Plus we start getting paid the various Hazardous Duty Pay, Family Separation Allowance (FSA), and so on, for being in-theater. Because I do have a family and do get FSA, my "extra" pay comes to $575 per month, not including the $3.50 daily "incidental" pay per day (I don't really get this one, it's for shaving cream, shampoo and such), and most of all, not including my tax-free-to-a-point status: I am not taxed on my pay up to the amount the most senior enlisted person in the Navy makes per month. That comprises most of my pay, so I am essentially tax-free for the next 6 months. Not bad.
The other reason we are here is to get training in MRAP rollover, which is similar to the HUMVEE rollover training we got in Ft Lewis. An MRAP is the next generation of HUMVEE - bigger, taller, and more IED resistant. It looks like it's about to roll over at rest - nearly taller than long. I will try to include a photo of one when I actually see one. Apparently in theater the MRAP is rapidly replacing the HUMVEE.
Once done with admin and MRAP rollover, it's just a matter of time before the Air Force folks in Qatar set us up with transportation to Kandahar and points beyond. No more first class for us - we fly military air from now on! Helmets and kevlar flak jackets will be with us at all times on this flight. And no movies...
Shhh... I am trying to spot an Ewak. Clearly I have been transported to the planet Tatooine, where Luke Skywalker hails from.
I'm really in the desert at Camp Virginia, the embark-debark location for troops headed to Afghanistan and Iraq. We arrived here two days ago, at 4am, after a 30 hour trip which began at McCord Air Force Base in Washington and went via Topeka and Leipzig, former East Germany. We had beautiful views of Mt Rainier as we left our Ft Lewis home of one month, more meals and movies than I can count, AND many of us got to sit in first class - a first for me.
The plane was a civilian charter plane on North America Airways. Don't try to find them on Travelocity, it doesn't really exist, at least not for non-military folks. The military charters these 767s and 747s to transport their troops to various spots throughout the world. Other than the fact that everyone was carrying an unloaded weapon (with firing pin removed, rendering it unusable), and that we were all in camouflage gear, it was just like a regular flight.
We arrived in Kuwait International in the pitch black with a waxing gibbous moon, dry air, temperature of about 60 degrees, and humidity at 5%. By the time we unloaded the plane (that was different than the regular airlines - we had a 40 person working party to do that) and made the 45 minute bus ride to Camp Virginia, it was light, and clear that we had arrived at a place 180 degrees out from the wet, mountainous, and mossy Ft Lewis where we had just come from. Flat as a laser, a dusty layer of talc-like brown powder filled the lower atmosphere, and nary a tree to be seen. We spotted a few camels but that was about it for life forms. Lots of Toyota pick-ups with turbined locals. No Ewaks.
Camp Virginia is an expansive piece of this drab territory filled with quonset huts as far as the eye can see. It is hemmed in by 6 to 8 foot tall New Jersey barriers (they are either Alaska or Texas barriers - true - but I don't know the difference between the two. They're big, that's all.) We have a small slice of Americana here: a Starbucks (I am sitting there now, using the Wifi at 2:42 in the morning - my circadian rhythm is non-existent at this point), a Taco Bell in a hut, a USO in a quonset hut filled with video game stations, TVs, and free phones (15 min limit) from which you can call the states, and of course, a MacDonalds.
We now eat in a DFAC designed to hold 1050 persons. It's massive, and it has Baskin-Robbins, a sandwich station, the usual salad bar, cafeteria food, a so on. You could get real fat here. Plus it has TV on where you can watch the 9pm EDT basketball game at breakfast time. We are 8 hours ahead of EDT here.
Why are we here? Well, we are now officially "Boots on the Ground" (BOG) which means that we have to get administratively in-processed to the theater. Our "ticker" has begun, which means our roughly 6 months in-theater time starts now. That's big. Plus we start getting paid the various Hazardous Duty Pay, Family Separation Allowance (FSA), and so on, for being in-theater. Because I do have a family and do get FSA, my "extra" pay comes to $575 per month, not including the $3.50 daily "incidental" pay per day (I don't really get this one, it's for shaving cream, shampoo and such), and most of all, not including my tax-free-to-a-point status: I am not taxed on my pay up to the amount the most senior enlisted person in the Navy makes per month. That comprises most of my pay, so I am essentially tax-free for the next 6 months. Not bad.
The other reason we are here is to get training in MRAP rollover, which is similar to the HUMVEE rollover training we got in Ft Lewis. An MRAP is the next generation of HUMVEE - bigger, taller, and more IED resistant. It looks like it's about to roll over at rest - nearly taller than long. I will try to include a photo of one when I actually see one. Apparently in theater the MRAP is rapidly replacing the HUMVEE.
Once done with admin and MRAP rollover, it's just a matter of time before the Air Force folks in Qatar set us up with transportation to Kandahar and points beyond. No more first class for us - we fly military air from now on! Helmets and kevlar flak jackets will be with us at all times on this flight. And no movies...
Wednesday, March 3, 2010
Farewell Fort Lewis!
Ft Lewis, WA
After 32 days, thousands of rounds of ammunition, literally days upon days of white space, we finally leave Ft Lewis for Kuwait and points beyond. Our training is finally through.
This week we spent two days in the field conducting a live fire exercise defending our convoy of 16 HUMVEEs. This was the exercise in which we put much of what we have learned to this point to the test, from radio communications, land navigation, IED identification, shooting downrange with a machine gun, and towing our HUMVEE to safety. The training was conducted on a make-believe terrorist camp, complete with plywood mosque and plywood minarettes (nice touch!) and Yankee Go Home signage. The road on the range was muddy, with huge puddles and large moguls -- in other words, perfect for driving a HUMVEE through. One of our gunners - all were in turrets manning their M-240 machine guns - got soaked with mud by 8:30. Long day for him.
We conducted the Live Fire Exercise on Monday and Tuesday - long days - and then back to the classroom today for some final words from the chaplain and other less motivational speakers. The last lecture was on how to spot a terrorist or spy in our midst. He was funny, obviously honing his Comedy Club skills, but it would've been better to have the chaplain speak last, as his words were at least inspiring. Spy in our midst - not really what I am looking for at this moment. I'll be looking for that IED on the road! Point taken, though.
We got word yesterday that one of our corpsmen won't be going downrange with us. Apparently he was what we call an "embedded alternate," though no-one knew, including the corpsman himself. If one of the other corpsmen got sick or hurt during training, he would have filled in. No one got hurt so he goes home. Unfortunately for him he'll have to do this whole 30+ days of training again if (when) he gets picked up to deploy. Stinks for him, big time.
I have to wrap things up pronto. The internet goes down in a few minutes, and there is no way of knowing when we can get back online. Our flight was at least changed from 7:20 am tomorrow to 5:20 pm. No one was really happy about staying up all night to scrub the barracks or bathroom floors. Now we can do all the buffing of the WWII era barracks floors tomorrow morning, and we get one last meal at the DFAC. I will miss the DFAC Diva's though, they were very kind to us albeit too heavy on the starchy scoops.
One last thing before I check in again downrange: However frustrated some of us were by the training, we all were able to stay in touch with our loved ones - huge for morale. When I was last deployed on a ship in the mid-90s, the only means in which to communicate was by letter, or occasionally by Red Cross message - sort of like Twitter via teletype. We planned our wedding that way. Sometimes we'd go 3 or more weeks without mail, especially in the Indian Ocean. Today we can jump on skype and I can see and talk to the kids, or scare the dog. That is something to be very pleased about, and with luck I'll have this available to me when I get to Kandahar. Stay tuned.
My skype buddy (my wife!), hidden behind an ugly doll. I am in the bottom left. Gotta love Skype!
Subscribe to:
Posts (Atom)