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!

The Way Things Work

Ft. Lewis, WA

If you've followed this blog for one post only you may have asked yourself "why do these medical folks do all that non-medical stuff before they go to Afghanistan to do... medical stuff?"  Believe me, I have asked this question many times.

Here's the answer:  We are augmentees working as a Navy medical unit, for the Army.  There are actual Navy medical units in Afghanistan (and other places such as Djibouti, Cuba, and Kuwait) which provide care to Navy and Marine Corps personnel mainly.  This latter group goes through medical training as a group on Marine Corps bases such as Camp LeJeune.  Their training is much different than ours.  The groups like ours are heading to Army Forward Operating Bases (FOBs) or Army-run hospitals.

The Army chain of command in these downrange places such as Kandahar, where I am going, have decided that non-Army augmentees are all to be treated alike and receive the same training, with few exceptions.  The one exception that comes to mind is the military police - they get even more time on the firing range, which makes sense.  What does not make sense is that a medical unit comprised of surgeons, internists, intensivists, nurses and corpsmen are treated as if they had no specialized training, or as if they were a group of JAGs, veterinarians, or entomologists.  The Army leaders feel that it is more important to train us in the use of M-16s, how to drive HUMVEEs, how to do hand-to-hand combat, and so forth.  In the 30 days we have been here we have had essentially no training in trauma (to include no Advanced Trauma Life Support, which should be a requirement), no training in Mass Casualities (MASCAL), no training in the unique aspects of massive blood product transfusions in the trauma setting,  and no training on any unique medical threats which we may be exposed to (is the enemy getting desperate enough to use chemical or biological weapons, and if so, which ones?).

The leaders and senior folks whom I bunk with all feel that this type of training would have been vastly more beneficial.  We should be running MASCAL drills every day, as far as we are concerned.  Some of the surgeons have suggested that we - as a group - should be spending our days working together in a trauma center like Shock Trauma or one of the other regional trauma centers.  This would have been tough to pull off, but then again, getting 63 of us to run a coordinated "Live Fire Exercise" as we will be doing in the upcoming 2 days is not easy either.

The Live Fire Exercise is the culmination of what we have learned up to this point.  We have already taken custody of numerous HUMVEEs (they fill the quad, I haven't counted them yet) and the Crew Cert Weapons -- essentially HUMVEE-mounted machine guns -- and we will begin convoy operations in a simulated battlefield scenario, complete with fake IEDs and other hazards.  We will shoot weapons at some point as well, presumably at something simulating the enemy.  Combat docs, weekday warriors! Maybe if we finish early we can fit in a MASCAL...

This past weekend we were granted a pass - Friday night through tonight at 7:30 pm.  Many people were able to tee up last minute flights, some at eye watering rates (we found out about the weekend passes last Monday morning).  The last minute pass submission was generated because it appears we may be leaving earlier than anticipated for Kuwait and points beyond.  We are supposed to depart on Thursday morning at 0720.  But there is a special surprise awaiting before then.

We have our last evolution scheduled to end at about 1600 on Wed afternoon.  We then commence barracks and bathroom cleanup and continue until 3am when we get inspected.  We then get bused to the military air terminal at 4am where we are hoping that a cup of coffee awaits us at the USO.  I can't figure out why the folks in charge feel compelled to make our last night in the Continental US before a 7 month deployment feel so... punitive.  From Ft. Lewis we fly to Topeka, KS, then somewhere in Maine, then Ramstein AFB, Germany, then onto Kuwait.  Should take about 24 hours I am guessing.  

Regardless, most of us just had a great time visiting our loved ones one last time, or hanging out together in Portland or Seattle.  Hard to focus on that truly bogus departure plan just yet.

"D" is for "Deadly"

Ft Lewis, WA

Our Seargant yelled,"Now you know how to perform a vehicle inspection - Hooah?!" I instinctively uttered a mini-hooah under my breath.  Been here nearly a month so it's starting to get Pavlovian.

"Hooah" in Army-speak means many things, but in this case it meant, "do you concur?" or something similar.  As I stood at the vehicle inspection point in the mock-FOB (forward operating base) listening to the Seargent I wondered to  myself, I wonder if the Spartans or the Roman Legionnaires had a Hooah analog?

Pay attention to this, I redirected myself.  This is important.  The IED is the hallmark weapon and assault tactic of the wars we are now in, and the resulting traumatic brain injury (TBI) is the hallmark injury - although the IED can mess you up in many ways.  I have cared for far too many IED victims during my training at Walter Reed and Bethesda Naval Hospital.  Pay attention.

Yesterday we spent an entire day learning various body and vehicular search techniques.  Learned it in the class room and performed searches on each other.  The thought of a surgeon or nurse doing these various pat-down maneuvers in our FOBs was a little unsettling - puzzling? - but we got the idea: security is everyone's job.  Unfortunately, last year around this time I learned of a tragedy that occurred to a wife of one of the physicians in my intern class.  She was a nurse doing her deployment on an Afghani FOB, was out running one day when she was gunned down by an insurgent who had snuck onto base by wearing an Afghani Army uniform.  One of her nurse colleagues running with her died as well before the insurgent could be subdued.  Horrible story, too close to home.  You must always be on the lookout, always part of the security "team."

We learned of the various ways the security forces keep track of the various contractors who work on the FOBs.  One way is via a special camera the military developed which takes retinal photos and has face recognition software as well.  Through this technology each individual is categorized and put into a database.  A ne'er-do-well can't try to sneak his way onto another FOB - he's in the database.  We used the uber-cameras on each other.  One of the wise-guys in my group classified me as a "male impersonator" (see photo).

We also got intelligence briefings on the latest IED tactics as well as ways to defeat the IED.  Although this is classified information you can imagine that the enemy has become quite proficient at making very deadly hidden bombs that are exceedingly difficult to locate and defeat.  But we are getting better too.

Today we were at the mock FOB - very realistic by the way - performing vehicle searches, going to the IED "petting zoo," and searching portions of the FOB for signs of IEDs.  If you stepped on one or tripped it, a piercing siren went off.  The day was capped off with a visit to a mock bomb factory manned by heavily accented men in traditional local garb and headdress.  Kudos to the Army guys who put in a good acting effort to make it seem real.  By the end I was tired of the sirens going off, as well as a loud firecracker which again, got the point across.  Wish we had had hearing protection for that one though.

This evening we had a poorly-coordinated gear issue - our third since I reported to Norfolk nearly a month ago.  It took about 4 hours to get our third seabag and another ruck sack full of new gear - the stuff we are really heading downrange with.  We received a new $500 helmet, a $1000 cold weather "kit" complete with Underarmor fleece type underwear and multiple fleecy layers designed to keep you warm to 60 degrees below zero (silly since it will be warming up just as we get there, and hitting triple digits within a month probably), a "sleeping system" (a sleeping bag, puh-leeze!), a sweet leatherman device, and so on.  Probably $4000 at least, total.

Apparently the stuff we got issued when we first got here came out of different pot of money, the training pot of money.  We turn most of that stuff in, evidently, next week. This makes no sense to me.  As a taxpayer I am appalled.

Happiness Is A Warm Gun

Ft Lewis, WA

I really don't believe that sentiment about the "warm gun."  I'm not really a "gun guy," but many folks here are.  Lucky for them they get a fair amount of practice on the range.  Yesterday we spent another full day sending lead at a bunch of bowling pin-looking targets.  Center of mass, baby.

Yesterday's training was called "Short Range Marksmanship," as we had to do several tasks while shooting, along the lines of walking, turning, and firing.  We also had a target with several different colored and numbered bullseyes; when the range safety officer gave us a command ("Middle Right!", "RED!," "Number 5!") we had a split second to engage that target.

Here's a telling gun story: while at the range I had a conversation with our Army liaison officer.  He revealed to us that he had the embarrassing habit of biting his nails.  Been trying for years to stop.  But this year was different: after discussing with his wife his desire to truly quit, he came up with the idea of buying himself a new .45 pistol as a reward for quitting.  Whatever works, I told him.

Like I said, I am not into the warm gun thing, but I can tell you I am getting a lot better at shooting an M16.  Unfortunately, the knowledge and skills I need to be effective in the ICU seems to be leaking out of my brain.  I do not know for sure why we do this - gun training rather than working together as a medical team doing medical things - but will expound upon my theories as to why later.


For lunch we dined on the MRE - the "Meal Ready to Eat."  MREs merit some discussion, if you are not familiar with them.  They are 2500 calories of pure bliss.  Not really, but they are OK, mostly tolerable.  They are very dense - things like dried crackers and cheese spread or peanut butter.  I think they are designed to stop you up, just like the cheese and nuts served on a cross country plane trip.  You can't fight the enemy if you are doing your business in the latrine now, can you?  One of the sailors told me a story that during his last deployment he had eaten MREs for 14 days straight.  No bowel movements the entire time.  He said when he came back to the main post and ate regular DFAC food that he spent an hour in the latrine with stomach cramps, evacuating his bowels.  Sorry for that visual.

MREs come in a multitude of different flavors - meat loaf, chicken tetrazini, beef enchilada, and a variety of vegetarian options.  The vegetarian MRE has a funny story - this is how I recall they were "born:" during the Bosnian conflict we would send MREs to the populace by the parachuted palates-ful.  Unfortunately they had non-halal meat in many of them, and the Muslim Bosnians wouldn't eat them.  Hence, the vegetarian MRE was born.  I have yet to see a vegan MRE but I'm sure the geniuses in the MRE factory in Cincinatti are working on it.

He Ain't Heavy, He's My Brother

Ft Lewis, WA

We've just had three days of training of various utility.  Actually, I could probably say at this point, we've just had 20 days of training of various utility.  But the past week did have some high points.  Our group of Navy folks split into two camps: the first half, primarily those heading to FOB Farah (Forward Operating Base in Farah, western Afghanistan), went to HUMVEE driver training.   These people received 40 total hours of training on how to drive a HUMVEE in various conditions to include actual 4-wheel drive ranges, nighttime with night vision goggles, and so on.  The week culminated in washing the HUMVEEs.  Can't run them through the base car wash you know...

The rest of us went to a course called "Tactical Combat Casualty Care," or TC3.  Sounds pretty high speed.  It did have value and was taught well.  The whole thrust of the course was to impart the sense of battlefield urgency when it comes to dealing with a soldier with a casualty, be it an IED blast or a sniper round.  The theme might have been "you don't take the hospital out to the battlefield," you "snatch and grab" the patient with the casualty and get him or her to a safer place, stop the bleeding, then get them to the next echelon of care.

The course began with an eye-opening video.  It was live footage of a convoy whose soldiers had just debarked from their vehicles.  The videographer captured up close and personal a soldier who had gotten a sniper round to the region of his upper thigh or lower buttocks.  You heard the 'crack' of the weapon in the distance followed by an "I'm shot!" from the soldier.  He went to the ground and then the chaos began.  The soldier was dragged to safety and then there was a time period of no first aid care that seemed to go on forever.  We learned later that it was all of 48 seconds.

During that time you could see and here the chaos of battle - multiple shots fired, shaky close-ups of soldiers whose faces barely masked the terror of possibly being sniped themselves.  At one point one of the soldiers began screaming "Medic! Medic!"  The casualty victim, who was beginning to show evidence of mental slowing consistent with shock managed to mumble "There is no f*king medic!"  That was the point.  YOU are the medic.  With the shortage of available personnel, we were told, many convoys deploy without a medic designated - or perhaps the medic gets wounded.  Snatch and grab, stop bleeding, take care of what you can take care of - quickly - and get the casualty to safety.  Eye opening, for sure.  Once that eternal 48 seconds had elapsed, one of the soldiers ripped off his flak jacket and several units of congealed blood underneath was covering the exit wound.  Fortunately the casualty victim survived.  I may have even cared for him at Walter Reed during my training as he had a semi-unusual name which I recognized.

During TC3 we learned - more appropriately, refamiliarized ourselves since most were doctors and nurses - tourniquet application, stretcher bearing, various snatch and grab techniques ranging from grabbing the casualty by the handle of his/her flak jacket to the fireman's carry, and so on.  We all got to do these carries with our buddies.  Some "buddies" weigh more than others.

On the second day of training we got to put everything together and run a battlefield simulated drill complete with sounds of gun fire, yelling of obscenities, and other various noises - all being pumped in at high decibel levels while we dragged around casualty victims, some being several hundred pound dummies.  We also got to drag these victims under a barbed wire fence of about 50 feet.  I was exhausted when it was done.  We were also covered with fake blood and dirt.

Yesterday, while the HUMVEE drivers cleaned their vehicles and did more driving, the rest of us did "Army Warrior Training" which was nothing more than a hodge-podge of things we haven't covered to date.  We learned how to throw grenades and set up a Claymore mine.  We got into chemical and biological warfare gear and ran a simulated drill.  The latter was useful as we only get training on this every blue moon, and there is a chance in Afghanistan that the enemy might try to use these weapons.  Still - Claymore mines??  Really?



The Claymore Mine - make sure you point the "Front Toward Enemy."  Indeed.

Magic Eight Ball

Ft Lewis, WA

Yesterday I and one of our senior enlisted (the "Chief") took a van ride together across post to discuss logistics with our immediate superiors at the Expeditionary Combat Readiness Center.  One of the issues I had to arrange was for a Catholic Chaplain to administer ashes to the Roman Catholic trainees who were being trained in the "outback" on how to drive a HUMVEE.  The Army has precious few Catholic chaplains and this was a herculean task under our present circumstances.

We are truly lucky to have superior senior enlisted, two chiefs who are about as good as they come.  They are excellent cat-herders, behind the scenes arrangers, and overall facilitators.  This makes all of our lives so much easier as it can be extraordinarily difficult to get 63 people of various ages (ranging from 18 to 55), cultures, and varying levels of enthusiasm to be at several places at the same time and in the right gear.  Harder than you can imagine.

The Chief  whom I was riding with in the van is a true character, your classic American success story in my opinion.  Born and bred in Queens with a strong accent, father was a NYC cop, who has made a great career in the Navy.  He's coming to Kandahar with me and I am very grateful for that.  I mentioned to the Chief that I had to arrange a meeting with the Army chaplain to get ashes to the HUMVEE range, as well as to get crucifixes for folks' dog tag chains, as requested to my by a certain junior enlisted who is also quite a character.  "Who asked for that?," asked the Chief.  When I told him he began to laugh and launched into a story.

"Before I left for deployment I was using this magic eight ball," he told me in his strong Queens accent.  "It was amazing and very accurate."  He told me how it had accurately predicted that his Yankees would win the World Series and in how many games, as well as other predictions.  "It was never wrong," he said.  "I asked the magic eight ball if I was going to die in Afghanistan.  It said yes.  Thirteen times in a row..."  He also told me that it told him he was going to die on a plane.  He had a deep-seated feeling of dread.  "When I got here I contacted a priest and he gave me a crucifix for the dog tag.  Since then I don't have that terrible feeling any more.  I keep the crucifix in my wallet" - and he showed it to me.  "Interesting," I said.  "What happened to the magic eight ball?"  "I smashed it at the dump," he told me.  He went on to tell me that he had taken out an extra $300,000 life insurance policy on top of his existing life insurance policy.  "Also, when you die your NOK gets a $100,000 check right off the bat!", obviously very pleased with this windfall.  "Used to be only $2000.  That's a great deal."  I am SO relieved, I thought to myself.  The Chief told me he had told his magic eight ball story to the crucifix-requesting petty officer, "and he has been acting skittish ever since."  You don't say, I thought to myself.

Later on that day I had to go to the post office so that one of the petty officers could send some gear home.  I am one of only about 6 people that can drive the van for some reason.  The post office clerk was so sincere and friendly when he found out I was deploying.  He gave me the Purple Heart embossed printing that I put in this posting above.  Weird,  in light of the magic eight ball prophecy.

Two people have given me St. Christopher's medals - my brother and his wife, and another friend, Mike.  I am putting those things on my dog tag chain pronto.

On a much lighter note, yesterday was Mardi Gras.  We celebrated by going to Popeye's to pig out on Cajun fast food.  I drove.

Salem... Nawme ma Tim as

Ft Lewis, WA

There are definitely some softer edges to our training.  Yesterday's Theater Cultural Awareness and Theater Introduction to Language Training (TCA/TILT) was one of those soft edges.  Definitely worthwhile to know about the culture one is about to be thrust into.  I had seen similar talks before during my time on ships in the Navy.  We'd usually get a visit by an embassy official from whichever country we were about to visit before liberty call was sounded.  The most memorable one from this previous life of mine was when my ship was pulling into Thailand and the official kept a serious and straight face when he warned sailors that "some of the women you may be hitting on might be well-disguised transvestites, and it just might be the case that this person is well versed in kick-boxing."  Apparently a sailor had recently "discovered" that his "date" was not the gender he thought he was (a la The Crying Game), and there was a bad outcome involving kick-boxing when the sailor decided to stiff his date, so to speak.  But I digress.

We got a quick overview on the birth of Islam and how the beliefs of both moderate and extremist Muslim values have diverged over the years.  We became well-versed in the differences between Shia and Sunni.  We also were schooled in the various tribes of Afghanistan, how the Taliban and al Queda fit into the big picture.  The sergeant giving the Islam talk attends a mosque but stated that he wasn't a Muslim.  He was a fairly typical white-bread, American Caucasian looking to me.  I was confused by his appearance and motivations, but he gave a decent brief.

We learned various do's and don'ts:  Don't point the bottom of your foot at someone (like giving the finger - I already knew that one); don't touch someone with your left hand - there's a hygiene angle in there somewhere, try to figure it out.  Don't talk to women in general unless your hair is on fire, or something like that.  How about a little Afghani cultural awareness in reverse?

Once done with that we went to the language lab and received two hours of instruction.  The computer programs were excellent, complete with avatar Afghanis and soldiers interacting, a mic that would record your utterances (i.e. usually feeble attempts), and coaching.  Very sophisticated.  But seriously, two hours in a computer lab is not going to generate much.  I had to look up the title of this post, which means "Hello, my name is Tim," in the little books they gave us from the Defense Language Institute.  If I were in the Army I would have access to Rosetta Stone (free!) to continue my Pashtun, Dari, or whichever dialect I wanted.  I'm working on getting the Rosetta Stone since I DO actually work for the Army these days.  Except I'd rather brush up on my French.  I really don't think I will have many opportunities to practice Dari.  If and when we do have patients in the ICU in Kandahar, odds are they will be hooked up to a mechanical ventilator (sorry, it's what I do!) and not really able to converse with me, even if they wanted to...

Today we got some really soft training - Mounted Land Nav.  We had to don our full battle rattle for this one (kevlar jacket, helmet, etc).  We got some brief classroom training, a map of the North Ft Lewis base, and red grease pencils.  We had our own HUMVEE drivers since our group has not been through the driver training.  Our jobs: navigate through a series of points given to us on post.  This was beyond easy, not only because I have run on virtually every road on the base.  The driver was accommodating.  I asked him if we could go through the base's Burger King drive through for a danish and coffee and he informed me that someone else had tried this a few years ago and it didn't turn out well for him.  Oops!

Random HUMVEE factoid:  weighs 12,000 lbs unloaded, 16,000 fully loaded.  6.7 L very loud diesel engine.