Cue the credits

This is who we were:

This is what we did:

This is why we did it:

Home!  199 days BOG, 232 days away from home.

The End.

Last night in Bangkok

All packed up and ready to go - 3 days early.

Going from 100mph to zero in a couple of days is a difficult proposition, but that is exactly what we did.  We went from always anticipating a page, walking around with a baseline level of anxiety (rocket attacks playing a not insignificant part in this), and ready to 'run' to the trauma bay to having literally nothing to do.  I'm still halfway expecting to hear a pager go off at any time.  The last couple of days at Kandahar were good though.  Got to greet the new team, say some goodbyes and pack up.  I wasn't really excited though until we took off for Kuwait - to say it hasn't sunk in yet would be an understatement.

We all mustered at our barracks around 1400 on Monday to drag all of bags one final time.  All but 3 of our 4608 crew got on the first available flight out of country with an R and R flight - couldn't imagine having two weeks of vacation anywhere in the world you wanted for free, but always knowing you had to go back for 3-9 months.  No thanks.  The flight was cramped and cold, but nothing could dampen our spirits.  We landed around 2200, Kuwait time, and were promptly taken back into the Navy.  We were met by the crew here, grabbed some quick food, our bags and hopped on a bus for the 2 hour ride to the base we will spend our decompression time.  Finally got into the rack around 0300, but could only sleep for a couple of hours as my mind was racing.  Our only job here will be to turn in our equipment, come to terms with our experience (this might take years) and hop on a flight.  Mix that in with a little laundry, haircut and gym time and there you have it.  Due to operational security I can't give specific flight times (I'll have to do a coded email to Nancy to make sure she knows where I am), but, God willing, I should be back in the US by early next week.

It's only Kuwait, but being back with the Navy is good.

Gear turn in.  What a relief to get rid of all that crap.

Here's to a huge sigh of relief and God Speed to everyone still fighting the good fight!

197 days BOG, 224 away from home.
All for now.

Bastion vs Kandahar - Part 2 (Censored)

I've only received a handful of hate mail from the last post, so I'm going to finish up and cross my fingers that I'm not extended for writing this.

6)  Traffic -  I've never driven a car in a British colony, having to drive on the opposite side of the road.  At Bastion the traffic rules were American and the Brits did most of the driving.  They had some obvious problems, including one who put a truck into the moat surrounding the roads there, but by and large you could walk in the middle of the 'road' and not worry about getting hit.  Kandahar, unfortunately, is exactly the opposite.  I'm not sure of the official acreage, but I'm pretty sure I could walk across the whole base in about 25 minutes.  Therefore the number of cars around doesn't make sense - it reminds me of Los Angeles where people drive two blocks to pick up gallon of milk.  Don't even think about crossing the street without looking both ways - 10 or 12 times.  Nothing should scare you more than a Third Country National (Pakistani, Bengali, Indian) driving a Toyota truck on an American Base in Afghanistan - perilous to say the least.  And don't even get me started with the Armored Vehicle 'Student Drivers' - yes they exist and yes I get out the way quickly.
Bastion - 3.5, Kandahar - 0

Rows of cars as far as the eye can see.

7)  Efficiency - (Content has been removed for purposes of maintaining a career in the Navy and not being transferred to Adek, Alaska).
Bastion - 4.5, Kandahar - 0

8)  Leadership - (Content has been removed for purposes of maintaining a career in the Navy and not being transferred to Adek, Alaska).  As an aside, they have a program here called CO for the day where we can vote for a staff member to be the acting Commanding Officer while following the real CO.  Apparently they were stuffing the ballot box with my name and by all accounts I should have won in a landslide.  But alas, it wasn't to be - I smell a conspiracy here or just repercussions of my nickname here - AWM (Angry White Male).
Bastion 5.5, Kandahar - 0

9)  Free Time (Morale, Welfare and Recreation) - Please see the GTL post for the things to do at Bastion.  It was austere to say the least and the highlight was the nightly gathering to smoke cigars in between the concrete blast walls.  As for Kandahar, there is Monday night yoga, Tuesday and Friday movie night, Wednesday and Saturday poker night, etc.  They have official 5 and 10K races every week (yes I ran one and promptly coughed up a dirt ball the size of a watermelon at the end).  Also, in their infinite wisdom, they also put in a football field with 'field turf'.  FIELD TURF!  Am I taking crazy pills - apparently so.  They had an inaugural football tournament which was well attended.  Unfortunately, as you might be able to tell from the photo below, the field has no easement so as you near the end of the turf there is about 3 centimeters transition of rubber before you careen off into rocks.  Good news is that we've only had about five injuries so far - bad news is that there is another tournament coming up next week.
I'm gonna give this one to Kandahar, I do loves me some yoga.
Bastion 5.5, Kandahar - 1.

Field Turf and broken bones courtesy of the US Government

10)  Cafeterias (DFACs) - At Bastion I had only two choices - Curry at the British cafeteria, or walk 20 minutes to eat at the Marine side - which, ironically, served Mongolian BBQ every night.  I did get a wicked case of food poisoning in October at Leatherneck, but beside that they had a good spread and you were able to take things with you - sodas, chips, cookies, milk, salmonella, etc.  At Kandahar we have no less than 5 choices.  They have a British cafeteria (no thanks), an Asian cafeteria (right next to the waste facility - again no thanks), Luxemburg (a fairly inaccurate attempt at European fare), Niagra (the American offering) and the Boardwalk - kabobs, pizza, hot dogs and the like.  So many choices, so much crap food.  This is a tough one, so I'm calling this one a tie, it was just the luck of the draw that I didn't get E. coli here as well.
Bastion - 6, Kandahar - 1.5.

Bastion in a Landslide!!

The BASTARDS of Bastion - British/American Surgical Team and Research Department

192 Days BOG, 219 away from home.

All for now.

5,000 Hits, a German Shepherd and a 2nd grade class

I started this blog with the intent of just putting up a couple of posts to keep people back home informed of what was going on here.  I didn't really think I would continue it the whole duration, must less have 50+ posts, but there you have it.  Last week, I went over 5,000 hits, which isn't a huge number, but still significant.  Had I signed on to have paid advertisements I would have pocketed about 5 dollars over six months.  I could have gone to the movies....by myself.  The stats also say that I've had 12 different countries view the blog.  There are the obvious like the US, UK, Germany and Italy, but also Japan, the Philippines and Russia - who knew I would be such a draw for the Red Army.  

On another note...

I happened to be standing in front of the OR scheduling board a couple of weeks ago when I was approached by an Army Vet.  He asked if I was an Orthopaedic Surgeon and if I could help him with some equipment questions.  Turns out that a contract dog (German Shepherd) had dislocated his hindfoot and he needed to do a fusion.  I answered his questions and then promptly forgot about the exchange.  Yesterday I got a call from the OR and was asked if I could help out as an assistant in a case that was about to start.  I got changed and walked into OR 1 to find the dog asleep on the table.  It was an interesting case and I certainly was glad I was able to help out, but they still wouldn't tell me the safety word for the dog so I had to leave the room before she woke up and tried to bite my arm off.

And another thing...

I got a wonderful package from my brother and sister-in-law last week.  Besides the normal food items and magazines there were about 30 hand made letters from my nieces 2nd grade class.  Apparently they were given a picture of me in uniform, told I was a surgeon and had a new wife.  I read through all of them and hung them up in my room and in my office.  As I read through them I tried to put together what they envisioned I was doing over here and this is what I came up with....

    I am a block shaped man in a white uniform (shorts of course) with huge teeth and hands, but small fingers.  Apparently I have helocopters wizzing by my head at all times, and am even hanging by a rope from several of them.  Some of the helocopters even have hair on them - I've actually seen that here.  There are also cactuses and rainbows everywhere, either that or they are peyote plants and everyone is on acid - I can't tell.  I also apparently have 24 new nieces and nephews and Nancy has moved out and moved in with them.  Is there something someone isn't telling me?  I guess I'll find out in a few weeks. 

My nieces 2nd grade class's homemade cards - what a wonderful gift.

187 days BOG, 214 away from home.

All for now.

Thanksgiving, A-style

Regardless of the circumstances I had a lot to be thankful for this Thanksgiving.  I had friends and family from across the states send me well wishes on email and facebook - I even had several people send videos.  The food was a little to be desired, but last year I was having a TV dinner by myself in a hotel room in Maine. The thing I'm most thankful for, though, was that there were no casualties today, no phone calls home to inform mothers that their son was injured, no Chaplains showing up at a wife's door, no explaining to young children that their parents weren't coming home.  So, other than the brief time I spent under the table, it was a good day.

We did have a VIP visit yesterday.  Nick Swisher, from the New York Yankees, stopped by with his wife.  Apparently they spent their honeymoon in Afghanistan visiting the troops several months ago and decided to do it again.  They even stopped by Landstuhl in Germany and visited some of the injured troops waiting to go home.  Despite the fact that I hate the Yankees, I'm now a huge fan of Swisher.  I told him I was a Phillies fan and he said he would tell Chase I said hello next time he hit a home run and he ran by him.  I told him he would have to say hello during batting practice because that might be the only time his bat touched a ball.  

All for now.

Motivation

Our group's t-shirt design says it all.

Well, I'm coming up toward the end of this deployment and although our group has had its share of frustrations dealing with the administrative side of the Navy, we have all grown as providers, gotten smarter and hopefully done some good.  I do have to admit, however, that it does become difficult every day for 6+ months to look down at your most recent trauma page and see that 4 more servicemen/women are coming in a after an IED and know that those four lives (and their families lives) will forever be changed.  I would be lying if I said I had a steady level of motivation to deal with this everyday.  As with most trying times, though, I had a defining moment earlier this week that will no doubt give me the motivation to continue to do what I do until my time is done.  It went something like this...

Jason and I were finishing a case early in the morning - around 9:30 -when both of our pagers went off alerting us of another casualty coming in.  'CAT A x 1 - IED - Bilateral Amputations'.  We get this page quite a bit, however, it can run the spectrum of mild soft tissue injures to 2, 3 and 4 extremity amputations, sometimes including the chest, abdomen, pelvis and eyes.  This particular one was bad.  They were already doing CPR when they came through the doors.  (As an aside, the chance of survival from blunt trauma where you lose vital signs prior entering the hospital is well less than 1%).  Despite this, we went to work.  Intubated, two large IV lines, blood, hemorrhage stopped, tourniquets applied, CPR continued - Chest thoracotomy in ED (Cracking the chest to do open massage of the heart).  Result - spontaneous cardiac activity returned.  His inital Ph of 7.0 was low, but not horrible.  We went straight to the OR.

For four fours the General surgeons explored his chest and abdomen.  The Ophthomologist and Neurosurgeon cleaned and sutured his face.  The anesthesiologist did a bronchoscopy to look at the airway.  The Ortho surgeons found all the arteries, veins and nerves and tied them off as well as cut away all dirty tissue.  During this whole time the soldier coded 4 times, but cardiac activity always returned.  No matter how hard we worked we could not stop the bleeding from his pelvis.  I performed a surgery I've only done once before and that time it wasn't during an emergency.  I took out the entire right side of his pelvis and was finally able to determine what was bleeding and stop it.  However, by then, it was too late.  The surgeon had been doing internal chest compressions for 45 straight minutes and we all finally knew the obvious.  Immediately after, a young Sailor came into the room along with the Chaplain and stood at attention.  The nurses cleaned the patient and draped him in an American Flag.  An announcement came over the hospital loudspeaker stating they would render honors to a fallen soldier.  Every single one of us - Doctors, Nurses, Corpsman, even the janitors - lined the wall exiting the hospital and gave this warrior one final salute.   

My motivation you ask?  Never to have to have this type of ceremony in my hospital again as long as I am here.

'From a distance we hear it

The sound of the helo's blades chopping the wind

And we run to it

Immobilize the spine, keep them warm, what are the injuries?

Airway, Breathing, Circulation

This one's bleeding out, that one's lost a limb

Together we work

Different nations coming together to save a life

Everyday we stare death in the face and say, no

We will prevail

Even with the lives of our adversaries in out hands

We prevail

We have no preference

We have no discriminations

We have no limits

We will walk through the fires of Hell with you

And bring you back alive

We will not be discouraged

We will not be disheartened

We will not give up

We are Role 3

And we are up to the challenge'

177 Days BOG, 204 away from home!

All for now.

Bastion vs Kandahar - Part 1

This sign says it all.

I don't even know what to say about this.  I'm never going here based on principle alone.

I've been in Kandahar now for about 3 weeks, so I've gotten a feel for the base, the hospital and the surroundings.  It's a lot different than Bastion/Leatherneck!  I thought I would do a head to head comparison, pointing out some of the main differences and see which one came out on top.  I'm going to try and not make anyone upset with this, as this is only my opinion - but then I decided, who cares if I piss anyone off - what are they gonna do - send me to Afghanistan?  

So, lets get ready to rrrrruuuummmbbbblllleeee...

1)  Hospital - This may seem simple at first.  Kandahar's hospital is a newly built facility with a brick structure (rocket proof), brand new OR's and all the accoutrement.  It's almost as if you are stepping inside any community hospital in the US.  We even have our own office, complete with a coffee maker, a computer and a bed.  The OR's are state of the art and have little 'Star Trek' doors that whisk open with a push of a button.  But, we are on deployment in the middle of the desert, so it seems a little surreal.  Bastion was a simple structure, basically a tent with metal beams, a huge open room OR, with the ER just 2 steps away.  We could also wear our uniforms anywhere we wanted and I didn't have to change into scrubs 5 times a day.  The biggest factor, though, is the distance from our rooms to the hospital.  I took it for granted at Bastion, but I could get between my room and the hospital in 3 minutes (527 steps - yes, I counted many times), but here it takes about 12 minutes - which is a long time when responding to a trauma (no I haven't counted the steps yet - too busy dodging cars to concentrate).  Winner - Bastion.

Bastion - 1, Kandahar - 0.

2)  Gym - I've been able to spend some time in the gym, both here and at Bastion.  The gym at Bastion (see the GTL post from a couple of months ago) was no frills.  Get in and get out.  The up side was that it was only 10 feet from my room and I found that during lunch there were only about 5 people there.  The downside was that is was hot and most of the equipment was falling apart.  Kandahar has a brand new Gym, with brand new equipment and is open 24 hours a day.  There are a couple of downsides though as they have a two shoe policy (they don't want you to track dirt in, go figure), it's always busy and it's not uncommon to find yourself working out next to a hairy Slovak who hasn't showered in days.  Despite this, I have to give the nod to Kandahar.

Kandahar - 1, Bastion - 1

3)  Housing - This one is easy.  The rooms here at Kandahar are twice as big, the showers have these huge rainforest-like shower heads, they are rocket proof and my roommate doesn't snore.  Winner - Kandahar.

Kandahar - 2, Bastion - 1.

4)  NATO partners - At Bastion we had the Brits and Estonians, here we have the Canadians and Dutch (although the Cannucks and Dutch are leaving in about a week for good).  The Brits had a great sense of humor, but could be abrasive.  The Estonians had no sense of humor and were always abrasive.  The Canadians say 'Ey' a lot and have a maple leaf on every piece of clothing they have.  And the Dutch have Amsterdam - enough said.  All of them, though, are great to work with and are excellent in their field.  I'm going to have to hedge my bets here and say its a draw.

Kandahar - 2.5, Bastion - 1.5.

5)  Boardwalk/Shops/Bazaar - This thing just blows my mind.  The Boardwalk is about 200 yards by 100 yards and has:  TGI Fridays, KFC, Mamma Mia's Pizzaria, Nathans Hotdog's, Cold Mountain Creamery, a German PX, a French PX (you can actually buy crepes), Dutch PX, Canadian PX, a bike store, barber shop, three or four carpet shops, two places to buy pirated DVD's and knock off electronics and five or six other random stores where you can buy anything from Nikes to Abercrombie and Fitch clothing.  And the coup de grace - a Hockey Rink - courtesy of our friends up north.  Winner - Bastion, I'm actually taking away points due to the sheer absurdness of the whole thing.

Bastion - 2.5, Kandahar - 0.

Yes, this is a Hockey Rink in Afghanistan.  No, it makes no sense at all.

(Sing along if you know the tune)  'America, f@%$ yeah, coming to the save
the mother (blanking) day, yeah'.  Heartburn and food poisoning 24 hours a day!  

Stay tuned, on the next episode when I will take on - Traffic, efficiency, leadership, free time and cafeterias.  

172 days BOG, 199 away from home.

All for now.