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.

Veteran's Day

My Grandfather, WWII Veteran Georgia B. Morrison

Tomorrow is Veteran's Day, so take at least a short moment out of your 'busy' day (off) to think about the 1% of the population, and their families, who did and still do the things that others won't.  They may not agree with the leaders that send them to God awful places, but they still do it so we can enjoy our freedoms and lifestyles.  (Oh, on a personal note to the Occupy Whatever movement - quit whining, get over yourselves, and get back to work.)

This is a link to a story of a young woman and her family she left behind after being killed in Afghanistan.  I started residency with her husband and I think of them often.

Moving on when mom is killed at war

By Wayne Drash, CNN

November 8, 2011 -- Updated 1325 GMT (2125 HKT)

Kristen Choe's mother, U.S. Navy Lt. Florence Bacong Choe,
was killed in Afghanistan two years ago.
http://edition.cnn.com/2011/11/08/us/cnnheroes-war-widower/index.html

All for now.

     

MERT

 

MERT team activated - they will be on scene in less than 15 minutes.

MERT stands for Medical Emergency Response Team and is probably one of the most intense jobs that one can have as medical professional.  They are a team of highly trained British Soldiers that are tasked with flying into dangerous areas, picking up severely injured patients and essentially keeping them alive until they arrive here.  In addition to the perils and dangers of flying anyway, they often take fire while swooping in to get patients and often times have to fight there way out.  The carry a cadre of people, including an Anesthiologist, Paramedic and a Nurse.  I can say without a doubt that they have saved many a life during my time here and my hat goes off to them.

About a month ago, while on a call to pick up a casualty, the MERT team came under heavy fire.  They were able to take off, but they took significant damage and had to make an emergency landing only minutes later.  One of the force protection crew was injured, but the rest were just shaken up.  They were all back out doing the job again in less than 24 hours. 

 

Working in a loud, small space, flying nearly 200 MPH

Another successful transport.  Door to door in less than 30 minutes.

Naples Reunion (Sort Of)

I've been in the Navy for a while now (13 years active duty) and have served at six different commands and moved 8 different times.  Along the way I've met a lot of great people (and some not so great).  Some of my greatest friends are from my Navy time (and greatest enemies).  If you spend long enough in the Navy you begin to learn what it means when someone says 'It's a small Navy' (in fact its the largest in the world by an order of magnitude).  It's not uncommon to know several people at a new command or meet old friends when deployed.  Well, it's been a long deployment, with many ups and downs, but by far the highlight is being reunited with one of my great friends (saving the lives of our servicemen not withstanding).

Jason and I have known each other for nearly five years now.  We first met when we were stationed together in Naples.  Since then we have made a lot of people different with our Laurel and Hardy approach to surgery, taken and passed our board exams,  gone off to fellowship, and one of us got married while the other had a child.  We have kept in contact often while back at home, which is rare as one grows older.  Jason has been at Kandahar now for about three months and before each of us left (actually even while we were at Naples) we talked about how nice it would be to be deployed together (well, nice is relative here).  Despite the odds it has come to fruition and we were reunited when I got transferred here about two weeks ago.  It's been tough being at a new command so late in the deployment (you know how they say you can't teach an old dog new tricks), but Jason has kept me sane and has been a great friend.  Despite being away from his young son and wife, he constantly keeps a positive outlook and works his butt off (mainly in the gym, but thats work too).  Here's to Jason and hoping he gets home soon.  

The dumbest thing I've seen

I might get in trouble for this one.

There have been a lot of 'weird' things that happen here.  Things that surprise me and make me scratch my head in wonder.  Weird things like a young child who had a terrible wound to the head, whom we all wrote off as another tragic result of war - only to have him walk out of the hospital with his father 4 days later.  Weird things like doing CPR on a labrador after they were medevaced on an Osprey (Marine transport helo, capable of fixed wing flight as well),  Sadly, he didn't make it.  Weird things like ICU physician trying to grow a garden in the middle of Afghanistan - it didn't take.  But there have only been a couple of moments where I thought - 'that is just dumb'.  Here is dumbest.

To be a Role III hospital you have to have certain capabilites, including multiple surgical specialties, a CT scan and an ICU.  We are able to take care of about 99.9% of the things that come though the door.  I can't even imagine what it costs to run this place with all the supplies and manpower, but its a lot.  There was a recent article in the New York Times that estimated that for every troop the US deploys here it costs the taxpayers about 600K to 1 Million dollars.  One would think, then, that anything that could save money would be a welcomed addition.  This seems not to be the case and in fact it seems we are spending more than ever.  Enter an absolutely non-essential, useless piece of expensive equipment.  Actually three of them - MRI scanners!  Some of you may think, wait, MRI's are good, they can diagnose a lot of things that xrays and CT scanners can't, and to some extent you would be correct.  However, there are a couple of major problems with these.  First, when we order MRI's we usually have a specific question we want answered that will change how we manage the patients.  In the time I've been here I could honestly say that I have contemplated needing an MRI once - on a patient with a spinal fracture, I wanted to see if there was an injury to the cord.  Other than that, even if we do know the answer then we can't do anything about it anyway - so whats the use.  Second, the MRI should be very patient friendly, meaning we should be able to get the patient in and out easily.  Well, the MRI is in the back of an 18 wheeler parked out in back of the hospital on a sloped foundation near the medical waste and laundry.  Sweet.  It also has no ramp, just stairs.  I suspect we will have as many injuries while transporting the patients on a gurney up those damn stairs.  Thirdly, MRI scanners are generally in use in areas that aren't prone to sand storms.  I can see the first time they leave one of the doors ajar and a sand storm comes through and ruins a 1 million dollar (conservative estimate) piece of equipment.  Not only that but MRI's attract metal and according to geological analysis Afghanistan sand has one of the highest ferric (iron) contents in the world.  So the first time we turn it on we may create an attraction similar to Disney's Space Mountain - it will be called 'Indoor Sand Storm Carosel'.  I'll be the first in line.
     According to NGO statistics Afghanistan only has one functioning MRI in the entire country - and its in Kabul, a long way away.  So one could look at this as something that could be useful for them.  But, alas, they are not authorized to use it - so strike four.  Overall, with the work to build the concrete foundation, the transportation of the machine and the set up, I think we are probably in for around 3-4 milsky - each.  Pretty good use of taxpayers money.
    Now, should I choose Admirals Mast or just a straight Courtmarital?

For sale - MRI - used only once.

All for now.

4608 - On the Move

Fleet Surgical Team, Noble Eagle 4608 (retired)

On May 2nd, 2011 I met half of the 15 people that would make up 4608 in Norfolk, VA.  At that time we had all heard rumors that we were going to Camp Bastion, but some of us would be stashed elsewhere to make up for shortages.  On May 8th at FT Jackson we met the other half - 1 ER Doc, 1 General Surgeon, 2 Anesthesiologists, 5 Nurses, 4 corpsman, a Master Chief and myself. Since then we have become good friends, worked our butts off and seen things that we will probably never want to talk about again.   

Our Noble Eagle number has now been retired and will no longer be filled - which can be seen as a good sign as we are no longer needed in certain parts of the country.  We have all been reassigned to Kandahar for the duration of our tour (3 stayed there to begin with and 3 are coming from an outlying FOB (Forward Operating Base).  It can also be seen as bad sign as the footprint of Navy Medicine is getting smaller here.  As you read this we will be settling into our new assignment and with any luck will be finishing out our final 6 weeks of deployment continuing to do what we've been trained to do.  

If you get a chance you can watch the video from the BBC and British Forces Broadcasting Service in which you will see me starting at about the 2:53 mark in the light blue scrub cap with a Union Jack on it - it was a gift from one of the British surgeons.  Unfortunately for the censors (and the Brits) the big '1776' and 'Don't Tread on Me' that I drew made it on the video.  One last jab!  Brilliant!

http://www.bfbs.com/news/afghanistan/behind-scenes-camp-bastion-hospital-52608.html

147 Days BOG, 174 Away from Home

All for now.

The Brits say the damndest things (Part 3)

As I pack up and leave Camp Bastion after almost five months I have mixed feelings.  It will be good to move on and be one more step closer to home, but I will miss the people here and the patients I've treated.  Before I leave, I wanted to just point out a couple more things that make the British unique.  So back, by popular demand...

The British are a very proud country and can twist almost any part of history in their favor.  For instance, I was told they threw the American Revolution because they saw that we could take care of ourselves and they didn't really try to win anyway.  Sounds a little fishy.  Another example is Henry the VIII.  To us he was the King that had six wives - three of which he just outright killed.  He disowned his first born daughter (although he brought her back in the fold just enough so she could become one of the most treacherous Queens in British history).  And finally he pretty much gave the finger the Catholic Church which lead to the creation of the Church of England.  This last item can be argued to have lead to the creation of the US as well as the continued strife between Northern Ireland and England.  Regardless of this he is remembered as one of the greatest Kings in their history.  

So, I've mentioned the game of cricket a couple of times in these posts, but one item I forgot to mention was how they spend their intermission.  In the US we think of famous half-time speeches of Knute Rockne (win one for the gipper) or Jim Tressel (don't tell anyone about the free tattoos boys and run it down their throats).  We think of bloody, sweaty men near exhaustion getting ready to play their hearts out for two more quarters.  Its a great image and makes for great drama.  Well, one day as I was agonizing over watching even more cricket I noticed that they had just announced that they would have the afternoon break after one more over (too long to explain what this is).  I asked one of the Brits sitting in the room what they do during the break.  Do they go over strategy, do they gulp gatorade, do they get impassioned speeches about winning one for their country?  None of the above he replied.  They have hot tea and cucumber sandwiches.  (Insert stunned silence)  Of course they do.  I cannot make this shit up.  

I think I have mentioned the near beer that is omnipresent around base and the Doctor's Lounge is no exception.  We basically had two refrigerators there, one for food and milk and such, and the other only for the near beer - which much to my surprise almost everyone had at the end of the day.  We even got special deals from the PX as it wasn't a very popular item - three cases for the price of one.  We usually stored about 10 to 12 cases under the bookshelves in the lounge so we would always have a ready supply.  One day, one of the newly arrived surgeons decided that the fridge appeared to be icing a little and wanted to take care of it.  I thought that wasn't a bad idea, why not.  His tool of choice - of course it was a 6 inch hunting knife.  As he started to chip away at the cumbersome ice there came a sudden hissing sound, accompanied by a small amount of steam and a faint smell of CO2.  Yes, he had succeeded in piercing the freon canister.  But wait, it gets better - his fix.....wait for it....Bubble gum.  It didn't work.  Shortly after we had a Kangaroo court to determine his fate.  The best statement of the night came from one of the US physicians.  'Makes sense that you would use a sharp knife to deice the fridge, because it's not hot enough outside to defrost it five minutes.'  

There is a basketball court near the hospital and we've usually play on Saturdays around five o'clock.  The baskets are old and droop about a foot, and we call those 'very forgiving rims'.  The court is also surrounded by railroad ties, so not much of an out of bounds area.  By and large we ruled the courts and after a couple of weeks the Brits would no longer play just the US players.  So we made a deal - lets play you in soccer on the same court, US v. UK.  Bad idea.  Turns out they are actually pretty good at it.  My thinking was that I will just play physical and kick the ball as hard as I could.  Final result - UK 12, US 2.  My personal stat line went something like this - Newman - two bloody knees, one pulled hamstring, one sprained ankle, 0 goals, a red card and a lot of Brits who hated my guts.    

I don't want to say the British are elitest, but if it quacks like a duck.  Recently we had a British celebrity come visit the troops.  Her claim to fame was that she stared in a talent show, won the contest, joined an all girl band (not one of the Spice Girls) and ended up marrying a very famous soccer star (again it wasn't one of the Spice Girls).  I had no idea who she was, but the entire conversation among the British Doctor's that day was about how she had no talent and didn't come from good stock.  However, she seemed to be a real hit with the troops.  As she made her way around the hospital visiting the soldiers she leaned over and signed an autograph for one of the nurses.  From way in the background came the sole voice of one of the British surgeons.  'Oh, my God, she can read afterall.'    Stay classy San Diego.

Most of you back home probably didn't even realize that the Rugby World Cup is going on right now.  The format is similar to the Soccer World Cup and starts out with a round robin where everyone plays each other and the top two teams in each group advance.  The tournament is made up of pretty much every nation that has ever been ruled by England, ie. Australia, South Africa, and even the US.  We didn't do very well, but that stands to reason - nobody in the US really cares.  They make fun of us for wearing pads while playing football, but I say that inventing a game, then making all the countries you've invaded start playing it and having a tournament to see whose best is even sillier.  I think we should take football to Spain and Italy have a Football World Cup.

Finally, the best quote I've seen from a Brit.  This was written on an end of tour assessment about one of the surgeons.  We get these as well and they say things like - performed such and such number of cases, helped with organizing lectures to train nurses, etc.  They are very direct and to the point.  But, this one went something like this:  

     'He never had an intellectual mind, but some other traits of his personality became evident during his stay.  He showed himself to be a hard-headed man, endowed with an impenetrable soul and an obstinate determination to carry out his will no matter how mindless it might be.'  Brilliant.

All for now.

Doctor's Lounge

  Typically, Physicians lounges are a place to relax and unwind in between cases.  Usually there are things to snack on and drinks.  Most of the time you can find a colleague to discuss patients with or the latest research article.  These things don't hold for this lounge though.  It serves as an office, movie theatre, meeting room, rarely has snacks (other than half eaten bags of pork rinds and gummie worms) and the only drinks are instant coffee (tea) and near beer.  Rarely do we discuss patients or research we mainly gossip and make fun of each other.  There is a small sitting area outside - however no one goes out there because its way too hot (although we are looking forward to sitting outside between October 10 and 13 which coincides with the temperature being less than 95 and before the rainy season begins).  The room is about 15 feet by 20 feet, has one couch, one love seat, two swivel chairs, one row of theater seats and the gimp seat (which is actually a broken chair on top of a crate - which ironically is usually where I sit).  This amounts to about 12 places for people to sit - currently we have 27 doctors (7 anesthesia, 6 general surgeons, 4 ortho, 3 emergency medicine, 4 general medical officers, 2 internal medicine and the Director).  Can you say standing room only?

This is one of the General Surgeons - Tony.  He was famous for being able to sleep anywhere.

British Physicians taking in a game of Cricket which lasts 5 days.

Notice no US doctors!

One computer for all of us to share for internet and email.

It could be worse, at Walter Reed/Bethesda we don't even have a lounge.

All for now.

Calvary to the Rescue

Aerial View

In general, the Navy operates around bodies of water with ships both large and small.  The last time I was deployed it was great to wake up in the morning and take my morning coffee smelling the ocean air, watching the ship make waves with nothing but water as far as you can see.  Unfortunately there are a couple problems compared to where I am now.  First, the only water around here are the hundreds of skillions of bottles of water sitting out in the 120 degree heat and no matter how hard you try, I'm fairly certain we couldn't bring a RHIB in here, much less a carrier.  The second is that the smell in the morning is not that of the ocean air, but more of a putrid, festering funk coming from the combination of burning trash, full latrines and uneaten curry from the night before.  Also, I don't remember a lot of sand getting into every orifice in my body, but it was a long time ago, maybe I just forgot about that.  This is usually the environment of the Army - and the main reason why I chose to join the Navy.

Since the opening of Camp Bastion Hospital the Army has not had enough surgical teams to allocate here and have asked the Navy to send IA's (individual augmentees) to assist them in fulfilling their obligations.  We have sent no less than 12 groups of Navy nurses, doctors and corpsmen every 6 months to do their damdest to save lives.  And they have done just that.  On October 15th this will all end and the Navy will no longer be at Camp Bastion.  Somewhere in the halls of some building in DC the Army and Navy brass hashed out a deal to take the hospital back into Army control.  It was a last minute deal as I already had been contacted by my replacements in the Navy and it wasn't until a couple of weeks later that they were even told that they would not be coming afterall.  Shortly after the October 15th arrival of the Army (10th Combat Support Hospital stationed in Colorado Spring, CO) the last of the Navy IA's will be leaving Camp Bastion for good.  Some of us will be going on other parts of the country to continue our work and other will be going home.  But, all of them will have brought great credit upon themselves in the highest traditions of Naval Service and all can move on knowing that 99% the patients who entered here were able to go home because of what they did!!  

10th Combat Support Hospital  Patch

Good luck 10th CSH - you have big shoes to fill.  Fair winds and following seas.

131 days BOG, 158 away from home. 

All for now.

Average Day

The only thing that is certain is that you can expect the unexpected.  I've tried to get into a daily routine, but it's proven difficult.  On Wednesday of this week (28 Sept) we had 16 Trauma calls and I didn't leave the OR until 10pm.  However, the day before, we had 1 Trauma call and I was pulling my hair out.  Usually we go in two week periods were things happen at specific times.  There was a two week period in June when it was assured that we would get woken up at 6 am for a trauma.  Two weeks later is was a given that we would have a nooner.  Then, in August, it was always just after dusk -  Ramandan and all.  Now its usually a mid afternoon call combined with every other night midnight calls.  You just never know. 

We have a specific set of things we do every week as well.  Monday is Team Quiz night (think Trivial Pursuit except the questions are heavily British, for instance 'How many Prime Ministers have graduated from Eaton, my answer - 'Who gives a F^%$').  Tuesday is CME (continuing medical education where one of the Doctors gives a lecture - I did one in August entitled 'How Orthopaedics is cool and you're not').  Thursday is JTTS conference where we present the US casualties over teleconference to the US (pictured above, getting ready for the conference by reviewing patient charts - we basically laugh at everyone else talking with the phone on mute).  Friday is pizza night - where we all order pizzas from Pizza Hut and sit in the lounge and eat as quickly as possible as we are usually interrupted by casualties - followed quickly by indigestion.  Sunday is pancake day.  Not sure who came up with this but we have more pancake mix that Aunt Jamima herself.  One of the doctors gets up early and makes pancakes in the lounge on a griddle we stole from the Marines.  Its nice to have things to look forward to during the week and it helps to mark the passage of time.  As they say here - the days are long, but the weeks fly by.  

Here is what I did on a typical day when I was the Number 1 Ortho on call (it was a Thursday)

0640 - Wake up, shower, shave.

0720 - Drop off Laundry

0800 - ICU rounds with team

0810 - First Trauma call - IED.  Patient with open hand fracture and shoulder (scapula) fracture. Ordered CT. 

0830 - Sit down rounds for all inpatients (usually about 15-25 patients in hospital)

0845 - Director Rounds with every department in hospital - He starts out by giving a history lesson (usually about British War Heroes - apparently their were a lot ) and then we discuss disposition of all patients - again.

0900 - To OR to operate on first trauma call of the day.

0945-1045 - Back to room.  Sat outside reading a book before it gets too hot.

1100-1105 - Work out part I.  

1105 - Second Trauma call.  IED.  Patient with multiple frag wounds.  

1115-1210 - OR again for cleaning of wounds and removal of frags.

1215-1300 - Work out part II.

1305-1330 - Lunch in room.  See last post as I'm trying to eat all that beef jerky.

1330-1400 - Shower number 2 and relax.  

1400 - Trauma call number 3 - GSW to chest.  No Ortho role here, but have to show up anyway.

1420- Back to room to try and nap.

1500 - Head back to hospital to prepare for weekly trauma meeting, reviewing charts. (See photo above)

1630-1730 - Trauma meeting.

1735 - 4th Trauma call.  IED.  Double Amputation.

1800-1930 - Operating room.

1930-1950 - Run to cafeteria for unidentifiable British meal.

1950-2015 - Nightly Director Intel brief.

2015-2045 - Nightly ICU/Ward rounds

2110 - 5th Trauma Call.  MVA.  Open tibial fracture and facial wounds.  

2130-2230 - OR for external fixation and closure of face wounds.

2245 - Head back to room, forget to pick up laundry.

2245-2359 - Relax and read, watch episode of Dexter.  Daydream about having a Scotch.  Don't actually have Scotch.

0001 - Lights out.

All for now.

Care Packages

Remnants of the packages I've received.  (My roommate has gotten 93 care packages and I think all 93 boxes are still in the room)

I wanted to send out a thank you out to those have sent care packages.  Sometimes these simple things can make the time here more tolerable and take a bad day/week and make it better.  We do have a PX/NEX here on base - where you can buy bed sheets, towels, movies, 27 different varieties of Marine t-shirts, any variety of energy drink you want, protein and creatine powder and magazines.  However, the variety is small and they run out of things quite often.  Its nice to have some things from home to snack on as many times we don't make it the dining facility and my dinner becomes a clif bar, bag of beef jerky, crackers,  and mac and cheese.  I also have enough handy wipes to effectively clean the entire country of Afghanistan.

So far I have gotten 32 care packages from many different people.  I'm still working on eating most of the food and have had to ask everyone not to send any more as we are soon going to another location soon and it is likely that I would not get them.  

There was one group in particular that sent several great packages to me so I could distribute to the injured troops.  They are a group out of Philadelphia (Ocean City, NJ as well) that volunteer their time to fill packages to troops that would otherwise not get much.  I have been able to give out almost all the items and everyone has been very appreciative.  The group is Treats for Troops, I invite you to visit their website and/or donate if you have the time.  

All for now.

Happy Birthdays!

Happy Birthdays to my family that I don't get to see nearly as much as I would like.

Dad - Sept 22nd

Joe - Oct 1st

Pam - Oct 1st

Steve - Oct 2nd

Of course belated to the sisters (Libby and Michele - May 8th and 10th)

Also a belated congrats to Ashley and Stan on the engagement - can't wait for the wedding.

Also have to mention my wife who I haven't seen since our anniversary, I've almost been away longer than we've been married - Love you, I'll be home soon.   

All for now.

IDF

I debated a long time as to whether or not I would post this, however, I had some great photos that I think illustrate what an IDF is, so I guess I will share.  I don't want to unnecessarily worry anyone, as this is not my intention.  All of us here find these more of a pain than a danger.  My buddy Jason at Kandahar can attest as they experience them ten fold more than we do.  In actuality, we have only had three in the last several months and I'm pretty sure Jason gets them every day.  

An IDF is indirect fire.  Essentially any bad guys will set up a rocket and put some half-cocked timing device (similar to a kitchen timer, or actually a kitchen timer), point it at the base and then run away.  Several minutes to hours later the rocket will take off and 99.99% of the time fall harmlessly in the middle of the desert.  (I do have to mention that a Trauma Surgeon from University of Pennsylvania was killed on Christmas Day in 2006 in Iraq as one landed on the chapel he was praying in - Kandahar now has rocket proof dorms and Hospital).  They serve several purposes to the enemy as they annoy us and disrupt our daily activities.  One of the two most notable for us here occurred when I was at the dining facility.  The loudspeaker announced two orders:  Stay where you are and put on your IBA (Individual Body Armor).  Well, which is it, you want I should stay here or get my body armor.  Because if I stay here, I can't get my body armor, and if I get my body armor I won't be staying here.  Needless to say, I stayed put and ate the rest of my chicken curry.  Then after about two hours the four other doctors that I was with decided we would make a run for it to get our body armor.  About 100 steps out of the dining facility another alarm sounded and I followed the lead of one of the British Surgeons and jumped into a four foot ditch.  Unfortunately it was the 'all clear' alarm.  Damn they sound alike.

The second notable one was during our routine surgery schedule - our hospital is not rocket proof.  Two teams were scrubbed in and all of us hit the deck immediately - the hell with sterility.  Fortunately Anesthesia isn't that hard and the machine did all the work while we laid on the floor for a half hour.  Below are two notable pictures of some of the crew.  I nodded off for a while, then the all clear came and I jumped up, rescrubbed in and finished the case.  

IDF alarm - some pray, some sleep.  I prayed then slept.

Good thing the KBR contractors clean the floor 20 times a day.

All for now.