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.

The Brits say the damndest things (Part 2)

This will be my second foray into trying to give you a glimpse of what it is like to work with the British. I thought it would be best to give you three examples of things I overheard from my compatriots and then try to explain them.

1.  Surgeon #1 - 'You sir, are a cad and a charlatan of the highest order'

     Surgeon #2 - 'You forget yourself, sir.  You are nothing but a scamp and a scoundrel, and I heave my contempt at you'

     Surgeon #1 - 'I find you to be a commoner and not even worthy of my scorn'.

     Surgeon #2 - 'You sir, have been weighed and measured and found to be lacking in all redeemable qualities'

This is usually what I hear over my morning coffee (instant, no less).  Full disclosure - I am Surgeon #1!

2.  'Oi!  Some bloody pikey nicked my trainers'!

You see, we had a British Orthopaedic Registrar (Resident in training) and every time he changed into scrubs one of the head surgeons would steal his shoes and hide them.  I have to admit, by the time he left I was doing it as well.  A pikey, by the way is a gypsy and trainers are tennis shoes.

3.  General Medical Officer on morning rounds presenting a patient - 'Patient XYZ is here for Helmand fever and has been pyrexial over night.  He opened his bowels three times in 12 hours.  We started a giving set and this morning he feels better and is currently outside sucking a fag'.

I don't even know where to begin.  Suffice it to say he was sick, had a fever, pooped (3 times), they started an IV and he is now outside smoking a cigarette.


Aside from their medical terminology, I've also had to learn their terms for tea and coffee (of which they have about 10 times per day).  You see, when you make yourself a cup you also have to offer to make everyone else in the room a cup.  This is disconcerting when you walk into the lounge and find 12 doctors sitting around.  If you don't offer then you are called a Jack wet (not sure if this is good or bad).  To make things easier they have codified them:
     A Whoopi Goldberg or Black Nun (she played one in a movie) is black coffee, no sugar.
     A Julie Andrews or White Nun (Sound of Music) is coffee one cream, no sugar
     NATO is cream and two sugars
     Hugh Grant is black coffee, two sugars (he was arrested for prostitution)
  
'I got it, three Whoopi's, two Julie Andrews, a NATO and three Hugh Grants.'


Other interesting tid bits:
-  One night I was taking care of a Afghani translator who worked for the Brits.  He had an injury that I had to operate on and was in the process of consenting him.  I explained the risks and benefits to him to include bleeding, nerve damage, infection, blood clots, etc.  I went into great detail about what I intended to do and advised him that I thought his recovery would be uneventful, if not painful.  His first words after this 15 minute endeavor in perfect english - 'Could you please have a British Surgeon explain this to me, I can't understand your accent'.  Seriously?
-  Many of the Surgeons here have trained in the U.S. at some point or another.  They all have somewhat of an understanding of American sports.  They also all have a favorite American sports team and none of them are necessarily from where they lived.  They also, incidently, are some of the worst teams in their respective leagues.  For example - Detroit Lions, Arizona Cardinals, Baltimore Orioles,  Golden State Warriors and of course the Dallas Cowboys.  No Phillies fans yet, but I'm working on it.
-  The Brits are a bit less constrained by social morals when it comes to daily newspapers and magazines.  One of their most widely read newspapers (similar to USA Today in the states) has a daily Page 3 girl.  This is a girl who is posing nude next to an article about the World Bank and an advertisement for tires.  Brilliant!  The reading material in the Doctor's lounge includes:  The New England Journal of Medicine, The Journal of the Royal College of Surgeons, Lancet (highly regarded medical journal), National Health Service Monthly, The Journal of the British Medical Society, and of course Nuts - a magazine similar to Playboy in the states, but much less tasteful.  By the way, we voted and Nuts is now the official medical journal of British and American Orthopaedic surgeons at Camp Bastion.
-  Recently there was a British Journalist who was here interviewing the British Doctors about their experiences while deployed.  Since I have started talking a lot like an Elizibeathen aristocrat they thought it would be a good idea to dress me up in a British Uniform and have them interview me.  Tune in to BBC channel 2 on October  15th at 9:30 to see British Orthopaedic Surgeon Headly Lamar interviewed about his experiences at Bastion.
-  Supposedly the British are having a reunion in January in Portsmouth (England) to recognize the contributions of their medical team to this deployment.  It's called a 'Medal Parade', and from what I'm told it is quite an important event. Apparently they get to invite 3 to 5 of the Americans they worked with to join them (at who's expense I'm not sure) and they all get to vote for whom they want to invite.  So far I'm the highest vote getter, however they tell me it is so they can tar and feather me on their own soil. Brilliant!


111 days BOG, 138 away from home.
All for now.

Sacrifice

Ten years ago today, my friend AJ and I were returning from a diving trip from the Bahamas.  We were getting ready to do a six month deployment on the USS Theodore Roosevelt.  Me as a Flight Surgeon, him as a pilot.  Among the group of friends at the time we were very much looking forward to a 'pleasure' cruise, one where we would make many port calls and attempt to burn the cities down with our antics.  Unfortunately this was not to be.  The next day, as we all know, nearly 3,000 people lost their lives when a group of men posing as true Muslims flew two airplanes into the World Trade Center, one into the Pentagon, and, due to the bravery of those on board, one into a field in Pennsylvania.  We were all changed that day and we became focused on one thing.  Avenge them.  And we did.  

Before that day, I had every intention of completing my time in the Navy then gracefully exiting stage left - on to bigger and better things.  But the things I learned from that time, and awe I felt as I watched 18 and 19 year old men and women doing some of the most dangerous jobs in the world for little pay and even less glory left me with a lasting impression.  This was no longer a starter job, this was going to be a way a life.

Since then I have trained entirely during a time in history that we have been at war and continue to wage war - although it's face and mission have chnaged - one truth continues.  There are still young men in women in harms way, men and women who have little skin in the game, but much fire in their heart.  Men and women who need someone to say 'I've got you if you fall'.  Many of my colleagues and I are those someone and we will continue to be there until everyone comes home.

The UK represents a group of countries much smaller than the US, on the order of a quarter of the size.  But they have suffered no less than us in this ongoing battle.  Quite differently than in the US, the entire Nation mourns the loss of life of one of their Soldiers or Marines.  Each time one is killed in Action they hold a Vigil for everyone on base to attend - and everyone attends.  This is a picture of one such Vigil.  It is very moving.

Every year there are somewhere between 70 to 100 Orthopaedic Surgeons from all branches of the military that deploy to hostile areas.  I would be remiss if I said I was the special in that sense - just because I deployed.  They all leave their families and loved ones to do what they have been trained to do.  They do their duty - sometimes begrudgingly - but they do it.  The point that I would like to make is that after ten years we continue to be gainfully, very gainfully, employed.  I'm certainly not the busiest surgeon that has deployed and I likely am probably fairly average in that regard.  We work in austere conditions and often times don't have the supplies we need.  We see horrific injuries that aren't seen in the average US hospital, and, humbly, are often times unable to help.  But, we get up every morning, dust off our boots and answer the call - constantly counting the days until we can go home again.  I often think about why we, as surgeons, make these kinds of sacrifices, and I believe that it is personal for each and every one of us.  For me it is a sacrifice worth making.

Day 106 BOG, 133 away from home.
All for now.

'Cruise' Stache

(DISCLAIMER - I THINK MUSTACHIOED MEN ARE REGAL AND CHARMING.  SUCH MEN HAVE HIGH INTELLECT AND A KEEN WIT.  PEOPLE LIKE TOM SELLECK AND MY FATHER-IN-LAW.  UNFORTUNATELY, I AM NOT ONE OF THOSE MEN.)

As far as I can surmise, there are only four reasons why someone would grow a mustache.  1)  Halloween is right around the corner.  2)  They desire to enter the adult film industry.  3)  They are hiding a cold sore.  And finally 4)  Just to see if they can.  I fall into category 4.  I have endeavored before to wear a freshly trimmed mustache, but only after I have grown a full beard and then shaved it to within Navy standards.  As a way of passing time I decided how long I could stand growing one here - I've started three times now and first time I only made it 3 days.  The second 12 days and finally now  - a whole 31 days.  I've been challenged by others to attempt to grow 'handlebars', but needless to say only pirates are allowed to do that while serving in the Navy.  The only good thing I discovered is that its still not gray, so I have that going for me.

31 Days with a stache - unfortunately at least 5 people said I looked 10 years younger after 

I shaved it.  Not sure that was a compliment.

In other developments...

  - Reached 200 cases at Day 101.  Slow down?   Eerily quite, we are all on edge for the end of the Eid ul Fitr celebration at the end of Ramandan.  Sept/Oct/Early Nov are usually the 'fighting season'

  - One of my British friends (the kind of friend who could get things for you in prison), was able to get us a satellite hook-up for British cable.  Good news is that I will be able to see two NFL games a week on Sky TV and possibly the World Series.  Bad news - more Cricket.

  - Got to see two good friends on their way home from deployment.  George and Edton are on their way home with the Marines and were able to stop by for a game of poker and cigars.   They spent almost 8 months away from home as well and are psyched to get back.  They were at Forward Operating Bases as a forward surgical team - at one they did 80 cases in 6 months, the other one about 20.  (We did not gamble for money - this is not allowed in the AOR).

Group from 2nd MLG on their way home and enjoying some

Poker and cigars from their hosts at Bastion.   BTW - they obviously had time enough on their hands to become very good at poker.  They took all our 'fake' money.  (Mustache in full effect)

All for now.  (Day 101 BOG, 128 Deployed)