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.