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.