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.