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)

4th Times the Charm?

Dr. William Brydon - the only British survivor of the first Anglo-Afgan war.

For those of you who are unencumbered with the knowledge of history, this is not the first foray of the British to Afghanistan.  In fact, by all accounts, this is the fourth time the English have come to Afghanistan to attempt hold sway over the natives.

The first was from 1839 to 1842.  The 'Cliff Notes' version goes something like this:
   1)  The British already controlled India, but felt the Russians were trying to invade Afghanistan to expand in central Asia.  (Turns out this probably wasn't the case - but, oh well - Colonialism at it's best).
   2)  The British attempted to get the the leader of Afghanistan (Dost Mohammed) to side with them.  All Dost wanted in return was to get back the disputed area of Peshawar from the Persians.  The British said no.  So what did old Dost do?  He asked the Russians for help.  Ooops.
   3)  The British took umbrage and decided that Dost had to go, so they invaded and installed a puppet named Shuja Shaw Durrani.
   4)  Lord Auckland signed a treaty called 'Simla Manifesto', which basically stated that the British were there to protect Durrani and his troops from other territorial disputes.  But, of course Persia had a pro-Russian dictator and things escalated as they are want to do.
   5)  The British invaded with 21,000 troops, led by Sir John Keane, in December 1838, crossing over the now infamous Khyber Pass.  By 1839 they had passed Kabul, took Kandahar and defeated the Afghan forces at the until-then impregnable fortress at Ghanzi.
   6)  Things were going swimmingly, until October 1841.  By that time there only remained 4,500 British troops.  The new commander, William Eliphistone, in an attempt to increase morale, allowed the soldiers to bring in their families.  Now the British numbered 16,000, but this included women, children and Indian laborers and the Afghans thought the British were trying to set up a permanent occupation and now they were pissed.
   7)  The Afghans began to flock to their new leader, the son of Dost Mohammed, Mohammed Akbar Khan.  A series of attacks began on the small, poorly defended British garrison.  The British had not planned very well and all their supplies were actually across a field 300 meters away from their camp.  It became a long 300 meters.
   8)  Finally, at wits end, William Eliphistone reached an agreement with the Afghan fighters to allow safe passage for their garrison and charges.  Unfortunately, he also gave up their guns.  Oops number 2.
   9)  On January 5th 1842 as the garrison was traveling through snow bound passes they were attacked with their own weapons.  A running battle continued thru two feet of snow until only one British survivor reached remained - Dr. William Brydon.

This all led to:

The 2nd Anglo-Afghan war from 1878-1880.  The 'Cliff Notes' version goes something like this:
   1)  See 1st Anglo-Afgan war.  Repeat as necessary for the 3rd.

As a disclaimer, I support the 'War on Terror', however, knowing history allows us not to repeat it - Alexander the Great, Ghenis Khan, Tabur - all great warriors.  What do they have in common - they all failed to conquer Afghanistan.  I would have loved to have been a fly on the wall for this conversation.

Bush:  'We have to invade Afghanistan to ferret all those who would support terrorist organizations'.
Blair:  'I don't know George, maybe just an Air War - no land troops.  We've been there before and it's a rough place'
Bush:  'Don't worry, third times the Charm!'
Blair:  'Wait, what?'

Day 95 BOG, 122 away from home.  All for now.

Hump Day!

Official count down calendar - Circled day at the end is the

very last day I could get home - Dec 23rd.

     The Navy is purposely vague on many things.  I've learned to deal with this, however it continues to be a problem that vexes me.  Currently, the problem lies with the actual duration of our mission here.  When I first got assigned for these orders I was told I would be deploying for six months.  No problem, standard deployment (although there are many, many others who do more - some in upwards of 18 months).  Then I was told that I would have to process for a week in Norfolk.  SOP, got it.  Oh yeah, there will be three to four weeks of training to get you ready for the environment you are going to be working in.  No problem, good idea.  Then there will be 5-7 days of travel to places like Maine, Germany, and Kuwait, where you will acclimate to the 125 degree heat.  Now wait just a minute.
     Anyway, I totaled up the time and it should be around 7 months or 210 days.  Then I picked up my orders and they said:  duration of orders  - 242 days.  WTF!  Where did the extra month come from?  I have no idea and no one else really knows either.  I've come to the conclusion that they build in extra time to have some flexibility for any contingency - or that they hate me for the time I was drunk and did a skit making fun of my chairman at the end of the year awards dinner.   Either way, I'm OK with that, however it's always nice to have a date to hang your hat on, to count down the days you have until you come home.  After running numerous scenarios in my head, I've finally come up with an estimated return home.  And this marks the official (arbitrary) halfway point!  I think.  I'm very non-committal on this statement if you couldn't tell.

In an effort to count down the days of deployments, people use a variety of methods.  I, personally, have a count down calendar (above).  I also have a visual cue from the huge bottle of anti-malarial pills that I was issued (190).  Finally, I've picked a number of dates to 'look forward to', as a way of passing the days.  Here are some examples:

May 1st - Duh, day 1. 
May 21st - Anniversary.
May 28th - Arrive in Kuwait.
June 2nd - Arrive at Bastion.
July 4th - Dress up as a minute man and sing 'Yankee Doodle Dandy' to annoy the Brits.
August 10th - My buddy Jason arrives in Kuwait.
August 25th - My buddies George and Edton get to go home and Dave arrives.  And Hump Day?
September 8th - Opening day of Football Season.
September 16th - Phillies lock up the NL East.
October 15th - Entire British command changes over.
October 23rd - Eagles start season 7 and 0.  And Phillies beat the Red Sox in a sweep in the World Series.
October 31st - Halloween - Dress up as a minute man and sing 'Yankee Doodle Dandy'. Yes it is still funny a second time.
November 10th - Average high temperature in Bastion finally drops below 100 every day.
November 23rd - Marks 180 days Boots on Ground.
December 1st - Marks 8 months of tax free pay.
December 7th - Day 194.  Should be official 'rip out' date of Nobel Eagle number 4608, meaning I should be leaving for Kuwait this day.
December 23rd - Latest day I could return.

As with all things, time will tell.  The only date that I'm positively, absolutely, 100% sure about is.....






The Phillies will crush the Red Sox in the Series.


One last thing - have you ever watched shows like Biggest Loser or Survivor and they have these really dramatic moments where people tell them how much they miss their family and don't know if they can't go on?  Last time I checked, on those shows they are only about 30-45 days long, you can leave at any time, your life is never really in danger and you are actually playing a game.  Quit Winjing!  (That is a British term for complaining).


All for now.

Coordinated Chaos

This is the main receiving trauma bay in the ED (we have 8 of these, although not all this size).  When we get a trauma call (the  so called Catagory A patient), the teams assemble, not unlike any major trauma center in the world.  From left to right:  Team leader (ER physician), runner (for blood and supplies), Radiology tech, Level 1 blood infuser nurse, Radiologist, Nurse leader (with back turned), ER resident and primary surveyer (leaning over bed), nurse (male with back turned to picture), Anesthesiologist and tech (facing toward picture and head down), Medication nurse (standing over yellow box), the three to the far right are two other Level 1 infuser nurses (can infuse a unit of blood or plasma in 30 seconds) and the man with the red cross is the transporter of patients.  Not seen are the three others just beyond the picture which is the Trauma Nurse coordinator who writes all vital information down as it is shouted to them, the Aeromed evac team to start getting ready to fly the patient home and the patient tracker who can contact commands and families to notify them.  

There is always a din of noise with side conversations, until the door swings open and the helocopter team leader comes in to report the patient while the ambulance teams gets them ready for treatment - then it goes silent and you could hear a pin drop.

Again, this isn't too different from any trauma center in the US.  What is different is about ten feet behind the Team Leader where you will find two of each of the Attending level physicians - Trauma Surgeons, Orthopedics, Vascular Surgeon, Plastic Surgeon, Anesthesiologists and the OR nurses - See Below.

Attendings waiting like coiled springs to jump into action.  There is the dreaded yellow line on the floor where we stand behind until called by the team leader to do our part.  In all its there are about 35 people in the trauma bay.

Within about 15 minutes we have stabilized, intubated and resuscitated the patient and they are now in the CT scanner.  Here the attendings are jockeying for position to see what has to be done.

CT scan is done and patient is in the OR.  This case needs Ortho and Trauma surgery - he gets prepped (and a quick bath to get all the dirt and mud off) and away we go.  This happens on average of 2-10 times a day.  (I'm at the head of the bed facing with black and white scrub cap on).

All for now.

The Brits say the damndest things (Part 1)

A popular saying in the British culture is that the English and the Americans are a people separated by a common language.  I have to say, I can't agree more.  The Scottish and Northern Irish notwithstanding (I actually don't even understand what comes from their mouths) the people of the UK (Wales and England) have a distinct, if not flowery language.  I've picked up a few of my favorite sayings in the past few months and would like to take occasion to attempt to describe them.  I would also like to make you aware of several things about the English that you may otherwise not know - all in jest, I assure you.  I do have to admit that most Brits have a very keen sense of humor, but it's a little more low brow than their demeanor might make you believe.

Aside from the obvious distinctions of what they call certain things, there are others that are more perplexing (the loo is a bathroom, as is an ablution, which sounds more like something you do in a Catholic Church while going through confession).  For instance, a theater is not a place to view movies, but rather the operating room.  On a number of occasions as the British attempt to tell a US Marine that they have to operate on them and then go on to say they are going to take them to the theater - well, you can guess what a 19 year old Marine would say to another man offering to take them to the movies and it's not fit for printing on this blog.
One of the terms that has entered my lexicon is 'manky' (pronounced main-key).  It can describe all number of gross things - like an infected wound, a full trash can, or when they wash their work out gear in the sink where I brush my teeth as they do nearly every day.
One of my favorite sayings is - 'You forget yourself, sir'.  This basically translates into F off, but sounds so much more dignified.  From now on when I get any anesthesiologist who back talks me - Bam - 'Why Doctor (fill in the blank), You forget yourself, sir/ma'am'.  I've been using it quite a lot lately.

Here are some other things I have noticed:
 - Their favorite American slang word is.....bullshit.
 - They think being called MF'er is a term of endearment - I have no idea who would tell them such things.
 - Michael Caine is their national hero. He starred in every British movie made from 1961 to 1995.
 - Brits actually make fun of Elton John more than we do.
 - Most of them actually do love the Beatles.
 - They actually like Rowan Atkinson.  Doesn't ring a bell?  Well, he's 'Mr. Bean' of course.  I find him quite annoying, however, apparently he was quite funny back in the day.  He had a show called Black Adder, which is a classic in the UK.  He starred with Hugh Laurie in this sitcom, who plays a dim witted Army soldier in the first world war.  I watched a couple of episodes and I was not impressed, but Hugh Laurie has come a long way.
 - They watch Darts on TV!  No, I'm actually serious.  They will literally sit for 3 hours at a time and watch two fat men throw darts at a wall.
 - One of their favorite movies of all time is Zulu (starring who else, but, you guessed it, Michael Caine). It is their 'Rocky'.  The story is about a small outpost of British soldiers (about 200) in the late 1800's that were attacked by over 3000 Zulu warriors in Africa.  They say the movie shows how valiant and brave their soldiers were and nearly 15 Victoria Crosses were awarded on that day (it is equal to our Medal of Honor).  What I say is that 200 men with rifles and canons will generally defeat 3000 half-dressed men with spears and wooden shields any day of the week and twice on Sunday.  Well played.
 - Although I can't confirm it, I really believe they think that they won WWII single handedly.

    I don't want to make this post too long, so next time I will tackle such things as:  shoewear, why a surgeon is called Mister, tea time, being called a Jack Wet, and of course Cricket.

All for now.