Friday, December 31, 2010

Life On The FOB: Part 8 - Driven To Drink

Happy New Year!  We would love to toast the New Year with some bubbly.  This, unfortunately, is not going to happen.  If there ever was a place that would drive one to drink, then this might be it.  However, it is a US Central Command prohibited activity.  Heck, it's a prohibited New Jersey in-training activity as we unfortunately discovered back in July and August.  Therefore, in the spirit of making-the-best-of-your-situation, I present the Top Ten FOB alternatives to drinking.

10. Drink the near beer.

Is that a lager or an ale?  Does it matter?

9.  Drink a double expresso chai latte' while yearning for the good old days when you got 12 hour-old percolated black turpentine from a 5 gallon stainless steel coffee urn served in a mugged cleaned annually for the de-ratting inspection.  Just kidding.

Clean styrofoam cups just don't have that 'oomph.'

8.  Drink the bottled water.

Dare ya.

7.  Drink the tap water.
Double dog dare ya.

6.  Continue the quest for the clean latrine (helpful after all that drinking).

5.  Perform life-saving surgery (helps to be sober).

4.  Ponder how cool the Air Force PJ's and Navy SEALS are.

Living in the drink.

3. Ponder how cool Dave, the orthopedist, is.

Let me check that non-alcoholic label again.

2.  Tire-rolling.

Got to work up that thirst somehow.

1.  Did I mention the near beer?

It's the thought that counts.

Wednesday, December 29, 2010

The Year In Review

The bomb makers gave us a quiet Christmas but it was back to business as usual the next day.  Two casualties:  a ten year old boy in an IED blast with eviscerated bowel and a severed femoral artery and an eighteen year old in a car accident that somehow involved gunfire.  (We often get sketchy details, to say the least.)

Our Air Force contingent is quickly winding down their deployment.  Their reliefs are expected to arrive by mid January.  They are quite excited at the prospect of going home.

We continue to perform humanitarian work as we are able.  Dave, our orthopedist, and Kat, our plastic surgeon, have been busy trying to save the arm of fourteen year old boy with an infected bone, known as osteomyelitis, in his arm.  His infection is so advanced that the interior bone was essentially pus.  Osteomyelitis that advanced is virtually unknown in the West because it would have been treated much earlier.  So much so that Dave was having trouble finding any similar case reports in the medical literature to help guide treatment.  Compounding his difficulties was our lack of ability to perform certain diagnostic tests such as a CT scan or bacterial cultures.  Nevertheless, Dave was committed to providing the best care that he could provide.   We took the boy to the OR for a removal of dead bone, to washout the arm, and to place antibiotic "beads".  Whether the treatment will be save the arm remains to be seen.

Since it is the end of the year, it is seems worthwhile to look at the FST's year.  The numbers include the units that have preceded us in 2010 including the Army's 758th FST and the first Navy FST.

Trauma codes:  485
Operative cases: 133
Survival rate:  99%
Memorials for American KIAs: One (too many). 

Not bad for a 25-person team but then there are a whole host of other accomplishments in which we can take commensurate pride: 

Porches built:  One
Babies born to FST families while deployed:  One
Pittsburgh Steeler hats distributed: 25

Warming the heads of so many Colts, Cowboys, and Patriot fans.  Now that's an accomplishment.

Circum-navigations of the earth on the treadmill:  2.8 (Just an estimate.)
Air Force holiday parties:  Three (Impressive considering that they only started in July.  Outstanding prospects for an unprecedented 2011.)

Putting the 'fst' in festive.

Skype minutes to home: Not enough. Never enough.
Supply trucks unloaded:  A whole dang lot.
Circum-navigations of the earth by cans of 'near' beer consumed:  2.8  (Just an estimate.)
Dave the cool orthopedist moments:  Not enough. Never enough.

The Fashionista

Friday, December 24, 2010

A Song For The Season

We want to send Christmas greetings to our families, friends, and supporters.  I think that we, like all service members, agree that the most trying aspect of deployment is separation from our loved ones.  Christmas is the day when this sentiment is felt most strongly.

The length and closeness of existence during deployment practically forces a unit to become family.  My friends who left the service long ago often remark that the camaraderie is the one element of military life that is hardest to replicate in civilian life, and that which they missed the most about their time in service.  So it is with us.  This year we will be spending Christmas with this family, even while never forgetting our own.

My gift to readers of this blog is music.  Bing Crosby recorded some of the most famous renditions of the Christmas classics.  He was also known for his support of troops in the European Theater during World War II.  In fact, in one poll, he was voted by those troops to have done more for GI morale than any other figure, including President Roosevelt, General Eisenhower, and Bob Hope.  The version of Silent Night that plays on my IPOD was recorded by him at the end of World War II for radio broadcast to the GIs around the world.  It has added meaning for us this year.  It begins with a few words,

"This is a happy Christmas all right.  A great Christmas.  Next year, pray God, all of you will be sitting at your own fireplaces and around your own trees.  This song that means so much to all of us."

It ends with bells, about which he says,

"The bells of Christmas 1945 ring out clear and free around the world to you.  Their message comes from the hearts of one hundred and thirty-two million grateful Americans: 'Peace on earth.  Goodwill toward men.'"

Here is Bing Crosby singing Silent Night as we wish for peace on earth amidst the grimness of war.

Here is also his version of I'll Be Home For Christmas which I extend to our loved ones.

May you have a blessed Christmas and holiday season.

Tuesday, December 21, 2010

The Best Card, Ever?

We have had a slow week which might prompt us all to believe that peace on earth is breaking out.  We should be so lucky.

As I have mentioned in past entries, it has been the pattern for insurgent activity to drop off in the winter.  Our case load so far seems to bear this out.  We continue to perform urgent care as it appears.  Appendicitis and hands caught in doors have been the "bread and butter."   Still, one of the soldiers who has passed through here warned us not to expect a slow down.  His belief was that many of the insurgents lacked the funds to make a trek home and would thus be around for the winter.  Granted it is hard to sift the wheat from chaff on the rumor mill.  (Heck, it's hard to to sift wheat from chaff on an intel report as anyone who has dealt with intel can tell you.)  However, this particular service member had the unenviable job of being embedded with Afghan units in the province which requires him to work, live, and sleep in town outside the wire.  He got the benefit of the doubt from us.

We are celebrating the holidays in our way which includes lots of cards.  Brandi, one of our motivated nurses, took the FST group picture and attached it to a Christmas card.  We are naturally partial to this card but it probably doesn't rise to "best ever."  The photo quality is not the greatest because our scanner, like our environment, is, well, austere but here it is:

Army green is so Christmassy.  Don't you think?

We have gotten so many Holiday and Christmas cards and care packages that it is hard to thank all of the individuals involved.  These are all very nice cards with drawings, decorations, personal notes, and wishes for our safety and success.

Stacks on the walls and under the tree.

There is one note, in particular, that really stood out.  So much so that we had to scan it.  Here it is:

Masterpiece on loose leaf.

David, I just want you to know that I/we are okay, and what I mean is still alive, which I should be since I am typing this (you'll just have to trust me on everyone else).  And I'll get right on that thank you card!

Friday, December 17, 2010

Life on the FOB: Part 7 - Winter Wonderland

As Christmas and New Year's approach, the business of the FOB continues.  Flight operations are ever present.  Convoys arrive and leave.  Maintenance, resupply, construction and training are ongoing and never ending.  Nevertheless, holiday spirit is apparent.  Here are some images that show that deployment has not turned us into Scrooges.

The US Postal Service, gets in the spirit.

How Santa fulfills his DOD contract.
 The wildly popular Charlie Brown look

All it needed was a little love.

Some favor a minimalist approach.

Tinsel tent
We have heard that in Qalat there is a longstanding tradition of trodding out into the woods to chop down your own tree.

Look, there's a perfect one...right...over...there.

At the FST, we improvised with the supplies available.

An iv pole will do in a pinch.

Supply trucks bring in brown paper packages tied up with string

Ready for Tiny Tim

If you are not infused with holiday spirit, then you might be infused with holiday spirit.

Good cheer in a saline bag

Monday, December 13, 2010

The Irony Of Success

Last week, an army special forces warrant officer was in an IED blast.  Given his job, this was not his first deployment of the wars, but it was to be his last before retirement.  In this mission he was sitting in the troop commander seat, meaning the front passenger.  This seat is perhaps the most dangerous seats in a vehicle because it is the first to pass through the kill zone and is closest to the side of the road where the explosive typically is planted.  His vehicle was the sixth in the convoy.  The first five vehicles either missed the pressure switch or failed to activate it, but his was not so lucky.

His unit was not taking the incident well.  The warrant was well-liked and respected.  They had set out to find the perpetrator but had had little success.  Instead they might find only the impotent rage that comes after an enemy attack without an enemy to fight.

Body armor, no laughing matter.

He arrived awake, with a single iv, and with tourniquets on three of his four limbs.  He had the injury that has come to define the Iraq and Afghanistan wars: multiple limb amputations but no abdominal, thoracic or head injuries.  In his case his legs were amputated at the knees and his right arm was fractured, dislocated and torn open.  His body armor saved his life but not his limbs.  We make much about the success of medical care in the current war but the jury is still out on whether it is our practices or the body armor that has improved survival rates. 

In surgery, the immediately agreed upon priority was to try to preserve his right arm.  Paul and Kat washed, revised, and packed the leg stumps while Dave and Ted worked on the right arm.  They washed the wound, cleaning out gross dirt and debris, identified vital structures including the vessels, the nerves and the muscle tendons, and stabilized the fracture with a frame.  Aric and I transfused more the 30 units of blood product. To what effect, we do not know.  This soldier is now a double amputee and is at significant risk of becoming a triple amputee.  If his arm does not succumb to infection, it has a chance to regain some function.  He faces dozens more surgeries and years of rehabilitation.  He was doing okay the next day at the hospital at KAF.  We do not have word beyond that. 

One of the phenomena of the current war is the survival of quadruple amputees.  It is not an exaggeration to claim that never, in the history of war, have quadruple amputees survived the battlefield.  Before I deployed, I remember reading about Spec Brendan Marrocco, the first quad to survive, and marveling at his resilience.  There are now three living quad's among about 1100 amputees from the Iraq and Afghanistan wars.  One of the three, Marine CPL Todd Nicely, is from my home town, St. Louis.  I am heartened to hear about their successes as they persevere through the ordeal of rehabilitation.  Still, the devastation of the body that remains means that we might be able to save their life but not the life they had.  That is the irony of success.

Saturday, December 11, 2010

The Game And The Games

Today is the Army-Navy game.  Or should we say the Navy-Army game.  Make no mistake, FOB Lagman is an army operating base.  The navy is a small school of fish in this pond.  Nevertheless...

The army may be able to dress us in their uniform, put us through their training, and attach us to their units but they can never make us join their team.  I will hand it to the army on one account, nothing like being here to make us enthused about the game like never before.

Hours before the game, there is some competitive jockeying but there are two different schools of thought on how to best represent.  Having become subject matter experts in what is cool and not cool, here is all you need to know about the difference between the services.

Officially sanctioned, not cool way.

Subversive, cool way


Epilogue:  Navy 31, Army 17.  

And the pièce de résistance:  FOB PA playing Anchors Aweigh.  Don't know who could be responsible, but we are shocked, simply shocked.

Thursday, December 9, 2010

Scenes From The OR

We have a single operating room that has the ability to handle two separate surgeries at once, hopefully with only minimal stepping over each other.  Surgery often consists of procedures on multiple sites, the chest, abdomen, extremities.  Everything from our manning to our supply and facilities is geared to provide that capability.   Sometimes with mass casualties, our surgeons are scrubbing in and out of the surgical field to attend to the needs of other patients in the resuscitation bays.  Here are some images from the operating room, which is our core mission.

 The OR techs start the process.

Linda and Sam scrubbed and ready for action.

Martin lays out instruments at the scrub table.
  Preparing the patient for surgery.

Many moving parts.

Surgery in progress.

Surgeons, Dave and Paul, at work.
 Meanwhile transfusion is ongoing.  Hanging blood is a two person task.

Some of our nurses hang and track blood products.

Afterward, the clean up.

Hand washing supplies.

Saturday, December 4, 2010

The Genesis Of The Porch

It was back to reality for the team earlier this week.  There was a passenger bus rollover in Qalat.  Combat trauma is our primary mission so our ability to see non-war-related trauma varies.  We see civilian trauma when we can ensure that our primary mission capability is not degraded.  However, we are also the only trauma center in Zabul province.  These conflicting realities sometimes creates real ethical dilemmas.  Unfortunately, we cannot alone fix the broken healthcare system in our province.  Nevertheless, when possible we take what comes and we have been in a "green" status all week.

In this incident, there were reportedly three fatalities and the local clinic was overwhelmed so we handled nine patients with a variety of injuries.  Among them was one young girl.  Later in the day, we had two suspected insurgents with gunshot wounds.  All told, in a twelve hour period, we treated eleven patients, performed four major surgeries, and transfused over 90 units of blood and plasma.

Also of note this week has been construction of a new porch for our building, an ongoing project for our Officer-In-Charge (OIC) which brings to mind a story.

On the first day, SEABEEs were created.

In the beginning was the gravel and the gravel was without form.  And then came the patients.  So the OIC said "Let there be a slab."  And there was a slab.  And the OIC saw the slab and it was good.

And then came the rain (not so often, don't kid yourself).  So the OIC said "Let there be an awning."   And there was an awning.  And the OIC saw the awning and it was good.

And then came the darkness.  So the OIC said "Let there be florescent lighting painted red so as to not attract insects which I have already created in abundance." And there was florescent lighting painted red. And the OIC didn't stumble in the darkness and it was good.

And then came the cold.  So the OIC said "Let there be a porch."  And there was a porch.  And the OIC saw the porch and it was good.

And the OIC saw everything that he had made and, behold, it was good.  And he rested.

But then came the paperwork...

Tuesday, November 30, 2010

Horn Of Plenty

In honor of the pilgrims we had an activity cornucopia to fill our holiday weekend which included:

the Dry-Tri row, bike, and treadmill run sponsored by a couple of our masochistic workout freaks,


Thanksgiving party favor-making courtesy of the Air Force (aka the fun service),

Chocolate, Oreo, Candy corn Turkey thing-a-jigs

the International Security Assistance Force Gravel Bowl,
Navy whups Army again, yawn.

debt settlement,

The high price of Dallas Cowboy fandom

And shopping, shopping, shopping.

Black Friday at the strip mall

Monday, November 29, 2010


It had been relatively quiet for the latter half of November.  There are several theories as to why.  It has been the Muslim holiday Eid-al-Adha which may have limited hostility.  Also, perhaps the "surge" which has been at it's peak this fall has had some effect on insurgent activity.  Finally, it has been the normal pattern for the Taliban to halt activity in the winter, reportedly to resupply and take refuge at home.  We had thought that this may have accounted for the slowness.  However, the weekend has proven that the war has not taken a seasonal hiatus yet as there have been daily cases.  One case was particularly grim.

Afghanistan is the most heavily mined country in the world.  Between the Soviet invasion and the current war, this country has been at war for 20 of the past 30 years and, as a result there is an enormity of unexploded ordnance (UXO in army lingo) throughout the country.  The United Nations puts the number of mines and UXOs in Afghanistan at 10 million, a number that is frankly hard to fathom.  Whatever the exact number, a Google search for "Afghanistan landmines" shows dozens of images that display the magnitude of the devastation from UXO.  It was only a matter of time before this fact collided with our reality.  That happened yesterday.

A 12 year old boy was brought to us.  He had been scavenging through a trash dumpster when he found a mortar round.  Mortar rounds, along with rocket propelled grenades, are often set so that they explode after completing a set number of revolutions.  This round must have been close to that number because it detonated in the boy's hand.  He lost his right hand, burned his left hand, and suffered abdominal and head injuries.  The good news is that he survived.  The bad new is that he faces a difficult future.

Thursday, November 25, 2010

Giving Thanks

In spite of what some may call an austere environment, we have much for which to be thankful.  Among these: our deployment is over halfway complete, we have not lost any of our team members, we live in a prosperous society that values and dignifies its individual citizens, we enjoy many times in our lives free from fear, and we have plenty to eat, a warm place to sleep, the support of our families and friends, and our children are safe.  For these things, we are grateful.

The true need for sailors in the desert revealed.
To celebrate turkey day the DFAC is serving a great spread. Many troops from the small outlying posts are arriving to join in.  The lines will be long but they are a deserving group.  Here is a video link to the 2009 Thanksgiving spread made by a member of one of the preceding Foward Surgical Teams. 

Finally, we are thankful for the holiday cards supplied to us by the 3rd grade class at Holy Infant School in Ballwin, MO and the 5th grade class at Boyce Middle School in Pittsburgh, PA.  

Thanksgiving cards on display
Here are some select excerpts from our young friends:

"I was a skateboarding banana for Halloween.  I pray for your safety."  - Lucas, 3rd grade
    And we pray for your safety, Lucas.

"You are a big HERO to me.  A story I think is funny is my friend Emma tried to hug a chipmunk and it tried to get her. She named him Montgomery."  - Osa, 5th grade
   Sounds like Emma is the big HERO.

"If I could be any character in Modern Warfare 2, it would be you." - Mark, 5th grade
   Unfortunately, Mark, I suspect you would have to play Operation.
"Doctors are the best."   - Jack, 3rd grade
    Future president of the American Medical Association.

"Because of you I feel safe.  Do you have a dog?" - Don, 5th grade 
    Don, what's really on your mind?

"Fix them all up and get out of there!!!!" -Zach, 3rd grade, 
   Now that's a succinct summary of the mission.

"Did you know 32 miners were trapped in a mine for 71 days.  They all got out.  This story should inspire you to show most stories have happy endings.  And I know you will too!" - Olivia, 5th grade
   Olivia, thank you for the thought of the day.

We hope that you have a Happy Thanksgiving.

Tuesday, November 23, 2010

Life On The FOB: Part 6 - The 300

On the eve of Thanksgiving day and our annual American exercise in engorgement and gluttony (and giving thanks; I'm not trying to sound too cynical), I thought I would share something about the food.  Okay, the food isn't so bad here.  One of the myriad of contracting companies prepares, serves, and cleans up.  It could be a whole lot worse.  Sure we miss fresh milk and have sporadic fresh fruit and vegetables, but at least it's not MREs which is what the troops on the very small outposts subsist on.  When those guys come here for business, they always seem so very, very happy to be in our chow line.  So how can we complain?
As you might expect, it is definitely possible to put on weight on deployment.  Which leads me to my next point, but first a segue way.

A couple of years ago a movie called The 300 came out.  It purports to tell the story of the Battle of Thermopylae in which 300 defenders of Sparta took on a massive Persian army.

Spartan warrior.  All cape, no clothes
Now I have no idea about the historical accuracy of the film.  But in the finest tradition of Hollywood portrayals of Ancient Greece ala Brad Pitt's Troy, it seemed to me chiefly notable for the chiseled physiques of the loin-cloth laden actors.  In fact, I would summarize the plot as: chop off a head, flex your pecs; militant speech, bulge the biceps; primordial screaming, flash the abs; super slow-mo sword shot, tighten those gluts.  Have I missed anything here?

Not to be outdone, we have our own version of the 300 on the FOB.  Namely 300 pounds.  As in, are you going to return home bench pressing 300 pounds or weighing 300 pounds?

So what's it gonna be?

The marathon man

Perimeter Road Running Diehards

 or the ice cream man.

Dessert Line Diehards

In the end, you may look like a stunt double for The 300 or like you chowed 300 tubs of hot buttery popcorn on movie night.  But then Brad Pitt never had to resist the pie tray.

Rolando, one of our corpsman, embraces hard core training.

Saturday, November 20, 2010

Organized Chaos

Our team was assembled from across Navy units worldwide.  Many of the members had little or no trauma experience since even the largest navy medical centers often defer local trauma to civilian hospitals in the area.  Most of the experience native to the team resulted from the residency training of the physicians and prior combat zone tours by some of the members.  The training effort to get every one up to speed has been considerable and ongoing.  This is because the resuscitation bays are nothing if not "organized chaos" especially during a mass casualty.  It is critical for people to know their role and stay in their lane in order to develop a pit crew type of coordination.

During one of the codes, the base public affairs officer was present to photograph the proceedings.  Here are some samples that demonstrate the process.

Outside triage performed.

Litters are carried in.

The crew converges.

Multiple procedures may occur at once.

 Patient must be lifted by hand for survey and xrays.


Once evaluations are completed, patients are moved for surgery or MEDEVAC.