Sunday, October 31, 2010

Halloween Party

The Air Force is the fun service.  The Army and Navy not so much.  The old joke is that when the Air Force builds a new base, they build the golf course first and then request a new appropriation for the runways.  So when you put an Air Force contingent, like our nurses, together with a holiday, you get, lo and behold, a party.
Let no holiday pass uncelebrated.
Dahlia and Tess:  ICU Nurses, USAF Officers. Party Girls. Superheroes.

Included in the the party favors was a pack of holiday cards from the 3rd grade class at Holy Infant School in Ballwin, MO.  Thank you to them.

Halloween Card Bonanza

Hope that you had a spooky holiday.

Kat comes as a surgeon.  I mean a vampire witch.  Wait, is this a costume?

Friday, October 29, 2010

Penetrating The Wire

We had an unfortunate case a few days ago.  An American soldier came to us with about 50% of his body having second and third degree burns including his arms, legs and torso.

He had been standing guard at one of the remote FOBs.  Insurgents penetrated the outer wire and staged small arms in the no man's land between the inner and outer wire.  They then approached the front entrance posing as Afghan police while simultaneously staging an altercation.  The scene drew this soldier out of his position.  He was hit with a Molotov cocktail.  The perpetrators then fell back to their small arms cache intending on an ambush.  A firefight ensued between them and some other guards.   The insurgents broke off the engagement and fled through the breech created in the wire.  They were not caught.

The good news is that we dressed his wounds, started his resuscitation, and quickly got him a MEDEVAC.  He should already be at the Brooke Army Medical Center in San Antonio where there is a world-class burn unit. 

It is another cautionary tale about the nature of this war.

February 2011. This is an update to the original post. The story was a lie. His army unit investigated it carefully because they were concerned about new tactics by the insurgents. Apparently the soldier wanted to go home because he was homesick and having relationship problems. He concocted the story and enlisted one of his buddies to collaborate it. The truth is that, while at his guard post, he soaked his clothes in diesel fuel and lit himself on fire. We can vouch that he got more than he bargained for if his intention was to get home.

I do my best to give an honest report and appraisal of what I see and hear within the constraints of operational security. I took his story at face value and will continue to do so when I speak to others because most of our patients and colleagues speak in good faith. 

Sorry to mislead. I do think that the story still represents a cautionary tale if now for different reasons.

Tuesday, October 26, 2010

USO: Supporting Troops

The USO is a great organization. 

USO volunteer in New Jersey

We have had a lot of friends and family offer their thoughts and prayers for this endeavor and on some mail days it seems we swim in care packages.  We are grateful for that.  However, if one wanted to do something else for the troops, you could do a lot worse than donating to the USO.   From care packages in San Diego, to airport hospitality centers across the country, to lunch counter at McGuire AFB before bordering overseas flights, to entertainment and shows in Kuwait, to recreation and phone centers every place, the USO has been present on each step of this journey.

USO serving lunch to deploying troops headed to Middle East

Here is their web site:

While I'm at it, I will also give a shout out to another organization that provides support for deployed troops.  The VFW sponsors free phone call days at the phone center here on the FOB which is a very nice gesture because keeping in touch with friends and family at home is the best sanity therapy around.

FOB Lagman Phone and Computer Center (aka "Skypeville")

Sunday, October 24, 2010

October Chill

The mornings have gotten cold here in Qalat.  However, there can be a 40 degree daily temperature range in the desert mountain climate so the afternoons are pleasant.  Team members have been digging deep into their bags to retrieve the cold weather gear that seemed so cumbersome to lug around in the heat of Kuwait.  There is an upside to cold weather.  We have been waiting for the cold and alternately invoking Moses to end our plaque of house flies.  But some of the buggers are still hanging in there.  So the battle rages on.

Our work has been steady.  We seem to be on the "an-IED-per-day-keeps-the-doctors-in-play" plan.  Most of our patients have been Afghan National Army.  We did treat two patients with stab wounds from the same incident.  Details were sketchy.  We weren't sure if there was a bayonet charge or if two dudes jumped them on the way to the mosque.  Our most serious incident involved four Americans who suffered significant facial trauma and head injuries in spite of their MRAP.  We believe that they may not have been properly restrained.  Getting thrown about inside your vehicle is hazardous to your head which is one more excellent reason to use your seatbelt.  You've heard of "Click-it or ticket" and "Seatbelts save lives".  I propose "Buckle for the blast." 

Every year the army sponsors the Army Ten-Miler run in Washington DC.  Army units hold shadow runs around the world including FOBs in combat zones.  So yesterday, on their day off, about 100 dedicated souls got up at 0600 and ran six laps around the perimeter road in the cold, against the wind, up the hills, over the rocks, and through the dust for about two hours.  Good on them.  I think they get a T-shirt.

Tuesday, October 19, 2010

ISAF Press Release

The International Security Assistance Force, or ISAF, has issued a press release on one of our patients.  We had not heard the story of this little boy's family when he was treated here.

Kat, our plastic surgeon from San Diego, took the lead on his treatment.  He was resuscitated and his burns were cleaned and wrapped.  From here, he went to one of the local civilian hospitals.  He was doing as well as could be expected when he left us but he faces a tough future.

Monday, October 18, 2010

Life On The FOB: Part IV - The Quest For The Clean Latrine

There is a spreadsheet that I keep on my laptop that counts down the time left on deployment.  It gives you the months, weeks, days, hours, minutes, and seconds remaining along with clever commentary to mark the milestones. 

The Quest Defined
Lately, it has been asking how many steps to the latines? Think the designer has been here himself?  Well the answer in our case is 65.

But the far more pressing question is how many steps to the clean latrines?  This is because the holy grail of FOB life is a clean place to sit and do your business.  Unfortunately, finding such a place is a more arduous task than you might imagine because, the clean latrine, as with any journey, is more an ephemeral state of being than an actual destination. 

Chivalrous Latrine Etiquette

Yet in spite of manipulating cleaning schedules, utilizing cipher locks, and threatening guard duties, we have thus far failed.  Nevertheless being dedicated knights, the quest continues. We are undaunted until we have scoured the four corners of the FOB.  For as a wise person once told me "Nothing worth doing comes easy."  And rest assured that once the prize is found, we will be delighted to share it with dozens of our closest noble friends.

Move Along, Lancelot

Wednesday, October 13, 2010

Instant Karma

Did I write that we were bored?  Uh yes.  Did I knock on wood?  Uh, no.  Be careful what you wish for....

A few hours after that last post everyone was in the midst of their afternoon routine when the call went out.  I was in the gym working up a treadmill sweat.  A civilian vehicle was caught by an IED.  In this case it was the secondary kill zone.  It had apparently stopped short of a suspicious object which served to flush it in the blast area of another IED.  The explosive element was a propane tank which limited shrapnel but caused a powerful concussive force.  Three passengers were killed, two survived, a father and his three year-old daughter.

Their injuries were extensive.  The girl had fractures to both of her tibias and a femur, pulmonary contusions, and, as we found out later, a closed head injury with brain bleed.  The father had a pelvic fracture, lung contusions, and injuries to his liver, spleen and spine.  We activated the walking blood bank and donors from the base lined up.  The surgeries went on for the next 6 hours just to get them stable enough for transport to the hospital at KAF. 

Twelve hours later we had our first enemy casualty.  He had accidentally detonated an IED that he was placing.  He arrived with a massive head injury and no pulse.  There was little that we could do for him.

Finally, this morning there were three army combat engineers from a route clearance team.  Another IED.  Fortunately none of the three were badly injured.  Chock up another save to MRAPs and body armor.

Route clearance is probably the most dangerous job here.  One bit of grafitti from the latrine wall put it this way:  "Route Clearance.  I look for what you run from.  I get blown up so you don't have to."  All I can add to that is "thanks."

Sunday, October 10, 2010

Ten Ten Ten

It has been a slow week which more than a few observers have noted is a good thing.  We are the one unit that every one wants to see wallow in boredom.

There have been only a couple of trauma codes recently.  It is not just Americans and Afghanis affected here.  Two Romanian soldiers were killed and a third was wounded in one incident. 

Romanian flag at half mast

We also had a soldier past through who had been in an IED explosion and only received a fracture to his fibula.  That's it!  He didn't even require surgery just a cast.  The amazing angle to his story was that it was his second IED blast in five days and third over the past two months.  His look in the resuscitation bay suggested that it was all inevitable.  But I was thinking that he was the guy to take to Las Vegas.

Anyhow, who are we to complain of ennui?  Not when you can make sport of swatting the boundless supply of house flies.

Unsportsmanlike conduct

Tuesday, October 5, 2010

The Golden Hour

The Role II mission in combat care is often described as damage control.  It is resuscitation and immediate surgical stabilization of life and limb threatening hemorrage in order to reverse the physiologic "death spiral".  It is not necessarily definitive care or recovery.

The golden hour concept stems from the fact that irreversible physiologic changes can occur within the first hour of profound shock.  There are three elements of the physiologic change, also known as the lethal triad.  These are acidosis, hypothermia, and coagulopathy.

Acidosis, or increasing acidity of the blood, occurs as individual cells throughout the body stop receiving blood supply and nutrients which disrupts normal metabolism.   Hypothermia occurs due to exposure and loss of blood.  Coagulopathy, or impaired blood clotting, leads to further blood loss.  These elements beget the other making a vicious circle, which we sometimes refer to as "circling the drain." 

The concept of the FST is to place emergency surgical and resuscitative capabilities close enough to the battlefield so that care is within reach in the golden hour.  Although this is more a conceptual time frame than a strict sixty minutes, it is a period during which the death spiral can hopefully be reversed.  When a patient arrives, we turn on the room heaters even on hot days to warm up the patient, push fluids and blood to stop acidosis, and thaw plasma to replenish depleted clotting elements.

Unfortunately, this is still not always possible.  We had a case a couple weeks ago in which the patient received a gunshot wound to the arm but because of weather, MEDEVAC was not possible.  Furthermore, the only road to his location was heavily laid with IEDs.  There was no way out.  The medics on site had to provide care for about 36 hours until the weather cleared.  The good news is that the tourniquet prevented blood loss and initiation of the lethal triad across the patient's entire body.  The bad news is that his arm was lost.  Sometimes there are tradeoffs that we have no choice but to accept.

Friday, October 1, 2010

LT Brendan Looney, KIA September 21, 2010

Brendan was killed in the helicopter crash in Zabul province near our FOB.  It was the last mission of his deployment.

Remembering Brendan Looney
         - The Looney Family and Friends

"He was an honorable man."

"He was proud of serving his country and being where he was."

"He believed in it (what he was doing); we believed in it; we believed in him."

"We are proud of him. We loved him."

"He never took the easy way out, nor was he given the easy way out."

"His spirit will live on."

"He touched everyone who encountered him."

"He loved his family, he loved his wife, he loved his life."

The family of Brendan Looney remembered him with these and other thoughts this week as they mourned his passing. LT Looney, 29, was one of nine U.S. service members to lose his life Tuesday in a helicopter crash in Afghanistan.

Brendan's family - parents, Kevin and Maureen; wife, Amy Hastings Looney; and siblings, LT Stephen Looney and his wife Alison, LTJG Billy Looney, Bridget, Erin and Kellie - have gathered together as one this week in the family home in Silver Spring, Md., to honor Brendan after he gave the ultimate sacrifice for our country.

In their current hour of grief, the Looney family asks the public and members of the media for a period of privacy that will allow them to devote the coming days to each other, and to Brendan.

A public visitation will be held for Brendan on Sunday, October 3, from 2-5 p.m. at DeMatha Catholic High School (4313 Madison Ave., Hyattsville, Md.). The funeral service will be held Monday, October 4, at St. John the Baptist Church (12319 New Hampshire Avenue, Silver
Spring, Md.) from 9:30-10:30 a.m., followed by burial at Arlington National Cemetery. At Arlington, Brendan will be laid to rest next to his Naval Academy roommate, 1stLt. Travis Manion, USMC, who gave his life in the line of duty in 2007.

In lieu of flowers, the Looney family asks for donations to be made in Brendan's name to either the Travis Manion Foundation ( or to DeMatha Catholic High School (

And while the family will not be making any public statements to the press at this time, they want everyone to be aware that comforting them during this challenging time is their knowledge that Brendan proudly volunteered to serve his country knowing full well what dangers lay ahead of him.

Afghanistan was where he was called to be, and he answered that call to make a difference in the world and in the fight for freedom.

The Looney's as a family fully supported the choices Brendan made to attend the Naval Academy and eventually become a SEAL. And though Brendan's decisions would result in his making the ultimate sacrifice for our country, they remain equally proud and supportive of their American hero for having the courage to make the difficult choices that he did. It was one they would expect the Brendan that they knew to make.

After graduating from the Naval Academy in 2004, Brendan began his military career among the members of the Navy intelligence community.  He requested a transfer to the Navy SEALs, which was approved in late 2006.

He then began BUD/S School in March, 2007, and graduated from SEAL Qualification Training as the Honorman for Class 265 on June 22, 2008.  Three weeks later, on July 12, Brendan and Amy were married. Within 48 hours of the conclusion of the ceremony, he was deployed to Iraq.

Brendan was deployed a total of four times during his naval service.  His first deployment took place when he was part of the intelligence community, with the three ensuing deployments coming as a SEAL. His final deployment, as a member of SEAL Team THREE, began on March 9, 2010.

Prior to his deployment this year, Brendan left his base in San Diego and flew to Annapolis with the dual purpose of visiting his family and attending the Navy-North Carolina lacrosse game that was played at Navy-Marine Corps Memorial Stadium on February 25.

Lacrosse was actually the second sport he competed in while attending the Naval Academy. He spent his first two years at Navy as a member of the football team before transitioning into a lacrosse player starting in the spring of his sophomore season.

One of the proudest lacrosse seasons for both Brendan and his family took place during his senior season at Navy. That year, Brendan and brothers Billy and Stephen helped lead Navy to the NCAA National Championship Game that was played in Baltimore.

On that Memorial Day in 2004, a partisan, patriotic crowd of nearly 50,000 lacrosse fans filled M&T Bank Stadium to support the Midshipmen in their eventual 14-13 loss to Syracuse. On September 22, 2010, 2,000 of Brendan's fellow U.S. service members gathered in Afghanistan to pay their respects to him and his fallen comrades as they departed for their final journey home. Receiving Brendan upon his return at Dover Air Force Base were 76 members of the Looney family and friends.

It has not only been members of the Looney family who have taken the opportunity this week to remember Brendan:

"As his roommate going through BUD/S and SEAL Qualification Training it was easy to see why Brendan was our Honorman; few could match his strength and endurance, and less could match his determination. As we served together at SEAL TEAM THREE I had the honor of watching him
lead his men and earn the respect of every member of our command. He was a Warrior in every regard, something every leader can strive to emulate. Brendan, you will be missed, but never forgotten." - LT Rob Sarver, USN (SEAL Team THREE Platoon Commander, Friend and Brother)

"Brendan was the hardest working member of the team - he had to be to show up his brothers - but his example of hard work and pushing the team was an instrumental part of our success in 2004. He was one of my few peers that I have really tried to emulate in my life. Brendan was a great friend and I already miss him so much." - LT Adam Reel, USN (USNA Class of 2004 and lacrosse teammate)

"Brendan was a true leader in all aspects of the word. He lived his life with unbound tenacity and zeal. He embodied everything we as SEALs value: toughness, ingenuity, brotherhood. I could always rely on Brendan, from dragging me underwater during two-mile ocean swims during BUD/S, to watching over my family while I was deployed. I've never met a person so perfect for the SEAL Teams. Being a Navy SEAL never defined who Brendan was; he defined what every Navy SEAL should be." - LT Flynn Cochran, USN (SEAL Team ONE Platoon Commander, Friend and Brother)

"Deep loyalty, good humor and genuine concern for others earned Brendan Looney the title 'best friend' to many men. Although a 'best friend'to many, it was always family first. As the oldest of six,
Brendan was a loving brother who led naturally by example with confidence, focus and fearlessness. As a graduate of the United States Naval Academy and leader of the Navy lacrosse team, Brendan was a standout athlete with chivalrous personality characteristics of high regard that he learned initially from his loving parents. A man who was in love with his wife and cherished his friendships, Brendan's humble and easy-going personality will be missed by all who knew him.  There was no task or goal that Brendan Looney could not accomplish. I would say, if God ever needed a warrior Himself, he would hand pick Brendan Looney." - LT Matt Midura, USNR (USNA Class of 2004 and
lacrosse teammate)

"For every Nimitz, Halsey and McArthur, there is a Brendan Looney.  Only because they were lost too young before having the opportunity to reach that level of greatness are people like Brendan Looney not instantly recognizable names. There is no doubt in my mind that Brendan was on his way to reaching that level. His loss is deeply felt by those who knew him. Our hope is that the void we feel in our hearts will be filled with the light and hope by which he lived his life." - Richie Meade (head coach of the Navy lacrosse team)

"Brendan was a strong, steady presence for everyone. Whatever needed to be done you could always count on him to make it happen. He led by example and he inspired others to make a difference. When Travis returned from his first tour to Iraq he spoke with Brendan, who shared his frustration with not being more engaged with our efforts. Shortly thereafter, Travis informed me that Brendan was accepted into the Navy SEAL training program and he knew immediately that Navy SEALs had just gotten an incredible leader. I could tell how proud Travis was of Brendan when he shared this story with me."

"Unfortunately, Travis didn't return home from his second tour to Iraq, but I know he was looking down proudly as Brendan went on to become BUD/S Class 265 Honorman during his SEAL training course and complete several successful tours defending our freedoms."

"Our country has lost a great leader but we've gained an incredible example of courage and commitment for future generations to come.  Brendan and Travis are back together again, true patriots who believed in this country. They are of the same cloth: Warriors for Freedom, Brothers Forever." - Col. Tom Manion, USMCR (Ret.) (father of Travis Manion)

To many, Brendan will be thought of as a member of the elite Navy SEALs, a standout lacrosse player and Naval Academy graduate. But to his family, he will always be known as a proud son, protective older brother and doting husband.

"Brendan did what he loved, and he wouldn't have it any other way. His memory will live on with each of us. He was my best friend and the love of my life. He was a hero who inspired more people than he will ever know," said wife Amy.