Sunday, January 30, 2011

Life On The FOB: Part 10 - Wetter Wonderland

Oh, Afghanistan, I didn't know you had it in you. 'It' being about an inch. That's my estimate of how much rain has fallen in the past two days. Our crisp desert FOB has been transformed to something new and exciting which I'll term the Wetter Wonderland. It features:

combat zone smoking which, like the postal service, comes rain, sleet, or snow,

Cig-ing in the rain

the big fashion houses launching their seasonal lines,

Classic accessorizing: watch cap, shower shoes, and a cig.

Trendsetting: Dave's Prada puddle jumpers.

 the appearance of new amenities,

New Jacuzzi spa for shower trailer.

Trout pond. Ready to stock.

and the botanical gardens readying for the spring extravaganza.

An ornamental accentuating the Hesco hedgerow.

FOB Blooms! in the Bulb Garden

Saturday, January 29, 2011

The Waiting Is The Hardest Part

I've had a bit of a hiatus posting due to internet problems and feeling under-the-weather. We are experiencing a torrential downpour here which is fortunate. How else were the locals to fill their swimming pools before the hot weather arrives? It also gives me hope of finding some greenery, and I'm not referring to the camouflage or the dining facility's meat loaf. Thank you very much.

We continue to get casualties mostly from areas along the Pakistan border, a marked difference from the autumn months when the action was frequently in the surrounding area. One of the casualties last week had multiple gunshot wounds including one that pierced the wallet in his breast pocket. Unfortunately, it did not stop the bullet but it may have spared him worse damage than the lung lacerations he received. He should survive the wound. His wallet is a different story. Sadly, it could not be revived.

One of the consequences of the more distant location where the action is occurring is the greater delay between the call for and the arrival of patients. This brings up the subject of the post, how to spend all that time waiting...

professional reading,

Danielle Steele's Handbook of War Surgery

fun and games,

Paul: transplant surgeon, pub-crawler

Manuel's array of talents on display

Uncle Kenny, the ex-Green Beret, tells tall tales

and intensive mental preparation.

She's got her radio, so lay off will ya?

Thursday, January 20, 2011

Dark Clouds

The new Air Force team is off to a remarkable start. Unfortunately, not the good sense. Yesterday, we experienced our busiest day in well over a month. Three separate IED blasts brought patients to us, many of whom turned out to be KIAs. It was a deadly day.

Initially, an IED attack occured near one of the remote FOB. Four patients became two when two died during transport.  Later, another IED detonated along the Pakistan border from which we received a border patrol agent who was injured beyond our help. Another attack resulted in a badly wounded Afghan soldier with spleen and liver injuries so extensive that he required nearly 50 units of blood product to stabilize him. Finally, a 10 year-old boy in a motor vehicle accident sustained arterial injuries.  To top it all off, MEDEVACs were held up by a rocket attack and subsequent casualties at KAF. The sum total left us to wonder if the day was an orchestrated campaign by the Taliban.

I happened to have a conversation with the local brigade combat team's surgeon.  He offered that, thus far, this has been a busier winter of combat than in past years.  Perhaps, because the weather has been warmer than usual which allows digging in ground not cold enough to be frozen, something I had not considered before. He also mentioned that insurgents seem to be directing their efforts towards placing lower energy IEDs.  The lower energy IEDs have subsequently been directed at Afghan units which seems to be consistent with our recent patient population. By the end of the day, his thoughts seemed prophetic.

Dark clouds rolled in overnight and this morning we woke to sleet and heavy rain.  It was as much precipitation as we have seen since our arrival and has turned our lovely dirt into lovelier mud.

Puddle of mud complementing Howitzer lawn ornament
Hopefully yesterday's events don't represent dark clouds of another sort hanging over the new team's head. They have a long road ahead with spring and summer combat just around the corner.

Post script: I found some pictures of MEDEVAC operations in Helmand province taken on the same day as our casualties.

Tuesday, January 18, 2011

Snow Cap

The rainy season has arrived. After months of dry-as-a-bone weather, there has been precipitation several days over the past two weeks. Lest we forget that we are at 5000 ft above sea level in January, much of it has been snow. On the coldest days, the temperatures have been below 20F. Given the fact that it was routinely over 100F in August, it begs the question: What the...?

Snow cap on distance peaks
Insurgent activity has been limited in our province this month.  However, there was an IED along the Pakistan border last week that hit a vehicle of the Afghan Border Patrol. 4 KIAs and 2 wounded. We were unable to get information about whether the IED was believed to be old or have been recently placed by insurgents operating from Pakistan. Securing the border has proved problematic even a decade into this war. Nevertheless, we remain at the ready.

Mountain back drop for the flags
The replacement Air Force team arrived safely by way of Manas, Kyrgyzstan. If you think it's cold here, try the Tian Shan mountains of central Asia in the former Soviet satellites. Yikes.

Sunday, January 16, 2011


After months together, we said goodbye to our Air Force contingent today. Their time in Afghanistan is complete. Mission accomplished.

Air Force team
One of the constants of military life is how quickly people move through it. Whether during deployments or at "permanent" duty stations, you often have intense relationships with fellow service members for a short period before moving on. Anyone who has served on active duty understands what I mean. Friends come and go rapidly.

Last goodbyes.

We appreciate all that the nurses and medics of the 466th Fighter Squadron did to serve the wounded and contribute to the mission. Whether they go on to new military assignments or to civilian life, we wish them the best and send them off with the naval service's traditional farewell:  Fair winds and following seas.

No looking back.
There is a new team on its way and we look forward to new collaborations and relationships.

Friday, January 14, 2011

Life On The FOB: Part 9 - The Zoo

The FOB is like a quaint little hamlet bounded by hescoe barriers and concertina wire.  Okay maybe it's closer to a corrugated tin-roofed, shanty-town with satellite dishes, but why quibble?  Anyhow, just like home, it has many amenities.  So whenever, we need a change-of-pace or a little pick-me-up, a visit to the zoo always makes for a great outing.  At the FOB zoo you can see:


Cute puppy !

Cute puppy ?


Pretty, mangy kitties.

rodents (as though you really wanted to see one),

Hands on display

the reptile bin,

Mice like trash and snakes like mice.  How sweet.

the aviary,

Hawk.  Don't ask where it came from.  Don't tell why it's here.

Birds-on-a-wire, FOB style.

and the bat cave ('Uncle' Kenny, our Green Beret-turned-OR-nurse).

Don't mess with the masked vigilante.

Tuesday, January 11, 2011


Patient movement is integral to our mission.  In a civilian hospital, a critically ill patient would go from the emergency room or the operating room to the ICU.  We can not do this.  The FST has limited holding capacity due to staffing, facilities, and equipment.  In addition, the military doctrine on casualty care holds that a patient is moved from Level 1 (the field) in one hour, from Level 2 (the FST) in 4-8 hours, from Level 3 (the medical centers at KAF and BAF) in 24-72 hrs, and from Level 4 (theater hospital in Landstuhl) in one week.

Post operative patient in "burrito".  Patient remains on the ventilator.  Chest tubes are connected to water seal containers at the foot of the litter.

The challenge for our team and the MEDEVAC flight crews is preparation and careful movement of patients on ventilators with the potential for sudden deterioration of their condition.  The burritos are designed for heat conservation since helo flights in winter weather can be quite cold, and hypothermia can result in bleeding and deterioration.  Portable ventilators and monitors are attached to the litters.  Blood may be sent with the patient.

Louie, our flight nurse, prepares a patient for MEDEVAC.

The litters are carried to ambulance which then transports them to the flight line.

Litter bearers

Ambulance loading.
Care continues throughout the process.

Air Force PJ tends to a patient.
Blackhawk helicopters are the workhorses of the MEDEVAC system, flying at night and in poor visibility to move patients to the next level of care.

Litter on flight line.
Enroute to the next level.
The rapid movement of patients from point of injury to a hospital in the US sometimes causes substantial disorientation for patients.  There is no gathering of one's belongings or goodbyes to their units and friends.  Imagine the shock when the soldier's last memory is lying in the dirt next to a just damaged vehicle, only to come to in a clean hospital room in the US a week later with no memory of the interim.

Saturday, January 8, 2011


After counting down midnight on New Year's Eve in the operating room while performing surgery on a Afghan Army soldier's liver damaged by a gunshot wound, we have had a slow week, and given our unit's mission, slow portends to a good year.  Don't you agree?

It is time for New Year's resolutions.  I think our main resolution is to finish the home stretch of the deployment and make it home safe.  But that seems too obvious.  Sort of like resolving to breathe, it lacks panache.  Fortunately, we have the DOD to help us out.  We watch Armed Forces Network here.  Interestingly, it is a subscription service and thus there are no commercials.  Instead, during commercial breaks we see a stream of public service type announcements, or maybe I should call them military service announcements.  "Fill Out Your Power Of Attorney Paperwork Online,"  "Gambling Can Be Addictive," "Preventing Sexual Assault Is Your Responsibility," "Obey Local Customs And Laws," "Fad Diets Don't Work," "Join the US Army European Command Band," and many, many more.  Heck there are so many potential New Year's resolutions that we can't keep up.  I wish that I could show a sample but I don't have the rights.  Not to worry because there are a couple suggestions I've found on the FOB.

Therefore, for 2011, we resolve to:

Resolving to stay alive improves your odds of keeping other resolutions. Bonus!

And if that is not enough, then one might resolve to be "The 3 B's." (I know that you think you count 4 B's but just go with it.)

Just don't BE afraid of mutual exclusiveness.
Good luck with your resolutions.

Wednesday, January 5, 2011

The Trauma Czar

The Washington Post ran a piece last week on the Trauma Czar at Bagram Air Field, or BAF as it is known in theater.  The article was brought to our attention in a recent edition of Stars And Stripes.  The gist of the article is how medical research is done in theater and what changes in clinical practice might result but it opened by lauding this young surgeon.  It is interesting to observe how the wheels of PR roll.

The air force major in the article is characterized as the trauma czar.  Often clinical guidelines are produced by the big theater hospitals like BAF without much input from 'down range.'  Then they wind up being treated more like protocols to be followed in that uniquely military top-down fashion.  Now at the risk of diminishing his accomplishments, which I don't intend, and at sounding like sour grapes, I want to point out the experience of our team.  Ted, our OIC, is on his third combat zone deployment as a trauma surgeon, while Paul, our medical director, is on his second.  They represent a wealth of experience in the field of trauma damage control surgery.  But we are a small team in a remote area of the country.  The Washington Post hasn't made it out to us.  Neither has this major.  My point is that what is printed in the press (and for that matter, blogs such as this one) usually only tell part of the story.   So allow me to toot our horn and leave it at that.

In other news, today, the 5th of January is exactly six months since the 5th of July, the day most of us left home.  We still have two and half months to go but are getting closer to homecoming.  There is light at the end of the tunnel.