Reunited

Reunion feels wonderful but it can also be unsettling. I was part of several reunions over the past few days and I wanted to share some of those.

In Germany our flight stops to refuel. Here we are reunited with the concept of having to pay for a bottle of water. This sounds funny but remember for months, our water has arrived boxed on enormous palates. We've become connoisseurs of which strange-sounding brand of bottled water tastes best...Dibba or Hayat or Oasis. Now bottled water costs us $2 from the vending machine. Also, we are also reunited with our first western-clean toilet. Beautiful. I have nothing more to say on that subject.

Volunteers welcoming a service member home.

Our plane touches down at BWI. There is an organization called Operation Welcome Home that welcomes back troops on the transports returning from the middle east. As I pass through the customs inspection they are just around the corner.  I hear the applauding volunteers. I stop.

It is the final stop for our team that came together so many months ago and has been family for that time.  It is the family that has lately been showing some warts. Tempers have been shorter. Politeness is in a more limited supply as we got closer to the end. But it has been family. So I stop there to say goodbye. Once we round that corner, we go our separate ways. I feel sadder than I would have guessed at this moment. I say goodbyes and thank you's and wishes for safe travel and pass along the navy's traditional salutation "fair winds and following seas." It is a small navy but the truth is that most of us will never see each other again.

After this I turn that corner to cheers from the volunteers. I shake their hands as I pass by. If you are ever in the DC area and looking for something to do, maybe consider shaking hands at BWI after a troop transport lands. At the end of the line, I see the first of the family reunions. Dave, our orthopedist, has met his family. The kids are hanging on his legs. He has a large family and many have made it. I stop to enjoy the scene. I will witness other reunions later in the day. Some are similar, others quiet and low key. Some service members return without a reunion, just a ride home to an apartment or barracks room.

Happy reunion

I wander through the airport feeling detached from the proceedings. Throughout the day, strangers in airports shake my hand and thank me for my service. I have not figured out how to reply to this. I appreciate the sentiment but it is awkward, nonetheless. I stop at a sports bar in the airport. Here I am reunited with a beer and a burger. I savor the taste. I wonder if the waitress knows that it is the best beer she has served all day. It tastes like home. Some kind stranger picks up the tab. I wish to thank him but the waitress tells me that the person has requested to remain anonymous. So I will thank him here.

I board one of my connections, a flight that I have just changed to catch. I am sitting in the last open seat. Next to me is a young woman. After take off, she begins to read a lacrosse magazine. The pages give reviews of each of the NCAA title contenders for the upcoming season. There are also stories about the hottest high school prospects from each region. I can tell from the way that she lingers on each page, that she is a true fan of the sport. The situation seems divinely preordained.

I am considerably introverted. I almost never talk to strangers on planes. Yet here I am, just returned from the war, sitting next to a obvious lacrosse fan and all I can hear in my head is 'Brendan Looney', about whom I wrote many months ago. Brendan was a member of what might be the first family of Naval Academy lacrosse. In 2004, Navy reached the NCAA lacrosse finals but lost to Syracuse. Brendan and his two brothers were on that team. I thought that Brendan had been an All-American but, in fact, it was his brother Steve. Knowing his lacrosse association, I am compelled to tell this woman about Brendan.

"Excuse me, are you a lacrosse fan?" opening with the obvious.

"Yes"

"Have you ever heard of Brendan Looney? He played lacrosse for Navy. They went to the finals but lost in 2003 (I get the year wrong). I was told that he was an All-American (I confuse him with his brother)."

She immediately establishes her lacrosse cred by saying "Hmm. 2003. I thought that was Notre Dame and Georgetown but maybe Navy too in the final four. I don't know his name but then I didn't really know the Navy guys so well. I'm from Ohio. Why do you ask?"

I tell her that Brendan was a SEAL and that he was killed in a helicopter crash in September in the province where I was. I tell her that he was well-known in Naval Academy circles but I am curious if he was known in lacrosse circles.

Her reply is simply "That is tragic."

Initially, there is no more said. Maybe that is the final word on the subject anyhow. Perhaps it is to harsh a thought for polite conversation. But then after awhile, she starts to ask me questions about where I've been and what I've done. She is pleasant company and it feels right to tell her some of it.  We talk for a while about the war and life choices. It is a good conversation. But mostly I just wanted her to know Brendan's name.

If You Don't Decompress, You Might Get Bent (Out Of Shape)

At least they had the sense to not say "Welcome Home."

Kuwait is the place for in- and out-processing from the US Central Command. We have to complete something called WTP in order to get our tickets home. WTP, or Warrior Transition Program, is the navy's answer to stressed out sailors returning from combat deployments. In a few days, God and navy willing, we expect to board planes for Germany and the US. 

WTP Sign

Our mission here is something called decompression. The navy's idea of decompression involves more living in open bay tents confined to a military base in a desert country with communal latrines. Feeling that stress relief? Now, we've been living in open bay tents confined to military bases in desert countries since being relieved two weeks ago but that is just quibbling. The good news is that they have some fast food chains and a bigger exchange and the weather is rather pleasant in Kuwait at this time of year.

Springle plaque from the memorial wall.

There is a nice tent that was erected in honor of CDR Charles Springle, a social worker attached to the 55th Medical Brigade, who was killed in 2009 by a soldier returning from Iraq. The tent has pergo flooring, an internet cafe, leather couches, and a large video game room with lots of realistic, multi-player war games (no joke) if you wish.

Springle Center

Decompression might be a first person shooter combat game, say XBOX HALO 3. Comfy chair is naturally the key.

We have some suggestions for the WTP. First that we skip it altogether. (Denied.) Or that it be moved from a desert military base to Italy or Germany for some real R&R. (Not going to happen.) Or finally that they change the name to WTF (By that I mean the Warrior Transition Funstop. What did you think I meant?). Funny how no one listens to us.


One last sad note. I bought a fold-up camping chair eight long months ago while in pre-deployment training at Ft. Dix. Possibly the best $10 I ever spent. It has been with me through Ft. Dix, Kuwait, Kandahar, FOB Lagman, and back to Kuwait. Alas, its journey must come to an end. Regretfully I leave it behind. In honor of my chair, I present the three pillars of deployment: chair, cigar, dirt.

Iconic pose.

Disturbing News

For the most part we have mentally left the FOB behind, but we are still watching the news especially while in theater. Two soldiers from the Second Stryker Cavalry Regiment, one of the main units that we supported at FOB Lagman, were killed by a member of one of the Afghani security groups who either switched allegiance or was a plant. Given that an Afghan security group took over base security on FOB Lagman about three months ago, while we were there, the immediacy of this incident is apparent. Additionally, the memorial wall at the navy compound in Kuwait has a plaque for LT Florence Choe, who was part of the navy medicine community and killed in 2009 in similar fashion. It could have been any one of us.

A Rocket Can Ruin Your Day

We finally made it to Kuwait which is where I wanted us to be before posting this entry. Hopefully this will prevent any excessive worry for our friends and family.

We were fortunate to never take indirect fire or sniper fire on FOB Lagman during our time there. Perhaps it is lack of cover in the surrounding country-side or perhaps the difficulty targeting a small base with crude guidance systems, but there was never a mortar or rocket attack. I don't think anyone harbors any illusions that the lack of attack was due to better acceptance of locals in our province. The closest that the FOB came to any attack during our stay was the discovery of an IED a few hundred feet from the front gate which was disarmed without injury.

KAF, however, is a different story. The air field undergoes fairly regular attacks. Insurgents usually set the rockets for remote launch, often with a cellphone, so that they will be gone once the location is discovered. As an aside, in Iraq insurgents were known to use blocks of ice as primitive timing mechanisms, as they would melt to allow something heavy to push the launch button. Anyhow, the rockets rarely hit anything of value but occasionally the insurgents get lucky. In December at least one person was killed and another wounded in a single salvo.

Sample rocket tube wired to launching device at training range.

On the day we arrived, during one of our out-briefs, the speaker assured us that, while there had been rocket attacks in the past, they had stopped. This pronouncement pretty much doomed us. The speaker happened to be a chaplain. Not sure where he gets his information.

Predictably around noon one of the days during our stay, the air raid siren sounded and a very deliberate female voice with a oriental-accent, think robotic Geisha girl, announced "rocket attack, rocket attack" over the loud speaker. Several of us happened to be hanging in our transient-stay tent, so we grabbed our body armor and helmets, and headed to the nearest bunker. We did this because, being transients, we apparently don't know any better. Many, many passerby's simply ignored the announcement and went about their business. I guess that says something about the frequency and accuracy of these attacks. Still, we were on our way home and were not looking for any extra risk.

Bunker party. Who brought the beer?

After a few minutes the "all clear" was passed and we emerged from our bunker as newly hardened combat veterans. (Wink).

We're On The Road To Somewhere

If it were up to those of us on the front, they would just pull up a 747, we'd board, and it would land at some convenient stop-off, say New York.  Alas, we do not run the show. And the power-that-be have other ideas. So we are slowly making our way home via all the required stops.

Hindu Kush. The final view.

For the first few days, we made it 300 feet closer to home. By that I mean that we moved out of our hooches and into transient tents near the FOB Lagman flight line. After only a few days delay, we then caught a helo hop to Kandahar Air Field putting us 60 miles closer to home.  By the way, did you know that all military travel is contracted through Haul-That-Herd Air Service? It's true. We can attest.

Rotary cattle car.

At KAF we have squeezed a few hours of administrative processing into several more days. No rush, it's only been eight months. Thoughtfully, our senior chief, who left three weeks early and is already home, posted on Facebook that he was praying for us. The team's consensus is that he's a saint. The upside, there's always an upside, is all the practice sitting around.

Sitting around on a flight line.

Sitting around at the KAF air terminal.

We should get out of Kandahar soon. Next stop Kuwait. 1000 miles closer to home.

Come on hitch a ride.

Spectacular Kandahar

So honestly it's not spectacular, except in the context of being 60 miles closer to home. I read the post I wrote seven months ago titled "The Spectacle of Kandahar." Spectacle is still the better description. Not much seems to have changed but we have had a few days to wander KAF, or Kandahar Air Field and I can't help make some observations.

The Role III Medical Treatment Facility is the newest, nicest building around. So much so that it sticks out. Red brick in a forest of brown tents and drab concrete.

Role III KAF.

The OR's are from another world relative to what we have come from.

Wow. Clean floor. What's that like?

The KAF Boardwalk is the central hangout. I heard that Gen McCrystal tried to shut it down before he resigned. But then he wasn't very much fun.

Ice cream, pizza, phones, and bargains for 'you, my special friend.'

 

War Memorial on the Boardwalk

You can buy cool stuff on the boardwalk.

Terror Chess. Art imitates life.

But the highlight of our visit is the site-seeing. You know rare things outside our humdrum lives...like trees,

I think that I shall never see, a site as lovely as a tree.

and bodies of water,

Three great things about this scene: 1) water, 2) greenery, 3) floaty toys (that's the Eiffel Tower way in the back).

and 'deluxe' accommodations,

It's the Ritz. No seriously, we think so.

 furniture,

Ikea, How do I love thee?

 and, of course, hockey.

Canadians and Slovaks would probably play hockey on the  moon.

How to summarize the place? Here is a metaphor seems to fit.

KAF. As delightful as a Journey concert.

Life On The FOB: Part 12 - A FOB Farewell

We depart the FOB with some unexpected ambivalence. As much as I have poked fun at it, it has, over the past seven months, become a home, a place with a familiar routine and an important mission. Don't get me wrong, everyone is anxious to be reunited with their family. But this is an experience that helps define a person, located in an unforgettable place adjacent to a remote town nestled in the Hindu Kush. We will almost certainly never it see again. Nevertheless, though we move on, for those who remain the routine persists.

Memorials are tended.

Unit coin collection continues to grow.

Construction crews continue to make improvements.

Bulldozer's paradise. So much dirt to move, so little time.

Meals are served. Latrines are cleaned (Such is the legend. The quest proceeds.) Facilities are maintained. Laundry is done.

Note to home: Honey, they did my laundry for me on deployment.

Supplies are delivered.

The Lost Ark finds a new home.

 Operations are planned. Patrols depart and return.

The job is fine but commuting is hell.

 The 'mart' opens for business. Bargains galore for "you, my special friend."

Last chance to get a special deal on that acrylic-encased scorpion that you know your spouse covets.

Troops congregate, socialize, and decompress.

Cigars, near beer, sunset, camaraderie As good as it gets...without alcohol.

I wrote many months ago that FOB life is a shared experience for veterans of combat zones. What more to say about Life on the FOB? Maybe just that it goes on.

A view worth remembering.

Death, Again

This was the post that I hoped to not write.

Today was the first mass casualty in many weeks. We were packing and preparing for departure when the knocks came on our doors. SEALs had radioed from a village that there had been an IED incident involving civilians. We assembled in the FST building to assist the new team.

Teams integrate to accept multiple patients

Six patients arrived: four adults, one boy of about 13 years old, and a newborn.

Brandi and Aric prepare the infant for MEDEVAC

The boy was the most seriously injured. He had no pulse and chest compressions were in progress. Ted and Paul joined the other surgeons to enter the boy's chest via a thoracotomy, one of the most radical resuscitation maneuvers that we perform. He needed blood delivered directly to the heart and manual compression of the heart.

Our team's surgeons assist the new team's surgeons in caring for the boy.

The team struggled to keep him alive with drugs and defibrillation shocks. There was a period when we thought that we had successfully restored his pulse and blood pressure but the boy's condition suddenly deteriorated and he died in the resuscitation bay.

Litters loaded into ambulance.

Another child's death was not the departing scene that anyone wanted. The war pauses for no one.

We Stand Relieved

We held a little ceremony to turnover clinical responsibility to the new Forward Surgical Team yesterday afternoon. The new OIC relieved Ted and the pagers were handed off to our counterparts.

Presentation of ceremonial guide-on.

We then moved out of the berthing areas into temporary rooms next to the flight line. That makes us three hundred feet closer to home. The truth is that if a plane were available there is no reason that we couldn't fly home now. We'd be sleeping in our own beds before the weekend was over. Unfortunately that is not how it works and we will spend the next few weeks making our way home via all the required stops along the way.

Some Things Change, Some Things Remain The Same

The turnover process is in full swing. Our relieving team is getting used to their drastically changed roles in medical care, that is relative to what they have been practicing at home. In the midst of this, the war goes on, the casualties continue to come in, and the stories unfold with ever new twists.

At the beginning of the week, a local national came in with a gunshot wound. He had climbed up onto a coalition vehicle and begun to attack it...with rocks. He was then shot by the vehicle's gunner. However, if you are inclined to feel uneasy about that, this tidbit clouds the scenario. The man was carrying identification that was obviously faked. He was a graying, wrinkled, middle-aged man with an id card that said he was twenty. Intelligence fingerprinted him and tried to identify him. He will survive. Maybe, if we are lucky, he will also answer some questions.

Two days later an ANA troop arrived with gunshot wound to the abdomen. His bowel was protruding out the front of the abdomen. The local ANA liason officer, who is Afghani, spoke to the unit members who came in with the patient and immediately reported the wound to be self inflicted. Unfortunately, the entry wound was actually in the back, the exit wound being the larger hole in the front. Once again in this war, clarity proves elusive.

In any event, Paul and Ted, operating together for what may prove to be the final time in theater, removed sections of the soldier's bowel and stopped bleeding while the new team observed operating room procedures, blood banking, patient movement, and the administrative flow. Real trauma is far more effective lesson than training scenarios. Hopefully, the opportunity will serve the new team well.

At Long Last, Relief!

Today is one of the most pleasant days, we have had in some time. The weather is a sunny 70's and, more importantly, our relieving team has arrived. The new team has had a long period of training and preparation up to this period. After 2 months of  transient living, they are happy to be at their final destination. Turnover begins today.

We are ecstatic to see them. Dare I say, that we can finally start the countdown to going home. Maybe not, my luck with predictions and expectations has not been good thus far so I'm retracting. No karma this time.

Okay I can't help it. Our days of latrines and porta-johns are numbered. There I said it.

Gun Safety 101

The week has been notable for a rash of accidental, self-inflicted gunshot wounds by ANA troops. Three incidents in the past week, to feet, legs, and even the abdomen. Invariably they were just cleaning their weapon when it went off. We have been trying to envision how one holds the weapon to accidentally shoot oneself in the stomach while cleaning it. Let the imagination run wild.

Over the past few months we seem to have a gun accident about every other week. We have seen the double shot, which passed through the arm and then the mandible with the round coming to rest in the mouth, and the buddy shot, as in "Whoops, sorry about that buddy." Then there was the chemistry experiment. This involved throwing some M-16 rounds into a fire, no doubt in a quest for the Nobel Prize in chemistry. The chemist only suffered a leg shot rather than death, dashing our hopes for the Darwin Award.

One of the theories that has been postulated to explain this rash of accidents, is that the Taliban have employed a secret plot. Namely, pose a threat, ensure that the other side arms themselves, and sit back while they slowly knock themselves out. At our current rate, this would seem to be a viable strategy.

Normally the last thing you would ask of a medical team is advice on weapons handling. It would be boring stuff like lock it up and keep it out of reach of young children. (We have no comment on the question of whether some of the personnel issued weapons here constitute young children.) However, in light of the current streak, I'm interrupting the regularly scheduled blogging to offer the Forward Surgical Team's Gun Safety Tips as a public service announcement to anyone willing to listen. They are:

Rule 1 - DON'T SHOOT YOURSELF.

Rule 2 - DON'T SHOOT ANYONE ELSE.

We realize that Rule 2 is not completely feasible given the mission so it has been reworked for the combat theater.

Rule 2 (Modified) - UNLESS YOU ARE IN A FIREFIGHT WITH THE ENEMY, DON'T SHOOT ANYONE ELSE.

Rule 3 - DON'T THROW SPARE AMMUNITION IN A CAMPFIRE.

Following these three simple rules will keep you, your buddy, and inquisitive chemists safe from accidental gun harm. Good luck. Now back to the regular schedule.

One of our junior officers demonstrates the EMPTY CHAMBER weapon cleaning technique.

Unveiling The T-shirt

Coming up with a unit's deployment t-shirt is a tradition in the military. Hopefully you have some creative minds and a decent artist among your personnel, not that lack of these stop anyone, trust me on that point. We were fortunate to have just such an asset. Garry Trudeau, the Doonesbury creator, became a friend to the unit after his visit. He did us a tremendous favor by designing and drawing the FST deployment T-shirt. They have finally arrived and look great.

Trying to figure out who is who.

Many thanks to him for donating his talents. We think it is pretty unique and will wear them with pride.

Dog Day Afternoon

We had an unusual request for patient care today.

One of narcotic-sniffing German shepherds from the air force K9 unit lacerated his rear leg. The nearest vet is a helo ride away in Kandahar, a bit far for simple treatment. So as jacks-of-all-trade (masters-of-none) and animal lovers (or tolerators, in some cases), we took the case. Hey, it was something different. After a quick teleconference with the vet, we make quick work of the wound.

Dog iv on the floor.

Paw and fur specialist at work.

I think we qualified for honorary membership in the Afghanistan Veterinary Society, Zabul Chapter. That, and a Scooby snack.

Don't quit your day job.