Ja Jestem Polskim żołnierzem! (I am a Polish Soldier)

I became an honorary member of Poland's army yesterday. A few of us from my unit were given the Star of Afghanistan bearing the seal of the President of the Republic of Poland. The President had visited FOB Ghazni in December following the tragic deaths of six soldiers in two days, and some of the members of the Polish medical team had recommended the award in appreciation for our help during that time.

I hope you will not think me unpatriotic if I say that this is the most meaningful award I have recieved on my deployment. From my perpsective, it means a lot because it is tied to an event that is important to me personally. When I saw the bodies of those Polish soldiers, I felt that they were my brothers as much as any U.S. soldier was- they had given their lives for the safety of all of us on the base.

There are countless awards, certificates of appreciation, and commander's coins given to you in the military, and very few of them hold any personal significance to you. This is one I will keep in my office, wipe off every so often, and remember my Polish comrades.

Who Needs a Reason?

It's been a while since we've done any kind of social activity with the whole unit; it's so cold and snowy people mostly stay in their rooms. But I got as many people together as I could today to celebrate an important day: our replacements started their pre-deployment Combat Skills Training in New Jersey today. One step closer to going home.

We made pumpkin bread, brownies, and pizza on the grill, thanks to many generous packages from my family. The board game saga of Officers v. Enlisted continued with Pictionary tonight. The officers won both rounds, bringing our record to... 3 wins, 12 losses

Mostly I just wanted an excuse to get everyone together and have some laughs. I will occasionally go days without seeing my teammates, because the work tempo has slowed so much, and I worry about people just hiding out in their rooms with no one to notice if they are happy or sad. So I needed a reason to get people out.

...and a reason to make the cookie-brownie Supreme Bars my sister sent me!

Am I too old for this?

Is there an age at which one is no longer allowed to frolic in the snow? I still see snow and think, "of course I'm supposed to jump headlong into that snowbank. That's what it's for." I'm not sure I have an excuse to act like this when my children are half a world away. I really miss goofing off with my kids! Yet I couldn't allow 24 inches of fresh snow on a sunny day go to waste now, could I?

Maya, Luke and Seth- your Dad is still a big weirdo bombeirdo!

Boots: Marching on

There have been some gloomy days recently, between the holidays away from family, the cold weather, and the slow tempo that makes us wonder, "what good we are doing here?". During our morning meeting, I was reminded of why I am here.

Army Specialist Menard belongs to the "Fightin' Fifth" 5th Engineer Battalion based out of Fort Leonardwood, Missouri. His commander in Ghazni (at his left shoulder, see Dec 8 Milestones post) visited him in the hospital to present him with his service medals, and forwarded some photos to us here in Ghazni. They are my favorite deployment pictures.

When I first saw these pictures, I didn't even see the medals. For me, his marks of bravery jumped out at me from his body. Do you see the hole in his neck? I couldn't get enough oxygen in him becuase blood was pouring out of the breathing tube I placed. So I asked the surgeons to cut a hole in his neck to see if bypassing his larynx would help us stop the bleeding from his throat. I fought to give him oxygen through that hole in his neck for two hours, my hand never leaving that tube in his neck. My textbooks tell me he should be brain dead from the lack of oxygen. I don't know how much he will recover, but a smile and thumbs up is a start!

Do you see the scar on his chest? Right through that opening was where I saw his heart stop, where I prayed and waited anxiously to see if the drugs, shocks, and blood would somehow start his heart up one more time. And each time it did. I am so proud of that little heart! It just would not quit and kept on fighting back to life. I'm glad it's safely behind his ribs and skin again, quietly pumping his blood without needing our hands to squeeze it.

I hope one day he'll be walking around without a hole in his neck, his scar hidden beneath his clothes. I like to imagine that one day he could be mistaken for an ordinary person were it not for his medals. Maybe they will help others understand that he is a hero. But I knew it a long time ago.

No One Was Hurt

A large fire started outside of our supply pods today. Last week, we had piled about 300 boxes of medical supplies together to donate to another Forward Surgical Team that is just starting up. The truck was going to take them at about 1100; the fire occured at about 0100. It looks like the fire started outside and then heated the metal walls of the container enough to ignite our own supplies inside. Luckily, no one was hurt, the fire did not spread to the ambulances parked 10 feet away, and we are still able to care for patients.

Investigators are still trying to determine how it started. The fire started in the middle of the night, in 19 degree temperatures, away from any electrical equipment. So one of their first questions was, "who did you tick off recently?" All of us immediately thought of the soldier who showed up last weekend too drunk to stand, but drunk enough to pull out his weapon and aim it at the Polish medics who brought him to us. Something like that gets you a date with the MPs and the base commander. As cute as it seems on MASH, having a distillery in your room is really not that endearing when you carry automatic weapons around.

Hopefully the fire was just a freak accident.

***update: The fire marshal found an IV fluid warmer battery that was melted, and he thinks that was the source of the fire. Sounds weird to we that a battery sitting on a shelf for months decided to spontaneously combust, but his guess is better than mine.

My Cup Runneth O'er (I Hope Not)

Some of you have expressed curiosity about how certain things work around here given the snow, lack of indoor plumbing nearby, and recent evacuation of portopotties. I understand some may afraid to read on, but for those of you not too yellow to continue, I will sprinkle some knowledge onto you. Or should I instead compare this torrent of learning to drinking from the fire hose? Most of us try to drown out nature's call during the night, but sometimes one feels practically bursting with motivation to go with the flow. Here are a few of the readily available means to contain one's...excitement.

The most obvious option is the good old fashioned water bottle. You cannot travel 100 yards on the base without going past pallettes of these. Readily available, certainly water tight, but the narrow opening requires a high degree of markmanship. Capacity: 500 mL, good enough for one midnight session, but not much more.

One step up from the entry-level models is the Gatorade bottle. Not as ever-present as the water bottle, but still easily obtained from the cafeteria for free. Slightly larger capacity at 591 mL, but more than one voyage and you'll have to change boats midstream. Most importantly, the wide opening relieves the anxiety of all but the most self-impressed.

Some of you must be thinking, "Don't you work in a medical facility?" One would guess that products made for this purpose would certainly be the best. Indeed, one of my "peers" prefers this model because it accodomates over 1000mL and has a large glow-in-the-dark lid. Which opens easily with the slightest push.

But as far as deployment durabilty is concerned, we haven't even gotten our feet wet yet. And we don't ever want to, which is why I swear by the medical irrigation bottle. Holds just as much the "other guys" but has a level base and symmetical shape so it stands more solidly. I've had to depend on the watertight screw-on cap more than a few times, so I recommend placing it under, rather than beside, the bed as an added precaution.

Furthermore, as tempting as it is to just roll over in bed and lean over the side, I cannot vouch for any system that does not involve a well balanced, standing approach. And don't think that keeping the lights off will help you get back to sleep faster, or that you can judge the fulness of the container by sound alone. One rogue shot or depth miscalculation will cost you ten times the amount of sleep you thought you were saving.

Females are not automatically excluded (imagine a funnel flattened sideways) and a few report "a hard time imagining going back." Most claim they do what they have to do to survive deployment, but afterward it's all water under the bridge.

Some may argue that the line of good taste has already been crossed, but the convenience of these home remedies has inspired some to creative, if distasteful, efforts. Knowing that I like to build things, one of our technicians approached me about the feasibility of drilling a hole waist-high in the wall, and running ventilator tubing down to the ground under the dorms. I like to tell myself he was kidding.

I have also heard reports of larger containers being, um, dual-purposed to meet all of one's needs. It's going to have to get a lot colder before I seriously consider that option.

So, there it is. You can either soak in the knowledge like a sponge or let it fall like water off a duck's back. But if you were worried before about being outside "the know", don't worry now:
"you're in"

(this post dedicated to the Edmonds, my sisters Becky and Lisa, and The Red Fox, an old family car)

I was running!

Sometimes you check the box on a goal even though it wasn't exactly what you had in mind. I didn't run a marathon, and maybe I never will. But since I ran a half marathon today in 23 degree weather, at 7200 feet, over junkyards full of gravel (not to mention chronic bowel issues from the local cafeteria- TMI?) I'm calling it good enough, and allowing myself a little satisfaction.

This is a big deal for me; before deploying, I had probably never run more than 3 miles at one time. 8 was the farthest I had run before today. But I psyched myself up, made a playlist of killer music, and ran. Here is a synopsis of my thoughts:

mile 0.1: This is it! I'm off! I'm doing it!

mile 1: What did I get myself into? Why did I tell everyone I was running a half marathon today? Oh yeah, to make sure I didn't wimp out. Too early for thoughts of bailing out, let's do this thing.

mile something: I'm not even going to track the distance for now. Switch to Forrest Gump mode, and just run until Dana says it's time to stop.

mile 6.5: halfway there. A little leprachaun jumping heel click to celebrate, then back to zoning out to The Eagles, Led Zeppelin, and some workout music Jen sent me. I still don't know if I'm going to do this thing, but I'm feeling pretty good right now.

mile 8: This is it- the furthest I have ever run. Crash through that mental wall, we've got miles to cover...

mile 10.5: OK, Body, huddle up, conference time!
Neck and Shoulders, you guys quit whining. I don't want to hear about you guys getting sore when all you do is hold Head up. Head needs to groove to the music a little, let him have his fun.
Heart, you're doing great. Let's keep those coronaries open. Maybe now is a good time to think about forming some nice collateral vessels for when a plaque ruptures someday. Not a good time? OK, you're busy, just file it away for later consideration...
Intestines, I don't have much to tell you. If you make me stop I'll be disappointed in you. Cowboy up and just do the best you can with that chicken from last night.
Legs, love you guys. "Who's my favorite muscle group right now? That's right thighs, you are! You are!"
Ankles, I was a little gung ho over those rocks earlier. I'll do better about stepping around them, but you gotta hang in there no matter what.
Feet, we've been through this. Even with double socks, Toes are going to get a little crammed. We're in ten dollar Wal-Mart shoes over ugly terrain, I know you're going through a lot. But throwing a blister tantrum only punishes you, and nobody likes a drama queen.

mile 11.5: Thighs, I was wrong to give you the impression that our relationship was a friendly one. Sorry, but I'm the BOSS and you do what *I* say, got it? We're not going to like each other very much the next 48 hours, but we are going to finish this because you're not here to like me, you're here to do a job. Stop complaining and get back to work!

mile 12.5: I wish Dana hadn't told me the distance. As soon as Body overheard it, everyone thought it was 4:30pm on a Friday and they could quit early. A little help from Parliament Funkadelic gets us through to the end.

mile 13.1: I DID IT! I ACTUALLY DID IT! HAHAHAHAHA!!!

My trip outside the wire

I got to go off base today for the first time since arriving in Afghanistan. I went scuba diving with my daughter. I can't remember her ever starting lessons, but she had her certification already so we went to Hawaii. Not a stellar diving day because we didn't see any Hawaiian cleaner wrasse or Picasso triggerfish, although the parrotfish and yellow tangs were still quite pretty. And the weather was absolutely gorgeous. Jen and I savored the warm lush scent of a brief summer rain in the sunshine.

I woke up to the sound of helicopters. The scene that lay before me did not compare well with my tropical adventure. Overnight it had snowed, and the portopotty outside my room had been taken away and not replaced. Stupid helicopters.

A Sad Day for the Polish and Americans

Today was the worst day for casualties that anyone can remember. Five Polish soldiers were killed in an IED attack on the highway. The EOD (Explosive Ordinance Disposal) crew said that it must have been planted weeks ago before the ground froze, and the insurgents may have been waiting for Christmas time to detonate it for maximum effect. By the time they got to us, none of them had heartbeats.

I helped them place of the soldiers in a body bag. I won't describe it except to say that even his crewmates couldn't recognize him, and it was disturbing even for those of us who work in battlefield trauma bays. When you're praying for the U.S. soldiers, take a moment to include the Polish ones and their families as well.

Just Trauma, No Drama

People told me about the "wall." It's that time 3-4 months into deployment where you are off the high of things being new and exciting and you just hate life and each day drags on. I have been steadfastly denying the existence of such a thing, because it reminded me of people saying things like "once you go through med school you'll stop caring about people's suffering," and "after a few years of marriage you'll get tired of each other, just wait..." (Thanks, Debbie Downer, for the insights but guess what? Dr. Wilde still suffers from a serious case of the hots for Jen. The whole "first year's jellybean jar" thing? Fuhgettaboudid)

I am still practicing denial about the wall, but I think I did put my foot through the screen door this weekend. I have been working all week to finish the shelving in the Lyons Den so when one person wants to make a snack, they don't have to feel sheepish about interrupting the movie that's going on in the same 10ft by 10ft room.

I had this crazy idea that when I finished the shelving and countertops, I would get to put things where I think they should go. I built the spicerack only four inches deep, so it wouldn't jut into your face like in the old room. It had this fanstasy of putting spices at eye level (instead of the 7-foot shelf like before), and using the Szegedi paprika Jen sent me to make my favorite dish in the whole world, chicken paprikash.

I measured the space for the microwave, the toaster oven, cut holes for the cords, meticulously cut vinyl flooring to use as a cleanable countertop and shelving surface. I constructed a slide-down curtain from a tarp, to cover everything up in case we need to use the room for a mass casualty. Saturday at 1130pm, I called it a day.

By 10am Sunday, I had already missed my chance at claiming my turf. What adorned the the spice rack? Five kinds of creamers and twenty flavors of coffee. The space for the toaster oven? A kettle full of coffee already brewed. My pitiful attempt at indignant defiance was to place my one little can of paprika by the sugar before heading to church.

Church #1: Protestant services. Four of us from the FST (two Mormons, one Baptist from Compton, one Methodist from Tennessee) make up the choir. We use a projector to let everyone know the words to sing during the eclectic mix of hymns and contemporary worship songs. Today, we couldn't find the projector, the nurse who usually sets it up gets called in to take care of a patient, and when we do find it there is no extension cord. I run from the chapel to the FST to get one while the preacher stalls by asking, "all right, I know there are some MORE prayer requests...let's hear them..." The songs some twenty minutes late.

I have time after practicing for our New Year's program to grab a quick lunch of disappointing honey-sausage taquitos (yes, they are as unappetizing as they sound) before Church #2: LDS services. Jared and I give the sacrament to each other and watch the Christmas Devotional. We don't get to hang out aftewards and sing Christmas hymns like last week because we get called back to the FST to meet some Lieutenant Colonel Whatshisface who is our new commander in Bagram that we will never see again. Salutes, speeches, gladhanding, blahblahblah. I am glad to be a lowly Captain that has no leadership responsibilities whatsoever, so I slip out.

1600: maybe the day will turn around. It's time to practice my favorite Christmas song, O Holy Night. We missed practicing the last two Saturdays because of traumas coming in, so I really want to get our little quartet together to work on the harmonies (or harnomies, as Jen's family likes to quote from a movie I don't know). But this is a no-go because the Polish are setting up for evening mass. Their musician pulls out a flesh-colored sphere that is uncomfortably reminiscent of female anatomy and jokes "five dollars to touch." Not the uplifting experience I was hoping for.

So I decide that darn it, I'm going to practice O Holy Night by myself in the iso-shelter (a medical container pod no one is in 23.5 hours of the day) because I love the song so much. I get through two verses when Ryan, who is my best friend here, comes in to restock the books for United Through Reading, where you videotape yourself reading children's books and send the disc to your kids. I step out to use the restroom, only to remember that all port-o-potties within half a mile have been removed because they are changing companies this weekend. By the time I walk through the 30 degree air my fingers and spirit have lost all enthusiasm at practicing the song on guitar.

I make the mistake of noticing Paprika's Last Stand was a losing battle; it is back in the old room.

So I eat dinner and do the only thing I know how to do when I am bitter and irritable and feeling anti-social. I take a nap.

I feel much better now, and talk myself through my emotions. I do not hate the world, I do not hate people in general. I don't hate coffee drinkers. I built the shelves for everyone to enjoy, and 20 of the 22 of us drink coffee, so it makes sense to put it on the low shelves and countertops. I do not hate the Sabbath Day or the people worked on moving the food over while I was at church. I should be happy that they took the initiative and helped out instead of waiting for me to do it.

I don't hate patients, projectors, extension cords, Polish musicians with portable silicone mammary glands, my best buddy Ryan, children's books, or people who don't appreciate the difference between sweet Szegedi paprika and cheap McCormick peppery paprika, and the reasoning behind four inch shelves.

I am simply having a bad day because I (can't) sleep fifty feet away from the helicopter pad, live my life within 1 square dust-covered mile, have not seen a healthy plant in three months, can't help my wife change diapers, and feel bad that my daughter asked Santa for a "transporter to Afghanistan" so she can visit me for Christmas and not have to cry when she misses me.

So, after my nap, I am awake at 2:47 am recounting the good things of the day: We haven't been rocketed recently, I am safe, family at home still loves me, God is there, the internet works today and I can read emails from my family, Jen sent me the volleyball I wanted for Christmas, they had provologne cheese at the cafeteria today (so I can make pizza this week), one of the Polish medics brought me two pieces of frozen chicken to make Paprikash with, and one of the techs shared his wife's cookies with me. And our trauma bay sat empty the entire day. So it was a good day after all.

Still trucking,
Matt

Hump Day!

Today was my halfway point. Three months down, three to go. The actual date I leave isn't really known yet, but it was still kind of a symbolic milestone. Because today had a little bit of everything in it, and was a good sample of "A Day in the Life of Matt in Afghanistan."

0900: Local Afghan Clinic. Busiest day since I've been here: 139 patients, all seen by one doctor. Recent orders came down that I can't see non-trauma patients as a provider of medicine, so I took blood pressures and sorted pills for the Afghan doctor. Two of the nurses, Melissa and Amy, help me make hygiene kits with toothbrushes, toothpaste, combs, washcloth, soap and lotion to pass out to patients on their way out.

1115: radio call comes out that a wounded soldier is coming. We walk quickly from the clinic 1/2 mile to the trauma unit.

Am I crazy yet, or did I just see a goat on base? Apparently capturing a goat is the Army's way of telling the Navy they are going to beat them in football today. No time try to make sense of that now, so I continue back to the trauma bay. Only one patient with a minor injury. Ryan, the other anesthesiologist, was on call and took him to the operating room.

Mail has come in the mean time. Pretty darn good day: 17 boxes! Yes! Can't wait to open them when I have some time. Some goodies for me, lots of donations for the clinic. But now I have to get ready for the next event of the day.

1300: It was Denise's birthday, which we celebrated at FOB Ghazni's only alternative to the cafeteria, "Oasis." It is and Indian restaurant with some Afghan influence. Like Tex-Mex, only...Indiafghan? I had the the tandoori chicken, and garlic naan. Pretty good eating for $7 a plate.

Yes, those are facial tissues being used for napkins. As soon as our food is served, another radio call "FST all, report to duty station." We quickly box our food and prepare the trauma bay again. Three casualties, one of them in shock from and IED blast. He gets a breathing tube placed, a chest tube on each side, and lots of blood, then to the OR. But he keeps oozing blood. Nothing beats warm, freshly drawn blood from healthy volunteers with plenty of platelets.

I took this picture 2 minutes and 39 seconds after the call for a blood drive over the public address system.

By 5 minutes, I counted 80 people with this patient's blood type lined up to give blood. You can see people running to us to give blood. This is the kind of response you get when people hear there is a fellow soldier is in trouble. Luckily we only needed a few units of blood, but we thanked them all for coming.

1730: patient stabilized and transferred to Bagram. Time to clean up the trauma bay and OR.

1800: move furniture, entertainment center, and TV into our new building so we can watch a movie for Denise's birthday. Connect wires, and drill hole through walls for TV wire so we can watch college football after the movie.

1845: I sneak off to the iso-shelter, take the toaster oven with me, and make clandestine chocolate chip cookies with the hand mixer and ingredients my wife and sisters have sent me. This is a bit of a risk, because this is where the blood drive took place, and since Denise is the nurse in charge of blood transfusion, she's liable to come in and look at records or something. I give Caitlin, another nurse, strict orders to keep Denise occupied whatever it takes.

1925: Ding! Birthday cookie checklist: Surprise? Check. Denise has no idea that I even had ingredients. Warm cookie smell emanating from plate? Check. Milk to go with cookies? Check. Time to go create some magic. "You made WHAT!? How?" Pretty sure I gained some leverage in the friendly turf battle Denise and I have had over what to do with the space in the new building (she wants yoga space, the guys want some gym equipment). And yes, I make baking cookies manly, because I did it while wearing a 9 mm pistol in the middle of a war zone.

2000: Movie time. Denise has been asking for weeks to watch "Elf." I persuade the guys that for her birthday, even college football can wait a little bit. It is the first movie to be seen in the new building we have been working very hard on.

2140: Man time. This is a special, almost sacred time where a few men get together with football playing in the background and discuss what construction projects need to happen next. Internet cable for the Wii for sure, we'll need some state flags and sports banners, maybe a neon beer sign for the new lounge. We'll need to barter our extra heating units for some more flooring material, build some benches, fix the sliding door, and so forth. Of course, these important isuues are best discussed with drill and hammer in hand, even though it's late and we have no intention of using the tools anymore tonight. Years of rich man tradition dictates that the one holding the measuring tape gets his turn to talk, and it would be a serious breach of etiquette to interrupt him until he puts it down.

2230: Family is getting their morning started back home, so time to Skype and see what Jen and the kiddoes are up to. Jen is taking Maya to the Nutcracker, then making cookies, then bringing them to the church Christmas party, all while battling a cold. Maya showed me her new cookie book she got from Olivia, Luke is playing Frogger with horribly chapped lips, and Seth bounced around a lot excitedly and says some things that are very important, if unintelligible.

0000: Midnight, past my bedtime. But if I don't blog the day now, I'll forget it tomorrow.

0056: OK, seriously time to go to bed. Good night, Ghazni. I'm on the downhill slope of the deployment now, because Hump Day is in the books!

Milestones and Reflections

I went to a change-of-command ceremony for the Route Clearance Patrol unit at FOB Ghazni. This is the sapper unit that clears bombs from roads in Afghanistan. Their commander was relieved by his replacement on the anniversary of Pearl Harbor, Dec 7th. I respect this commander a lot because he is always there to support any of his soldiers that come our way. I've had him hold pressure on wounds, tape IVs in, cut off bloody uniforms, etc. (When you are in my trauma bay, I don't care who you are. There is a bleeding soldier and I need your hands. I've drawn some sideways looks by asking the commander of the entire base to help carry a litter. I felt vindicated when he thanked us later for letting him "be with my guys.")

This unit has cleared 19,000 km of roads, been the victim of over 50 explosives and 39 firefights. One of these firefights was an Taliban ambush of 120 against their own 30, in which all of the US soldiers survived. You can see in the background the Afghan National Army unit being trained to someday clear roads on their own.

The outgoing commander acknowledged the generals, colonels, and command sergeant majors briefly, and then spent over 3 minutes of his 10-minute speech thanking the FST (Forward Surgical Team, my unit). This was a touching surprise, as we are usually the embarassing Air Force stepchild on the Army base, because we do things like sport mohawks for a few hours, and shoot stuffed animals at the range. But there is sort of a special bond between our units: they appreciate us fixing them up when they are hurt, and we really appreciate them going out everyday to face hidden explosives.

Even more welcome and unexpected was some news about one of his soldiers. The blood on my "boots" came from a soldier belonging to this unit (see Sep 29 entry and http://www.katc.com/gallery-images/pfc-bret-j-menard/20/) as did three other fallen soldiers pictured earlier in this blog. I learned that PFC Menard is not only still alive, but sits up in a chair, motions for his glasses to look at pictures, and will soon have his tracheostomy (tube in his neck to help him breathe) removed and start speech therapy. I lost count of how many times this hero's heart stopped, and somehow fought back into a rhythm again. But it was at least 6 or 7 just during his time here.

This made my day.

As I near the midpoint of my deployment on Dec 10th ,my thoughts also turned to Sgt Lyons, ("Sacrifice, Oct 26, http://www.dvidshub.net/news/79695/seaside-park-native-killed-eastern-afghanistan) whom we were not able to save. I still grieve for him and his family, and still admire his bravery for choosing a job as dangerous as his.

We are almost finished constructing a new building to expand the amount of patients we can take in the event of a mass casualty. I say "we" because the contractors built the structure but my team has to build the walkway and finish the inside. I cut the last of the flooring material today, and hope to glue it down tomorrow and start building shelving units next week. I have proposed to my team that we call it "Lyons' Den."

"Big Brother"

In earlier, less realistic times, I had made the life goal of one day running a marathon. That is not going to happen. I am, however, training for a half marathon in January. Our executive officer is about as crazy as my sister Sarah and her husband Garrett when it comes to running: running less than 6 miles is a bad day, acceptable is at least 10. She has been my running coach, asking me every day what time we're going to run, how long, etc. I've learned that I have to be decisive and firm about setting limits because I have to quit after about 6 miles, and then she'll just run in place next to me, looking at me like, "ready to start running again?"

No, Dana, that's all I have. You go ahead, knock yourself out with 6 more miles in 40 degree weather. I'm done.

I was taught in cultural awareness training back home that the men here respect womanhood and value respectful distance during interaction with any female, fearful of insulting her honor and reputation. I'm sure my teachers are correct, but Dana and I sometimes have a different experience when we run. All of which is an unnecessarily long introduction into the events of today.

Today was especially bad. There were 6-8 local men sitting on top of a cargo truck sitting quietly. As we jog past, they all stare unabashedly at her and point and holler like they just saw Elvis. It was as if seeing a redhead in shorts was some kind of visual catnip for them and they just went nuts! I couln't help it. This is not how real men act towards a woman. I stopped in my tracks, turned around, removed my sunglasses and looked right back at them. "Is there a problem?" I hollered back, in a tone that I hope conveyed my annoyance clearly (I was feeling pretty brave because I know Afghan civilians are searched for weapons before coming on base, and there was a group of US soldiers across the street, each of them carrying an M-16 or larger weapon). They immediately looked away, and pointed to a pretend object in the opposite direction, as if to convince me that what they were *really* looking at was a dust-covered hill that they somehow just became aware of in all its drab brown majesty. Whatever, guys, I don't speak your language but I'm a man and I know a cat-call when I see it.

Nodding to them as if to say, "Yeah...that's what I thought!" I turned around and kept running. They had disappeared by the next lap.

Probably the least culturally sensitive thing I've done since I've been here, but I'd do it again tomorrow in a heartbeat.

Yoga in Ghazni

I have done a lot of new things here: build furniture, anesthetize cats, sleep 50 feet from a helicopter landing zone and now yoga. One of the nurses is very into it, and thought it would be relaxing, fun and a way to let go of some bitterness that sometimes happens when you spend several hours everyday in stressful situations and in company you didn't choose.

It was a lot of fun.

My favorite is the "tree" that you can see above. If you need to bring your focus in your own feelings, you close your fingers. If you want to send out some peace and tranquility to others, you spread your fingers. Mine were spread very wide and pointed toward the nursing dorms.

A Bomb in the Road, a Fork in the Road

We had our first pediatric patient today. A boy appearing to be about 8 years old (most Afghans do not keep track of their age) came in with his thumb and all of the skin on his palm blown off, and a military tourniquet around his arm. As they brought him onto my trauma bed, he looked up at me with stoic brown eyes, trying to be brave despite being surrounded by people with uniforms and guns cutting his clothes off. I tried to speak to him in a soft voice and got some help from our interpreter in reassuring him that we are trying to help him. He asked us, "Can you fix my hand?" We told him we will try.

As is always the case, we treat first and try to put the story together afterward. So once the kid was stable under anesthesia, our executive officer began gathering info from the medics and the "uncle" who accompanied him. Uncle is a term used loosely like in Polynesia, where any adult male family friend is an uncle.

Depending on which story you believe, this orphan boy was either pressed into service by the Taliban to make home-made explosives (which would explain the skin stains on his hands) and plant them in the road so they don't have to, or he was gathering scraps of wood for a fire when he uncovered a land mine (also possible; Afghanistan has the most mines per square mile of any place on Earth, and some of the Soviet and Italian models look a lot like Tinker Toys). In either case, I don't blame the kid for being in the wrong place at the wrong time. I blame people who think it is okay to put bombs in the ground to hurt random people.

The orthopedic surgeon did the best he could to stop the bleeding, but said the child's hand will probably never be functional and most likely need to be amputated within the next few weeks. I wish I could give him his hand back, and give him a home and a family. But I can't. So I gave him what I could: a compassionate anesthetic, some clothes (from the Operation Desert Blossom shed), and a contribution with my other team members for taxi fare to Kabul Children's Hospital.

I don't know if he's too old to overcome hatred towards Americans or not. Will he grow up raised by the Taliban to make explosives, or will this be the event that makes him turn away from them? Will he believe the Taliban if they tell him he will be rewarded in heaven for killing U.S. soldiers and citizens, or decide he wants to find out for himself if a new government will protect him? Will there be anybody around to help him shape his future?

I don't know, but I am going to give Luke and Seth a big hug when I get home.

Another project completed...

My biggest project yet: an entertainment center for our lounge. An oversize desk had been serving as the place to put the TV, Xbox, Wii, DVD player, and other random junk that people just throw onto unoccupied counter space. I am guilty at home of filling up table space with junk mail, bills, school reports, and random tools I forgot I even got out.

So now that I know the people who control the wood around here, and have collected a decent stockpile of tools, I'm pretty much spiralling out of control. People are talking about builing a gym enclosure next, and asking me to design it...not sure I'm ready for that yet, but after a couple of days break I probably won't be able to say no.

Why is Kitty So Sleepy?

Animals are the Hillary Clinton of military bases. No one feels lukewarm toward them. Some hate the feral cats and dogs that wander the base, and some love them so much they sneak food to them and let sleep in their room. So the recent campaign to euthanize all the animals at FOB Ghazni has polarized the troops.

The issue came to a head last week when all the cats were collected (and no, you can't herd them) and lined up to be put to sleep. Unfortunately, it was on Sgt Fernandez' birthday, and she names and feeds all the cats, and referring to the one named Bella as "my daughter." As in, "I've got to check on my daughter and make her dinner," etc. So after the first cat was euthanized, there was a dramatic and tear-filled campaign to stop the killing. It was like "Occupy Cat Street." The Sergeant Major got involved, overruled the Infection and Vector Control unit, and the cats were freed under the condition they get fixed by the Polish vet. It was the Forward Operating Base equivalent of a Presidental Pardon. Huge deal.

In any case, Bella got fixed and needed her sutures removed a few days later. Sgt Fernandez was very anxious because her daughter would not hold still to let her remove them. I was joking when i said, "well, there is an operating room with an anesthesia machine not being used..." but Sgt Fernandez' face was so hopeful that I couldn't backtrack once it escaped my lips. Not after the birthday she had, which was ruined not only by "Feralgate" but also because we had to cancel the cookout due to rain, had severely injured patients come in, followed by a blow-up between the factions among the nurses.

Since I didn't help in the cat crusade, my gift to Sgt Fernandez was to help her get Bella's stitches out. So we went to the operating room, performed a "Final Time Out" to positively identify the patient (Bella), the surgeon (Sgt Fernandez) and the surgical procedure and site. I couldn't help but grin as I said, "and we're performing a removal of feline sutures...under general anesthesia!"

Then Bella got a mask full of anesthesia gas, made a sound like she was very angry, in heat, or both, and difted off to sleep until the sutures were out. It was my first animal anesthetic.

Halloween in Ghazni

We made the most of a pointless holiday in a foreign country, on a base where children are not allowed. And we had a great time. During the daytime, a bunch of us from the Forward Surgical Team went reverse trick-or-treating, knocking on doors and handing out Halloween bags of candy. Americans, Polish, Afghans, and others all got some candy. It seemed like most of the locals had been here long enough to understand that October 31st means free candy.



Later there was a Halloween party at the dining hall. I expected very little from it, but I thought I should go out of social obligation since the staff had worked so hard decorating the place. Those of you who remember my teenage years will not be surprised that I was among the first on the dance floor when "Ice, Ice Baby" was played. Did I request Billy Jean and do the Michael Jackson dance, throwing my military cap to the side after a high kick? You KNOW this!

Sacrifice

A few hours ago, that one line was all I had in me to write. But there is more I want to share about the soldier who gave his life today, and about my time with him. He came to me with no pulse and did not react to my inserting a breathing tube despite giving him no medication. We all knew he may not live long, and that his brain had probably already stopped functioning. As we condsidered whether to go on with treatment, the surgeon said, "we're going to get him to see his family" as he opened the chest with a scalpel and massaged the heart in his hands. I gave epinephrine, and there was a feint but definite pulse.

We rushed him into the operating room to control the bleeding from the main arteries to the legs, both of which were torn open. The surgeon firmly took the hands of a terrified 22-year-old surgical technician and placed them around the patient's heart, talking him through how to squeeze the heart as the surgeon himself placed a clamp around the aorta, and hurriedly sutured the arteries. And so I found myself trying to reassure this kid who joined the Air Force to be a mechanic, "Keep it up, you're doing great. I feel the pulse in his neck when you squeeze like that. Good job." "I don't know what I'm doing! I'm scared s***less!" was his panicked reply. Even through the surgical mask, I could tell the color was gone from his face. So I tried my best to help him see that he, more than any of the doctors, was keeping the patient alive.

Soon freshly drawn blood arrived, some of which was from the base commander who happened to be the same blood type, and some from his buddies on his team who were with him an hour before, when he found a detonation wire for a bomb. Perhaps the enemy wanted him to find it so they could shoot him from their sniper holes. I imagine some of his buddies were the ones shooting back, and some were the ones carrying him to safety, but they were all there to try to give blood.

Even with all the blood I gave him, and many kinds of heart medications, his heart just wasn't squeezing enough on its own for him to be stable for long. I gave him what little anesthetic medications I could, and found myself talking gently in his ear. "Partner, I'm so sorry if you're feeling any of this. We're doing surgery on you, and I can't give you very much pain medicine right now because your heart is too sick. Just hang in there." The other anesthesiologist is my friend and a devout Christian, so I asked him to pray quietly with me. We asked God to bless this soldier so he won't hurt, bless all of us taking care him to know what to do, and bless his family back home. Then we quickly went back to infusing blood as fast as we could get it from the many volunteers.

When the wounds were all repaired, they sewed him back up as I gave him more and more heart medications. We took him to the recovery room, and the surgeon asked me,
"Is he stable enough to fly?"
"He has a chance, but the longer we wait, the lower it is."
"That's not the question- can he fly or not?"
Well, if I'm going to err, it's on the side of optimism. "Yes. Send the helicopter."

The helicopter did not even have time to get off the ground from Bagram. I was wrong. He was no longer responding to the heart medications. I can't tell you how hard it was to say, "Cancel the helicopter. Stop giving the blood; we have to have save it for someone it might help. Tell his friends outside to come in and see him because he is going to die soon." I hate this decision. The surgeons have done all they can do it fixing his wounds, and it's my job to say we either keep trying to make his heart beat or declare it futile, and save resources for others. I know it's the right decision. And that doesn't help at all.

His heart kept trying to pump for few beats at a time, only to get weaker afterwards. We turn off the loud things like the suction machines and ventilator to give his friends a more dignified setting. I breathe for him quietly by hand and ask my collegues to help me clean him up a little bit before his friends come in. We can't look at each other because we are in varying stages of holding our emotions together. I tell the patient how proud I am of him, how I have a family back home that is safer because of his bravery, and how he is surrounded by friends that love him. I don't know if he can hear me or if it helps him. It helps me.

One by one, leather-skinned, battle-hardened soldiers come in. Some kiss his forehead, then have to walk out because they are overwhelmed. Some stay and talk to him, and caress his forehead or pat his shoulder gently. One of them is the other patient on his way to the operating room for his own surgery. They place their stretchers side by side, so he can reach his bloody, bandaged hand across the gap to touch my patient's face and say goodbye.

My co-workers ask me if I need a break, but understand when I tell them that I want to be there with him through everything. I feel his pulse stop, give him his last breath, nod silently to the nurse to note the time, and let his friends know that we'll step away to give them privacy and time.

I went to the ramp ceremony tonight, where they load the coffin draped in a flag onto the helicopters. No bright lights are allowed to prevent enemies in the surrounding mountains from knowing people are gathered. I can only see a few feet in front of me, but the sobs and shuffles on gravel from many directions tell me that much of the base has gathered here. We render salutes to a hero's body hidden in the darkness, carried by his friends. "Somewhere up there is the soldier I spent the day with," I think somberly to myself. Soon we hear the roar of helicopter engine, and I see blurred silhouettes of two helicopters rising in front of me. A brilliant flare in the sky makes them invisible, and renders its own dazzling salute to the fallen hero. The desert wind sends a chill, and everything inside me feels cold.

Sacrifice

Two American soldiers were brought to us today. We saved one of them.