What follows is a very scrunched and degraded version of a few clips of my current home. I'm limited by bandwidth and the fact I'm using a military network. You will probably need Quicktime to watch this. More professional (read, interesting) clips will be put together in the future, but I don't know if I'll ever be able to upload them while deployed. They'll probably be put together after I return to the states. The best part is, I'm putting them on this website as opposed to forcing everyone to watch them during the holidays. See, I am thoughtful.
Filtering by Category: Army
Is that a tube in your chest…
or are you just happy to see me? A couple of action shots of a guy who had what was apparently a shrapnel wound to his posterior thorax that resulted in a hemopneumothorax (blood and air in the chest cavity, compressing the lung). We started an IV, gave him some pain meds & antibiotics, and I placed the chest tube seen here. We evacuated him to our forward surgical team and he's doing well according to reports. Yeah, I don't exactly look professional in that first shot, but we tend to joke around a lot during traumas, especially after we have stabilized the patient and know that they're going to do alright.
I had assisted with a few of these during PA school, but this was the first trauma patient that actually needed a chest tube that I put in myself. During OIF 1 we just never got anyone with penetrating chest trauma that really needed a chest tube. It's surprising just how hard you actually have to push to penetrate the pleural lining, but it's very obvious once you do. After penetrating and opening the hole up with hemostats there is a great rush of air (in the case of a pneumothorax) and blood (if there's a hemothorax as well) and the patient usually immediately begins to breathe easier, which this one did. That also explains the last picture (I probably needed a face shield). I'm sure I'll get several more under my belt before I'm done here.
More action photos…
These are 3 pictures from when I tapped a kid's knee last week. The first is me prepping the knee, then it's me and SPC Strain not posing, and finally Dr. Paresh Patel (the battalion surgeon and an ER doc by trade) also not posing. The tap was negative so we ended up just treating him for an overlying cellulitis that resolved after a few days.
The vacant stare and protruding tongue are products of Ketamine, an anesthetic agent that works very well for short procedures. We have to use it fairly often for young children because they get so distressed by the environment and the procedures we perform here. We use local anesthetics first, but they usually still get very upset by the process so we often sedate them. These kids get what I call the "Ketamine Stare" where they lay with their eyes open staring, but they are unaware of what's going on. I put on a little Pink Floyd first and with the Ketamine onboard, send them to the Dark Side of the Moon.
A new month
It's now September, so another calendar month is gone by. August was a fairly good month in retrospect. I left Jalalabad on August 6th and came to FOB Blessing which has turned out to be a positive change in most aspects. I'm pretty happy with the living arrangements, and I have settled into a comfortable routine here.
In the last month I have seen more serious trauma than I saw during my whole OIF deployment. That statement must be qualified by the fact that we didn't have a steady supply of local nationals that we were seeing and Iraq hadn't really heated up yet during my time there. After four years in Occupational Medicine I was feeling pretty rusty on trauma management, but just a few weeks here can knock a lot of rust off. Yesterday, I placed a chest tube in a local national that was hit by shrapnel and then we evacuated him to Jalalabad for further care.
Things to look forward to in the next month include the completion (hopefully) of the new dining facility which will result in the relocation of the MWR facility to the former mess hall area (which will allow more room) and possibly a small PX being put into the previous MWR facility. September and October are still fairly busy from an operational standpoint, so we will probably continue to get a steady flow of trauma patients.
The return of gator boy
Just a follow up post on our favorite freezer bag wearing local national. Or should I say, local ninjanal. Here he is getting his sutures removed, obviously in great distress and in fear for his life. I wish all kids were like this.
Here's a closeup of his laceration, well healed after about 8 days.
More Pics from Blessing
Some assorted views about the camp. The first is the view out the back porch of the aid station. The area below is a volleyball court and the wall is the perimeter for the main camp area. Outside the wall is the small flight line where helicopters land and they store fuel and other supplies.
The second picture is the of the little shop and ANA (Afghan National Army) meeting room which is adjacent to our front door. The shop sells mostly copies of movies and music and assorted electronics. I hear he can get about anything you ask for if you give him a couple of days. So far I haven't broken down and bought any movies (they're 2$), as we have plenty to watch on our computers and in the aid station.
The third picture is of my living area. Narrow to be sure, but it's actually pretty functional. The nicest thing about it is it's my own private area and it's part of a room I share with our doctor and platoon leader (both of whom are very good neighbors so it's nice and peaceful). I have my little sitting area and a place I can play guitar, use my computer, etc. at floor level. My bunk is up high and I've got a small light for bedtime reading. There are plans in the works to get the local carpenter to build a desk in the back (where the 4 drawer chest is located) and build a frame to keep the bunk up high. Our platoon leader already has this setup, so we should get it eventually but we have to wait for other higher priority projects to get completed.
The last picture is of yours truly during one of those deployment highlights, the opening of a package from home. Aeyoung sent a bunch of candy and school supplies for the local kids, but she didn't forget about me and included a lot of nice toiletries (awesome towels) and some music and game magazines as well as snacks. Everyone looks forward to the resupply flights that come about every four days in the hopes of getting mail from home.
The Zen Masters of Afghanistan…
or ninjas, or firewalkers, or whatever other badass pain insensate icon you can compare to these kids. Here’s a couple more of our stalwart local patients.
The little boy with the interesting headgear and gator (it was raining and we needed to keep the dressing dry) was hit on the top of the head with an axe, according to the story we got. Luckily, it must have been a very lightweight axe as it only penetrated the skin and didn’t reach the bone. He was completely lucid and not showing any neurological defects during the hour he was with us. I threw some stitches in and off he went. He got the gator because he sat there as stoic as a supreme court judge the whole time without complaining or moving. Yeah, these kids are tough. We still get the occasional hysterical screaming kid, but we get more of these kids with zen like patience and bearing.
The little girl behind the old man lost her right eye and suffered shrapnel wounds to her face and leg. I treated and stabilized her initially and then we evacuated her to the forward surgical team where she stayed for a few days. She is on a list to get a replacement eye prosthetic (glass, I think) which will probably be performed in Kabul when it eventually happens. She was another monk like patient; she cried a little bit but otherwise didn’t squirm or fidget during the whole process of cleaning up her wounds and bandaging them. Normally we would have sedated her, but since she had head trauma, we couldn’t give her anything that would cloud her clinical picture.
She’s too young to realize the magnitude of her loss, but the day this picture was taken (about 10 days after the event) she was smiling and playing with her sister and responding to me when I talked to her.
The toughest kids in the world
These children in Afghanistan have a very hard life by any standard, especially by Western standards. Almost daily we are seeing children with significant burns, blunt and penetrating trauma, or infections that have progressed much farther than they would in the US. This little girl is about 3 years old and she was burnt when she apparently knocked over a boiling tea kettle. She was brought in about 12 hours after it happened. We sedated her and cleaned up her burn and dressed it. We arranged for her transfer to a burn center in Kabul and she flew out yesterday. She'll probably do okay in the long run, but it's hard to see these kids going through all the suffering they do when some simple safety measures could prevent these accidents.
My wife is more popular than me…
and she’s not even here. Aeyoung sent a big package that I received yesterday and it had quite an assortment of candy and snacks that she asked me to give to the children that come into our clinic. As the picture below proves, she’s now held in high regard by the locals. The jury is still out on me since I usually am approaching them wearing gloves and carrying syringes and scalpels. It’s amazing how comparable a tootsie pop is to fentanyl.
Some more pics…
Here are some more pics. The first is a view from our flagpoles out into the Korengal valley below. The second picture is of our trauma treatment room. The third is a little girl who suffered arm and hand burns after turning over a pot of boiling liquid.
I’m in demand…
This is a picture of the front door to the aid station at Camp Blessing.
I’ve been in Afghanistan for about five weeks now, the last two at a new base with a different battalion after one of my peers had to be replaced. I was moved to one of the infantry battalions at Camp Blessing, which is in a more remote and contentious area in A-stan. I actually find the life here much preferable to the last place I was at (Jalalabad). The weather here is a bit cooler, the aid station we occupy is a permanent cement structure that keeps the temperature cooler and more stable around the clock, and everything that I would need to do is within about 300 meters walking distance (aid station, dining facility, gym, laundry, bathroom). We see mostly local national children here and we get to do surgical procedures mostly on a daily basis. Lots of abscesses and skin infections with the occasional trauma thrown in. In the two weeks I have been here, we have had two mascals (more patients than we can treat at one time) although in both cases there were only two “serious” patients so both the doc and myself were able to manage them within our scope. We’ve intubated four patients, and put in four chest tubes (one guy got two). We’ve seen everything from shrapnel, to GSW (gunshot wounds) to MVAs (motor vehicle accidents).
We also see alot of kids with burns and other questionable blunt trauma injuries. It’s not uncommon for children here to be running around open fires with cookpots full of boiling water and other dangerous substances. Safety practices are essentially non existent so we see alot of stuff you wouldn’t see in the states. Personal hygiene is also not a priority here so we see alot of infections that wouldn’t normally occur in the US. I wouldn’t have thought it, but I find the work here quite agreeable. I normally prefer the steadiness of occupational medicine but there is definitely a different vibe to seeing people with true objective illness and injury as opposed to the typical sick call patient we see in the US. When you see a 6 month old kid with an eyelid full of pus the size of a golfball, it’s not even a question as to whether or not they deserve your attention. So many of the problems here are correctable with an intervention or two so it’s much more satisfying when you treat them and then see them get better. And they are almost universally appreciative for the help.
This is opposed to the typical soldier on sick call who has some sort of minor musculoskeletal issue that will only get better with time and a small amount of effort/common sense on the soldier’s part (which is often lacking). There are plans to get a new PA to replace the one that left and theoretically that would mean I get sent back where I was, but I am beginning to think it would be better to remain here. The work is real, the living is better, and time is going by faster while I’m here. Time will tell.
The first few weeks…
are now gone by. I am currently in Jalalabad, Afghanistan working out of a consolidated treatment facility colocated with a forward surgical team. We have moved two different times already, and are due to move again when they finish building new housing and a clinic. That’s due to happen in Sep/Oct but I will probably miss it as I am getting ready to backfill for a provider from an infantry unit that is being sent back to the states. Hopefully I will still have connectivity where I’m going, but I won’t know until I get there. I intend to upload some photos and video when I get the chance.
Staying Connected
I type this post from a MWR (Morale, Welfare, Recreation) center on Bagram Airbase in Afghanistan. I’ve been in country a few days after a 22 hour journey from Texas. We’ve been staying in tents and going through some required inprocessing and training. We are due to depart for our permanent(ish) home for the next 15 months later today. Right now things are really heating up in Afghanistan as they cool down in Iraq. Just two days ago there was an insurgent raid of Taliban and other foreign soldiers on a small outpost (this is all over the news, btw) which resulted in 9 American deaths and 15 American casualties. It’s the largest and deadliest attack on US forces in 3 years. We will be providing the medical care at the base where the 15 were evacuated to. They were stabilized and then evacuated onto a military hospital in theater. I’m still not sure how to feel about the way things are going. In some ways I am motivated to hopefully be part of taking the fight back to the enemy and making the Taliban and their allies pay for this attack. Right now I’m also mostly just wanting to get to our permanent home and to get settled into a routine. I’m still not sure exactly where my permanent home will be, and probably won’t know that for several days. And of course that can easily change as the mission changes. I will continue to update the blog with entries and later with photos once I can get full connectivity.
The countdown commences…
I leave for my extended sojourn in a few hours. It’s now nearing midnight on the 10th of July. I expect to be gone for 15 months, returning in October of 2009. I plan on regularly updating this blog when I get the chance, if I have connectivity. If I don’t, this may be the last post for a long time. I appreciate all expressions of support and prayer from those who gave them. I will be keeping in touch as best I can.
Yes, I’m still alive
It's been a tumultuous couple of months courtesy of my employer. I've changed duty stations, changed units, and gone on a couple of "field trips" since my last post. I returned yesterday from a trip to California which featured lots of sand but unfortunately, not much water. I'll try and update more here in the next few days as time allows.
Molehills
I'm sure everyone of us has many opportunities in their professional and personal lives to interact with people who tend to focus on the irrelevant. The old saying "making a mountain out of a molehill" is unfortunately still valid. In my work especially, I deal with mostly adminstrative medical evaluations for employment and it seems to be a near daily occurrence that someone in the process will decide to focus on a point that is trivial to everyone else in the world (except them) to the exclusion of the truly important issues at hand. In my line of work, it's often more trouble to put someone in their place as opposed to just patting their hand until they go away and dump their molehill on someone else.
On a related subject, it's painful yet sometimes fascinating that you will get patients who are much more concerned about some administrative aspect to their exam as opposed to the fact that you are telling them they need to change their lifestyle or they're going to die before their 60. The typical response you get is something along the lines of "Ok, I realize that I'm overweight, hypertensive, diabetic and at imminent risk for a fatal heart attack in the next five years if I don't stop smoking, overeating, drinking, not exercising, etc. But is this going to keep me from working overtime this weekend? Because I really need to pay for that new bass boat." Not to mention people who get upset because it's such an inconvenience for them to come into the clinic once a year for 2-3 hours to have an exam that is a condition of their continued employment. Most of them don't consider that their health should be more important to them than it is to us, but that's usually not the case. The unspoken but very common philosophy is work until you die, even if you could extend your life by twenty or thirty years with a few lifestyle choices.
Career possibilities
My most recent foray into the wilderness provided ample time to ponder the next few years ahead, especially in the realm of career moves. Currently I am scheduled to move to Fort Bragg, NC later this year (time tba) and should be going on an OEF (Afghanistan) tour next year for approximately 15 months based on current info. After my return I should have about 14 months left on my current contract and at that point I will probably have a better idea of what the next few years after will hold (US political landscape specifically).
Ae Young and I have discussed our options and preferences and at this point I am leaning towards signing another 4 year contract if I can negotiate a career move that's acceptable to us. We have decided that geographically we would most like to go to Germany. We haven't been stationed there, and we both would like to travel to points of interest around Europe, the Mediterranean and the former Soviet Union.
Currently I owe the Army 3 1/2 years, which would put me at 23 years time in service. If I sign another bonus contract, then I would be obligated until 27 years. Another option is pursuing a PhD in either Public Health or Education, depending upon the needs of the Army. That option would probably extend my career until 32-33 years active duty by the time school and contract were completed. That's another one of those choices that are too early to predict. Right now I think that retention is pretty good, at least in the PA ranks. With the recent bonus option, I think they have managed to stabilize the numbers, but the long term is still tough to predict. The majority of people who took the bonus will be due to exit at the same time, mostly in October 2010. That will also likely place a premium on assignment choices as everyone will probably be using the threat of retirement to negotiate for better assignments. If everyone asks for the more desirable postings, there won't be enough to go around.
I have my concerns that the Army in general is setting itself up for a big fall in retention numbers when the majority of the active force has been on multiple combat tours. I think retention was initially steady since soldiers were allowed to get tax free bonuses if they reenlisted while deployed. The problem is that most of these reenlisting soldiers were on their first OIF tours and now they are paying the price of multiple OIF/OEF tours, mostly measured in terms of losses. I have a feeling that the initial jubilation of getting a large, tax free bonus will be greatly tempered by the realization of the eventual cost in life and time away from home, family and pursuing life goals.
Ah, collective punishment…
how I miss it. The military has decided to cut off access to multiple "social" sites, like myspace, youtube, etc. as a means of preventing unwanted information getting leaked by soldiers. The intention is understandable, and these targeted sites are probably the most likely places that a large number of soldiers could inadvertently (or not) reveal classified or sensitive information. The opportunity for those leaks still exists, but the likelihood is decreased now. Still, I can't help but remember my days as a young enlisted soldier when the screw ups of a few led to punishment of the many. I can't argue the logic that these sites aren't mission essential and can lead to decreased bandwidth for more relevant traffic. It does add more to "the suck" of deployments, though.
Off to the woods…
I'm taking a little camping trip at the behest of my buddies in the federal service. I'll be away for a short while but will return with renewed vigor for all things civilized. That will initially be focused on the running water, electricity, non-dehydrated food, you get the picture. Once the hierarchy of needs has gotten past the rudiments I'll be back at the electric lobotomizer. I'll take lots o' pics of trees, dirt, field expedient latrines, etc. so no one feels left out.
April Showers
actually the weather is quite nice today, but we did have some serious rain this weekend, so the official mowing season has arrived. And that's just FAN-FRICKIN-TASTIC, MAN! Seriously. The annual milestone inspection has essentially passed at work and we did pretty well without any serious deficiencies. Everybody has probably breathed a big sigh of relief and returned to their functional levels of ambivalence. I know I have. (anyone from work reading this should disregard that last statement as me just trying to sound cool and get back to something more productive than reading my blog). :) Aeyoung and I are looking forward to two weeks of leave starting next week with 5 days in Vegas. We haven't traveled much since we've been married (not counting the work sponsored relocations) and since I'm going to be going on an extended leave of absence next year, we want to take advantage of the time we have. The sad part is that we probably won't be doing any gambling other than throwing a couple of coins in a hotel lobby slot machine. We're not so big on giving money away with nothing to show for it. We plan on checking out the Grand Canyon, Hoover Dam and whatever looks interesting in Vegas that week. We'll probably watch a few shows and just relax.