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.
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.
Belated Rush Reviews…
It's been nearly a month since I saw Rush in Houston and Austin on a Saturday and the following Wednesday (Apr 19/23rd). The delay is more work/life related on my part than a lack of desire to post a review. Both shows were great, and I won't post as detailed a review as from last August as the show was mostly the same with the exception of a few set list changes and a new video before the second set. I am probably in the minority of people who aren't as happy with the set list changes because I really was happy to hear Entre Nous and Circumstances as I had never heard them live before (and they are both great tunes). They decided to go back to a few classic staples since this second leg was hitting several cities that hadn't been on the tour itinerary in several years. The other deletions are Secret Touch and Distant Early Warning. I'm a big fan of Vapor Trails (and Snakes & Ladders) so I was also disappointed for them to remove Secret Touch.
I recently read Neil Peart's book "Ghost Rider" which took place in the interval between the death of his daughter & wife (both occurring within a year's span) and details how he rode his motorcycle for thousands of miles over the next few years as part of his recovery process. In the text of the book are many literary references, but the main focus of the book is sort of an autobiographical travelogue with intermittent flashes of his grieving process in the form of narrative as well as reprints of many letters he wrote during that time. Dispersed throughout the tome are several slices of what would eventually turn into the lyrics of the next album (VT). After reading it I gained a new appreciation for many of these songs (as well as his lyrics in general). Gives me a new level of disgust at the blogger who ranked him (Neil) as the second worst Rock lyricist of all time.
Here's the new setlist:
Setlist:
Video Intro (features all 3 band members)
Limelight
Digital Man
Ghost of a Chance
Mission
Freewill
The Main Monkey Business
The Larger Bowl (with McKenzie Brothers intro)
Red Barchetta
The Trees
Between The Wheels
Dreamline
Intermission
Video Intro (What's That Smell? features all 3 members, Jerry Stiller)
Far Cry
Workin' Them Angels
Armor And Sword
Spindrift
The Way The Wind Blows
Subdivisions
Natural Science
Witch Hunt
Malignant Narcissism
Drum Solo
Hope
The Spirit of Radio
2112: Overture / The Temples of Syrinx
Tom Sawyer (with South Park intro)
Encore:
One Little Victory
A Passage to Bangkok
YYZ
Video Outro (Alex, Neil, Jerry Stiller)
It was great to see them, especially in Austin. They played the Frank Erwin Center in the theatre setup which seats about 8000 total. The acoustics and the intimacy of the indoor environment allowed for a perfect live setting. I think it will be better to space the shows apart because the novelty did wear a little bit since it had only been 5 days between shows. I think the perfect schedule would be to see them about three times per tour with at least a month between shows. I would also try and see them in as different an environment as possible. I think for the next tour (I feel like they have at least another album/tour in them) I will try to see them somewhere like Red Rocks or The Gorge in Washington, Vegas, and somewhere in Texas.
New Music Appreciation Post
So I've been on somewhat of a new music surge (at least compared to the normal for me) as of late. I think it started when I downloaded several songs on Neil Peart's house music set list (the one they play before the shows) from Itunes. Among the groups I was newly exposed or gained a new appreciation for were: Porcupine Tree, The Mars Volta, The Tragically Hip, Jeff Buckley, King Crimson and early Genesis. Porcupine Tree especially hit a nerve with me and I subsequently have bought four albums by them. I especially like "Fear of a Blank Planet", "In Absentia" and "Deadwing". For reasons I'm not quite sure of, I also finally bought "Hunky Dory" by Bowie. I always liked the tunes from that album (Mick Ronson was a key player/producer) and I'm not sure why it took this long. I had been listening to "Life on Mars" repeatedly after hearing it a recent movie ("Life Aquatic with Steve Zissou?"), and decided to get the album.
I also recently bought albums by Amy Winehouse (Back to Black), Sheryl Crow (Detours) and Robert Plant/Alison Krauss (Raising Sand) but have only really got into the RP/AK effort. In my explorations I also got to checking out Itunes mixes by other users. These are basically just mix tape made by other Itunes users, but the nice thing is you can search them by keyword. So, in my typical music preference vein I searched for sad or melancholy mixes and actually found a really good one that has several tunes that I have grown quite fond of. Some of the artists on the mix were: "The Weepies", "State Radio", "City and Colour", "Jason Reeves", "Gregory and the Hawk", and "Cocunut Records". It's a really great mix tape and I'll be checking out the other stuff from these guys in the near future.
Thank you sir, may I have another?
Unfortunately for many Rush fans in Houston and New Orleans, the shows got swapped to make way for the NBA playoffs which means Rush is playing Houston on Saturday the 19th instead of Sunday the 20th and there a lot of people trying to get rid of tickets they can't use now. On that note, I saw a deal on some Houston tickets for about half what they were going for before the date change. This is still a markup from box office, but it's so much cheaper than it would have been, and now with the show on a Saturday instead of a Sunday, the opportunity was too good to pass up. So we're now going to see Rush in Houston in two days (11th row on Geddy's side) followed by the Austin show on Wednesday night. Fan-frickin-tabulous if you ask me. And you did, you did.
A Classic…
This has been around for years, but it deserves inclusion in the musical humor hall of fame:
Deja Vu all over again…
For months I have been saying that I would be cutting back on my concerts with an extended vacation coming up and some inflationary belt tightening. However, the day is drawing close when Rush will be playing Austin on the 2nd leg of their Snakes & Arrows tour. A few days ago I was sitting in my office thinking about the upcoming concert and realizing I would be one hour's drive away from a Rush concert and I was missing it to sit at home and watch TV or something else extremely worthwhile. I knew that wouldn't work, especially since I'll have no chance at seeing shows for 12 months (e.g. Yes in August).
Rumors abound about set list and overall show presentation changes and upgrades for this leg. Foremost (at least in my mind) is the rumor that perhaps an entire album will be played and the leading candidates include Hemispheres, A Farewell to Kings, and Moving Pictures. While I have serious doubts as to the veracity of these predictions, I am still entertaining the idea of hearing an entire album from the vault. Oh yeah, for those who recall the dancing of the gloat, here comes the 2nd verse (same as the first):
We're not quite as close as the last show, but this time we're in the middle front floor section and being on the 11th row will probably mean a better sound mix.
Oh, sweet nectarishness…
So, in a fit of uncontrollable concert fandom I just broke down and scored some tickets for an upcoming "2nd leg" of a well known concert tour (at least if you read this blog). Since I don't have the tix in hand, I'll withhold on the full disclosure until I can post some scans for your viewing pleasure (you know who you are)…