Saturday, July 30, 2011


Sleep.  I’ve desired it for days and last night I held it captive for 7 hours until it escaped.  I feel refreshed, renewed and now positive thinking is trickling back into my being. I rolled out of bed, set my iPod to Jimi Hendrix, crack open a red bull and begin the day with a slight smile on my face.
 I never thought I would be content living in an 8X8 plywood room, but in these circumstances I could not be happier.  It’s my new shack away from home. This is the room that has been past between orthopedic surgeons for years as noted by their individual hand carved last names in the makeshift wood desk. In 6 months my name will added too, solidifying this life experience.  It’s obvious that previous inhabitants added their personal touches along the way. What will I add? If my wife was here this room would be renovated to the highest interior design level. Custom carpet, the highest quality paint, and a feeling of home; she’s always good at that. In my hands, simplicity prevails; a Phoenix-Fly tee-shirt on the wall.  I miss my wife. 
Today we began the transition of our team taking over forward surgical responsibilities from the previous unit. This is also known as “Relief in Place/Transition of Authority” or “RIP/TOA” in the military community. I quickly met the outgoing orthopedic surgeon yesterday and today he will school me with the in’s and out’s for FOB (forward operating base) survival.  As a surgeon on a FOB I cannot leave, thus I have been told I will be considered a “FOBette”. It’s not a gratifying name, and I have been told the “special forces” soldiers will surely make light of that, but my family could not be happier. Our FOB periodically gets attacked, but the majority of injury and death occurs on the outside the gates; usually on tactical missions.
What the military has really excelled at over the last decade is the echelon system of evacuating a soldier out of the theater. In this system a wounded soldier starts at a forward surgical team (FST) for triage and lifesaving stabilization. These are located at strategic points in the theater that conflict is most likely to occur, and they cover a set geographic location. Our forward surgical team (FST) is composed of 20 medical persons including doctors, nurses, medics, and operating room (OR) techs. The soldier is then moved to a combat support hospital (CASH) for further stabilization and some definitive treatment (depending on the severity). A “CASH”, is usually associated with a major military base in the country. This is followed by transfer to Germany, and then to a medical center (MEDCEN) within the United States. As you progress through these echelons the medical treatment capability increases.  If needed, soldiers can be transported through the complete system of echelons in about 48 to 72 hours; which has saved multiple lives.  My priority is US military and coalition troops, but we also support the Afghan national army (ANA), and occasionally the local Afghan population. I’m not sure how I feel about it at this point, but I may be responsible for treating an insurgent as well; following the Geneva Convention doctrine.
The first order of business was a long and tortuous briefing about varying responsibilities for FST members.  I was then introduced to the facility, orthopedic equipment and implants that are available to me, followed by computer training.  For being in the middle of third world country this is a modern medical operation.  At the end of our discussion we were told we would be doing a mock mass casualty tomorrow.  This will be our last step before our team takes over complete control of this FST Monday.
It’s been a long day and I want to capture more sleep. I’ll talk to you tomorrow.
P.S. I love you Melissa, Turin, Talon, and baby Myla.

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