Pictures

It’s 2 AM and I’m laying restless in my makeshift wooden bunk. My thoughts are flying faster than I can catch them; my emotions are on overdrive.  My wife has been emailing me pictures of her and my children.  Common sense says this is a great way bring enlightenment to your days, but for me it only deepens a void within me.  To me these pictures are not just a thousand words; they are a thousand reminders of memories not formed, times I’ll never be able to make up. My kids are growing up just like any other children, but without their father.  They are devoid of a man who loves andb cherishes them greater than any other, and who would protect them from harm at all cost.   Six months is an eternity when you are a father.

Sleep was tough to take prisoner last night and 7:30 AM has now approached. Another day has sprung, throwing me into my daily fate.  Fortunately I’m not in a rush this time; an alarm clock was my wingman. I grab my favorite caffeinated beverage, kick my iPod to Queen and begin my day with a smile.

The way I look at it my days can be divided into 3 types: heaven, hell and shades of gray. The events of the day will determine the type.  Heavenly days to me would be boring non-traumatic and simple days, but possibly surgical lifesaving as well. There are no lotteries in this place, no luxury beach vacations; just hard reality. Hell days don’t really need explanation, but if you need one look up Hell in a dictionary. The last and likely most common would be shades of gray. These encompass the typical working day with multiple levels of bull shit; the level of shit correlates to the shade.  I assure you all three will be experienced, hopefully some more than others; I prefer the smell of roses if you’re wondering.

I saw my first non-emergent patient at 9:30 AM. She was a U.S. army 50 caliber MRAP gunner and tough as nails. This was a patient that was transferred to me from the previous orthopod for management of a foot injury. She is determined to quickly get back to her unit and it is apparent she is healing at a similar tempo.  This soldier is characteristic of many I encounter.  There is an unwavering connection to her unit, a bond strong enough to challenge family connections.  The notion of “leave no soldier behind” is a way of life; especially here when life can slip away at less than a moment’s notice. I can’t describe in words how motivating this is to me as a physician. It emotionally connects me to patients, something we are taught in medical training to be careful of; sometime rules are meant to be broken.

Late morning approaches and Joe J and I head to the gym.  Unlike most days today is different; it’s the start of “Ramadan”.  This is a religious time, 30 days long, where the Islamic culture abstains from eating, drinking and tobacco use from sunrise to sunset.  To show respect the U.S. army requires soldiers to not do the same in the presents of an Afghan unless in designated facilities.  There have been provoked attacks on U.S. and coalition troops in the past for not respecting their religious culture; I don’t plan on stirring that pot anytime soon.  It’s obvious to me their work intensity from previous days has decreased, but with the temperature hitting 108 degrees and no hydration I would expect nothing different.

At the conclusion of my workout I receive a call from our commander about a local Afghan that was at the front gate of our FOB.  He had surgery for an improvised explosive device (IED) injury 8 weeks ago at Bagram.  He was here for follow-up.  I agreed to see him once the usual personal inspection was performed by the military police (MP’s).  This inspection is a very thorough body search and scan for weapons, bombs and implanted IED’s.   Insurgents have gone to great lengths to evade our detection and this included implanted IED’s in humans, animals, and any other imaginable object organic or nonorganic. I’m informed the main injury was to his left arm and hand and that he still had retained wires that need to be removed.  He is sent to X-ray and I head to the FST to evaluate him.  Once I arrive he is lying on a hospital bed with every FST member around him; with snazzy drills, saws, plates and screws who doesn’t get excited about orthopedics?; ok maybe they were bored. 

Our interpreter “Rocky” is present to help me communicate with the patient.  Rocky is a                       non-intimidating skinny 20 year old local Afghan who speaks excellent English. He insists I use “Rocky” because he assures me I can’t pronounce his real name.  I tell him he reminds me of a famous movie star in the U.S., who played a boxer, and he told me I was full of shit; I think we’re going to get along well.

I quickly disappear to X-ray to view his films, form an opinion and return to see the patient.  This man appears well nourished which is not typical of the local Afghans we see.  I examine the patient and find he also had extensive skin grafts which appear to have taken.  Joey T (general surgeon) debrides one of his wounds and I remove 3 of the 4 wires from his hand.  This gentleman was extremely thankful to our team which meant a lot to us. I later learned he worked with the coalition forces driving a truck carrying supplies to surrounding FOB’s; this is how he was injured by an IED.  Trust is at a minimum here on the FOB, but may be with time it will grow and two cultures will attain mutual understanding; at least that’s my hope.

Talk to you tomorrow.

P.S.  My precious son Talon, Daddy is sorry he missed your very first day of preschool today.  When you dream tonight please leave room for me. Dream Daddy was there holding your hand, and I will do the same.  Please forgive me. I love you.

M