"The White Cloud"

Today began with the excitement that our fellow surgeon Joey T (aka “The White Cloud”) returned from FOB Salerno; this FOB is located in the Khost region of Afghanistan; where Pat Tillman was killed. He left us temporarily to assist their FST during a busier than normal time; it’s nice to be back to full force especially because we expect our volume to increase in the near future.  Joey T and I are both surgical staff at Fort Knox and have a great friendship from working the past year together prior to deployment.  Being my first deployment into theater I have to admit my stress level was slightly subdued to the comfort of this relationship, and I think it would be apparent to most here that this translates into our working relationship as well.  

Following morning report the consults poured in with fury.  All were U.S. soldiers and one of them did need surgery for a fracture of his thumb; unfortunately after discussing the soldier’s situation with the command at Baghram the case quickly was stolen from me for infection concerns at our FST.  I understand the reasoning but felt depleted as another day of boredom would result.  I started the process of sending the soldier but he ended up not leaving today because of weather between us and Baghram.  Over the last 10 years a lot of studies have been done on patient outcome from surgery in theater. The consensus is there is an increase in the infection rate due to the nature of the severity of the injuries we treat and the fact that some real virulent strains of bacteria are present in this environment.  As such definitive surgical procedures on U.S. forces are restricted; only emergent cases can be done. Afghan National Army (ANA) and Afghan nationals are able to have definitive surgery by us if we don’t compromise our primary mission of emergent treatment of our troops. 

It has been 1 month since I entered this theater and days are starting to run together in a assortment of mental images; routines rule life and detours from them are rare. It’s easy to find yourself growing irritated with vices and quarks of others that originally were tolerable.  Social science has shown this to be the case on multiple occasions when people are isolated for long periods of time without physical access to the surrounding world in boring redundant daily conditions.  Hopefully our surgical volume will increase to bypass time faster.  Joe J and I are actually trying to form an alliance with the local Afghan surgeons so we can bring some of their more complex cases to our FST so we can mentor them. This really is a win-win scenario considering we get to perform more surgery, we improve these surgeons’ skills, and the Afghan population receives modern care from us and from their surgeons into the future.  There are many difficulties for this process including implants and other medical supplies but we are working on different possibilities to overcome these obstacles. We have included our friends on the Special Forces side to help form a conduit of communication with local Afghan providers; were moving at a slow pace but it’s something. 

Trauma did not rear its ugly head so far today; likely because our friend Mr. “White Cloud” returnedJ. The night is still young and we’re ready. Talk to you soon.

P.S. I love you Melissa, Turin, Talon and baby Myla.

M