"Hearts of Greatness"

Yesterday morning I was informed a Soldier would be seeing me after our morning report for injuries sustained during a mission the night before. This Soldier was different though, he was furry, cute, and showed his appreciation through licking your face and wanting to play. His name was Gizmo and he was an 80lbs Special Forces Belgian Malinois work dog.  This pup injured himself during a mission on steep rocky terrain when he slipped and fell injuring his front right side which has caused a limp ever since.  There are no orthopedic veterinarians in our region of Afghanistan so I happen to be the next best thing; after meeting Gizmo I think he agreed.  I examined him and localized his pain to his shoulder and paw.  We needed to do X-rays to further evaluate my new patient so our FOB vet gave him a mild sedative.  Once he was in a calm state we positioned him and radiographs were taken.  Fortunately for Gizmo he had no fractures and likely just contused his shoulder and paw.  His sedation was reversed and specific instructions were given to his handler which included an oral anti-inflammatory. Gizmo will follow up with our vet after 2 weeks of recovery to clear him for future missions. It’s not every day a patent of mine licks me to show their thankfulness, but as long as their cute and furry I don’t mind.

This morning I was barraged with consults and follow-ups.  It took me some time to catch up but eventually I succeeded. Sergeant W was one of the more interesting stories today.  He was sent to see me after sustaining a knee injury in a high elevation mountainous area; actually too high for a medevac helicopter to reach him. He spent more than a day at an extreme elevation waiting to see if a Blackhawk could reach him but after a period of time an airlift was not in the cards. So through rough steep terrain 2 fellow soldiers had to carry him down to a location where the altitude was amenable for a Blackhawk to reach him.  The trek took his comrades 12 hours of effortful hard earned sweat, but gallantly they succeeded and Sergeant W was medevac to our FST. I never got to meet these 2 helping Soldiers and likely will never have the chance.  They were a part of Sergeant W’s unit and he informed me that a beer back in the U.S. will not suffice; he will be buying a keg. I don’t think he will ever live this event down. Call it a hunch. After evaluating him I sent him to Germany for an MRI of his knee for further radiographic investigation.  This Soldier will likely end up back in the U.S. for surgery but his long term prognosis is excellent.

Tomorrow is going to be a memorable day for me.  I recently was promoted to Major and the ceremony will be tomorrow at 11A.M. An in theater deployment promotion is definitely a morale booster for me. I have been notified some special guests will be present for the event and feel honored. I decided the officer that will lead the ceremony will be Major Joseph Jennette one of the general surgeons on the FST with me.  Joe and I have become very good friends over the last 2 ½ months and I anticipate for the rest of our lives.  There is something about friendships that develop in theater.  It’s an intense stressful period of time in your life unlike anything the civilian world can match.  Your life is always in jeopardy, and there is not much comfort material items can offer. The only comforts are trust in the man/woman next to you going through the same experience. This trust comforts you, motivates you, and brings everything out of you. No Soldier left behind is a real mantra of life out here. I’m not on the other side of the wire like the real heroes in my opinion but I feel it.  There is a common patriotic, spiritual and emotional bond between us all and it can’t be ignored. If you’re listening or not it will eventually overcome you and instill greatness in all hearts within its grasp; it sure has mine.

I miss you Melissa, Turin, Talon and baby Myla.

M

"The Life I Left"

It’s been a long 2 ½ months since I left my family and previous life back at Fort Knox.  I left my new born daughter Myla when she was 2 weeks old and now she has past 3 month and her new smile doesn’t have daddy’s face for reciprocation. My boys Turin (4 yrs.) and Talon (2 ½ yrs.) are getting used to growing up without a father.  Phone calls and the occasional Skype is not the solution I thought it would be.  As time moves forward I see a disinterest in my children communicating with me.  Days have melted into one another and I am forced to become a single individual torn from established fatherly roots, who gets used to not being around his children; that scares the hell out of me. The social ramifications of family separation are all around me and no one is immune.  Time in this environment jades family lines within everyone in its grasp, especially soldiers with longer deployments.  When a person encounters a stressful situation they have two choices, adapt or resist the situation; most choose to adapt to lower the stress threshold.  When soldiers during deployment adapt the stress may decrease during the course of their commitment but eventually when the home environment is reencountered the adaption mechanism is called on again. This mechanism becomes a stress in its self and domestic issues can ensue; on both sides.  My wife who is an active duty U.S. army ER physician is slotted to deploy to Afghanistan soon after I return; I can’t imagine the mental, emotional, and family unit repercussions we are going to experience in the not so distant future. Kate Plus 8 isn’t a part of this movie; no Hollywood here just real life. 

The last 2 days have been relatively calm with light trauma and orthopedic consult galore.  I’ve sent 3 soldiers home for injuries that preclude them from preforming their missions; each one fighting to stay, but I have the fortune of seeing their long term when they only see today, right here and now.  It seems the volume of non-traumatic injuries is increasing as local FOB’s and aid station learn of my existence. 

Many of the trauma patients we see are under the diagnosis “traumatic brain injury” or also known as TBI.   This involves a head injury mild to severe which is usually caused by an explosion of some sort.  IED (improvised explosive devices) are the leading cause and their diagnosis is increasing.  In the past TBI injuries were poorly understood and treatments available were almost non-existent.  The high incidence of TBI’s in this war has lead the medical command as well as health care providers to better understand how to diagnosis them and also to find treatment modalities that will improve soldiers outcome.  Part of this investigation included a grant for a MRI at a major base within Afghanistan to research changes in effected individuals.  Early data from theater has found its way to the civilian side of life too. The NFL is also doing research on players with multiple concussions in a similar manner.  Together both the NFL and military will formulate diagnostic techniques and treatment plans for individuals with TBI.  We have a long path to follow but eventually our effort will be worth its weight in gold.

I miss my family J

M

"HERO FLIGHT 002"

Trauma over the last two days has been non-stop; some serious and others not.  The missions in our region have increased at a rapid pace as well as the injuries associated with them.  One specific area seems to be the hot bed and the unit attached there has taken the brunt of the trauma.  We have seen probably 20 soldiers from that unit in the last month and unfortunately more than 1 has been KIA (killed in action), including a U.S. soldier from yesterday. It pains me and the rest of our team every time we see soldiers from this unit because we can only begin to imagine the mental and emotional turmoil they must be facing.  There’s no stop button on this game called life and sometimes when there is no reprieve it can overwhelm you; something were getting used to seeing on the faces of our heroes.

Yesterday started like any other and our team would never have known what was coming our way.  The morning started with an easy 3 soldier IED trauma where the injuries were back pain and mild TBI (traumatic brain injury).  We combed through the patients with our multi-point trauma resuscitation protocol and found most were well with the exception a few obscure findings which necessitated two of them to be transfer to Baghram for advanced imaging.  A medevac Blackhawk eventually made it to transfer these patients and then members of our team began the process of preparing their stations for the rest of the day.   

Two hours later we received a call that a large IED hit an MRAP with 6 U.S. soldiers and they were going to be medevac to our FST; ETA 30 minutes.  After 10 minutes we received notification that 3 of the soldiers had orthopedic injuries, 2 were TBI/spine, and 1 soldier was KIA; these soldiers were from the ravaged infantry unit we have reluctantly gotten to know too well.  About a minute from landing the beating props of the Blackhawk could be heard and we all put our game faces on. Once it landed Charlie Company met the bird and transferred the soldiers to the FST. The door of the Humvee swung open and the soldiers were quickly brought inside.  All three general surgeons and myself began evaluating the patients.  My attention was focused on one soldier who had an obvious deformed open facture of his distal tibia.  My initial exam showed very weak pulses in his foot so once anesthesia gained IV access and pushed some sedation I realigned his leg and put a better temporary splint on; his pulses were regained and his dusky foot became pink.  I then bounced to the other patients to do my orthopedic evaluations.  Two other soldier had a concerning orthopedic injuries.  X-rays were done on all the patients then I reviewed them.  My initial patient had the most significant injuries and it was clear I would be taking him to the operating room to externally fixate his leg and wash his large open wound out.  He also had a significant pelvic fracture and various other fractures.  While he was headed to the OR I splinted fractures of the other soldiers and then made my way to the OR. Once in the OR I went to work.  I washed the soldiers open leg wound used x-ray to realign his leg then externally fixated it.  After 2 units of blood and other biologic resuscitation products the soldier was stable and transferred to recovery maintained in an intubated state. After all the patients were deemed stable Baghram was called for medevac and a “Steel Angel” was sent.  1 hour later we loaded them on the bird and off they went. The U.S. soldier who was KIA was transferred to the morgue when he arrived to FOB Fenty.  We were informed his body would be sent to Baghram on a “Hero Flight” at 11P.M.; the second one for the FST.  The whole FST would be there and unknown to us; other friends.  

8:00 P.M. arrived and with it a medical joint special operations command (JSOC) surgical team.  Some type of special operation mission was going down tonight and they were here for their medical support.  The only thing other than our FST resources they needed was an orthopedic surgeon; their orthopod left the day previously and I was obviously excitedly obliged to help if need be.  This was not just any JSOC medical team but rather this was the team that responded to the Seal Team 6/special operator Chinook attack; when 39 heroes and a special operations pup died.  It was obvious after discussion about their experiences in Afghanistan they were physically, mentally and emotionally drained.  Their stint here was overwhelming and tomorrow they were leaving for home after tonight’s mission.  We hung out with them to raise their spirits and when it was time for the “Hero Flight” they joined us.

It was a warm moonless black night. At least 150 active uniformed U.S. soldiers lined a walkway from the morgue to a helipad where a “Steel Angel” would arrive to take our fallen hero to Baghram and then to his family.  After a longer than expected amount of time a Blackhawk could be heard in the distance; blades beating to the rhythm of our hearts.  Once it landed it slowly taxied to the ramp loading area at the end of the lined up soldiers. After about 5 minutes when the crew of the bird was ready for the transfer all the soldiers in the formation were brought to attention and then to salute.  The hero’s body was slowly wheeled down the walkway toward the Blackhawk; shrouded in a brilliant American flag.  Sobs of soldiers could be heard all around me; tears rolled down my face the second he passed me.  The hero was moved inside the bird and after a minute or so the “Steel Angel” disappeared into the darkness of the night. Goodbye my friend.

Fortunately the JSOC mission went off flawlessly and my services were not needed. The team spent the night in our FST and then left this morning.  I shook all of their hands and commended them on a job well done; a smile of relief exuded from all of their faces knowing home and their families were only days away.

P.S. I love you Melissa, Turin, Talon, and baby Myla. I’ll be home soon as well.

M

"The Extra Mile"

The last 4 days have been peppered with small trauma here on the FOB and orthopedic consult galore.  It seems the injury of the week has been knee ACL tears; some soldier will stay in theater with this injury if their jobs allow easy activities, but most are infantry which precipitates a ticket home.  Some soldiers have an obvious sense of relief when I send them home, but most fight me tooth and nail to say in theater with their units.  Their fighting spirit is greater than themselves and their fellow warriors are their family away from home; anything less than staying by their side is abandonment and neglect.  I have to admit my respect goes beyond expectation to these motivated individuals and pushes me the extra mile for them. 

One of the traumas we had 4 days ago had a story like movies are made of. Three U.S. soldiers were medevac to our FST after they were injured from an insurgent ambush in a valley within our region.  Here is their story. 

45 U.S. soldiers and multiple ANA (Afghan National Army) soldiers were given the task of clearing an “Insurgent Hot” valley from one side while another group would clear from the opposite side.  This group of soldiers was dropped in via Blackhawks the night before.  They set up camp at the mouth of the valley the night before and prepared for the following day.  When dawn arrived they began their journey into the valley; alertness peaked and expecting the worse.  Intel reports indicated that up to 100 insurgents laid hidden in the valley.  The terrain was very rough which slowed their movement greatly.  After about 1 ½ hours they were ambushed from 3 sides.  The initial attack is where the brunt of the injuries began.  Two of the three soldiers we treated at our FST were in the middle of this ambush.  One of them was the lead and the second was the third soldier in the patrol.  The scenario was intense; almost fateful.  The third soldier in the patrol dropped one of his ammo clips and went to retrieve it.  At the exact moment he was bent over an RPG (rocket propelled grenade) which was aimed and fired at him bounced of his back and hit the soldier in front of him square in the shoulder. When the ordinance exploded the two pounds of C4 that soldier was carrying detonated.  The second soldier was killed instantly and the soldier in front of him, and behind him (the two at our FST), were hit with the blast and various propelled objects in the area.  The soldiers in the area took cover immediately and an extreme firefight ensued.   The injured 3 soldiers we got were the first of many to see us out of the 15 we saw in total.  It took 3 days for them all to see us because the firefight prevented multiple Blackhawk missions from going in and taking the injured.  With the help of Apache helicopters and air force F-15’s and F-16’s dropping thousands of pounds in bombs with no friendly fire incidents the unit survived with only one U.S. casualty and one ANA casualty.  The imagery of this story as told by these soldiers will stay with me forever; likely in my nightmares.  Our surgical team was effective in treating them and many were able to return to duty to fight another day with their units.

Hearing stories like this is a real reality check.  I’m relatively safe within the confines of this FOB while the real heroes are outside the wire risking everything.  Some days my adrenaline get going and wants to be a part of the real fight but then I step back and realize that these soldiers are partially fighting confidently because they know my surgical team and I will be there at their time of need.  We all have our place in the grand scheme of life and right now I’m right where I belong.

Peace my friends,

M

"All Nighter"

Last night I finally went to sleep at 1AM after a busy day of everything.  15 minutes into the enjoyment of my sleep there is a frantic knock on my door from our nurse anesthesia provider.  “Special Forces just brought a patient in bad shape we need you now!”  Thankfully I was not fully asleep at this point so it was relatively easy to pry myself out of my bunk.  I get dressed and head to the FST to see what the excitement was all about.  As I enter the reinforced steel door to the FST 10 sets of eyes are staring at me with intensity; 2 of them Special Forces medics.  I quickly learn that the patient was a 25 year old Afghan woman who was shot in the thigh by an insurgent as they were trying to escaping from our elite commandos; oh and by the way she is 6 months pregnant.  I go to see the patient and find her leg has a tourniquet placed and there is a significant amount of damage to her mid-thigh.  We quickly get x-rays of the injured area and then the woman is taken back to the operating room.  While she is being prepped I go back to radiology to view the films; wow, the middle third of her femur is gone. This must have been one hell of a GSW (gunshot wound) round that she was hit with. I quickly head back to the OR where our commander Mike M is ready with the patient to assist me.  After scrubbing in we take down the tourniquet and find a significant amount of bleeding so we then place a controllable inflatable one in its place.  The exit wound of the GSW on the front of the thigh was massive and it was fairly obvious a femoral artery injury was present based on the bleeding. I explored the wound to evaluate the femoral artery with Mike M and we found this patient was very fortunate the artery was mostly intact with just a small tear.  I repair the artery and then let the tourniquet down; bleeding is now controlled and the patient now has good pulses.  My next step was to externally fixate her femur.  With a third of it missing and only a mini fluoroscopic machine it was a challenge to align it.  After a little time it was finally fixated and stable.  X-ray was brought in to confirm alignment and then we sterilely dressed the wounds.  During the case our nurse used a Doppler ultrasound to listen for the baby’s heart beat to confirm fetal viability; 160 heart beats per minute confirmed the baby was still alive. She was brought out of anesthesia and then transferred to our recovery area.  We called Baghram to medevac the patient for a higher echelon of care and were told she would be picked up by a Blackhawk in 2 hours.  In reality I am only the first orthopedic surgeon of many that will be needed to reconstruct her leg.  This was a significantly morbid injury and in this society I hope she will heal and recover but the negative weight of this environment is tipping the scale away from her favor. Once it was all said and done I ended up falling back into my bed at 6AM.

M

"Busy Season"

The last few days have managed to keep our Forward Surgical Team rather busy.  Multiple traumas have been thrown our way and we dealt with them effectively.  One of these traumas was a U.S. Soldier who during a route clearing mission was shot by an insurgent in the arm by an AK-47.  Here is how the events played out.

It was 8:00PM and “dust off” called our FST to inform us 2 U.S. soldiers were being medevac to our FST.  The only information was one of them was likely a traumatic brain injury that was stable and the other was a GSW (gunshot wound) to the arm; ETA 30 minutes.  After about 20 minutes we received further info that the medevac team was becoming increasingly worried about the soldier with the GSW as he was losing a lot of blood on the Blackhawk so the medic placed a tourniquet on the extremity.  My excitement went up not only because of the injury at hand but because this was turning into a technical orthopedic case for me to treat.  After about 5 more minutes the Blackhawk landed and Charlie Company went to meet the bird.  They transferred both patients to our FST and then the real work began.  Sargent H was the soldier who sustained the GSW to the arm and he was blood soaked from the bleeding from his arm.  Initial inspection showed a significant injury with obvious boney and soft tissue injury just above the elbow.  We left the tourniquet intact for 5 more minutes while x-rays were taken to better evaluate the injury and then wheeled him back to the OR to stabilize and save his arm.  While the patient was being prepped for surgery I went back to radiology to view the x-rays of his arm; this injury was more severe that I initially thought. After I quickly came up with a mental game plan I headed back to the operating room where our Sargent was ready for me to scrub in.  This ended up being a 3 surgeon event with me at the lead.  The field tourniquet was removed and a machine controlled inflatable one was put in its place after we saw the extent of the injury and bleeding.  Mike M and I focused on finding and surgically exposing the brachial artery to gain control of the bleeding. After a careful dissection we came upon the artery and repaired one of many vascular injuries found.  My attention was then directed to the forearm where I performed a fasciotomy and found the AK-47 round severed his radial artery.  This was where the majority of his bleeding was coming from but with as damaged as it was it was un-repairable; so I tied it off after confirming another major artery to the forearm was still intact. I fixated the Sargent’s arm after the best reduction of his bony anatomy I could get to protect the repairs performed.  There was a significant nerve injury at his elbow as well as other injuries but I feel I attributed greatly to saving his arm.  I can’t say what his functional outcome will be but can assure you when he left us on a “Steel Angel” for the higher levels of care, some of the best surgeons in orthopedics will be awaiting him to start the reconstruction and rehabilitation efforts he will need. 

Another notable patient I saw today was my cute little Afghan girl “Kaenat”; she was doing well with the exception of her hip spica cast. Two weeks in the Afghan world was like 6 weeks in the United States; I ended up having to completely replace it.  This is just part of the farm I bought taking on this case so I tried to stay positive.  After I was done and she recovered from the anesthesia she left to go back in the Afghan world. I will be seeing her in one week now to follow closer her progress. My faith in her care is low at this point. 

Otherwise my NFL combine bench press event went very well; I won. I bench pressed 225lbs 19 times with only weighing 183 lbs. It was nice to win on September 11th and I dedicate all that effort to our troops.  I had a U.S. army trainer take interest in me after watching my performance; he feels I have more potential after seeing mechanical issues with how I bench pressed the weight.  So another competition will be in my future; should be fun.

Talk to you soon.

P.S. I miss my wonderful wife and family.

M

"Today's Reality"

The last two days have been covered with light trauma; just enough to keep us busy without boredom and now we have arrived at the 10^th anniversary of September 11^th.  It is surreal to see the images of that day replayed constantly on satellite TV here in Afghanistan. We are reliving that moment every minute we are here as it not only changed our country but also the world as we know it. Major conflicts of the past (pre 9/11/01) are now only text book words of an old world with a very different reality. Today’s reality is more about “unknown chaos” which seems to be growing. September 11^th was an event which occurred within the backyard of America but the following aftershock was felt in the homes and hearts of freedom loving individuals around the world. Gone are the days of the cold war when there was an identifiable enemy that we could up their ante to stay in control and on top; now our enemy are religious zealots and infected rabid individuals within our own moral societies.  The seas are looking rough for our voyage into the foreseeable future.  We as moral citizens need to heed diligence to work as one to force the insurgent minded to forfeit their plans by making it near impossible to see them through.  We as a world moral society need to restart a grass roots campaign to raise our children in a loving just environment to better allow our offspring to make good moral human decisions that rebel against hate, inequality and false religious pretention. I feel there is a collective moral consciousness evolving in this world as a reaction to recent historical changes, and it is growing by the day.  It is not exclusive of religion, nationality, or geographic location and has awoken something deeply spiritual within us.  If it is coming to you embrace it and be a part of the moral revolution that is following it. We as humans are all the same with only circumstances separating us. Once we realize that we will reunite without boundary, understanding the power we hold together is greater than any one individual, culture, religion or false ideology.  God bless all souls lost 10 years ago in the wake of this sickened terror. God bless all the lives ended in the fighting that precipitated in the shadow of this tragedy. God bless America in this time of mourning. 

P.S. My combine bench press competition is tonight; this effort is for our fallen heroes.

M

"The Tempo of Trauma"

The new trauma tempo seems to be hanging around. Last night I was woken up at 2:30AM by our XO for 2 ANA soldiers that were being medevac to us.  Reports suggested they were involved in some sort of guarding activity when they were sprayed with AK-47 rounds by insurgents in our local area.  The surgical team was mobilized and we waited for their arrival.  After 20 minutes Charlie Company brought them to us and our work began.  Surprisingly only one of the two had severe injuries which is where most of our attention was directed. This soldier had multiple gunshot wounds to his arms and legs. After our trauma resuscitation and evaluation were amazed to find that no major bone trauma was present and even with 1 ½ inch holes in his arms and leg soft tissue his pulses were present; that was not expected and obvious someone ethereal was watching over him.  There was nothing orthopedically specific for me to do that Mike M could not handle so I headed back to my shack to sleep; thankfully I did.

6:00AM and yet another waking knock at my door.  One of our sergeants informed me that Charlie Company had a stat consult for a U.S. soldier with a shoulder dislocation.  I wearily got out of my bird nest and headed out the door. The diagnosis was surprisingly correct and after anesthesia woke up to sedate the soldier I performed a closed reduction of his shoulder and placed him in a sling. Afterwards I attempted a third round of sleep but failed so I headed to the DFAC for breakfast and got ready for morning report. Once I got there I was informed a U.S. soldier was going to be medevac to our FST for a combat firefight sustained knee injury. They were unsure of an actual ETA because the LZ (landing zone) was still hot and until some fashion of safety is present the medevac rotary crew they could not leave. Joe and I went to work out while we were waiting. When we got back there was still no word on an ETA. We did learn that the injury which was initially described to use a “deformed knee” was actually stable with a low likely hood of fracture; likely ligamentous, so the adrenaline dropped some.  Finally after hours of waiting, the soldier (who was actually from Special Forces) showed up for me to examine him.  I learned he was a SF commando; he looked and acted every bit the part; bearded, tattooed, in phenomenal shape, and an underlining chip on his shoulder. Fortunately, he was very gracious toward me for seeing him.  I went through my orthopedic exam, made my diagnosis and treatment plan which I discussed with him and the SF medic. He will see me again in the near future for reevaluation. 

The remainder of the day was uneventful except for some orthopedic consults from Charlie Company; nothing too significant. Darkness is starting to set in and a nighttime of unknown with it. I’ll talk to you soon.

P.S. I’m thinking of you honeyJ

M

"Drought Ended"

Yesterday we got hit with trauma after days of drought stricken life.  It was about 4 P.M. when we received a call from “Dust Off” (helicopter medevac team) that they were transporting 2 soldiers to our FST; one U.S. soldier and an Afghan National Army soldier.  We were given an ETA of 30 minutes which actually turned out to be accurate.  Initial reports were the injuries sustained were caused by an IED and the ANA soldier sustained the brunt of the force.  Once they landed Charlie Company transferred them from the Blackhawk to the FST.  The ANA soldier was brought in first followed by the U.S. warrior.  It was apparent the ANA soldier needed immediate medical care as he was starting to fade on us in our trauma resuscitation area; the U.S. soldier was stable.  After our evaluation it was found that the ANA soldier had an unstable cervical spine fracture, significant facial injuries, a traumatic arthrotomy of his knee (laceration into the joint), penetrating abdominal wounds, and various other issues of concern.  The patient was taken to the operating room for a joint effort from Joe J, Joey T and I.  The two Joe’s explored his belly for bowel and other related injuries and I focused on his knee.  Fortunately the two Joe’s found the source of bleeding in his abdomen and stopped it. I on the other hand washed out his knee and focused on removing an abundance of shrapnel from his legs.  I don’t have the ability at our FST to surgically stabilize and further evaluate his spine so we immobilized it as best we could.  After we completed our surgeries we called Baghram to secure transfer and the soldier was then packed up for transfer.  During our events in the OR the U.S. soldier continues to do well.  He sustained a laceration to his leg; which was washed out and loosely closed, and a closed head injury which appeared mild.  He was transferred to the TBI (Traumatic Brain Injury) section of our base for evaluation and overnight accommodations.   A “Steel Angel” eventually landed, picked up the ANA soldier and disappeared into the night for Baghram.

Today we were privileged to have the director of theater trauma visit the surgeons for an evaluation of our FST, and review of past, current and anticipated future medical trends in theater.  It was a really informative meeting with inter-military studies some of which were classified.  I never truly appreciated information like this in the past but when it’s a daily part of your life it becomes a valuable asset. This is a great example of how the military of the past has made giant leaps.  Communication between military medicine assets has brought much treasured information about best treatment guidelines for trauma patients in the military setting. This information is then disseminated to civilian trauma centers around the world for benefit of all. I have seen this first hand in my civilian medical training and feel honored to be a part of that system today. I look forward to using the information I gained today to better treat our forces and friends.

P.S. I miss my family.

M

"Meeting of Minds"

Today eight surgeons with cultural and religious differences met on neutral ground for a “meeting of the minds.” I did not know what to expect or how productive this event would be but in the end I’m left with positive anticipation.  The biggest concern prior to this meeting was the corruption of the political and medical system here in Afghanistan. It is well known that outside aid to this country is substantial but amazingly a great portion of it does not make it to the patient in need.  Fortunately our mission is one of mentorship and not providing medical supplies.  My suspicions will remain high of the end intentions of the providers we meet today as their main concern was “what can we give them?”, and not as much of “what can we teach them.”  The meeting was led by my co-surgeon Joe J who has some experience with Afghan local national care from a previous deployment.  It was apparent that these Afghan surgeons had an agenda they wanted to follow but Joe J and the rest of us shut them down quickly to stay on the point of our purpose; mentorship. We learned about the current make-up and capability of the Afghan medical system; which is depressing, and the projected five year plan for improving it. If we can work within our mission I’m certain we can improve the care of local nationals.  U.S. military withdraw is imminent and I would like to know I improved this place to some degree in the short time here.  At the end of the meeting I reinforced that our intention is one of compassion and not politics and I hoped theirs was the same. Afterwards I spent some time with the Afghan orthopedic surgeon who was present.  He excitedly showed me multiple surgical cases he has done in recent months and asked for my opinion.  With the extreme lack of orthopedic hardware I was impressed with ingenuity he used with simple supplies; this learning experience is definitely going to go two ways.  We all shook hands and said our final farewells, and then out the door into the summer heat they went. Mike M, Joey T, Joe J and I then met for a meeting recap.  We were all felt the meeting was positive and look forward to pursuing it further.  There is still a significant amount of work ahead to get this underway but at least today we can say the process has started. 

Joe J and I went to the gym following the meeting.  Today will be the last day to work on my combine bench press effort so I added another 10% to my intensity today; 6 days left until the event and my adrenaline is already pumping. 

After my workout I saw a bunch of orthopedic consults for Charlie Company this including a Sargent who was lucky to still be with us.  He was shot at multiple times by insurgents and sustained only a superficial wound to his leg; 5 bullets were stopped by his body armor, 3 in the front and 2 in the back.  So if you ever wondered if the money that was spent on this equipment was worth it now you know.

Goodnight.

M

"Lucky Coin"

Captain K did not plan on meeting me today but her lucky coin landed on tails, not heads like she was hoping for.  During a medevac Blackhawk mission she was injured and unfortunately became one of the soldiers that would be sent to our FOB; a club she was not anticipating joining I’m sure.   The FST was not informed of the event until the good Captain showed up with the other injured soldiers.  She was initially evaluated by Joe J for the typical trauma evaluation and then I followed.  It was obvious that she fractured her arm from visual inspection and x-rays confirmed this.  The biggest concern immediately was one of the major nerves to her arm was not working and the sensation this nerve is responsible for on her arm was lacking as well. I brought her to the operating room to stabilize the injured arm and hoped in the process I would be able to alleviate the pressure the nerve was under.  The Captain was put under a general anesthesia and then my work began. I was able to reduce her arm in a much better position and stabilized it.  She was extubated (brought out of anesthesia) a short time later and transferred to recovery. There I waited patiently for Captain K to come out of anesthesia; I was rewarded with the return of function of the nerve in question.  She will be transferred to Baghram tomorrow and likely given a one way trip back to the States to recover. I explained the situation to her dismay.  She was distraught of the thought of leaving her unit with so many more missions that needed to be accomplished. After taking an excessive amount of time explaining her situation she looked at me with eyes of defeat in acceptance.  All of the other soldiers that arrived were stable with neck and back pain from an IED blast and nothing for me to do orthopedically.

After our trauma ordeal we had a meeting of the minds between me and the other 3 surgeons about the mentorship program were trying to start with local Afghan surgeons.   Today it was confirmed that we are a “go” for a meeting with 4 Afghan surgeons on Monday; one of which is the director of a large local hospital near us.  What we are trying to avoid is the doctors we mentor becoming dependent on us because one day we won’t be here and we don’t want the local medical system to falter when this happens; past experiences of others has shown this to be a possibility.  There is also a lot of corruption in the local medical system and we are not here to precipitate that environment. I look forward to trying to make this medical mission work; cross your fingers.

Joe J and I followed our meeting with an intense workout at the gym. I can’t remember a time in my life I ever worked out this much. It really gives you time to reconnect with your body and put it back on track.  I know this is only temporary while I’m here because the minute I leave my real life will be overwhelmed with life responsibilities some wanted and others not.  I will also add that next Sunday (September 11^th) the NFL season begins; which every American on this base is excited about, and I will be participating in a “NFL Combine Lift Off”. The event, which is sponsored by the MWR and USO and divided into weight classes tests how many repetitions of 225lbs you can bench press; I’m interested to see how well I can do.

Trauma has been slow lately and it was not expected considering Ramadan ended September 30^th.  We have been told that motivation for insurgent attacks increases around this time because their religious fasting is complete and temperatures are beginning to cool slightly. In the end we are ready

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

M

"Thoughts About Rain"

Today our FST was happily shrouded in a rainy gloom; the first real rain since we arrived and it was pleasantly cooler as a result. Rain I’ve been told is a predictor of minimal insurgent activity because they fortunately would rather stay indoors immersed in slumber; no one is lowering their guard I can assure you.  Fortunately for me I was able to ignore the weather outside and be productive seeing patients that were consulted to me from Charlie Company.  In reality today was a cast clinic as a lot of non-surgical fracture are present here on a daily bases.  Most ironically are sports related as inter-unit sporting activities are popular on the FOB.  One such soldier is Sargent who was involved in a recent soccer tournament.  This soldier fell during one of the many matches and fractured his wrist which required me to reduce and splint it last week; today he will be blessed with a cast, and I hope black is his favorite color because that’s all we have. 

Joe J and I have been working diligently to form a relationship with local Afghan surgeons to form a mentorship program so we can improve their skills by assisting them with complex surgical cases at our FST.  Not only is this a benefit for the Afghan community but it also keeps us busy which has been lacking in our lives lately.  Our OGA (other government agency) friend, as well as our interpreters have been a great help over the last 2 days to start this process. At this point it looks like we will be meeting multiple local Afghan surgeons next week; details are being worked out. 

Actually today was a good day to reflect on my experience here in Afghanistan thus far. This is not a one-dimensional personal and professional voyage but rather a very multi-facetted broad journey.  The separation from my family has been the greatest challenge of all. As every day goes by I’m bombarded by photographic images of my children and wife that only help to grow frustration of my absence within myself.  Some days can be much worse than others, especially days like today when boredom sets in from lack of motivation and activity.  Thankfully ten years in Afghanistan has matured the communication a soldier can have with their family; especially with the advent of Skype.  Another personal front is the interaction with the Afghan culture.  Initially I was very suspicious of the natives here and to a point I still am based on past incidents the armed forces have experienced in the past, but I’m developing a self-protective mutual respect for them. We all have different religions, spiritual views, ideal’s, wants, and desires but in the end even with all of our unique layers we have the common bond of being human being. Sometimes these layers obstruct communication leading to conflict but it is our responsibility to remove each other’s layers through respect and honest perseverance for the better good; it’s not a perfect science as we all know. Finally after having time to filter through my endless daily thoughts and feelings; what’s the point of being here and what are we fighting for? I have learned quite a bit about the demented cultural and religious convictions of the specific individuals we are fighting against; there’s no sit down tea parties and the rules of engagement for humanities disagreements as we know it are forever changed.  September 11^th was truly a day of modern infamy for the highway we are headed down for generations to come; and we all should be fearful.  As we commence this anniversary realize a sect of radical ideological persons brought hell to us in the United States. These insurgents don’t care what we believe, care about or feel, they just want us dead; we are infidels to them and genocide of our society is their intent.  We are at war with an adversary that believes dying for their demented cause will give them a key to heaven; the worst quality you would want in an enemy.  They hate our freedom, our moral ideologies, our respect for life and desire for peace; we are their moral enemy even though we never raised our sword in their direction.  Afghanistan is a major point of this war because this is where the ground zero of the insurgent breeding mostly began after the Taliban gave refuge and protection to them; currently other states are taking up the slack since we occupied Afghanistan.  This is our new reality and like it or not these fateful events really have just begun.  Our being here is two sided; we brought the fighting to the insurgents on their turf with a hope it would protect the backyard our friends, and families occupy in America.  In reality it has worked and if me being here protects my wife and children from these frantic ideologically sickened individuals I’ll happily stay. God Bless America and all freedom seeking right minded countries and individuals of humanity. Our sword of righteousness is raised and will only sharpen more as it is tested.

Goodnight.

M