"Made in U.S.A."

It’s 4 A.M. and I’m torn from sleep by the rapid opening of the rusty steal door at the entrance of my barrack; knocking resonates from my door followed my Joe J’s voice. He informs me our special operative friends have brought us early morning business from a mission that just concluded. I force my senses to wake up, get dressed and head out the door to the FST. I open the door and am greeted by many familiar Special Forces faces that appear to be happy to see me.  Next to them is a blindfolded restrained bloodied middle aged bearded Afghan male on a gurney. My SF friends inform me this Afghan is a Taliban insurgent who was captured from the night’s mission.  They needed me to stabilize his orthopedic injuries before he is transferred to an Afghan run detention facility for interrogation and holding.  I examine the insurgent patient and identify many obvious conflict inflicted injuries and order appropriate x-rays to better evaluate them. After a review of the radiologic images I formulate a surgical plan.

It’s interesting to note this is the first confirmed insurgent I have been faced to treat. Multiple other similar surgical cases were laced in obscurity with no confirmation of insurgent intent.  But now here he is in the flesh. The enemy were fighting against that would slit our throats if given a chance; murder our wives and children. A sense of disgust boiled deep within my veins and I would be lying if I told you the non-physician part of me didn’t wish eternal harm on him. Images of the deceased U.S. soldiers I’ve treated raced through my mind compounding my distain. It took a deep internal strength to control myself and maintain a professional composure; my white coat mentality fortunately won the best of me on this occasion. Who knows, maybe the day I meet my fate and am standing face to face with my creator I’ll reflect positively. I guess the American culture embedded within my center breeds compassion as well as the familial roots that raised me.

The insurgent was prepped for surgery and taken to the operating room. His fortunes afforded him my best efforts as that’s all I know how to give in the surgical environment.  Multiple injuries were addressed and surgically stabilized. The last orthopedic procedure was his leg which required a long leg “bivalve” cast. After it was complete I felt the need to remind this insurrectionist who he should thank for reconstructing him so on his cast in big red letters I wrote “Made in USA”, maybe a passive aggressive gesture but to me and my fellow soldiers; priceless. 

The chill of a new season is descending upon us here in Afghanistan. One noticeable difference is the absence of brilliantly colored leaves of the Kentucky landscape surrounding my home. These last months in theater will no doubt be the most personally challenging for me. The holiday season is approaching at a fast pace and with it my absence to my wife and children. Daddy missed his daughters’ first Halloween costume and the exuberance of his sons as they were “Buzz Lightyear” and “T-Rex”. Pictures don’t ease the pain and time does not stop in my absence. My oldest son who is nearing 4 years old has resigned himself to near complete avoidance of me when I call home, but yet he cries for daddy when he injures himself or feels insecurity. Talon my youngest son has crying spells at pre-school during his mid-day naps that are growing more common by the day. If they only could comprehend their daddy feels their anguish. If they only knew daddy’s dreams were filled with images of them.

I love you Missy, Turin, Talon and baby Myla….

M

"3 WEEKS"

3 weeks of my life have fallen away since my last blog. This time has been filled with a stagnant slowness that reeks when I ponder its effect on myself and my team. With the exception of a few interesting moments my world has been filled with useless boredom, infinite endlessness, and surgical obscurity.  Periods of time like this feel nothing short of prison. I’m forced to stay in this Hell physically while my mind and emotions scream to be let free. It’s almost a feeling of helplessness and loss of control; time does not stop in your absence.  Being busy is the distraction which makes this life tolerable but when that’s not available everything in life that is important to you becomes overwhelming. My lack of attention span does not do well in this environment so I have resigned myself to focus on everything and anything to bring my center to something productive; some medical but the majority not.  I find that the longer I live like this I become more secluded and introverted; something not typical of me. It’s interesting to note I am not alone. Fellow surgeons and members of our forward surgical team show similar tendencies.  The fact that antidepressant medications are so common in the military population is now understandable. Displacing fathers and mothers from their children and significant others is not natural and rarely has a positive outcome.  You lean a lot about yourself in an environment such as this.  

This past week I was asked by a member of the U.S. State Department to interview a potential Afghan orthopaedic surgeon for possible appointment in a surgical clinic just off the base. I was brought to another location on the base for the interview. Present for the meeting was the head Afghan doctor of the base, the member of the U.S. State Department, Joe J, an interpreter, and I. The scene was nothing short of a movie. Armed guards at the entrance of the room and building, brilliantly colored Afghan chairs in a circle on a handmade Afghan rug of matching intensity, and a sterling silver tea pot in the center with matching cups for all the meeting participants. The meeting lasted about an hour. I questioned the surgeon through the interpreter about his surgical experience.  The hard part was my personal comprehension that orthopedics is behind the U.S. here in Afghanistan by 30 years or so. I had to readjust my expectation of what is normal to me. If chosen this Afghan surgeon will work one-on-one with me and future FOB orthopaedic surgeons to introduce him to modern practices; something that will be invaluable to him and the Afghan population once we eventually leave this country. It’s very gratifying for me to be involved in these engagements. It’s a way for me to give to this country for their future.

One of the few traumas that our FST encountered was an IED blast to an Afghan convoy.  4 ANA soldiers were involved in the ordeal and one was critical. This is an example of protocols trumping life. In the U.S. and westernized nations when a patient comes to a hospital involved in a trauma situation a significant effort is put forth to save life and limb. After initial stabilization and operative intervention patients can be sent to long term rehabilitation and recovery units for maximum benefit. Here in Afghanistan that is unfortunately not the case. There are no resources or financial backing for these long term services so a decision has to be made on protocols which dictate the likelihood of someone surviving a traumatic situation.  The exception to this rule is American and coalition troops for which heroics are king. The worst case scenario for Afghan nationals is by far head injuries. There is no acute surgical intervention my team and I can provide for them and nowhere in the immediate setting to send them for treatment.  Imagine the detriment and emotional turmoil our team faces in this situation.  We were forced to watch a 20 year old Afghan die in front of us.  Anesthesia made him as comfortable as possible and our individual spiritual beliefs were with him. These situations don’t improve moral of our team and to a point contradict everything we learned as physicians in our training.  This game we know as life is not fair and we can only hope it improves in the long run. 

I’m at the half way point of my deployment and it couldn’t end soon enough. It’s amazing how your dreams become more vivid as the days disappear making the journey that much harder. I miss the beautiful faces of my wife and children; I miss the wind flowing over my wingsuit in the crystal blue sky. I miss more than I ever expected and my greatest motivation is knowing I will eventually make it home to everyone and everything I love.

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

M

"Terror Plot On The FOB"

Yesterday at morning report we learned of an unknown hidden danger within the borders of our FOB.  A cell of approximately 13 insurgents somehow infiltrated the confines of our base as local Afghan national workers over the last year; two of the insurgents even made it to a fortified secure location.  An intelligence tip focused on two insurgents initially which then opened up to the larger group. The insurgents plan was a coordinated attack within our FOB for maximum casualties.  We were not informed of the specifics but know the Afghans involved were apprehended and their terror mission was debunked. 

When I first arrived to the FOB months ago I was extremely suspicious of everything and my senses were peaked. Over time they blunted as the feeling of security increases from days of monotony.  If thirteen plotting insurgents can make it on this base without notice a reevaluation of security measures is in need. My wary will restart the process of questioning everything and my fellow team has indicated they are doing the same.  Barb wire, large foreboding walls, armed guard towers and gates apparently are not enough. Internal tension and security measures have changed to a noticeable level here and I would assume the same is occurring throughout the theater.  

After an exposed terror plot and temporary loss of electrical power on the FOB my promotion ceremony eventually took off.  About ten individuals from higher command came in addition to members of both my team and Charlie Company.  Joe J introduced me to the crowd and then I gave an impromptu speech.  It was a memorable experience being promoted in theater; an event that I will carry forever. Being a member of the U.S. army is an honor in itself but when you compound this with the heroes I work with on a daily bases this honor is elevated beyond expectation.  If there was one less elevated note of yesterday it was my family could not be there with me; especially my wife Melissa who was promoted to major in the U.S. army yesterday as well.  Melissa is an emergency medicine doctor for the U.S. army at Fort Knox. My wife and I have lived parallel lives since we started medical school together.  We accepted the military scholarship and were commissioned to second lieutenants together, went to medical school together, were promoted to captain together, were together during residency training, and stationed at Fort Knox as staff physicians together. If there was ever an example of soul mates we would be the definition.  We are by far stronger together than apart and our dreams are one in the same (Disclaimer: a few minor exceptions existJ).  For the record I am the senior major as I was promoted 8 ½ hours earlier; eastern standard time is behind Afghanistan time.  Somehow that fact will not fly in our household; call it a gut feeling.  I think my wife will just consider me a major pain in the ass; domestic business as usual in the Duber household. 

Talk to you soon my friends.

P.S. Congratulations on your promotion beautiful.

M