Sunday, October 23, 2011


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.


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