"SPEECHLESS..."

I really don’t know what to say anymore.  Finding the words to write into a blog about my experience here in Afghanistan has turned into an event of endless frustration and torture. Motivation has dried up in my personal drought.  Being here is a mental and emotional daily beat down. Experiencing war first hand (from a surgeons perspective) is nothing like I thought it would be and something I was ill prepared for no matter how much effort I put in prior to this deployment. Trauma has continued to flow in a bloody river of sorts. Yes, I have made a difference in soldiers’ lives but I’m at my emotional whit’s end managing war ravaged amputations of our soldier’s limbs and death.  When I’m overwhelmed with trauma my mind has a mental block to the situation I’m surviving in but when periods of monotony compose my days between the traumatic ones I find the only way to escape is sleeping. At least I can dream of my life back home; my wife, my kids and everything I love.  There is no romanticizing the job I do nor the life I’m forced to live here in Afghanistan and the same could be said for the endless ravaged heroes I care for on a daily basis, their efforts far outweigh any I could bring to this table; that’s why we call them heroes.

It seems these past few weeks have dealt the worse hand to the E.O.D. soldiers.  The volume of IED’s that insurgents are placing has increased and their wicked tactics have worsened.  Not only are the primary IED’s being placed to damage  passing coalition vehicles but secondary devices are put nearby to maim or kill E.O.D. personal whose mission is to disarm them.  One such incident our FST had to deal with is rather noteworthy.

 Four E.O.D. soldiers were on a mission to disarm a suspected IED.  Prior to getting to the suspect position they encountered an unknown large IED that blasted the MRAP they were traveling in. The force was so intense it picked up the vehicle and flipped it end to end. When the rescue crew arrived it was determined the area was unsafe due to multiple secondary IED’s in the immediate area. The extraction plan was then changed. A medevac Blackhawk was used to hoist the injured soldiers to safety and they were then transferred to our forward surgical unit for treatment. When they arrived all four were brought into our facility. Only one of the four soldiers was able to drag himself in under his own power; the others were carried in on stretchers.  It was apparent that the injuries were to the lower extremities.  One of the soldier’s legs was covered in his own blood and he was withering in pain.  It was not obvious what the injuries were to this soldier on my initial views. This soldier’s multicam uniform was quickly removed and one of our general surgeons began his trauma resuscitation while I focused on the effected extremity.  Once his pant leg was removed there was an obvious open tibia fracture staring at me. I continued to use trauma shears to cut of his leather boot and was taken back at what I saw; his foot was amputated in the middle of its length. What amazed me was his boot was completely intact with no obvious signs of trauma. The force of the blast was of such a magnitude that it caused this level of injury. I later learned the haul of the MRAP was intact so it was the shock wave that propagated through the floor that caused this injury. I immediately had our radiology technician take x-rays to further assess the damage. The injury was worse than I could have imagined. Nearly every bone in the soldiers’ foot was severely fractures into pieces no bigger than an inch or less, and the end of the tibia was unrecognizable.  This was among the worst lower extremity injuries I had ever seen.  There was no chance of reconstructing his lower extremity, thus, I was forced to take the soldier to the operating room where I amputated his leg; one of many I have been faced with here in Afghanistan.

Two days following the E.O.D. soldiers leg amputation lightning struck again; this time my emotions had a hard time controlling themselves. 

A young 19 year old U.S. female Specialist was on a mission in the rugged terrain north of Jalalabad with her fellow unit soldiers when they hit an IED. An extreme blast was encountered similar to the last group of soldiers we dealt with days earlier.  A medevac Blackhawk was dispatched to their position and they were transferred to out FST. When the Blackhawk landed they were quickly transferred to our trauma bays for evaluation. Of the four soldiers sent to us for medical care a young female specialist and an American born translator fared the worst.  My attention focused on the 19 year old Specialist. She was screaming from pain; tears drenched her face.  Her leg was covered in blood and the bottom of her boot, which was ripped open, was slowly pouring out blood. A tourniquet which was ineffectively applied to her leg was failing.  One of our general surgeons started the resuscitation while I focused on her leg. Her injury was severe to her lower leg and even though I had not seen x-rays or removed her boot I knew what was likely from the soldier I dealt with days earlier.   Our anesthesia provider was trying to calm her down with sedation with minimal success. I was able to finally remove her boot on the injured leg; everyone in the immediate vicinity was taken aback by the extent of injury. I knew without a doubt reconstruction of this soldiers leg would be unacceptable based on the severity of the injury. Amputation of this young woman’s leg was the only option.

My heart kind of dropped with this realization. This would be the first female amputation for our team and me personally from a traumatic cause.  Time stopped within myself while my mind tried to comprehend the ramifications for this soldier that are about to take place.  This soldier was young and just starting her life. She was a college student, not married and without children. Her life plans will now sail a different course that she or her family never anticipated. 

The young soldier was brought back to the operating room for her unexpected meeting with fate; and in the end mine as well.  Our anesthesia team gently put her to sleep and then my work began. Once I finished she was extubated and transferred to the post-surgical area to recover. While I was completing my surgical records the young specialist asked for me, so I went over to her side to see what she wanted.  Once by her side she looked me in the eyes and asked how everything went. My heart dropped with emotional discomfort and personal turmoil at that moment. I was taken off guard that she was not only so lucid this soon after surgery but the simple question she asked at a moment for me like this. Most times I have only good news to tell my patients; your knee replacement went wonderful, your shoulder is going to do excellent, but this soldier’s reality is different. I put my hand on her shoulder and told her what was done; her tired eye’s swelled and tears flowed and she grabbed my hand on her soldier. I immediately went into “positive mode” as I usually do in hard timed with patients. I explained the technological advancements in prosthesis design and that she will walk again. For men it’s an easier sell but for a female it’s not as there is nothing feminine about prostheses. The social ramifications seem much more negative for a female in these circumstances. I spent about 20 minutes compassionately discussing the soldiers’ situation with her and then she blindsided me with another request; can you tell my mom? Uneasily, I agreed.

When injured soldiers come to our FST and they are stable we have a dedicated cell phone for them to call their families to let them know what happened and that they are ok. Soldiers and their families are always appreciative and it gives a noticeable relief to the injured soldiers. 

The young Specialist dialed her family and after one bad connection I could hear the phone ringing in the background, then “hello” from a woman’s voice. She slowly led her mom into the situation without any specific detail of the injury. After about five minutes of patiently waiting she handed the phone to me. The soldiers’ mom really did not understand the extent of the injury and now the stressful discussion lay on my shoulders. It was as hard to tell her mother the situation as it was telling someone their family member had died back in my surgical internship.  Her mother did not take it well as would be expected; she and her husband nearby were sobbing profusely.  She had a hard time excepting the reality of the situation and must have asked me the same questions 5 times over about a 10 minute conversation. I tried to be as insightful and positive as I could. Once I was finished with the discussion I handed the phone back to her daughter. Their following conversation was laced with crying, and words of love.

My time here has been nothing short of an emotional and mental roller coaster; parts born from my Afghanistan experience and others from the stress of being separated from my wife and children.  I’ve shed more tears in the last 5 ½ months than the last 15 years of my life, some related to the injured soldiers I’ve treated but most from the heroes our FST has lost.  I was anticipating this experience would strengthen my personal fortitude but in reality it has taken my positive points of view and skewed them into jadedness.  My days have been filled with unexpected emotional forecasts and over time this lack of control becomes overwhelming. The stress of family from a distance, the constant threat of attack, soldier’s injuries and demise, and the lack of an outlet to relax deteriorates your strength as a person over months on end.  I’m not here to judge the grand reasons we are still within this theater of war. The only valid perspective I can give is my own, and can tell you on a personal level this environment is not for me.  I feel like I’ve been locked in a cage of moral negativity and pushed to live a life not of my choosing.  The army I signed up for in December of 2000 is not the army of present day. I don’t know how I will look back at this experience in 10 years and I hope I can gleam some positivity from it, but today I feel that is unlikely.  

I have a little over 3 more weeks here in Afghanistan before I start the long journey back to Kentucky. I may be leaving this war here in Afghanistan but I’ll be confronted with a different unfamiliar post war family reconstruction when I arrive home. My young boys are at war with me for being gone and don’t communicate with me at this point; although, they asked Santa for their daddy to come home from the army for Christmas. The newborn daughter I left 2 weeks after her birth does not know her father and my wife has learned to live without her husband in her daily life.  I have learned to live without the responsibilities of a father and have become a self-centered personally indulgent individual. I have a lot of social reintegration myself waiting and it’s not going to be without a sizable amount of stress. Fortunately for me I have been able to maintain communication with my family. The soldiers who are isolated living on the Afghan mountainside are not so blessed. I can’t even begin to imagine the turmoil they will face with home reintegration. 

It seems many back in the U.S. individuals support the troops in various degrees.  Some offer gratitude, nods and handshakes, and others are active in supporting our troops through their time sending care packages, writing letters, knitting hats, and making a difference in a soldiers world both in theater and back in the United States.  I don’t want to rain on someone’s proverbial parade but if you aren’t going to take an active part in making a difference in our troops lives don’t bother with the handshakes, nods and superficial forms of gratitude; we know your happy in your comfortable world where you don’t have to risk everything for a nation that we as soldiers care so much for. The last thing freedom needs is to be cheapened by superficiality. Everyone has the opportunity to make a difference. You can shy away into your protected corner or spread your wings and let freedom ring loud and clear. The choice is yours. God bless America, and all individuals who seek freedom.

Thanks for coming along for the ride.

I’ll be home very soon Melissa, Turin, Talon and baby Myla. I love you more than you will ever know.

M