On My Way Home

I am standing next to our motto. If you can read it. " Militaris Primoris, Semper Curantis: Soldier First, Medical Forever


Well, my sort of vacation is almost over. I did get to spend time in the sand. It was actually more like rock, hard dirt and stones. It just that it wasn’t beach sand on an ocean somewhere. Soon it will be time to rejoin normal living. I must admit I am leaving with mixed emotions. Don’t get me wrong. I am looking forward to coming home, but as with most things there are good and bad things that I have experienced. There are definitely a number of things that I won’t miss. The latrine for one. It is a glorified outhouse. Too many people have to use it. Quite frequently, the toilets would back up and you would have to use the “poop stick” to stuff the crap down into it so you can use it. The combat showers as we call them (I think the Marines call them Navy showers). Anyway, you jump in, wet yourself, turn the water off, then soap up head to toe, then rinse off. Should be in and out in 2 minutes. I must admit, I usually took 3 minutes. There is also walking everywhere on stones. The big and small pebbles slip under your foot so you can’t get any traction. It takes twice the energy to walk the same distance as on a hard surface. Day in and day out with these stones is lots of fun. Another thing is our wonderful internet, or I should say frequent lack of internet. We rely on a satellite dish which frequently is disrupted by the weather. Also, because of costs, we have too many people on it which also slows it down quite a bit. It sort of makes Comcast or AT&T look real good.



Just like in Iraq, the dust storms sometimes get a little thick





Some of the things I will really miss are the people I met and worked with. These are a great group kids and doctors. I know they are all adults, but most of them are under 30, except the doctors and the command staff, so they are like kids to me. Everyone got along pretty well. No major arguments or disagreements. When a trauma came in, they would all snap to it and do their jobs without question, no matter the time of day or night. And they did a marvelous job. I would put this crew up against any ER trauma team in the country. They really did a great job.

I have it easy compared to most of them. Most of these kids are here for a year. I have only 3 months, so I can’t complain at all. We have been through some bad traumas together, sometimes difficult times. We also have had quite a few laughs together. We shared popcorn at night watching a movie. We shared stories and pictures and home life happenings. One of the younger lieutenants had a new baby boy back home about a month ago. We all had a cigar with him that night. (I didn’t have one, but I was there congratulating him with the others). They were always watching my back and I watched theirs. They push me to run in the late afternoons. I push them to get up early and work out. When you literally eat, sleep and work together almost every minute of the day, you do get attached to one another. The people at FOB Shank are what I will miss the most. I do feel a little guilty. I almost feel like I am running out on them because they have to stay and I am leaving. I know they would like to be going home as well. I sort of feel like I am leaving a wounded comrade behind. If it wasn’t for my family and friends and commitments at home, it wouldn’t bother me to be here longer. However, I do miss my family and friends. I am anxious to go home.


Major Provenzano(Commander),myself, LTC Aldridge, LTC Bruce, LTC Hoeffner, and MAJ Sucher



The flag that flew outside the colonel's den






I finally saw the whites of the eyes of our replacements. Interesting, the Orthopedic Surgeon, COL Brad Brucker, is the doctor whom I replaced in Mosul in 2008. So I guess that it is fair play that that he replaces me after I replaced him.

So now we are in our process of going home. My travelling group is smaller than when we first came out. 2 of the surgeons are staying there for extra duty. They should come home in 2 -3 months. LTC Bruce, LTC Hoeffner and myself are now in Bagram. We have been here for a day and half now. In fact, the Taliban gave a nice little send off. They rocketed us a few hours before we left. They must have heard that we were leaving and wanted to show their appreciation. The little bastards are getting better. Their rockets usually hit about a mile outside the FOB. These hit about 200 meters away from our tents. Thanks, boys.

We turned in our ammo already. I don’t feel like John Wayne anymore walking around with my weapon and ammunition on my hips anymore. I am not sure how we travel from here. Since Mother Nature was having fits with her volcano and screwed up everything, things are quite a mess. We do have reservations to fly out of Kuwait on the 8th. They are working on maybe flying us to Germany from here and then to the states. We may get stuck in Germany for a while, but that would be ok. I hear the Germans have good beer.



My little cubbie hole all cleaned out except for some little items that the next guy may find useful


I must admit that it has been a real education working with Middle Eastern population. Their ways of survival are much different than ours. There some very good people here. For instance, the little girl that I took care of after a grenade injury to her ankle, her father was very appreciative. Every visit he would bring me a package of some dried fruit and raisins. I was too afraid to try them, but I accepted them anyway so I wouldn’t hurt his feelings. Then, there was the family of a little girl who didn’t make it. She was hit by one of ANA pickup trucks. The family wanted us to change the records to say that a US truck hit her. They knew that they could get some money from the US govt. if she was hit by one of our trucks. Kind of like when there is a bus accident at home, and low life people get on the bus after the accident and claim injuries.


The 909th FST.





Well, this is probably my last posting. It has been a good tour for me. I have no regrets. I just hope and pray that everyone else are as lucky as me and make it home safely.
Tom

There Is A Reason We Don't Go Outside The Wire

As most people know, I didn’t quite make my scheduled flight. Mother Nature with her volcanic activities decided to change that. It really isn’t too bad. I have been delayed only a week, so it could have been a lot worst. Oh well.


I had the opportunity to meet a lot of different people here. One of them is a doctor from Czechoslovakia. His name is George. I can’t even come close to saying his last name much less spelling it, so we will just call him George. Anyway, George is a nice, young guy. He is a little ambitious but nice. He is doing a study with steroids in the Czech troops. This is legit and even has papers from his government authorizing it. No wonder all these Czech troops are so big. I think George is part of the study. He has big arms, but also a big belly to match. I think he needs to try running a little bit more. The Czechs have a driver for their doctors, so gets driven from their side of the compound anytime he wants. He frequently comes over for our lectures. Their government is nicer to their doctors than ours.



This is the Czechoslovakian doctor, George. He is a primary care doctor.













The Czechs are here mainly for humanitarian reasons. They don’t go out on patrols looking for the Taliban like our boys do, but they do know to defend themselves when they have to. One mission outside the wire last week really made George nervous. His team of a few doctors, nurses and medics, with their Army combat support soldiers went to this one village that never has had any Americans or foreigners in before. They brought medical supplies. The Chief of Police told them that they were safe until 3 PM. The team was dropped in by helicopter and the hellos left. For some reason they were still there and about 3:30 PM RPGs started to come in. It took them a while to figure where they were coming from. Once they did, their combat soldiers return fire with their grenade launchers. That took care of the attack. It was the first time George said that he had ever been fired upon. He had to hit the ground and things were flying and blowing up all around them. He said there are reasons why doctors don’t go outside the wire and he personally experienced one of them. Fortunately there were no major injuries, just one soldier we actually treated for some shrapnel to his leg. He will be fine. George said he won’t go out on any humanitarian missions any more. He was pretty shook up about it for a couple of days.



Some local villagers that George's team brought humanitarian care to distribute.




It also brings up a point on how difficult it is to accomplish anything here. You really have no idea on who you can trust or believe. Lying and cheating and stealing are almost second nature to the people out here. Who knows if that Chief of Police was a Taliban or just friends with them or what? Why did he know that they were safe until 3PM. Of course, with such massive poverty out here, I guess they just learn to lie and steal to stay alive. If you don’t get caught lying, then good. If you get caught, then no harm, you didn’t have anything to lose anyhow.


One of the nurses from Charlie Med had a visitor today, her mother. Her mother is an Army nurse and was with the 909th when they deployed in 2003 to FOB Salerno. She is on her way to another FOB, so she stopped in to visit with her daughter. She also said hello to the remainder of the group who were with her in 2003. Reminds me of when I visited my son in Iraq when I was leaving Mosul in 2008. She also brought us some patches that we can wear on our ACUs.




Part of the original 909th FST from 2003. CPT Timm's and her mom are obviously in the middle. The helicopter was arriving to pick up routine patients, not bringing in trauma ones.





Ok, it is time to brag. We, the doctors, had to take our PT test out here. That included doing push-ups, sit-ups and a timed 2 mile run. The air is a little thin here at 6800 ft. but I did ok. I got 299 out of possible 300, so that is not too bad for an old guy like me.




The other doctors and I decided to show off before our PT test. We were too tired to pose after the test.




The good news is that I saw the whites of the eyes of our replacements today. They arrived safe and sound. It will take them a few days to adjust to the altitude and get situated. Then, we will start our process for home. I hope to leave Kuwait about May 8th. I will spend a few days at Fort Benning, then hopefully home.
Tom

Pat Tillman Run April 17 2010

Last Saturday, the 173rd sponsorded a run in honor of Pat Tillman. Pat Tillman was killed on April 22, 2004 while stationed in Afghanistan out of FOB Salerno. Apparently, they have been having this annual run for a while, but this is the first time it was held at FOB Shank. It was 4.2 miles, including a monstrous hill run that we do twice, once just wasn’t good enough. We had over 600 runners, not bad for a base of 2-3000 troops. Because I am the only Orthopod here, I had to run carrying a radio the entire time. I think that explains why I didn’t win. I actually did ok for an old guy here. I finished 3rd in my age group ( 50-59), but then again, I admit there wasn’t a lot in my age group. One of my co-surgeons, LTC Sam Aldridge, just turned 50. He was one of the younger guys in our age group, so he had an advantage. He finished first in our age group. I frequently run with Sam. He is a very good runner and road biker in the summer. He usually finishes ahead of me, so it was no surprise that he finished first.

I have included a few photos from that run.



This is a photo of all the people from the 909th who ran. A few had to stay back and be available if something came in.




A fair amount of Jordanians were there supporting their runners. They were having quite a celebration and dancing in front of the start line. If fact, they continued their dance at the finish line also. They had more dancers than runners.




The local Afghanistan had their representatives as well. I am not so sure that they are used to long runs. The whole race they would sprint, then stop and walk, then full sprint, then stop and walk. I bet I passed some of them 5 or 6 times during their walks, then they would pass me when they sprinted.




The run was a lot of fun. Actually, it was more fun when the race was done. They had a lot snacks, all nutritional of course. They even had a couple of cakes with pictures of Pat Tillman on them. I didn't stay around to sample it (I know that is unusual for me). One of the medics from our sister medical group, Charlie Med, won the race. He is from Kenya, so that gave him an advantage. He is a nice young man, a medic. Some day he wants to go back to his country help out his people. I think that is very admirable. By the time I finished, he already had his feet up and was on his second cup of coffee.




Picture of the hill we ran up and down. We would run up on the far right, run across the ridge, which is the border of our FOB. Then run down coming from the left. We did that twice just for fun.




The main group I hang with the most. Far left, Major Joe Sucher (Gen Surg), LTC Randy Hoeppner (CRNA), LTC Mike Bruce (Gen Surg), yours truly, and LTC Sam Aldridge (Vascular/Gen Surg). Major Sucher is not in our age group. (By the way, there are a lot more people in my age group than pictured here.)



I am carrying my radio. I just made the turn off my second run on the hill. I was glad the hill part was done, at least for me.


Tom

I Have It Easy

It has been a while since I updated my blog. My publisher is on my case (just kidding). It is hard to keep coming up with ideas. Now I know what writer’s block is all about.

Now, for a little history of the 909th FST. This FST was first organized about 1989.Their first deployment was to FOB Salerno 2002-2003 in Afghanistan, just over the mountain range south of here. From that original group, there are 5 soldiers who were on that deployment who are still with us today. They are our command, First Sergeant, XO (Executive Officer) and a nurse and sergeant in the OR. The rest of us, about 16, all have replace and added to the original. They brought along some pictures of their deployment at FOB Salerno. We have it easy compared to what they went through. When they first arrived, they had to build everything. It was just a small FOB at that time, anywhere from 75 to 200 soldiers. They had to build their own out house, showers, put up their own tents and do their own laundry and cooking. One of the guys bought a pet monkey from some local kids. They built a cage and even took it to the vet to get all the shots. The best part was giving it a bath. They had to sedate it do it. They kept it for a while until a higher up found out about it and made them give it up. I have posted some pictures from their deployment.


Original sleeping quarters while putting up tents and wood structures



Laundry day







Building a base for a tent














Giving Mojo,the monkey, a bath



Piss tubes. No explanation needed
















Woman's facility











We had our patch ceremony which is after you are in theatre over 30 days. You receive a patch that you wear on your right shoulder. The Army ACU (Army Combat Uniform) is half Velcro. The right shoulder area under the flag is blank unless you have been deployed. Then you wear the patch of the unit that you deployed. So if you see an Army soldier and want to know if he/she was deployed, just look at their right shoulder to see if there is a patch under the flag or not. And by the way, we wear the flag with the stars always pointing to the front, so on our right sleeve, it looks backwards, but that is intentional.




My patch is of the 173rd Airborne Combat team. The 173rd Brigade has a long history starting with WW1. They were active in WWll and Korea. They were the first airborne brigade in Viet Nam. They had the most combat time in Viet Nam than any other brigade, 6 years. In fact, the country western song “8th of November” by Big & Rich is about a famous battle of theirs in 1965 in War Zone D. They had very high casualties from that battle. The unit does a memorial marathon every year on that day for the last 9 years. In 1971, the unit was deactivated to a reserve unit and lost their airborne status. In 2000, it was reactivated to airborne and stationed in Italy for airborne support of the entire European theatre. After 911, it made an airborne jump in 2003 for OIF (Operation Iraq Freedom) in northern Iraq. They have been in Afghanistan since 2007 for OEF (Operation Enduring Freedom).


Speaking of memorial runs, we at FOB Shank are doing a first annual Pat Tillman run. Pat Tillman was the professional football player who gave up his career to join the Army to fight in Afghanistan. He was killed April 2004 and was stationed out of FOB Salerno. It is a 4 and ½ mile run this Saturday. They have been doing this run for a number of years but this is the first time at Shank. Our entire unit is doing it by strong encouragement of our command, very strong encouragement. The best part is that the tee shirts are leftovers from a run in 2009 in San Jose. They are all women’s double XX shirts. I wonder why they had so many extra, extra large shirts left over. They are giving us woman’s clothing to wear and they worry about gay’s in the military. I haven’t figured that one out yet.
Hopefully, I will be home in about 2 ½ weeks.

Tom

I Met a Hero Today

I Met a Hero Today


Specialist Kelso



I met a real live hero today. Actually, I met him 2 months ago when I first arrived, but today I really found out about him. He is truly a hero, an American Soldier. He is a medic with Charlie Med, which is the medical unit with us in Afghanistan. Charlie Med is like our sister unit. They take care of the non surgical, day to day medical problem, kind of like an Acute Care office. Anyway, his name is Specialist Kelso. He is 24 y/o. Joined the military in 2006, he had his first deployment in May, 2007 as a medic. Medics, by the way, are often called “doc” by the soldiers whom they take care of out in the battlefield. He was one of 20 men from Second Platoon, part of the 173rd (More about the 173rd later). They were in Afghanistan’s Korengal Valley, often referred to “As the Valley of Death”. By the way, what brought this conversation on was the fact that his group found the Kevlar (helmet) and ammo pouch of a fallen comrade in that valley. There is a book about 4 Navy Seals on a mission in Afghanistan, called the “Lone Survivor”, by the one survivor, Marcus Luttrell. Their mission was in 2005. The Kevlar and ammo pouch belonged to one of those Seals that didn’t make it. His first deployment was in that valley were the battle had taken place 2 years earlier. The book is great and I highly recommend to anyone who wants to read about one man’s incredible survival ordeal during their battle with the Taliban. Anyway, back to Kelso.

At age 22, then PFC (Private First Class) Kelso spent his first deployment in this 6 mile valley where they built a FOB. His story is amazing. They had to build their own hesco walls with picks and shovel. They didn’t have any tractors or bulldozers there at that time. They often were in firefights with the hescoes only half filled. There were times in which he would have to duck behind the half built wall because a firefight broke out. In fact he told me that he was involved in over 450 firefights during his 13 months there.

One time PFC Kelso was manning the guard tower. He heard a swish go by and a RPG landed to his right about 20 meters away. He didn’t worry because he thought the guy shooting it was a pretty bad shot. The next swish landed about 15-20 meters to his left. The Taliban were just getting their barrings. The third landed in the sandbags just below him. This sent a piece of shrapnel making a gash through the side of his Kevlar. Luckily, he only had some minor scrapes.

One of his best accomplishments was one of his first casualties that he had taken care of. This soldier is a friend of his who was blown out of his humvee by an IED. He eventually became a bilateral amputee, but Kelso told him at the time that he was taking care of his friend that would he would be able to stand at his sister’s wedding. 9 weeks later his friend stood at his sister’s wedding.

Vanity Fair did an article on this unit I believe in 2008 called “Into the Valley of Death”. ABC’s Nightline did series of documentaries on them, not sure when exactly. There is a movie coming out this summer about their tour. Trailers can be found at www.restrepothemovie.com.

I saw part of the Nightline documentary. The Army had blown up some houses after they were fired upon the night before. There were some injured civilians that the Army took care of. The film shows a couple of elders of the village complaining to the soldiers about the damage and injured, and who is going to pay for it and what amends the Army will make. If you want to get mad, SPC Kelso told me that later on they found out that those 2 elders were actually Taliban and a few months later they actually ended up killing them both. Lying is almost second nature here. Sure is hard to fight a war when you don’t know who the enemy is and don’t know who to trust.

I am glad a I had the privilege to have met and be able to work along with one of our true heroes. Makes me glad to be here and help our country.




By the way, on a lighter note, my wife sent me an Easter basket. It was a complete surprise to me. I am sure it is a surprise to her that I would actually allow a picture of myself with the mask. Got to enjoy life each day that God blesses us with it.

Happy Easter

Tom

Medicine in Afghanistan

It has been an interesting week in Afghanistan. The weather has turned and spring is here. Days are beautiful, about mid 70s, but still cool at night. Still need a fleece at night. Unfortunately, with the nicer weather, we have gotten busier, but still not too bad.



This is one of our kids injured last week with a grenade fragment. He is doing pretty well. Someone gave him the squirt gun and he was fearless with it. I can't show his face for security reasons.



I learned a few things about Afghanistan. One of our translators is a former Afghanistan physician. He left here in the 1980s and came to America eventually. He never licensed in the US, so he worked as a lab technician. He has been back in Afghanistan now for about 2 years translating for us. Interesting, since the war with Russia, the medical system has gone down hill. A good majority of the better trained doctors left. Their formal medical school is a joke. Training is poor at best. People who gained experienced as a medic in their military or other medical background, moved up the ranks to fill the void, so they became doctors and surgeons. Not many do any residency here. Therefore, there are really a lot of quack doctors here. They don’t have a medical board, so anyone who has the money can buy a degree. So when you go to a doctor here, you don’t know if he/she knows what they are doing or not. No wonder the average person here doesn’t trust the doctors. My daughter,Kristin, who is in 3rd year of medical school would be a full fledged doctor by now over here.

Most of the time we don’t operate on the local people unless it is the Afghan military or maybe a relative of a council man and we politically are trying to bring good will to this area. The other day our general surgeons operated on a local for a hernia. Supposedly, he had his hernia fixed before. When the surgeon got in there, he found all fresh tissue. If the patient had it fixed before, there should be a lot of scar tissue around. There was none. So whoever fixed him before, just made an incision and closed him up. They never touched the hernia. That was why it came back and we had to fix him. Imagine the field day that the lawyers would have back home.


We, the doctors, have offered to help out the locals, but it is difficult. The command won’t let us go off the base because it is too dangerous. The translator told me that the Taliban is kinder to the medical personal because they use them too. Whenever he leaves the base and comes back, he gets stopped by the Taliban and checked out. The Taliban still control a lot of the back roads in the mountains here. I am not so sure that the Taliban would give me the same courtesy.

We had to do sandbag duty this week. The bunkers are lined with sandbags and with time, they tend to slide down. So we formed a chain gang and restacked them and also added new ones. It wasn’t too bad. The good thing is that it is still a little early for those little critters to be hiding in the dirt or between the bags as we picked them up.



Can you guess which one is me?





We also have a Wii game here. We actually use it for true medical reasons. For our traumatic brain injured patients, often their coordination and thought process are slow. On the Wii game, they can do a baseline, then test them everyday until they are back to normal. This one tests their balance. I haven't hit normal on mine yet, so they are keeping me here for a while longer.


Tom

A Day at FOB Shank

This is a view of the tents. If you look close, past the tents, is the open field that we run the perimeter by the hesco wall. You can barely see one of the guard towers at the edge of the field. This is where they are building the landing strip out of clay and dirt. If it rains, it turns to mud and the planes can't land.

The weather is definitely getting warmer. I don’t know if we are going to get any more snow or not. Yesterday, I bet it was at least mid 70’s. It was actually hot outside. I went running with a group of 20 something year olds. We covered about 4 ½ miles. They were kind to me. They would lead the way and when they were far enough ahead of me, they would come back for me. The path is all dry dirt, sand and stone. When a truck or MRAP would drive by, it would kick up a wonderful cloud of thick dust. Sure made my breathing a lot more challenging. I am still coughing up crap. I was in bed by 8:45 PM last night. Thank goodness we run every other day and not every day.


This is a close up of a small village just outside our FOB. In front is the hesco wall, which is basically a 8 or 10ft tall burlap bag with wire mesh, filled with dirt and rock. It is pretty effective for stopping things, especially things that go boom.




During the day, it is much nicer, but at night still need a coat ,or a fleece is what we wear a lot. It is typical desert, warm during the day and cold at night. With the warm weather we are seeing more activities and unfortunately injuries. The other day one of our convoys was dismounted in a village right outside our gate. One of the unfriendlies threw a grenade over a wall into a crowd so no one saw him. One of our soldiers had some small injuries, but 2 kids, a 7 and an 8 year old were injured. One had some serious abdominal injuries. Our general surgeons did great and he needed a few operations, but we anticipate he will be ok in the long run. I took care of the little girl. She lost half of her ankle bone, the talus. I am reoperating on her today again. I suspect she will have a limp the rest of her life. When we prepped her for surgery, it took me a few minutes just to scrub the thick dirt and mud off her foot. I doubt if she wears any shoe, maybe sandals at best. A podiatrist could busy 24 hours a day out here. Plus the kids are all small and look malnourished. I thought she was about 4 or 5 years old. I was really surprised to learn she was 8.


Dr Sucher and I were out the other night watching the laser show put on by our airforce gun plane, the Spectre.



The skies have been clear at night. We were outside looking at all the stars. There must have been several thousands of them in sky. I bet I saw the entire Milky Way. There is very little reflective light from any bases or cities around here, so we can see quite a bit more sky than what we can see in Chicago. Interesting, some of our planes were putting on a light show for us. They were blowing up something in the mountains just outside the FOB. You couldn’t hear it, but their rockets or whatever left a green tracer laser like path to the mountains. Then you see a small flash in the mountain side. Fun to watch but I wouldn’t want to be on the receiving side of it.




We rotate putting on lectures for the medics and nurses. I was demonstrating where we insert the pins on an arm for an external fixator










One of the local national military sustained a femoral shaft(thigh bone) fracture. I am inserting one of the pins to connect to an external fixator

Tom

The FST

This is the entrance to our FST, the 909th. All injured patients are brought through these doors. There is a tent just to the left where all patients are stripped to a blanket only, to make sure no weapons or suicide bombs are smuggled in.


Things are going ok. I am getting into a routine of seeing patients, getting a work out in the morning and being available for consults and traumas. Most of the traumas injuries we see are in the local nationals, as we refer to them, mainly the Afghanistan military and some police. I am always suspicious if they are good guys or some bad guys who made it into their military and are spies for the Tailbon. Either way, if they are brought in injured we do our best with what we have to take care of them.


This is our OR with 2 beds. Only one time did we have to use both beds at the same time. The blue structures are the arm boards. We move them to the side, then carry the injured on the stretcher and place then on the table. We operate with them on the stretcher (litter).



This is our ICU (Recovery Room) with a stretcher holder in place. We keep patients here until arrangements are made to helicopter them to Bagram.



One of our vascular surgeons did a great job saving a local national’s leg the other day. Their vehicle, a pickup truck, was hit by an IED. The Afghan military have very little to protect themselves, just the body armor and their AK -47. They don’t have MRAPs like we do. Anyhow, he had shrapnel tear through an artery in his leg. Our medic who first responded put a tourniquet on him; otherwise, for sure he would have bled to death before we have been able to treat him. We stabilized him, resuscitated him, and took him to the OR. In the OR, we explored his leg, found the artery with a big gaping hole in it. The vascular surgeon put in a bypass, a gortex graft that basically looks like a flexible straw. He tied this in above and below the hole. This restored the circulation to the rest of the leg and saved his leg. If he would have been treated by the local hospital, he would have ended up with an amputation. Once he was stable, he was transferred to Bagram for definitive surgery.
I am including pictures of my work facility. It is not quite like the hospitals back home. We don’t have a doctor’s lounge or locker room or even a scrub sink. We have an ACLS (essentially our ER or evaluation room), an operating room and what they call ICU, which is actually our recovery room. From the ICU, if they are critical, the Medivac helicopter will pick them up and fly directly to Bagram for further treatment. If the injuries are not too bad, once they are stable, they are transferred to another tent which is essentially a holding area.


Woke up one morning this week to this stuff. The good thing is that it is gone by the next day.




I am working with a Czechoslovakian doctor on a local national military leg. I am doing a fasciotomy for an open fractured tibia. Because of anticipated swelling, I release the thick band of fibrous tissue (fascia) that holds the muscle in place. The swelling can get so intense that it can block the circulation to the muscle and nerves, causing them to die.








Closer view of the surgery. I eventually perform the same thing on the other side of the leg. I also applied metal fixation (external fixator) to stabilize the fracture.


Tom

This Is What We Do

The 909th FST in action during one of the mass cal ( Massive Casaulties)



There was an Australian News team that did a documentary about the war in Afghanistan. They filmed this last fall about the medical unit and the treatment the wounded receive in Afghanistan. It was filmed at FOB Shank. The unit was the 8th FST. My unit, 909th FST relieved the 8th FST here in early Feb. The documentary filmed a day at the FOB, almost at the peak of the amount of injuries before the winter set in. Since the filming, the winter has fortunately slowed down the number of injuries. However, we still get days just like this. This is a 20 min film that very accurately shows what we do here. We met the doctors who are in the film. We overlapped them for about a day before they took off and we took over. We operate in the same OR, the same treatment bays, and the same mass confusion and rushing around that is shown on the film. Unfortunately, we hear the same screams, and feel the same pain and sometimes helplessness. The FOB is a little bigger since the film. We now have metal plates where the helicopters land. That also makes it a little easier to roll the injured into our treatment area.
Towards the end of the film, they show a 16 y/o boy who was shot and paralyzed by the Afghan Army. They have been taking care of him weekly for months. The family brings him in once a week and we debrided and dress his wounds. The family really has no where else to take him. There really isn’t any other medical facility around, unless they travel to one of the major cities, which is extremely difficult. We have continued his care since they left. He has not shown up for the last 2 weeks. He was looking pretty terminal the last few visits. We suspect he finally expired.
The room at the end of the film was the doctor’s room. It is a section of the tent, that had a wooden wall built into it to section off part of the tent to make it almost a separate room. We call it the dorm room. Some call it the brothel because it reminds them of what one looks like on TV. I think they bought out all of Amazon.com. They filled it up with so much crap, it is worst than a college dorm room. But that is ok. If that is their escape from reality here, they deserve it. I am not living in that room. I am only a Major and don’t have enough rank. The Lieutenant Colonels stay there. However, most of the evenings, all the docs go to that room and watch Sopranos or some movie because they have a TV. We don’t get any TV programs, so we just watch DVDs. I am in the big tent with 12 other guys. I can’t complain. I am doing fine.
Since the documentary was done by an Australian news team, I don’t think it will ever be shown in the US. Too bad. For those who are familiar with a documentary done by HBO a couple of years ago, something like “Bagdad ER”, this film is right in line with that. It was just released this month. I highly recommend it. The link to their website is:

“http://www.abc.net.au/foreign/ “ Click on "The Golden Hour'

Because of the bravery and courage of our young men and women in uniform, defending our nation, this is what we do.



This is all the docs from the 8th FST and the 909th FST. We are standing on the new helipad that was just placed a few weeks before our arrival. This picture was taken the day we arrived. The 8th left the next day.



This picture was during the same mass cal. You can see the hair on my head now, so I apologize for not having a haircut.



Tom

Things That Go Boom

At dusk after we received 3 inches of new snow outside my tent Feb 19 The weather here is up and down. It seems to be the same for a few days, then changes. It will be snow and rain for 2-3 days, then clear skies for 2-3 days. When it is snowing and raining, everything is socked in. The satellite goes down and no internet for a while. Long distance phones go down. The place is snow covered for a while, then turns to mud everywhere. The mud gets tracked into the tents and covers everything. You get used to it. It gets to the point where you just accept it and don’t bother cleaning it off things. When the sun comes out, it takes 2 or 3 days to finally dry, then the mud is replaced by brown dirt and dust. Then it rains and repeats the whole process again. The other night it snowed about 2 or 3 inches. It looked pretty for a while until the next day when it turned to slush and mud. The 155 Holwitzer. The ground shakes when this goes off The other day I was sitting in my tent on my computer and heard a loud boom. The ground and entire tent shook like the ground does when T-Rex was coming in Jurassic Park. About 5 minutes later, it would happen again. We were not getting mortared or rocketed. I walked around a bit and found our huge guns going off. We have 3 large, 155 Howlitzers. We also have four 119 Howlitzers that shoot 105 rounds. Each of these shells weigh from 65 to over 100lbs. These are cannons that they pull in the back of a truck. The barrel is bigger than the barrel on a tank. My friend and I walked up to them, got within about 25 ft and they shot another round. The shock wave from firing can almost knock you over. You had to have earplugs in or you would go deaf. They tell us that the range is 26 miles, incredible. I don’t know if it was a training exercise or they were shooting a specific location to support a mission. I would hate to be on the receiving end of that thing. I am glad we were shooting out instead of receiving it. The smaller 119 Holwitzer shoots 105mm rounds. After the 119 fires, you can hardly see due to the gun powder smoke Things have been slow which is a good thing. With the weather so bad, nothing is moving. I have clinic twice a week in which I see a few simple things, like broken hands, minor cuts, etc. I think they are waiting for the weather to get better, and then I think we will make up for the down time. I guess I should enjoy it while I can.

Tom