Tokyo

FINALLY... the sumo tournament.

I love this shot. Steve looks like a gigantic kid on the Japanese subway.

Steve having a beer at a 'skybar' in Ebisu (as the brewery itself was closed)

So sadly Steve left just a few days ago, but I haven't had the chance to put up any Tokyo pictures. I'd say we had a great time in Tokyo because we did, however, we ran into some interesting challenges. The first one was completely my mistake and I made us miss our Sumo tour on the 12th. The tour company was not very accommodating at all and we were unable to arrange another tour. We did, however, make it to the Sumo stadium on our own and enjoyed some traditional Sumo Wrestling (English commentary radios available after 1600 made it a bit more exciting). We also shared some traditional Sumo stew called Chanko. The second day we were in Tokyo was a Monday. For those of you reading this who I'm sure are soon to visit Tokyo yourselves, nothing is open on a Monday. We first tried the Ebisu brewery, then the photography museum. We called the aquarium which was going through renovations. We again tried to rebook the sumo tour, then ended up heading to the Kabuki theater (the only one in Tokyo I knew of). When we arrived we discovered the theater to be torn down to rubble to make room for the new one. Steve took a picture. All we could do was laugh. Another interesting adventure we had was on Steve's last night. All we wanted to do was have a drink at a bar with some ambience. The first one we chose in Shibuya had a large cover fee and the music was so loud conversation was not an option. We then decided to move the party to Shinjuku to the New York Bar and Grill on the 52nd floor of the Tokyo Hyatt. This bar was made famous in the movie "Lost in Translation" (which I don't recommend). Nonetheless, by the map we had, we had a bit of a walk from the subway station. How we missed a 52 story building I'm still not sure, but we passed it up and had to turn around. We finally found the building which was actually more than just a hotel, but an office building as well. The Hyatt was only floors 39-52. The entrance to the hotel from street level (i.e. entrance to the elevator) was by no means obvious and we had to ask a poor security guard to point us in the right direction. And of course we couldn't go right to the 52nd floor, but had to get off at the 41st I think, walk from one side of the building to the other, through a restaurant and library to get to the elevator to take us to the 52nd floor. The drinks were highway robbery by American standards, but by that time I really didn't care. The live band was jazz and the view great. Steve and I noted that probably half the buildings were tall enough to require the blinking red lights to avoid planes running into them. That's Tokyo.

Below is Mt. Fuji sunrise.

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Fun in Japan

So the baby brother came to visit me in Japan and we are having too much fun besides occasionally wanting to strangle each other with all the traveling we're doing. There are so many good pics, I had a hard time trying to figure which ones to post, but here are a few.

Steve at Station 8 when we climbed Mt Fuji

Steve at Mazda Museum posing in front of concept car.

Steve feeding the sacred deer at Nara Park

Posing as Samurai at Osaka Castle

Steve and I at traditional tea ceremony

Japan Pics

As I promised, here are a few pics from my home in Japan. It is a bit hard to explain what it looks like, so I finally have some visuals. I had some video, but for some reason it is not uploading, so I only have pics of the roof (and the stairs that I carried everything up to get on the roof). Take note, the picture of Mt. Fuji is from my roof. Also included are a few pictures from the Tanabata festival in downtown Fussa just outside the main gate. I borrowed the Yukata I was wearing, but I might just have to get one of my own for next year :-)

First Day Back

It was my first day back to work in the Urgent Care Clinic. I actually didn't see my first patient until 1100, but then it started to get a bit busy- smashed hand from door slam, hypoglycemia, severe nausea and vomiting turning out to be pregnancy, known miscarriage with heavy bleeding, abd pain from constipation - you know, the usual. I felt very slow getting any work done. It will definitely take some time to get back into the swing of things, but I'm sure I'll get there eventually. Thank goodness I have tomorrow off.

So many stories still to tell from Afghanistan. I think I mentioned earlier a brief visit from Afghanistan's president, Hamid Kharzai. I'm hoping I'll be able to post a small video. I also wanted to mention my two Afghan mandibular reconstruction patients. Both of these men were had their lower jaw blown out by gunshot injuries. They arrived maybe a week or two apart. I take very little credit for the care of these men as it really was our wonderful ENT doc who did some amazing, but rather unsuccessful surgeries on both of them. They both originally had a piece of their hip bone removed and grafted to reconstruct their lower jaw and then a free flap from their abdomen placed over the bone. Sadly neither of these took very likely to the poor nutrition of the Afghan population. The first one, who I would refer to as the nice one, as the other was a bit high maintence and stubborn, had a second jaw reconstruction done with a bone graft from his fibula (lower leg bone) complete with skin flap. It looked good at first, but it just didn't take either. I think the ENT doc was seriously considering somehow getting some leeches which are apparently fairly common place in these types of surgeries in the States. I just have to commend my dear surgical colleague here though because the hip graft surgeries each took between 7-8 hours in the operating room. The fibular flap was upwards of 14-15 hours. CRAZY! But he still did it. It was very frustrating, however, to see these men spend so much time with their jaws wired shut and when finally removed still unable to eat for fear of infection from any oral contamination. Hence both these gentleman were on tubes feeds for weeks. Nothing by mouth except moistened sponges on a stick to keep their mouth moist. My dear nice Afghan male appeared to become rather depressed and he was eventually transferred to a FOB (forward on base) who happened to have a highly specialized ENT physician trained in jaw flaps. He didn't return before I left, but I do hope all is well. The other gentleman appeared to resign himself to a long stay at the hospital and became much less stubborn.

I might have to tell the crazy bomb maker story next.

Delayed

So I'm sitting in Chicago's O'Hare Airport waiting for my flight back to Japan. So far we are 2 hours delayed. I can't really complain as I have no crabby tired children. I have no medical ailments and I'm not hungry (as I just treated myself to a gourmet carmel apple- fruit right? And an iced latte). I'm hoping the Ambien will still work once I finally get on the plane.

One part of coming home that I forgot to put in my last posting was my arrival in Baltimore and being greeted not only by my beautiful sister and nieces, but a whole welcoming committee from the USO at Baltimore. Before I left of Afghanistan, I always felt a little guilty when random people would thank me for my service after they found out I was in the Air Force. Going through the line of the welcoming committee and shaking hands with all there made me feel like I really had done something finally. Granted many more have sacrificed a whole lot more than I did while I was there, but now I've experienced the war zone to some extent, walked in the blowing dust with my teeth crunching on the dust that got through, carried my M9 around with my like it was my cell phone and have woken suddenly in the middle of the night from rockets or mortars dropping (usually relatively in the distance) and now have some right to be called a veteran.

My arrival into N.KY was not a military greeting, but it certainly was a great reunion with my parents, aunt, sister and nephews. (I love being Aunt Sally). Balloons and signs. Dad even posted a big sign in our front yard welcoming home Doctor Sally (which they called me in Afghanistan). So many people at our church festival the next evening knew I had just returned and greeted me a warm welcome home. I wasn't used to all the attention, but after a couple of beers at the festival I was quite comfortable chatting about the last 6 months. I did see a lot while I was there and have several specific stories to tell, but thinking about the whole experience is more of a feeling than a memory - good and bad. It is a bit difficult to convey in words and not every story is something I want to share, but I have no problem saying it was - well not a life changing experience, but a life learning experience.

Looks like we might actually be boarding soon so I better get off my computer and start listening to any new announcements. More to come later.

Home Sweet Home

Finally back home- well that kind of depends on how I'm defining home at this time, but back in the States nonetheless. I've been thoroughly enjoying time home with my family - parents, siblings, nieces and nephews who have all grown up so much since I left and are so incredibly cute (the nieces and nephews that is).

I have so many stories yet to tell from my days in Afghanistan as well as pictures to post. The internet at Bagram was so slow and spotty that I finally just gave up. Now I don't know where to start. First I think I might describe my homecoming a bit. July 2nd, 2010 was literally the longest day of my life. We left Kyrgystan at around 0730 with stops in Turkey and Germany and finally arrived in Baltimore around 2100 (please add about 9hrs time change). We, meaning all the other soldiers and I, were in a large chartered plane with minimal comforts. My seat did not recline, but the one in front of me sure did and it stayed reclined pretty much the entire trip. It didn't help when food was served as my tray table did not unfold completely with the seat reclined. I slept very minimally and was relatively warm and sweaty in my ABU's. Now the exciting part of the trip came with about 3 hours left before hitting BWI when I was tapped on the shoulder by the chief OR nurse who I knew well, a Lt Col, telling me that a pregnant woman was likely having some Braxton Hicks contractions, but I should probably check her out. So yes, there I was with a 34 week G2P1 pregnant female whose first child was born at 36 weeks now having regular, low grade, but persistent contractions that were not remitting with rest and water. No blood or fluid, but slightly concerning. Thank the Lord for our OB nurse who sat with her and timed her contractions which improved slightly by the time we reached BWI and were met by medics. The poor girl had traveled to the States to spend her husband's deployment with her family (very understandable), but flying at 34 weeks on such a long flight from Germany (she had boarded in Germany) maybe not such a great idea and with child number one in tow. Obviously things worked out fine, but I was slightly concerned for a bit that should she have any bleeding or fluid loss that I'd have to check her cervix with nonsterile gloves behind the curtains of the airline stewards' bay. Not fun for me, but certainly not fun for her.

Pictures shown are a few from my last days in Bagram as well as my first meal at my sister's house- Fresh asparagus and corn-on-the-cob from the farmer's market, amazing mushroom pasta and some steak all washed down with some good red wine. Couldn't have asked for anything better.

Battle at Bagram

Coffee and chatting with French UAV friends. Above me, Jordanna and Lt Bouret

(commented on in my last blog entry).

Okay, so hands down, the most exciting thing this week was getting attacked during the wee hours of the morning. I won't go into details, but I will say it was a little scary at the time. Nonetheless, I was pretty safe at the hospital. Fortunately and surprisingly there were not that many US casualties. I'm now working on the inpatient ward for the last 5 weeks of my tour here, so I'm getting to see the traumas again. The worst we had was an amputated foot. It was a rough day, however, as far as morale goes. A lot of people were scared and we were all locked down in the hospital - no one coming or going, no planes coming or going. Miraculously our wonderful nutritionist got us food for breakfast (pancakes!) and we dealt with MRE's at lunch and dinner. We were allowed to leave late that night but obviously security was still extremely tight. Now that that is over though, things are pretty much back to normal operations and it is currently a beautiful Sunday afternoon.

Now that I'm on the inpatient side of things, I get to see a few more interesting cases. Yes, of course there are still the heart attack rule outs and the occasional pneumonia and cellulitis, but often the trauma stories are interesting. There was recently a pack of 5 soldiers who came in pretty beat up after their MRAP ran over an IED. They spent all their time in the ICU before they were shipped off to Germany, but the one kid I got with a rather minor (compared to some) facial lacerations and tooth loss had an interesting story. I kept hearing bits and pieces, but once he was rather awake after his sedation from surgery, he drew me a picture of the events and did the best he could to describe the incident without his 5 upper front teeth and the fattest upper lip I've seen. Apparently this kid was in a tower and saw a jingle truck (Afghan decorated truck) come racing toward one of the gates that doesn't usually get trucks. He shot at it and it exploded sending shrapnel into his tower and thus injuring his face, however, he continued to shoot at some of the insurgents who were behind some barriers and shooting at him and some soldiers on the ground. He said he thinks he took down three before his back up got to him. I'm pretty sure this kid saved a couple lives if not many. Good kid too. I'm not sure he realized what he did.

Catching Up

So I'm a little behind on my blogging. I have no real excuses, but it has been busy in the clinic. It seems I can never catch up with my notes. Well, we sort of had break today and I'm all caught up, except that tomorrow is my Sunday to work, which just means more notes.

Seeing as I work this Sunday, I had Friday afternoon off which I spent with my Jewish, Army, Yoga, newly-promoted-to-Captain buddy Jordanna. Jordanna works in supplies and basically gets the infantry guys what they need. She also works we the coalition forces to get them what they need as well. In other words, she has connections. Friday afternoon we used one of her connections to spend some time in part of the French area on base, right on the flightline. This French unit was working missions with unmanned aircraft for reconnaissence. It was a beautiful day and we arrived walking onto their shaded little deck outside their office with helicopters flying overhead. We walked into their breakroom to be greeted with a bunch of French soliders yelling at the TV screen as they were playing some version of MarioKart on the Wii. We then enjoyed a cup of good strong French cafe with Jordanna's Lt contact and met his boss, Maj C. This was followed by a lovely tour of the control room for these unmanned aircraft. Everything I saw in that room was complete OPSEC, but very cool stuff to say the least. We chatted a bit more while we waited for one of the planes to land and I got to show off the little French that I remember. We got a picture in front of the tiny little plane once it landed which I'll have to post once we get a copy of it from Jordanna's friend. Needless to say, it was a nice day.

Bringing the conversation back to work, I've been trying to help this young infantry soldier with severe back pain. This kid is tight as a drum and almost got killed on his last tour when he was thrown out of the turret (the gunner position) of an MRAP 3 years ago. Not to mention he's about as type A as one can get which contributes, in my opinion, greatly to his back pain. I've tried everything up my sleeve for back pain. His been adjusted with OMT. He wears a portable TENS unit he got from PT. He stretches daily. And when I saw him on Thursday he was taking Seroquel 100mg and Valium 10mg at night to sleep which barely gets him 3-5hrs of sleep. He takes a valium in the morning,Mobic (an anti-inflammatory), Baclofen 3 times daily, plus about 12 percocet (narcotic pain med)/day. His pain, however, was doing pretty good on this. He's absolutely desperate to get extended to February so he can take the sniper position that just opened up. He's a good kid and I just discovered he's from Kentucky. I'm sure we probably have one friend, family or acquaintance in common. He works hard and was raised pretty much by his grandmother because is mother is an alcoholic and crack addict. So Friday he comes in again all distressed (which is normal) and tells me he just threw out all his percocet and Valium (which I had just refilled the day prior) because he just found out his grandmother died and he wants to get off all the narcs and sedatives so he can do his missions as he has nothing to got back to. With extreme discreteness, I've had him see a psychologist a couple times in the outpatient clinic (as opposed to the psych clinic which has a stigma attached to it). I simply don't know what else to do with him. He's suppose to have gone on a 9hr mission today and I can almost guarantee I'll see him in clinic tomorrow. All I can do is pray that he does the right thing and doesn't get hurt.

I've already nearly written a book for this post so I'll have to save the next two for the next post, but I wanted to mention that I got to shake the hand of Afghan President Hamid Karzai last weekend. I have footage of his speech to us, but it is too large of a file to get it uploaded. I also have great footage of all the outpatient clinic providers sing Karoke to the Jackson Five's "ABC, 123" in payment for losing against our techs in a game a Cranium. It wasn't pretty, but very funny. Again a bit long to upload, but I'll see if I can't clip it and give you all a taste of it.

Off to bed.

Full Moon

It is actually a very beautiful night in Afghanistan. If you look at one part of the sky you see a gorgeous, golden full moon near the horizon and the other side of the sky is silent lightening behind the clouds and mountains. It was a nice little walk back from the gym.

At work, however, the day was busy - lots of musculoskeletal issues which always takes a bit more time for the exam as well as the note-writing. Oh well I'll just catch up on my notes tomorrow. I have been rather frustrated lately, however, with the numbers of patients I'm seeing here who shouldn't be here in the first place. It is usually a combination of factors. Believe or not, often the soldiers, especially the infantry want to come. They want to be a part of the team and don't want to let anyone down. The part they don't realize is that if they have a medical issue that requires frequent visits to the doctor with occassional profiles or quarters (limited duty or days off), they are leaving their unit one man down. Here in theater, there is no replacement, no extras, you've got what you've got and your unit will remain one man down until you return. The other big factor is, in my opinion, soldiers not being screened well enough or simply waived on with crazy medical conditions. I had one dear gentleman, a man in his 50's, who was scheduled to return home in about a month. He came to me because he was a little concerned that the bruising on his calf was an indication of his congestive heart failure acting up. Now for those non-medical people reading this, that means he has a condition in which his heart does not pump efficiently in the very simplest of terms. Looking back at his records from the States he was taken off his digoxin and lasix just before deploying. These are two very serious medications that need to be monitored which is likely why he was taken off of them. Thankfully this gentleman did not have any problems without them and was definitely not having a CHF exacerbation when I saw him, however, had I been the physician seeing him pre-deployment, he would not have been medically cleared. Oh and did I mention he also had COPD (chronic obstructive pulmonary disease). Now come on! Really?

My second recent case is a kid who was deployed with anxiety. Okay, so many people have problems with anxiety, however, he was put on medication for it - Effexor. This is also a no-joke medication which was titrated up to a fairly significant dose, brought down to a medium dose and then just stopped so he could deploy. Now I ask you, if you had anxiety do you think going thousands of miles away from your family and into a war zone would make your anxiety any better? By the way, stopping Effexor cold-turkey without titrating often has bad side effects like nightmares. This doesn't do much for one's anxiety.

These are only two of the cases I've seen in the past week. There are many more and I hate to show my frustration as it is usually not the fault or intentional fault of the patient that they are in the position they find themselves. Nonetheless, it falls to me and my colleagues to figure out whether their medical issues can be managed effectively enough to keep the patient fit to do their job safely as well as not put their unit at risk or to decide if they need to be sent back stateside. Seeing as the military has spent the time and money to get them here, we often find ourselves keeping patients/soldiers here against our better judgement. I often feel like I have my hands tied.

Alright I have vented enough. I will now attempt to enjoy the peaceful solitude of my BHut room before drifting off to sleep.

Just a few pictures from Bagram. There is actually a spring here - a little green and other colors here and there. I went for a jog around the perimeter with a colleague, Miss Zelda, she's our wonderful PA and absolutely hilarious. She was taking pictures left and right - sheep and shepherds and poppies and mountains. It had just rained so there wasn't so much dust in the air. It was actually a very pleasant run.

Also got a new haircut and redo of the highlights. Feel like a new person after a day at the salon.

Happy Easter and More

So my techs and I got into the Easter spirit on Sunday morning clinic. I love my techs.

Also just wanted to post some other pictures from the last few weeks. Combat dining-in was messy, but fun.

Jason, my yoga buddy, just left to go home to Pennsylvania. The yoga clan at BAF will miss him.

Also a picture of my office. The more pictures the better. My office is becoming very cozy.

DV's (Distinguished Visitors)

Okay, so the day the president came to visit Bagram was my day off, hence, I didn't go into work and check my email to find out that we were having a DV, much more the president. I've been tortured since with great pictures of my techs shaking hands with the president. Nonetheless, there were other DV's that same weekend. I guess James Gandolfini from the Sopranos doesn't come close to the president, but he came into the outpatient clinic to get a trigger point injection and I was the lucky doc. Apparently he is former Army medic (immunizations tech). He is from Brooklyn and continues to live in Brooklyn.

Really... Pig Tails?

I know it has been awhile. It has been quite busy here. We were down to only two providers for the entire clinic for a bit, but we thankfully have our wonderful female PA back from Kabul. And she's female which helps the gender ratio a bit.

So I have to vent about a incident that occurred last week. There are somethings about the military I appreciate and others I really don't. I love the crew I work with in the clinic. They keep me laughing on my bad days. Last week, however, I was walking out of the core class at the gym and was ordered out of the gym by a first sergeant (sort of the enlisted member charged with keeping their troops in line). She absolutely laid into me about me wearing pig tails in the gym as it is out of regulation. She claimed I had been warned before (which I never have) and that I should know better after nearly 4 years in the military (3 of which were residency and a completely different story) as well as threatened me with an LOR (Letter of reprimand - very bad on the military record) if I ever wore pig tails again. Let me remind everyone here that I have short hair now and I was in my PT uniform, not ABU's and it was the best way to wear my hair to keep it out of my face during my workout. I was so thoroughly taken aback by being accosted in this way that I didn't remember her name. However, just yesterday I had a soldier come to me about a profile for chronic knee pain. He probably shouldn't have been sent to theater, but since he was there I was going to do my best to keep him pain free and able to do his job which meant yes - on profile for a little while until we determine if the therapy (steroid injection in the knee included) would help. He said his first sergeant would want to speak to me. No problem of course. His first Sgt could call or come in anytime during clinic hours. Guess who the first sgt was? My pigtail lady of course. She recognized me and I surely recognized her, but nothing was mentioned of the pigtails or my current hairstyle. I made my argument for the soldier and she left only to call back asking again if the soldier would be able to do his job. I repeated for the 3rd or 4th time that I didn't know and that we would have to wait to see if the plan of care worked well enough or not. She said that wasn't good enough. Her command wants to know if he will be able to work or not. You can see how frustrating my job can be sometimes. Granted this might have been a little harsh, but I told her I forgot my crystal ball and that she and her command will have to wait. After I hung up my techs gave me a high five.

Was that too much?

Enough about that. I've also started teaching yoga classes once a week at the gym and I think I'm going to like it. Last night went very well and I got several compliments. I'm looking forward to creating another routine for next week and choosing the music. Jen, got any good celtic albums for yoga tempo?

Anyway, I better get going. I have to shower and go to a quick meeting with our new hospital commander - another female family doc I know from the States. That's the nice thing about the military.

Hopefully more pics soon.

Ambien Day

For anyone that has ever had any problems with sleep and seen a physician about it, you've probably heard of Ambien. I usually prescribe Ambien a couple times a week. This is not unusual, however, today, for whatever reason, I think I prescribed Ambien 5 or 6 times. Everyone was coming in with sleep problems. I can't say that I'm having very much luck in the sleep department either. I guess that says a lot about the living conditions here. Often people are rooming with 4 or 5 other people if they are lucky enough to be in a dorm. I had one poor guy who had been here for 10 days in transit, about to go home, but put up in a clamshell tent with probably 75 to 100 other people who are in and out at all times of the day and night. He easily got a prescription for Ambien. Other people have been here for about a month and just haven't gotten their bodies to make the transition. It is not perfect, but I'll say it again, I'm very happy to be in my little B-hut room.

On another note the weather is getting a bit warmer here which always bodes of more activity. I know the surgeons have been rather busy of late, but don't know details. One OR nurse who was coming to see me for some, you guessed it, Ambien said she'd just seen a case of a soldier who pretty had the whole left part of his backside and thigh blown off after their vehicle hit an IED. Most of the bad injuries are from IED's and I think the enemy knows it. And yes, there are a group of soldiers whose job it is to go out, find and disarm IED's - the EOD (explosive ordinance something or other) guys. I really think you have to be a little crazy to do that job, but I did just treat an EOD guy who'd been at the job for 8 years (all limbs intact). His wife was on anti-depressants and he'd seen several buddies die. Thank you very much, but I'll stay in my little office and clean up the vomit, sample the bloody poop or urine, do the prostate exams, lance the abscess and evacuate clots from hemorrhoids - no problem.

On a happier note, had a great time at country night this past Saturday. I'll be the line-dancing, two-stepping queen when I get home.

Mental Health

In the last week, I've seen 3 patients, 2 active duty, who would very much benefit from seeing our Combat Stress (i.e. mental health, i.e. psych) providers, but they absolutely refuse. Very resistent and, of course, these are the very people who really need the help. No they are not suicidal or homicidal. That's part of my job to figure that one out, but all have serious sleeping issues that I'm convinced are a product of their stress, frustration, PTSD, anxiety or combination of all of them. My favorite analogy to how much our minds can affect our bodies is that of the emotion of embarrassment - this very much an emotion, all in your head, but what happens to your face? You turn completely red - a physical manifestation of your emotion. I think that's a pretty good analogy, but no, didn't work on these guys. Oh they agree with the analogy, but they just don't think they are crazy enough to see psych. Now how do you convince a guy who has hypnagogic hallucinations (hallucinations occuring just before losing complete consciousness into sleep or right as you are waking up and are not that uncommon) of urinary incontinence which feels very real to him, that he is not crazy? I don't know, but you let him vent for about 30 minutes about how frustrated he is with his job and his command, using a curse word like I use "um" when I'm nervous talking. He's following up with me next week.

On another note, it was Ash Wednesday today. We had a nice little service in the hospital conference room at 1030 with dear Fr. Pat who always wears his Navy desert camo stole. Now in the gospel today, there was the bit about 'don't look like you are fasting when you are' and 'go pray in the privacy of your home' etc. Sort of ironic that we wear ashes as a very obvious symbol on this day of fasting. You are always greeted with one of two responses to the ashes from a person who does not also have ashes on their forehead. Either it is "Oh, is it really Ash Wednesday already!" or (with a very strange look) "Um, do you know you've got this big black spot on your forehead?" I will say, though, that it did bring about a nice conversation with my last patient of the day who was actually deciding whether he wanted to convert as his wife was Catholic. It was nice to do a bit of explaining in that respect.

Well, I better try to get some sleep. It has been a little restless lately and I'm just hoping I don't wake up at 0300 to run to the porta-potty because of the two cups of tea I had at the UAE compound tonight with dinner.

Interesting Day

I was just finishing up my lunch trying to figure out what I was going to do with a 2o- something kid who was complaining about his sternum painfully "popping in and out"and had a normal chest xray, when there was an overhead announcement in the hospital of a level 3 (as opposed to level 1 or 2 which are more critical) trauma with several patients. This didn't quite phase me as I wasn't too worried about a level 3. Then I get summoned from one of my techs saying everyone is needed in the ER for the traumas.

If any of you follow the news or at least try to follow the international news, you might have heard about the avalanche in Afghanistan. So far on CNN, it is reported that 60 were killed after being trapped in the Salang tunnel in the Hindu Kush mountains. We received a lot of the survivors. I have no idea of the numbers. I think at one point I heard 180 people. Most of these, however, did not end up as patients in our hospital, but rather people who just needed a place to warm up and lay their head for the night. There were not actually very many "traumas" either. In fact about 30+ people waited in the steamy trauma bay for 2-3 hours waiting for these patients that eventually trickled in. I waited my 2 1/2 hrs in the trauma bay before I went back to our clinic to start seeing some minimally injured patients. Seeing patients through an interpreter is always interesting as is muddling through the culture differences. I first saw a family of 4 from 4 months to 11 yrs dressed partly in traditional Afghani clothing with added western-style overcoats and shoes. All actually pretty healthy with maybe a cough or runny nose, but nothing bad. I haven't treated a kid in over 7 weeks - it was nice to hold a baby again. I also listened to lungs through a burka - not the greatest exam, but she's still breathing. She also had a headache so she got a Toradol shot in the arm, but she wasn't allowed to show bare arms in front of the interpreter. One of the more interesting cases was that of some frostbite. It was my first experience with frostbite. We had to cut this Afghani's wedding ring off. I felt horrible. His hands actually didn't look that bad; they were fairly swollen and red. I just don't know what they will look like tomorrow or the next day. Will he get blisters? Will he develop necrosis (dead tissue)? Will the tips of his fingers turn black and autoamputate? I won't have a way to follow up with this guy, but he was thankful to get some tingling sensation back in his feet with clean dry socks and shoes. And the last most interesting patient who I actually didn't assess, but was told about first because, as my tech said, was covered in gasoline. WHAT? There is a guy covered in gasoline in our waiting room? Um, does this not sound good to anyone else? I go up to our window to find this rather plump Afghani male in traditional (loose fitting) clothing standing there. My first few thoughts included, oh dear, is going to set himself on fire or does he have a bomb hidden under his clothing? Come to find out that he only wreaked of gasoline because he'd been trying to fix his car that had stopped running in the snow. Nonetheless, he got a shower and changed into our beautiful blue scrubs before he was seen by my colleague.

Strange day and I'm going to bed. There might be more tomorrow.

Sweet Surprises

I love getting mail. This is not a plea for mail, but just to describe that getting a package when we check the mail for the outpatient clinic at 12:30 during our lunch break makes the day a little more exciting. Who got what in the mail? Who got the 2 big packages of oreos or Hershey bars or family pictures to hang up? I absolutely love collecting the mail from the mailroom and handing it out. I feel like Santa. Anyway, I got this package today, a small square box, from a return address I didn't recognize. I didn't recognize the name either. We're kind of trained to be a little cautious about packages we don't recognize, but it was from the city where my mother works and seemed quite harmless. I opened it to find a perfect little care package from a co-worker of my mother's. What a very wonderful surprise! I think I showed it to everyone in the clinic. The socks are totally out of regs, but no one in the office cares and I'll wear them until someone dares call me on it. I'm such a sock person! Thanks Judy.

Dr. Eilerman

Here's a picture of me in my office that one of my med techs sent me.

Rain (and Mud) in Afghanistan

So the last two days it has been raining, not hard, but raining pretty much nonstop. I'm sure most of you have heard about the dust around here. You simply can't avoid it. It is everywhere and gets into everything. Well that dust has now turned into mud. Now everything is quite muddy. It makes walking to the DFAC quite an obstacle course. I wouldn't mind so much getting my boots muddy, but most of the time I'm in my gym shoes and PT uniform and I like to avoid wet socks. The back of my PT pants looks like I've been jumping in a mud puddle which, I guess, is not too far from the truth.

Today, however, is quite a beautiful day as beautiful days in Afghanistan go and I have the afternoon off. The best thing about the rain is that it covered the mountains in snow again. We are surrounded, I would guess, three-quarters by mountains. Snow-capped they really are quite beautiful. The is only tainted by the foreground of connexes and MRAP's and tents and wires. I do promise to post pictures soon, now that I've taken some.

As far as the work, not much new. I was involved in the resuscitation of a few new traumas the other day - a bunch of soldiers in an MRAP (mine resistant, ambush protected vehicles) blown up by an IED. The MRAP's do a pretty good job of keeping the guys from getting blown up, but they get rattled around inside the darn things like rag dolls and often come out with some serious spine fractures. I heard someone or some group in Washington is re-evaluating the design. I don't know. These recent traumas came out of it pretty well from what I understand.

That's about it for now. I'm going to sit back and read my Nook at the coffee shop. Not much of a coffee shop really, but I got a free latte today because the guy working the register was a patient I "treated" for the common cold. There are some perks to this job (pun intended).

Irony of being in a war zone

Alright, so I've been a little bad about my postings. I've been meaning to write, especially about the way life is around here.

So supposedly we're in the middle of a war. Thank God I don't see the real action, but I have definitely seen some of the injured from the fighting of which I'd rather (and probably most of you would rather that I) not write about in detail. Nonetheless, I live in a 8 room ply-wood hut that has ducktape insulating the windows and where the walls do not extend to the ceiling between rooms (felted material, rather, keeps our privacy). This is not to complain, because as I've written before, I'm exceedingly grateful for my B-hut room. I wear my holster with a loaded gun around my waist to and from work, walking across large gravel stones that would give anyone tendonitis. You absolutely cannot avoid the dust- everything you own is covered in it, including the everything in the PX. I eat with plastic utensils on disposable cardboard-like trays everyday. Again, I point this out not to complain, but to show the irony that the other day, I walked down to one of the two beauty spa's we have here on base and got my hair highlighted and cut. Apparently at the other beauty salon you can get a massage as well. There are a dozen jewelry and rug shops near the PX and we have two gyms with good equipment and classes. There are poker nights and techno nights, salsa and taekwando classes. You'd have to wonder how we have time to fight a war.

Speaking of life on base, as far as laundry goes, you can take your laundry to a laundry service we have here with about a 3 day turn around time, however, I have heard on good authority that detergent is not used, but rather they use the sanitation cycle (i.e. incredibly hot water). We who work at the hospital are lucky enough to have 3 washers and 8 dryers at our disposal, but it can get very crowded and the wait time can get long. Just about 2 weeks ago, the laundry room was closed because some people weren't following rules. I ended up doing a bunch of my laundry by hand, as I like using soap. The laundry room, thankfully, was re-opened just a few days ago as I was getting to the very end of my clean clothes. If there is one domestic chore I really hate doing, it is laundry, however, I have never been happier to fold my clean dry clothes as I was the other day. Thank the Lord for washers and dryers. I miss my HE W/D that is in storage. So sad.

I usually like to include a patient story or two because often they can be rather humerous, however, I can't say that anything I've seen in the last few days has struck me as something to write about. Okay there was the guy who I saw twice in one day for a cut in his fingers. That morning he'd cut his thumb with his knife- bled pretty good, but it had stopped by the time I saw him and didn't need stitches. Later that afternoon he came back for a laceration on his index finger of the same hand for the same reason. Apparently he'd been using his knife as leverage attempting to pry something open. He was rather embarrassed and I joked about him being one of those cutters (depressive psych disorders) which he obviously wasn't but hadn't learned his lesson the first time. Oh and there was the interesting case of the guy who came in with a "corn" on the bottom of his foot which was wretchedly painful. I started cutting into it and discovered it was more of an epidermal inclusion cyst which our dermatologist finished excising as neither he (the dermatologist) nor I had ever seen one of these things on the foot. I thought the guy was going to cry when he could walk without pain after we were finished. Very satisfying.

Alright, I've babbled enough. If I actually write more frequently I won't forget what I want to write and it won't be as long.

I promise pictures soon. I just need to check OPSEC guidelines.

Random

Can't really think of anything all that interesting to write about from today so a couple random things:

- On a serious, wartime note, I saw a patient the other day who was active duty, but in civilian clothes and beard because he worked with the local nationals, informants to be exact. Said his job wasn't that stressful, but recently one of his informants was captured and tortured by the Taliban by sticking a needle in the pad of his finger then ripping it out perpendicularly. It tore up his fingers pretty bad. Taliban thought he was only working with the Afghan national police. If they had known he'd be talking to us Americans, he would have been killed. Scary stuff. I think I'd be a bit more stressed. Even now, as vague as all that was, no names, places or dates, I wonder if the Taliban would scan blogs to find any information. Obviously OPSEC or operational security is big here.

- On a lighter note, another patient told me today the story of his son getting a tooth stuck in his ear. Instead of putting his first lost baby tooth under the pillow for the tooth fairy, the kid stuck it in his ear. THe parents had no idea, but it wasn't until two and a half years later when he'd been having balance issues and being generally clumsy that the kid was seen by a doctor and the tooth in the ear discovered.

- My last patient of the day today was so one flown in from another FOB with a splinter in her leg. Apparently she'd been sitting on an old wooden picnic table for a picture and just moved the wrong way. The splinter had been there and causing pain for about 5 days, but no one at the FOB wanted to go in to dig it out. You could feel, but not see the darn thing about 1.5 cm in length in her leg. A little lidocaine, a scapel, and about 20 frustrating minutes later I cut a nice little sliver of wood out of her leg. She wanted to save it so we stuck it in a lab tube for travel.

- And one last thing- last Sunday after church the guy sitting in front of me told me I had a beautiful voice. Now those who know me and have heard my singing KNOW the guy must be close to deaf. Dear, dear boy.

That's about all remotely interesting from here. I'll really have to start posting pictures soon.

Just another day a the office

I've been working in the outpatient clinic now for about 4 days. Don't ask me why; it is a bit of a sore subject as I like the work and the interesting patients on the inpatient ward. Nonetheless, there are a few benefits to the clinic- relatively regular hours for one. I also have my own office which is like my second home and another place to keep my belongings (secured). I like the people in the clinic, too. Nothing against surgeons (well only one, but I won't go into that now), but they are usually a bit arrogant and not always personable.

Anyway, today was an interesting smattering of patients. Diagnosis of a ventral hernia, bloody diarrhea, another fake shoulder pain, a wretched case of vertigo (poor guy) and my favorite of the day- thumb pain from accidental morphine injection. ??!! I know. So the story goes that this patient was working in the pharmacy and disposing of outdated medications, one of which was a morphine autoinjector (for the field). This person had never seen one and was curious about how it worked, so holding in her right hand with her thumb on what she thought was the plunger end, she took off what she thought was the needle cap on the other end and POW- a mL of high dose morphine right into the thumb. This was just before Christmas and she thought she was doing okay after her thumb had returned to normal size and the horrible itching all the way up her arm ceased (itching is a side effect of morphine). However, she was still have some significant pain in her thumb and hand. And she comes to me for help. Can't say I've come across this one before. Xrays of thumb were fine. Sent her home on T3's. Think I might have to discuss this one with a few other docs - get a few opinions.

Happy New Year's?

I feel like I've been here for at least 2 weeks and it has barely been one. Half the time I don't know what day or time it is because I've been working the nightshift. I worked New Year's Eve and sadly it was busy. I got a few nontrauma patients- chest pain, appendectomy, two crazies, but we also had a 5 person trauma come in. They were all Canadian Coalition forces who had suffered an IED blast while on convoy. I was actually running one of the resuscitations- basically going through the ABC's of airway, breathing and circulation. My patient was conscience and doing well besides a nice T12 burst fracture - unstable spine fracture- and a L humerus fracture. Not too bad, but it was my first time running my own table. Four of the five ended up coming to the ward (my responsibility) after a thorough evaluation from ortho for their mostly extremity wound/fractures. These guys I just mostly babysit for the 24-48hrs they stay at Bagram- their injuries are mostly surgical and I just make sure they don't crump from any other reason. Sometimes this is easy to do and other times, no so much.

I think at midnight I was in the ER writing admit orders for a guy with purely soft tissue injuries from shrapnel. Someone had gotten some non-alcoholic champagne and we toasted to the new year. Hopefully it will be a good new year. It is predicted to get much busier when the weather starts to warm up. I'm bracing myself for the onslaught, but trying to remind myself of patience and the educational value to this whole experience. I know I will get tired and homesick and frustrated and sad, but I hope to keep focused on my tasks and keep my priorities straight. Only one week in and I know it will be a long 6 months.