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.