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.