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).