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.