A week of 'Hit or Miss'

It's been a week of 'hit or miss' as we say when it comes to incoming casualties to the hospital. We had a 36 hour period of calm, then a steady flow of patients, nearly all requiring some form of orthopedic care. Being the only Ortho surgeon here means I respond to nearly every call when casualties come in. This week, one of our 'patients' was a K-9 (German Shepard), who was unfortunately, caught in the blast zone of an IED. Fortunately some of our corpsmen and a veterinarian tech were quickly able to patch him up. It's always hard to see severely injured patients, but it's especially difficult to see children or animals injured or killed. They are truly defenseless in this war, and the prevailing tone around the hospital quickly turns very somber when a child or animal is hurt. The death of a fellow soldier also brings the same sentiment. When a soldier dies, we at TQ Surgical honor him or her by 'Manning the Rails'; the entire company stands at attention along the hallway out of the facility while the fallen Soldier/Sailor/Marine is carried out on a litter draped with the American Flag. We as a surgical team have experienced this and it's sad no matter how many times it happens. Afterwards, however, our team comes together with renewed focus towards the next patient.

Being busy so far, I haven't had many opportunities to see the rest of the base. The history around this base is interesting. Apparently, Saddam and his sons used a sprawling ranch house on Lake Habbinayah before the war for torturing and killing many Iraqis (shia). He also buried numerous MiG 25 and Su 25 Iraqi Air Force fighter jets, presumably from the time of the Gulf War. Many of these have been dug up. The 82nd Airborne first took over this base, but now it's a Marine base, although we have Army integrated among us.

The days seem long here. There have been many times we'll do a case in the morning and by that evening, it will feel like the case happened the day before. Having said that, we are nearly at the one month mark. I was told today that we'd better appreciate the warm weather we've experienced, because it's going to get very, very hot soon.

As far as the surgical cases here are concerned, it's been challenging. Many times I've had to defer to the general surgeons. A patient may come in with a severe extremity injury and I'm ramped up to go in and fix it. However, if the patient has a head injury or is otherwise unstable, I have to just simply put a splint on the extremity and send the patient out to the next level of care. I certainly want to do more, but it's how the system is supposed to work in order free up space for the next round of patients. In that respect, it's much different than civilian trauma care.

The pictures posted include our fearless patient (one with LCDR Neptune).
One picture of the Arabian night.
A tribute to our en-route care nurses, a picture of their Kevlar helmets.
A picture of HN Labindano putting on a splint (I'm working like crazy to train these guys up!)
An x-ray of what happens to your foot, if you're lucky, after an IED blast.
A picture of the 'body bags' we use to keep patients warm during MedEvac transport on the helicopters.

Happy St Patrick's Day

Well, it's official. I am finally very tired. We have been operating constantly for the last week. From one to seventeen patients at a time, we are receiving a steady flow of patients both Iraqi's and American service members. I think my daily blog is going to end up being a weekly blog. It feels like we've been here for 3 months, but it's only been 2 weeks. The outgoing surgical team has returned home and the entire responsibility of patient care falls on our shoulders. It's an awesome responsibility, but one that we're proud to provide. I liken this experience so far to being on trauma call during residency, being on call 24/7 and the casualties can and will come in at anytime. However, when I get the call to respond to a urgent surgical medevac I truly haven't felt overburdened or stressed about getting out of bed to go to work. I've quickly learned that my job here is much, much easier than the young (usually 18-24 years old) soldiers, sailors and marines out there on patrols and convoy ops, at check points, and clearing neighborhoods. They are doing the hard work and they rarely complain. Nearly all of them also want to return to there units after being wounded. It's tough to tell a young lieutenant that he'll need to leave his men behind to get more definitive care back in the U.S. They usually have a large amount of guilt associated with leaving their friends behind to fight without them. There's many patients dealing with Post Traumatic Stress Disorder.

I'm also learning about the Iraqi Army and the Iraqi Police. I probably have treated more of them than Americans. So far, we've seen some of them with self inflicted gun shot wounds to the extremities. I've been told that in order to clear there weapons they need take them off of safety and have negligently shot themselves. Some of these patients can't return to duty because of it which is extremely counter-productive to the overall mission here. Also, we have to very careful where we send them after care. They are high profile targets for the insurgents or death squads.

As for life at TQ, I've been too busy to enjoy life outside the hospital. I hope that can change in the next couple of months. I finally have a room to myself and I'm slowly getting settled in. Many of us officers have started classes toward gaining our Fleet Marine Force Warfare Pin. It's something to do out here other than work. It's the Marines' way of saying us Navy guys are part of the Corps. We also have a huge share drive of media files (movies, shows, etc.) we can download from for downtime. We're all waiting for the summer heat, but we have been told to expect some rain in the next couple of months, which is horrible here in the desert. I hear its a sloppy mess all over the camp when it rains.

I have a picture of me and two nurses from the New England region (Groton and Newport), LT Lora Martin and LCDR Chad Deaton. They're both ERC (En-route care) nurses and have one of the most dangerous medical jobs out here. They go out with sick MEDEVAC patients on helicopters. Many of them have experienced being fired on with small arms fire and rocket propelled grenades. They should get special recognition for this, but unfortunately at this time, they don't.

There's a picture of me and CDR Erin Moore one of our surgeons who specializes in vascular surgery. We were busy debriding what was left of the heels of an Iraqi Army soldier who stepped on an IED.

The guy with dusty foot is what happens to splints after just 2 weeks out in the desert.

I also have a picture of the some of TQ Surgical waiting for a MEDEVAC helicopter to land to bring in an urgent surgical patient.

The next picture is me and LCDR Neptune (one of our OR Nurses) at the Hajji shop where you can buy anything from an external hard drive for you computer to bootleg DVDs.

The last picture is me with the outgoing surgical group having hot tea and smoking cigars at the Hajji shop. It's sort of a weekly ritual for the troops to unwind and sit outside on a clear night.

Well I'll try to keep the info coming, but unfortunately this war keeps Ortho docs like me very, very busy.

Take care

Sorry for the Wait

I apologize for the long wait between postings. Unfortunately, I've been very busy here since last week. I also found out that the computers here don't recognize Microsoft Works documents so I'm typing up this posting from scratch rather than saving a copy on my thumb drive to copy onto the blog when I get to the internet cafe. Internet access here can be spotty. There are times when all internet access is shut down when something happens to someone affiliated with the base in order to limit inadvertent contact to family members. These periods can last from hours to days depending on the circumstance.

As for life here. It's not bad so far. We are learning a lot from the previous group. Patients come through any time of day, but usually the mornings are less busy than the evenings. The nature of the injuries, as I suspected, are grave. Many times the decision I have to make is when do I stop and let the next level take over. I did my first external fixator case a few days ago on a patient with a severely fractured leg and foot. I'm don't think he's going to keep the leg.

I've also found time to check out the Hajji shop and tea house. Iraqis like to sip tea and smoke cigars in the late evening. Many of the Marines and Army guys like to do the same. It's a nice way to relax at the end of the day. We are also working on getting the interpreters to consider starting an Arabic language class. That should be interesting.

I'll try to post some images with this entry. Right now we are in another email blackout period.

Some info on the pictures above. The photo of me and the other guy is Chris Carr one of the general surgeons. One day I accidentally picked up his uniform top and put it on. I didn't realize I had it on until I got to the chow hall and one of the other officers told me. You may notice that we have each other's uniform tops on.

The picture in the OR is me and CAPT Thompson. He's the outgoing Ortho Hand surgeon. He's the program director of ortho for the Navy in San Diego. I'll try not to send any bloody, grotesque operating room pictures.

The Dirty/Clean picture is how the laundry gets done here. Just drop off on laundry day and you get back clean, folded clothes in a plastic bag 2 days later. If only it were like that at home. lol.

The beer picture is actually non-alcoholic beer. I didn't realized so many different beer makers offer a non-alcoholic version. I guess they have to make their money on soldiers somehow.

Take care.

Welcome to Iraq

Well after a very, very, very long departure process, we finally arrived to TQ, Iraq. The entire ordeal took a week and the timeframe from Kuwait was over 24 hours. Needless to say we were all very exhausted and after eating some breakfast at the chow hall (excellent food), the majority of us went into hibernation. I hibernated for about 7 hours. Angela Early, our trama surgeon scrubbed in on a case immediately. Fortunately, they haven't been too busy here since we arrived.

The base here is huge and many nice amenities for a forward operating Marine base (PX, Internet cafe's, Coffee house, Gym/Aerobics, etc.) They also have other shops run by local nationals. The terrain is baron desert. So far the weather has been bearable with highs in the upper 70s and lows in the 50s. We are learning as much information from our outgoing counterparts as we can before they go. So far, we seen some tough cases. Over 70% of the casualties are orthopedic, so I'll be very busy. Most of the patients are Iraqi's and their disposition after treatment is one of the biggest problems the medical community has to face.

I getting use to life on base and having to walk nearly a half block to go to the bathroom (especially bad in the middle of the night). I'm also beginning to learn the nuances of Arabic culture. I'm still thought in a little shock (and some jet lag) that I'm here. I posted some pictures and will keep them coming when I can.

We'll talk more later.