...and then the rains came

...and then the rains came. We got our first major rain here at TQ and we're seeing up close how this place changes from baron desert to muddy floodlands. The morning after Easter I had to walk to the shower and a 2 foot lake was in front of the shower trailer. The worst part about the rain is the eventual clean up. You can't keep the mud out of your hooch. This past week and a half started out with rain and ended with warm, dry weather. This allowed us to have a BBQ picnic to welcome the new staff from Al Asad. We had a good time with all the near beer and steaks we could enjoy and played volleyball.
Overall, patient flow has been average to below average. Only one mass casualty (over 3 patients) since Easter. Thankfully, no major problems here on base. We had one special patient come through. He was an 18 month old Iraqi boy who was hit by sharpnel from a mortar round in the hand. He instantly melted the hearts of all the staff. Unfortunately he had some tendon and nerve damage which needed to be surgically addressed. Its in situations like this when we find out how frustrating it is to care for Iraqi civilians. They have very little, with respect to health care infrastructure, in our area for traumatic/surgical conditions. It's a topic of heated debate around here, because taking care of Iraqi civilians is not within our mission scope, but we find ourselves from time to time dealing not only with medical issues, but with case management and disposition issues that are extremely challenging. Some of the docs have even had ethical conflicts with standards of care when it comes to treating Iraqis. There's obviously a serious void of Iraqi health care professionals, and we hear occasional stories of corruption amongst some Iraqi officials. It gives you the impression that no matter what happens, some form of humanitarian/medical aid will need to be present here for years to come. A slim majority of patients in our level III facilities are Iraqis and they are generally not permitted to be sent out of country. Unfortunately, we had a Marine pass away after a spirited effort by everyone to try and save his life. Not only did he have severe extremity injuries (above knee amputation and upper extremity arterial injury) , he had undergone emergent chest and abdominal surgery, and more than likely subcame to intracranial bleeding. These are the toughest loses for us. We feel that if a patient can reach us with a pulse, then should be able to save them. I know it's not always possible, but it's more disheartening to lose someone who had signs of life when they reached you.
Day to day, we are trying to keep our minds occupied to help the time pass. Recently, I've turned into an aerobics nut. I must confess that I never tried aerobics before this deployment, but now I'm hooked. It's much more entertaining than running on treadmill, and at the end of the session, I sore in places I never thought could be sore. We are also starting our tradition of the moonlight campfire porch. This is an area just outside of our living spaces where someone sets down a battery powered lantern which we sit around in a circle and swap stories under the bright desert starlight. You have to do things like this or else you'll go crazy from the intermittent boredom.

Pics of the week (thanks to LCDR Neptune for some of the pics):

The lake by the shower trailers

LCDR Neptune enjoying the rain water

CAPT Jernigan fights off the flames from the grill

A picture of one of Saddam's MIG fighters

A make-shift cast shoe (with home made laces) for one of our peds patients

Our friend gets up close and personal with the camera

Our friend posing after his dressing change

CAPT Rodridguez helping me study up on my pediatric hand surgery

Picture of CDR Deordio consoling our friend

A nice shot of LT Morales and his perfect form for his volleyball serve

HAPPY EASTER SUNDAY!

Happy Easter! Well, it's the day that the Son of God, Jesus, was resurrected! As you can see the staff at our chow hall, chose to erect a life-size replica of Him to celebrate the Holy Day. We were all trying to guess what the statue was made of. Since we weren't allow to touch it, and it looked like butter, we hence forth called it, 'Butter Jesus'. What is more amusing is the idea that the chow hall workers ,most of whom are likely Muslim, probably thought that most of the Christian Americans would love to have a statue of Jesus in the chow hall.

There's been other interesting events this week, including a lecture by one of the docs (LTC Burns) from the Minnesota National Guard who runs the Battalion Aide Station or 'BAS' on the physiological effects of crucifixion. The pictures show a young Marine who was challenged at the end of the lecture to hang for as long as he could on the nails in the cross. He was able to last for 5 long minutes, but he was pretty sore. Interestingly, the most frequent cause of death from crucifixion was asphyxiation. He also told us that prior to crucifixion it was customary to be severely whipped with a whip laced with iron shards and pieces of animal bone much like what was seen in the movie, 'Passion of the Christ'. The only ones not whipped prior to crucifixion were women and children. It's a little bitter sweet that I'm so close to many of the Biblical sites here in the Holy land, but I'm confined to this base for my entire time here.

This week, we also got the chance to visit the BAS I mentioned above, that's run by Minnesota Army National Guard. They are all pretty nice guys. Unfortunately, many of them have been here at TQ for 18 months. They were suppose to go home back in March, but their tour was extended until July 2007. One Master Sergeant told us the last time he was home was July 2005! We all empathize with those guys, because they are here much longer that we are and they don't receive the same benefits as we do on active duty. One of the pictures is me at a little coffee shop they run called the 'Ground Hog Grind'. Their motto is, "If you didn't like today, don't worry tomorrow will be exactly the same!"

The pictures above show 'Butter Jesus'

Me and my new surgical cap.

Me and the Ground Hog Grind Sign

A picture hung at the BAS of the Minn Nat'l Guard Unit and their response to Sen. John Kerry's botched joke about being stuck in Iraq if you don't do well in school.

Another picture at the BAS of Chuck Norris. Amazingly, he is wildly popular with Marines and other Armed Forces personnel. He's been here many times and they just made him a Honorary Marine.

The young 'crucified' Marine and LTC Burns

Light Armored Vehicle

Picture of my 'Wall of Fame'

Some of the gang at Easter Dinner

Sandstorm Sunday

It's Sandstorm Sunday. This is our first sandstorm since we arrived. It's not too bad, but the fine grain sand gets EVERYWHERE here. Computers, cameras, living spaces, and any other crack or crevice on your body gets sand in it. Overall it's a good thing for us because when sandstorms take place, the fighting pretty much stops, and there are virtually zero flights going in and out of the area. This is also the first Sunday morning we've been able to sleep in or finish going to church services.

This past week has actually been a refreshing break. Incoming casualties have been slow, which has given us time to enjoy other pursuits. I am proud to say that I have completed and passed my Marine Corps physical readiness test (PRT). You're tested on the most pull ups and sit ups you can do in 2 minutes, and a timed 3 mile run. The passing standards for the test are set by age. Given that I wasn't in peak shape, I'm glad it's over. I finished my run in just over 27 minutes (I know, I'm slow as a turtle!) We started at 0900, and by 1000 the sun is bright and hot here. One the good things about the test was we ran on a road that leads over to the town of Habbiniyah and the lake. It's a nice view; I wish I'd taken a picture, but I was concentrating too much on my run.

We've received a scant number of Iraqis this week (civilian, Army (IA) and Police (IP)). We had a young Iraqi boy who was caught in a gunfight and had a bullet lodged in his upper thigh. One of the general surgeons removed the bullet intact. The boy was fine. We worry alot about unexploded ordinances on our patients. It's not uncommon for Marines, IA or IP to have grenades on there person, or even worse, explosive material lodged within their body. There are contingencies for this problem, but we often have to fight that normal impulse in most medically trained people to rush over and start helping a severely injured patient.

Our reinforcements from Al Asad arrived this week. Most of our capabilities have been 'PLUSed UP' with the exception of Orthopedics of course. We now have six general surgeons and 2 more anesthesia providers, along with additions in a host of other medical and nursing positions. Al Asad became a level III facility and was taken over by the Army. That means (among other things) that they have a CAT Scanner and a number of other surgical sub specialists, as well as ICU beds and ancillary services like physical therapy. Therefore, they can be a valuable resource for us. However, with the switch, the Navy personnel there were no longer needed and reassigned to other locations. We can always use the help, and from what I hear, they tell us the food is MUCH better here.

The images this week include:

Hesco Beach Club (where the volleyball is played)

LT Day looking sharp in his food services garrison cover

LT Laquihon hold comforting his patient with the Padre in the background

Me in between sandstorm gusts.

LCDR Carr (again) who wishes to be called Gator given his never ending consumption of Gatorade

LCDR Carr and his Hajji mask attire.

LCDRs Neptune, Carr, and Early braving the elements of the sandstorm.