...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.

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.