Lotsa pics

Just in case anyone forgot the real reason we were sent on this desert vacation, last week quickly reminded us. We had two trauma activations with four patients each, separated by a couple of days, that indelibly educated our new crew about the potential violence surrounding the KRAB. In keeping with our theme, though, there were no "true" general surgery emergencies that needed fixing, only orthopedic extremity injuries. So, our ortho guy (Jake) let me jump into the fray and externally fix a fractured femur (ie: stabilize with external pins and rods before final internal fixation in Germany or the States). It was fun to have a little something to do, but it really served to remind me why I chose NOT to pursue a career in Orthopedics!

(not one of my usual trade tools)

(our OR has no A/C and is HOT...we're usually swimming in a sweat bath by the end)

I'm sure it will come as a surprise that we managed to find some extra-curricular fun this week as well. Remember that huge vehicle I stood next to for a picture several weeks ago (the MRAP)? Well, we convinced someone to take us for a ride around the KRAB and let us do a little 4x4 action of our own. These behemoth's weigh around 14 tons and are encased in armour with a gunner's turret on top. They were designed to combat the ubiquitous presence of IED's (improvised explosive devices) during the early parts of Operations Iraqi and Enduring Freedom. MRAP's (Mine-Resistant Ambush-Protected) are all-wheel drive and loaded with electronics, communication and other offensive equipment. The version that we commandeered, though, was a medical MRAP configured to transport patients within the base in the event of a mass casualty situation. In case anyone's wondering, this is definitely NOT a standard (or even allowed) activity. Like that's ever slowed us down before...

(Me in the driver's seat)

(I can hear CJ saying, "Pay attention to the road while you're driving." :)

And, to keep us cooled off during the summer heat, the Fire Dept held their semi-annual Fire Muster last Sunday. This is a multi-event, team challenge involving lots of water and strength drills. Of course, it's well known that this activity was originally developed to show the ladies just how tough and strong our Fire guys can really be (no shortage of testosterone over here). We competed in a tug-of-war, a hose and accuracy drill and a bucket brigade, after which we were in second place overall. Unfortunately, our luck ran out on the final event: the joust (using fire hoses to "push" a bucket along a rope past our opponent's mark). As you can see, a soggy wet and fun time was had by all (water conservation efforts were on hold for this day). And it only took about 30 minutes to dry our shoes out completely in the arid 115 degree heat!

(giving it all we got)

(some tug-of-war losers)

(The Hose Joust: that green bucket is on a rope tied to two fire engines)

(losing the joust and getting soaked)

(our base Commander sharing the love with some of the cheering section)

Cita, you're always in my prayers! I love you...

The Replacements Arrive

Although three of us docs have been here for over two months, the majority of our EMEDS is on a different schedule. So, the "replacements" for those guys arrived about a week and a half ago and have been getting settled. Most of them are from Florida (Eglin AFB is the main supplier of personnel to our facility) and will be here for the next six months. Their predecessors were ecstatic to see them arrive, but their energy dissipated as the news that they would sit here at the KRAB for an extra week sunk in. Have I mentioned the efficiency of the Armed Forces yet? Have no fear, they finally left this weekend and should be happily sipping margaritas at home before the end of the week. We'll miss our roommate and running partner, Glen (flight doc), the most but are stoked for him to get home to his wife and FIVE kiddos.


(Glen's in the middle)


Literally right as these new folks were getting settled, and before my planned mass casualty exercise, we were privileged to take care of a few more of our Army brethren. Yet another Russian-made, shaped-charge grenade was thrown at a convoy of Humvee's and brought us four patients. One was injured and required some relatively minor operating, two were minimally injured and the fourth was gravely injured as the grenade exploded right behind his head. Despite his devastating injury, we kept him alive and hurried him out of here in an attempt to get him to Germany per our protocols (to either be an organ donor or say goodbye to his family). The other injured patient is finishing up his treatment in Germany and Walter Reed.

On a brighter note, many of the new crew is excited to join in our fitness efforts. Here, Jake (ortho) and I made a curious decision to run "hills" in the middle of the day, when the temp was around 115. By "hills", I mean one of the 75-ft tall, pyramidal mounds that dot the base, usually topped by a radar or some antennas. I'll admit that it was RIDICULOUSLY hot and, even after consuming plenty of water, caused lingering nausea for some time! Hey, we gotta find something fun to do around here.

(note the lush vegetation)

And for our weekly culture, we enjoyed last weekend's KRAB's Got Talent show, our monthly event to showcase the hottest future stars of the Air Force and Army. Quite a few good musicians and singers stood out this week, as well as an old-school robot-breakdancer that was phenomenal. I think the funniest was the guy who dressed up as a Viking (complete with the mop-wig, helmet and shield) to sing an Italian aria. He had a "translated" version on the projected screen that explained he was singing about things like scratching his butt with salad tongs!



Love to my fam' and my lady.

Secret Weapons

Well, another week has passed at the KRAB...and yet another severe dust storm is upon us. Although somewhat comical in their consistency, they do tend to disrupt airflow (AKA: flights landing and taking off). I'm pretty sure the several members of our group who were scheduled to depart today after dutifully serving their 6-month term weren't laughing when the skies darkened yesterday. But, as always, a positive can be found if earnestly sought. And that upside comes in the form of cooler temperatures. Today, we all felt quite a reprieve from the heat and almost everyone noted how much "cooler" it felt. The thermometer at 2:30 this afternoon read 113. How about that for perspective!

To be complete, I should explain that last week was clear and HOT (even for Kirkuk). I have yet to find any reliable web sites for weather forecasting in the area, so those back home may not appreciate the realities of our summertime. And I know that the temperatures I'm writing about are accurate because our public health guys have a special thermometer directly outside the EMEDS (it reads dry temp, wet bulb temp, radiant heat temp and a few others). On Saturday, the hottest day, the dry bulb (standard thermometer) read 121.6 at 1:30PM! As proof, here is a pic from Friday (much cooler).

And the radiant heat temp (including the sun's rays and the heat reflected back off the ground...in other words, what we feel outside) read a toasty....

Don't feel too badly, though, because we're quite accustomed to it by now. In fact, I find myself really looking forward to our early Saturday morning run around the base when the temps are still in the 90's.

As the days without anything resembling a surgical problem add up, we did have another VERY high point this week. It began with a connection made during treatment for a minor sports injury. To say thank you, a member of the group that shall remain nameless (at their request) offered to have us over for a BBQ. Naturally, we accepted and found ourselves enjoying some of the finest sirloin and rib eye steaks I have ever tasted! These guys new how to do it...with sauteed onions, garlic and plentiful sides. Again, their method of acquiring of these foods shall remain undisclosed. However, they saved the best for later and quietly invited us out to the weapons range one afternoon for some serious guy fun. Our hosts brought several fully automatic rifles, high-end pistols and a suppressive fire rifle that laid down 800 rounds per minute. I'm sure you can gather from these pics what an awesome time we had!

(I like this action shot with shells flying)

(The SAW)

Cita, thanks again for the SWEET box of goodies you sent! I couldn't be more proud of your amazing single-parenting skills with our lil' man. And, I love you always.

Making Waves

What happens when you put a group of talented, stubborn individuals together in a small cage with no real access to the outside and very little work to be done? Petty issues become MUCH larger ones. This is doubly true in the Air Force where the "institutionalized" interact regularly with folks like us, who were trained by, and think like, the rest of the surrounding world. That sets the stage for some rather interesting confrontations. Last week was an excellent case in point. I'll try to summarize to avoid making this blog several pages long.

Normally, the higher-ranking physicians are given single rooms (called POD's) while deployed. However, due to some odd circumstances and the inability of our command to make difficult decisions, I room with the Ortho guy and one of the Flight docs in a standard dorm room (we are the only three Majors living MOD's). I have actually enjoyed the company and we plan to keep this arrangement even when single rooms again become available. Unfortunately, and for reasons none can explain, we were given the worst room in the building (nearest the loud, broken door we all used to enter/exit, smaller than all other rooms and containing important communication equipment that prevented us from sleeping away from the wall bordering the hallway). This seemed odd at first, but we settled in nonetheless. The problem with this plan was that some of the guys work all night and literally come and go EVERY hour, all day long. So, after numerous nights of waking up EACH hour, I finally tried sleeping with earplugs. It worked, but I was unable to hear my relatively quiet pager when someone needed to speak with me. Clearly, a remedy was in order.

Our MOD has four unoccupied rooms for transient personnel that need a bed for 1-2 nights as they pass through (typically 1-2 times monthly). Inexplicably, these are some of the largest and quietest rooms, located in the center of the MOD. So, we asked our MOD Chief (don't even ask, every noun or thing has at least one person as its Chief) if he minded us switching rooms and allowing the infrequent transient the pleasure of our ridiculous room. We explained our jobs and the need for sleep without earplug use and he agreed that it made sense. So, on a Sunday afternoon, we moved our lockers, shelves and bags from room 16 down to lucky number 13. And for three days, we had the best, most restful sleep of our short tour thus far.

What could be wrong with this? Ahhhh, never forget the ego of some senior NCO's (which has been known to bruise easier than a ripe peach). Unbeknownst to our group, one of the senior NCO's in our EMEDS (who naturally has his own room in a POD) is "in charge" of room assignments and was extremely unpleased with our callous decision to "bypass" his authority by not asking his permission first. I tried to reason (first mistake) with him, explaining that no one had alerted us of his "reign" over the rooms. I stated that, frankly, it had never occurred to any of us to ask someone who wasn't our boss and didn't live in the MOD if they would permit the move. We had asked the MOD Chief and were given permission. To no avail. Our commander was quietly (and of course, behind closed doors) briefed of the situation by said NCO and requested (by email of course, direct confrontation is to be avoided at all cost) that we return to our original room. I hope you're enjoying the "rational thought" involved in these decisions!

Dutifully, we moved back as directed and then requested (through the above-mentioned senior NCO) a room change with Services (an ironic name, don't you think?). In typically mature fashion, he waited three days before making this request with Services....there must be punitive consequences after all. But, a week later, we were finally "granted" permission to change rooms.....right back into room 13 where we had moved in the first place!! If any of you wonder why the various government services take so long to execute relatively simple tasks, this should shed some light on the processes involved. After three moves in less than two weeks, here is a picture of me reading on the couch (which was already in our room but apparently not a part of the standard floor plan, per our NCO, and therefore not authorized to be on the floor).

On a lighter note, we have been engaged in a very competitive ping pong tournament over the past week. The finals will be later this week and most games draw at least 6-8 spectators as a cheering section. Thanks to Dad for purchasing a table when I was a teenager and having a several-month match that honed my skills! I think tonight's match is the quarterfinals....

We were also blessed with a very rare award by one of the Army infantry battalions for our care of their soldiers. They presented it in their traditional cavalry uniforms, complete with riding hats. Very cool. It may be hard to read this picture, but it was a VERY special honor to our EMEDS and was only the 23rd such award this group has ever given (remember, the Army is over 200 years old).

Finally, we had our monthly 5K race (on the base roads) yesterday morning that was a great time. We received t-shirts and water bottles from the sponsor (one of the huge contracting companies here) and enjoyed the fleeting break in the weather. Less than an hour after completion, the dust descended (literally) like a fog bank in San Francisco with visibility of ~150 feet that would have cancelled the race. Today, the ground and all outdoor surfaces are covered in a layer of dust reminiscent of the ash after Mt. St. Helens erupted!

Until next week...

Always in love with you Cita!!

Fun, Food and Flying

Yet another KRAB week has passed. Although the days can seem to sometimes crawl, I continue to be amazed by how quickly another weekend arrives. God bless the gym and the running routes on base!! I had no trauma patients this week but did manage to treat a few common general surgey issues, including a young soldier with acute cholecystitis that was at a more forward base. Unfortunately for him, his illness struck during one of our weekly dust storms and I was forced to transport him by ground to Kirkuk. He stayed here for a little more than a day until the skies cleared and he was off to a cleaner facility with laparoscopic equipment to have his gallbladder removed. I have to admit, though, that a small part of me kept hoping he would deteriorate and allow me the privelege of shucking out that gallbladder the old fashioned way!

I am still working on arranging the driving training for this vehicle, but here is a sample picture of one of the MRAP's on base. These are the primary Army convoy vehicle, and were specifically designed to withstand IED blasts (improvised explosive devices, the most common terrorist weapon here). They come in many different configurations with various toys attached (this happens to be a medical MRAP, as is obvious by the red crosses).

This weekend, we had the best "trifecta" of food thus far. Friday was a BBQ at the Provincial Reconstruction Team's compound (the nation-builders that support education, healthcare and other Iraqi reform projects) and some interesting conversations with folks that I don't normally get to meet. Saturday was our weekly BBQ-and-a-movie at the EMEDS (we watched the original MASH movie) and Sunday was another EMEDS event with lots of incredible Korean BBQ (sweet beef, spicy pork, kimchi...). Thank you Sgt Parker for all of the time and effort spent preparing and cooking, it was worth it. Below is Dr. O manning the 'que, toasting some fantastic pineapple slices while enjoying a little treat from Baskin Robbins. Yes, deployments can be tough sometimes!

And, last but not least, I enjoyed some time on a flight simulator this weekend. We use them to train upcoming Iraqi pilots, but they always have unused time. So, the civilian instructors are happy to teach us enthusiastic neophytes and watch us try not to crash. By the end of the session, I could take off, fly around, do an aileron roll and land without any verbal instruction. I will definitely be making this a regular stop on my weekly rounds!

I love you always Cita!!

In continuing the trends of ebb and flow in trauma surgery during Operation Iraqi Freedom, this week brought no new patients. Good for the soldiers and local nationals....not so good for me. But, we always find plenty of things to occupy our time here at the KRAB (Kirkuk Regional Air Base). As the summer moves along, the temperatures seem to be heating up a little as well. Yesterday, the dry-bulb thermometer capped out at 117 degrees with radiant temperatures off the ground (mainly asphalt and rocks) hitting a sweltering 132 degrees! The strangest part is that it really doesn't seem that hot to me anymore. We still go running around the base (on safe, specified running routes, of course) but we tend to start early and finish before 8AM...right about the time triple digit temperatures roll in.

Along with the climate and surroundings comes some interesting critters. The several thousand Airmen, Soldiers and civilian contractors here make a fair amount of trash each day and this attracts rodents (mainly rats). And guess what animals like to eat rats......

...that's right: snakes. Since I arrived here, four vipers have been caught. Two in living quarters, one in our EMEDS, and one at the Firehouse. Thankfully, no one has been bitten that I know of, because the antivenom is a helicopter flight away at a different base! The big snake above is obviously dead already, but the smaller one below was still alive when caught in one of the rooms of my building (for a very short while).

The docs and nurses obviously spend a lot of time together and we've begun some fun weekly rituals to pass the downtime. We watch M.A.S.H. episodes pretty much every night before dinner and have "BBQ & a Movie" nights on Fridays where we rig a projector outside under the netting of our lovely KRAB island, as seen below:

There are tables, benches, a radio, mounted speakers, a BBQ, coolers and, of course, a small pond with a running waterfall and fake fish! Naturally, the entire area is covered by camouflaged netting...for ambience.

Here is a pic of four of us in the ER (L to R: myself, Dr. O (Ortho), Dr. D (ER), and Dr. K (FP)).

We've even begun networking with lots of people on base and have some sweet activities planned, most of which I can write about as time permits. Between the various armoured vehicles, helicopters, planes and weapons here at the KRAB, I think our group will manage to find some great memories during this deployment!

(Sunset on the flightline)

Until next week.....

Lovin' you Iraqi-style my Cita!!

A little business..

***Family Warning: This post contains graphic photographs***

This past week was a bit busier in many respects. We had our first mortar attack since my arrival (while trying to Skype with my wife, no less). She didn't particularly enjoy hearing the explosion followed by the giant voice on the loudspeaker as I ran into a nearby bunker holding my laptop! Thankfully, no one was injured and I was able to let her know that I was fine. This used to be a daily occurence before the Army increased their presence here six months ago and stepped up patrols outside the "wire". Thank you Soldiers!

Unfortunately for the troops, we also started seeing some more traumas this week (the action tends to heat up during summertime). We do not do humanitarian work in Iraq, but we will treat locals if wounded by our troops or during an engagement. As such, we saw an EPW (enemy prisoner of war) who was shot in the face by a high-caliber rifle. Despite the gruesome appearance, he required relatively little heroics on our part.

We also saw a young Soldier who was shot through the forearm by a high caliber rifle (most injuries here are gunshot wounds or related to explosions). He was flown in by the "dust-off" chopper as shown below on our helipad:

As you can see by the following picture, he had a significant injury and required work by both myself and our Ortho doc. Despite shattering his ulna, severing an important nerve and injuring one of the two forearm arteries that required repair (thank you U of U vascular surgeons for your time and training) he retained a fair amount of function. He was all smiles as he flew out the next day (once the dust storm lifted) to continue his complex reconstructive course at a specialized hospital. Our job in Kirkuk is to stop life-threatening bleeding, stabilize all injuries and then transport to the main military hospital in Iraq for further care. They will then send patients on to Germany and the States if needed.

(notice the well-applied field tourniquet)

Regretfully, we also saw our first casualty of my tour. A young Soldier was hit by an RKG-3 (a hand-thrown grenade with a shaped charge), suffering devastating neck and chest wounds. We found out later that a teenager had thrown it! He probably died within the minute, but we worked hard on him for some time before deciding to cease our efforts. It turns out that he had already won a Purple Heart (one week prior) after surviving a separate attack with minimal injuries. Later that night, the base held a Ramp ceremony for him. More than fifteen hundred Airmen and Soldiers lined up on the flightline to respectfully solute his flag-draped casket as he was carried onto a plane headed back home. He will be placed alongside the many thousand other brave men and women that have lost their lives in service to their country. Specialist, we will not forget you!

We saw a few other patients, but I thought I would leave you with a picture of an Iraqi dust storm as it engulfs our forward base. Thank you for all of your prayers. Love to my entire family and especially to my Lady...I'm always with you Darlin'!!

P.S.: We have a GREAT chapel here with awesome worship and services on Sunday. I've even begun to meet a few solid Christian guys this week and have found a couple of Bible studies occuring throughout the base. Thank you Lord for always providing!!