Tuesday, October 16, 2007

The best thing about Iraq

So I'm driving along Route 33W near Charlottesville on my way to Shenandoah National Forest. As soon as I start gaining altitude, the sky becomes curiously overcast and I can see the wind is picking up by the minute.
Skyline Drive exit. I roll up to the ranger toll booth in the new Mustang I rented for the next 20 days. A quick stop in the mountains as I head out to visit friends and family all points beyond. A blast of winter air hits my face as I drop the window to pay the entrance fee.

"Yeah, reading 42 degrees right now. She's dropping fast. Shoot, it was so warm yesterday, too."

Crap. It was 89 degrees in Norfolk when I left. "Great! Hey, I'm meeting a lot of people up here tonight. There's supposed to be this huge concert at Big Meadows Campground, and everyone I've talked to is coming out. Have you seen them yet?"

Ranger looking at me with her mouth open and brow furrowed: "Um, what?"

"Yeah, huge rock concert at the campground. Supposed to be a couple' hundred showing up. You didn't hear about it?"


"I have an extra ticket if you want to go. Is this going to be a problem?" I ask ever so innocently.

"Well, yes! We can't have that up here. Who issued the permit for this? This is a National Forest!!!"

I can't stand it any more, and give up the joke lest I be accused of having fun at someone else's expense. I get a complimentary glare along with my Skyline pass. She needs more humor in her life. . . not aware of this fact yet.

Register, find the camp spot, and set up the tent. Find long sleeve t-shirt, jacket, and the hat I just so happen to bring along. I haven't mentioned this yet, but 42 degrees is quite the change from where I came from. I'll get to that in a minute.

George pulls up in his custom conversion van. Complete with bed. Obviously when he mentioned camping in the mountains to me as I was traveling back from Iraq, we each had our separate ideas of what constitutes "camping". His version is looking so much more appealing than mine right now.
Procure the firewood, make some coffee, and fire up the grill. As I start jumping up and down to maintain body temperature, George and I are tag-teaming both the grill and the fire simultaneously as dusk fades quickly to night.
After some top sirloin and hamburgers, the campfire is roaring along quite nicely. Which is a good thing when your current perspective of cool mountain air goes something along the lines of "Oh God, I'm going to lose an appendage to frostbite before morning". I forgot my flask of Irish whiskey, but at least I brought plenty of beer.
So here's the plan: if I drink enough beer and sit close enough to the fire to singe my pants, I should be able to 1) raise my body temperature high enough to fall asleep, and 2) once asleep, the alcohol should keep me there until morning. It's not a very good plan. I already know this. . .but it's all I got.
9:30 and I bid George a good night as he's talking about how many thermal blankets he has in the van. "That's great, George". I'm walking to the bathrooms with toothbrush and toothpaste, and swear I see a few flakes of snow float just beyond my night vision.
I'm in boxers, thermal shirt, and a winter cap. Leave the hiking socks on for good measure. I can do this. Heck, I just came from Iraq and a little cold front isn't going to ruin my superhero image. The sleeping bag zipper was checked and re-checked four times to ensure I couldn't zip up a few more centimeters. Maybe I can get a tight enough seal to re-breathe CO2 all night; a double effect of drowsiness and re-claiming lost body heat.
I'm wide awake. Worse than that: I'm already freezing. Don't worry, I tell myself, the beer is going to kick in any minute now. Settle yourself in, and let nature's medicinal barley and hop fermentation take care of the rest. Yeah, right.
An hour later, and I find myself at the bottom of the sleeping bag. In the fetal position. I can't stop shivering. Where did that beer go! I haven't drank in months, and there's no way my freakin' liver processed all that alcohol so fast! Doesn't this work for blizzard casualties?
The bottom of the sleeping bag. This is where I spent the next nine hours; a quivering mass of protoplasm. No sleep. All night. . .I think.
Morning finally comes. Character-building experiences like these only bring me closer to my final interpretation of what eternity looks like.

"Sleep OK, George?"

"Well, it was a little chilly when I first got in the van, but that didn't last long. I slept so good last night, I didn't even notice I was sleeping on my arm wrong. Bugger kinda' hurts this morning. The thermal blankets get so hot after a while. Oh, hey how did you make out in that tent."

George can be a funny guy. "Well, lets see. First of all, I didn't sleep. Second of all, I was crammed at the bottom of that sleeping bag in the fetal position all night. George, it's. . .oh, 80 degrees colder than where I just came from."

George chuckles "Yeah, I can see how that can be a difference."
Thank you George.

I've been on American soil 19 days now. I'm not counting. In fact I had no idea until an hour ago when I decided I thought I should know since I keep telling everyone "about two weeks". All the "wow" factor has just about run it's course. Culture shock at every turn is slowly fading as I integrate back to life again.
I'm still enjoying. Savoring every second. Culture shock and all. The only adjustment I'm really worried about at this point is temperature shock.

In all honesty, when I really have to pin it down, the hardest thing about coming back are the questions. Not a lot of questions. A lot of the same questions.
"So, how was Iraq?" Can I answer this one in two sentences or less?
"Well, should we be there?" Dunno, ask Rumsfeld.
"When are you due to go back?" I just left, people. Do I really have to ponder when I have to go back? Dunno, ask Cheney.
Every time, without fail, I know I'm giving this pained look as I attempt to answer yet another thoroughly complex question that I know will take hours to actually answer. How do I streamline the responses into a politician's soundbite? Dunno. . .
So I've resorted to this: "I can tell you the best thing about Iraq." This is getting them every time. I'm not trying to bait anyone. Just looking for a way to avoid the questions I'm not ready to answer.
"The best thing about Iraq is that I'm not there."

Monday, September 24, 2007


Nostos (Greek: νόστος) (pl. nostoi) Homecoming. It is a theme dealt with in many Homeric writings such as the Odyssey, in which the main character, Odysseus, strives to get home after the Trojan War.

Fishing trawler a half mile up the coast. I just walked over the berm from the cabana, and the trawler is the first thing I spy. She's slowly crawling my way, and only several hundred meters from shore. Great booms reaching out over the water like the tentacles of an octopus. But it's the birds that really nab my attention. A cloud of shorebirds lazily floating, diving, and endlessly rotating around the old trawler. The atom doesn't exist without the electrons, and the electrons have no function if it weren't for the atom. It's like that.
The surf is washing over my feet. The sun is climbing with nary a cloud in the sky. And it dawns on me: I'm here. Shorts, bare feet, and a beer. This is me, I'm doing this, and it just won't process.

Forty eight hours ago I was going through customs at Ali Al Saleem in Kuwait. We get briefed on the x-rays, screening processes, and I get to hear the same old story about the Marine that tried to smuggle two grenades just yesterday in his sea-bag. This is by far the busiest Marine ever, because he's smuggled thousands of them by now. After carefully packing my gear, a customs officer and I dismantle the entire thing again as we look for indigenous plants, M-16 rounds, and any domestic farm animals I may have run across and decided to keep. I asked her for the list of authorized contraband, and she rolled her eyes. I was asking more for my amusement and sanity more than anything else. . .and thought it was decent original material until she said "Yeah, yeah, we've heard all the jokes before. Even that one."
After customs, we were locked into a little compound with tents and a Green Beans Coffee Cafe. Each tent was packed with units going home. We shared with an Army medical unit out of Baghdad. They were Michigan reservists, and the soldier sitting next to me was from Detroit. Talked about the state of the Lions and Jon Kitna this year. I gave him credit for how Barry Sanders found a way to de-construct my Bears at least once a year when he was in the league, and we laughed away an hour talking about military medicine, family, football, and all we would do when we got home.
Ten p.m. they load us into a bus caravan for the two hour drive to Kuwait International Airport. And there we sat: ten minutes became twenty, and humorous rumors swirled around the bus about how they were tricking us. As if to prove the prediction, a customs officer hops onto the bus and tells us to get out. What?! "Two weapons have been lost on the base, and the gates are in lock down" he tells us. A few of us offer our weapons if it gets us to our planes any faster, but the offer was politely declined. So we pile back out and sit around the customs compound another half hour. A few shouts to form up, and we get excited again. False alarm.
Midnight ticks over, and we get the go-ahead. Form it up! Head count! Get on those buses! My pleasure . . .
The second the wheels lift from the tarmac that plane erupted in shouts, laughter, and clapping. It's official: they're actually letting us go home.
Eight hours later, and it's a dash through the Shannon, Ireland terminal. Over a hundred and twenty very thirst Soldiers, Sailors, and Marines have a fever. And the only prescription? A pint of Guinness stout is the way to cure this malady. We order our pint and extras. After the first one goes down, it's a balderdash as we mix and match the rest of the beers on our table. The last seven hours of the flight went much better than the first eight. . .
Saturday morning landing in Cherry Point, North Carolina. The cheers and clapping bring the plane to a roaring good touchdown. Flight crew laughing and clapping right along with us. After un-loading and loading our gear several more times on the flight line, we board buses for the hour ride to Camp Lejune. Families are there waiting. We coordinate to make sure new Dads get off the buses first. And there we are: exhausted, soaked in sweat, and smelling up the bus like a petting zoo.
Nobody cares. Buses roll up. Wives are holding their cheeks, crying and trembling in their beautiful summer dresses. Dads rush off first with laughing and running children jumping into their arms. Moms join the fray. A few parents make it too, and they stand patiently in the background waiting their turn, and waving little American flags. I hang back a minute or so; just taking it all in. A Rockwellian moment comes to life outside my little bus window. And right here/right now: all somehow seems right in the world.
A few of the guys will wait before they re-unite with family. Some are from as far away as Washington state and Guam. Tim rented a cabana on the beach for Saturday and Sunday night. I finally made it out Sunday morning after finishing some paperwork. Dump the daybag, ditch the uniform, and grab a beer. It's shorts, flip-flops, and an immediate walk up the berm onto the beach. And the beach is where I stayed the entire day. The cabana was just a beer outpost. . .because I have so much to catch up on. Every second savored. And that magnificent fishing trawler is only the beginning.

Wednesday, September 19, 2007

Camp Virginia, Kuwait

25 by 100 foot hut. The stench was overpowering by midday. The smell of old crusty uniforms in desperate need of a change out and stacked bodies in need of a scrub. So I sat outside and read James Herriot until the heat got to me, then re-entered when forced with few other choices.
We were at the Taquaddum A/DACG (arrival/departure air control group) terminal, and it was 20 hours and counting. No sure thing when flying out on your way home, we were on terminal standby.
The hut is the staging area and occasional place of permanent residence when one has nowhere else to go. The hut is too small. The hut smells like a hundred years of stink. The hut is all we have. The surgical team, a smattering of Fallujah corpsman, and a company of Marines are all staking a small piece of real estate. With scattered cots and chairs, the hut filled quickly in the morning, and by 9 AM, all seats were taken as we watched another group of Marines come and go. When the seats and cots were all doubled up, bodies started filling the floor, and required deft footwork to extract yourself in/out. Foosball table? Just became a zipcode for two Marines sleeping under it.
We all survived. Three MRE's and a few sneaks out to the chowhall/DFAC and we finally had our flight to Kuwait on a C-130. After a six hour transit that included loading the bags, unloading the bags, re-loading the bags, head count, repeat X2, we made it to Camp Virginia, Kuwait 36 hours ago. Tomorrow, customs in the afternoon and a flight home very early Saturday morning. Counting on a layover in Shannon, Ireland for a pint.

Thursday, September 13, 2007


The first one was different.
Not in the way you would expect.
It's not as if the first VBIED scared the religion into me, and all the rest got easier.
Quite the opposite, in fact.
With that first concussion wave dissipating, what I was about to realize was that as the reverberations faded, it was only the beginning of the experience. Of course I knew I was going to Anbar. Your gonna see some bad shit. Thought I was ready for it. Standard issue "bring it on" attitude: check.
The false bravado fell to the wayside as soon as those casualties started pouring in. I was quickly reminded that "talking the talk" has nothing to do with "walking the walk". You just can't predict how you will react until the bodies hit the floor.

I think it's because they were right there. Just didn't expect that. Just didn't think they could drive so close to the base, or penetrate right into the market like that. These suicidal men were driving trucks packed with explosives and chlorine, and hitting very close to home. Way too close. Announcing their martyrdom and deaths like a lion announces his domain over the Serengeti. To them, collateral damage isn't just a byproduct of their wickedness: it's the goal.

The aftermath rolling into Charlie Medical with that first VBIED was a shock to the system. With each subsequent blast, including those occasional unannounced controlled detonations, my feelings of impending dread only got worse as time went on.
Because then I knew what could happen.
Because then I knew it could be a very shitty day.
Because with each blast, I immediately entered the realm of the unknown. Casualties, oftentimes innocent civilians, started rolling in within minutes. How many was the first wave going to bring? Two? Ten? How many waves were there going to be? How long would they continue to pour in? Did the checkpoint get lucky and spot him before he got close to anyone else, and trigger the VBIED early when he panicked?

It was 3 AM, and I was wide awake. The surgical team has moved out of Ramadi, and is marking time on a small Army forward operating base (FOB) awaiting a plane ride to Kuwait. An Army artillery battery, only 3-4 kilometers away, is keeping me awake with the steady drumbeat of outgoing fires. It started on the eve of September 11th, and the nightly barrage has continued right into Ramadan. I have no idea what units they are supporting, or where they are firing at. I'm no longer in the know; just unclaimed baggage spinning around the "I would like to go home now" carousel. But the concussion of outgoing artillery is similar to a VBIED explosion. To close for comfort. I know this because it hurts. Deep down inside. When the first volley catches me by surprise, I keep hitting alert mode, wondering where the casualties will come from. I'm not sure if I can explain how it feels. It's just a deep twinge of pain in my chest developed over months of listening to detonations and dreading what comes next.

Sheikh Sattar assassination

Genuine Leader.
These are just a few of the adjectives I have heard used to describe the man who was responsible for bringing peace to Ramadi more than any other.
Sheikh Sattar was the mastermind and visionary leader who created and lead the way to the Sunni Awakening and was a top official of the Anbar Salvation Council. Uniting 42 clans together, tired of seeing his fellow Countrymen brutalized, intimidated, and murdered by Al Qaeda and other insurgent forces, Sheikh Sattar last year was the most influential leader in all of Anbar in bringing cooperation with U.S. authorities and providing personnel and winning the confidence of the local populace to secure the city of Ramadi with hundreds of young men eager to join the immature and woefully small Iraqi Police force at the time.

With his residence less than a kilometer from the Ar Ramadi back gate, Sheikh Sattar was continually attempting to build relationships with us by inviting units to his compound for afternoon tea and dinner. Our relationship was open and friendly. One of the surgical team members was just there last week. . .on the same day Sheikh Sattar was in Al Asad meeting with President Bush. Tonight, I'm saddened to write that he was assassinated a few hours ago just outside his compound by an IED blast.

As the surgical team sits here in Taquaddum and counts down the few remaining days left in Anbar, it's been a somber mood as we talk about all the good he has done and the personal loss felt. Sheikh Sattar's death is going to be a blow to the progress made in Ramadi and may initially shake the confidence of the city and it's officials. On the other hand, we sincerely hope that his death only further resolves the rest of the city and officials to double their resolve to eradicate Ramadi of it's violence and instability in the face of this shameful murder.

Friday, September 7, 2007

Anbar, meet the Ospreys

Loitering in the chow hall last night, I was sitting with the CASEVAC (casualty evacuation) corpsmen stationed here in Taquaddum. Having worked with them over the past seven months, I've never had the opportunity to sit and actually hold down a conversation until tonight. Flying missions with them was always a rushed affair filled with yelling report over the roar of prop wash and vague hand signals in the helo while we transported critically ill patients to Level III hospitals.
When I first arrived in Anbar in February, mission breakdown followed these general rules: daytime medevac was handled by the Marine Corps. and a pair of H-46 helicopters with two CASEVAC corpsmen, while night missions were handled by the Army aeromedical Blackhawks and a flight medic. However, I noticed over the past month that medevac missions called during the day were becoming more of an Army show. The invite is open to whoever shows up at the door, but only Blackhawks were coming to party. I made a mental note of it, but wasn't quite sure what to make of the change. Another clue was the Marines we found at our medical helo pad in Ramadi last week taking measurements.
So last night over pie and coffee, they told me the Army has completely taken over casevac and medevac duties in Iraq. The CASEVAC corpsmen I was sitting with said they've essentially been unemployed for the past three weeks. Question is, why?
Turns out, this is all related to the impending mission changes of the Marine Corps. H-46, as they are being replaced soon with the MV-22 Osprey. Army H-47 Chinooks have moved into Taquaddum, and Al Asad is finalizing preparations for 10 MV-22s out of New River Marine Corps. Air Station.
With over 19 years of research and development under it's collective belt, the MV-22 tilt rotor Osprey enters the fray in Anbar. Currently in transit on one of the Navy's helicopter assault carriers, the MV-22 is slated to begin operations in western Anbar before the close of September.
Considered a superior replacement to the Marine Corps. H-46 dual rotor medium lift helicopters, 5 MV-22 squadrons have been stood up coast to coast and are gearing up for deployments. The cornerstone of Marine assault support for over 40 years, the H-46 will be completely replaced by the MV-22 by 2018. Landing like a helicopter, but flying like a prop plane, the MV-22 is a one-of-a-kind production aircraft jointly developed by Boeing out of Philadelphia and Bell-Texron out of Ft. Worth, Texas.
Entering it's first real world mission, the Osprey comes with a long history of controversy and teeth gnashing in Washington and the Pentagon. Believe it or not, then Secretary of Defense Dick Cheney under the Bush senior administration spent his entire SecDef tenure trying to drive a stake through the heart of this program. Riddled with cost over-runs and legitimate questions of safety, engineering feasibility, and actual tactical usefulness, the Osprey program was shut down by Cheney only to be revived again by the Clinton administration.
Initial concerns center around several issues that may come into play as the Osprey takes over assault support for combat operations in Iraq:

  • The prop wash during landing is significant. The Marine Corps. needs the Osprey to respond to point of injury areas and medically evacuate casualties from the firefight. Wash from the propellers will be an issue here. In Ramadi, we didn't have the luxury of a concrete landing pad. Just a good old fashioned "improved" landing zone with dirt and rocks. The first time an Osprey lands at Charlie Medical will be an interesting event to say the least.
  • At over 200mph, the Osprey will be fast, but lacks the ability to defend itself. Instead of having machine gunners facing out either side of the aircraft like the Blackhawks and H-46, the plans are to have one gunner located on the rear ramp area.
  • Heat signatures are higher compared to other helicopters. Speed, maneuverability, and countermeasures will need to offset this liability.
  • Helicopters are crucial to the mission because they are just plain useful in so many scenarios: running supplies, dropping off troops almost anywhere they are needed, aircraft personnel recovery (TRAP), ecetera. The Osprey is touted to be better at everything, taking Marine Corps. combat operations to new paradigms of tactical ability. Deploying with a Marine Expeditionary Unit, the Osprey will need to be able to land and take off from every Naval vessel afloat, or it's not going to be operationally useful. It has yet to prove itself in the arena the Marine Corps. performs at it's best: land and support a mess of triggerpullers on the beachhead and send them forth in an overwhelming tempo of speed and firepower.
My thoughts are a mix of scepticism and a genuine desire to see the Osprey come into Anbar and be a resounding success. For the Osprey to land in Anbar and prove incapable of supporting the mission is a thought I just don't want to entertain. We have sacrificed 23 lives, billions of dollars, decades of research and development, and pinned the Marine Corps. entire forseeable future on this one aircraft. The buy-in of the MV-22 isn't just big deal, it's going to define the Marine Corps. for the next four decades.

Ramadan, Up-Ticks, and Stage Left Exits

Ramadan, the holiest month of Islam, is upon us. Following a lunar calendar that varies slightly from year to year, Ramadan, the ninth lunar cycle month, will begin around September 12th. Consistently over the past few years, the preceeding period and Ramadan have been markers of significant insurgent activity and concentrated attacks on Coalition units.
Ramadan and it's implications for our current benchmarks of success are so intertwined, General Odierno has been quoted in the past few days stating this year's Ramadan will forecast our ability to begin troop reductions, currently at 155,000 troops with the surge forces.

In Ramadi, we have seen a slight up-tick in activity in and around the city. Combat engineers running multiple missions have found an increase in IED activity yet again. Running four missions simultaneously, three came into significant contact with IED emplacements.
Ramadan is not the only explaination. Historically since OIF2 (we are currently in OIF5), unit turnover leads to insurgents taking full advantage of the confusion and inexperience of newly placed units. The combat engineers along with a few Marine units are either turning over control to replacements or are making preparations to draw down certain sectors of Anbar. New guys go in with the eagerness and aggresiveness of freshmen on the first day of class, often leading to early mistakes. With veterans coming out on second or third tours, we are hoping for a shorter learning curve this time.

As for the surgical team, our replacements arrived four days ago. Heralded by a SVBIED that morning, the new team arrived via convoy in the afternoon soaked in sweat and caked with dirt and the pent-up exhaustion of travelling for four days straight. After a few hours of sleep and dinner, they dug right in and were eager to start taking over the mission. We were more than happy to accomodate em'.
Yesterday evening we turned over operations to the new team. Preceeding transfer of authority was three solid days reviewing procedures, flight equipment, mass casualty walk-throughs, walking blood bank, logistical reports, ect. With the new team in place, filled with the corporate knowledge of seven months experience of the old team, Ramadi surgical has officially left the building. It took half the night sitting on the flight line, but we finally caught an H-53 to Taquaddum and collapsed into a bunkbed somewhere in TQ around 2 AM.

Sunday, September 2, 2007

BBQ with the Weekly Standard

Teflon Don http://acutepolitics.blogspot.com/ and I are swapping stories around the BBQ in front of Charlie Medical. Missions have been completed, and within days we begin the long journey home to friends and family and pick up the pieces we left off 8-12 months ago. The Army medical staff are throwing one last BBQ before the old surgical team gets replaced and heads out later this week.

A civilian walks out from the dark where TD and I are standing, and asks "Hey guys, what's going on. How much are you charging for some steak?"

"Well, it's only 10 bucks a plate. These are really good steaks! Been marinating them all afternoon."

"Uh, right then. I was walking by and was just curious." As he starts walking away.

"Whoa, wait a minute. Just kidding on the entry fee. Who are you with?"

"I'm a journalist."

"Really? With who?"

"Weekly Standard."

Teflon Don and I look at each other at the same time and think "Wait a minute, we know this guy!"

"As in The Weekly Standard?" I start coaxing him back with the promise of mouthwatering steak. Right now, Teflon Don and I know a lot more about him than he does of us. "What's your name?"

"Matthew Sanchez."

"Yo, man. You were the one sending out emails to the milbloggers about the notorious Baghdad Diarist, right."

"That was me." As he gives us the oddest look.

I point to TD "Your talking to Acute Politics, and I'm Desert Flier. You emailed us!"

Matthew, just shaking his head, quips "Again and again: what a small world it is."

I never mentioned the Baghdad Diarist before. Didn't want to give the soldier any more exposure, since he deserved none. His name is Scott Beauchamp, and he was submitting some disturbing and far-fetched stories to the New Republic several months ago. Matthew Sanchez with The Weekly Standard was one of the first to contact the New Republic and openly question the authenticity of the stories being published. After getting the run-around, Matt went to Camp Falcon, where supposedly Scott was operating out of, and contacted the public affairs officer and other base officials. It was Matt's inquiries that lead to a full blown investigation, CNN and Fox news coverage of the Baghdad Diarist, and exposing the outlandish stories for what they were: lies that directly affect public perception of our professional organization.

Read about it here:

We spent the evening talking about the state of Anbar, the EFP threat in and around Baghdad, and IED hunting (TD's specialty) in Ramadi and Fallujah.

You may have heard EFPs (explosively formed penetrators) mentioned in the media over the past few months as the newest armor-penetrating weapons used by the insurgents. They have a specific design that allows maximum armor penetration of molten copper upon impact, and can be fired from a stand-off distance, or be placed in IED's. http://en.wikipedia.org/wiki/Explosively_formed_penetrator

Also discussed at length were the casualty rates from IED blasts. Matt was under the impression the rates were around 30%, and said general perception back in the U.S. is that vehicles hit with IED's usually result in fatalities. TD and I both dispute the statistic, and I would like to dispel the misperception. It's a highly variable and ever changing number depending on tactics, type of vehicle, exact location of the IED (underneath vs. offset on the roadside).

Here is a typical scenario: route clearing engineers are the ones who find the IED's. They are driving heavily up-armored vehicles that have V-shaped bodies specifically designed to deflect undercarriage blasts. The blast, more often than not, is going to disable the vehicle. However, having said that, most of the time the riders escape with only concussions and feeling a little banged up. Armor penetration and fatalities usually result if 1) the vehicle is a humvee (even the up-armored humvees are highly vulnerable), or 2) a secondary IED is hidden next to the first, detonated as the disabled vehicle's occupants spill out. Standard procedure is for them to stay in place until the entire scene has been secured by the rest of the combat engineers.

Time marches to the beat of a slower drummer the closer we get to home. I leave you with Teflon Don's memorable quote of the night: "None of the fun of missions; all of the suck of Iraq." My sentiments exactly.

Ramadi 5K

Things continue to trend in the right direction here in Ramadi. Occasional flare-ups in violence not withstanding, Anbar province crawls towards peace as the days drag on.
On that note, the Morale and Welfare folks have been coodinating 5K runs once a month as operational tempo allows. We had one last week, and all of the surgical team runners showed up for this one, along with quite a few from Evac Platoon.

The guys in the tan shirts are part of the Coalition forces from Uganda. They provide internal security (post exchange, chow hall/DFAC, ect.) on most of the larger bases in Iraq.

Saturday, August 25, 2007

Recent Fleet Marine Force pinning ceremony for our surgical technicians and our independent duty corpsman:

Friday, August 24, 2007

Fleet Marine Force Qualifications

On November 10, 1775, in Tunn Tavern, Philadelphia, Samuel Nicholas was commissioned to raise two battalions of Marines. As the Marine Corps. first commandant, Samual Nicholas was tasked with raising a Continental Marine fighting force for the protection of combatant naval vessels as a young nation sat on the cusp of a full British invasion (not The Beatles; the other invasion) mere weeks before the signing of the Declaration of Independence by our forefathers.

Not only were the Marines charged with protection of the ship at all costs, they were also responsible for protecting the officers from mutiny. Hence, Marine berthing was smartly placed between officer and crew berthing spaces in those early days.

With over 300 amphibious landings to their name, the Marine Corps has been serving proudly for well over 200 years. Considered shock troops by most Countries in the world, the Marines are both revered and feared at the same time, and as the only fighting force born in a bar: it's no wonder the Marine Corps. has never backed down from a good brawl.

As Navy personnel attached to a Marine unit in Iraq, we had the unique opportunity during the deployment to immerse ourselves in all things Marine Corps. At times, it seemed like an endless process of classes on tactics, weapons, communications, structure, history & tradition, aviation, ect. We wore our uniforms to Marine regulations, completed six mile "humps" in the desert with our gear, and followed all USMC physical fitness standards while serving the greater Anbar region as the Ar Ramadi surgical team.

Below are some of the pictures of our recent pinning ceremony for the officers. After completing exhaustive sign-offs over five months and enduring hours of questioning and challenging our knowledge by a panel of Marine Corps. Officers, we earned the right to wear the Fleet Marine Force (FMF) warfare device with pride and distinction.

RH, our detachment commander~affectionatly known as "Blue"

Back Row: Martin, Bob, Mark, myself, and Chad
Middle: Sgt. "Mac" and LT Brown from Evac platoon
Kneeling: Dave

Monday, August 20, 2007

KBR and Team Blinky

D squared: "First the fan seems to shift into a lower speed regardless of temperature setting. Then it makes some funny noises. Before we know it, the hut temp starts rising despite our attempts to crank down the controller to 16 degrees celsius. The inside temp has been climbing into the 80's and now 90's in the afternoon. We try to shift modes into "fan only" and we have also started pouring water on the outside condenser to cool it off; it sits in direct sunlight all day. Well, anyway the fan eventually shuts off and the unit goes from a red light and starts blinking "red".
Two KBR HVAC "experts" have responded to our trouble call tonight. One guy is outside grabbing some tools, and the other is standing in our hut looking at the A.C. unit and listening intently to D squared explain our problem. He's giving the appearance of using active listening skills, and nods at all the appropriate pauses, just in case we think there's a breakdown in communication.
After D squared gives an exhaustive and thorough explaination of our woes, the second KBR guy comes in. KRB number one looks at him, and as we lean forward expecting keen insights and nods of understanding, maybe a few "Ah, Ha! Elementary, of course" moments...he simply states "Blinky, Blinky" to the second guy. KRB guy number two gives a solumn and grave nod, wincing as he displays deep knowledge of the "Blinky, Blinky." It's going to be a long afternoon...

The ensuing week brought both insight and bemusement to how KBR HVAC guys work. Most are from Turkey, and we have a hard time communicating with them. I have a harder time understanding where the credentials came from. Several "teams" show up on various days to fix our AC unit and compressor, each with their own brand of comprehensive HVAC know-how:

Team Blinky comes in with the standard assumption that our unit is low on freon and just needs a charge. Out comes the compressed freon, a few hoses and gauges, and "presto" Team Blinky is convinced our unit is running like a top. It's midnight, and we try to tell them "sure, it seems to work now. It's been cooling down for hours. Why don't you come back, oh, say around 2 PM tomorrow afternoon." Big smiles from Team Blinky as they just want us to sign the service order so they can get out of there. I don't think they get it.

Team Two comes the next day and announces "All those other guys put too much freon in these things. They run so inefficiently and never last. You just can't over-pressurize these units." He proceeds to bleed out around 80% of the compressor's freon for better or worse as he quips "Wow! Did you see that stuff spray out of there? Don't let em' see you do that in the States'!"...noted.

Team Three comes two days later. Hut temps are ranging in the low 100's during the day, and our modest digs are now rendered useless. Half of us move into a tent, and the other half move into the operating room. Team three's preconceived notion: those filters are always getting clogged, and no one cleans them right. They spend two hours straightening drain hoses and cleaning the filters that were just cleaned within the week. "We clean filters. Good now. You sign right here, it's OK." Turns out: not so much...

We complain loud and long enough, threatening to shut down the operating room, that KRB agrees to put in a bigger 3 ton unit. After six days, a little progress.
So, the HVAC supervisor comes out for a site survey and to figure out why team after team has failed to recognize that our unit is just plain out of commission. He's even more amusing to talk to than Team Blinky:
Supervisor: "these things are breaking down all over the place. They aren't even designed to work in the heat."
I'm struck by the paradox, but it gets better as Eric suggests we move the new compressor to the side of the hut where it's shaded 80% of the day.
Supervisor: "What? That would ruin it! No good."

"The shade? No good? How is this possible?"

We go round and round looking for clarification on exactly why shade is bad, yet the A.C. units aren't designed to work in the heat. Nothing coherent is forthcoming...not that I expected it.

Sunday, August 12, 2007


"Just what am I supposed to do with this patient?"

"It's not my call to make. Don't know what I can tell you beyond circumstance and treatment."

"Well, was he doing anything before he was intubated?"

"He came in intubated, so we don't have much of a baseline to go on. He seemed to have some upper extremity movement and looked like he was miming a fish's mouth when we lightened anesthesia to attempt to wake him up. I think he's got some outside chance of a recovery, so we wanted to give him that chance."

"Alright, well I know it's not your fault. I just wonder what we are going to do with this guy."

This was part of the conversation I had last night with an ER physician in Balad. Our patient was an Iraqi civilian that decided to gun towards an IP checkpoint, and held heavily armed men in low regard this afternoon. For some reason, this is a common occurence. Civilians really like to speed close to convoys, get their vehicles lodged into convoys, and just plain not pay attention to big signs that read 'STOP, CHECKPOINT AHEAD" or "STAY BACK, DEADLY FORCE AUTHORIZED" in Arabic. From what I gathered from our interpreter, this guy was unarmed, not suspected of being an insurgent, and just wasn't very good at following instructions while wielding a 2 ton weapon on wheels.
As he barreled towards the checkpoint, he was shot in the neck and subdued. We heard about him when it happened, because he was originally supposed to come to Charlie Medical. Instead, we aren't really sure what transpired over the course of the afternoon, but we knew he was Ramadi General-bound. Case closed. Or so we thought....
We commandeered an entire table for dinner, and the surgical team was sitting down to chow. Up runs one of the surgical techs looking for us. He was told by Charlie Medical that indeed the patient was again coming to us, but Ramadi General had him in surgery. Well, this didn't make much sense. We'll roll with whatever comes, so we finished up and started back to medical to wait for his arrival.
Our detachement commander gets a call on his cell. The patient just arrived, is intubated with gastric contents in the breathing tube, and he is obtunded (not arousable). Bob sprints ahead now to assess the airway situation and find out why a previously stable and "in surgery" patient has mysteriously shown up at the door a suddent train wreck.
He quickly assesses that somehow the patient was improperly intubated. The breathing tube was inadvertenly introduced down his esophagus instead of the trachea. However this happened, we now have a patient with a stomach and bowels filled with a whole lot of air, and none to very little in his lungs. How did it happen: don't know? How long has he been deprived of oxygen: don't know?
He still has the gunshot wound to the neck that hasn't been explored or repaired yet, so we rush him to the OR. All major structures intact except some cervial vertebra damage, Martin does the exploration, cleanout, and is closing the wound within an hour.
Which now leaves us with a huge dilemma to sort out. With a superficial and seemingly easily recoverable neck wound, we now have a patient on our hands that is one big question mark. He seems to have been deprived of oxygen for some length of time. It is obvious that he currently has deficits; we tried to wake him up after surgery, but it wasn't happening. With these types of injuries, it is impossible to know what the outcome will be. What function and cognitive ability will he regain? 50%? 80%? The only way to realize what the outcome will be is to give it time. Weeks to months of time....and that is why we made the decision that I would fly him to a bigger hospital. Somewhere with CT scanners and a neurosurgeon on staff. The only place in the Country where he has any chance whatsoever. But we also asked a lot of Balad last night, too. We are asking them to accept the burden of initial and secondary care, giving up limited resources, to a patient that may or may not recover. They accepted, as all of the caregivers out here, to have the patience to see him through, no matter the outcome. Like us, every day they press the "I believe" button and just go with it.

Like my patient, Iraq is a wounded Country. As with a brain injury, there's no quick prognosis and no quick fix to Iraq, either. Standing where we stand, there is no crystal ball to gaze into and give us all the answers. You'd be better off looking for starfish in the Mississippi River. So we have to ask ourselves what will give us the best chance for a secure Iraq? Citizens free to go to the marketplace without wondering if they just palmed their last pomegranate waiting for the place to go up in a fireball. Without Iran and Syria squeezing from the borders like a nerfball in a vice. I don't purport to have all the answers, but I'm intimitely aware of how all wounds heal....with time and patient support.

Saturday, August 11, 2007

Incognito to 180-Out

I'm actually sitting here in front of the 'post entry' screen. It's felt like such a long time, and I have been thwarted in so many ways. I'm lucky I still remembered how to log in...

I'll start by laying out a small littany of excuses for my most inexcusable absence: I no longer have internet access, which means a trek down to the internet hut and waiting for a terminal if I want to check email or post an entry. For one reason or another, every time I have had a chance to come down here, it's either been shut down for service, shut down for maintenance, or just a general sense of desert apathy.

I have also been consumed with earning a warfare designation since June. Navy personnel attached to Marine Corps units have the option to follow Marine Corps regulations if they so choose and stand before a panel of Marine Corps officers to show their knowledge of doctrine, tactics, history, organization, weapons, tactics, ect. A few of the officers and all of the enlisted team members have been dedicated to this task for months, and included living, eating, and breathing Marine Corps. The officer board was held recently (we all passed, somehow) and our enlisted board will be held by the Command Master Chief within the next few days.

But, by far, the most noteworthy information I have to share is the current state of Ramadi's security. A stark contrast to what we saw in February when we arrived in Anbar, Ramadi is now one of the top success stories coming out of Iraq in the past six months. Iraqi Police have been working hand in hand with our units in and around the surrounding Province, and attacks have been virtually non-existent for weeks on end. The media has also keenly picked up on our successes, and have been reporting that Ramadi, and the cooperation and open exchange of information with local Sheiks we have enjoyed, should be the model considered for transforming the unstable, hold-out Provinces left in the Country.
Next month, our leadership will be answering some tough and pointed questions about the authorized surge force that started arriving in February with our surgical team. A portion of the surge is here in Ramadi and the surrounding Anbar region. And with this surge, we have seen dramatic change and success. However, general consensus is that even though the surge certainly had some positive influence to the security of Ramadi, most of the credit goes to the Anbar Awakening and local clans and Sheiks aligning with us against Al Quaida and other insurgent elements.
Sure, the extra Marine units didn't hurt, but the influence of having 20,000 local Iraqi men in uniform patrolling the streets, manning all checkpoints, and setting up curfew and roadblocks in and around the entire city warped us almost instantly into an atmosphere of calm.

In five short weeks, the replacement surgical team will be here. After unit turn-over, we will begin the journey back to Kuwait. Destination: home. The change here in Ramadi, and indeed all of Anbar over the past seven months has been amazing. Totally unexpected, but worth witnessing many times over: almost complete security from utter chaos. 180-out.

Monday, July 16, 2007

Saddam's Place

"So, where are you from?"

"Funny...Is Moose your real name?"
"Who do you guys really work for?"
"You ever say anything besides yes?"

I've learned over the past few years how conversations usually go when you talk to an OGA. That stands for "other governmental agency". In other words, you have no idea who they work for, what they are doing, or how long they are staying. Our modern day version of government 'spooks'.
A few of us took them up on an invite to an isolated part of Ramadi along the banks of the Euphrates for some weapons range time. These guys live in a fairly nice house. It used to be an Iraqi General's house during the Saddam regime. Marble floors, top shelf tiling in the bathroom. Was that a Viking rangetop in the kitchen? Not only do the OGA's live in top digs, they have their own cook. This was getting better by the minute! Prime rib cooked to perfection and steamed asparagus to start. Now I know how the other half of Iraq lives...
We went up on the roof for a better survey of the river and a little sun. When I consider how brown and tan the desert is, I am always amazed at the contrast near permanent bodies of water. The banks are teaming with vegetation, long reed beds lining the river, and grove upon grove of date palms as far as the eye takes you. Across the river, the OGA boss pointed out Saddam's old Ramadi palace. He had retreats tucked away anywhere he travelled, and Ramadi was no exception.

"You guys interested in a boat ride?"
What else could I say but......"yes". We didn't need a second invitation to jump on the chance for a trip down the Euphrates. I mean, who takes boat trips down the Euphrates River?
After calling in to security that there would be traffic on the river and assigning someone as "overwatch", we cruised the Euphrates in the late afternoon. Pictured are some close-ups we were able to get of Saddam's house. It's part of an outpost called Blue Diamond, and is mostly staffed by Iraqi Army and Iraqi Police.

Saturday, July 14, 2007

Meet Knuckles

Indigenous to Iraq and most of the Middle East, hedgehogs are occasionally found on-base and the surrounding area. "Knuckles", our resident hedgehog, was found by some KBR contractors and brought to Charlie Medical.

There are 16 species of hedgehog, and can be found throughout parts of Europe, Asia, Africa, and New Zealand. There are no hedgehogs native to Australia or North America. They adapt well to dogs and cats, but can be threatened by them; i.e. spend a lot of time rolled into a ball.

Knuckles has hundreds of hard and pointy spines, which are hollow hairs made stiff with keratin. They are safe to touch, and are non-poisonous and aren't barbed. Their best defense when threatened is to roll into a ball with all of their spines exposed, although they are also known to make a run for it or attack back by throwing their spines against the attacker. Think 'sonic'.

His nose is more of a snout, similar to an Aardvark's and is specially designed as a bug vacuum. Hedgehogs make great pets if 1) you don't mind the fact that they are nocturnal and will be running around the house all night, and 2) they chirp and sing all night, too.
I have no idea which ones, but apparently it is illegal to own hedgehogs in certain states. Iraq doesn't count...so Knuckles is here to stay as long as he likes.

Tuesday, July 10, 2007

Should We Stay Or Should We Go Now...

I live in a vacuum. I have Internet access, obviously, but it's slow and mostly unreliable. However, when I do have it, I make a point of scanning today's headlines, the progress (or lack thereof) interpreted by the media, and editorials from a number of sources.

What I do offer on a personal level to you is an eyewitness account of what is happening in my little part of this world and this war. Ramadi, although a small portion of Anbar Province by geographical size, is a highly prominent city. What comes and goes through Syria must pass through Ramadi.

What I read in popular media is that a percentage the public wants out. As in, withdraw the troops from Iraq. The Senate, with the Democrats leading and a small but growing minority of Republicans joining them, are insisting on a definitive timetable of with drawl. The drumbeats have been pounding for months, and are steadily growing into a crescendo that can be heard well beyond Washington.

Is it just me, or is there so much rhetoric flying around that the truth is somehow getting lost. Day by day, I find it harder to ascertain who is actually staying objective and who has hidden agendas, biases, has an axe to grind, or just plain likes to hear themselves talk.

I won't do this often, as this blog is not my personal political platform. I ask you to consider a few key points:

  1. We are here. I won't get into why we initially came, but the fact is irrefutable: here we are with a significant presence in Iraq and the Middle East. We have a foothold in by far the world's most unstable region.

  2. Many brave men and women have lost their lives for this tenuous foothold. After all they and many others have sacrificed, to leave now would be a disservice to them, their families, and all that we want to accomplish: a stable and prosperous Iraqi government free of terrorism. A Middle East free of extremes.

  3. It sure doesn't seem like it now, but a permanent, or at least long-term, Western presence in the Middle East may lead to significant stabilization of a historically unstable region.

  4. We are heavily investing in Iraq's economy and infrastructure and making progress every week. We pull out, we miss out.

  5. Finally, after years of indifference and outright hostility, regional tribes, clans, and sheiks are aligned with us. There were mistakes along the way. The road we initially took was littered with misunderstandings. But week by week, the potholes are disappearing. Like a recently paved interstate, the clans and councils from Baghdad to Anbar are rapidly taking over their own security and governmental processes. Are they self-sufficient and self-reliant. Nope. Not even close. However, if it wasn't for our resources, infrastructure, and corporate knowledge they wouldn't stand a chance to succeed. Pulling out now is a poor option indeed.

  6. Baghdad, and the main government currently in place, is not meeting our benchmarks. However, we also did not meet our own benchmarks: Baghdad and parts of Anbar Province are still wickedly dangerous places. We have a plan to correct that problem, but it's only been in place for a month. The surge needs more than a few weeks before politicians deem it a failure. From where I'm standing, that borders on the ridiculous. Time may prove me wrong, but at least I won't mark my opinions before giving it a chance. The Iraqi government will continue to miss deadlines and benchmarks so long as Baghdad and the surrounding provinces remain unstable.

  7. I finish with a question: we have maintained a presence in Europe for over 50 years. Does the U.S. have a permanent place in Iraq, too?

Progress is slow, I admit. However, who gets to set the timetable for success? Who defines success, and what is it? Right now, there are still many more questions than answers. That is exactly why setting timetables for withdrawl would, in my humble opinion, be a grave mistake. I fear it would spell a total failure and complete negation of my and many others' sacrifice. Our options:

  1. Set a timetable and start phasing troops out of Iraq. This Country is guaranteed to fall into anarchy. Iran will more than likely move in from the East, while Syria moves in from the West. The sectarian squabbling between Shiite and Sunni we see now will pale in comparison to how badly this region would spin out of control. Iraq goes down in history as my generation's Vietnam: an abject failure at best; catastrophic mistake if radial idealism and anti-Western hatred spread throughout the globe.
  2. We stay permanently in a few key areas around Iraq. Worst case scenario: Iraq becomes my generation's Cuba. We maintain a tolerated presence despite occasional open hostility.
  3. We stay permanently, and Iraq becomes my generation's Post-World War II Europe. We maintain a presence and work hand in hand with the Iraqi government. We patiently wait until they are organized and stable enough to take the lead, and we give them full autonomy while maintaining open-ended leases on a few key military bases.

To borrow heavily a few lyrics from The Clash, my question stands as this: should we stay or should we go now? If we stay there will be trouble, and if we go it will be double...


(pulled from Yahoo news) Despite a steady procession of Republicans calling for a change in course, several GOP lawmakers warned against a precipitous withdrawal.
"I believe that our military in cooperation with our Iraqi security forces are making progress in a number of areas," said Sen. John McCain, R-Ariz., who recently returned from his sixth trip to the region. The GOP presidential candidate said he noted a dramatic drop in attacks in Ramadi in the western Anbar province.
Sen. Lindsey Graham, R-S.C., who accompanied McCain to Iraq, also cited progress since Gen. David Petraeus took command several months ago and the additional troops began arriving.
The Iraqis are "rejecting al-Qaida at every turn. I don't want the Congress to be the cavalry for al-Qaida," he said.
Graham was also part of a group of senators who met privately during the day with Stephen Hadley, the president's national security adviser, and Lt. Gen. Douglas Lute, a top adviser on the wars in Iraq and Afghanistan. The senator said afterward the White House is looking at new ways to hasten progress in two primary areas: destroying al-Qaida in Iraq and forcing the U.S.-backed government in Baghdad to make political progress.


Friday, July 6, 2007

D squared has a birthday

July 5th; D squared's birthday. Re-deploying with me from Al Asad, he is our OR nurse, and hails from Florence, Kentucky.

The chow hall, in honor of his birthday and independence day, set up this ridiculous I-don't-know-what in the middle of the food service area. He looks happy, so who am I to question...

Thursday, July 5, 2007

The TQ Surgical Team

Patrick, a fellow flight nurse stationed with me at Portsmouth, Virginia, started a blog later in our deployment.
He was originally with me at Al Asad, but went to Taquaddum shortly after I re-deployed to Ar Ramadi. TQ, between Ramadi and Fallujah, is situated on a large lake and has a large airstrip.
Lots of pictures, including some unearthed Ilyushin Il-28 bombers originally made in the old USSR, and later license-built in China. They were widely used for over four decades in twenty different nations, including Iraq.

Wednesday, July 4, 2007


The link below is a collection of current milblogs out there, including short interviews and guest editorials:

Independence Day

Big voice booms "Clear all roads from Trooper Gate to Charlie Medical. I say again clear all roads from Trooper Gate to Charlie Medical."

Iraqi civilians were struck by a VBIED that was gunning for an Iraqi Police checkpoint. Two families in a big minivan, including seven children! All survived and were treated by Charlie Medical for minor and deep lacerations. It looked like a mess when they came in, but after getting wounds washed out, sutured, and clean sets of clothes for everyone, things shaped up to be a lot better than it could have. One little girl had a severed wrist tendon, and she was taken to the OR for repair. The whole family was released late in the afternoon with a few big bags of toys and extra blankets for the kids. Before they left, we gave the toddlers some Fourth of July cake. From how much ended up on their face and in their hair, I think they really like it! We all knew they were back to normal when they started chucking cake around patient hold...

Tim, D squared, and I had just enough time after the case to walk to the Alamo (3rd Infantry Division Headquarters) for a Battalion cookout and Fourth of July talent show. I'll say this much: entertaining.
Our day culminated in Eric, D squared, and I climbing up for a better view of the Ar Ramadi Fireworks Show. Evoking images similar to what Francis Scott Key witnessed at Fort Henry when he penned the Star Spangled Banner, Palladin artillery sent up volley after volley of illumination and signal shells for about fifteen minutes. The Star Spangled Banner, originally written as a poem, and later adopted as the United States National Anthem, was inspired by Key as Fort Henry was being pummeled by the British in the War of 1812.
Our Independence Day display of bombs bursting in air was reminiscent to the display our forefathers and young Nation saw 195 years ago. I couldn't have asked for a more authentic celebration of National pride, tradition, and freedom.

Tuesday, July 3, 2007

Apache rescue

The apache rescue of one of our soldiers July 1st made it into mainstream media news. Check the links below to read the story and watch the video:


Pilot rides helicopter out of Iraqi firefight

WASHINGTON — Giving up his seat to a wounded soldier, an Army officer strapped himself to the side of an Apache helicopter gunship that airlifted them out of a furious firefight in Iraq, the military said Monday.
The Army called it an "unusual casualty evacuation," but Chief Warrant Officer Allen Crist's selfless act goes way beyond heroism.
Realizing that Spc. Jeffrey Jamaleldine needed medical attention fast, Crist put the critically wounded man in his own spot on the Apache on Saturday.
Crist then rigged a harness to strap himself to the fuselage and crouched on the stubby left gun wing of the aircraft.
With Chief Warrant Officer Kevin Purtee, of Houston, at the controls and Crist hanging on for dear life, the Apache flew out of the battle zone. It kept low, about 200 feet, until it reached a field hospital, the military said.
Jamaleldine, 31, of Fort Smith, Ark., was later reported in stable condition.
Army officials could not immediately recall an Apache ever being used before for a medical evacuation — and certainly not with the co-pilot riding outside.
Crist and Purtee, from Company B, 1st Battalion, 149th Aviation Regiment, were part of a four-Apache team that came to help U.S. troops pinned down under heavy fire in Ramadi.

Monday, July 2, 2007


Sitting in EVAC with Tim watching the Buick Open on the Armed Forces Network. Not a big golf fan, but I'll take any distraction at this point.

"Just past midnight. We finally hit one July."

"Yeah. The month you're in doesn't count, and the month you go home doesn't count either. Guess that means we only have one month left in Iraq?"
Tim's laughing and not quite agreeing at the same time. Either way, we both herald the disappearance of June as we crawl one month closer to home.

"Four casualties inbound. Mikes unknown; still engaged in a firefight." says one of the EVAC platoon medics.
"Army or Marine?"


Tim and I walk out to patient receiving. Waking up some key staff, including some surgical teammates. Hospital CO is up as well as the XO. 3rd ID Sergeant Major drives up; his men have been ambushed and are taking a beating. The unit is having a hard time getting them out of the fight.
Finally, a humvee guns up to Charlie Medical out of the dark. One out of four casualties arrives so far. Soldier with gunshot wounds to his extremities. Medics, corpsman, and physicians go right to work; no surgical intervention needed, and he will be fine. Humvee looks worse than the soldier: turret is torn to pieces, but the gunner is OK. Two more casualties finally arrive via Humvee...also OK. More gunshot wounds, but all stable. No surgery needed; we start making arraignments for MEDVAC.

Fourth casualty is critical. GSW to the face and no way to safely get him to Charlie Medical by road. A decision is made: one of the Apache gunships providing close air support will touch down, the gunner will get out, and we will just airlift him in the Apache. Effective; and a first for anyone present.
He has some facial damage and airway swelling. In the OR, Bob does an awake intubation to protect him from continued edema (swelling). Mark flies all four patients to Balad, and they do well.

9 AM we get a detainee from last night's firefight. Both feet shot, the surgical team takes him to the OR for debridement and a complete washout. After post-operative recovery, the detainee is taken, complete with security entourage, to a detention center in Baghdad with an attached hospital.

1 PM finds Jason and I trying to figure out another detainee's injuries. Initial chest film looks good, but the patient's oxygen levels aren't "quite right" and he seems to be guarding a mystery injury. Tim and I are in the x-ray room 5 yards away, and I'm right in the middle of looking at the detainee's chest film, when a detonation and subsequent deep bass of the concussion wave knocks the wooden window covers back. My initial thought: "mortar attack was pretty close." Jason and I both look at our patient and immediately request he be put in patient hold for observation. We need the trauma bay cleared out...as in right now. All staff immediately start pulling down litters, setting up triage stations, and the trauma bay jumps to life as all stations are manned with medics and corpsman.

"VBIED" cracks over the radios. My initial thought was wrong, but somehow doesn't matter when the results are the same: casualties. Snap a quick picture from Charlie Medical on my way to Tactical Command, only a few short steps away. Truck-borne IED has taken out a local bridge. Small arms fire coming from the back gate. The few remaining staff running to Charlie Medical from church service and the barracks.
New insurgent tactics recently include attacking Anbar infrastructure. This is the second local bridge targeted over the past few weeks. A communications tower was targeted last month. This attack was coordinated with several others in Anbar throughout the day, including another bridge in nearby Fallujah.
A shift away from local civilian populations, as the insurgents found that Sunni leaders have united against outside aggressors and are now working directly with U.S. and Coalition authorities under the Anbar Salvation Council.
Radios continue to stream information: two casualties inbound. Both Iraqi civilian. They weren't close to the blast, and only have some superficial scraps and soft tissue injuries.
The rest of the afternoon was spent on standby as more casualties arrive. Another abandoned VBIED was blown up by an Explosive/Ordnance platoon near the bridge. Not sure if the driver was found, or what happened to him.
Midnight. An Angel ceremony for the fallen. The entire Army unit is in formation, and the surgical team falls in off to the side. We get word that the men lost today were the heart and soul of their platoon. Tragic beyond words. In formation, it's just an unspoken rule that no one talks. Thirty minutes of silence amongst one another. Each man left to his thoughts and prayers for the fallen and the families and friends left behind. Yet in the silence, we all feel so connected...we stand as one collective Spirit to honor those who gave all. 200 silent salutes in the night as an H-46 lifts them gently Home.
One July. One 24 hour period; midnight to midnight.
One day that couldn't go fast enough.
One day that I will never forget.

Tuesday, June 26, 2007

Anbar Waffle House opens for business

A dear friend whipped up a fantastic idea: surgical team waffles! She send out a waffle iron, pancack mix, maple syrup, buttermilk powder, and a can of pumpkin.

All I had to do was "procure" some milk and eggs. Grocery stores, or "Souks" are off-limits. Haven't found any Wa-Wa's or 7-11's yet. No easy task; this took a coalition of the willing and some smooth talking at the chow hall. Worth it. Along with some freshly ground Starbucks, this was the finest "homecooked" meal I've had in months!
Surgical Team says: Thanks Missy!

Sunday, June 24, 2007

Slave to the System

"Dude, you're not on the nine-line!"

"What, your kidding me! I'm going to have to go on this one! Either that, or the patient stays on the deck, and we re-submit another request."

"I already have a monitor." The flight medic yells above the roar of the rotors 20 yards away.

I shrug my shoulders, as if to say "What now?"

The flight medic yanks a thumb with a resigned "get in" to the blacked-out helo silhouetted against the soft glow of green landing lights. I grab my flight bag, run ahead, and jump in. The Army evac team, on my heels, carries my patient up alongside, and I help them guide the litter along the carousel skids.

Patient settled in, and vital signs stable. Struggling to quickly get my 5-point harness on before take off. I wasn't fast enough to get buckled in, but no matter: takeoff was soft as butter. Besides, as soon as we are in the air, I have to hop up and start assessing our casualty.
VBIED attack: I follow my patient from the trauma bay to the operating room, and coordinate getting him to the Baghdad CSH just as Martin, Tim, and RH finish repairing abdominal wounds, a blown out knee, and a gaping right shoulder injury.
Anytime a patient is critically ill, and is either unstable or needs to remain ventilated, a flight nurse goes on the mission. We bring along specialized ventilators and monitors, and unless the flight medic happens to be infinitely familiar with our equipment, can become a complicated mess in flight.
Hence, the need for me to be included on the "nine-line", which is essentially a mission tracker that includes casualty identification, flight route, and crew. If I go on the mission, all coordinating services need to know I am on that helo, similar to any flight manifest throughout the rest of the world. Otherwise, if something happens during the mission, the Tactical Recovery of Aircraft and Personnel (TRAP) team won't have any idea who I am or why I'm near a crash site. Wrong assumptions would put me at high risk. Not to mention if I somehow get separated from the aircraft: they won't know to look for me, if they never knew I was on the mission to begin with. I ended up running into complications, but it wasn't anything worse than getting stranded at another base while trying to figure out how to get back to Ramadi.

The patient did well. Stable for the flight, I busied myself with watching his oxygen status, changing out oxygen tanks, and giving IV fluids and some pain medications. Flight medic taps me on the shoulder and signals "two mikes out". I have just enough time to clamp and store his IV fluids back into the "hot pocket" and check the oxygen tank one more time. Once we touch down, it's too late for housekeeping. We count tasks in seconds, and have precious few to spare. Flashes of light off to my right as our Blackhawk launches countermeasure flares. In all reality, I'm too busy with my patient to care. It registers in the back of my mind "Hmm, wonder why we're launching chaffe?" I hear the pilots and crew chief talking over the "comms", and they don't know why it launched either. Our countermeasure flares can be triggered manually, but are always on sensors, too. The helo computer sensed some sort of heat threat, but none of the crew saw anything. Safe assumption it was just excess heat from a roof vent. Sixty seconds later, and the Blackhawk touches down in Baghdad. We carry the patient to a 4X4 "gator" and drive 25 yards to the ED entrance. Patient care is transferred to the Army ED physician, and the medic and I grab flight equipment and monitors for the dash back to the helo.
Here is where my return to Ramadi gets a monkey wrench thrown into the mix. The Blackhawk crew had no idea they were going to have to go back to Ramadi that night, and were caught unprepared. Visibility was closing in to around 2 miles in Anbar Province, so they broke the bad news to me: I was going to Taquaddum with them, and would have to find my own way back. They offered to drop me off at TQ surgical.

Small consolation...and here's where the "it's not just a job, it's an adventure" part kicks in:
Random thoughts as we were targeted with a volley of RPG fire on our appoach to TQ:
"How long can a Blackhawk hold a hard bank at 90 degrees to the Earth?" as the pilot violently pulled the helo left, right, and left again to avoid being hit.
"Can my heart really go this fast?"
"I can't believe I'm not on the friggin nine-line; they'll have no idea who I am if this thing goes down...$%*! figures!"
Sandwiched in between the flight medic (primary job when not taking care of patients: the pilot's eyes on the left, or port, side of the Blackhawk) and the crew chief (starboard eyes), I'm totally reliant on theirs' and the pilots' skill at evasive maneuvers. I'm not sure what I was doing during that wild forty five seconds, but my thighs were burning sore for three days after this one. If there's a way for humans to actually make diamonds, this has to be one of the fastest methods.
We hauled tail to the TQ flight line, pilots cursing and creating new explitives along the way, Cobra gunship straining to keep up, and were met by the ground crew. Spotlights were hastily set up right on the flight line, and aircrew crawled all over the craft to assess for damage. Lead pilot jumps out and says "Whew! There's one to write home about, Doc!"
Truth be told, I'm getting to the point where I would rather write about how many days (82) I have left...

I spent two days trying to figure out how to get a flight back to Ramadi. It normally takes two or three days minimum to reserve a seat for a flight. For instance, an Assault Support Request (ASR) requires on average a three day wait. So I tried to get on a routine medical run the next night. The "milk" run consists of a few H-46 helicopters that fly patients back to their units every so often. They made two passes through Taquaddum that night. The first time, I was bumped by a patient and their escort going to Balad. "No problem" they said. "We'll get you when we come back later tonight". Around 2 AM, five hours later, they touched down at TQ surgical again. I was on the flight line standing with 100 lbs. worth of flight equipment and monitors waiting for the signal to hop on. Never happened. They briefly stopped, a Marine ran out of the back (he was returning to his unit), and they kept right on rolling through. I was stood up like an ugly prom date as I watched the helo quickly disappear into the ink black sky.

The next night was equally as frustrating, but a little more fruitful: the Army was able to put in an emergency ASR, and told me to be at the Taquaddum flight terminal at 8:30 PM for a 10:30 PM flight. Caught a ride to the terminal and lugged all my crap to the manifest check in. They had no idea who I was, and couldn't find my flight number anywhere. "Sorry, Sir, but you aren't in our system. If you want, you can go to the billeting tent and we can put you on standby." Completely torqued, I started calling everyone and their brother to find out how I got into this mess. I called Charlie Medical and the Ramadi air terminal: no luck. I disappeared from the system. Great. I called the Ramadi air tracker next, and they found an open seat on a Blackhawk later that night, but it was going to the TQ medical pad. Stranded in the wrong place again! I called TQ surgical and asked if anyone could come back out to the terminal and give me a ride. "But we just dropped you off!" an exasperated corspman defeatedly states into the phone.
"Yeah, yeah, I know. Just a slave to the system."

Monday, June 11, 2007

I may be off-line for a few weeks, and hope to return soon. Your support and readership is appreciated........

Friday, June 8, 2007

Meet Suhad

After two surgeries to repair her liver, diaphragm, and stomach, Suhad finally made it back to Charlie Medical last night. She is the girl that was accidentally shot with an AK-47 a few days ago. Her surgical incisions are healing well, and I found her this morning eating breakfast with her brother, Towad, in patient hold. She had follow-up surgery the day after I flew her to Al Asad, and quickly recovered. Within days, she is ready to be united with family.

With no sign of pain or discomfort, she and her brother talk while she plays with some of the toys and stuffed animals donated this morning. We took some pictures, and her brother asked me if I could print some out for them to take home. They both seemed to like the picture printouts more than the toys!

Their stay with us will be short. After lunch, the Iraqi Police will swing by and pick them up to take them back home. We hope that the care they receive and the genuine concern for their well being will leave a lasting positive impression..........

Thursday, May 31, 2007

Operating in the Dark

Twelve year old girl and her brothers were playing around the house, and she was accidentally shot with an AK-47. We don't know the specific circumstances of why or how it happened. It just did. Nor does it matter to us, of course. Not part of the job description. We are here to do all we can irregardless of who, what, how, or why.

The bullet ended up causing some internal damage. Double chest tubes were placed and open abdominal surgery was performed, including liver and stomach repair. Stable for the case but critically ill, she needed immediate MEDVAC to a higher level of care. At the level III hospital, they will be able to perform diagnostic tests that we just can't perform at Charlie Medical, such as an extensive CT scan looking for subtle damage and/or hidden bleeding that won't be found unless you know exactly where to look.

Little known fact: Ar Ramadi is run entirely on generators. Every light bulb, DVD player, TV, you name it is run from a generator. Walk anywhere on base and you will quickly notice the maddening and inescapable drone of a nearby generator. Unlike the stable power grids in Western countries, generator power fluctuates, causing routine brownouts and surges. Brave is the soul who uses a computer on Ar Ramadi without surge protection. Generator power also happens to be a lot less reliable. The picture below was taken as the power went out during the middle of the case. "Grab the flashlights" RH quips as one of the corpsman runs outside to start the axillary generator for our lone OR light. Monitors and anesthesia machine had to rely on battery backup for 20 minutes while we waited for power to be restored. As for our case, not a beat was missed. We kept right on operating in the dark.

Stable for the flight to Al Asad, I was able to give a liberal amount of pain and sedation medications to keep her comfortable for the helo ride. The image below was taken in-flight. I have her in a protective bag we refer to as a "hot pocket" to prevent evaporating heat loss at altitude. The doors are all open, and a lot of air is streaming through during flight. Oxygen tank slipped between her legs, I have the ventilator and monitor placed on a folded blanket pad on her lower legs. We are ever vigilant to ensure anything placed on the patient has thick padding to prevent any discomfort. I left myself an IV port taped on her shoulder for quick access as I give blood and medications during the flight. Just off to the side is my flight bag, an extra oxygen tank, and a portable suction unit. No time to sight see during the flight. It's an endless loop of assessing vital signs, ensuring the ventilator is working correctly, the oxygen tank isn't empty, and checking her to make sure she is comfortable and isn't waking up. For her to awaken in this environment would be a frightening, disorienting, and frustrating experience......so I do all I can to keep her peaceful and blissfully asleep for the ride.

After dropping our patient off at the medical helo pad at Al Asad, we fly directly to the "fuel farm". Aircrew told me repeatedly we were "on fumes" as the helo sat on the medical pad, resulting in a mad dash to grab flight equipment and make a run for it. After a top-off, we race back to Ramadi with the Cobra Gunship close behind.

A hot and hazy day in Anbar. Put a little damper on my ride back, since I was hoping to take some pictures. This was my second time flying to Al Asad during the day, and I'm already starting to see some familiar landmarks along the route, crossing over the Euphrates River several times. The desert is made of endless swaths of flats, dunes, crags, and ranges of rustic browns and tans. But for all of her beauty, she is still devoid of greenery or overt signs of life. The only exception being the major bodies of water: lakes, rivers, and their tributaries. Anything small just evaporates in the torrential heat. In these select and reserved locations the desert wells up and seems to burst with life. Thick foliage and luscious date groves reveal a vivid palate of colors as they cling tenaciously to the river bank. Beautiful..........

Surveyed a few homesteads clustered close to the water banks. They have taken advantage of the fertile strip of land running parallel to the water and are actively cultivating small orchards and tending farms along the Euphrates and small tributaries. A lack of equipment, and possibly know how, is preventing any of the farmers from truly efficient irrigation farming, the modern day practice of storing water to tightly control soil saturation. Instead, they have either fallen back, or never stepped forward, from flood irrigation. At least once a day, the family turns out for the "bucket brigade" as they form a chain a short distance from the river to their crops. They just fill the buckets from the Euphrates, and dump it on the fields. Despite the hardships the Iraqi people endure, an encouraging sign that life sustains and thrives........with suffering comes perseverence. With perseverence, character. And with character.......hope.
Update: I receive many curious inquiries as to how our patients fair after they are taken to a larger hospital. The surgical team keeps tabs on patients two ways. First, we have a computer program on a secured terminal in the office that allows us to track patients not only in-theatre, but all the way to Landstuhl or the States'. Second, our surgeon calls the accepting surgeon the day after. He will call daily if the patient is serious or unstable, then passes down patients' status to the rest of the team.
The little girl I flew to Al Asad is doing great. The CT scan showed a little fluid collection around her liver, which is to be expected considering the injury. She went back to surgery the next day and was weaned from the ventilator the day I brought her. My friend at Al Asad emailed and said our girl instantly became the ICU princess.