Friday, April 27, 2007
Thursday, April 26, 2007
Posted by Carl at 11:30 PM
Monday, April 23, 2007
Sitting at my desk writing letters after lunch when the biggest crunch yet flings things off my shelf. D squared and I look at each other for a milisecond, jump up, and run out of the hut to go to Charlie Medical for our flak and kevlar. We take a quick look up and see the plum of smoke just a short distance past some barracks.
I jump on the HESCO barrier and snap a quick picture, D squared on my heels. "You know we are supposed to get our asses down when we hear an explosion, not climb shit to see what's going on!" I say to him. He laughs, and we mock our own stupidity as we make our way to the hospital backside. For those who now want to throttle me: the detonation already happened......trust me, I hear whizzing overhead I'm not the guy looking over the berm for a peek.
"VBIED attack right outside the gates. At least a dozen patients in route." the Army TOC says. Radios are crackling and humming to life as information starts pouring in. Better go drain the bladder; bad guys just ruined my day. Within minutes, patients come in groups of 2-4 on M-113's, Iraqi Police Vehicles, and humvees. I start roving around like a hired gun: sticking IV's, airway managment, initial assessments, pushing drugs, hanging antibiotics, pulling patients out of vehicles, preparing intubated patients for flight. Trying to make triage decisions about where they should go when they come in.........
Security is crawling around Charlie Medical this time. Marines and Army infantry with weapons at condition one (locked and loaded). Iraqi Police streaming in with patients-no time to clear weapons, everyone on edge.....second VBIED strikes somewhere else in the city as we treat the initial injured....thoughts of when it's going to end.
Children coming in. They all look OK. Minor lacerations here, little bumps and scrapes there. Smiling at me as I give one a hug. Small miracles in small packages.
Insurgents strike at the soft and vulnerable underbelly of the civilian population. Their only purpose is to create chaos and instability. Today was a restaurant. Charlie Medical and the surgical teams treat 39 casualties before it's all said and done. No chlorine this time, thankfully.
Indiscriminant, without warning, and senseless. On one hand, we are proud to be here serving. Medical services to all comers: civilian, children, Iraqi forces. At the same time, team members expressing frustration at our inability to slow the violence. All the infrastructure we are dedicating to the Iraqi people, wiped out in an instant of flying debris, burning tissue, lives transformed to ruin. And for what?
It's 10:30 PM and I'm trying to put some final edits on this entry when the "big voice" starts bleating "incoming-incoming-incoming, I say again: incoming-incoming-incoming". The team sinks with dread as we hold tight for the all-clear signal and word of injuries. Tim can't wait, and gets out of bed and heads to Tactical Command. No casualties. 11:30 PM, and we start all over again "incoming-incoming-incoming, incoming-incoming". Nothing this time either, the only casualty being the sleep I was hoping to salvage after a long and emotionally draining day.
Funny thing about the big voice: It's almost the antithesis of actual incoming.....
Posted by Carl at 9:59 AM
Saturday, April 21, 2007
In the summer of 2003, he wrote home expressing his concern that some soldiers did not receive any mail or support from home. Being a caring and loving mother, she decided not to allow a situation like that to continue. She contacted a few friends and extended family to ask if they would write to a soldier or two. Within a few short months, Soldiers' Angels went from a mother writing a few extra letters to an Internet Community with thousands of angels worldwide.
With more and more merchants donating services, money and items for packages, the Angels reorganized as a 501 c 3 non-profit so all donations would be tax deductible.Soldiers' Angels currently supports thousands of American Service Members stationed wherever we raise our Country's Flag and the number is growing daily. Soldiers' Angels are dedicated in supporting our military during and after their deployment.
In December of 2004 a worldwide support forum was created. In hopes of providing a place where needs of our heroes can be fulfilled In July 2006 This ordinary mother's youngest son, Bretton Varn started Boot Camp and looks forward to serving his country.
Please spend a few minutes navigating their website. Consider joining them to "adopt a soldier". There are men and women toiling on our battlefronts, possibly without the support they deserve from home. They need you......
Posted by Carl at 1:44 AM
Wednesday, April 18, 2007
"Two wounded inbound. IED attack" the Army coordinator says. We go to the OR, turn on the lights, start warming fluids, ensure the oxygen generator is turned on along with the anesthesia machine. After that we wait, always with a mixture of anticipation and anxiety.
"Headlights coming down the alley" yells one of the surgeons. Four soldiers quickly unload a casualty off the humvee and run into the trauma bay as we direct foot traffic. I'm standing in casualty receiving and start to follow the patient in when I'm frozen in my tracks: he is so dark from dirt and mud that he doesn't look like he has a uniform on and I can't make out his facial features. He has to be Iraqi civilian. I'm a little confused because the word was two Army soldiers? I do a double take and don't see anything beyond the upper portion of his thighs. Nothing there but empty space....
The medic is on their heels, and he looks as pale as a silverlit moon. His uniform is caked with dirt. Sweat streaming down his face into his eyes; he doesn't even notice, because he's practically running blind into the trauma bay when the chaplain and I stop him. Chaplain asks him if he's the medic, and he can only shake his head in the affirmative. We quickly thank him for doing such an outstanding job of getting the patient to us, and "chaps" takes him aside to talk to him and comfort him.
I, on the other hand, follow on the heels of the litterbearers into the OR. Staff is streaming in to help. I position myself on the soldier's right flank and establish IV access while simultaneously putting monitor equipment on. Quick scan of the room to see if crowd control is needed, and I spot an unknown visitor wearing a tan flight suit with no identification. I quickly walk over, introduce myself, and request he immediately identify himself. "Company Commander" he says. We talk for a bit, and I ask about the patient. "Just married a few months ago while on R and R. Such a good guy" he says. What to say back....? We both stand in silence for a few moments. I ask him if he's OK with staying, and he seems fine. I quickly go back to work. The orthopeadic surgeon, Tim, and general surgeon, Martin, are working on the extremities at the same time. Mark and I take great care to package him up for the flight to Al Asad....we start giving sedatives and pain medications immediately.
His unit: their love for him is unquestionable. His buddies press into the OR the second we finish working on what's left of his legs. A few with shellshock and patched up arms and legs from the blast are at his side and don't want to leave, hollow look in their eyes and mouths stuck permanently in "O" mode. Eric talks to them about how well their battle buddy, their brother in arms, did with the surgery....they are so upset with themselves as if they were to blame. Eric gives one a bear hug; reassures them it isn't their fault. We let them....no, we are honored to let them, be the litterbearers back to the ambulance for the short ride to the helo pad.
They all walked behind the ambulance to the helo pad, and helped Mark and I load him onto the Blackhawk. We stand together one last time as the Blackhawk spins up rotors and gently wisks him to the 399th CSH at Al Asad. Not a muscle twitches until helo and patient are out of sight.
Posted by Carl at 2:27 AM
Saturday, April 14, 2007
The team just walked back to the hospital from lunch.
"Patient coming in 10 mikes (minutes)." says one of the Army staff.
As we quicken our pace, we ask what happened so we can anticipate what we will need.
"Not sure, it was a roll-over accident. A Marine."
We are already at the receiving area, and wait for the patient to arrive. After a few minutes, I wander around the corner and see some of the Army staff running to the front of the hospital. Instincts kick in, and I'm right behind them. Sure enough, a few humvees come to a halt in front, and 8 Marines scramble out and put one of their own on a litter and make a run for the front door. We direct them to the trauma bay and quickly triage him straight to the OR.
"We don't think he's breathing" He had a nasal breathing tube placed in the field at the point of injury, but it comes out from the frantic activity. Eric places another within seconds. Checking for a heartbeat-just can't tell from all the confusion, but skin is dusky and pale. I start chest compressions while the surgeons start cutting. Instruments are flying off the sterile field, thorasic cavity is clamshelled and held open with rib spreaders. We find bleeding everywhere-thorasic cavity, retroperitoneal, and abdominal. Walking blood bank is activated as we pour lifesaving and oxygen-carrying hemoglobin into him. No idea, however small, is spared for saving a life.....desperation is in the anesthesiolgist's and surgeon's voice. Despite herculean efforts, we lose a Marine. He was the turret gunner. Another fallen Angel......
Just finishing some dinner when the radio blurts out gunshot wound just arriving in the trauma bay! Almost finished trays are thrown towards the side as the team runs next door to the hospital. A SF soldier on base is hit by a stray round from a firefight on the perimeter. He's wisked to the OR as we intubate and start the thoracotomy within minutes--all staff on hand and running around the room scrambling for supplies and sterile instruments for the second time in hours. The bullet rips through a lung and lodges in a vertebra. Bleeding is quickly controlled, so we close his chest, stabilize him, place double chest tubes on the affected side, and I fly him to Al Asad. He took the flight well, and I was able to give a liberal amount of pain and sedation medications to keep him comfortable.
The blackhawk finally gets me back to Ramadi after 11 PM, and we planned an Angel ceremony for the Marine lost today. After midnight, we line the route from the hospital to the helo pad with glow sticks and line up to pay our respects for a fallen comrade that was taken too soon. The desert winds kicks up and sends a sharp chill though my spine as I think about the fallen and my own mortality. As the H-46 gently lifts our Angel back to his family, we all gently lift up our prayers for him, his friends and unit, and especially his family.
Update: the SF soldier I flew to Al Asad had the breathing tube removed and he was talking to his buddies today.......prayers answered.
Posted by Carl at 9:39 PM
Friday, April 13, 2007
Two Army folks start laughing with us. "The desert wind is perfect." they shot back.
"Who are you guys with?" we ask.
"PsyOps, sir." she said.
"Yea, and I bet you flying Hello Kitty kites to confabulate the insurgents."
They both start laughing hysterically and say "Um, since you mentioned it, look up!" Sure enough, she was flying a Hello Kitty kite!
Psychological Operations----I should have known better.
PSYOP are planned operations to convey selected information and indicators to audiences to influence their emotions, motives, objective reasoning, and ultimately group behavior. PSYOP is one of the oldest weapons in the arsenal of man, and is considered a non-lethal weapons system.
It has been said the pen is mightier than the sword. When used properly, words can be an inspiration to motivate others:
"Remember the Alamo"
"Give me liberty or give me death"
"I regret I have but one life to give for my Country"
"Ask not what your Country can do for you. Ask what you can do for your Country."
credit Major Ed Ruse (ret) for the educational piece on PSYOP
Ok, so PSYOP wasn't really using Hello Kitty to win the hearts and minds of insurgents, but it provided great comic relief.
Interesting side note: United States PSYOP units/soldiers are prohibited by law from conducting PSYOP missions on domestic audiences. Anyone ever stationed overseas has invariably suffered through those cheesy Armed Forces Network pentagon-sponsored commercials (no public advertising is allowed on government media stations). Someone tell me those "motivational" commercials aren't crafted by PSYOP......I'm not buying it.
Posted by Carl at 7:29 PM
Posted by Carl at 7:23 PM
Garry Trudeau, the author of Doonesbury, launched a military blog last year dedicated to lending voice to military members stationed overseas in support of the war on terror. It's an eclectic mix of entries by service members standing watch for America from all over the globe.
Welcome to The Sandbox, our command-wide milblog, featuring comments, anecdotes, and observations from service members currently deployed to Iraq and Afghanistan. This is GWOT-lit's forward position, offering those in-country a chance to share their experiences and reflections with the rest of us. The Sandbox's focus is not on policy and partisanship (go to our Blowback page for that), but on the unclassified details of deployment -- the everyday, the extraordinary, the wonderful, the messed-up, the absurd. The Sandbox is a clean, lightly-edited debriefing environment where all correspondence is read, and as much as possible is posted. And contributors may rest assured that all content, no matter how robust, is currently secured by the First Amendment.
His latest entry is a small collection of my latest posts, and can be found here:
Posted by Carl at 2:23 AM
Wednesday, April 11, 2007
Yesterday morning I was working on the flight gear I brought from Al Asad. Impact ventilator checks, monitor checks, re-supplying my flight bag and medications. When all was laid out, an IP patrol truck dropped off another young child after he was hit by a vehicle. Pelvic and femur fractures, including a left thigh filled with blood. (no compartment syndrome, but that was the least of his/our problems at the time). He was barely conscious, and we had to intubate him. He also suffered obvious head trauma, so we splinted his left femur fracture, applied an abdominal binder to tamponade (prevent bleeding into an open space) his pelvic area, started giving blood, and flew him to Balad (neurosurgeon on staff).
The afternoon held promise for yet more excitement. It was a little after 1 PM, and sure enough an explosion rattled our hut door. This was followed by another 30 seconds later. We rushed over to casualty receiving and waited for word from the Army tactical operations center (TOC)-after 20 minutes we figured out the explosions were outside the front gate. We also came to the broad assumption that nobody knew nothing else. Whatever it was, we didn't get any patients.
Posted by Carl at 3:46 AM
Monday, April 9, 2007
Spent the past few days travelling in-theatre. As we shut down the Navy shock/trauma in Al Asad to make way for the Army's Level III hospital, the ortho/trauma team put together some critical supplies in Al Asad for the Ramadi mission. The supplies were supposed to convoy to Ramadi, but a logistical SNAFU kept them in Al Asad. So I flew up to hand carry our gear back to Ramadi.
Trying to get around in-theatre is an inconsistent process. All part of the adventure. I have to send an assault support request (ASR) through Marine Corps. aviation and wait for the request to run up and back down the chain of command. My initial request was granted for Thursday night, but required a connecting helo flight in Taquaddum (TQ) . When I got to TQ, I re-manifested for the next flight and was told it left without me. The manifest personnel in TQ told me this happens on a nightly basis: flights arrive early to get a head start on their runs for the night, and will not wait for you if you haven't arrived yet. Essentially the response is: tough luck, find another mode of transportation. In theory, a confirmed ASR mission number is the same thing as a plane ticket; bird in hand so to speak. However, in practical application out here, anything goes. I ended up catching a C-130 in the morning instead. Of course, that meant spending the night on a cot on the flightline.....
Coming back was equally interesting. I apparently had not one, but two ASR mission numbers. So one of the helos was on the medical pad in Al Asad last night looking for me. They called Ramadi and told them I disappeared. I was on the flight line with all my gear manifested for another flight. This was despite the Army tactical commands at both Al Asad and Ramadi working together over a two day period to get me back. I travelled with two H-53 Helos loaded with Iraqi Army personnel deploying elsewhere in the Anbar Province.
This all brings me to the chlorine VBIED attack I missed Friday. The surgical team was in the middle of triaging and treating patients from a vehicle roll-over in the morning when the blast occurred. They said the blast was significant enough to shake the trauma bay, and they actually felt their clothes lift from the concussion. Within minutes, Bradleys, Strikers, and Humvees descended upon Charlie Medical with patients from every conceivable direction. The entire Army/Navy team worked over 14 hours straight to stabilize, treat, and transport the patients that lived. We were flying patients all over the theatre: Balad, Al Asad, Baghdad, ect. Reports vary, but Charlie Medical said 27 died, and over 40 were treated at our facility. Actual numbers (especially injured civilians) may be higher.
Chlorine VBIED attacks have become more commonplace (9 since January) in the Ramadi/Fallujia Sunni Triangle region. The first attack was January 28, also in Ramadi. The insurgents are reaching out in wider circles to spread panic among the general population. Chlorine is easily available and difficult to control. Although this is making sensational press, weaponizing chlorine is not especially effective. Generally, the heat will quickly neutralize chlorine vapor, and the vapor that survives the heat is not only a visible gas (greenish tint), but has a noxious smell. This makes it fairly easy to avoid, unlike some of the more deadly gases out there such as VX. Chlorine is also water-soluble and is easily irrigated. Having said that, some of the patients did require airway management related to the chlorine exposure. A large vapor level will liquefy alveoli (gas exchange pockets in the lungs) and can quickly cause death. As of now, we are working on ways to counter this threat in the future....and that's all I can say.
Posted by Carl at 7:22 AM
Tuesday, April 3, 2007
Via official channels, Ramadi is quiet. There have been significant crackdowns by the Iraqi Police over the past week, and daily critical incidents are down.
However, maybe there's more truth to my post about "Police gone wild" than I first thought. Monday is the day we lost the child. He was hit by the Iraqi Police. Tuesday, another civilian came in with significant trauma. He was also hit by Iraqi Police.
He came in obtunded with a GCS of 8-9. Anesthesia secured his airway, we gave mannitol (osmotic diuretic to decrease brain swelling), and hyperventilated him. I flew him to Balad within the hour. I knew this was going to be a rough flight when we started giving him doses of epinephrine before I left--not a good prognosticator. Anyway, I was able to get him safely to Balad via Blackhawk. I was so busy managing his blood pressure, heart rate, and end-tital CO2 that it felt like the flight was only about ten minutes. As soon as we touched down, I raced ahead to give report to the ED physician. They asked me where I was coming from, and I temporarily blanked and said "Al Asad". After a few odd looks, it dawned on me that I was disoriented from the flight, so I quipped "I don't know: Iraq!". Always looking to break the tension whenever I can.
Apparently there were significant explosions outside the base while I was flying. As we were coming back to Ramadi, I saw a few fires burning in the distance and a lot of IP vehicle activity...as of now I have no idea what happened. Heard when I got back that several detonations were felt.
If this pattern of running over civilians sustains, I'm going to suggest the IP's switch over to mopeds or something.....At least a gang of AK-47 wielding moped riders won't seem as threatening to the trauma team the next time the front gate "accidentally" forgets to clear weapons.
We also toured the Camp Ramadi fire department yesterday to find out what equipment and capabilities they have. Impressive.
After the brief, one of our anesthesia providers "Bob" asked with all seriousness "So, do all of the fire station vehicles have IED's?" You could have heard a gnat scratching itself as the firemen all looked at each other. One finally said "I sure as h... hope not!" Bob had meant to ask if the trucks all had automated external defibrillators (AED), not improvised explosive devices (IED). I can't do justice to how funny that was.....
Posted by Carl at 10:03 PM
Mark and Chad are the two flight/trauma nurses I have joined in Ramadi. We trained together in Camp Lejune before coming out, and I picked up the Ramadi mission hand in hand with them.
Mark has been running a blog also since arriving. I am linking his blog to mine today, so be sure to check him out. Great video of Ramadi trauma in action along with local sights.
Posted by Carl at 8:25 AM
Monday, April 2, 2007
Just want to introduce some fellow bloggers in-theatre with me. I don't know where they get the time to craft such fantastic sites or where they discovered decent internet access, but we are all lucky to have these talented sets of eyes and ears to the ground......please visit their links when you get a chance.
Also, I want to thank everyone who has been posting comments and leaving feedback. I don't have individual emails, so shoot me one when you get a chance. Otherwise here is a big collective Thanks for reading and sharing, and thank you for your support and prayers!!!!
Posted by Carl at 10:26 PM
This is the backside of the hospital, and is our casualty receiving area. The vehicles that come barreling down this alley are as varied as the patients. Everything from Bradleys and Strykers to Iraqi Coalition vehicles and MIA1 Abrahams.
Two days ago we added massive concrete barriers between the passageway and our receiving area. Don't you want to know why???
Here's a story you don't want to miss: I was standing in the trauma bay when we got a heads up that suspected insurgents were being brought after a firefight out in Ramadi. So the teams assembled quickly outside to receive the patients (modus operandi). So imagine the surprise when two Iraqi Police trucks whip around the corner bristling with AK-47's from truck beds, windows, ect. And one IP standing at the .50 Cal mount with all weapons fully loaded! HOLY SH.. was all I was thinking, if you want the truth. We know and work with the Iraqi Police fairly close at this point, but still: who really knows who the bad guys are? They could have vaporized most of the trauma team in seconds. The front gate failed to get them to actually clear all weapons before entering. Can someone say "dropped the ball". We immediately put in a priority construction request the next day.
Posted by Carl at 10:09 AM
Mild trauma trickled in all day. Head bumps here, superficial penetrating shrapnel there.....this evening after chow: devestating. Young Iraqi boy comes in after getting run over by a truck. His left thigh was torn in half, with muscle and connective tissue bulging out of a hasty field dressing. Serious head injuries we just didn't have time to evaluate. We tried in vain to get IV lines started on him, but no success. Breathing became slower as it crept towards agonal, and we just got an intra-osseous line as he crashed on us. Heroics kicked in, and we attempted cardiac massage, tried giving blood through the osseous lines, and resorted to intra-ventricular fluid/blood administration. He was anoxic for 10 minutes and we just couldn't stand to give up-reality caught up with us. It was all I could do to compose myself as I gently held his leg (I was running fluids/blood and medications at the foot of the bed) and lifted his innocent Spirit up to the good Lord..........Only His strength keeps me going; I know it isn't mine. Can't express how deeply hurt and vulnerable the team feels when we can't save a child...............
Posted by Carl at 9:59 AM
Sunday, April 1, 2007
Friday and Saturdays picture of our SWA Hut (southwest asia) progress. When the current team found out we were augmenting them, they had nowhere for us to live (we are currently "camping" in a small wooden hut; no furniture; beds that mysteriously collapse in the middle of the night). The hut is being build right behind the hospital so they can run and grab us in a hurry when trauma comes in. That's D squared and Eric standing inside for the picture... Needless to say, we can't wait to move in! Anyone have any gaudy lawn ornaments they are willing to donate to a good cause????
Side note: can I change my address one last time? This should be the right one:
LT Carl Goforth
C Co 3rd BSB
1 BCT 3 ID
APO, AE 09396
Posted by Carl at 3:02 AM
Posted by Carl at 2:35 AM