Desert Flier

The best thing about Iraq

2007-10-16T04:56:00.000-07:00

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?"

"NO!"

"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."

Nostos

2007-09-24T14:09:00.000-07:00

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.

Camp Virginia, Kuwait

2007-09-19T18:49:00.000-07:00

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.

Detonation

2007-09-13T21:48:00.000-07:00

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

2007-09-13T11:48:00.001-07:00

Visionary.
Loyalist.
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.
http://afp.google.com/article/ALeqM5jomov3JqgMOnLUQkIxK3sA1kuJWg
http://afp.google.com/article/ALeqM5iBCQfCAOUt2UMB5_vjfF3C8zQviQ

Anbar, meet the Ospreys

2007-09-07T21:50:00.000-07:00

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.
http://www.cnn.com/2007/US/04/13/osprey/index.html
http://www.defensetech.org/archives/003429.html
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.
http://www.fas.org/man/dod-101/sys/ac/v-22.htm
http://en.wikipedia.org/wiki/V-22_Osprey
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

2007-09-07T04:47:00.000-07:00

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.
http://afp.google.com/article/ALeqM5hrYME1TsN-AE9yT35fqRxarZtB4g

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.
http://acutepolitics.blogspot.com/
http://badgersforward.blogspot.com/
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.

BBQ with the Weekly Standard

2007-09-02T22:38:00.000-07:00

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:
http://www.weeklystandard.com/weblogs/TWSFP/2007/07/reporting_from_fob_falcon.asp
http://www.matt-sanchez.com/

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

2007-09-02T21:54:00.000-07:00

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.

2007-08-25T04:33:00.000-07:00

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

Fleet Marine Force Qualifications

2007-08-24T08:26:00.000-07:00

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

KBR and Team Blinky

2007-08-20T13:40:00.000-07:00

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.

Dilemma

2007-08-12T23:10:00.000-07:00

"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.

Incognito to 180-Out

2007-08-11T22:36:00.000-07:00

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.

Saddam's Place

2007-07-16T23:44:00.000-07:00

"So, where are you from?"

"Yes"

"Funny...Is Moose your real name?"

"Yes"

"Who do you guys really work for?"

"Yes"

"You ever say anything besides yes?"

"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.

Meet Knuckles

2007-07-14T02:33:00.000-07:00

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.

Should We Stay Or Should We Go Now...

2007-07-10T23:26:00.000-07:00

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:

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.

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.

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.

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

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.

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.

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:

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.
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.
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...

http://news.yahoo.com/s/ap/us_iraq;_ylt=AuvYUv2gOXIR0uA6c9rlH35X6GMA

(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.

http://www.nytimes.com/2007/07/10/world/middleeast/10iraq.html?hp

D squared has a birthday

2007-07-06T08:36:00.000-07:00

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...

The TQ Surgical Team

2007-07-05T01:49:00.000-07:00

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.

http://tqsurgical.blogspot.com/

VAJoe

2007-07-04T22:15:00.000-07:00

The link below is a collection of current milblogs out there, including short interviews and guest editorials:
http://www.vajoe.com/blog/2007/07/03/lt-go-of-desert-flier/

Independence Day

2007-07-04T10:46:00.000-07:00

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.

Apache rescue

2007-07-03T22:23:00.000-07:00

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:
http://www.strategypage.com/military_photos/200773212455.aspx
http://www.blackfive.net/main/2007/07/apache-pilots-r.html

http://

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.
http://www.chron.com/disp/story.mpl/world/4939405.html

One

2007-07-02T12:01:00.000-07:00

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?"

"Army."

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.

http://uk.news.yahoo.com/rtrs/20070703/tpl-uk-iraq-clash-43a8d4f.html

Anbar Waffle House opens for business

2007-06-26T02:31:00.000-07:00

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!

Slave to the System

2007-06-24T22:06:00.000-07:00

"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."

2007-06-11T23:01:00.001-07:00

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

Meet Suhad

2007-06-08T00:21:00.000-07:00

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..........

Operating in the Dark

2007-05-31T08:29:00.000-07:00

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.

Hearts and Minds

2007-05-31T07:37:00.000-07:00

Some of the top commanders and colonels in the area toured Charlie Medical yesterday. RH, our head surgeon and detachment commander, gave them a tour of the OR and our capabilities. While discussing area topics and patient care for the local populous and Iraqi Forces, the colonel had some genuinely positive encouragement regarding the care we are rendering in Ramadi.

As stated in previous posts about Doha, and her sister Gofran, they are the orphaned children of an influential local family. The colonel said, in no uncertain terms, that the care we are providing to civilians, naming these children specifically, has resulted in a calming effect on the city.
He is quoted as saying those surgical procedures have done more recently to stem the violence than 30 raids could ever do.
Bravo Zulu to Charlie Medical and the Surgical Team......

Darwinian Award

2007-05-27T21:07:00.001-07:00

Sitting in EVAC this afternoon. Jarhead just started 5 minutes ago on the Armed Forces Network, and I haven't seen it yet. Rolling past the opening credits, with a phalanx of trucks crossing the desert in a hazy mirage, Charlie Medical reverberates with a detonation. "Wait, that wasn't the TV." This one rattles the windows for about 4 seconds....big one.
We all look at each other and give out a collective sigh...and wait for the radio to start chattering. Within 30 seconds, we start getting some garbled messages, so we hold tight a little longer. Then the bad news cracks across the air waves loud and clear "VBIED".
I walk across the way to my hut to pick up stethescope, trauma shears, and a portable oxygen saturation reader. Others start hauling down our supply of litters as other medics start opening up the mass casualty supplies.
Within ten minutes, all of Charlie Medical is present and accounted for. Trauma bay gets a once over to make sure all monitors have cables, oxygen tanks are full and ready to go. We aren't waiting to hear if we are getting casualties......it's an assumption. The only question is how many and how bad is it going to be.
Sure enough, a patient rolls in with second degree burns over 60% of his body. But the soldiers that bring him say he was burned friday. Huh? Apparently, the patient was seen and released at Ramadi General, but obviously is in need of more extensive care. We are approached by the family, so we see what we can do for him. In the meantime, we are worried about the casualties that will be streaming in any second. Someone echoes what we are all thinking "what's going on here, we should be seeing casualties already?"
As we assess and start dressing the burn patient's wounds and hanging antibiotics, the first sergeant walks through from Tactical Command and tells the surgeon "No casualties from the VBIED".
We all have this incredulous "what the....?" look on our faces. Turns out the VBIED driver only managed to blow himself up. His incompetence has an end result of one death....his own. This is a first for me, and I'll take it as a sign the insurgents are scraping the bottom of the bad guy gene pool at this point.

The VBIED driver gets my nomination for Darwinian Award for the month of May.

Ramadi all-nighters

2007-05-23T21:57:00.000-07:00

1:06AM brings a loud rap on our door "11 in-bound. Mikes unknown".

Knocking the fuzz out of my head as we all stumble around the room putting our uniforms back on. Hopping around on one foot, I avoid a collision with D squared just as someone flips the lights on.

Feeling like I'm floating to the back of Charlie medical, I run down a mental checklist of how many patients, where we are going to triage them, and making little bets in my mind that this could be a long night.

15 minutes later, the TOC announces "Casualites are being diverted to Ramadi General". This is the local civilian hospital. They must be closer to the scene than we are, but are a little less cabable. We have been supporting them with supplies and keep in contact with them, but the back of my mind is telling me this is going to be more than they can handle.

Most of the staff drifting off. Trying to quickly re-capture what they missed of slumberland, and I don't blame them. A few, including myself, decide to stay awake for a while to see what develops.

1:36AM and I hear the tell-tale drone of armored track vehicles. Several of them. Eric says "well?" I'm throwing my stethescope back around my neck "This can only mean one thing. Lets get busy."

Two M-113's arrive filled with casualties. They bring along a full compliment of humvees and Strykers filled with heavily armored and weaponized soldiers "IED blast!" they say. "We thought Ramadi General was taking this one?" "Hey, just following orders. We don't know anything" they say as we immediately start unloading patients and begin triage. Two walking wounded hop out: this is an encouraging sign, even though their tuniks are splattered with blood. They are quickly ushered to the side, and a few medics start tending to some superficial wounds. Then we start hauling stretchers out.......here we go.

Eric and I take station two. Iraqi casualty is on his stomach and moaning something so incoherent even the interpreter has no idea what he's saying. His entire lower back is covered in a makeshift damage control bandage. Eric starts taking it off to assess what the heck it is, when unmentionables start spilling out. I tell him "Umm, you better put that back!" He agrees promptly, as I gather some sterile supplies to re-dress the gaping wound. I quickly re-pack his back, and five of us struggle to turn him over: we need a proper assessment, IV lines, and vital signs. On his stomach, I can't even tell if he's still breathing. We get him turned over, and I'm finding abnormalities all over......arms and legs aren't supposed to be jello in my hands. "X-ray! I need films as soon as you get a chance." Get an IV, Eric is assessing his airway. RH, our head surgeon, is looking over my shoulder "bring him back to the OR now. We have our first case." The X-ray tech is asking me what films we want. "chest, KUB, better get a pelvis, oh, and all estremities, too. Just get everything..." My patient is sliding downhill, so RH decides abdominal surgery needs to happen sooner rather than later so we can visualize and repair damage. We perform multiple bowel resections and Chad flies him to Al Asad as soon as possible. He was unstable for a bit, but does well for the flight.

This was the beginning of the end of our sleep. We get word of more incoming casualties during the first case: American unit hit by an IED next. At least one "urgent surgical". The lone OR is tied up with Iraqi Police, so we tell the Army Tactical Command to set up a landing zone to fly the American casualties to Taquaddum. A short flight, and it makes sense to tap into other Anbar medical resources. More Iraqi's pour in throughout the night: a GSW victim is in the trauma bay, so I break out of the OR to assess: our two surgeons are scrubbed in, and they need a discriminant eye to hover for a few minutes to see if he needs to be taken back to the OR. We already have another patient on standby and waiting to come back. GSW to the chest, and the Army PA (physician assistant) and our Independent Duty Corpsman are placing a chest tube on the affected side. They drain any blood and avert a hemothorax. Two PA's and I use an ultrasound to assess his heart, and the pericardial window is void of blood: fantastic sign. We are sending him to Ramadi General now that he is stabilized.......thankfully the bullet didn't hit anything major.

With no end in sight, we have another trauma case come in with more penetrating abdominal injuries just as we are finishing another case. The room is quickly sterilized to the best of our ability just as we roll the next patient in. He's in good shape, considering, and doesn't appear to be in too much pain. More bowel resections, and we finish our last patient for the night as the sun gently crests over the horizon signaling a new day in the Anbar Province. The surgical team cleans the OR for the last time tonight, washes up, and we meet behind Charlie Medical for breakfast to cap an exhausting night. The chow hall is a welcome site: eggs, gravy, biscuits, and fresh fruit. Bellies full, stamina depleted, we simultaneously collapse into bed ever ready to do it all over again.

Salvation Council's Tough Stance

2007-05-19T19:25:00.000-07:00

An interesting interview took place a few days ago in Baghdad with the head of the Anbar Salvation Council, Sheik Hamid al-Hais. He eludes to the surge in police recruits over the past few months in Anbar Province, and has some hard-hitting statements about our struggle with Al Qaeda in the area. We have the local and regional sheiks aligned with us, and the results are impressive and cannot be discounted. Critical daily incidents are down significantly in the area compared to a year ago, and the emergency response units we are guiding through training on-base are the reason. Loyal to their tribes, these men are patrolling their lands and protecting their own from Al-Quaeda's purposeful targeting of innocents and attempts at destabilization. Our success in Anbar is directly tied to theirs...

"We have our own tribal legal system and this is constant and cannot be changed. Murderers must be killed under tribal law and unless we use this force against terrorism, terrorism will continue to rise."
The Salvation Council is part of a movement called the Anbar Awakening run by Sheikh Abdulsattar Abu Risha, whose alliance of tribal leaders united against the threat posed to Anbar province by Al-Qaeda's militants.
Anbar's mainly Sunni population once largely supported attacks on US forces and Iraq's Shiite-led government.
Many, however, have become sickened by Al-Qaeda's attacks on civilians and tribal leaders and are angered by the insurgents' interference in the region's traditional ways of life.
Since October, sheikhs have funnelled thousands of tribal fighters into the police and "emergency response units", which now fight alongside US and government forces while retaining their loyalty to their sheikhs.

Hais, who despite his tough talk looks urbane and cosmopolitan in his smart business suit and neat moustache, says he can now field 15,000 armed fighters, most of them now nominally in the police but still under his orders.
How many of these were once in the resistance, fighting the Americans? "Fifty percent and maybe more," he said.
And why did they change sides? "Because of the behaviour of Al-Qaeda. Al-Qaeda did not distinguish between the innocent and the guilty. They killed the resistance, they killed sheikhs, they killed everyone," http://news.yahoo.com/s/afp/20070515/wl_mideast_afp/iraqunrestsecurity

Our search continues.....

2007-05-18T21:54:00.000-07:00

We still have abducted personnel in the area, and the efforts to find them persist day and night. Please keep these men and their loved ones in your thoughts and prayers......

U.S., Iraqi Units Continue Search for Missing SoldiersAmerican Forces Press Service
WASHINGTON, May 18, 2007 – Search efforts continue for three missing U.S. soldiers who are believed to have been abducted by al Qaeda on May 12 in Quarghuli Village, Iraq. Soldiers from the 2nd Brigade Combat Team, 10th Mountain Division (Light Infantry), from Fort Drum, N.Y., and the 4th Brigade, 6th Iraqi Army Division, have been conducting non-stop searches for the missing soldiers -- all assigned to the 4th Battalion, 31st Infantry Regiment, 2nd BCT -- since their abduction. http://www.defenselink.mil//news/newsarticle.aspx?id=46072

Week two, much progress

2007-05-18T00:55:00.000-07:00

"These guys are doing much better."

"Tight groups, good range discipline."

"They seem locked on compared to last week. I'm impressed."

Just some of the comments I heard as I spent another afternoon at the weapons range providing medical coverage for the special forces trainers and Iraqi Police SWAT recruits. This marks the second week of a three week course. There is a noticable difference right away: they arrive and assemble in formation. The Iraqi Police Captain pictured below is a dynamic presence this time. His authority is palpable as he barks out orders that are followed without hesitation. The Iraqi Police have great weapons presence now: no waving the muzzle around while loading. No need for well-timed ducking on my part. Movements are crisp and in unision to command, rounds on target, foreshadowing a force to be reckoned with.

Doha's older sister, Gofran

2007-05-15T06:47:00.000-07:00

"She just can't stop smiling! I think she's even happier than her sister." Someone says as we play around and socialize with Gofran, Doha's older sister. She has the sweetest smile and I can sense her warm disposition as she looks down with a sheepish grin and plays with the fuzz off her new pink bunny. We just can't help ourselves when the children come in, and I ran to my "stash" to bring her a few more toys.

Also injured in an insurgent attack in February, Gofran has a large chunk of shrapnel embedded in her right thigh. She of course commands all of the attention in Charlie Medical this morning.

Tim and I remove the shrapnel embedded between the fascia and her thigh muscle. D squared is in the background getting supplies while Eric and Katie provide light facemask anesthesia. The piece of shrapnel is one inch in diameter, and comes out with a two inch incision and some gentle tugging. The cavity itself looks good: no infection and no muscle or bone damage. After a brief postoperative recovery period, Gofran is on her way with her brother again with some instructions, extra supplies, and a follow-up appointment. She leaves us minus a hunk of shrapnel, but gains an armful of toys and many new friends.

2007-05-13T20:33:00.000-07:00

A short public affairs video about the medical and surgical teams at Camp Ramadi taking you through some VBIED attack footage.
http://www.youtube.com/watch?v=9RFL1Dut9Ok

Iraqi SWAT training

2007-05-09T08:08:00.000-07:00

"These guys are funny that way. Sometimes they act like 15 year olds in a 30 year body. "

"How do you mean?"

"Well, take for instance yesterday on the range. I was walking down the line looking at groupings and commenting 'tight group, or good job on that one' you know, that sort of thing." He says "And this one guy, see the one with the tan cammo t-shirt and cap? Anyway, he gets all defensive on me and basically says 'what about mine! Very nice, no? I am good shot!' So I had to make sure they all got complimented."

The Iraqi police recruit that felt left out was former Republican Guard, so he certainly has a reputation to protect. I somewhat empathize. I was talking to one of the special forces guys at the weapons range. Some medical personnel from the surgical team spent the afternoon providing medical coverage for the SF instructors as they took Iraqi police recruits through tactical weapons training.

As Ramadi continues to improve on security, it was felt that now is the time to give the police force extra training. The Ramadi police colonel was asked to go around the different substations and find his 'best' men to begin training for a possible Iraqi SWAT team. I spent the day out there with them as the trainers put them through the paces.

This afternoon was sort of a mixed bag: on one hand, I am witnessing the future of a Country. The success and our ability to eventually draw down our forces here hinges on their progress. And I saw some bright spots: a few with good range and weapon discipline. Of course, this is my own little microcosm of perspective. However, I also confess we have a ways to go. Waving your rifle around as you load a full magazine wasn't instilling any confidence, and I found myself creeping behind the Humvee at times. The penchant to shoot 'Rambo' style from the hip was eyebrow raising. They ended the afternoon shooting their U.S. Govt. issued Glock19s, some employing the SnoopDog 'wanksta' style of shooting, aka palm down. Although amusing, that got a few head shakes, too.

Also got an opportunity to shoot the AK-47 and a few other weapons in the special forces platoon. The rifle on the left is the M107. This is a .50 caliber long range scoped sniper rifle. The rifle on the right is a MK48 machine gun. Both were powerful weapons, but the M107 is the most powerful and largest rifle in the military's arsenal. Effective target range is 1400-2000 meters. Impressive. This weapon is said to have devastating 'target effect'; read: what it hits tends to disintegrate. It is also considered to be a 'target multiplier'; read: impact of the round destroys multiple targets that lie in close proximity. In other words, if you aim this at personnel, you wouldn't want to be the guy standing next to him either. Order of operations for the M107:

SF trainer sets the scope sight for an ammo can 500 yards away
He describes how to load, where the safety is, and how we have to keep our face at least 6" from the scope if we want to keep our nose intact; I break out of a heat coma as he immediately commands my full attention with that comment
Furthermore, we have to have our bodies lined directly behind the weapon to absorb the kick, and we don't want any skin or our face anywhere near the ejection port; people have lost their eyesight
I no longer want to go first, so I slowly creep behind Mark
Mark goes first, and not only survives but says "Holy blank, you gotta try this"
My turn: I load my round and begin to sight in the ammo can. I constantly remind myself that I have to breathe, too
I get sight alignment / sight picture and slowly squeeze the trigger wondering if I can still fly patients with a disarticulated shoulder
The first round goes off, and my world just went dark. I am aware of my surroundings again after a short 3 seconds
I fire three rounds total, stagger to my feet, and get a few chuckles as I stumble back with a sheepish grin from ear to ear
The ringing in my ears and the feeling like I'm talking in a tin can only lasts a few hours
Worth it.........

Deja Vu, Monsieur

2007-05-08T22:50:00.000-07:00

Sit down to dinner with Tim, D squared, and Eric. Chaplain is a few tables down and comes over with his radio: "Guess what guys? GSW to the chest 15 mikes out."
Five minutes later "chaps" is leaving "Sorry guys, but the patient just rolled up." Eric is up and gone in a flash. This seems to be the recurring chow routine. Still missing at least a sip of coffee before we check out. Tim and I collect the leftover trays and make our way.

Patient hits the trauma bay:
Entrance wound to his left chest, but no time to look for an exit wound yet. First up is starting some big IV's, a central line, and several Army personnel on the left placing a chest tube. Eric is at the head of the bed and gets the patient intubated. Chest tube in place, and we get an initial flood of blood: hemothorax. "Can we re-infuse it?" someone asks. "No, we don't have the autotransfuser connected. We will have to connect one as soon as we can" I say as the patient continues to slide downhill. "That's it, we need to open his chest." says Eric with a sense of urgency. Clammy patina and color is quicky turning ashen, the color of cold gravy. Our surgeon: "Grab the lines, grab the chest tube. We are going to the OR now." I'm somehow grabbing IV's, pulling off trauma bay monitors, and balancing the chest tube collection chamber while on the move.

Operating Room:
Anesthesia machine on, hot line powered up, barely controlled chaos as everyone flies around the room: grab sterile instrument sets, hang the fluids on pressure bags and crank up the fluid rates. Eric says "I want 4 units of packed blood cells now. Who is the runner, and I need you to move now" as the patient looks, well, blank. "Someone feel again for a pulse." No pulse, chest compressions started, our two surgeons throwing on sterile garb while simultaneously starting the thoracotomy. No time-every second is more precious than the last. Eric and I are pushing fluids and now blood as fast as our hands can move. Extra hands are recruited to help us pump blood and fluids even faster.

The temperature outside: 110. For the first time, the OR temp is climbing beyond comfort. We just have to turn the AC on for relief. V and D squared walk over to turn it on, and....nothing. We know the heat works-been using it for months. We know the fan works-been using it for a few weeks. We now know the AC units are down-both of them. In no time, everyone is drenched in sweat. On call for this flight, I'm stuck with the flight suit on. As soon as the patient is stabilized I will be working on a flight to Al Asad as quickly as possible. Suit is soaked before the case is over, and my night has just begun.

I have it easy compared to the guys scrubbed in. They are wearing sterile gowns/mask/gloves on top of uniforms. No chance to step out of the room for relief or to hydrate, they are on the verge of heat exhaustion after an hour. Eric becomes the official Gatorade representative.

Blood arrives. Eric and I both grab one along with blood tubing. "Just keep the blood coming, and we are activating the blood bank as of now. Make it happen". The Army moves lightening fast, the Big Voice is calling out basewide for donors, and we have life saving whole blood in what seems to be minutes. The whole blood is a huge score for the patient: we are now giving him warm oxygen-carrying hemoglobin along with replacing the clotting factors he is losing to his injuries. Martin resects the patient's left lung: the round went right through it. Arterial line placed and Martin finishes damage control and is satisfied he stopped all of the thorasic bleeding. He starts closing the chest back up and places two new chest tubes to drain any residual blood. Blood chemistry and hematocrit counts are almost perfect despite the significant losses of the patient's own volume. Another save.

Flight:
It's nightfall. Around 10 PM and the temperature is still 100 degrees.
So much for desert temperatures dropping precipitously at night. Yeah, I always heard that one too.
Patient does well. I'm giving blood in flight, groping for IV lines, changing out the oxygen tank, tweaking the ventilator settings to prevent high airway pressures, writing down vital signs and medications given on a piece of tape on my flight suit, and searching for the drug access port so I can give some sedation and paralytics.
We touch down on the medical helo pad, and I run ahead to give report to the accepting physician.
The Blackhawk is in no hurry to go back to Ramadi. It's their bird and my priority status was just relegated to "passenger". They go to the "dust off" and we sit there for 30 minutes before going to the fuel farm for more JP-5. The helo is blacked out, and the rotor spin drowns out any chance at hearing anything. The adrenaline rush is winding down now that I safely passed my patient off to the Army CSH, so I close my eyes and shut down mentally for a few moments.

Sensory deprived moments: Strapped into my jump seat sandwiched between the crew chief and flight medic as the turning rotors rock me into a rythmic trance after hours of trauma, surgery, and flying. The cabin feels like a miniature furnace late into the night. Smelling the requisite aroma of hot engine exhaust, hydraulic fluid, and a dozen other lubricants, propellents, ect. But this is a dedicated patient evacuation helicopter, so take the normal industrial smells and add a mixture of flight suits soaked in sweat, the patient, and the faint metallic smell of blood, old and fresh. A smell I will not soon forget........

Minor Setbacks

2007-05-07T08:20:00.000-07:00

Heading towards the chow hall for lunch, and we feel the tell-tale concussion of a detonation. "Sure hope that's a controlled det" quips D squared. If an engineering team or EOD team finds a roadside IED or weapons cache, they destroy it on the spot if possible. So hearing random detonations is a somewhat common occurence.
Fifteen minutes later, we are just about to sit down, and another faint shock wave is felt from inside the chow hall.

"You feel that one too?" Says D squared.

"It's gotta be controlled detonations."

"So close together? I don't think so, they aren't announcing anything" he says as the "big voice" remains silent about controlled det warnings. "Lets hurry up and try to finish our food. This might be another one of those days."

We sit down and quickly try to get through a tray of food. As a few minutes tick by, I suddenly feel the need to speed through my tuna wrap and macarroni salad. Other medical personnel nearby have radios, and they squawk to life after a few bites. Eric jumps up and heads to another medical table to clarify. Sure enough, the Army TOC starts sending out staccato messages of "inbound patients, I say again patients are inbound to Charlie Medical". Trays are hastily snatched up as we make our way next door to Charlie Medical. Little did we know those couple of bits of food were going to have to carry us through another afternoon of trauma patients. Never got a chance to take a sip of that coffee.
The "big voice" picks this moment to come to life: "clear all roads to Charlie Medical. I say again, clear all roads to Charlie Medical." The big voice chimes in all afternoon as waves of patients come in for treatment.

Despite today's setback, the intel we are receiving mirrors what is in the media: Ramadi and the Anbar Province are improving. Sunni leadership in Anbar have formed the Anbar Salvation Council (ASC), and are working with U.S. leadership. The ASC is officially opposed to al-Qaeda, and is working towards stabilization of the region. Sheik Fassal Al-Giood of the ASC states "al-Qaeda has not stopped attacking Anbar. Today's incident is a reaction to our work."
As stated in a previous post, Doha gets a second chance, Ramadi has seen a surge of new police recruits and officers. Much of the raw infusion of new officers is due to the ASC leadership supporting regional stability and sending their tribesmen to the recruiting stations to become officers.
After all is said and done, Charlie Medical treats 15 blast casualties. The critical are flown with an En-Route Care RN to Al Asad. An update from a good friend at the Army CSH at Al Asad said one of the patients remained in critical condition this evening, and will require intubation and a ventilator at least overnight.
http://news.bbc.co.uk/2/hi/middle_east/6631663.stm
The last two photos were taken off the AP wire.

Milblog Documentary

2007-05-06T09:11:00.000-07:00

A link to a documentary produced last year featuring some of the most prominent 'milbloggers' at that time. Most are still active in the community, and continue to inform.
After watching, I came away agreeing with the comments they were making "it started as a fluke", "I thought it would be a better way to inform family and friends", "once I started getting emails and feedback, I felt I now had a responsibility to everyone". I echo those sentiments, and feel this is one of the few ways to "humanize" the war, to lend a voice that would otherwise never be heard.
The title is Talking to Somebody without Talking to Anybody. I have a slightly different take: When I sit down to write an entry, I feel as if I am reaching out to talk to Everybody. Just my interpretation.

Side note: YouTube has portions of the Milblog Conference recently posted in the past two days.

Remembering Sgt. Mike Stokley

2007-05-06T09:03:00.000-07:00

Sgt Mike Stokley, son and husband, is remembered by his father, Robert, at the 2007 Milblog Conference in Washington D.C. A message about the price we pay, and who pays it.....

2007-05-06T03:56:00.000-07:00

A great article about En-Route Care Nursing by the Marine Corps. News. Features a few colleagues "roughing it" at Taquaddum (not that I'm complaining). We went through training at Camp Lejune, including water survival and flight training, and now cross the desert together keeping patients stable while racing them to higher levels of care.
http://www.usmc.mil/marinelink/mcn2000.nsf/main5/92253599E321409A852572C200170567?opendocument

Doha gets a second chance

2007-05-06T02:47:00.000-07:00

"Well, I say we just keep her. She can stay in the barracks with us."

"She is so cute, I would just love to adopt her as my own. Is it ok if we just 'claim' her as ours?"

Just a few of the comments I hear as I wade through medics and corpsman on my way to see Doha. She's the MVP of Charlie Medical this morning and is coming in to get pins extracted from her femur. A few days ago, Tim removed the rod that connected the two parts of her leg together when it was broken during a VBIED attack. This morning, we remove the last of the hardware as the most recent radiograph films show excellent healing.

She lost her father in the attack. He was no ordinary Ramadi citizen, but one of the more influential leaders of this emerging province. His deep commitment to the safety and well-being of Ramadi directly resulted in a phenomenal push for Iraqi Police recruits. This one man takes most of the credit for the robust police force we now have in Ramadi and the surrounding areas of Habbaniya and Khalidiyah. His legacy of faith and passion for his Country still reverberate in this area, as his death resulted in another wave of new recruits that showed up for training after the attack.

We remain encouraged by the positive reports we are receiving about life in the surrounding areas. New markets and restaurants are opening every week, and although Doha was orphaned and her life forever changed on that day, lets hope that a renewed Ramadi and Anbar Province will give her the life she deserves: a life without fear or repression; a life filled with opportunity to take her second chance and do great things.......

2007-05-06T02:39:00.000-07:00

Had a great conversation with Badgers Forward today at lunch. He's responsible for keeping our convoy and patrol routes clear of IED's. Badgers Forward runs an insightful blog about life in the Sunni Triangle and his responsibilities as he spends time on the road between Ar Ramadi and Fallujah.
http://badgersforward.blogspot.com/

2007-05-02T21:03:00.000-07:00

This week in Washington is the annual "milblogger" conference. By coincidence, the Army has recently published a 79 page regulation directed at Army milbloggers stating mandatory registration of all blogs by Army personnel and personal email scrutiny.
Blogs have become a powerful tool for the ranks and continue to attract a lot of attention from leadership both in Washington and in the field. The concern is that authors are not educated about or aware of operational security, and are giving away valuable information via their entries.
Is it just me, or do I have more at stake to ensure I don't give out operational details more than anyone else? I know the vast majority of milbloggers are acutely aware of this paradox and potential risk, and we carefully scrub any information that could lead to information gathering.
One of the first thing on my plate upon arriving in-theatre was to notify my command that I was going to operate a blog while deployed. After some initial questioning and general flak, I was given the nod and was warned to protect confidentiality, privacy, and above all OPSEC. I also happen to know that Central Command has reviewed my blog along with our public affairs officer. I can't say I felt "embraced" by leadership, but at least they felt comfortable enough to allow me to lend my voice. If one phrase described their attitude, it would be "vague tolerance".
My fear: there may be a general crackdown on milblogging without any real evidence to support operational risk management. My opinion: without us, you will never get the stories from the "trenches" so to speak. These are the stories the media either never hears about, or refuses to publish.
Freedom of speech is the concept of the inherent human right to voice one's opinion publicly without fear of censorship or punishment. Please do your part and support all of the milbloggers out there who play by the rules, and breath life into the daily struggle.

"Once milblogs are outlawed, only outlaws will have milblogs-you can quote me on that" Greyhawk, publisher of the Mudville Gazette

http://blog.wired.com/defense/2007/05/the_army_has_is.html
http://blog.wired.com/defense/2007/05/white_house_wei.html
http://time-blog.com/swampland/2007/05/let_slip_the_blogs_of_war.html
http://www.blackfive.net/main/2007/05/new_opsec_regul.html
http://www.defensetech.org/archives/003467.html

Ortho/Trauma Team

2007-05-01T00:46:00.000-07:00

Ready, willing, and able. You call, we answer.

Some days, more than others, we just want to come home...

2007-04-27T20:21:00.000-07:00

http://www.youtube.com/v/ervaMPt4Ha0

Day Flight

2007-04-26T23:30:00.001-07:00

Flew my first day mission a few days ago. Iraqi Police came in with a gunshot wound to his abdomen. After three hours in the OR, we had to remove his spleen and part of his pancrease. There was shrapnel lodged near his vertebra, but we were able to safely remove it without causing any neurological compromise. He ended up losing a lot of blood before and during the case, and we couldn't wait until nightfall to fly him to Al Asad.

D squared, Eric, and Mark helped me package him up for the flight. Then I drop the "nine line" with the evacuation team and we wait for aeromedical evacuation support. If it happens to be a day flight, the Marine Corps takes responsibility and will usually send an H-46 Sea Knight. At night, the Army responds with a Blackhawk that is specially outfitted with an "H carousel" for medical evacuation.

Sure enough, as the little black dots race into our helo pad, a Sea Knight touches down so I can fly my patient to Al Asad. As an escort, a Cobra Gunship touches down next to us.

The patient was stable for the flight. He isn't out of the woods, so to speak, but we have a good feeling he will do well. The Army 399th CSH at Al Asad is an impressive facility with dedicated staff and deep resources.

The Iraqi landscape is beautiful, and I was thinking about how I finally got the opportunity to see it in daylight. Too bad my camera batteries died on the helo pad right before takeoff. The photo ops would have been excellent on my return flight, since my only responsibility would have been to sight see.

The desert from 2000 feet in the air looked like a scene from the movie Dune. Every conceivable shade of tan, with burnt orange streaks running through numerous steppes and crevasses as if it were trying to carve out its own existence. We stick to the decidedly unpopulated routes for obvious reasons, but can't completely avoid small villages and outposts. I saw a few bombed out abandoned homesteads, but also saw a few outposts along a major highway that were thriving with activity and trucking. Most of the architecture is simple: concrete block or other hardened material. Others, however, were quite striking: they looked inspired by the Georgian Revival style. Two story with a large oval overhang from the front supported by 4-6 colonnades with a grand porch mirroring the overhang.

Cobra gunship flying as our wingman. He's to the right and just aft (behind), occasionally veering off to evaluate potential threats. The sun is positioned perfectly, and I can see both of our shadows silhouetted on the desert floor as we race along to Asad.

Another interesting sight was an abandoned train station. The station itself was completely intact, having escaped damage from the war. But the access road from the main highway had craters from rockets that perfectly prevented a vehicle from passing from the road to the station. I was thinking about how it was going to be cheaper and easier to repair the road compared rebuilding the station......I'll take the little victories along with any big ones that come our way, too.

VBIED's rock Ramadi

2007-04-23T09:59:00.000-07:00

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.....

Soldier's Angels

2007-04-21T01:44:00.000-07:00

The Soldiers' Angels was started by a self-described ordinary mother of an ordinary young man turned hero, Sgt. Brandon Varn. Brandon was deployed in Iraq and has since honorably completed his mission and has returned back to his proud and loving family.
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.

"I was with that which others did not want to be, I went to where others feared to go, and did what others failed to do. I asked nothing of those who gave nothing, and reluctantly accepted the thought of eternal loneliness that I feel. I have seen the face of terror, felt the stinging cold of fear, And enjoyed the sweet taste of a moments love. I have cried pain and hope, But most of all I have lived times others would say were best forgotten. At least some day I'll be able to say, That I was proud what I was, A Soldier." ~anonymous

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......
http://www.soldiersangels.com/

Dedication...

2007-04-18T02:27:00.000-07:00

"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.

I help load him into the ambulance for Mark, and turn to run ahead to the helo pad. As I turn, I come to a screeching halt again for the second time tonight. His entire unit is lined up and at attention along the route to the helo pad. As the ambulance slowly pulls out, they render colors to their wounded brother. I was so proud of them all; they would see one of their own through anything........the air heavy and charged with emotion, I find myself stumbling because this time it's my turn to be blinded by tears as I try to make it to the landing area before the ambulance.
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.

Now we wait for the updates and pray that he will continue to have a good life with his new bride beyond this violent collision of reality. Who deserves it more than this man?

2007-04-14T21:39:00.000-07:00

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.

2007-04-13T19:53:00.000-07:00

My posts on Iraqi Police "gone wild" was just listed on Military.com's Featured Blog via The Sandbox.
Humbled at the recognition...........

http://www.military.com/blog/featured

2007-04-13T19:29:00.000-07:00

"Hey, this isn't Camp Wannabe. There's no kite flying here!" I quip as D squared and I walk behind the Alamo to investigate mysterious kite flying activity.
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
http://www.psywarrior.com/psyhist.html

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.

A night on the perimeter

2007-04-13T19:23:00.000-07:00

As a deep crimson sun gently sets over the land of the fertile crescent, a small front moves in. With it comes a blanket of sand and dust.....and movement beyond the perimeter. Our perimeter guards spot activity near the flightline, and Paladin tanks begin yet another intricate dance with the enemy. Illumination flares are launched into the night sky. With the night air inflated with sand and dust, the flares look like miniature orange orbs floating across a backdrop of concertina wire, radar dishes, and perimeter outposts. With continuous volleys of light, unknown shadows slink back into the darkness.......

Garry Trudeau's MilBlog: The Sandbox

2007-04-13T02:23:00.000-07:00

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.

Blog Intro:
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:
http://gocomics.typepad.com/the_sandbox/

Another child hit

2007-04-11T03:46:00.000-07:00

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.

Chlorine VBIED attack in Ramadi

2007-04-09T07:22:00.000-07:00

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.

http://seattlepi.nwsource.com/national/1107AP_Iraq_Chlorine_Gas_Glance.html
http://www.allheadlinenews.com/articles/7006973707

Do all the firetrucks have IED's?

2007-04-03T22:03:00.000-07:00

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.....

2007-04-03T08:25:00.000-07:00

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.

http://mgreeniniraq.blogspot.com

Fellow Bloggers

2007-04-02T22:26:00.000-07:00

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.

http://www.mudvillegazette.com/
http://acutepolitics.blogspot.com/

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!!!!

Iraqi Police gone wild

2007-04-02T10:09:00.000-07:00

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.

2007-04-02T09:59:00.000-07:00

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...............

Our own little slice of heaven in the middle of U Know What

2007-04-01T03:02:00.000-07:00

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
Camp Ramadi
APO, AE 09396

The cost of a decent meal

2007-04-01T02:57:00.000-07:00

The cost of every meal in Ramadi: fill your two sandbags. The memories and character-building: priceless....

Here's a great way to cure adolescent obesity in the U.S. I bet this would keep the kids out of fast food restaurants!

Friendships where you least expect them....

2007-04-01T02:35:00.000-07:00

Wanted to take a little time to introduce two great friends I met at Al Asad. Kathy is standing behind the exhaust of a burnt out MIG. She lives in Oregon and is an Army reservist attached to a unit from the NorthEast. She is an OR nurse, and was instrumental in getting the Army's Level III hospital up to speed. Kathy introduced me to vanilla chai lattes, and I showed her some of Al Asad's "don't miss" sites (e.g. Abraham's Oasis, anti-aircraft outpost, the hospital's lost dungeons). We had an absolute blast the last few weeks I was there.

Cameo is the pool/swim instructor at the Al Asad indoor pool. She is retired Army and also has a son stationed in Kuwait. If it wasn't for Cameo, I would have never timed myself for a half-mile swim (21:19 thank you very much), or learned the butterfly stroke (still learning....) She wanted me to thank everyone who sent swim goggles---it was a huge help!!!!

To meet these two special women out here was beyond what I expected. They provided a lighter touch of humanity to what is otherwise a desolate and sometimes inhospitable place. They both have the biggest hearts, care deeply for others, and it shows in all they do. I am blessed to have found such special relationships where I never would have expected.....thank you both!!!!

Not your Grandpa's RV...

2007-03-31T13:01:00.000-07:00

Check this thing out! We use this armor-plated bus to transport personnel to/from some of the small forward bases near Camp Ramadi. Solid armor plating thoughout (hitting the side is like trying to punch a concrete wall--experience speaking here). Impervious to small arms fire and RPGs, this is travelling in style. Heck, every seat has a weapons port for shooting on the go. All passengers get to join in!
The KBR contractor is kindly pointing out the bullet dents. This thing laughs at small arms fire!
My initial question when looking at this thing is this: who decided not to protect the wheels???? Sure, the bad guys can't penetrate the body, but the wheels seem a little vulnerable to me. The thing would be a sitting duck.
Well, that's my two cents worth.

IED plants

2007-03-30T09:29:00.000-07:00

Today, more of the same. Insurgents were caught red-handed planting IED's. The Iraqi Army shot through the vehicle, and brought the casualties to us. We couldn't believe our eyes when one of the insurgents was a 12 year old boy. He sustained a serious GSW to his left foot, and we took him back to the OR for a washout and evaluation. He lost his pedal pulse, but still had posterior tibialis circulation. A good portion of his foot was tore apart---and reconstuction is beyond our capacity. So we placed a cast after the washout, and he will go to the Level III detainee hospital this evening.....the question that begs to be asked is: Why is a child placing IED's!!!!! We will never know his individual story, but the possibilities are both varied and frustrating. Was he coerced by family or friends? Is this something he believes is right? Is he in it to get paid? We are just lucky to catch him before his actions take the lives of those who patrol to keep him and us safe......
Another insurgent had massive thoracic trauma----chest tube placement quickly became a trauma bay thoracotomy with open heart massage----no good, he passed. May whatever God he worships have mercy on his soul.....

Jim Spiri with NPR

2007-03-30T06:38:00.000-07:00

"Umm, do you think there's another range nearby that we don't know about?" D-squared said as we share an incredulous look. "Do you hear where that's coming from? Nah, I don't think there 'just so happens to be another shooting range across the river in town'" I said back. We were sitting outside our primitive wooden hut the second day in Ramadi talking about life's deeper issues and pontificating our future, when an eruption of gunfire crackled about a mile away intermixed with the rude outbursts of machinegun fire. That's what makes life so strange out here......Camp Ramadi (where we now live) is itself a veritable fortress only vulnerable to IDF (indirect fire; usually mortars or RPG; no worries.....they have bad aim), but the city lies a short distance away, across the Euphrates River. We can see the famed glass factory (explosion last year caused a 70+ mass casualty) and plentiful housing/businesses from the temporary huts. We can sit outside on a lazy, sunny afternoon and a whole different world is occuring just a few short steps away......mostly what we see day-in and day-out is the aftermath of Ramadi's insurgent encounters. No worries----haven't felt any stray rounds whiz our way yet.

Turns out there was a major joint operation planned a few clicks away from the base entrance between the Iraqi Police and Marines. They are working hard to secure Ramadi "sector by sector". Yesterday's sector was especially close. An Iraqi Police Colonel in charge of Ramadi's 800 IP commanded the operation.
A positive note must be mentioned: there has been a recent fundamental shift in attitude by the local sheiks. They have shown geniune interest in what we are trying to accomplish, and have been given permission to allow their private militias to participate in cleaning up the city of insurgents---time will unveil whether this new change will be effective. The question that always beckons is this: Who do we trust, and where do their true interests lie?

Last night, I just so happened to meet Jim Spiri, a freelance photojournalist with NPR. He was the only journalist covering the operation, and needed some help transferring his digital recorder files to a jumpdrive. I was in the right place at the right time with my laptop, and we spent the evening talking about Ramadi and the region in general. He was a fantastically interesting man with quite the life story, and also shared all of the pictures he took over the past two days including convoying in from Taquaduum, securing parts of Ramadi, a Ramadi city council meeting, buying and giving away fresh fruits and foods to local needy from the Souk (shopping area), and following the Camp Ramadi Civil Affairs personnel on "winning hearts and minds" details throughout the immediate area surrounding Ramadi.

Ar Ramadi

2007-03-28T07:40:00.000-07:00

Flew to Ar Ramadi last night via CH-53 with everything I own. The flight was uneventful (perfect), and we got settled into some temporary barracks around 2 AM.
We are supplementing a small trauma surgery unit that has been here almost a month. They consist of a surgeon, two other en-route care/trauma nurses, anesthesiologist, and two OR techs. With our orthopeadic team, we add an orthopeadic surgeon, OR nurse (D squared), anesthesiologist, and myself. The team here is small and works well together, and they are happy to get the assistance. We are working with 3 ID 3rd BSB Army medical.
Well, not a lot of time of course. Much more to follow soon!

Address:
LT Carl Goforth
CLB-6 (surgical)
Unit 73871
FPO, AE 09509-3871

Desert Flier....

Ar-Ramadi bound!

2007-03-25T19:01:00.000-07:00

Well, I knew I wasn't going to be without a job for long. Actually, we found ourselves gainfully employed the past week cleaning the old hospital and packing up the entire contents. Right down to the last lap sponge!
We used the existing airbase hospital for our operations (the Army built a brand new freestanding modular hospital 50 yards away), and in the basement (affectionately known as the dungeon) are a long series of interconnecting tunnels and secret passageways.....the side entrance is sealed off, but if it was open, I would be able to travel to different parts of the base without ever stepping foot on ground. We were using some of the old entrances for storerooms for our hospital supplies--and we found storerooms we didn't even know we had! When we did turnover with the previous group, apparently they forgot to tell us about all of the supply spaces--and we had to count and account for every piece of medical equipment and/or consumable in our possession! So to make a long story a little shorter, we spent a solid five days accounting for everything we had, hauling every bit of it out of the dungeon to be packed into an endless sea of crates and pallets to be shipped off to another base for future use. No need to go to the gym to find a workout.
Saturday, we squeezed in an Officer vs. Enlisted softball tournament. There was a lot of creative trash talking before the games (we each had two teams) and apparently some bets were made--the losers get their heads shaved by the winners. The officers now are sporting temporary chromedomes--perfect for the desert heat! I have a lot of new pictures to post, and hope to get them on Picasa ASAP.

Tomorrow I fly to Ramadi with a small orthopeadic/trauma "package" consisting of an Ortho physician, OR nurse, OR tech, and myself. We plan to stay in Ramadi for the remainder of the deployment--Ramadi is 1) Urban 2) A direct route from Syria to Baghdad and 3) Busy--we are being told that we are badly needed. I pray the good Lord will continue to guide my hands and feet--there's a lot more work to be done....

New address:
LT Carl Goforth
C Co. 3rd BSB
Camp Ramadi
APO, AE 09396

Many thanks to all those who have sent cards and care packages. And thank you still to those who sent goggles to the swimming pool here at Al Asad. Your acts of kindness touch many that you will never know, yet are actively struggling day and night to protect and fight for what we all believe in......
Signing off until Ar-Ramadi!

Northwest Herald Article

2007-03-18T21:06:00.000-07:00

Many things happening right now:

The Army is having their ribbon cutting ceremony this morning. At noon, they are opening their doors for business. So we are close to having Level III medical capability in Anbar Province.

Our shock/trauma team threw a huge BBQ party last night with the Army staff to celebrate the transition and how well we have been working together. Trust me when I say that getting over inter-service rivalries is not an easy thing to do....it's all about building community.....

There is an article in the Chicagoland Northwest Herald about my father, Carroll, and how he keeps up with my experiences through the blog. I will try to post a link either in this entry or added to my links on the sidebar.

All this, and we still manage to run our shock/trauma unit waiting for the Army to open. We currently have several Iraqi patients that still need treatment and care from IED blast wounds. Our focus continues to be on care rendered "par excellence" despite all the day to day distractors.

Military medicine in the face of mounting casualties

2007-03-15T16:05:00.000-07:00

Walter Reed staff still strong:
With all of the scandal and drama going on at Walter Reed Army Medical Center, it seems to me that many people may forget the soldiers who work there. I was stationed at WRAMC for almost four years and, while I never worked in the main hospital, I got to know many soldiers who did. It has to be difficult for them to rise above all the controversy, but I know they are doing so.
The problems at Walter Reed are not new. However, the problems are not with the wonderful doctors, nurses and enlisted soldiers who get up every morning (or night) to care for our wounded warriors. It’s easy for the American public and even other servicemembers to write off military health care as the worst on Earth, and these stories about WRAMC make it even easier. But I feel obligated to point out that a hospital is much more than a building.
It’s more about people helping people. This concept was demonstrated to great effect by Patch Adams. And, while the facilities at Walter Reed may be run down, the medical staff there certainly is not. That is why they call Walter Reed the premier medical treatment facility in the Department of Defense. Keep up the good work, guys.
Sgt. Benjamin T. Shutt
Camp Hovey, South Korea

Of note: Walter Reed is on the BRAC list for closure. I wonder how much was actually the commanding officer's negligence compared to a general lack of funding. Other than projects that are already ongoing at the time, once a base is slated for closure, that usually means no new contracts for maintenance and/or upgrades. As a military nurse that has worked in a variety of conditions while deployed, I know firsthand what it takes to do more with less.....and I am certain that the staff at Walter Reed have been doing an outstanding job considering the odds stacked against them: eroding facilities, mounting casualties from the war, and staffing shortages from deployments.
Since the start of the war, 7,005 patients wounded in combat have required medical air transport back to Germany or the U.S. The total number of patients requiring transport back to the U.S. since 2003 is 32,544. The figures aren't staggering compared to WWII, but are high enough to be impressive and put a heavy strain on a system that is designed for peacetime patient volumes. After three years of war, we find ourselves all a little surprised at how little progress we have made (think: backwards). The staff at Walter Reed is caught in the middle, and I'm sure it breaks their heart to see their facility dragged thru the mud endlessly over an issue that is beyond their control.

You have enemies? Good. That means you've stood up for something, sometime in your life. Winston Churchill

A hillbilly's letter to Stars and Stripes

2007-03-15T15:57:00.000-07:00

A plea to Iraqis
I am an ordinary American citizen known as a hillbilly, not a redneck. There is a difference: A redneck wears his grandma’s Thanksgiving silver platter as a belt buckle and a hillbilly uses his Grandma’s fine imitation crystal glasses, aka Mason jars, for multiple purposes.
I have been in Iraq for 15 months, and I have flown home a couple of times.
[To the] Iraqis: The view of your land from above is beautiful, left me speechless. Then all of that beauty I was seeing is erased by the stories I have read of all the blood that has covered your land. Whether you are Sunnis, Shiites or Kurds, if you could board a plane and see the beauty of your country from above, I believe you would try harder to come together as a nation. I have been told the Sunnis and Shiites have been at war for thousands of years. It would seem, probably easier said than done, that those differences could be set aside in order for your elected government to get your country on its own.
If you keep killing each other at the rate you are, the only Iraqis who are going to be left are the ones living in other countries.
If I were an Iranian or Syrian military adviser, I would be home relaxing, just waiting for a call to let me know “It’s time to move into Iraq, the Iraqis have successfully killed each other off.”
Doesn’t being an Iraqi mean anything to you, or is being a Sunni or Shiite more important than being an Iraqi and having your own country?
Please attempt to make me understand what appears to be your country’s demise.

David H. Thompson Jr.
Camp Anaconda, Iraq

Other than a few technical errors (Islam is only 1400 years old), David isn't too far from the truth....talking to the Iraqis that work on base quickly reveals their frustration with the different sects in Iraq turning against each other. Sunni Muslims used to be in power (Saddam was Sunni), but are the Country's minority. Shiites now have power in the Iraqi government, but it seems the balance of power between the different groups of Muslims in Iraq is something they just can't overcome.....at least not anytime soon.

Army's newest Level III Hospital

2007-03-15T11:38:00.000-07:00

Associated Press: The opening ceremony of a new military hospital operated by the 399th Combat Support Hospital (CSH) will take place at 10 a.m., Monday, March 19, 2007, in Al Asad.
This hospital is the first military hospital to be built in the Al Anbar Province. Previous military hospital buildings in that region pre-existed. It will be the primary medical support hospital for the Marine Expeditionary Force, Coalition and Iraqi Forces, including the Iraqi Police, in the Al Anbar province.
The 399th CSH reports directly to TF3 MEDCOM commanded by Maj. Gen. Ronald D. Silverman. TF3 MEDCOM is composed of more than 30 medical units and around 3,000 Soldiers. It is responsible for all medical care for service members throughout the Iraqi theater of operations. TF3 MEDCOM capabilities include combat support hospitals and includes an Air Force theater hospital, multifunctional medical battalions, pathology, dental, combat stress, veterinarian medicine and preventative medicine. TF3 MEDCOM headquarters is based out of Forest Park, Ga.
Forty percent of U.S. casualties come from the Al Anbar Province. The primary benefit of having this hospital in the Al Anbar province is that it will reduce the amount of time before Marines, Coalition and Iraqi Armed Forces receive level III (Surgical and Stabilization) medical care in the region.
The Al Asad hospital will also feature a women's clinic, outpatient specialty clinics, primary sick call, community health, mental health, occupational therapy/physical therapy and ancillary services such as lab, blood bank, X-ray/CT scan and nutritional care.
Other important special care that the hospital will provide include critical nursing care, intermediate care, emergency medicine, trauma surgery, orthopedic surgery, family practice, internal medicine, OB/GYN, pediatrics, psychology, radiology, pulmonology, cardiology, general surgery, vascular surgery, hand surgery, oral/maxo-facial surgery, anesthesia, nutrition and outpatient follow-up care.
The 399th CSH is an Army Reserve unit with its headquarters in Taunton, Mass., and commanded by Col. Bryan Kelly. The top enlisted Soldier in the unit is Command Sgt. Maj. Mitchell Delvalle. The unit is currently staffed with Soldiers from 39 different states and is a multi-composition unit of both Active and Reserve Soldiers. The 399th CSH operates two hospitals; the other being in Tikrit, Iraq

The above article came out today about the Army's 399th Combat Support Hospital. They are opening up on Monday. 40% of Iraq's casualties come from the Arbar Province? I didn't even know that! I think I just discovered my lack of sleep problem....

Thanks to all who quickly offered to send swim goggles. It will go to a very good use. Response has been great, and I think around 15-20 pairs will be shipped. Here is the address to send them:
Cameo Lawrence
KBR Site B-1
Unit 73348
FPO, AE 09333-3348

Blast injury update

2007-03-13T14:16:00.000-07:00

The lone surviving child from the IED blast last week came back thru our hospital yesterday. He and his father stopped thru from Balad Hospital back to his hometown, Haditha. His entire back and multiple posterior neck/head wounds are stapled. All are healing nicely. He may not have any physical scars after all is said and done with; lets pray the emotional scars are light and quickly adjusted to.
We also had more patients yesterday after an IED blast. One had to be flown to a Level III hospital after an ex-lap and bilateral tib/fib ex-fix. The rest were discharged back to their unit after overnight observation. We have started flying the Army flight nurses with us so they can see the different facilities we can MEDVAC to. Guess it's another sign that the "changing of the guard" will take place soon. Gee, and I just got here....
Other than that, I toured the Army's new Level III hospital today. They still have much preparation left to do. But the facility itself looks great: 12 bed fully capable ICU, and a 20 acute care ward. They plan to have 2 CT scanners (they have one right now, but it needs parts...a lot of parts). Looks like I get to stay a few weeks longer, but still going day to day with a big question mark over my head.

One small request: Would anyone be willing to send out swim goggles? The pool staff here have been incredible, and they are providing a much needed respite to all those at Al Asad. However, they are down to two pair of swim goggles, and are in desperate need of more.

God's deeper understanding

2007-03-11T08:21:00.000-07:00

As I strive to understand the deeper nature of Islam, I will continue to post entries in this vein. I have the priveledged opportunity to have conversations with the Iraqi staff here at the hospital.
Our interpreter is from Baghdad, has a cool alias (Mr. Allen), and plays a crucial role in our ability to communicate with the Iraqi nationals that come thru our doors. He has a deep love and passion for his Country--and his heart is set on a peaceful Iraq. I have gained a much deeper appreciation and affection for the Iraqi people since arriving and going to work. There's nothing like first hand experience to add to wisdom and gain true perspective.
Other than Mecca and Medina, Baghdad has been the cultural center of Islam for most of it's history. The Caliphate (spiritual heart of Islam) was located in Baghdad for over half a millenium. I can attest to the fact that Mr. Allen is torn by what is happening in his Country; he has a family and future generations that hang in the balance....
Vanessa, a great friend from my Marine Corps. days, helped me gain some perspective into God's workings both in Iraq and the world. I'm pasting her email in reference to a book she read about Islam in the past year:
"It's by Christian authors and they gave the history of Islam, ET., one thing I remember them saying quite vividly is that Mohammad prophesied that they would conquer the world, religiously speaking,--and--they are behind schedule at this point and desperate to bring that prophesy to fruition! Thus, the brutal non-stop violence. Thankfully, God in His wisdom has them fight amongst themselves as this slows their progress, sort of like the building of the Tower of Babel! Because they are divided into Shiites/Sunni's and other splinter groups that can't agree with one another, their hampered somewhat in that quest of conquering the world."

Thanks Nessa for keeping me in God's perspective!

2007-03-09T21:05:00.000-08:00

Past few days-quiet. A welcome reprieve from the storm.

I've been spending my downtime reading The Crisis of Islam by Bernard Lewis. He mentions some interesting facts about Bid Laden's comments before 9/11. Muslims are, for the most part, acutely aware of their history more than Americans (this is a vague generality, of course). They rarely identify themselves by geographical location as we do, instead refering to geneology.
I mention this, because Osama Bin Laden declared a call to Jihad based on "what has taken place over 80 years ago." Asking any American at that time what the reference was would have resulted in an inability to answer. But Muslims are very aware of the events early in the 20th century: The downfall of the Ottoman Empire in Constantipole. In 1918, the British empire defeated the last Caliphate, leading to a de-centralized Islamic faith. And after three centuries of weakening Muslim influence and stongholds, Christdom and the Western World in general prevailed.
And now the Western World finds itself in what we would like to call a War on Terror. Undoubtedly, we stive to have Muslims on our side to fight a common enemy, the terrorist. But so far, we have been unsuccessful.....and have been losing ground the last few years instead of gaining.
We need to ask ourselves if the Muslim majority is really with us, or does the seemingly sympathetic view of the foreign fighters and Jihadists reflect their true feelings? I feel I am qualified to possibly add one informed comment on Iraq, and the Anbar Province in particular: The U.S. is struggling to police a sectarian civil war.......we are absolutely caught in a wedge that seems impossible to get out of. It wasn't our original intent, but is the paradox we currently find ourselves in.

Our dangerous dance

2007-03-06T15:58:00.000-08:00

Update: the patient we tried so hard to save quickly died after arriving at Baghdad hospital. He's in a much better place than we are, to be sure.

This brings me to this post's topic: Resource Management. The team has spent a lot of time talking about how to manage trauma over the past few weeks. Taking care of patients in this austere environment is much different than treating the same patient in the United States....supply is always a consideration, but out here supplies become downright precious.

Besides dealing with trauma and loss, the next hardest thing we have to face out here is the judicious management of resources.....

We just want to do the right thing: we are trained to save the life....and giving up is the last thing to cross our mind--ever. But we have had some heavy debates over the past few days, and had to set some unfortunate boundaries and limits. When we activate the walking blood bank, we are taking potential future donors out of the picture for two months....activating it twice in one day for the same patient is unheard of. One false move on our part, and a future blast or gunshot victim with very treatable injuries may die weeks from now because of a futile decision we make today.

Deciding who gets the resources and who doesn't forces choices on us that quite frankly we just don't want to make......it has deep and lasting ramifications for a trauma team that just wants to "do good", but especially for the patients and their families and friends back home.......the fact that every decision we make out here has consequences one way or the other is constantly on our thoughts.

Carry on, Old Glory

2007-03-05T16:36:00.000-08:00

Pictured in front of our barracks is Jeff, an old acquaintance of mine from Portsmouth Naval Hospital. He's an orthopedic surgeon, and was part of the trauma team we just replaced.

Jeff was the barracks officer, and worked hard at making some improvements, including the addition of a flag pole and a flood light to fly our colors 24/7. I have taken on the responsibility of displaying Old Glory from Jeff......and it's been another welcome diversion from shock/trauma.

The flood light wasn't working when I took over the job, and Jeff and I got that fixed the day before he took the freedom bird home. That night, a wicked sand storm kicked up, and broke my flood light within two hours.....back to square one. I got it fixed again two days ago....so far, so good.

Abram's oasis

2007-03-05T15:47:00.000-08:00

Al Asad is located just a few short clicks from the Euphrates River about 180 kilometers due West from Baghdad. This base is built on a historically biblical site.......the local population has maintained for thousands of years that Abram, Sarai, and Lot stopped here and camped a short time while travelling from Ur to Haran. This spot is so revered, that it is one of the reasons Saddam Hussein built his premier airbase here. It is well known that he spent a lot of time on this base, and used it to train Iraqi Olymic teams alongside the military.
The oasis is tucked away on a protected area of the base, and is only a two mile run from the barracks. Standing here felt surreal.....what a priviledge to have somewhere quiet to retreat to from time to time that is sacred to Christians, Muslims, and Jewish faiths alike.
The picture can only capture a fraction of how beautiful this spot is.....I can't help but be struck by the beauty of the desert here........the date grove surrounding the oasis is lush, full of color, and bursting with life.

This is how we roll

2007-03-04T16:41:00.000-08:00

My day typically starts in the afternoon, and carries on until the job is done. Our first patient arrived around 3 PM: multiple penetrating trauma from IED blast. By the time we got him off the helo and scrambled to shock/trauma, he was unresponsive......and pulseless. Our first clamshell (cracking the chest open to access great vessels and the heart quickly) of the day....and it was futile.
6 PM: We put the call out for all medical personnel-mass casualty inbound in 15 minutes! Two helos land simultaneously with four patients. Does anyone have to guess IED's at this point? Two more clamshells and 20 minutes later; two more fallen angels. My patient was devestated, but alive. Multiple penetrating trauma to his abdomen with fragments blown out his back.....legs flopping around from shattered femurs. His left hand? Nothing left. He came in initally responsive, and the surgeons wisked him first to surgery within 10 minutes (we already completely exposed, lined (large bore IV's) him, and intubated him within 2-3 minutes). Three hours later, and we had initiated the walking blood bank not once...but twice. For those in the know, I give you the following: He initially got all the packed RBC's we had (10 units). Following that, he received an additional 36 units of whole blood (this is not a typo: 46 total units of blood). We also gave two doses of factor VII (rapid acting clotting factor). In no way can I describe how tenuously he clung to life......our flight nurse just got back from taking the patient to Balad, and said he never worked so hard to keep a patient alive in his life..........
It's 4 AM and winding down. I'll be up at 7 AM for laundry turn-in (of all things). Formation at 8 AM for weapons and flak/kevlar accountability. Then a few hours after that: we roll all over again. Shock/Trauma goes back to work....
Can I just say that nothing, I repeat nothing, would have fully prepared me for this. The chaos, the mayhem, the disorientation of so much devastation pouring in with such regularity.

Faith...

2007-03-04T16:14:00.001-08:00

Luke 14: One Sabbath, when Jesus went to eat in the house of a prominent Pharisee, he was watched carefully. Placed in front of him was an ill man. Jesus asked "Is it lawful to heal on the Sabbath or not?" But they remained silent. Jesus healed the man, then asked "If one of you has a son or an ox that falls into a well on the Sabbath, will you not immediately pull him out?" And they had nothing to say. To paraphrase Jesus' message of Luke 14, He again caught the Pharisees in a paradox.....and blasted and exposed how their strict interpretation of Sabbath and rules couldn't possibly be adhered to.....by anyone.
I heard a sermon once on Luke 14, and I quote the pastor saying "religion is one of the most dangerous things in this entire world." He started with this, and immediately had my full attention. I ask you to think about that statement....does it give you the same pause it gave me? His message: religion can be consumed with (and hindered by) sacrament, ritual, traditions, and rules. Now I ask you to think about how religion can be the most dangerous aspect of all mankind. This is when I came to the realization that religion is different than faith. Simultaneously intertwined....yet in a way also exclusive of each other.
I thought about this sermon and Luke 14 yesterday in the middle of trying to save a young school boy's life. The boys took a shortcut home from school, and it just so happened to be a common convoy route......they weren't so lucky. Four died instantly before we could get to them. Two made it to shock/trauma alive. Despite cracking open his chest, we lost another precious child in our arms. And it all makes me wonder why? In what name do the insurgents operate by? And I just keep thinking of Luke 14.....and how religion is playing a role in tearing this Country apart..........because it sure isn't the shared faith that we believe in the same loving God.

Imminent Move

2007-03-02T00:32:00.000-08:00

Getting what seems to be a rare chance to add an entry. The hospital has been busy, and the en route care nurses are flying every day. There are five of us, and we take turns being "on call" for 48 hours. It isn't my turn to fly again until next week. Those that are not on standby to fly staff the shock/trauma bay and recovery/ward. When trauma comes in, we get a heads up, and usually it's an "all hands" effort. Every spare pair of hands is needed.
The sad reality is that there are IED blasts every day. I can't go into details due to security concerns, but we have unfortunatly received some high level patients recently.....these men continue to dedicate their lives to the security and wellbeing of Iraqis at the expense of their own health. Inspiring and humbling to all the staff. We are taking in patients every day and the hospital is humming with activity. Everyone is doing a fantastic job, and we are gelling together as a team very quickly.
Also, the Army has almost competed a Level III hospital (we are a level II....less diagnostic capability) right next door to us. They plan to be fully operational soon, and this will shut us down. The plan is to re-distribute us somewhere else in-theatre to "beef up" other Level II camps. Right now, my frontrunners are Ramadi or Falluja, but it's all just a big question mark right now.
Other than working, I have been catching up on my sleep and trying to keep myself healthy. The past few days have been rough, and I've been feeling a little under the weather. Hope to bounce back soon.......

I have updated the photo gallery and made some additions if you haven't taken a look in the past few days.
Also, I always make a little time to read the comments (thank you all!) but may not have time to address everyone individually on the blog itself. I have much better access to my military email account. Please drop a line when you get a chance......especially if you have questions about a post, or just want to say hello.
carl.goforth@acemnf-wiraq.usmc.mil

IA, IPF, and insurgents...oh, my!

2007-02-26T18:25:00.000-08:00

We had our first fallen angel (deceased active duty member) come thru the hospital yesterday.....talk about having reality smacking you in the face. Hard on all the new staff, especially. When we know an angel is coming in, we line up along the route from the helo pad to the hospital and pay our respects at attention and salute him/her as they are carried down to the SSTP (shock/trauma/casuality receiving area). They sacrificed all for our way of life.....and I felt honored to pay my respects.
We care for a wide variety of patients.....basically it's whoever rolls thru the door. We took a suspected insurgent to surgery two days ago to wash out and I&D some lower extremity wounds. He was behind a door that the patrol couldn't open. They blew it up with a C-4 charge, and he happened to be behind it (they gave him fair warning first). I'm telling my team that first and formost: you are in no position to judge anyone that we are called upon to care for, and that I expect everyone to be treated decently, regardless of nationality or actions that may have brought them there. So far, so good.......
We were also caring for an IPF (Iraqi Police Force, IA: Iraqi Army) member that fell off a ladder and had several burst fractures along his spine. He and his brother stayed with us for several days.....we were lucky to have his brother, who spoke pretty good English! We also have two interpreters on staff.....I can already tell I would be lost without them....
I purposely started off a little somber, that way I could end on a lighter note: I'm also getting some time to explore the base when I'm not at work. One of the departing ERCN's (En Route Care Nurse) showed my buddy Pat and I some of the cooler parts of the base that are within running distance. Yesterday afternoon she showed us the Al Asad Oasis, an old abandoned Russian MIG, and an old Iraqi outpost. A welcome diversion from the hospital to say the least.
As promised, Saddam's Pool story: this base also housed some of the Iraqi Olympic Team, and the indoor pool is quite impressive when contrasted to the simple and utilitarian structures surrounding it. The legend goes that Saddam was here often, and he would tour the air squadrons, soccer team (stadium isn't too far away, either), and swim team progress.....the slowest swimmer was often hung in front of the pool to "motivate" the other swim team members........I don't remember if they won any medals, so I suspect this somehow wasn't the best motivator....anyway, it makes for a great story whether it's true or not.

To Baghdad, adventurous Stranger

2007-02-22T18:08:00.000-08:00

Flew my first patient last night with a trauma nurse I am replacing. All of our MEDVAC's are flown by the Army's 45th Aeromedical evacuation squadron based here at Al Asad. We exclusively fly H-60H's (Blackhawks) with the patient carousel in the fuselage, and are sandwiched between the crew chief and the helo medic.
My patient was an Iraqi Policeman that presented unresponsive and was in Diabetic Ketoacidosis (DKA......in other words very high blood sugar levels and acidotic...he had an impressive pH 6.90). We intubated him, started IV's, chest xray, labwork, ect. and then called for a MEDVAC.
Ummmm, I'm not sure exactly how to explain the flight.........don't want to alarm anyone. But flying into Baghdad is a "unique" experience all to itself. For the most part, there isn't much to see in transit.....a lot of desert with scattered homesteads.....fairly routine. But once we start approaching the Army Hospital in the heart of Baghdad, the pilots have a lot to deal with: we are approaching a hostile urban terrain complete with houses, street traffic, towers, antenna, and other low altitude aircraft. Not to mention they are trying to land. Have I mentioned yet that we aren't the only ones flying 1,000 feet off the deck trying to bring casualties to the hospital? So, they had no problems identifying the Army Chinook flying a few hundred feet below us.......it was the second Army Chinook they didn't see until it was almost too late........I'm glad the Blackhawks are much more maneuverable.........but it came with some interesting views of the neighborhood rooftops out my window. I don't think they intended for me to be able to count roof vents like that.
As if that wasn't fun enough, leaving was even more challenging: the new pilot forgot to turn off the landing lights before liftoff.....so about 30 seconds after taking to the air, the hospital ATC radioed them to warn them just as they started seeing tracer rounds.......none to worry: we launched about 6 flares (deflecting heat source and distracting light to throw off the enemy) and didn't gain any new air conditioning ports in the craft. The pilots were laughing about it once we got out of Baghdad (I'm plugged into their communications system while flying, and I'm still trying to decide if that's a good thing or a bad thing)..........I guess it's all fun and games until you leave your lights on in indian territory! Just remember, I get all this and a paycheck to boot.....lets get some.
I'm inspired to quote C.S. Lewis as Digory and Polly come across the mysterious bell in the grand hall in his first book:
Make your choice, adventurous Stranger;
ring the bell and bide the danger.
Or wonder, till it drives you mad, What would have followed if you had.

Disclaimer: apologies to anyone who doesn't speak medicalese or military jargon.....this blog is going out to a broad audience, and I just can't explain it all....however, Google is only a few clicks away.....it will shed light on some of the technical stuff you may have questions about.
Also, I have been taking pictures, but just can't get the internet time to upload them yet....should be within the next week, including panoramic shoots from the roof of Saddam's Olympic Training Pool (story will have to wait for a future post, sorry!).
I finally have an email address:
carl.goforth@acemnf-wiraq.usmc.mil
Also, here is my mailing address:
LT Goforth
CLB-2, HSS/medical
Unit 73655
FPO, AE 09509-3655

God Bless and good night.......

Our first case

2007-02-20T19:20:00.000-08:00

First: thank you everyone for your posts and feedback....deeply appreciated!
My team hasn't wasted any time with relieving the current staff: our first case came in last night.....a 6 year old Iraqi girl triggered an IED. She had penetrating abdominal injuries, and broke one of her legs (tib/fib fx). Our general surgeon and ortho surgeon went right to work, and my good friend Pat flew her to Baghdad in the middle of the night.
We met our counterparts yesterday, and they have a mixed look of exhaustion and relief.....they are glad it's over, and are anxious to turn the "watch" over to us. We will spend the next few days working together so they can impart "pearls of wisdom" and lessons learned.

Anbar Province, Al Asad

2007-02-20T01:24:00.000-08:00

Arrived in Anbar Province via C-17 a few days ago. Al Asad is a large airbase built by Yugoslavia during the Iran-Iraq war. The perimeter of the base is around 25 miles, and I have only seen a fraction so far.
Still trying to acclimate to this part of the world. Last night was the first night I have slept since I got here, so things are looking up now!

From Kuwait:

2007-02-15T07:40:00.000-08:00

I flew over Baghdad last night around 2 AM on my way into Kuwait City. Two observations: It looked like a lively city with a lot of lights, which is a good sign; the lights were not in the form of tracer rounds aimed at the plane----even better sign.
I am at Camp Virginia, Kuwait while I wait for the final leg of the journey: Al Asad. The flight was as long as I thought it would be. We stopped in Newfoundland first. The flight crew said the ice cream was the best, so we ran across the tarmac to the terminal for chocolate ice cream. It was 20 degrees, but I really didn't have anything better planned. The second stop was in Budapest, Hungary, of which there are two districts: Buda and Pest, separated by the River Danube. We weren't allowed off the plane, nor did they bring us any goulash...so we must have been in the Pest district.
The feedback I am getting back on the site is phenomenal! Thanks! Why does it seem like everyone is enjoying the blog more than I am????? .........that's not fair, people.

Imminent departure......

2007-02-12T11:38:00.000-08:00

I fly out tomorrow afternoon to begin my long journey to the sandbox.
I finished packing my seabag (king size; 100 pounds) and pick up my weapon on the way to the airfield.......get this for military intelligence: I'll have my weapon for the flight, but I still can't have a knife or mouthwash.........
The trip average is 36-38 hours (including fueling stops/plane turnovers, ect.) and I'm sure I will be offline for a few days. The next post will be either from Kuwait or Al Asad..........thankyou all for your continued support and prayers........

Combat Town

2007-02-10T11:52:00.000-08:00

Don't get me wrong, I appreciated the day's worth of squad tactics and clearing buildings of "insurgents". But does the Navy really want surgeons, trauma nurses, and corpsman ridding the world of bad guys? Lets just say if you see me in the news doing this.......that things are definitely not going as well as we had hoped........

En Route Care Training

2007-02-10T10:20:00.000-08:00

Finished up the last of three weeks of training friday. Wednesday-Friday the trauma nurses went thru a new course developed by Naval Operational Medicine. It was a mix of classroom instruction on flight physiology and environmental stressors along with equipment familiarization and trauma scenarios. The class culminated friday with a trip to New River Marine Corps Air Station for in-flight training. We split up the class and flew around coastal N. Carolina for the morning with two instructors and a sim-patient along with monitors, IV's, oxygen, ect. I have done simple MEDVACs in the past while I was on a surgical team, but quickly realized this was an entirely different realm of "complicated". Our helos will be flying with all doors and windows open while in theatre, and the prop wash is like a mini jetstream blowing thru the fuselage. The noise prevents us from hearing anything....I'll be lucky if I can hear myself think. Here's the biggest kicker: I will probably be flying at night. The pilots are becoming more adverse to daytime operations, and most flights will be at night in a blacked out cabin.........my instincts will be heavily relied upon.

Helo Dunker

2007-02-07T14:37:00.000-08:00

The Navy's infamous Helo Dunker! Here's how this works: swim in and strap into your assigned seat. After everyone is strapped in, the crane operator drops the dunker into the pool and it immediately flips upside down.......once all violent motion stops (their words, not mine), you have to get yourself unbuckled (you are upside down and completely disoriented), locate a window (no, we are not allowed to go out the large hole in the back...), open the window, and climb out. The trick is to figure out which way is up before you run out of oxygen! Two Navy divers enter the dunker as soon as it plunges into the water for safety in case someone can't get out of their harness or can't find their way out.

Desert Flier

2007-02-07T14:01:00.000-08:00

Greetings! Welcome to my Desert Blog..................I am deploying to Iraq and will be posting my musings and thoughts as well as lots of pictures (click the link above the photo). This is my first blog, and will be "under construction" until I get a good feel for how I want it to look.......so check back often and leave feedback!

I am a trauma and critical care nurse in the Navy currently stationed in Portsmouth, Virginia. However, I have been attached to a Marine Unit since January 19th, and have almost completed my field and didactic training before deploying to Al Asad, Iraq. My job will be to fly critically injured patients from a forward airbase back to a higher level of care either in Baghdad (Army Hospital) or Balad (Air Force Hospital).