Begining of the End

Hi everyone!

Getting close to the end now. Sorry I haven’t posted for a while. Many of the things that were so new and exciting upon my arrival have become mundane to me now. I’m worried that I might bore you with constant repetition, as I’m becoming bored with my existence here in Balad. Was I ready to go home before? I’m doubly ready now, and I feel my exasperation will grow geometrically from today.

The Army anesthesia folks who began this tour with us have left. I will miss Major Brian Pitcher, most. He is from Walter Reed ARMC in DC and is a superlative CRNA and officer. He was tireless worker and generous with his cigars. I’m lucky if I can count him as a friend. Their replacements are unknown commodities and we are still getting to know them. We have a new Captain and a Lt.Col. So far they have been doing fine, but frankly I only have three weeks with them and my heart’s not interested in making new friends as such. I’m so much more interested in saying goodbye to the ones I have.

Speaking of cigars, I’m smoking like crazy. Crazy for me that is. I have smoked about 4 cigars in the last year. Here in Balad I smoke that much in a week. Cigars aren’t like cigarettes. I don’t get that “I’m addicted-craving” feeling from them. But, I know they’re not healthy for me. Its one vice I still get to enjoy here. My friends who fly bring me Cubans from Germany (shhhh!) Sounds like a code word doesn’t it?

“Senor K, the ‘Cubans from Germany’ will be arriving by plane late tonight. Meet us at the flight line and bring money or chu-know what will happen . . . and don’t try to double cross us again!”(Click)

Brian, my uncle sent me a serious quality assortment, which I have run through already, and I wish I had more. (Thanks Brian they were schweet.) As vices go they are pretty benign. Hell, we roasted a whole pig at Mardi gras. If Allah is offended by porn and booze I guess he turns a blind eye to all the swine we eat here in the land of the prophet. I have more disdain for Muslim bullshit than ever after being here. Islam forces these people to live in a backward state forever cursed to follow the precepts of that false prophet Mohammed. Many of the jingoistic people here are, shall we say, less than accepting of the Iraqis, I just have pity for them.


My roommate and I barbequed tonight. We got a small pan and some charcoal. He was able to buy two thick, well-marbled rib eyes from the PX three days ago, and we marinated them until tonight in soy, honey, grapefruit juice and spices that we cobbled together. Man, were they good! We resurrected them from their spicy entombment and slapped ‘em on the grill over the piping hot coals. Ice cold near beer, and chips with salsa. It was the best meal I have eaten here. We even sat outside and continued to eat while a mortar exploded a couple thousand yards from us. We didn’t even take cover. Whatever, it was too good to stop. I just can’t wait for a big glass of cabernet to drink with my steaks when I get home. I’m salivating as I think of it.
Hear that Kim?

Now is the time to send anything else to me. I have less than a month to go I will be out of country about ten days from the end of the month, and I will not be here to receive anything you have to send. Make sure I don’t have to ship it home as I already have a couple hundred dollars of stuff to send right now. God willing I’ll be home soon, and I look forward to seeing you all.

BeeGees and Eyebrow Hair

Hi everyone.
I’m ready to come home. Just in case you wondered.
This letter was going to be a catharsis. I had a bad day yesterday, and I was going to unload by writing you. E-mailing you guys and this subsequent Blog have been a way to pass the time and get out my missives to the huge list of people that I need to correspond with while I’m here. I don’t have the time or the speed to type out letters to everyone so this seemed to be the best way to accomplish that task.

But as I sit here now I’m having second thoughts about spilling my feelings all over the page for you. I hope that you all read what I send, but I suspect that mostly I’m sending my thoughts out into the electronic ether, to be casually glanced at as proof that I’m still alive; which is fine. But, in the interest of keeping the meager audience I may have I’m going to spare you the emotions and stick to the story.

My patient yesterday was a ten-year-old boy. I guess ten because a lot of Iraqis don’t know their ages. They don’t know their weight either. Weight and age are unimportant to them as far as I have seen. You are alive or dead, old or young, fat or skinny. Maybe you are thirty, which can be old or young depending on the amount of wear on your tires. But he was young, pre-pubescent and dying.

We were told he was coming from Baghdad after an unfortunate encounter between a brick and his head. The Army’s 207th Head and Neck Team are posted with us in Balad. So we get the every neuro trauma from the entire theater. The neuro team is really fantastic. Some of the lazier people here don’t like their presence, because it means we get all of the severely head injured patients. Severely head injured patients are a lot of work, both intra-op and post op, but I don’t care. It’s become the most high profile thing we do. Without them here the suspicion is that the Army in Baghdad would only send us the cruddy cases they didn’t want.
But back to the kid. . .

His head was swollen and purple. He had a massive sub-cutaneous hematoma throughout his scalp. Giving him the appearance of a hydrocephalic. His pupils were fixed and dilated, a really bad sign. I placed a subclavian central line in him while the rest of the team prepped and assisted with the surgical setup. Craniectomies bleed a lot. So we spent a bit of time preparing to combat that before the start of the actual surgery. (Incidentally, he had blood products administered upon his arrival in the ED, which was due to the blood policy I spearheaded.)
Then the surgeons began their task. I continued a full-bore resuscitation with blood, plasma and fluid. 700ml of blood were lost in his scalp prior to his arrival. Maybe one liter was oozing out onto the field. The neurosurgeon had told me right at the beginning that he though the kid was too far gone but of course we were going to try anyway, which I agreed to. Things proceeded well for a few minutes. But by the time a quarter hour had passed, he was dwindling. I asked for, and got help from an operating room RN, Emma Piehl and my boss Lt. Col. Schank. We needed three people just to keep up with the blood loss, ventilatory efforts and pharmaceutical interventions. Trauma surgeries were proceeding in every room so there were few personnel to spare. Brett Schlifka, the surgeon, called over to me and said that he was sure that the brain was dead. The tissue was white, secondary to the swelling that had starved it of blood and nutrients. My team were maxing out an epinephrine (adrenaline) drip and trying to keep him well ventilated despite the fluid that was shifting into his lungs.

This child was dead, but his heart didn’t know that yet. Dr. Schlifka suggested that we cease giving blood, as it was futile. I kept him alive long enough to get him to the ICU where his heart exhausted its last beats about thirty minutes later. I had never been so depressed over a patient’s death, before I encountered this child. As an RN I didn’t have the responsibility for my patients’ lives that I currently do. It weighs so much heavier upon me now.

Now, for the really depressing news. I went to get my hair cut today. Going to the barber here is an experience. The barbers are I believe, Indian (dot, not feather). There are so many Asiatic third country nationals here: Philippinos, Nepalese, Pakis, Malays etc. It’s hard to keep them straight. I think these dudes are Indian, however.
Anyway, the barber is cutting my hair and in the background they have a stereo blaring pre-disco Bee-Gees. The kind of BeeGee's you hear on AM. My barber, I believe in an effort to add to the surrealism of the scene, is whistling along to “Lights go Down in Massachusetts”. I’ve got an Indian, entranced by the musical stylings of the Australian Brothers Gibb, who are singing a song about a NewEngland state, as I sit in Iraq. I don't think this is what people expect from the new globalism but this is the strange reality of it.
and just then , he does it. . .

He takes the scissors and cuts my EYEBROW HAIR!
Aw shit! I have wild old-man eyebrows?! Why didn’t anyone tell me? Now it’s shit like that; that can make you really depressed.

Big Gun and the Big Board

Hi everyone.

So more cool events unfolded here for me in a brief respite from the monotonous grind of casualty-care, that we do everyday at Anaconda.

Recently I gave anesthesia to an officer who I cannot describe in further detail, but suffice it to say he is very well connected and highly placed in our organization here at Balad. Because of the kindness shown to him by his surgeon and I we were invited to go on a behind the scenes look at our base defenses.

It began with a look at the weapons caches we have captured from the insurgents in the area. He had his staff show us piles and piles of weapons, of all makes and models from ancient WWII equipment, to the latest AK47s from the eastern bloc. We saw the mortar tubes, captured from the various Muslim insurgents, that have plagued this base as of late. Most interestingly he showed us various IED devices and how they were triggered. I’m frustrated when it comes to describing the things I saw; because they are secret. If anyone were to know what we know, say by stumbling across a careless blogger for instance, the enemy might change tactics. So vivid description will have to wait until I’m face to face with all of you.

Following that we went into the JDOC (Joint Defense Ops Center). The real secret stuff is in here. Remember in ‘Dr. Strangelove’ when the American general played by George C. Scott loses it because the soviet ambassador is going to see the BIG BOARD! Well the JDOC is the home of the big board for the area it is supposed to cover. I can't even tell you the area it covers. ARRGH! I just can’t tell you more than that, but it was really awesome, and I truly mean that. Our enemies are so outclassed technologically; I’m at a loss for words. It is really impressive to see how this NASA-like command center has real time control of the battle space, and integrates seamlessly with the troops in the field and planes in the air. I don’t feel anymore protected but I see now why we are as safe as we have been. I just wish I could I could truly tell the story. Kudos, to the men who devote their tour to keeping the bad guys on the run.

Finally we went on a tour of the actual fortifications and gun batteries around the camp. At the end of this we got a tour of the 155mm self-propelled howitzer. This is a cannon on tracks. It can lob a shell up to 30mi away. It looks like a big tank, but the armor is thinner and it is not as fast as a tank. Our host then let us put it through its paces. What a machine. I actually got to drive it around a small track and slog it through deep mud and gravel. Easily in the top five coolest things I have ever done in my fifteen years of military service. It’s an automatic and drives with a little steering wheel; anyone of you reading now could drive it. But, it weighs 27 tons and when it is moving you get a real rush of power (similar to an American SUV). Sadly we did not get to fire it but I could tell the crew would have loved to demonstrate that for us as well.

Later, I sat outside smoking a cigar and contemplating all that I have done lately, I watched the Blackhawks come and go just 100ft above my head and I came to the realization that I have done and seen so many things that I always wanted to do as a boy, I’m living the dream. My twelve-year-old self would have passed through puberty in one day if he had seen what I saw today. But I would trade it all in less than a second to be back in the arms of my wife and to hear the tinkly voice on my toddler or be goobered on by my baby. I’d give all this crap up just to be back with them and not have to leave their presence ever again (at least until the teenage years).

. . .I miss them so.

Famous in France

So I’m famous again. You may remember that I was in some footage from ABC back when an IED blast injured their anchor and cameraman. I was shown for two nights on ABC, and footage of me showed up for about three days on Armed Forces Network. Now I’m in a magazine.

Match-Paris magazine from France did a piece on our hospital and it just went to press. My commander approached me in the serving line in the DFAC. He was walking towards me, all grins. I got the same feeling I used to get when the principal would single me out in school; that “oh shit what did I do feeling”. But he was quite happy and presented me with my own copy. It’s all in French of course, but I can make out some of it. I didn’t get interviewed or anything but I got a whole page photo spread of me placing a large femoral catheter into an Iraqi prior to his craniotomy (brain surgery) to remove a bullet. J. Stormo is in the picture too, right behind me. Several other people from the 332nd are featured, and we all received our own copies. I can’t read French but I’m told the piece is laudatory of our efforts here. It’s really nice and I think I’m going to frame it. Unless you guys think that’s too gauche. (ha ha) Bye for now. I’m going to eat some Landjaeger and have a near beer.