Monday, August 2, 2010

The Luck of the.......Afghans?

Things have been going ok at FOB Lagman as we wind down our deployment. We’ve been getting a few patients here and there and when we don’t have patients the time sure drags. Well, the past 24 hours have NOT been dragging. We’ve had several patients and there is one in particular I would like to tell you about.

I returned from dinner last night and, as usual, after watching some guys throw a few darts (no body armor this time) I went to my room with the hopes of getting to finish watching Galaxy Quest that I started watching earlier that day (Judi loved it and I still haven’t seen it from beginning to end). Well, that plan was foiled when I overheard one of our corpsmen say, “we’re getting an urgent patient in two minutes!” Another one of those Afghanistan surprises. So, I jumped out of my bed and headed for the FST wondering what was in store for us now. I overheard some folks outside the door mumbling something about an 8 month old being shot in the face. Wonderful! When you hear the words “8 month old” and “shot in the face” the things that run through your mind are not good. She arrived with a dressing covering her entire face with blood on the outside (oh, shit), but appeared to be otherwise well. The first news is that she is actually 3 years old, not 8 months, and she did not have any other wounds that we could see. So, after looking her over and getting her vital signs it was time to take off the dressing. While we began to cut the dressing off I started thinking to myself, “this is going to look horrible.” To my surprise she had only two small holes in her check (assumed to be entrance and exit wounds). It appeared the bullet entered just in front of her ear and exited the middle of her cheek, not even piercing into the inside of her mouth. It was really unbelievable. What a lucky young girl to have such small wounds from a gunshot to the face. A half an inch one way and the bullet hits major arteries and/or veins and a half inch the other way and it's in her brain - neither of those scenarios ends well. I’m hoping some of that luck rubbed off onto us. Similar to a previous young girl we cared for, I don’t recall her crying much either.

After I realized that she was going to be alright I started thinking about how this would play out back home if it happened to one of my neices who are about the same age and I can't imagine it. But here, in Afghanistan, its not that big of a deal. This little girl was accompanied by her twenty-something older brother and he showed absolutely zero emotion throughout the entire ordeal. It's really an odd dynamic and one I am glad I won't have to endure much longer.

Since I mentioned darts, here is a picture of the new dart board backing the commissioner and assistant commissioner recently purchased and plan to leave as a memento for the team that relieves us.


Left to Right; Dart Commissioner Cheuk Hong and Assistant Dart Commissioner Shane Lawson

We also have a new addition to our team. Last week we welcomed 7 new Air Force personnel, 3 nurses and 4 medics, and they have been nothing short of fantastic. They "hit the deck running" as we say in the Navy and have jumped right into caring for the casualties and assuming many of the additional duties the Navy team had been performing. I am a big fan. Below is a picture.

Left to Right; SRA Anderson, SSGT Sneed, SRA Murtagh, MAJ Clark, TSGT Cole, MAJ Garcia, and CPT Cox

I want to wish my mother, Ginger, a happy birthday. She turned seventy-something yesterday.

Finally, I can't remember being this excited about the start of NFL training camp. Casualties-permitting I will be immersed in everything NFL, I just wish I didn't have to rely on Ed Bouchette and Gerry Dulac for the majority of my Steelers news.


Take Care,

John

Saturday, July 17, 2010

The Ultimate Sacrifice

I just returned from a heart-wrenching memorial service for soldiers who died while supporting combat operations this week here in Afghanistan. I didn’t know these men, or even recognize their faces or names, but the least I could do was attend their memorial service and pay my last respect. This is the second of these services I’ve attended here, both of them for soldiers from the same company. I feel for them all.

I sent a detailed e-mail to my wife, Judi, a couple of weeks ago describing how I have become much more emotional after serving on this deployment. I find myself unable to hold back tears when I witness, or even hear or read about, the outstanding things our soldiers, sailors, marines and airmen are doing in this war. I held it together throughout most of the ceremony today; even through all the stories, recounted by their fellow soldiers, about what great men they were – true American Heroes. It wasn’t until the end of the ceremony, when they do the “roll call”, that my emotions got the best of me. In the roll call, the unit of the fallen soldiers stands at attention in formation when the Company First Sergeant begins calling random names of the company and they reply with a hearty “here First Sergeant!” The First Sergeant then calls for one of the fallen and it goes something like this:

First Sergeant: Specialist Doe!
No response
First Sergeant (after a short pause): Specialist John Doe!
No response
First Sergeant (again, after a pause): Specialist John Andrew Doe!
No Response

You then hear the Final Volleys (21-Gun Salute), followed by the playing of Taps, and then everyone in attendance approaches the helmet, boots and rifle of the fallen to give one “final salute” for giving the ULTIMATE SACRIFICE. May God bless the families of these great men.

I hope I never have to attend another one of these ceremonies.

Take care,

John


THE FINAL SALUTE

Saturday, July 10, 2010

Kellen Winslow Jr is No Soldier

I know I just posted yesterday, but I feel the need to tell this soldier’s story while it’s fresh in my mind. I came back from breakfast today to the report of a soldier coming to the FST who was involved in an IED blast. He arrived stable and alert complaining of pain in his right arm and right leg, both were still attached – thank God. He was dismounted (out of his vehicle) when an IED went off, striking him on the right side of his body. He had significant soft-tissue injuries to his right arm and leg, but not much bleeding or other trauma. While I’m assessing his injuries and getting a history he tells me this is the second time he’s been “blown up”. He was also hit with a grenade in Iraq in 2008. Now I’m thinking, that is a phrase I hope I never have to utter….”blown up a second time”. Oh, I forgot to mention, he followed that statement with, “fucking Taliban”! Fucking Taliban is right, brother.

I felt compelled to tell this young man’s story (he’s 23) because I’m sure there are so many more like it that American’s DON’T hear about. I started thinking how many other American heroes are out there who have been “blown up” multiple times and have lived to tell about it? I don’t think enough of them are telling their stories. This kid is 23 years old and has served in two different combat environments, risking his life so that other American kids can be free. He will return to the states and receive his second Purple Heart which will go unnoticed to most of America and that, my friends, is a crying shame. If you’re reading this blog you need to tell this soldier’s story to as many people as you can. There is something seriously wrong in a world where Lebron “Fucking” James gets an hour of the spotlight on national television to talk about his signing of a bajillion dollar contract to play basketball while the story about a kid around his age who gets “blown up” for a second time fighting for his country will go unreported. Ok, I’m off my soap box, but seriously the toughness of these young men is remarkable and I LOVE them all. And if I ever saw Kellen Winslow Jr I would give him an earful. He’s no soldier! And he has no idea what war is…no idea. This young man is the epitome of a SOLDIER! For those of you unfamiliar with the Kellen Winslow reference here is a link:

http://www.youtube.com/watch?v=I82BPA5QAaQ&feature=related

So, right before this soldier goes back to the OR he looks at me and asks, “If they find any shrapnel in my arm or leg can you save it for me?” My answer, “you bet your ass I will!” In case you’re wondering, we did find plenty and I tucked it in his boot as he went out the door for his helicopter ride to the Role 3.

As is customary for this blog, I like to end on a lighter note so here is a link to a great Second City Television skit about getting “blowed up”. Enjoy!

http://www.youtube.com/watch?v=_dfoVqhQVyQ

Take care,

John

Friday, July 9, 2010

RO-Medical to the Rescue

I mentioned in a previous post that we share the FOB, and the FST facilities, with the Romanian Army. They are a wonderful group of men and women and we have grown quite close with the Romanian Medical team who share our building. The team consists of two Romanian Family Practice Physicians, Dr Adrian and Dr Daniel, a dentist, Dr Chris and numerous medics – they go by first names as their last names are typically very difficult to pronounce with lots of consonants.

Earlier this week we had a minor (minor for us) mass casualty event after a bus crashed in Qalat city. We had very little notice, not surprising, and ended up receiving 5 seriously injured Afghan locals. The first two required intubation (placing a tube into their lungs so to assist breathing) which our CRNA’s managed expertly. Seriously, the Nurse Anesthetists we have, Shane Lawson and Robbie Ladd, are two of the best I have ever known. Their skill level is at or better than many stateside Anesthesiologists. They have managed some of the most difficult airways and made it look routine. We have had at least 5, maybe more, patients with unbelievable facial trauma and blood coming from every orifice on their face and Shane and Robbie step to the head of the bed and insert an endotracheal tube with ease. It’s pretty cool to watch. The other three patients had broken and dislocated bones and a pneumothorax (collapsed lung), but nothing really life-threatening. One of them had to be taken to the OR to fix his dislocated knee, which is why I mentioned the Romanian Medical team. Because of the seriousness of the first two patients we were a little short-staffed so the Romanian’s stepped up to help out and they ended up caring for the patient who required surgery. Even Doc Chris, the freakin’ dentist, was in the ICU helping with the two intubated patients. They will be leaving the FOB soon and asked for a group photo with us wearing the Navy FST -shirts we gave them. They will be missed.

From left; Dr Adrian, Lodin the Interpreter, Dr Daniel and Dr Chris (I have no idea what Lodin is trying to do with his fingers. Perhaps its an Afghan gang sign. Or he's a confused University of Texas fan). Check out their scrub caps. Is that NATO at its finest or what?



The Group Photo



The day prior to the bus crash we had a US soldier come to us with blunt trauma injuries from an IED blast. He arrived to the FST without a pulse and we were unable to save him. Another tough day.

The day before that we had a 9 year old boy brought to the FST after the donkey he was riding on (you only get stories like this in Afghanistan) walk over an IED. He was severely injured and required extensive surgery on all 4 extremities. We were able to save them all, but he lost the pulse in his right arm just prior to transfer. We found out he had to have that arm amputated the following day – very sad.

July has been a busy month for us thus far and I anticipate it will stay that way until Ramadan starts in early August. For those of you not aware, Ramadan is the Islamic month of fasting, in which participating Muslims refrain from eating and drinking from dawn until sunset and they offer more prayer to Allah. It is my hope that because of the fasting and the praying that they also stop the fighting and the bombing. I think it starts 11 August, just a few weeks before we are due to leave. It would be a nice going-away present.

My beautiful wife and I celebrated our 13th Wedding Anniversary on 5 July and I posted a video I made for her on Facebook. I am also going to try to post it here just to see if I can do it. She will be going on vacation with her family tomorrow to the Outer Banks in North Carolina. I wish I could be there with her. I miss you Judi.

John

video

Monday, June 28, 2010

The One Where He Lacks Inspiration

Once again, I have had no inspiration to write. With each passing day the end of this deployment nears and the team is beginning to focus on what they will do when they return. The discussions range from the first thing folks will eat (my favorite is Sharese White’s a hamburger and a Guinness) and where they will vacation to the simpler desires of Shannan Cook’s just wanting to use actual plates and silverware. Me? I am most looking forward to taking a nap under my Steeler Blankie (yes, I have a Steeler Blankie and I’m not afraid to admit it. I got it from Suzi Brannock and it is one of the best gifts I have ever received) with Judi in my arms and Cowher Doggie resting his chin across one of my legs. It’s probably my second favorite thing to do. Then I want to take Judi to Las Vegas. I know I’ve mentioned it before in this blog, but I can’t tell you just how much Judi and I love Las Vegas. I have been looking at the suites at the Venetian every day and checking out what shows we might want to see. Right now there couldn’t be two lamer comedians performing at the Venetian – David Spade (sorry Jordo I know you loved him as Finch in Just Shoot Me) and Wayne Brady. I hope that schedule changes. Ok, enough about home, time to refocus.

We continue to receive casualties and they continue to be mostly Afghans. Over the past few weeks it has been feast or famine. We may go two or three days without a patient (talk about looooooong days) and then we will get three or eight. Yesterday we had four – three from an IED (one gentleman died in the FST) and a young Afghan child who got her hand caught in a machine that makes bread. The young girl did not have any fractures, but she had a very complicated injury (her skin and soft tissues were severely torn) that required washout and repair in the OR. Had we not been here to treat her she would not have received the care she needed in this country. Our surgeons did an unbelievable job cleaning and closing her wound. She should go on to live a normal life. It’s a feel-good story and one that makes being here worthwhile. I almost forgot to mention that she was probably in the FST for 3 or 4 hours and I never heard her cry. She was very tough, but it comes with the territory. You kind of have to be to grow up in Afghanistan.

Speaking of the war, I’m not sure what to make of the "shake-up" at the top. I hear that some of the Rules of Engagement may change with General Petreus now running the show. Not exactly sure what that means for our team, but it may mean less casualties and that is always good.

To end on a high note, I received some good news this week when I was informed I was selected for promotion to Commander (Lieutenant Colonel for those familiar with ranks of the “other” services). The promotion, of course, comes with a bigger paycheck but it also comes with greater responsibilities. Judi and I are very excited about the opportunity. When my recruiter, HM1 William Jones (I still remember his name), came into my nursing class at IUP in 1993 and gave his spiel about all the Navy had to offer I thought it was an excellent opportunity and figured I would do my four years and come back to PA. But the longer we stayed the more we enjoyed it. I’m not sure how I was able to stay in for 15 years, but I’m certain I could not have done it without Judi. Thanks Baby! We are in for at least 5 more.

Finally, if you happen to be driving past 119 South Main Street in Carrolltown please don’t be alarmed. That isn’t a new zoo. It’s just Judi and her sister Becky showing their love for animals by taking care of eight, yes eight, stray cats in addition to the two dogs they already have.

Take Care,

John

p.s. thank god soccer is over! Only "33" Merril Hoge days until the Steelers open camp - can't wait!


Cowher Under The Steeler Blankie

Friday, June 11, 2010

Combat Darts Anyone?

***Editor's Note***
John's Blog is back. He had to make some minor changes to previous posts and comments in order to adhere to certain operational security and confidentiality rules. He would like to apologize to the followers of his blog for the brief hiatus and is happy to be back...bitches.

Every Thursday the FST has a "game night" as long as we don't have patients. Typically we have a dart tournament, play texas hold 'em, board games, or play x-box. We've been doing this since the beginning of the deployment and darts is, by far, the most popular event. Many of the team members have been getting pretty good at darts (not me) so last week I just threw out the idea of making it more challenging by forcing everyone to wear their body armor while throwing (never thinking that anyone would go for it). Well, everyone thought it was a great idea so this week's tournament was called "Combat Darts".

Just to give you an idea of how popular darts has become here we actually have a commissioner, Cheuk Hong, and Assistant Commissioner, Shane Lawson, and they have set some basic ground rules (see photo below). Even the Romanian Dentist, Doc Cris, plays.


Take special note of violation 2, hitting the wall. People often miss the entire board (especially me) and 5 pushups really isn't that big of a deal. However, imagine those 5 pushups with 40 or 50 pounds of body armor...not so easy.

Me Doing One of My Many Pushups

We also have a trophy that goes to the winner of each tournament. It's one trophy and it works sort of like Lord Stanley's Cup in that it is passed from winner to winner. As you can see from the pictures, Doc Z was the winner of the last tournament and he came to this week's tourney proudly displaying the trophy. Although, he had to give it up to the new Champion, Shane Lawson.

Z


Z Presenting Trophy to Shane

Doc Funk Action Shot (note the commish observing in the background)

Speaking of Lord Stanley's Cup, what a great final game - ay? Too bad the Flyers couldn't have pulled it off. I wanted to poke fun at Jeremy Roenick for sobbing post-game, but I've bawled here much worse than that, so he gets a pass from me.

I also wanted to mention a very touching act from one of our corpsmen, Doc Funk. I mentioned in a previous blog how little the Afghans have and how guilty I feel about having to cut off their clothes. Well, apparently Doc Funk felt the same way so he petitioned a t-shirt company, "80's Tees" to donate shirts for the Afghans who have theirs cut off. The shirts arrived yesterday in the middle of a short lull between the 8 trauma patients we received and one of them was this awesome Steelers t-shirt. We were having a rough day so as soon as I saw the shirt, and how small it was, I knew I had to try it on; 1)Because it was a Steelers shirt and 2) Because I thought it would bring a smile to our teams faces. Here are a couple of pics.






When I wake up tomorrow I will only have 89 days until I see my beautiful wife and loveable dog again. Judi, I am too excited to sleep! And I love you more than you can imagine.

Take Care,

John

p.s. please pray for my brother Scott. He's a Captain in the US Army who has served his country honorably for the past 18 years and is going through a very rough time in his life right now.

Saturday, May 22, 2010

I Curse Sir Walter Raleigh

Business has certainly picked up for the FST here at FOB Lagman. We have been getting bombarded with multiple casualties; all from.....you guessed it - IEDs. I'm guessing this is most likely how it is going to be for the remainder of the deployment. It's now 2100 and we've been going strong since 0930 this morning. We received two different sets of Afghan Army casualties, two at 0930 and another four at 1430, all with critical injuries. It’s amazing how long a 40 year old body can go, especially considering it was pounding out High Intensity Intervals on the treadmill at 0530 this morning. We also had a nice Sand Storm that caused a delay in getting the first two patients transported to the Role 3. It’s something you can't plan for that ends up eating resources and wearing out your personnel. Although, I think I've described this team enough in this blog for you to know that we are willing to do whatever it takes to provide the highest quality care possible to ANY patient that comes through our doors. MVP of the day goes to our Orthopedic Surgeon, Sharese White, who had to take one patient from each of the evolutions to the OR, both cases lasted several hours.

The high point of my day was that I was able to take a 10 minute break and call Judi. Most of us missed lunch, but I did get my Saturday "cheat day" dessert in - God I love caramel! Here are some photos from the day and a link to the video that inspired the title of this blog. I think Barbie will appreciate it.

Take care,

John

http://www.youtube.com/watch?v=Sg6X28CThik&feature=related

p.s. while I was waiting for the pictures to load I walked to the ICU to make sure the second OR case was transferred to Kandahar and was informed that he may be staying the night because Kandahar is receiving incoming rocket attacks. I'll call tomorrow to check on RK.




Those Aren't Clouds Behind the Flags, It's Sand


Sharese, Between Cases, Telling me I'm #1

The OR at the End of a Long Day

Sunday, May 16, 2010

The Jinx

I should have known better than to actually write down last night that I hoped I could spend today watching Reno 911! and not caring for casualties. Medical professionals are a superstitious bunch and I broke the cardinal rule. I was awakened at 0530 this morning to a radio call for everyone to report to the FST. Another IED blast with more Afghan men missing extremities. We finished up at about 1200 after transferring 2 patients to the Role 3 in Kandahar. Below is a pic of me at the end of this event. FYI, we finally got wireless internet so now I can use my laptop in my room and am not limited to 30 minutes at the MWR.



Once again, Happy Birthday to my beautiful wife, Judi!

Take care,

John

Saturday, May 15, 2010

HAPPY BIRTHDAY!!! Or is it BIRTHMONTH???

This week was up and down for the FST. We had a couple days with no patients and a couple that were somewhat busy. We continue to get patients who were victims of IED blasts, more now than when we first arrived. I had a conversation over dinner last night with Shane Lawson, one of our two CRNAs, who has been deployed several times and he mentioned that most of the injuries he saw in Iraq in 2004 were from high-velocity weapons and were not as severe compared to the injuries we are currently seeing in Afghanistan. We took care of two Afghan men this who injured by an IED. They both had fractures of there calcaneus (heel) bones, which take an incredible amount of force to break. One also had fractures to both bones in his lower legs. He was transferred to the Role 3 in Kandahar where his left foot was amputated the following day. I spent today taking care of another Afghani who was also a passenger in a pickup truck that hit an IED. His right foot was mangled (an actual Orthopedic diagnosis I found out) and was amputated in our OR. It may seem that we are becoming apathetic towards some of these injuries, but we are not. Many simply seem the same.

The highlight of the week was Thursday, which was the 102nd birthday of the Navy Nurse Corps. The Nurse Corps was established in 1908 with the first women to serve in the Navy known as "The Sacred Twenty". It is tradition to have a cake-cutting ceremony where a chaplain performs a "blessing of the hands" and the most-junior and most-senior nurse cut the cake. This FOB does not have a full-time chaplain, so Doc Z substituted. I had the baker at the dining facility make us a cake and we had a small ceremony. Here is a picture:

Pictured left to right; LCDR John Eckenrode, LT Shannan Cook, LCDR Sue Howell, LCDR Robbie Ladd, LT Shane Lawson


Following the cake-cutting ceremony was another special event - the shaving of LCDR Robbie Ladd's head. In an attempt to raise money for our MWR Fund (Moral, Welfare and Recreation) we had a silent auction to shave Robbie's head. What's the big deal, you ask? Robbie loves his hair. The running gag throughout this deployment was how long it takesRobbie to do his hair and how much "product" he uses in it. The winning bid was $150 from our Orthopedic Surgeon, LCDR Sharese White. She fronted the money and then let the corpsmen do the shaving. They really had fun with it and Robbie was an excellent sport, plus he looks pretty good with a shaved head. Here are some pics from the event.



Sharese turning over the money to Robbie. Check out that 'do. Who wouldn't want to shave it?


Is Zo enjoying that or what?


The Aftermath

I'm publishing this post on the eve of what is the most anticipated day in the John and Judi Eckenrode household - Judi's Birthday. Once again, my birthday was not all that important to me growing up, but for Judi it's quite the opposite. As a matter of fact, not only do we celebrate Judi's birth DAY, but we celebrate Judi's birth MONTH. I'm sad that I won't be able to spend her birthday with her, but she will get to spend it with her entire family and I think they will be able to make it special for her. Hopefully I can spend the day watching reruns of Reno 911! and NOT treating casualties. I was able to send her a gift from the bazaar (it was Cowher's idea). I wanted to get her something big, but she recommended I save it for the Vegas trip and who can argue with that?





HAPPY BIRTHDAY JUDI!!!!

Oh yeah, I almost forgot. 16 May also marks the half-way point for this deployment. What a nice coincidence that it also falls on Judi's birthday.

Take care,

John






Sunday, May 9, 2010

I Was Overcome

Another date that will be forever etched in my mind is Thursday, 6 May 2010. I had just returned from the gym. It was about 1330 when I walked into the FST building expecting to see what I normally see at that time of day, a few folks sitting in the ICU area reading, bullshitting or on the computers. There was no one there, which was odd, but I could hear some voices in the ATLS area (where our trauma patients enter our facility), so I realized we must have received a patient. What I didn’t realize was that I was about to be involved in the care of a patient with the most horrific and devastating injuries our team may ever see. Now, we typically are notified by telephone or radio when patients will be arriving, but in this case there was no “heads-up”. There was a medic on this patient’s team who performed some initial life-saving interventions at the scene and then had him driven directly to us since we were the closest medical facility. He had vital signs (blood pressure and heart beat) until he got to the front gate of the FOB, less than a minute’s drive to the FST.

I walked in just minutes after his arrival, amazed at what I saw. I watched as HM2 Gavin Rampertaap was performing CPR. I watched HM3 Kevin Hines assisting the patient’s breathing with a bag-valve mask through a breathing tube inserted by the medic (I don’t know how he placed the tube; you could barely see where the patient’s mouth was on his face). I watched HM2 Alonzo (I call him Zo) Shields running to the OR to get equipment. I watched HM3 Hasan Hafiz and HN John Hitchcock cutting off the patient’s pants from what was left of his legs – both were mangled. I watched HM2 Patrick Malveda applying a tourniquet to what was left of the patient’s right arm. I watched Doc Z, bald head and all, inserting a large bore IV into a big vein in the patient’s chest so I could start transfusing blood. I watched LCDR Sue Howell documenting everything that was being done to the patient while at the same time trying to get information about the incident from the medic who brought him to us. I watched CDR Charlie Godinez directing the entire team as he pondered his next intervention; which happened to be another emergency thoracotomy (see earlier post Birthday Cakes and Bombs). After all of the above interventions failed to get the patient’s heart to beat again, he was pronounced dead. This resuscitation was different for me. I had a different perspective. Maybe it was because I was only transfusing blood – I don’t know. I kind of stood back and watched the expressions on the other team member’s faces as they worked. It was surreal, like I wasn’t really there.

We decided early on in this mission that we would debrief as a group after every resuscitation – to talk about what we did well, or not-so-well, and to provide “lessons learned” in the event we have a similar patient in the future. Whoever led the trauma resuscitation leads the debrief then proceeds around the room asking for input from every member of the team who was involved. So, CDR Godinez started and when he was through he went around the trauma bay asking for comments; I was somewhere near the middle of the group, but I wasn’t really listening to what anyone was saying. I just kept thinking about the effort those young corpsmen just put into trying to save that man’s life. I’m almost certain none of them ever saw anything so shocking in their lives. Any one of them could have easily thought the situation was too overwhelming for them and just walked out, and everyone else there would have understood. But, they didn’t. They pressed on, without missing a beat. The next thing I know I hear CDR Godinez say my name, but I found myself unable to speak. I was so overcome I was crying – tears and snot running down my face. I simply shook my head side-to-side. I wasn’t crying because a great American just died in front of me with injuries that would make almost anyone else vomit. I was crying because I was overwhelmed with pride; I was proud to be a part of this outstanding team, doing incredible things, under austere conditions, in a fourth-world country. But mostly I was proud of the corpsmen. They are all between 22 and 29 years old. Many are married and most have children. They don’t get paid a lot and the most junior often get some of the worst taskings here, but when the shit hits the fan like it did on this day, you know they are going to be there, doing what they do, and it’s an unbelievable thing to witness. I am honored to know, and get to work with, every one of them!


THE FST NINE

Front Row Left to Right; HN John Hitchcock, HM2 Zo Shields, HM2 Tommy Turtle, HN Anthony Funk
Back Row Left to Right; HM3 Hasan Hafiz, HM2 Gavin Rampertaap, HM2 Shamica Wilson, HM2 Patrick Malveda, HM3 Kevin Hines


One of the greatest bands in America, Live (from Pennsylvania, of course), released a song called "Overcome" that became synonymous with the terrorist attacks of September 11, 2001. It’s been almost 9 years since I first heard that song and I am still overcome. Here is a link to a great performance of that song.

http://www.youtube.com/watch?v=0XzJYjZ6Cio&feature=related

Enjoy!

I usually try to end my posts on a good note, so here goes.

After the debrief I didn’t want anyone to see me crying any more so I went back to my hooch (slang here for living quarters, I didn’t use it at first, but it’s grown on me). Shortly after I sat down there was a knock on my door. My first thought was, Motherfuc$! Who is that? Then I hear LCDR Robbie Ladd, one of our CRNAs, say, “There’s someone here you have to see”. I’m thinking, unless its Judi there can’t possibly be anyone I want to see right now, but he pressed the issue. So, I come out of my hooch and he leads me out the front door of the FST and there in front of me is this beautiful dog. Not just any dog, but an actual working dog – a bomb sniffer – and since she’s a working dog you are allowed to interact with her. Turns out just that afternoon 9 working dogs reported to the FOB. When Robbie saw this one he yelled to her handler and actually chased them down to have him bring the dog back to the FST because he knew I’m a dog-lover and seeing her might cheer me up. Boy was he right. I played with her for nearly half an hour. Her name is Sonya. She’s no Cowher, mind you, but she’s an excellent substitute.



Me and my new best friend on the FOB, Sonya.



Take Care,

John

Tuesday, May 4, 2010

It’s Like Déjà vu All Over Again

Sorry I haven’t blogged in some time, I’ve been lacking inspiration. Every day seems to bleed (no pun intended) into the next. We haven’t had a mass casualty situation since the Osprey crash and probably had more than most year-long deployments with the two that we worked through so far. We continue to receive casualties, mostly Afghans, one and two at a time and they all seem to have the same types of injuries and even look the same with their faces covered with blood. I can’t post the pictures I’ve taken (they are for educating medical personnel when I return to the states), but I was going through them last week and had to start putting special captions on them because I was having trouble distinguishing one casualty from another. It’s getting to be like Groundhog Day, without all the laughs from Bill Murray.

One thing that broke up the monotony last week was a visit from a Navy Psychiatrist. He travels around Afghanistan to assess Navy deployer’s psychological well-being. He’s been researching care for the caregiver for several years and has a lot of experience in this arena. He spent three days at FOB Lagman just walking around the FST engaging folks in casual conversation. Then he provided a short presentation on caregiver stress and had the FST complete a survey. It was eerily similar to Dr Sidney Friedman’s visits on the TV show MASH. His visit didn’t do much for me, I kinda knew what he was up to, but I do think he was helpful for some of our other team members. The biggest thing I took home from his presentation was that, in his experience, medical personnel from small teams like ours will "destroy" each other long before the “bad guys” ever will; and it usually starts to occur around the half-way point of the deployment which is right around the corner for us. I can sort of see it starting, but I think we are too good of a team to let it happen. I know I’ll do my best to not let it happen. One of our goals from the beginning was that everyone, EVERYONE, will cross the finish line together.

Also one of our Surgeons, Dr. Henry “Hank” Zielinski (a proud Pole Judeburger), celebrated his 60th birthday on 29 April. That’s not a misprint, he turned 60! The guy is amazing. Followers of this blog might remember me writing about the days of training we went through at Fort Jackson - much of it wearing that damn IBA, and me complaining about it along with many other things. Well I don’t remember Doc Z, as he’s commonly referred, complaining once…about anything…ever! And he’s freakin’ 60 years old! Oh yeah, and he volunteered for this mission. He really has been an inspiration to everyone on the team. In a show of rebellion against his aging Doc Z decided he was going to shave his head so he could look more like his “hero” John Eckenrode – his words, not mine. When I presented him his birthday card at morning muster that day I, of course, used a Steelers reference. A couple of years ago, it may have been at Media Day for Super Bowl XLIII, I can’t remember exactly, Coach Tomlin was talking about the Steelers’ tight end Heath Miller, #83. A reporter asked him if Miller was the most low-maintenance player on the Steelers team and Coach Tomlin, without missing a beat, replied, “Low-maintenance? He’s no-maintenance.” And that’s Doc Z, no-maintenance. An interesting final note about Doc Z is that he is actually a Knight. He was dubbed Sir Henry Zielinski by The Order of Malta. Here is a link about the order if you are interested:

http://www.orderofmalta.org/site/knights_malta.asp?idlingua=5



Not that he didn’t look great with hair, but how cool does Sir Henry look bald?!?!?!

I got another care package from Judi with some things I needed and, of course, a few surprises. This time she sent a 43 T-shirt and magnet. Below is a pic of me in the shirt. Gotta love her!!! And thanks to Barbie for the Wasabi Soy almonds – love ‘em!

Some of you may not be aware that poor Cowher doggie had some swelling in one of his paws that was causing him to limp. Judi took him to the vet who said he just had some shoulder arthritis and prescribed an anti-inflammatory medicine. He’s much better now.

I want to wish a Happy Mother’s Day to all the mom’s out there, especially Judi and my mother, Ginger. It a Mother’s Day tradition that my family takes Ging to one of her favorite restaurants – Luigi’s in Clymer, PA. Sorry I can’t make it this year, maybe when I get back in September.

Take care,

John



Tuesday, April 20, 2010

Ginger Always Said, “You Are What You Eat”

We had a reasonable week on the FOB this week so I decided to blog about something enjoyable...food! My memories of growing up and the importance of food as it related to my family are not the same as Judi’s. Don’t get me wrong, I have some very fond memories of food as a kid. My favorite is probably my family’s Friday night tradition of my Dad treating his 8 kids to 5 large Delrose pizzas. I have eaten pizza all over the country and to this day the best pizza I remember eating came from Delrose or “Momma Delrosa” as we referred to her. The Moon Hotel is a close second by the way. I also don’t recall eating out much as a kid, maybe that’s because my parents were raising 8 kids, but Judi showed me just how much fun food, and eating out, can be. I only think about the meal I’m eating at the time. Judi, not so much. We’ll be eating breakfast and she’ll be excitedly thinking about, and planning, her lunch and dinner – sometimes even the following day’s meals. Almost everything we do revolves around food. And Cowher is no different. I think if he’s not eating he’s thinking about food and he goes to bed dreaming about what he’s going to eat as soon as he wakes up. I may get credit for picking him out at the Humane Society and for training him, but he is his mommy's boy.

When the FST is not busy with patients it can get pretty dull. So, all you think about is the next meal and you plan your days around them. This is one of the areas where Judi and deployment would actually be simpatico. My non-busy days go something like this:

0530 wake up

0545 gym for 40 minutes of cardio (20 treadmill, 10 elliptical, 10 stairmaster)

0630 back to the FST and check e-mail while I cool down

0700 shower

0720 breakfast – 3 egg omelet with ham, mushrooms and peppers, 3 hard-boiled egg whites, oatmeal, a variety of the fresh fruit pictured below, bottle of water mixed with crystal light raspberry green tea and a cup of coffee

0800 muster at the FST

0815 trauma drill – we do one every day just to stay proficient

0930 go to MWR to check Facebook and yahoo e-mail – 30 minute time limit - sucks, though we are very close to having internets in our rooms

1000 back to FST – eat a South Beat Diet bar, sit around and bullshit, read gossip magazines (thanks Nancy!) wait for 1100 for lunch

1100 lunch – turkey, ham and provolone on wheat bread with pickles put into a Panini maker (rules), a fresh red, orange, yellow, green pepper and tomato salad with honey mustard dressing, broccoli, green beans (no garlic), or corn depending on what they have that day

1130 back to the FST and do the same thing as 1000 wait for workout time

1330 gym to lift, current schedule is one body part per week starting Monday with Chest, Tuesday Back, Wednesday Arms, Thursday Shoulders, Friday Legs

1415 back to FST for another South Beach Diet bar, cashews or almonds, and beef jerky

1430 check work e-mail again, read more gossip mags, turn on TV to watch a repeat of whatever sporting event is being televised on Armed Forces Network (AFN)

1630 MWR again for my 15 minute call to Judi - God I miss her!!!

1700 dinner – depending on the day I usually load up on whatever protein they have (roast turkey, pork, chicken, grilled fish – they serve tons of fish and there is not water anywhere near Afghanistan). Fridays are surf ‘n turf with steak and either lobster tails or king crab legs (yes, I wrote lobster and crab legs and can you believe some people complain about them being overcooked? Really!?!?!). Saturday is my cheat day where I devour whatever cake they make for dessert (pineapple upside down cake is my favorite) with a huge scoop of praline and caramel ice cream that I smother with even more caramel and chopped nuts. I figure my Saturday dinner has about 2,000 calories

1800 shower

1830 back to room to watch a movie or something on the computer

2100 lights out and hope I’m not awakened by a helicopter crash or IED blast

The word around Afghanistan is that the food at FOB Lagman is some of the best in the country. I certainly don’t take full advantage of it. They have a fast food line where they serve cheese steaks, hamburgers, hot sausage, chicken tenders, corn dogs, onion rings, mini pizzas, and stuff like that. Then they have a main course line that serves proteins that I mentioned above plus side dishes like stuffing, mashed potatoes & gravy, steamed veggies. Then you walk up a ramp to another level where they usually have a “theme” night with Mexican, Chinese, or Italian. Sometimes they have a wing night or a curry night; you get the idea. Then they have about 5 or 6 different desserts (not including the ice cream bar and cookie trays). They say, you know “them”, when you return from deployment you either bench 300 pounds or weigh 300pounds – now you can see why. I’m shooting for the 300 pound bench.

Take care,

John

p.s. I would like to go on record as being on board with the Steelers trading 7 to get Sam Bradford. Also, I already have plans to get up on Friday at 0400 to watch the first round of the draft on AFN

The Guys Who Make My Omelet Every Morning



Fruit, Fruit and More Fruit



They Even Cut it Up for Us - Are we Spoiled or What?

Friday, April 9, 2010

Ladies and Gentlemen…Elvis Has Just Entered the Building

I had hopes for a much more upbeat blog this week, but the “gods” of War just aren’t cooperating. Well, it was actually a pretty good week until early Friday morning. We had a few patients each day – nothing overwhelming and nobody died. Then I heard a knock on my door at 0100 Friday. I had just gone back to my room after transferring a patient who suffered a broken foot (he couldn’t get out of the way of a Humvee) when I heard a knock on my door and Cheuk Hong (one of our Trauma Surgeons) yells in, “There was another helo crash, 7 miles from our FOB, and we’re getting anywhere from 6-14 casualties.” I immediately think he’s joking, so I don’t answer. Then he knocks again and yells much louder, “John, did you hear me?” I open the door and see Cheuk dressed in his scrubs with his OR hat and goggles on and I immediately realize by the look on his face that he ain’t kidding. So, I quickly throw on my sweats (going commando btw) and scrub top and try to mentally prepare myself for what I’m about to see…AGAIN! When I get to the trauma area I hear someone outside the door say, “I don’t know how many are coming, but they’re asking for extra fire extinguishers at the site.” My heart immediately sinks in my chest. As bad as it is treating a trauma patient its even worse when they are burned. It’s one of the most nauseating things you can ever experience. Luckily, I won’t have to go into that here because all the casualties were removed from the helo before it caught fire. We then find out that it was an Osprey that crashed. There has been a lot of controversy about the Osprey since its inception into the military arsenal and this crash was not going to help its image (you can Google it for more info).

***WARNING***there is foul language throughout the rest of this Blog.

The first wave of casualties began to arrive and the first guy through the door got my across the room diagnosis of “He’s fucked up!” His left leg was bent in ways it ain’t supposed to bend. Joe Theismann had nothing on this soldier. He also had multiple other fractures and lost a lot of blood. He was the most severe “live” casualty and was taken to the OR shortly after his arrival. The second casualty comes to my bay. He’s a young soldier who would fit right in with the Carrolltown crew. His right foot was bent 90 degrees inward and it was purple. As with any trauma, we proceed to cut his clothes off and his first words to me were, “Get my Copenhagen out of my right thigh pocket. I just got it in the mail yesterday and I don’t want it to get thrown away.” The guy was just in a helo crash, his foot is a mess and all he’s concerned about is his snuff. Can you say Differ Joe? So, we get some pain medicine on board and reduce his dislocated ankle (pull it back into place) and place it in a splint. He’s stable, so I begin my head-to-toe assessment to check for any other injuries. While I’m doing that they bring in another patient – CPR in progress. The young soldier arrives with a tracheotomy in place (a hole cut into the front of his neck so he can breathe) that was done at the scene, blood covering his entire face and head and an Army medic doing chest compressions. My patient turns his head to see who it is and yells, “No fuckin’ way! That’s my best friend, I’ve deployed with him three times! NOOOOO!!!!!” After several minutes of CPR, we can't get his heart to beat again and he is pronounced dead. The guy I’m taking care of just stares up at me and I see a few tears run down the side of his face. What do you say to someone in that situation? I just rubbed the top of his head and said, “Let it out man.” He didn’t. He bucked up like you would expect a soldier to, but I fear for his future psychological well-being. This war is awful!

The night continues at a frantic pace as more casualties arrive. Not long after the first soldier who passed away was taken from the FST another young female was brought into the very same bay - also with CPR in progress – an eerily similar scene that also ended with her not making it out alive. This time, I had a few of the corpsmen stand between my patient and her so he could not see what was going on. We later found out she was a civlian who was recently married with a young child back home. This was not a soldier dying for her country; this was a young civilian with so much to live for. Did I mention this war is awful?

The next patient that I took care of was not as severely injured, but he has a great story. All patients who arrive after suffering a traumatic injury have a rigid collar placed around their neck to protect their cervical spine (to prevent paralysis). I think I mentioned above that all trauma patients also have to have every piece of clothing they are wearing cut off so we can fully assess the extent of their injuries. This also includes jewelry. Well, this patient was wearing a St. Christopher medal around his neck that did not have a clasp so it had to be taken off over the collar around his neck. He was stable, so I and another corpsman tried for a minute or so to get it off, but it kept getting caught on his collar. So Cheuk says (you know Cheuk, the guy who woke me up), “Cut the fuckin’ thing off!” This soldier looks into my eyes and says, “My Grandfather wore this necklace in Korea and my Father wore it in Vietnam, please don’t cut it off.” I immediately looked at Cheuk and said, “We are NOT cutting this off!” And after a little more maneuvering and some help from St. Christopher, we were able to remove it without cutting it off. I wanted to walk out right there and bawl my eyes out, but I couldn’t. There were more patients to take care of.

After a few additional, less severely injured, patients came and went we began to clean up the carnage and transfer our last patient (the first patient who came in and went to the OR). We saved his life. He received so much blood that the blood that is currently keeping him alive is no longer his own. I love this team I'm on!!! I looked at my watch and it was 0800. I knew it was too late to call Judi, but I can’t tell you how much I wanted to. I think, if I can’t talk to my wife I might as well do the next-best thing and certainly what she would do in this situation – eat. So, my new favorite corpsman, HN “Bring in the Noise, Bring in the” Funk brought me back some fresh fruit from the DFAC for breakfast. I still can’t get over the quality of fresh produce we get here. Dave Cymbor would be soooo jealous. My breakfast consisted of the following: two kiwis, some cantaloupe, a granny smith apple, two plums, strawberries, grapes, an orange and some watermelon. When I was done eating I walked around the FST trying to unwind and piece together some of what had just happened. There was no way I was going to try to sleep. Then I went to the gym and did 40 minutes of cardio. Boy did my feet hurt when I was done. After that, I came back and took a shower then went to the MWR (the place where the computers are) to check my e-mail and peruse Facebook to see what new stuff Samantha Rezk posted at 2 o’clock in the morning.

When I was getting ready to leave I looked across the room into the Green Beans coffee shop that shares the same building with the MWR and for some reason I decided to get a cup of coffee. I almost never get coffee from Green Beans, but I felt like it for some strange reason this day. I was the only one there so I decided to strike up a conversation with the guy working behind the counter; which is odd for me because I’m not the “strike up a conversation with a stranger” type. Anyway, it turns out he’s from Kenya and he signed a 2-year contract to come to Afghanistan to make coffee. I asked him his name and his reply floored me when he said “Elvis.” I said, “No way!” then I proceeded to spell it, “E-L-V-I-S? Your parents named you Elvis?! I don’t believe it!” He opens his passport and shows me the picture below. Now for those of you who don’t know it, there’s not a bigger Elvis fan that I know than Judi. I looked back at him and told him I had just had a very difficult night, but he just made my day. Thanks Elvis!

Take Care,

John

Elvis’s Passport Photo



Flags at Half Mast to Honor the Fallen from the Crash
Please Pray For the Families They Left Behind

Friday, April 2, 2010

Birthday Cakes and Bombs

I was going to blog this week about the team’s ingenuity in discovering you can bake a cake in the Operating Room autoclave (medical instrument sterilizer), but too much has happened that I would rather talk about. **WARNING**, there are graphic descriptions of injuries to follow.

Some of you may have heard about the recent helicopter crash that happened very early this past Monday morning. There was even a small story on Yahoo about it. Here is a link:

http://news.yahoo.com/s/ap/20100329/ap_on_re_as/as_afghanistan

When we are not in the FST building we carry radios so that we can be contacted should we get notice about a patient(s). I was awakened at 0100 on Monday with the following call, “Teams 1 and 2 to the FST, 14 patients incoming – 2 urgent surgical, 12 routine”. My room is about 50 feet from the FST so I was the first one there. When I arrived, I asked the duty corpsman what happened and he tells me there was a helicopter crash 6 miles from our FOB. Now I’m thinking, how could there have been a helo crash and only 2 of the casualties are urgent? In my short experience here I have come to realize what is reported to us about the incoming casualties and what actually arrives are usually two different things. So, I’m thinking the worst. About 30 minutes after I got out of bed the casualties began arriving. We only received 13 of those 14; one of the Afghan interpreters came on the helo, but refused treatment claiming he had no injuries. We ended up transferring 4 of them to the Role 3 in Kandahar for further definitive treatment and other studies we were unable to provide at the FST. Everyone on our team was surprised there weren’t more serious injuries other than some closed head injuries and broken bones. They were all very fortunate. The rest of our patients last week were not as lucky.

We had our first death the following day. An ANA soldier suffered a gunshot wound to the head and right shoulder. He came to us with a blood pressure and electrical activity on the ECG monitor, but no pulse. We worked on him for about 30 minutes – even performing an emergency thoracotomy with cardiac massage (cut his chest open and squeezed his heart) in the trauma bay (never a good sign) – but were unable to resuscitate him. When we removed the dressing from his head to assess his wound I saw the worst injury I had EVER seen in 15 years of nursing – the top of his skull was shattered with brain and blood oozing out. I discovered “ever” doesn’t last all that long here. Unfortunately, I witnessed more devastating injuries the following day.

Wednesday, 31 March 2010 was probably the most challenging, and physically and emotionally draining day of my life. Several of our team members were eating lunch at about 1100 when we got a call on the radio about patients coming to the FST. 4 ANA soldiers were injured in an IED blast (Improvised Explosive Device – if you are not familiar, you can Google it, they are heinous instruments of war). We were getting 3 of them; the other was dead on arrival. The three we got suffered various blunt trauma injuries, all with traumatic brain injuries or TBI (a fancy new term for concussions of various degrees). The most seriously injured suffered 5 fractures in his left leg – femur, tibia, fibula, talus and crushed calcaneous – and his right leg had a fractured talus and dislocated ankle. He was in the OR for about 3 hours. This was NOT the injury I mentioned above – I wish it was.

Not long after he came out of the OR the phone rang. There was another IED blast in nearby Qalat. We were going to be getting 4 injured Afghan children – yes, children. 4 boys, brothers and cousins aged 8-14, were herding their sheep when they “tripped” an IED. Two of them were severely injured and unconscious. The other two had only minor injuries – minor for Afghanistan. One of the severely injured boys had multiple shrapnel wounds to all 4 of his extremities and face. The other had traumatic amputations of both arms just below the elbows and his left lower extremity – though not amputated - was mangled. He also had complex facial lacerations and a right eye injury. After a lengthy resuscitation, he was taken to the OR where his arm wounds were cleaned and dressed and his left leg was amputated above the knee. After further examination of his eye, it may not be able to be saved. The two young boys were transferred to the Role 3 in Kandahar at about 1100 p.m. I just went through 12 hours of “somewhat” organized chaos and it seemed like 30 minutes.

I, like most of the rest of the surgical team here with me, thought I had a pretty clear idea of the types of injuries I would encounter during this deployment. I even told Judi that I wasn’t really concerned about the injuries I would probably see – I thought I could handle them. I was more worried about the potential injuries I might suffer. I’m not so sure about that now. One thing I am sure of is that I don’t think the Navy could have selected 20 better, more qualified people for this mission. What I described above does not truly capture the volume and acuity of injured patients we treated this week and our team did it without missing a beat. I was going to post a picture of our group later on in the deployment, but I can’t think of a better time than now. I’ve only known them for a few months, but I learned more about their character in 12 hours on 31 March 2010 than I think I ever will about anyone...EVER.

If you wonder how a person who just went through what I described above unwinds, I can tell you. He picks up his cell phone, walks outside under the stars, calls his beautiful wife and listens to her tell him a funny story about how she tried to outsmart their dog by hiding a baby aspirin in shredded chicken only to get schooled by him when he spit it out onto the floor. It’s that simple. Thanks for being there Judi! I love you!!!

John

p.s. remember, you can click on the photos to enlarge them.

Me with two of the Afghan boys while the other two were in the Operating Room



The NAVY Forward Surgical Team



Front Row Left to Right; HMCS Pietro Martone (Senior Enlisted Leader), HM2 Shamika Wilson (Leading Petty Officer, Surgical Tech), LCDR Chris Coetzee (Orthopedic Physician Assistant), LCDR Robbie Ladd (Nurse Anesthetist), LCDR Sue Howell (Critical Care Nurse), LT Shannan Cook (Perioperative Nurse), HM2 Patrick Malveda (X-Ray Tech), HM2 Tommy Turtle (ER Corpsman), LCDR Sharese White (Orthopedic Surgeon), CDR Charlie Godinez (Trauma Surgeon and OIC).

Back Row Left to Right; LCDR John Eckenrode (ER Nurse), HM3 Kevin Hines (Surgical Tech), HN John Hitchcock (ER Corpsman), HM3 Hasan Hafiz (ER Corpsman), CDR Hank Zielinsky (Trauma Surgeon), LT Shane Lawson (Nurse Anesthetist), HM2 Gavendra Rampertaap (ER Corpsman), CDR Cheuk Hong (Trauma Surgeon),, HM2 Alonzo Shields (Surgical Tech), HN Anthony Funk (ER Corpsman).