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?

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

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).