Surgeon's Journal from Iraq - Part II

Published: Friday, January 7, 2005 at 2:02 p.m.
Last Modified: Friday, January 7, 2005 at 2:02 p.m.

OCTOBER 4, 2004

Four Little Marines

We knew at the hospital tonight to expect casualties as the Army and Marines were cleaning up Samarra, which had been a hotspot of insurgency. In fact, I had seen a briefing on the invasion plan the day before, during my visit to Summerall. Later that night a call came in that the Medevacs were bringing in six marines, four of whom were said to have critical shrapnel injuries to their abdomens.

The hospital mobilized its resources and we were ready with medics, surgeons and nurses. The Medevacs called and said they were 30 minutes out with the Marines, but that two of the healthier ones had been taken to closer facilities.

It is not uncommon to be surprised at what actually shows up with the helicopters. However, this time we couldn't believe it when the helicopters landed and they brought out four boys ages 10-12, who were shepherds near the Syrian border. They had encountered an IED (improvised explosive device).

The kids all had leg injuries but had actually been seen at a local hospital first... The kid I was working on already had an abdominal exploration with a drain out of his abdomen. They did not speak English, and we had no paperwork. I began to get a feeling for what my brother Dan, who is a veterinary surgeon, must have to deal with when his patients can't tell him what is going on.

Because of the severe orthopedic injuries all four boys went to the operating room. Our orthopedic surgeons operated for 16 straight hours trying to salvage their legs. In other parts of the country, they would have had amputations. We re-explored the abdomen on my guy just to identify the extent of his bowel injuries - he had a satisfactory repair of a mid-jejunal injury.

The next morning, our hospital ward had four little guys with stuffed animals in their beds watching DVD's of American movies. It was as if these kids had been through "a time warp". a bunch of young shepherds from two thousand years ago, watching their sheep see an explosion; and the next thing they know they are transported on helicopters to an American Combat Support hospital of the 21st century. Another one of those striking images of the cultural differences we are enmeshed in...

OCTOBER 10, 2004

Out of the Water

My unit is on the move. We are presently in Balad, a huge airbase in central Iraq with 25,000 Americans. We are waiting for a plane to take us to our new destination, way out in the boonies, so to speak. We are supposed to set up our portable hospital at a base where there are apparently only 250 soldiers.

Yesterday, we spent the whole day pressure washing our trucks and trailers removing mud and grime (so the Air Force will allow us to put them on their planes).

I am taking advantage of pseudo-civilization while I can. This Balad is a lot different than the first Balad I encountered where we spent the whole Dr. Beaver in Afghanistan Young Iraqui shepherd wounded by an IED - improvised explosive device day at the dusty airstrip in 110-120 degree heat. The base has a beautiful gym (like a Bally's fitness Center) with a racquetball court and complete set of gym equipment. There is also a movie theater showing free movies three times a day. You have to clear your weapon before you go inside, just like at the dining halls. I have gone to a couple of movies, where the best part is at the beginning when The Star Spangled Banner is played - the entire theater jumps to their feet in attention. very patriotic and moving in a way.

Both movies I have gone to have been interrupted by mortars, which is OK since it is a shelter. It turns out that Balad is the most frequently attacked base in Iraq. It has happened every day I have been here. The perimeter fence line is surrounded by vegetation and also a major highway, which allows the attackers to escape. Last night we had to spend two hours indoors while the troops took care of a rocket threat. With all the alerts, I have to say I have never heard or felt a mortar here in Balad. This is unlike Tikrit, where I heard and felt most everyone, including the last day when a rocket landed at the end of our street. I was fine with leaving at that point. Every morning in Tikrit at 9 a.m., our guys would dispose of unexploded, recovered ordinance. After awhile it got to the point where the first thing we'd do when we heard an explosion was to look at our watches to see if it was 9 a.m. . the second thing would be to grab our flak vests if it wasn't.

Balad also has an Olympic size out-door pool. It had been a long three months in the desert, so two days ago we all went down for a swim to beat the heat. We were hanging out swimming, watching the scenery when an announcement came out: "Everyone out of the Pool for alert status RED". (another mortar attack). So we got out of the pool and waited in the bunker for about 30 minutes, then at the "all clear" we came back to the pool. It was as if we were at the beach and had to get out of the water because a lifeguard saw a shark. another one of those surreal experiences over here.

OCTOBER 14, 2004

Greetings from Afghanistan!

Our unit has moved to Afghanistan... We were sent to here to help out after the elections. We are in Bagram in the high plains of eastern Afghanistan. The snow-capped peaks in the background remind me of Denver or Salt Lake City...

We just arrived here, and our replacements are on the way... We will see if everything runs smoothly and we can change airline seats with the new guys and fly home - I kind of doubt it...

I really just got in. One thing is the air is fresh and clean mountain air, not the blowing silt-loam dust of Iraq. There is also a real coalition here on this base. As I walked to breakfast this a.m., I encountered armed forces from Korea, New Zealand, United Kingdom and Slovakia. My partner PJ said it was like that bar from Star Wars with all the different uniforms... It was weird being saluted by people from other countries...

They say it is safer here with the exception of land mines, which are around the base. But they are marked clearly near the hospital. I am anxious to get home, just hoping the travel arrangements fall into place.

OCTOBER 19, 2004

Bagram - Landmines

We are still waiting to be flown to our bases in the countryside, so we had a little time to walk around the perimeter road. We saw engineers on each side of the base actively getting rid of land mines. One of the ordinance guys said that occasionally the locals, even kids, would find mines and "hand them over the fence".. The ER here saw four victims this week losing limbs and eye-sight from land mines, mostly unfortunate local nationals. Afghanistan, I am told, became the most heavily mined country in the world as the Soviets desperately tried to maintain their grip before leaving.

To clean up the base they have bull-dozers with chains in front of them and smaller remote controlled bulldozers as well. On the other side of the base, they had dog teams that are trained to be quiet and sit near the mine. the spot is confirmed with another dog then a metal detector is brought in. Very slow going, about 1,500 square feet a day per dog, I believe is what I heard. The fields are huge so it is going to be awhile.

OCTOBER 22, 2004


We took a Chinook helicopter ride out to Asalabad (Abad), Afghanistan. The Americans have a base here in Southeastern, Afghanistan that is so close to the Pakistan border that I can see it from my tent door. It is here the hunt for Osama goes on (among many other places).

The ride out was enjoyable as we followed the river valley below. We had an Apache helicopter escort on the way there. Down below we could see locals plowing fields with oxen. It appeared they were harvesting wheat, corn, and sugarcane. In the desert areas, families in tents were visible, tending herds of sheep. As we came into the landing zone the Chinooks did a "hot landing" and basically pushed all our gear out the back as they did not want to be on the landing zone more than 15 minutes. Last week a rocket was sent into the landing area that caught some jet fuel on fire.

On arrival, we set up our portable hospital, and that afternoon we had our first patient - an 8-year-old boy who lost his left thumb and forefinger in a shotgun accident. The Special Forces have set up a clinic/aid station that is manned by a Special Forces physician assistant and his medics. When the base gets rocketed or mortared - they shut down the clinic.

Lots of local nationals are treated, and importantly, local doctors are involved in their care. As in the Peace Corps, it seems they are teaching the locals how to fish and not just handing out fish.

The Afghans I have met have been very friendly. The relationship with the locals is good. I have had more interaction with locals here in just a few days then during my entire time in Iraq. I think we should try these methods in Iraq. Of course, it is not that easy with the security situation in Iraq. You never know which vehicle near your convoy could be a suicide bomber.

On the Iraq convoys I have been on, we raced through the traffic and ran Iraqi vehicles off the road or pointed our weapons at them if they got too close. In Tikrit, I have only seen locals picking up trash under armed guards. At the hospital in Iraq, we were also only treating Americans, the Iraqi Army, and those we had injured. I am sure resentment could be building up. With the security situation there, it is hard to know which is the chicken or egg. I think we need to try something different or it will only get worse.

Our base in Afghanistan is located in a valley. The base reminds me of the foothills of Colorado as you drive into the mountains on I-70, with scrub brush and hills that get progressively larger up to the mountains. We took a hike up to an outpost called "Bull Run", about a mile from camp.

There were some Florida National Guard members up there on the top of a peak providing perimeter security. The guys, in their early twenties, were from West Palm, Orlando, and Melbourne. They have the occasional rocket attack and called in some artillery support last night that quieted things down.

During our hike up, we saw some locals bringing water and MREs to the outpost on mules. The view from on top is fabulous and you can see for miles. The stream below seems like it would be good for fly-fishing. George, an ICU nurse, and I picked out some bowls and hills that we thought would make a nice ski resort.

Last night it was almost a full moon as dusk arrived early with the mountaintops shielding the sun. Under the moonlight, I stood outside my tent listening to the Islamic call to prayers echo through the valley. Asalabad could be a popular tourist destination - if it were not for the land mines and Al Queda.

OCTOBER 29, 2004

Shagall Valley

The Khona River dissects through the hills of Southern Afghanistan; its many years of cutting through rock has created canyon-like walls in places. Multiple terraces scale up the mountainside from the river, with little rocky plots of land growing wheat, corn, sugarcane and in some places, opium. Villages dot the river valley with walled compounds and castle-like fortresses with watchtowers to guard against the countless invaders that have passed through the valley. In some places I doubt things have changed in literally millennia as I saw oxen working fields and donkeys carrying goods to market; however, small tractors and Toyota pickup trucks are starting to show up to help with the farming.

For years, the Shagall valley, a tributary to the Khona River, has been unfriendly to American visitors. Indeed the most recent roadside bombs in our province were traced back to this valley. Not long ago an American patrol was ambushed in a narrow pass up one of the valley tributaries. Because of this, the U.S. Marines were currently doing a sweep of the area, looking for a fight with the local bad guys, which they would find a few nights later.

At the same time, the civil affairs team wanted to show America was here to help; so they scheduled a 2-day medical mission into the valley. The mission had multiple facets, showing an Afghan face by using local police and the new Afghan Army. The Afghan army has embedded American trainers that travel with them and advise them. State department representatives also met with local elders to assess the political situation and get a handle on the opium trade in the area.

The first day the medical mission was held in the local police station with one room for men and another for the burkha-clad women and their children. We saw hundreds of patients and there was little time for thorough exams and histories. For the most part, anti-inflammatories were dispensed for musculoskeletal complaints, along with vitamins. Sinus and ear infections and amoebic dysentery were treated with antibiotics; and multiple children were given deworming medication.

At the conclusion of the first day, we moved to set up camp in the valley. Gun trucks were placed around the perimeter with guards. We knew the Marines were stirring up a hornet's nest 5 kilometers away and that we would be a softer target. Afghan soldiers were then placed on the outer perimeter and with scouts on the hilltops.

That evening we shared lamb and pita bread with the Afghan army. It is Ramadan now, so the locals and Afghan Army were fasting throughout the day. They were singing with laughter when the meal was brought out. That night, we slept next to the vehicles under the stars.

The following morning we set up our clinic from the back of our Humvees in an open field. A large crowd had formed with many walking miles to be seen. Unfortunately, we ran out of medicines; and we had to send a hundred or so people away empty-handed. Despite that fact, the mission was deemed successful, as this was one of the first times Americans were able to stay in the valley.

That afternoon I returned to the base to find my replacement had arrived - and that I could go home. The Marines, however, had decided to stay an additional day and were attacked from both sides the following night. I had found this out, as it was with these same Marines with whom I able to catch a Helicopter ride out of Asadabad to start my journey home.

OCTOBER 30, 2004

Flight Home.

We jumped on the helicopter full of marines flying to Bagram and a few hours later we caught a "redeye" Air Force flight to Ramstein Germany.

The next morning on arrival, there was a rainbow to welcome us back to the civilized world. The Army met us as we got off the plane; and went out of its way to get us on an American Airlines flight to El Paso just a few hours later.

Here's a short plug for American Airlines - they were very patriotic; they gave us a round of applause, free drinks and upgraded us to First Class on the Chicago to El Paso leg. Passengers along the way came up to us and thanked us for our service. I cannot imagine how it was for the guys coming back from Vietnam.

While we were waiting in Chicago, an American Airlines representative started talking to us in the O'Hare lobby, then took us to the business suite and set us up with free internet. All the employees along the way were extremely courteous and helpful with our baggage and customs. Now all I need to do is "out process" and fly back to Florida - hopefully on American Airlines.

I would like to thank everyone again for their support and prayers along the way. Please remember the thousands of ordinary Americans, just like you and me, who continue to serve our country.

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