Monday 22FEB10

Sorry it's been so long since my last post. I've been waiting for something interesting to happen. Well it finally has. This patient is a 25 year old Afghani female (we're guessing because she did not know how old she was). Last July she was hit in the belly by either a bullet or shrapnel. She had damage to her colon. So, a laparotomy was done, and to make a long story short, she ended up with a colostomy bag. Two weeks ago she came to the ANA hospital to get it reversed. The ANA general surgeon did not want to do the procedure. I'll leave the answer to the why out of the story. Anyway...we we're able to get her transported to the Role II hospital run by Spain, at Camp Arena (about 5 miles from here). Camp Arena has many countries taking part in this mission. Some of the folks I met were from Albania, Lithuania, Spain, Italy and Bulgaria. A very small US contingent is present. A Bulgarian surgical team took care of her. I was able to able to make arrangements with Colonel Paulino (US Army nurse) and the Bulgarian Surgeon to visit Role II and be with her during the procedure.  She basically became my patient while at Camp Zafar.

Anyway...picture 1) The Surgeon (left), his assistant (middle) and the nurse (right). Very good team. The surgeon knew more English than I knew Bulgarian...so we chose to communicate using English. It was broken...but good enough.

Picture 2) This is the entrance to Role II hospital...nothing to write home about, (what?) but I thought you might like to see where I went. The entrance does not do the hospital justice...it's actually a very nice place...I was impressed, and actually wouldn't mind spending more time there.

Picture 3) This is the reanastamosis in action. In the surgeon's left forcep is the proximal colon. In his right forcep is the distal end. The posterior, or "back" side of the colon has already been sewn together, and the anterior, or "front" side will be next. They didn't wait for you to read this...it's already done.

She is recovering nicely and will now be able to poop in the normal fashion :)

Mike

Having a bad day?

I had more pictures to post, but my connection is so slow today that this is the only one that took. Anyway, This poor guy is a member of the ANP. About a week ago, there were 5 ANP involved in a gunfight... with each other.  It happened about a mile from here and apparently you could see the tracers flying over camp stone. I don't know, I was sleeping. So the story is (I can't confirm it) 4 of the ANP tried to "have their way" with this guy. He didn't like the idea of that so he started shooting at them. When he was done shooting, he sped away and slammed into a road barrier and now has MAJOR head trauma. Of the other four, one is dead, two are doing well and are on a regular ward, and one is in the ICU right across from this guy. Essentially, this guy is also dead. The only thing keeping him alive is the vent. His pupils are fixed and dilated, his brain is exposed (see above). Today, Doc and I talked with the ANA docs about shutting down the vent. None of them wanted to be responsible for turning it off, because that would be killing him. They said they will have a meeting to discuss it. I said I would do it. Then the discussion (b/t me and Doc) turned into if one of us did it, they could say an American killed an ANP. So...we decided against that. We will leave the decision up to them. We're not gonna do it.
Mike

Super Bowl Monday???

We got the day off today for Super Bowl Monday. That's right...Kickoff was at 0400. Almost the entire JMOC crew showed up. We had all sorts of "football food" wings, pizza, smoked salmon (thanks wendy).  Still no beer though. A couple of folks used the day off for some much deserved Sleepin in. Those of us that got up, walked to to the JMOC in our first snow of the year. It is really cold out, but none of the snow stuck. After the game, it was so clear out that I went to the "tower" towards the middle of camp for some pics. They are from each direction. The top picture is East. Iran is just over those mountains. About an hour drive. The second picture is facing south. The orange building is the "house" right next to mine. BTW...it's still available in July. The third picture is facing West. Behind those buildings is Camp Zafar...the ANA base (where I work). The fourth picture is out of order but oh well...Those are called "onab" they come from the onab tree. They are a type of fruit that I have never had before. They are really chewy, and sort of taste like a cross between a fig and a raisin. I put the battery in the picture as a reference for size. Apparently they are not in Herat, They came from Farrah, a district south of here. They were a gift to me from an ANA soldier that I helped take care. He was the one with the bullet in his ankle. The fourth and fifth picture are North and Northeast. Just wanted you to see the mountains back there. If you click on the individual pics, they enlarge, and you'll get a better view. Have a great day and congrats to the N.O. Saints
Mike

Adding some beauty to my blog

Looking back over some of my past few blogs...I see that they have been a little less than positive. I apologize. So I thought I'd switch things up a little this morning and show you my beautiful family. These pics were taken on the morning I left for Afghanistan. Have a great day.

UGH

Haven't been in the greatest of moods the past couple of days....work has been tiresome and frustrating. It's better to just say hi and end the post before I bore you with Afghanicrap. Please see my friends post at:  docnthedirt.blogspot.com     he's got some new stuff up.

mike

Scenes from "ou there"

So this morning, instead of going to the hospital, I decided to go to one of the Kandaks (ANA battalion) with SGT Micham and SGT Drella. The are two Army medics with the JMOC team. Today was graduation for twelve ANA infantry soldiers who just completed CLS (combat lifesaver course). SGT's Micham and Drella were the teachers of this class. I have to give them props because they did an outstanding job. Refreshments followed the ceremony and the ANA soldiers were very proud of themselves. Afterward, we decided to do a little off roading. We drove out the back gate to see what was "out there". As you can see...not much!

Two ways to get hurt

The first picture is the foot of an ANA soldier who got shot in the foot during a fight with the Taliban. Believe it or not...this debreidment took place under local anesthesia. The second picture shows you what I found in the GARBAGE in the ER. Every day, I stress the importance of using the sharps containers. When I walked into the ER and started going through the garbage, the nurses and medics scattered like roaches when the lights get turned on. They know its wrong, and still continue to do it. I had yet another talk with the senior ER nurse, he continues to blame the night shift...whatever...I am determined to fix this problem. Next step is to bring in the CO...he scares the crap out of people. Maybe that's the solution.

For Rent

7' x 9' Condo in lovely Herat, Afghanistan. Cable ready with 10 channels (5 come in pretty good). Wireless internet for $80/ month, and you can leave your landscaping headaches behind. Spacious closet over the bed. Built in dresser on the wall over elegant office desk. Kitchen is near the built in corner armwoir. Loads of storage space under the brilliantly elevated bed. It's 4' high. The master bath is huge and comes with 2 sitters, 1 stander, 3 showers and 2 sinks. As you can see, I have two artists that I have commissioned to decorate the place, but I need more art. I guess they did some for me, but their work got left behind somewhere during their travels. The art and artists DO NOT come with lease. Heavily gated and armed security. Access to freeway a little difficult, but plenty of helicopters to get you around. Available in July. These condo's are in high demand, so act fast.

never stand behind your buddy when he pulls the RPG trigger

This young man is a member of the ANP (Afghani National Police). He came to us sometime yesterday. He has Severe burns to his right hand and face (as you can see). His patrol came under an ambush by the Taliban. When they returned fire, he was standing behind a Rocket Propelled Grenade launcher (RPG) when the trigger was pulled. With an RPG, everything (except the grenade) comes out the back of the weapon. He is actually very lucky. He is breathing on his own, and is in good spirits. When I asked permission to take his picture he smiled. I told him he could close his eyes if he wanted. He didn't want to. Our other admission was a young ANA soldier who was the only survivor of seven. His crew also came under Taliban attack. I felt that taking his picture would have been very inappropriate. I don't want it to sound like the Taliban are doing well...they're not. The ANA and ANP do a very good job. There is always collateral damage though. Welcome to Monday...It's actually Saturday here, but it's their Monday as far as the work week goes. Something to make you wonder....Yesterday was Jumma The Afghani day of prayer. Apparently the Minister of Agriculture asked the Nation to pray for rain. There hasn't been any rain in a long time... It has been raining ALL day...coincidence??  Whatever, it's a day without dust!     Mike

What's wrong with these pictures?

Greetings from the ANA OR. I'm actually in my room posting this now, but these pictures were taken in the OR this morning. In the picture you see a stone. It is a little bigger than a golf ball, and a little heavier as well. It is very rough in texture. It sort of feels like a hedge apple, but a little sharper. It is very dense. The problem is...it came out of the pt's BLADDER. The pt. presented with urinary retention and a feeling of heaviness in his bladder...you think???. I personally, in 19 years in the OR, have never seen this before. The second picture was taken right as they pulled it out. In the third picture... Notice the Doc in the white lab coat? What is he doing? He's not "scrubbed in". He was so interested that he just walked in...grabbed an instrument (not sterile, they used it for the prep) and started poking around. I about had a stroke...and they all laughed at my reaction. Apparently...this is acceptable. I said we will talk about in our class on Sunday.

pics on friends blog

hey all,

things are picking up at the hospital. I don't know if it's due to the warm weather or what. last night we got two ANA soldiers in with severe burns. For some reason the ANA doc's like to do wound debriedment at the bedside. Brian and I just sort of shake our heads. We have to remember that we're here as mentors...they don't have to listen to us. Our multiple leg fx has turned into a disaster. He is so infected, that we recommended taking the leg, because he'll probably die from sepsis if they don't. I don't know why they are hesitant. They did bedside debriedment on him also. If you visit docnthedirt.blogspot.com he has some really good pics posted of what we are dealing with. I should remember to bring my camera to work. Another peculiar thing happening at the hospital...the staff has finally received their weapons. They didn't get ammo though, so now they are asking us if they can "borrow some bullets". Don't worry, we don't "borrow" our bullets to anyone! Have a good day, I'll try to get some pics up soon.
Mike

really???

Hey all,
I was talking to my wife earlier today, and she mentioned that I needed to update my blog. Sure enough...I do. I didn't realize it has been so long since my last entry. That could be a good thing because it would mean time is flying by. Unfortunately, that's not the case. Nothing really very interesting has been happening around here. The majority of my patients are still guys getting in the way of unlicensed, crazy drivers, and guys that still haven't figured out that it's better to unload your weapon before cleaning it. Getting the ANA to order supplies before they run out is always fun too. On a different note (sort of)... We had a ANA General come from Kabul to speak to his medical (troops) this morning. It was about public health, personal hygiene etc... He was able to stretch this lecture out for 2 hours and 45 min. Funny thing is...25 min into the lecture, my terp leaned over to me and said, " I have a flight to catch". I was like...WHAT? He got up and left. So I sat through the rest of the lecture (in Dari)...WITH NO TERP!!! Holy cow that was fun. So...I went to the terp office to get another terp...well, let's make a long story short...because quite frankly it scares the crap out of me.. Apparently, in some sort of way, he has connections with the Taliban, and is not "a good guy". Needless to say...he's no longer my terp. I should get a new one tomorrow. 3rd time's a charm...right???
On a positive note...I'm very proud of my OR crew...They are doing an excellent job, and taking pride in their  work.  BTW...who is bustedputt?

starting out with a bang (literally)

If i haven't already said it...Happy new year. Today was our first full day back at work following the holidays. We had a staff meeting before going to the hospital at Camp Zafar. So, we're sitting in the meeting and find out that ALL of out interpreters are being replaced today. Apparently there were some issues with the terps and the staff that we relieved. I know some of the issues but will spare you the details. It is difficult to start over with a new terp. Building a relationship is hard enough to do, but when you don't know or trust (yet) makes for a difficult day. But...my guy seems to be pretty much on the good side. He has been down range terping for the guys in the field, and says he likes it here because there is less chance of getting shot or hotting an IED. He has been in two IED attacks, and likes the safety of the hospital. However, when we left the hospital, there was a huge blast outside of the front gate...none of us really know what happened, but our sirens never sounded, so apparently nothing bad. We got four more patients over the last two days. 1 gsw, and 3 guys busted up (that's a medical term) really bad from getting hit by cars. Maybe one of our missions over here should be teaching the Afghani people how to drive without mowing over pedestrians. En Shallah...

Merry Christmas and Happy New Year from the Joint Medical Operations Cell Herat, Afghanistan