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Monday, March 29, 2010

The Sopranos 29 march at 2106

Ya'll are just going to have to figure out military time.  Trying to post AM and PM is killing me.

So today we had another event besides the President snubbing the hospital staff.  Some of the Sopranos came and some football player as well.  James Gandolfini was there, some lady no-showed, and the dude who plays Paulie was there.  Also some football player I have never heard of.  Gandolfini- looks like his picture.  Football guy- very nice for the few moments we talked after some idiot made a tall joke. 
Paulie- he was an @$$.  We had to stand in the greeting line while they came through and he got to me, LOOKED ME UP AND DOWN and ACTUALLY PINCHED MY CHEEK! and said something like, "wow, I need a good nurse."  I think I mustered a thin smile when I told him he'd have to find someone else since I'm not a nurse.  He moved on.  After that, he proceeded to joke with the women, putting his hands all over and his arm around our head nurse who is a no-nonsense woman in her 50s and I could see right through her smiling and humoring him and I thought she might punch him out at one point. 

He was able to get a minor procedure done by one of my family docs and he came out saying something about having to take his pants down.  Three times he said it.  He didn't have to take his pants down........

It just reinforced for me why I  don't get star struck.  Well, hardly ever....  I think I could love a visit from Robin Williams, Steven King, or Katherine Hepburn (well, I guess that one won't happen).  OK, and maybe The Rock.  He wouldn't even have to talk to me- he could just stand there and look pretty.

But the best part was I got to see my friend Col (Dr.) Lew Hofmann!  He was the doc traveling with the team.  He is one of the best FPs and one of the most humble people I know.  His claim to fame is that he was one of my faculty in residency.  And he was my doctor for the first 3 months of my pregnancy with James.  And he is an accupuncturist who trained with the guy who pioneered Air Force accupuncture.  Oh yeah- he's the reason Dick Cheney is still alive, as he was the VP's personal physician for 8 years.  We had a great time catching up again (I saw him in Feb) and he took the time to talk with my doc who took care of Paulie since she is interested in accupuncture as well.  And........  I trained her when she was a student.  So there we were, three generations of FPs chatting there in the hallway.  I told her whatever I taught her wrong was all his fault!

Anyhow, it was a pain in the butt having to follow stars around, but I'm glad I got to see my friend Lew all the way across the world.

A Midnight visit 29 Marchat 0530

A couple of days ago, we were notified that there was to be a high level Afghan Official coming to visit and we needed to provide a crowd of a few thousand. In the military, we call that a Rent-A Crowd. I needed to get up a Rent-A-Crowd for Hillary Clinton in Japan once- it was a challenge. Sometimes, we get volunteers, other times, we just have to tell people to go. Not sure if we had any difficulty with this one, but it was scheduled for last night at about 1130PM. I thought that was an odd time, but I figured, it’s their country. I suppose they can send an official whatever time they want. I also thought it might have something to do with security since we were also not allowed to bring any weapons with us, not even the knives that most of carry for personal protection. I thought that was weird as well, because we are all required to be armed at all times and face severe disciplinary action if we aren’t. But again, I figured, it’s their country. Then we were due to have a Purple Heart ceremony last night at about 7PM. They usually occur between 6 and 7PM because that’s when the Generals are free to come over and do it. Then that got cancelled at the last minute. Word was that the President was coming and he might want to do them. Turns out, he was the “Afghan official” the Rent-A-Crowd was for.

I stayed at work until about 830PM, and did not hear anything else about the visit. Then I went back to my room and did some work on the computer. I turned the lights out at about 1030PM and left my contacts in, figuring I’d get woken up in about an hour to come to the hospital for the Rent-A-Crowd that was sure to be needed there if the President were coming. I was awakened at 0230 by my pager telling me a rocket had just been launched over the F-15s. I got dressed and put on my IBA, helmet and weapon and then went in to work. This is where it gets interesting.

Apparently, it was not such a big secret that the President was here. It was all over CNN, live, while he was doing his speech to the troops. Then he came over to the hospital. He was met by the top leadership and then all but the commander were dismissed. Secret Service made everyone who was not actually needed to work with patients leave. Some doctors really wanted to see him, so they crowded around the doctor’s work room and other places, trying to take pictures and then were told by the Secret Service to leave there. One got very angry because he thought he deserved to be greeted by the President for all the hard work he had done here.
The President went to the ICU and saw a soldier who was doing relatively well and did the Purple Heart Ceremony. Then he went where the sickest wounded are. There he spoke briefly with a soldier, then turned to leave and had to be reminded that he had not given him his Purple Heart. So he did. There was one other soldier there that was due to be decorated. He was a high double amputee with a large abdominal wound that had packing in it- basically an unconscious torso with a severe abdominal wound. The President apparently looked very uncomfortable, but he went over to that soldier and pinned a Purple Heart on him as well, and he said some words to him, even though he was unconscious. I’m told that he seemed uneasy the entire time he was on the ward.

Then he left.


Sometime around his take-off, the rocket was launched and landed near the F-15s. I’m not sure where that was in relation to where Air Force One was at the time.

Saturday, March 27, 2010

Avalanche 8 Feb

This was a huge deal.  It shows how fast our hospital can expand.  Real article is here and it's also summarized below.  the pictures are in the real article at the link:
http://www.af.mil/news/story_print.asp?id=123190048

Master Sgt. Jan Fink holds a young avalanche survivor who was medically evacuated Feb. 9, 2010, to Craig Joint Theater Hospital at Bagram Airfield, Afghanistan. Dozens of Afghans were taken to Bagram Airfield after avalanches struck a mountain pass in the Parwan Province. Sergeant Fink is assigned to the 455th Expeditionary Medical Group. (U.S. Air Force photo by/Tech. Sgt. Jeromy K. Cross)

Afghan Dr. Abdul Rasheed and Senior Airmen Katrevious Swift talk with an avalanche survivor Feb. 9, 2010, at Craig Joint Theater Hospital at Bagram Airfield, Afghanistan. Dozens of Afghans were taken to Bagram Airfield after avalanches struck a mountain pass in the Parwan Province. Airman Swift is assigned to the 455th Expeditionary Medical Group, (U.S. Air Force photo by/ Tech. Sgt. Jeromy K. Cross)

Afghan doctors Shekib Hassanzada (left) and Abdul Hashim and Senior Airman Katrevious Swift discuss avalanche survivors? assessments at Craig Joint Theater Hospital at Bagram Airfield, Afghanistan. Dozens of Afghans were taken to Bagram Airfield after avalanches struck a mountain pass in the Parwan Province. Airman Swift is assigned to the 455th Expeditionary Medical Group. (U.S. Air Force photo by/Tech. Sgt. Jeromy K. Cross)

Master Sgt. Jan Fink assesses an avalanche survivor's wrist Feb. 9, 2010, at Craig Joint Theater Hospital at Bagram Airfield, Afghanistan. Dozens of Afghans were taken to Bagram Airfield after avalanches struck a mountain pass in the Parwan Province. Sergeant Fink is assigned to the 455th Expeditionary Medical Group. (U.S. Air Force photo by/Tech. Sgt. Jeromy K. Cross)

Afghan doctors along with Airmen from the 455th Expeditionary Medical Group assess avalanche survivors who were medically evacuated to Craig Joint Theater Hospital Feb. 9, 2010, at Bagram Airfield, Afghanistan. Dozens of Afghans were taken to Bagram Airfield after avalanches struck a mountain pass in the Parwan Province. (U.S. Air Force photo by/Tech. Sgt. Jeromy K. Cross)


Chaplain (Capt.) Peter Ma talks with avalanche survivors who were medically evacuated to Craig Joint Theater Hospital Feb. 9, 2010, at Bagram Airfield, Afghanistan. Dozens of Afghans were taken to Bagram Airfield after avalanches struck a mountain pass in the Parwan Province. (U.S. Air Force photo by/Tech. Sgt. Jeromy K. Cross)

Master Sgt. Jan Fink assesses an avalanche survivor's wrist Feb. 9, 2010, at Craig Joint Theater Hospital at Bagram Airfield, Afghanistan. Dozens of Afghans were taken to Bagram Airfield after avalanches struck a mountain pass in the Parwan Province. Sergeant Fink is assigned to the 455th Expeditionary Medical Group. (U.S. Air Force photo by/Tech. Sgt. Jeromy K. Cross)

Airmen from the 455th Expeditionary Medical Group work in the emergency room to save avalanche victims who were medically evacuated Feb. 9, 2010, to Craig Joint Theater Hospital at Bagram Airfield, Afghanistan. Dozens of Afghans were taken to Bagram Airfield after avalanches struck a mountain pass in the Parwan Province. (U.S. Air Force photo by/Tech. Sgt. Jeromy K. Cross)

Airmen from the 455th Expeditionary Medical Group work in the emergency room to save avalanche victims who were medically evacuated Feb. 9, 2010, to Craig Joint Theater Hospital at Bagram Airfield, Afghanistan. Dozens of Afghans were taken to Bagram Airfield after avalanches struck a mountain pass in the Parwan Province. (U.S. Air Force photo by/Tech. Sgt. Jeromy K. Cross)

Medical teams render assistance after Afghanistan avalanches

by Staff Sgt. Richard Williams

455th Air Expeditionary Wing Public Affairs

2/10/2010 - BAGRAM AIRFIELD, Afghanistan (AFNS) -- A series of avalanches struck a high pass in the Parwan Province of Afghanistan that have reportedly killed or injured hundreds of Afghan travelers. The avalanches, which occurred Feb. 8 and 9th, cut off a major route between Kabul and northern Afghanistan.

Afghan doctors and coalition members of Task Force Medical East, 82nd Airborne, 30th Medical Command and the 455th Expeditionary Medical Group along with volunteers from across Bagram Airfield sprang into action, rendering medical care and assistance.

The initial call was received by the TF MED-East Tactical Operations Center at 3:28 a.m. notifying staff members there of the avalanche. At the time, approximately 150 people were trapped with helicopter evacuation as the only means of exit, according to Army 1st Sgt. Brian Fassler from TF MED-East.

By 12:50 p.m., 60 to 70 patients were inbound to Bagram Airfield.

The hospital staff began to prepare for a possible mass casualty situation, and within 45 minutes Craig Joint Theater Hospital here went from a 41-bed facility to a more than 100-bed facility, equipped and ready to receive patients.

Staff members at Craig Hospital, the primary military medical treatment facility for the entire country, prepared for surge operations that required a quick reaction force to implement proper security measures for the hospital and to prepare additional assistance areas for a mass influx of patients, said Capt. James McDaniel, the 455th EMDG/TF-MED medical readiness officer.

To assess care needs and ensure the hospital was not flooded with a large number of minimal-care patients, Soldiers from the 82nd Airborne and 30th MEDCOM set up a triage unit at the airfield's passenger terminal.

Sergeant Fassler explained that once initial assessments were made, individuals requiring medical attention were loaded onto busses and transported to the hospital. Remaining individuals were transported to an area where they received further assistance from coalition staff members.

Sergeant Fassler pointed out that normally with a battlefield injury the patient comes directly from the field to the medical facility.

"We perform various battle drills that prepare us for these types of situations," he said. "This is unique because we are receiving patients from an event that happened seven hours ago and they will be clinically cold and some have varying phases of hypothermia and frostbite so this is a complete non-battlefield-related injury situation."

Sergeant Fassler added that the highly trained staff at the medical facility is prepared to receive as many patients as are sent, and the real challenge is getting the patients from a remote location with avalanche covered roads and no clear places to land helicopters.

In addition to the Craig Hospital staff, medical and nonmedical volunteers flooded the area to assist with patient care, litter carry, security and a host of other duties.

Captain McDaniel pointed out that there was a group of Afghan medical professionals who were vital to assisting the injured.

Local Afghan doctors with varying backgrounds, from internal medicine to an orthopedic surgeon, happened to be participating in a trauma mentorship program at the hospital and jumped in to provide care to many of the patients.

"This experience is important so they can see how we prepare for medical emergencies of this magnitude," Captain McDaniel said.

He also explained the importance of the Afghan medical professionals as interpreters and liaisons to the patients in a cultural capacity.

"For some of the patients coming from remote areas of Afghanistan, this may be their first and only interaction with coalition forces," the captain said. "The importance lies in the fact that we are professional and sensitive to their cultural needs. The assistance we receive from the Afghans helps to convey the respect and professionalism these people need and deserve."

The Afghan providers played a vital role in providing medical care to their own people. It was evident the local-national patients were more comfortable being treated by their fellow countrymen.

"We have had doctors and medics from all over the post coming to assist, and that is important because this was a Bagram Airfield-wide emergency not just a Craig Joint Hospital issue," Sergeant Fassler said.
Army Lt. Col. Joe Marsiglia, the TF MED-East tactical operations director, was impressed with not only the response from medical agencies on Bagram but the non-clinicians as well.

"I was amazed with the amount of assistance received from all of the units here, not just the medical personnel assigned to the hospital," he said. "When the call went out, we had volunteers from everywhere and were having to redirect assistance."

Colonel Marsiglia said no matter how much preparation goes into a training scenario, nothing prepares individuals for these types of large-scale situations and the response and support from all coalition agencies was top notch.

Thursday, March 25, 2010

Walking on an F-15!!!! 25 March at 9:52PM

Today I went with a group on a tour of the F-15 area. “Biff” met us and showed around the area where they get their schedules for the day. Then we went and saw the life support equipment. That’s the stuff that keeps them alive- the helmet, the night vision goggles, the survival vest that weighs about 20 pounds, and the G-suit. They got one of the girls on the tour into the G-suit and blew it up- she got pretty uncomfortable!

After that we went and listened to the pre-flight briefing regarding all the activity that had happened recently in the area we were going to. Then they showed us the “Greatest Hits’ video. That is one of my favorites! We watch them at the wing meeting as well. This is where we get to see the results of them dropping bombs on people. I know it sounds callous, but that is a great sight to see!  I see the results of the enemy's handiwork every day in the torn up bodies of our soldiers.  It's nice to see it's not one sided.

I’ll tell you some of what they told us- all open source and not classified. There is an alert team. Goal is to be on target in 30 minutes. Our guys say that’s not good enough. They get called out for Close Air Support (CAS)- That’s the mission where the jet is supporting the guys on the ground. They can either bomb from on high or do a “show of force”, where they drop to about 500 feet and scare the CRAP out of the enemy so they scatter and stop whatever they were doing. We have guys called JTACs (Joint Tactical Aerial Controller) embedded with the Army. Our guys are the ones who call in the plane when they are pinned down or they see something that needs shot or bombed. When the Army guys are pinned under fire, the F-15s get called to help them out. Biff says the Army guys have about 15 minutes of bullets. So 30 minutes won’t really get the job done, will it? Our guys go from hanging in the alert facility to being over target and shooting something in 15 minutes!  they are very proud of that fact and I don't blame them.

They have something called terrain mapping navigation. This is where the computer watches the topography and the pilot turns over control to the airplane. He said it is the scariest feeling ever to trust your plane not to kill you. They skim along at just a couple of hundred feet off the ground as the radar looks at the ground and guides the plane. He says at night they can’t see a thing. They are going about 5 miles per minute, so there would be no time to be scared if they crashed. He said that it is so sensitive that if there is a telephone wire it will pull up. In the history of this guidance system, it has NEVER FAILED. Wow.

I also got to walk on the wing and sit in the cockpit. I had a bunch of pictures taken, which I will post a different day, since it is now after 10pm and I have to go to bed. It takes about 10 min to upload a pic. If it works. Last night I tried to upload a ramp ceremony pic I got off the web, but it wouldn’t go. Besides the other turmoil I have been going through the last couple of days (leadership stuff that I’ll post in a few weeks when it’s all over), today was a great Air Force day.

Wednesday, March 24, 2010

Fallen Comrade 18 Mar at 10:20PM

Today I witnessed my first Fallen Comrade Ceremony. Remember the rocket attack we had earlier in the week that killed the civilian? Turns out he was a Bosnian who was a fire fighter and working side by side with our active duty guys. Today they had the ceremony where his coffin was transferred to the airplane that would take him home to his family. There was a long procession of fire trucks and other vehicles that came out to where the plane was waiting. They lined up, forming a column that the casket was carried through. The entire fire department was also lined up on either side to watch the casket proceed. Then all the fire fighters went and made a formation behind the ramp of the airplane while four men and the chaplain went up into the belly of the aircraft with the fallen fireman and performed a small ceremony. There were several of us from the hospital who went and we lined up separately so we could pay our respects, but we were not in their “family’s” business. Then the fire department saluted as the ramp of the airplane closed. When it was over, they fell out of formation and walked away, some hugging, some had been crying, and others were stoic- not talking at all. One man told me he had trained the Bosnian over 10 years ago and they had worked, played and essentially lived together, as firemen do, for those 10 years.


I will do many more of these while I’m here. Most are in the middle of the night. All are solemn. All represent a fallen hero who is going home to his family.

Monday, March 22, 2010

Pink Mist Written the week of 14 March

If you are a Grey’s Anatomy fan, you remember the Pink Mist episode. We had our own small version of that today. Two men came in after an IED hit about 30 minutes away. They had both been seen at the Forward Operating Base (FOB) where we have Forward Surgical Teams (FST). One had a CT scan there and another had his huge abdominal wound packed with dressings and a gigantic external fixator on his leg to prevent the shattered bones from moving around. The idea of the FST is to do immediate life saving care about 10-40 min from the time of injury and then get them to us as fast as possible. Sometimes it’s over the road, sometimes by chopper, usually by plane. The pt with the head injury was whisked away to the OR. I was in my office picking the brain of one of the Special Ops guys, so I didn’t go to this trauma. Turns out that he had a CT of his head showing a foreign body, but it wasn’t clear exactly what it was.   While the team was in the room prepping him for surgery, the radiologist was looking at the CT we had done. His heart must have stopped. But not for long, because he leaped up and instantaneously found the surgeon and told him what it was. It was what we call a UXO- unexploded ordinance. That can be anything. We are doctors and nurses. We don’t do UXO! We see it, isolate it, and call it in. We practice this over and over again outside looking at stuff lyining in the GRASS during Wing Exercises. You just don’t expect to find one in a guy’s head. So the alert was put out, the OR was evacuated except for essential personnel (by this time the other guy was in the other OR crashing with an undetectable blood pressure), and the personnel who were left had flak vests and helmets brought to them. We set up guards to divert foot traffic away from the OR and called the EOD (Explosive Ordinance Disposal).  On the CT it looked like a 50 caliber bullet, but it had unusual looking stuff in it. Sounds low risk, right? But like I said- we’re doctors and nurses. That is not for us to figure out! The EOD guys showed up and told us yes, that’s what it was. A Russian one, it turns out. On the CT, it looked like a bullet, with a small bit of trapped air in the point, then a pointy bit of stuff behind that (what the radiologist called a “lipstick appearance”- like lipstick in a tube) and then some the casing was full of stuff that was not metal. That’s about all you can tell on xray. The EOD said that it was activated by the projectile striking an object, then the air is forced onto the fuze (yes, that’s how you spell it), which was the lipstick point. Then the fuel inside explodes. This kind of exploding bullet is outlawed by the Geneva Conventions.  He said no worries- just take the thing out and hand it to one of them. I just had one question. What if it does go off for some reason- it drops on the floor or just spontaneously explodes for no reason- what is the worst that would happen? Big explosion or little? They said little. So the doc and the EOD guy go to the OR and the surgeon removes the thing from the guy’s head. It was very impressive on CT- it had penetrated just under the top right side of his skull. It had lifted a piece of bone, like when the dog hides something under the edge of the carpet. He had a small amount of brain bleeding as well. Incredibly, he’ll probably be fine after he wakes up out of his coma. Amazing.




I have never forgotten that Pink Mist episode. In it, the EOD guy explodes in the hallway after carrying the UXO out of the ER. Turns out that maybe our reaction was overkill for just a sdmall exploding bullet. But my pledge was to do my best to get every member of my team home intact- mentally and physically. This was a good opportunity to practice something we don’t do often and we have a few lessons learned to incorporate next time it happens. Most of all though, I was very impressed with everyone’s quick reaction and their willingness to do whatever needed to be done. From the nurse who refused to leave the OR because his patient next door was dying, to the airmen who stood in the hallway with their M-16s, making sure no one got past them into the danger zone, to the surgeon who risked it all to do the operation. I have a great team here. And every day something happens that I have never seen before…I wonder how long that will last?



the 4th one looks like the one we got out of the guy. 

Sunday, March 21, 2010

Successes 21 March at 10:21AM

I just finished running 6 miles.  Mile 6 was uncomfortable, but not nearly as miserable as mile 5 was last week!  I feel great!  It was really dusty and I could hardly see the mountains because of the dust in the air....but I guess I'm getting used to that.  It didn't really seem to bother me that much.  And I am finding things to look at (I get really bored when I run).  There is some construction on base and they have made some progress since last week.  There's a road I'm thinking about running next week that goes right next to the perimeter fence.  Should be safe in the daytime, except for the little kids throwing rocks.  I need to start taking a camera with me.  I saw some flowers I wanted to take a picture of.  If it turns out well, I'll post the pics and my thoughts- they are in a very interesting place.

The other success is that for the first time in my life (EVER!) I have lost weight accidentally.  I generally get really annoyed by people who can do that.  The genes on both sides of my family favor large women.  There are only a couple of reasons I'm not everweight- Jack insists on it, I can't stand the thought of it because it would slow me down and be unhealthy, and I exercise like a crazy woman.  Even on the rare occasions that I get sick, I don't lose weight.  In fact, since one of my stages of hunger is nausea (hungry feeling, hunger pains/twisting, headache, nausea, grouchy), I think my body interprets every single from my gut area as hunger.  Whenever I feel yucky, I think food will help.  And it usually does!  Weird.

Anyway, I have not had a scale in 3 weeks.  OK- we do have scales in the hospital, but I wear different clothes all the time, with a 4.5 pound gun, without the gun, sometimes in ABUs, sometimes in PTU (PT Uniform), sometimes in the morning when I remember and sometimes in the afternoon.   How am I supposed to keep track like that?  I like to have my own scale in my own place at the same time every day.  The women reading this will understand.  Anyway,  my scale finally arrived- I lost 3 pounds in 3 weeks!  WOW!!!!!!!  And I was afraid I was eating too much at meals.  But I am eating 3/4 of a tray of veggies and a little meat.  And most of the meat is not that good, so I am only eating bits of the stuff I love the best.  I feel terrible throwing food away, though.  I bet the food we throw away on this base could feed the whole country.  It's crazy.  I wonder what the Afghans who work here think?  I have seen them eat gigantic piles of bread and fruit- something I bet they cannot get at home. 

Anyway, just wanted to share my run and diet successes.  Since it's Sunday, it's time now to clean my room (sweep, mop,and take out the trash- it's already neat), then go to lunch, then go to work, check off another week on my countdown list and write letters and watch the shows Jack sent me on DVD (thanks, honey!!), then drop off laundry before I go to church at 3PM, then pick up other laundry after church, then go back to work for awhile, then go to dinner, then maybe try to Skype the family.  I tried last night, but the connection was too slow- I think everyone was on the internet at the same time.  I am settling into a routine here that is quite comfortable.

Saturday, March 20, 2010

I am my father's daughter 20 March @ 9:40PM

I'm sure you all (especially James!) will will bust a gut to hear that it only took me two weeks to cut myself with my new knife. The knife I keep clipped to my pocket as a tool and as personal protection is a side opening switch blade.  It's military issued and perfectly legal (so I'm told).  Well, it switched open (blade pointing up) while I was sitting on the floor talking to someone today and I didn't notice. I got up and walked out of the room and reached down to adjust and BAM! Next thing I know I was dripping blood. Thankfully, I was right across from the ER. I washed it off and asked for a Band-aid and the doc had the bright idea of some Dermabond- skin Super Glue.  It looked great for awhile, now it has opened up again.


I only laugh because I somehow manage to slice a finger several times per year.  My dad has this same extraordinary talent, so I'm pretty sure it's genetic.  When we were kids, he was always building something and often ended getting cut or scraped or wacking a thumb with the hammer or something. I remember one time I was helping him put in some French doors our to the deck and he somehow scraped his upper arm on a nail or something.  Blood was dripping down into the saw dust stuck to his arm.  It was gross and really cool all at the same time.  Even back then I was sort of fascinated by blood.  i like other people's more than mine, though!


And the best part about my current injury? To show people, I have to hold up my middle finger! BAHAHAHAHAAA!!!!!!!!!



This is a picture of me in our front office.  Completely unrelated to the cut finger.  For the life of me, I can't remember why I was holding a Pepsi can. 

Wednesday, March 17, 2010

Naming Military Operations 17 Mar @ 10PM

I had always wondered about this, and today I read an article on it that I though you might enjoy.
Today at the wing staff meeting, I got to watch film of our good guys blowing up the bad guys.  I LOVE watching those videos.  In one, our bomb hit two guys known to be bad guys.  The plane tracked them for FIVE HOURS until they were out in the clear and they would not hit anything else.  Then, about an hour later, they saw a guy stumbling around the bomb site.  They were 99% sure it was one of the guys they had just hit, but since they did not have eyes on that particular individual 100% of the time, they erred on the side of caution and let him go.  Don't believe it if the news says we are indiscriminant.  They are beyond careful.

An operation by any other name
By Lionel Beehner

I've always found the code-naming of U.S. military operations a puzzling and somewhat pointless exercise.

Some names are inspiring (Operation Noble Eagle), others less so (Operation Productive Effort). Some sound lifted from a bad '80s action flick (Operation Haven Denial), others literally are lifted from a bad '80s action flick (Operation Red Dawn). Some, like the 1983 invasion of Grenada, channel a mad man's diary (Operation Urgent Fury); others, like our 2006 southern Afghanistan invasion, sound vaguely kinky (Operation Mountain Thrust). Even the operations given foreign names, such as Operation Tawakalna Ala Allah (roughly "God help us"), do not inspire confidence.

I am reminded of this ritual because the Pentagon just renamed the Iraq war. Operation Iraqi Freedom is now — drumroll, please — Operation New Dawn. I understand the rationale to suggest we are now in the winding-down phase. A "new dawn" suggests the worst is well behind us. Yet, oftentimes this nicknaming ritual — first adopted by the Germans during World War I — is just a clever way of putting a kinder, gentler face on war. It is as much a public relations gimmick as it is a means of preserving operational security or boosting morale.

Take the 1989 invasion of Panama, originally called Operation Blue Spoon. It was renamed Operation Just Cause because the previous title did not "underscore the purpose of the operation and inspire the forces and the people back home," according to a 1995 report released by the chairman of the Joint Chiefs of Staff. The New York Times, in an editorial titled "Operation High Hokum," mocked the name change, saying that "sometimes the margin between necessity and excess can be thin indeed, as reflected by the code names for military operations."

Code names originate partly from a Pentagon computer that spits out random word combinations, partly from midranking officers lobbing suggestions, which then must go up the chain of command for approval. Some are kept quiet, for security reasons, yet others become part of the popular vernacular (Operation Desert Storm).

There are classics of the genre (Operation Barbarossa — the Nazis' 1941 invasion of the USSR), as well as duds (the computer-generated Operation Blue Spoon). They range in their Winston-Churchillean bravado, though, as the British leader once quipped, they should never imply "overconfident sentiment," yet nor should a mother have to say that "her son was killed in an operation called 'Bunnyhug' or 'Ballyhoo' ."

Sure, Operation Iraqi Freedom sounds nobler than Cobra II, the name given to the ground invasion and spinoff of the World War II operation to liberate France (proving that the Pentagon, like Hollywood, is fond of sequels). Former commander Tommy Franks wanted to call the campaign Operation Desert Freedom, writes Spencer Ackerman in The Washington Independent, but "then someone thought that the rest of the Arab world would take 'Desert Freedom' to mean 'The Americans are invading here next' and thought better of it."

Maybe the code-naming of future military operations should be thrown open to the public or put to a vote. That might lend the ritual a refreshing air of honesty. Operation New Dawn might be renamed Operation Hit The Exits, or Operation Get Outta Dodge (although let's pray Operation Mountain Thrust is not renamed Operation Keep On Thrusting).

There is nothing wrong with code-naming wars to garner public support. But it should not serve as bureaucratic window dressing for fiascoes such as Iraq.

An administration that wisely tossed the "war on terror" term into the dustbin of nomenclature history should know better.

Lionel Beehner, a freelance writer, is a member of USA TODAY's board of contributors.
Posted at 12:15 AM/ET, March 17, 2010 in Beehner, Forum commentary, Military issues - Forum
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Tuesday, March 16, 2010

on the way to bagram from Manas 7 March @ 0200

Pictures 17 March @midnight- I should be sleeping!

16 March @ 11PM

Nothing too exciting today. The ER was actually quiet today. For awhile. Then we got 2 traumas- M-RAP IED and 4 more on the way from another base through the aerovac system. I spent a lot of time doing routine commanderly stuff like reading email, editing a medal, writing a civilian appraisal for back at Shaw. I helped fold the roof of a tent. Spent awhile eating lunch. Spent a while eating dinner. Took my predecessor to the PAX terminal to get on an airplane home- yay for him! Ran 4 miles this AM. Tried to pick up my laundry, but they were closed at lunch- argh! Walked around and met some new people in my squadron. Tried understand the aerovac system and make sure the number of missions we do now will be adequate this summer when we get busy (it won't) and they we can get more when we need them (we can) and that we have enough people to enter all the stuff in the computer to get the pts on the airplane (we don't) but that they had a plan to get more people trained (they didn't) and helped them understand how to do that (they do now!). I've also come to learn that having only a certain number of beds does not mean that we are full. They will keep coming and we will put cots all over the place and call more airplanes to come get more patients and they will come- we have about 30 going out tonight. They go out in the cargo hold of a military plane. You know how you complain when you can;t sleep in a regular hospital? Or your pillow is not so fluffy? Or the food sucks? Picture being in the dark, in the cargo hold of a plane, with ear plugs in so you don't go deaf. Maybe in ICU status. One guy had a heart attack and is on drips and stuff. Others have had surgery just a few hours before. Or they have a concussion. Or maybe they just have knee pain and are going to Landstuhl to get looked at. Anyway- it's a 7 hour flight- yuck.


I talk to tons of people- that I sit next to at lunch, stand next to in the BX. The outside the wire guys are pretty nonchalant about what they do. One Army guy is here waiting on his ride home. He has been here 9 months and his job was to be in the lead M-RAP as his Provincial Reconstruction Team (PRT) goes around village to village. He is lucky- the walls around his turret went higher than most. Good thing, because as they drove through towns, the roofs of the buildings were slightly higher than him. So they could look down on him- how scary. The PRTs are supposed to have a team called a clearing package. They clear the way, look for mines, take the first IED, etc. His team did not have one, so he was it. He had these things on the front of the vehicle called the rollers- they would roll over pressure plated IEDs and explode them. One of them was so strong it blew the roller right off. Another time, an insurgent fired an RPG at him and it missed. He said he learned a new tactic that day- Aug 27th last year- the guy jumped and ran ahead to another one he had placed. This time, he didn't miss. The turrent went up in flames. All my new friend got was some shrapnel in his knee, although he couldn;t believe he was still alive. Probably what kept it from being worse was the RPG cage around the vehicle- they get stuck in there before the full force hits the skin of the vehicle. He got hit 7 times in 9 months. Now he's here. I started talking to him because he had 3 Red Bulls in his hand at the BX. He said they became his best friend out on missions. Now he is safe, and he is tired all the time. I think his body must be in rest mode. It's had enough excitement and it wants to chill out. Amazing stories and I'm sure I'll hear more of them.


If I can figure out how, I'll post some pics I took recently.

Monday, March 15, 2010

First Serious Trauma 15 March @ 9PM

This AM we had a rocket attack on base. One foreign contractor killed while he slept, two American Contractors with minor injuries. I get paged when we get attacked- this was my first one. The drill is get ready as fast as possible, then throw on body armor (Individual Body Armor- IBA) and helmet and get to work. Hospital personnel can use our badge to get around on base when others are stuck where they are- just like any other base. I think we'll be seeing a lot more of these as the summer heats up. I am in a hardened dorm on the first floor and my bed is on the opposite side of the room from the window- so don't worry- I'm pretty safe.

Later in the ER, we got a local national who was attacked by a landmine. That's the story anyway. He had left facial injuries and his right arm was nearly blown off at the elbow. Now, how does a landmine blow off your arm and the opposide side of your face? Most people step on landmines. We don't know yet (and I might be able to tell you when I do know), but it's awfully suspicious to me. I suspect he was either poking it with a stick (maybe doing some kind of mine clearing activity?) or he was building something and it blew up in his hand. I'm trying to picture how that would happen and it seems less likely. I'm going with the stick poking theory. Anyway, he came in from off base with a tournequet on and the rest of his arm below the elbow was just a hanging piece of meat. They ended up having to amputate due to the severity of the injury. He'll probably lose an eye as well. But if our hospital were not here, he would have probably died.

It is amazing to see the appreciation of the guys that depend on us to take care of them. The ones who come visit their buddies have great respect for what we do. And we respect them for what they do as well.....none of us wants to be out where they are! If a person makes it to us alive, he has a 99% chance of leaving alive. Amazing.

I saw my first Purple Heart Ceremony the other day. It was amazing. These two guys were all beat up lying in their bed or sitting in a chair and the commanding general and command chief came over to present their medals. It was a very moving simple little ceremony. They will both leave the AOR and go home to recuperate. Everyone in the hospital treats them as heroes.

Sunday, March 14, 2010

Arriving at Bagram 3-7-10 @ 730PM

Left Manas last night and flew to Bagram. It was relatively uneventful except that I had to carry an extra bag that most others didn’t. First, we had to find our own bags out in the logistics load yard. In the dark. We were told to check the bins for our names and then in that bin would be our bags. My name wasn’t on any bin. So another girl and I saw a bin with a bunch of bags in it going to Bagram and she and I jumped in and started throwing bags out and calling people’s names to come get them. That’s where nearly all the bags were, even though most of our names were not on the list.

Then it was time to load the bags onto the pallets. We were supposed to fly in a C-17, which is a huge plane that has plenty of seats and cargo room. That one was diverted for mission reasons and we ended up taking a C-130 instead. Which has much less seating room and WAY much less cargo space. The pallet builder explained the situation and told everyone with 3 bags to consolidate to two if they could. Then we still had too many bags, so he suggested that everyone with three bags come pick up one of their bags to carry onto the plane with them. No one moved. I waited for the troop commander (a Lt Col doctor) to tell people to get moving, but he didn’t. The pallet builder was visibly annoyed- he had a schedule to keep and he needed to get moving. When no one did anything, he told us that they would build the pallets and whatever was left over would need to be carried on. Well guess whose bag was one of those! Yeah- mine! The one person who only had ONE bag and one of the two people who threw the other bags out of the bin. Good grief! I think my patience is being tested on this trip.

While in the air, I had to go to the bathroom. What an interesting activity if you are on a cargo plane. The toilet is there so you don’t make a mess on the plane, not for your comfort. The guys have it easy- they just walk up to it and pee in the receptacle. To turn it into a toilet, they pull down this seat, as well as a step to get to the seat and a curtain to cover your butt while you pee. I said “cover your butt”. That’s because it doesn’t go all the way around and cover the front and your head sticks out as well in front of the curtain. I had to go, so I didn’t care! The guys were kind enough to look the other way while I went. It was relatively dark anyway, but I was the only female who went on the plane.

I arrived at Bagram at about 3AM. We got in processed, and then were supposed to get met by our unit reps. Mine didn’t show up. I found out later that they were supposed to get a call, but no one did. Oh well. I knew the drill. Get your billeting room, get your linens, and then wander around in the dark and try to find your room. Get to said room, creep quietly and try not to wake the other occupants of the room. There were three others in my room and although I was quiet at 0500, they were a bit stressed to find they had a new roommate. I would have been as well. I assured them it was only one night until my unit got my room situation sorted out (they were supposed to have a room reserved for me, but it wasn’t). I was slightly annoyed with my new unit at this point. But while on the plane at BWI, after they lost my luggage, I had prayed for peace and no anxiety and I was not angry or stressed. Just slightly annoyed. After discovering I was assigned to a room of 3 and there was an empty room across the hall, I went back to lodging and asked the lady to move me into that room. She said she wasn’t supposed to, but as long as I was out by the next night, I could have it. I unloaded my stuff in the new room and then went off in the dark to find the dining hall (DFAC) because I was starving and needed to eat. After wandering through a maze of shacks, I found it and then couldn’t find my way in. When I did, I discovered that I could only get a sandwich- argh! Which I was not allowed to eat there. So I made my sandwich and made it back to my room without any wrong turns- I was so proud of myself! I put my head on the pillow at about 0603 and at about 0609 the first jet took off, followed by the second. “This is going to be a looooong deployment”, I thought.

I had hoped to sleep until lunch time, but I awoke at about 0800 and couldn’t go back to sleep. This after only getting about 3 hours the night before. I got up and showered and went to went to the DFAC for lunch, but I got there 20 min before it opened. I had taken a newspaper to read while I ate. The guy told me I couldn’t come in yet. I told him I had just got off the plane and had nowhere to go while I waited (the dorm was a 10 min walk away-pointless). He said I could come in a sit down. Then some other guy told me the same thing after I sat down. He said I could have a sandwich. I said in my firmest Don’t Mess With Me voice, “I was here too early and had a sandwich for breakfast. I just got off an airplane. I’m starving and I have nowhere else to wait. I’m going to sit in that corner and read my paper until you open.” I must have looked over the edge, because he backed off and left me alone.

After lunch, I went to work, found someone in the hallway that I happened to know from another base and asked where my office was and then started my in processing. Turns out, they knew I was coming and left a message to be called, and the message was lost. They had a room for me that the lodging office couldn’t see somehow. So the guy I’m replacing and the guy who found me (who I know from previous assignment) got a truck and got my stuff and helped me move into my new room. I got the big tour, met tons of people, and then went to dinner with the Chief who is the superintendant of the med group. I also know him from a previous base. Then another guy joined us, as well as the group exec, who I ALSO know from a previous base. We laughed and told stories and had a great dinner.

Now, I’m writing this is in bed, airing out my smallpox, and wondering when I’ll ever to get to publish my posts since there is no public internet here. I have to wait until I get internet in my room. Should be within the next week or so. Now, I’m going to finish the iPod movie I started on the plane, eat my pie for dessert, and then take an Ambien and read Steven King until I fall asleep. Newcomers Orientation is tomorrow.

Saturday, March 13, 2010

Contrasts 3-6-10 @ 9:07PM

Tonight I am leaving Manas. As I was walking through the base with my linens in my arms, my back pack on my back and my briefcase slung over my shoulder, I passed the local club, Pete’s, blasting music. It was a catchy tune; some of you may have heard it- “Stanky Leg”. I was grooving to the beat as I walked past, listening to the crowd inside whooping and hollering and having a great time. As I walked on, I came to another sound of music, nearly as rowdy, with some great drum beats and some awesome singing. These were live voices, not a CD. There was clapping, and singing, and shouting. This one I lingered at. It was coming from the Chapel. I dropped off my linens and checked out of my room and then went back to listen to the gospel music for a few minutes before I had to report for my flight.

It struck me that both groups were having an equally good time, in completely different ways. And probably the people frequenting each would not be comfortable in the one they weren’t in. And I felt better for some reason knowing that also I could enjoy the first on occasion, it was the second I preferred.

Friday, March 12, 2010

Can't Sleep!! 3-6-10 @ 0430

It’s 0430 and for some reason, I can’t sleep- so I think I’ll write.

Today I went to the small clinic here at Manas to see a nurse anesthetist that I know from Yokota. I saw him at dinner the other night. I was surprised to see him here because this is such a small base- I was wondering why they would put someone with his skills here as a clinical nurse. When I got to the clinic, he wasn't there so I asked to meet the doc- Turns out it was a resident that I trained who stayed on at Offutt to teach. i found out that the Manas clinic has a small surgical capability because they are so remote from medical care.

The clinic was very nice by deployed standards- it was just built a couple of years ago. Before that it was in a tent. Dr Cooper says in the two months he has been here, he has assisted with an appendectomy, a serious leg fracture, treated a woman who was unconscious from a car crash, and treated a serious case of pancreatitis. They also had a visit from local Kyrgyzstani doctors who wanted to come see a modern American hospital. A modern American hospital! It was a dinky little clinic with one OR bed and one "inpatient" bed. But to them, it was incredible. It was a good exchange program.

Speaking of exchange programs, the nurse anesthetist suggested that he’d like to come to Bagram a get some more experience and be a bit busier for a couple of weeks and maybe his counterpart there would like to do the same thing. That sounds like an interesting idea. I’ll have to check it out. I think the logistic will be a challenge- the Bagram provider will have to come here first because they can’t be without one here, and the air travel will have to be worked out, but it seems like a great idea right now.

OK- going to bed. This looks to be a bit incoherent, but what do you expect at 0430????

Thursday, March 11, 2010

Ground Rules for Blogging in the AOR

The AOR is the Area of Responsibility- that's what we call the deployed location.

As you can see from the previous one, most of my posts will be after-the-fact. I can't give travel info while I'm traveling. There are enemy ears out there who would love to shoot down an American plane full of military service members. You can't even call the airport (the "PAX terminal"- stands for passenger terminal) until the day of and find out the schedule.

I can't tell you how many people are stationed here, how many injured we get, how many air evac's (evacuations) we have. Anything that tells of troop movements ahead of time or announces our capabilities to the enemy- I can't tell you that. But I can tell you bits and pieces after it happens.

I've been here 5 days now and it's almost easy to forget we are in a war zone. But we are. There are people trying to get on the base all the time who want to kill us. We take care of patients in the hospital who would kill my doctors in a second if they could. But they give absolute 100% compassionate care that is completely equal to the care the Americans get. The wounded Afghans get a guardian who stays with them for the length of their recuperation- we feed the injured and their guardian 3 meals a day. I'll have a lot more to say about this topic in the future as I learn more, but I am already impressed at the professionalism of my people.

Suffice it to say that you will get a great flavor of life at Bagram Air Base, but I won't be telling you any numbers or stats that you can't get on the news. Hope you enjoy following this blog!

Traveling to Afghanistan- written 3-5-10 at 4:30PM

Wow. This travel thing has really tested my patience. I was TDY last week when I got word by email that my travel dates had been moved from late in the week to early in the week. So, I only had one duty day back before I had to go. I managed to get all my stuff packed up and finished out processing in time to go. James had wanted to go to the airport with me and we left a bit late, so I was really stressed that I would get to the airport too late. But Jack drove like a demon and we made it just fine. But the flight was cancelled! I knew I needed to get to Baltimore for the military flight out because there was not another flight for a week. Remember that- it becomes important later! They were able to get me on a flight through Philadelphia and on to Baltimore that would get me there just in time.

Have you ever had the experience of standing at the baggage carousel waiting for your bags, and seeing the crowd get thinner and thinner and then you are the only one standing there? And then the conveyor belt stops? If not, then good for you. Because that means that your bags are not on that flight. That’s what happened to me. All three of my bags and all two of another guy’s deployment bags were still in Philly and would not make it to Baltimore until the next day. By then, we would be on our way to Afghanistan. Great. I filed a claim and the lady said that they would put my bags on the next military flight- a week later. I told her I was very upset that my bags were lost. She replied,"they're not LOST, we KNOW where they are." I almost punched her in thes throat. Good thing I packed my “72 hour bag” and had it with me! Lesson to the wise- #1- pack a 1 week bag, not a 72 hr bag. #2- put feminine supplies (a woman can never predict what stress will do to her body!), a PT uniform and an extra T-shirt in the bag next time! Other than that, I have everything I need for awhile.

I make it to the military flight just in time to board. That flight went very smoothly. I had expected to stop in Manas Air Base, Kyrgyzstan next. But we stopped at Ramstein Air Base, Germany. I had about 10 minutes to visit the USO and grab some "supplies" (God bless the USO ladies!) and then we were off again. I had expected to stop in Manas Air Base, Krygistan next. But we stopped at Incirlik Air Base, Turkey. I had expected to stop in Manas Air Base, Kyrgyzstan next. And we did. We landed in the early AM, got a bunch of briefings and then I got the key to my room and some linens. I was able to buy a small microfiber towel that is kind of like a chamois- it works great. I could have bought a PT uniform, but I had no shoes to go with it, so that was kind of pointless. My plan is to borrow a set when I get to Bagram and my Squadron. And a uniform T-shirt. The one I’m wearing will start to smell funny soon.

So far, I’m not sure where my bags are. I tried to call the facility in Baltimore, but they’re closed now. I’ll try later. The US Airways lady told me they’d send my bags to the military facility. The military facility told me they’d put them on the next military flight next week (remember that from the beginning of the saga?). The people here at Manas told me it happens that way some times and other times they end up on a commercial flight and end up in the commercial airport here in Krygyzstan and then they call the base because they recognize the bags as American and the Americans MUST know what to do with them. And they do. So we’ll just have to see.

Monday, March 1, 2010

Good Vs Great

The events of the last few days have really reminded me something. I knew this before, but I never really put together in this sort of thought process.

If you want to be good at something- just get it done. Be reliable. Don't make people ask twice.

If you want to be great at something, do all of the above. but let the person you're serving know what's going on. Tell them the next step, and the one after that. Know WHY things are done the way they are, so that when something unexpected occurs, you can work around it. Or if you just don't like it, you have a better chance of fixing it. Keep promises. Don't assume an email is communication. Call and follow up.

Put yourself in the shoes of the other person and anticpate their needs and their questions- answer them and explain before they have a chance to ask.

That's how to be great and not just good.