Tired....

Yeah- that came from me.  I know I am always doing a million things at time.  I like to have my cake and eat it too and I like to do it a 100 mph.

But this week, I'm tired.  I'm tired every morning when I get up.  Tired when I go to sleep.  Tired during my workouts.  After my 4th bad run in a row on Monday I realized that I had increased my bike mileage and my running mileage simultaneously and I was not getting enough sleep either.  Saturday, my long run day, I had planned before bed for 11 miles, got up and decided the usual 10 would be fine, and by my 3rd miserable mile I decided that 8 would be even better.  All 8 miles were horrible.  That was after I got up at 0445, put 

my eyes in, brushed my teeth, got half way dressed, got undressed and started back for the bed, then got re-dressed and left.  I should have stayed in bed.  All 8 miles were horrible.  Rested on Sunday.  Ran 8 miserable miles on Monday and realized I needed a rest.  Did only 24 EASY miles on the bike Tues, ran a miserable 2.6 miles Wed, 20 more EASY miles on Thursday, and then I hit today.  Got up at 0445 as usual.  Put the eyes in, brushed the teeth.  Tried to think of what I wanted to do today (today is my do whatever sounds good day).  Nothing sounded good.  Gym sounded horrible.  Running sounded miserable.  Not even the bike sounded good.  So I remembered Saturday and went back to bed.  I slept for 90 more minutes.  Missed Grand Rounds.  And went to work feeling great.  I felt so great that I went after work and did the elliptical for 45 min.  Then I still had some energy, so I ran a mile totally barefoot around the hospital.  Stepped on a big rock, but other than that, it was great!  Now, I have to remember to go to bed on time and see what how far I feel like running in the morning.  If I feel good, I'll do 6 and if I don't, I won't.  Gotta rest sometimes.

Injured Vs. Killed... A Different Kind of War

The traditional thought in previous wars has been that it is more advantageous to “our” side to injure, rather than kill, the enemy.  This is because it takes up a lot more medical resources from the other side to take care of their wounded soldiers than their dead soldiers.  That’s the reason that full metal jacket bullets are the standard, rather than bullets that fragment.  Bullets that stay intact will cause localized damage and only kill if they hit a vital target.  Fragmenting bullets cause significant tissue damage and are much more likely to kill.  Also, the Hague Convention specifically prohibits fragmenting bullets.  And bullets that explode if they are aimed at a person.  Speaking of Conventions, the Geneva Conventions prohibit tear gas in war, but allows Napalm.  I don't really profess to understand that one.
 
In contrast to most of history, the US has taken on responsibility for caring for the wounded that are caused by us.  So our hospital is mostly full of Afghans.  We care for US and coalition forces, civilians injured due to US or coalition action, plus Afghan National Army (ANA) and Police (ANP) that are injured.  We also take care of any enemy that are injured on the battle field.  The unit that injures them collects them after the battle and puts them into the US medical system.  They are required to supply a guard and then we take care of them in our hospital.  Also, we take care of all the medical needs of the prison detainees (the DFIP- Detainee Facility in Parwan; that’s the province we are in- this is the Guantanamo Bay equivalent right here on Bagram).  There is a full complement of medical specialists at the prison to care for any need they might have.  If they need surgery, even most elective surgeries, we provide it.  Those guys come with two guards from the prison.

Our prisoners get top care.  They get the same exact compassionate care that any American or coalition forces would get.  If the enemy is more injured than an American, he gets treated first.  They get state of the art orthopedic and plastic surgery.  They get reconstructive surgery.  They get fed and cared for.  This can be pretty stressful on our nurses and technicians because sometimes these patients are not as grateful for their care as the Americans are.  We go into care-giving because it feels good.  When people are spitting at us or trying to resist care, it's hard to feel good.  But our medics are heroes and even when they feel in their hearts that they don't care, they act like they do.

Bottom line, is…if we only injure them, it causes a drain on our resources, not the enemy’s.  What a change in the way we prosecute a war!  That’s not to say it’s any better or any worse.  It just is.  I understand the benefit of keeping these prisoners for interrogation purposes.  Plus, we are living in an age where ethics are a bit different than they used to be.  There are a lot of politics involved in our current situation.  It’s not my place to pass judgment on the reason WHY we have changed how we operate.  I just thought it was an interesting turn of events.

Afghan Dinner

I just came from eating one of the best meals since I have been here.  It's my third time eating Afghan food and I have not had a bad dish yet!  Our interpreters like to have meals periodically and they invite the docs to share.  The wife of one of the interpreters cooks massive amounts of food.  It's good to know to plan for these meals because there is so much food!  Today we had basmati rice (with cinnamon, raisins, carrots, and meat), the best okra in the world (cooked with microscopic bits of tomato and who knows what else but also some kind of yellow oil), potatoes cooked with the same yellow oil and onions, chicken, and naan (the flat bread).  Oh my goodness!  The bread is so good soaked in the oily stuff!  Anyway, I practically have to fast all day to be able to eat a plate load- but somehow I managed!

One of the interpreters is leaving in a few weeks with eight other Afghans to come to America to live permanently on visa.  Right now, he drives 2 hours to work and 2 hours home every day to Kabul.  He will get a visa to live and work in the US (he is going to California, where apparently, there is a large Afghan population).  Our government and an aid organization will help him pay for a plane ticket, rent, buy clothes and food, and help him find a job.  He has to pay some or all of it back (I wasn't real clear on that point).  He has a wife who speaks little English, but she was enrolled in a private university (not sure where- here, I think) taking computer science and he says she's very smart and will learn English quickly.  He also has a 2 year old and a 6 month old.  He is so happy to be going to America.  The program is set up so that if they work closely with Americans for a year, and fill out a bunch of paperwork and pass the background check, they can get to America.

Our interpreters put themselves at risk by working for us.  They don't allow themselves to be photographed when reporters come.  They can't park a car outside the gate because someone may put a bomb under it.  There are plenty of people working for the Americans off base who have had their families threatened.  So for them to work for us can be very dangerous.  But this program is a way to reward them for their sacrifice.  And our interpreters are all smart and have skills to contribute to American society.  Some of them are doctors.  Three of the women (the only women) are all American citizens and are allowed to live on base.  They all speak at least 4 languages, some as many as 6 or 7.  They are very nice and are a pleasure to talk with.

And they make great food!

Waiting

Every night I go to bed and every morning I wake up surprised that nothing happened.  When I first got here, we got attacked almost every week.  In late April, it slowed down and we got attacked in mid-May.  Since then, they are still few and far between, so I keep wondering when the next one will come.  So..I wait.  And every morning I wake up surprised that I slept through the night.

And....I'm waiting to go home.  I'm still really liking my work.  We're still doing some awesome stuff here.  but it's starting to get old.  I feel like things at home are moving on without me. I'm sure they miss me, but it's hard to be here while they are there.  So I wait to go home.  10 more weeks and I should be there.  In the meantime, I wait.

Afghanistan Pictures

This one is a Pararescue squadron helicopter.  One like this was shot down 2 weeks ago and killed four pararescue men from our base.  Their motto is "that others may live" and their symbol is 2 green footprints.  

This is the view off the top of the Korean hospital here on base.  They really didn't want us going to close to the edge- we were a good sniping target.  It's beautiful.  Too bad it's so dangerous out there.

I was walking back from the dining hall one evening and saw this perfect photo op.

Freedom Isn't Free

Of course, I've heard that a million times in my life. But it has never meant the same to me before as it does now, spending Independence Day in a war torn country.  We have been having record numbers of casualties, as can be easily seen by reading the Air Force Times and seeing the pictures of the men there.  There used to be a few every week.  I always make it a point to read their names and how they died.  Now there are two rows of them every week.  And imagine that there are probably 10 injured for every one killed.  My surgeons were up all night last night and the night before taking care of guys who came in.  Yesterday, I was sitting in my office and someone said they needed me to go see patients in the ER. Now, I've gone down before to help out there and when there is an overhead page that we have traumas and there are 3 or more, I usually go.  I'm not always needed, but it's nice to have an extra hand if there is the need.  Well, yesterday, the entire ER was full- every bed- and they were piled down the hallway.  We sent a plane full of patients out yesterday and the hospital emptied out and a few hours later we were full again.  Then another plane load today. We used to do about 1-2 fallen Comrade ceremonies every week.  Now we do at least one every day.  And it will probably be like this all summer.

It's amazing what great attitudes these guys have.  They want to be out there killing bad guys.  I went through the hospital today delivering 4th of July goodies and went through the wards.  A couple of guys were going back to their units and all they wanted was to get the guys who hurt their buddies.  And I hope they do.  They know how important their job is and they know that they keep America safe.

I went and ate some BBQ and watched a video of fireworks tonight.  We can't have real fireworks because of airplanes and bad guys.  But the video was nice and it had the usual patriotic songs. " Proud to be an American" really got to me this year, for obvious reasons, I suppose.  For all of political faults that drive me crazy, I still think we are the greatest country on Earth.

I know that what we are doing here is important.  I hope we are successful in the long run.  I think it will take a long time, though.  And I have not met one single person who thinks that the draw down planned for next year means a dang thing.  They think we will be here for at least the next decade.  They are also pretty confident that if given the right tools and the right rules, we could root out the bad guys and make America safer.  But no one has much hope for the country itself.  They are pretty sure it will always be dirt poor and corrupt.  here they have traditions of blood feuds, killing, and corruption that goes back thousands of years.  The people I have talked to are pretty sure that is not going to be changed by us.  I tend to agree with them.

I hope our work makes America safer and helps to keep us free.  But it comes at a price.  A price that is unbearable for some families.  I hope in the end that the lost lives, the broken bodies, and the broken minds are worth it.