They shall grow not old, as we that are left grow old:
Age shall not weary them, nor the years condemn.
At the going down of the sun and in the morning
We will remember them.

The Coming of the Ship

Almustafa, the chosen and the beloved, who was a dawn unto his own day, had waited twelve years in the city of Orphalese for his ship that was to return and bear him back to the isle of his birth.
      And in the twelfth year, on the seventh day of Ielool, the month of reaping, he climbed the hill without the city walls and looked seaward; and he beheld the ship coming with the mist.
      Then the gates of his heart were flung open, and his joy flew far over the sea. And he closed his eyes and prayed in the silences of his soul.
      But he descended the hill, a sadness came upon him, and he thought in his heart: How shall I go in peace and without sorrow? Nay, not without a wound in the spirit shall I leave this city.
      Long were the days of pain I have spent within its walls, and long were the nights of aloneness; and who can depart from his pain and his aloneness without regret?
      Too many fragments of the spirit have I scattered in these streets, and too many are the children of my longing that walk naked among these hills, and I cannot withdraw from them without a burden and an ache.
      It is not a garment I cast off this day, but a skin that I tear with my own hands. Nor is it a thought I leave behind me, but a heart made sweet with hunger and with thirst….

The PROPHET, by Kahlil Gibran

Bastion Role 3

Bastion Role 3 Hospital. When we were doing our WTP as we were heading out we had one of those touchy feely sessions and one of the questions that was asked was how would you rate your deployment on a scale of 1-10.  There were a lot of 5s and 6s, some 7 and eights but when it came to me I said without hesitation: 10/10. All the badness of the deployment: away from home, family, and the ugliness of war, couldn’t take away from what was done at BR3 and being able to be part of that experience. 

There was and still is a lot of criticism of how things were done at Bastion, mostly by the other American MTFs (Medical Treatment Facilities) in Afghanistan.  Mostly this was centered around “ oh that must be the way the British do it”, and especially the way we handled the multiple lower extremity amputation from IED blasts.  In the 7 months that I was there we saw thousands of trauma casualties and others and did a phenomenal number of operative cases, transfusing thousands of units of blood products. I said in one of my earlier posts that some called BR3 the busiest trauma center in the world.  In my time there, that was probably a true statement. We did close to 300 IED amputation casualties which amounted to probably well over 700 amputated limbs:  clearly the largest cohort of any MTF in the world.   In a time frame before me and during my time, a best practice approach was developed for the handling of these casualties which yielded results that were as good as or better than any other facility and with reduced blood loss.  Perhaps rather than criticize BR3, the other MTFs should look on how things were done there.  This was all done in an environment where no one really had any personal agendas. It was just a group of people with one common goal: BEST CARE.

This brings me to the real reason it was the experience it was.  I took over 2000 pictures while I was at Bastion and a sampling of the results is shown below.  The theme I think is evident: An extraordinary place doing extra ordinary work by a group of amazing people: A 10 out of 10.

The Gibleteers

I know I have talked a little about the "3 Gibleteers" but not in a way that relates the true meaning of this group of 3.  Given the nickname by a British Orthopod (I think affectionately) it comprised myself and the two other general surgeons of the 4608.  Myself (middle), Chris on left and John on the right, and between the 3 greater than 150 years of experience (ouch that sounds so bad). I got to spend the greater part of 9 months with these two and it was truly an honor to serve with them.
John was the steadfast of the group, and although not a trauma surgeon, he used his experience to become one of the most solid surgeon at Bastion. Even under the worst circumstances it was  great to be with John at the OR table. 
Chris I have talked about: my Battle Buddy and the person who seemed to keep me centered.  He could sense when I would head towards one of my moods and just never allowed me to go there.  We were "surgical paired" for a good portion of the deployment and I couldn't have asked for a better partner at the OR table. 
It will be hard to go back home now and not have that experience across the table when operating.  It is one of those rare adult events to be able to develop these close bonds.  I am thankful that I could do that this late in my life.

In All This Rain

(written on plane ride from Kuwait to US and home)

Sitting on a plane heading home I am having trouble trying to put this whole experience into perspective.  A large part of the experience was horrific. It was and is a brutal war.  We all will somehow have to deal with that part and come to terms with it.  There are however, much more important images and memories that already are solidifying the experience in a more positive way.  The one that will stand out for me and I think for many of the caregivers at Bastion R3, is the treatment of the casualties and the positive impact we all had on their lives.  It was definitely true for the Afghan local nationals, but even more so for the wounded and injured Brits and US Marines; especially for us, the Navy contingent here, the US Marines.  In my 20- years of trauma care I have gotten somewhat use to seeing and dealing with civilian trauma; still the children and innocent  civilian casualties were difficult but it was  the British and US Marine injured combatants  which raised the situation to a whole different level. 

There is a general consensus that goes around the medical field that you should not get attached emotionally to your patient.  This is a canard, a lie.  It is simply an excuse not to give 110% to the care of the patient.  We got to see the US Marines and the British soldiers in their most noble state, and witness this incredible sacrifice and honorable commitment.  It made you feel that you could not fail these noble souls.  Everyone at Bastion returned that commitment. You cannot have witnessed their sacrifice and not be changed.

(Picture is of note written by 3/5 Commander to our Navy OIC when presenting their Battalion with US flag flown over Bastion)

In Perspective: The 4608

There will be many memories, good and bad from this deployment. But clearly the one that probablly will stand out as being one of the most positive is our unit NE # 4608.  It is hard to put into words and sum up The 4608. We were in many ways the orphans of Afghanastan.  What is clear though is the pretty much perfect performance of every single member regardless of where they were.  From the start at Ft Dix Training, to EMEDS, to Afghanistan the unit set the bar for performance and mission accomplishment.  It was/is truly an amazing group. It was so great to be part of it, and will be something I will always remember. The picture shows our 4608 flag which the Corpsman made and then everyone signed and I will keep.  As it is a symbol of this group, it will be something that will remind me off all the good of this deployment.

WTP = Warrior Transition Program

We are just about finishing our WTP.  It is most great to have the entire unit back together again and we have talked a lot about our different experiences.  The WTP program itself is pretty neat...kind of nice base (but not home) and a bunch of R&R as we set to head home.