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. 

My New MRAP

So I don't know whether you remember a post quite awhile ago about my MRAP I was taking home.  Well I decided to trade it in on a new model which was availabel at KAF!!!..more a family type, seats 8 in fact....the best part about this one is a new option only available this year: An automatic targeting weapons system in the turret...it is all the rage. I opted only for the 30 CAL model not the 50 CAL model since that seemed a little too much.
This will be so great in the BRONX!!!!!

The Journey Home: Last Stop!

Finally in Kuwait after like a 30+ hour military journey. It was so bad it was actually comical, having to lug bags all over the middle east about 100 times, but we are finally here on the last on the last leg of journey home. Pic is of tired crew on C130 on last leg to Kuwait. As usual through all the crap they performed great! The whole DET and especially the Corpsman have set the bar everywhere we have been.

 

The 4608: Back Together!

Well we are all here back in KAF (what a zoo) and for the first time all of the 4608 is back together and on our way home and it feels great to see everyone again!!!!  The pic is of all our corpsman united for the first time in 6+ months

The 4608 at Bastion

Our unit the 4608 has been divided up since we arrived at Bastion.  We are about to all get back together as we head home!  This is our group here at Bastion.  It was a very intense and hard time here for all of us but everyone did such amazing work in such a professional way.  It truly was an honor to serve with them.

The 3 Gibletteers

The 3 surgeons from my unit the 4608 also know as the 3 Gibletteers, getting ready to RIP OUT hopefully VERY soon.

A Last British Vigil

Attended what hopfully will be my last British Vigil here at Bastion for 3 British Soldiers.  It has been a very bad week for the British, and also for the USMC and the Gorgians. It would be nice if this were the last vigil period. But I think that won't be the case
After 7 months it is very much time for our DET to head home.

Heroic Efforts for a Hero

Again kind of violating my basic blog rule to talk about one particular casualty but it was the one mentioned in the previous post and it is such an extraordinary set of events for a hero and has played so on everyone's emotions here.  Its hard to put in this blog since it would not be right to put down the details, but as stated just such an amazing effort to save this one hero, from the Medivac in the field to the FOB he first went to, to the unbelievable efforts here at Bastion by everyone, to the Special Critical Care Team that flew in from Germany to get him back home. I know for us here at Bastion it was so much more than just giving the best medical care possible. It was an outpouring of love and caring and prayers: a total commitment. At the end of our tour this really crystallized why we are here, and of our young heroes that get injured, but also of the medical heroes here at Bastion and all over Afghanistan that give their all to provide the best care that these injured deserve. In the midst of all the devastation to see the outpouring of good and caring reaffirms the height of the human spirit.

Bastion R3 in Perspective: BLOOD

About 5 more days and our DET is about to RIP OUT!  Hard to believe it has been about 7 months here. It is hard to put things into perspective but I count myself extremely lucky to have been stationed here.  In the overall scheme of trauma combat care in Afghanistan, this unique hospital has afforded its practitioners the materials and environment to take care of the casualties pretty much as needed, with not really any tacked on "agendas".  In my very limited view of combat care this seems to be a somewhat unique thing.

In the time that  our unit has been here we have taken care of close to 1000 casualties and to put things really into perspective, transfused well over 5000 units of blood products. That blood figure alone is truly amazing when you think about it.  We basically don't have to think about blood, and assume that there always will be basically an unlimited and instantaneous availability of blood products for our wounded.  If one had to put your finger on one thing that stands out and probably allowed us to save more lives it is that fact.  It seems that it is pretty much possible here to keep up with any blood loss when we are operating, giving the surgeons that precious time needed to control the bleeding. We have just treated one ISAF casualty that has gotten over 70 units of prbcs and 70 of FFP in a 36 hour period. What a phenomenal accomplishment for a combat hospital in the middle of an Afghan desert.  And credit goes to the blood bank/lab here and to all the surrounding logistics both US and UK that keeps that supply of blood going. Oh and yes to our walking blood back too.  For the first time we started to run short of blood products (platelets mostly which seems to be the most precious) and word got out and we have had 100s from both UK and US camps come to get tested and get into the "walking pool", just to make sure we never do really run out!

Battle Buddy

So in combat everyone is suppose to have a battle buddy. Kind of someone you are attached to at the "hip" basically keeping an eye on each other, watching their back etc etc.
Well this is kind of my battle buddy, my co-surgeon partner, roommate and well yes...my battle buddy.

Bastion R3 and CT Scanners

Well it is hard to believe but our DET is getting ready to leave so I am thinking of things I haven't covered here. One is definitely the CT Scanners. Two 64 slice CT scanners with fancy software packages. They are very amazing.  The injection protocols are basically set up for multiphase so it is possible to see the "basic stuff" plus pretty much a whole body arteriogram, including run off to the extremities which we need alot. I am going to see if I can pack one of these scanners in my sea bag and take it home.
Pic is of 3D reconstruct and demonstrates another interesting topic: Proximal Vascular Control. Clamps are on the Common Iliac Arteries but the interesting part is how quickly and how well the external and internal iliac arteries reconstitute. This data and pictures is not available any where else in the world, simply because we are the only place that does this control and then CT.