The Kite Runner

"A Hospital is no place to be sick."
-Samuel GoldwynUS (Polish-born) movie producer (1882 - 1974)

Today was an interesting day. Like I said before, the clinic has now become a hospital. When I first got to the hospital I decided to visit the inpatient ward. The beds are so close to each other that you can almost roll from one bed to another. Most of the injuries are war related. You see many fractures and leg amputations. Most of them are young guys too. I spoke with one of the patients for a while. He was telling me about how he was fighting the Taliban, alongside Americans, on the border when he received his injury. He said that they shot a rocket at him and that is how he got his leg injury. I felt sorry for him. They do not have the same luxury of disability or social security that we do in the states. They are paid a small lump sum for their injury and are left to get by the rest of their life without any additional compensation.

I headed down to the ER and I spoke with the doctor. He told me about 2 patients that were brought in last night. The police had arrested one man for robbery. When he was in custody the man's brother tried to rescue him and it resulted in both of them getting shot up pretty good. They ended up being Orthopedic patients so they were recuperating in the Otho ward. The funny part of it was that right next to the 2 criminals was a police officer that was recovering from a gunshot wound. He had shot himself while cleaning his gun. It is almost like the cops and the robbers decided to take a timeout and live in peace while they both healed. You would never see that in the states. I have been to hospitals that treat criminals and they have their own ward and the patients are usually hand cuffed to their beds. Take a look at an x-rays of one of the injuries. The fracture is pretty obvious.



I spoke with the man that was arrested and, believe it or not, he was a pretty nice guy. Of course, he said that he was set up and was wrongly accused. He was the first Afghan that I have seen with a tattoo. I thought that it was neat so I took a picture.



I went back downstairs and I went back to the ER and I saw a man with blood all over his shirt. I took a closer look and he appeared to have a big bump on his head. I asked the police officer what happened and he sort of smiled and laughed and said that the man was told to leave an area and he did not listen. They were cleaning up his head wound before they sewed it up. Another person came in with a pretty bad laceration to his chin.

I went back upstairs to visit with the OB doctor for a while. I tried really hard to teach her about fetal heart tracings. Fetal heart tracing is similar to an EKG. It is the information that the 2 monitors that are placed on pregnant ladies belly when they are in labor provide. The OB doctor told me that they do not have any monitors in all of Afghanistan (I did not independently verify this). I could tell that she was having a hard time at it so I kind of gave up because they probably will not be getting any fetal heart monitors anytime soon. One of the nurses that works in my office is a OB nurse and her husband is an OB/GYN doctor. They are mailing a bunch of OB related stuff like pregnancy wheels, paper measuring tape, and a few other OB related things. We have 6 weeks before the first baby is delivered so we are kind of under a little time pressure to get the room up and running to make the first delivery.

I had another big group of care packages waiting for me when I got back. I passed almost all of them out. I have a few more left in my room that I need to distribute. We went over to ISAF to celebrate one of our teammates birthday. It is always nice to eat somewhere different.

The movie The Kite Runner is coming out soon and I came across an article by the Author of the book, Khaled Hosseini, regarding his trip back to Kabul after many years of being away. It is such a great article that I thought that I would reprint it on my blog. It gives a really good example of what Kabul is like. So sit back, relax, and take your time reading it. Just a little warning there are some parts that are graphic so if you read this with your children then I would take caution.

Here is the link to the article

http://books.guardian.co.uk/review/story/0,,2227662,00.html

"The long road home Khaled Hosseini's bestselling novel, The Kite Runner, was set against the devastated landscape of his native Afghanistan. In the run-up to the story's release as a film, the author recounts the horrors and hopes of his first visit to Kabul since 1976 Saturday December 15, 2007The Guardian Ahmad Khan Mahmoodzada as Hassan and Zekiria Ebrahimi as Amir in Khaled Hosseini's The Kite Runner

"I once saw the Taliban beat a woman so badly, her mother's milk leaked out of her bones," an old shoemaker said to me in Kabul as the two of us sat by his shop front and watched traffic bolting by Haji Yaghoub mosque. In some ways, that sentence summarises my feelings about my trip back to Afghanistan after an absence of three decades: a marriage of the horrific and the poetic.

The horror was ubiquitous. It started the moment Kabul came into view from the window seat of the 727, a sprawling city the colour of mud and dust, bereft of the trees or blue waters I've always seen when flying over other cities. It continued when the Ariana aircraft touched ground at Kabul airport: strewn all around the runway were overturned trucks and carcasses of old airplanes, burnt fuselages, remains of wings gone to rust. Outside the terminal, amid Kalashnikov-toting military personnel, I was mobbed by beggars dressed in rags, all of them children. One of them - a frail boy of six or seven - got bullied by the others; his mud-caked hand lost its grip on the 5 afghani bill I was handing through the car window, and he let out a cry of such despair and sorrow it rang in my ears the rest of that first, terrible day.

Kabul has changed a great deal since I last saw it in 1976. The traffic is suffocating now, pedestrians, mule-drawn carts and bicycle riders weaving perilously through the clogged lanes of honking cars and taxi cabs, 3 million people roaming a 30 sq mile city designed for less than half that number. The air smells of diesel fumes and smoke from the trees people burn for firewood, and sometimes the wind-stirred dust is so thick you can't see the end of the block. The dust gets in your teeth, your eyes, your ears; everyone stops in their tracks and waits for the wind to die down. I was driven through Kabul on my second day there, a grand tour of what nearly a quarter-century of wars does to a city, to a people. As I gazed out the car window at the endless destruction blurring by, I realised that there is not a single block in Kabul that hasn't in some way been scarred by war. The so-called "posh" parts of town have dirty, unkempt homes with shattered windows, set along roads riddled with potholes big enough for a small child to lie in. The areas that bore the brunt of the mujahideen infighting - Karteh Seh, Karteh Char, Deh Mazang - have simply been flattened. They are little more than block after block of demolished homes, schools reduced to rubble, movie theatres, pharmacies and shops pulverised to piles of dirt and bricks. The crumbling Darul Aman, the old royal chateau built in the early 20th century by King Amanullah Khan, is pocked with holes from rocket attacks, standing at the end of dusty Darul Aman road like an abandoned, haunted mansion. I recall my father taking my brother and me there for picnics outside the chateau, but the flowers, trees and grass are long gone, too. Across the street, Kabul Museum is little more than a storage house for ancient artifacts that have been shattered by club-wielding Taliban.

The poverty and disarray in many areas is unspeakable. I saw an old woman wearing cracked bifocals picking slimy lettuce leaves from a fly-blown heap of trash. I saw a dead horse on the side of a crowded street and learned that it had been electrocuted when it had sipped from a rain puddle and a loose power line had touched the water. Passers-by hardly seemed to notice. One-legged war victims - some of them children - and maimed former mujahids walk the streets on canes, or just stand around leaning against walls and watching traffic, as if waiting for something. At the tomb of Ahmad Zahir, a famous Afghan singer, I stared at the bullet holes in the stone, put there by hateful Taliban who had fired with machine guns on the tomb of a man killed more than 20 years ago. "In Kabul, dying once is not enough," a young panjshiri man said to me at the grave site. As I walked away from the grave, I was mobbed again by burqa-clad women and barefoot children, their hair matted with dirt, faces oozing with sores, their teeth rotting already, begging for baksheesh. They took what I handed out and said, "May God give you plenty, Kaka! May God never make you unhappy!" The locals tell you the widows are to be pitied, but not to give money to the children, that it promotes a culture of begging. Maybe that's true, but some of these children, I learned from speaking to people, get beaten by their parents if they don't come home in the evening with a certain amount of money. On some of them, I saw the tell-tale bruises and burns. Desperation is an ugly thing. So is hunger. I don't know if handing out money to them was the right or wrong thing to do. I know only that turning from them required a strength that I simply did not find in me.

In the mountains that crown the city, children walk down winding dirt roads from up to 2,000ft to the city below to stand in line at the well and fill pails or antifreeze containers with water. They load them on their backs and carry them up to their homes - a process that takes hours every day. Then their mothers hand them dough, and the children walk down the mountains again to stand in line at the community oven to bake it. They wrap their bread in cloth and climb back up the mountains. There is a haggard, vacant look in the eyes of these children as you drive by them, as they disappear in the dust in your rear-view mirror. One man, a former police officer now working as a bodyguard, told me his son had failed mathematics and had to repeat third grade. "He is intelligent and he wants to be an architect and make buildings for Kabul," he said, smiling sadly, "but how can he study when he has to walk up and down the mountain all day?"

One policeman, who wanted to arrest me for videotaping him at a crowded intersection and ended up inviting me to his house for dinner (an offer which I politely declined), told me he made $40 a month to feed a family of 12: his wife, his four children, his dead brother's two wives and five children. He told me he hadn't been paid in three months and that he had borrowed money from every friend and relative he knew. He eyed the passing sleek black NGO Land Cruisers with disdain, a sentiment I found very common in Kabul, and complained that the government had given millions in aid money to the NGOs, which then spent it on fancy cars, fancy offices and fancy guesthouses. "What good are these NGOs? What have they done for us?" he said. "I have yet to see them put two bricks together." He told me the government had to find ways to put the aid money where it was most needed, in the pockets of average people. "We are thankful that the Taliban are gone and that we are safe walking the streets," he said, "but people are hungry now and they are getting desperate." He told me of a man he knew who had bought a loaf of bread, crumbled it to pieces, laced it with rat poison, and fed it to his eight children and himself. He told me of another man who, unable to feed his children any longer, had doused himself with gasoline and set himself on fire in the middle of the street. The policeman saw the shock on my face and nodded glumly. "It's true, my friend. It's all true. Tell this to the people in America."

I spoke to people on the street about life during the mujahideen infighting and Taliban rule. Mohammad Agha, a thin man with a haunted, weather-beaten face older than his stated 33 years of age, told me every home in his neighbourhood had been hit by rockets between 1992 and 1996. "My neighbour's home was hit one day, and I went into their basement. I saw a leg here, a breast there, meat everywhere." They had had to identify the victims by their clothing. His own house had been hit one day while he had been at work, and he had run home, expecting to have to dig his family's body parts out of the rubble. Instead he found his father sitting under their mulberry tree, clutching Mohammad Agha's children in his arms, all of them miraculously unharmed. "God is so great, words fail me," Mohammad Agha said to me. He told me that, one day, shortly after the mujahideen took over Kabul, he was walking by a house when he heard screaming. He knew the officer at the door from school and was able to get through. He found three young women in one room, their clothes torn off their bodies, and a mujahid soldier struggling with another woman in the living room. "He wore a ring on each finger, but there was one last ring he hadn't been able to pull off the woman's finger. So he had forced it into his mouth and he was yanking the ring off with his teeth, blood dripping from his mouth, tearing the meat off the woman's finger." He shook his head and told me that was one of the worst things he had ever seen in his life. "And I've seen people nailed in the head, cut in half with saws, their eyes gouged out with bare hands," he added. He told me how the mujahid forces in the mountains used people for target shooting: that they would bet 1,000 afghanis for a pedestrian, 2,000 for a bicycle rider, 3,000 for a car. 1,000 afghanis is $20. "You know the worst part?" he asked. "Some of those people are now working for the government, driving fancy cars." I spoke to my driver, Awdi Khan, a plump, kind-faced man in his late 40s. I told him that some people in America whisper that the reports of the atrocities committed by the Taliban are exaggerated. He scoffed at this. "Then they should have been here with us," he said. "There were executions every Friday or every other Friday; certainly hand-cutting every week. They would announce it on TV on Wednesdays: 'So-and-so, son of so-and-so, from so-and-so area, will be put to death for this or that crime.' The hands ... " he paused, " ... they would tie to a ring and parade them in front of the people at Ghazi Stadium." He told me how he sometimes had to pray midday namaz three or four times. "You would be walking down the street and some Talib would tell you to go to the mosque to pray. You would swear to him that you had just prayed, but he would hit you with a whip and call you a liar. You'd pray once more, then cross the street, and get stopped again."

But here is the most amazing thing of all: amid the despair, sickness and destitution, I saw beauty and kindness that brought me to my knees. And I saw what I had come to Afghanistan to see: signs of rebirth and hope, signs of a people allowing themselves to dream again. I saw men planting grapevines and trees on the hill that leads to Bagh-e-bala, King Abdur Rahman Khan's old palace, which overlooks the city. I chatted with a young shepherd playing the flute on that hill, the bells on his sheep jingling as they fed on grass. He thought his life was much better since the Taliban had been largely ousted - he could play his flute again. Children flew kites from rooftops and young men in pirhan-tumban played volleyball at the Shar- e-nau Park. People smiled and little schoolgirls sang songs as they skipped to school, holding hands. I saw people painting old homes, building new ones, digging gutters, going to the movies and playing Bollywood soundtrack songs and rubab music at street corners. Kebab-makers fanned skewered lamb on charcoal flames and, more than once, offered me free meals. Awdi Khan took me to a section of Kabul river that people had turned into a bazaar. "Afghan people make do with what they have been given," he said. The droughts had dried the river, so people had set up shops in its empty bed, selling carpets, clothes and cheap jewellery. "They call it Titanic City," he said. It rained for the first time in years while I was there, and within days the river was flowing once more. "No more Titanic City," Awdi Khan said, smiling, "but people are happy. We need water for the trees and the wells. We need Kabul to be green again." Kabulis love flowers once more. They buy them from stores and place them on the windowsills of their broken homes, sometimes planting them in the empty shells of old mujahid rockets - Rocket Flowers, they call them. They deck out their cars with pink flowers and white ribbons on wedding days, driving and honking through Chicken Street past muddy ISAF jeeps. Despite the squalor around them, Afghan dignity has managed to survive. I tried to hand a young boy money once at Koteh Sangi. He shook his head and said, "I am not a beggar, Kaka." Then he invited me over to tea at his house. The "house" turned out to be three and a half crumbling, roofless walls with a wrecking-ball-sized gaping hole in the middle of one.

I have returned to my own life now in America, a life whose even minor conveniences suddenly strike me as decadent. I have had a few days to reflect on my return to Afghanistan, as I drive around town, as I stand in line at the grocery store, as I lie in bed at night, my two children sleeping safely down the hallway. The enormity of what has happened in my homeland is overwhelming, but what comes back to me is not the poverty, the destruction, the aftermath of years of violence. Nor is it the nostalgic satisfaction of seeing once again my father's house in Wazi Akbar Khan where I grew up, or Istiqlal, my old school, or Cinema Park where my brother and I saw so many old westerns; all of these settings I used for my novel The Kite Runner. No. What I think of mostly is the people I met, their faces, their names, their smiles. I think of the stories they so generously shared with me, and how they have managed to survive in the face of what has happened in that land, how they have salvaged their dignity, their dreams and hopes. How they have stayed kind. I think of the strength of the Afghan people. I think of their humility. Their astonishing grace.

The author's latest novel, A Thousand Splendid Suns, is published by Bloomsbury (£16.99). The film of The Kite Runner will be released on December 26."

I look forward to seeing the movie.

Thanks for reading.

UV Light

"There is nothing new under the sun but there are lots of old things we don't know."
-Ambrose Bierce, The Devil's Dictionary US author & satirist (1842 - 1914)

"A man should never be ashamed to own he has been wrong, which is but saying, that he is wiser today than he was yesterday."
-Alexander PopeEnglish poet & satirist (1688 - 1744)

Today I spent some time discussing different medications that was in a shelf of a medicine cabinet in the ER. I held up a box of tetanus vaccine. I asked the ER doctor what were the indications for the vaccine and how long does the immunity last once the vaccine is administered. He knew when and how to use it but then he said that the vaccine only gives you 6 months of immunity against tetanus. I corrected him and I told him that it is actually good for 10 years. His reply was, "No, this vaccine is from China, it only lasts 6 months." We both laughed. He was still wrong.

I held up a bottle of Atropine and I asked him for what conditions does he use it. He said that he would use it to control severe nausea and gastrointestinal upset. I walked over to a Advanced Cardiac Life Support poster that we put up last week and I showed him where in the algorithm that it should be used. It did not strick me until tonight that Atropine could probably be very effective in controlling gastrointestinal over-activity because it works on the parasympathetic nervous system which effects gastrointestinal motility. We probably do not use it in the states for that reason because it is potentially very toxic. So he was not entirely wrong he is just behind the times I guess you could say.

Similarly, there were numerous vials of Aminophyline which was commonly used for asthma in the 1970s but is not commonly used anymore in the states because it has a lot of toxic side effects and it has to be monitored closely. Incidentaly, I have yet to see any asthma inhalers. I think that it may be a cost issue.

I held up a vial of Calcium Gluconate and I asked the same question. He said something about its use with diabetes. I told him that since they do not have a lab where they are able to calculate a patients calcium level then he probably should not be giving it to anyone.

I held up a vial of Vitamin K and I asked when does he use this. He answered that it would be used on someone that has a bleeding problem. In the states, Vit K would be used to reverse someone that is taking too much Coumadin. I have yet to meet anyone on Coumadin in Afghanistan and unless we are dealing with a Vit K deficiency, which is pretty rare, it probably does not have much use in an ER. He also had vials of Vitamin B6. In the states we use this only when we prescribe a common tuberculosis medicine called INH. I wonder if Vitamin K and B6 are needed because nutritional deficiencies are common in Afganistan.

We then went through about 5 different blood pressure medications. One of them was Digitalis. This is another medication that needs to be monitored by a lab and I know that they do not have that capability.

I went upstairs and I learned that they were going to have their first surgical case in the OR. I was very excited for them. I have been told that they have the nicest operating room in all of Afghanistan. Here is a picture.

I walked into one of the ORs and the surgeon was very hesitant to have me go in the room. He explained that the UV light was on. When I first learnt that they used UV light to sterilize their operating rooms I sort of smiled to myself thinking that they were misguided. Tonight I was a little curious to see if I was correct because it was not the first time that they have proven me wrong. I actually found that there was a lot of literature on the use of UV light for germicidal irradiation. It has been in use for over 100 years. In 1903 the Nobel Prize for Medicine was awarded to Niels Finsen for his use of UV against tuberculosis. Here is a link to an article.

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Here is another article that I found on the first operation under UV light.

"January 15, 1936 a Duke surgical team led by J. Deryl Hart, MD, performed the first operation under ultraviolet (UV) lights.

The early days of Duke Hospital saw rash of postoperative infections, some fatal, in patients with large, “clean” surgical wounds. Duke surgeons investigated this puzzling problem. Tests showed the cause of the infections to be staphylococcus aureus. They focused their investigation on how the bacteria got into the operating rooms, as all personnel followed prevailing aseptic procedures for themselves and the patient, as well as sterilization of all equipment used in operations. They found that surgical staff brought the bacteria into the operating room on body hair, particularly in the nose. The most careful scrubbing didn’t eliminate all the bacteria on a person’s body.

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To combat the problem, Hart’s team turned to ultraviolet lights. They determined the exact power needed in UV lights to kill the bacteria in the operating field with the least risk for operating room personnel. Surgical staff, because they frequently worked under UV lights, had to wear protective clothing with visors to shield their eyes. The patients were safe as they were in the operating room only once.

Results were seen immediately. Patients experienced less post-operative pain, and, most important, infections fell from 33 percent to 3.8 percent, with no fatalities. Other hospitals following Hart’s lead experienced the same results. The cost for this improvement was minimal: UV lights sold for less than $10 each from retail outlets.

This research garnered national attention for the new Duke Hospital."

I got to thinking a little bit more, and I was reminded that a year ago, before we moved into our new home, we hired someone to get rid of the tobacco smoke smell from inside the home and they used UV ozone. So here I was thinking that they were doing something that was futile and I did not even bother to research its validity or even realize that I used the same method to rid my home of tobacco smell a year ago. Talk about pie to my face. I am still going to emphasise the use of bleach and other common methods to reduce germs in the OR, but they can continue on with their UV light. Here is the light. It hurts my eyes just looking at the picture.

The VCR program did their weekly sorting tonight. A few of you might recognize some of the boxes.

Some kid is going to look very stylish with these snake skin boots.

Muslims will be celebrating another Eid soon. It is officially called Eid ul-Adha and it lasts four days, a day longer then the Eid that took place after Ramadan, hence the name, "The Greater Eid."

I included a small summary from Wikepedia if you would like to learn more about it. Here is a link to the entire article.

"Men, women, and children are expected to dress in their finest clothing to perform Eid prayer (Salatu'l-`id) in any mosque. Muslims who can afford to do so sacrifice their best domestic animals (usually sheep, but also camels, cows, and goats) as a symbol of Ibrahim's (Abraham's) sacrifice. The sacrificed animals, called "udhiya Arabic: أضحية" also known as "qurbani", have to meet certain age and quality standards or else the animal is considered an unacceptable sacrifice. Generally, these must be at least 4 years old, and weigh 26 st. At the time of sacrifice, Allah's name is recited along with the offering statement and a supplication as Muhammad said. According to the Quran a large portion of the meat has to be given towards the poor and hungry people so they can all join in the feast which is held on Eid-ul-Adha. The remainder is cooked for the family celebration meal in which relatives and friends are invited to share. The regular charitable practices of the Muslim community are demonstrated during Eid ul-Adha by the concerted effort to see that no impoverished Muslim is left without sacrificial food during these days. Eid ul-Adha is a concrete affirmation of what the Muslim community ethic means in practice. People in these days are expected to visit their relations, starting with their parents, then their families and friends."

Thanks for reading.

Chess Master

"Avoid the crowd. Do your own thinking independently. Be the chess player, not the chess piece."
-Ralph Charell

It is the Muslim holiday Eid for the next four days so we will be doing a lot of work in our office. It was a good opportunity to visit Camp Phoenix to get our HUMVEEs worked on. We needed new brakes and a bunch of other things fixed. A number of stars will be coming to visit the camp this week. You may recognize a few of the names, Kid Rock, Robin Williams, Lance Armstrong and the current Miss America. I watched them set up the stage. Hopefully I can get a few good pictures.

I was shopping in the px and I came across a Special Ops checkbook cover. I wondered what was so special about a Special Operations checkbook cover and why do they need to write checks anyways.

We had a Camp Eggers MWR Christmas party tonight. I included a chess quote at the top because I beat Adam at chess tonight. He put up a good fight but it just was not enough to beat the Chess Master. Maybe next time Adam.

The Air Force brass quintet played a bunch of Christmas Carols at the party. They were pretty good. After they were finished we enjoyed a wild game of bingo. We are a crazy bunch over here. We really know how to party.

Here is the Air Force brass quintet in action.



I loaded some new picasa photo books. Feel free to take a look.

Thanks for reading.

Ha Ha Ha

"You pile up enough tomorrows and you'll be left with nothing but a bunch of empty yesterdays. I don't know about you, but I'd like to make today worth remembering."

-Meredith Willson, The Music Man

It was actually a pretty productive day, unfortunately, most of it involved office work that is not very interesting so I will spare you the details.

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I received an iTunes gift card from my wife and I was able to download some new music. While I was on iTunes I also downloaded the latest episode of This American Life. When I was back home it was the highlight of my drive to listen to it on the way to work. They allow you to download a free podcast every week. You have to pay for older episodes. You can click on the logo to go to their website.

This weeks episode is a good example of how the show can make you both laugh and almost cry in the same episode. Take a listen. I promise you will be addicted. It is like nothing you have ever heard.

I received a whole box of Christmas stockings. I will bring them to the office party that will be happening soon.

A good friend of mine sent me a harmonica. It will be so fun to learn how to play.



I was also sent 2 new books. I think that I am the only person over here that has not yet read them. I plan to start with the Kite Runner first.

The wonderful kids from the Gaffney, South Carolina 8th grade class left me a great comment on yesterday's blog. I also received a bunch of letters and poems from them. I find it so funny that they are no longer able to say Ho, Ho, Ho and that it has been replaced by Ha, Ha, Ha.

It is so funny because I have a picture of the students and I bet that I could match their comments with their picture, especially !!!X!DREW!X!!! (")(-_-)("). He reminds me of myself when I was his age.

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Here is one of their poems.

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Here Comes Christmas

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Christmas is coming

and everybody wants a lot of gifts

but that is not what Christmas is about

Christmas is for the love of Christmas.

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It's just right around the corner

and no one can wait

it seems like Christmas is gonna be late

but the birth of Christ is not too late.

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I wish you a Merry Christmas

and the best of luck, never give up hope,

Ho, Ho, Ho, Merry Christmas

to you and all.

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Hope you have a wonderful Christmas.

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Thanks for reading

Hope and Freedom Tour

"Take a music bath once or twice a week for a few seasons, and you will find that it is to the soul what the water bath is to the body."
-Oliver Wendell HolmesUS author & physician (1809 - 1894)

"I think I should have no other mortal wants, if I could always have plenty of music. It seems to infuse strength into my limbs and ideas into my brain. Life seems to go on without effort, when I am filled with music."
-George Eliot



Today we were visited by some country music stars. Take a look.

Here I am with Darryl Worley

and Keni Thomas.

Their plane was supposed to get in a lot earlier and because we have been having a lot of bad weather lately they did not end up coming in until 11:00pm. The plane flight here is ridiculously long and the last thing that you want to do when you get here is take a bunch of pictures and sign autographs. They were real troopers. They all had great attitudes and seemed genuinely happy to be here.

While we were waiting around for them to come it was kind of fun because different people were doing karaoke and some folks were country dancing. It is always so strange and surreal to see seemly normal things like line dancing and then you look down at their leg and see a 9mm in the leg holster or an M16 on their back. It is a strange contrast seeing normal activities that are taking place in a very strange place.

Take care, it's bed time.

Shopping Intervention

"It is difficult to live in the present, ridiculous to live in the future, and impossible to live in the past. Nothing is as far away as one minute ago. "
-Jim Bishop

"I always say shopping is cheaper than a psychiatrist." Tammy Faye BakkerUS wife of Jim Bakker 1961

The snow really came down last night. Kabul is somewhat surrounded by very large mountains and for the first time they were all covered with snow. You have to really be careful walking around here because it is very slippery with all of the ice.

Last night a few stars came to visit Camp Phoenix. It is too bad that I missed it. A lot of people took pictures. I should have some more coming. Take a look. Maybe you can recognize a few of them.

Robbin Williams


Lance Armstong

Kid Rock

And that guy from the Daily Show. The Daily Show is one of my favorite shows back in the states. I would record it on a regular basis.

The Eid break was nice and now it is time to get out of the office and back to clinic work again. This next week will probably be the busiest of my entire deployment. I can’t go into any details yet but stay tuned. It should be interesting.

Tonight we had our team Christmas party. It was fun.

I am a little concerned about my friend Adam. I think that I might have to do a shopping intervention on him. We were joking with him tonight saying that he could probably open up his own shop with all of the stuff that he has bought. This is just a very small fraction of the things that he has bought and sent back home to his family.



When he opens his shop he will need to get the different standard phrases down that all of the vendors use. "Looking is free," and, "It's OK...just looking," or the so very believable, "Mister, I have not gotten any business all day. You are my first customer. I give good deal."

I was in the Coffee Bean having a Chai Latte with cinnamon with my good buddy Puff Daddy and I noticed this box with a sign on the front. It had a bunch of envelopes in it. The note in the card reads:

"Destiny began collecting and sending greeting cards to the troops in 2005 when she was only 10 years old. She read requests on anysoldier.com and found that most service men and women wanted cards and letters from home for the holiday." It goes on to say that she has sent out over 7,000 letters. I grabbed one and opened it expecting at most a signature, because after all there are about 100 cards there, it had about 12 different signatures on it. Wow.

I will send her a thank you and feature her on my community service site. Here she is.



Thanks for reading.

War Injuries

"I'm glad I didn't have to fight in any war. I'm glad I didn't have to pick up a gun. I'm glad I didn't get killed or kill somebody. I hope my kids enjoy the same lack of manhood."

-Tom HanksUS movie actor (1956 - )

Today when I got to the clinic not much was going on in the ER so I headed upstairs. I saw that the Orthopedist and was about to start his rounds so I decided to accompany him. I am not sure if the patients were just covered by sheets the entire time, but I never really had never appreciated how serious their wounds really were. Seeing all of their injuries today really took me by surprise. The hospital has only one Orthopedist and he has to manage patients that get sent from all throughout Afghanistan. The vast majority of the patients sustained war-type injuries. I do not mean be insensitive in any way, but it really felt like I was walking through a Hollywood movie set. The injuries that these people had were just horrific. The were the result of rockets, large caliber bullets, and large explosions. The patients were all very young too.

The first patient that we saw had an amputated foot and an external fixator over both legs to repair extensive fractures. The next patient had a deep gaping hole, the size of a grape fruit, over his right buttock. There was a smaller entrance wound over his right groin. The next patient and an extensive compound fractures over his right lower leg. When the Ortho doctor approached the patient he removed a small piece of gauze that covered his wound. A piece of bone fragment the size of a quarter could be seen protruding from the wound. He removed the piece of bone and discarded it in the trash and then his assistant covered it back up with gauze. The Ortho doc said that he did not have any more external fixators to repair his fracture. I asked why he did not have a cast on his leg and he said that he was still waiting for the edema (swelling) to go down. The next patient was completely missing his left arm and an eye. The next patient was partially paralyzed from a gun shot wound to his spinal cord. His foley catheter was lying on the floor. There was patient after another with similar injuries. I asked the Orthopedist how many of his patients were in the hospital and he replied, "18. "When I told him that it was a lot he smiled and replied, "That that is nothing, I had 120 patients in the old hospital."

As I was walking out of the room I saw a patient lying on a plastic mattress without a sheet. I asked the head nurse why he did not have a sheet. He told me that the patient had gone to the bathroom 3 times in his bed already and they were not going to give him any more sheets. I felt bad because the patient was incontinent from his injury which made him partially paralyzed. All I could do was just take it it all in.

I went back down to the ER for a little lighter atmosphere. The ER doctor and the PA were there. They are always in a good mood and we always joke with each other. I wish that I could play a recording of the PAs laugh. It is so funny. It sounds like a high pitch squeal. It is the kind of laugh that triggers laughter from others. The PA invited me to visit his apple orchard. He says that he owns 9 acres of land.

Look what they did to their medication dispenser. Each drawer has a different liquid in it- hydrogen peroxide, saline, betadine, and alcohol. I tried to explain to them that it probably is not the best idea, but what can you do.

I visited the lab and it was almost like going through a time warp. Take a look at some of these reagents. They do all of their labs by hand. I am not sure if you realize but in the states most clinics and hospitals used large automated machines to do their labs. It was like visiting a chemistry lab. They had all kinds of reagents: Thymol, Urea, Copper, Sulfuric Acid, Calcium Carbonate, probably every element in the periodic table. I am so curious what they do with Copper. I will just have to ask them next time I am there.

A friend of mine was sent a talking parrot. Take a look. It is the perfect pet. You never have to clean or feed it.

Take care.

Pine-sol

"We merely want to live in peace with all the world, to trade with them, to commune with them, to learn from their culture as they may learn from ours, so that the products of our toil may be used for our schools and our roads and our churches and not for guns and planes and tanks and ships of war."
-Dwight D. Eisenhower34th president of US 1953-1961 (1890 - 1969)

I loaded about 300 new pictures in the Dr. Massaud photo album. He takes amazing pictures. Loading them onto picasa was like cooking a turkey. I started it last night and it was not finished uploading until middle of the day. I already mentioned it on a previous post, he won the camera from a BBC contest. He said that he wanted to document the effects of 30 years of war so when his country gets rebuilt people will not forget how terrible it is to go through war.

Today at clinic I walked into the ER to see an older man in his mid 60s lying on the exam table. The ER doctor told me that he was a judge and he was just attacked by 4 Taliban members on his way to work. They had just shot him in the head. The bullet went from the back of his head and out his upper brow. His wife, who wore a burqa, was by his side holding his hand. There is not a lot we could do for him. I helped get him an x-ray. We did a neurologic exam and it was normal. The judge was admitted to the hospital and, ironically enough, they placed him in a bed located right next to a criminal.

I was somewhat disheartened standing amongst all of the patients in the ward. I am fairly disappointed with the level of care the patients are receiving. In the states any one of the patients admitted would probably be followed by 5 different specialists- Internal Medicine, Physical Therapy, Infectious Disease, Orthopedics, General Surgery, Social Worker, etc. Instead, the patients have their family members take care of them. I spoke with a father who said that he has followed his son from a distant province so he can help to care for his son at our this new facility. He has almost spent all of his savings. His son was with a group of other soldiers when they were ambushed by the Taliban. Everyone died except his son. He had numerous gunshot wounds to his abdomen. A large verticle post-surgical scar is visible over his mid abdomen with a couple of drains protruding from it. His father has had to purchase all of his medications, and even the colostomy bag that he has to use, from a local bazaar. There were no sheets on the mattress. The sheets that were there were filthy.

The interpreter that was with me (Dr.Massaud) was visibly upset. He said to me, "It is not right. This is a very brave man here. He stood out in the cold snow with his AK fighting very bravely for his country and this is the treatment that he gets."

I went to speak with the housekeeper about the sheets. He said that it is not his job to collect the sheets he only cleans them. I went to speak with the head nurse and he said that there is no one on the payroll to collect the sheets so the sheets are not being washed.

It have found that it is very difficult to get across the do more with less concept. In our military we just get by with what we have. We say mission first. You check your pride at the door and just get the job done for the sake of the mission. I tried to convoy the importance of patients' first to the head nurse but I do not think that he was very receptive to it. Before I finish this deployment there will be sheets on every bed and they will be cleaned everyday. I will make sure of it.

Speaking of cleaning, it is so funny how the house keepers always want to impress you whenever you are there. Yesterday we were in a small circle talking in the lobby and one of the housekeepers literally took a long vacuum and started vacuuming in the middle of our little circle. Today in the ER a few of them were in the ER with a mop cleaning all the floors, stools, and walls. I looked at the solution that they were using and it was pine-sol. I spoke with the head housekeeper and I asked him why he does not use a diluted bleach solution because pine-sol is not a very good disinfectant. He said that pine-sol was very good at disinfecting. We debated back-and-forth for 5 minutes. I think next visit I will focus on mop water and bed sheet washing. In all honesty, I think that it is actually more important then teaching medicine. If you can disinfect and have a semi clean environment for the patients then that is half of the battle. The healing part is easy, most of it is done by the patient.

Take a look at the Goat House DFAC (chow hall). They made this impressive display all by hand. I saw them carving the figurines. It must have taken 3 weeks. I am sure that it is not written in their contract. They just do it because they enjoy doing it.

Adam and I went to evening mass at the Italian Embassy. It was really nice. It always amazes me how consistent Catholic mass is where ever you go. Here we are in Kabul, Afghanistan, with a priest that is from Italy, and they are singing all of the same songs, saying the same prayers, and doing the same routines that go with a Catholic mass. There is something very comforting about it. Take a look at some of these beautiful paintings in the church.

Take care.

Italian Embassy

"A human being is part of a whole, called by us the Universe, a part limited in time and space. He experiences himself, his thoughts and feelings, as something separated from the rest--a kind of optical delusion of his consciousness. This delusion is a kind of prison for us, restricting us to our personal desires and to affection for a few persons nearest us. Our task must be to free ourselves from this prison by widening our circles of compassion to embrace all living creatures and the whole of nature in its beauty."
-Albert EinsteinUS (German-born) physicist (1879 - 1955)

"If there were in the world today any large number of people who desired their own happiness more than they desired the unhappiness of others, we could have paradise in a few years."
-Bertrand RussellBritish author, mathematician, & philosopher (1872 - 1970)

"Realize that true happiness lies within you. Waste no time and effort searching for peace and contentment and joy in the world outside. Remember that there is no happiness in having or in getting, but only in giving. Reach out. Share. Smile. Hug. Happiness is a perfume you cannot pour on others without getting a few drops on yourself."
-Og Mandino(1923 - 1996)

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Today we worked a half day and tomorrow we have the day off. The only good part of having a day off is I am able to sleep in. Other then that, I actually do not like them very much because the day tends to drag. It is not like I can spend the time with my family and escape this place. The days go by much faster when I am working at the clinic. I mentioned it a few days ago that I was going to have a very busy week. I was suppose to take a trip but it ended up getting canceled at the last minute.

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Adam and I went to the Italian Embassy for the midnight mass (it actually was at 9:00pm). There were a couple of news cameras there. I think because the Prime Minister is in town. At the end of the mass the priest asked everyone to say Merry Christmas in their native tongue. 15 people must have come up to the podium. They were from all different parts of the world. It was really fascinating to see and hear them all. At the end of the mass the priest announced that the Ambassador invited the entire congregation back to his home for pastries and chocolate milk. After he said this the congregation let out an, "Ahhh." Apparently, it is considered a big deal for the Ambassador to open up the doors of his home to guests. I felt very lucky that I was able to be a part of it. Take a look at some of the pictures.

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Here is the outside of the church.

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Here is the inside of the Embassy.

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I told Adam that I wanted to meet the Ambassador earlier in the night. A little latter we were standing by the large table full of pastries enjoying a cup of very thick chocolate milk (I should say chocolate pudding) and Adam asked, "Where is the Ambassador anyways?" I whispered into Adam's ear that he was standing right next to us. He immediately grabbed my camera and tapped the Ambassador on the shoulder and asked if he could take a picture with me. It was pretty funny. The Ambassador was very friendly. We had a short conversation and he asked if we had seen his plane. I said that I had not. He told us to make sure we take a look at it before we left. Here it is. I assume it is very old.

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We gave the priest a ride over to Camp Eggers because he had to give the real midnight mass over at Eggers.

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Thanks for reading.

Merry Christmas

"You must be the change you want to see in the world."
-Mahatma GandhiIndian political and spiritual leader (1869 - 1948)

Merry Christmas. People were especially friendly today. Random people wished me a Merry Christmas as I passed them by. Everyone seemed to be putting their best face forward even though we all know that we would rather be home with our families. I think that it is especially hard when you have young children. I really feel like I should be there for them during the holidays. I am looking at pictures that my wife has been sending and I think to myself that I can never get those moments back. I will just have to make up for lost time when I get back.

I uploaded pictures from the last VCR trip. I did not attend it so none of the pictures were taken by me. Someone that cares a lot about me does not want me going on anymore non-work related trips. So I will just have to help with the sorting for now on. I am sure that some of the toys that were sent from readers of this site were distributed to the children in the hospital. The hospital that they visited was a children's Orthopedic hospital. It is one of the main, may even be the only, place where artificial limbs are made in Kabul. We have a lot of police who are in need of prosthetic limbs so maybe we can try and establish a relationship with them.

Tonight we had 2 comedians perform for us. They were pretty funny.

It is almost 1:00 in the morning and I am editing and about to publish this post. As I am doing this I am watching my children open Christmas presents on my webcam. My wife is showing me the presents after they are opened. This will hopefully be the last Christmas that we spend apart.

Thanks for reading. Merry Christmas.

Turbulence

As you journey through life take a minute every now and then to give a thought for the other fellow. He could be plotting something.
-Hagar the Horrible

When we remember we are all mad, the mysteries disappear and life stands explained.
-Mark TwainUS humorist, novelist, short story author, & wit (1835 - 1910)

The only thing that makes life possible is permanent, intolerable uncertainty; not knowing what comes next.
-Ursula K. LeGuin

He's turned his life around. He used to be depressed and miserable. Now he's miserable and depressed.
-David Frost

Turbulence is life force. It is opportunity. Let's love turbulence and use it for change.
-Ramsay Clark

We must not allow the clock and the calendar to blind us to the fact that each moment of life is a miracle and mystery.
-H. G. WellsEnglish author, historian, & utopian (1866 - 1946)

This is a super sized post because you get extra videos and extra quotes today. The videos are from Dr. Mossaud. I love videos that show a little slice of Kabul. The first one is the long version of a Buzkashi game. I also included a shorter version on the video in case it takes too long to download. It is so funny because from my impression it looks like a ton of people are gathered around another big group of people riding horses all huddled in a circle. Someone grabs a dead decapitated goat in an attempt to bring it to the other end of a field. In the process, the group of men on horses charge towards the crowd that runs away like a matadors being chased by a bulls.

The other video a really young kid doing very hard work. I think he is pounding steel. Next to him are other people sharpening knives, etc. Of course no one is wearing eye or ear protection. The last video is a tour of bird alley. You see an old man making bird cages and you see all kinds of birds in this crowded alley.

Today I noticed a 360' difference in the quality of the patient care. I walked into the inpatient ward and every bed had sheets on them and they were all clean. The room did not smell. I asked the patients if they were satisfied with their care and they all unanimously said that they were very happy. I spoke with the head nurse and he said that everyone ended up pitching in to help out. You could tell that he was very proud of what they had achieved.

Brand new defibrillators came in the other day so I set one of them up in the ER. They were pretty user friendly. I went over the different cardiac life support algorithms and I showed the ER doctor how to use the machine. We placed electrodes on one of the assistant so we could view an actual EKG on the monitor. I was not sure how to print out a rhythm strip so I started to look through the user manual. The assistant immediately jumped off of the bed and joking said that he was through being a patient if I needed to read the manual.

A police officer was brought in by his fellow officers. He had just been dragged by a taxi that he had stopped and was trying to question. I was very impressed to see that the ER doctor actually filled out a standardized form requesting an x-ray. He also showed me an excel spreadsheet where he kept all kinds of patient statistics. Things have really started to come together.

I received a great Christmas present from my day care provider today. It was one of those gifts that you have to run back into your home to rescue when your house is on fire. It came with a dictated letter from my 4 year-old daughter. Here are parts of it:

Dear Daddy,

I love you. Happy Christmas! I goed to Bethany's birthday. I like when you are home. I know that you miss me. I miss you too. Goodbye. I love you.

Thanks for reading.

2 Apple Tree by 2 Apple Tree Length Vision

"People often write me and ask how I keep my wood floors so clean when I live with a child and a dog, and my answer is that I use a technique called Suffering From a Mental Illness."
Heather Armstrong, Dooce, 07-07-06

"Tomorrow is the most important thing in life. Comes into us at midnight very clean. It's perfect when it arrives and it puts itself in our hands. It hopes we've learned something from yesterday."
John WayneUS movie actor & director (1907 - 1979)

I love that title picture by Dr.Massaud. It is going to stay up for a few days.

Today I continued to see progress. It is progress that is small and subtle, but added together through time will equal big changes. Forinstance, the inpatient ward did not smell as bad as it normally does, doctors were doing wound care with gloves on, and nurses were changing bed sheets.

I visted with the Physical Therapist for a while today. I wanted to let him know that I considered him one of the most important people in the hospital. Most of the inpatients are Orthopedic patients that are recovering from amputated limbs and serious fractures. I told him that it is essential that he gets out of his 1st floor office and work with the inpatients upstairs. Despite having brand new equipment, such as treadmills and stationary bikes, he still insited that he needed new equipment. He pointed to his old cervical and lumbar traction devices. They look like mideval torture devices. I told him that this equipment is not important for the work that he needs to be doing. I informed him that in the states all a Physical Therapist that works in a hospital needs is a belt around their waist. I told him that the most important thing he should be doing is getting the patients up and moving. Here is the cervical traction machine.



Seeing pictures from the last VCR trip to the K.O.O. inspired me to try and get some artificial limbs for some of our patients with amputations. It turns out that we already have a contract in place with the K.O.O. and we were just not taking advantage of it. I would like to see at least one patients get a new prostetic device before the end of my deployment. I have arranged to have one of the patients seen this weekend. Ultimately, I would like to establish a regular scheduled visit to the K.O.O., like a shuttle service that runs there every 2 weeks. I will keep you posted.

I had a long debate/discussion with the ER doctor. He was giving an IV to a lady that was 12 weeks pregnant (by the way, just getting him to use an OB wheel to determine how far along she was was a challange in itself). He said that she came in with a note from an outside doctor that said she had abdominal pain which was the result of having kidney stones. I asked him if he did a urine test to check for a urinary tract infection. He answered, "No," because she was already diagnosed and that the doctor just ordered for her to get IV fluids. I tried to get across the concept of covering one's diarer. There are no malpractice attorneys in Kabul so doctors are not exactely concerned about getting sued. I tried to teach him that you should never trust what someone tells you. To always have a jaundiced eye to what others are telling you. Always verify for yourself just to be sure. I finally was able to convince him to get a urine study. The patient ended up not having a urinary tract infection but the ER doctor did say, "She has an abnormal lab! She had a hemoglobin of 8." Normal is >12. I said, "Good job. What did you do with her?" He replied, "I sent her to OB." That was not exactly the answer I was looking for.

We then had a 5 minute debate about how best to improve her anemia. He wanted to give her iron dextran which comes as a shot that you give in the arm. Aside from being very painful, it could also be very dangerous for the mom and the baby because you can potentially get a very serious reaction from it.

While I was in the ER I saw that they had 2 of the eye charts that I brought in the other day hanging on the wall. I asked the assistant if he knew how far away a patient had to stand to do a proper visual acuity check. He incorrectly answered 30 feet. I asked him how he planned to measure out the distance and he said that since he owns an apple orchard he is very good at judging distance. The distance will be the same distance between 2 apple trees. We both laughed. So I guess a patient should have 2 apple tree by 2 apple tree length vision. Works for me.

Thanks for reading.

Center of the World

"When the traveller from the south beholds Kabul, its ring of poplars, its mauve mountains where a fine layer of snow is smoking, and the kites that vibrate in the autumn sky above the bazaar, he flatters himself on that he has come to the end of the world. On the contrary, he has just reached its centre."- Nicolas Bouvier, L'Usage du Monde

Today was a down day so I did a lot of reading. I had to resort to living vicariously through the photos of LtCol Johnson who was invited to a lunch meeting that took place off base. He was able to drive to the top of a very tall mountain and take some beautiful pictures. The pictures allow you to see how large and beautiful Kabul really is. I included a little history of the different places that I researched off the web. Hope you enjoy.

Kabul City Walls, from Radio Afghanistan: "Around the emergence of Islam, the Kabul Shahan dynasty, a remnant of the small Kushanids, ruled ancient Kabul and its surrounding areas. King Ratbil Shah (or Zanbil Shah), a king of this line, was a very cruel tyrant. To stop attacks from abroad, the Shah decided to build a high wall around the city. He forced all the youth of the city to build the wall as soon as possible. So, the youngsters of the city were working very hard under the watchful eye of wardens supervising the construction of the wall. If anyone refused to work, he was buried alive in the walls. Thousands of youth fell victims to the tyranny of the evil king. The wall that still remains today on the Shirdarwaza and Aasmae mountains is a reminder of that dark era."

Habibia High School, from Google: "Afghanistan’s Who’s Who attended this important school in Kabul. Hamid Karzai, former King Zahir Shah and nearly 50% of the Afghan ministers graduated from this school, just to give an example. Though, the Taliban reduced Habibia to a bullet-ridden shell, it was reconstructed with international support and reopened with a modern and up-to-date look in 2005."

Here is a 3-D view.

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Pul-e Khishti Mosque, from Kabul Caravan: "Standing in the centre of old Kabul, the Pul-e Khishti Mosque was originally erected in the late 18th Century, but largely rebuilt under Zahir Shah in the late 1960s. Its can be picked out by its large blue dome but is otherwise architecturally indistinct, a mix of international modern style punctuated with traditional Afghan tiling."

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From Google: "Mosque in Kabul known under various names such as Masjid-e Pul-e Khishti or Pul-i-Khishti Masjid. Client for construction of this mosque of the Abdali period/style was Zaman Shah (1770 - 1844), the fifth son of Timur Shah."

Here is a 3-D view.

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Shah do Shamshira Mosque, from Google: "The large two-storied mosque across the river from Timur Shah's mausoleum stands on the site of a mosque originally dedicated in 1544. The present building was commissioned by King Amanullah's mother and constructed in the 1920s. Its name, meaning the Mosque of the King of Two Swords, relates to an early legend concerning the arrival of Islam in Kabul. "

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From Kabul Caravan: " Shah-Do-Shamshira Mosque Built in the 1920s on the site of a mosque dating back to the 16th Century, the Shah-Do-Shamshira Mosque is an architectural disaster. A two-storied structure in yellow, decorated with Italianate stucco, giving an effect that could be described as 'Afghan Baroque'. The name- the Mosque of the King of Two Swords- relates to the Arab conquest of Kabul, and the legendary death of a general fighting the Hindu defenders. Wielding two scimitars, the general led his troops to victory, despite having been beheaded in an earlier battle. The mosque sits on the north bank of the Kabul River facing the Mausoleum of Timur Shah."

That is pretty impressive that he was able to fight despite being beheaded in a previous battle!

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Here is a 3-D model of the mosque.

Thanks for reading.

Rusty Chai

"Confusion is always the most honest response."
-Marty Indik

"If confusion is the first step to knowledge, I must be a genius."
-Larry Leissner

We passed by a KFC today. Take a look.

When I arrived at the hospital I was offered Chai. I had always been curious how it was prepared so I decided to watch.

I politely declined the chai. Then I declined some more. And some more. They thought that it was because the glass was dirty so they cleaned the glass. I declined again. Finally, I caved. I said, "What the heck, poor me some chai." I probably am a little anemic anyways. I could use the extra iron.

I did a lot of emergency training today. I brought along a CPR mannequin and we practiced CPR and advanced cardiac life support algorithms. It is a little challenging because they do not have ventilators in the facility so if they end up having to insert a breathing tube there will be no way to maintain it.

I went up to OB to do some mentoring. The OB doctor was with a patient and she asked me if I could come in and help out. I am not sure if it is because there is a language barrier, but every time I try and get a basic patient history it reminds me of the old Who's On First Abbott and Costello routine. It is almost comical how I get absolutely nowhere. I am absolutely stumped because I can not give any good recommendations. Here is how the encounter went. I will try and recreate it for you. Keep in mind the patient wore a burqa so I do not know what she looks like at all and all of the dialogue is through an interpreter.

OB: "OK, Doctor, this patient is infertile. She would like to get pregnant. She had a pelvic infection in the past and her husband has a low sperm count."

Me: "How old is she?"

OB: "35."

Me: "Does she have any children?"

OB: "She has 2 children."
Me: "So then she is not infertile. How long has she been trying to get pregnant?

OB: "Five years."

Me: "Well, if her husband has a low sperm count then that is probably the reason. There is not much that we can do about it."
OB: "He has been getting injections of testosterone."

Me: "Does he have low testosterone level?"

OB: "Why does it matter?"

Me: "Well, you should only get injections of testosterone if you are low in testosterone."

OB: "Should I give her a shot of antibiotics?"

Me: "Why would you give her a shot of antibiotics?"

OB: "Because she had a history of an infection?"

Me: "Is she having any symptoms?"

OB: "No."

Me: "Then why would you give her antibiotics?"

OB: "Do you have a scale?"

Me: "Why do you need a scale?"

OB: "You told me that you would bring me a scale."
Me: "But we are talking about your patient right now."

OB: "What about Vitamin E?"

Me: "Why would you give Vitamin E? There are medications that can help with ovulation."

OB: "We do not have those medications."

Me: "Does she have regular periods?

Fast forward 5 minutes. We had a long discussion on what I meant by "regular periods."

Me: "Let me talk to the patient for a second. Now tell me why you have come to see the doctor today."

Patient: "5 years ago I had abdominal pain and I was told that I needed to have surgery. After the surgery I was told that I will never be able to have children again."

Me: "OB, that is very important detail that you failed to mention. Why did you not tell me that a surgeon said that she will never be able to get pregnant."
OB: "Oh, she is not sure."

Me: "She does not know if she had a hysterectomy or a tubal ligation?"

OB: "It was right after the Taliban fell and the doctor did not tell her very much. She had appendicitis."

Me: "Oh, so she had appendicitis. They did not tie her tubes or do a hysterectomy."
OB: "She is not sure. So what should we do? Should I give her a shot of antibiotics?"

Me: "Why would you give her a shot of antibiotics?"

OB: "Because she had a pelvic infection in the past."

Me: "But is she having any problems now?"
OB: "No."

And on and on it went. Keep in mind you can not do an exam, you can only do very limited blood work (nothing relating to her problem), and you can not reliably do an ultrasound. Of course, in Afghanistan there is no in vitro fertilization. You can almost understand the OB doctor's frustration. She wants to give her something. If the patient walks out without any treatment then she will be dissatisfied with her care. I left leaving that problem unsolved.
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I have a theory that people back home are trying to make me fat. Why else would they send me so much food. These cookies were made by a culinary class from The Art Institute of Colorado. My base also send me 2 big boxes of delicious nuts, tropical fruit, peanut butter, candy, etc. My wonderful day care provider even sent me a bunch of goodies. I share everything with my teammates and some Afghans. Everyone appreciates all of the gifts. The beef sticks and the cheese will be served at the New Years party.

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Thanks for reading.

Behave Like a Duck

Always behave like a duck - keep calm and unruffled on the surface but paddle like the devil underneath.
Jacob Braude

All growth is a leap in the dark, a spontaneous unpremeditated act without the benefit of experience.
Henry MillerUS author (1891 - 1980)

Be life long or short, its completeness depends on what it was lived for.
David Starr JordanUS biologist, educator, & ichthyologist (1851 - 1931)

I have learnt silence from the talkative, toleration from the intolerant, and kindness from the unkind; yet strange, I am ungrateful to these teachers.
Kahlil GibranLebanese artist & poet in US (1883 - 1931)

You teach best what you most need to learn.
Richard Bach

That last quote is very fitting because I am relearning how to place chest tubes so I can teach it tomorrow. It is a little challenging when you are a Family Practice doctor and are having to train doctors who mainly see war injuries. I will be happy to get back to high cholesterol and low back pain when I go home.

I was talking with one of the patients that was brought in yesterday evening. He said that he was with a group of people that were ambushed by the Taliban. He was the only survivor out of 8 people. He appeared to be handling it very well. I am not sure that I would have the same calm demeanor under the same circumstances.

The hospital is getting very busy. I am trying to be like the duck in the quote. There is just so much that needs to be fixed and a lot of it is beyond my scope of practice.

I can not take credit for any of the new photos. They were all taken by participants of the last VCR trip. I was not able to attend it. They did a lot of good for some very poor people. The conditions that they live in is just heart breaking. You can see from some of the pictures that they were able to give new shoes out to some children.

Somebody asked me if they should still send blankets and other stuff. The answer is yes. I will post a little blurb about the VCR program and include their address at the end. It is probably better if you start sending stuff directly to them now since I am nearing the end of the deployment.

The Camp Eggers Volunteer Community Relations (VCR) program enhances the partnership with the people of Afghanistan while providing a venue for US and Coalition troops to assist others. Through this program, Camp Eggers VCR volunteers interact with local nationals at various locations in the Kabul area, including schools, orphanages, medical centers and Internally Displaced Persons camps. The Afghan people in these locations are not as fortunate as we are and could greatly benefit from your support to improve their quality of life.

The VCR program is also involved with forwarding items to US service members located at smaller forward operating bases (FOBs) and other locations that may not have the PX facilities that most of the larger camps have.

VCR
CSTC-A, Pool House
APO, AE 09356

Thanks for reading.

Happy New Years

"Cheers to a new year and another chance for us to get it right."
-Oprah Winfrey, O MagazineUS actress & television talk show host (1954 - )

Happy New years! It was business as usual at the clinic. They received a bunch of new supplies today. The ER is starting to to look like a real ER. It is unfortunate that things tend to disappear if they are not locked up so the ER doctor made sure to put everything away under lock and key right after he received them.

The Physical Therapist was excited to see me. He asked me to come his office so I could see the patient that he was taking care of. He showed me a patient that had his arm inside of a tunnel with a UV light inside. He said that the patient was healing from a fracture and that the machine was suppose to help with healing. When I first saw it my first reaction was disbelief. Then I thought about it some more. I bet that it was commonly used in the 60s or 70s, like a lot of other equipment that they are still using. I would not be surprised to see an iron lung in one of the rooms.

We were low on interpreters so I had to use on of the doctor's kids that spoke pretty good English. He is pretty sharp for his age but I do not think that he had the whole interpreter thing down. The OB doctor wanted to know what had happened to her computer because it was missing. I looked at the child and I said, "Where did the computer go?" He looked at me back and said, "I don't know." Then I said, "No, ask her what happened to the computer." Then the OB doctor would answer me back, "What happened to the computer?" It basically was a three-way conversation that went on for 5 minutes where we all we asking each other where the computer went from English to Dari then back to English.

I was walking down the stairs when I saw an elderly lady carrying a heavy box down the stairs. I asked if I could carry it for her. It was funny, but at the same time a little depressing, because the box was too heavy for me to carry own my own. I had to ask her for help. Even the elderly over her are pretty darn tough.

I took a look at what was inside the box. It looked like a bunch of old, rusty, and dirty metal devices. I took a closer look and I realized that it was a bunch of external fixators. I asked her where she was going with them and she told me that she was going outside so she could clean them with a hose.

Today is Dr. Massoud's last day. It is a big loss for us because he is a great interpreter. He is also really great at helping me get photos and videos to post onto my blog. Like all interpreters, he is moving to the U.S. for a better life. He will be moving to Indiana. He is also a doctor but the degree will not be of much use in the U.S.. I am afraid that he will be in for a challenging next couple of years until he can get established. I will try and keep in email contact just to see what he is up to when I get back. He gave me a bunch of great videos that I plan to post tomorrow.

HAPPY NEW YEAR!!!

Smile In Times of Trouble

"Hope smiles on the threshold of the year to come, whispering that it will be happier."
-Alfred Lord TennysonEnglish poet (1809 - 1892)

"Before you put on a frown, make absolutely sure there are no smiles available."
-Jim Beggs

"Sometimes your joy is the source of your smile, but sometimes your smile can be the source of your joy."
-Thich Nhat Hanh

"Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around."
-Leo BuscagliaUS author & lecturer (1925 - 1998)

"The harder the conflict, the more glorious the triumph. What we obtain too cheap, we esteem too lightly; it is dearness only that gives everything its value. I love the man that can smile in trouble, that can gather strength from distress and grow brave by reflection. 'Tis the business of little minds to shrink; but he whose heart is firm, and whose conscience approves his conduct, will pursue his principles unto death."
-Thomas PaineUS patriot & political philosopher (1737 - 1809)

I thought that it would be interesting if I showcased some of Dr. Massoud's photos. The first bunch is him giving away some of the donations that were sent by 6 M.I.K. readers. What always gets me is the ever-present smile on people's faces. We could really learn a lot from them. It does not matter if they are homeless children living in street having to make a small fires out of trash to keep warm, or young police men that are paralyzed from the waist down with large abdominal wounds and a colostomy bag, to a criminal that is handcuffed to a bed post and that has been waiting 10 days to get his fractured leg fixed, they all return back a genuine smile when you smile at them and they are very warm and friendly when you talk with them. It seems as though they are able to live life to the fullest not in spite of, but probably because of, having been through 30 years of continuous war.

Here are some kiddos with some of the donations that were sent by readers. It gets really cold at night and they do not look like they are dressed very warm.



These are just a couple random kids ridding on the street with their donkey.

A Kabul car wash.

Here is a kiddo with a donated kaleidoscope. It is probably the first time that he has ever seen one.

School supplies.

Markers and coloring books.

Scented bubbles. They look like they are having a lot of fun with them.

Imagine seeing this site back in the states. A young kid with a cow carcass hanging from the back of his bike.

I have to warn you about this video before you view it. This is a clip from a Kabul marketplace. In this particular section of the market they are selling lamb heads and other internal organs for consumption. In another scene they are roasting lambs head over an open flame.



This other video is also disturbing but for different reasons. It is a video of kids swimming in the Kabul river. The Kabul river has to be the most disgusting water that I have ever seen. Along the sides of the streets there are large drainage ditches that collect and drain sewage. It all eventually pours into this river. You can also see just a ton of trash along the banks. Someone said that they even saw a dead horse in the river. The kids do not seem to mind at all.

This last video is of a typical Kabul market place or bazaar.

Thanks for reading.

Inshallah

"Familiarity breeds contempt - and children."
-Mark Twain, Notebooks (1935)US humorist, novelist, short story author, & wit (1835 - 1910)

"To believe is to know you believe, and to know you believe is not to believe."
-Jean-Paul SartreFrench author & existentialist philosopher (1905 - 1980)

"Happiness is nothing more than good health and a bad memory."
-Albert SchweitzerFrench philosopher & physician (1875 - 1965)

"When we seek for connection, we restore the world to wholeness. Our seemingly separate lives become meaningful as we discover how truly necessary we are to each other."
-Margaret Wheatley

Today I attended a Morning Report for the first time. For those of you that are not familiar with what a Morning Report is, it is where doctors get together to discuss cases that were admitted overnight and existing patients in the hospital. The person that usually leads the Morning Report is the on call doctor from the night before. They had pretty good attendance. There were probably 25 doctors there. I tried to just be a fly on the wall but I have a feeling that my presence caused them to go into a little more detail then normal.

I spent some time in the lab today. I am so amazed that they are able to do just about every lab all by hand. I asked the lab technician to write out a list of all of the labs that they did expecting a very short list. He must have listed 20 different tests including cholesterol and triglycerides. I was surprised when he said this so I asked him to show me how he does it and he pointed to an area of the lab that had a bunch of tall pipets and a small machine. I will have to watch him perform some of the tests to see how they are done.

I spent some time with the OB doctor. We were able to locate her computer. She had 2 pregnant patients that are due to deliver in a week. I asked her where she was planning to do the deliveries and she said if they come during the day then she will deliver them in the hospital and if it is after hours then they will come to her house. Women are not allowed to drive so they had to both take a taxi to the hospital. The OB doctor lives a half an hour away so her husband will have to drive her to the doctor's home. I could not imagine delivering babies in my home. Homes and apartments are not very big in Kabul. I can imagine sitting at the dinner table and getting a knock at the door and having it be someone that wants you to deliver their baby.

We were able to get an ultrasound on both of the expecting mothers. Their bellies were small for their dates but the ultrasound showed that they were growing just fine. I told the OB doctor that she has a lot of work to do to make the OB department ready. I think that she is waiting for me to do it. There is never any sense of urgency. I do not think that the concept exists over here. There is a common term that is used over here which is, "Inshallah." Translated literally it means, "God willing." It essentially means that whatever happens will happen. It is in God's hands. So when confronted with the inevitable reality that a baby will be delivered in a week and that nothing is ready to prepare for it, the sentiment is "Inshallah."

Today I received the mother of all boxes. It took 2 people just to carry it. It was from reader in Pensacola, Florida. It was filled with children's toys and snacks. It also came with a bunch of whoopee cushions. I will now be spreading hope, freedom, and the tomfoolery of whoopee cushions to the children of Afghanistan. Collecting and sending the donations was a very generous gesture. You know, a lot of people write about how great it is that I am showing the good that the military is doing over here, but I really think that just as important is the good that is coming from people back home. It is the true untold story (along with the forgotten spouses that are left to care for the home). I am just one person and I have received countless boxes from people back home that do not even know me and they are eager to help deployed soldiers and poor Afghans. That last quote is so true, we really are necessary to each other.

Take care.

Lighting A Fire

"The fragrance always remains in the hand that gives the rose."
-Heda Bejar

"That best portion of a good man's life, His little, nameless, unremembered acts of kindness and of love."
-William WordsworthEnglish poet (1770 - 1850)

"The greatest use of life is to spend it for something that will outlast it."
-William JamesUS Pragmatist philosopher & psychologist (1842 - 1910)

"It had only been my repeated experience that when you said to life calmly and firmly... 'I trust you; do what you must,' life had an uncanny way of responding to your need."
-Olga Ilyin

"Drawing on my fine command of the English language, I said nothing."
-Robert BenchleyUS actor, author, & humorist (1889 - 1945)

"Courage is the art of being the only one who knows you're scared to death."
-Harold Wilson(1916 - 1995)

"Every man is guilty of all the good he didn't do."
-VoltaireFrench author, humanist, rationalist, & satirist (1694 - 1778)

"Look well into thyself; there is a source of strength which will always spring up if thou wilt always look there."
-Marcus Aurelius AntoninusRoman Emperor, A.D. 161-180 (121 AD - 180 AD)

"The world is my country, all mankind are my brethren, and to do good is my religion."
-Thomas PaineUS patriot & political philosopher (1737 - 1809)

Those are all great words to live by. I think that I am starting to get a little carried away with the quotes. It is just such an enjoyable activity searching for them every night. They are like life's little instruction manual or someone really smart giving you some really good advice.

I posted a new slide show. I had such a great response from the last one that I decided to do another one. The photos were all taken by people who participated in the last VCR trip. I unfortunately can not take credit for any of them. Speaking of photos, I have built up enough donations for the turps (interpreters) to go on a other one of their missions. Along with the donations also went my camera so I will be photoless these next couple of days until they return. I really appreciate receiving all of the donations, but at the same time, it is really nice getting rid of that large box that was occupying a large portion of my room.

Today we did not have a lot of time at the clinic because we had to stop by the National Military Hospital and pick up some supplies. I fortunately was able to make up for the lost time. I think that it was some of the most productive 60 minutes that I have had yet. I went back to the OB department and I was a little disappointed to see that nothing had been done. Being a mentor also means that you have to be a motivator. With a little positive encouragement we were able to move 2 beds for ladies to sleep on after they deliver and 2 exam tables that we can use for deliveries. We just might have everything ready in time for for the deliveries. I will keep you posted.

Thanks for reading.

My Damnedest

"Happiness isn't something you experience; it's something you remember."
-Oscar Levant(1906 - 1972)

"Always and never are two words you should always remember never to use."
-Wendell Johnson

"I write down everything I want to remember. That way, instead of spending a lot of time trying to remember what it is I wrote down, I spend the time looking for the paper I wrote it down on."
-Beryl Pfizer

"It was on my fifth birthday that Papa put his hand on my shoulder and said, 'Remember, my son, if you ever need a helping hand, you'll find one at the end of your arm.' "
-Sam Levenson(1911 - 1980)

"Remember that nobody will ever get ahead of you as long as he is kicking you in the seat of the pants."
-Walter WinchellUS gossip columnist & broadcast journalist (1897 - 1972)

"Do not spoil what you have by desiring what you have not; but remember that what you now have was once among the things you only hoped for."
-EpicurusGreek philosopher (341 BC - 270 BC)

"I always remember an epitaph which is in the cemetery at Tombstone, Arizona. It says: 'Here lies Jack Williams. He done his damnedest.' I think that is the greatest epitaph a man can have - When he gives everything that is in him to do the job he has before him. That is all you can ask of him and that is what I have tried to do."
-Harry S Truman33rd president of US (1884 - 1972)

"It behooves every man to remember that the work of the critic is of altogether secondary importance, and that in the end, progress is accomplished by the man who does things."
-Theodore Roosevelt26th president of US (1858 - 1919)

That first quote is so true. I look back at so many of the times in my life that I was genuinely happy and if you would have asked me at the time I would have thought that you were crazy. Medical school is a great example. This deployment will probably be another one- it is just too early to tell right now.

-

Today was a low tempo day. It is the one day that we are able to sleep in. I always find it ironic how I find myself drinking a lot of coffee and working really hard just to make sure that I stay up late so I can take advantage of being able to sleep in the next morning. I always end up waking up early so it usually ends up backfiring on me.

Today we visited the bazaar. I am trying to load up on movies before I go back home. I visited the Women of Hope booth. For those of you that do not remember, it is the charity program that was started by Betsy 5 years ago after attacks on 9/11. She decided that she needed to come over here to Afghanistan to help out poor Afghan women and children. She now has over 70 women that make all kinds of things for her that she sells at the bazaar every week. Each of the ladies has another 5 women that work for them. The women are mainly refugees that have had their husbands killed in war. If it were not for Betsy then many of the women would be homeless begging on the streets. The work that she has done and the number of lives that she has impacted is incredible. It just goes to show you how just one person can make a huge difference.

-

Here is her website in case you wanted to visit it.
http://www.womenofhopeproject.org/

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I received an email tonight from a really good friend of mine. He is an Air Force surgeon based out of Florida. He was due to get out of the military this May after 24 years of service. He was just told that he will be deploying to Balad, Iraq for 6 months. As you can imagine, he is not thrilled about this. I have written this before, there are different stages that you go through when you find out that you will be deployed, especially to a war zone. He soon will reach the sadness phase but it will soon be replaced by the acceptance phase (or the resignation phase, just kidding). I loved the quote on courage from yesterday’s post. It tells of how being courageous and being frightened are not mutually exclusive. It is the same with deploying, I am not happy about leaving my family behind for 6 months, but I am here because I knew that there was the possibility when I signed my contract and I have to uphold my end of the deal. If I have to be away from my family then I want to know that my time was spent doing the best that I could do. Or as Truman said my "Damnedest."

I was thinking about who I was going to hand over the 6 M.I.K reins over to when I go back home. I think that it would be great if my friend who will be deploying to Iraq could do it. I kind of like the sound of 6 Months In Balad. I will have to ask him.

They just opened up a new pizza place and internet center. They were handing out free pizza and other delicious samplers earlier today. Take a look.

-

Before I sign off I want to make something clear. I want everyone to know that I am not trying to take credit for things that I have not done over here. I am trying to showcase the good that the military as a whole is doing. In the process I am just capturing a tiny fraction of what is being done. I am no longer at Camp Phoenix but I bet there have been a number of humanitarian missions that have come and gone without a single report to the outside world. I think that what we are doing over here is important stuff and I think that it needs to be made public. Think of me as a reporter and not necessarily the subject matter. I do not want to make it seem like I am taking credit for things that I have not done.

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By the way, we had our best night ever last night with almost 200 hits. I think that we are going to hit the 10,000 mark very soon. Thanks for helping make this site what it is.

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Thanks for reading.

My People

"Most of us think ourselves as standing wearily and helplessly at the center of a circle bristling with tasks, burdens, problems, annoyance, and responsibilities which are rushing in upon us. At every moment we have a dozen different things to do, a dozen problems to solve, a dozen strains to endure. We see ourselves as overdriven, overburdened, overtired. This is a common mental picture and it is totally false. No one of us, however crowded his life, has such an existence. What is the true picture of your life? Imagine that there is an hour glass on your desk. Connecting the bowl at the top with the bowl at the bottom is a tube so thin that only one grain of sand can pass through it at a time. That is the true picture of your life, even on a super busy day, The crowded hours come to you always one moment at a time. That is the only way they can come. The day may bring many tasks, many problems, strains, but invariably they come in single file. You want to gain emotional poise? Remember the hourglass, the grains of sand dropping one by one."

-James Gordon Gilkey

The interpreters dropped off the donations yesterday. I created a slide show of the pictures that they took. It is really sad to see the conditions that the people live in. They basically live in tents held up by branches. It has been snowing a lot and it gets really cold at night. I am not sure how they do it. The things that were donated were all from readers of this site. It was mainly some food, snacks, and toys. I told the interpreter that he should only do it if he really wanted to and that I did not want to pressure him into it. His reply was, "Of course I want to do it. These are my people and I also want to help them." It would be so nice if everyone in the U.S. thought of each other as, "My people."











When I arrived at the clinic I encountered a sobering scene. They were bringing in 6 coffins into the basement. I asked who they were for and someone replied that they were flying in 6 victims of a suicide bomber attack. I asked if the entire coffin gets buried and the doctor said that they bury only the body. They donate the wood to the poor after they are finished with the coffin.

I am coming back to my blog entry that I started earlier. I received an email from a blog site that I am a part of informing me that a fellow milblogger has passed away in Iraq. It is very eerie because he left a final blog post to be published in case of his death. I wanted to publish his last entry because it is something that is very powerful and moving. I am a little lost for words so I will just let you read it.

Here is the link to his site:

http://andrewolmsted.com/

Here is a local newspaper that published his blog.

http://www.rockymountainnews.com/news/2008/jan/05/just-devastating-news/

And here is his last post

Andy Olmsted
by hilzoy

Andrew Olmsted, who also posted here as G'Kar, was killed yesterday in Iraq. Andy gave me a post to publish in the event of his death; the last revisions to it were made in July.

Andy was a wonderful person: decent, honorable, generous, principled, courageous, sweet, and very funny. The world has a horrible hole in it that nothing can fill. I'm glad Andy -- generous as always -- wrote something for me to publish now, since I have no words at all. Beyond: Andy, I will miss you.

My thoughts are with his wife, his parents, and his brother and sister.

"I am leaving this message for you because it appears I must leave sooner than I intended. I would have preferred to say this in person, but since I cannot, let me say it here."G'Kar, Babylon 5

"Only the dead have seen the end of war."Plato*

This is an entry I would have preferred not to have published, but there are limits to what we can control in life, and apparently I have passed one of those limits. And so, like G'Kar, I must say here what I would much prefer to say in person. I want to thank hilzoy for putting it up for me. It's not easy asking anyone to do something for you in the event of your death, and it is a testament to her quality that she didn't hesitate to accept the charge. As with many bloggers, I have a disgustingly large ego, and so I just couldn't bear the thought of not being able to have the last word if the need arose. Perhaps I take that further than most, I don't know. I hope so. It's frightening to think there are many people as neurotic as I am in the world. In any case, since I won't get another chance to say what I think, I wanted to take advantage of this opportunity. Such as it is.

"When some people die, it's time to be sad. But when other people die, like really evil people, or the Irish, it's time to celebrate."Jimmy Bender, "Greg the Bunny"

"And maybe now it's your turn to die kicking some ass."Freedom Isn't Free, Team America

What I don't want this to be is a chance for me, or anyone else, to be maudlin. I'm dead. That sucks, at least for me and my family and friends. But all the tears in the world aren't going to bring me back, so I would prefer that people remember the good things about me rather than mourning my loss. (If it turns out a specific number of tears will, in fact, bring me back to life, then by all means, break out the onions.) I had a pretty good life, as I noted above. Sure, all things being equal I would have preferred to have more time, but I have no business complaining with all the good fortune I've enjoyed in my life. So if you're up for that, put on a little 80s music (preferably vintage 1980-1984), grab a Coke and have a drink with me. If you have it, throw 'Freedom Isn't Free' from the Team America soundtrack in; if you can't laugh at that song, I think you need to lighten up a little. I'm dead, but if you're reading this, you're not, so take a moment to enjoy that happy fact.

"Our thoughts form the universe. They always matter."Citizen G'Kar, Babylon 5

Believe it or not, one of the things I will miss most is not being able to blog any longer. The ability to put my thoughts on (virtual) paper and put them where people can read and respond to them has been marvelous, even if most people who have read my writings haven't agreed with them. If there is any hope for the long term success of democracy, it will be if people agree to listen to and try to understand their political opponents rather than simply seeking to crush them. While the blogosphere has its share of partisans, there are some awfully smart people making excellent arguments out there as well, and I know I have learned quite a bit since I began blogging. I flatter myself I may have made a good argument or two as well; if I didn't, please don't tell me. It has been a great five-plus years. I got to meet a lot of people who are way smarter than me, including such luminaries as Virginia Postrel and her husband Stephen (speaking strictly from a 'improving the species' perspective, it's tragic those two don't have kids, because they're both scary smart.), the estimable hilzoy and Sebastian of Obsidian Wings, Jeff Goldstein and Stephen Green, the men who consistently frustrated me with their mix of wit and wisdom I could never match, and I've no doubt left out a number of people to whom I apologize. Bottom line: if I got the chance to meet you through blogging, I enjoyed it. I'm only sorry I couldn't meet more of you. In particular I'd like to thank Jim Henley, who while we've never met has been a true comrade, whose words have taught me and whose support has been of great personal value to me. I would very much have enjoyed meeting Jim.

Blogging put me in touch with an inordinate number of smart people, an exhilarating if humbling experience. When I was young, I was smart, but the older I got, the more I realized just how dumb I was in comparison to truly smart people. But, to my credit, I think, I was at least smart enough to pay attention to the people with real brains and even occasionally learn something from them. It has been joy and a pleasure having the opportunity to do this.

"It's not fair.""No. It's not. Death never is."Captain John Sheridan and Dr. Stephen Franklin, Babylon 5

"They didn't even dig him a decent grave.""Well, it's not how you're buried. It's how you're remembered."Cimarron and Wil Andersen, The Cowboys

I suppose I should speak to the circumstances of my death. It would be nice to believe that I died leading men in battle, preferably saving their lives at the cost of my own. More likely I was caught by a marksman or an IED. But if there is an afterlife, I'm telling anyone who asks that I went down surrounded by hundreds of insurgents defending a village composed solely of innocent women and children. It'll be our little secret, ok?

I do ask (not that I'm in a position to enforce this) that no one try to use my death to further their political purposes. I went to Iraq and did what I did for my reasons, not yours. My life isn't a chit to be used to bludgeon people to silence on either side. If you think the U.S. should stay in Iraq, don't drag me into it by claiming that somehow my death demands us staying in Iraq. If you think the U.S. ought to get out tomorrow, don't cite my name as an example of someone's life who was wasted by our mission in Iraq. I have my own opinions about what we should do about Iraq, but since I'm not around to expound on them I'd prefer others not try and use me as some kind of moral capital to support a position I probably didn't support. Further, this is tough enough on my family without their having to see my picture being used in some rally or my name being cited for some political purpose. You can fight political battles without hurting my family, and I'd prefer that you did so.

On a similar note, while you're free to think whatever you like about my life and death, if you think I wasted my life, I'll tell you you're wrong. We're all going to die of something. I died doing a job I loved. When your time comes, I hope you are as fortunate as I was.

"What an idiot! What a loser!"Chaz Reingold, Wedding Crashers

"Oh and I don't want to die for you, but if dying's asked of me; I'll bear that cross with honor, 'cause freedom don't come free."American Soldier, Toby Keith

Those who know me through my writings on the Internet over the past five-plus years probably have wondered at times about my chosen profession. While I am not a Libertarian, I certainly hold strongly individualistic beliefs. Yet I have spent my life in a profession that is not generally known for rugged individualism. Worse, I volunteered to return to active duty knowing that the choice would almost certainly lead me to Iraq. The simple explanation might be that I was simply stupid, and certainly I make no bones about having done some dumb things in my life, but I don't think this can be chalked up to stupidity. Maybe I was inconsistent in my beliefs; there are few people who adhere religiously to the doctrines of their chosen philosophy, whatever that may be. But I don't think that was the case in this instance either.

As passionate as I am about personal freedom, I don't buy the claims of anarchists that humanity would be just fine without any government at all. There are too many people in the world who believe that they know best how people should live their lives, and many of them are more than willing to use force to impose those beliefs on others. A world without government simply wouldn't last very long; as soon as it was established, strongmen would immediately spring up to establish their fiefdoms. So there is a need for government to protect the people's rights. And one of the fundamental tools to do that is an army that can prevent outside agencies from imposing their rules on a society. A lot of people will protest that argument by noting that the people we are fighting in Iraq are unlikely to threaten the rights of the average American. That's certainly true; while our enemies would certainly like to wreak great levels of havoc on our society, the fact is they're not likely to succeed. But that doesn't mean there isn't still a need for an army (setting aside debates regarding whether ours is the right size at the moment). Americans are fortunate that we don't have to worry too much about people coming to try and overthrow us, but part of the reason we don't have to worry about that is because we have an army that is stopping anyone who would try.

Soldiers cannot have the option of opting out of missions because they don't agree with them: that violates the social contract. The duly-elected American government decided to go to war in Iraq. (Even if you maintain President Bush was not properly elected, Congress voted for war as well.) As a soldier, I have a duty to obey the orders of the President of the United States as long as they are Constitutional. I can no more opt out of missions I disagree with than I can ignore laws I think are improper. I do not consider it a violation of my individual rights to have gone to Iraq on orders because I raised my right hand and volunteered to join the army. Whether or not this mission was a good one, my participation in it was an affirmation of something I consider quite necessary to society. So if nothing else, I gave my life for a pretty important principle; I can (if you'll pardon the pun) live with that.

"It's all so brief, isn't it? A typical human lifespan is almost a hundred years. But it's barely a second compared to what's out there. It wouldn't be so bad if life didn't take so long to figure out. Seems you just start to get it right, and then...it's over."Dr. Stephen Franklin, Babylon 5

I wish I could say I'd at least started to get it right. Although, in my defense, I think I batted a solid .250 or so. Not a superstar, but at least able to play in the big leagues. I'm afraid I can't really offer any deep secrets or wisdom. I lived my life better than some, worse than others, and I like to think that the world was a little better off for my having been here. Not very much, but then, few of us are destined to make more than a tiny dent in history's Green Monster. I would be lying if I didn't admit I would have liked to have done more, but it's a bit too late for that now, eh? The bottom line, for me, is that I think I can look back at my life and at least see a few areas where I may have made a tiny difference, and massive ego aside, that's probably not too bad.

"The flame also reminds us that life is precious. As each flame is unique; when it goes out, it's gone forever. There will never be another quite like it."Ambassador Delenn, Babylon 5

I write this in part, admittedly, because I would like to think that there's at least a little something out there to remember me by. Granted, this site will eventually vanish, being ephemeral in a very real sense of the word, but at least for a time it can serve as a tiny record of my contributions to the world. But on a larger scale, for those who knew me well enough to be saddened by my death, especially for those who haven't known anyone else lost to this war, perhaps my death can serve as a small reminder of the costs of war. Regardless of the merits of this war, or of any war, I think that many of us in America have forgotten that war means death and suffering in wholesale lots. A decision that for most of us in America was academic, whether or not to go to war in Iraq, had very real consequences for hundreds of thousands of people. Yet I was as guilty as anyone of minimizing those very real consequences in lieu of a cold discussion of theoretical merits of war and peace. Now I'm facing some very real consequences of that decision; who says life doesn't have a sense of humor?

But for those who knew me and feel this pain, I think it's a good thing to realize that this pain has been felt by thousands and thousands (probably millions, actually) of other people all over the world. That is part of the cost of war, any war, no matter how justified. If everyone who feels this pain keeps that in mind the next time we have to decide whether or not war is a good idea, perhaps it will help us to make a more informed decision. Because it is pretty clear that the average American would not have supported the Iraq War had they known the costs going in. I am far too cynical to believe that any future debate over war will be any less vitriolic or emotional, but perhaps a few more people will realize just what those costs can be the next time.

This may be a contradiction of my above call to keep politics out of my death, but I hope not. Sometimes going to war is the right idea. I think we've drawn that line too far in the direction of war rather than peace, but I'm a soldier and I know that sometimes you have to fight if you're to hold onto what you hold dear. But in making that decision, I believe we understate the costs of war; when we make the decision to fight, we make the decision to kill, and that means lives and families destroyed. Mine now falls into that category; the next time the question of war or peace comes up, if you knew me at least you can understand a bit more just what it is you're deciding to do, and whether or not those costs are worth it.

"This is true love. You think this happens every day?"Westley, The Princess Bride

"Good night, my love, the brightest star in my sky."John Sheridan, Babylon 5

This is the hardest part. While I certainly have no desire to die, at this point I no longer have any worries. That is not true of the woman who made my life something to enjoy rather than something merely to survive. She put up with all of my faults, and they are myriad, she endured separations again and again...I cannot imagine being more fortunate in love than I have been with Amanda. Now she has to go on without me, and while a cynic might observe she's better off, I know that this is a terrible burden I have placed on her, and I would give almost anything if she would not have to bear it. It seems that is not an option. I cannot imagine anything more painful than that, and if there is an afterlife, this is a pain I'll bear forever.

I wasn't the greatest husband. I could have done so much more, a realization that, as it so often does, comes too late to matter. But I cherished every day I was married to Amanda. When everything else in my life seemed dark, she was always there to light the darkness. It is difficult to imagine my life being worth living without her having been in it. I hope and pray that she goes on without me and enjoys her life as much as she deserves. I can think of no one more deserving of happiness than her.

"I will see you again, in the place where no shadows fall."Ambassador Delenn, Babylon 5

I don't know if there is an afterlife; I tend to doubt it, to be perfectly honest. But if there is any way possible, Amanda, then I will live up to Delenn's words, somehow, some way. I love you.

Bas Mar Jan

"No man is an Island, intire of itselfe; every man is a piece of the Continent, a part of the maine..."

John Donne, Devotions XVIIEnglish clergyman & poet (1572 - 1631)

I recently learned about a great program out of Camp Phoenix called Operation Outreach. They are doing some wonderful stuff. I will post their last newsletter. I think that this is my favorite post yet. It figures that I did not even write it. It is written by Capt Wellik. Hope you enjoy. Break out the tissues you are going to need them.

Meet Bas Mar Jan. She is a 5-year-old little girl who we saw in our TMC (troop medical clinic) at Camp Phoenix in April 2007. She suffered from Tetralogy of Fallot, which is a life threatening heart condition where she had several things wrong with her heart. Her heart essentially pumped blood that was very low in oxygen. Her oxygen saturation was 73% the day that we saw her. Healthy is around 99%. As you can see, her lips were blue. Her fingers and toes were dusky blue in color and were clubbed which showed the long standing oxygen deprived status her little body had been operating under.

Her father is a very caring individual and said that he carried her almost all the time because she had such difficulty breathing. The chest x-ray showed that the majority of her chest cavity was taken up with her enlarged heart. Operation Outreach worked diligently to make arrangements for her to have heart surgery in India in order to save her life. In true Operation Outreach fashion, she didn’t leave the clinic until she had new socks, shoes, jacket, and stuffed animals.

Through the very generous donations of Friends of Operation Outreach, stateside churches, assistance from babyheart.org, Pogs for Kids, and EVERYONE at Camp Phoenix, we were able to quickly fund and proceed with making arrangements for Bas Mar Jan to have her life saving heart surgery.

On 13 May 2007, Bas Mar Jan and her father came to the Camp Phoenix TMC for one last check up before flying to India. She was cleared for surgery and Operation Outreach made sure that she had plenty of toys and crayons to keep her busy during her stay. Her surgery went very well. She did have some minor complications, so her stay was extended to ensure that she was doing well before she was discharged.

Bas Mar Jan was released from the hospital on 20 June 2007. 163 LTF was fortunate to be able to pick her and her dad up from the airport. They returned to Camp Phoenix for a quick checkup before returning to her home in Jalalabad to be reunited with her brothers and sisters.

Her father said that she hadn’t been eating well while she was in India because she didn’t like the food. While at Camp Phoenix, Bas Mar Jan’s face lit up with a huge smile when she was given Afghan food for the first time in a month.

Care after surgery is a very important step to ensure that she has the best chance at a long and healthy life. High quality medical care is hard to find in Afghanistan. Operation Outreach made sure that Bas Mar Jan was going to have the best care possible before even starting surgery. Volunteers networked to make arrangements with pediatric heart specialists at the private French Children’s Hospital located in downtown Kabul.

On 24 June 2007, Bas Mar Jan was ableto meet Security Forces (SecFor) as she was taken to the French Children’s Hospital for her first post-operative visit. She was quite the celebrity and now has a very special (forces) fan club! She had an appointment with a pediatric cardiologist and an ultrasound performed on her heart which came to a total of170 Afghanis which equals $3.50 US dollars!

Operation Outreach funded her surgery, five week hospital stay, post-op care, as well as the plane tickets, hotel, and food for Bas Mar Jan, her father, and an interpreter. These expenses only totaled $7,000 US dollars! However, money can’t buy the unbelievably healthy smile that Bas Mar Jan now shows off so easily for the camera.

Her father was constantly thanking everyone for giving him a healthy daughter. As he would place his hand across his heart in thanks, he kept saying“I get to keep my daughter. She’s perfect…she’s just perfect.”

A special thanks to the commanders of Camp Phoenix for supporting these missions which are truly“winning the hearts and minds” of the future of Afghanistan.

We would also like to thank the many anonymous supporters of Operation Outreach and hard working members who made these success stories possible.

Operation Outreach is continuing to fund surgeries for children found with heart defects. For money donations, please go to http://www.babyheart.org/ and write in the comment box “for Operation Outreach children in Afghanistan” and your money will be designated for us and you can utilize their tax-exempt status.

Thanks to LTC Kohler of Public Affairs for unlimited use of his pictures.

For donations including shoes, coats, and blankets, and school supplies, please send to:

Operation Outreach

C Co 163 LTF

Camp Phoenix APO AE 09320

What a wonderful story. Thanks for reading.

Atequellah

"Don't let people drive you crazy when you know it's in walking distance."
-Unknown

"Part of being sane, is being a little bit crazy."
-Janet Long

It was snowing really hard today. The streets were really wet and muddy. When we arrived at the clinic they were starting their morning report. I sat really close to the interpreter so he could whisper what was being said. They were kind enough to pause during their report so that all of the information could get translated.

During the day I spent most of my my time up in the ER. That is where most of the activity usually is. The on call doctor was the Neurosurgeon. I was asking him about the patient that was sitting on one of the exam tables. He usually tells me that I never visit with him so I wanted to try and see if I could spend some time discussing his patient. I was not buying his diagnosis of inguinal hernia on an older lady with right lower quadrant abdominal pain and painful urination.

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A little later I approached the surgeon who was applying betadine over a patients calf. I asked him what he was about to do and he said that he was going to take fluid out of a patient's calf. I gave him one of my you have got to be kidding looks. I thought to myself that there was no way that he could be serious. The surgeon proceeded to insert a needle into the patient's calf and he actually drew up about 40ml of cloudy amber fluid. I was quite surprised. I looked at the paper work on the desk and I saw that not only did the surgeon get an ultrasound that confirmed a large cyst but he also sent part of the fluid to be analyzed and he also did blood work. The assistant that was there looked at me and said, "What, did you think that we did not know what we were doing?" I felt somewhat guilty for having my doubts.

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On the way home we encountered a very sad scene. I am not sure if you remember, I previously described a homeless family of beggars that sit down in the middle of the street between passing cars. Some of them even have young children that help them out. They were there like always, but this time the street was filled with slush and mud and the snow was coming down really hard. The conditions could not have been any worse. It is very cold outside and it is not like they can go home to a warm house and take a shower afterwards either.

Similarly, you may also remember all the way back to when we did the CMA, I blogged about a little kid with a heart defect. After learning about Operation Outreach and Baby Heart and how they help children with heart defects, I decided to write to them to see if there was anything they could do to help him out. I have kept his phone number ever since the CMA and I have thought about him on a regular basis. I just did not even know where to begin to help him. I will keep you posted on any info that I get back. Here is his pic.

In the meantime I thought that I would give another plug to the Camp Phoenix Operation Outreach program:

"Our humanitarian-assistance group at Camp Phoenix, Operation Outreach, has already sent two children, Bas Mar Jan and Welyat, for heart surgeries, and both have had excellent outcomes. We’re now raising funds to send a three-year-old boy, Atequellah, for surgery. He suffers from ventricular-septal defect (VSD), a congenital heart defect that will result in death if left untreated. Outreach has raised just over $7,500 to date; we have another $9,000 before we reach our goal.

If you would like to support us in our efforts to help these two little boys, please visit the web site of the International Children’s Heart Foundation (ICHF) at http://www.babyheart.org/. On the home page, you'll see a picture of the little girl mentioned above, Bas Mar Jan, and some information about Operation Outreach. Click on the photo to donate in support of Atequellah. In your comments on the donation page, please type “Operation Outreach, Afghanistan.” ICHF will designate the funds for our use.

Operation Outreach continues to accept new and gently-used clothes and shoes, as well as school supplies. Though children are our primary focus, we accept donations of women’s and men’s clothing as well; there’s an active “market” here in which families can trade one needed item for another. We also request liquid or powdered baby formula for the many mothers who lack enough milk to feed their infants, as well as toothbrushes, toothpaste, and soap."

Our address is:
Operation Outreach

C Company 163rd LTF

Camp Phoenix

APO AE 09320

Here is another little kiddo that needs your help.

Thanks for reading.

Ferment The Humors

"Exercise ferments the humors, casts them into their proper channels, throws off redundancies, and helps nature in those secret distributions, without which the body cannot subsist in its vigor, nor the soul act with cheerfulness."
-Joseph Addison, The Spectator, July 12, 1711English essayist, poet, & politician (1672 - 1719)

"A good exercise for the heart is to bend down and help another up."
-Anonymous

"The need of exercise is a modern superstition, invented by people who ate too much and had nothing to think about."
-George SantayanaUS (Spanish-born) philosopher (1863 - 1952)

I spent a lot of time in the OB department because they expect to have a couple of deliveries this weekend. I learned some very interesting information about the OB care that I thought I would share. The doctors and midwives that I am working with have been delivering babies for over 30 years. Women are never given any pain medication during deliveries (including epidurals). They seemed a little confused why I would even ask about it. The more I thought about it the more I was convinced that it was not a good idea to push the issue. When you give a laboring mother pain medication, like morphine, it can occasionally effect the baby. Since they have no way of monitoring the status of the baby, and they will probably end up giving too much of the pain medicine, I decided that it was probably better if they kept the status quo going. Not to mention, they really do not have a way to resuscitate a baby if something were to go wrong.

They also do not believe in braking the bag that holds in the amniotic fluid. In the states we sometimes break it to help speed the delivery. The doctors were very adamant that it should never be done. They gave somewhat of a strange reason for it, something about how the placenta will go up through the diaphragm and the baby will not be able to breath. It was another case where they were probably better off not doing it because, again, they do not have any way of monitoring the baby and they may end up doing more harm in the process.

Another big difference is the length of time a women stays in the hospital. I have been told that they are discharged only 3 hours after the baby is born. I bet HMOs would love to set up shop over here. When I was pushing for there to be 2 beds in the maternity ward for the mothers to sleep in over night the head physician looked at me with a stern face. I knew that I was about to get a talking to. He said to me, "I have been practicing in this hospital for 31 years. We have never had beds in the maternity department before." I tend to pick my battles and this was one that I felt pretty adamant about. Infant and maternal mortality is pretty dismal in Afghanistan and this 3 hour discharge may be part of the reason. It only took 20 minutes to change 31 years habit.

Some of their practices were similar to the way we do things, we both perform episiotomies and we both also encourage breastfeeding.

LtCol Johnson relayed a funny story to me. He told of how the Physical Therapist provided him with a list of things that he needed. This was the same person that has the UV tunnel that is suppose to help heal injuries. LtCol Johnson was excited to finally receive a list requesting supplies that was generated through the proper channels. Could he be asking for heating pads? Elastic bands? Maybe some orthotic devices or braces? Here was his list:

1. A computer
2. Some rugs
3. Tennis shoes

He asked the Physical Therapist why he needed the tennis shoes and he said so his patients could run on the treadmill. When he asked him what size shoes he needed his reply was, "Small, medium, and large." It could be like a bowling alley. You could turn in your slippers for tennis shoes to help ferment the humors.

When we got back to our base we went to a going-away celebration for our Wolf Pack friends. It was held at the Ministry of Defense. We enjoyed naan, kabobs, and rice. The Wolf Pack were the ones that taught us how to do our convoys. We will try and pass the information on to the group that replaces us.

Thanks for reading.

Dust of Progress

"It is wise to direct your anger towards problems -- not people; to focus your energies on answers -- not excuses."
-William Arthur Ward

"He that is good for making excuses is seldom good for anything else."
-Benjamin Franklin US author, diplomat, inventor, physicist, politician, & printer (1706 - 1790)

"Ninety-nine percent of all failures come from people who have the habit of making excuses."
-George Washington Carver US horticulturist (1864 - 1943)

I think I the majority of my day was spent battling excuses. I started to write about what seemed like a never ending list of excuses that people gave me, why problems could not be solved, but after I read it over it did not seem very interesting at all and it kind of sounding like I was complaining too much so I cut it out. I will just say this, if some people could convert their time and energy that they use to come up with all of their excuses and direct it towards finding solutions to their problems then a lot more progress would get done. Similarly, I believe that the world is divided into two types of people, the No People and the Yes People. Here is how you can tell which one you are. If someone comes up to you and tells you about a problem, and while they are explaining their problem to you you start thinking of reasons why it can not be solved, then you are probably a No Person. I encounter a lot of No People in the hospital.

I walked into the ER and there was a patient lying on one of the beds. I asked the ER doctor what was wrong with her. He said that she had urticaria which meant that she had a rash all over her body. I watched the nurse administer some medication. With his dirty hands he injected calcium gluconate directly into the patient's vein. He then threw the syringe and the uncapped needle into the trash. I tell you all of this detail because I want to illustrate what kind of challange I am facing. Just about every step of the care that was given to this patient was done incorrectly (including the medication that was given). The nurse did not wash his hands before he gave the injection. He did not wear gloves when he injected the medication. He did not wipe the patient's skin with alcohol. He should not have injected the medication directly into the vein with a needle. He should not have throw the needle away in the trash. Most importantly, he should not have ever given calcium gluconate in the first place. It does not help with urticaria.

I told the nurse that it is very important that he washes his hands between patients. I shook his hand and then I showed him my hand and I said, "You see, I now have germs on my hand. I need to wash my hands." I then went to the sink and washed my hands. His reply to me was, "I am an old man. I can not was my hands with cold water."

We passed by some new signs on the way home. I am not sure what they mean.

We picked up our colleagues at the Serena Hotel. They put together a disaster preparedness conference. The Serena Hotel is the nicest hotel in all of Kabul. I thought that it was an interesting contrast showing the nicest hotel of Kabul along with the slideshow up top.

Here is another example of progress that not all people get to enjoy. It is a billboard of an upcoming condo or hotel that is being built. I can guarantee that the average citizen will not be able to afford to live there. Another downside of progress is that the cost of living increases for the poor. Let's just hope that the poor does not get left behind in the dust all of the progress that is taking place.

Stay tuned. I will have a brand new slideshow tomorrow. Thanks for reading.

Five-Hundred Pound Barbell in a Steroid-Free Fitness Center

"If slaughterhouses had glass walls, everyone would be a vegetarian."
-Paul McCartney

"Troubles are usually brooms and shovels that smooth the road to the good man's fortune; and many a man curses the rain that falls upon his head, and knows not that it brings abundance to drive away hunger."
-Basil

"Delores breezed along the surface of her life like a flat stone forever skipping along smooth water, rippling reality sporadically but oblivious to it consistently, until she finally lost momentum, sank, and due to an over- dose of fluoride as a child which caused her to suffer from chronic apathy, doomed herself to lie forever on the floor of her life as useless as an appendix and as lonely as a five-hundred pound barbell in a steroid-free fitness center."
-Winning sentence, 1990 Bulwer-Lytton bad fiction contest.

"The two most common elements in the universe are Hydrogen and stupidity."
-Harlan EllisonUS science fiction author & screenwriter (1934 - )

"Storms make oaks take deeper root."
-George HerbertEnglish clergyman & metaphysical poet (1593 - 1633)

"The brain is a wonderful organ. It starts working the moment you get up in the morning and does not stop until you get into the office."
-Robert FrostUS poet (1874 - 1963)

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I added some more pictures to the slideshow. The folks that attended the last VCR took some really good pictures. They were really able to capture the desperate conditions that the people live in. It is import to take into consideration how cold it is. Some of those little kids are barely dressed. I can not imagine how they do it. They also do not have any running water so it is not like they can hop in a shower and clean up.

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Today part of our team visited a slaughter house. It is where the hospital gets its meat.

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LtCol Peters said that they had just butchered a lamb so steam was coming from the meat because it was still warm.

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The clinic was business as usual. I spent about an hour with the Ortho doctor drinking chai and discussing business. He has a lot of pull in the hospital so it was a very productive meeting.

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In the ER a patient was brought in that was sobbing uncontrollably. He was also writhing from his belly pain. The ER doctor said that he had just been poisoned. That was about the only interesting patient that came in. We are still on baby watch.

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Take care.

First Do No Harm

"Smoking is one of the leading causes of statistics."
-Fletcher Knebel

"Quitting smoking is easy, I've done it thousands of times."
-Mark TwainUS humorist, novelist, short story author, & wit (1835 - 1910)

The story behind how I got the pictures for the slide show is kind of funny. A father of a deployed service member found my site and then he emailed his son who is also at Camp Eggers to tell him about it. It turns out that I was the driver of a car that the son was ridding in when we went on one of the VCR trips. He sent me an email and asked me to teach him all about milblogging. I was more then happy to show him the ropes. I will post a link to his blog when he gets it up and running. He was kind enough to let me have some of his pictures. I still do not know how they live in those tents with this weather.

We had a very productive day at the clinic. I attended their Morning Report. They basically went over how many patients were seen overnight. I let them know that in the future it would be a good idea to go into more details about some of the cases or to discuss different medical topics. It can get very interesting when you have a number of doctors in a room all discussing a patient's case. The real purpose of a Morning Report is not just to discuss who was seen, it also should be an oppertunity to learn new information. I think that it would be neat if I taught the ER doc how to do a case presentation using Power Point. If we have an interesting patient tomorrow then I will see if we can work on it together.

Change tends to happen very slowly in the hospital and it is not because of lack of motivation. Obstacles get placed in people's way which tend to slow down progress. It is especially difficult when you are female. You are sort of the low person on the totem pole. I have been trying to get the OB department to fix up their room in order to get it ready for their 2 deliveries that should happen this week. They have not been able to make any progress because they have not been allowed to access the necessary supplies. I had to do a little convincing to get the head nurse to release some of his supplies. The OB department now looks pretty good. They now have 2 delivery beds, 2 hospital beds, and 2 bassinets with clean sheets and blankets and all of the supplies to support a normal delivery. We still do not have all of the fancy monitors and baby warmers but they will come with time.

I visited the inpatient ward and it was obvious that someone had been smoking. I knew which patient it was so I approached him to give him a hard time. It was a patient that is paralyzed from the waist down. He adamantly denied that he had been smoking. I picked up a pack of cigarettes that was on his bedside table and I asked him what they were doing there. Little did I know he actually was holding a lit cigarette under his blanket. What can you do?

I had a long discussion with the surgeon regarding a patient that I was concerned about. The patient should really have been in an ICU. He had been transferred from a U.S. facility after having had multiple gunshot wounds to his abdomen. A large portion of his bowl had been resected and he had drains coming from his 2 ureters, bladder and he also had a colostomy bag. The father was providing all of his nursing care. The patient was having uncontrollable nausea and vomiting. The patient and the father were both crying when I was talking to the surgeon about his case. One of the tubes that drained the left ureter had fallen out. The surgeon grabbed the catheter with his bare hands, grabbing hold of the tip, explaining to me what he thought was wrong.

We went down to X-ray where he showed me a film that showed how the catheter used to be in its proper position within the ureter. He asked me if he should reinsert it. It is somewhat of a complicated question because in the states we would have labs, ultrasounds, and specialists to help you make tough decisions. The surgeon may end up making things worse attempting to perform a procedure that he is not familiar with and which he probably does not have supplies for. I told him if he knew how to do it and had all of the supplies then he should probably do it. I also told him that he should use his best judgement and do what is best for the patient and not just act because I am raising the issue. I also tried to give some suggestions on fluids and nutrition. I will be sure to check on him tomorrow.

Thanks for reading.

Simple Drops of Water

"Beauty is in the eye of the beholder and it may be necessary from time to time to give a stupid or misinformed beholder a black eye."
-Miss PiggyUS Muppet and Pig

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"Think of all the beauty still left around you and be happy."
-Anne Frank, Diary of a Young Girl, 1952German Jewish diarist (1929 - 1945)
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"People often say that 'beauty is in the eye of the beholder,' and I say that the most liberating thing about beauty is realizing that you are the beholder. This empowers us to find beauty in places where others have not dared to look, including inside ourselves."
-Salma Hayek

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"Everything has its beauty but not everyone sees it."
ConfuciusChinese philosopher & reformer (551 BC - 479 BC)

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The pictures from the new slideshow are courtesy of the participants of today's VCR trip. I was told that they were able to distribute coal (1 large & 1 little bag), a food bag, and a big box of winter clothes & blanket to each family. They gave out some other supplies, 2 tents, and they were able to fit some of the kiddos for boots. I heard that the conditions out there were just terrible.

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I noticed this sink this morning and I thought that it was really neat what had happened. The faucet had dripped overnight and the drops formed a column of ice. It sounds kind of corny but it sort of reminds me of what Kabul is like. To the casual observer Kabul would appear to be an old, run down, city with a lot of dust and makeshift shops. But there are times when its beauty really presents itself. When you look at one of its huge mountains with all of the homes embedded on the hillside all covered with the snow, it makes you realize that this is a really beautiful place. That column of ice will eventually melt but I will always look at that sink a little differently. I will always remember the beautiful sculpture that it made with just simple drops of water.

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Of course today was bazaar day. I went out with Adam. The Women of Hope people were out there selling their stuff. Here are some handmade dolls and camels.

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Some wine burqas.
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Other antiques.

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And of course, everywhere you had to hear that same phrase from all of the vendors. I am going to miss hearing it when I leave.

Thanks for reading.

Placid Island of Ignorance in the Midst of Black Seas of Infinity

"Training is everything. The peach was once a bitter almond; cauliflower is nothing but cabbage with a college education."

-Mark Twain, Pudd'nhead Wilson (1894)US humorist, novelist, short story author, & wit (1835 - 1910)

"The most merciful thing in the world, I think, is the inability of the human mind to correlate all its contents. We live on a placid island of ignorance in the midst of black seas of infinity, and it was not meant that we should voyage far. The sciences, each straining in its own direction, have hitherto harmed us little; but some day the piecing together of dissociated knowledge will open up such terrifying vistas of reality, and of our frightful position therein, that we shall either go mad from the revelation or flee from the deadly light into the peace and safety of a new dark age."

-H.P. Lovecraft, "The Call of Cthulhu"

I got lucky today. Dr. Mossaud came by one last time to say goodbye to everyone before he leaves for the states. He was able to find me to give me some more of his pictures one last time. What I love about his pictures is they are a little slice of the real Kabul. I can only take pictures from my vehicle driving 30mph. He is able to get up close and personal. The title pic is just great. It is a small business owner serving up some simple kabobs out of his little shop. He is talking with the little kid that is with him. They just seem like they are having a great time.

Here is inside Kabul University. I will be uploading all of his pictures into a photobook. Kabul University looks just like every other university that you would find in the states.

Here are 2 guys pulling a heavy load.

You visit with this gentleman for two reasons. He is able to take away any spells that have been placed on you or he can place a spell on someone if you like. He writes the spell on a piece of paper and you are suppose to carry it or wear it on a necklace.

This wheelchair has been converted into a little shop. They can be so resourceful.

Here they are selling fish. Adam said that it looks like a baby's mobile.

Here they are selling chickens. I think I will stick to purchasing rotisserie chickens at Sam's Club.

Here is another small business owner. He is a cobbler. There is not a lot of overhead for this shop.

Here is a site that you will not find in the states. A shop dedicated to selling burqas.

Carrots on the back of a cart.

Today at the clinic we did some trauma training during the Morning Report- CPR, intubation, needle decompression for tension pneumothorax, treatment of sucking chest wounds, tourniquets, c-spine immobilization, etc. I think it went pretty well. I tried to encourage hands-on participation.

We did an EKG on a General that came into the ER. He was having chest pain. It looked like he was having a heart attack according to the EKG. You are sort of limited on what you can do over here. He also had uncontrolled high blood pressure and diabetes. He was sent upstairs to be seen by the Internal Medicine doctor.

I am still working with the nurses trying to get them break a number of their bad habits. I am trying to reinforce the use of gloves, trying to get them to not throw away needles in the trash, and I am encouraging frequent hand washing. They have this habit of injecting medicine right into the vein with a needle. It is a hard habit to break especially when the nurse has been doing it this way for 20 years.

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There was a funny moment when Dr. Peters was showing someone how to do an EKG. The nurse said to me, "Look, he is not wearing any gloves." I had to tell him that it was not necessary for him to wear gloves when doing an EKG. I can sympathize with the nurse. Imagine having to change a habit that you had been doing everyday for over 20 years. It is like someone telling you that you had to wear shoes on your hands instead of your feet.

I have to do some damage control. Apparently one of the students that writes to me is upset that I never mention her in my letters. I recently sent them a men's hat and scarf and a blue burqa. Here is her letter.

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Hello Stephanie. Thanks for writing. I am glad that I am helping you to learn about different cultures. I have also enjoyed learning about Afghanistan. Say hello to everyone for me.

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Take Care.

Potato Water

"Time flies like an arrow. Fruit flies like a banana. "
-Groucho MarxUS comedian with Marx Brothers (1890 - 1977)

Today we had some really heavy traffic. I thought that I would include a few videos that I took during the traffic jams. The first one is of a group of kids that approached our car. I think that it is a good reflection of people's overall opinion of us being here. In my experience it has been overwhelmingly positive. Just about everyone returns a hello (or a salam) and a smile.

This other one is a beggar that sits down in the middle of the street. When you are in heavy traffic you are somewhat boxed in and it is challenging trying to avoid someone that is sitting on the ground almost in front of your car.

Today at the hospital I was able to get some quality teaching in. My favorite ER doctor was there. We were discussing an older lady that was there because she felt faint and was having abdominal pain. She had somewhat of a fast heart rate. We were trying to figure out what was wrong with her. I did not have an interpreter so I really could not ask very many questions or get a very good history. We went through her meds. She had 3 different anti-inflammatory pain medications and 2 different medications for her stomach. She was also having loose stools. When I asked what color her stools were the ER doctor pointed to her kid's shirt which was dark brown. I suspected that she had a bleeding ulcer so I recommended that she get sent to lab for some blood work.

It is funny because the ER doctor pretty much never does a physical exam. On the rare occasion that he does do one he usually finds something grossly abnormal and it usually ends up being a mass. I have already described the time when a lady, who happened to be wearing a burqa, came in with a headache. He felt behind her ear, and surprisingly, he proclaimed, "Oh, there's a mass!" Well a similar thing happened today when he put his hand on the patient's belly (over her cloths). He immediately proclaimed, "Oh, there is a mass!" It turned out that it was just a very large lipoma but it was still amusing how he is always able to find the masses.

I went with Dr. Peters upstairs to the inpatient ward. There is a new patient up there that is in pretty bad shape. He was injured from an explosion that happened 2 months ago. He breaths through a small tube in the front of his neck and he is partially paralyzed from the waist down. He is fed though a tube that goes directly into his stomach. Of course, his family does all of the nursing care. I spoke with his brother and I asked him what type of food he feeds his brother through the stomach tube. He said, "Water and juice." I then said, "No, what type of food do you give him?" He looked at me kind of confused. I repeated, "He has to get some kind of food." His brother replied that he gets the water from boiled potatoes. We really need to see what we can do about getting our patients some better nutrition. The problem is Afghan people pretty much eat the same thing everyday- naan, rice, and maybe some potatoes and onions with the occasional lamb stew or kabob. I imagine that it would be difficult for an average family to find food that would be appropriate to give through a feeding tube.

LtCol Johnson just called me to see if I was OK. He heard a loud explosion. It turns out that it just happened at the Serena Hotel. This is from Google news.

Explosion goes off at luxury Kabul hotel Staff and agencies14 January, 2008By AMIR SHAH, Associated Press Writer 3 minutes ago KABUL, Afghanistan -

An explosion and several rounds of gunfire went off Monday at a luxury hotel frequented by foreigners, reverberating throughout Kabul, police said. An American citizen inside the hotel said she saw a body she believed to be dead and pools of blood in the lobby. Mohammad Arif, a police officer, confirmed the explosion at the Serena. Ambulances and U.S. troops rushed to the hotel after the 6:12 p.m. explosion. The Serena is newly built luxury hotel frequently used by foreign embassies for meetings, parties and dinners. The nicest hotel in the city, visiting Westerners often stay or eat dinner there. Valentino described an explosion faraway, then gunfire, another distant explosion followed by a large explosion very close — all within a "couple of minutes."

We were just there a few days ago. I blogged about it and posted some pictures. It is amazing just how quickly news gets to the internet. You can hear an explosion and then a few minutes later you can search for it on Google news to learn what it was about. If you look at the story you can see that it says 3 minutes ago. We are living in an amazing world.

Thanks for reading.

A Little Nut

"The world is not yet exhausted; let me see something tomorrow which I never saw before."
-Samuel JohnsonEnglish author, critic, & lexicographer (1709 - 1784)

"What we hope ever to do with ease we may learn first to do with diligence."
-Samuel Johnson, Lives of the Poets English author, critic, & lexicographer (1709 - 1784)

"A cucumber should be well-sliced, dressed with pepper and vinegar, and then thrown out."
-Samuel JohnsonEnglish author, critic, & lexicographer (1709 - 1784)

"Returning violence for violence multiplies violence, adding deeper darkness to a night already devoid of stars... Hate cannot drive out hate: only love can do that."
-Martin Luther King Jr.US black civil rights leader & clergyman (1929 - 1968)

"No snowflake in an avalanche ever feels responsible."
-Stanislaw J. Lec Polish writer (1909 - 1966)

"If you smile when no one else is around, you really mean it."
-Andy Rooney US news commentator (1919 - )

"Nobody made a greater mistake than he who did nothing because he could only do a little."
-Edmund Burke Irish orator, philosopher, & politician (1729 - 1797)

"The greatest oak was once a little nut who held its ground...."
-Unknown Quotations by unknown authors

"Think twice before you speak, and then you may be able to say something more insulting than if you spoke right out at once."
-Evan Esar, Esar's Comic Dictionary American Humorist (1899 - 1995)

There is not really a theme to the quotes. I just found them to be either poignant or funny. The title pic was taken by a participant of the last VCR trip. I hope that you have a faster internet connection then I do because I was not able to see the video that went with the slideshow.

Today was a snow day both literally and figuratively. I previously discussed how Capt Traversa, the author of A*W*A*C* blog, described days where recent events effect your ability to move about. He called them snow days. It always makes you a little anxious after any event. Aside from the tragedy of it, it is always important to have a reminder of where you are and how you should always remain vigilant.

I was reading a New York Times article today about Afghan weddings. I provided a link to it. I have always thought that it was interesting how you can drive around Kabul and see a city that is recovering from years of continuous wars and then you see huge beautiful wedding halls every few miles. Here is an example of one. You have to excuse the quality of the picture it was taken from a moving vehicle.

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It almost looks like a Vegas-style casino. I am not sure whether or not you can appreciate the size of the building but it is pretty huge. I also am not sure what a Paris wedding is. Maybe they just liked the name.

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Weddings are a big deal over here in Kabul. A wedding cost similar to what we would pay in the states. That is actually a lot of money considering most people only make $100-200 dollars per month.

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Here is another one.

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The culture prevents men and women from dating, so as you could imagine, many of the young men are eager to get married. The problem is, not only does the wedding cost a lot of money, but you also need to give a lot of money to the bride's parents before they will approve it. So, as a result, men have to spend many years saving up so they can afford to get married. That's funny because in the states it is usually the other way around. Just kidding.

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Thanks for reading.

Snowball Fights

"Neither snow, nor rain, nor heat, nor gloom of night stays these couriers from the swift completion of their appointed rounds."
-Herodotus, Inscription, New York City Post Office, adapted from Herodotus Greek historian & traveler (484 BC - 430 BC)

"I wanna hang a map of the world in my house. Then I'm gonna put pins into all the locations that I've traveled to. But first, I'm gonna have to travel to the top two corners of the map so it won't fall down."
Mitch HedbergAmerican comedian (1968 - 2005)
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"There are fine things which you mean to do some day, under what you think will be more favorable circumstances. But the only time that is surely yours is the present, hence this is the time to speak the word of appreciation and sympathy, to do the generous deed, to forgive the fault of a thoughtless friend, to sacrifice self a little more for others. Today is the day in which to express your noblest qualities of mind and heart, to do at least one worthy thing which you have long postponed, and to use your God-given abilities for the enrichment of someone less fortunate. Today you can make your life - significant and worthwhile. The present is yours to do with as you will."
-Grenville Kleiser

"The falling drops at last will wear the stone."
-Lucretius Roman Epicurean poet, philosopher, & scientist (96 BC - 55 BC)

"The aging process has you firmly in its grasp if you never get the urge to throw a snowball."
-Doug Larson

The roads were pretty icy today, but like the postmen in the quote, it did not stop us from the "swift completion of [our] appointed rounds. "

I am always amazed at the diversity of medical problems that come in through the ER. Imagine having a regular ER with its fractures and patients with chest pain, now add patients that have war injuries, then add post operative follow-up patients, then add pediatrics well-child visits, then add criminals and prisoners. Literally, anything could walk through the door at any minute. One gentleman was shoveling snow off the top of his roof and slipped and landed on his face and arm. He had a really good fracture.

A criminal was brought in that had pretty impressive injuries over his lower extremities possibly caused by a baton. A father brought in an 18 month-old girl that had not reached her walking milestone. A women that had just had a hysterectomy came in to get her stitches removed.

Upstairs I spoke with one of the prisoners that was hospitalized for chest pain. Her surprising spoke very good English. I have come to the conclusion that I would be a very poor judge because I tend to believe everything people tell me. Of course, everyone says that they are innocent and wrongly accused. I do not envy the judge that has to decide innocence or guilt. We had a long discussion about his heart condition. I was glad to see that he was getting appropriate care just like any other patient would have received. Once patients walk through the doors of a hospital there are no longer good guys or bad guys, only patients. Some of them just so happen to have handcuffs on.

For some reason there were a lot of spontaneous snowball fights today. I am not sure what it is about the snow over here but I am able to make the perfect snowball. I was walking with one of the contractors, engrossed in an important conversation, when all of the sudden, "Wham-o!" A snowball got me right in the face. It was pretty funny. I was able to deliver my revenge after dinner with a sneak attack of my own.

Thanks for reading.

Toxic Pig Brain Mist

Iron rusts from disuse; stagnant water loses its purity and in cold weather becomes frozen; even so does inaction sap the vigor of the mind.
-Leonardo da Vinci, The NotebooksItalian engineer, painter, & sculptor (1452 - 1519)

Wherever you go, no matter what the weather, always bring your own sunshine.
-Anthony J. D'Angelo, The College Blue Book

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If I find 10,000 ways something won't work, I haven't failed. I am not discouraged, because every wrong attempt discarded is another step forward.
-Thomas A. Edison, Encyclopaedia Britannica US inventor (1847 - 1931)

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Have more than thou showest; Speak less than thou knowest.
-William Shakespeare, 'King Lear,' Act I, Scene iv Greatest English dramatist & poet (1564 - 1616)

Today the weather changed drastically from mid day to evening. It went from beautiful and sunny to cloudy skys and heavy snow fall.

We helped unload a large container full of medical supplies. We definitely got our work-out for the day.

While we were unloading the supplies we watched some kids have a snowball fight. They had one of the most amazing snowball throwers that I had ever seen. It was 2 ropes attached to a handmade basket for a snowball to sit in. Every time they launched a snowball you would hear a loud crack of the rope. It made the snowball soar.

Muslims will be celebrating another holiday this weekend. It is called Day of Ashura. I linked a Wikapedia article in case you were interested in learning more information. This last week you could detect a noticeable change around the city. Cars had large flags on them and a lot of banners were erected.

I am almost embarrassed at how little I knew about Muslim culture before I came here. I think the more we can learn about each other the more we will get along and prevent prejudices from developing. The more you get to know someone the more you realize that we are essentially all the same.

I do not normally do this because I try and stick to Afghan related topics, but I found an ABC News story so funny that I had to share it. The title of the article is, "More Sick From Toxic Pig Brain Mist." Here is a link. The comments on the article are also pretty funny. I can say with confidence that toxic pig brain mist will never be a problem in Afghanistan because Muslims are not allowed to consume pork. As a matter of fact, we make sure that we do not give out any stuffed toy pigs to any of the children. We try and respect and be sensitive towards their religious and cultural beliefs.

Thanks for reading.