Thursday, August 19, 2010


The trip home from Al Udeid was more comfortable than the C-130 heated-tin-can run through Iraq, but no less tiring.  We stopped 3 times during the 26 hours from Al Udeid to BWI, and I slept for 6 hours at a local hotel prior to the flight home to San Antonio the next morning.  [Here's a shout-out to American Airlines which put me in First Class on both connections from BWI to San Antonio.  That was an unexpected and much appreciated treat].  Alas, I arrived to a smiling family, and have enjoyed the reunion with them since.

The day after coming home, I was at the pool with my kids and ran into an older gentleman who works there.  He welcomed me home, and then commented on the "mess over there" and "how screwed up those people are."  I took that as a queue: "Yes," I said, baiting, "after we bombed there water purification systems and power plants, they have become a bit surly."  This is not what he was intimating, and as he looked away, and his expression changed from an approximation of admiration to a suggestion of disgust, he then pointedly asked me if they weren't surly before we got there.  Ever since the crusades, there has been a mutual, generalized mistrust between muslims and christians, so I guess I couldn't find this surprising.

Whether or not it was a mistake to go into Iraq as we did - this is a much more difficult query than most people tend to make of it, given modern history in this area of the world - it is undeniable that our tactics for the invasion were imprecise and not pristine.  As has been said many times, we overplanned for the warriors, and underplanned for the civilians.  And worse, we were ill prepared for interloping Jihadis who, cleverly, and obviously in retrospect, ensnared our focus and drew us to unavoidable civilian casualties (ie. al qaeda mortar rounds launched from schoolyards, mosques and markets toward American troops), and the societal costs of the destruction to the infrastructure.  Whereas a bunker may have served as one of Saddam's hiding places, it was not on the night dozens of women and children were inside of it taking refuge from fighting in the streets, when heavy ordinance came down upon them.  These are the casualties of war, but in an offensive, these deaths appear reckless to residents who lose a child, wife, or sister, and then join a terrorist insurgency, which became the great thorn in the heel of OIF.  I talked to many Iraqi who did not become insurgents, but who became disillusioned with us after these types of things occurred, and after the years of frustration with inconsistent basic services due to the lingering insecurity generated by the terrorists.  They wanted us to leave.  But as the security has improved, inroads (albeit, just inroads at this point) have been made for repair of much of what they were accustomed to in Iraq: first-world medical care, a vibrant economy, an admirable secular educational system, and reliable utilities.

I always knew that caring for wounded American and coalition troops would be fulfilling, but this is where my experience taking care of HNs became the pleasant surprise of my time in Iraq.  We saved countless Iraqi civilians and many children who would otherwise be dead, and each husband, wife or parent returns home with their child with a new view of Americans.  A bilingual Iraqi physician told me that prior to meeting us, these Iraqis know only George H. Bush, who they perceive as abandoning them, George W. Bush, who they perceive as destroying Iraqi society in the quest to rid the world of Saddam Hussein, and US Marines, the tip of our spear, and the deadly edge of our sword.  According to this physician, we change the way they view us: the real Americans, a representation of the compassion and industry present in our general populace.  People are people.  These people suffer the same human frailties and greatness, and they got to see this from us - fighting sleep on call in the middle of the night, losing patience and yelling at a nurse, life saving surgeries and medicines.  I am contented to have helped to save a few, and improve a few of these lives, and in the process provided more glue for these folks to put their country back together.  I hope that the person who hasn't been over there and prone to make poolside comments about those people keeps these things in mind.

It has been a uniquely flattering to hear nice things from so many strangers who read this blog; I guess they are all within 2-3 degrees of Kevin Bacon, but friends of friends of friends are people I don't know, and bearing witness to power of the internet in this fashion, and knowing the anecdotes reached people has been a special experience for me.  The blog became a chore on occasion, and I often lacked the inspiration I needed to deftly pluck out a captivating story.  Thank you for allowing me some elbow room in this regard.  My goals were accomplished:  1) to tell the story to non-military Americans of the day to day life for Americans deployed in the AOR - not the glory or gratuitousness draped across the marines in the HBO specials, but rather the basic sustenance for those most resembling regular folks back home; 2) to remind folks back home that despite the news, that the war is still on (even now - with withdrawal of the last of combat troops - our military members are not in a safe place); 3) to pass the time - I learned a few things about myself in this process, and found it a fine catharsis and release valve for banalities of daily deployed life for a dust-stomping oncologist.

So, thank you for reading, thank you for your encouragement, and thank you for remembering our military in a time when it is easy to forget what they are out there doing for you.

Saturday, July 31, 2010


Al Udeid would not be a bad place to be deployed if you had a domicile which was not a tent and the weather was like February year round.  The last time I was here the air was relatively dry, the evenings were cool, and the days were blue skied; hot in the sun, temperate in the shade.  The endless white rubble known as Qatar is not so merciful in the summer months.  The only ones outside at noon are madmen and Englishmen, as many an Indian has said.

For these few days in Qatar, I have adjusted my schedule, both in deference to the CST which I will soon be rejoining, and, more importantly, at the moment, as a strategy to deal with the heat.  I sleep through breakfast and lunch, sit in the Chaplain's makeshift living room (an air conditioned lounge that has wireless internet) until the sun goes down.  Then it is time to make the 1/2 mile trek to the dining facility.  Here I am again today: bloggin', email'n, surfin', and readin' the news.

The heat here is worse than Iraq.  The temperature is not as high, but the humidity is much higher, and when it is 110 and humid, it sits on you like a full length hot towel.  You feel like the cheese in a burrito.  One can really understand the dish-dash-ah and the gutrah - the long white cloak and headdress, respectively - worn by the locals.  I guess every place has a less pleasant/unpleasant season.  The 6 months of nasty heat here seems inequitable share of nasty - like an Alaskan winter.

It is a shame to be stuck in this Haji Grand Central Station for over a week (combining time here on the way to and from Iraq) and be unable to get to Doha which is less than an hour drive.  Doha is home to a million people.  Curiously, most of them are expatriates; a larger portion of whom are laborers from South Asia.  The middle east is so different from what we are used to in the US or Europe.  It would be interesting to walk around and see how things are done.  Under different circumstances, I wouldn't mind seeing Doha, as well as Abu Dhabi and Dubai, which are the principalities of the UAE.  That said, I don't see a dedicated trip for the this purpose in my near future.

Alas, here I sit.  Alone in the desert, waiting to come home.  Interesting how the military creates such intense desire for a 22 hour flight with 5 layovers.

Friday, July 30, 2010

There has to be a better way to do this

The best thing about yesterday is that I don't have to live it twice.

I climbed out of bed at 0300 to clean my CHU, and make final preparations to leave with a show time of 0700.  In the military, there are flight times and show times.  Flight times are just as you would imagine, they are times of the flights.  The show times are anywhere from 3-4 hours prior to the flight, and if you don't make arrive for the show time, you lose your ticket - it is given to a standby customer.  (This is just like commercial air travel, except that Delta doesn't give away your ticket until you "no-show" at the boarding call.)  The 1100 flight was delayed, however, until 1545.  So, I sauntered about the base until the new show time of 1245.  I then lugged my gear - 125lbs of my belongings, 70lbs of battle armor and kevlar helmet, and 50lbs of chem gear - to the meeting spot, where we proceeded to tag and load our bags and take the bus to the terminal 1/2 mile away.  

I thought our trip from my base to Al Udeid would consist of the 2+ hour flight over 1000+ kilometers of desert packed into the Air Force's favorite tin can: the C-130 Hercules.  I was overly optimistic.  Clad in 
IBA and helmets, 40 of us, packed tightly as cigarettes in their case, made our way north 300-400km to Kirkuk, where we dropped off 6 and picked up 13 soldiers and airmen, back down to Baghdad where we dropped off 10 more, changed pilot crews and added some cargo, and then, finally, south to Al Udeid, Qatar.  The 4x4000hp Allison Korean War era engines buzzed as a mammoth wasp for the entirety of our 3 legged, 5 hour voyage.  The blessing of our delay left us landing on our desert peninsula within the Persian gulf at 2130, mercifully, after the setting sun.

Soaked through our undergarments and battle-ready burlap-canvas camouflage (ie. ABUs), we sat through an hour of briefings, dropped our checked luggage in a bin, lugged our the remainder of our gear through customs, dropped off chem gear and IBA, and then waited in the steamy night for a bus to the transient housing office.  My psychologist colonel friend had a driver taking him to the DV (distinguished visitor) housing unit, so I caught a break, skipped the bus, and hitched a ride with him.  My attempts to hole up in DV quarters posing as his aide-de-camp were apparently more transparent than I had guessed, so I was curtly shipped back to second class.  I shrugged, picked up linens, and walked 1/4 mile to a 45 person tent filled mostly with hygiene-challenged 18-25 year old soldiers that smells like 3 day worn sweaty socks dipped in a septic tank and left to dry on a line.  But at least the air was cool in this tent, so I stripped off my saline-laden stink, took a deep breath, and re-dressed in shorts and a t-shirt.

I walked another 1/4 mile to the bar, had three glasses of water and a Guinness.  All is forgiven.  Counting down hours until commercial air takes me north and west from here.  

Tuesday, July 27, 2010

Leave no trace

When it is 130 degrees Farenheit with 8% humidity, you need to drink your water.  This is the desert, so water is brought into the base from elsewhere.  I cannot tell exactly where it comes from, but given the risks of terrorists poisioning our water, I am sure it is not from the local spickets.  Drinking water arrives in stacked plastic-wrapped pallets of 1L water bottles, which are subdivided into cases of 12 bottles.  These pallets are deposited around the bases, and the water warms in the sun extracting whoknowswhat from the polyethylene terephthalate bottles.  The plastic bottletops twist open without the characteristic release of tension and snap which we have all grow so accostumed to in the US.  They say the water bottles are not recycled, but who knows why they don't have that seal.  (Knowing how many people urinate in these bottles, I want to believe that they are never reused).

The bottles end up in the trash, along with everything else; the cardboard boxes, the styrofoam trays on which I eat, at least, 2 of my daily meals, the mounds of paper, the expired food, all go into the trash, and all of it is burned.  In reality, I have thrown out more in the past 6 months than I have in 6 years at home where I recycle with abandon, separate all types of refuse, and make all efforts to wash and reuse those items which can be reused.  Military discipline (and martial law) assure there is no litter in sight, but the garbage cans do fill. 

Preparing to pack my things, I gave a pair of tennis shoes to the Pakistani janitor, a rug to the Indian who drives the floor cleaning Zamboni, and old towels and hangers to my partners - there seems no reason to carry these things across the pond, and they should be able to use them.  This is not reaching my goals for stewardship, but cuts down on the garbage.

Recycling and stewardship have become a tertiary priority, a statement of volunteerism, and they are quickly set aside when the burden grows elsewhere - I even notice this at home where we are less dedicated to composting or separating recycleable goods with 3 children to care for, than we were by ourselves before them - and, here in a deployed setting where environmental considerations are a luxury which seem to impede the mission.  When will our jobs of stewards of this planet become mandatory?  When will the pursuit of oil and wealth be secondary to the impact on the surroundings, as in the case of the BP oil spill in the Gulf?  Do we have to sully the entire planet and render all environments toxic before we place stewardship higher on the moral standard?

The military has its objectives, it just seems that we can accomplish the mission in a way that doesn't leave what we are fighting for so stained from the battle.

Saturday, July 24, 2010

Drawdown of military medicine

Six months ago, the plans for the drawdown of military, and civilian support, personnel in Iraq were public knowledge.  Reduction of military force by 50% in September 2010, and removal of all troops, with exception of training operations and diplomatic missions by September 2011; or something approximating that, anyway.

Most active duty troops are relatively young and healthy, but the sheer number of folks here leads to the statistical inevitability of strokes, heart attacks, seizures and what-ails-you walking through our door.  These cases have previously been dispersed among the many hospitals and small clinics throughout the country.  This year, we expected to see an up-tick in the number of medical admissions when the peripheral bases started to close this summer.  What we did not expect was the simultaneous increase in violence - or at least the perception of such - as there are diminishing number of facilities prepared to care for trauma patients.  In addition, the young surgical crew here is hungry, and doing far more elective cases than the previous group. 

So, these have all led to a significant increase in business, decrease in sleep, and mild regret among my colleagues as to my departure - or at least the departure of my work.  The hospital's first priority is to care for the trauma of US soldiers, and that mission will be met.  The elective procedures may start going away, and that will provide more time for the surgeons to care for trauma victims, but other services we provide are not as elastic.  The care of host nationals (HNs), for example, is, in part a humanitarian effort to win the hearts and minds of those in the areas around us.  The choice of which of the patients are chosen to receive care here, however, is somewhat arbitrary.  People will be happy when we discharge the 21 month old boy who has been here for 1 month in the hospital, a most certain rescue from death from his burns.  People are less pleased when Command accepts a terrorist with a gunshot wound over a infant with a simply reversible birth defect at the gate.  Compounding this, recently, our follow-up clinics have been canceled, so once a HN patient is discharged from the hospital, they are on their own for follow up medical care.  I liken this to dropping off an individual on a deserted island with a laptop and a cell phone.  The medical infrastrucure in Iraq simply is not mature enough, or hasn't rebuilt enough, to handle complications or complete staged procedures for complex patients.  Nonetheless, this is all part of the plan to slowly remove ourselves, and any dependence on us, from inside of Iraq.

Planning for removal of 100,000 troops and 100,000 contracted support personnel is based on some known variables, and it must remain mutable for those unpredictable surprises.  We are counting, or at least hoping for less violence during the drawdown.  For the sake of the care of the troops, if nothing else, let's hope this is an accurate assumption.

Sunday, July 18, 2010

Eatin' up, with my bad self

For months, I avoided soul food night specials at the DFAC and chose, instead, a bowl of cereal or pop tarts.  The macaroni and cheese was served in cut blocks as the pasta had melted into itself.  The "fry" on the fried chicken seemed much greater in mass than the "chicken" of fried chicken.  The vegetables?  Overcooked, and molten, indistigunshed.

As of late, however, Sunday night has become a culinary delight.  I never seem to remember it ahead of time, but when I walk down to the DFAC, and discover that it's SOUL FOOD NIGHT, well, I am a happy man.  Tonight, I eschewed the ribs and macaroni and cheese delicacies, and, instead, partook in the gumbo - which, as a charming mix of shrimp and left over chicken curry adorned with plump pieces of floating hotdogs, may not rate as 'Nawlins finest, but makes a nice dish, all the better mixed up with cornbread, and washed down with sweet tea.  The larger portion on my plate was collard greens, without the pork parts, and a heaping mound of blackeyed peas.  I used to consider this the penance for the sins of the "gumbo mash" described above, but my vegetarian wife will be happy to know that I now enjoy these as much.  (The better to wish in the next New Year, I suppose).

Honestly, the food here is tremendous.  We are blessed to have hot food, and people who cook it for us.  There are no MREs, and the dreaded constipation that accompanies it.  There are many selections, and frankly, some of the food is tasty.  I am always amazed at how they are able to offer these gargantuan trays of fresh fruits and vegetables to thousands of soldiers in the middle of a dust bowl; especially, considering that the food is brought from all parts of the world, all of which are more than 1000 kilometers away.  The dishes all have a little taste of the sub-continent, and I am happy to leave this behind, but that is more to escape routine and a welcome of choice, not for lack of quality.

Really, this is a far cry from anything in deployed settings in the past wars, and you do find yourself a bit guilt-ridden with complaining about a shortage of Diet Coke or Honeynut Cheerios, having Pepsi Light and Total, to suffice.  If anything, though, you recall the cornicopia available to most Americans, at any time of the day, and truly appreciate that remarkable convenience.  Gulitily, I am looking forward to this in a major way.  In the meantime, however, this white boy is digging his curry-chicken gumbo mash with a large side of greens. - vinegar and hot sauce at the ready.

Saturday, July 10, 2010


Going home soon.  There is not much time left for me in this accursed country, but the hands of the clock have slowed; they are my never boiling watched pot.  When your tour is measured in weeks or days, you can realistically cross days out on the calendar without worrying of running out of ink.  This doesn't make sense to me as I will just spend more time staring at the calendar.

My children may not be stopped from this, but they are weary of the weight of our separation, and the younger ones have started to wonder if I am every returning.  School has been out, but my wife has maintained a routine, for her own sanity, and their benefit.  Surely, they remain occupied for most of their day.  Perhaps my arrival home will be noted with a shrug, or less, by my sons, who have lived without me for longer than they can remember.  I hope and believe that this will not be the case.

The crews here have changed over.  Those who saw me come in, and showed me the ropes have returned home.  I talk of February and rain here, and the those newly deposited into this stink are disbelieveing, as if they are things of another epoch.  Strangely, the contractors from the sub-continent, while always polite and professional, have lately started to afford a familiarity of mutual respect.  They don't check my ID at the gate when they see my face; I am served my usual breakfast off the buffet by issuing a smile and without uttering a word; they even bring me curry sometimes to my office.

Let the outprocessing scavenger hunt begin...  ...oh, gladly.   More on this later.