Power up

The hallways in the hospital have been dark tonight.  Air conditioners are turned warmer (or off).  The base stopped carrying the AFN (Air Force Network).  There was an initial request to reduce power consumption, followed by a second, more forceful message which basically said, "if you don't, we're gonna 'insert-punative-action-here'."  Just like anywhere else in the world, people are very slow to voluntarily reduce their power consumption.  If they weren't we would not be talking about global warming as much as we are.

The military, is a dictatorship, however, and punative actions happen regularly to meet demands.  Often the demands are mutually exclusive; for example, "double your output, and half your work force."  In this case, continued power consumption at the rate the base was using was not commensurate with the amount of fuel left to burn.  So, when everyone (not me, as I avoided doing my laundry and wore dirty clothes to save warming wash water and powering a dryer) ignored the warnings, the electricity nazis sprang into action.  Some Army battalion commanders just shut off the power, making surly infantrymen even more so.  Granted, that was an easy fix, albeit Draconian when the temperatures are over 110 degrees.  The kindler, gentler Air Force commanders have assigned squandron superintendents to reduce consumption, in a more nuanced fashion.  This explains why only the emergency lighting is turned on right now in the hospital.  It also explains why the hospital is 28 degrees Celsius.  This is ok when you are dressed in scrubs.  The fevering patients are not pleased, however.  [It is striking that everyone of the 200+ CPUs in the hospital are cooking all night, even though only about 20 need to stay on for the nightshift.  The hilarity of this was not lost on this author who was told by the "systems" people (see tomorrow's blog) that shutting down the CPUs was a bad idea as the network links would be irrevocably lost.  Why, you may ask, would a network connection be forever lost because the computers shut down and turn back on in the morning?  They couldn't explain this to me].

I digress.  Power has been spotty, except for mission-essential (weapons systems, hospital, planes), due to this shortage, but not bad overall.  Again, nothing to complain of in the scheme of things.   It does make one wonder why we don't have an overabudance of solar power given the abundance sun here, but I guess for the same reason Arizona isn't off the grid.

Life, limb or eyesight

Friday is the Muslim holy day.  On May 21st, it was a pleasant evening in Khalis, and a crowd of locals were relaxing outside of a coffee shop in the busy market, enjoying the change in weather.  A vehicle containing an improvised explosive device exploded in front of this crowd, and destroyed many shops.  The blast killed 30 people, and left another 4-5 dozen injured. 

As this town less is than 15 minutes from here, we started to receive report that the bulk of the seriously injured patients were on their way here.  This caused an initial panic, and in the end we only received 2 of these patients, one who had minor injuries, and ther other, who came to our ER pulseless, had his leg amputated, but who is now eating breakfast and happy to be living.  There were rumors that the road and bridge over the Tigris from Khalis to this base was blocked - presumably, by terrorists - but I have no idea of whether or not this was the case. 

Given the quality of care we have provided for many Iraqi citizens here, we have daily requests from outside of the gate for admittance and care at our Joint Theater Hospital.  Obviously, we are not set up to become a local trauma hospital (or community hospital for that matter) for ill and injured Iraqis, but the policy, as stated by people above me who make policy, is to accept only patients from the community who arrive at the gate with risk to life, limb or eyesight.  The same day as the aforementioned bombing, for example, a head-on collision just in front of the base led to 5 trauma patients (all of who survived, and 3 of whom have already been discharged) come in to our ER simultaneously. 

The "life, limb or eyesight" policy has its holes, but does, at least, provide some humanitarian assistance to truly urgently ill patients.  It is a tough call for a 20 year old Army medic to make, however, with only a walkie-talkie to the ER to help sort through information.  Head-on collisions, for example, are particularly dangerous, and lead to high-impact low-survivability trauma, so taking these 5 patients from the accident, when only 2 of them really ended-up having urgent needs, is acceptable.  There are those who try to game the system, as you might imagine.  Patients are sometimes driven to the gate, unloaded from a still-moving vehicle (sometimes supine from a pick up truck), as the delivery vehicle speeds away.  When this happens, the patient often has IVs and a name bracelet from another local hospital.    We do what we can for these people, but you can imagine how this makes steam come out of my bosses ears.

And it can lead to confusion.  A young burn victim who alights himself making a bomb gets free admittance and care, but an infant with a potentially fixable birth-defect, may be denied and returned to the hands of a sobbing mother, destined to go without a life-saving (eventually) procedure.  Children with cleft lips are turned away, even as our head and neck surgeon has no planned cases.  Though all of these decisions are made through reason, and with the best interests at heart, many people - outside of the gate, and within the hospital - cannot reconcile these decisions.  Sometimes, it is the greatest challenge to win hearts and minds.

Generally speaking

One of the benefits of working nights means that you aren't around during the day.  Particularly, here, that means you miss the Dallas Cheerleaders or Hooters girls when they come through, but you also miss the visits from the DVs.  Distinguished Visitors (DVs) are the military equivalents of VIPs, and they often are not distinguished, but they are almost always General grade officers in the military, or civilian equivalents.

We have had Iraqi and American legislators, governors, heads of agencies (eg. Red Cross) and all of the paparazzi-worthy military (eg the guys you see on the evening news).  This week General Green, the 3-star general in charge of the USAF Medical Corps paid us a visit.  He is supposedly a nice guy, and approachable enough.  I have heard different things of General Odierno, the head of the military in Iraq, who was due this week also, but canceled do to something, undeniably more important.  I lack firsthand experience with any of these people because I come to work at night.

The funny thing about their visits, however, lies in the preparation dedicated to each of their visits.  The "Bio" or CV for each DV comes via email to the whole installation prior to their visit.  If the DV is important enough, we are usually also sent instructions on how to act with a reminder to hold our backs particularly straight, and have our desks particularly orderly.  There is a literal red carpet that sometimes comes out (though I have not seen this here in the AOR) - as if they came to receive their Oscars - and their are near life-size portraits of these individuals on placards at entrances to the building.  Each duty section selects a particularly spiffy, well-put-together individual to give a prepared 30-60 speech about the capability of their duty section; "Our patient wards include 20 beds with the capability to expand to 40 beds in the event of a mass casualty..."  Laughing, visibly, within the line of site of these individuals during their sermons is considered poor form.

And then, there is the entourage.  The aide-de-camp, the public affairs official, the body guard(s); the more important the DV, the larger the entourage.  This gaggle always includes the local commander, or in the case of the less important DVs, the vice commander.  Rounding out the entourage are the chief master sergeant (top enlisted person) and the local superintendents (the top enlisted persons aside of the chief - whose jobs are most amorphous), and a token soldier, seaman or airman who either suffered a battle injury, earned the Medal of Honor, or represents an underrepresented ethnic group.  Sometimes, the Chief gets lucky and finds someone who can be all 3.

Me me me

One thing about deployed life that is difficult for the many single people here to understand is that it is, ironically, an unbelievable selfish time.  Our military is a volunteer service, and we all know that being sent away to one shithole or another is part of the job - the part that feels less voluntary, and indeed is almost entirely involuntary, is the particular shithole to which one is sent, and, of course, the time, length and particulars of internment to said shithole; not to mention the politics and obscured path to righteousness among many of the more recent military forays.

I digress; the point at hand is that when you are on your deployment, your primary, and near solitary non-work focus is upon yourself.  Surely, some deployments are more mission intensive than others; the mission consumes all of the waking time for some of our forward deployed troops.  Away from the front lines, there is time away from work, and it is not spent cooking, cleaning, caring for children or parents, and commuting from one place to another.  Commuting, at least for me, and the majority of the 20 thousand people here, involves a negligible period of time, and usually serves the added advantage of loosening up my legs for the self-indulgent body sculpting which is soon to ensue.  The clothes are washed for free by a service provided by the government - they even fold your socks - and the food is hot and cooked 4 times a day.

After work in the morning, I go to the gym, and have nearly broken 20 minutes for a 5k run - the fastest I have run since high school - and the spare tire is gone.  I have read several novels. Daily, I complete my (near daily) blog, play guitar, and spend time writing letters or emailing my family.  I have watched nearly 4 seasons of the Sopranos, both seasons of Rome, all episodes of It's Always Sunny in Philadelphia, all three seasons of Californication (all of which I recommend), and about 30 movies.  [I have commented previously on the volume of digital media here, and it really is dumbfounding the amount of digital media is made available to us, whether purposely, as designed by Uncle Sam to keep the masses docile and sane, or via an accident perpetrated by the ease and infectivity of digital media sharing]. 

And not all of this is on my time off, as such would be impossible.  On slow nights at work - as is the nature of trauma, we wax and wane between frenetic and comotose - I accomplish a grand majority of the movie watching (see Man Cave from March blog), blogging, and guitar playing.  Now, quixotically, and very ironically due to the consolidation on base, I have a larger office, and a 'man cave' of my very own (see forthcoming blog: Man Cave III).

When I tell my wife these things (maybe I shouldn't?), she sometimes rolls her eyes, and this reminds me of how she, as did I prior to coming here, has very little time that is her own and for her own enrichment.  Parenting is its own joy and reward, do not mistake me, but raising 3 boys leaves little time to play guitar, go to the gym or wax poetic.

So, in my final stage of grief [see blog Being here (and too much philosophy)] - acceptance - I am "looking at the bright side."  And so the irony of an act of patriotism - selflessness, embodied - has rewarded me with a sabbatical from selflessness.  This is a free pass to do the introspection many middle-aged (am I really that, now?) American men need to a divorce and a Porsche to accomplish.  Ok, it is dangerous, uncomfortable (often, though not always), and most importantly, a previously unperceivable sacrifice to miss the lives of my wife and children.  But...    ...the glass is half full.

The beauty of a clean day

The yellowing sky to the east, with fading stars and the moon above were the first clues the dust was down.  Quickly, the rising star of ours heats the cool night air, and the convection currents stretch the rare, singular portion of the day, that, when the sky is clear and the lungs are not full of dirt, elicits rare smiles, deep inspirations and peaceful sighs from lone soldiers off to eat or come to work, the marching batallions still cool in the full gear which will cause them to sweat liters later in the day, and the legions of drivers, windows-down, contently moving their jeep, truck or tank down the road.  But today's mission will not be in blindness of sand, and, given the cooler morning air and clear sky, will surely include an enjoyable shaded moment for lunch or rest in the afternoon.  A quick rain brought the dirt from the air back to where it belonged, but before this, the monochromatism of the landscape was startling.  Contrast was absent, and visibility severely diminished.  There was no whipping, conical sand gales, but the dryness, and the steady breeze had erased all but a small fraction of the landscape's palatte.  Each breath led to a cough or sneeze full of its contents.  The windows of all vehicles were opaque, as if painted to be so.  Air intake fans had, and still do, deposit daily coatings to everything that is inside. 

So, I aim for a quick sleep, after only 13 hours of the past 84 spent in slumber, so that I can take a late afternoon walk, to where (well, there is no where to go), I am not sure; but to walk and breathe clear air while the birds are awake, the palm leaves still rustle, and life is vibrant - and not toilsome, beneath a merciless hot, and dirty fog - prior to my 12 nightime hours inside the hospital.

Hot stuff

I woke up at 1845 today.  The sun was nearly down, and the sky was darkening.  It was 105 degrees.

I lamented on the crack in my Anesthesiologist friend's new glasses.  She said they spontaneously broke in the sun while walking to lunch.

Scorpions sweat here.

When I told a colleague that I was scheduled to go to Iraq this year, I asked him how hot it was in the summer.  Both of us were in San Antonio, and had suffered a particularly blistering summer together there.  He had returned a year ago from a deployment to Iraq himself.  "San Antonio," he said with a smirk, "is a memory of winter for you."  I laughed.  He couldn't be serious.

The main question I have is to how this could be the part of the world (not Italy, not Hawaii) that people have been fighting over for the past 5000 years?  Is it the monochromatic landscape?  The camels?  The fun loving Sh'ria law?  No, it must be the climate.   But its a dry heat.

Well, not really, yet.  Apparently, once the rain stops, sometime around now, it doesn't rain again until the fall, and as it heats up the humidity starts to drop.  Right now, it is 110, and still a little humid, since it rained a week ago, or so.  I understand that once the puddles are all gone, the air dries out and the temperature rises.  to 130 or so.  As the temperature is rising here, schedules need to be adjusted to accordingly.  I am planning for this, and aiming to spend as much of the day from 0900-0500 within air conditioning as possible.  And I will try not to burn my scalp.

Operation Proper Exit

Wounded soldiers are stabilized here, and sent on their way as soon as it a plane is available and it is safe to fly home.  Over the past decade, most of these patients have spent time in Germany as a secondary triage point on their way to the states.  The majority of their recoveries, however, have been in the States, and usually, in DC or San Antonio.  Wounded warrior rehabilitation takes place for months after amputation and wound healing are complete. 

With this in mind, the time that most of these individuals spend in our hospital is a blur.  They remember images, pain, confusion, but have no tacit string of memories.  And this is what they have told me first hand when they return.  To help soldiers deal with the psychological damage they endure with war injuries, Operation Proper Exit, the brainchild of soldiers themselves, and now executed by Rick Kell and his relief organization Troops First, brings wounded OIF soldiers back to the theater in order to provide these men and women an opportunity for closure and emotional healing.  One of their stops is our hospital, and I have had the opportunity to meet these people who are 2-5 years down the road from their injuries.  All 16 of the last group to come through walked into the ICU, but 15/16 had prostheses, and a few had 3 artificial limbs hidden by their baggy uniform. 

The project is designed for the soliders who were injuried, but has the unexpected, and welcome benefit of adding to the care of our current soldiers who are still dealing with the acute aspects of the injury.  Most of the more ill patients are not in a position to greet these physically-righted, as best as possible, returning soldiers, but most are, and seem to appreciate them.  A brotherhood within a brotherhood, are the injured from war.