“Another note from Mack, Jaded Julie. I am at a loss for words, so I’ll just read his:
‘Hi, everyone,
This weekend was quite eventful. I was in a double IED blast. We were in a compound and there were two houseborne IEDs that went off, first one about 15 feet away from me; then while we were taking care of the guy hurt worst in that one, a second bomb went off. I just got done being checked out in the Aid Station at Howz-E-Madad. Only a little sore, have a mandatory 24 hour rest period that we do for soldiers who have been in IED or bomb attacks as part of the mTBI (mild traumatic brain injury) policy for prevention of worsening, etc.
I had been on this patrol mission since Thursday. Last night a guy stepped on an IED, lost his leg but also had terrible pelvic injuries; we did all we could do for him, (treating him in a grape field). He had two surgeries today, I think, and is on a flight to Germany. I already had a pretty depleted Aid Bag today when the IEDs blew up; now it's completely trashed as are my clothes and everything. I still have someone's blood on me; it took forever to get everyone flown out and I finally got a helicopter ride back here about 10 PM or so. I am going to leave the bloody stuff in front of the house and go take a shower.
Take care and stay in touch----Mack’
After reading this, I sent him a note suggesting that this might be a good time to revisit the concept of a board-certified physician going on patrols.”
“You can already guess his reply, Curmudge. He will probably say that the horrible wounds suffered by the troops make it all the more essential that he be there. If it hadn’t been for Mack and his medics, the soldier who lost his leg would have died right there in the grape vineyard.”
Monday, October 11, 2010
Monday, October 4, 2010
Afghanistan ER
“Hey, Curmudge, it looks as if you have another note from Mack.”
“It’s pretty short, Julie, and is mostly a thank-you note to his brother. Here, I’ll read it to you:
‘Thanks so much for the last package. I've been doing a lot of field time with this big thing you've probably seen in the news.... Would've been downright unhealthy without all the wet wipes, toilet paper, Gatorade, and of course, the cookies for morale and a break from just straight MRE's (field rations). Very interesting and slightly precarious last several days. Last night I was on the ground 400 meters from a kinetic strike (F-16 making two runs dropping a two-thousand pound bomb each time). Most terrifying explosion I've ever experienced and I think the rest of the group felt pretty much the same.’”
“Not anything about emergency medicine in this one, Curmudge. Let’s assume that’s good news.”
“As much as I appreciate getting these notes, they always leave me a bit shaken. At least this time it was the enemy on the receiving end. Nevertheless, I’m reminded of how much danger the troops—even the medical personnel—are in.”
“It’s pretty short, Julie, and is mostly a thank-you note to his brother. Here, I’ll read it to you:
‘Thanks so much for the last package. I've been doing a lot of field time with this big thing you've probably seen in the news.... Would've been downright unhealthy without all the wet wipes, toilet paper, Gatorade, and of course, the cookies for morale and a break from just straight MRE's (field rations). Very interesting and slightly precarious last several days. Last night I was on the ground 400 meters from a kinetic strike (F-16 making two runs dropping a two-thousand pound bomb each time). Most terrifying explosion I've ever experienced and I think the rest of the group felt pretty much the same.’”
“Not anything about emergency medicine in this one, Curmudge. Let’s assume that’s good news.”
“As much as I appreciate getting these notes, they always leave me a bit shaken. At least this time it was the enemy on the receiving end. Nevertheless, I’m reminded of how much danger the troops—even the medical personnel—are in.”
Friday, September 24, 2010
Afghanistan ER
“Hey, Julie, Mack has been ‘out of the office’ for several days and just sent this note:
‘I was just on a 10 day mission. Was projected to be pretty dangerous with lots of casualties, but didn't turn out too bad. I did have one scary patient where I put in a chest tube in a partially-built guard tower. Whole thing was pretty exhausting. I did wade across the Argandab River during our "push." You should look that one up, since this is apparently a pretty notable river here.
We have another mission coming up very soon, (sooner than I would have wanted for rest purposes). By the way, please send another roll of duct tape (not for medical use).’”
“I think I understand what an Afghanistan emergency room is, Curmudge. It’s any place where a wounded soldier needs the urgent care of a physician.”
“Perhaps Mack’s team should adopt the motto, ‘The best of care anywhere. Literally, anywhere.'”
‘I was just on a 10 day mission. Was projected to be pretty dangerous with lots of casualties, but didn't turn out too bad. I did have one scary patient where I put in a chest tube in a partially-built guard tower. Whole thing was pretty exhausting. I did wade across the Argandab River during our "push." You should look that one up, since this is apparently a pretty notable river here.
We have another mission coming up very soon, (sooner than I would have wanted for rest purposes). By the way, please send another roll of duct tape (not for medical use).’”
“I think I understand what an Afghanistan emergency room is, Curmudge. It’s any place where a wounded soldier needs the urgent care of a physician.”
“Perhaps Mack’s team should adopt the motto, ‘The best of care anywhere. Literally, anywhere.'”
Wednesday, September 15, 2010
Afghanistan ER
“Hey, Curmudge, I see that Mack copied you on another email to his friends. It appears that he only writes to them when something exciting has happened.”
“Exciting isn’t the right word, Jaded Julie. This time it was tragic. I’ll read part of what he wrote:
‘Hi, everyone,
Hope your Labor Day holiday was good. Ours over here got pretty tumultuous. We were sitting down to a special Labor Day dinner they had in the mess tent when the word came that incoming (fire) was expected. I had to leave half my dinner behind as everyone had to go to bunkers, etc. A mortar hit a Hesco (barrier wall) and bounced into a bunker. It blew up at head height right in the middle of a group of American contractors that worked with us. It was the worst mass-casualty event I've ever been involved with. People lying all over the place with terrible head injuries gurgling blood etc. Two died within the hour, then one more died the next morning at the hospital where we had flown him. (I tried as much as I could to help him.) Several more still in bad condition. It's taken a couple of days to just clean the blood off ourselves and the equipment. Still getting more incoming, lots of time in body armor. Our morale is very good, including mine (so far). I have a tiny ‘cottage’ that one of my medics and I built so I don’t have to sleep in a tent all winter. I’ll try to send a picture of it. I can say that I own property in Afghanistan, albeit in an unsafe neighborhood. Anyway, we’ve got a burned baby coming in. Gotta go--Mack.’”
“Curmudge, it sounds as if on Labor Day the term ‘triage’ reverted back to its original meaning.”
“The training of the whole medical team undoubtedly kicked in; but after things settled down, all of them—Mack, his PA, and especially the young enlisted medics—must have realized what an emotional experience their first mass-casualty event had been.”
“Exciting isn’t the right word, Jaded Julie. This time it was tragic. I’ll read part of what he wrote:
‘Hi, everyone,
Hope your Labor Day holiday was good. Ours over here got pretty tumultuous. We were sitting down to a special Labor Day dinner they had in the mess tent when the word came that incoming (fire) was expected. I had to leave half my dinner behind as everyone had to go to bunkers, etc. A mortar hit a Hesco (barrier wall) and bounced into a bunker. It blew up at head height right in the middle of a group of American contractors that worked with us. It was the worst mass-casualty event I've ever been involved with. People lying all over the place with terrible head injuries gurgling blood etc. Two died within the hour, then one more died the next morning at the hospital where we had flown him. (I tried as much as I could to help him.) Several more still in bad condition. It's taken a couple of days to just clean the blood off ourselves and the equipment. Still getting more incoming, lots of time in body armor. Our morale is very good, including mine (so far). I have a tiny ‘cottage’ that one of my medics and I built so I don’t have to sleep in a tent all winter. I’ll try to send a picture of it. I can say that I own property in Afghanistan, albeit in an unsafe neighborhood. Anyway, we’ve got a burned baby coming in. Gotta go--Mack.’”
“Curmudge, it sounds as if on Labor Day the term ‘triage’ reverted back to its original meaning.”
“The training of the whole medical team undoubtedly kicked in; but after things settled down, all of them—Mack, his PA, and especially the young enlisted medics—must have realized what an emotional experience their first mass-casualty event had been.”
Wednesday, August 11, 2010
Afghanistan ER
“Hey Curmudge. I see that you received a note from Mack.”
“Right Jaded Julie. He copied me on an email sent to several of his friends here in the States.”
“I understand that he is a battalion surgeon in Afghanistan.”
“That’s his title. Actually he is an emergency medicine physician. Would you like me to read part of his note? Here it is:
‘Just wanted to say hi. Pretty exciting last several days. My medics and I have taken care of a lot of people, 49 traumas in 2 months. Mostly Afghanis, (Military and civilians including kids). Took care of a 5 year-old boy with gunshot wound to head, very serious, flew him out stable. We've saved a lot of lives. Yesterday I was on a patrol and we got ambushed and had half-hour firefight. No one of us hurt. The Kiowas (helicopters) came in to shoot them up. I played guitar in the chapel service last Sunday…’“
“One question, Curmudge. What was a board-certified physician doing on a patrol?”
“It must have been a slow day back at the battalion aid station. He undoubtedly left his PA in charge.”
“Curmudge, is there a lesson in this story?”
“I hope so, Julie. There in the midst of a war and a dusty, almost Biblical setting, they are achieving the basic goal of medicine everywhere. As Mack said, ‘We’ve saved a lot of lives.’”
“Right Jaded Julie. He copied me on an email sent to several of his friends here in the States.”
“I understand that he is a battalion surgeon in Afghanistan.”
“That’s his title. Actually he is an emergency medicine physician. Would you like me to read part of his note? Here it is:
‘Just wanted to say hi. Pretty exciting last several days. My medics and I have taken care of a lot of people, 49 traumas in 2 months. Mostly Afghanis, (Military and civilians including kids). Took care of a 5 year-old boy with gunshot wound to head, very serious, flew him out stable. We've saved a lot of lives. Yesterday I was on a patrol and we got ambushed and had half-hour firefight. No one of us hurt. The Kiowas (helicopters) came in to shoot them up. I played guitar in the chapel service last Sunday…’“
“One question, Curmudge. What was a board-certified physician doing on a patrol?”
“It must have been a slow day back at the battalion aid station. He undoubtedly left his PA in charge.”
“Curmudge, is there a lesson in this story?”
“I hope so, Julie. There in the midst of a war and a dusty, almost Biblical setting, they are achieving the basic goal of medicine everywhere. As Mack said, ‘We’ve saved a lot of lives.’”
Wednesday, April 14, 2010
When Education Becomes Indoctrination
“Curmudge, our topic for today looks rather ominous. Perhaps we should start with an example. Our last discussion ended with the males of the village acquiring enough education to build systems for providing clean water and basic sanitation. Then what?”
“In their madrasa the boys undoubtedly learn reading and writing. However, if their teacher is an Islamic radical, he may also be indoctrinating them with the belief that the United States is the ‘Great Satan’ that must be destroyed by people achieving ‘martyrdom.’”
“So Curmudge, in our eyes these so-called ‘martyrs’ become murderers and suicide bombers by blowing themselves and innocent people to bits. It doesn’t do much good for these people to grow up with clean water and sanitation if their ultimate desire is to be dead before they’re old enough to grow a beard.”
“It’s even worse, Jaded Julie, when a whole nation becomes indoctrinated. Sixty-five years ago (I was 11 years old) American civilians viewed Japanese kamikaze pilots as a small group of deranged zealots willing to crash their planes onto American ships off Okinawa. Only slightly later did we learn that the whole Japanese nation had been brain-washed into believing that Americans were a sub-human race to be resisted unto death. This was clearly demonstrated by Okinawan civilians jumping to their death off high cliffs before the advancing Americans.”
“I can understand the history, Curmudge, but their psychology blows my mind. I hope the Islamic terrorists possess the only remaining vestige of such a warped mindset.”
“Unfortunately it’s not true, Julie. The modern-day North Koreans have been propagandized in much the same way as the World War II Japanese. The North Korean educational system teaches a belief in the unique moral superiority of the Korean race (1); Americans are depicted as an inherently evil race and sketched as jackals with paws and snouts.”
“Golly Curmudge, that would seem unbelievable except that it has been pounded into the minds of North Korean children for the past forty years.”
“There’s more. ‘They are also told that the South Korean masses, for all their material comfort, are ashamed of being under the thumb of the Yankees and yearn to live under Kim Jong-Il.’ The propaganda apparatus continues to assure the North Korean people that their economic sacrifices (over a million starved to death in the 1990’s) are essential to support their ‘military first’ regime and protect them from the Yankees.”
“If we didn’t know authoritatively that all this is the truth, it would seem like some sort of diabolical fairy tale. How will this situation end?”
“For our purpose, Julie, we can conclude that education can be a force for good; but when it becomes propaganda, it can become unspeakably evil. History is full of additional examples. For North Korea, the end game is a total unknown. Watch out for further writings by B. R. Myers to keep up to date on the situation (2). However if you want to sleep well at night, read medieval novels by Ken Follett.”
(1) Myers, B.R. The Cleanest Race: How North Koreans See Themselves—and Why It Matters. Available from Amazon.com. See also review by William Alexander.
(2) Myers, B.R. North Korea on the Edge. http://online.wsj.com/article/SB10001424052748704100604575145672974954144.html?KEYWORDS=BR+Myers
“In their madrasa the boys undoubtedly learn reading and writing. However, if their teacher is an Islamic radical, he may also be indoctrinating them with the belief that the United States is the ‘Great Satan’ that must be destroyed by people achieving ‘martyrdom.’”
“So Curmudge, in our eyes these so-called ‘martyrs’ become murderers and suicide bombers by blowing themselves and innocent people to bits. It doesn’t do much good for these people to grow up with clean water and sanitation if their ultimate desire is to be dead before they’re old enough to grow a beard.”
“It’s even worse, Jaded Julie, when a whole nation becomes indoctrinated. Sixty-five years ago (I was 11 years old) American civilians viewed Japanese kamikaze pilots as a small group of deranged zealots willing to crash their planes onto American ships off Okinawa. Only slightly later did we learn that the whole Japanese nation had been brain-washed into believing that Americans were a sub-human race to be resisted unto death. This was clearly demonstrated by Okinawan civilians jumping to their death off high cliffs before the advancing Americans.”
“I can understand the history, Curmudge, but their psychology blows my mind. I hope the Islamic terrorists possess the only remaining vestige of such a warped mindset.”
“Unfortunately it’s not true, Julie. The modern-day North Koreans have been propagandized in much the same way as the World War II Japanese. The North Korean educational system teaches a belief in the unique moral superiority of the Korean race (1); Americans are depicted as an inherently evil race and sketched as jackals with paws and snouts.”
“Golly Curmudge, that would seem unbelievable except that it has been pounded into the minds of North Korean children for the past forty years.”
“There’s more. ‘They are also told that the South Korean masses, for all their material comfort, are ashamed of being under the thumb of the Yankees and yearn to live under Kim Jong-Il.’ The propaganda apparatus continues to assure the North Korean people that their economic sacrifices (over a million starved to death in the 1990’s) are essential to support their ‘military first’ regime and protect them from the Yankees.”
“If we didn’t know authoritatively that all this is the truth, it would seem like some sort of diabolical fairy tale. How will this situation end?”
“For our purpose, Julie, we can conclude that education can be a force for good; but when it becomes propaganda, it can become unspeakably evil. History is full of additional examples. For North Korea, the end game is a total unknown. Watch out for further writings by B. R. Myers to keep up to date on the situation (2). However if you want to sleep well at night, read medieval novels by Ken Follett.”
(1) Myers, B.R. The Cleanest Race: How North Koreans See Themselves—and Why It Matters. Available from Amazon.com. See also review by William Alexander.
(2) Myers, B.R. North Korea on the Edge. http://online.wsj.com/article/SB10001424052748704100604575145672974954144.html?KEYWORDS=BR+Myers
Wednesday, April 7, 2010
Will education be the key to the Third World's health problems?
“Curmudge, it’s hard for me to forget about the problems of that Third World country that was our imaginary destination a few weeks ago. Wouldn’t the people’s lives be better if they could somehow get an education?”
“Jaded Julie, it depends on their culture and ultimately, on their government. With their hanging latrine, the people we visited were already one rung up on the sanitation ladder. I’m sure you recall that 2.6 billion people don’t even have a basic latrine, and many of those folks might not even appreciate the value of one. So the first step in education would be to put sanitation in the mindset of the populace.”
“What about formal education like reading and writing?”
“The dominant belief in some cultures is that women should not be educated. So in those locations at least half of their intellectual capital is wasted. Fortunately those children who are able to attend school will eventually be able to interact with their government and nongovernmental organizations (NGOs) to learn about developing clean water systems and basic sanitary facilities.”
“So, Curmudge, how might they obtain clean water?”
“It depends on the locale. They might dig a well or collect rainwater. Even in the U.S., my mother and her sisters used water from the rain barrel to wash their hair; it was softer than the spring water that they drank. Surface water in the Third World would have to be purified to make it safe. That could be done inexpensively by filtration through a ceramic cone or treatment with Clorox or similar chemicals. A solar still should be adequate to produce drinking water for a small family.”
“What about sanitation? There must be something for undeveloped countries that is better than that hanging latrine that we saw.”
“There are several systems, Julie, including composting pit latrines and their commercial version, the Ecosan waterless toilet. We needn’t discuss operational details other than to say that they are simple and should be inexpensive. I’ve seen these, fitted with solar panels, in national parks in the U.S.”
“We’ve done it, Curmudge. We’ve solved the water and sanitation problems of the Third World, at least theoretically. So everyone should live happily ever after.”
“It’s not necessarily so, Jaded Julie. Governments or ethnic groups can come along and turn everything we’ve said on its head. We’ll talk about that next time. You won’t like the story.”
“Jaded Julie, it depends on their culture and ultimately, on their government. With their hanging latrine, the people we visited were already one rung up on the sanitation ladder. I’m sure you recall that 2.6 billion people don’t even have a basic latrine, and many of those folks might not even appreciate the value of one. So the first step in education would be to put sanitation in the mindset of the populace.”
“What about formal education like reading and writing?”
“The dominant belief in some cultures is that women should not be educated. So in those locations at least half of their intellectual capital is wasted. Fortunately those children who are able to attend school will eventually be able to interact with their government and nongovernmental organizations (NGOs) to learn about developing clean water systems and basic sanitary facilities.”
“So, Curmudge, how might they obtain clean water?”
“It depends on the locale. They might dig a well or collect rainwater. Even in the U.S., my mother and her sisters used water from the rain barrel to wash their hair; it was softer than the spring water that they drank. Surface water in the Third World would have to be purified to make it safe. That could be done inexpensively by filtration through a ceramic cone or treatment with Clorox or similar chemicals. A solar still should be adequate to produce drinking water for a small family.”
“What about sanitation? There must be something for undeveloped countries that is better than that hanging latrine that we saw.”
“There are several systems, Julie, including composting pit latrines and their commercial version, the Ecosan waterless toilet. We needn’t discuss operational details other than to say that they are simple and should be inexpensive. I’ve seen these, fitted with solar panels, in national parks in the U.S.”
“We’ve done it, Curmudge. We’ve solved the water and sanitation problems of the Third World, at least theoretically. So everyone should live happily ever after.”
“It’s not necessarily so, Jaded Julie. Governments or ethnic groups can come along and turn everything we’ve said on its head. We’ll talk about that next time. You won’t like the story.”
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