Finally Going Home!

Yes, I am still posting. I plan to finish reporting on my last days of deployment . . .

The last two weeks in Afghanistan entailed a whirl-wind of events beginning with the official announcement that we had a rough guestimate of a departure date somewhere around the 20th of February. On the 14th we were informed, through word of mouth (there never was an official announcement) that we were to have everything packed up because we were probably moving into tents in only two short days. We were only issued to Sea Bags to pack our stuff in and all the useless gear we never used but were issued took up most of the space in those, so began a frenzy of sorting through our accumulation of 6 months worth of stuff in our dorm rooms and multiple trips to the post office. Over the next few days, I think I spent more time waiting in lines at the Kandahar Air Field Post Office than I did doing much of anything else.

On the 16th we loaded all our stuff up on flat-bed trucks called Bongos and were moved into tents that had just flooded the night before. February in Kandahar is the rainy season and, because the ground is so hard, the water just sits on top and everything floods. The picnic area of the boardwalk resembled a pond instead of the dirt football field that it normally serves as.

Instead of our nice beds in our dorm rooms, we now had to sleep on small, foldable cots with our sleeping bags, although some of us were smart and actually brought our linens and blankets to make it a little more cozy. I do have to admit that I thought our living situation was going to be worse than it turned out to be. We had heat, at least most of the time. The heater was run off of a gas generator and our second night there, the gas ran out and the heater turned off. It was about 40 degrees in our tent when we woke up that morning! And to top it off, there was no more hot water for the showers. After that, I discovered that if I took a shower around 5 pm there was always hot water.

Over the next few days, we waited for our replacements to arrive so that we could orient them to their new jobs, however they were delayed and meanwhile, we had to keep working. For us night-shifters, this meant trying to sleep during the day in the tent and then having to find somewhere else to hang out on your nights off because people were trying to sleep in the tent. I spent most of my nights of just hanging out at work because there was nowhere else to go. Living in the tents also meant a greater risk of injury from a rocket attack which of course we had two of while we were there. We had to quickly roll off our cots, placing our arms over our head for protection. Then, after two minutes of lying on the ground, we had to quickly slip on shoes run and run out into the dark across an obstacle strewn courtyard, trying to avoid tripping over things like rocks and pieces of rebar. We had to rendezvous in a cement bunker on the other side of the courtyard and stand in the cold for 30-45 minutes before the “All Clear” would sound. I had taken the warmth and safety of my blast-proof dorm room for granted, that’s for sure!

Finally, our replacements arrived and were ready for turn-over on the 20th. Lucky them, they only got one day of orientation as we were scheduled to depart the very next day! I discovered that one of replacements was a Lieutenant from my unit back home, so that was kind of fun to reconnect with him before I left. It was pretty wild that one day our group was smoothly running the whole trauma hospital and then one day later, we had handed it all over to a completely new group of people with a total turn over of approximately 120 people!

Rough Night In The ICU

Well, over the past couple weeks all we have had to complain about is all the mud we have been tracking into our rooms and the hospital due to the several days of rain around here. Now when it rains in Kandahar, it’s not like Seattle where it rains sometimes for days with no break in precipitation. Here it just drizzles for a short time and then stays gray for the rest of the day, then may drizzle again later on. However, because the ground is so hard packed here, the water is not absorbed and, instead lies on top of surface, causing large puddles and even flooding in some areas. The mud that forms from the rain mixing with the “sand” (more like fine, powdery dirt) becomes pasty and loves to cling to tread on the bottom of our boots. The hallways of our NATO housing are scattered with clumps of dirt as well as the hallways of the hospital. Housekeeping sweeps and buffs the floors every night, but as soon as the day shift crew walks through the doors, the shiny linoleum quickly becomes tarnished with dirt.

I will warn you that this blog entry may be disturbing to some. I wasn’t sure if I should write about my experience at work last night, but I think my friends and family should know what a night in the ICU here can be like. It is not all about Bazaars and birthday parties here. We are fighting a war over here. So here it is . . .

Last night, I was just about to head out the DFAC to grab something to eat for dinner when my phone rang. It was the ICU charge nurse requesting me and my room-mate to please come in as soon as possible because they were getting several patients from the OR. Several Army personnel were injured by an IED. When we arrived, there were so many people running around that it took several minutes for someone to even take notice of our presence. We asked people if they needed help, but everyone kept referring us to the charge nurse to receive our assignment. Eventually, I was assigned to a 25-year-old Army soldier named Patrick, due to come out of the OR at any time. All I knew was that he had multiple blast injuries, including major head trauma.

As soon as I saw the OR team rolling my patient through the door that separates the ICU from the OR suites, I grabbed the foot of the bed to help direct it to the right bay. The anesthesiologist, an older bald man with a slightly eccentric, grey mustache, asked me to get the ICU doctor. I found our intensivist and informed him that the patient had just arrived. Once at the bedside, the anesthesiologist told him everything that was done in the OR, but despite their efforts, he did not feel that the patient would survive very long. The patient was currently on the maximum dose of vasopressors (drugs used to improve contraction of the heart as well as blood pressure) and had already received over 30 units of blood products.

Once we got the monitor hooked up, his blood pressure was reading only 50/30. Essentially there was nothing else that could be done. He was bleeding out from multiple injuries, including his head, and not even surgery was able to stop it at this point. When I looked at his eyes, his pupils were fixed and dilated, a strong indication for brain death. When I lifted his head to reposition some tubing that had been caught under his neck, I could actually feel my hand mush into his skull. He was bleeding from his nose, his mouth and his ears. His left arm and both legs were wrapped tight with ace wrap bandages, but I could see large amounts of blood already oozing through.

When the anesthesiologist finished giving report to the ICU intensivist, they made a collaborative decision to withdraw support. I received orders to give morphine “to keep the patient comfortable.” Giving morphine to patients prior to withdrawing support is often a palliative measure that benefits the caregivers and family/friends of the patients more than it does the already-brain-dead patient. I administered the morphine and then, along with an Air Force medical technician who was helping us out, the two of us cleaned up Patrick’s face, chest and hands so that he looked more presentable. I knew there were several of his buddies anxiously waiting to come see him.

Because it had been so busy with so many casualties, the ICU doctor had not had a chance to inform Patrick’s Unit Liaison that we were withdrawing care. Luckily, his Chaplain walked in and I informed him of the fact that there was nothing else that we could do for him. He went out to the hallway where Patrick’s Unit members were waiting and notified them that this would be good bye. I was also told, by the Chaplain, that an Army General would be arriving in about 30 minutes to perform a Purple Heart Ceremony. I immediately informed the ICU doctor that I wanted to do whatever it took to maintain his blood pressure long enough so that he would still be alive for the ceremony. The doctor gave me permission to continue resuscitative measures using the vasopressive drips, as well as fluid boluses, to keep him alive just a little bit longer.

In the meantime, a female soldier who had been shielded by this hero during the blast, and thus only suffered a few minor injuries, was brought by wheelchair to his side to say goodbye. She immediately broke down in tears and starting screaming, “Fucking Taliban.” Through her sobs she spoke of her regrets that she wasn’t able to somehow stop this tragedy from happening. A wonderful female Medical Liaison for the Army personnel, stood next to her, explaining everything that we were doing to keep him comfortable. She consoled her, telling her that there was nothing she could have done. I had to grit my teeth as tears welled up in my eyes. “I must maintain my composure,” I reminded myself.

After she was wheeled back out of the ICU, I let the other member’s of Patrick’s Unit come in, four at a time, to say good bye. Some only stayed for less than a minute, then quickly retreated, while others lingered for longer periods of time, whispering words into Patrick’s ear. The Chaplain stood at the bedside, offering support and condolences. I continued to adjust the drips and hang more bags of fluid while I watched his blood pressure drift down to 35/20. I anxiously eyed the clock every few minutes, hoping for the General to arrive sooner rather than later because I wasn’t sure how much longer Patrick would live.

Finally the General walked in and stood next to me while an entourage of people, including a photographer snapping photos, filed into the bay. While the General waited for everyone to squeeze into the small space, he turned to me and shook my hand, saying, “Thank you for your service and providing such excellent care to our soldiers.” I replied with, “You are welcome, Sir and thank you for your service as well.” He then stepped up next to the patient and someone called the group to attention. The General presented Patrick with the Purple Heart Medal by placing it over his heart. The photographer snapped a few pictures. The award was then removed and placed into a protective case. And as quickly as they arrived, the General and his entourage were gone.

A few of Patrick’s buddies lingered, just standing with heads hanging low and hands behind their backs, probably feeling a lot like I did just before my mom died, hoping that suddenly the vital signs will reverse and go back up, proving us all wrong. But eventually, the drugs and the fluid boluses couldn’t keep up and I lost his peripheral pulses. I told the Chaplin that it was time to turn everything off and remove the breathing tube. I informed Patrick’s friends that they were welcome to stay, but if they wanted to step out, now was the time. My respiratory therapist then removed the tape holding his breathing tube in place and pulled it out as I turned off all the IV pumps. Within five minutes a flatline appeared on the monitor and I said, to the people who were gathered at Patrick’s side during his last minutes of life, “He’s gone,” and turned off the monitor. Shortly after that, the ICU doctor came and officially pronounced the time of death.

After allowing Patrick’s “family away from home” to sit with him for a while, another Corpsman and I bathed him and removed all other tubes and lines. Two Army men arrived from the Mortuary and we helped place Patrick’s body into a rather fancy black bag. I then placed a U.S. flag over the body and informed as many people as possible that we would be having a ramp ceremony. Approximately twenty people lined the hallway near the exit out to the loading ramp. We all stood at attention and then saluted Patrick as he passed by, providing him with one last honor before he departed the Role 3 hospital. It was a sad night for us as it had been a while since we had experienced the death of a U.S. soldier.

As I sit here in my bed, listening to the artillery fire somewhere off in the distance and feeling the building shake from bombs being detonated, I think about how complacent we have become over the colder winter months. But now, as the weather is beginning to warm up, rocket attacks are occurring more frequently and casualties among the coalition forces are increasing. We have mostly had local nationals as patients with injuries from things like falling off donkeys and burns from oil lamps or infections. Now, after almost three months of very few coalition force casualties, I was reminded last night that we are still in a war zone.

Going to See the Wizard

Going to See the Wizard is what we call it when you get the opportunity to take a tour of the Flight Control Tower here at the Air Field. Some friends and I were lucky enough to have a connection, giving us access to the tower. We met up with Dave, a former Navy Air Traffic Controller who now works as the supervisor of the Control Tower here at KAF. He was a very nice, older man, who obviously enjoys being a tour guide in addition to his current job.

To access the control room of the seven story tower, you have to climb up 14 flights of stairs because there is no elevator, only a utility hoist up to the top. We definitely got our workout! The building of the tower was funded by NATO and was just completed the end of March. Prior to this, the tower was essentially a shack, one-quarter of the size of the new tower with several blind spots. The new tower provides for better visibility and operational control.

The tower is staffed 24/7 by 3-4 staff members employed by ATC Midwest, a company contracted by NATO. One person is assigned to Ground Control, one is assigned to Air Traffic Control and the third person is responsible for administrative tasks and paperwork.

While we were up in the tower, we were able to see a C-130 take off, several helicopters practicing take-offs and landings and two RAF Tornados (British jets) take off. I went out on the cat-walk outside to watch the jets take off and they are so loud that you can feel your lungs rattle inside your body. I will miss the sound of the jets when I leave KAF; no matter how many times I have heard it and watched those jets take off, it is still exciting each and every time! And there is no where in the states that a civilian person can be that close to a jet taking off.

The visibility was so good that we could see all of the mountain ranges on all side so of KAF, even the ones in Pakistan. We could also see outside of the base into Kandahar city. I took a picture of the mosque that is just on the other side of the wall. This was a really great experience and I am grateful to the Midwest staff members for allowing us to temporarily intrude on their world.

New Life at KAF

Well, everyone, the other night I had a baby!

Our pediatric intensive care doctor came in even though it was his night off and asked me if I would be willing to be the nurse for a 16-year-old Afghan female and her soon-to-be born baby. Special Forces came upon her in a village and, supposedly, she had been pushing for several hours with no results, so they called it in to the Role 3. Because one of our doctors here is actually an OB/GYN specialist, he was excited to accept a patient that apparently needed a c-section. I have no postpartum experience except for a 3 week rotation in nursing school almost 13 years ago and I did a 3 week rotation through a Neonatal Intensive Care Unit as well. I have cared for one neonate since nursing school at Naval Hospital Bremerton a couple of years ago, but sure, it sounded like something new and exciting! Besides, after being surrounded by so much tragedy including the recent injuring of almost 20 people here on base and the death of a young Army soldier from a rocket attack, it would be nice to bring a new life into our hospital.

So at 10:32 pm, a 5 lb 12 oz boy was born into the world via c-section in our OR. My friend Brenda was a Labor and Delivery nurse for 16 years before becoming an ICU nurse, so she was in the OR assisting with the delivery. She brought him out to me and his father was very ecstatic that it was a boy. He clapped and had a huge smile on his face. The child’s grandmother was there too and she also was full of smiles. Shortly after the baby came out, the mother followed. She looked very young too me, not even a day older than fourteen, but the family said she was sixteen. Supposedly the husband was twenty-five, but he looked well into his 30s. The Afghans do not really keep track of age the same way we do. They have a different concept of time, so who knows what their real ages are.

Momma was definitely exhausted, probably from all the pushing, but baby was perfect! We were not sure if he would even be alive because no one could tell us exactly how long she had been pushing, but everything went well. For the first hour after birth, the baby was very active with his big, dark brown eyes wide open, looking all around! He never cried, even when I had to give him four different injections with needles!

Later, once we got momma and baby settled and baby fed, we let dad and grandma into the ICU to be with her. Next to the bed where we had them residing, there is a big cart full of clothes, toys and toiletries that people donate for us to use on our patients. Well, grandma discovered the cart and began shopping! Pretty quickly she had a new pair of sunglasses, gloves, and socks as well as shaving cream, razors and deodorant. At one point when I came to check on the baby, the father was wearing a pair of women’s white gloves. It was pretty funny.

All-in-all, it was a pleasant change from what we usually have to deal with in the ICU here. In fact, we have one of the rocket attack victims in the ICU and he wasn’t doing too well that night. Several of the members of his unit were at his bedside all night and some of the females were crying. They heard about the birth of the baby and I let them come see him. One of the women said, “Thank you. That really helped me feel better.” It was pretty amazing to see such a small bundle bring so much excitement to our hospital.


I actually had a nice Birthday here in Afghanistan, spread over two days! My birthday began in the middle of working a night shift in the ICU. I was caring for a 10 year boy with severe nausea and vomiting after having his stomach repaired. He had a fragment wound to his stomach from an IED blast. He was so cute and we kept laughing, trying to figure out what we were saying to each other in our own respective languages. He was only allowed small sips of water, but one time, when I had my back turned, I caught him sneaking out of bed and grabbing a water bottle from the bedside table. He poured himself a new cup of water and feverishly guzzled it down! Then he just looked at me with a big smile on his face. He would try to have full conversations with me as if I understood exactly what he was saying. He went from feeling very sick to looking 10 times better by morning, so he helped keep my spirits up when I had to pick up a second patient who had his brains blown up by an IED.

Once off work, my friend Brenda and I went to the Dutch restaurant called All Season’s Café where she treated me to dutch pancakes. Unfortunately, they were all out of syrup and the pancakes weren’t anywhere near as good as Dutch Mother’s in Lynden, WA, but it was nice to sit and chat on this sunny morning and, hey, what else can you expect in Afghanistan? At least pancakes are an option. Then I went home and slept for a few good hours. On my way to work, I stopped off at one of the jewelry shops on the Boardwalk where, a couple days earlier, I had seen a necklace I really liked. The shop owner had actually set aside the necklace for me, “just in case you decided to come back for it,” he said. I guess he knew I liked so much that he assumed I would come back to get it. It is made of Topaz pear-cut stones with small Tourmaline teardrop shaped stones in between and then uncut garnet, my birthstone, running up each side to the back. All three of these gems are mined here in Afghanistan.

After my jewelry purchase, I went to work only to find out that I was given the night off because they had enough nurses! My friends Sherry and Sydney, both getting off day shift, took me back to All Seasons for Near Beer and cheesecake. We sat on the overstuffed leather couches in the middle of the restaurant and chatted for a while. I showed them my necklace and, Sherry, who has become somewhat of an expert at buying jewelry around here, said that she thinks I got a good deal!

Later that night, back in my room, I was able to talk to Thomas, who was working in Seattle because it was daytime there. This is when I received the best birthday gift yet; Thomas told me that his request for a transfer to the Bellingham area was approved and the official report date is set for February 28th! This means that we are permanently moving back to Bellingham to live in our beautiful home again! I will miss many things about living downtown Seattle, but we can still go stay one weekend a month in a really nice hotel for much less money than it has been costing us to pay both rent in Seattle and our mortgage in Bellingham. Besides, we can now start thinking about starting a family!

The next day, Friday the 7th, the birthday celebration continued. I started my morning at the gym and then went over to the British compound to their coffee place where Sherry, Sydney and I sat outside in the 65 degree sunshine and dipped Biscotti into Cafe Mochas. It was very nice and relaxing. Then we hit the jewelry stores again, just to look and see if there was anything else eye-catching. No one bought anything, but it was still fun to look! I went back to my room and Skyped with Thomas for about an hour and a half even though it was the middle of the night for him. I then rested for a couple hours before getting ready for a birthday party at the hospital for Sherry, me and one of the male Dutch nurses.

The party was great because CDR Beasely from Trauma grilled up the most tender, delicious-tasting chicken I have had in the past 5 months. He also made Paella with shrimp that was so yummy I had to go back for seconds. Our friends also had several ice cream cakes made for us by the ice cream shop on the Boardwalk. Lots of people came from all areas of the hospital, including the Dutch nurses. And after we were all done eating, several of us went out to the flight line and smoked Cuban cigars and warmed our hands over the grill as we watched the jet engines light up the sky as they took off for a night mission. Eventually, as the temperature dropped into the 30s and we became chilled to the bones, we began dispersing and wandering back to the warmth of the NATO dorms.



The Stars Come Out

Last night was busy. I cared for a triple amputee, a U.S. Army soldier who had stepped on an IED. Despite coding once in the trauma bay and once in the OR and receiving 28 units of blood, he was surprisingly stable for me. Once again, the human body amazes me. In these younger, healthy people, the can suffer a lot of damage and still stabilize with the help of medicine. The human body normally holds 5 liters of blood. He had been transfused with 10 liters total of new blood, meaning that he probably didn’t even have any of his own, original blood left in his body. Yet, here he was with rock stable vital signs.

Later in the shift, we received a 14 year old boy who had been building an IED under the instruction of his Taliban uncle. While he was attempting to assemble the IED, it exploded and blew off the kids hand as well as resulted in fragment injuries to both of his eyes. Not only is the Taliban evil to us, they have their own children and nephews doing the dirty work for them. Luckily, U.S. forces were able to track down the uncle and arrest him. But now we have a child who was assisting with Taliban operations, so what do you do with him? Nothing except our security personnel will scan his retinas and take his fingerprints to place in a database. It is so sad that these kids are taught to kill at such a young age.

On a lighter note, last week, hundreds of people gathered at the center stage of the boardwalk and stood in the cold for two hours to watch a star-studded USO-sponsored event. The event began with a surprise visit from Admiral Mike Mullins, Chairman of the Joint Chiefs of Staff, the highest ranking member of the military! He said some really nice things about how much we are appreciated back home for the sacrifice we are all making and that he understands the stress our loved ones back home are facing, especially this time of the year. I was very impressed with how personable and down-to-earth he seemed.

We also got to hear Lance Armstrong as he MC’d the entire event and told little stories here and there about how we accomplish anything if we put our minds to it. Kix Brooks of Brooks and Dunn played his guitar and song a few songs and Kathleen Madigan, a popular standup comedian, made us laugh with all her great jokes! Lewis Black put on his comedy act, maintaining his reputation as the most negative person in the world. At last but not least, Robin Williams, who called out to us as he stepped on stage, “Good Evening Kandahar!” just like he did in the movie “Good morning Vietnam.” He told lots of sick jokes, but he also joked about his new heart valve as he recently had to have heart surgery. All of the celebrities commented on what a shithole Kandahar Air Field is and how they think they will have to have their lungs cleaned out when they get back because of all the dust. Oh, and the smell of the poop pond! Robin couldn’t get enough of that! Robin actually said that Iraq is a paradise compared to KAF.

I was really impressed by the presentation put on the other night, but what touched me most is that these celebrities didn’t just go to the largest, safest and most comfortable bases here in Afghanistan. They actually went out to some of the Forward Operating Bases and stayed in tents and breathed in the dust and felt cold, just like the military service members here. No special living quarters for them. My room is nicer than where they had to stay. It meant a lot to the troops that they were willing to sacrifice some celebrity comforts to come perform for them.

I have attached a link to the USO story about their tour and the main picture was taken here at KAF that night. I am out there somewhere in the audience behind the celebrities!




Kold in Kandahar

Okay, so now it’s really cold! The high yesterday was 46 and it’s currently 27 at 08:00 am. It’s amazing how it was in the 110s when we first got here! I have to wear gloves now when I walk to work and the sun goes down around 4:30pm. So in order to keep warm, I have been going to the gym. I kinda plumped up the past couple months because of all the snacks from my care packages! Not that I didn’t enjoy every one of them, but it is time to stop. I have no excuse not to be in great shape. The gym is just outside the door! I have made it to the gym the past 8 out of 10 days. Hopefully I will be able to keep up my routine. On my nights off, I have been waiting until around 10:30 pm to go because it is not that crowded. I have convinced one of my co-workers to be my workout buddy so that we can help motivate each other and hold each other accountable.

As far as work is concerned, the night before last night, when I arrived to work, the charge nurse told me that the ICU doctor had specifically requested that either she or I be assigned to take a 9 year old boy who had suffered multiple injuries. I guess he didn’t feel that the other nurses on that night were strong enough in their pediatric nursing skills. This was very flattering, especially since I never even had any pediatric experience until I came here.

The boy had picked up a piece of unexploded ordinance and it blew up. He suffered a brain injury due to a fragment entering the front right part of his skull and exiting the lower left out the back. He had fragments to both of his eyes and one of his eyes was completely destroyed. He had multiple jaw fractures, hand fractures and feet fractures. Multiple fragments went into his abdomen as well, puncturing his liver, bowels and one up towards his right lower lung, causing it to deflate. I received him from the operating room after 10 hours of surgery during which the surgeons put a drain into his head, fixed his jaw fractures, removed fragments from his left eye to save it, put a tube into his lung to re-inflate it, resected his colon, and fixed his hand and feet fractures. They also had to take a vein from his leg and place it in his arm in order to restore blood flow to his hand.

Amazingly, this kid stayed stable for me through the entire night with a rock solid blood pressure, no bleeding and eventually woke up in the morning, moving everything purposefully. Despite a fragment rattling through his brain, he appeared to not have any brain damage. It is absolutely amazing how resilient the human body can be, especially in these kids.

On a lighter note, I bought an 8”x11” handmade Afghan rug today! I had been eyeing a particular one in the rug store here at the Boardwalk for about two weeks now. Most Afghan rugs are primarily dark red with either black or dark blue designs, but this one had more browns and olive green, like the color of my dining room walls and just stood out more than any of the other ones. The rug vendor said that they don’t usually use these colors, so this is a rare rug to find. Out of the 30+ rugs of that size that he had available, this was the only one with a different look to it. It is 260 knots per square inch which makes the rug very high quality. Used Afghan rugs of this size with half the knots per square inch are selling on the internet for more than what I paid for. I was able to bargain the vendor down by $650! I thought that was pretty good. I found similar rugs for sale on e-bay for $5,000-7,000! Even a machine-made rug of that size from Macy’s will run you $1800. Anyway, it doesn’t really matter what it cost, it’s the meaning behind it; it is something from here that I will always have and will be able to pass on to my family.