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 20^th of February. On the 14^th 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 16^th 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 20^th. 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.

Birthday

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!

http://www.uso.org/About-Us/News-and-Stories/USO-News/Top-Stars-Join-Admiral-Mullen-for-Annual-USO-Holiday-Tour.aspx

 

 

 

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.

 

Thanksgiving at KAF

I worked all night last night, so I was actually considering just sleeping through Thanksgiving, but my Army friend, who is being transferred out to one of the Forward Operating Bases (FOBs) tomorrow morning, wanted me to go with her to have Thanksgiving Lunch at the Niagara Dining Facility (DFAC) as a sort of going away event. I have really enjoyed working with her for the last 3 months, so I thought I would be a good friend to her on Thanksgiving Day.

The Niagara DFAC served a big Thanksgiving lunch from 11:30 to 13:00 just for U.S. military service members, and then opened it up to all others from 13:00 on. With only one hour and forty-five minutes of sleep under my belt, I dragged myself out of bed, threw on my Navy sweatshirt and shorts, strapped my required glow-belt around my waist, donned my shoulder holster carrying my M9 and waited for my friend to knock on my door at 11:45. As I waited, our new ICU Department Head and her room-mate, who live right across the hall, emerged from their cocoons with their cravings for Thanksgiving fixings. Lunch for two turned into lunch for 5 as my room-mate decided to come with us as well.

As we approached the DFAC and saw the line streaming all the way out past the jersey barriers (large wall-like, concrete barriers that supposedly provide protection from rocket attacks) that surround the DFAC, grumbling from the group began. Someone said, “I’m not sure I want to wait in that line for food that will probably taste like cardboard.” I remarked back, “What else do you have to do? It’s Thanksgiving.” Just then we could hear the muffled sound of a band playing music inside the building. This lifted everyone’s spirit and we decided it would be worth the wait.

Almost an hour later, we finally reached the salad bar first. There was shrimp cocktail, which thoroughly excited everyone in our group, as we are all seafood lovers. My room-mate took a salad plate and filled the entire plate with just shrimp. There was also salmon lox and, of course, cranberry sauce at the salad bar.

At the hot counter, you had a choice of turkey, ham or both. I chose both along with sweet potatoes and macaroni-n-cheese. The stuffing looked like

regurgitated cat food, so I passed on that option. There were mashed potatoes as well, but I prefered the  sweet potatoes.

The desert bar offered up pumpkin pie, pecan pie, a vanilla custard tart and bread pudding. It was Thanksgiving so I indulged and took one piece of pumpkin pie and one piece of pecan pie!

Once I was able to break out of the crowd of people hoarding around the food, I suddenly realized that the DFAC was decorated with Happy Thanksgiving signs and paper turkeys. There was a massive center piece in the room consisting of ice sculptures, a large cake, fruit and nuts. People were congregating around, having their colleagues pose for pictures with the ice sculptures and/or cake.

We were worried about finding a place to sit, but there was a table in back with enough chairs for all five of us, so we quickly swooped in and saved it with our trays. Several of us made our way back into the crowd of hoarding foodies to grab beverages or, in some cases, other food items we couldn’t fit on the tray the first time through.

We enjoyed our time together, stuffing our faces, commenting on which items we thought were really good and which items were just so-so. I’m not sure if there was a single piece of shrimp left by the time we were done eating and everyone agreed that the macaroni-n-cheese was especially yummy! I didn’t care so much for the pumpkin pie as it tasted a little bland and dried out, but the pecan pie was moist and delicious. The turkey was pretty bland, but I ate about half of it doused with cranberry sauce. The ham, on the other hand, was excellent.

We enjoyed the music that was being played by a Brass Quartet in the far corner of the room and, at one point during our meal, the band had the entire DFAC crowd sing Happy Birthday to someone who was celebrating a Thanksgiving Day Birthday. The atmosphere was spirited and uplifting and it was nice to just sit and chit-chat. We shared stories about our Thanksgiving traditions from back home and attempted to ensure our friend who is leaving for another FOB that it will be an exciting experience for her.

By the time we were done eating, I felt like I was going to explode! I actually felt like I had finally eaten a decent meal here at KAF. They did the Thanksgiving meal better than I had expected. My tummy was happy!

I do miss my husband and my family. I have enjoyed many wonderful Thanksgivings with my family and friends and look forward to doing so again in the future. Happy Thanksgiving to everyone and thank you to those who sent decorations and Thanksgiving treats! I also give thanks for all the thoughts and support you all have provided throughout my deployment.

Jet Fuel

When Jessica and I were children, I remember how she always loved the smell of fuel—logging trucks, snowplows, airplanes. Anytime we were around anything that gave off the smell of diesel fuel or jet fuel, she would take a deep breath in and say how much she loved that smell! Well, Jess, you would have loved the experience I had this morning, but let me start at the beginning.

I spent last night caring for two Afghan boys, one was ten years old and the other was twelve. The 10 year old was in a motor vehicle accident and suffered a skull fracture. He definitely acted like a patient suffering from a neurological injury because he would open his eyes, but would never really focus on you. Every time I tried to do anything with him, he would try to kick me away with his feet. He would also grind his teeth and spit up all his oral secretions. He was very restless and would frequently put his legs over the bed rail or he would flip his whole body around, his head facing down at the foot of the bed and his feet at the head of the bed. He was pretty cute, though, so I couldn’t get too frustrated with him. Besides, the Afghan children are much smaller for their age than American children. He was about the size of a 6 or 7 year old, so I was able to reposition him back up in bed easily.

The 12 year old boy was with us because he had gotten his shemagh, a scarf worn by Afghan men either around their neck or around their head, caught in a grain mill. In order to keep from getting sucked into the mill, the boy had to rip his head out of the scarf as it tightened around his throat. This resulted in multiple fractures of his jaw bones, several layers of skin getting ripped off, and two large cuts into his lips. These injuries lead to the swelling of his tongue and airways. When I had him two nights ago, he had to have a breathing tube, called an endotracheal tube, down his nose into his lungs so that he could breath. Tonight, he was breathing on his own, but his mouth and tongue were still extremely swollen so he wasn’t able to swallow his saliva or talk. I had to continuously suction his mouth and, even with the interpreter at the bedside, it was difficult to communicate because the boy would just point and we would have to guess what it was that he needed.

If this child had not been brought in to us, he would have died because his airway would have eventually closed off from the swelling of the injury. But, now, with the help of intravenous steroids and a mechanical form of ventilation, he will be fine. In addition, he would have been extremely disfigured in his face if it were not for the amazing work that our Ear, Nose and Throat surgeon does here. I told this doctor that he should consider going into plastic surgery when he gets back because he does wonderful work!

The two kids actually came from a different area of the country and, now that they were stable, it was time to send them back to the medical facility at the Forward Operating Base in the region where their families live. This would allow for the patients to be closer to their relatives and then be easily discharged back into their community. However, in order to get them back, they had to be packaged up and flown by fixed-wing aircraft.

Normally, a team of U.S. Air Force personnel come and pack up the patients by hooking them up to transport monitors and other equipment and then loading them onto gurneys. This morning, however, no one arrived to start prepping the patients, and when we called to find out if anyone was coming, we were told that there had been a miscommunication and, thus, no one was coming. This meant that we were going to be responsible for getting the patients all ready for the flight and that we would also need to make arrangements with our own ambulance to get the patients out onto the flight line. And oh, by the way, the plane is scheduled for departure at 06:15. It was 5:30 when we were told all of this.

Well, this began a whirlwind of activity. This was a job that was normally the responsibility of a specially designated team that is deployed here specifically to do this part for us. The packaging, the transporting, and the loading of the patients onto to the aircraft was not something I had ever been trained to do. Our Respiratory Therapist tracked down the portable monitors and equipment we needed to monitor the patients during transport. The Officer of the Day, who should have been manning the Quarter Deck (front office) of the hospital, went and brought us gurneys, while the other ICU nurses helped me load my patients onto the gurneys.

The 12 year old boy had not spoken since he had the endotracheal tube removed the previous morning, despite frequent encouragement do so, until we were just about to roll him out the door. He suddenly became wide-eyed and franticly tried to spurt out something that sounded very slurred, as his tongue remained pretty swollen. His family member, probably his grandfather, leaned close over him in an attempt to hear him better. He finally blurted out one clear word and the old man smiled. I had tucked a stuffed bunny rabbit that we had given the boy earlier in the night, down near his feet under the strap that was securing his legs to the gurney. The old man pulled it out and held it up to the boy’s face so he could see. Out of all the things to say at that moment, the boy just wanted to make sure the rabbit was going with him!

Meanwhile, the lead officer from the Tactical Operations Center for the hospital gathered up a group of Corpsmen from the Hospital Ward to drive the ambulance and help load and unload the patients. We wheeled the patients out to the ambulance, hoisted the gurneys up into the back, placing the 12 year old up on the designated gurney shelf in the back of the ambulance and the 10 year was placed on the floor of the ambulance, because normally this ambulance is meant to carry only one patient. These are not ambulances like the nice fancy ones back home. These are military vehicles that have been converted into make-shift ambulances.

I climbed up into the back of the ambulance with the patients and waited while one of the Corpsmen brought me a portable suction machine so that I could ensure the two kids wouldn’t drown in their secretions on the ride out to aircraft. Several people kept yelling that we had to go because the aircraft was running behind schedule. I yelled back that we couldn’t drive off until I had the right equipment to ensure the safety of my patients. Meanwhile, someone threw me a pair of goggles and told me to put them on when I got out to the flight-line, otherwise the jet fuel would burn my eyes. I was handed the suction machine and then the heavy ambulance doors were slammed shut, leaving me in the back of the ambulance, very dimly lit only by the daylight shining through the two small windows in the back. There was no interior lighting like in modern, American ambulances.

The ride out to the aircraft was somewhat bumpy and I was glad to have the suction machine because the younger boy required it’s use a couple of times. After a few minutes, I felt the vehicle change direction and then begin to move backwards until I heard someone yell, “That’s good. That’s good!” It seemed as if the double doors blew open on their own as I suddenly felt something burning my eyes. I remembered the goggles from earlier; they were still on top of head. I quickly pulled them over my eyes just as they were starting to water. Then as I climbed out of the ambulance, the smell hit me hard, that smell that reminded me of my sister’s obsession—jet fuel. Boy would she have loved to just stand out there on that runway this morning and taken in the fumes of the majestic C130!

Then back to reality as several people quickly pulled the two patients out of the ambulance and ran them up the ramp into the bowels of the aircraft. I walked up the ramp, hoping it would be quieter inside than it was outside, but was sadly disappointed. I had to yell my report to the medic who was taking over care of the boys and hope that he at least heard the most important parts. I then knelt down next to the 12 year old and boy, touched his head and smiled at him, hoping to make him feel more comfortable about the trip he was about to take. He seemed to understand everything that was going on and, once the Air Force personnel were done frisking his family member, as he slid in behind me and smiled at the boy, the boy finally smiled back.

 

Fall In A Far Away Land

I can feel winter encroaching, trying to steal away the last of the desert warmth, bringing darkness earlier and earlier each day. During the day, it is still warm enough that I break out into a sweat when I walk the mile from the NATO Dorms to the Hospital, but as soon as the sun goes down, the chill sets in. People can now be seen donning jackets, caps and even gloves from around 4pm to 10am.

This is one of my favorite times of the year back in the States. I love  the crisp mornings and the colors of the season, especially the bright reds of the maple trees in my yard.  I miss the scent emitted from burn piles as people attempt to rid their lawns of dead leaves and pine-needles. And most of all, I miss planning for Thanksgiving dinner, making green bean casserole with the crunchy onions on top, stuffing and my mother-in-law’s southern-style macaroni-n-cheese and corn pudding.

Now that the cold nights appear to be here to stay, we have been experiencing an influx of burn patients from the local community. As there is limited electricity, especially in the smaller villages, the Afghans use kerosene lanterns and oil stoves to keep their families warm. We have cared for several children that have been burned from kerosene lanterns and, unfortunately, the oil stoves can be very dangerous as the Afghans often attempt to refuel them while they are still burning.

Just this past week we admitted five out of ten family members to the ICU who were burned when the stove exploded while the mother attempted to refill the oil. Dad had 25% burns, mom had 40%, their 10 year old girl had 65%, their 7 year boy had 70% and their 3 year old boy had 40%.  Within less than 12 hours of admission, we had to let the 10 year girl and 7 year boy go. With more than 60% of their bodies burned, their prognosis for any sort of positive outcome was almost non-existent.

In the states, we would have been able to resuscitate those two children and after months of hospitalization and multiple surgeries, they would have been discharge to begin a long and difficult rehabilitation with intense physical therapy and probably more skin grafts. This would be possible in our country with the health care resources we have, but even if we could have kept those children and performed the multiple surgeries they would have required over the next several months, our hospital doesn’t have the rehabilitation resources required to provide the quality of life necessary to survive in this culture. It was a difficult decision for our doctors to make, but after a lengthy discussion among every single doctor in the hospital, the Commanding Officer and the Director of Nursing Services,  the decision to provide comfort care only was made and that is what we did.

I noticed a stark difference in the way that the Afghan parents dealt with the death of their two children compared with how parents in our country deal with death. In our society, we tend to want to remain with our dying loved one not only until the very end, but even for a period of time after they have passed. However, these parents chose to say goodbye to their children early in the night and did not want to see them again after they said their goodbyes. We kept them separate from their two dying children, but pushed the couple close to one another so that they could pray with each other and cry with each other. We also moved their 3 year old son, who did have a positive prognosis, next to the mother so that she could reach out and console him whenever he cried.

The couple went through a roller coaster of emotions through out the next two nights as they remained under our care. Having heard so much about the repression of the Afghan women, I was surprised to see this couple relate in much a similar way as any married couple in the U.S. They seemed to have a mutual respect for each other as they spoke to each other and cried with each other. The woman cried openly while the man tended to cover his face and weep into his blanket, although not always. Even though I could not understand the language, I could decipher that they were reciting prayers to Allah frequently throughout the night as well.

At other times, when they may have been experiencing feelings of denial, they actually spoke in tones reminiscent of a regular day-to-day couples chat. I’m not sure what they were saying, but it seemed pleasant. At one point, the woman was trying to ask me something and after pointing at or holding up every single object in the area, the couple actually started laughing at me because I couldn’t figure out what she was asking. When I finally had the translator come over and help me, he told me that she wanted to get up and sit in a chair. The three of them tried to teach me to say “ksseenawem” which essentially means ”I want to sit up” in Pashto. After laughing at my pronunciation a couple times, I finally got it, but by that time, she no longer wanted to get up. Oh well. At least I tried my best to communicate with them. They were very patient with me and, via pointing and other gestures, we were able to figure most things out.

Then, later in the night, the mother heard one of our other pediatric patients crying on the other side and she suddenly became convinced that it was another one of her eight children. She would not stop crying until we decided to roll the child’s bed over where she could actually see for herself that it was not her son. This then resulted in a long period of prayers from the mother and more tears from the father.

The translator told us that they do not tell them that their children are going to die, when the doctors ask them to like we do with loved ones in the States, because that is not how they prefer to deal with death. They prefer to be told once it is over and, in the meantime, just tell them that their lives are in the hands of Allah to decide what He will. I think there is a much stronger acceptance of death in their culture than in ours as well. These people live a hard life and their society is used to premature deaths from accidents and illness that we otherwise have the means to prevent, fix or cure. The average life expectancy for the Afghans is only 44 years of age. Our life expectancy in the U.S. is 78 years of age, almost double.

Veteran's Day Poppies placed at memorial on the Boardwalk remembering
those who sacrificed their lives while fighting terrorism in Afghanistan