Summer update from Kandahar

Please know that
I'm doing just fine out here!

I must admit though, things have really heated up here. Both the degree of
fighting and the temperature. Everyday has been over 100 degrees for the
past week! Luckily I have a great air conditioner in my room. I switched
over to night shift 6:30pm-7am in May and I really don't mind sleeping
through the heat. We are supposed to switch shifts again next month but who
knows. I really don't mind working nights because I keep my same sleep
hours even on my nights off. That way I'm never tired at work. I literally
sleep all day everyday. And on my nights off... well there's not nearly as
much to do around here as during the day. Luckily, when I switched to
nights so did all of my friends. We watch movies, go to the gym (which is
conveniently located next to our barracks), surf the internet, play games,
read, etc etc. Sometimes we go to the boardwalk and sit on the picnic
benches in the middle of the dirt and watch the yellow moon and observe
like the two stars that can be seen in this dusty place.

Kandahar is located in a valley and on a clear day the surrounding
mountains are quite pretty. On an average day though, we can barely even
see the incoming flights approaching the runway right next to the hospital.
Oh yes, that's something else that is fun to do. There are tables behind
the hospital that sit next to the runway. At night we can go out there and
watch the variety of jets, drones, cargo planes, etc land and take off.
They say it's the busiest single runway in the world and I believe it!
There is always a line of planes waiting to take off.

A few nights ago I got a knock on my door and my friends told me to get
dressed. Apparently we were going to tour one of our medical planes. I was
still half asleep but I got dressed and we walked over to the hospital at
11pm. Almost everynight there's a medical flight that takes our American
casualties to Bagram Airforce Base in Northern Afghanistan and then
Landstuhl, Germany. We pack them up in the ICU, gather their personal
belongings and any necessary medication (sedation, analgesics,
antibiotics), get extra units of blood in a cooler, make sure they have
their purple heart medal and ribbon, an American themed quilt made by
gracious quilt clubs back home (http://qovf.org/), a copy their medical
chart, and of course make sure they are stable for transport.

A critical care transport team (US Air Force) with a doctor, nurse,
respiratory therapist, and medic come to the unit usually three hours
before take off. (Yes it takes them FOREVER to transfer the ICU patients
over to their equipment.) They have their own IV pumps, ventilators,
gurneys, etc and by the time the patient is loaded you can usually only see
a face and some toes. They are covered in their equipment (see pic). Most
of our patients are sedated and will luckily never remember the
transport. Anyways, we are accustomed to the transport process within the
ICU, but really had no idea how they get them to the plane. So that night
we went to watch the full process.

After the team wheels the patients out of the ICU they load them into a
white school bus that parks behind the hospital (see pic). They load from
the rear with the least sick patients first and keep the most critical
patients near the doors just in case they have to make a quick exit. The
gurneys snap into the interior of the bus and are also secured from the
floor and ceiling. This can take a while to load everyone. The litter
bearers who help load are all volunteers from around base who want to help
the wounded and consider it an honor to be involved. It helps having all
the extra muscle! Once everyone is loaded on the school bus and the plane
communicates they are in position for loading, the bus drives over to the
plane. This is only about a 1 min drive to two ramps down from the
hospital. All that loading for such a short drive! The bus is able to park
close to the plane, which has its rear ramp lowered and is ready for the
patients.

My friends and I were able to walk up the ramp and tour the C-130, but not
before the Air Force made us wear these goofy scuba-like goggles for eye
protection .  We're convinced it was a prank on the Navy but we
went along with it anyhow! The plane is able to stack gurneys five high and
four across, which file down the middle aisle of the interior (see pic).
Plus there's room for ambulatory patients. Luckily, there are usually only
one or two ICU patients that need to be flown out, but they are capable of
taking several more if needed. Depending on how the patient is classified
based on acuity, they either fly out within 12 hours, 24 hours, or 48 hours
from time of admission. It's like a hurricane that comes and goes in the
ICU. The unit gets so busy caring for these guys and then in a matter of
hours they are gone again. Off to better, cleaner, safer facilities.


It was really neat watching the plane taxi around the runway and finally
take off into the sky with our precious cargo. Most of these guys end their
journey at Walter Reed in DC for rehab. They probably don't remember ever
even being in Kandahar, and certainly don't know who we are here. But they
have their quilt that we give them and a journal with our hospital patch in
which staff and their unit can write notes to them. I'm proud of my
hospital, it's medical capabilities and motivation to honor the wounded. It
really is a fulfilling role to manage the care of a freshly wounded
soldier. I can't really even describe it in words.

On that note, the fighting has picked up quite a bit in the last few weeks
and we have seen an influx of severe injuries. A few days ago we got 11
Americans at once, six requiring ICU care. Since we only have 12 beds and
we were already full of nine Afghans from the bombing that happened in
Kandahar the day before, we had an extremely tough time finding room and
equipment for everyone. We had to put four ventilated Afghans in our supply
area!!! In those two days our three operating rooms did 80 operations! I
was even pulled to the OR twice to rapidly transfuse blood. We have a
machine that transfuses an entire unit of blood in less than one minute.
(about 350ml) Some of our patients will receive 100 units of blood in the
first several hours they are with us. That is why one nurse will be in
charge of the machine and will not have any other job but to transfuse. At
a unit a minute, the paperwork and bags of blood can get quite overwhelming
if not closely managed. It's not a fun job but an important one none the
less.

These guys are very sick and require extremely skilled surgeons to correct
the injured vascular system and amputate if the injury is too severe. Then
they roll them to the ICU where we give more blood, monitor for excessive
bleeding from the operation sites, maintain electrolyte and pH balances,
ensure their lungs are ventilating appropriately, try to bathe the dirt and
blood that is singed into their hair and skin, and of course keep them
sedated with IV gtts of fentanyl and propofol so they don't have to
remember the trauma their body is fighting. All this while their friends
come to visit and see them for the first time since the injury.

It is very emotional for their buddies to see them in this (often limbless)
condition and the nursing staff has quickly learned to be a shoulder to
lean on for these guys. I think all of them feel responsible when one of
their brothers is injured and they take it especially hard when a limb is
lost. Last night I had a special forces medic who lost an arm and a leg
yesterday during an IED blast and his unit spent the entire night next to
his bed, holding his other hand, whispering in his ear, writing in his
journal. These are special forces guys who probably haven't cried in years
but were in so much pain watching their only medic fight so hard to stay
alive. They told me that after the explosion hit his motorcycle, he was
awake and calmly explained to them how to apply the tourniquets to his arm
and leg. He also asked them for pain medicine and explained where it was in
his bag and how to give it. After hearing them talk about him it is easy to
imagine what a great medic and soldier he is, and it is a fulfilling
experience to care for him all night though I will never actually know him
or see him awake.

It is such a strange world out here because last night we also received the
Taliban fighter responsible for detonating the bomb that injured him. We
had both of them on our unit at the same time! We have to treat them the
same and pretend we don't know that he's a Taliban detainee. We recovered
him from surgery, allowed him to wake up and transferred him to the ward
where he'll be guarded closely by a member of that same Army unit. Then I
went back to taking care of the medic who he allegedly targeted. Anyways, a
night like last night is becoming more of the norm. We will be ready for
anyone who comes through the doors though.

Our guys are going to get injured whether or not I am here, but I'm
thankful I can be a part of a team that can keep them alive and send them
home to their families. This deployment truly is an experience of a
lifetime and I will always remember what it's like to share the "day of
injury" with our troops. It is a traumatic day for everyone involved but
it's when they need us, the trauma, OR and ICU teams the most. There is so
much more that is going on here on a daily basis but words don't really
even begin to explain what it's like. This is a special place though and I
know that this is where I need to be right now. I will continue to work
hard in the ICU and enjoy my time as I can, but come September I'm on the
first plane outta here! Until then, just know that my friends and I are
sticking together and doing fine.

We are reminded daily how lucky we are to have a relatively safe place to
live and work, and how extremely lucky we are to be headed back to the
States soon. It's hard to complain about much when we are surrounded by so
many injured troops who have some major battles ahead of them. We are
seeing a lot of double, and even triple amputees who are going to need a
lot of community support in the months and years ahead. I have been
extremely impressed with the Wounded Warrior Project. They provide some
great resources for our injured troops and their families, both financially
and emotionally, here and back home. If anyone feels like they want to do
more for our them but don't know how, I highly recommend checking out
http://www.woundedwarriorproject.org/ where you can learn about donating
money, time, running races, etc. Their slogan is "The greatest casualty is
being forgotten". I couldn't agree more.



Hugs from the sandbox,
Heather