Cease of the Cease Fire

This week we were in the middle of a cease fire that was requested by the Taliban but it was short lived. I don’t know the whole story of why, all we hear are speculations, but we were feeling the effects for the couple of days it lasted. The case load had gotten very light, which was a good thing here and I’m sure it was wonderful in Bastion who had been getting hammered with patients since they had arrived. It didn’t last long though, we’ll see if it will ever happen again. Either way we are still ready to rock, so bring it on!
As of 31 JUL we have done surgeries on injuries caused by the following; 64 gunshot wounds, 60 improvised explosive devices (IEDs), 5 suicide vehicle bombers, 5 suicide vest bombers, 4 rocket attacks and 31 non-battle injuries (appendectomies, etc.) These cases were completed by the Danish/US team and the Dutch/US team combined, it does not include the cases that the Canadian/US team have completed on alternate primary call days. It’s been busy, but a lot of fun and a fantastic learning opportunity. So far I have scrubbed 70 hours and enjoying every minute.
The picture is of me scrubbed in to a craniotomy case with Dr. Christie and Dr. Trache. I’ve been told that I need pictures of me actually working because no one would believe me! Haha. I tried to get a picture of the Noodles surgical team but I couldn’t catch up with the person that has the card in their camera with it. I forgot my camera when we took the pick, perfect! Hopefully I’ll post it in the entry next week.
Shayna is doing great, so far a much smoother ride than the first surgery. I’m very proud of her being able to go through the stress of two surgeries, a move to Wisconsin and still being able to complete her courses for her Masters degree, way to go hun! Woohoo!
CASES:
27 JUL: 1. Washout right ulna. 2. Bronchoscopy, removal of needle. 3. Open reduction internal fixation mandibular fracture, tracheotomy. 4. Thoracotomy. 5. Fasciotomy left lower extremity. 6. Removal of shrapnel c4-c5 vertebrae on 5 year old kid.
29 JUL: 1. Craniotomy. 2. Facial reconstruction. 3. Washout and closure left arm, washout and external fixation right ulna. 4. EGD.
31 JUL: 1. Washout left lower extremity. 2. External fixation left radius. 3. Open reduction internal fixation left humerus. 4. Washout right leg, external fixation adjustment. 5. Craniotomy. 6. Wound vac change right leg. 7. Washout bilateral legs, removal of shrapnel. 8. Appendectomy.
Shayna I love and miss you very very much and I can’t wait to see you. Time is flying by. Everyone else take care and I’ll see you soon.
Janine, thanks for the Danish cookies, everyone in the OR loved them, and we hope that you’re having fun in Bastion, let us know how it’s going.
Dave

Crash

We had a helicopter crash this past week, I’m sure you’ve seen it on the news, if you haven’t look it up on Fox News or CNN. From what we’ve heard it was a Russian company that is contracted by someone to carry supplies and civilian personnel around to their places of work. This particular helo took off with 18 passengers and 3 flight crew (2 pilots and an air crewman). The pilot told us that he took off, flew for about a minute or so, and the engine gave out. They fell to the ground, the impact caused the helo to catch fire, don’t know if it exploded or not. 16 of the passengers were killed (all contracted civilian workers), two injured with burns and cuts. We took care of the pilot, co-pilot and air crewman, many nasty fractures but no life threatening injuries. The crash happened just as we were finishing the cases for the day and hoping to get out of there early for once, it ended up being a 15 hour workday even with the second OR team called in. It was exciting but we are all hoping that we don’t get another aircraft crash for a while, if ever!

I started my rehab on my left ankle, after being hard-headed and not doing anything for a while! Shayna sent me an article from a Runners World issue and that coupled with the exercises I learned today I should be good to go in a couple of months. One of the exercises I was told to do is to pick up socks with my toes and put them in a container to strengthen my arches. I figure that by the end of the deployment I’ll be like a chimp and be able to use my feet as hands, I’ll be much more efficient. I’ll be able to give Shayna a massage with my right foot, fold laundry with my left foot, use the remote with my right hand and eat with my left hand! Haha. The physical therapist (Pia, from Holland) stated that it was fine for me to run just as long as it doesn’t hurt. She also stated that she would like me to run short distances outside on the uneven terrain when I’m not tired (yeah right) to help strengthen the ankle. I don’t know if I’m going to do that, I may just stick with the tread mill so I don’t twist it again. We’ll see.

Can you tell which one is me in the picture? Haha. Peter is standing behind me, he is our Anesthesiologist from Holland. They don’t have American football in Holland, that’s a shame because Peter is a very big person as you can see in the pic! We are going to take a picture of team Noodles (NLD + US=Noodles) and I’ll be posting it. Again, the team is very nice and we work well together.

Shayna had her second surgery, placement of the external fixation on the left leg, on Thursday and is doing fine. I told her that this round will be much better than the first because she’ll know what to expect, and it is so far! Woohoo. I’m very happy that she decided to stay up in Wisconsin during the recovery, it’s really nice of her family to take her in and take care of her. Thanks to my parents also for opening their door to her, and Dan for arranging and getting her flights. It is all much appreciated!

Just found out today, 22 JUL, that my roommate Ron will be leaving for Kuwait in the near future. The reasoning is that the Canadians do not recognize a Nurse Anesthetist as an anesthesia provider. It is a gross misuse of personnel, which is agreed upon by all the US personnel and most of the Canadians here at the hospital. So basically we are sending Ron to Kuwait and receiving an Anesthesiologist from Kuwait in return. It’s a shame that some of the people in higher positions are not fighting this harder than they are. Ron is an integral part of the Canadian surgical team and will be missed. This is another reason why I’m going to turn down Lieutenant Commander and retire as a Lieutenant.

CASES:

19 JUL: 1. Tracheostomy. 2. Open reduction internal fixation left humerus. 3. Washout left arm. 4. External fixation left leg, vascular repair left leg, washout right hand with finger amputation, washout right leg. 5. External fixation left acetabulum, external fixation right femur, splint right ankle fracture, splint right wrist fracture.

21 JUL: 1. Incision and drainage left leg, dressing change right leg. 2. Wound vac change right leg. 3. Bullet extraction left leg. 4. Burn debridement both arms and face. 5. Amputation right thumb and index finger, washout right leg and left hand. 6. Appendectomy. 7. Craniotomy, bilateral eye washout and inspection. 8. Craniotomy.

23 JUL: 1. Craniotomy. 2. Craniotomy. 3. Washout multiple back wounds. 4. External fixation adjustment, suture removal. 5. Tracheotomy, facial repair. 6. Appendectomy. 7. Bilateral leg amputations (below the knee). 8. Washout right arm. 9. Appendectomy. 10. Washout right leg below the knee amputation, left lower extremity fasciotomy, left lower extremity external fixation.

25 JUL: 1. Vascular repair, auto venous graft. 2. Egd. 3. Thoracotomy. 4. External fixation left arm. 5. Washout wound vac right arm. 6. Percutaneous tracheotomy, central line placement.

Shayna I love and miss you soooo much, everyone else take care and I miss you too! Haha.

Dave

Mis-comm-u-ni-ca-tion

I’m going to start this week with a funny story. Well I think it’s funny, and I have a twisted sense of humor sometimes! Parris is a guy that’s deployed with us and he’s a good, down home guy from Colorado. Omar is a really nice guy from Holland. They work out in the gym together every night or so. The other night Omar looks at Parris while they are lifting weights and says, “Hey Parris, show me your balls” of course this catches Parris off guard and he says, “No, I’m not going to show you my balls”. Omar insists and again states, “Come on Parris I want to see your balls”. Parris is getting pretty mad at this point and looks at Omar and says, “Man, I’m not going to show you my balls”. Well this is where the miscommunication took place, Omar explains to Parris that in the Dutch language “balls” means muscle balls, or the biceps muscle when flexed. It was a funny story and now everyone is saying that Omar likes the “balls”! haha. It may not be that funny, but it was a good thing to happen so we could all get a much needed belly laugh.

Ralph, or as we call him “King Ralph”, is our Dutch all around surgeon (general, ortho, etc. surgeon). He looked at me this past weekend and said, “Hey, tomorrow is Sunday”. Of course I had no idea what day it was. I told him that I have two days out here, primary call day and secondary call day! He hasn’t been here that long , so his days haven’t jumbled into each other yet.

The picture of this post is of me eating the best cookies I’ve ever tasted made by Shayna and her mom Mary. Fantastic, and this is not just my opinion, they went around like hot cakes! Thanks again hun for such a good birthday present!

Shayna is doing well, really psyched to get the second surgery done and then two weeks after that to get the first external fixator off of the right leg. She also finishes her first semester of her Master’s program in the upcoming weeks. I’m very proud of her, I couldn’t even make it through one Master’s class! If all goes to plan she’ll be done with her first Master’s degree by mid-next year, and then trudge through her second Master’s shortly after. She’s going to try to get into the USAF as an Officer by the end of this year. I really think that she’ll be able to do it. So needless to say we will not be settling down in Tampa in a couple of years, we’ll be there eventually though.

Only 7 paydays left, woohoo! Time is really flying by, and although the working hours have been extremely long it has been a good ride so far! I’m learning sooooo much about scrubbing that it’s helping me with circulating cases. You can’t beat a “hands on” lesson on instrumentation and how they work, even though I’m taught in either Danish or Dutch! Haha.

CASES:

13 JUL: 1. Open reduction internal fixation facial fractures (8 plates!), enucleation (removal) of eyes. 2. Exploratory lap, colostomy, washout left forearm, incision and drainage left leg. 3. EGD. 4. Exploratory lap, colostomy. 5. Craniotomy. 6. Washout left arm, washout left leg, removal of foreign body.

15 JUL: 1. Washout bilateral legs. 2. Washout left leg. 3. Tracheostomy. 4. Washout right hip.

17 JUL: 1. Right leg amputation (below the knee), scrotal closure, external fixation left lower extremity, washout left hand, amputation ring finger left leg. 2. Extraction lower wisdom teeth. 3. Extraction of teeth, incision and drainage neck abscess, closed reduction mandible. 4. Abdominal washout. 5. IVC filter placement.

We had another ramp ceremony (or angel ceremony as we called it in Iraq) today. I haven’t been going to the ceremonies because that is one of two things that bothered me after I returned from Iraq. The first thing that bothered me was every time I heard a door slam I thought that it was a suicide bomber lighting himself off and I would think about running to the OR, the second thing was when I would hear the song Amazing Grace, that was what they would play with a bagpipe as they would take the remains to the flight line. I really don’t want to have such horrible memories from this deployment. I don’t know if that makes me an inconsiderate person but I do know that I respect every person that gives his or her life for this cause.

It is now the 18th of July and I just had breakfast with Don Shula! Okay, I really didn’t eat breakfast with him, but he was in the galley this morning eating across the room from me. He was joined by Warrick Dunn and an actor from Nip Tuck and some female actress or singer or something. It’s really nice that people like that take time out of their schedule to visit the troops.

Shayna I love and miss you very, very much and keep your head up, you’re almost done with your surgical journey. Everyone else take care and I’ll be seeing you.

Dave

The Push

The Push
We’ve read in the news that as of 3 JUL 09 the push to destroy the Taliban has begun. We have not seen a lot of bad guys coming through with injuries, hopefully they are being sent to Allah to enjoy their 72 virgins, which I have been told by a credible source is actually 72 nuns with shotguns! 68,000 US troops are going to be here by the end of the year which is being compared to the Fallujah push in 2004, hopefully we’ll get similar results.

The picture is of me saying hello to everyone. I was feeling pretty tired at that time, I think we were on our 14th hour of surgery. Actually I was very tired! Haha. Shayna is doing very well back in Wisconsin, getting great care from Mary and Larry. The cat is doing good, loving the attention from Larry. Shayna is also getting the chance to see a lot of her family, which is always a good thing. She is now getting all of her information ready for surgery number two, which will be on 24 JUL. The second one should be a bit better for her since she’ll know what to expect, and she’ll be a little closer to NY from WI instead of CA.

I’m now up to 40 scrub hours, I believe I need to hit 500 in order to be able to take the test for the RNFA certification, if any of you know the particulars could you please email me at ltjgdave2003@yahoo.com so I can start on any of it while I’m out here. Thanks.

This week was by far the longest and busiest week yet. Thursday we had our first 24 hour work day, we all knew that it was coming and it won’t be the last. Yesterday was a 15 hour work day, felt kind of short compared to the previous workday! So that’s 39 hours of work in 2 days, again this leads back to the aforementioned overtime question! Haha.

CASES:

5 JUL: 1. Open reduction internal fixation mandible, washout and external fixation of right leg, washout and steinman pin insertion left foot. 2. Washout right leg, fasciotomy. 3. Bilateral fasciotomies of lower legs. 4. Incision and drainage of left arm.

7 JUL: 1. Washout bilateral legs, wound vac placement right ankle. 2. Abdominal washout, removal of foreign body right axilla (armpit), right eye repair. 3. Appendectomy.

9 JUL: 1. Open reduction internal fixation distal locking plate left femur. 2. External fixation revision pelvis. 3. Molar extraction X 4. 4. Washout GSW left pelvis. 5. EGD. 6. Tracheostomy, dressing change bilateral legs, central line placement. 7. IVC placement. 8. Angiogram left jugular. 9. External fixation right ulna. 10. Exploratory laparotomy.

11 JUL: 1. Dressing change foot. 2. Tracheostomy, leg washout. 3. Washout and closure of leg wound. 4. Washout and wound vac placement leg. 5. Exploratory laparotomy, bowel resection, exfix right leg, slab left arm. 6. Emergency laparoscopy, clamshell thoracotomy. 7. Tracheostomy, facial wound exploration and washout. 8. Craniotomy. 9. Exploratory laparotomy.

Well that about does it for this week in lovely Kandahar, Afghanistan. I’m not running due to strict orders from my wife Shayna and the Orthopaedic surgeon here, I don’t want to disobey either of them! Haha. So we’ll see how that goes. Shayna I love and miss you very much, everyone else take care and keep in touch.

Dave

Ch..Ch..Ch..Ch..Changes

It’s been a week of changes. We said goodbye to the Danish team and welcomed aboard the Dutch team. I also have a change coming tomorrow, I’m one year older at 41 but I still feel like I’m in my 20’s, thanks in no small part to Shayna! Haha. I’m sure that this new group of medical professionals will be just as good as any of us here, one team one fight! Ron and I ran the Peachtree 10K today the 4th of July, it’s the same race that takes place in Georgia, same bib numbers and everything. Well Ron ran it, I ran .5 miles and twisted my #$@%$% ankle again! Not good. Our bibs have Afghanistan written on them, I’ll keep that one. No medals were awarded, but we get t-shirts and you can’t beat a t-shirt.

The first picture for this blog is me holding a bullet that was removed from a patient, non-coalition which is good. I’ve accumulated about 28.5 hours of scrub time so far and have even done a couple of external fixations, I’m loving it. I told Shayna that I’m thinking about going for the first assist certification (RNFA) when I get back. Okay Chris you can say I told you so at any time! Chris is my buddy from Lemoore that tried to convince me to work on the cert several times while we worked together.

The second picture is of me holding my birthday present from the Danish team. It says that I’m the best US OR nurse on Kandahar Airfield, it’s funny because I’m the ONLY US OR nurse in Kandahar! Haha. Thanks guys!

I wanted to officially say goodbye to Janine, Bodil, Sasha, Harriet, and Dr. Nielsen, Dr. Sorensen and Dr. Truxoe from the Danish team. Guys, Jere and I showed up at the terminal at 1945 and you had already checked in. We couldn’t get in to see you and I apologize. I hope you had a good flight and Jannie be safe in Bastien. Hopefully Shayna will get stationed overseas with the Air Force or Army and we’ll make a trip up to Denmark to visit. Take care and we miss you already!
Speaking of Shayna, she is doing really well. She is now in Wisconsin getting first class care from Mary and Larry, her mother and father. Mohinder (the cat) is now in Wisconsin staying with Larry, both the cat and Larry are having a lot of fun! Larry was actually in California with us when we initially picked the cat up, so they are long lost buddies reunited! Haha.

CASES:

28 JUN: 1. Abdominal wound closure. 2. Abdominal wound closure and colostomy placement. 3. Abdominal wound washout and closure. 4. Groin washout and closure, bullet retrieval. 5. Right ear repair.

30 JUN: 1. Maxillary splint. 2. External fixation right leg, closure of hip wound. 3. Appendectomy.

2 JUL: 1. Tracheostomy. 2. ORIF mandibular fracture.

3 JUL: 1. Open reduction internal fixation maxilla fracture, left eye orbital plate placement. 2. External fixation left femur, left patella repair, left shoulder washout. 3. Open reduction internal fixation left ankle fracture, washout right hand (open wound right index finger). 4. Lip repair. 5. Repair of facial laceration, repair left foot fracture, fasciotomy (sp?).

So that’s about it for this week. Been very steady but nothing overwhelming yet! Stressing the “yet” part. We get to our ½ way point coming up soon, can’t wait for that, finally over the hill on the downward slope. Time is flying by and I hope it continues. Shayna I love and miss you very much, everyone else take care and I’ll be seeing you.
Dave