Wednesday, August 25, 2004

Most Memorable Experience

Contributed by SK2 Martha Allen.

My most memorable experience was at the beginning of my deployment, sometime in February. It was just after midnight and the camp was buzzing with the sound of one of many 1st AD convoys that had just rolled into Arifjan from up north. The one-way street was packed; trucks lined up as far as the eye could see. You could barely hear the camp generators over the still-running convoy engines! Yet the soldiers, packed into LMTVs, lying on top of their gear…were sleeping… PEACEFULLY! Not a sound, a light, or a movement could wake them. The soldiers, their gear, and their vehicles were almost undistinguishable. They were so covered in dirt and dust, you could hardly tell where one ended and the other began…. This was the most poignant, poetic, amazing sight… It brought tears to my eyes! And I realized, at that moment… the work we do here, no matter how small…is for the infantry men, the war fighter, the hero… our heroes!

Finding Humor ... and Dignity

Here is a portion of a letter I recently received from my doctor friend up north. In it she illustrates how it is possible to find humor even under the worst of circumstances.

"Courtesy, respect and good manners have ganged up on doctors over the past generation or so to dissuade us from referring to a patient as 'the gallbladder', 'the seizure', or 'foreign body impaction' (use imagination). We have gone to great lengths to encourage the use of formal names and titles in an effort to preserve dignity and to create an atmosphere of equal footing between doctor and patient.

The way things are organized here, the soldiers, department of defense employees, contractors, coalition forces-otherwise the good guys, are listed by their names. The Iraqi civilians and prisoners are listed by a number. Many times, we receive unconscious casualties without any information. These are the 'drive-bys' dropped off by field medics, MPs or, very often, dragged to the front gate and left there by who knows. I have discovered that a lot of the numbered patients are brown and so assumed to be Iraqi and are all considered bad guys until we get the real story. In fact, there are a lot of brown people here who actually are KBR (Kellog-Brown and Root, the US government's contractor of choice) sub-contractors and employees. But starting out brown and unconscious, the assumption is that you're a bad guy and you get a number. I guess it's like John Doe, but there are so many, we'd be numbering the JDs anyway (we are well into the four digits).

On the positive side, except for the depersonalizing number system, the human body wounds, bleeds, and heals the same, good guy or bad guy. This is fortunate because learning just one human physiology is more than enough for me and so we treat all patients the same. The only clear difference in care is in the evacuation. We can evacuate to higher level medical facilities any American or coalition civilian if they are stable enough for transport. The natives of course remain here. As it turns out, even with all our limitations, the US Combat Support Hospital System is the highest level of care in the whole country at this time.

As a result, our very critically ill Iraqis and other brown people stay with us for weeks or even months. We get to know them in a way we can't with others who are here and gone, usually within 1-3 days.

It is impossible to care for someone day after day and refer to them as #6492. We can't even go back to our old habits of naming them by their malady like 'the gallbladder' because we would have to say something like 'the multiple fragmentation injury to the abdomen with a through and through to the left chest, a comminuted femur fracture and multiple gun shot wounds to the lower extremities.' It doesn't roll off the tongue.

So, one way or another, the patients acquire names. We don't ever, that I can see, actually think about names, they just sort of take hold and spread so that the only people who really care about the number nomenclature are the admin, lab and pharmacy. Or the politicos.

I have taken pains to set this up or else I'm afraid the names I am about to tell you would seem callous. Hopefully, you can take this in some context. So here goes:

One patient had crushed arms, in splints with traction causing him to have two large, white bandage wrapped extremities held extended above his head for quite some time. Again, I don't know how or even when it happened, but he slowly became known as "Touchdown". Another man who was actually an Iraqi Interim Government Police Chief, had charged through gunfire to throw himself over an RPG (big rocket) which exploded in his belly. He did this to save a group of 6 or 7 high ranking American officials he was escorting. We ended up calling him 'The Sheriff'(again, clearly a good guy, but gets a number anyway). This stuck like glue since the only radio station we get in the ICU plays the same limited mix of 70s music everyday and so we hear 'I Shot the Sheriff' with annoying regularity. It was a natural.

A real bad guy had been shot and had his right arm vaporized below the elbow during a firefight. He was captured and was being evacuated back to the CSH for treatment. On the way, his own insurgency cell hit the evac vehicle with a booby-trapped explosive (IED). This then blew one of his legs off. He had a long recovery and came to be known as "Lucky".

Another man is called "Blue". No one seems to remember how that came about. He has been here for over 4 months and has had multple, staged, orthopedic, skin and muscle flap/graft surgeries complicted by bone infections. I can't follow the link, but he is worth mentioning because he is a true obsessive-compulsive. He spends his entire day cleaning himself with q-tips, and gauze. He looks about 70, although he is probably 50. He has a 12 inch long, snow-white, meticulously combed and trimmed white beard. I estimate he is about 5 feet tall and weighs 100 lbs not couting his external fixator devices (scaffolding for the leg). He has been placed in the part of the tent that actually has a 'window', (plastic and opague, but a window none the less) which gets diffused sunlight. His longevity, age and the fact that the nurses have turned over all wound care and dressing changes to him have earned him the prime real estate.

One thing about Blue though is disturbing. Although we have given him dental floss, he insists on pulling strings of gauze from his wet to dry leg dressings to floss his teeth. Given he is so clean otherwise, this is unusual. I am told he prefers the taste to our mint flavored waxed, packaged American floss.

There are so many more -- a guy with scars demonstrating very old, recent past, recent, and brand new fresh gunshot wounds to every part of his body. We call him Tu-Pak. One man who required massive transfusions which depleted our blood supply and so required an emergency blood drive. We drained every person with his blood type who was on duty in the hospital that day. We named him Sponge-Bob. Another guy with incredibly thick, curly black hair combed straight upward is known as Kramer. A turkish guy is "The Turk" which is not original but feels good to say.

Every name is a replacement for the anonymity of a number and a reflection of something personal about our injured people. Perhaps that is a rationalization for our behavior but I think it is on the benign end of the spectrum given the circumstances. I understand from the translators that the awake and alert ward patients have named us as well. For some reason, I am called Dr. "Mama" which they assure me is a term of respect (I'm too flattered). It's better than what they call the big Ortho guy who examines wounds, changes dressings at the bedside and adjusts traction. They call him Dr. Ala'am which means 'pain'. Mama is just fine."

Tuesday, August 10, 2004

Selfless Service and Loyalty: Love

Selfless service and loyalty are values that many of us were taught as children and, for some, in our early religious educations. These values, and others, are the moral compasses which guide us in our everyday lives, through every decision we make, and in every action we undertake. These same values also compel soldiers to fight through all conditions to victory no matter how long it takes and no matter how much effort is required. They define a soldier's selfless commitment to the nation, mission, unit, and fellow soldiers. It is this professional attitude that inspires every American soldier. Selfless-Service: Put the welfare of the nation, the Army, and your subordinates before your own.

Selfless service is a key component of the "Warrior Ethos." The "Warrior Ethos" is a set of professional, moral and ethical values that is the basis for all U.S. soldier behavior and professional development. These standards are taught to soldiers in basic training and reinforced throughout our careers. Members of the military simply would not be able to do their jobs if they were not, to a certain degree, selfless. Otherwise, they wouldn't be willing to put up with even the ordinary hardships of military life, much less be willing to risk their lives.

Selfless service and loyalty go hand in hand. One has to replace a desire for personal gratification with a desire to elevate someone else to achieve selfless service. Loyalty is the act of binding oneself intellectually or emotionally to a course of action, a person, organization or a way of life. Loyalty requires that one place another's interests above those of all others. Selfless service and loyalty are synonymous with love. The act of selfless service and loyalty are demonstrations of the highest form of love. Only the one who loves can truly serve and show true loyalty.

Religions have preached selfless service and loyalty for thousands of years. Christianity and Hinduism both value these principals. According to Hindu beliefs, selfless service through work leads to a union with God. The morality of Jesus teaches us to do unto others as you would have them do unto you; love your neighbor as yourself; love your enemies and pray for those who persecute you. It is a morality of love, of selfless service and commitment, and loyalty to "the least of these." Love is the attempt at or accomplishment of satisfying the needs (not wants) of others, and not the satisfying of personal needs or vanities. "True Love" expects no return. "True Love" is not a give in order to receive relationship.

I think that these qualities are well illustrated by the actions of many of the soliders serving overseas. An example of this dedication to duty, selfless sacrifice and service can be found in the 518th Gun Truck company. This company is the first of its kind in the Army. It was created in theater and its purpose is to provide overwatch and protection for convoys traveling in Iraq.

These are really amazing people. The typical rank of a member of this unit is E4 or E5 and their salary is approx. equivalent to someone who works for Wal-Mart. Each day they wake up, run to their vehicles, climb in the gun turrets, and drive down the road escorting convoys -- willingly and with a great sense of pride. The convoys they protect are primarily commercial contract convoys composed of civilian drivers from countries all around the world.

Commercial drivers earn big bucks over here and they get to leave whenever they want. Joe Snuffy Soldier will be here long after that commercial driver, his replacement, and the replacment after that has come and gone. Joe Snuffy, the guy (or gal) on their Wal-Mart salary, will gladly ride in front of any of them acting as their human shield. And he or she will take a bullet for them on their Wal-Mart salary. It is what they do. It is who they are. This is the essense of selfless sacrifice and it is an expression of their love for their fellow man.

Sunday, August 01, 2004

"Dear John ... "

The earliest reference to a "Dear John" letter appeared in an American publication in 1945. Here's the exact quote: "'Dear John,' the letter began, 'I have found someone else whom I think the world of. I think the only way out is for us to get a divorce,' it said. They usually began like that, those letters that told of infidelity on the part of the wives of servicemen. The men called them 'Dear Johns'."

It's a sad, but true fact that "Dear John" letters are a real part of every military deployment, and the deployment in support of Operation Iraqi Freedom is no exception. However, in these "modern times," the "Dear John" arrives not only by letter, but via email and "morale calls" as well. (

Here's a note from a member of's message forum: "I think it's extremely sad that the wives or the husbands or girlfriends or boyfriends can't even stand a period of seperation (no matter for whatever reason, deployment or not). I understand it is very difficult for everyone who's deployed and their spouses/bf/gf. But you marry someone because you love that person, not so you'll have someone to sleep with or so you don't feel alone. Those soldiers are fighting for their lives and their safety, and what support do they get from back home? A dear john letter/email/phone call? Now they have nothing to look forward to."

With the advent of technology -- e-mail, cell phones, instant messanger and calling cards -- a soldier can stay in touch with home on a daily basis. This is mostly a good thing; however, it can sometimes be a bad thing. Just as those phone lines and e-mails deliver good news, they also deliver bad news. War causes stress. That is an understatement. When you add the stress of family situations and other problems from home on top of the tribulations of combat, and an unforgiving and austeer environment, it can become almost unbearable for some.

Here's how one British unit chose to address the 'Dear John' problem in their unit. "In 161 Battery it was traditional that if any member of the Battery got a 'Dear John' while the Battery was away anywhere, then the letter was pinned on the Battery Notice Board and each and every member of the Unit wrote back a 'Dirty Bitch' letter to his 'ex' just to let her know that what she had done was a shitty thing and that we all hoped that her new found love gave her Herpes. I think I approve.