Death

Death is a personal journey. It's a trip we all know we must take, but one that we don't necessarily want to take right now. When it comes time to take that journey, I hope that I have the strength and courage to take it with such grace as my brother, Jim, and his now deceased wife, Lara. Lara, if you remember my last post from 5 months ago, was diagnosed with a primary brain cancer, glioblastoma multiforme, while they were on their boat sailing around the world. That was 5 months ago. On Thanksgiving Day she left us for a much, much better place.

I am putting this in writing because I want readers to know what I think of my brother. Her journey, tragic and horrible, was short and she is now in Heaven. Jim and his wonderful daughters now have the hard road ahead of finding their way without their wonderful friend, wife, and mother.

I sent this book excerpt to Jim early on. It is from "Mortal Lessons" by Richard Selzer:

---------------------------------------------------------------

I stand by the bed where a young woman lies, her face postoperative, her mouth twisted in palsy, clownish. A tiny twig of the facial nerve, the one to the muscles of her mouth had been severed. She will be thus from now on. The surgeon had followed with religious fervor the curve of her flesh; I promise you that. Nevertheless, to remove the tumor in her cheek, I had cut the little nerve.

Her young husband is in the room. He stands on the opposite of the bed, and together they seem to dwell in the evening lamplight, isolated from me, private. Who are they, I ask myself, he and this wry-mouth I have made, who gaze at and touch each other so generously, greedily? The young woman speaks.

"Will my mouth always be like this?" she asks.

"Yes," I say, "it will. It is because the nerve was cut."

She nods, and is silent. But the young man smiles.

"I like it," he says. "It is kind of cute."

All at once, I know who he is. I understand, and I lower my gaze. One is not bold in an encounter with a god. Unmindful, he bends to kiss her crooked mouth, and I so close I can see how he twists his own lips to accommodate to hers, to show her that their kiss still works. I remember that the gods appeared in ancient Greece as mortals, and I hold my breath and let the wonder in.

-------------------------------------------------------------

Revelation 21: 4-5

And God will wipe away every tear from their eyes; there shall be no more death, nor sorrow, nor crying. There shall be no more pain, for the former things have passed away. Then He who sat on the throne said, "Behold, I make all things new."

-------------------------------------------------------------

To my friend and brother, Jim, we only know a portion of your pain. You have the full measure of our love and respect. It is not enough. I'm sorry.

I hold my breath and let the wonder in.

The final post

I've got my things I'm good to go.

You'll meet me at the terminal.

Just one more plane ride and it's done.

....with apologies to Jack's Mannequin, "Bruised"

And you know it's time to go,

Through the wind and driving dust

Across the fields of mourning

Light in the distance.

And you hunger for the time

Time to heal, desire, time

And your earth moves beneath

Your own dream landscape.

Oh don't sorrow, no, don't weep

For tonight, at last

I am coming home

I am coming home.

....with apologies to U2, "A sort of homecoming"

"We all went up to Gettysburg, the summer of '63: and some of us came back from there: and that's all except the details. " Captain Praxiteles Swan, Confederate States Army

“It is not within our power to forget or gloss over circumstances which we believe to be evil…They tear at us, buffet us, goad us, scorch us, stifle us — and you tell us to forget about them?” Cicero

"The disparity between what we are told or what we believe about war and war itself is so vast that those who come back, like Lefèvre, are often rendered speechless. What do you say to those who advocate war as an instrument to liberate the women of Afghanistan or bring democracy to Iraq? How do you tell them what war is like? How do you explain that the very proposition of war as an instrument of virtue is absurd? How do you cope with memories of children bleeding to death with bits of iron fragments peppered throughout their small bodies? How do you speak of war without tears? " From The Photographer by Emmanuel Guibert.

I've been gone from home for almost 10 months. 10 final thoughts.

1. I went to Kandahar in 2009-2010. I saw many horrible things. I saw many good things. I will never forget this place.

2. Simply put, this has been the most professionally rewarding experience of my life.

3. Simply put, I would gladly accept a less rewarding experience for just one less injured soldier or child.

4. Jonah: 1278 days old. Naomi: 2235 days old. Deployment: 284 days. I've been gone for 22% of Jonah's life and 13% of Naomi's life. I know many have done more. I hope I can make it up to Jonah and Naomi.

5. Most people here are more affected when someone from their own country is injured or killed. When a child is injured or killed, everybody hurts.

6. I've been through the move from our old tent/plywood hospital to a new brick and mortar building. I liked the old tent/plywood hospital. Better sense of community in it. It felt like being in a war zone.

7. To the families of the wounded: We did everything we could. You have the hard job ahead of you of helping your soldier heal. I wish you well.

8. To the families of the dead: We did everything we could. Your soldier received the best care possible. We treated them as we would our own son or daughter. I can't begin to imagine your pain. I am so sorry.

9. If you are reading this, the odds are that you are sitting at home in the States in the air conditioning. Perhaps your biggest concern today was that when the trash was picked up they spilled some debris on the ground and you have to go pick it up. We're better than this. Consider giving to the following organizations: www.homesforourtroops.org, www.uso.org, www.specialops.org, www.operationhomefront.net, www.fisherhouse.org.

10. I can envision getting off the plane and seeing Ruth, Naomi and Jonah. Chills go through my body as I think about it. I want to laugh, I want to cry, I want to hug them all at once. I want to be whole again.

Final surreal moment from this deployment:

I was in the operating room the other night working on a patient. The surgeons had done a herculean effort to save this young man who had been grievously injured by an IED. He was still bleeding and had a very tenuous grasp on life. I was doing my part with my wires and catheters stopping internal bleeding in his pelvis. His injuries were too severe and he died. At the exact same time, on the other side of the world, a team of surgeons had their hands and instruments inside the brain of my sister-in-law removing a malignant tumor. She has a rough road ahead of her. I don't think it is possible to pray enough.

So, there you have it. Thanks for reading. Thanks for the support that you've given me and more importantly, the support you've given Ruth, Naomi and Jonah. I am blessed.

"For peace in our hearts, for peace in our homes, for friends and family, for life and for love, for work and for play, let us pray to the Lord, let us pray to the Lord."

Two more.

Two more posts. I think that's about all I've got left in me. Here's what I've come to realize after being here for almost 9 months: the rawness of emotion that I felt with the early deaths that I witnessed has passed. That's not right or wrong, its just reality. They say time heals all wounds, but in maintaining a theme I've struck on before, this wound shouldn't heal. The fact is this: young men and women are dying everyday in a country that many in America have trouble finding on a map, and the vast majority of Americans are neither engaged in this war personally or emotionally. The only time it really breaks into their consciousness is when U.S. troops do something that, by today's warfare standards, is considered wrong.

If 9/11 was really the earth-shattering event that we thought, then this war would be on the front page everyday until it was over. Yes, 9/11 was an earth-shattering event for us, but as with everything, the rawness of emotion that we felt at the time has passed. What are we left with? We're left with a war where the deaths come in ones and twos. When you have that kind of war for 9 years, then the nation loses interest. And in a democracy like ours, when the nation loses interest, you know the poll-bound politicians aren't far behind.

I watched some more young men die this week. Their deaths will raise the interest in their hometowns for a period time. Then, as it always happens, the interest will fade and their families will be left to pick up the pieces.

I'm fortunate. In the supposedly apolitical field of medicine, my job over here is very easy. Take care of patients and get them home safely. But I'll admit, as I come to the end of my deployment, as I think back on what I've seen over here, as I look on yet another shattered body (whether or not he survives), I wonder is it worth it? Are we winning? I'm not even sure what constitutes "winning" in this war. I think that the job we are doing over here, in our hospital, is the most important job in Navy Medicine today. I am thankful for the opportunity and thankful that we've been able to make a difference in so many people's lives. But, my God, at what cost???

Memorial Day.

A day for barbeques, picnics, and family fun. Too often that seems to be the only connection people have to this holiday, oh yeah, and it's the unofficial start of summer. A little bit of history:

Memorial Day was officially proclaimed on 5 May 1868 by General John Logan, national commander of the Grand Army of the Republic, in his General Order No. 11, and was first observed on 30 May 1868, when flowers were placed on the graves of Union and Confederate soldiers at Arlington National Cemetery.

When I lived in DC I would periodically make trips to Arlington National Cemetery to visit my grandfather's gravesite. If you have never been to that cemetery, I strongly recommend it. It's a place of history, a place of remembrance, and a very sobering reminder of the cost of war.

Approximately 12% of the total U.S. population served in World War II. Less than 1% of the total U.S. population has served in these two wars which have lasted twice as long as World War II. I don't say this to encourage everyone to join the military, because I'll admit, I'm ambivalent about my own kids joining the military. I say this to make the point that these wars, despite their length, are not felt as personally as previous conflicts.

I think they need to be felt personally, and I'll admit, that's part of my reason for writing this blog. Almost 5500 young men and women have died since the start of these conflicts. Thousands more have been severely injured. I've, unfortunately, seen my fair share. I've also seen my fair share of young children who have been severely injured or killed. And when I say young children, yes, I'm talking about little Afghani kids who were in the wrong place at the wrong time. Realistically, I'm at the age where I could be a father to the young U.S. troops who are injured or killed. These are kids, all of them.

We send them out as soldiers to do the bidding of our government, and I see them come into the hospital as kids. Scared, injured, bleeding kids. Kids peering up from their stretcher and trying to see their friend, calling out his name, wondering if he made it when the IED went off. Kids that are hoping and praying that they aren't the guest of honor at the next Memorial Day. And for every kid, there is a family back home, hoping and praying that they are never handed a folded flag. I cannot express how impressed I am with those kids. Words fail me.

So, I hope, that as you enjoy the unofficial start of summer, that you also take a moment and remember these kids, Americans, Afghanis, all of them.

Back to reality.

Is there ever a good time to die? I'm sure everyone has different opinions on that, but I know this, I'm thankful that my Aunt Nina died while I was home on leave. That sounds weird to say and it feels weird to write. Here's the basics - diagnosed with Parkinson's disease in 1985, former book editor at Newsday in New York, and more recently editor of Book World for the Washington Post. Incredibly sharp, witty, and more importantly, family. Ours is a family of readers, and she took it and ran with it. She'd been ill for years and in hospice since February. She took a turn for the worse the Monday after I got home, and then died on Thursday morning, May 6th, the day before here 70th birthday. I was hoping to be able to see her. I was not successful, arriving in DC hours after she died. However, that being said, I was able to be there for the funeral. I was able to see family. I was able to tell my daughter about her. I was able to see many great pictures of her life, which included great pictures from my grandparent's place, Mill Point, in North Carolina.

Life and timing are never perfect. There's never a perfect time to buy a home, never a perfect time to go back to school, never a perfect time to have a baby. This was pretty good timing.

So, I left home on a Monday morning around 8 a.m. and arrived back at KAF at 3 a.m. on Thursday. It was a long trip, but if you have a good book (as my Aunt would agree) then it makes travel much more palatable.

I get back to work which feels a bit like having my parole revoked...not that I know anything about that. When I started writing this a couple of days ago we were up to our ears in the final stages of the move into the new hospital. As of today, we moved into the new hospital. After the fun and games last night (type Kandahar Attack May 2010 in google and see what pops up), it is nice to be in a brick&mortar hospital that is rated as a bunker. While the leap in technology and facilities is amazing, I did like the tent/plywood hospital.

The best part about returning to Kandahar is without a doubt the fact that I have now entered the final stage of this deployment. The final stage that will end with another really long plane ride, followed by goofy giggles, grins and hugs from Naomi, Jonah and Ruth...and a bitter dog who wonders why she has to give up part of the bed. I can't wait!

Brief respite.

A perk of being deployed for over 270 days is that you get to take a couple weeks of leave. So, with the knowledge that time is scarce, here are a couple of thoughts/observations from my time at home.

1) 5+ hour flights jammed knee to knee on a C130 in body armor makes routine flights on airlines seem like flying 1^st class!

2) The fatigue and disorientation of 2+ days of flying is quickly wiped away by the look of wonder and joy on Naomi and Jonah’s faces.

3) For as long as I live, I will never forget the look on the kids’ faces when I came off the plane.

4) The first morning at home, I got up with the kids and let Ruth sleep. Naomi asked where Mommy was and I told her she deserved to sleep in after 7 months. Naomi’s reply: “But Mother’s Day isn’t until next week!”

5) The reintegration back into homelife happens pretty quickly. I’m already crossing things off the “To-do list.”

6) Washington, DC, is still one of my favorite cities. I’m glad we had the opportunity to share it with our kids.

7) Jonah gets it now. He gets that deployment means Daddy is gone for a long period of time. He doesn’t want me to go back to “Scanistan.” I don’t blame him.

8) If everything happens for a reason, then the reason I took leave at this time was to be back in the States so I could attend my Aunt Nina’s memorial service. I missed seeing her alive by hours. Damn.

9) I feel rather disconnected from the war after just a couple of weeks. It’s not a bad feeling, just weird. I’m guessing not much will have changed when I get back.

10) Ruth still seems sane after 7 months with the kids by herself. I’m not sure I would fare as well.

11) Our dog, Lilly, is underwhelmed with having to share the bed with me.

My next post will be back in Afghanistan. About 2 months after that I should be home. Naomi gets it. I hope Jonah understands.

Swim.

You gotta swim
Through nights that won't end
Swim for your families
Your lovers your sisters
And brothers and friends
Yeah you've gotta swim
Through wars without cause
Swim for the lost politicians
Who don't see their greed as a flaw

The currents will pull us
Away from our love
Just keep your head above

---from "Swim" by Jack's Mannequin

I listen to my ipod a lot. At the gym. Sitting at the flight line reading a book. While dictating reports on CTs and x-rays. I can think of many songs and how they weave themselves into the story of my life. This is one of the songs that will remind me of this deployment.

Is this a war without cause? While I certainly agree that there are many lost politicians who don't see their greed as a flaw, I'm not sure about the preceding line. What determines the cause of a war? Is it the words of the lost politicians? Is it the general will of the people? Is it the headlines?

My perspective on this war is skewed. I see the broken and battered bodies of the soldiers and civilians (and occasionally the bad guys) who were in the wrong place at the wrong time. Many of the civilians we see are not injured as a direct result of the war, but the severity of their injuries is such that we are trying to help them...to improve relationships. That is my take on this war. We are here to improve relationships. Our goal in helping the severely injured soldier is to get him (or her, though that is uncommon) home, so he can continue the relationships of his life. We understand that some of the soldiers will get home and then die due to the severity of their injuries. But, if we can help them get home, they then have the chance to see family. They have the chance to see the son or daughter who was born after they deployed. They have the chance to seek the comfort that comes from holding hands with loved ones.

We treat the injured civilians as our own. We give them care that is completely unheard of in this country. If by doing that, we can get the 2 year-old (who looks so much like Jonah that I just want to hug him and never let him go) back to his village and his family where he can hopefully have what passes for a normal life in this country, then we're improving relationships.

Think what you will about this war. For me, the cause is improving relationships. I've seen enough death here to last a long time. I'm more interested in the lives that we help. Maybe, just maybe, we can improve a few relationships over here that will pay off in the long run. If we don't, we know that we tried. You can define victory in many ways. I'll settle for a definition that includes being able to get severely injured young men and women back home.

For 209 days the currents have been pulling me away from my family. Next week, volcano* permitting, I'll be going home for 2 weeks, then it's back here for another 6-8 weeks and I'm done. I can't wait!

*speaking of volcanoes, Michael Crichton's book "State of Fear" dealt with ecoterrorists triggering natural disasters to make their points. I wonder if the Taliban is responsible for the volcano??? ;-)