Happy Thanksgiving!

"No human counsel hath devised, nor hath any mortal hand worked out these great things. They are the gracious gifts of the most high God, who while dealing with us in anger for our sins, hath nevertheless remembered mercy.

It has seemed to me fit and proper that they should be solemnly, reverently, and gratefully acknowledged as with one heart and one voice by the whole American people. I do, therefore, invite my fellow-citizens in every part of the United States, and also those who are at sea and those who are sojourning in foreign lands, to set apart and observe the last Thursday of November next as a day of thanksgiving and praise to our beneficent Father who dwelleth in the heavens.

... commend to his tender care all those who have become widows, orphans, mourners, or sufferers in the lamentable civil strife in which we are unavoidably engaged..." A. Lincoln, 1863, on the declaration of Thanksgiving Day.

OK, it's no surprise, President Lincoln could write better than I ever will, so I thought it fitting to include a bit of the text from his declaration when Thanksgiving was made a national holiday. Hmmmmm, he made that declaration while we were engaged in the Civil War.

So, here are some things I'm thankful for while "sojourning in foreign lands."

I'm thankful for a wonderful family. Ruth, Naomi, and Jonah bring an indescribable joy to my life. Sometimes when I'm skyping with them, I don't really want to talk, I just want to watch them move and talk and laugh. I already daydream about our reunion and getting tackled by Naomi and Jonah and rolling around on the floor with them. I'm thankful for Ruth. She keeps the family running when I'm there and even more so when I'm gone. To quote Jack Nicholson, she "makes me want to be a better man."

I'm thankful for friends and family. I'll admit, I'm not the best at keeping in touch. But the memories of times spent with friends and family are precious to me. I look forward to making more.

I'm thankful for our dog, Lilly. Many of you know that we had to put our first dog, Dorsett, to sleep this year. That is a loss that I still feel. For those of you that are dog people, you know that you can't replace a dog. But if you're lucky, you get a new dog who is a new friend and that makes you happy. I'm happy.

Finally, I'm thankful for the opportunity to serve. The military serves a vital role for our nation. Part of that role involves sending young men and women into harm's way to do a job that is sometimes unpopular. If they are going to get injured in some corner of a foreign field (with apologies to Rupert Brooke), then they deserve the best care they can get and that is what we are giving them.

"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."

Combat Radiologist

For those who say we never touch patients. For those who say we sit in dark rooms and look at pictures because we're afraid of patients, I offer the following story.

The medevac report comes in. IED attack on an armored vehicle. CPR is being performed in the helicopter.

The patient is brought off the helicopter. He's pale, very pale, the kind of pale that comes from significant blood loss. He's not breathing on his own. He's missing most of his right leg below the knee. He has a large gash on his upper inside thigh. He has a tourniquet on the same leg.

He's rushed into the OR. I put the ultrasound probe on his chest to look for any cardiac activity. I look again. There is none. It's over. Young 20s. Gone. We cover him with a blanket. My eyes briefly water. I move on.

I'm not afraid to touch patients. I don't sit in the dark and look at pictures because I'm afraid of patients. Sometimes I'd rather sit in the dark because I know what I'm going to see, and it's not going to be pretty.

I saw his casket loaded onto a C-130 the next day for the flight home. His casket will be met by his wife and new baby. His wife will now mourn the loss of her second husband. Her first husband was killed in Iraq. She celebrated her birthday on the day he was killed.

Welcome to Afghanistan.

I've been here for three weeks. In that time I've seen more amputations and traumatic death than in the 14 years since I started medical school. I watched a soldier cry today as he awoke from anesthesia to find that he now missing his left foot after stepping on a mine. I briefly thought to myself that he's lucky that he's only missing a part of one limb, why's he crying? He's otherwise uninjured. These thoughts were quickly replaced with feelings of shame. How can I think those things? Apparently I can. And it only took three weeks.

In the practice of medicine we often find ourselves developing attitudes about patients and diseases that the average person would find abhorrent. We're supposed to be better than this, but we're also human.

The patients I see are making a sacrifice that is completely foreign to the vast majority of Americans. They deserve the best we can give them, in actions and thoughts. I give them my best with my actions. For a couple seconds I didn't give them my best with my thoughts. It won't happen again. I'm sorry.

No title

I'm stuck. I don't have a title. Now what do I do?

Are you ready...more of the same. Work didn't change. The pattern continues. Quiet during the day, picks up around dinner time. I would say that bothers me because I want to get home in time for supper...but that's not true here.

This was the week of the random single piece of shrapnel or single bullet causing devastating injuries. This was also the week of looking at a CT in a patient who came in for kidney stones and diagnosing lymphoma in him.

I managed to Skype with my oldest brother, Jim, while he sat on his boat in Cabo, Mexico. Aahhh, the beauty of technology. He asked how the war was going? From my view through the wrong end of a telescope it's going fine. People get injured. We take care of them. If they're well enough, they go back to their units. If not, they get a long plane ride home and try to rebuild their lives. Are we making a difference? Yeah, we are, for the individual. Jim's response to my rambling, "Isn't war all about what happens between individuals?" or words to that effect. Yeah, I guess it is. I can't control what happens in DC, Kabul, or some lonely road where someone waits to blow someone up. I can only control what happens in my little part of the hospital and try to make a difference for them.

Speaking of war and individuals. This was also the week of a nutjob wearing an Army uniform and killing 13 people because he was a little distressed about getting deployed. Oh yeah, in case you didn't hear he is also a psychiatrist and graduated 2 years after me from the same med school. No, I didn't know him. We'll hear stories and theories over the next weeks/months/years about he was a victim, a terrorist, oppressed, etc. Cut the crap. He was and is a murderer. No more, no less.

On a more upbeat note. This was also the week of multiple trips to the British dining facility for the curry bar!!! And there was much rejoicing. They also have soft serve ice cream on Mondays, Wednesdays, and Fridays! And there was even more rejoicing.

Saw some amazing pictures from home. Pictures of a guy jetskiing in front of our house from the flooding from the nor'easter! Fortunately Ruth and the kids were safe and dry (except for some water damage in the sunroom). I have not seen rain since we left the States. It's fun talking with the kids on Skype - they mostly view it as a time to jump around like crazy in front of the camera. I miss them.

Groundhog Day

I've been here for just over two weeks and am settling into a schedule. I'm alternating 24 hour shifts at the hospital, starting at noon each day. I'm trying to hit the gym at least 2 out of every 3 days. Meals are at one of 5 dining facilities. Went to the British one tonight which was a big hit because they have a curry bar! Had some excellent lamb curry. Had a fun discussion with one of our Australian doctors about why cake with sauce is called pudding, and pudding is called custard, and fries are called chips and so on. This discussion on food also had to get around to that dessert I saw the other day at one of the dining facilities called (and this is the polite name) "Spotted Richard." Hmmmmmm.

It has been relatively quiet at the hospital for the past two days. I took a tour of the new hospital which will open sometime next year. It is going to be a monumental upgrade from the collection of huts/tents we're in now. The panoramic photo is from the roof of the new hospital. Our current hospital is in the foreground bottom left of the photo.

One of the saddest things I've seen so far is the cute as a button 11 year-old girl who stepped on a landmine (remnants from when the Soviets were here). She lost one leg below the knee and the other leg, while saved, has some pretty extensive damage. She has no family except for her uncle. He's asked us to do everything we can to save her other leg because "No Afghan male will marry a woman missing both legs."

Currently working on clinical practice guidelines regarding the use of interventional radiology in theater. We're breaking new ground here and a lot of what we're doing is trying to educate the various physicians about the capabilities that we have here and how it can play a role in the management of battlefield trauma.

Tomorrow is Veteran's Day (or Remembrance Day for our Canadian friends). These long-running conflicts have increased the number of veterans in the U.S., many of them with visible injuries, just as many (or possibly more) with injuries not readily detected. Say thanks to one of them. Say a prayer for them and their families. Don't wait for Memorial Day to think of the ones who didn't make it home alive.

Kandahar, Afghanistan

We arrived here at around 3 a.m. last Tuesday after a nice flight from Kuwait in a C-17. The base is a sprawling mixture of tents, modular living units, more tents, concrete blast barriers and buildings of different sizes and shapes. There are a few paved roads and the rest are dirt roads. Dust is a common theme here with a constant low-level haze at ground level. We can see some small mountains to the north, otherwise, all I see is the base and more buildings. The weather is basically sunny and up to mid 70s during the day and down in the 40s at night. I'm told that winters get cold and also rainy. Great...can't wait to see what kind of a mudpit this place becomes!

Since this is a NATO base, there are a multitude of uniforms, flags, and languages. It's sort of a game to try to figure out who's who in the zoo. I'm working in a hospital that is a mixture of small connected portable buildings and some

tents. The hospital is staffed by the U.S. Navy, Canadians, and Dutch. I have one 16-slice CT scanner, a couple of ultrasounds, plain-film x-ray, and a C-arm in the OR that I use for interventional cases. My IR supplies are currently in a variety of boxes in various rooms and one of my first orders of business is to consolidate and inventory the supplies. We will be staffed with two radiologists, myself and a general radiologist.

So, as in many things, the job can be slow at times, but when it picks up, it is frightening. I've seen multiple traumas already and I'm pleased to say that we do a good job with them. The injuries are not the kind that you see in the U.S., and we should all be thankful for that. So often as radiologists we are too far removed from the actual patient, but I'm very happy to be in the trauma bays when the patients roll in because it makes imaging easier when I have a sense of what has happened to the patient.

Living arrangements: I'm in what is effectively a small college dorm room. I share the room with Jon Gibbons, an anesthesiologist and med school classmate. We have real beds and internet in the room. Life could be so much worse so there is really nothing to complain about from that aspect. We have a nice gym outside our door and are in walking distance to most of the base amenities, including multiple dining facilities (and they have helpful handwashing stations inside of them!) Speaking of the internet - this is a dramatic quality of life issue. I'm able to skype and call (via magicjack) from my room!

So, there you have it. A brief intro to Kandahar. Not too exciting, I know. More to follow.