Turf Wars




My roommates' self-described "cleanliness"

So when I moved in I had a few roommates and I decided since they were all leaving relatively soon, I wouldn't step on anyone's toes and just try to be at peace with living in chaos for a little while.  Not so much!  I had skyped Tom and the boys on Christmas day.  I didn't really get to talk to them but I watched them as they opened their presents.  One would think my roommates would be okay with this, especially because it was at the end of the day and they would be getting up relatively soon for shift change.  One in particular, Lt Cornman, had a huge issue with it.  She wrote a nasty note on the white board outside the room.  I asked her what her reason was and we had a huge argument.  I told her I wasn't going to live like a pig anymore and she needed to clean her crap up.  It turned into a meeting with the flight commanders and like I expected, she hung herself.  She not only was rude, disrespectful but she lied straight to our leadership! 

Our leaders made it a point that we are at war.  What's interesting is the war we wage is with each other.  It seems that everyone in this room tiptoed around this person's personality and I was the one to stand up to her.  She is an ugly person and I would hate to think she would stay in the Air Force and one day be a leader.  I think what is wrong with the military is that we let people like this excel because we are too afraid to call them on their stuff.  This is one who will probably get promoted because no one wants to deal with her.



Dr. Fortuna showing his sensitive side

Another turf war going on is with one of our docs.  He's just got a lot of opinions of how things should be and some people just want to but heads with him.  They call him an asshole behind his back and maybe he is.  I haven't had an issue with him yet but he did the most amazing thing yesterday.  He picked up our little burn baby and rocked him.  It's amazing what children can do to your heart.

Sabid

Sabid is a patient who was admitted the day we arrived to Bagram.  She was diagnosed with 47% of her body burned.  I believe this to be an underestimation.  The only parts of her not burned are her face, chest, upper arms, hands and feet.  People who are classified at 50% burn have a 100% mortality here.  Right now, she is on room air with sats at 98%, her white count today was 24, down from 48 and I had the most amazing day with her! 

Most of the folks are getting a little burned out, I am one of them.  I wish the docs would quit torturing her and make her comfortable.  Every other day she goes to the OR and her body (no skin) is debrided (scrubbed and cauterized).  She has of course grown very depressed over the last month and you can't go into her room without her constant fearful crying.  She is anticipating the pain before it even starts.  I can't really blame her, she's a 14 year old bride of four months in an arranged marriage.  Her husband has never come to see her because his brother says he is too young.  The brother-in-law is with her constantly and he feeds her, moves her limbs so she doesn't contract and encourages her to get better.  Who says these Afghan men think women are less than dirt?

Anyway, today Sabid defacated on herself.  There is no best way to clean her.  I thought of her room and there is a shower in there.  After investigating the possiblity of using this water without causing some sort of infection to bathe her, we walked her into the bathroom.  It was painful for her but once we ran the warm water on her, she seemed to calm down and enjoyed her shower.  We washed her hair, french braided it and really spiffed her up!  She looked beautiful.  Once we got her back to bed, we tucked her in and started to warm her up.  Since she hasn't any skin, she has no way to keep her body temperature.  Sabid also doesn't eat because she hates our food (so do we by the way) so without nutrition, she isn't going to be able to heal the skin she does have.  After the shower, she told her guardian she wanted an apple, orange, rice and meat.  There was no way she was going without!  I found an apple and fed her, and she looked at me with her beautiful eyes and smiled.  That was the most amazing feeling I've ever had with a patient.  She then fell into the most peaceful sleep I've seen her in.  After work, I found the rice and meat and brought it to her.  I hope she eats it and I pray she is a miracle.

Christmas Day

It didn't seem like Christmas until the end of the day.  I hadn't listened to any carols or watched any movies.  I think I just tried to ignore the fact I wouldn't be home.  I tried going to church last night but was annoyed and didn't feel any spirituality.  I just wanted them to stop singing so many songs so I could come home and sleep.  I was able to get off a little early today and was able to skype with Tom and the boys.  That's when it his me that it was actually Christmas Day.  I cried a little as I watched the boys open their gifts with all the excitement they had built up.  I am so lucky, I felt like I could just reach out and touch them.  The tears were that of joy, thank God for technology.  Konner came up and hugged the computer. 

After skyping, I went back to the unit for our Christmas Party.  Castillo and White set it all up and we had an actual, non-DFAC Christmas dinner!   I made homemade cranberry sauce in an electric teapot!  It truly is adapt or perish here (the clinic motto).  We had ham, green bean casserole, an assortment of pies, lumpia and so many other wonderful dishes.  I ate until I was stuffed so full I couldn't eat anymore.  We also had a white elephant gift exchange.  That was a lot of fun too.  Later, Annie and I danced to Elvis' "Blue Christmas" and made everyone laugh.  Now it feels like Christmas.  If I had to spend the day away from my family I am so glad I am with these people.  This is the reason I joined the Air Force.

The Best Christmas Ever...According to Tovar



My Lego Christmas

Today was a very interesting day.  My patient, an Afghan man who came to us from the sky had a bowel movement.  While cleaning him, I saw something unusual, and discovered it was a 25 inch tapeworm!  Needless to say I got a great ab workout because I wretched and threw up a little in my mouth.  Castillo, laughing, asked if I needed a trash can.  So not knowing for sure what to do with the worm, I called for one of the more seasoned deployers, Capt Delker.  After several others came over to see the worm, Tovar exclaimed "This is the best Christmas ever!"  Delker told me I had to pick it up and put it in a container for the lab.  I totally thought he was yanking my chain but I did it anyway.  Anyone who knows me knows this is a HUGE step in my personal growth.  After that little episode, my patient then decided to pull his dobhoff tube!  Yes, that was so special.  SSgt Castillo and I pulled out the WWF wrestling moves trying to place it again and while I was very up close and personal with him, HE LICKED ME!  I think I'm engaged now.  No worries, Tom, I happily declined!  Tonight, I'm takig a five minute combat shower.

Christmas Carolers with weapons in tow

I saw an amazing thing today.  Tovar one of the folks I deployed with never struck me as having a sensitive side.  He was caring for a baby who was burned in a house fire.  In the bed  next to the baby was his 10 year old sister.  He cradled the baby in his arms and let the two visit for a while.  It was the most special moment and it reminded me why I became a nurse. 

Later, Santa visited and brought presents.  It made me feel sad that I couldn't be home wrapping gifts and watching March of the Penguins.  That's a silly tradition Tom and I started some years ago, but this Christmas Eve feels especially lonely.  I miss my family and I hope they have a wonderful day tomorrow.  I hope I get to skype with them.

On another note, we also had carollers come through the unit.  As they came through, they sang various Christmas songs; one being "Peace on Earth".  It was a little ironic to be singing songs of peace and love while carrying M-16s and M-9s.

Lazarus

Today I think our docs forgot that it was Christmas and decided to perform an Easter miracle.  We received a patient from the Egyptian hospital and he was clinically dead.  The only reason he was breathing was due to the fact he was on a ventilator.  For clinicians, his Ph was 6.8, K 8, Mg 5.0, core temp 84 degrees; for non clinicians, he was dead.  So for whatever reason our docs decided it was worth putting a ton of precious resources into saving this guy.  I really don't understand why and nether do many of the other nurses on our floor.  When I left, his temp was rising because of all the warm blood we poured into him but honestly, I'll be surprised if he makes it.  No, it wasn't one of our Americans.  I think that's why I'm annoyed by this because those resources could have gone to a better purpose.  This man has no chance here in Afghanistan.  The doctors are only as good as our better nurses (not the best nurses).  Most of the time when we send these folks to a local hospital, they're put in a corner to die.  So we pour all these limited resources into a person that has no chance once we send them to a local hospital.  It is so agravating! 

Anyway, we're having a white elephant gift exchange for Christmas.  I got a six back of St. Pauli's N.A.  Tovar is going to go through some free stuff and give that.  It should be a lot of fun.  Katie of course isn't going to participate.  Her comment was "'F' that!"  That's okay, she's making tons of enemies.  I have quit going to meals with her primarily because I can't take the negativity.  I can go negative too fast and it's much too early for that right now.  I am building my confidence as a nurse and officer and cannot allow someone to take that from me.  I'm running out of time!!

Nursing...it's more than a title

Today was an interesting day.  When we arrived, I changed into scrubs and when I bent over to tie my sheos, my butt split out!  They weren't even tight.  I reported to the floor and we had admitted three pediatric patients, ages 1, 2, and 10.  All three of them were in a gas stove explosion in their home; there were sixteen in all but some went to Kandahar for treatment.  We have a token PICU nurse so of course she was assigned two of the kids and I had two of them.  One of her kids' foley fell out so it needed to be replaced.  I went over to help her and she got angry that this ten year old girl didn't want to spread her legs and let us stick a tube in her.  She threatened the little girl through the interpeter "We can do this the easy way or the hard way but it's going in.  If we do it the hard way, I'm getting people to hold you down."  At this point, I  stepped in and told her to stop.  She needed to get this little girl something to calm down, like versed.  She threw the stuff down onto the bed and stomped off.  I was completely stunned. This person who specialzes in kids, intensive care type kids, was throwing a fit and threatening this little girl.  I have already decided she will NEVER care for my children God forbid they need to be in a PICU.  I did report her and here comes the other disappointment.  My leader whom I admire completely, blew it off because she didn't think this person could be that way.  She wasn't at the bedside and frankly I was scared for the little girl.  Later, when I asked her about the situation, she stated she didn't think the translator was telling the patient what she wanted her to know.  Of course not!  If I were translating I wouldn't tell this little ignorant girl I'm going to overpower you and rape you with a foley catheter!  I had little respect for this person before today, now I have none.

The other thoughts about these kids is that they have a high tolerance for pain.  My little princess today had 2nd and 3rd degree burns, covering 31% of her body.  She was easily consolled with a little cooing and a bottle.  Very sweet little girl and everyone fell in love with her.  Some have told me not to get attached.  I don't think I am but I will provide the best care I can to her while she's in my care.  I don't know.  I think I go out of my way for my patients and I want to treat them like I would want to be treated.  I don't think it's because I'm new or naive, I just believe in the Golden Rule.  I know many other people do not bur I just think it's the right thing to do.  Anyway, Tovar and Annie said it'll all come out eventually. This person can't hide under the Col's skirt all the time.  She has lost the respect of the docs and the techs.  It's going to be a long deployment for her.

Purple and Afghan Hearts

Today, there were two special things that happend.  The military is not always about blowing people up and taking over other countries.  The first things that happened was with my patient who was a local national.  Her case was a humanitarian case.  This woman has not been able to move for six months.  Our neurosurgeon operated on her and she can now move her hands and feet.  She doesn't have complete movement but it's better than it was before.  Today, while I was caring for her she called me her "sister".  To the Afghan people this is a very high compliment and I felt so honored.  These people may be uneducated but they are very kind and appreciative of what we're doing for them. 

The second thing that happened was caring for a Marine.  He is a 25 year old who was eight days from going home.  He was hit with an IED.  EIGHT DAYS!!  He wanted to call home so after several attempts to get a good line through, he talked to his dad.  I was on this end of the conversation but he said "I don't think I'll be doing any mountain climbing soon."  He's missing both legs, three fingers and part of his scrotum.  I can't believe how many marred people we will have when all is said and done.  Gen Townsend came in to give the Army soldier a purple heart but he visited the other two in the bay.  He came up to Dan and said "I can't award you with a purple heart since you're a Marine, but here's a Purple Heart coin you can keep in your pocket."  It was pretty awesome.  I knew my patient wouldn't remember much, so I wrote it all down and attached it to the coin.  At least he knows who gave it to him and when. 

Thinking back to the Korean and Vietnam wars, I am so happy the American public is more supportive of our military now than they were then.  It's too bad the vets of those previous wars endured such anger.  Col Mcneill said it's probably because those vets were drafted and it wasn't a volunteer service.  I think in that case they should have been more respected becasue they were "voluntold". 

The 1st Hail and Farewell




Lisa, Tovar and me

 



Picture worth 1,000 laughs

The most admirable leader, Col McNeill

I know I've been writing a lot about the tragedies in the unit but tonight or complaints about how jacked up things are here but tonight I want to write about something completely different and upbeat.  We had our first Hail and Farewell.  The NutMed people put it on and decorated their unit beautifully.  Everything was like a winter wonderland, all blue and silvery.  They had some food and near beer.  There was karoke, cake, spring rolls and a really good time.  Being there made me think about all the wonderful times I had at Edwards going to the different functions and the interaction of people.  It made me remember one of the reasons I wanted the join the Air Force in the first place, the camaraderie.  Tovar and I sang into a bottle, Col McNeill laughed a lot and everyone except Katie seemed to have forgotten about work for just a moment.  There were some folks dancing to Michael Jackson's "Thriller" and a few of the guys got up and sang to "Big Butts".  Earlier in the evening I was siting across from the anesthesiologist.  He opened a beer for someone and no kidding the lid flew into my eye and splashed beer all over my hair and face!  It was a classic you-tube moment!  It took me saying to this person, "That's okay, God saw fit to give me another eye" before he realized what he did.  This is the Air Force that I remember and love.



NutMed Transformed to a winter wonderland

























Emotional Rollercoasters

Today was really a rotten day.  First as I was caring for my burn patient, I learned her caregiver was her brother in law.  I asked why her husband never came to visit and he stated because he is only 15 and too young to see her like this.  That broke my heart.  Then I learned that the Taliban often contaminate the Kerosene that these people use for heating their home in order to cause them harm!  I was so angry when I learned this.  These people have to qualms with anyone and they're being terrorized just so another group can have power over them.  This poor child is burned so badly, I don't think she's going to make it.  She has no skin on over 50% of her body and she cries in pain each time we have to do a dressing change or care for her.

This next patient wasn't mine, but he was a young boy who was blown up by a land mine.  The docs worked on him for four hours and then decided it was a lost cause; primarily because his brain was coming out of the bottom of his skull.  I sat and looked at this young child, who in my mind was out playing innocently and then came across an old land mine and now he's gone.  His father broke down and sobbed on the unit.  In the U.S.  I could put my arm around him and comfort him, but not here.  It angers me so much to see the destruction of these children.  I started to cry but then asked Tovar to say something stupid and he obliged.  It made me laugh but I still think I'll cry tonight for all these children in this war torn country.

Empathy Lost?

Robin Williams

Today I experienced my first death of a child.  He was only 9 and came in with severe dehydration.  He was at the local hospital but they couldn't do much for him so they sent him to us.  He was already too sick to heal.  I didn't cry or feel bad and it scared me to think maybe I have lost my heart and empathy. 

Later, I took care of my burn patient.  She is 14 and although they say she's 47% burned, is actually more.  Only her breasts and face were left unscarred.  In this culture, she is already married and has children.  God, she's only 14.  Her childhood was taken away so early.  Anyway, I had to change her dressings.  As she is crying out in pain and she is stroking my face, I felt my eyes well up with tears.  Thank God I haven't lost my ability to feel, at least not this early.  I decided I didn't feel anything before because I hadn't met that other patient. 

Kix Brooks and Bob Di Piero

Robin Williams and Kicks Brooks came to the unit today for a little USO tour.  That was pretty great.  I don't want to get caught up in the celebrity of things here because I have a job but I really wanted my picture taken with Robin Williams,  Tom had his picture taken with him eight years ago, now I have a picture to go along with my story.  Unfortunately, Lance Armstrong got too tired after meeting the Emergency Room folks and called it a night.  So much for the 7 time winner of the Tour de France.

Robin Williams greeting the staff

Admiral Mulllins wife also came through the unit.  I thought that was pretty great considering she is a spouse and she came to a war zone to see what we do.  I am so glad I joined the military.  I hate the conditions right now in my living space, I hate being separated from my family but I am so glad of the worthy job I am doing.

Technology and War

I was able to Skype with Tom and the boys the other day.  I was very frustrated because of my living conditions, I am not able to talk to them, only hear them.  I could see them but not touch.  After we finished I started thinking about all the wars before this one and how difficult it must have been for those left behind and those at war.  There was no internet, google, Skype, cell phones, etc... It was all handwritten letters that may or may not be delivered.  By the time you received news, it had been a few weeks.  How fortunate we are to have this ability to not only talk to our loved ones but to see them too. 

But then I think about technology and all the evil things we do with it; IEDs, nuclear weapons, bombs that can wipe out an entire city.  I know that technology is something we can gain good from but why must it be used to control countries or populations?  I don't know, just random thoughts.

Transitions

Not really sure what the title of this post should be but it's just random thoughts I've had.  We had one patient who tried to kill himself because his wife was bragging about all her affairs.  Not really sure if he'll make it.  Today we had three Marines in the American bay.  All three were bilateral above the knee amputees from IED explosions.  It made me wonder how many Americans are now handicapped because of this war.   Another admission was an ANA (good guy) and when he got to us, he was dead.  His brain was so swollen you could see it on the side of his face.  He passed in our unit and because he is Muslim there are certain things we have to do.  It isn't like cleaning a body and then throwing it in a big plastic body bag.  When a Muslim passes, we are to point their head toward Mecca.  Only males and shroud males, and females shroud females.  I was not able to provide end of life care to this patient because I am female.  I thought it was interesting because while they are alive, I can bathe them without issue.  There are other things we're supposed to do, not sure of all the details but I'll be finding out tomorrow. 

I really wish my confidence would hurry and kick in.  I was in the ER when these people came in and was helping.  I felt more in the way. 

I wish I could feel like it was Christmas but I feel so empty right now.  I have never been away from my family, especially during the holidays.  I feel so lonely but I am making some new friends.  Jessica, my bunk mate is cool.  She made my bed for me the first day and we chat a bit at night.  She's funny, she never eats at the DFAC (who can blame her) and she's a little quirky but super nice. 

Col McNeill is awesome, she is the kind of leader I aspire to be.  She was with all of us cleaning the dorms last night at my first official GI party.  There were no other Colonels present; says a lot doesn't it?

We got 50  new people in today so my room is at a capacity of 8 females; who the hell thought it was a good idea to house 8 women in a 10x10 room?  Oh yes, 8 shower stalls and 8 toilets.  It makes you want to laugh doesn't it.

I shared Tom's pre-deployment checklist with Col McNeill today and she just laughed.  She said we definitely need to add to it because it is mostly all true.  Funny how important that checklist is becoming.  It's something that I can look at and laugh when I'm feeling frustrated and lonely.

December 10, 2010

Today, we all met up to go to our mass briefing, Combat "O".  We never made it because when we finally got there no one told us it was being moved.  Another well planned event.  While we were sitting at breakfast, we all came to the consensus that although we've been here a week, it feels more like a month.  I have been assured by others that feeling will go away and when it's time to leave we'll all feel like it's flown by.

Yesterday I took care of a local national (LN) and an Enemy Prisoner of War (EPW).  Interesting, I NEVER thought I have that type of patient.  The LN had pelvic surgery yesterday and came back a mess.  Heart rate high, BP low, K 6.3, BS 272....everything was completely whacked out.  I had commented his K was high because of the blood he was given but things still weren't being corrected.  I asked the anesthesiologist if this patient could be bleeding and the answer was "no".  Well this morning I found out they returned the patient to the OR because, yes he was bleeding.  I needed that validation!  It has been so long since I took care of a truly sick patient.

So this is a blog on my thoughts and anyone reading this and getting offended does not have to read it anymore.  The EPW is an issue for me.  I as a nurse am obligated to provide the same type of care regardless of the patient and I have no issue with it.  The problem I have is other people see me as a bleeding heart.  I think this person is still a human and no I don't like him blowing up my fellow Americans but he is fighting for what he believes in.  One Airman said he was glad when the last EPW had died.  I just simply made the comment that he should not be happy that another human being died.  It's just a weird place for me to be in right now.  I'm told I will change my feelings on that too.  I hope not, I don't want to lose my sense of humanity.

Hospital Orientation

Today was actually the second day of orientation but I had my own patient.  He is a six year old Afghan boy who was hit by a vehicle.   His grandfather is a four star Afghan general.  When I arrived, I was told the caregivers are usually men and do not assist in the care of the loved ones.   It's supposed to be up to the women, however the women aren't allowed to come in the hospital.  Anyway, my little guy had some TBI, a ventric and he is now trached and pegged.  He was posturing yesterday, which is an ominous sign but today he was reacting to my suctioning him.  I was so happy to see his little leg move as if to push me away from him.  He started to look around a bit and the best part was that he yawned.  He looked so normal, natural and healed.  I don't know what is outcome will be, but I pray it is good.

His cousin was by his side all day.  We didn't know each other's language but I would smile and him and gesture.  He smiled back and he came over to help with the cares of this little guy!!  This made my entire day.  I know it won't always be this good, but Col McNeill made the comment "No one does what we do" and she is so right.  I don't know how many nurses on the civilian side have the kind of experiences we have.  It's an awesome feeling.

Church and the Cave

Enough said

I went to mass today with a few of my friends and it was a completely different feeling.  First, we all were carrying weapons.  Never did that in church before.  Second, the priest was wearing combat boots and when we prayed to St. Michael, it was odd knowing that I was in this combat situation.  I don't think the full effect has hit me yet but I'm sure soon it will...and I'm afraid I won't be able to live up to my expectations.  The priest was very funny, he made some jokes that I'm sure I'll get as my time here continues.  I think I'm more impressed with the fact that I went to church after such a long absence.

Annie in her cave

Now to the reference of the cave.  My roommates do not talk to me or one another.  The room is ALWAYS dark and when I'm here I feel like I have to tip toe all the time.  God I hope I can move in with my friends so that I can feel somewhat normal.  I don't know how I can study in such an environment.  I have no motivation being in this cave, I feel more like the Taliban hiding out than I do the person who is helping in the fight against them.  The other thought on my room; 40 year olds do not belong on the top bunk! 

I am going to try and ignore Katie's ridiculous fits.  Maybe she doesn't know how to handle stress well.  I know sometimes people look at my rank and don't see the whole person.  Maybe I'm looking at her rank and expecting more than I should.  She has only been in the military a year and maybe she hasn't had the exposure I have. 

I was able to talk to the boys yesterday, I felt so teary eyed when I was hanging up.  I wanted a snuggle so much.  I hope these feelings pass, because if they don't I'm in for a long six months.

Combat showers.  What can I say about them.  They're short but I have adapted and I am very proud of myself.  I think I adapt well to my surroundings.  There are some things that are irritating and annoying but once I figure a way to incorporate them into my life, they aren't as bad.  I know I had a lot more to say but right now, I just can't remember all of it.  Until tomorrow.

Shock

Russian Tower

Lisa and I on Tuna Bridge

We arrived in Bagram at 0630 on 1 Dec 10.   I really didn't know what to expect.  The flight over was uneventful, we were in our battle rattle, which was extremely uncomfortable for a two hour flight.  I just put my head inside my IBA and went to sleep like a turtle.  Too bad I didn't have the helmet on because then I may have looked like a turtle!  When we landed, we departed the C-17 through the back end.  It was cold and dismal.  I think my shock started then.  We carried our bags across the flightline to a run down room where we were briefed.  The inprocessors looked through out deployment folders and Annie was told she would have to return to the states because she didn't have her 522.  I can't possibly understand why her 522 wasn't there, only six people had looked through the folders and stated they were "complete".  We were able to get a ride from the hospital so luckily we didn't have to trek all the way through the base. 

When we arrived at the hospital, no one expected us.  This seemed fitting because that's how the whole trip has been.  Tovar, five time deployer, has stated this is the "worst deployment ever".  I can only hope this is my worst!  We had a briefing and were run through the hospital doing different tasks.  Luckily we had our Colonel with us.  She's so awesome, so realistic and I could easily walk through fire for her.  We then got our rooms.

Annie

I can't describe the shock of walking into my room and seeing how overcrowded we are.  There are four bunk beds in an 10x10 space.  Along with the bunk beds are four desks, four small dressers and four armoirs.  What a disaster!  Poor Annie and Michelle have it much worse.  Their room honestly looks like a crack house.  That is the best way I can describe it.  They are sleeping on their beds WITH their luggage.  There has to be a better way.

Our first night here, we had a fire alarm.  I thought I had set it off with burning the strings on my gun holster but thankfully someone else had burned some noodles.  Poor thing, she was really embarrassed. 

Waiting to get weapons issued

I find some personalities difficult and I do hope these people will gain perspective on what the big picture is and stop complaining about silly things, like the combat showers and how it is not conducive to their hair.  Today we went to IED training and of course, the second sand storm of the season (apparently there were no sandstorms this season until we arrived; yes we brang it!).  We stood out there for a couple of hours, it was difficult to see, the sun disappeared behind the sand; but for the minimal time we were there the realization that there were people patrolling the perimeter or staying out in that environment for much longer periods of time hit me.  I am not the hero, they are.  They are who protect me at night so I can help heal them tomorrow.