166 Days: My Journey Through The Darkness (10 page)

26 June 2008

After two months I couldn’t believe I finally arrived at the firebase I was assigned to; the deployment was a third of the way over! As the Chinook landed on the helicopter landing zone (HLZ), it was so nice to see Becky out there waiting for me. We ran to each other and hugged. We’d been separated for almost three weeks and it felt so nice to have her back. As I got my things set in my room, Becky and Hal, the junior medic, showed me around the base. They pointed to an empty spot next to the rooms which was where the dining facility used to be. Just before Becky’s arrival, the dining facility burned down due to a gas leak, so they were relying on local nationals who worked on the base to prepare their food; this was not good news for my digestive system. They guided me to the bathrooms we would be sharing with all of the guys.

Hal explained the rules, “Here’s the bathroom and showers, I have designated a thirty minute time for ‘female showers’ every day, meaning the door can be locked and the guys will stay out. The rest of the day you are welcome to the facility, but you are on your own when it comes to privacy.”

“There is no more modesty after being here for any amount of time,” Becky added.

As we walked through the bathroom I could see what they were talking about. The stalls were made of thin aluminum walls; therefore, privacy was not something that would be easy to come by. When I looked down at the toilet, I saw porn magazines lying on the back of it. No privacy indeed.

“Sorry about that,” Hal apologized, clearly embarrassed. “You’re living with a bunch of men.”

“No problem, I get it,” I said quickly, ready to move on to the next part of the tour.

I was a little uneasy to say the least when I saw the location of the clinic. It was right on the outer edge of the firebase and when I opened the door to where the patients would come in I was literally looking out into the local area. The only thing separating us from “them” was some concertina wire (c-wire) and a security checkpoint armed with ANA soldiers.

Once I got past the location and focused on the actual clinic itself, I must say I was impressed. It had tiled floors, four treatment bays, a pharmacy, supply room and a portable x-ray machine. There was no lab capability, but there was a glucometer and urine dipsticks for very basic workups. As I looked through the supplies, I realized I would have limitations on what I could do for the patients I saw. The way I had been taught to evaluate patients was with many more resources, such as a lab, radiology, and specialists just a phone call away. I would have to make do with what I had. Just as we did during the MedCap, we would see the patients with an interpreter, also known as a “Terp”. I met the Terp I would work with most often, his name was IG (pronounced “eye gee”).

While I was in the clinic we saw a few patients, which gave me a chance to work with Hal for the first time. As we did assessments and physical exams of the patients, I could see his thought processes and understand his training background. He had a strong knowledge on how to manage trauma patients, but admitted basic skills with medical management. With each patient we treated he was eager to learn from me, while I appreciated his experience as well. I felt we would be able to work together and complement each other well.

Once the clinic closed we resumed the tour of my new home for the next several months. Hal explained the firebase was once a Taliban headquarters we overtook in 2002. It was eerie to think I was standing in the same buildings that were once occupied by such malicious people. As we walked, one of the guys came out wearing no shirt, and a pair of “Ranger panties” which were very short shorts the guys were issued for physical training.

“Hello ladies,” he smirked as he strutted by us.

“What the
hell
are you doing man?” Hal said, “How about you show some respect dude? Go put some clothes on.”

“My bad Hal! I didn’t know they were out here,” the team guy said as he continued on his way to the gym. Becky and I looked at each other and smiled.

“Sorry ladies, that was completely unacceptable. The guys aren’t used to having a female presence out here, but I will make sure they treat you with respect,” Hal said apologetically.

“Thanks,” we said. It was nice to know he cared. I knew Greg and Mike, Becky’s husband, would appreciate someone like Hal looking out for us.

Hal dropped me off at the Operations Center (OpCen) where I met Ivan, the intelligence sergeant. He took me up to the roof and pointed to all of the surrounding villages and told me they were all filled with hostile forces, with the exception of one. He instructed me on how to ask basic questions, in order to gather intelligence from the patients I would be treating in the clinic. “You’d be surprised what you can get out of people by just asking such basic things,” he said.

“I never would’ve imagined,” I acknowledged, as I took note of what he said. He explained this region had been a Taliban safe-haven for many years and just recently we had gotten control over it. So, naturally there were still a lot of locals who supported our opposition.

“Expect the firebase to get attacked on an almost daily basis. Usually it’s not that big of a deal, but I want you to be prepared,” Ivan continued to explain.

I thought of the conversation I had with Bob back at BAF, telling me we may be asked to assist the team if we got attacked. “What do we need to do when that happens?” I asked.

“The biggest help you guys can give us is manning the radios and the camera while we take a wall. Sometimes you can locate the insurgents on the camera and you can call the coordinates to the mortar pit.”

“Ok, got it,” I replied. Everything I had been told in preparation for coming there had been true. All of the strange looks and the “They’re sending
you
there?” comments we got back at Bagram, when we told people where we were going suddenly made perfect sense. I could feel goose bumps on my arms.

After my briefing with Ivan, I met the senior medic, Kyle, and instantly got bad vibes from him. He came across as arrogant and overly confident, which is a dangerous combination in medicine. He hadn’t been feeling well, apparently due to eating the food prepared by the local cooks.

“I’m sorry to hear you aren’t feeling well, what are your symptoms?” I asked.

“Well, obviously I have gastroenteritis. I have generalized abdominal pain and intermittent episodes of diarrhea,” he explained with extreme confidence.

“That sucks, how long have you been suffering from it?”

“It’s been a full twenty four hours, pretty serious stuff,” he said, “I am just finally getting over the worst of it. Pretty much everyone here has had the same symptoms.”

“Do you know if everyone is washing their hands? Poor hygiene can make things like this turn in to a widespread problem,” I offered.

“Of course I thought of that!” he snapped.

“Great, I am glad you did. Have you gone to the kitchen where the food is being prepared to see if there is an obvious reason why this is happening with everyone?”

“You have no idea how things go out here, I have it under control,” he scowled. He was very territorial and didn’t want me or anyone else coming in and telling him how to run
his
show.

“I’m glad you’re taking care of it,” I said, as I walked away feeling a discomfort in my gut that was not at all due to the food…this guy was not going to be easy to get along with.

About an hour after meeting him I was in my room unpacking, when he came in with a “patient” for me. The patient was of course complaining of diarrhea, like everyone else, so I asked him all of the alarm questions which, if positive, would lead me to believe it was a bacterial infection requiring treatment with antibiotics, instead of the typical viral or toxin-induced diarrhea. When all of his answers were negative and he looked fine, I offered him symptomatic treatment and educated him on proper hydration and letting it run its course.

Shortly after the patient left I realized I had been set up. During the time I was talking with the patient, Kyle decided he would “critique” my work. A nationally certified Physician Assistant was being “evaluated” by a medic.

“After listening to you question the patient, I feel you should have dug deeper in the history. You could have really missed something,” he accused.

“Really? Well, Kyle, what would
you
have asked differently?”

“Well, uh, that’s beside the point,” he avoided.

“How so?” I challenged.

He quickly resumed his accusations, “Given the patient’s history, I personally would have started him on antibiotics, regardless of whether they were necessary or not.”

This was the
wrong
answer. I began to get irritated and defensive. I explained again to him the statistical evidence of diarrhea, the signs and symptoms of a bacterial infection and why it is wrong to use antibiotics so freely. I recognized the possibility of traveler’s diarrhea (a short course of loose stools that affects people traveling internationally) which, again, is often self-limiting and unless the symptoms are severe, it is not necessary to prescribe antibiotics. I then pointed out that our people were experiencing a day or two of mild symptoms and then they were fine. This sparked a huge debate.

“You don’t know anything about how we do things out here. We have to keep the boys in the fight, that’s the goal,” he strongly expressed.

“You know what Kyle, you’re right, I don’t know how things work out here, and I see your point of keeping them ‘mission-ready,’ so what is your regimen?”

“Well, it depends on the patient,” he replied. Again…
wrong
answer.

“No….if you are going to treat someone with an antibiotic, you need to do it correctly.” I was furious by this point. I was trying very hard not to lose my cool, but I could not believe the total lack of respect from him. As the discussion became heated, we decided to take it up to the roof to hash it out. We talked in circles and I realized he didn’t want a solution as much as he wanted to get a rise out of me to see where I stood and what kind of a “threat” I would be to his “show.” I had not anticipated this type of hostility from one the guys, but I imagined it would not be the last time Kyle and I would disagree. I knew I had to maintain my responsibility to practice safe medicine.

Surprisingly, once we finished arguing, we had a decent conversation and he explained the importance of their mission and specifically, the region we were in. He explained that because the people were so easily influenced the main fight was not on the battlefield but more in winning their hearts and minds despite all of the lies the Taliban tried to feed them. “Do you have any idea how difficult it is to turn an Islamic man against a fellow Islamic man?” he asked. I wondered if it was even possible. It was disheartening to see how much their religion - something the people held so sacred - was being used to manipulate them into doing unthinkable things. He then went on to explain the importance of the information we would be gathering by interacting with the people in the clinic.

I had to say that after our talk I did feel better, but I was still disappointed in how the first day of many at the firebase went, especially with how well I meshed with the other team I was with. I hoped it would get better; otherwise, it would be a long four months. They had a mission scheduled the next day. Due to our vulnerability with them gone, Becky and I would not be seeing patients in the clinic while they were out. Instead, we would man the radios in the OpCen. I said a prayer that night that nothing bad would happen, but I had a feeling deep in my gut something would.

27 June 2008

We woke up at 0330 to pull radio watch for the guys while they were out on their mission. It was expected to be relatively short, the team arriving back to the base early that afternoon. The team commander, Curtis, said he did not anticipate any contact, but cautioned the guys to be on the defensive as always when they traveled through hostile areas. They rolled out about 0430 and the day began.

I sat and watched as Becky gave me the rundown on how the radios worked and the standard operating procedures. I also learned how to operate the surveillance camera, which was quite impressive. I found myself somewhat overwhelmed with everything; having never seen or operated any of the equipment before, but Becky reassured me eventually it would become second nature. The morning was pretty quiet early on, filled with OJT on radios, conversations and the occasional Sudoku puzzle. Around 1030 the team got into their first firefight. The Taliban tried to ambush them and had placed a roadside IED along their route. Luckily the guys identified and destroyed it and engaged the enemy without injury. As the day went on, they got into several more fights and requested Close Air Support (CAS) several times for assistance in taking out the enemy.

During one encounter, a Rocket-propelled Grenade (RPG) took out an ANA vehicle and injured two of the soldiers inside. The report came over the radio: “We have one casualty with a gunshot wound (GSW) to the hand, and another with multiple GSWs to the chest.”

“We should hear the 9-line medevac request soon,” Becky said as we stood by the radio waiting anxiously for the next transmission. After a few minutes passed, it came.

“The patients have been stabilized, will maintain position and proceed to the firebase for medevac. Over,” said the voice over the radio.

“That doesn’t make any sense; didn’t they say there was a casualty with multiple gunshot wounds to the chest?” I asked.

“I thought that’s what he said,” Becky answered. We looked back through our notes in confusion. The transmissions were intermittent and it was unclear what the status was with the patients, other than they were temporarily stabilized. For the next couple of hours, the team continued to engage the insurgents off and on. Becky and I sat on edge as we listened to their every word.

Along their route home they intercepted radio traffic from the enemy. We heard the radio operator’s instructions come over: “Firebase, be advised, we anticipate enemy contact just east of the firebase, request for recon of this location with surveillance camera.” We both ran to the camera and looked in the location they suspected, but we couldn’t see any sign of activity.

I felt so helpless, imagining what they were going through; knowing somewhere, very close by, someone was waiting to attack them. We couldn’t do anything but watch and wait. We watched with the camera as the trucks approached the gate, all of a sudden we heard a loud BOOM!! We scanned the footage on the camera and saw where an RPG impacted near the trucks. At that point the entire situation turned into chaos.

“Base! Get the medics out to the clinic to receive our casualties!” the voice screamed over the radio. Becky and I jumped up and grabbed our things and started to head out, all the while hearing constant gunfire and RPG explosions right outside the gate of the firebase; and right by the clinic. As we hurried out the door, one of the guys who had stayed back with us came running after us.

“Becky! Stay here! I need you to man the radios. Jenn, go down to the clinic without her, I’m heading down to the mortar pit!”

What the
??? I had no time to react, I just ran across the base as fast as I could, over the rocks, praying I wouldn’t get hit as I heard the horrible booms and bangs of combat happening all around me. Once I got to the clinic, and inside the door, I ran to the trauma bays and made sure they were prepared to receive our casualties. I found myself running back and forth between the bays, frantically trying to prepare any and everything I might need, yet my emotions were so heightened, I couldn’t think straight and found myself having to retrace my steps several times to make sure I didn’t forget anything. And then….it happened. BOOM!!!

The explosion was so loud, and so close to the clinic, that it shook the entire building. In that instant; a moment that consisted of mere seconds, the most profound thing happened to me. I jumped off of the ground, with the most incredible fear I had ever experienced, and as soon as my feet hit the ground an unexplainable calm came over me. It was like someone flipped a switch in me that turned off all of the irrational thoughts provoked by fear, and turned my logic and common sense on. I remember telling myself, “Jenn, don’t do this, not now. Get it together and do your job.” That was all it took… I was in the zone. I can’t begin to explain how it felt to go from feeling I could die, to being focused on the task at hand with such clarity; it seemed I had been doing this for years. The minutes seemed like hours, but I was ready to receive whatever came through the door.

Eventually the booms stopped, but were quickly replaced with the banging on the door to the back entrance to the clinic. As I walked to the door I replayed everything I learned in my training about inserting a chest tube and controlling bleeding from blast injuries and gunshot wounds. I was ready for whatever was behind the door - or so I thought.

Expecting to see our guys when I opened the door, I was shocked to find a truck filled with local nationals who had been escorted in by the ANA. In the backseat I saw a child lying in his blood soaked clothes with his father beside him, screaming frantically at me in Pashtu to help his child. I found myself unprepared and completely caught off guard for this situation.
Where were our guys? Were they a triage priority over this little boy? Where was a Terp to help me understand what they were screaming at me?
I was expecting multiple gunshot wounds to the chest and a hand wound! I stumbled through my thoughts and I looked to my right and saw the HMMWVs and Kyle (my most recently acquired nemesis) standing outside. I waved him over to get some clarity.

“Where are our casualties?” I yelled.

“They haven’t made it to the base yet.”

“What about the patient with the chest wounds? Is he still stable?”

He looked at me with confused eyes and said, “What are you talking about? We don’t have anyone shot in the chest. We have a leg wound and a hand wound.” I felt instant relief despite my confusion.

“Help me carry this boy into the clinic so we can assess his wounds,” I said. Despite our previous confrontation he quickly ran over to assist. Becky quickly joined us and together we got the boy inside. Once he was on the table, I cut away his clothes and was able to see the extent of his injuries. He had a wound in his right upper abdomen from an RPG that was deep enough that it exposed part of his liver and bowel. The entire left side of his abdomen was rigid and distended leaving me to believe he had significant internal bleeding. Thankfully all of my emergency room experience surfaced and we stabilized him in textbook order. It was quite a sight to see. Becky, Kyle and I; three strangers just days ago, now working in harmony as a team to try to save this boy.

“Becky, I need you to control any external bleeding, get IV access and wait for my order for medications,” I instructed.

“I’m all over it,” she answered.

“Kyle, elevate his feet. Let’s try to keep him warm; we don’t need him going into shock or developing hypothermia.”

“No problem,” he replied, “I’m also keeping a log of vital signs every five minutes and will let you know if there is any change.”

“Great, thanks.” I said. “Becky we need to give him a fluid bolus, but it needs to be calculated on his weight.”

“Alright, I’ll get it ready,” she quickly answered and ran to the pharmacy to get the fluids. Hal came in and began to take down the necessary information for the 9-line medevac to get the boy back to the surgeons I had just left at TK.

“Just so you guys are aware, the two ANA patients are stable and ready for medevac,” Hal said.

“Ok, it was a hand and leg wound?” I asked. I looked up as I prepared the medications for the boy.

“Yes ma’am, all superficial, the bleeding is controlled and dressings applied,” he said.

“Nice work Hal.” I said.

It was interesting to watch Kyle in this situation. Mr. “Know it All” from the day before completely backed off and watched me run the show. As time passed, I became increasingly concerned for the boy due to the extent of his wounds and the high risk for infection, given the nature of his injuries. I could see his bowel was clearly perforated, which meant he now had feces in his abdominal cavity and the potential for him to decompensate quickly was very real - whether it be from respiratory distress or hypovolemia (low blood volume). I knew if we didn’t get him out soon we would be in a situation none of us wanted to be in. We managed to keep him stable and comfortable for the next hour until the medevac helicopter landed. Once the helicopter arrived we loaded him, and the two stable ANA casualties on board and it was over.

After cleaning the blood off of the equipment, putting the clinic back together, and prepping to receive whatever else was out there, we went up to the OpCen for the After Actions briefing. We sat and listened to the details of the mission and report of the estimate of the enemies killed in action (KIAs) being in the thirties. As I looked around the room at these men, I sensed relief that it was over, but the hunger for another fight was behind each of their eyes. I couldn’t begin to comprehend the mentality it took to be able to do what they did every day.

When the meeting was over, I got up quietly, walked to my room with Becky following close behind, both of us knowing what would happen next. We closed the door and collapsed in each other’s arms and I finally cried.