Battle For Mosul

Preface:  I wrote this while I was in Mosul in 2010 in Nineveh.  Now with the Battle of Mosul raging I thought it was again appropriate.


The glamor gone, the days go on and the rain, the ground does drench
Cool morning walks, 3 and one half blocks, to the gym's stuffy smelly stench.
But the run is great, makes me appreciate, the time I have on my hands.
Though the mud is deep, it makes good clay, for me to be in the potters plan.

Ancient town, now I'm in, the town where Jonah saw
His deep disdain just melt away after heeding heavens call.
Now today, 5 times a day, Islamic tongues now low
And conflict raises in my heart as it did in Jonah's soul

Why do they want to kill each other, like animals they prowl
And proclaim, "In Allah's Name" but instead the demons growl
But God is great and back then he gave compassion unto Jonah
And still today He loves all those that live in the mud of Nineveh

Fear

I picked up a new book of memoirs written by MAJ Dick Winters from the 101^st easy company.  I read the preface and then later that evening found myself looking for a movie about surgeons in war.  I realized that I was longing for something specific.  I was longing for someone else to share my experience with.  I was looking to see if anyone had depicted the experiences of a combat surgeon.  Depressingly, I found several text books on combat surgery and educational material on surgery and the history of surgery, but never on memoirs of a combat surgeon. 

There are elements of deployment that anyone who has deployed and only those that have deployed can relate.  And as I have said previously, there are many things that my combat arms brothers share that I will (Lord willing) never experience.  These things make them a club unto themselves, a band of brothers.  Us medical corps types, although greatly appreciated remain outside of the circle.  But likewise, there are things that we experience that they will never experience…. save maybe the combat medic.  And even within the medical team, the surgeon alone bears tremendous burden and responsibility.  We are put on a pedestal.  We are expected and counted on to save the soldier.  If the solders survive long enough to make it to the FST, they are expected to survive.  They place their full confidence and trust in us.   It is with this sacred trust that they go out confidently into harm’s way, knowing that we stand ready, always.  And we surgeons, must always reflect that confidence to them so they know we are ready.  But here lies the problem for the surgeon.  We are human.  And in the moment that only the surgeon can see the laboriously exposed injury in the abdomen, or chest, or pelvis, and the surgeon is the only one who knows what must be done, do they have the commensurate skills to accomplish the task.  In that moment, the answer will be yes or no.  And if the answer is no, the soldier dies and the combat surgeon dies inside.  Every time an alert of a casualty comes through the lines of communication, the surgeon knows that once again he will face this painful, humbling question.   I must admit, it is out of fear of this question that, at present, motivates me to study.   And this too frustrates me.  I have told others that God has made them for a purpose and when they find that purpose, there is great fulfillment in honing their skills to better fulfill their purpose.   This creates a positive cycle that further motivates them to get better and better, as they feel more and more fulfilled.  But for me now, I am feeling more fear than fulfilment.  This fear I know comes from insecurity.  And this insecurity comes from placing my trust in the wrong thing.  Earlier this year I counselled one of my senior residents about this very thing.  He felt that the only way he could rest well was if he knew all the right surgical answers. My advice to him then, I now need.  I told him I thought it was interesting that, as smart as he was, why would he think that seeking all the right answers to the little things would bring him comfort, while leaving the truly important questions unanswered?  The question is true for me today.  As I, motivated by fear of not knowing how to face a problem, study, miss the answer to the question my heart is really seeking, “God, will you take care of this soldier through me?”   And the answer to this question is always a resounding yes!!!!!    That’s why the Paul emphatically writes to Timothy in 2Tim1:6-7, “For this reason I remind you to fan into flame the gift of God, which is in you through the laying on of my hands, for God gave us a spirit not of fear but of power and love and self-control”.

This is the struggle.  And my heart wants to connect with others that have experienced this too.  But as I read this, I realize that this is a struggle for all that are afraid.  Our fear is rooted in insecurity.  And our insecurity comes from misplaced trust; trust that is not rooted in God but rather in smaller things.

"But seek first the kingdom of God and his righteousness, and all these things will be added to you." -Matt 6:33

Reserve Parachute

There is nothing new going on at this point in the deployment. Things are very very routine now. This is the point in the deployment where it is what you make of it. You can squander time away waiting for the next day and the next day until the deployment ends. Or you can make the most of each moment.

I know that my experience here is much different than most of the soldiers' experience. They are out kicking doors in and supporting those who do. I have often described my job to those soldiers that see me sitting while reading on the front porch "doing nothing" as being a reserve parachute. I remind them that the soldiers' reserve parachute is hardly ever used, but when it is, it always saves your life.

Immigration and Friendship

There has been much bitter debate recently concerning this temporary ban on immigration from 7 countries that President Trump signed by executive order. I have even lost a friend over the issue after he told me to seek counseling because I clearly was not thinking right to hold the opinions I held. He then insinuated my thoughts must be clouded by PTSD. Yes he did fit the stereotype of a young professional in Los Angeles in the acting business. So what should I expect? But is was sad. It was sad because we went to the same church in junior high and in high school. He had been out to our ranch and been friends with the family for a long time. And then, just like that, he told me he didn’t want to dialogue with me on any topic or in any medium. I have been thinking about his last post all day. Fortunately, I have the time to think about it (normally if this happened back home, my life is too busy to allow myself to dwell on things, and I just cut weight and move on….right or wrong that’s what I do…..I know that is horrible).

Some of the things floating around in my mind are: was it so important to convey what I thought was truth, that it caused the relationship to fracture? Does the perception of “friendship” sustained by cyber stocking “friends” out of curiosity even constitute real friendship? What is the Christian response to the immigration crisis? Is the world coming to an end?

Now I know I have a penchant for worst case scenario stuff, so I will let the “is the world coming to an end” question have a by and not consider it now.

Instead I will address some of the others. I think one of the keystone questions is the second, “Does the perception of “friendship” sustained by cyber stocking “friends” out of curiosity even constitute real friendship”. Friendships are very complex. They require time and attention. They require love, compassion, empathy, and commitment. Interestingly facebook does not make those prerequisites before you “friend” someone. In truth Facebook is bastardizing the term friend and cheapening it to the point of meaninglessness. In my scenario, I was hurt because at one time we had been friends, and through facebook, the illusion that we were still friends created the sense of friendship. But was it friendship? I don’t know. What if I see him again? Will I not be kind and try to pick up where we left off (last time I saw him was at my friend Jason Ofner’s wedding in Hawaii). I imagine so. But what about him? I can’t control how he will respond. And he clearly doesn’t want me to contact him any more….he made that extremely clear. So I am left still with the question of, “What is a cyber friendship?”

It is a peculiar thing. Some people have lost marriages over cyber friendships. Those friendships lead to physical friendships. And then on and on, or down and down. And I guess right now I don’t even really care to define what a cyber friendship is, because I have already determined that it is definitely not an actual friendship, but it can carry trappings of actual friendship along with emotional baggage if you get “un-friended”, or at least it did for me. Now, there are plenty of people that I am cyber friends with that I wouldn’t care at all if they unfriended me. But this situation did sting a bit. But now on to the “why” of my un-friending.

What to do about the immigration crisis? I read an article by a Wheaton grad in the Huffington post about what a Biblical response to the crisis should be… the link is here:

http://www.huffingtonpost.com/entry/the-immigration-ban-and-the-refugee-crisis-a-bible_us_588ec859e4b0de286b25750e

I felt like it was a classic Christendom response: Give a few verses that support a presupposition and voila, It is unbiblical to put a 90 day suspense on immigration from 7 countries.

There is no doubt that I am failing at living out the great commission. There is no doubt that I am failing living our Matthew 25. There is no doubt that I do not love my neighbor as much as myself. I am failing, failing, failing. Jesus told me unless you sell everything and give it to the poor and follow me, you are not worthy of the kingdom of God. And he is right! Amen! Hallelujah! I am an utter failure. So this immigration thing is just one more thing that I am failing at. But I cling like leech to flesh to Romans 8:1 “Therefore there is no condemnation for those who are in Christ Jesus” and Romans 6:23 “For the wages of sin is death but the free gift of God is eternal life”, and John 3:5 “ Truly, truly, I say unto you, unless one is born of water and the Spirit, he cannot enter the kingdom of God.” To me, there is nothing I can do to be good enough. Likewise, there is no amount of bad that I do that his grace cannot overcome. But the operator, life giver, redeemer, is Him….not me. I can go down to a river and say all the good things I need to say before man and dunk myself underwater and look like a good person, but if I am not “born of the Spirit” too, I am nothing. Just as in Matthew 25, the guys that were good but God cast them out…. they were not born of the Spirit. So how do I get “born of the Spirit”? That is up to God. Again, I cannot do it to myself or make myself good enough for the Spirit to live in me. If God wants me to be born of the Spirit, I will be born of the Spirit. I have no more control than an actual baby has control over his being born. Just like a baby, you are either born or you’re not. And the only way to know the difference is to start living. And if you live, you were born.

So how the heck does this all apply to immigration? Well like this…. Yes, you need to love your neighbor. So the natural question that follows is: Do you? Do you love your neighbor? It is so easy to post strong opinions on the internet about how Christians should not support Trump because he is banning Muslims. And that banning Muslims is wrong and not loving. But I have already confessed to the fact that I suck at loving anyone besides myself. So what about you…. oh righteous ones that are soooo filled with political love for Muslims that are getting a 90 day temporary hold on Visas do you love your neighbor. I mean the one who lives across the street from you. The one next door to you. The one in the cubical next to yours. Do you even know their names? Would you even know how to ask if they were to need something? Would they come to your house to ask because you have made it so obviously clear that you care about them? Or do you, just like me….pine away at your keyboard and solve all the world’s problems from your LCD screen? Oh if the world would only see things your way….then we would live in a utopia. It is time to Love our neighbor. That’s what Jesus said, so start doing it Eric. Then you can worry about the people millions of miles away from you.




Dang…. I thought I was all done and was proud of myself, then I started thinking of all the ways people could criticize this. One : its too simplistic…… if you just act locally and are not involved with the political process, then Nazis will take over and send you to the gas chamber. Well I guess that could happen. But the questions I have are these: 1- did I exercise my right and vote (yes). 2- do I see atrocities being committed (well not by the current administration…..just by Muslims in Afghanistan). 3- when would I consider civil disobedience (hmm that’s a hard one because the Bible basically says how the end will go, and it’s not going to be pretty….so, ….. is fighting going to postpone the inevitable?) So overall I think I am OK with not flying to JFK and protesting…. especially because there are many people who need to be loved right where I am.

Two: your view is pretty fatalistic: I guess it kinda is. I won’t pretend to know the answer to the predestination vs free will thing. But I do know that Jesus said to love others and I try but I suck at it. And even Paul said he was bad at it and called himself the worst of sinners. And Peter pretty much sucked at it and disowned Jesus. And King David sucked at it and slept with his neighbors wife and then had him killed. So if they can try and then fail, so shall I try and also fail. And the result will be the same. I am condemned to die and only by God’s grace through the free Gift of Jesus Christ do I have eternal life.


Now I am going to bed.... Thank you Jesus for all that you have done for me. Please be with my Wife and children as they are at home. Please help my Wife study hard and do well on her upcoming test. Please let my children be a joy to you. Let them grow in the knowledge and understanding of your Word. And that your Word would be written on their hearts. Please encourage my wife and strengthen her to meet the challenges You place before her. Protect them from the evil one and lead them not into temptation. Thank you for all you have done for me. Thank you for my family (Dad, Mom, Brother, and Sister and their spouses) Please be with each of them and bring them the Joy of the Lord to be their strength. In Jesus Name. Amen

Moments

Missing home. Thankful for a good unit and command.

Tired of ILE. Glad to have my own space.

It rained all night.Brisk cloudy and wet outside, but thankfully not dusty. Good visibility. Muddy. Glad for electricity. Don’t feel like running today, but feel lazy for not running.

Thankful for hot coffee. That is all.

Simple Times

There are a few things that are unique to deployment that I have found over my last several. This evening I was reflecting on how simple life can be on deployment. Now I don't mean simple as in "easy", but rather as in "not complicated". I know this only to be true to my role as a surgeon prepared and waiting for my expertise to be employed. Many other soldiers here have vastly different experiences and would hardly classify their deployments as simple. But for me life here is simple. I have one purpose, to prepare myself and my team to take care of the injured. Now that purpose has many manifestations: training my medics, upkeep of the FST physical structure, checking equipment, and checking refrigerator temperatures for blood products. But all of these things are singular in focus for one mission objective - take care of the injured. But there are other things that some would consider intolerable that actually help simplify life here, namely the austerity. There are very few options here. There is no time spent standing in front of a full pantry wondering what I "really" feel in the "mood" to eat. Likewise the closets aren't full of choices of clothes to wear. There is no determining where you will go or how you will get there or when you need to fill up the gas tank. You will always be with the team on the FOB. And if that FOB happens to be only 200 meters by 200 meters, then there is not much decision of where you will be at all. (Its like a kid deciding where in the classroom he wants to sit). And the list of stripped away complexity goes on and on. All of this simplicity by many is interpreted as suffocating and intolerable. Those people are very unhappy. The byproduct of this simple or austere lifestyle is time... the most precious commodity. I was reminded this week with some somber news about a family friend that time is never a guarantee. Some people who seem to have plenty of time get none and those that seem on deaths door occasionally get more than expected. What am I doing with my time? Am I loving my wife, kids, family..... God? Often, I find myself not even thinking about how I am spending my time. Like someone running through a mall and just sliding my credit card through random credit card readers while not even thinking on what I am actually spending my money. The only reason that I am able to take time now and ponder on all this is because of the forced simplicity that I am living right now. And while my life is increasingly simple, my wife's life is increasingly complex. And all this time here just adds to the debt that I already owe her for the 3 other deployments where the same happened. Meanwhile, the kids are growing. They are getting bigger every day. Each day I pray that God would guide them toward himself and that His Word would be written in their hearts. Before I left, my 3 y.o. son told me after having been spanked and put in his room for open defiance of his mom and dad, that he talked to Jesus and Jesus would make him feel better. My heart burst open! My Savior loves my son. He loves all my kids! In the afternoon and evenings here, after getting ILE (Intermediate Level Education for the Command and General Staff College) stuff done, I have been reading the book Bonhoeffer by Eric Metaxas, while drinking hot cider (thanks for the cider mix) and listening to classical music. I thoroughly enjoy that experience! Not only is it a great book about a great man, but I also get TIME to reflect on my life and my life's purpose. I think about how I fit into my family and my extended family. I think about lost opportunities for connection and strategies for regaining those connections. And in those moments I also recognize my own failings. I realize I don't pray enough, or read the scripture enough or meditate on them enough. Those are the things that will keep me on course and help me navigate through difficult times to come. If I am granted the blessing of time to come.

One More Time Into the Fray 2016-2017

Well, here I go again. One more Christmas and New Years in Afghanistan. This will be my first deployment to a region I have already been. However I am sure that things will be much different. 5 years ago, I was over here and now I am back. The process of getting here was familiar as ever, but I had blocked out some of the more unpleasant aspects of preparing and then leaving. The two hardest things were the packing the night before leaving knowing that these were the last hours I could spend with my beloved wife. All we both wanted to do was pause time and allow us to celebrate our anniversary without a deployment hanging over us. So instead we drank champagne while I packed my duffle bags. Happy Anniversay....

I had clearly forgotten how long the flights to get to the Middle East were. That was completely blocked from my memory. However it is strange how I could dislike something so much yet find comfort in the familiarity of it once it was again experienced. For many of my travel companions, this was their first deployment. These were all new bewildering experiences that were contently disrupting any sense of normalcy that one may have had, like waves crashing against a poor soul struggling to get up and out of the ocean surf. But for me, the comfort of knowing what to expect (even if it was knowing to expect suckville) and the assurance of knowing that God had me at the center of his hand, allowed a relatively smooth and even fun transition to deployment. At times I even felt like a tour guide..... "and now ladies and gentlemen, in a few minutes we will stop and off load all our gear for no apparent reason just to load it back on again for some reason.... happens every time....oh yeah and there are no bathrooms at this stop so please pee in a bottle or hold it." At least I knew what to expect and it helped others not get so bent out of shape when those ridiculous things came. And I was very pleasantly surprised when for the first time in all my trips we stopped in Ireland! I had heard many of my friends talk about stopping there, but I had never experienced it before. And now .... at 3 am, we were in Ireland. So cool! Even if all I saw was the airport. It was so neat to hear their accents and fortunately there are some pretty cool pub owners in the airport that kept there place open all night for us.... which is where I had the best burger I have ever tasted in my life..... it even had a fried egg on it and some sort of sweet jam and sizzling bacon....oh so good!

The one rookie mistake that I made was forgetting my power converters....darn those European plugs.... fortunately some of my battle buddies remembered theirs and I powered up all my devices for the next 6 hour leg.... ugh. From there it was on to Kuwait and then another flight to Afghanistan and a few days wait in a major city before taking a puddle jumper to my new home. see the pic from my puddle jumping window....

The further and further I went out, the more body armor I noticed everyone wearing...we are definitely not in Kansas anymore Toto. At this phase it began to sink in that we are really still at war. And guys are really fighting and bleeding and dying for the cause. And it is my job to make sure the latter two are stopped short. Then after a week of travel the day before Christmas eve me and my ortho buddy arrived at our new home...

And met our new team, facilities, and a few interesting people....

The we learned that inorder to get into the DFAC (Dinning facility) you have to do pull ups...

And that the only place to "do you duty" was ....

.... I literally had to stop someone from going in just so I could snap the picture. But all in all I is a great place and has a nice gym and obviously internet connection (since I am able to continue this blog). So on Christmas the guys of my FST tried to make it as much like home and they cooked gingerbread pancakes and bacon....the XO is an awesome cook from New England....

So that's about it for now..... I will leave you with just a funny story that happened to me today in the gym. Every day I run about 3 miles to try to stay in as good of shape as the warfighters out here....each of them is like a college athelete! When they aren't on a mission, they are either eating sleeping or in the gym. So anyway, here I am in the gym running with these guys. And they like tough-guy music....Metallica, SlipKnot, Alice in Chains....etc. So we are all in there together tough music playing and heavy lifting of weights and the whole bit..... and as I am running and listening to my music, I smile and laugh a little cause they can't hear what I am listening too in my earphones.... I know that everyone assumes I too am listening to tough guy music. Little do they know that I am jamming out on my 5th mile to Amy Grant's "Lucky One". Well, that's it for now from Helmand.....

Random...the home stretch

Here are a few random shots .... home is coming soon!!! Praise GOD!

Seasons Greatings

Hey there everyone!

I just wanted to say thank you to all of you who have sent me care packages for Christmas. The weather had been bad recently so a lot of the mail had got stuck in Kandahar, but today I got a bunch of boxes from friends and family. Its like a late Christmas. I was busy in my room this morning opening all these boxes filled with thoughtful gifts and cards. I love you all.

Christmas here was good. I tried to pack as much in as I could. I played the piano and sang at the Christmas Eve service at the Chapel (see the pic below). I stayed up all night on Christmas Eve and manned the TOC so that the people who normally do could have a night off. I called home. Then the next morning (Christmas Day), again I played for the praise and worship team for both the 11 AM service and the 9AM Service and I preached at the 11 AM service. Then I crashed for a few hours. Then I woke up and manned the TOC again all night on Christmas night. Needless to say, by Monday morning I was exausted. But I felt that I had given all I could so that Christmas could be special even in Afghanistan.

Merry Christmas everyone and may God bless all of us as we seek His will this coming year.

The Christmas Season

It can be hard sometimes to get in the mood of the holiday season when you are surrounded by rocks and dirt and can only wear a uniform. But I am not letting those factors get in the way of me celebrating this awesome Christmas season. In fact I have never been geographically closer during the holiday season to where it all went down 2000 years ago. So thank you to all of you that sent care packages for Christmas. From candy canes, stockings, baby Christmas trees, fudge, truffles, gum drops, Christmas Coffee, and the like it has all served to brighten my days and the days of my fellow tent mates. So here are a few shots of the Christmas joy around my Middle East World.... I love you all.

Meaning

Here I sit at half past 2 in the morning, listening to the playlist on my sister’s blog. Tears come to my eyes as I listen to the music. Aim so blessed. I look over the pictures on her blog and see the smiles and the kids and warm embraces. The family that I grew up in is now grown. We are scattered all over the globe. Christmas will be different this year. I see the smiles of my own kids in my mind. Life has taken the innocence of a little boy and in its place left sweet memories of growing up. Now I see the wonder of innocence in the eyes of my own son and daughter. And I pray that I can be as good a parent to them as were my parents to me. I dream about my family at night. I can hear my wife’s voice. What did I do to deserve such abundant blessings? Life is frighteningly short. From swaddling to crawling to walking to running and falling it all passes quickly. This war reminds me that some things are worth dying for. But some die too soon; life slipping through my hands and my heart. Like a broken glass, Lord, fill me.

Resuscitation

Well the last 24hrs was a blur. It was a peaceful Sunday night and I was just about to change out of my multicam uniform and into my flannel PJ pants and T-shirt when there was a pounding at our tent door. My tent mate opened the door and one of our young specialists was at the door. “Hey, there is a GSW coming in from the gate. It’s an Afghan who was shot in the chest,” immediately came out of the young soldier as the tent door swung open. “Great” sarcastically mumbled my anesthesia buddy from the room next to mine. “Hey Weaver…did you hear that”, I called out as I reluctantly put my multicam pants back on. “Yep,” replied the sleepy voice of my anesthesia buddy.

As I walked out of my tent, there were a few of the new soldiers that had just arrived to the FOB to relieve some of the guys that had been here for 360 days, walking around. “You ready?” I asked them. “Ready for what?” they replied. “GSW to the chest in 15 minutes” I answered. They had only been on the FOB for one full day and they had never deployed before. Their eyes were as big as saucers as we all headed over to the hospital.

As I walked in to the hospital, my best friend out here (the orthopod), asked if I had heard about the trauma coming in. I told him what I had heard and went to the ER to get the trauma bay and medics ready.

The medics were in their place and I, as I always do, began running through a mock scenario of what we were about to see. I ask them “if…fill in the blank… happens, what will you do” type questions. It’s like a little warm up to get them thinking in the right direction.

Before long, the patient is being unloaded from the field ambulance (a modified humvee) and brought into the trauma bay. He is soaked in blood. Blood is dripping from his blood drenched pants, which were the only thing he was wearing at this time. The translator immediately starts peppering this 35yo guy with questions to get an assessment of how “with it” he is and if he has any medical problems. The patient is barely conscious and his vital signs reveal that he is about 10 minutes from crossing over to the other side….so to speak.

The medics get IV’s in place and draw blood work, while the rest of the team quickly evaluates the patient like a NASCAR pit crew. There is a large exit wound about the size of a kiwi in the middle of his right clavicle. Blood is welling up in this cavity like someone had left a water fountain running with a clogged drain. We shove a large curlex roll into the hole and I let the team know that we need to be in the OR now.

I head back to the OR to talk to my head scrub tech (who also happens to be in a Bible study with me) and let him know that we are going to need the major vascular set open and possibly the thoracotomy set too. He calmly says, “No problem,” and continues to get the sets opened, counted and ready.

Justin, my ortho friend, asks if I will need him to help. “Yeah, that would be nice.” I let him know. And we both go back to scrub our hands. By the time that we are ready, the patient is ready too.

Long story short, we repair the lacerated subclavian vein, tie off some bleeding smaller arteries, and get him out of the OR to continue warming and resuscitating the patient. And he does great. The next day we take the breathing tube out and send him to a local Afghan hospital at 4:30 in the afternoon. That night I only slept 3 hours. It’s amazing what is involved in one small word….resuscitate.

In human physiology, resuscitation happens at the cellular level, and it has to do with oxygen delivery. Each cell in the human body needs oxygen to live. People breathe in oxygen and it gets transferred in the lungs to a certain kind of molecule in the blood. The blood carries the oxygen to the cells through smaller and smaller blood vessels until the vessels are so small that the blood can only pass in a single file line. When the blood cells travel by tissue cells that have low oxygen levels, the blood cells release the oxygen that they have stored in them to tissue cells that are literally suffocating.

The ultimate reason people die when they get shot is because a bunch of cells are suffocated due to lack of oxygen delivery. Now how does that happen? Well given the above information, if you don’t have one (or enough) of the following, you can’t deliver oxygen to the cells: oxygen, blood, functioning lungs (basically I spent all night “tweaking” these three variables to optimize oxygen delivery to this Afghan’s cells). Interestingly, if only a few cells die from lack of oxygen, the body can “deal with it” and make some new cells. But at a certain point, or at a certain number of cells, the body can no longer compensate for the amount of tissue that died, and the whole body dies too.

Now I know that Paul didn’t know all this when he wrote Romans 12 or I Corinthians 12. But I know that God did. You can have a greater understanding of God by looking at “His Image”… namely, by looking at human physiology. It is no coincidence that the Greek word for the third person of the Trinity is pneuma (πνευμα), "breath, motile air, spirit". Where there is no pneuma, there is no life! Where there is no Spirit of God you cannot have life; and where there is no oxygen or breathing, you cannot have life. Furthermore, where there is no blood, there is no life. Without Christ’s blood we cannot have eternal life.
Now an important distinction to point out is the difference between resuscitation, and resurrection. I am not in the professional business of resurrection (although there have been a few times in my life when I witnessed this happen in the OR or ICU….truly miraculous). But I more frequently deal with resuscitation. Resurrection is going from dead to alive. Whereas resuscitation, a tough word to spell if you do not know the Latin roots behind it, comes from the Latin root word cito, citare, citavi, citatum—to set in motion, rouse, excite, hence, to resuscitate is to ‘set (one) in motion again.

I spent the last 11 years learning how to physically resuscitate a human. I need to be as passionate and effective at spiritual resuscitation. One person who is great at spiritual resuscitation is my mother. She is like a DeBakey, or Mayo, or Hopkins of spiritual resuscitation. Spiritual resuscitation involves focusing people on the person of Jesus Christ and through prayer and Biblical teaching getting them to “breathe” again. Let’s hope we all “get this skill set down” before the final board exam… it’s expected of us.

Things I Miss

By far the hardest part of deployment is being away from my family:

Bath time

Movies on the couch with Kari after the kids are asleep

BBQ steak

Swimming with the kids in the backyard

"Exploring" the neighborhood with the kids

Bedtime stories with Ian

Coming home after work and Ian running to hug me as he raises his arms to have me pick him up

Watching Diego with Ian and Audrey

But most of all I miss the love of my life and anything we do together...I love you Kari

Angels Crying

Today was an exhausting day. I woke up to after staying up way too late to go over to the clinic and see some follow-up patients. These patients were Afghan army soldiers that we had taken care of after they were shot by the Taliban in the legs and abdomen two months ago. They were doing well. After fixing their intra-abdominal wounds, we had put external fixators on to stabilize the fractures and sent them for definitive surgery at a local afghan hospital. We found out later that they don’t have any capability at that hospital to do the definitive surgery that they need. Instead that hospital took them in, collected the money from the government to take care of them and after they were “stable” they got discharged from the hospital. The problem is that the hospital does nothing for the external fixators. They just leave them on! And then we see them back at 2-3 months after the accident and our eyes were like saucers to see the ex-fixes still on. The fractures don’t heal very well. But they are slowly healing. The ex-fix is not supposed to be the definitive surgery for these types of fractures.

Anyway, we were seeing these follow-up patients when the radio started blasting that there had been an IED explosion and 4 afghan locals were wounded. About twenty minutes later, they were coming out of the back of the Field Litter Ambulance… two kids, two adults. The first one out the door is an older female…she’s dead. The next one out is a stretcher with two kids on it. The kids were so small that they were laying with one head at one end of the stretcher and the other kids head at the other end of the stretcher and their feet didn’t even meet in the middle. There was a boy and a girl. The girl was about 5 and barely over 20kg. She was trying to roll over to one side but not crying or moaning. She had huge black eyes and abrasions over her face and head. Her left arm and leg are bent in ways that God did not intend. The little boy…a little smaller than the girl was crying (thank God for crying…it means that the airway and lungs are intact). I was almost as happy to hear that little boy cry as I was to hear my own boy first cry when they pulled him through the c-section incision when he was born.

I went busily to work on the little girl. ABC. A…airway; she was unconscious and could not protect her own airway if she were to vomit. She needed to be intubated (a breathing tube placed in her mouth and down into her trachea to prevent her from suffocating). The anesthesia providers went to work and easily intubated her. Next…. B ….breathing; they squeezed the ambu bag and her little chest didn’t rise, but we could hear breath sounds on both sides. Her O2 saturation was low but had come up slightly. We got a chest x-ray that revealed the problem ….she had air outside her lung that was collapsing her lung on the left. I placed a chest tube to release that air and that helped things a little bit. But still she had low O2 saturation…..think, think, think, what could be doing this. The x-ray showed that the tube was in good position and the repeat x-ray after we had put the chest tube in showed that the air was evacuated but what was I missing…..why was her O2 saturation so low……well her stomach was full of air, so we put a tube through her mouth into her stomach to relieve that air which helped, but she still had low O2.

I looked at the chest x ray one more time and thought about the mechanism of injury, then it hit me….pulmonary contusion! She had sustained a huge blast from the IED. That blast basically slammed her lungs into her chest wall causing huge bruising on the inside of her lungs. The only way to get more oxygen to the lungs was to increase the pressure of O2 in the airways. This can’t be accomplished with a non-cuffed endotracheal tube. We needed a cuffed endotracheal tube so that we could make a seal around the inside of the air way and thereby increase the pressure of the O2 in the airways. We did this and BINGO she started to get better…at least in regard to the breathing part.

A….dealt with. B….dealing with but improving. C…circulation. It is amazing how God makes little kids. During this whole event, her blood pressure was pretty steady and even appropriately high to help perfuse blood to her badly injured brain. Still I add a central line to the left subclavian vein to the mix to give us a fighting chance to be able to resuscitate this little girl.

Now how about the brain… What was I to do with the head injury? Clearly she had a horrible head injury evidenced by her “raccoon eyes” and non-reactive right pupil. I gave her a dose of mannitol that helps lower pressure on the brain but she needs more than that. She basically needs a neurosurgeon RIGHT NOW. In the US she would already be in the OR….not here. So we call the nearest neurosurgeon.
The response I get is chilling…no neurosurgical intervention for Afghan locals that come in to the ER with a GCS of 8 or less. That is the Clinical Practice Guideline (CPG) in theater.

The words hit me like a ton of bricks. The neurosurgeon on the other end is actually someone I know from back home in the states. He says he will take her if I think that the head injury is the only thing that’s wrong. He wants to help, but it has to be an isolated head trauma.

I wish she only had an isolated head trauma. I put the phone down and take another look at her. For the first time in the hour that we have had her, her vital signs look stable. I look at the repeated Chest x-ray. She has one of the worst pulmonary contusions that I have ever seen. She has blood coming out of her lungs and into the ET tube from the bad contusions. She has a broken arm and a broken leg. This is the opposite of isolated head trauma. I grab the phone again and with a frog in my throat I tell him thanks, but she is not an isolated head trauma. He again says sorry. I say, “I know”. And we hang up.

So now I have stabilized her but her brain will continue to build up pressure until it no longer functions, and I can’t do anything about that.
So now I check on the other two patients that are alive. The little boy is doing fine. He is crying and the nurses are taking care of him like he is their child. There is something remarkable about seeing an American nurse holding and caring for a child like that. It is as if they temporarily adopt the child as their own. But he is doing fine. He is just a bit bruised and cut up but he will be fine. The last patient is a 35yo woman who is 9 months pregnant. The baby seems to be doing fine, although all we can check is fetal heart tones which are appropriate for gestational age. But the lady has a bad contusion on her head and had lost consciousness at the time of the blast. She has a closed head injury and needs a CT scan to make sure she doesn’t also have a intracranial bleed like the little girl.
The people in charge of arranging medivac flights get the next call. We let them know that we have two category alpha patients that need medivac to the local Afghani military hospital. I am not going to let the little girl die in this hospital. I feel strongly that the Afghan people need to see and treat the consequences of the IEDs that their own people are making. Despite some push back from the transportation arrangers, my friend that oversees them arranges that both the pregnant woman and the girl get sent to the Afghan military hospital. I know full well that the woman will be OK, but the little girl will die in about 12 hours. I just hope that the parents, if they are still alive, will be able to be there before she dies.
After a few minutes, the flight medics show up and the sound of blackhawks preparing for takeoff fills the trauma bay. We package up the patients, securing all the lines and take them out the door on stretchers and load them on the blackhawks. A few minutes later, they are out of site on their way up north.
I sit outside behind the ER exhausted. I sit for a while and reflect on the situation that just presented itself to me, while picking up little stones and throwing them at a coke can that had missed the trash can. I was a confused mixture of tired, angry, sad, and relieved. I was proud of what the team accomplished. We had stabilized 3 very sick patients and got them transported. We fulfilled our mission. But ultimately we can’t do what the little girl needed. I reason with myself that even in the US this girl with her head injury and her pulmonary contusion (not to mention the broken arm and leg) would have been “touch and go” for a while. She might not have made it even in the US, let alone out here in 2nd century Afghanistan. My stomach starts to growl and I head over to my tent to meet my buddies for dinner.
After dinner, I went walking through the hospital when the commander walked up to me and said that the Special Forces guys have a detainee that they need to have medically cleared before they send him for interrogation. So we lock off the back of the ER (the same room those hours before we fought to keep the little girl alive) and in walks a young man in a blindfold with a security escort. I look this 22 year old over and get a complete history and physical examination. He is perfectly healthy. He even smiles at me while I check his cranial nerves.
Just then the Special Forces SSG says, “I heard you guys were busy today.” “How’d you hear that?” I asked. “This is the guy that planted the IED” He coldly responded. Just then my blood boiled. This arrogant 22 y.o. punk that smiled at me just killed 16 of his own people including that little girl. The story that the Special Forces gave me was that the bomb had been planted for an Afghan army convoy that was supposed to go over that route today. Instead the convoy delayed a day and four cars packed with local Afghanis, headed to an engagement party for a couple that was getting married in a few weeks chose that route. That explains the little dress that the girl was wearing that kept raining sparkly sequence onto the stretcher as we cut her clothes off.
What a backward country. “We all, like sheep, have gone astray, each of us had turned to his own way; and the Lord has laid on him the iniquity of us all.” Isaiah 53:6. We all need a shepherd. Look what we are doing to each other.

Simple Pleasures

There are a few things that I look at during a deployment that keep me somewhat contented with my present situation. I thought I would sit down and share a few of these little things.


We have relatively good showers here as compared to my last deployment. But even still there is something that is not very appealing about taking a shower with 10 other guys. But what few recognize is that if you break with conformity, there are some great benefits. Case in point, the first stall.

You see, the shower stalls are all very small. There is an A/C unit and ventilation system. This creates a flow of air from the back to the front of the walkway in front of the showers. Now the purpose of this is good, to prevent too much humidity from building up in the showers and cause a bad mold problem. However the byproduct of all this is creates a small physics problem. When the shower curtain is closed and the hot shower is running the cool air falls down and the hot air rises, the curtain is pushed into the stall. This means that everyone who takes a shower also ends up cuddling with the curtain. That’s OK if you like rubbing up against the same curtain with which about 100 other naked guys also cuddle. In addition to this when each person gets out of the shower, they leave the shower curtain open. This causes moisture to be trapped in the folds of the curtain. This moisture never dries out and thus little areas of mold start to grow in the folds, leaving the next guy to cuddle with the moldy curtain.

But the first stall is magical! No one ever uses the first stall because it is right by the front door. There is a perceived threat that if just at the point when you are about to step in the shower, the front door will open and you will be “hanging in the breeze”. But if you can get passed this unreasonable fear, you can find the secret of the first stall. At the very top of the wall of the first stall (and only the first stall) there is a 2 foot by 6 inch opening to the outside where the hot water pipes come into the shower building. This opening allows a gentle breeze from to inside of the stall and out to the hall that actually bellows the shower curtain outward, giving the showerer 6 more inches of valuable space. This breeze is very dry and thus dries the shower out very shortly after the shower is completed. In addition, no one uses this shower so there aren’t multiple people getting the stall wet and causing mold to grow; leaving me with practically my very own shower stall, clean and dry.

But there are more little things that make this deployment enjoyable. Time. I have more free time here than I ever have had in my entire life. It is great to be able to sit down and read a book for several hours per day. Having time at this period in my life is great for me. During medical school and residency, I was working inhumane hours. Now that I have finished that season of my life and now that my national boards are done, I can finally enrich my life with other things besides medical education. I am reading Joel Rosenberg’s Inside the Revolution and Augustine’s Confessions and Bill O’Reilly’s Pinheads and Patriots and Margaret Hogan’s My Dearest Friend – Letters of Abigail and John Adams. In addition to these, I am in a Bible Study and reading the Bible from cover to cover. This is a great time of personal, spiritual, and intellectual growth. The downside of this is it comes at a great cost to Kari and the kids. Of this deployment, my wife is far more the heroine than I a hero.

A few other simple things….the sunsets here are just as beautiful as home. The moon rise is magnificent. The stars are as clear as they are out in Proctor Colorado. We have encredible pecan pie and pralines and cream ice cream at the dining facility (DFAC). I have an actual bed. And I have a family that loves me.

Life is good. Thank you God.

We Will Never Forget

I take off my shoulder holster and hang it on a nail on my desk in my tent in the western Afghan town of Shindand to write these thoughts down. AFN is broadcasting the ten year anniversary memorial services at ground zero in New York. They raised the original ground zero World Trade Center flag as children that were merely infants at the time of 9/11 events, sang the national anthem. Moments of silence were observed at the exact times of the plane crashes and the collapses of the buildings. The President, our first black president, reads Psalms 46. The names of all the victims are announced.

I remember where I was 10 years ago. I had just finished one of the morning classes in Kirksville and headed into the lounge. About 10 other medical students were fixated on the TV as the news was replayed over and over again of the first plane hitting the first tower. Then we watched in horror as on live TV a second plane flew in from the right of the screen and plunged into the second tower. I knew on that day, as did the 20 or so other HPSP scholarship medical students, that our lives had suddenly taken a huge turn. I had a feeling at that time that I would be sitting in a place like this doing what I am doing.

All around the world people are commemorating today in their own various ways. In Kabul today they are having a large ceremony and raising the flags of over 30 different coalition countries that are militarily invested in this War On Terror. And they are doing this the very next morning after being hit with a car bomb that injured 77American troops. Here at Shindand, there is a 24 hour ruck march of remembrance during which soldiers from midnight of September 11th to midnight of September 12th will take shifts carrying the American flag around our flight line. Each person on the FOB remembers in his or her own way the events of 9/11. Some people seem calloused, while others are a very emotional. All of our lives collectively were changed on that September morning, resulting in all of us being here now.

I remember how angry I felt at the time. The thought that people would kill innocent people in the name of Allah seemed unthinkable. But now, the head of those responsible for the tragedy, Osama bin Laden, was killed by Navy SEALs, shot once in the head and twice in the chest. He has now faced the final judgment of God. And now the 3 other top Al Qaida leaders were captured. We are a strong nation.

But despite the patriotism, I cannot escape the chilling words of our Savior Jesus Christ, “When you hear of wars and rumors of wars, do not be alarmed. Such things must happen, but the end is still to come. Nation will rise against nation, and kingdom against kingdom. There will be earthquakes in various places, and famines. These are the beginning of birth pains. You must be on your guard….” When we say we will never forget, let’s never forget the important things, the things that are eternal.

Keep On Keeping On

Deployment has a way of sneaking up on my emotions when I least expect it. The other day I thought that I was doing well, when some news came my way rather unexpectedly. This particular piece of news, although I cannot share its contents, was not good. And from laughing and joking with my colleagues, we all sort of paused and looked at each other. After a weird collective insecure silence, we all quickly finished our conversations and scattered to reflect, each in our own way, the content of what we had been told. This left me missing home tremendously.

For about 3 hours I was in an official funk. I didn't want to talk to anyone. I didn't want to eat. I didn't want to do anything. I just wanted to sit and be miserable all alone. And, I don’t understand why when I am in a funk; I also want to listen to depressing music. But whatever the reason, I was definitely in bad shape.

Then, I went to dinner with my normal group that goes to dinner together. We all vented our frustrations. Before long I realized that I was here with other people that really know what I am going through, because they are going through the same thing too. I know this sounds obvious as I write this, but when you are wading through the bog of emotionality, the retrospectoscope is nowhere to be found, and practical reasoning is just out of reach.

Each one of us carries each other’s burdens as our own as we share a common experience. And it is surprising that this is all within a primarily secular environment. Why can’t we translate what we experience here as soldiers, back to our churches as soldiers for God? Personally, I think it is because back home we, deep down, don’t really believe we are in an all-out war for the souls of those we live around. And the Evangelical Church’s idea of community isn’t even close to the kind of community that is established here. In truth, life here is far closer to a commune.

But whatever the reasons were, after dinner we were feeling much better. That’s when I looked up and saw this huge flag in the hanger of the fire station near the hospital. I turned to the PA that works with me and suggested that that would make a perfect back drop for a picture. He agreed. And after asking the fire dept guys if we could climb on there truck, we laughed as we snapped a couple of pics each.

God Bless America, may we keep true to the Biblical values that founded our great nation.

Who is the Enemy

Being deployed is sort of surreal. From one minute you can go from goofing around with friends, with a levity that is almost like home (minus the gun strapped to you), to the next when you are fighting to save an arm or a face or a life. Even more unreal is trying to comprehend the objectives or thoughts of this insurgency we are facing.

Before I go off on dissertation about who actually is “the enemy”, let’s examine my day a few days ago. I will try to accompany the events of the day with chronological pictures I took that day.
The morning began very ordinarily. I woke up and went for a 3 mile run. I came back and hopped in the shower (which is much roomier than my last deployment, and cleaner; but I still fear that if I drop my soap I will never be able to reach it again), then back to my room for a QT (Exodus right now…just past the 10 Commandments), then over to breakfast.

After breakfast I read several books or articles and checked in at the hospital to see if anything was going on. All was quiet over there and back to my room I went until our lunch gang gathered and my traditional three lunch companions headed over to lunch.

After lunch we were feeling pretty industrious so we thought we would round up some wood and make a desk for an office that the officers had graciously been given to “do whatever you want to do with it”. So it became our mission to make it the coolest place in the hospital to “hang out” in….we’re not there yet. Ergo the gator and the construction hats.

We completed our project and placed it in the office (I was thankful that I didn’t cut my fingers off with the circular saw), just in time to have one of the medics find us and tell us that several traumas were coming in from an IED blast.
After evaluation of the traumas, it was determined that two of them needed to go to the OR. The first was an older gentleman that had been walking in the local market when the IED went off. He had shrapnel rip through his neck, chest and abdomen.



After we fixed him, we moved on to the next individual that had a hip fracture and his nose mostly ripped off from the same IED. We fixed him too. We then sent them to the local hospital now that they were out of the woods….so to speak.





So here comes the diatribe. What is the Taliban hoping to accomplish buy killing and maiming its own people? It is militarily incomprehensible. That is why there must be a spiritual answer. And for me, the only way to understand what is going on over here is summed up in Ephesians 6:12 “For our struggle is not against flesh and blood, but against the rulers, against the authorities, against the powers of this dark world and against the spiritual forces of evil in the heavenly realms.”

The works of the IED makers and those that place them are evil! It has nothing to do with Islam. They are misled by the devil himself. They are motivated by evil. They listen to those who are evil and they are unfortunately guided by evil prophets/imams or whatever you want to call them.

Not that I believe in the Quran, but to illustrate my point that these people are not “good Muslims” I quote from the Quran itself, “The Prophet Muhammad (s) said: “Anybody who believes in Allah and the Last Day should not harm his neighbor, and anybody who believes in Allah and the Last Day should entertain his guest generously, and anybody who believes in Allah and the Last Day should talk what is good or keep quiet (i.e. abstain from all kinds of evil and dirty talk).“ Sahih Al Bukhari, Vol: 8 Hadith 47.
Clearly these people don’t get it!

These people, as I call them, are still the same people that Christ came to die for. Let me never forget that fact!

Just Another Day

Today was the beginning of my second week here. This past week I began to settle into a preliminary groove. I am starting to get to know some of the personalities around the CSH. I have been introduced to some of the “drama” as well. But I believe that my daily testimony, and joy for what I do, should rub off on those around me. It seems that there has been a void or vacuum of leadership on the part of the surgeons in the CSH over the last few cycles. Now people are hungry for someone to fill that position and complete the picture of a high speed CSH. There just hasn’t been any driver at the proverbial wheel. Consider that changed as of now!
Its amazing how much the world longs for fellowship. Both religious and non-religious desire fellowship. Today a moderate sized group of us went, as is our custom on Sundays, to the Italian side of the FOB for lunch. I sat back and watched as we all ate, laughed, talked, and listened to one another. For 2 hours we all just “hung out”. Both enlisted and officers a like seemed to, for a brief period, forget that we were in a war zone. We talked about home, loved ones, music, movies, and of course “ragged on” one another relentlessly. It was also mentioned that the ICU was thinking of naming there new mascot….a camel spider that was caught in the ICU…any suggestions?
With full stomachs and smiles on our faces we loaded back up and went back to the other side. Once back at the CSH, we jumped out and scattered to each of our jobs again. But I think that each person that went to lunch was a little more confident in his or her abilities and purpose here. This is because they know the people they are working with, and who will be there with them when the proverbial excrement hits the rotating blades.
It is strange to think that this peaceful afternoon came after a hectic morning which began with a wakeup call to get the trauma team to the ED because there was a man there with bilateral GSW to the legs. After that case finished, we washed up and a few of us went to church then lunch…..just another day in Afghanistan. I feel so sorry for the Afghan people. They are killing themselves like we did in 1860. It is so sad. God please have mercy on us.

The Child

Last night sucked. We had a mass casuallty situation. A vehicle borne IED was detonated in a public place killing several and injuring eight people including a 6 year old boy, all of them afghanis. The first patient to go to the OR was a 65yo male who had shrapnel wounds in is abdomen, chest and neck. We explored his abdomen to look for any wounds, then opened his cardiac sac to make sure the heart wasn't bleeding. We then explored his neck to repair any injuries there. We then washed and closed the 30 open wounds that were made when the glass from the IED shredded his body. We finished that, then i when back to the ICU where the other surgeon was putting a chest tube in the 6yo boy. Apparently, a fragment ripped through his chest and out through his spine. When this occured, the lung on that side collapsed and simultaneously the child fell to the ground unable to walk, as the glass severed his spinal cord. Laying helpless on the ground and unable to take a deep breath to yell for help, the child rapidly started to suffocate. By the time the father who was not far away got to his boy, the lack of oxygen to the brain cased the brain to start swelling resulting in irreparable brain damage.
The father scooped the child up (the child dripping in blood from his injury) and carried him to the casualty collection point, all the while the child still could not breathe. It wasn't until the chest tube was placed at our ER that the child could then breathe. But by that point the damage was already done. When I got out of the OR to the ICU, the father was sitting by his sons bed, his traditional clothing soaked in his sons blood. The Father looked bewildered, sitting in the middle of the ICU with 5 other bleeding and burned patients in the other beds, and American ICU and ER nurses quickly and maticulously attending to the rapidly changing status of their new patients.
I walked over to the young boy with my scub cap, and OR attire still on. I placed my hand on his little foot and bowed my head and prayed. Fighting back tears, and thinking of my own son, I prayed that this was in God's hands and that he would care for this little child. I prayed that the family could recover from such a devastating loss, of which the father at this point clearly had no idea what was in store for the child. And I prayed for my family; to keep them safe. And I prayed that God would let me recover from seeing mankind's cruelty to one another.
As I opened my eyes, the child's father looked up at me and slightly bowed his head, to which I returned the gesture.
I then turned and walked over to my patient, made sure the the ventilator settings were correct and then left the room.
I still don't understand how mankind can be so cruel and thoughtless. My only comfort is in knowing that God cares for that kid and when he dies in a week or two after he leaves the care of an American hospital, that God will welcome him to Glory.

Amen