Kandahar 11

I missed a couple of now-obvious ones in the last update. When describing bathroom noises, I might have mentioned “Colonel Colon” playing his “booty flute.” Also should have added something like “snag yourself in the nostrils when wiping out the hostiles.” And, I should have said that, after my friend’s husband took a hit off his asthma inhaler, they continued make “sweet, wheezy love” instead of “sweet, sweet love.”

It wasn’t Lawrence this time that made the loud booming noise that shook the building and startled all of us a few weeks ago – it was a vehicle-born IED (improvised explosive device), basically a truck with a couple hundred pounds of explosive mixed in a tank, that a couple of insurgents drove up to the outer barrier of the base and set off. It was pretty impressive; shook lots of buildings on base and created a mini-mushroom cloud. No one was actually able to get onto the base, but things locked down for a couple of hours, people had to actually put on their body armor and patrol the compound, and we had to post guards at the entry points to all the buildings.

Later that night, a guy from EOD (Explosive Ordinance Disposal) came to the clinic because of an ingrown toenail. For some reason the power was out, so we were sitting out front, just talking. It actually would have been a nice night to just BS if we weren’t in a combat zone and all. I told him we’d wait a few minutes to see whether the power would come back on, but worst case, we could try removing it by flashlight.

When others inquire what EOD does, he asks whether they’ve ever seen The Hurt Locker (which could be a euphemism for soo many things, e.g., the cramped bathroom stalls in our living quarters). If so, he tells them that it’s sort of like that, but without the Tim-Cruise-in-Top-Gun maverick cowboy antics. In fact, one guy I spoke to told me that any EOD who acted like that probably wouldn’t last very long, either from blowing himself up dead or the other guys in the squad putting an end to that kind of reckless behavior pretty quick. He spoke pretty nonchalantly about having seen and knowing guys who’ve gotten hurt or killed by IEDs. It’s part of the job, I guess. One of those things you just get used to.

The defining feature of this war, really, is the ubiquitous use of IEDs. Sure, there are some complex attacks against bases – coordinated assaults where multiple insurgents try to breach security and hit high-value targets, e.g., like the VBIED the other day - but these tend to be the exception. There was another attack not too long ago on the FOB not far from KAF where they keep fuel supplies. And while there are more than a few of these, most of the attacks on US/coalition forces are by IEDs.

IEDs have become especially effective since troops have been encouraged to patrol on foot. Foot patrols are seen as more compatible with the “winning hearts and minds” strategy than driving around in Humvees, or perched high atop an MRAP (Mine Resistant Ambush Protected) vehicle, looking down on the locals. Unfortunately, the trade-off for trying to win hearts and minds has been the loss of arms, legs, and genitalia; and I’m not being facetious. There was an article in a recent Stars and Stripes (military newspaper that is surprisingly much less biased than I would have imagined) about how kids are getting their testicles blown off, damaged beyond repair, or else having them removed during the resuscitation/stabilization process when they arrive at the surgical units on bases.

I asked a surgical nurse who I recently met about it, and she said that there has been some serious discussion about this specific issue. There’s a question of whether the military should start offering sperm banking services; at the very least, whether they should counsel the kids, who will potentially be going out on patrols and be exposed to IEDs, about whether they have plans to have children, and, if so, giving them information on sperm-banks.

The insurgents come up with all kinds of ways to kill people dead with IEDs. Recently, they’ve put them into turbans and have killed Afghan government officials as well as another very popular and respected leader who many thought could have been instrumental in brokering some new, more peaceful equilibrium in the situation here. They’ve been using young children as well, brainwashing them, which is very not cool.

A few weeks ago, an Afghan woman, apparently legitimately injured in some sort of vehicular accident, was brought onto base and taken to the hospital. When someone noticed wires among her clothing, they did a more thorough search and found she had an explosive vest strapped to her body; fortunately, they were able to disable it safely. I don’t know whether the vehicular accident was opportunistic for some nearby insurgents who happened to be in the vicinity, or whether they caused the accident with the express intent of turning her into a suicide bomber.

The article went on to say that there are a lot of these kids who say they’d rather lose an arm or leg than lose their “third leg”; in 2010 almost 10% of casualties in Afghanistan had genitourinary injuries. It’s become enough of a concern that these kids are being supplied undergarments made from heavy silk (and there’s a design underway that also integrates Kevlar).

Is that an M-16 in your bomb panties or are you just happy to see me?

These ballistic boxers are supposed to provide additional groin and femoral artery protection against IED blasts, and some patrol leaders have started checking to make sure their guys are wearing them before they head out. Some guys apparently call them their “bomb panties.” The tagline for one of the products goes: Protection for your privates, both literally and figuratively.

Kandahar 10

Saw another guy from security forces in my clinic the other day, so I asked for an update. He had some interesting stories to tell. He does a bit of traffic-related stuff here and there (says they caught someone doing 65mph and the max speed limit is 40kph, or about 25mph), but tries to avoid that as much as possible; much more interested in doing base security, snagging bad guys and all. As I mentioned previously, there's a lot of contraband, so he catches plenty of people with alcohol, primarily contractors.

There are drugs as well, and he busted a tent full of Army guys one night who were smoking Spice ("They'll let anyone in the Army," in his words). Spice is an umbrella term for various synthetic canniboids, chemicals related to THC, the psychoactive substance in marijuana. It doesn't show up on routine drug screens, and apparently the K9s either can't or are not trained sufficiently to sniff it out. It's garnered quite a bit of attention over the past few years and initially was sold legally in smoke shops, though it has since been ubiquitously controlled and/or banned internationally. He said he found 7-8 lbs of the stuff, which suggested they were probably trying to distribute it.

He randomly goes to the dining facilities where many of the TCNs (third-country nationals) usually eat. They conduct line-ups and random searches at that time in addition to the other more targeted searches they perform based on intel received. Occasionally, they've found TCNs with components to construct IEDs and every so often there are reports of suicide vests; fortunately, none of them have been used. Every now and then they'll confiscate USBs and cell phones, too, which the TCNs are not supposed to have with them. Someone will use a camera to take photos or video of whatever it may be they or others might want to know (the flight line is a definite "no pictures" zone), and then they transfer it to the USB in order to smuggle it off base since it's much easier to hide a USB drive than a camera.

Vehicles go missing at times, usually the Gators, little open-aired gas-powered golf cart like utility vehicles. Whoever steals them will paint them a different color, and although sometimes they find them and return them to their original owners, often they simply disappear. Other larger vehicles - work trucks with hoists and even heavy machinery - have been driven right off base and sold in downtown Kandahar. Some of these vehicles cost over $100,000 and are sold for $10-20,000. Apparently they just drive right through the front gate and no one stops them.

If you know what to look for or who to ask, there is a bustling prostitution industry going on as well. Some of the women who work as vendors at the boardwalk are from the Philippines and Kyrgyzstan, and I guess there are some military women who occasionally offer their services as well. The vendorettes make something like $500 per month, but can pick up an extra couple of hundred bucks a week for a few minutes of extra work, or seconds, depending on the guy's stamina, I guess. As an aside, and speaking of stamina, I had a friend back in Boston who told us that her husband sometimes had to stop and take a couple of hits off his asthma inhaler before he was able to continue with their sweet sweet lovemaking. That should be a scene in an R-rated comedy if it isn't already.

Anyway, he told me that one girl lost her job and had to head back home. Airport security inspected her things and found $50,000 in cash in her luggage. I wonder whether she wasn't transporting money related to other illicit on-goings for other people, but she said it was all from prostituting herself. I'm no mathlete, but even if she was charging $200 per poke (probably a generous estimate), that would be 250 pokes; if she gave any discounts or "Buy 4 Get One Free” coupons, that number goes up even more. That's a lot of pelvic exertion. Hope she's keeping up with her Kegels.

This guy says he loves his job. "It's my favorite deployment by far. It’s like the Wild West out here." I admit that I live in my own head a lot - I'm the guy with his nose stuck in a Kindle, reading while walking to and from the dining facilities, boardwalk, etc. - so I'm usually not up on a lot of the gossip that goes on wherever it is I work. But, that we don't hear about most of this stuff that goes on suggests that these guys are doing their jobs fairly well, and I respect them for it.

I have my own struggle for survival going on every day – me vs. the Taliban flies. I hate those little effers. They sneak into our clinic and seem to congregate in the office I share with Joe. They're not like our American flies, either, and not just because they don't speak any English. American flies are, well, more like Americans - pretty content to just hang around your food, get fat, and then develop diabetes and die. The Taliban flies are wily and wiry. They buzz around your head and bite at you. I swear they've declared jihad on my face and the back of my head. I've become pretty handy with the fly-swatter.

And speaking of pesky bloodsuckers – contractors. I'm not a very big fan. They've been on our compound over the past couple of weeks. The American contractors mostly just stand around and watch while the TCNs do all the work - electrical wiring, new lighting, and cleaning air-conditioning filters. I saw one guy in our computer room for hours many days, drinking coffee and surfing the internet, and it seems they’re always on break. One morning I was "minding my own business" in one of the bathroom stalls and the door opens. Whatever - it's a communal male bathroom, no big deal. Then a female voice asks, "Is anyone in here?" - Um ... yes. - "Oh, well why didn't you say something?" and she headed back out.

Why didn’t I say anything?! Who says anything every time a public bathroom door opens – or ever, for that matter? I don't know how it works in female restrooms, but there are rules when more than one guy is in a male bathroom at the same time: for instance, no using the urinal just adjacent to another guy if it's possible to leave one open (only possible if there are three or more urinals); keep your conversation to a minimum - a simple "Sup?" with a slight head tilt/chin lift will usually more than suffice; and, as with gorillas, use extreme caution with making prolonged direct eye contact as it can be interpreted as a sign of overt aggression. The only people who tend to break these rules are drunks at a bar or club and “anti-homosexual” Republican congressmen in airport bathrooms. Just saying.

Keep direct eye contact to a minimum

And we certainly don't announce ourselves every time someone opens the door. I have to work with these people – I don't want them to know it was me blowing out my bowels on the toilet bowl, and vice versa. I don’t need to know that General Johnson or Colonel Smith was the guy in the stall next to me making noises from his “bum trumpet”, his “stench French horn”, his “ass saxophone” - you get the picture – noises so unearthly that they strain (no pun intended) the limits of what should be physical possibly. Really it comes down to a matter of maintaining proper military respect, bearing, customs, and courtesies.

In college one morning I dreamt about being back home. I was hanging out with Megan (my little sister), who plays the violin. I asked her to play something for me. She at first refused, telling me that she wasn’t any good, but I continued to encourage her to play something, anything. She finally relented, picked up her violin, then proceeded to strum a note on one of the strings. Duh-duh. The string was a little out of tune, so she told me she had to adjust it, and so she kept playing that one note over and over. Duh-duh. Duh-duh. Finally, I came out of my sleep and realized I was a dreaming; I also heard once again the sound of that un-tuned string – duh-duh – and at that time realized that my roommate was farting in his sleep across the room.

So I finished up my "morning chores" and walked out and past this woman, who was standing outside the door, leaning against the railing at the top of the stairs. She is a prime example of a "booty-do." If you don’t know, a booty-do is a woman who's so fat that her stomach sticks out more than her booty-do. The male counterpart is, of course, the dickie-do; not such a rare creature anymore, this species is so fat that he can't look down and see his own wiener (that’s my one allowed wiener reference for this update). I didn't say anything to her as I passed and walked down the stairs, but I heard her say "Hey baby!", and then she must have puckered her lips because I heard her make a kissing sound. Gross.

Since we're talking about the bathroom, the JAG here (his name is Lance), stopped by the other day to ask us some questions about sanitation and hygiene; specifically, they pertained to the implications of someone peeing in a water bottle at night in their room and then throwing those urine-filled bottles away the next morning in the bathroom garbage can. Yes, this is actually happening. And it's not a phenomenon isolated to a single pod. It’s not like our sleeping areas are located a couple of hundred yards away from the toilets, or it's freezing cold outside, or there are rabid animals prowling about (just rabid Taliban flies). Not that any of those situations would make it OK, but I might sympathize a little. Every single row and every single floor of our living pods has its own bathroom and shower room. If you're sleeping at the other end of the pod away from the bathroom, you might have to walk 20 yards to reach it, if that. Joe had to go to the commanders’ meeting and brief them about this. Most of them just started laughing and couldn’t believe it, either.

So accessibility is pretty good, but one problem once you reach the bathrooms is that the stalls are really narrow and short, not leaving a whole lot of room to maneuver. I don't know whether they were made for Chinese people, or just made in China, but it's a very tight fit in there. If I’m in there for more than a few minutes, my patellofemoral syndrome (runner’s knee) starts acting up a little. We usually call it the “theater sign” because your knee will ache if you’re sitting in a cramped movie theater seat, but I think the “Chinese torture chamber sign” works, too.

I’ve never had this particular conversation, but I’m assuming I’m like most people who like a little leg room when casting out one’s digestive demons. Being scrunched up prevents one from being able to relax all those pelvic floor muscles and associated sphincters in order to allow easy passage of one’s “dark passenger” (that’s a Dexter reference for those of you who watch). Tell me if I’m wrong about this, but I don’t think so.

Another problem is that there's very little head room in front of you. This makes maneuvering yourself onto, and off from, the toilet seats a bit challenging. One's natural inclination is to bend forward a bit to counterbalance and control one's downward momentum onto the toilet seat; likewise, it helps to have a little momentum, by throwing your head forward, when you stand up. But, with the door so close, you end up hitting your head on it, or you have to try and dead-lift squat yourself up from the toilet seat. This is especially precarious if you've been sitting there for a while, your leg falls asleep, and isn't back to full functioning.

And forget about it if you have your uniform and weapon with you. It’s a nightmare trying to take off my gun harness and uniform top and hang them up. Listen, I’m trying to take my talents to South Beach, not play a game of Twister. And while I don’t think “pooping dog” is the name for any real yoga pose, I’m pretty sure I’ve performed it and maybe even mastered it by now.

Things become especially dangerous because of hook-hangers on the doors. Not only do you run the risk hitting your head on the door, but also possibly poking out your eye-hole while tidying up your pie-hole; you know, jabbing yourself in the ear-hole while digging around in your rear-hole; hooking yourself in the mouth while cleaning up the dirty South. You get the picture. It does make it easier to maneuver if you leave the door open a bit when you sit, then close it once you get settled, as well as opening it again when you have to stand up to wipe. But, then you run the risk of someone opening the main door and catching you in a somewhat compromising position, which I'm sure violates some of those bathroom rules I mentioned earlier.

Kandahar 9

Manas is the base in Kyrgyzstan through which most troops on their way to and from Afghanistan pass. There are huge sleeping tents, dining facilities, gyms, a few restaurants, and a bar at which you can get your 2 cans of beer or glasses of wine per day. This is kind of a big deal since Afghanistan is a dry country. I’ve heard all kinds of stories about things people try to do to get alcohol to Afghanistan (and I mentioned a few previously). I heard a story about a guy who was having vanilla extract sent because it had just enough alcohol to hold off his withdrawal symptoms. There are similar stories about people drinking mouthwash.

I saw on the History channel one time a show about bootlegging, and they talked about what the “proof” on a liquor bottle means. During British Empire times, sailors were sometimes paid their wages in rum. To make sure that the rum wasn’t watered down, they would prove its potency by sprinkling gunpowder into the rum, then attempt to light it. If the gunpowder ignited, then the rum’s alcohol percent by volume was at least 57% or so. In the US nowadays, the proof is basically just twice the alcohol by volume. In general, any liquor above 40% alcohol by volume should light on fire.


I don't have a lot of experience with lighting alcohol on fire, but one time I thought it’d be an interesting experiment to spray a few pumps of hair spray, which has alcohol in it, on my arm and light it. Do not try this at home. I thought it’d just burn off real quick and no real harm, but I can say that, actually, it burns really hot. I may or may not have ran around the apartment screaming like a little girl and maybe got a little nauseated by the smell of burnt hair. During residency we went without the alcohol gel sanitizer in our exam rooms for a month or so because they originally placed the dispensers near the rooms’ light switches, which turns out is a pretty serious fire hazard. The gel in Purell or other alcohol-based hand sanitizer is about 62% alcohol by volume.

So apparently there was a guy last week, passing through Manas, who doused his hands with hand sanitizer before leaving the building he was in. Usually the alcohol evaporates quickly, especially if you just use the little amount that it usually requires to do the job; if you wave your hands around in the air, it can speed up the evaporation process. This guy didn’t do either and instead went immediately over to a nearby smoke pit where he attempted to light a cigarette; instead, he lit the alcohol on both hands on fire, sustaining 2nd and 3rd degree burns to his appendages. That’s one way to get an immediate ticket back home …. but, I don’t smoke. I think he deserves at least an Honorable Mention nomination for a Darwin Award.

Kandahar 8

Mostly the same old same old here. About 3.5 months to go, which is 3.5 months too many. I did receive a call from my replacement, which was a little bit of a boon to my spirits. My tentative date of departure from here is January 5, 2012. I don’t count down or mark calendars, but I think that puts me at just over a hundred days left. We get 2 weeks of rest and relaxation (R&R) after we return, and I plan on going snowboarding in Austria and/or Switzerland and/or France and/or all of the above for two weeks when I get back. If anyone wants to come to Europe at that time for some serious shredding the pow-gnar, let me know.

I strained my back about two or three weeks ago doing some lunge-reach exercise with kettle bells. Locked me up pretty good. I’d sort of tweaked it a bit before that but was able to continue doing my regular workout stuff, but that didn’t allow it to get better and set me up for pulling a muscle or two a few days later. Joe told me I should rest for a week or two, and I listened a little bit. I mean, I stopped doing any lifting or pushups or pull-ups, but I got on the spin bikes and have been doing that every day for at least an hour or two. My back feels a lot better, and I’ve lost another 4-5 lbs. The upside, my abs stick out a little bit (or my belly sticks out less – same difference in my book); the downside, as my face has gotten a little thinner, my ears stick out even more. Not a good look for me.

I arrived at work the other day and only one other person was there – our supply person, who’s not a medical technician. I asked her where everyone ran off to, and she replied that they had just left for the Canadian gym. Someone ran into the clinic a few minutes earlier asking for medical help. They thought someone at the gym was having a seizure. I missed most of it, but apparently when Joe and the techs arrived, the woman was on the ground, gasping irregularly, and nonresponsive. Joe thought he lost her pulse, so gave her some mouth-to-mouth and they did some chest compressions.

By the time I arrived, the EMTs were there and had placed EKG pads on her. She had a pulse so they were just bagging her as some of the gasping breathing persisted. Joe told me that one of her eyes deviated out to the side. Apparently, the woman is a 33 year old American contract worker. She had diabetes and it hasn’t been well controlled, though she works out regularly. As it turns out, her blood sugar was fine when they checked it. We found out later that she had a hemorrhagic stroke, a brain bleed. I asked someone who works at the hospital and they think she died after they transported her out of here, but that's still unconfirmed.

Speaking of people who have recently died, there was also a soldier who recently died back in the States after he'd just returned from Afghanistan. Rabies will kill you dead without getting treatment. Guaranteed. Apparently, he'd been bitten by an animal while deployed, but apparently didn't tell anyone, which is obviously a bad idea. Now it's a "priority issue" for everyone because, of course, it has to look like we're all taking this very seriously. And it's not that I don't think rabies is serious, but everyone who in-processes here is warned that rabies is endemic to Afghanistan, so don't touch any animals. It seems like common sense. And it's one guy who wasn't very smart, but was very unlucky. That doesn't make it a high-priority issue (I still say that not getting your limbs blown off and/or killed dead by an IED still ranks as the highest priority issue here), but it does make it a seemingly extra-important issue because it was in the press.

Anyway, back to brains bleeding. I remember being in medical school and our team had an 18 year old patient who had a stroke. The kid was 6’5” or so and had a scholarship to play baseball in college – the “All-American” kid, everything going for him. He was working out one day lifting weights, next thing he knows his head hurts and he can’t move half his body. He’d ruptured a congenital aneurysm, or a blood vessel that has weak walls and sort of balloons out until it breaks. Scary to think about, that you might have a ticking time bomb in your head that could go off at any moment. I think that would be a hard thing for anyone, but particularly for people who are especially active.

Griff and I went skiing in Korea last year, and afterwards we were watching a movie called “Murderball”. It’s a documentary about a wheelchair rugby team. As they introduce the team members, they tell each guy’s story about how he became a quadriplegic. Some of the guys had freak accidents while biking or whatever, and in an instant could no longer properly control (to varying degrees) their bodies from the neck down. Well, after less than 15 minutes of hearing those guys tell their stories, and thinking about a few of the accidents I’ve had riding mountain bikes, I had a visceral reaction to it - literally felt sick to my stomach and became so depressed and scared that I had to turn it off. Really.

I remember talking to Mom years ago and she mentioned that she’d taken Maddy to the vet and had her put down. She had those horrible allergies and nothing was really working to relieve her symptoms. I asked her, facetiously, “How would like it if your children put you under for having allergies?” She answered, in Grandma Etta fashion, something like, “If I’m old and as miserable as that dog was, I’d do it myself.”

Old and allergies are one thing, and probably not justifiable reasons for putting your parents to sleep ("probably" being the operative word, though I'm open to debate), but I'm not sure how I would feel about being paralyzed from the neck down. My instant reaction is to say, “Just put me out of my misery.” Don't think I’d want to live like that. I mean, Christopher Reeves was inspiring and all to lots of people, but I don’t think I want to go through all of that. Plus, he was wealthy and famous and probably received extremely exceptional attention because of his celebrity and advocacy. I seriously doubt most quadriplegics have those kinds of resources available to them or get that amount of attention. I guess you can’t really know how you’d feel and respond except in the unfortunate case that it happens to you.

As you may have heard, the military quietly suspended the “Don’t Ask Don’t Tell” policy about homosexuals serving openly in the military. And while I absolutely agree that it was a way overdue policy change, I am still not gay, so this isn’t a coming out announcement. I know, I know. I’m a fabulous, nearly 36 year old male, not horrible looking, smart, fairly athletic, EXTREMELY charming, goes on hiking and camping trips with his buddy with the creepy mustache named “Griff”, hasn’t brought home a woman to meet the family, and is still single. I also know that Bill asked my buddy, Brian, whether he suspected I might be gay as we were traveling through Nebraska and stayed at their place on our way to California to start our respective residencies back when. So I get it. But that doesn't mean I'm gay; it just means that maybe I'm awful and girls don't like me, and that I'm a menace to society.

"USA! USA! US ... HEY there big guy!"

I do, however, find my job has me talking about and touching other men’s genitalia way more than I’d prefer; and I’d prefer not-at-all. I often tell people that my job isn’t all glamour and call-room hookups with naughty nurses. Sometimes I say, when someone asks about what I do, that I stick my fingers in people’s butts. For money. It’s part of my job, and it’s not all that great. Trust me.

Coincidentally, just the other day I had another man's penis in my double-gloved hands, freezing off little cauliflower clusters of genital warts. He explained to me that part of the reason he waited so long to be seen for this issue was that he was nervous and embarrassed that, when at "parade rest", his wiener is kind of small. So I proceeded to reassure him that there are men who are "show-ers" and those who are "grow-ers."

In a cold room, and at their smallest, the "show-ers" would seem to have the longer penises, but the "show-ers" don't get much longer when they get an erection. It’s basically “what you see is what you get.” On the other hand, the "grow-ers" are guys who are smaller when flaccid, but then get considerably larger when they're tumescent, i.e. sometimes big things come in little packages, no pun intended. All the while, I methodically applied a freezing solution to his phallus flower garden. Fortunately, nothing I did to the guy allowed us to find out how much of a "grow-er" he is, although I suppose applying a freezing cold applicator to his genitals might have had some beneficial effect to that end as well, thank goodness.

Also had a guy come in for breast tenderness just under his nipple. I stood behind him, with his shirt off, rubbing both his nipples (cause you have to compare the affected and non-affected side, after all) and said, "I really hope no one barges in on us right now. That would be some awkward explaining to do." Then I had to tell him that, unfortunately, I probably ought to examine his balls (breast masses can sometimes be associated with testicular masses). Sometimes I think I’m way underpaid for the crap I have to do.

And then there was one of the Canadian guys who works at the gym. He came up to me one day while I was on the spin bike, asking what hours I work at the clinic, and if he could stop by to chat. Most of the time when people want to “ask you a question” in private, it really means “I think there’s something wrong with my balls and/or wiener.” In Gono-Korea, we saw a lot of STDs. When guys would come to morning sick call with those types of complaints, the euphemism was “foot problem,” as in “Doc! There’s something wrong with my foot – my wiener is dripping all over it.”

Anyway, the Canadian guy thinks he got herpes from a girl he’s been sleeping with. He was telling me all about these painful bumps/sores that he has on the inside of his foreskin. I sat and answered his questions for the better part of an hour. At the end of our conversation, I told him that was way more time than I ever wanted to spend talking about his junk; and I'd prefer not-at-all. A few days later he gave me one of the better designed t-shirts from the Canadian Air Force run. And as I’ve said before, it’s all about the t-shirts. And donuts.

And then there are all the people with gastrointestinal issues. I admit, after I had those two weeks of diarrhea after returning from Nepal (during which time I was wearing sweatpants to bed in case I farted and shat myself in my sleep), I don’t have a lot of sympathy for people who come in and tell me they’ve had non-bloody, non-fever, non-cramping diarrhea since “this morning.” One guy came in complaining of blood in his stool (from hemorrhoids). He was thoughtful enough to take a picture with his iPhone and show it to me. Um ... thanks? People get pretty freaked out when they see blood in the toilet, so I usually reassure them that even a tiny bit of blood in the toilet bowel can make it look like a battle scene from "Braveheart" in there, or the opening beach scene in "Saving Private Ryan." I sometimes wonder what they do with those pictures afterwards. Hopefully they refrain from posting it to their Facebook page, though I wouldn’t put it past some of them: “Sergeant Johnson … had blood in his poop today! OMG! LOL! BRBPR!!*”

*(BRBPR = bright red blood per rectum)

I saw a girl the other night who was complaining of being really nauseous and vomiting several times before she arrived to see me. We've been seeing a good bit of gastroenteritis lately. I can't say whether it's something going around or not, but when you have lots of people working and eating in close proximity, and who maybe don't wash their hands as diligently as they should, it can obviously be passed around. I had her lay down in order to exam her abdomen (which wasn't overly concerning, though she was a bit tender over her stomach), but I guess that sitting her up made her a little dizzy and ratcheted up her nausea. She told me she needed to throw up, so I grabbed the garbage can. When I got it up by her face, she let go a salvo of yellow-green liquid vomit without any chunks. I held the garbage can and rubbed her back while she let it all out. I asked if she'd eating a yellow piece of candy, and she says she had an apple Jolly Rancher (or a Jolly Rogers, as Dad would say).

After she recovered, she asked, "How can you just stand there so calmly and rub my back while I'm puking right in front of you?" I don't know. It's like lots of other slightly unpleasant things that you just get used to, like changing baby diapers, or eating vegetables. Yeh. Kind of like that. I remember watching a friend get his ingrown toenail cut out in Lithuania, and I almost passed out then, but now I rip out toenails all the time.

I didn't always have even that much fortitude when it comes to vomit. The very first patient I worked with as a medical student had end stage liver disease (drugs and alcohol will do that), and he ended up dying; not a great start to my career. I went in one morning to round on him, and he was more disoriented and out of it than usual. As a brand-new medical student on my rotations, I wanted to be very thorough, so I made sure that I sat him up so that I could really get a good listen to his lungs, though it was probably unnecessary.

He didn't react to all the moving around so well, however, and he started gagging and dry heaving. That can be bad enough to witness as it is, but when you're right next to this guy who already smells sick and you're hearing the gagging amplified through your stethoscope ... ugh. That's when I got grossed out and had to make a quick run for the bathroom. At that time I learned from experience that bananas do indeed taste more or less the same coming back up as they do going down. My friend, Brian, laughed at me when I first told him, but then he was almost offended that it happened. He said something like, "A doctor puking because a patient grosses him out? That makes no sense! That's like a lawyer who doesn't know how to lie." I guess I've grown a little since then, and I don't mean that in the "grow-er" vs. "show-er" sense.

Kandahar 7

Reader response from recent update:

Hey Stupid-

Here's an idea for you. Don't go in the air unless absolutely necessary. Anything in the air is a target. Remember the little story I told you about the bird:

Once upon a time there was a non-conforming sparrow, who decided not to fly south for the winter. However, soon the weather turned so cold that he reluctantly started to fly south. In a short time ice began to form on his wings, and he fell into a barn yard, and almost froze to death.

A cow passed by and crapped on the little bird. The sparrow thought this was his end. But instead, the manure warmed him and defrosted his wings.

Warm and happy, able to breathe he started to sing. Just then a large cat came by and, hearing the chirping, investigated the sound. The cat cleared away the manure, found the chirping bird and promptly ate him up.

The moral of the story:
1. Everyone who shits on you is not necessarily your enemy.
2. Everyone who gets you out of the shit is not necessarily your friend.
3. If you are warm and happy in a pile of shit - keep your mouth shut.

KAF is your little warm and "happy" pile of shit for another 4 months. No need to go flying around.

Thank you Reader X. Sage advice. Got a kick from the “Hey Stupid-“ opening.

I ran a 5k last weekend for something or another cause. I don't know which one. It doesn’t even matter; I just do it for the t-shirts and Tim Horton's donuts at the end. Yes, the Canadians have a Tim Horton's at their compound, which is conveniently located right next to ours. The donuts are delicious, though I only get them on days when I have to work the entire day and feel sorry for myself. I ran an 18.30. In my defense, my legs were really sore from spinning, I couldn’t fall asleep until after 2am the night before, the race started at 6am and I didn’t warm up or anything, and I’m getting old and slow. There’s another one this weekend for wounded Canadian Army midgets. Or something like that. Like I said: t-shirts and donuts.

Oh Canada! ... Oh My! Canada!

So, I'm the clinic OIC here: officer in charge. There are only two of us officers in the clinic. Joe is a Major, so he obviously outranks me, but his duty is sort of the chief medical officer on base for the Air Force (even though Magnum is a LtCol, his duties have him off just working with the flyers). In effect, Joe has really been the OIC of the clinic. He's here in the mornings and early afternoons, when most of the "action" goes on. He also has been seen as the point of contact for leadership since he has to go to meetings with them every day. He occcasionally tells me, "Hey man, you're the OIC. I don't mean to step on our toes or anything." I tell him I appreciate his concern and then nothing really changes. All of that is absolutely fine by me. Every once and I while I order him, in the name of the clinic OIC, to get out of the clinic when his shift is over rather than hanging around, but he doesn't really listen.

Joe’s a nice guy, and we get along. He kind of reminds me of my friend, Brian Montenegro - Latino ancestry, but kind of really “white.” I don’t know, he just eats sandwiches all the time, married a white women, and likes top-40s pop music (don't worry Brian, I won't tell about the time I came home from the hospital and found a Celine Dion CD in the stereo that definitely did not belong to me). SSgt Williams, one of our techs, tells him that he’s qualified to be a school teacher because he has a notebook butt and pencil legs. He has a bit of an angry streak, though, and prefers to nip things in the bud if anyone gives him any attitude; has a little bit of “tough guy” in him.

I end up playing the peacemaker and the one to whom people come to complain or vent their frustrations. It’s not my forte, but I try to seem like I’m listening. I usually give some relatively vague feedback about how I can see some validity in every party’s concern in whatever the dispute might be, give some generic exhortation for patience to see whether things don’t work themselves out, and suggest that different people have different styles of communicating, but we all need to try and communicate better regardless. That kind of stuff. And usually the knots do unravel and things are fine again. We’re not that busy, and there are only eight of us working in the clinic, five of us who are directly involved in patient care. Things are really not all that difficult or stressful, though, and so I don't get why there's any drama in the first place.

It could be worse, though, so I guess I'll shut my mouth now about my pile of shit here.

Kandahar 6

Joe has been excited about getting me on one of the aerovac flights here in country. Aerovac is basically medical transportation for wounded kids or others with medical issues that need more workup than we have the capabilities to perform here at KAF; we also call them "bandage flights." So the other night, he sends one of the techs from the clinic to find me at around 9pm. I was a little worried that something was really wrong, but Joe tells me that they have a bandage flight the next morning and one of the patients needs a medical escort, which I can do even though I'm not a flight doctor (though I'm probably still overqualified - they usually they send a nurse). The guy's condition wasn't real serious or anything, and more than anything, it was an excuse to get me on a flight. So I said OK and left to get things ready for the next morning.

Show time is 2 hours before the flight is supposed to leave, even though I just ended up sitting around with one of the other flight docs talking for an hour and 50 minutes. The guy I was escorting was a 40-something year old Army troop who was complaining of chest pain. He maybe had some minor abnormalities on an echocardiogram, and the cardiologist at our hospital didn't have some of the equipment to do more sophisticated testing, but which they do have up at Bagram, which is where we would be going.

Another 2-3 guys with relatively minor injuries were also loaded up into the C130. They've outfitted them so that stretchers with patients can be stacked up inside. The C130s have been around forever, and have been the work horse cargo airframe for the Air Force for relatively short distance transport. They're propeller driven and the trip is noisy and often bumpy.

C130 Hercules

We first headed over to another nearby FOB (forward operating base) and there picked up another couple of patients, one of them attended to by the CCAT team: critical care air transport. Those patients are usually very seriously injured and they're intubated and on a ventilator. We took off again from there and then flew up to Bagram, which is located up farther north and is nestled in on three sides by mountains. I'd heard about that and was actually hoping to have a clear view, but it rained all morning, the first rain I've seen in two months, which was actually a welcome change.

The nurse on the flight told me that I should hop off in Bagram and stick around with the patient. The C130 would be going back to another FOB, then return back to Bagram before we'd fly back to KAF and hopefully be back around 230-300pm, about the time I start work at the clinic. The lesson as always: don't listen to nurses. If the cardiologist decided the guy needed still more workup, he'd be sent on to Landstuhl, Germany, in which case I wouldn't be going with him; on the other hand, if he was cleared to return to duty, he wouldn't need me to fly back with him because he would have been declared healthy.

I did get to eat lunch there, and they have real Baskin Robbins ice cream there. I had two bowls of caramel and pralines for lunch, and it was delicious. I know I have an ice cream eating problem (actually, I have no problem eating it, I have difficultly stopping myself from finishing the carton in one sitting), but I haven’t had any since I first arrived here at KAF. We have soft serve here at KAF, but it's horrible - the flavors are off. And the irony isn't completely lost on me that I'm complaining about having ice cream in the middle of a third-world wasteland in the middle of a war zone.

As it turns out, the weather caused some trouble for the airframe on which I originally flew, so they had to divert back to KAF, stranding me in Bagram. Luckily, with Joe's help and some persistence, I was able to arrange a way back; the passenger terminal initially told me that there wouldn't be another flight until the next evening. The lesson as always: don't listen to those people ... or nurses. I talked to another senior enlisted lady, who was really helpful. I explained that I'm one of the two doctors that takes care of all the Air Force peole down at KAF. Fortunately, an Air National Guard C27, sort of a "shortbus" version of the C130, out of Mansfield, Ohio, landed in the early afternoon and allowed me and a couple of other guys trying to get back to Kandahar to travel back with them.

We first had to fly to another FOB and pick up some Army general. We were supposed to be there for 20 minutes or so, but it ended up being almost an hour. That's how it goes with those guys. When he asks, "Hey boys! Am I late?" the answer is, "No Sir! We arrived extra early." Anyway, this FOB was in the middle of nowhere and was the one I mentioned before that is currently under construction, by all appearances fairly recently begun. We're talking still-open trenches and recently poured concrete block to support fence poles. As I've said before, for a conflict that's supposed to winding down (MISSION ACCOMPLISHED) it seems curious that there are currently brand new bases going up.

It ended up being a really long day. Woke up around 4am and didn't get back until almost 9pm. I'm glad I went and experienced it, and I'm glad that it made Joe happy to make that happen for me. The reality is that it wasn't really all that great, and not just because I was stranded. I mean, it's not really all that much better than flying on any other sort of transport or commercial aircraft except that maybe you have a little more leg room. But, there was no one bringing me little snacks or drinks. I guess I'd go again, but it's not something that I'm just dying to try once or twice a week like some of the other flight docs here. While I was talking to Joe on the phone, trying to figure a way back, I actually heard myself say, "You know, I just want to get back to Kandahar." Hearing myself say that, and maybe even meaning it, was by far the most distressing part of the day.

Kandahar 5

Things are supposedly beginning to wind down here. The Canadians are already starting to pack up some of their equipment, and indeed, when I spoke with some of my combat engineer spin-class friends, they told me that they don't go outside the wire anymore because their job now is primarily clean up. They have just under 90 days in country. Most of the Romanians very recently left. They stayed in sleeping barracks along the way to the dining facility that I usually go to, and they were always hanging around outside, smoking cigarettes and drinking orange Fanta, in their shorts and/or shirtless (they must not have gotten the NO SUNBATHING ALLOWED! memo), giving each other back rubs, seemingly having a relatively swell time of things, all things considered. And then, POOF!, they're gone. I think that the reality is that we're not really going to wind down as much as it might seem - the US at least - and our military will remain here in not insignificant numbers for many years. For one, I still hear about bed shortages for new incoming troops; also, there's still a lot of construction going on around here on KAF. I was recently on a new base that was in the midst of construction. We're talking newly dug fence lines with newly poured concrete and newly set fence poles in them - they haven't even gotten around to stringing up the Concertina wire along the top.

Very recently the Stars and Stripes, one of the military newspapers, has been reporting that both the Iraq and Afghanistan governments have been "requesting" that US forces remain in their countries in greater numbers and beyond the timelines officially stated. If we do leave en masse, without significant financial and other support, I think this place is going to fall apart again into various factions and under the influences of other players, some not so friendly, e.g. Pakistan and Iran. It burns me that we have made a Faustian bargain where we give Pakistan billions of dollars a year in order for us to continue this war (transporting materials overland and some intelligence assistance). Meanwhile, the ISI, Pakistan's equivalent of the CIA, is channeling that money to the Taliban and al-Qaeda, not to mention they harbored bin Laden for years despite being our "friends."

Post WWII, the US spent the modern day equivalent of hundreds of billions of dollars to help Europe rebuild. As much as I enjoy living in Germany, we really shouldn't be there anymore - certainly not nearly in the numbers we are - almost 60 years after WWII and nearly 20 years after the end of the Cold War. And yet at Ramstein they opened a monstrosity of a mall - a gaudy abomination, really - just a year or two ago. Certainly Geilenkirchen, where I am, and all the tiny little bases and outposts should be done away with.

The fact is that the US isn't leaving Germany anytime soon, however, and we've been at peace with die Germans and generally like them. Although I did just read an article that the US will be decreasing the official number of troops by 5,000, down to 37,000, from a high of over 200,000 in the early 1990s. The 37,000 number is deceiving, though, as it doesn't count all the civilians living there and being paid by the US government (also very generous compared to what they'd make in the States - your tax dollars at work) in various support and other roles, including medical and education (i.e. teachers), not to mention those affiliated with weapons systems and the like.

In fact, people of German ancestry make up the largest single ethnic group in the US, and, during World War I, German Americans predominantly took a neutral position to US involvement in the conflict. During WWII, US soldiers actually liked the German people with whom they came in contact (at least when they weren't shooting at "our boys") moreso than even the English, and certainly more than those prickly French. Stephen Ambrose, in Band of Brothers, noted that of all the peoples the American G.I.s encountered in Europe during World War II, they identified most with the Germans, whom the American soldiers regarded as "clean, hard-working, disciplined, educated, middle-class in their tastes and life-styles ... just like us."

The point is die Germans happen to be a hell of a lot more like "white Christian" America than "white Christian" America is similar to Afghans. I don't see even a tiny fraction of the money and effort the US gave to rebuilding Europe going into helping Afghanistan rebuild. Also, there's just not as much incentive for us to be here. Yeh, sure, they grew some terrorists here while the Taliban had control, but overall, the country is horribly underdeveloped, and although there are some mineral resources that could apparently be exploited, there's absolutely no significant infrastructure to collect and transport it, not to mention the persistent security issues.

This seems particularly unlikely what with the financial concerns our country has gotten itself into, in no small part because a decade ago our country's leaders thought it would be a good idea to start the two longest running overseas wars in US history. Also, they decided that it's better to spend trillions of dollars blowing the place up - contractor profits at least grow that way, as do the subsequent campaign donations - rather than helping a failed state rebuild so that ordinary people can try and live ordinary lives. It really hurt that the Bush administration neglected Afghanistan in favor of starting another war in Iraq, which was unsubstantiated, Dick Cheney's recently published autobiography be damned. The Congressional bipartisan September 11 commission found "no credible evidence that Iraq and al-Qaida cooperated on attacks against the United States." The rest of the international community was of the same mind, and the US squandered much of the good will we'd received after the events that occurred in 2001. After the initial, and relatively modest, effort here, the Taliban had basically been run off, and the US forces had the general gratitude and good will of the Afghan people. Helping Afghanistan rebuild at that time would have most likely come out to a tiny fraction of the cost in blood and treasure of the conflict that's been ongoing since, and many experts think that the rebuilding would have had a very good chance of being successful, assuming the support and attention from the international community had remained focused.

I just finished reading an interesting book about the cultural and political history of Afghanistan, and particularly liked one short anecdote the author told. He was living and studying in Afghanistan during the 1970s. People in the rural areas of Afghanistan had recently gotten access to radios and heard reports about the Vietnam war. He then relates, "When I was informed about the end of the Vietnam War by some nomads who had heard about it on the radio, they insisted that Vietnam bordered the United States. When I objected that the immense Pacific Ocean separated the two by many thousands of kilometers, they said I must be wrong because you could not fight a war with a country unless you were next to it. They were wrong on the facts but perhaps right on the principle." While I understand that things are more complicated than that, it seems like that would be a very good place to start with our foreign policy, particularly as it pertains to waging wars. (You hear that Canada? Eh? You guys are next!!)

One of the main concepts that ran through the book was the idea that Afghanistan has been a difficult country to rule, for their own rulers and for foreign powers who have tried. The moniker "graveyard of empires" has been used to describe this characteristic, though it's not entirely accurate. The author of the book I read says, “Afghanistan uses the hyperbole of history (unconquerable and a graveyard of empires) to exaggerate its strengths in order to deter invaders. It has relied on its indigestibility to get them to leave. But like the puffer fish, this is a tactic employed by the weak and vulnerable, not the strong and secure. It comes with a high price tag too, since when deterrence failed, the ensuing conflicts, particularly over the past thirty years, devastated both the country and its people.”

One reason it's been difficult is that the Afghan people have been pretty independent-minded, particularly in the rural areas. Afghan tribal customs are fairly egalitarian in the sense that anyone could envision his own rise to leadership. The traditional saying goes something like, "Me against my brothers; my brothers and me against our cousins; my brothers, cousins, and me against the world.” Sort of how it's OK for me to beat up my little brothers, but no one else is allowed (and you know I can still take all of you, so don’t even think about trying anything). So they don’t really like being controlled by others all that much, not least of all each other.

If a foreign, particularly non-Islamic, state tried to control Afghanistan, different groups might all come together to run them off, but tended to immediately resume old rivalries once the common enemy was run off. Whereas to outsiders they might seem very patriotic to the idea of an Afghanistan nation, they are actually hindered by various internal divisions. Historically, as long as the central government in Kabul met basic expectations (e.g. basic security), didn't demand excessive tribute, and then left them alone, the population living outside of the capitol cared little what the ruling elite chose to do.

For a lot of its history, this country has been valued primarily for trade routes (the "Silk Road" network) linking the Far East, primarily India and China, to the Persia/Iranian empire, the Ottoman/Turkish empire, and eventually to Europe. Particularly during the colonial era it was seen as a buffer state between British-controlled India and the Russians, the so-called Great Game (or Tournament of Shadows as the Russians called it) for control of Central Asia, all those "Stans" down there. In fact, this has been the real difficulty in subduing the country - fighting off the other empires and countries that have wanted to control this area, rather than the rebellions by the inhabitants or the legendary fierceness of the Afghan fighter. I guess the other reason is the "because it's there and because I'm a megalomaniac" factor of emperors and conquerors.

I mentioned some of my concerns previously with contractors being so significantly involved in the business of war, and it is a business. And in our country, where CEOs and boards are more or less legally obligated to only maximize profits without concern for the greater public good, I find that more than a little disturbing. It's not enough just to make money, however. We hear all the time on the news how relatively successful Company X has made millions, even billions, of dollars in profits, but because the company didn't make as much as they projected, or as much as shareholders think they should have made, Company X gets taken over, or the CEO gets replaced (but not before getting a lucrative severance package) by some other psychopath who will fire as many people (who don't get lucrative severance packages) as it takes to make the books look better. A business that's organized around providing services for military endeavors is still a business, and they want to, at the very least, maintain profits, if not grow them. So it begs the question ... who's next? Iran? Somewhere in Africa? We still will have people here in Afghanistan, so at least there's that, but "growth" is the operative word in all of this. (You hear that Canada? Eh? You guys are next!! I'm serious!)

Kandahar 4

Brett asked that write shorter updates. I'll see what I can do. This won't be one of them. I've been writing down thoughts here and there for the past few weeks, and sometimes they accumulate. I apologize if some of this is not interesting, but these updates are as much for me than they are for you. Maybe more. If you'd prefer I not clog your email Inbox anymore, let me know and I'll stop.

I wrote in my last little update that my curiosity was "peaked" rather than "piqued". I apologize for any confusion caused by my mistaken homophones.

It has yet to rain, and I don't think it's done so for months prior to my arrival. There's dirt and dust everywhere. Fortunately, we haven't had any of the sandstorms that you sometimes hear about, especially in Iraq, but all the vehicles are covered, inside and out, with a fine layer of dirt. The sides of the roads are powdery little berms of the stuff that get easily stirred up by the passing 4x4s, Humvees, armored vehicles, and lorries; often the sky is hazy with it. It's relatively better in the early morning and later in the evening before and after the main traffic of the day occurs, but I still refuse to run outside, as much as it pains me to run indoors. Some Airman (low-ranking enlisted) contacted the clinic a few weeks ago saying that he wanted to organize a marathon on base for one charity or another. There are lots of such events to raise money for cancer research, wounded warriors, POW-MIA, down on their luck strippers with hearts of gold, etc., etc. The Canadians seem to sponsor a lot of them, but the Aussies are organizing one here in the next few weeks, and the US has its fair share.

Most of them, however, are 5k or 10k in distance, which is manageable. Rarely there has been a marathon/half, which is what this kid proposed. He contacted us because they need medical support for the event. He didn't have very many details, however, about the exact route with mile-markers, where they've set up aid stations in the past and how many they'll need, etc. Not very well planned. I mean, if you're going to ask us to support your run so that you can put a little bullet point on your deployment commendation letter, you really ought to have the details worked out as much as possible beforehand. Fortunately, Joe was able to talk to the kid's supervisor and have them lower it all the way down to a 5k/10k run. Usually, these things have to start early in the morning - between 0530 and 0600 - so they can finish up before most of the traffic starts, avoid some of the extra dirt and dust, and, of course, the heat as the morning progresses.

A marathon would have meant a start time of probably 0500 and required that we stick around until 1000 or 1100, which just can't happen when we have morning clinics to see and when there are still airframes to be serviced and missions to be performed. KAF is supposedly the busiest airfield in the world with something like one airframe taking off or landing here every 30 seconds. It's quite an orchestrated operation: fighters roaring and drones buzzing off, helicopters hovering down, kicking up all kids of dirt and debris in their downwash, and ambulance Humvees going out to meet them to pick up casualties, fuel trucks ceding the right of way to cargo and passenger planes taxiing to the take-off location. A couple of us sat out by the flightline last weekend one evening, just watching the traffic, and while that number may be a bit apocryphal, it can't be too far off the mark.

Since I'm talking about the how dirty this place is, apparently the Kandahar poo-pond is world famous. A quick Google search will bring up loads of mentions from personal blogs and respectable news organization websites alike. I know Jon Stewart mentioned it on the Daily Show after his visit here. Thankfully, our compound is more or less on the other side of the base from it, but some of the main living areas are located fairly close, and if the wind comes in from the west, it blows the odor right over these sleeping modules. One of the dining facilities is over that way, and it doesn't exactly whet one's appetite to walk through that on one's way to eat. There used to be all kinds of signs up nearby, and I wish I'd have gone over and taken pictures of them because some of them were clever and funny. I mentioned my favorite one before, "Don't eat the brown trout." There was another one offering Scuba lessons and "No Lifeguard On Duty: Swim at Own Risk." Apparently, however, some general didn't approve (probably an uptight Army guy) and had all the signs taken down. I think that's ridiculous. This place not only has a literal shit-hole within a few hundred yards of living quarters, but it's a shit-hole in a metaphorical sense. Those signs were a harmless way of injecting some harmless humor into what really is an absurdity of living a few hundred yards from a pond filled with human and other industrial waste.

With so much heat and dust, it's important to get enough water to drink. There is a treatment facility on base which provides water clean enough with which to shower and brush your teeth, and it's also suitable for cooking, but we're not supposed to drink it in any large quantity. Instead, huge palates of bottled water are shipped in and then placed around the base. I've been very anti-bottled water for years now. First of all, I think it's a huge scam. At best, it's already safe-to-drink tap water that's been run through a big industrial filter, if even that. Plus, the amount of oil that is wasted in distributing this product is absurd. Not only are you using oil products to make the plastic in which the water is held, but you're also using huge amounts of fuel to ship it. Unfortunately, we don't have that choice here. The recommendation is to drink at least 5-10 bottles a day. If there are 30,000 people on base drinking the minimum of 5 bottles, that's well over 150,000 bottles per day. It's just disappointing. Most of the bottles aren't recycled, either, but rather burned with the rest of the trash. Word is that another treatment plant has been under construction and should be up and working soon, but I don't think they have the waterlines built yet to distribute it, which they're supposedly planning on doing, i.e. more construction in a warzone from which we're supposed to be drawing down.

http://storyofstuff.org/bottledwater/

http://www.onlineeducation.net/bottled_water

http://www.ewg.org/reports/BottledWater/Bottled-Water-Quality-Investigation

One day I returned from the Canadian gym to discover that the water in our compound wasn't functioning: showers, taps, toilets. There was some issue with some of the water lines out somewhere. I admit, I sweat. A lot. I'd like to think it's because I exert myself more than everyone else, my body is more efficient at cooling itself and produces more sweat to that end than ordinary humans, and, to paraphrase Uncle Mike's line about how his bald head is like a solar panel, my sweating is a high-powered water cooling system for a high-powered love machine. My shorts and shirt were completely drenched through, and the walk back in the dry, dusty hot air was enough time for some of the sweat to evaporate, leaving my skin feeling kind of sticky and grimy.

I didn't know at the time that the water shortage was not base-wide and that there were working showers at one of the other nearby US compounds, so I made due with a combat shower. Now, I'm not sure what the exact definition of a "combat shower" is, but it seems that it's more or less an improvised and/or partial shower. So, just getting your hair wet in the morning can count as a combat shower as can, let's say, grabbing 5 bottles of water and a bar of soap to clean yourself up as best you can. I will admit that 2.5 liters is probably less than ideal, but if you use it sparingly and concentrate your soaping and rinsing to your armpits and ... since we're in a combat zone, let's call them "strategic areas," you may not feel quite as clean and fresh as you'd like, but at least you won't offend your co-workers and other innocent bystanders.

Unfortunately, one of the docs here does have a wee bit of a hygiene problem, and "wee bit" may be the understatement of the year. He's a LtCol flight surgeon and, with his bushy deployment-mustache, kind of looks like Magnum P.I., though Magnum P.U. might be more apropos (thank you, folks, I'm here every day from 3-11pm). He works with one of the flying squadrons, so he's not here most of the time, but does come in and works one, rarely two, mornings a week when Joe flies with one of the aircrews. He's a genuinely nice guy, brings over perfectly fine leftover fruit from the aircraft maintainers' morning food deliveries (so much food is wasted here), and he really went out of his way when I first arrived to show Joe and I around the part of the flightline where he normally works. But he smells. Bad. Epically so.

Now, I will admit that I'm not the most clean person out there. I shower regularly, wash dishes, etc., but, I'm a little cluttered at times, especially my desk. Although that may not be such a bad thing. More and more research suggests that the rising incidence of asthma and allergies in kids may be due to too little exposure to microorganisms that humans have typically experienced - the hygiene theory of allergies and asthma. The cutesy, media, headline-grabbing expression is "EAT DIRT! PREVENT ASTHMA!" This is not what any of those researchers literally mean to say. But, apparently, kids who grow up on farms seem to have fewer allergies and less asthma. It may be that the greater exposure to more of the bugs and allergy-causing particles with which humans/humanoids have evolved over millions of years help our immune systems to learn how to function, build up immunity against harmful bugs, and also learn how to not over-react to bugs and particles that are not harmful (that is, not over-react to pollen in the air in the form of hay fever and hypersensitive airways in the form of asthma). What I'm trying to say is, my lungs are nice and strong, and I try to keep it that way. This is not to say that hygiene isn't important. Clean water, effective plumbing and sanitation systems, and better food preservation/refrigeration have done more to increase our average lifespan than all the subsequent medical efforts since. And living in total filth is problematic, e.g. perhaps a third of Europe's population was killed off by the plague, a disease spread by fleas living on rats living on garbage and sewage in medeivel cities. But cleaning every surface in your house with bleach may actually be doing your children less good than you think, and maybe some harm.

Another factor that may be helpful in preventing allergies and asthma is having older siblings (Brett might live forever if that's true). It also seems that more time spent indoors may increase a kid's risk. It might be that exposure to inside bugs and particles (or being exposed less to the outside stuff) might somehow be more harmful, but it could also be a proxy for kids getting fatter, which could be a factor. It could also be that being outside implies more physical activity and more expansion and exercise of a kid's lungs, which might make them more resistant to getting inflamed and from narrowing too much (which is what happens with asthma). Maybe it's a bit of all of those things. Another thought is that antibiotic use in kids may actually have a negative effect for asthma and allergies. Obviously there are situations where they are life-saving, but not nearly as often as most people think. It is probably only a very tiny fraction of ear infections that require antibiotics, even when a kid has a fever and a swollen ear drum.

As I mentioned, and in the spirit of full disclosure, I am not always the most tidy. There was the time I left for Guatemala a few years ago during residency, and my friend, Brian, kindly offered to start my car and drive it a bit while I was away in order to keep the battery charged. We drove my car to the airport, then he drove it back to Vacaville. Brian's a great guy, a guy's guy, if you will. And he's extremely clean. We're talking this guy brushes his teeth with AJAX and gargles with Clorox as mouthwash. So three weeks or so later, he stopped by the apartment building and got in my car, and almost barfed by how bad it smelled. If I remember the details correctly (and if I don't, it doesn't matter, it's my story and I can tell it how I like), he told me later that he literally was looking under the seats and in the glove compartment, searching for whatever small animal it was that had snuck in and died. Said he opened all the doors, and then found the culprit when he opened the trunk - a three week old bag of garbage that had been liquefying, brewing and fermenting in a dark, closed trunk, heated daily by the hot California sun. I don't remember if he told me that he passed out or not, but when he recovered from whatever initial shock he suffered, he graciously threw it out and did what he could to sanitize the site. As it turns out, I'd cleaned my apartment before leaving for Guatemala and intended to throw out the garbage as I drove out of the complex. I stuck a full bag in the trunk on one of my trips to load the car, but, in the fluster of leaving, forgot about it.

And then there was the time this year when I left for Nepal for three weeks. I'd cleaned my apartment and was ready to leave. I figured that I should just turn off the power in my apartment because I try to do what I can to not blatantly waste electricity. Well, I accidentally didn't flip back on the breaker switch that powers the refrigerator. And while it's not tortuously hot in Germany in April/May, "temperate" is still not an appropriate temperature at which to store food intended to be frozen. When I arrived back three weeks later, the plastic wrapping around a whole frozen chicken in the bottom drawer of the freezer was bulging, filled with decomposition gases, and there were at least two dozen flies either having already lived out their lifespan and lying around dead or buzzing around the scene. There were some other bags of rotten vegetables and other food stuffs that were equally rancid. And then there were abandoned maggot cocoons scattered about the floors. Took me forever to clean things up. Yech.

But those were mostly accidents. And while I wouldn't say that Magnum P.U. is intentionally offensive, he's at least committing a crime of hygiene-omission, if not against humanity, certainly to the medical technicians who work with him in our clinic, to the patients who come into the clinic, and to his roommates. Now, I get it - some people are more pungent than others. I mean, I can't help it that my man-musk makes the ladies go crazy. And a guy I used to work with doing construction back in the day could shower and deodorize in the morning and reek to high heaven by lunchtime. In fact, the guys at work used to him Onion Boy. "Hey Lance?! Where's Onion Boy today?" It wasn't that they couldn't smell him and that's how they knew he wasn't around, but rather that they could smell anything at all that tipped them off. Anyway, this guy's skin was a little more oily than normal and there must have been some secretion in it that was like creatinine for stench-producing bacteria.

I'm not usually here when Magnum works, so I mostly just hear about it later from the technicians, but boy do I hear about it. One of the techs sprays air freshener every time he leaves a room and once she even less-so subtly followed him around a bit and sprayed while he was present in the same room. One day, three people who came to clinic were overhead saying, in one way or another at various times and various places, "it smells like dirty ass in there." Maybe those weren't their exact words as I may have toned down the language for our under-17 readers. Another tech today told me that he has "not exactly a sour smell, but it burns your eyes when you walk in the room". She also told me that he "peed with damn door open," the thought of which made me laugh. I just imagine strolling by the bathroom here in the clinic, looking over, and seeing the back of some dude with his flight suit unzipped, sleeves hanging down by his side, looking up at the ceiling and letting out a sigh (and maybe even doing the pee-shiver) while he splashes toilet bowl water all over the place. And it's not like the bathroom is in an inconspicuous corner of the clinic somewhere. Not quite as funny as the time in college when we overhead a couple our roommates, one of them 6ft 9in tall, have a pee-stream sword fight. A guy that tall should be careful - he might shoot someone's eye out, or worse, poke their eye out. Yikes!

It doesn't stop there. He also rummages through people's things and eats their food. I had to stop by one morning while he was working in order to unlock the narcotics and controlled medications cabinet. I looked for the spare key in one of my desk drawers, which also has water-flavoring packets and other snacky-snacks in it. Well, while I was searching for the keys, he reached in, grabbed a packet, looked it over to see if it was an acceptable flavor, and just took it. Now, I wasn't angry and didn't really care that much, but he didn't even give a "hey man, you mind?" I guess he rummaged through another one of my drawers before he left and grabbed some stuff. And he claimed to be looking for movies to borrow from the collection in back, which is located next to the large main refrigerator (recently emptied), but apparently came back without any movies. He'll walk into the small lobby, grab a magazine, usually one of the gossip rags, and talk about how those magazines are "deployment porn." Every time. And after he leaves the clinic for the morning, the techs open all the doors and windows in an attempt to get a cleansing cross breeze going, despite the fact that it's often over 100 degrees outside. One tech told me, "I like it better when he emails me."

Our logistics guy who left about a month ago was roommates with Magnum. He stuck it out for most of the year, but it got to the point where he couldn't tolerate it anymore and the last month or so he was here he lived in the clinic. He found a cot, made room to store his things, and showered here. For a month. Part of what makes the situation a bit delicate is that Magnum is a lieutenant colonel, so many of the enlisted people are hesitant to say anything to him. But, the previous doc here was also a LtCol, and he actually did say something to Magnum about his hygiene, but it would seem that council fell upon deaf ears. Maybe he needs to clean the wax out of them. He leaves soon, but probably not soon enough for some people.

Then, the other day, he graciously offered, unsolicited, to work one of the mornings for me since Joe had to do an investigation, short notice, for a couple of days. He came in and was at peak pungency. Well, the chaplain, who's a LtCol, came in and noticed it. He asked one of our MSgts about it and she explained the situation. The chaplain said it was unacceptable, asked who Magnum's supervisor is (probably the general), and said he'd take it up with that person. We're assuming some correction was given because he hasn't been quite as "sour smell that burns your eyes"-pungent recently. It reminds me of the scene in Anchorman, where Paul Rudd's character puts on the cologne, "Sex Panther - 60% of the time, it works every time" - then walks through the office to cries of, "it smells like, like a used diaper filled with Indian food", and "this is worse than when that raccoon got in the photocopier", and it "smells like a turd covered in burnt hair." It's that bad.

Stay clean, but not too clean.

Kandahar 3

I was at the Canadian gym, which is where I go just about every morning, and a couple of the trainers and I started talking. I don't remember exactly how we got on the topic, but one of them began telling me about how he's seen a bunch of US military guys down at the boardwalk who have gang tatoos: Latin Kings, Crypts, Bloods, MS13, etc. He plans on becoming a cop after he returns back to Canada, so he's a little more current on his gang ink than I am.

I guess he's been here before and worked as a medic at the hospital. Says that every couple of weeks someone would come in, worked over pretty good, usually females, but also some guys, who'd been raped and/or beat up, some of them gang raped. Turns out that South Park, as it's called, is one of the camps/compounds here on base. It's almost entirely Army troops, and it's where most of these assaults have occurred. He suggested not going down that way alone at night.

My curiosity peaked, I started reading some more. As it turns out, there is something of a gang problem in the military, mostly Army. In general, something like 0.02% of the US population belongs to gangs; in the US Army, it's thought to be between 1-2%, 50-100x as high and that estimate was 4-5 years ago. It's reasonable to think that it could be higher than that now. From what I read, there have been reports of drive-by shootings, drug trafficking, and other gang activity near some military bases, and even some gang activity that goes on overseas - setting up "franchises," if you will. There have been reports of some of these gang members who have stolen body armor and mltiary weapons from warehouses and sold them.

Now, I really try to be sympathetic to the idea that a lot of kids who grow up in unfortunate situations join gangs for various reasons, not least of which is a sense of belonging and family that they might not otherwise experience in their lives. And I know that many go into the miltiary because they don't have better options, which I think reflects poorly on a society that gives hundreds of billions in bailouts to already wealthy bankers rather than invest more in schools, infrastructure, after school programs, affordable daycare, student loans for college, and living wages so that parents don't need to both work, nor work so much, in order to make ends meet. I also think that military service can be a way for some people who don't have other options to get a job, pay taxes, get education, stay out of trouble, etc.

And I'm all for rehabilitation programs for all kinds of criminal offenders, particularly for those of lower socio-economic status and for nonviolent offenses. But, I'm not sure I'm OK with the idea of military service as a form of rehab for someone who's just been convicted of a crime and has gang affiliation. At least not immediately as a trade-off for jail time (although jailtime has its problems - I think I'm more in favor of work/education type programs).

Some of the articles I read further described how some of these guys get out of the military and now have training in warfare, particularly close quarter urban warfare considering the recent wars that have been fought, and they have some sense of discipline, all of which can be taken back and used to better organize and train other gang members - some gangs reportedly even actively send members into the military to that very end.

Some of the fault also lies with recruiters, many of whom are, if not outright liars, certainly less than fully honest, saying pretty much whatever it takes to get kids into the military and meet their quotas. They often don't inquire about or report gang membership of potential recruits if they think it would prohibit someone from joining. I'd say that's a very sinister and dangerous form of "don't ask, don't tell." For what it's worth, I'm infinitely more worried about gangbangers in the military than I am about gays banging in the military.

Kandahar 2

Early one morning last week, I was awoken by a loud rumbling sound that lasted 4 or 5 seconds, accompanied by a heavy vibration that traveled through the whole unit of our block of rooms. My very first thoughts, PG version, were, "Holy crap! A mortar must have gotten through the early-warning detection system and landed nearby." The way it's supposed to work is that an alarm goes off when the detection system senses a mortar in the air, then there might be a thud or explosion sound, etc., then you haul ass over to a hardened facility and wait around until the female British voice gives the "all clear", and you return to whatever it is you were doing before - usually back to sleeping since the fuses are inconveniently often timed to go off in the middle of the night.

So the PG version of my next thought was, "Oh crap! It's really early and now I've got to get out of bed. Thanks, Taliban!" You have to understand that the domicile block walkways and stairs are made from pressed sheet metal, the scaffold is constructed from crosslinked metal beams, and the walls are very thin. So I waited for a minute or so, expecting the alarm, unable to fall back asleep, but it never came. Then Joe happens to walk in about that time (he had been on an overnight flight with one of the aircrews). I ask him what the sound was. He explains that one of the guys in the block of rooms, Lawrence, was leaving KAF, and Joe saw him dragging his big roller-bag of luggage down the stairs, letting it fall and slam onto each one of the steps as he dragged it down and away. Noise travels easily enough as it is, but when an inconsiderate idiot drags his bag down the steps at 445am, it's especially noisy; not to mention that it sounds and feels like I imagine a nearby mortar strike would. Damn you, Lawrence!

It's over a month since I arrived here in Afghanistan. Five months too many still to go. I wish I could say that the experience has somehow become more meaningful since my last update, but it hasn't. I can say that figuring out a daily routine does help pass the time. There's something to be said for that. My usual routine now is to wake between 7 and 8am and go to breakfast. I then head over to the Canadian gym and workout (the gym at our compound closes from 8am until 2pm). I still do p90x, but might try to mix in some TRX, a different workout. A couple of days a week one of the Canadian units has a spin group, and they let me sit in on that. It's nothing like riding my mountain bikes, and it almost makes me sad that I'm reduced to spin class, but I suppose it's still better than nothing. I asked a lady who participates in the class what the guys do, and she tells me that they're engineers. Most of the guys are shorter and squat, with shoulders half-again as wide as mine (which isn't necessarily saying that much) that taper down to waists half-again as small as mine (ditto), so I tell her they don't look like engineers and pretend to push my glasses up my nose. I look more like an engineer than those guys. She laughs and tells me that they're combat engineers, which means they build and/or blow up stuff as needed so that friendlies can move where they want and unfriendlies can't. Involves a lot of construction work, demolitions, etc., and they carry and sometimes have to shoot guns while they do all that.

Since I left Germany, I've lost about 10 lbs, so I guess all the working out is helping. After the gym, I usually go and clean up, then head back to the DFAC for lunch. After lunch, I usually just go and read or study, or watch Daily Show and Colbert Report online. By 3pm, it's time to head over to the clinic for my shift, which ends at 11pm. Most of the time only a few people will show up - a busy night I'll see 4 or 5, but occasionally, especially Friday through Sunday, there might not be anyone. If that's the case, I'll do more reading, or emails, and sometimes I'll have a movie going on one side of the screen. My shift ends at 11pm, but most nights I can leave a bit earlier. I tell MSgt Mason, the tech on evenings with me, that he can call me if anyone comes in and really needs to be seen (one night a guy showed up at 1055pm complaining of bloody stools - putting your finger in someone's butt right before your own bedtime doesn't exactly sweeten ones dreams). And then it's pretty much straight to bed. Not all that exciting.

Occasionally there are other things to break up some of the monotony. Greg Stecklow, from back in Ohio, is in the Army Reserve and happens to be here as well. I somehow found out through Facebook that he's here. Anyways, we met up for lunch the other day. Our lives have, for the most part, proceeded along very different paths since we graduated from high school, yet coincidentally have converged here 17 years later. I also heard from a patient that Jon Stewart would be passing through as part of a USO-sponsored tour of Afghanistan. Karl Malone and David Blane (the magician dude) were also along. I waited in line the next morning as they herded people to the photo-op area at the USO, 10 people at time. I know he's kind of a short guy, but I was surprised that he looked as little and skinny as he did. And to be fair, standing next to Karl Malone, we all look small. Shook hands, said a few words, then took a group photo (the guy to whom I gave my camera officially sucks at photography). Stewart was friendly and at least was trying to ham it up for everyone, which I appreciated. The other guys just sort of stood around. And tomorrow, there's a group of us going over to the K9 unit to get a look around there. Should be interesting.

So the uniform rules. Bear with me, this will take a while. The entire base is no-salute, which is fine with me. EXCEPT that apparently we're supposed to salute generals. Don't really understand that one. Saluting everyone gets really old really fast. You can wear your full uniform at any time (with the field hat or floppy boonie cap when outside), but if we're in our compound, we don't have to wear the hat, but you can if you want. No hats indoors, of course. You must wear your uniform when you're on duty. When you're not on duty, you have the option of wearing the official physical training (PT) gear, with or without the matching ball cap at any time, but I just learned yesterday that you may also wear the camouflaged boonie cap with your PT uniform, which is an exception here to the general rule that prohibits this, BUT, you can't wear the camouflage field cap. You must wear the official PT shorts or pants whenever you go to the gym, and there's a sweatshirt and jacket you can wear as well if it gets colder.

(Aside: I've been wearing my Five Fingers shoes to work out, which I've been doing for well over a year, but yesterday some guy, who was giving me the stink-eye for 10 minutes before he finally approached me, said that I can't wear them without socks. Well, they're designed to be worn without socks, and I've actually read that it's up to the commander as to whether you have to wear or socks or not, and so far no one else has said anything to me, including the chief master sergeant of the entire wing. So I figured it was OK. I start to tell him that I'd read you could wear them with or without socks, but he cut me off and assured me that the Air Force Instructions say that you have to wear socks. I wasn't going to argue with him there, so I just said, "OK. Thanks," and he left. Reason number 1024 that I can't stay in the military - idiots who think it's their personal, sacred crusade from God Himself to enforce stupid and/or nonexistent rules).

On Saturdays, there's a bazaar where Afghani merchants sell various souvenirs (although it's been suspended during Ramadan), and if you're going there in the PT gear, you must wear the PT pants - no shorts allowed. Other than that, there's nothing else you can wear outside of your room except to and from the bathroom/showers (I recommend flip-flops for the showers). As I mentioned before, we have to carry our weapons (I carry around an M9 handgun, but lots of other people have to carry larger machine guns) with us wherever we go - to the community room, to the dining facilities, etc., EXCEPT if you're going to the gym. Then you're allowed to go there and back without it; but, no stopping at the dining facility or the shopette or boardwalk on your way back from the gym, even if it's along the route back to your room. Rather, you must go back to your room, grab your weapon, and then go eat or shop (preferably after showering). (Considering that most everyone on base carries a weapon, it occurred to me after the fact that I probably shouldn't have yelled at that one dude playing volley one night several weeks ago and called him a "dick." Even though he was totally being one. Lesson learned.) And you're not allowed to carry bags of any sort into most buildings, including dining facilities, the USO, and the base exchange/shoppette. Some of the gyms require that you bring an extra pair of shoes - ones that you don't wear outside at all - in order to work out there. From dusk until dawn you're required to wear a reflective belt no matter which uniform you're wearing, even though the Air Force PT uniform has reflective material on both the shorts and shirt. Pretty simple, right?

Apparently, for a while there, they had security forces picking up people if they found them without their weapon, ID, or reflector belts, and placed them in a makeshift holding area in the center of the courtyard at the boardwalk until their supervisor came to get them (which I personally think is somewhat extreme and degrading - it was primarily an Army-inspired program, and the Army is, moreso than its sister services, an extreme and degrading organization in many respects). And through Ramadan, we are no longer allowed to wear our PT gear outside of the compound unless we're going to a gym to workout. Otherwise it's full uniform. Further, during Ramadan, there's no eating or drinking outside of the compound, including at the boardwalk, where nearly all the restaurants are located.

You probably heard about the Chinook helicopter that was just shot down and 30+ people died. That wasn't too far from here. Apparently the fighting season has been picking up; the poppy harvest was late this year. Afghanistan grows something like 90% or more of the world's opium that is then turned primarily into heroin, and the money they get from that crop is used to finance the al-Qaeda and Taliban forces against NATO forces here. It's also Ramadan, the month of fasting from dawn to dusk and of giving up certain vices and pleasures. It apparently is a time when some of the fighting further picks up: both between different groups of the Taliban and the various warlords and tribal groups, and between all of them and the coalition forces. We don't see much of the aftermath here at our little clinic since we mostly deal with low acuity stuff. Saw a couple of kids a few weeks ago after they were released from the hospital who'd been beaten up pretty good when an IED went off near them while they were attempting to diffuse a different one. One kid had some burns and a couple of them had ruptured ear drums. Their chief wasn't so lucky, apparently.

There have been quite a few announcements sent out about "distinguished transfers" which is a euphemism of sorts for putting dead kids on airplanes and sending the bodies back to the States. This is a bad war - always has been, even from the start. It's also become a contractor war in the sense that there are now more contractors working in this war zone than there are active duty military. Many of them are US citizens, and many of them get paid ridiculous amounts of money for doing rather menial work (e.g. post office workers making 6 figure salaries for helping me return my Kindle to Amazon after I dropped it and the screen broke). The TCNs (third-country nationals) come from all over: places like Nepal, India, Pakistan, other SE Asian countries, and other places as well. Many of them do even more menial tasks like cafeteria services, cleaning bathrooms/showers, and some construction work; they usually don't get paid so liberally, but it's still much better than what they'd get in their home countries.

While most of them are just guys trying to make some money to take home, and probably could care less about sides in this conflict, it does raise all kinds of issues. For one, while most of these guys are just trying to make some money off the US taxpayer, there are some among them who have malicious intentions against the people living here on the base. And it's not like they're thoroughly screened when they walk off the plane or closely supervised when they're digging ditches to lay new fiber-optic cable around our compound. There are efforts to find contraband, and there have been some "success" stories. For instance, one guy I saw in clinic told me how one of the K9 handlers was doing some training with one of the bomb dogs. The dog, however, didn't go to the place where the handler had placed the training decoy. When he tried to redirect the dog, it refused and stayed where it was. The handler then looked carefully and saw where something had been placed in the ground. As it turned out, someone had somehow planted and IED in the training area there. My point being, a contractor war significantly increases the risks on base, especially one as huge, disorganized, multinational, and crowded as KAF.

Bomb-sniffing dog. He must be able to smell guns as well cause that's the only thing hidden in my sleeves.

I think about the warning given by the Irish Replubican Army after the Brighton Hotel bombing in 1984. Margaret Thatcher came out of it unhurt, but 5 others died and many others were injured. Thatcher gave a rousing speech about not being deterred by terrorists, etc. The IRA responded with a statement promising that they would try again, and issued this warning: "Today we were unlucky, but remember, we only have to be lucky once. You will have to be lucky always." It really is such an asymmetric war here in so many ways, and asymmetric not in the sense that NATO forces have this ovewhelming advantage in technology, but that the relatively basic weapons that Al-Qaeda and the Taliban are using are as effective as they are. And for many of the Al-Quaeda and Taliban guys, they only have to be lucky once for it all to be worth it to them. And they're getting "lucky" quite a lot, unfortunately. I know I mentioned this before, but Al-Qaeda and the Taliban are destroying our armored vehicles that cost hundreds of thousands of dollars and blowing up our kids with IEDs that cost as much as a pizza to make. These are lessons that our "great leaders" should have learned from Viet Nam and from the failed Soviet invasion here in the 1980s (although, to be fair, the CIA provided the mujahadeen with millions of dollars in aid and weapons, some of whom are the very groups that are killing our kids still today, so it's kind of our government's own fault to some degree). Though it may not be completely true, Afghanistan has been called "the graveyard of empires" for a reason.

Our clinic people on one of the MRAPs (Mine Resistant Ambush Protected)

Some of the guys I see are security forces, so I try to pick their brains about some of the stuff going on here. Spoke with one guy the other morning. He says that going after contraband goods keeps them pretty busy. The welcome letter to KAF actually says, "General Order No.1B (GO No.1B) is enforced at KAF. Among other things, GO No.1B prohibits the possession or consumption of alcoholic beverages and/or nonprescription drugs, possession of pornography and entering sleeping quarters of the opposite gender. These are serious offenses and the consequences are severe." Despite the general order for the base that prohibits alcohol, it still gets here. Some people try to have it sent via mail from distributors, and sometimes the glass shatters in shipping, so they can easily get those idiots. But there are some distributors who pack alcohol in plastic bottles or with well cushioned packing. One guy apparently received a case of Miller High Life, and I guess it looked and felt suspicious enough that they checked it. He said they caught another group of guys trying to use rubbing alcohol to make liquor, too. Not smart. Rubbing alcohol supposedly can cause blindness, and I say that the only thing that should be causing blindness on this base is .. Well, nevermind. And apparently a plastic half liter bottle full of vodka will go for about $70. There have even been a few DUIs. One Army girl partied until about 2am, then had to be ready to drive one of the armored vehicles by 6am. She was still drunk at that time and ran this $200,000-300,000 machine off the side of the road and into a ditch. I'm guessing she doesn't qualify for her next promotion.

Since we're talking about porn, liquor, and fornicating (no, I'm not confessing anything), one of the guys I know here is the SARC officer: Sexual Assault Response Coordinator. He says that there's been all kinds of crazy stuff that's gone on. Apparently, one women says she went to one of the gyms to workout, thinks that someone may have spiked her water, then doesn't remember anything after that until she woke up the next morning in a port-a-john. Oh, and by the way, with child. Pregnant. That kind of stuff. Now, I'm not saying that I don't believe her story, but that's pretty hard to believe.

I saw a woman one morning last week ago for "Plan B." She'd had sex the night before and I guess the condom broke. So it seems that most people interpret General Order 1 to mean that troops aren't allowed to have sex, but that's not true. It doesn't make any prohibition of sex, it simply makes it a little more logistically challenging. So, out of curiosity, I asked her where she goes for the festivities, and she casually answers that she and her boyfriend go over to the Kandahar hotel. As it's name implies, it's literally a hotel here where people coming through can stay. Makes sense.

Saw another woman a couple of weeks for sleep problems. Gave her some meds and a handout on sleep hygiene that I hoped might help. She showed up again the other night for the same problem, so we delved into things a bit more. Turns out she's pleasant enough, but admits that she's a little high-strung and nervous at baseline. When she deployed here (it just so happens that her boyfriend deployed here at the same time), she left her two kids with her ex-husband back in the States. He lives with his girlfriend, who my patient described as a "that bar-whore." So now her ex-husband just got deployed, my patient has two more months before she returns home, and her ex-husband left the kids with "that bar-whore." Now my patient says that when she tries to go to sleep after her night shift, her mind is racing, worrying about her kids, and she can't wind it down.

She also tells me that her migraines have gotten more frequent (most likely from the lack of sleep) over the past few weeks, and she's been getting nauseous. So I ask her, pertaining to the nausea, whether it's possible that she's pregnant. She quickly and emphatically tells me that that's impossible. I ask her why? Her boyfriend is here, after all. Well, she tells me that it's not allowed per General Order 1. Being the guardian of her overall well-being that I am, I explain to her the finer points of the General Order, and pass along the inside info about the Kandahar hotel. I suggested that maybe an energetic frolic in the sack might help with her stress and headaches (unless she's like most women and gets the headache right before the fun starts - so typical). As an aside, I haven't actually visited the Kandahar hotel, but I'm going to suggest you bring your own plastic mattress cover if you do. Well, she looked genuinely surprised and even a little upset as I related this to her. "You mean all this time ... ?" I sat there quietly and nodded, trying to be sympathetic. Her look seemed to say, "It's like being deployed with your boyfriend for four months, and only just now finding out we could have been doing it this whole time .... IT'S LIKE RAY-EE-YAAAAAIN ON YOUR WEDDING DAY. IT'S A FREE R I I I I I I I DE, WHEN YOU'VE ALREADY PAID." Not technically ironic, but definitely unfortunate.

Anyway, I wish I could say that I'm severely depressed being here, and maybe that way be able to leave this place. But I'm not. Just mostly bored and counting down the months. I'm mostly just trying to keep my mind and body engaged by exercising and reading/studying.

I've gotten a few questions about sending things here. Really, there's no need. I can get most things that I want and need here on base, and orders I've made from Amazon and New Balance have gotten here in less than a week. A couple of the other people here in the clinic get packages from time to time and there's way more junk food laying around here than is good for me. But thanks for the offers.

That's it for now.