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!)