Busier...

I’ve been busier lately… less so with prevention and more with actual pathology. Depression, suicidal ideation, anger, marital problems, sleepwalking. My practice here is less intense than at home, with less documentation, less overall work, but I think it’s harder to actually help people here, just due to ongoing, unremitting stressors.

I also have fewer options. The options basically consist of: “keep going to work” or “let’s get you out of here.” There’s very little in-between.

We have a small variety of medication options and I am the only game in town for psychotherapy. Most minor to moderate problems resolve on their own, or if they don’t resolve, they at least become manageable with time. Many times I just see people in the acute phase, and when the pain dulls after a few days, they find that they’re okay.

As time wears on I have become more known on the FOB and I see more and more patients in more places—chowhall, the showers, the gym… It’s a small town here. I find that I have a good feel for the pulse of the FOB—I know who the bad NCO’s are, I know about the stressful operations, I hear the rumors and the myths.

Now that my NCO has returned we have to plan our next mission (outreach to other outposts) and it’s my turn. I may leave very soon, but I’m not holding my breath due to all the problems flying. Truthfully, I’m comfortable here and I wish that I wasn’t expected to travel (make them come to me!). Luckily there have been relatively few emergent situations where our skills are needed, and if that luck holds we will have a light travel schedule into the autumn.

The sounds of war are usually distant here at our FOB—and that’s the way I like it. One thing about war is that sound is a major factor. Explosions and gunfire are loud, and loud sound carries far. Your brain tries to sort out the difference between benign and threatening sounds. Many things blow up in this country, whether it be unexploded Soviet ordnance going off on its own, a donkey stepping on a landmine, NATO aircraft dropping bombs, Taliban shooting mortars, FOBs shooting training rounds.

Yesterday, I was eating dinner with several people when a horribly loud screaming sound came out of nowhere, it rose to a crescendo within 2-3 seconds. Everyone stood up, dinners dropped, wide-eyed, poised to run for cover, when the sound rapidly formed into the familiar sound of a jet engine. A US Navy F18 Superhornet (from a carrier in the Indian Ocean) had buzzed the FOB at about 500 feet.

At his speed and altitude, the roar of the aircraft came suddenly, without warning, frightening everyone on the FOB. The jet made a second pass, just as low, and received many middle-fingers.

I can say that I am much more keyed into loud sounds here… I’m always listening. Once or twice a week it keeps me from falling asleep, but I comfort myself with the laws of probability, and a good book.