Getting Up Close

Sometimes it's easy to forget that I am in Afghanistan. I can lose myself in talk about my children, plans for the future, favorite pizza places… You do that to disassociate and feel a little normal.

Inevitably the reverie is broken up by the dull thud of an explosion, near or far, or cracking sounds of gunfire. Mostly those sounds are not immediately meaningful—it means that violence is taking place somewhere else: an Afghan checkpoint is being attacked, the Taliban are randomly and inaccurately lobbing ordnance at Afghan or US posts, someone is test-firing or engaging in target practice, so on and so forth.

I have developed the standard hyperawareness of those sounds. I hear something and suddenly focus all my attention on identifying the source. Was that a mortar? Was that the coffee maker? Was that the next door neighbor slamming his door? I get mildly anxious and I have this strong desire to classify the sound as benign or otherwise. I think that's pretty standard, and I see people jump all the time at loud sounds—from rookies like me to battle-hardened vets.

I got a lot of dirty looks the other day when I accidentally slammed the cooler door in the chow hall.

Football season has started now and that means Autumn and Ramadan. Cooler temperatures are starting to prevail. People are staring to wear jackets in the evening and early morning.

I'm back from a four day mission—a visit to a combat outpost in a small town that is known as a Taliban stronghold. I didn't post to the blog because there were only four public computers at the outpost and a constant queue—I used my 20-30 minutes on the computer to check my fantasy football lineup, read the NY Times and check my personal email. It was a busy trip and I'm tired, but not from being a combat stress doc.

The second morning of my trip started off nice—coffee and conversation with the medic. We were talking primary care medicine and discussing how to motivate people to make lifestyle changes that are so important in the management of chronic disease when our talk was broken up by a distant explosion.

Fifteen minutes later Afghan police roll up to the medical facility in a Toyota Hi Lux. A badly bleeding Afghan soldier is sitting up in the back of the truck--- he had been blown up while attempting to disarm an explosive device at the base of a cellular phone tower. His face is a mask of dirt and blood. His eyes are piercing and intense but he seems to look right through as I carried him on a litter into the aid station, a trail of blood leading up the ramp and across the floor, splashing on combat boots and the plywood walls.

I'm not much of a blood and guts guy—not at all interested—but I saw a bit more than I wanted. The man had been pulverized by an exploding anti-tank mine. Despite the carnage wreaked upon his body he was remarkably calm. It was bloody, organized chaos, the US medical team doing great work to stabilize and package the guy for a medevac. I was drafted into the medical team just because I was there… and everyone pitches in.

After the medevac we were left with cleaning up the chaos—the detritus of a medical emergency, trash and blood everywhere, the heavy smell of body odor and blood in the small room.

Had a nice lunch and I was able to easily eat a hot dog with ketchup, and two peanut butter cookies. I went to the MWR for some emails… thought about maybe taking a nap or watching a DVD…

A boom and then another but these were closer than the morning explosion. Soldiers in the MWR room were playing "Medal of Honor" on the Xbox.

No one really moved until the machine-gun fire started, but then things moved rapidly.

I quickly decided to log out of my email account (!) while next to me a guy was madly trying to finish an email—typing while standing up and pushing his chair away. Small explosions and an increasingly loud staccato of gunfire ratcheted up my heart rate.

I trotted out, not liking the sounds I was hearing outside the walls of the outpost. Not a hard decision to put on my Kevlar and my body armor and, yes, at that moment I was happy I could sling the M16 rather than just having the M9.

What the hell was going on? Were we being attacked? Outside of my hut people were running around, donning armor.

I couldn't decide where to go—the bunker? command center?—so I went to the medical aid station and decided I would just follow their cue…

They were happy to see me at the aid station. "Hey Doc—get some gloves on we've got casualties coming in."

Before long, wounded Afghan soldiers started rolling in—gunshot wounds, shrapnel (the booms were RPGs in the village). I fell into a catch-all role of fetching things, assisting with movement of stretchers and patients, keeping armed Afghans out of the aid station. I saw what an AK 47 round does to a man's abdomen when it enters one side and goes out the other. One guy took a round to the stomach but it didn't come out—the PA explored the hole with a gloved finger but quickly retracted his digit when he touched intestines.

The scene was played out to a soundtrack of machine-gun fire. Again, bloody but organized chaos followed by a Blackhawk medevac.

I kept my body armor on for at least twenty minutes after the gunfire stopped… I figured my wife would have approved of that, and I didn't care what people thought.

For the second time in the day I cleaned blood off the floor, picked up empty morphine auto-injectors, wrappers from Israeli bandages, and bloody latex gloves. Tracked all around the floor were bloody imprints of lugged Vibram boot soles.

I won't get into the details, but suffice to say that we (US personnel on the outpost) had nothing to do with the firefight. The storyline was something out of a classic western—two gangs having a shootout in the town square while the innocents hide, trying to avoid stray bullets.

Forgive me this statement; I'm shooting from the hip but sometimes I can't help but think that it's their country; let's just give it all back to them, every dusty, fly-covered, Islamic inch of it.

Driving back to my FOB we pass through multiple villages. It's later afternoon and there are small children everywhere along the road. The littlest children are dressed in bright, sequined fabrics. Big brothers carry little sisters and watch as our armored vehicles rumble down the road. I watch a little girl, maybe 3 or 4 years old, wave at us, give us a thumbs up. She spins in a circle and dances by the side of the dirt road and then waves at the next US truck that passes. I see another dark haired boy come out of a hut, he's about the age of my son and he waves and gives us a thumbs up, a smile lighting his dirty face.

It breaks my heart. I see my children's faces.

If we must stay here, to build schools and bridges, grow businesses, train police, kill Taliban and Al Qaeda. If we sacrifice under Afghan skies, let it be for these small children who dance in the streets in the eye of a hurricane of violence and poverty.