Transcendence... for an hour

I'm back at home, returned from the south of Afghanistan. I managed to catch a ride on a Blackhawk where I was the only passenger. I buckled in, gave a thumbs up to the door gunner, and we lifted off the earth. We flew through Ghazni and Sharana across the miles of open desert. I didn't want the flight to end-- I was at peace, the thrumming of the rotors and the rush of the air insulated me from the war and all my attendant emotional lows. That hour on the helicopter was a warm, detached dream, watching villages, sand, and dry hills slide below the aircraft, and I felt nothing, which was nice for a change.

Exile!

The rumors of this being the end of the world are true. Everyone here joked that I was stuck for a good two weeks once I got off the helo. Today was my theoretical departure day but there is no flight scheduled. I've already settled into a sustainable rhythm, so it doesn't really matter how long I'm here. I have what I need: books, my laptop, a comfortable place to sleep, food, a small gym. I've seen a few patients which justifies my visit, but there really isn't much work for me to do.

 

I'm afraid to admit this, but it's nice to be compartmentalized from any potential work that there might be in the north. Work makes the time go by, and travel makes the time go by, but being stuck here at least keeps me away from places that are less pleasant. Not that this place is "pleasant", but so far it has been relatively benign.

 

Here there is more a sense of isolation and a sense of being somewhere foreign. There is just a small village, a small market, the small base, and miles of trackless desert. At night you look up directly into the wheel of the galaxy, undimmed by any light pollution, the nearest city being hundreds of kilometers away. In the quiet at night I listen to chanted prayers from the village.

 

The tempo here is slower an the war seems further away and that's okay.

 

Down South

Writing from southern Afghanistan. I wrote in my journal that the area is just a sun-blasted desert (southern Nevada) dotted with small villages. I don't know how people survive here. This area is much more remote than the north-- very small mud villages with roads that are nothing more than two-tracks through the desert. I flew here with a layover at a huge base to the northwest of my location. I stayed in transient tents from about 3am until 7am, ate breakfast, and then sat around at the air terminal for about 5 hours. I didn't even go to the main part of base because I would have had to drag around my weapons, body armor and two small packs-- about 80 pounds of gear. Better to just sit and wait, so I read a bad novel.

 

The FOB I am at now isn't bad. Let me enumerate the positives: there isn't much direct or indirect combat in this area (the area is so vast that the Taliban just avoid US forces), I am quartered in a concrete building, the base has an observation blimp, I am away from my Army commander and his command sergeant major, I have lots of free time, the gym isn't bad.

 

The negatives are minor-- pee tubes instead of urinals (I don't mind them except they stink), and burnout cans instead of plumbed toilets. The medic here also annoys me.

 

I am scheduled to leave in a few days but everyone says I will be here longer because flights are always canceled to this place. We will see. I do know that I will not have to come down here again.

 

For now I'm just practicing keeping it day-to-day. I am finding that if I can find contentment in the moment, regardless of where I am or what I'm doing, it makes the day go by smoothly and I don't feel the worst effects of sadness, fear, or despair gnawing at me. I can keep that stuff at bay by just finding ways to enjoy the moment, even here in this horrible corner of southwest Asia.

 

OK. Now I'm off to find something else to enjoy!

 

Living in the Future

I'm getting a new battle rhythm, based on the needs of our commander. It looks like we will be expected to try to visit each of the FOBs or COPs in our area of responsibility at least once per month or sooner. This isn't out of necessity, but is driven by some Army policy that is enforced by some Army Colonel somewhere, and is reinforced by the commander here. We were shooting for a six week interval or for an as-needed schedule, which is what was done by the last team. Oh well, things change.

 

I am making peace with this by trying to control the mode of my travel as much as possible. Flying is the preffered way to travel. Not only is it more comfortable but it is faster and you have a decreased chance of experiencing an ambush, and a zero chance of experiencing an IED. I suppose you take on the statistical chance of an aircraft mishap, but there are always risks with every mode of travel. Even staying in one place has its risks.

 

Anyway, I've resolved to tell myself that I am quite capable of enduring any hardship. The hardships that are projected ahead for me include a few more trips to places that are "OK", and at least one more trip to a place that is "not OK". That's not bad. The good thing about each mission is that when it's over I feel very relieved-- like checking off an unpleasant and difficult task. We've been to all of our locations over a period of almost three months, so theoretically that only leaves time for one more rotation. In between these missions there is my standard clinic work and a fair number of quiet days and nights. I really don't mind the missions because time flies by rapidly, even when I'm not doing much.

 

I have an upcoming mission to a smaller FOB to the south but I have to fly through one of the larger regional FOBs to get there. I will spend at least one night at this large base. I think they have a coffee shop and an air strip! There is another combat stress team there, so I'll visit with them, get in some internet time, read some books, wait for my flight the following day.

 

This trip should eat up the rest of September, bringing me into October. If I time things right I will be able to take some R&R at Bagram in mid-October and be back in Gardez by the third week in October for the home-stretch of the deployment.

 

I feel like I'm breaking the rules of "how to live right" by being obsessed with the future. What ever happened to living in the present? Maybe I'll keep giving that a shot, but it's challenging under the circumstances. My everyday life isn't bad-- my routine at my home FOB. It's comfortable, safe, productive. Even missions to most of our locations turn out pretty mundane. The most difficult part is finding a room to stay in and getting adjusted to new people and a new place. By the time you get a sense of the place, you get a flight or a convoy out. Not so bad.

 

Looking back, the time has gone fast. I got in country on July 11, left home on July 7. It flew by. Looking back even further-- I left for training on April 28, and that was about five months ago. It seems like just a few weeks ago. Five months from now I will be relaxing in Vegas, wondering how time went by so quickly.

 

 

Psychologists Vote to End Interrogation Consultations

The vote, 8,792 to 6,157 in a mail-in balloting concluded Monday, may help to settle a long debate within the profession over the ethics of such work. Psychologists have helped military and C.I.A. interrogators evaluate detainees, plan questioning strategy and judge its psychological costs. The association's ethics code, while condemning a list of coercive techniques adopted in the Bush administration's antiterrorism campaign, has allowed some consultation "for national security-related purposes."

This is far from being binding; it has to first be put into the APA Ethics Code and then adopted into state licensing statutes. But it's a first step, following the physicians of the American Psychiatric Association.

I have seen first hand the value of what we get from interrogation-- it's an important part of war-- but I don't think licensed health care professionals should be involved.

Introduction to the short story "In a Far Country" by Jack London

"When a man journeys into a far country, he must be prepared to forget many of the things he has learned, and to acquire such customs as are inherent with existence in the new land; he must abandon the old ideals and the old gods, and oftentimes he must reverse the very codes by which his conduct has hitherto been shaped. To those who have the protean faculty of adaptability, the novelty of such change may even be a source of pleasure; but to those who happen to be hardened to the ruts in which they were created, the pressure of the altered environment is unbearable, and they chafe in body and in spirit under the new restrictions which they do not understand. This chafing is bound to act and react, producing divers evils and leading to various misfortunes. It were better for the man who cannot fit himself to the new groove to return to his own country; if he delay too long, he will surely die."


My job: helping people (myself included) develop that "protean faculty of adaptability"

Temporary Break

I just got back from another mission and I am now at my FOB, hopefully for a few weeks at least. I have now visited every FOB and combat outpost in my area of responsibility.

 

I am going to take a temporary break from blogging, until I sort some things out in my head. I'm going to keep writing, just not publish for a while, maybe a week, maybe more, maybe less.

 

I am walking a thin line between sharing information and descriptions that need to be shared and also sharing too much of myself right as this all happens. It really comes down to the fact that I can't write about what I am experiencing without writing about grief and fear and I don't want my family and friends to go on the grief and fear ride with me.

 

Suddenly this past week it all seemed to get more serious-- maybe it was just a switch that was thrown, maybe it was a combination of seeing shot-up guys, this last mission, being pissed off at the Army. It's not like it wasn't serious before, but I passed through some portal this week.

 

As I told my NCO, I don't have acute stress disorder or anything. I just had a few nights where I would have quit if I could. I would have dropped all my shit in the dust and walked away, back to my family and I would have never looked back to this place.

 

But then I woke up in the morning and, since everything looks better in the morning, I realized that I need to keep going.

 

I don't want people to worry about me because my job is pretty damn safe compared to ther people's jobs, it's just that I am going through my own struggles with my job and its tasks and duties. I'm pretty durable and I just need some time-off from the blog. I'm going to write and see what happens-- post some stuff when I'm ready.

 

I'm closing down on the halfway mark-- about one month away-- I need to focus on getting to that mark and then re-orient myself to finishing the second half of this.

 

Thanks for all your support. People have been great and I appreciate hearing from you via email and on the blog. Thank you!

 

 

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.

Enemy Dogs

Apparently the FOB dogs qualify as "America's Enemies". There are the two usual suspects, my officially named "FOB Dog" and another, smaller, scruffier, short-legged white dog. Yesterday a new dog made an appearance. He looked like a combination of a wolfhound and a greyhound. He was light brown, rail-thin, with prominent ribs. He had a slight limp-- something was wrong with one his back legs. I noticed him as I walked out for my afternoon PT. I came close to getting my camera but was too lazy to walk back.

He watched me closely and moved off to one side. At about the same time I arrived a senior NCO walked over and was scrutinizing the dog. The dog eyed both of us. The NCO fingered his 9mm and said "I gotta get close enough for a good shot."
I said, "You're going to shoot him?"

I had a sinking feeling in my gut and I had to walk away. I didn't want to see and hear the poor dog being shot. Another NCO with an M4 walked over and charged the weapon. The dog had apparently been shot at before because as soon as he heard the the bolt rack a round into the NCO's gun he started running.

The dog wasn't dumb. I guess you don't survive long as a dumb dog in Afghanistan but about 15 minutes later I saw a group of Soldiers walking towards the corner of the FOB where the dog had disappeared. Shortly after that I heard three shots. Apparently whoever did the deed wasn't a very good shot.

I don't know why that dog was executed but the others are tolerated. He was larger and more haggard looking, maybe that was it. I dont know why they don't just seal up the holes and keep the dogs from getting into the FOB. They do cause problems-- they knock over trash cans and spread garbage around.

Most people don't seem to care about shooting dogs so I don't know what makes me different. I have observed that Soldiers seem eager to shoot the dogs-- like they want to kill something and jump at the opportunity for sanctioned killing.

A Soldier's job is to be prepared to kill, so it isn't too bizarre to imagine that they are eager to kill. Maybe I idealize the concept of the warrior who loathes killing and only uses lethal force when truly necessary. I wonder if it is true that first person shooter games numb a person's sensitivity to violence-- a lot of these guys go on missions all day and then come back and play Xbox 360 all night. Ready to shoot all day and then virtual shooting all night. It must be exciting for them to shoot a dog. I'm serious.

It's like maybe they are titillated by the potential to unleash lethal force, which makes them eager to charge their weapon and get clearance to destroy. At some level I understand that but my understanding is still hampered by own goal of avoiding any situation that would involve me even thinking about firing my weapon. I'll do it if it comes up, but as a non-combatant I will make every effort to minimize my chances...

This all taps into one aspect of my job here-- that we take anger seriously, whether it is towards the self or others, because lethal force is always two quick movements away.