Bare Feet

What do you tell a man who shuffles in smelling of dust and diesel, hands shaking, red rimmed eyes, voice quavering as he explains how the children's empty shoes were thrown haphazardly upon the road.
What do you tell a man who beats his fist against the table, once for anger, once for pain, and once for shame because his body and mind went silent when he saw the children's bare feet and small fingers curled and still.
What do you tell a man when he drops his face to the floor, lost in the thought that what was meant for him had turned the children into memories with one hollow thunderclap of combustion and shrapnel.
It is the way of this world. Tomorrow the sun will rise. But I can't say that. Sometimes there is nothing I can say.

Return

I returned from that FOB and it was remarkably uneventful. I was on my fifth day, steeling myself for a seven to eight day stay, when I found out that there was a flight coming in that would be headed to Salerno, a large regional base that is situated right on the Pakistan border. Getting on would be a gamble, because I wouldn't go to my home, but I would be out of that place. I made some phone calls to some people I knew at Salerno (I've been here long enough and traveled enough to actually know people around this country) to try to arrange some lodging and arrange some social interaction. Salerno has a coffee shop and frequent flights to my home FOB, so I figured that I would give it a shot.

I packed my rucksack and geared up about an hour before the flight was due and I went down by the LZ to wait. After two and a half hours of sitting in the dust the Chinook roared in over a ridge. Overhead, an AH-64 Apache circled like a shark, ready to pounce on anyone that tried to lob mortars or RPGs at the lumbering Chinook. Three of us ran through the dust and rotor wash to scramble into the helicopter. I was out of that place and headed someplace new.

To my surprise, the Chinook lifted up out of the valley and swung west, away from where I knew Salerno to be. We flew only a few hundred feet above wooded ridges, the Apache attack helicopter trailing in our wake. Within five minutes I knew that we were headed to my FOB and I started to hope that we were going to stop. The Chinook dropped down into the LZ. It turns out that my bird was waiting to reunite with a second Chinook before heading home to Salerno.

I signaled for the crew chief to let me out and I grabbed my gear and jumped off. I was home and I was happy. I have been very lucky with travel this year...

I'm cautiously hoping that the next time I get on a bird I will be headed to my real home.

Waiting

Still at this FOB, in the middle of nowhere. I completed two days of clinical work when I first got here but this is day five. Might be another three days before I get out. I am able to get some work done from a distance-- phone consultations with my technician and with commanders who's Soldiers I care for. Mostly I try very hard to pass each 24 hour period without getting bored.

Today started off well because they had a few bananas-- that puts my fresh fruit/vegetable count at two kiwis and a banana in the last week. Watched Monday Night Football on Tuesday morning while eating powered eggs and reconstituted hash browns.

Last one?

Is this my final routine mission? I think it might be.

I am at a notorious FOB in the wilds of the Hindu Kush, but it has improved since I was here last. These FOBs are getting these great gyms, I think to get Soldiers through the winter. This place isn't that bad actually.

I probably won't be busy. Out here it is tough-guy territory, so no one is eager to talk to a psychologist because of how it may look. That's okay with me. I brought many hours of video and four books, and I already mentioned the gym. I have a pretty decent room and a concrete bunker nearby. A funny side-note is that I am staying in the same room that a well-known CBS reporter stayed in while she was here for several weeks-- she signed the wall. Maybe I should sign it too when I leave...

Don't Relax

This from Army Times:

"The vice chairman of the Joint Chiefs warned Monday that U.S. troops and their families should not expect to relax if operations in Iraq wrap up soon. Marine Gen. James Cartwright, speaking Monday in Arlington, Va., before a symposium sponsored by the Military Officers Association of America, predicted the situation in Afghanistan won't be resolved as easily or quickly as was the case with creating a semblance of political stability in Iraq. And even if Afghanistan is stabilized, the future is going to be one of military challenges, he said."

What stands out to me is the following phrase: "won't be resolved as easily or quickly as was... Iraq". Did I miss something over the past 5 years? Was Iraq resolved quickly and easily? Has it even been resolved?

The other interesting bit is that he said "even if Afghanistan is stabilized..."

Now here's a nice military story...

"Australia navy off for Christmas"

Most of Australia's navy is to be given two months off over Christmas as part of a new strategy to cope with crew shortages, the defence minister says. Joel Fitzgibbon said the extended break was a way of encouraging sailors to stay in the service... Mr Fitzgibbon said: "We're doing a lot of work trying to find new and innovative ways both to retain skilled people and recruit new people."

I like the idea of finding "new and innovative ways to retain skilled people and recruit new people." Not that taking two months off is an option for our deeply committed military, but the DoD has to come up with something or in five more years of sustained conflict we will have a diluted military.

We will be left with more of this: "U.S. Army and Marine Corps grant more felony waivers" and more waivers in general for people could historically could not join the military.

Quaffing beer and eating sausages

Last year, the German armed forces shipped more than 260,000 gallons of home-brewed suds to its troops serving in northern Afghanistan, as well as more than 18,000 gallons of wine. On a per-soldier basis, that was the equivalent of a ration of 26 ounces of beer a day, all year long.

OK, there is a down side to all that beer:

In March, an armed forces report found that more than 40 percent of soldiers ages 18 to 29 were overweight -- compared with 35 percent of German civilians of the same age. About 70 percent of the soldiers were heavy smokers. Nearly one in 10 was described as clinically obese. The March report concluded that the rank and file quaffed too much beer and ate too many sausages, while avoiding fruit and vegetables.

However, US Soldiers manage to be overweight and smoke heavily, even though they can't have beer, so how could harm a few daily ounces of beer be that much worse? We don't eat much sausage, but people eat burgers and ice cream for lunch here, and that can't be good.

Winter

I haven't posted to the blog in a while, having lost some motivation for doing anything other than the minimum. I'm at day 129 in-country and a general lassitude has set in over the past few weeks. I have been seeing a lot of patients, which keeps me busy, but a new conflict with the local Army chain of command has left me slightly demoralized. I won't get into it in this public forum but this is the third or fourth "conflict" I have had with a group of Army officers and senior enlisted.

At every turn it seems that I am reminded that the culture of the USAF and the US Army are very different. Someone who would know emailed me and said the air cavalry are "all about butt sniffing and dick-measuring". I don't play those games very well, so that puts me at odds with the senior butt-sniffers on this FOB.

Luckily, my true chain of command back at Bagram has my back and they have supported my decisions and the manner in which I have executed the combat stress control and behavioral health mission here in this region of Afghanistan. The Army sees me as just another Captain who is at their disposal, while the Air Force sees me as one of a few psychologists who have specific and clearly defined roles in this theater. I like this about the Air Force—they are more likely to value you based on your skill-set and treat you accordingly, while the Army primarily values you as a body, or a slot-filler, and any treatment you receive is directly proportionate to your rank.

I still feel positive about my ongoing work with Soldiers. There are a lot of good guys here who have very stressful jobs. I do what I can to help them; regardless of whether that is treatment in country or getting the out of here. The ongoing combat in Afghanistan is off the radar screen of American media—there are still firefights and mortar barrages and guys sleeping out in the cold and the dirt. They say the winter is hard on the Afghans but I am observing that combat operations in the cold are hard on anyone. From what I read in the newspapers, the generals want to wage a busy winter campaign here. Winter isn't even here yet, but it is getting cold fast.

Bandwidth

The relative calm for us has continued since early October. In the last 39 days we have done three missions to outlying outposts and two trips to Bagram. We have two more missions scheduled in the latter half of November. Contact with the enemy seems to have quieted down but I'm not sure why.

I have an open invitation to attend daily battle update briefings—these are meetings that review current combat operations and current intel related to our immediate area and adjacent regions. When I first got here I consistently attended these meetings, partially to familiarize everyone with my face, but also because I wanted to know what was going on, as if knowing would make it easier for me to navigate the deployment. Since late September I have avoided them. Everyone now knows me and I no longer want to know what's going on.

By not knowing about every mortar or rocket that falls, and not knowing where every IED is found I am able to peacefully go about my daily business, plan my missions, see our patients and the keep the larger reality of the war at bay. I kind of see it as a way of freeing up bandwidth in my head. Without that daily download of ominous data I can concentrate on my job, and when it is time to relax or focus on myself it is much easier without visions of RPG-toting Taliban or IED-emplacing villagers.

This is a luxury, I know, because I don't need this daily feed of intel to do my job. I think I actually do my job better without it. Some people live immersed in this information and it must make it difficult to find any peace.

Bad Mood

 Election day and I spend it at a small outpost with a bunch of heavily armed deranged racist hillbillies. I wish more people would use birth control.

Good Mood

 It's November 5 now and I am writing from one of the smaller outposts I cover-- one I haven't been to since early September, and I feel pretty good.

It was a quick flight on a Chinook—no more than 30 minutes out of the broad river valley where my home FOB sits and then down into a huge forested canyon system that gouges a path towards Pakistan.

A corner has been turned and I seem to be able to see light through this thicket of months, weeks, days and hours. I've even started to ask myself if it was really that bad… how quickly I forget.

In the spirit of forgetting I have been enjoying my time here at this outpost. I've gotten two workouts in at the luxury gym here. They don't have much cardio equipment (a stair climber and an elliptical) but they have a decent selection of weights and kettle bells and big Afghan rugs on the floor for diabolical sessions of ground work; a painfully large selection of core exercises and push-ups.

As far as real work goes, I still have to brief the medics on managing suicidal patients in theater and I have to see two to three patients. The military doesn't get much bang for the buck by having me here, but I suppose it is better than the Soldier not having any treatment or having the Soldier leave the outpost for a week or more to see a doc at Gardez or Bagram.

The guys here try to make it more interesting for me… Yesterday afternoon I turned down an invitation to go on a mission to the Paki border. The words "fuck that" just popped out of my mouth before the invitation was fully formed by the commander. I had second thoughts afterwards, and I asked myself if I would regret not going on that mission. I silently argued that it would develop some good camaraderie with the platoon, and that it would be pretty cool getting a photo of myself in battle-rattle standing on the Pakistan-Afghanistan border.

 

I believe in luck but I believe that I create my own luck. I'm going to keep my lucky streak going…

November is rolling...

I'm getting ready for the November mission schedule. As it stands we have four scheduled missions and of these four, only two of them fall into the "bad" category. I'm going to get one "bad" mission out of the way this week.

I am strangely light-hearted about this travel. I think it's a combination of decreased "critical incidents" and the fact that it is November. This will be our last full month of missions. December should be a half month, since I won't want to risk either of us going to an isolated FOB after mid-December, getting stuck, and delaying our end of deployment tasks or actually delaying re-deployment.

It has gotten colder. Cold is relative, but we are having daytime highs in the low 60's and nighttime lows in the 30's or high 20's. There's snow in the mountains. When we travel now we have to bring the heavier sleeping bag, fleece, and people are even breaking out the Gore-Tex.

With the colder weather, drop-in traffic in my clinic has slowed somewhat, although it still rare that a day goes by without a customer. Most of my business consists of "back home" issues—relationships, money, family problems. I also get all the blowback from disciplinary issues. I think this unit has inconsistent standards when dealing out war-zone justice, but a generalization is that the lower your rank, the harsher your punishment will be. Unfortunately the lower ranking guys have the poorest coping abilities, the least power, and the most stress. So they end up in my office.

In the non-distressed population, there is definitely a stigma associated with talking to the psychologist, or the combat stress doc. They have good fun yelling at me across the FOB: "Hey doc, I'm stressed! Can I make an appointment?" One of the lieutenants, who works for the commander occasionally comes with a message — he hesitantly knocks, comes part-way through the door. I tell him he can come in but he says, half-joking, that he doesn't want anyone to think he's actually coming to talk to combat stress—"I don't want anyone to think I'm crazy sir."

I tell him that it's too late. "I already know you're crazy because you joined the fucking Army."

That joke gets a lot of mileage here but I don't like to use it much. I don't like the "crazy" jokes because I think it reinforces the persistent idea that you only see a psychologist when everything has fallen apart, when you have no place to turn, when insanity seems imminent. I preach here and at home that it is better to manage problems before they get too bad.

Actually, Soldiers seem generally less concerned about mental health treatment impacting their careers than Airmen. Airmen worry about flying status and security clearances, and in the Air Force there is less acceptance of adjustment problems, meaning that you are more likely to get kicked out. I don't have statistics to back this up, but the Army seems more embracing. I could say that the Army is inspired by a certain Emma Lazarus poem inscribed in Upper New York Bay.

Most of my traction with Soldiers has been via sleep medicine. I conspire with the medics to send sleep complaints to me, and I do my evaluation, educate them, put them on a stimulus control or sleep restriction plan and most of them get better. If I have been thanked for anything here, it has been for helping people sleep better. And that's no small thing in this place.