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.

Quick Update

Things have slowed down in our part of the world, which is fine by me. I know it drives some of the Soldiers nuts. I enjoy the steady and quiet rhythm, the monotonous days. Ramadan (September) was active for the "enemies of peace" in eastern Afghanistan. I don't want to overstate this, because there is still a lot going on in certain places, it's just that our slice has been absent casualties for some time now, which I like very much. There is still a lot of indirect fire and IEDs, but my clinic numbers have dropped. I've also heard that the number of medevac flights have decreased significantly.

 

I think the cooler weather, football season, the World Series, the approach of the holiday season and the end of 2008 has lifted morale to a degree. There is still a lot left to do here (for all of us) but the change of the seasons makes the passage of time more tangible.

BAF was successful...

Back at my FOB after another sleepless night of waiting and waiting and then the Chinook, which is now a very cold ride as we slide into the fall. Flying through the high passes I observed that there is snow on the north facing aspects of the peaks. That's pretty cool. It will be a great ride through the mountains in January on my way out.

 

My BAF visit was successful. I got a brief taste of civilization and a little rest. I mostly enjoyed the bathrooms and showers in the hospital staff dorms, but I also got excited about the coffee shop, the big, open air gym (I would pay to belong to a gym like that), and hanging out with the other docs at the combat stress clinic at the hospital. Let me tell you, the Air Force really knows how to put together some nice living facilities in the war zone.

 

Other news: I found out that I have a replacement in the pipeline-- the person is going to the lovely Army Combat Skills Training in November and then will be joining us after the new year starts. I'm not 100% sure that they will be replacing me, but I was the earliest provider, so it would make sense that the first replacement takes my billet... That isn't notable news in itself, but it does mean that the end is approaching, and that's encouraging.

 

Being back with the USAF retarded my acculturation process-- just as I was getting acclimated to the Army and its mysterious ways, I spent four days with my Air Force brethren and got a shot of nicotine-and-obscenity-free air. OK, there was a little Army-bashing going on, which is unfair, but there is a big culture divide between certain elements of the two services. I am deployed with mostly scouts and infantry and I don't know much about the Army, but apparently that says it all. The fact that I am a member of the not-very-high-speed medical corps doesn't help either...

 

Don't get me wrong, these are good guys, tough guys, who do stuff I would never volunteer to do, but the charm of living with them has worn off. Jeez-- I just wish they would flush the toilet once in a while and maybe write some bathroom graffiti that consists of something more than: "I WUNT TO F^@K GERLS"

 

That was a slight exaggeration. Slight.

 

Keeping my spirits up and waiting for the snow!

More BAF...

Day two accounting:

 

11 hours of sleep

1 triple latte while reading Harpers

1 casual breakfast while watching Sportscenter

2 hours at the gym

1 clean, hot shower

1 hour on fast internet

2 James Bond movies at the "theater"

0 hours of work

 

A little respite

Ahh... back at Bagram Air Field (BAF) for a few days. I left my home FOB at 1am and arrived at Bagram at 4am after a freezing cold Chinook flight through the dark. I walked a few miles from the rotary terminal to my temporary lodging, and then drank myself silly with coffee. I had three cups of Air Force coffee (marginally better than Army coffee) and then went to the Green Bean (an actual coffee shop) and had a $4 mocha latte. Pretty good. Actually, just being in a coffee shop (imagine a faux Starbucks) was nice.

 

I watched one quarter of Monday Night Football (nice treat, but bad loss for the Broncos) and spent an hour or so talking with the other members of my unit who are posted here at the Bagram hospital. Wow! Being around Air Force people is great! I haven't heard the word "fuck" for about 15 hours now!

 

Being at BAF is great too! The internet speed is 10 times faster, the DSN phones don't have a 10 second lag, I have my choice of dining facilities and the bathrooms are clean. I think today I'll do some shopping, get a workout in, make some phone calls and then catch up on sleep.

 

My sleeping arrangements are adequate. I'm in a dorm room, taking up a bed by the door in a four person room. It's hot and stuffy in there but it's a clean, safe place to sleep for a few nights-- and there are non shit-stained toilets and non moldy showers for a change. It's the samll things in life...

It's enjoyable to walk around on pavement and concrete instead of dirt and crushed rocks.

 

I remember bitching about BAF when I got here in July. Now it's less crowded and cooler, and my perspective has been warped by living in Paktya province for the last three and a half months. I'm going to enjoy Bagram while I can and when I leave this time I will be reassured that I have the minority of my deployment left before me.

APA LETTER TO BUSH: NEW POLICY LIMITS PSYCHOLOGIST INVOLVEMENT IN INTERROGATIONS

Finally, my professional organization joined the rest of the medical community. It will be interesting to see how the DoD adjusts to this. I don't see how psychologists could have been that helpful anyway...


WASHINGTON—The American Psychological Association sent a letter today to President Bush, informing him of a significant change in the association's policy that limits the roles of psychologists in certain unlawful detention settings where the human rights of detainees are violated, such as has occurred at the U.S. naval base at Guantanamo Bay, Cuba, and at so-called CIA black sites around the world.

"The effect of this new policy is to prohibit psychologists from any involvement in interrogations or any other operational procedures at detention sites that are in violation of the U.S. Constitution or international law (e.g., the Geneva Conventions and the U.N. Convention Against Torture)," says the letter, from APA President Alan E. Kazdin, PhD. "In such unlawful detention settings, persons are deprived of basic human rights and legal protections, including the right to independent judicial review of their detention."

The roles of psychologists at such sites would now be limited to working directly for the people being detained or for an independent third party working to protect human rights, or to providing treatment to military personnel. The new policy was voted on by APA members and is in the process of being implemented.

For the past 20 years, APA policy has unequivocally condemned torture and cruel, inhuman or degrading treatment or punishment, which can arise from interrogation procedures or conditions of confinement. APA's previous policies had expressed grave concerns about settings where people are deprived of human rights and had offered support to psychologists who refused to work in such settings.

Noting that there have been credible reports of torture and cruel, inhuman or degrading treatment of detainees during Bush's presidency, APA called on the administration to investigate these alleged abuses. "We further call on you to establish policies and procedures to ensure the independent judicial review of these detentions and to afford the persons being detained all rights guaranteed to them under the Geneva Conventions and the U.N. Convention Against Torture," Kazdin wrote.

Army meatballs and red wine

I joked with Colleen that this blog should become a wine and beer tasting blog in January... I know that's potentially a bad joke give the association between redeployment and alcohol abuse, but I have to admit that a glass of some big juicy Cabernet sounds amazing-- especially Mondays, which is pasta and meatball night here.

This is good news if you like red wine and you're a smoker:

A study from Kaiser Permanente researchers published today found a strong link between red wine consumption and a decreased risk of lung cancer in men. The researchers studied 84,170 men ages 45 to 69 who were part of the California Men's Health Study. They found lung cancer risk is lowered an average of 2% for each glass of red wine consumed per month. The greatest risk reduction was found among men who smoked and who drank one or two glasses of red wine per day. They had a whopping 60% reduced risk.

The only things I've had in the last three months that have been remotely alcoholic have been one overripe banana and one can of non-alcoholic Heineken. However, I know that Army personnel occasionally get busted on the FOB for alcohol possession-- they get vodka from the Afghans who work on the post. This is a Muslim country, but apparently in addition to opium, heroin, and marijuana, there is readily available alcohol as well. Maybe I'm naive but I've been surprised that both drug and alcohol use is as common as it is here.

What's funny (and vaguely related to the rest of this entry) is that if you smoke opium and get caught you will be sent home faster than you will if you charge your rifle and shoot it at another Soldier (and miss). Is that funny?

Yes, sometimes I feel like I am stuck in a penal colony.

That could lead to another entry about Army recruiting, but I'll stop now.

Beautiful Children

Back from another mission to the south. This trip reinforced my secret opinion that I am a wasted resource being deployed to these far-flung outposts. I spent three days doing absolutely nothing, apart from walking around making small-talk, advertising that I was there and available. It was a small outpost and the medics had a few Soldiers in mind when they thought of who might benefit from seeing me, but no one sought me out for consultation.

On the fourth day of doing nothing productive I hitched a ride on a convoy that was headed back to my home FOB. As usual for this country, it was painfully slow and bumpy, banging along at 10mph over terrible roads. Driving slowly through villages I am astounded by the beautiful children here. Most of them are dark haired and dark eyed, but some are light or red haired and blue-eyed. The little girls are clothed in brightly colored gauzy clothing, the boys in plain white, tan, or brown loose fitting shirts and pants.

At one point in a small village a dented Toyota sedan pulled onto the road and inserted itself between our gun-truck and the 5 ton truck behind us. Our gunner called out that a car had pulled into the convoy, which is an unacceptable breach of security. A crowd of school-aged girls minding two or three toddlers were standing around off to the side of the road, giving us thumbs-up and staring up at the huge armored vehicles. Our driver braked hard and slammed the truck in reverse, suddenly accelerating backwards to force the car off the road and out of the convoy. I watched the dark eyes of the nearest child widen and her mouth tighten in fear as she picked up the small toddler at her feet and twisted around, shielding the child from imminent threat. I was struck by both her obvious fear and her beauty. She was absolutely beautiful in a way that seemed so familiar.

When the Toyota pulled off the road, intimidated by several thousand pounds of armor and the matte black barrel of a heavy machine gun, we reversed direction and proceeded to crawl up the road. The girl relaxed slightly and placed the child back in the dust. As she disappeared behind us, her face remained in my mind and I wondered what her voice sounded like, whether or not she went to school, if she had ever danced to music, if her parents hugged her and told her they loved her. I thought of my daughter.

Later, in Gardez City, a small black-eyed boy ran alongside the truck, waving to us and holding his thumb up. In his left hand he delicately grasped a kite made from sticks and discarded thin blue plastic. The surface of the kite was ragged with holes and it was small, maybe 12 inches across. But I could tell by the way that he carefully held the kite that it was precious to him. For a kid in the US it would have been nothing more than a piece of trash. I couldn't help but see my son running after us, his small hand holding a favorite toy.

Seeing beauty and echoes of familiarity in the Afghans keeps my mood and outlook moderated to some degree. The anger and fear fades when I look at those kids. This seems to last only as long as the relative calm and mundane progress of days is uninterrupted by death and destruction. When the loud and messy reality of war reasserts itself into my life, those darker emotions roll over me. By virtue of being confessor and psychologist for dozens and dozens of Soldiers, I know I am not alone in this.

Being able to maintain a consistently rational and humanistic perspective is, I think, impossible for me. To completely rise above prejudice and irrational anger I would need to let go of my fear of death, and let go of my attachment to my life and my hypothetical future-- become some kind of selfless warrior.

This darkness that overwhelms rational thought is something I didn't understand before this year, even though I am getting only a small taste. I think this may be one aspect of what separates combat veterans from everyone else. There is something visceral and crude that crawls up your spine and sits on your soul.

Earthquake

Last night I woke after 3am to my room shaking. I came out of a deep sleep and wondered what was causing the movement. It moved the building, wood creaking, and rocked my cot back and forth. My sleepy mind slowly ruled out wind, someone shaking the building, and a rocket attack. It was kind of soothing and surreal, and then it stopped and I fell back asleep. Here's the link.

Football

Another convoy, another five day trip to a different camp. I rode with the route clearing package-- a huge convoy of vehicles led by specially designed vehicles that find and either safely detonate or deactivate IEDs. These are National Guard guys and I like them. The huge convoy rolled for three hours to the next FOB and then stopped on the road while my vehicle drove a side road to drop me off inside the perimeter of the FOB. Not VIP treatment but as close as it gets for me...

This is my second trip here, so they know me. I get to stay in the same room, the same cot. Not much happens. I'll make myself known, walk around and be social, give the people who need or want to speak with me the chance to come out of the woodwork before I leave.

This afternoon I sat down in the MWR in an overstuffed chair and watched 45 minutes of the Colorado Buffaloes getting beaten by Texas (recorded and re-broadcast on the Armed Forces Network) and then I watched Sportscenter. It was nice. It felt "normal" but it left me feeling a little sad, a little wistful for October back home and watching football on Saturdays or Sundays.

I brought two novels, a non-fiction book on parenting, a stack of magazines, and a handful of movies. I should be able to settle into a schedule of sleeping in until 7am, drinking coffee (I also brought a pound of coffee), working out, and cleaning up by late morning. My "business hours" will run from lunch to late afternoon and then I might sneak in another workout, eat dinner, and retire to a night of reading and DVDs.

Not bad work if you can get it eh?

Am I turning into a bigot?

September is gone and that's a good thing. It was a bad month around here for everyone. Ramadan left a foul taste in my mouth. Sometimes I worry that my experience in this Islamic country will permanently bias my view of Muslim people. Killing in the name of Allah seems so barbaric and primitive, but then if you look around here you can't tell what century it is anyway.

It's easy to just give up cognitively and emotionally, and take a position that we should just leave them to cut each other's head's off the way they have always done. I go back and forth between this perspective and something more fitting of an educated child of the West. Even so, I have a new understanding of where the old stereotype of the crusty Vietnam vet who hates Asians comes from. It's illogical, but hatred finds good purchase in the frightened mind.

Being here has made me more forgiving of my own country. For all of our faults and our war-mongering ways, there are cultures out here that are darker and much more brutal. Yes, we are greedy, wasteful, and slightly imperialistic. We are arrogant too. But some of these people (Mullah Omar, Jalaluddin Haqqani for example) are way scarier than Sarah Palin or even Dick Cheney. The way females are treated, the whole beheading thing, the rate at which blood is spilled in these countries, the extreme and absolute interpretation of religion. Evil is relative.

I'll kiss the ground of the good old USA when I get back (metaphorically—airports are unclean) and I'm sure this experience will have changed my civic and political perspective. A conglomeration of anger, pride, and renewed patriotism. I know that this service will have made me a better citizen.

That said, I'm getting out of the military in about 270 days. I'll throw a party.

Which one is the real Left Captain????

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.

Odd Combination of Pride and Frustration

Kind of a second lowpoint in the deployment for me the past day, although I can't put a finger on why. I'm only at around two months here at the FOB but when I look back at the spring and summer I realize that all of May and parts of April, June and July were eaten up by training and preparation for deployment. It seems like it has been a long time since I last lived my normal life-- Deployment has been dominating my thoughts and daily life for most of this year and will continue to for the rest of the year. Mostly I'm fine, but I really have to avoid looking at pictures of my family...

I find it interesting that a not insignificant number of people here really like the deployment, or at least don't mind it. These young men and women like their jobs, aren't married, don't have kids, don't pay rent or pay for food and they make extra pay while they are here. Not a bad deal for a 20 year old. This is why a professional, volunteer Army works-- there are people who want these jobs and are willing to do what it takes to get through 12 and 15 month deployments (although there seems to be universal agreement that 15 month deployments are not good for anyone).

This is an important point, because people continue to join the Army and re-enlist knowing that these one year deployments are now standard fare. Frankly I'm impressed that people do it, but also thankful that there are people who want to serve in this manner. It isn't for everyone and some people know this ahead of time and thus avoid joining any branch of the military, other people find out that it isn't for them half way through their first deployment...

Nevertheless I am constantly surprised when I hear the statistic that only 1% of the US population serves in the military. I'm not sure how accurate that is, but it causes a combination of pride and frustration; I'm proud that I am one of those few and frustrated that more people do not volunteer.

That sums up my experience of military service though: an odd combination of pride and frustration. Half the time I rue the day I raised my right hand and the other half I feel confident that I will be proud of my service for the rest of my life.

Great Climbing?

It's a shame that there are people who like to dismember Westerners here, because this place has some spectacular geography-- of course there is the Hindu Kush but there is great rock everywhere here. It would make for a great climbing destination.

Naps

Our security detail waiting for us to be done with the visit. This is a true demonstration of the flexibility of a Soldier: if you get downtime you take advantage, even if it means sleeping in the dirt under your truck. The shade is nice and cool.

Tera Pass

The road over the Tera pass connects Paktia and Logar provinces. It was recently paved during the reconstruction effort here in Afghanistan. It's pretty nice pavement and seemingly unscarred by IEDs, unlike the new highway between Kandahar and Kabul that is apparently just a mess, constantly bombed by the Taliban and company. The top of the pass is around 9000 ft. The traffic going over was pretty light. You'll notice that terrain looks bone dry. Despite this there are multiple springs dotting in this area-- fresh water just popping out of dry rocks.

Road Trip Photos

Outside of Gardez City. The roads here are terrible, in general, but local drivers are very respectful of the convoys.



Driving through Gardez City reminded me of my few visits to Mexican border towns. Lots of garbage, open air shops, clusters of people sitting around, rundown buildings and beater vehicles.

More Photos on the Way

The upload time is too long this afternoon-- I'll need to try later. One thing I really miss is fast internet. I'm starting to think that a 45 second page load is pretty damn fast.

Another Mission

My second mission this week came and went uneventfully. It was short notice and the commander specifically requested my presence on the trip—a quick visit to a nearby FOB, up towards Logar Province. It is a small outpost out in the desert at the bottom of Tera Pass (which we drove over).

I rode in the relatively bombproof confines of an RG31 MRAP, second truck in a four vehicle convoy. It is an uncomfortable ride, even on pavement, so I can’t imagine a few hours on nasty dirt roads. That said, I will always celebrate the MRAP over the Humvee.

In contrast with my ride with the engineers we were heavily armed this time. These guys roll on trips loaded for bear: every vehicle has a 50 cal or a Mark 19 grenade launcher and these are backed up by squad automatic weapons and personal weapons. On this subject, I've taken to bringing my M16 on trips with me, using the following logic: if I am in the unlikely situation of actually needing a weapon, I will want the rifle over the pistol in pretty much every scenario.

When we got there we met the FOB commander and the platoon leader and were briefed on the state of things, and then went out and mixed with his platoon. I did my combat stress officer duty and talked with the guys, checked in with the platoon sergeant, talked with the medics, talked with the FOB commander. Everything seemed to be going well other than boredom, and problems getting flights in and out.

On the way back I had a perspective shifting conversation with an interpreter who was riding in with me. I asked him about himself and he shared that he had a wife and two small sons in another city. He talked about growing up during the Soviet-Afghan war and how he wants his sons to grow up in peace. “I don’t care about my life, I do everything for my sons.”

Maybe I’ll post more on that later, but it put a human face on the war for me. Sometimes I feel myself slipping into an uncaring place, just wanting to get the hell out of here and leave this place behind. Listening to people’s stories gives color and meaning to the mission again. Don’t get me wrong, I’m not getting all idealistic, but talking with him made me care.

Leaving Jaji

The Left Captain at the LZ-- hoping the Chinook crew chief lets him on!

Deliverance

The bird that came to fly me back to my FOB-- it was delivering a few guys and a generator from BAF. It was almost full but they let me on!



The cushion of air that these things create with their dual rotors is impressive. It pushes you around and throws up heat, rocks and sand.

Rules and Easy Step By Step Instructions

I thought this was amusing-- very specific guidelines on how to use the latrine. These are posted inside each toilet stall. This was taken seriously too-- no one wants to mess with the first sergeant there. He means business.

More Jaji photos

This is new construction below the outpost-- a new district center that will house the regional government. Next to it is a police station and another compound with an international group who clears landmines. You can see the typical Afghan combat set-up on the road: a Toyota pickup with a heavy machine gun mounted in the bed.




This is sunset looking into Pakistan. The mountains in the distance were snow covered into mid-June.

This is a view down into Jaji. Very green, very pretty. Colleen pointed out that it looks like good wine-country. Through the razor wire I could see and hear little kids playing down near the houses.

Jaji Photos

The old ruins-- who knows how old. Currently occupied by Afghan military or police.

Leftovers from the Soviet-Afghan war on the hill inside the outpost.

Need to Post Pictures--

I'll need to post some pictures-- this place is quite scenic. The outpost is situated on a small ridge that juts into a deep valley. The bottom of the valley is verdant, with neat orchards and terraced agricultural plots, mixed in all that are stone and mud houses and compounds. Above the valley are steep and sparsely wooded mountains. The mountains rise to the east, probably to around 10000 ft, right on the Pakistan border.

Below this outpost is the square outline of some ancient fort, with the remnants of towers at each corner. The walls are melted and crumbling. It is situated on a small plateau that overlooks the bottom of the valley. Currently, the Afghan National Army occupies the remains of the fort with a small tent city.

I think, but I'm not sure, that this valley probably drains down into Pakistan and the outpost is here to serve as a deterrent to Taliban movement from Pakistan. It is rough duty for these guys (and a few women) and they earn every last cent of the their hardship pay.

These outposts are really marvels of modern technology-- almost completely self reliant and with tight security. The US Army is pretty impressive. I wouldn't want to be a bad guy up against this outfit.

Mission 1

On a sudden mission, so my posting may be sparse until I get back to my "home". I'm at a small outpost about 10 miles from Pakistan (no worries, a quiet location in 2008). I'll take some photos. It is VERY small. I was asked to visit this location to see a few soldiers who have been blown up by IEDs over the past two months. Going to assess their current status and make a treatment reccommendation which may include leaving here. At such a small location I need to be sure, because every person counts.

I was given temporary quarters (no electricity) but it will do for now. I'll put in a movement request and see if I can get out of here in less than a week!

Random Sights...

I don't know the story behind this but it's kind of funny. There is a barbed-wire fence that is enclosing, well, nothing. So I guess that's the joke.






This is the Afghan bakery on the FOB-- if you enlarge the photo you can read the advertising painted on the outside of the building. Mostly he supplies naan to the Afghan mercenaries who live on the FOB. They heat the ovens with a wood fire and whenever I run by this place in the mornings I choke on the thick wood smoke. I think sometimes he burns plastic too-- probably just burns all of his garbage in there, or at least it smells like it.

Tech Problems Resolved

Technical problems have been largely resolved it seems. The Morale, Welfare, and Recreation building has a shaky electronic infrastructure. It houses seven VoIP phones and the only un-firewalled internet access (about 10 computers).

The internet and phones lines go down frequently but were recently out of action for about a week. I guess they have two guys in Afghanistan who travel around and fix this stuff, so we had to wait for one of those guys to get here.

The lack of phones really pissed off a lot of Soldiers.

Military Psychologists and Interrogation

Sometime in the fall of 2007 I received an email from some big shot in Washington DC or at Langley inviting me to volunteer for the behavioral science consultation teams, or BSCTs. The BSCTs are the teams of psychologists and technicians that provide some sort of unspecified (secret) consultation to interrogation teams at detention facilities. I have to admit that I briefly considered getting on the list, not because I want to be involved in interrogation, but because I thought Guantanamo might be a safe deployment, and it has a beach. I deleted the email.

What's interesting about the USAF powers-that-be asking for volunteers is that it signifies the controversial nature of these jobs. Psychologists have made the argument that by participating in interrogation teams, one may be inherently violating the ethical codes that govern the profession and the state licensing statutes. One of the central principles of all ethical codes is non maleficence, or doing no harm, and nterrogation hinges on a threat of harm-- I think that's what distinguishes it from "questioning".

A few years back the American Psychiatric Association resolved that their members will not participate in these teams, so military psychiatrists do not deploy in support of these teams:
“Physicians must neither conduct nor directly participate in an interrogation, because a role as physician-interrogator undermines the physician’s role as healer…,” and “Physicians must not monitor interrogations with the intention of intervening in the process, because this constitutes direct participation in interrogation.”

But my professional organization, the American Psychological Association, has debated this for the last three years.

The psychological association's most recent ethics amendments strongly condemn coercive techniques adopted in the Bush administration's antiterrorism campaign. But its current guidelines covering practice conclude that "it is consistent with the A.P.A. ethics code for psychologists to serve in consultative roles to interrogation and information-gathering processes for national-security-related purposes," as long as they do not participate in any of 19 coercive procedures, including waterboarding, the use of hoods and any physical assault.


Interrogation is, by nature, a psychological process and it makes sense that psychologists would fit naturally into these roles. From news accounts I have read, the military has reverse engineered the knowledge we have regarding interrogation resistance. We have solid ideas about how to resist interrogation, so we use this as a starting to point for developing techniques to break down resistance. It is generally accepted that straight-up violence can produce false positives— some people will say anything to stop the pain—this is a tried and true technique (I think it was pioneered by the Catholic Church back in Medieval Europe). But there are other ways to wear people down, exploit weaknesses, get them to divulge information that is not the direct result of coercion, thus limiting the likelihood that it is a "please make it stop" confession.

The problem comes when you take into account that psychologists in the military are licensed as health care providers and held to standards that are similar to those of physicians. If we participate in some process that actually harms or has the potential to harm an individual, then we violate our professional codes.

I know many psychologists who have left the APA due to it's open stance on interrogation. I know how I feel—I vote by not choosing to work in this capacity (which is an easy thing for most non-military psychologists). I feel that licensed behavioral health professionals should not work on interrogation teams. If the DoD wants psychological expertise, then they should train doctoral level consultants who are not licensed as health professionals. If psychologists want to work in this field, they should let their licenses lapse.

The topic of interrogation always makes me think of the character Gitmo from the Daily Show. If you haven't seen the show (who hasn't seen the Daily Show?) or if you haven't seen Gitmo, you should look for it on You Tube...

Gitmo, the Elmo puppet from Guantánamo Bay, became a vehicle for expressing the writers' "most agitated feelings about torture in a way that is — not to be too cute — that is not torture to listen to, and that is not purely strident,"

The Pretty Sewage Trailer

This is the sewage trailer-- pumps the sewage from the latrines and takes it off the FOB to get dumped in a field. My B-Hut is the one to the right, so that's why I always bitch about the smell of sewage. Note the hand painted mural of the F-16. Every vehicle here is hand painted or decorated in some way...

This is the back of the trailer-- an idyllic painting of a mosque, greenery, pavement, and snow covered mountains. I have to note that nothing is green here and there is no pavement to speak of, so this painting on the sewage trailer is an expression of fond hopes perhaps?

The Pessimist Inside

Dear Afghanistan—the sweet melody of gunfire and concussions from exploding ordnance. I am finding that I have an increasingly cynical view of the state of things in Afghanistan. I forgive myself for that. My job here is to do my job, and no where does it say that I’m required to think optimistically about our mission here.

It seems so alien here to me that we must also seem like aliens to the Afghans. We are barricaded up in our forts and when we do leave the wire we are covered in armor and armed to the teeth.

This is a country of nomads, mud hut villages, war bands and chieftains. Violence is an everyday event here. Women are chattel and lives in general are disposable. This seems like the way life is here, and it hasn’t changed in this country for thousands of years. I am skeptical that we can alter the course of this country when our culture and way of life is so different. We may as well be from a different planet.

I have to admit that this attitude leaves me with a lower level of motivation—makes me think that I just want to get home and forget about Afghanistan.

I’ve spoken with combat arms guys who like their jobs—they like killing bad guys and the overall purpose or end point of the mission is irrelevant. Their job is to kill the enemy so it doesn’t matter why, and it doesn’t matter whether or not it ends.

That is an adaptive stance for a Soldier, because how could you keep on risking your life for something that seemed pointless. For them, it’s not about the destination, it’s about the journey. They chose the path of the Soldier and this is the way it is.

I think that’s my struggle. Part of me thinks it’s pointless and I don’t want to risk my life for something that is hopeless or misguided. I find myself dismissing the Afghans as a people who chop off heads in the name of Allah, so why should we care, why should we sacrifice our children for these primitive people who will just keep on killing each other and killing western soldiers for as long as we stay here.

I just have to openly admit to this dichotomy in my thinking. One side of me is very much a positive US Air Force officer who is here doing a good job, being the brave, uncomplaining Airmen who is playing my role in support of Operation Enduring Freedom. The other side of me is a man who feels caught up in a pointless war in a medieval hell-hole, and I just want to get it over with and forget about the whole thing.

I flip back and forth. I know the second viewpoint is not very conducive to good morale so I keep that thinking corralled as much as possible. I have to express it and those of you know me well will recognize that, but it is also very important for me to live that other role as a military officer.

But, I see now how combat veterans come back with deep resentment and bigoted attitudes towards the people of these countries we fight in. I’ve made comments about these attitudes on this very website so I guess I’m eating crow a little bit, because I am admitting to some of those same attitudes…

Maybe more on that later.

New Post Soon!

Technical problems have slowed down my posting. I'll be back with new material within 24 hours!

On Being a Consumer in Afghanistan

One thing I must say about Afghanistan-- and maybe this is true of all third world countries-- the amount of time and effort put into a small service-for-pay by an Afghan is a far greater value than back at home. For instance, the haircut.

Since being in the military I have at least quadrupled the number of yearly haircuts I get. This is the cost of keeping your hair short; you have to cut it frequently or else it looks really bad. Mostly I cut my hair myself (with a little help from my spouse or, one time, my five year old) but at least once a month I go to the barber.

The barber is generally hit or miss. Sometimes you get someone who takes their time and really does a good job, trimming the edges, making sure there aren't stray hairs, cleaning up your head and neck afterwards, but mostly you get a once-over with the clippers and a fast trim around your neck and ears, and it takes less than five minutes, and it costs eight or nine bucks, plus tip.

So, the haircut in Afghanistan takes place in a tent, floor covered in Afghan rugs, smell of incense, very much like you would imagine an Arab tent in the Sahara, except there is a small TV playing Pakistani news or Bollywood movies from India. The barber charges $5 per haircut and he is intricate and precise, even with the simple head shave. He goes over things twice, three times, and uses small scissors to make sure that every hair is cut and shaped uniformly. He uses a brush to thoroughly clean off the neck and head and shoulders and uses some sort of scented powder as an "after-shave" for your head. In short, he works his tail off for $5. It is by far the best barber-haircut I have ever gotten.

I have had the same experience with the tailor and the bread-maker; they work very hard to provide a simple service and they charge very little. Of course the price is much cheaper than at home, but the remarkable thing is that the service is far superior than what we get in the US. It's really nice to be a customer here.

On Monday I'll risk the local bazaar and see what they have for sale. I want to experience that, maybe send something unique home. I am conserving my cash because there is no way to get more cash here-- I need it for haircuts and to pay for shipping my belongings back to Las Vegas in December (I want to travel light on the way home). I guess I'll set aside money for shipping and 4 and 1/2 months of haircuts and see what I have left. I've heard they have silk and wool rugs, but I'm sure some are quite expensive.

Vaguely Romantic Notions

The sunrise burns red every morning over Pakistan, blotted out by either smoke or dust in the troposphere. For being a country that has neither industry nor fleets of automobiles, the air quality here is horrible.

I had some vaguely romantic notions about Afghanistan before I got here, but they have largely dissipated. I can see the ruins of two hill forts that supposedly date back to 2300 years ago, and that's cool, but they are mined so no one goes up there, and the novelty of seeing them in the distance has worn off.

The landscape here is severe, torn, and littered with the combined detritus of modern warfare and Third World poverty. Dust, diesel, burning garbage, and sewage is what you see and smell here. The Afghans all look hard and road worn. Females are all hidden away, I'm assuming they stay in the mud huts. The kids all have old eyes. From afar you see a child, but when you get close you have to ask yourself "is that a small 16 year old or a steel-eyed 8 year old? It's strange. People say that all the time, that the kids here are tough beyond their years.

I was speaking with an interpreter-- an Afghan man in his 40's-- listening to the tale of the downfall of his family, and I realized that Afghans my age (36) have grown up with constant war and worsening poverty. One million Afghans were killed during the Soviet-Afghan war and the country dropped from being almost the least developed in the world to, now, being the least developed in the world, just behind Angola. Some of his family managed to flee to the US, himself included, but now he has returned, trying to give something back to his native country by working as an interpreter for NATO.

It's an interesting story and I'll jot it in down in my journal to tell later (remind me). Unfortunately I can't publish everything here!

Anyway, carrying on. Safe and sound...

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.

Irony: (1) incongruity between the actual result of a sequence of events and the normal or expected result (2): an event or result marked by such incongruity*

Article in today's Wall Street Journal-- "Taliban Is Seizing, Destroying More NATO Supplies". Maybe it's just the way it is worded...

"About 90% of U.S. goods destined for Bagram, the main U.S. military base in Afghanistan, make an eight-day journey from Pakistan's Karachi port through the Torkham border crossing into Afghanistan, according to U.S. officials. Weapons and ammunition are flown into Afghanistan.

The majority of NATO supplies transported through Pakistan continue to reach their destinations, say Western diplomats and army officials. The U.S. government estimates it has lost only about 1% of its cargo going from Karachi to Afghanistan.

Still, the targeting of supply chains marks a new and troubling development. The militants' tactics appear designed to bog down foreign forces and wait them out, the same strategy adopted successfully by Afghan insurgents against the Soviet Union in the 1980s.

In response, NATO forces are adopting some of the Soviets' tactics. They are paying more money to local warlords to guarantee safe passage over roads and importing more fuel from central Asia, across Afghanistan's northern borders with Uzbekistan and Tajikistan, where roads are still safe. That presents logistical challenges and drives up the cost of the war."

*http://www.merriam-webster.com/dictionary

Slower Days and a Quick Brief on the RG-31 (Military Trivia That is Not So Trivial)

My posting has been slow lately, perhaps a reflection that not much is going on here. Combat has been slightly less frequent and there have been no casualties (well, some of our guys surprised some "bad" guys planting an IED and the encounter was a bit one sided, if you know what I mean). Slow is good, from my perspective.

Part of the slowness is that I'm still waiting for my Staff Sergeant to return from the south. He has been stuck for two weeks now, safe and sound, but stuck. It's really hard to move around in this country. Mostly the delays are due to weather in the mountains. The Chinooks need to fly through a number of passes to get anywhere, and if there are high winds or thunderstorms they don't fly. People get stuck places for weeks, and all you can do is sit around and wait for the next scheduled flight. Luckily, he will have visited our two furthest outposts and we will be unlikely to return.

As soon as he gets back I'm going to make the rounds to the outposts that are in the north section of our area. I'll let him stay here for a while and enjoy "civilization" and I'll go to a few other outposts. I'll consider hitching a ride in a convoy as long as I can get a seat in a $500,000 v-bottomed RG31. They are pretty much safer than the flat-bottomed Humvee M-1114.

US Forces are getting a lot of the RG31's (somewhere between 500k and 1 million per unit, courtesy of the US taxpayer credit card, thank you very much) because the Humvees just don't cut it anymore here in the world's biggest ammo dump. I read on the internet that the Humvee is close to ground, wide, and flat-bottomed, which means that the vehicle will absorb a relatively high percentage of a blast from beneath, transferring that force to the occupants and making the vehicle more likely to be breached. The RG31 is a high-riding vehicle that is v-bottomed like a boat, which deflects the blast out and up, rather than just absorbing it. Poor Afghan Army guys drive around in older Toyota HiLux trucks, which are really cool looking but definitely not IED resistant.

That said, I'll be happy to wait around for at least a little while to catch a flight.

FOB Dog Update

Our FOB dog is still alive but they haven't fixed the wall where he gets in. I got a few photos of him yesterday when I found him hanging out in the mortar pit. I currently can't post any photos because the public computer network is down and I can't access Blogspot from my work computer. I can post text entries remotely, by email, but I don't know how to post photos remotely. I can't check comments either, so if you've posted a comment and I haven't responded-- I don't when I will be able to...

The Blues, the FOB dog (update), and Please Send Hallucinogenic Gas Dispensers

I haven't posted in a day or two. I've been here one month and I think I'm experiencing a brief period of "adjustment disorder with depressed mood". As I told my brother-in-law, I am finding that the Army and I are very different. The honeymoon period is over, so now I have to adjust to the reality of this relationship. It's not a match made in heaven-- more a union of convenience (for the Army) or an arranged marriage, which is appropriate for this part of the world.

I said this before, but I'll expand on it. I have observed that I have a few external "strikes" against me, as I am considered to be a medic (actually, worse than a medic-- a shrink) and I am Air Force. Even the Army medics are somewhat marginalized, especially the doctors. They are possibly seen as being coddled or soft, whereas the actual "medics"-- enlisted Soldiers who go on missions and rub elbows with Soldiers in the dirt-- are more accepted and even appreciated, which makes sense.

The Air Force thing is mostly a barrier because there is constant griping that USAF deployments are shorter. They will point out that they will go through a third USAF psychologist before they even leave next year. I understand this, it sucks, and I don't think it's fair. But I consistently counter this by asking who was dumb enough to join the Army in the first place. Usually this goes over well because I think while Soldiers complain about the length of deployments, they also hold this as a point of pride-- it's one thing that sets them apart from other service members. To be honest, I didn't use that counter on the squadron commander when he said, "Six months? I could do six months standing on my head." I just smiled. Good thing he can't read minds.

It's an ebb and flow. Things have been mostly up, so it is reasonable to expect to have a few down days or weeks.

Moving on...

The FOB dog came up at the Battle Update Brief today. The squadron commander observed the location on the perimeter wall where the FOB dog infiltrates into and exfiltrates out of the FOB. The dog somehow gets in... It's remarkable. In the brief, he asked the First Sergeant to make sure that the breach is addressed. I'm not sure why it's a big deal. Maybe there are concerns that the little dog will one day wear a suicide vest, or come over at night with an AK47?

The First Sergeant grumbled an assent and said, "I was planning on shooting the dog anyway." I knew he was at least partially serious (I know the guy casually, but I have him profiled).

So after the meeting I grabbed him on the way out:

I said, "Sergeant "X", don't shoot that dog-- you better not shoot that dog."

He said, "You mean the pretty little dog? That dog craps in my horseshoe pit and when I play horseshoes I don't want to step in dog crap."

I said, "You're just a sick bastard and you want to kill something don't you."

Another NCO chimed in, confirming my suspicions, "Sergeant "X" if you need that dog killed, you let me know."

I said, "Just fix the wall so he can't get in. Don't you like dogs?"

There was a little more banter but I hope that I appealed to his humane side. I like the FOB dog. Reminds me of my dog.

If he kills it or has it killed, I will TORMENT him until I leave (a la Doctor Faustus).

Do you know about Dr. Faustus? The supervillain psychiatrist (of course) associated with Captain America?

Faustus has no superhuman powers but has a genius intellect, and is extremely charismatic and can modulate his voice in a highly persuasive manner. He has a Ph. D in psychiatry.

Faustus regularly employs hologram projectors, hallucinogenic gas dispensers, androids, and elaborate props. He also hires henchmen to impersonate various people as a part of his scheme to drive victims insane.

I gotta figure out how to get a hold of some hallucinogenic gas dispensers.

"I will be home and showered and probably three beers in by the time Carmichael makes it in."

My "distraction of the moment" is following Armstrong at the Leadville 100. Yes, I know he's degenerated into a womanizing tabloid figure (what was up with the whole Olsen twin thing?), and I have been reminded that I should be following the Olympics, but I'm curious to see how much of a bad-ass Lance still is on the bike-- and a mountain bike no less. The race is Aug 9, by the way--- www.leadville100.com

Pushed to predict his finish time for Saturday's race, Armstrong said he thinks he'll come in in the neighborhood of eight hours, or about an hour behind the winner — which at Leadville equates to about fifth place...

"I fully expect to get beat up," he said.

He did, however, engage in a little trash talk with coach Chris Carmichael, a Leadville veteran who will compete again this year.

"I know I can beat Carmichael. I will be home and showered and probably three beers in by the time Carmichael makes it in."