Dr Beths Afghanistan Blog...(A doctors life in the Red and Green life machine..) 20 Nov

Sat 20^th Nov – Sun 21^st am - Two torrents today – sultanas and casualties

A flood of parcels today; something to do with a backlog as trucks couldn’t pass through Pakistan during Eid, and most definitely not the RAF’s fault, the RAF assures me. ....and a torrent of Christmas related items fell out of brown paper packaging; even my usually restrained (until December) family didn’t disappoint with the traditional advent calendar in card size. But the best present was of course the biggest, a welly boot box size, and the awe of all jealous onlookers. Yet somehow so light it could only possibly contain candy floss. After much ripping and then tunnelling through copious amount of polystyrene I found 7, admitted perfectly preserved, cereal bars. Thank You so much Granny, much enjoyed.

The casualties however came first; two at a time in the morning and then three or four; smattered across the nationalities and fighting parties; requiring a variety of measures from resuscitation via early surgery to stabilisation and transfer to CT, to just common sense reassurance and slow time management. The team works; staff are flexible in their uses when needs must, and it is a happy calm team that welcomes every casualty. To be able to be the first to greet and reassure the awake patient whilst assessing their injuries, and then to follow their care through imaging, disappear while they sleep for surgery, and then be there to provide ongoing care and analgesia when they wake is the biggest privilege. Often I get to top it off by speaking with the family when they are unable to answer the concerned questions through either emotion or uncertainty.

All that is then left is the paperwork scenario that surrounds a quick departure to home country when required. In honesty, the UK system is awesome; the US is harder but their lines of communications are rather different and I do think of Bastion as the Centre of the Universe forgetting their main effort in Kandahar, Kabul, Bagram and many others! Always comes through no matter what the obstacles en route.

Then comes the night shift – very different spectrum of injuries – the 24hr charity football match provided 3 ankles injuries all luckily soft tissue, but 3 soldiers confined to desk work for week or two; yet the charity events are great for morale and seen as a way of ‘doing their bit’ – as if they need prove anymore! And then the lower priorities fly at night....small fragment wounds, twisted ankles, mild concussions, abdominal pain, skin infections and the wide spectrum of non-battle afflictions common in this adverse environment. Keeps me and my colleagues on our toes at least!

Dr Beths Afghanistan Blog...(A doctors life in the Red and Green life machine..) 16 nov

Shouldn’t come in early....even to sit around and eat breakfast, not if I want to get anything of my own done, or a quiet time; it’s busy and there are questions to be answered, and even if the nursing staff do apologise beforehand, it still gets my mind moving and it’s in my face. Patients need attention too, and they do; that’s probably what I do best so I get involved, and the only thing that becomes prioritised is my breakfast, can’t do without. A regular diet of All Bran or Porridge Oats and dried fruit, the latter two lovingly sent by family, knowing my peculiarities. My other foible is appropriating boiled eggs from the unused Halal breakfasts, which rather surprisingly consist of 2 x boiled eggs, a fried egg, some hash browns, kinda French toast and a pancake....not quite sure what they make of it, but I certainly found a longterm Afghan resident eating a big bowl of walnuts for breakfast today instead. They are not averse to my coke cans though; having finally got frustrated with my cans infrequently disappearing from the fridge, assuming unrealising staff had taken (given that the US ‘chowhouse’ contains fridges of free soft drinks in addition to icecream,) I decided to label my coke – 10 minutes later two fathers accompanying recovering children were engrossed in CBeebies with a labelled coke on the side!

Local bombmakers and snipers appear to have made the pilgrimage as the Haj festival has been relatively quiet so far; tell that to the young man who is recovering after being shot in the abdomen yesterday; but maybe he’s lucky cause it was the third rate sniper on the ground instead.

Hence I am able to enjoy some of the last sunshine, and learn more about Star Wars than maybe I ever wanted to - surrounded by men of obsession tendencies – an element of which seems to be required to be a good surgeon.

Dr Beths Afghanistan Blog...(A doctors life in the Red and Green life machine..)

D day -1 (getting ready to deploy)

On the eve our mission to get to Bastion, via a number of ‘undisclosed’ stops. Each flight carries the potential of mechanical setback pre and in-flight, and each stop is of undetermined length...I hear there is a daily unpredictable risk that the metal cargo door will expand so much in the heat on the runway that it will not shut, so we sit around until the temperature drops!

As a hospital we have received a glowing green light, at least procedurally; we have a massive conglomeration of personnel from tri-service and multinational (US & UK anyway) backgrounds who have achieved some degree of unity within 72hrs; we just need to ensure this survives contact with the enemy, our enemy being casualties coming through the door. Hard to glean too much about the personalities, strengths and abilities of the staff with whom I will work when we treat fake patients, certainly not my forte. I do hope that they have learnt a little about me though, enough to support my weaknesses and push me where I require it, but enough to know that I will work as hard as is required and remain loyal to them and my patients.

Me, I’m nervous; anxious is probably a better word. Not about my safety (although I do wish people would stop asking that stupid question of my mother, insensitive springs to mind); but anxious about my ability both to do the job as well as I want to, & to cope mentally with the sight of grown men crying or alternatively being more stoic than I am when faced with their own worst nightmare. No point wasting either energy or sleep worrying now though, will deal when it occurs and pack some herbal sleeping tablets since red wine won’t be available to me. It still is though, so here’s to a last Thai meal and a tasty bottle.

3 Weeks into tour...

So how to summarise these first three and a significant 24hrs more - workload massively outstrips my distorted perception of time. It has flown by, some in a semi-wakeful haze, and other images so much more focused; the red amongst so much sandy camouflage; the dark skins of the locals and the cries of a sad series of children surrounded by a bunch of scissor and stethoscope wielding white strangers working in a well practised routine.

Sleep is a luxury, and in my case, jealously guarded from crap, but so often interrupted by necessity or just spending time chatting with both patients and colleagues, even interrupted for exercise; all of which ensure I retain my sanity. Sugar however is no luxury; we are very well looked after for easy snacks foods, much of it care of our embedded US colleagues; the rest by family! My craving is porridge, nuts, protein and anything other than bloody cheese baguettes for lunch; never for such an longtime have I ever been so incarcerated by my vegetarianism! But I have no inclination to give myself any wiggle room; it no longer appeals in any shape or form. Raisin bakes however, I can thoroughly recommend, oh and Clif bars!

An endless row of changing young USMC faces sit facing blue screens behind which sit the unchanging detainees ostensibly awaiting further medical attention until they fit the very high standards set by the US detention facility, being mobile without the aid of crutches seems a high bar to set to a detainee who has a high hindquarter amputation......we await judicial process. Where I was going with this train of thought is that it is those young guards who provide the Clif bars generously, and gorge themselves on the only fast food at Bastion (beside the hospital) pizza. Usually these USMC guards have recently been through the hospital with a minor injury or illness and are given this role as ‘Light Duties’/recovery time; or as one marine told me ‘everyday is one more day i get to keep my legs’. There is no suitable answer to that. The few British guards don’t bring food but they do make cups of tea, generous with their time and smiles instead, the ward staff, in turn, are liberal with their kit-kats.

I had made a few notes for the first few days of this deployment that I thought might spur me into memory of each day and act as sources of inspiration for typing; how wrong, they sound bland as black and white facts. However 1 tale still appeals – the oft quoted communication barrier between the Americans and ourselves; a US surgeon requested in post op notes that the patient who had just been through major bowel surgery should be on a ‘sips and chips regime’, so the nurses obediently fed said patient with the cookhouse chips washed down with sips of water, against their better judgement i hasten to add. Only on ward round, when the patient had wolfed the offered chips down, was it realised that the intent had been chips of ice. The lady in question did however recover very well but lost no weight.