FHE

The LDS group has a recurring FHE meeting Wed nights. I've missed the two prior, but made sure to attend this week. I was all set for a great social experience with fellow saints. The only other person who showed was the group leader, we had a nice chat but ended up calling the event and heading home early.

MASCAL update

The dust of yesterday's chaos is still settling. Half of the patients brought in yesterday are still in the hospital, but are on their way to recovery (for some, the road will be longer than others). Today brought another level of chaos to the hospital. There were probably 100 people who stopped by to see the wounded. Teammates and leaders (American and Afghan) came to honor them, came to console them, came to learn their stories. My favorite is two of the Afghan soldiers who were pinned down behind a building where Taliban members were shooting at them and lobbing grenades over the wall at them. They were both badly wounded and before passing out were able to put tourniquets on each other's legs, saving each other from continued loss of blood. Their unit then blew up the building and pulled them to safety, both of them still have their lives and their legs because of the many hours of training, practice, and foresight done before they started this mission. Often in life we applaud the heroics of the moment. We need to remember that it's the time leading up to the moment that will determine your ability to succeed when called on.

https://www.stripes.com/news/middle-east/pentagon-identifies-army-specialist-killed-in-afghanistan-1.524965 

Additional information on the event has come to light as the soldiers are recovering. During the delay while still under-fire, there were two of the Afghan soldiers who successfully applied tourniquets to each other’s legs before passing out from loss of blood. The tourniquets successfully stopped the blood flow and not only saved their lives, but our surgeons were able to repair the damage, release the tourniquets, and save their legs. I’m amazed at what medicine can accomplish today.

Winning

Intro meeting with the Wing/CC, BG Baker. He has a very interesting leadership style focused on building relationships. He spent most of our time asking me about me, where I’m from, my family, what I’m interested in, etc. After learning about me and telling me about him, the only work related question he asked was, “What does winning look like?” His goal wasn’t for me to lay out a 9-step plan about what I was going to accomplish during this deployment, it was to think about what success might look like to me. It may be an accomplishment, but it might also be something unsubstantial/intangible, like building a great team that does great things. He didn’t want me to give an answer during our interview, but to save it for when I’m getting ready to go home (his tour ends in a month or so). The answer seems obvious, there’s not a major accomplishment, the goal is to leave things better than I found it and to make things better for the next several rotations. My goal is to help others find their way to success, if I can do that, we all win (patients, staff, the mission, etc.).

MASCAL

Today was amazing and made the hardship and trials of being away from my family almost feel worth it, almost.

Around 0930 we got the call that we had inbound casualties coming straight from the point of injury (a US/Afghan mission against terrorism). Over the next several hours the helicopters were unable to land due to continued combat in the area. This morning, the plan was to hold another MASCAL exercise around dinner-time. However all this got thrown out the window when we got a call that there was a real MASCAL response needed. Typically we receive our patients from one of the forward operating “Role II” clinics (minor surgical capability designed to receive trauma from the field, save life and limb as possible, and conduct damage control surgery prior to shipping them on to one of the “Role III” hospitals – there are two, we are the largest). Today, we were the closest facility and the battle was still raging. We saw the helicopters take off from the “dust off” pad, next door. We heard the radio communication directing travel and recovery. Then we heard the helicopters get called back from the scene as there wasn’t a safe route to land. Finally after about 3.5 hours a second set of helicopters was able to land (the first had to return because they were running low on fuel) and retrieve casualties. When we started, the expectation was 5 patients, when the helicopter landed, the count had risen to 10, by the time the helicopters made it back, we had 16 patients unload for care (3 were dead before they left). From the Pt Admin team to the trauma surgeons, this facility stepped up and took care of business. PT Admin tracked patient movement, patient belongings (including weapons, ammo, clothing, and personal affects, some coated in blood). The clinical staff sorted patients by triage categories and each disaster team surged into action. By the end of the day everyone who arrived with a pulse was stable and resting. I am very proud to be part of this team and of this mission of bringing life back to those wounded trying to bring freedom.

MASCAL

This morning, the plan was to hold another MASCAL exercise around dinner-time. However all this got thrown out the window when we got a call that there was a real MASCAL response needed. Typically we receive our patients from one of the forward operating "Role II" clinics (minor surgical capability designed to receive trauma from the field, save life and limb as possible, and conduct damage control surgery prior to shipping them on to one of the "Role III" hospitals – there are two, we are the largest). Today, we were the closest facility and the battle was still raging. We saw the helicopters take off from the "dust off" pad, next door. We heard the radio communication directing travel and recovery. Then we heard the helicopters get called back from the scene as there wasn't a safe route to land. Finally after about 3.5 hours a second set of helicopters was able to land (the first had to return because they were running low on fuel) and retrieve casualties. When we started, the expectation was 5 patients, when the helicopter landed, the count had risen to 10, by the time the helicopters made it back, we had 16 patients unload for care (3 were dead before they left). From the Pt Admin team to the trauma surgeons, this facility stepped up and took care of business. PT Admin tracked patient movement, patient belongings (including weapons, ammo, clothing, and personal affects, some coated in blood). The clinical staff sorted patients by triage categories and each disaster team surged into action. By the end of the day everyone who arrived with a pulse was stable and resting. I am very proud to be part of this team and of this mission of bringing life back to those wounded trying to bring freedom.

https://www.stripes.com/news/middle-east/pentagon-identifies-army-specialist-killed-in-afghanistan-1.524965 

Additional information on the event has come to light as the soldiers are recovering. During the delay while still under-fire, there were two of the Afghan soldiers who successfully applied tourniquets to each other's legs before passing out from loss of blood. The tourniquets successfully stopped the blood flow and not only saved their lives, but our surgeons were able to repair the damage, release the tourniquets, and save their legs. I'm amazed at what medicine can accomplish today.

Long days

The days are long, but the weeks are short. Being away from my family is hard. Supporting a mission where saving lives is a daily event makes it feel more bearable. I look around and see so many men and women away from their families serving a cause greater than their own interests. We treat warriors and families fighting for the chance of freedom from oppression. The chance to live without fear. I feel part of something noble and hope I can live up to the challenge of making things better.

Bagram Mountains

Regardless of the bitterness, fear, and hatred in this area they sure do have some beautiful mountains. 

Sparky’s Park

On the edge of the hospital compound, two of our staff spend their down time building. I'm impressed with not only their desire to improve their surroundings, but by their carpentry skills. Before they got started, the area was scrub brush/weeds and gravel. By the time they finished, awesome "Sparky's Park" (named after the Gp/CCs call-sign). There's "Craig Cabin" (named after SSG Heathe Craig – the hospital's namesake), a fire pit, benches, lounge chairs, gazebo, corn hole pit, serving bar, a movie screen, etc…

Charleston trio

This morning the final member of Team Charleston arrived, SrA Narvarez joined SMSgt Foster and I in Bagram. As with everyone who arrives, we met the flight at the terminal, helped collect everyone's bags, brought them back to the hospital and helped get them to the right dorm. As I was helping carry bags, I came across another familiar face, SrA Narvarez's husband, and was a bit confused at first. What a great surprise! He is on the flight crew carrying a USO tour around the world and just happened to get here yesterday, leaving tomorrow. Here's a photo we took a few days later.

Today we were also part of a documentary interview by PBS. I wasn't part of the interview process and didn't insert myself as I'm too new to try and take over any ownership of the mission here yet… However, as I thought about the interview, I did a little research and found the following from a previous interview of the mission here… https://www.stripes.com/news/bagram-hospital-braces-for-more-casualties-as-us-intensifies-afghan-war-1.510639

FHE and IDF

Scott told me that one of the other Sq/CCs is also a member of the church. Today I met him. Really nice guy from Tonga. His name is Rob Kongaika, but he goes by Kong out here. He leads the other LDS group here, over on the other side of the base. He's been here for about 10 months and should be heading home by the end of June.

We had our first IDF (indirect fire) attack last night/this morning. Apparently there hasn't been one for over a month. Today was also the official declaration from the Taliban to start "fighting season" for 2018. The story, as I've heard it, is that they take a break over the winter to farm and harvest their poppy fields, so they can sell the opium and buy their weapons for fighting over the summer. The base is protected by a computer networked array of machine guns (C-RAM). There are two weather balloons equipped with high-definition cameras and ground based infra-red cameras that are all tied into a computer system that controls a series of robotic machine guns designed to shoot the projectile (bomb, missile, rocket, etc.) in the air, before detonation. This leaves our biggest threat as the remaining fragments hurtling through the air. This one hit the ground and created a hole about 2 ft across and 8 inches deep.

Korean Hospital

Back in December I went TDY to the DC area with all of the AF's medical commanders (I was Col Lambert's "plus one"). One of the presentations was from last summer's Trauma Czar here at Bagram. The focus of the presentation was about a second hospital here that the South Korean's used to staff. I think the priority of their mission was humanitarian healthcare for the local Afghans. Two years ago, they redeployed their presence and gifted the hospital to the Afghan government. It's been sitting there vacant ever since. About 80% of our patients are Afghans and the goal is to help them establish a presence in the facility, so they can take care of their own patients. We are looking into bringing some of their staff into our facility for training, then as they staff the vacant hospital, send some of our staff to their facility to continue a train/advise/assist mission. So far it looks like they are stalling any movement towards this goal (my guess is that they are afraid that if we get them set up, we'll leave and take our expertise home). Today, we had the opportunity to cross the gate to the Korean compound, take a tour of the hospital, and meet with the Afghan General who has been tasked to evaluate operational capabilities and eventually become the first commander of the hospital.

The tour was both cool and strange. When the Koreans left, they abandoned everything that wasn't a personal item. The facility had a post-apocalyptic feeling to it. All the medical equipment and supplies are still sitting around. The pharmacy is still fully stocked (expired meds, but the shelves are full). The inpatient beds are still lined up and ready for use. There is even a row of wheelchairs lined up in the main lobby (super cool: there's a standard looking wheel base with a plastic patio chair sitting on top). Besides being void of staff, the only other thing out of place was a 2 year layer of dust. I have a few photos of the empty building, but it just looks like no one's there, you can't really get a good feeling for it, nothing is falling apart, there are dust covers on important things, etc. The following are the two shots that I thought were worth sharing. The first is the "friendship" gate to the facility, the gate separates the Korean hospital from the rest of the base (since they were designed to have Afghan patients come/go during the day. The second photo is a close-up of the interesting wheelchair.

Death & Path of the Patient

Death of a Patient

Earlier this month the hospital received a mom and her two small children (boys aged 2 and 6) who were caught in the cross fire between some Special Forces soldiers and the Taliban. The mom tried to run from her house with her boys when she heard the battle start. Unfortunately they ran straight through the shooting. Mom and both boys were shot and wounded. All were recovering and were slated to be discharged on Monday. The little boys were cute and were loved by the nursing staff, the two year old walked around like he owned the inpatient ward; they were cute and a lot of the staff were able to get their baby fix as the littlest loved the attention from everyone. Unfortunately, early this morning our staff found mom unresponsive and were unable to resuscitate her. With the Afghan culture being opposed to the practice of performing autopsies, we are unable to positively identify her cause of death, but assume she had a pulmonary embolism. Our staff was stunned and shattered, “Nobody dies today” is our med group mantra. This also rose some new cultural concerns as we tried our best to continue to care for the boys as we coordinated with dad to discharge and return his broken family. Our team of linguists also provide a wealth of cultural advice/expertise, but in the Afghan culture doesn’t allow cross gender support in preparing the dead for burial. Our male admin techs are versed in how to prepare our male casualties and are guided by our interpreters. However, our female admin techs have never been involved in this process and our linguists weren’t allowed to be in the room to provide visual guidance. We eventually were able to get support from our base mortuary affairs office, coordinate a transfer time with dad and drove the family to one of the base entry control points for the hand-off. Dad didn’t want us to tell the boys, which then caused some of our nursing team to break into tears when they asked to see their mom after breakfast. 

Path of the Patient

One of the things that we do in this hospital is take DVs on tours, showing off the great things we do and reflecting on some of our shortcomings (especially if the DV is someone who might be able to help us fix things). I have walked through the DV tour once with our CMSgt. Col Matthews believes in the model of, “See one, Do one, Teach one” and told me this morning that we might have a tour this afternoon (with some Hollywood Stars here on a USO trip) and that he wants me to lead it. No pressure, I’ve been here over a week… Fortunately the tour got cancelled and I get a few more days to learn what goes on here!

BIRTHDAY weekend

Diana (Luke's mom) threw a Birthday party for Stew at her house Friday night! It was amazing. She barbecued hamburgers and hot dogs. They had an ice cream cake, balloons, fire pit, and amores. They ran around outside and stayed up late. Stewart has really great friends. Luke, Jimmy, Jonathan, Amelia, Allison (Stew's current crush) were all there. 

Stew and Amelia

STEWIE!!

                           

JIMMY!!

Bobby (Lukes stepdad) started the fire with a blow torch

   

MASCAL exercise

Today we ran a MASCAL exercise and processed a dozen or so patients through our trauma bay. My two roles for this type of event are Command/Control and Crowd Control. For this exercise, Col Matthews ran the command/control portion of the event and as there was no crowd to control (onlookers, patient commanders, public affairs, etc.), I was left to wander aimlessly throughout the various stages of the process and learn how things are done and why. At the start our patient admin team clears the patient of anything that could be dangerous to the hospital or staff (weapons, explosive ordinance, intentional or just part of their equipment) and provide a packet of tools to assist with access to care along the way. Each patient is given a "trauma name" that is pre-registered in the e-health record (made up names like Kleenex, Tulsa, Amarillo, etc.), this helps simplify ordering lab tests, meds, radiology scans, etc. Once we find out the patient's real name, we are able to add the trauma status to their health record, but as long as they remain in our care, they are referred to by the trauma name (this helps ensure that nothing is dropped, overlooked, or misplaced). There were very few hiccups along the patient path and most of those were exercise glitches vs. treatment problems. This first exercise was designed to allow the departing team to train the first half of the arriving team, passing along valuable lessons learned so we don't have to repeat past mistakes and can learn the efficiencies from our predecessors. We have some work to do, but nothing major.

The following photos are from an earlier exercise, but are a good depiction of the initial receipt of a patient. I will not post any photos that are too graphic or identifiable.

Birthdays and other Changes

Happy Birthday Stewart! I am sad today that I'm not there with you and unable to ordain you a Deacon. I am proud of who you are and the seriousness that you approach your life. I am grateful to be your father and for having you as one of my sons. You are a great kiddo!

Today my best friend turned over command of this squadron to me. Col Matthews (my new boss) talked about the great things that Scott has accomplished over the past 6 months and how much faith he has in my abilities to follow suit. Scott talked about how great this experience has been and how awesome his team was in performance of their duties. I was brief, grateful for the opportunity to serve, excited about the work to come. This facility does amazing things in support of the fight for freedom in Afghanistan. As a sign of how important this mission is, several layers of commanders that lead and/or are supported by the medical mission attended; multiple Services, General Officers, Colonels, Civilian agencies, Afghan Commanders, etc. We held the ceremony in an area of the hospital called "Warriors Way". This is a venue that every trauma patient passes on their way to the saving arms of our healthcare team. Most patients come laying prone on a litter and roll right under a giant American flag (maybe 30 feet wide) and know that they are home and safe. This facility is a sign of hope and freedom recognized by US, coalition, and Afghan forces alike. If you make it this far, you are probably going to survive (last year there was a 99% survival rate); if the patient doesn't survive, their injuries were so bad that they would have died if they were injured on the operating table. Amazing!

https://www.facebook.com/133592286657075/posts/2146170475399236/

Happiest of Birthdays to our Stewart

12 years old today!!

We watched and sang along to The Greatest Showman on a school night. Birthday celebrations are important. 

Dance party followed the movie. We have some pretty wild partiers!

replacement scriptures...

Stew has been wanting a watch for quite some time. He was saving up his money, and refused to buy things until he had enough. It is fun to give your kiddos things they really want.

Friday April, 17 2018

Emma and Ander came out of seminary with 2 bouquets of flowers and this lovely card. Sister Ward has been such a great support to our kiddos (and therefor to us) these past 2 school years. Feeling loved... 

Nurse Tammy at PSA has been bringing Emma and Ander to the Walmart (almost halfway home) after school, to make it easier on me to get the kids. So, I ripped the cute cover off the card from sister Ward and made a second card and handed off one of the flower sets to her. It worked out beautifully. 

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Friday evening Stew had an end of season basketball dinner at CC's pizza. Shaun Dempsey (Holdens mom) took them (thank goodness)  The coach wanted them to carb up in preparation for his tournament the next day. 

Luke, Dawson, Jimmy, and Jonathan all wanted to have a sleepover. I usually don't allow that unless its at our house. Since we have to be out of the house Sunday I let him go to Jimmy's. I really don't like when he is gone, but I have been so distracted cleaning this house... Emma was off with Jordan and Mia... It has been a super busy few months. Emotionally, I am exhausted. It is interesting what a body and mind can sustain. 

In our cleaning frenzy, I have had the kids wash all sorts of things using old toothbrushes. 

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Anderson like to throw things, tonight it happened to be his blue deployment ring. This is where it ended up...

thank goodness we still had chairs in the house

Jefferson's House

aka Mcersons/Jefferlane

April 17, 2018

Glenna Jefferson invited our family

of 5 to join her family of 5! Who does 

that? She is one of the most high 

functioning women I know.  

                       

Glenna's

Butternut squash soup with cilantro and lime. yum

Tomorrow is Stewie's 12th Birthday. Emma and i went to 4 different stores looking for doughnuts with sprinkles... we settled on doughnut holes with sprinkles. 

Family Home Evening

May16, 2018

 

We miss John! He likes Mellow Mushroom - so...

love love love

My sweet girl

Greek Salad...

Garlic cheese bread...

Cute boy!!!

Bagram LDS Group

First Sunday in Bagram. Went to church with a small group of members from the hospital, all will be redeploying soon. As I walked into the little chapel, I was immediately greeted by a familiar face and a smile. Tyler Horner, one of our friends from Helotes, TX (he was in our bishopric when we moved, I was his home teacher) is here as a deployed Civilian. After we left TX, Tyler got an assignment in Germany and they’ve been there for the past several years. Now he’s here supporting human resources for the US Army civilian population in Afghanistan. It was a fun reunion. We met up for dinner and I was able to meet some of his coworkers as well.