Picture Of The Day - 29 JUN 2010 "Jingle-Pillar"

29 JUN 2010 - Jingle-Pillar

At first glance, you might consider this a bit boring for the FaST Surgeon blog. Or you might remark "What the.. Why would he show us a picture of a Caterpillar?". Ah... my ulterior motive is to shed light on the fascinating need for Afghans to "pimp-that-ride", no matter what it is. More commonly you will see reference to the "Jingle Truck". I have a whole series of Jingle truck pictures, but they're for another day. For now, enjoy the wonderful beauty of the Jingle-Pillar! :)

Dust In The Wind

Dust permeates everything in Logar, Afghanistan. There is nothing in FOB Shank that doesn't have dust on it. After being here for some time, you just accept it. But I have found one thing that makes the dust more than just acceptable. The dust makes for some nice photos during sunrise and sunset. All the photos below were taken on FOB Shank. Enjoy.

Photo By: LTC Bruce

Photo By: LTC Aldridge

Photo By: LTC Bruce

Photo By: LTC Bruce

Photo By: LTC Bruce

Photo By: LTC Aldridge

Picture Of The Day - 28 JUN 2010 "Hollywood Bullet"

28 JUN 2010 - Hollywood Bullet (Photo By: SFC Penn)

OK... some time ago I made the mistake of telling my readers that bullets only get removed in Hollywood movies and rarely in real life. Well, I guess that wasn't so much of a mistake, but this photo makes me feel like I have to back pedal a bit :).  So, the full truth is that there are some instances where you do have to take bullets out. This one, in particular, was lodged in a bone next to some important nerves and large vessels. Hence the reason for the trauma (me) and orthopedic surgeons standing proudly together with said bullet, knowing the bone will heal and all the nerves and vessels are intact. Good times. Although, nothing very Hollywood about it, unless someone wants to give COL Brucker a leading man role in their next action film... I believe that he's available for auditions in about a month. ;-)

Picture Of The Day - 27 JUN 2010 "Reverence"

27 JUN 2010 - Reverence (Photo By: COL Brucker)

Picture Of The Day - 26 JUN 2010 "Troops"

26 JUN 2010 - Troops

I got a package from good friends of mine. It was a HUGE package, filled with snacks, magazines, coffee, gum, drink mix...etc. But the best thing in the box????? The little personal items that their children made. I put their artwork on the wall of our patient aid station. The medics of the 173d Airborne Charlie Med Co. that worked with me that day posed for this shot.

For all those who wonder what happens to the artwork and letters that children make and send to out troops.. I'm here to tell you that they all end up on a wall somewhere. It may be in an office in Kandahar, or a helicopter terminal in Bagram, or a tent wall in some combat outpost. I have seen hundreds of these. Most say something like "Thank you, troops"... I want you all to know that they're really appreciated. We thank you all. 

If you're child or class sent a soldier a letter or a work of art, please pass this thank you to them.

Picture Of The Day - 25 JUN 2010 "Transitions"

25 JUN 2010 - Transitions

Battlefield trauma care requires numerous transitions. The patient transitions from the battlefield to the aid station. From aid station to the FST. From the FST to the CSH. From the CSH in theater, to the hospital out of theater (Landstuhl Regional Medical Center). Finally, from LRMC to stateside. Its a heck of a process.

This photo also is filled with transitions. Some medics are transitioning from night to day crews. One is coming from being out "on the line" to helping "inside the wire". Another is transitioning through special training with the FST back to his regular unit. There are a lot of pieces moving around the chess board. Sometimes I catch myself just being awed by the shear complexity of the logistics that keep this whole machine running.

Picture Of The Day - 23 JUN 2010 "Salute"

23 JUN 2010 - Salute

 From the US Army Quartermaster Center and School:

ORIGIN OF THE HAND SALUTE

No one knows the precise origin of today’s hand salute. From earliest times and in many distant armies throughout history, the right hand (or "weapon hand") has been raised as a greeting of friendship. The idea may have been to show that you weren't ready to use a rock or other weapon. Courtesy required that the inferior make the gesture first. Certainly there is some connection between this old gesture and our present salute.

One romantic legend has it that today’s military salute descended from the medieval knight's gesture of raising his visor to reveal his identity as a courtesy on the approach of a superior. Another even more fantastic version is that it symbolizes a knight's shielding his eyes from the dazzling beauty of some high-born lady sitting in the bleachers of the tournament.

The military salute has in fact had many different forms over the centuries. At one time it was rendered with both hands! In old prints one may see left-handed salutes. In some instances the salute was rendered by lowering the saber with one hand and touching the cap visor with the other.

The following explanation of the origin of the hand salute is perhaps closest to the truth: It was a long-established military custom for juniors to remove their headgear in the presence of superiors. In the British Army as late as the American Revolution a soldier saluted bv removing his hat. But with the advent of more cumbersome headgear in the 18^th and 19^th centuries, the act of removing one’s hat was gradually converted into the simpler gesture of grasping the visor, and issuing a courteous salutation. From there it finally became conventionalized into something resembling our modern hand salute.

As early as 1745 (more than two-and-a-half centuries ago) a British order book states that: "The men are ordered not to pull off their hats when they pass an officer, or to speak to them, but only to clap up their hands to their hats and bow as they pass."

Whatever the actual origin of today’s hand salute, clearly in the tradition of the US Army it has always been used to indicate a sign of RESPECT – further recognition that in the profession of arms military courtesy is both a right and a responsibility of every soldier.

Compiled by the
U.S. Army Quartermaster Corps Historian
Fort Lee, Virginia

Goodbye, Farewell and Amen (For Sam)

If I used rocks to spell "GOODBYE" here in Afghanistan... it would be like looking at one of those cards that the eye doctor uses to test for color blindness... it would take some effort to pick out the "GOODBYE" rocks in the sea of other rocks that permeate every inch of this FOB :)... Therefore, these photos will serve as my lasting GOODBYE to Sam.

20 JUN 2010 - Fathers Day BBQ

I know that this whole post may be considered a bit much. But for anyone who has truly spent time with Sam, they would know why he is worth such praise. On Fathers Day, CPT Timms did a good job of giving him the send off that he deserved and clearly appreciated.

20 JUN 2010 - Sam "holds court" at the Father's Day BBQ.

Of course, Sam is an expert story teller and spinner of yarn. When he speaks, you just can't help but be engaged (note the photo above). He is self-deprecating, and would be the first to tell you he talks too much. Frankly, he just somehow has something to say that always adds to the conversation.

Sam and SPC Saf computer fix.

Sam also just has this innate ability to be helpful no matter what the problem. Whenever we pulled duty at the aid station (AKA primary care clinic), we had to deal with how to document clinic visits on a computer that lacked the all important "ENTER" key (it was tricky). Finally, SPC Saf and Sam whittled out an "ENTER" key from a tongue depressor, bubble wrap and moleskin. Sheesh..........Only Sam can fix a computer with hillbilly technology!

21 JUN 2010- Sam and I operate together for the last time

The final two days were closing fast. Of course, trauma stops for no-one. I found great pleasure in operating with Sam on this day. In actuality, we rarely got to operate together during this deployment. I found the "give-and-take" of surgical decision making very natural and easy to do with him. If you're not a surgeon, it would be hard to understand... but when two surgeons operate together there are times when they will have differences of opinions. Being flexible in your opinion and able to discuss different techniques and approaches while in the middle of a trauma case is key to an optimal patient outcome.

22 JUN 2010 - Commander, Sam and I (Photo By: SFC Beisiadecki)

The final full day. Getting our last photos together was an undertaking. I worked the aid station yesterday, and Sam had a whole heck of a lot of goodbyes to make around the FOB.

22 JUN 2010 - Detachment NCO drops Sam one last time ;)

We had a lot of fun getting these photos. Doing push-ups was Sam's idea (of course). He was always a big ham for photo ops. Not so much for any reason other than because he just liked to have fun, especially at his own expense. Of course, doing push-ups for Sam is no big deal. He can "max" his PT test. He also won his age group in the FOB Shank Pat Tillman memorial run and the 10K "Fun Run" (he even paused during the fun run so that he could run with some of the other younger guys).

22 JUN 2010 - An Afghanistan dust devil send-off

Well.... as we continued to grab more photo opportunities with Sam... a dust devil played a visit. This was one of the hotter days since we've been in theater. But as the afternoon wore down, the temp dropped to a really comfortable level.

22 JUN 2010 - Sam and his ICU staff

22 JUN 2010 -Solidarity

22 JUN 2010 - Sam wanted the now famous "Dr. Mike Bruce trauma pose" with Specialist Nguyen

23 JUN 2010 - 2:52AM

Well... this morning came early. Sam had everything packed. The big tough box was mailed days before. The duffles were setup. And by 10 minutes 'till 0300, the coffee maker was on and ready to brew.

23 JUN 2010 - 2:53AM

Sam loves his coffee. He had a cup, seemingly in his hand all day long. He brewed a pot early every morning, and folks would come by the hooch because they knew he would have a special coffee brew ready for them.

23 JUN 2010 - 2:55AM

Most mornings, Sam would make special coffee deliveries to the tent next door. He would spend 10 or 20 minutes sitting on the wooden steps just kicking off the day... regaling us with stories of yonder times. He always had a story to tell :)

23 JUN 2010 - 2:56AM

So, I watched as he got his last cup of coffee... He replied to a text message.. .one of hundreds of messages that he seemed to get through the day. Sam hates email... he barely can use a computer.. but somehow the old fart can text. How do you explain that?... I'm sure his answer would be "I have four teenagers at home".. that was his stock answer for many things related to his ability to maintain his inner youth :)

23 JUN 2010 - 2:57AM

Then.......... poof.. like an apparition... he's gone. Out the door to a waiting gator driven by SPC DeLeon. He's off to the rotary PAX terminal. We got our goodbye. Its quick.. simple.. Its a guy thing.

Sam's Sunflowers

I step out the door.. Sam's flowers are blooming. I head out to the Rotary PAX. I've already said goodbye, but its a nice morning and I can use the mile walk.

23 JUN 2010 - 4:59AM

It's quite bright in Logar province by 4:30AM and the sun begins it's ascent over the mountains by 5AM. Sam is already landing in Bagram as the shutter closes on this photo. GOODBYE

Picture Of The Day - 22 JUN 2010 "Close Quarters Combat"

22 JUN 2010 - Close Quarters Combat

Again... from "The Oracle": "Close Quarters Combat (CQC) is a type of fighting in which small units engage the enemy with personal weapons at very short range, potentially to the point of hand-to-hand combat or fighting with hand weapons such as swords or knives."

That pretty much sounds like what surgeons do every day. Its just that the biggest enemy for a surgeon is bleeding. We know how to fight the enemy. We know the terrain and we have a variety of tactics and weapon systems to combat the enemy. But its combat. Most battles we win. There are some battles that we lose. To ultimately win the war, we continually study our enemy and constantly advance our tactics. We will never willingly accept defeat.

Picture Of The Day - 21 JUN 2010 "Specialist"

21 JUN 2010 - Specialist

SPC, Spec4, Specialist. A rank with an interesting history. I won't bore you with all of it, but you can find it here on what COL Brucker calls, "The Oracle", AKA Wikipedia. Below is a short excerpt from Wikipedia:

"Specialist grades paralleled the corresponding grade of non-commissioned officer (E-4 through E-7) only in terms of pay. The Specialist grades, although they outranked the Enlisted grades (E-1 to E-3), were outranked by all Non-Commissioned Officers (E-4 to E-9) and lacked the authority conferred on them. This is the major differentiation between a Specialist and a "hard striper".

When the so-called "Super Grades" (E-8 and E-9 ) were introduced in 1958, the Specialist grade titles were changed to Specialist Four through Specialist Seven and the notional grades of Specialist Eight and Specialist Nine were added on top.

Only the lowest Specialist grade survives today, as the higher grades were gradually phased out. Specialist 8 and 9, which had existed only on paper, were eliminated in 1965. Specialist 7 was abolished in 1978 and Specialist 5 and 6 in 1985. At that time, the rank of Specialist 4 simply became known as "Specialist," which is how it is referred to today."

The Army depends on their specialists to step up into roles of advancing responsibility. They possess expert knowledge and experience in their field, and thus become critically depended upon to support the mission. Our O.R. scrub techs are specialists that form the lynch pin for smooth operations. We depend on them to be well prepared for an operation, to give us (surgeons) what we need, when we need it, and to get everything ready for the next operation.

Of note, these are Reservists who don't do this for their "day job" in the civilian world. But they have to maintain their skills and be ready perform as soon as they hit the theater of war. They perform superbly. Thanks to our specialists of the 909th.

PS>>>> Here is a link to all the Father's Day BBQ photos at the FaST Surgeon Picasaweb album

Picture Of The Day - 20 JUN 2010 - "Fathers Day"

20 JUN 2010 - Fathers Day

CPTs Timms and Johnson (T&J), along with the 173d Charlie Med and 909th FST put on a fantastic Father's Day BBQ. I have loads of great pictures from this event, but so very little bandwidth to get them posted. I will try to get some uploaded to the FaST Surgeon Picasaweb album. I would love to say something touching, cerebral, or at least thought provoking. But, I don't need to enhance (or spoil) what simply was a good time had by all. Suffice it to say that it was as good as any neighborhood BBQ that I've ever attended (minus the beer). Thank you T&J! .. and thanks to the grill masters... the food was awesome.

Picture Of The Day - 19 JUN 2010 "Sedulousness"

19 JUN 2010 - Sedulousness

It takes a lot of folks willing to work very hard in order to provide this level of care. There is no other military, that I know, that can bring this high of a level of resource to any part of the world. Our military does it by calling on all its elements (Active Duty, Reserves and National Guards). 80% of medical assets are reservists or national guard. That means our family, friends, co-workers and employers take on a huge burden to ensure that we're able to be here. Thank you all.

FOB Friday - Part III or III (Toys)

RC Car - FOB Shank, Afghanistan

There are just things that simply don't come to mind when you think about soldiers and foreign wars. Certainly radio controlled toys never crossed my mind. But as I walk / jog around the FOB, inevitably I see a soldier or two with ripping up to dust and rocks with one of these suckers.

Soldiers from the 230th Engineer Battalion

As I left the hotdog eating contest, I ran into these soldiers having some fun. Unfortunately, one of them just snapped an axle. That'll be 10-14 days out of commission while he waits for a new part to come in. Its quite something to see folks with M16s and RC cars. I could say something that seems obvious, like "boys with toys", or "we're sending boys to war.. see! they're still playing with toys". But that's clearly belittling and simply narrow minded.

Catching Air - FOB Shank, Afghanistan

First. Boys never grow out of playing with toys. Everyone knows the cliche' that the toys just get bigger and more expensive.

Going For It - FOB Shank, Afghanistan

Second. These soldiers prove over and over again that they take on any role given to them and complete each task with great professionalism. In other words, when its time to work, they work hard.

The Crash - FOB Shank, Afghanistan

And when it comes time to play.... They play hard and they have fun.

SPC Heptner - 230th Engineers - FOB Shank, Afghanistan

Thanks to SPC Heptner and his friends for putting on a great show for the camera. And thanks to the 230th engineers for all they do!