Afghanistan

Stepping out of the 747 into Kuwait was much less awe-inspiring than my last visit.  For starters, the temperature was much milder - somewhere in the 70’s.  The rest of my time there was very familiar, however.  We were again loaded onto the familiar white bus with the shades drawn and driven to our next destination.  This time, it was Camp Arifjan - not Ali Al Salem - and this is where I stayed for the next few days awaiting my flight to Afghanistan.  All 1000 nearly-identical bags were offloaded in a waiting area for us to claim and transport to our temporary billeting.  Arifjan seemed a bit larger than Ali, and it had much more of a “permanent presence” feel to it, but all-in-all Kuwait is Kuwait (at least the parts we get herded through).  There was no additional training and no trip to the range.  Just some waiting.

Finally, we were manifested on a flight departing on 17Feb.  Our showtime to the “Inbound” terminal was 1030 local.   After a good deal of waiting, were again herded onto busses, and we were carted off to Ali around 1300.  After surviving several harrowing experiences on the highways of Kuwait and being vetted through several checkpoints, we finally arrived at the passenger terminal in Ali.  We were officially checked into the flight, palletized our luggage and commenced with the Army’s favorite activity - waiting.  Finally, our patience and good behavior was rewarded with yet another bus trip.  This one ended on the flight line next to  an Air Force C-17.  We boarded the aircraft, strapped in, and were wheels up around 2008.  We landed in Bagram about three and a half hours later.  The local time was 0116.  After yet another baggage rodeo, we were finally met by a contingent of 3MMB (the 3rd Multi-functional Med Bn), our parent organization, and personnel from the 911th FST.  We were ushered to housing and allowed to settle in.

Flying on a C-17 was a unique experience.  My previous trips on military aircraft were in C-141s which were so uncomfortable that I jumped out - all five times!  The seats on this aircraft resembled airline seating, only a little smaller and more tightly spaced.  Yes - smaller and tighter than airline seats.  Things were a bit disorienting in the belly of this beast.  There are no windows for reference.  It’s actually difficult to even determine when you've begun taxiing, and spatial disorientation was pretty common during maneuvering once airborne.  Due to the time of the flight and the lack of any visual stimuli, and despite the narrow seating, I slept for the majority of he trip.  

From what I can tell, Afghanistan is probably a very beautiful and rugged place.  Bagram Airfield, however, is not; it is situated in a bowl, surrounded on all sides by the jagged peaks of the Hindu Kush.  The higher elevations are currently covered in snow.  Unfortunately, due to our low-lying positing, there is a permanent haze around Bagram which is likely a combination of vehicle emissions and the ever-present dust which even the frequent rains have not been able to subdue.  When the haze lifts enough to allow for a glimpse of the surrounding mountains, their majesty is somewhat humbling.  In many other parts of the world, views like these are enjoyed from the warm comforts of a ski lodge following a thrilling day on the mountain.  No lodges, no lifts, no skis here [or snowboards, Kim, Michelle, and David (that list just gets longer and longer)].

I’m still settling in to this place somewhat.  Trying to make sense of the layout and daily responsibilities.  Setting up some kind of routine will be essential to passing the weeks here.  I just hope that routine doesn't involve hours upon hours of sitting on my duff.  There must be something to do here; I just have to figure out what that might be….

Facing west, the near ridge line of our "bowl" is visible.  Note the inviting dirtscape in the foreground. 

CRC Foibles

As I mentioned last time, the entire goal of CRC is to get everyone on an airplane at the end of the week.  To that end, I suppose that they did an adequate job.  Unlike my last experience, however, I can’t say that it was with quite the same style.  While I did end up on the plane, it wasn’t exactly without incident….

The first few days went off without a hitch.  However, come Tuesday, the wheels came off of the bus.  This whole incident can actually be traced back to an error which probably occurred last fall.  When the initial “tasker” for this deployment came out, it seemed that the final location was, perhaps, in question.  By the time my orders were cut, the final destination had been chosen - Afghanistan.  The tasker, however, left this open-ended with a destination of Kuwait, and this ambiguity carried forward to my orders.  When I inquired, I was assured that all would be well.  Everyone goes through Kuwait anyway.  Fair enough.

Not so fair for the good folks at CRC.  Because my orders did not mention Afghanistan, I was told that they could not issue me the appropriate equipment for that location.  I would, instead, be drawing from the Kuwait “menu.”  In an effort to head off this little debacle, I had previously mentioned to the supply sergeant that my orders did not reflect my actual final destination.  I was reassured that this would be no problem.  My name and CRC # were noted on a list, and I was told that I would be able to receive the appropriate equipment come Tuesday.  Easy enough.

Then came Tuesday.  Despite my conversation earlier in the week, they were still set to issue me gear for Kuwait. This meant that I would be receiving the wrong uniform among other issues (ACUs instead of the Multi-Cam pattern used in Afghanistan and Iraq now).  I again explained my predicament and the fact that I would not be staying in Kuwait.  My ultimate duty station would be in Afghanistan.  Too easy.  They worked a little magic and I was told that I could get the Kuwait Multi-Cam draw.  This was a pared down version with no boots and no holster among a few other things.  I tried to explain my predicament, and they did not seem to be interested.  Unless my orders said Afghanistan, I wasn’t going to get the gear to go there.  Why this information was not relayed to me when I first brought it up, I can not even guess.

It was now incumbent upon me to remedy this situation.  My first task was to reactivate my FaceBook account.  Why?  Because in the year 2015, the most convenient method of communication that the Army has devised is social networking.  So, I contacted the unit I would be joining and asked what to do.  The 11.5hr time difference was not exactly helpful in trying to accomplish this task.  I then contacted Womack to see if they could amend my orders since they are the ones who actually cut them.  No worries.  I had a new set which reflected Afghanistan within a few hours.  I returned to my supply sergeant and explained that I had new orders and was told that I could make up for the non-issued gear on Thursday.  Thursday was range day, but, being the Expert marksman that I am, that should not be a long day.

As expected, I had qualified with the 9mm by 0830 on Thursday.  We had previously been assured that once we were qualified at the range, a bus would return us to the CRC site immediately.  That would have been nice.  Instead, we waited for two more groups to qualify, and didn’t leave the range until well after 0900.  Since it’s about an hour ride back to CRC, that put us back on site at about 1015.  After weapons cleaning and check-in, it was pushing 1035 by the time I was ready to return to equipment issue.  At that point, I discovered that my “apppointment” was actually for 1000.  Needless to say, I didn’t make it.  I would have to wait until 1300.  Minor setback, major annoyance.

Thursday was a tangled mess of inconvenience, but ultimately, I think I came out of it relatively unscathed.  But, the final insult did not come until late that afternoon.  We all gathered for the last time for the pre-flight brief.  This was also the time that all of our final small items would be issued.  For me, all that meant was nametapes for my [Multi-Cam] uniform.  Much to my dismay - but not at all shocking - I received four brand-spanking new ACU nametapes.  This meant that the only uniforms which remained in my possession (I had sent my only set of ACUs home already) could not be worn since they would not be complete sans nametape.  The real beauty of the situation is that the Multi-Cam uniform is only worn in theater.  Therefore, no clothing sales store in the US can or will sell accessories for this pattern.  There are shops set up in town who can do it, but I had no way of getting there.  My only potential salvation was a small kiosk set up by the PX which, I had been told, had the capability to make them.  I arrived 20min before closing and was able to have two made (he only had material for two).  Salvation!

The remaining 12hrs of CRC went off as expected.  We rallied at 0230 Friday morning with all of our bags.  We then commenced the interminable waiting process.  We were then boarded onto a 747-400 operated by Delta (it was chartered with full Delta crew).  We finally began moving at 1607Z* (local time was 0907MST).  Fifteen minutes later, I was wondering if we were going to taxi all the way to our next destination.  Finally, we were lined up on runway 21at Biggs Airfield.  The turbines spooled up, and we headed down the runway; wheels up at 1625Z.  There were a couple of intermediate stops, and we finally touched down in Kuwait at 1153Z on Saturday, 14Feb.  Happy Valentine’s Day.

Interestingly, I had discovered upon my arrival to CRC that their motto was “Whatever’s Next.”  That didn’t instill a whole lot of confidence in me, honestly.  I suppose that I get the point - they’ll ‘prepare’ you for whatever’s next.  Unfortunately, as things got more and more tangled for me, I simply found myself wondering, “What next?”  And, as I sit here in Kuwait, awaiting my next round of travel, I find myself wondering the same thing…..

*In the interest of keeping things straight in my head, I converted all travel times to UTC, or GMT, or Zulu (whatever you want to call it).  For those in the Eastern Time Zone, you would be UTC - 5.  Until Daylight Savings Time starts - then you’ll be UTC - 4. Try not to get too confused.  The point is, it was a long day.

Back to the Sandbox

I left home on February 6th.  The kitchen remained in a complete shambles as the renovation continues.  Hopefully, Michelle will get things in order before I get home.  As I entered the airport in Fayetteville, I suspected that my life would likely resemble the chaos in that kitchen for the next few months.  On the opposite side, I can only hope that I come out with a revitalized and refreshed outlook on life.  Granite countertops and all.

I actually debated whether I would pick up where I left off with this blog.  I was actually quite happy to take a 5-year hiatus from documenting the absurdity of my experiences and spend that time stateside.  I took the opportunity this afternoon to go back to the ramblings from the “Bucca Days” and was somewhat intrigued to find that there has been some traffic on this blog which picked up, coincidentally, with my departure on 6 Feb.  As if that weren’t motivation enough, I’ve already amassed enough tidbits in the two-and-a-half days since leaving home that I feel compelled to document them.  If not for the sake of the interested reader, then for my sanity.

As previously mentioned, I left home on Friday, 6 Feb.  Wheels up at approximately 1125 EST.  After relatively brief stops in Charlotte and Phoenix, we touched down in El Paso, TX around 1715 MST. El Paso?  What?  What happened to Ft. Benning and CRC Lane and all that????  Well, ladies and gentlemen (and others), times have changed, and CRC (CONUS Replacement Center for the newcomers) has moved to beautiful Ft. Bliss, TX.  More on that later; I haven't even gotten out of the airport yet.

I made my way to baggage claim, and, on the way, I passed the Military “concierge” desk.  There was a pleasant gentleman there who noticed my apparent look of general disorientation, and as I approached the desk, he inquired, “CRC?”

“Yes!”

He told me to continue to baggage claim, grab my belongings, and return to him, and he would arrange for transportation.  Well, damn, that was easy.  So, I ambled over to the baggage claim carousel and proceeded to wait.  Finally, the belt started to roll, and I eagerly anticipated visual identification of my duffel.  And waited.  And anticipated.  And waited.  And got a little frustrated.  And waited.  Well, you get the picture.  Finally, the conveyor was empty.  As were my hands.  The young line boy came through the door and noticed my dissatisfied look.  He asked what I was waiting for.

“An Army duffel.”

“No more duffels.”

Not good.  On his advice, I headed to the airline counter (names have been withheld to protect the guilty) where I initiated a claim.  Apparently due to the short layover in Charlotte, my bag had been re-routed via Houston and would be arriving in El Paso sometime around 9pm.  It would then be delivered to me that night or the following morning.  Whichever worked out best.  For them.  Not for me.  What would have worked out best for me would have been to leave the airport with my baggage.  Oh well.  Just the first of many likely SNAFUs.  Semper Gumby.  (Google it….*)

I returned to the Military “concierge” and explained my predicament.  I would be continuing on sans luggage.  Easy enough.  He then assuaged my consternation by letting me know that, once upon a time, a group of fourteen had their luggage lost.  Weapons and all.  At least my duffel was unarmed.  He then made arrangements for travel to Ft. Bliss and the new CRC.  It was a short ride, and the remainder of the evening was uneventful.

The following day, I “In-Processed” CRC in the same clothes in which I had arrived.  Just a day old, so not too bad.  My belongings arrived around 0930, and I was showered and refreshed by 1230.  Thus far, aside from the baggage issue, I’d say that the CRC experience has been relatively uneventful.  While the environs are vastly different, I’d say the overall tone and objectives have been pretty similar.  The first couple of days have been fairly heavily focused on the completion of computer-based training.  Monday was the “Soldier Readiness” cattle-call in which we all make certain that our immunizations, labwork, legal, financial affairs, etc… are up-to-date.  I cleared through that whole process by 1330.  I think I was one of the lucky ones.  And, this deployment is now off to a relatively unassuming start.

*Wikipedia (the authority on all subjects in the known universe) has a somewhat limited explanation of the term.  I’m pretty sure that its use is not exclusive to the mentioned organizations.

On Weather....

   When I first got to this part of the world, perhaps the most challenging thing to adjust to was the heat. For something that the majority of people only grant a cursory acknowledgement, the weather really is an important aspect in our lives. Perhaps it is the very uncontrollable nature of weather that makes it so important. Our daily activities lie at the mercy of giant air masses which ebb and flow across the Earth's surface creating a myriad of meteorological phenomena ranging from breath-taking beauty to an awe-inspiring maelstrom. Here at Bucca, I have been witness to several atmospheric events - some pleasant, others not-so. The good news is that the temperature has mellowed dramatically. Daytime highs are comfortable in the 60's, but nighttime can be downright cold. As the sun slinks behind the horizon, the temperatures can dip into the low 30's making one question whether he really needs to go pee that badly.

   Before the cold sets in, though, we are, from time to time, blessed at the end of the day with a picture-perfect sunset. Mother Nature works her magic with a mid-level broken layer of stratus clouds which serve as a backdrop for this event. The sky seems to glow a deep magenta hue, and the edges of the clouds appear as if they are on fire - fueled by the final rays of the retreating sun. The day then slowly fades into the horizon as a brightly-lit and unobscured moon assumes the watch.

   One thing which I have been awaiting with some trepidation has been the "Rainy Season." I have heard tales of this rumored time of year during which sustained rain showers are not uncommon, and they are only interrupted by the occasional torrential downpour. The sand which was once so cumbersome to walk through transforms to a thick, heavy mud which is now impossible to walk through. I have seen a few few thunderstorms in my time here, the first of which was back in October. I had thought that this was heralding in the season of damp gloom; however, it has yet to descend upon Bucca, and I only hope that it waits as long as possible.

   Perhaps the most dominant atmospheric condition here is the perpetual wind. Southern Iraq is flat. Kansas flat. There are no mountains, hills, buildings, trees, or even grass to disrupt the onslaught of the driving winds. These forceful gales are responsible for giant sandstorms which blow in across the desert shrouding everything in obscurity as visibility precipitously drops to mere feet. I have only been witness to one such event, and it was back in September, shortly after my arrival. I had just left the PX (on what was undoubtedly an unsuccessful shopping trip), and was on my way back to the Ole Homestead when I glanced up to my right. Blowing in from the northwest was a giant cloud of sand and dust. Where I stood, it was perfectly calm, but this ominous tsunami of silt was fast approaching. I quickly ducked into the nearest building I could find whereupon the dust storm settled in. The building rattled and the wind howled outside. The fine particulate dust found its way in through every crack and crevice of the building leaving a fine coating on everything inside and the unmistakable taste of dirt in my mouth. It was over in about 20 minutes.

   As unpleasant as one might imagine that to be, it pales in comparison to the extreme unpleasantness of the common prevailing winds. Wind, in and of itself, should be no more than a minor nuisance. Unless you consider that the prevailing winds around Bucca seem to blow from the east. A quick Google search for Bucca should provide you with enough satellite imagery to ask, "What are those dark splotches outside of the Camp?" Those, ladies and gentlemen are great lakes of human waste. And they are situated just outside the birm. On the eastern side of Camp Bucca. The combined excrement of twenty-some-odd thousand people is collected and deposited there. And there it sits. Aside from the natural processes of decomposition and evaporation, I'm not sure that anything else is actually done to manage this waste. But, what I can tell you is this: When those vicious winds pick up and come careening across the flat desert and over this comparatively warm cesspool, they become heavily fragranced with the co-mingled essence of the byproducts of an entire community numbering greater than 20,000 individuals. As one walks eastward along the 1/2 mile road to exit the TIF, this driving wind constantly bathes the body, soul, and senses (primarily olfactory) in an unearthly, gut-twisting stench which I refer to as BuccAroma. If this could be tamed and bottled, the makers of Mace would soon find themselves unemployed for the repulsive power of BuccAroma is unparalleled in the known universe.

   Today, however, is a relatively pleasant day. It's 64 outside, there is a slight breeze (which fortunately is only lightly fragranced today) and a cloudless sky. I hope that things stay this way for just a little while longer....

Merry Christmas From Bucca

   Steve frequently finds himself rambling on in a stream-of-consciousness style (and occasionally in the third person, apparently). Whilst it may seem to be the aimless meanderings of an over-taxed mind, if you stick with it for a while, a couple of things might happen:

#1 You might find yourself amused.

#2 He occasionally makes a point.

Holidays in Bucca . . . .

   There are a few ways to think about this topic (all are almost equally depressing). It seems like life here is on "Hold." It's almost like someone paused the movie of my life to go mow the lawn. Oddly enough, everyone else in it is still moving around. Time here has less meaning, and the calendar is simply an obscure connection to a world in which things change depending on the day and it's important to keep track of what day it is. Fall came and went, and I didn't even notice. Suddenly, it was Thanksgiving, and now Christmas. I know that these things are going on, but there's no real connection. I'll come home in the Spring and try to start living again, and I'm sure I'll wonder what happened to 6mos of my life . . . .

   Someone once asked me if they have the Fourth of July in Britain. The obvious answer to anyone even remotely familiar with history would be, "No." This is, of course, preposterous. They absolutely have the fourth of July in Britain. It comes right after the third - only it seems to pass with little to no fanfare.

   Are there Holidays in Bucca? Of course. We had Thanksgiving. I cancelled the OR - no elective cases. There was an enormous spread in the DFAC including most all Thanksgiving favorites plus some interesting additions - lobster tail? For all of the hype surrounding that fourth Thursday in November and the importance of togetherness that Families throughout the United States assign it, it was little more than another day in Bucca. The day after the fourth Wednesday. With better food.

   Surely, Christmas must demand some degree of recognition! Yes, I presume it does. There was a Christmas Eve Mass held in the Chapel which I attended. Several dozen desperate soulsc crowded into the Chapel and lifted their feeble voices up to Heaven in a meager attempt to squeeze whatever Christmas Spirit they could from the evening. In one sense, Christmas is more pure here. There really is no commercialization of the day. It is celebrated for what it is - the birth of Jesus. And, just like in Seuss's How the Grinch Stole Christmas:

It came without ribbons! It came without tags!

  It came without packages, boxes, or bags!

And he puzzled three hours 'til his puzzler was sore.

Then the Grinch thought of something he hadn't before!

"Maybe Christmas," he thought, "doesn't come from a store.

Maybe Christmas . . . perhaps . . . means a little bit more!"

   And so, it is here. Christmas in Bucca. I can't say that I've avoided the hype entirely - I do, after all, have a giant 7-ft inflatable snowman on top of my POD. And, for those who sent packages, boxes, and bags, Thank You very much! While it seems more widely recognized and embraced than Thanksgiving was, it has yet to be more than another day in Bucca. Oddly enough, it's the fourth Thursday in December. While the above might seem like mature insights, don't be fooled. Though I am closer to Bethlehem than I've ever been in my life, I've never felt further from Christmas.

   While the true meaning of Christmas is something more spiritual, I think most people welcome the Holiday Season as a time of gathering. With family in all four time zones, it seems the only time we're ever all together. So, to my family - Mother, Father, David, Michael, and Kim (and however many Aunts, Uncles, Cousins, and other relatives are gathered), and to my wife and daughter, Merry Christmas from Bucca!

   

   Now, I'm off to have some Roast Beast.

BuccaSpace

I know, I know.  It's been too long. Kind of like waiting for the new season of Lost to get started. I guess I could always blame it on a writer's strike, or something.

I will now attempt to fill my reading audience in on everything new that has happened since my last update over a month ago.

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And, that's about it, folks.

I thought, perhaps, that I'd ramble about a few observations that I and my colleagues have made. It all started one night when we were watching Office Space. I have seen this movie twice before, and I remember it being entertaining. But, now I see beyond the hilarity of its dry wit and off-the-wall antics. I can understand the almost universal appeal of this film. Save for the retired, unemployed, or self-employed we all know every character in the movie. They're in the cubicle next to us, or the corner office down the hall. Indeed, every character in the movie exists on FOB Bucca in some incarnation or other. Well, all but Jennifer Anniston's character. And she is sorely missed....

There are many Lumberghs running around. I am not really at liberty to delve into specific instances, suffice it to say that my fellow Providers and I frequently find ourselves casting bewildered gazes at each other and saying, "Ummmmm, Yeah.... We're gonna need you to just go ahead and, uh, . . . . . . ___________"

We have our "Pieces of Flair." 

My favorite is the IBA. The Army refers to it as the Individual Body Armor. I think it actually stands for Individual Burden, Asinine. Don't get me wrong, I wholeheartedly believe in the effectiveness of this product. I've seen how devastating injuries can be without it, and I've seen it save lives. The lives of our boys and girls who roll out beyond the wire in armored vehicles kicking down doors and taking fire and dodging IEDs. The IBA is an invaluable asset in a combat environment. While I'm technically in a combat zone, the closest thing I've seen to combat is a really heated Ping Pong game. Nevertheless, on my trek into and out of the hospital, I must wear my IBA. I really feel safer as a result.

My other favorite is the reflective PT belt. Now this makes TOTAL SENSE. There is a small amount of vehicular traffic out on the LSA. In an effort to make myself more visible to this traffic, and therefore immune to being run over, I am required to wear a reflective belt. But only when in PTs. If wearing the standard Army ACU, no reflective belt is required. Let's think about this.....

The Army spent a lot of money (probably millions) to completely re-design the combat uniform and create a pattern which will effectively camouflage its wearer in a variety of environments - including the desert. It is a tactical uniform, and one key purpose is to allow its wearer to more effectively blend into his/her surroundings thus LIMITING VISIBILITY TO OTHERS such an enemy combatant (or perhaps, even the unwitting driver of an SUV). 

The Army also spent a lot of money (probably millions) to completely re-design the PT uniform. Granted, one impetus for this was that they wanted soldiers to have a stylish get-up that they'd be proud to wear as opposed to the old 1970's version that I'm pretty sure JJ from Good Times had a few sets of. But, they additionally took advantage of fantastic new technological developments and incorporated reflective logos and striping into the new uniform. That's right, the uniform itself has reflective print on it. Built in. In the design. Right there, permanently adherent to the very cloth of the uniform is a big-ass "A" on the back and the word "Army" on the front. Integrated.

I understand completely why there is no reflective material on the ACU. That's not really my question. My question is this:  Why, then, when I need to get up at 2:00am to go pee and I'm wearing my PT uniform with its inherent reflective properties am I required to don my reflective belt? However, at 7:30pm when I'm walking along a road with relatively frequent traffic as I'm making my way back from the hospital after taking out another appendix and I'm wearing my uniform which allows me to blend in with the environment, there is no requirement to wear anything to make me more visible to the SUVs, busses, and Polaris vehicles passing by. Perhaps it's because I'm wearing my IBA, and that will prevent injury in the event of an impact......

This is, possibly, the world's saddest camel. And not simply because I'm sitting on it. The real point here is - notice the bright blinding reflection of the flash from the shirt and also from the shorts. Contrast this highly visible reflective print to photos in previous posts of Steve in ACUs. Note there, the conspicuous absence of any reflective area. 

I am up to my knees . . . .

. . . In appendices. 

The long-awaited Appendectomy Rant.

During my third year of Residency, I travelled to Ft. Bragg, NC for a three-month rotation. This was a splendid time in the life of a young, developing surgeon. After completing two grueling years of subordination, it was a chance to develop my own "style" if you will.  During those three months, I was one of two residents working in busy community-style hospital. We did all kinds of standard General Surgery procedures which would be considered "Bread and Butter" cases as well as a smattering of more involved surgery. While down there, I split call with the other Resident - Blundy*. We basically alternated taking call every other night during the week and every other weekend.

As the Surgeon on call, we were the first to be notified of any potential surgical case. Very few call nights passed without a trip to the hospital. At the time, it seemed that an inordinate number of these trips were for acute appendicitis. I remember thinking that I was taking out a lot of appendices while I was there. To be honest, I don't really remember how many young soldiers' appendices fell prey to my knife, but in retrospect it was probably on par with what one would expect taking care of a population that size. In the remaining 3yrs of my residency, I probably took out an equal number to what I did at Ft. Bragg. I thought appy hunting couldn't get much better than the fertile grounds around Fayetteville.

Then, I got to Camp Bucca. I have now been here just over two months. In that time, I have removed 15 appendices. Fifteen. While this number may not sound shocking to anyone, consider this:

The average annual rate of appendicitis is reported to range from 84-230 per 100,000 population.

The approximate detainee population at Camp Bucca is 15,000.

Some simple math places the expected ANNUAL incidence of acute appendicitis in a population of that size to be between 12.6 and 34.5.  

One might ask, "Why such a large range?" One answer would be that the higher number is adjusted for age and represents the highest incidence that I have found reported. It is the 10-19yr age group. Not knowing the average age of Bucca (though I'm pretty certain it is significantly higher than 19), I use it as the upper limit of reasonably reported data. The only prospectively gathered data I could find put the incidence at the lower end.

Okay, enough scientific blabber. I have taken out 15 appendices in 2 months. At this rate, one might reasonably predict that I should remove a total of 45 before I leave, and that in the span of one year, it would be expected that 90 appendectomies would be performed. Ninety is a much larger number than 12.6 or 34.5. 

The next logical question would be, "Gee, Steve, that's pretty high. Why do you suppose that is?" I do not have the answer to this question. It could have something to do with age, although even when you consider the age group at the highest risk, it's still far less than the rate we're seeing here. It could have something to do with diet; there is a reported correlation between low fiber and appendicitis (apparently fiber prevents any and all diseases related to the colon and rectum. If every one simply had enough dietary fiber intake, Colo-Rectal Surgeons would be out of a job). While the food contains an adequate amount of fiber, I'm not sure anyone can really say how much of that is being ingested. 

While I do not have an answer, I do have plenty of animosity. I cringe when I see the ER docs. Any sentence containing the phrase, "...right lower quadrant pain..." causes an extremely distasteful visceral reaction. I thought that no sound could elicit such a Pavlovian response other than the maddening chirp of my pager. I was wrong. The complex interplay of phonemes which make up the above phrase is exponentially more powerful than the simplistic beep of a pager.

Another thing which I do not understand is why I hate appendicitis so much. It really isn't that much of an inconvenience for me. It's usually a pretty short (30min) case. There is no laparoscopic equipment at Bucca - they are all done the old fashioned way. This should be a great opportunity to do a case that's rarely done back home. After all, prior to arriving here, I hadn't done an open appy in several years! Nevertheless, appendicitis carries an excessively frustrating connotation for me. I don't know if this was cultivated during my time at Ft. Bragg and simply lives on to today, or if there is some more deeply seeded hatred for this worm-shaped organ with no known physiologic purpose. Whatever the reason, I find myself here, in this most miserable of places, taking out an unprecedented number of these most miserable organs.

* - Names have been changed to protect the innocent. But they know who they are. Yes. They do.