A Day in the Life....

...of  a Camp Bucca Surgeon. Is not very fascinating.

It's been a while since I graced this board with "Steve's Thoughts," so  figured it was about time to indulge my grateful fans (all two of them) with a little something new. I've pondered about what subject matter I should address next. After arriving here, my travels were over, and it seems like one day has simply blended into another. Nothing new or exciting happens from day to day, and therefore there was little material to write. As mundane as things might seem to me, though, I'm sure that the question of "What do you actually do in a day?" is still lingering. I shall attempt to address just that query.

Mornings:

I'd like to set up a "routine" but that would require dedication to waking up by around 0600. While I'm fully capable of this, it's nice to actually sleep in until 0730-0800. Nevertheless, there have been days that I got up in the morning and went for a 2-4mi run to start the day. These could be counted on one hand. Most days, I simply get up and go about the standard morning preparations and head off to the hospital. 

There are several ways of closing the 3/4mi distance between "home" and the hospital. By far, the most convenient is to walk. It takes about 15-20min to make the trek over a combination of sand, gravel, and hardpacked mud in 35lbs of body armor, but my feet are always available to take me. The bus, while much easier on the body and a good deal faster, only runs every 50min. From time to time, a kind passerby in an SUV will stop and offer a ride. Most of the time, they simply smile and wave, "Good morning! Hope you're enjoying your walk."

Workday:

My OR days are Monday, Tuesday, and Thursday, and things kick off around 0900, so I like to show up a little before that. If I'm actually up early, I'll make sure to round on everyone (usual inpatient census of between 3-5) and change their dressings, etc. prior to the start of my first case. Otherwise, they get seen throughout the morning between cases. I generally schedule three cases per day which allows for the all-too-frequent add on appendectomy, etc....  Wed is my easy day because I only have an afternoon clinic; I guess the mornings are for administrative tasks. Like sleeping.  Friday is an all-day clinic. So, each week I get to see detainees for one and a half days of clinic. Their complaints vary from hernias, lipomas, and hemorrhoids all the way to thyroid and rectal cancer. Unfortunately, Camp Bucca can't really support surgery for low rectal cancer, and Steve - despite doing a large number of thyroidectomies in residency, or perhaps because of it - has a healthy enough respect for that gland to avoid operating on it in this environment without assistance. All in all, most days are done by 1500 at the latest. Again, this can always be delayed by the excessively common appendectomy.*

Evening: 

The evening begins with the walk back to the Pod. See above. Now, here's where things get mixed up a bit. There are a variety of ways to pass the remainder of the day. Relative staples include:

- Dinner

- Gym

- Ping Pong/Pool/Foosball

- Movie night with Anesthesia

If the workday is over early enough, we can sneak in a workout prior to dinner. Otherwise, it's an early dinner then Gym, then movienight (relatively regular at 2000 every night - by the way, feel free to send movies, we're running out). We always leave a little flexibility in our day, though. We've been blessed with other opportunities to occupy ourselves such as Ultimate Frisbee or other sporting activities. If none of these are going on, and it isn't one of the handful of days that I actually got up to run in the morning, I'll top off my day with a run at night.

Shower.

Sleep. 

Repeat x 180.

Weekends are a little different matter. Nothing scheduled happens at the hospital on weekends. So, I get to go in at my leisure and make sure that my folks are all still breathing, etc. Then, I get to try to invent creative new ways to while away the hours. These are typically the Ping Pong days or Other Ridiculous Activity days (i.e. eat 30 bowls of ice cream in 24hrs). 

I hate Camp Bucca. Everyone does. That bond, I think, is what unites us. The majority of the people here are well-meaning folks, and it's the people that make a deployment tolerable. While this was supposed to be the most professionally meaningful time of my life, it really has turned out to be one of the most professionally meaningless episodes. I am thankful that I can share this cynicism with the entire OR staff. These relationships give rise to absurd thinks like the ice cream challenge, and for all of its stupidity, it is one thing that has kept us all closer to sane.

And that's how one spends a day as a General Surgeon at Camp Bucca. For those who care to know, my caseload breaks out to about 50% hernias/hydroceles. 15-20% appendectomies (seriously), 10-15% anorectal, 3% cholecystectomies, and the rest are a mixture of lumps/bumps/etc...

*Appendectomy rant will be available shortly as a Footnote. 

Camp Bucca

   Though the passing scenery was less than stimulating, I consider myself fortunate to have had a window seat for the flight to Camp Bucca. Even though it was no more refreshing than staring into a hair dryer, the constant flow of air perfumed with the aroma of burning Jet-A was immeasurably preferable to the stale, stagnant air in the middle seats. After a short flight, our aircraft gently alighted upon the helipad at Bucca, my new home for the next six months.

   I grabbed an anonymous duffel bag and walked straight out from the helicopter until I had cleared the wide sweeping arc of the rotor before turning ninety degrees to my right to exit the pad. The ground surrounding this was covered in loose rock making foot traffic highly cumbersome - especially when decked out in body armor and carrying a forty pound duffel bag. Just the same, I found my way to the collection point and was eventually greeted by someone from the 115th CSH. My belongings were loaded onto an SUV (Ford Explorer, I think), and I was transported (along with two others) to Billeting.   Those who have Military or other Government experience will find this to be an all-too-familiar scene. The assistance I received from these fine people was about as valuable as a handful of Russian Rubles. They fit the bill of the typical civilian government employee who has a job title which gives him/her dominion over something which you want/need, and they are about as willing to relinquish rights to said item/service as a mother bear is to let you play with her cub. So, after being told that there were no "Pods" available, I was ushered to tent S-3, one of the temporary lodging areas.

   First - a POD (also known as a Containerized Housing Unit - CHU) is an 8x20ft box not dissimilar to one of the containers used by the PODS (Portable On-Demand Storage) company. It is climate controlled and there are two decent-sized wall lockers to store my belongings. I can "furnish" it as I see fit with just about anything I can find/buy/build. I share this space with one other person, and all said it is not significantly different from sharing a college dorm room.

   

   My first accommodations - Tent S3 - were a different matter. This is a huge tent which is partitioned off into several rooms with some slipshod plywood flooring and walls (S-3 is the far tent on the left in the picture). Each "room"has eight bunks (four sets of bunkbeds) and about as many tiny wall lockers. Some unfortunate souls are sentenced to live in these S tents for several months "until a Pod becomes available," (See above comments regarding the Award-Winning Customer Service of Billeting). The light switches in S-3 control the lighting for three of the "rooms." As such, you kind of have to "coordinate" with the inhabitants of the other "rooms" as to when they shall be on or off. This effort had all of the "coordination" of a drunken giraffe.  (Pictured are the "Main Hall" of S-3, and my comfy diggs)

   On the upside, it is air-conditioned. It is comfortably cool at night, cold even sometimes. But, the little A/C unit cannot fend off the heat of the midday sun, and it will heat up to uncomfortable levels by 10:00am. T

his makes "weekend rest" difficult. Fortunately for me, I had only one weekend to suffer through. I was in my Pod in about one week's time. This, no doubt, was the result of much jockeying on my part, and the insistence that the ONLY General Surgeon for the entire camp deserved as much.

   Well, back to 3 Sept. After putting all of my belongings in Room 1, S-3, I was shown where the B Co headquarters were. From here, we were given a quick walking tour of Bucca on our way to the DFAC (Dining FACility). I'm not sure why I made the distinction "...quick walking tour." There really are no "long" walking tours - just not that much to see. The LSA (Logistics Support Area - i.e. the main part of the base where everyone lives, eats, and play) is separate from the TIF, and the hospital is located in the latter.  After lunch, I was driven the 3/4 mi to the hospital where I met with the surgeon that I would be replacing. I was given a quick rundown of the physical layout of the facility with particular attention to where the bathroom was (outside, not air-conditioned, flushing toilet, no sink). After this "orientation" and a short introduction to the DCCS (Deputy Commander for Clinical Services), we returned to the LSA (or FOB - Forward Operating Base. Though I'm sure that there is a clear distinction between what constitutes an LSA versus a FOB, they seem to be used interchangeably around here.)

   I was then left to fend for myself. I wandered around and found my way back to "Downtown" Bucca which is home to the basketball court, the PX, Subway, Burger King, Pizza Hut, a coffee shop, and several services including the Barber Shop, Beauty Shop, and Spa. Yes. Really. A spa. No. I have not availed myself of their services. There are also a number of Haji Shops. One might think that this is some type of racial epithet, but those who are proprietors of said establishments actually call them "Haji Shops." Such is painted on signs in front of the store.

   After wasting sufficient time, I decided to return to the one familiar location - the DFAC - for dinner. Afterward, I wandered some more, but the heat kept me from going too far. I eventually returned to S-3 to find the outgoing surgeon waiting for me. Now, I had anticipated that there would be at least several days of overlap so that I could get accustomed to how things run at the hospital. I cannot describe how thrilled I was to discover that, instead, he was boarding a Blackhawk at 0630 the following morning. He handed me the pager and marched back toward his Pod for his final night in Bucca. Fortunately for everyone, it didn't go off.

   After this fun-filled day, it was time to turn in. After all, I had to find my way to the hospital the following day by 1000.

Camp Buehring

   Ali Al Salem is like the Atlanta of the Middle East; you can't get anywhere without traveling through there. My stay was measured in hours, but during that time I discovered proof that we had indeed won the war in the Middle East. The sweet smell of fried food sang to me like a siren from across the sand and gravel, and the bright shining beacon of the Golden Arches illuminated the night as a symbol of freedom and capitalism. I had the #2 combo.   

   In the regions around Ali Al Salem are a number of encampments, one of which is Camp Buehring. After departing Ali Al Salem in the middle of the night, our hour and a half bus ride finally dropped us off at Buehring. We were ushered to our tent around 0230, and told that training would commence at 1430 that afternoon. I think I finally got my cot prepared and settled in by 0430.

   Our first exercise was to attend HEAT training.

While it might stand to reason that we should be acclimated to the ridiculous temperatures in the region, this is yet another Army acronym which stands for Humvee Egress Assistance Training. We all strapped ourselves into a Humvee mock-up which was then rolled over, and we had to then escape from an upside-down vehicle. True, releasing the seat belt is an essential step in this process, but it should be undertaken with great care. Gravity is a bitch. The HEAT training we had just encountered was indeed very valuable. Apparently Humvee rollovers are a major source of non-combat related injuries in this part of the world. I hope that I never find myself in a Humvee, but if I do, I'll know how to get out.

   Getting accustomed to the extreme temperature was a whole other matter. I grew up in Alabama. Next to the Tennessee river. I had been in Arizona just prior to deploying. I thought I knew what hot meant. I was wrong. The heat here is oppressive. The sun is intense. How ancient cultures came to worship this Vampirous Devil in the sky which literally drains your will to live, I'll never know. The moon is a much more inviting Heavenly body. Night is almost tolerable as the temperatures plummet into the nineties. Daytime highs are in the mid-120s up to 130. How anyone survived in this environment wearing a full chemical suit and protective mask is beyond me. For all of my complaining, I am grateful that the most I had to wear was my uniform with body armor. That was enough.

   I stayed at Buehring for a total of about 3 days prior to heading to my "final" destination - Camp Bucca. Those days were filled with exciting training about IEDs and how to recognize friendly forces and avoid shooting them. Perhaps the most crucial part of the Buehring experience was our trip to the range on Monday morning. Allow me preface this story by saying that we were issued our weapons less than one week previously. We had all been to the range at Ft. Benning 4 days prior and shot 50 rounds to actually QUALIFY with said weapon. I'm not sure what powerful force might have intervened in those 4 days, but there must have been sincere concern that our weapon might have been rendered non-functional by the rigors of

travel. In an effort to avoid this grave circumstance, we were roused at 0400, loaded on - you guessed it - a bus and carted an hour away to the range. Upon arrival, we were given a magazine with 5 rounds which we were to fire in the general direction of an array of silhouette targets.

No one was interested in whether or not we actually HIT the target. This was simply a way of proving that our weapon was indeed functional. We then got back on the bus and drove the one hour back to Buehring.

   In the morning twilight, I gazed out of the window of the bus (for some reason the curtain restriction had been relaxed this day). Between the range and Camp Buehring was a vast panorama of sand. There was no hint of civilization or nomadic herders in the vicinity. I'm fairly certain that if we had simply walked out the main gate at Buehring and fired our weapons in some general direction away from the Camp we could have proven that they were functional and would have caused absolutely no harm to anyone or anything. Although I complain about this foolishness, I will say that I am somewhat happy about it because I did get to see a camel caravan - the only one to date.

   Other creature comforts at Buehring, and further proof of the dominance of American Capitalism came in the form of Starbucks. Right there in Kuwait. 

I could enjoy a little after dinner latte following my 6-pack of tacos from none other than Taco Bell. When dining there, I made sure to wear my IBA and bring the M-9, though! Despite my precautions, Taco Bell in Kuwait proved to be safer than Taco Bell in Atlanta. Go figure.

   On Wednesday, 3 September, it was finally time to leave Camp Buehring. I awoke, ate breakfast, and again gathered all of my belongings. This time, I hauled them to the flight line to await boarding a UH-60 Blackhawk - my ride to Camp Bucca. 

All told, it was about twenty minutes of flight time before we arced in low over Bucca and settled onto the helipad. We had unceremoniously crossed into Iraq about 2-3 miles previously. The sand here looked no different than it had in Kuwait. There were no "Welcome to Iraq" signs down below to denote the transition. I had, nevertheless, arrived in Camp Bucca, Iraq.

The Longest Day

   While hardly worthy of this title by many people's standards, it certainly felt like it truly was a never-ending day. I previously mentioned that it started as our wheels left the tarmac at Lawson Army Airfield, but in reality, that was already almost twelve hours into it. It all actually began at about 0700 on Friday, 29 August, 2008. I awoke in Room 18, building 4001B at Harmony Church, Ft. Benning, GA. Harmony Church is the part of the Ft. Benning reservation that now houses the CRC. This hallowed ground used to be the training site for the US Army's elite Rangers. It was now a training site for a much less elite group.

   After waking, I gathered up all of the things which would make the trip to Iraq with me. I had previously sent a foot locker ahead that was full of things which I figured I would either NEVER need, or at least not need for a few months. I dragged three full-to-bursting duffels out to "the shed" and lined them up for loading onto a truck. On my person I kept a backpack and - of course - my trusty M-9.

   After depositing my belongings, the waiting began. We sat around CRC for another several hours while our bags were whisked away, and we finally formed up to load our busses at around 1030. We then made the bus trip to Freedom Hall (Waiting Terminal pictured at right) where commenced the hours of waiting to board the plane. During this time, there are a myriad ways of occupying oneself. There are 11 large television screens, a local church group has free books available, and there is Wi-Fi internet available for $10/day. In addition to that, we were fed twice and moved into a briefing room to learn that we should not attempt to hijack the aircraft.

   They tell us that operational security will not allow them to disclose the actual time of departure. Should this information fall into the wrong hands, the outcome could be disastrous. I presume this is also the reason that we sat in Freedom Hall all day; the actual hour of departure was thus well-protected. During this time, we also went through security screening to make sure that we weren't carrying anything more dangerous than an M-9 pistol or an M-16 assault rifle.

   Finally, it was time to board the aircraft. We returned to the briefing room we had previously been in and were called by name to board the aircraft. Upon reaching my seat and stowing my backpack in the overhead bin, I sat down and suddenly realized that this aircraft was insanely hot (Freedom Flight at right). After baking for about fifteen minutes, the plane was finally fully loaded, the doors were closed, and the engines spun up providing some degree of air conditioning. And, finally, it was time to leave Ft. Benning.

   The first leg of our trip took us to Maine where we landed at around 2230. We were greeted by a host of retired military and other supporters and went through their receiving line. It was certainly nice of these folks to be out there at that hour. We hung out in Maine for about an hour and a half before it was again time to board the plane. This time, when we went wheels up, I knew that I was leaving American soil and wouldn't return for quite some time. While the gravity of this realization may have spurred some profound contemplation earlier in the day, I was quite tuckered out by now. I crossed the Atlantic in my sleep.

   We arrived in Leipzig, Germany in the afternoon on Saturday, 30 August. Again, we were allowed to deplane for about an hour and a half. I walked around the airport a bit, but there wasn't much to see or do. My first trip to Germany was a bust. We again boarded the plane, this time bound for Kuwait City. This was a relatively short leg - about four hours. As we made our approach into Kuwait City, I remember thinking that it looked just like any other city from that vantage point. Downtown was brightly lighted, the red brake lights of thousands of cars dotted the highways. We may as well have been flying into Minneapolis for all I knew. That all changed after we landed.

   Stepping out of the cabin door of that DC-10, I drew my first breath of Kuwaiti air, and the most profound utterance I could conjure was, "Holy shit." Not a particularly forceful expletive, it was more a measured understatement - an attempt to relay my own inability to yet assimilate the day's events. It was 1930 on 30 August, and exiting that plane and breathing the air of the sovereign Kingdom of Kuwait was, I thought, the beginning of the end of this epic journey which began over eighteen hours and 8000 miles ago.

   Of course, more busses were in our future. We were taken to Ali Al Salem airbase and unloaded. Here, we were officially "scanned in" to theater. This was Day 1 of deployment. 

Unfortunately, we arrived at Ali Al Salem at 2330 and didn't get scanned until one hour later. My official arrival date, therefore, was 31 August. After listening to a few briefings about not drinking in theater, we went out to gather our belongings off of the baggage truck (Kuwaiti Baggage Claim above). A lucky few of us were heading to Camp Buehring prior to continuing on to our final destinations. We set our bags aside for yet another bus ride.

   Bus rides in Kuwait are not much fun. We are required to keep the curtains closed and are not allowed to look outside. I'm not sure what the reasoning behind this is. Perhaps they are protecting us - if no one knows who is in the bus, it won't be a target. I'm sure that a caravan of large white busses leaving from a military installation on a regular basis wouldn't raise the least suspicion in the mind of anyone bent on wrongdoing. On the other hand, there isn't much to see, anyway. Sand is sand is sand. My travels finally ended at Camp Buehring, Kuwait at approximately 0230 on 31 August, 2008. We settled into our large tent and bedded down prior to beginning our training about twelve hours later.

Going to the Desert - Part II

   In the month between learning about my deployment, and actually going there, I had a few things to take care of. One of them was the American Board of Surgery Qualifying exam. This is a torturous 300 question computer based exam that is the gatekeeper to the oral Certifying Exam. They've promised to send a detailed score report to my home, but as far as I'm concerned, this is a pass/fail exam. I passed.

   In addition, I had the pleasure of touring all of Ft. Huachuca in an effort to get all of my administrative paperwork in order. Most of this was wasted time, gas, and effort to get someone to initial a piece of paper. In the end, this was all for naught, as no one really cared what I had accomplished in Arizona. Everything that would need to get done would get done at the CONUS (Continental United States) Replacement Center (CRC) at Ft. Benning, GA.

   The CRC (photo at right is "Main Street" CRC) was initially conceived as a method of ensuring that civilians in the employ of the Department of the Army as well as civilian contractors who would be working within a theater of operations in the Middle East were prepared for the situation in which they would soon find themselves. It was in indoctrination into not only the harsh geographical climate, but also into the political and social climate of working with and within the US Military in a deployed environment. As it matured, the CRC also took on the responsibility for pre-deployment spin-up of Reservists, National Guard, and Active Duty soldiers who were deploying as individual replacements or in small groups. Represented among those 450 people present that week were a motley crew of civilians mixing with professional soldiers much as oil mixes with water.

   CRC turned out to be a solid week of equipment issue and briefings. We received more gear than we could possibly use. Uniforms, boots, cold weather gear, a folding shovel (entrenching tool for those who know the lingo), chemical suit, full body armor (That's me at left in full "Battle Rattle"), and a Beretta 9mm to mention just a few things. Altogether, this would more than fill 3 standard issue Army duffel bags. So far, much of it remains unpacked and unused. In addition, we were herded through the clinic to make sure our immunizations were up to date and that we were medically fit to deploy. The primary objective of CRC is to make sure that as many people as possible load the plane at the end of the week to go to Kuwait. To that end, they will nearly bend over backwards in an effort to make sure that you have everything you need. Plus some. This monumental task is repeated weekly by the folks down there in Ft. Benning. For all of the inconvenience that was experienced during that week, this was, hands down, the most helpful and efficient process the Army has ever subjected me to. The week culminates with a trip to Freedom Hall at Lawson Army Airfield and hours of waiting prior to boarding the Freedom Flight. As I sat in that DC-10, pistol strapped to my side, I peered out the window to see the CRC staff lined up on the flight line, at attention, saluting our aircraft.

  We taxied to the runway and the three General Electric engines roared to life. Our heavily laden aircraft lumbered down the strip for what seemed like an eternity before I felt that familiar shift of our weight from the undercarriage to the wings. We were airborne. It was 6:40pm on Friday, August 29,2008. Thus would begin what would feel like the longest day of my life.

Going to the Desert - Part I

After finishing 6yrs of General Surgery residency at Walter Reed, I was ready for my first assignment as an Attending Surgeon. For those of you who don't know, this is a time to spread one's wings for the first time and see what happens when you flap them really hard. If everything has gone right, then you should fly. Otherwise, you end up in a heap of blood and feathers.

It's also nice to have an "adult" bird around to help you out when things get a little tougher than you thought. Someone to help guide you through that tough crosswind that just took you by surprise. In the Army, there are a few such places with Neophyte surgeons just out of residency paired with a more senior, established surgeon to provide the necessary guidance when the hatchling bites off more than he can chew.

Ft. Huachuca, AZ is NOT one of those places. Raymond W. Bliss Army Health Center is a clinic. It is not a hospital. There is no ICU; there's not even a ward to admit patients to post-op (or pre-op for that matter). And so, my illustrious career as an Army surgeon was off to less than stellar beginnings. My one salvation in this situation was that I was set to deploy overseas in December. I didn't know where I was going. I didn't know what to expect, only that I'd finally have the chance to go "over there" and help out our boys at the point of injury.

July 11, 2008. 

I am awakened at my Sister's house in LA at 7:30am on a Saturday. I chose not to answer the phone because it was not a phone number that I immediately recognized. When it finally hit me that I should recognize it, I realized that it was my now-former Program Director. This call could not be good news. I discovered via voicemail the my deployment had moved up to August - one month away. I was now to deploy with the 115th Combat Support Hospital (CSH) to Camp Bucca, Iraq - one of two Theater Interment Facilities (TIFs) in theater. Think prison camp. I was tasked with performing elective surgery on Iraqi detainees (suspected insurgents). Thank you, Uncle Sam. I would look forward to this opportunity, except that it's not far enough in the future to look FORWARD.

More to Follow . . . .