Letter from a Doctor at war...

Below is a letter written by a Doc receiving our wounded. Gives further insight to the sacrifice our men and women are doing overseas.

Hey guys!

Well, I?ll fill you in on a little of what goes on here?The Andrews? Aeromedical Staging Facility (ASF) is a place that's been around since the Vietnam war at least...and it probably has not seen as many casualties in its hallways and rooms as there are here now, since the time of that Southeast Asia conflict. We have missions either coming and/or going out each day (except sometimes Thurs), and our typical over-night ward census is around 25 to 35, but sometimes it gets even above 40 patients. The predominate mood of the personnel on the medical staff who work here tends to evolve over time, after arriving here?usually, at first shock and amazement...often to disgust and disillusionment...then on to acceptance and detachment... It's a job that's got to be done, and the only way to effectively keep from developing a DSM-IV psychiatric diagnosis (like the numerous PTSD and adjustment disorder patients we?ve had return from Iraq so far)...is learn to compartmentalize to some degree or another?

Every other day of the week, a C-141 or C-17 lands on the runway of Andrews AFB, arriving from Ramstein Air Base carrying up to 45 patients fresh from the Iraq theater, after usually only a 24 to 72 hour staging and stabilizing period that they've spent at the Landstuhl Army hospital in Germany. The sickest and most severe patients come off the plane first. Only the strongest team members among our ASF staff (which includes approx 20 nurses and med techs that are here with me on a four month TDY; most are deployed out of Wright-Pat AFB), can lift the first few stretchers that come off the aircraft and into the waiting ambulances. The very severe CCAT patients either go right on to Walter Reed Army Medical Center (for Army patients) or on to Bethesda Naval Medical Center (for USMC patients). It takes up to six men and women to lift one of these patient litters, since also on board each stretcher is usually the following equipment (suspended about the patient's chest and abdomen, on a frame attached to the sides of the litter): a ventilator, cardiac monitor, numerous drains (e.g, JP drains from massive wound sites), chest tubes and drains, NG tube and suction/drain, Codman intracranial pressure (ICP) monitoring systems, Venodyne pumps (to prevent deep vein thrombosis), foley catheter, and sometimes a feeding tube, as well as bags of IV fluids, antibiotics, blood transfusion products, morphine, etc. Sometimes it's hard to actually even see the patients beneath the plethora of modern medical devices they are buried under. The fact that some of these warriors are missing limbs, to top it all off, doesn't make the load seem any lighter... These are the living memorials of the worst of war's nightmarish effects, barely alive and clinging on a thread?

After the ambulances and ambuses from Bethesda and WRAMC pull away with their patients, and with the CCAT teams, comprised of nurses, doctors, and respiratory therapists, that have also deplaned with the most critical patients...we load the remainder of the patients, some on litters and some ambulatory, into our waiting ambuses to take back to our staging facility/ward, for overnight staging and patient management (and sometimes sleep for them). Our casualties span the gamut and range from multiple shrapnel wounds from improvised explosive devices (IEDs), which is just a sterile name for roadside bombs... to bullet wounds (many times the bullets are still embedded in the wounds)...to fractures and sprains from rolled-over humvees and other vehicles?to numerous Psychiatric cases, such as post traumatic stress d/o and major depression?You can usually easily detect who these types of patients are right as they step off the plane, by the sign of the "hundred-yard-stare" which is evident in their eyes. We see lots of very interesting things, and hear many curious stories about what things are like on the ground, and out along the roads, in Iraq. Overall, the morale seems high, and I frequently hear wounded soldiers tell me that they regret not being able to be back in Iraq or Afghanistan with their units, fighting with and defending their buddies who are still over there. Often when injured soldiers who are Special Forces come to us, they?re accompanied by an attendant and watched like a hawk at all times. It's kind of spooky to think that an E-4 knows such important intel that he can't be trusted alone for a minute without any non-special ops people around if he's injured and under medication.

On a typical night we will go through up to ten to twenty vials of IV morphine sulfate. Periodically, cries and moans come from rooms as I walk down the hallway making rounds, while medical technicians pull gauze from gaping wounds (every bullet and shrapnel wound gets a dressing change each night on our ward). In seconds, nurses rush to the scenes, often with needle caps between their teeth and alcohol swabs and syringes in hands, ready to provide relief with their injections for anxious wounded soldiers.

I'm usually able to get out of the ASF by 0130 or 0200 on the nights of our incoming (three to four days per week), and I drive home to my room to forget the worst of the sights and sounds, one more time. I'm up by 0630 or 0700 the next morning, back to the ward for my rounds, and then out to the flight line to load our overnight guests onto waiting C-130's, which will take them to various Army and Marine posts around the country. Most go back to hospitals that are closest to the bases that each mobilized (or, "mob'd") out of. A few, like some of our SOF patients, go who-knows-where...Some of these covert ops types, are even whisked away on private commercial jets...maybe in attempts to thwart anyone who may be out there attempting to track their movements and gain access to their knowledge.

Well, lots more intriguing stuff to write, but I gotta get back to the room and catch up on some badly needed sleep... and after a nap, then get up some energy to go and find a decent meal somewhere. All of us here realize that things could always be worse, and we could be over in theater getting bombed and shot at! Everyone on staff here seems to be holding up okay, though, and things seem to have settled into somewhat of a routine. Sometime soon, we?ll be having some debriefing sessions, in order to help anyone that may be getting affected emotionally/spiritually by the work here. There?s of course lots of carnage to witness and tough medical and trauma cases to continuously manage, as well as the ever present awareness of the acuity of this war that we?re engaged in over in the Middle East? What is inspiring, however, is witnessing the courage and strong spirits of many of the wounded young men and women we receive back from over there? There?s always hope left for our country, as long as we continue to raise self-less and brave kids like these?.

Glad we can still stay in touch. God bless everyone, and stay safe during the holidays!

- Eric

Sent by: PMA