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Surgeon's Journal from Iraq

Thomas Beaver, MD

Dr. Thomas Beaver is a thoracic surgeon at the UF College of Medicine . He has been called to active duty in Iraq. Thanks to Dr. Beaver for sharing his journal with us.

July 25, 2004: You've got mail!

I suppose it should not have come as a big surprise to me when the following paraphrased e-mail popped into my inbox:     "Now is the time to notify Major Beaver that he will be mobilized for Operation Iraqi Freedom with the 933rd Forward Surgical Team (FST) in Iraq." In fact, I was supposed to have been mobilized last year to San Antonio, but it was called off at the last minute. I also had been receiving phone calls about once a month and frequent E-mails from soldiers deployed overseas. The fact that 27 out of 28 surgeons - excepting myself - from my unit had been mobilized sealed my fate.

Although like most surgeons, a conservative by nature, I will admit to having mixed feelings about our intervention in Iraq . Watching the movie Fahrenheit 911 certainly didn't dissuade any misgivings I had. That being said and out of the way, I should say that I feel confident about my mission and feel good about serving...let me share why... Once I was officially notified I really could not believe the number of people who - after joking about a prolonged summer vacation or skipping out on the call schedule - would take an extra second to say that they would pray for me or to outright thank me for going over there. The average age of the American soldier in the Southwest Asia theater is 19 - which means most of the army is really 18 and young 20-year-olds.  I feel fortunate to help take care of these kids who didn't ask to be put in this situation.

After finding out I would leave in less then a month, I curtailed my operative schedule to go home and see family. That week I went home, my extended family had a reunion and I was able to see uncles and aunts that I hadn't seen in 15 years - all wishing me well and again thanking me. The day before leaving, several friends had remembered my departure date and called with final words of encouragement. I still keep in touch weekly with the six or so guys with whom I attended high school, college, and postgraduate school at The University of Wisconsin. With the majority of my friends politically left-of-center, there was considerable banter via E-mail regarding my mission and again about the war. I was surprised when one my more free-spirited friends (a struggling actor/waiter in Hollywood ) sent me the following e-mail....

"Hey Tom,    
I heard you're going to Iraq . They are very fortunate to have your talent and skill. Come back safe. You still have a lot of lives to save ...Good luck and God bless. .... I have a good movie recommendation if you haven't seen it yet: Antoine Fuqua's "Tears of the Sun.” It shows a quote by Edmund Burke at the end of the movie... "The greatest thing allowing evil to grow is good men doing nothing." Saddam Hussein was evil and we did something about it."

July 29, 2004: Getting there

It started out unbelievable ... the army had rented a 747 to take the 350 of us over to Kuwait . The available business class seats were allocated first to individuals who helped out with loading the duffel bags and then the "privilege of rank" was on my side as I ended up with a little extra legroom....

When we got to Kuwait it was another story ...we arrived late in the afternoon and waited in more lines as we were re-issued more equipment including long underwear for the desert (in case we had to stay in the winter) and two additional pairs of new boots the army was testing (so that I now had a total of four pairs of boots to lug around for a 3-month tour). The scene at Camp Doha in Kuwait was controlled chaos as hundreds of troops are being moved into and out of theater every day. We were housed in a large warehouse with endless bunk beds and told to sign up for the next plane heading into Anaconda base in Balad, Iraq.  We were told we would have an hour or two notice of departure so we headed to the chow hall (great food and lots of it in another warehouse, like the world's largest Denny's, with Fox news blasting away on multiple big screens). Not trusting the army, one of us waited at the manifest desk. At 3:30 in the morning our scout was suddenly told that we had ten minutes to wake everyone up and get them on the bus to the airport....Each of us scrambled and ran with our now four bags of gear (at 70 lbs a piece) to get on the bus...It was quite the scene. We were loaded onto buses and then into the back of a C-130 cargo plane with canvas jump seats.

We flew from Kuwait to Anaconda, which was hot, desolate with sand blowing in our faces - no wonder guys are getting depressed over here...I can not understand why anyone on earth would live there. The thought occurred to me that when they tell you it's not about the oil - - - then it is all about the oil... On arrival, we were told to wait outside for the next helicopter to Tikrit. We waited all day in 110-115 degree heat, now about 48 hours without sleep. My new partner PJ Schenarts and I were able to take a bus over to the commissary to get a coke and we came under code "red," which we did not know meant you should not go outside... turns out there was a mortar attack on that location last week.

Finally, at 9:00 that night we loaded up on buses and were put on large Chinook helicopters with our gear...We had to put our body armor ceramic plates and Kevlar helmet on and walked up behind the Chinook with the exhaust feeling like a blast furnace in our faces...Crammed on board we flew "lights out" up to Tikrit. The tail gunner cleared his M-50 machine gun and I was thinking "Holy *^%$& Dorothy, you are not in Kansas anymore"... it was surreal - like I was watching a movie and then realizing I was IN it. I have to admit I was crouching down in my body armor and helmet. We landed in a dark field and we scrambled off as new troops scrambled back on and the copter was off in five minutes... It was pitch black, and we were met with Humvees from our unit. I had finally arrived in Tikrit.

July 30, 2004: First days

We are at FOB (forward operating base) Speicher, which is located on an old Iraqi air force base. It is a large base away from the city, so I am told we are relatively safe (though mortar rounds occasionally do come in). After sleeping-in the next morning we were taken to the 67th Combat Support Hospital...It is a mobile hospital consisting of multiple tents connected together. On the perimeter are large concrete barriers for protection. Inside, the hospital is surprisingly well supplied with digital x-ray machines and a fairly modern operating suite -- again, surprisingly well stocked.

During our initial tour, a helicopter brought in an 18-year-old American soldier shot in the head just below his helmet through and through. They were performing CPR on arrival but it was clear immediately that he was dead... Later that day the members of his unit came by to check on him...Later that night we did an appendectomy.

Today I am waiting to get into the OR to wash out the lacerations on an Iraqi Policeman. A car overran a checkpoint and threw him into some razor wire. My new partners are re-exploring another American soldier who was shot in his flank between his armor plates. He lost his kidney and part of his colon. My trauma days at Denver General Hospital are coming back to me and I am feeling more and more comfortable here...time will tell... More later...

Aug. 3, 2004: Land of contrasts

I went for a run this morning and it was really a beautiful morning. Sunrise was coming up in the east… not scorching hot like it can get over here. The base closes down one of the cross camp roads for exercise so I was not alone. Towards the end of the run, you could hear the day begin with the sound of diesel engines and trucks starting to move out. Really, rather a peaceful morning.

In the shower I heard some guys talking about going back out on patrol. One said, “It's been 30 days since I've been out beyond the wire…”   I was thinking to myself that I never have to go beyond the wire (outside the base) where the risk is exponential… Later in the A.M., we rounded on a 34-year-old who was struck by another IED (improvised explosive device) last night. He lost his right leg and his left leg is badly mangled (and will likely be lost as well). The legs were literally shredded by the blast. There is a feeling of frustration and helplessness to see a younger soldier with such a huge loss. To guard against the IEDs many humvees have been “up armored,” which basically involves bolting extra steel on to the doors of the vehicles. Other troops have placed their flak vests on the floor and outside their trucks. Despite the protection, it appears to me that the only way to guard against random IEDs is to stay within the wire…

Aug. 11, 2004: Midnight madness

We live on an old Iraqi air base in one of the many three bedroom cookie cutter houses that make up our 4 x 6 block neighborhood. Our surgical team has been assigned three of these houses, with the doctors living in the middle of three. Unfortunately, the construction is shoddy and the plumbing has been abandoned.  We have chased lizards and mice out, and exterminated a few cockroaches and scorpions as well. The electrical wiring is sketchy. I am told a year or so ago a soldier was electrocuted when he tried to shower in one of the houses…

It was not surprising when our window air-conditioning unit blew out the socket yesterday, so it was hot and muggy. I had finally managed to get to sleep around 1 A.M. when one the enlisted guys came running and shouting into our house… “Johnson” and “Smith” (names changed) are fighting with their weapons locked and loaded… Turns out that next door one of the guys was playing his DVD player and laughing and was told to be quiet… rather than be quiet he got his M-16 and put a round in the chamber… there was a struggle between the two but no bullets were fired… the nurses and OR techs were able to separate them…

Of course anytime a soldier turns a weapon on his fellow soldier it is a huge - problem not to mention that nobody felt comfortable going to sleep in the same house with these guys…

Both soldiers were taken to the hospital for toxicology screens and combat stress psychiatric evaluations… Our commander spent all night in the hospital with these two guys …they are separated now and things are cooling down. It's not like we are in daily combat; but I have only been here a week and the heat, desert, and close living conditions have already become annoying…

Aug. 14, 2004: Drop and give me twenty

It has been a slow week…. Yet we had a mortar/rocket attack last night…It was interesting to see how fast the Docs who had been here awhile hit the dirt…This time I followed suit…

We were in the doctor's lounge talking and watching a DVD when we heard the blast and felt the ground rumble a bit... The announcement came over the radio: “We are being attacked – full battle rattle (put all gear on and have your weapon ready…)” We all crawled to our flak vests and helmets; put them on and headed outside to the bunker…We had been carrying our flak vests around for the past two weeks and I was finally glad I had it.

After an hour or so, they sounded the all clear and we were able to head home… For the most part, I feel very safe over here… just episodes like this that remind me how random things can get…

Aug. 21, 2004: Hello from Iraq and thanks for the emails

Here's the latest...Tonight they brought in an Iraqi who ran a checkpoint Based on what I have seen tonight that is not a good idea...he was shot up pretty good...and the driver did not make it...hard to know what was really going on but apparently they were confused.. He will lose function of his left leg but made it...

Other than the occasional random mortar, it's been quiet here, though Baghdad has been busy with the action in Najaf.

I continue to stamp out appendicitis on the front lines of Iraq, this time in a 40-year-old First sergeant. I am batting 100% so far; so not too bad after an 8-year hiatus (makes it easy when they are men though). I am also able to do this operation without the cardiopulmonary bypass machine so I was proud of myself...

Our FST (Forward Surgical Team) is gearing up for a move of half our unit to another location...I can not say where or when, but do know I will be in the second wave so I will be staying put in Tikrit for awhile. In anticipation of the move, our team went to the shooting range this week to train with M-16 rifles. Based on my performance after one day I don't think the enemy should be too worried about me…something to work on; meanwhile I will stick to surgery...(In my defense it was my first time shooting the M-16 and it is hard to shoot with a flak vest on and a helmet creeping down over your face). While we were at the shooting range, a couple of Apache attack helicopters were also target shooting on some old Iraqi vehicles in the field next to us. They were shooting more or less from directly above us into the nearby field…a couple of missiles and I think a 50 cal. -- very impressive to watch…

Later we met up with an M-1 Abrams tank crew that was at the commissary picking up supplies…They let us have a look around their tank -- again amazing firepower. Glad these guys are on our side…

Aug. 29, 2004: Hearts and minds

A frequent question from home is "what do the locals feel about Americans?” I have had limited contact until today when I went over to Camp Danger, located on the edge of the Tigris River in Tikrit, Iraq. There is lush vegetation there; which made me believe that it was plausible that civilization could have indeed started at the mouths of the Tigris and Euphrates Rivers. When Adam and Eve were sent out from the Garden of Eden I think they were sent over to where I am staying at Camp Speicher (lots of dust and desolate). I should say that on the helicopter ride over from Speicher to Danger I was able to see farms with irrigation equipment, which hopefully means things are springing back to life…

Saddam was born in Tikrit; and Camp Danger is located on the site of his hometown palace grounds. In fact, there are quite a few palaces located on bluffs overlooking the Tigris River and along a series of little lagoons that were created by diverting water from the river. These waterfront palaces are grandiose, showy and give new meaning to the term “lakefront property.”  The palaces were built for Saddam and his cronies. They tell me that they were built after the first Gulf war, from money derived from the United Nations Oil-for-Food program. Another rumor is that the architect that designed the lagoons was executed by Saddam for putting the street lights directly in the middle of the sidewalks. The US Army has set up shop in the palaces, because they are basically sealed off in a fortress that can be defended (the view isn't too bad either…).

Unfortunately, the locals have been mortaring into Camp Danger from across the river. The palaces themselves are worth a trip, but I was also invited on a Civil Affairs visit into the surrounding villages by Captain Kentley, a physician assistant. The Civil Affairs team works with the locals as an outreach program to befriend the local population and to improve their community (which hopefully might quell the mortars). Our mission was to go into the villages, provide medical attention where needed,  and to share stuffed toys and candy with the children. We also had a dentist along so that was a bit ironic. This was my first time “outside the wire,” -- interesting for me on that score as well.

We traveled with helmets and flak vests in four Humvees with machine guns and weapons loaded. We zipped in and out of the traffic along the roads and out into the countryside. We crossed the river on a Corps of Army Engineers pontoon bridge. The area reminded me of South America with the mudbrick houses, and cows and chickens strolling the countryside. The children would often wave and occasionally gave us a “thumbs up,” including little two and three year olds. In Arabic this can mean a bad thing, but they say with the number of Americans around they say they have adapted the American meaning of “thumbs up”…(though with some of the teenage boys I was not convinced…).

On arriving at the village, we visited with the locals and distributed antibiotics where appropriate. At the first house, a little boy ran away into the woods when he heard the doctors had come to see him. We handed out stuffed animals and candy: this became a bit of a free-for-all but I was pretty sure everybody got something -- even the little ones. At the second stop we met a young boy with cerebral palsy. The mission leader talked with the boy's mother and related that he also had a six-year-old boy with cerebral palsy at home in Seattle. It was one of those times that made you think people are people wherever you go…

Our last stop was with some children and local men. Our mission leader met with the men to identify their concerns, while I played Santa Claus. The men were upset about some locals that were killed at an American check point last week.  One of the boys that was following me around had learned some English: “Mister, give me Pepsi, Mister give me money… He pointed all around and said Ali Babba and said Mister you no Ali Babba.” I was joking with one of the other kids for taking too much candy telling him his hands were too big … rather entertaining… Yet, at the same time all this was going on, I was glad there was a machine gun nearby and a sergeant with an M-16 behind me….

The civil affairs team is doing the best it can with limited resources; and Captain Kentley was superb. She is working with the local teaching hospital trying to improve their nursing program. I felt happy to be part of the team today. Having said that, there is much more to do and that costs money. I met another member of her team, Dr. Morgan, a veterinarian, who is working with the local veterinarians to better screen and identify brucellosis and tuberculosis in the livestock. She is also developing an artificial insemination program and has coordinated for a team of Australians to do an inservice (American companies would not come into the country). Her third project is trying to get a local Tikrit dairy up to US FDA standards, so that it can supply milk to the US military and possibly export it. This milk would be the European extended shelf-life variety. If she can pull it off this would be a win-win for everybody-- helping develop the local economy and decreasing the need for army convoys. That's it for a snapshot about local life but it is all I have seen so far…

Sept. 7, 2004: Continuing violence

Today we admitted 3 Iraqi policemen that were victims of a VBIED (vehicle borne improvised explosive device or car bomb). They had second and third degree burns over 30-40% of their bodies: mostly their face, arms and back, along with some shrapnel injuries. There is nothing like a bad burn patient to remind you how dangerous it can be over here. The explosion occurred as these men were standing outside the police academy in Kirkuk. The local hospitals were overwhelmed; so they were sent to us. These policemen will survive*; yet will have scars for the rest of their lives. Eleven other police recruits were killed in the blast.

It's hard to imagine such a brazen attack in the U.S.; yet it occurs monthly - probably weekly over here. The perpetual violence is discouraging. In order to show the Iraqi people a new future we must maintain security. We had a visit from a Lt Col who patrols the area north of here who described the tremendous need for basic necessities and health care in his sector. Without stability, charity organizations such as Doctors Without Borders will not come into the country. I suspect it is for this reason that the State Department is redirecting money slated for development projects to security. As for the reason for the continued terrorist attacks, I got an interesting insight from an orthopedic surgeon, who was stationed in Mosul (our sister hospital just north of here). Mosul is in the Kurdish zone; and the locals were telling him that after the fall of Saddam for three months there was no terrorism there. Then terrorists from Iran and Syria arrived.  Since that time the Mosul base / hospital has been receiving regular Mortar attacks.

They finally localized the origin of the mortars to a circular intersection within the city that has 5 roads leading out of it. They staked out the intersection and last week they found a sedan with 4 men slowing circling around… The men quickly opened the back doors-- launched a few mortars and attempted to speed off… They were quickly lit up by our snipers with 2 of the 4 occupants killed at the scene, one dying later and a third detained.

In the car they found a price list for mortar attacks (e.g. $200 for a mortar into the Mosul base, $150 into the base X etc… The surgeon was telling me the educated populus in Mosul was happy the Americans are here and are looking forward to Democracy. However, the poorer population, especially young males with limited job skills, were targets for recruitment by the foreign terrorists. The terror attacks are also affecting the local civilians, who are not happy with violence. However, after years of Saddam, they still do not trust the government; perhaps analogous to people afraid of the local drug gangs in their neighborhood; but not sure they can go to the police…

Although, this is only one perspective it offers some hope into the situation -- that with time and continued effort we can succeed.

*two later died from sepsis

Sept. 11, 2004

Three years since the day that started this all…

Half way around the world we had a small memorial service:

A medical service officer who was stationed at the Pentagon and one of our emergency room medics, who was a fireman in New York, both shared their experiences and some photos.

The pentagon officer said that the area the plane hit was actually being renovated at the time so was fairly empty or the death toll would have been higher. Since that time security at the Pentagon has been stepped up. From ten entrances they have gone to three, with multiple checks. You can no longer access it directly from the subway. Following that day he spent many 18-hour days helping to identify victims after the event.

The fireman was called to the World trade center on 9-11 and watched the second plane hit on his way to the second tower. You could tell he is still affected by the day. He recalled how as a Fire lieutenant he had ordered five of his men into the second tower who never came out. He also lost two cousins, both firefighters, in the first tower. He personally was carrying a grandmother and a child out of the second tower when it collapsed; he was thrown into a storefront window across the street. He was called to active duty shortly afterwards and was mobilized to come to Iraq.

Everyone has his or her own story. I was at the top of the trade center 3 days before it fell while on a business trip to New York. I can remember finding out about the first plane while I was in the operating room back in Florida. By the time I had finished the surgery both towers had fallen. I am told that when John F. Kennedy was shot many people remember exactly where they were and what they were doing as well.

I am not sure where this is going; only that September 11 was a defining moment for our country. I do know that there are an awful lot of ordinary Americans over here doing their best to somehow try and keep an event like 9-11 from happening again.

Sept. 21, 2004: The routine

We leave for the hospital at 7am, driving about 5 miles to get there on some roads that circle around the airfield. The physicians round together in the morning, seeing our patients. Elective operations are scheduled as necessary  (mostly orthopedic washouts and skin-grafts for our burn patients). At nights we play cards or chess, write, catch up on e-mails, read books and/or watch DVDs…The camaraderie has been great; and we have a great group of surgeons. There are a few card sharks in the crowd and I am glad we are not playing for money…A few times, like last night, a mortar will hit and we grab our gear and head to the cement bunkers.

Recently, it seems a roadside bomb or shooting will interrupt the day...

Yesterday we had a young soldier, who was shot on a convoy. The gunshot had entered on his side between his protective breast and back plates. It damaged his liver, vena cava, spleen and both kidneys -- he unfortunately did not make it.

Several soldiers have written their names, social security numbers, religion and blood types on their helmet bands or t-shirts. This young soldier had actually tattooed this information on his flank. The lethal bullet entered just below his tattoo. It left quite a visual impression on me for the evening… The next morning “The Routine” starts again.

Sept. 27, 2004: Training day

The active army loves to train and train and train and train… My particular unit is called a FST or Forward Surgical Team. We are a 20-person group of surgeons, anesthetists, nurses, and medics trained to deploy rapidly and set up mini-operating rooms where the fighting is hot. Some FSTs have moved as many as eight times in the past year. Our particular unit has moved only once. We have been fortunate (in my opinion) to be working with a semi-fixed Combat Support Hospital. However, there is always the chance that we could move  ... where and when I do not know - as this is out of my control…

In order to have an FST ready to move, the army prescribes set procedures and thorough training. What that meant for our unit was that we were going out into the field to set up our tent hospital three times in 36 hours…More specifically, waking up at 5AM…packing up our Humvees and trailers with our tents and 50 to 100 pound boxes of equipment, then driving out to the end of the airfield and setting up our mini-hospital in 110 degree heat. We ate our MRE's (Meals Ready to Eat) with the dining facility visible in the background…. It kind of reminded me of camping in the backyard only Mom didn't bring out peanut butter and jelly sandwiches…

That evening we packed everything up again, moved to another part of the field and set up everything again – this time to see if we could do it in the dark…The good part was that it was a full moon and I set my cot up to sleep under the stars…The bad part was the next morning when I realized how close we were to the perimeter fence line…

The following morning we packed up everything again, and moved to another part of the field -- this time to set up two tents in case our orders divided the unit in two. By now, the 50# and 100# boxes were getting heavier…. but we got through it… We also improved our set-up time from three hours to about 45 minutes…(though the boxes were now being moved around by one of our nurse anesthetists a bit like the gorilla in the Samsonite commercial).

Despite the fact the whole exercise seemed to me a bit like “Sisyphus” (the guy in Greek mythology who had to roll the stone up a hill, watch it roll down then roll it up again for the rest of his life...), I have to admit that the training did develop some team bonding and it was also interesting to see the “mini-operating room” all set up (at least the first time)… though the best part of it all was barbecue we had to close the training.

Oct. 2, 2004: FOB Summerall

I had met Lt Cole, a physician assistant from the Forward Operating Base (FOB) “Summerall,” earlier this year at our Combat Support Hospital. We had discussed the possibility of me coming up to give his medics a few talks on trauma and, at the same time, heading out to the shooting range to fire some automatic weapons… After weeks of talking I was finally able to pull it off…

Originally my partner, PJ, was going to come with me with bigger plans to head into the local town on another humanitarian mission. However, my commander did not like the idea of something happening to two of his surgeons “outside the wire.” In the end, only I was allowed to go (must mean I am expendable…), though I was not allowed to leave the FOB…

My commander was also not too keen on the idea of me riding in a convoy so I was told to find a helicopter ride up there… I felt fortunate to get a ride, but I got detoured flying around northern Iraq as the helicopter I was on was also assigned to fly the fitness expert and “Tai Bo” aerobics instructor, Billy Banks, between a couple of the bases (Kirkuk and Mosul). He was on a USO tour… Of course, I did not find this out until he and his entourage hopped on my Blackhawk …He was very cool and posed for a picture with me. I thanked him for supporting the troops.

Northern Iraq reminds me of the southwest U.S., with its hills cut out of the earth from many years of erosion like the Painted Desert in Arizona with only one color of paint –Iraqi grey. As I had seen before, there is vegetation and life near the Tigris River, sort of like the Rio Grande valley in New Mexico.

FOB Summerall is about half an hour north of Speicher, next to a city called Badjyi. This had been a “hotspot” earlier in the year but some of the bad guys were thought to have moved down to Najaf, and later to Samarra (this week's news). The unit at Summerall is an artillery battery that was converted to a mechanized infantry unit.  It was interesting for me to see the combat side of things, with Bradley Fighting Vehicles parked at the mess hall.

Summerall had been relatively quiet until last week, when a group of American soldiers was ambushed on a patrol. One of the soldiers was hit but continued to return fire until they pulled him to safety. He was bleeding profusely and told the medics to tell his parents he loved them, because he was going to die...

It turns out this was the soldier that I had written about last week with the tattoo…I had included some pictures of him in my talk regarding emergency room thoracotomy (opening the chest right in the emergency room as a desperate means to save a life)…I had not realized that the medics I was talking to were the ones that had taken care of this soldier…so I was not sure how the slides were going to go over…

The medics were telling me that particular day it took awhile for the choppers to get their patient to the combat support hospital. The medics were upset that he had died and were wondering what else they could have done. In some ways, it was good as I reassured them that this particular soldier had nonsurvivable injuries. He would have died even if he had been shot outside the emergency room front door… These medics are on the front lines out here and are responsible for the initial first aid. I think they are doing a wonderful job. They showed me their aid station and I toured their FOB and gave a few trauma lectures to the group.

I also met some Special Forces medics stationed up there; and earlier that afternoon one of them took us out to the range to shoot some automatic weapons including AK-47s and some WWII models like the Sterling, which has a silencer on it. I am sure we have all seen the action-hero movies with Rambo and Bruce Willis… So I played Bruce Willis for about an hour or so at the shooting range…it was interesting to fire those weapons…

One of the medics at Summerall, Sergeant Fish, has his hands full.  He is tasked with training the Iraqi medics …He is really good at his job… He was telling stories about how - the first week - he had to start with the basics like getting them to shower everyday… slowly but surely, he is getting them in shape… The Army Times had an article about his efforts, which he showed me -- though he was not cool with the photo of the Iraqi medic kissing him on the cheek…

Later that day I toured the FOB headquarters with the computerized tracking systems that let them follow the action in the field… Star wars came to mind…I also sat in on a daily update that reviewed activity in the area with plans for upcoming events, so-to-speak. Because of these events, I felt it was important that I get back to the hospital the next day. Unfortunately, the following morning there were no helicopters available so I arranged to hop down to my base, FOB Speicher, on a convoy… Before I left, Lt Cole and I were going to drive up and check out the 155mm Howitzer battery, when we suddenly heard a familiar blast noise…. The radio soon came to life reporting another IED had exploded just outside the front gate on Main Supply Route (MSR) “Tampa” that heads down to FOB Speicher… The injured were taken to the other aid station on base; so we jumped in the ambulance and rushed down to meet them. Luckily, no one was hurt badly; just a few scrapes and a cut lip…the soldiers looked like young college age kids, shaken up a bit, but joking about the close call…

I have to admit that my enthusiasm level for taking a convoy was not very high; and dropped even further when the IED went off… especially when I saw the thin doors on the ambulance that I was going to be co-piloting (not “up-armored”). On the other hand, I thought at least one IED had already gone off so maybe that was it for the day… I did have an M-16 with me and I have been getting better at shooting… We drove down the highway with our M-16s poking out the window, following the Humvee with the 50 cal. machine guns… I had an uneasy feeling about the ride down to Speicher, as I knew that things were heating up in various parts of the country… I guess it was a combination of curiosity and uneasiness about what I had gotten myself into…As I caught an image of myself in the rearview mirror with the M-16 -- I told myself the next time I drove to the “real Tampa” I would remember this day.

The reality of all this is that some of these soldiers spend all day driving around in convoys and patrols. I am sure they have uneasy feelings as well…The convoy leaders I was traveling with have had to make as many as four trips a day for supplies and parts. Last week, I had met some convoy drivers at the gym. They were sharing their experiences with IEDs blowing up a mile in front of them and then seeing car parts land next to them…or being shot at from Mosques along the highway… It is these guys and their medics who are the heroes over here.

Oct. 4, 2004: Four little marines

We knew at the hospital tonight to expect casualties as the Army and Marines were cleaning up Samarra, which had been a hotspot of insurgency…In fact, I had seen a briefing on the invasion plan the day before, during my visit to Summerall. Later that night a call came in that the Medevacs were bringing in six marines, four of whom were said to have critical shrapnel injuries to their abdomens…

The hospital mobilized its resources and we were ready with medics, surgeons and nurses…The Medevacs called and said they were 30 minutes out with the Marines, but that two of the healthier ones had been taken to closer facilities…

It is not uncommon to be surprised at what actually shows up with the helicopters… However, this time we couldn't believe it when the helicopters landed and they brought out four boys ages 10-12, who were shepherds near the Syrian border. They had encountered an IED (improvised explosive device)…

The kids all had leg injuries but had actually been seen at a local hospital first... The child I was working on already had an abdominal exploration with a drain out of his abdomen…They did not speak English, and we had no paperwork… I began to get a feeling for what my brother Dan, who is a veterinary surgeon, must have to deal with when his patients can't tell him what is going on….

Because of the severe orthopedic injuries all four boys went to the operating room. Our orthopedic surgeons operated for 16 straight hours trying to salvage their legs. In other parts of the country, they would have had amputations…. We re-explored the abdomen on my patient to identify the extent of his bowel injuries -- he had a satisfactory repair of a mid-jejunal injury.

The next morning, our hospital ward had four little guys with stuffed animals in their beds watching DVD's of American movies. It was as if these kids had been through “a time warp”… a bunch of young shepherds from two thousand years ago, watching their sheep see an explosion; and the next thing they know they are transported on helicopters to an American Combat Support hospital of the 21st century… Another one of those striking images of the cultural differences we are enmeshed in... …

Oct. 10, 2004: Out of the water

My unit is on the move to Afghanistan to help provide support expected insurgent activities during the elections. We are presently in Balad, a huge airbase in central Iraq with 25,000 Americans. … We are waiting for a plane to take us to our new destination, way out in the boonies, so to speak. We are supposed to set up our portable hospital at a base where there are apparently only 250 soldiers. Yesterday, we spent the whole day pressure washing our trucks and trailers removing mud and grime (so the Air Force would allow us to put our trucks on their planes).

I am taking advantage of “pseudo-civilization” while I can. This Balad is a lot different than the first Balad I encountered where we spent the whole day at the dusty airstrip in 110-120 degree heat. The base has a beautiful gym (like a Bally's fitness Center) with a racquetball court and complete set of gym equipment. There is also a movie theater showing free movies three times a day. You have to clear your weapon before you go inside, just like at the dining halls. I have gone to a couple of movies, where the best part is at the beginning when The Star Spangled Banner is played -- the entire theater jumps to their feet in attention…very patriotic and moving in a way. Both movies I have gone to have been interrupted by mortars, which is OK since the theater is a shelter. It turns out that Balad is the most frequently attacked base in Iraq. It has happened every day I have been here.  The perimeter fence line is surrounded by vegetation and also a major highway, which allows the attackers to escape…Last night we had to spend two hours indoors while the troops took care of a rocket threat. With all the alerts, I have to say I have never heard or felt a mortar here in Balad. This is unlike Tikrit, where I heard and felt most everyone, including the last day when a rocket landed at the end of our street. I was fine with leaving at that point…Every morning in Tikrit at nine A.M., the army would dispose of unexploded, recovered ordinance.  After awhile it got to the point where the first thing we'd do when we heard an explosion was to look at our watches to see if it was 9 A.M.…the second thing would be to grab our flak vests if it wasn't…

Balad also has an Olympic size outdoor pool. It had been a long three months in the desert, so two days ago we all went down for a swim to beat the heat. We were hanging out swimming, watching the scenery when an announcement came out: “Everyone out of the Pool for alert status RED”… (another mortar attack)…So we got out of the pool and waited in the bunker for about 30 minutes, then at the “all clear” we came back to the pool… It was as if we were at the beach and had to get out of the water because a lifeguard saw a shark.… another one of those surreal experiences over here…

Oct. 14, 2004: Greetings from Afghanistan!

Our unit has moved to Afghanistan...We were sent to here to help out after the elections. We are in Bagram in the high plains of eastern Afghanistan. The snow-capped peaks in the background remind me of Denver or Salt Lake City...

We just arrived here, and our replacements are on the way...We will see if everything runs smoothly and we can change airline seats with the new guys and fly home -- I kind of doubt it...

I really just got in. One thing is the air is fresh and clean mountain air, not the blowing silt-loam dust of Iraq. There is also a real coalition here on this base. As I walked to breakfast this morning I encountered armed forces from Korea, New Zealand, United Kingdom and Slovakia, My partner PJ said it was like that bar from Star Wars with all the different uniforms...It was weird being saluted by people from other countries...

They say it is safer here with the exception of land mines, which are around the base. But they are marked clearly near the hospital. I am anxious to get home, just hoping the travel arrangements fall into place.

Oct. 19, 2004: Bagram - Landmines

We are still waiting to be flown to our bases in the countryside, so we had a little time to walk around the perimeter road. We saw engineers on each side of the base actively getting rid of land mines. A member of the ordinance team said that occasionally the locals, even kids, would find mines and “hand them over the fence”…. The ER here saw four victims this week losing limbs and eyesight from land mines, mostly unfortunate local nationals. Afghanistan, I am told, became the most heavily mined country in the world as the Soviets desperately tried to maintain their grip before leaving…

To clean up the base they have bulldozers with chains in front of them and smaller remote controlled bulldozers as well. On the other side of the base, they had dog teams that are trained to be quiet and sit near the mine…the spot is confirmed with another dog then a metal detector is brought in….Very slow going, about 1,500 square feet a day per dog, I believe is what I heard. The fields are huge so it is going to be awhile…

Oct. 22, 2004 Asalabad

We took a Chinook helicopter ride out to Asalabad (Abad), Afghanistan… The Americans have a base here in Southeastern, Afghanistan that is so close to the Pakistan Border that I can see it from my tent door. It is here the hunt for Osama goes on (among many other places)…

The ride out was enjoyable as we followed the river valley below. We had an Apache Helicopter escort on the way there. Down below we could see locals plowing fields with oxen. It appeared they were harvesting wheat, corn, and sugarcane.  In the desert areas, families in tents were visible, tending herds of sheep. As we came into the landing zone the Chinooks did a “hot landing” and basically pushed all our gear out the back as they did not want to be on the landing zone more than 15 minutes. Last week a rocket was sent into the landing area that caught some jet fuel on fire.

On arrival, we set up our portable hospital, and that afternoon we had our first patient – an 8-year-old boy who lost his left thumb and forefinger in a shotgun accident. The Special Forces have set up a clinic/ aid station that is manned by a Special Forces physician assistant and his medics. When the base gets rocketed or mortared -- they shut down the clinic.

Lots of local nationals are treated, and importantly, local doctors are involved in their care. As in the Peace Corps, it seems they are teaching the locals how to fish and not just handing out fish… The Afghans I have met have been very friendly. The relationship with the locals is good. I have had more interaction with locals here in just a few days then during my entire time in Iraq.

I think we should try these methods in Iraq.  Of course, it is not that easy with the security situation in Iraq. You never know which vehicle near your convoy could be a suicide bomber. On the Iraq convoys I have been on, we raced through the traffic and ran Iraqi vehicles off the road or pointed our weapons at them if they got too close… In Tikrit,  I had only seen locals picking up trash under armed guards. Also at the hospital in Iraq, we were only treating Americans, the Iraqi Army, and those we had injured. I am sure resentment could be building up…With the security situation there, it is hard to know which is the chicken or egg… I think we need to try something different or it will only get worse.

Our base in Afghanistan is located in a valley. The base reminds me of the foothills of Colorado as you drive into the mountains on I-70, with scrub brush and hills that get progressively larger up to the mountains. We took a hike up to an outpost called “Bull Run” about a mile from camp. There were some Florida National Guard members up there on the top of a peak providing perimeter security. The guys, in their early twenties, were from West Palm, Orlando, and Melbourne. They have the occasional rocket attack and called in some artillery support last night that quieted things down.

During our hike up, we saw some locals bringing water and MREs to the outpost on mules. The view from on top is fabulous and you can see for miles. The stream below seems like it would be good for fly-fishing. George, an ICU nurse,  and I picked out some bowls and hills that we thought would make a nice ski resort. Last night it was almost a full moon as dusk arrived early with the mountaintops shielding the sun. Under the moonlight, I stood outside my tent listening to the Islamic call to prayers echo through the valley. Asalabad could be a popular tourist destination -- if it were not for the land mines and Al Queda…

Oct. 29, 2004: Shagall Valley

The Konar River dissects through the hills of Southern Afghanistan; its many years of cutting through rock has created canyon-like walls in places.  Multiple terraces scale up the mountainside from the river, with little rocky plots of land growing wheat, corn, sugarcane and in some places, opium. Villages dot the river valley with walled compounds and castle-like fortresses with watchtowers to guard against the countless invaders that have passed through the valley. In some places I doubt things have changed in literally millennia as I saw oxen working fields and donkeys carrying goods to market; however, small tractors and Toyota pickup trucks are starting to show up to help with the farming…

For years, the Shagall valley, a tributary to the Konar River, has been unfriendly to American visitors. Indeed the most recent roadside bombs in our province were traced back to this valley. Not long ago an American patrol was ambushed in a narrow pass up one of the valley tributaries. Because of this, the US Marines were currently doing a sweep of the area, looking for a fight with the local bad guys, which they would find a few nights later…

At the same time, the civil affairs team wanted to show America was here to help; so they scheduled a 2-day medical mission into the valley. The mission had multiple facets, showing an Afghan face by using local police and the new Afghan Army. The Afghan army has embedded American trainers that travel with them and advise them. State department representatives also met with local elders to assess the political situation and get a handle on the opium trade in the area.

The first day the medical mission was held in the local police station with one room for men and another for the burkha-clad women and their children. We saw hundreds of patients and there was little time for thorough exams and histories. For the most part, anti-inflammatories were dispensed for musculoskeletal complaints, along with vitamins. Sinus and ear infections and amoebic dysentery were treated with antibiotics; and multiple children were given deworming medication.

At the conclusion of the first day, we moved to set up camp in the valley. Gun trucks were placed around the perimeter with guards. We knew the Marines were stirring up a hornet's nest 5 kilometers away and that we would be a softer target. Afghan soldiers were then placed on the outer perimeter and with scouts on the hilltops. That evening we shared lamb and pita bread with the Afghan army. It is Ramadan now, so the locals and Afghan Army were fasting throughout the day.  They were singing with laughter when the meal was brought out. That night, we slept next to the vehicles under the stars.

The following morning we set up our clinic from the back of our Humvees in an open field.  A large crowd had formed with many walking miles to be seen. Unfortunately, we ran out of medicines; and we had to send a hundred or so people away empty-handed. Despite that fact, the mission was deemed successful, as this was one of the first times Americans were able to stay in the valley. That afternoon I returned to the base to find my replacement had arrived – and that I could go home.

The Marines, however, had decided to stay an additional day and were attacked from both sides the following night. I had found this out, as it was with these same Marines with whom I able to catch a Helicopter ride out of Asadabad to start my journey home.

Oct. 30, 2004: Flight home

We jumped on the helicopter full of marines flying to Bagram and a few hours later we caught a “redeye” Air Force flight to Ramstein, Germany…

The next morning on arrival, there was a rainbow to welcome us back to the civilized world. The Army met us as we got off the plane; and went out of its way to get us on an American Airlines flight to El Paso just a few hours later…

Here's a short plug for American Airlines -- they were very patriotic; they gave us a round of applause, free drinks and upgraded us to First Class on the Chicago to El Paso leg…Passengers along the way came up to us and thanked us for our service…I cannot imagine how it was for the guys coming back from Vietnam…

While we were waiting in Chicago, an American Airlines representative started talking to us in the O'Hare lobby, then took us to the business suite and set us up with free internet…All the employees along the way were extremely courteous and helpful with our baggage and customs…Now all I need to do is “out process” and fly back to Florida – hopefully on American Airlines…

I would like to thank everyone again for their support and prayers along the way. Please remember the thousands of ordinary Americans, just like you and me, who continue to serve our country.

--Tom Beaver