The Sandbox

GWOT hot wash, straight from the wire

Welcome to The Sandbox, a forum for service members who have served or are currently serving in Iraq and Afghanistan, returned vets, spouses and caregivers. The Sandbox's focus is not on policy and partisanship (go to our Blowback page for that), but on the unclassified details of deployment -- the everyday, the extraordinary, the wonderful, the messed-up, the absurd. All correspondence is read, and as much as possible is posted, lightly edited. If you know someone who is deployed who might have something to say, please tell them about us. To submit a post click here.

SPEECHLESS |

March 04, 2012

Name: Major Mark Duber
Stationed in: Afghanistan
Hometown: Cleveland, Ohio
Milblog: Warbird Doctor Diaries
Email: markduber@gmail.com

I really don’t know what to say anymore. Finding the words to write into a blog about my experience here in Afghanistan has turned into an event of endless frustration and torture. Motivation has dried up in my personal drought. Being here is a mental and emotional daily beat down. Experiencing war first hand (from a surgeon's perspective) is nothing like I thought it would be and something I was ill-prepared for no matter how much effort I put in prior to this deployment.

Trauma has continued to flow in a bloody river of sorts. Yes, I have made a difference in soldiers’ lives, but I’m at my emotional wits' end managing war ravaged amputations of our soldiers' limbs and death. When I’m overwhelmed with trauma my mind has a mental block to the situation I’m surviving in, but when periods of monotony compose my days between the traumatic ones I find the only way to escape is sleeping. At least I can dream of my life back home; my wife, my kids and everything I love. There is no romanticizing the job I do nor the life I’m forced to live here in Afghanistan and the same could be said for the endless ravaged heroes I care for on a daily basis. Their efforts far outweigh any I could bring to this table; that’s why we call them heroes.

It seems these past few weeks have dealt the worse hand to the E.O.D. soldiers. The volume of IEDs that insurgents are placing has increased and their wicked tactics have worsened. Not only are the primary IEDs being placed to damage passing coalition vehicles, but secondary devices are put nearby to maim or kill E.O.D. personal whose mission is to disarm them. One such incident our FST had to deal with is rather noteworthy.

Four E.O.D. soldiers were on a mission to disarm a suspected IED. Prior to getting to the suspect position they encountered an unknown large IED that blasted the MRAP they were traveling in. The force was so intense it picked up the vehicle and flipped it end to end. When the rescue crew arrived it was determined the area was unsafe due to multiple secondary IEDs in the immediate area. The extraction plan was then changed. A medevac Blackhawk was used to hoist the injured soldiers to safety and they were then transferred to our forward surgical unit for treatment. When they arrived all four were brought into our facility. Only one of the four soldiers was able to drag himself in under his own power; the others were carried in on stretchers.

It was apparent that the injuries were to the lower extremities. One soldier's legs was covered in his own blood and he was writhing in pain. It was not obvious what the injuries were to this soldier on my initial views. This soldier’s multicam uniform was quickly removed and one of our general surgeons began his trauma resuscitation while I focused on the effected extremity. Once his pant leg was removed there was an obvious open tibia fracture staring at me. I continued to use trauma shears to cut of his leather boot and was taken back at what I saw; his foot was amputated in the middle of its length. What amazed me was his boot was completely intact with no obvious signs of trauma. The force of the blast was of such a magnitude that it caused this level of injury. I later learned the hull of the MRAP was intact, so it was the shock wave that propagated through the floor that caused this injury. I immediately had our radiology technician take x-rays to further assess the damage. The injury was worse than I could have imagined. Nearly every bone in the soldier's foot was severely fractured into pieces no bigger than an inch or less, and the end of the tibia was unrecognizable. This was among the worst lower extremity injuries I had ever seen. There was no chance of reconstructing his lower extremity, thus I was forced to take the soldier to the operating room where I amputated his leg; one of many I have been faced with here in Afghanistan.

Two days following the E.O.D. soldier's leg amputation lightning struck again; this time my emotions had a hard time controlling themselves. 

A young 19 year old U.S. female Specialist was on a mission in the rugged terrain north of Jalalabad with her fellow unit soldiers when they hit an IED. An extreme blast was encountered similar to the last group of soldiers we dealt with days earlier.  A medevac Blackhawk was dispatched to their position and they were transferred to out FST. When the Blackhawk landed they were quickly transferred to our trauma bays for evaluation. Of the four soldiers sent to us for medical care a young female specialist and an American born translator fared the worst. My attention focused on the 19 year old Specialist. She was screaming from pain; tears drenched her face. Her leg was covered in blood and the bottom of her boot, which was ripped open, was slowly pouring out blood. A tourniquet which was ineffectively applied to her leg was failing. One of our general surgeons started the resuscitation while I focused on her leg. Her injury was severe to her lower leg and even though I had not seen x-rays or removed her boot I knew what was likely from the soldier I dealt with days earlier.  Our anesthesia provider was trying to calm her down with sedation with minimal success. I was able to finally remove her boot on the injured leg; everyone in the immediate vicinity was taken aback by the extent of injury. I knew without a doubt that reconstruction of this soldier's leg would be unacceptable based on the severity of the injury. Amputation of this young woman’s leg was the only option.

My heart kind of dropped with this realization. This would be the first female amputation for our team and me personally from a traumatic cause. Time stopped within myself while my mind tried to comprehend the ramifications for this soldier.  This soldier was young and just starting her life. She was a college student, not married and without children. Her life will now sail a different course that she or her family never anticipated. 

The young soldier was brought back to the operating room for her unexpected meeting with fate; and in the end mine as well. Our anesthesia team gently put her to sleep and then my work began. Once I finished she was extubated and transferred to the post-surgical area to recover. While I was completing my surgical records the young specialist asked for me, so I went over to her side to see what she wanted. Once by her side she looked me in the eyes and asked how everything went. My heart dropped with emotional discomfort and personal turmoil at that moment. I was taken off guard that she was not only so lucid this soon after surgery, but by the simple question she asked at a moment for me like this. Most times I have only good news to tell my patients; your knee replacement went wonderful, your shoulder is going to do excellent, but this soldier’s reality is different. I put my hand on her shoulder and told her what was done; her tired eyes swelled and tears flowed and she grabbed my hand on her soldier. I immediately went into “positive mode” as I usually do in hard times with patients. I explained the technological advancements in prosthesis design and that she will walk again. For men it’s an easier sell; there is nothing feminine about prostheses. The social ramifications seem much more negative for a female in these circumstances. I spent about 20 minutes compassionately discussing the soldier's situation with her and then she blindsided me with another request; can you tell my mom? Uneasily, I agreed.

When injured soldiers come to our FST and they are stable, we have a dedicated cell phone for them to call their families to let them know what happened and that they are okay. Soldiers and their families are always appreciative and it gives a noticeable relief to the injured soldiers. 

The young Specialist dialed her family and after one bad connection I could hear the phone ringing in the background, then “hello” from a woman’s voice. She slowly led her mom into the situation without any specific detail of the injury. After about five minutes of patiently waiting she handed the phone to me. The soldier's mom really did not understand the extent of the injury and now the stressful discussion lay on my shoulders. It was as hard to tell her mother the situation as it was telling someone their family member had died, back in my surgical internship. Her mother did not take it well as would be expected; she and her husband nearby were sobbing profusely. She had a hard time accepting the reality of the situation, and must have asked me the same questions five times during a 10-minute conversation. I tried to be as insightful and positive as I could. Once I was finished with the discussion I handed the phone back to her daughter. Their following conversation was laced with crying, and words of love.

My time here has been nothing short of an emotional and mental roller coaster; parts born from my Afghanistan experience and others from the stress of being separated from my wife and children. I’ve shed more tears in the last 5 ½ months than the last 15 years of my life, some related to the injured soldiers I’ve treated but most from the heroes our FST has lost. I was anticipating this experience would strengthen my personal fortitude but in reality it has taken my positive points of view and skewed them into jadedness. My days have been filled with unexpected emotional forecasts and over time this lack of control becomes overwhelming. The stress of family from a distance, the constant threat of attack, soldiers' injuries and demise, and the lack of an outlet to relax deteriorates your strength as a person over months on end. I’m not here to judge the grand reasons we are still within this theater of war. The only valid perspective I can give is my own, and can tell you on a personal level this environment is not for me. I feel like I’ve been locked in a cage of moral negativity and pushed to live a life not of my choosing. The army I signed up for in December of 2000 is not the army of present day. I don’t know how I will look back at this experience in 10 years and I hope I can glean some positivity from it, but today I feel that is unlikely.  

I have a little over three more weeks here in Afghanistan before I start the long journey back to Kentucky. I may be leaving this war here in Afghanistan but I’ll be confronted with a different unfamiliar post-war family reconstruction when I arrive home. My young boys are at war with me for being gone and don’t communicate with me at this point; although they asked Santa for their daddy to come home from the army for Christmas. The newborn daughter I left two weeks after her birth does not know her father and my wife has learned to live without her husband in her daily life. I have learned to live without the responsibilities of a father and have become a self-centered personally indulgent individual. I have a lot of social reintegration myself waiting and it’s not going to be without a sizable amount of stress. Fortunately for me I have been able to maintain communication with my family. The soldiers who are isolated living on the Afghan mountainside are not so blessed. I can’t even begin to imagine the turmoil they will face with home reintegration. 

It seems back in the U.S. many individuals support the troops in various degrees. Some offer gratitude, nods and handshakes, and others are active in supporting our troops through their time, sending care packages, writing letters, knitting hats, and making a difference in a soldier's world both in theater and Framed Duber selfback in the United States. I don’t want to rain on someone’s proverbial parade, but if you aren’t going to take an active part in making a difference in our troops' lives don’t bother with the handshakes, nods and superficial forms of gratitude; we know you're happy in your comfortable world where you don’t have to risk everything for a nation that we as soldiers care so much for. The last thing freedom needs is to be cheapened by superficiality. Everyone has the opportunity to make a difference. You can shy away into your protected corner or spread your wings and let freedom ring loud and clear. The choice is yours. God bless America, and all individuals who seek freedom.

Thanks for coming along for the ride.

I’ll be home very soon Melissa, Turin, Talon and baby Myla. I love you more than you will ever know.

Comments

Is there anything else to be said?

Thank you for this. Good luck with your reintegration into your new normal. This should be required reading for anyone with any influence over our involvement in Afghanistan. I can not imagine any benefit that would justify our continued presence. God speed and welcome home!

Please accept my heartfelt thanks for your service and pass along a special thank you to your wife, your children, your other family members and friends. As the mom of 2 Airmen, I understand the sacrifice. My youngest son deployed last October, leaving an eight day old son at home. Unless you live this life, it is impossible to truly 'get it'. My prayers will be constant...praying for your safe return to your family, praying for a soft transition into your world, and praying for all those who you have touched while serving our nation. Freedom is not to be taken for granted, and I am so deeply grateful for all who have sacrificed so much.
God Bless.

I have enormous respect for the author and for his honesty and willingness to share his experience and emotions. At the same time, I am astonished at our (not the author's, 'our' meaning the US public's) ability to live only in the present and not think about the implications of this kind of real time sharing for our understanding of what previous generations went through. My father served 6 years in the RAMC from 1939-45; he left for North Africa shortly after my sister was born in 1942, and did not return to England until late 1945. There was no phone call to my mother during those years, just the occasional microfilmed V-mail. Many many World War II veterans had far worse wars, with longer separations and less communication. As recently as the 1960s I spent a year in East Malaysia without a single phone call to or from home, and exchanges of letters taking three weeks to get a reply. In earlier colonial wars, the expeditionary forces had even greater isolation from home. But somehow most managed to reintegrate if they survived. Yes, the instant and ubiquitous communications make for more stress and emotional turmoil in ways, and yes, the indifference of the public to what is going on is stressful, but let's also recognize that our predecessors had it much worse and managed to come through it. The human being is a very resilient animal.

Thank you, Major Duber. Even those of us who try to follow it all rarely get to hear the trauma surgeon's perspective, and we need these harrowing details. Your stories are gripping, and should cause us all to THINK...you are to be commended for pulling no punches. Please keep writing, even as you begin the challenging 're-integration' into society. Wishing you a safe conclusion and journey home.

Thank you Major Duber, for giving us a piece of your heart. Your insight is one that so rarely is told. I just want you to know that not all of us women find prosthetics as ugly or unfeminine. Prosthetics have come a long way in the last forty years (I only wish I had medical insurance to be able to upgrade mine) and they allow us to do quite a bit more than we used to be able to do. Please know that the young woman whose leg you amputated (is she a LEAK or LEBK?) will find her way in this world will be a challenge at times, but it will also be filled with much beauty. From those of us women who went before her, we are here to help her. Who knows, she just may bring home the gold in the Paralympics someday...or the Olympics if they ever allow us to compete with the temporarily able bodied and kick their butts. And if she is a LEAK, then her knee is great for taking off soda and beer bottle caps when you don't have an opener(it really amazes little kids and beer drinkers). And cats will enjoy scratching on it, at least all of mine have.
Have a safe journey back to the Real World and God Speed.

Thank you, Major Duber! If you still are in contact with the young injured servicewoman, tell her that the Shepherd Center in Atlanta does astounding things with rehab of the body and mind. My son in law was in a cycling accident that left him a paraplegic, and the Center has helped him back into triathlons with modified equipment.

Have a safe trip back. I teach school in rural Southeastern Ohio, and we've sent many kids to the Middle East over the last 10 years.--from a fellow Ohioan

“Speechless” is an appropriate title for your blog; as I read through your story, my kids came up to me and asked why I had tears streaming down my face. As a soldier, we cram combat livesaver class into a drill weekend and complete our warrior task and battle drills so we can “check the box” on our first aid requirements; we often ignore the possibility someone will be seriously injured. Your detailed account of extreme pain, emotional toll and severe stress makes it reality. We deploy this fall; I pray if the unthinkable happens to one of our soldiers, we have a “Major Duber” in our corner. I hope all is well with your family and God bless you for all the lives you’ve saved.

Thank you for your service, brother. As a fellow veteran, it truly means a lot.

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