Sopapillas

Our MS-II year has begun. We are gaining a whole new sympathy for the whiney MS-IIs before us. It's hard not to notice that a whole different kind of love permeating Lecture Room D than this time last year in Lecture Room E.

In case there was any question, and despite some rather creative accounting, Alpha Three was crowned Honor Platoon, with Eddie Dolomisiewicz and Rebecca Hardy as the official Kerkesner Rockstars. We do have to give a whole lot of credit--there were plenty of other rockstar achievements in Kerkesner adventures outside of our little circle of victory. It's worth getting them to tell their stories as well.

Ours got some level of quasi-closure at Guapo's today. But, of course, it wasn't any sort of resolution. Getting the promised reward just made it even more clear that we had never been in it for the reward.

This is about where I have to admit that Major Burns was right all along.

Thanks, sir.

For those who are wondering, the Alphaholics, and all of the original platoons, will get to stay together for Bushmaster. Hopefully, they'll consult with Major B in the intervening years and do some tweaking. In between, we're back to being regular medical students. Maybe they'll give us breaks occasionally and let us storm a building somewhere with water guns. The library would probably be a bad idea, just because of the whole water thing, but I think the cafeteria would be a good place to simulate urban warfare. We could just ambush some ethics discussion group to capture a known insurgent leader.

LRC laser tag anybody?

Whoops--sorry.

So I accidentally used Html without realizing it, which has led to some confusion about how to get to Bushmaster photos. The email address has been corrected. Apologies.

Complete Albums Are Up

The complete Kerkesner albums--all 1442 photos--are now up on the Alphaholics Facebook page: http://www.facebook.com/photo.php?pid=3208518&op=2&o=global&view=global&subj=1590892337&id=726287017#/group.php?gid=224911420640&ref=search

The order is a little funky because of how I had to load them in bulk. As always, to request the full digital file of any of them, contact me directly.

How to Access the Bushmaster Moulage Photos

So photos of gunshot wounds to the head, even simulated gunshot wounds to the head made of wax and stage blood, can be pretty disturbing for the general public to see.

Which is why I can't just post them here or on the facebook albums for random people to stumble across.

So I posted the best 85% of them on a blog of their own: http://bushmastermoulage2009.blogspot.com/

The catch is that, in order to comply with administration requests about the use of these, we've had to restrict access to it. So here's the dealio. Email bushmastermoulage [at] gmail [dot] com with "[your email address here] has read the disclaimer and wants access to the moulage photos" as the subject line. I'll check it every couple days or so during clerkships, and we can go from there.

I'm in the process of uploading the rest of the Kerkesner photos onto the Alphaholics page on Facebook, but it'll probably be a while.

Major Burns, You Owe Me a Helicopter

Excerpts from conversations after arriving home last night at 8:10 (or, in the words of half the bus, "eight-freaking-ten"):

"Yes, Mom, I'm back. Just got in . . . no, it's fine, just turned my phone back on--thanks for checking in . . . no, only a little beat up . . . yes, I'm going dancing tonight--it's Friday. I was just getting in the shower now . . . no, not that stinky anymore--I did shower last night . . . just want to spackle my face and look like a woman again . . . holy cow, where did that bruise come from?. . . ."

"Hey, baby, I've missed you."
"I've missed you, too."
"What happened to your wrist?"
"Oh, um, well, they zip-tied me. And it was already kinda scraped from hiding in the woods in the dark from the guys chasing us with M-16s. It's okay, really. It only hurts when something touches it. Baby, is everything alright?"
"That was not the answer I was expecting."

"Are you coming to IHOP after?"
"Yeah, I've been eating MREs for two weeks. I could use something that hasn't been in a package for ten years."
"They don't make Hawaiian pancake MREs?"
"Please don't give them any ideas."

"You were doing what again?"
"Wait--I have pictures. My camera's in my purse . . . hold on . . . here."
"What did they do to you?"
"Fragmentation wound to the right cheek with facial bone fractures. Here, I'll zoom in."
"It healed so well."
"Yeah, mostly. There's still a bruise. Here, let me show you one of Jaime."
"Her eyeball's hanging out."
"But look how happy she is playing cards."

If Thou Shalt Endure It Well...Thou Shalt Triumph Over Thy Foes

For a few years between undergrad and medical school, I would use a week of my vacation to volunteer as a tent/cabin "mommy" at a camp for teenage girls. Besides making sure they didn't kill themselves or each other on dutch ovens or ropes courses, my job was to eradicate spiders and bees, sing them awake in the mornings, and keep a close watch on group dynamics and morale. Every night before lights out, I would stop by their tent to take a group pulse and teach them something useful.

It is usually the nature of the beast that when the end of the week is in sight, the girls get antsy. Skin gets thinner. The complaints bubble to the surface. Offenses are given and taken. Crabbiness can spread like an epidemic. One year, to head this off at the pass, just beyond the mid-point, our nightly pow-wow was on the difference between enduring and enduring well. Fourteen-year-old girls can be rather sharp. They know the difference between dragging themselves to the finish line and charging triumphantly through it. They just need to be reminded that they're capable of charging, and that that is what we expect of them.

I am proud to say Alpha Company charged to the finish line. The USUHS motto is "Good Medicine in Bad Places," and Fort Indiantown Gap-Jazzeristan, Pennsylvania was definitely a bad place today. The Jazeeris have been attacking almost non-stop. I lost track of the number of us who have been shot and blown up. I hate it when they blow me up. But time after time, we took it like the Marines we were pretending to be (except for the screaming and freaking out), and the MS-4s brought us in, sorted us, treated us, and sent us back out (even though we never seemed to last long without getting hit again).

The days have started to blend together. I started the morning with a fragmentation wound to my cheek, with blood dripping into my mouth and nose and interfering with my airway. A lot of what I've learned from this exercise is how much I don't know yet about pharmacology. Because there were holes all the way from the inside to the outside of my cheek, they had to give me a huge antibiotic cocktail to keep the bacteria from the oral mucosa (mostly strep) and skin (mostly staph) from infecting the exposed tissue between the two. Then I went into surgery, where a series of mannequins and mannequin heads proxied for me while the MS-4s practiced intubations and the senior surgeon taught us how to construct a "hot pocket" to prevent hypothermia while air-evacuating me.

But soon I was back again for sick call with a nasty case of cellulitis on my leg, having tripped on a tent stake and scraped my skin a week before. Because I couldn't walk, I couldn't be returned to duty. While I was waiting to evacuate, some Jazeeri nationals (who bore an uncanny resemblance to Marion Keehn, Drew Hill, Sameer Saxeena, Amanda Elam, Amy Alexander, and some of the staff NCOs) approached the EMED camp and began to hurl rocks and sticks at our perimeter security. At first I was a little disappointed with the force with which the security guards threatened them, given that their claim that we needed were the ones who were trespassing in their space was kinda valid, but who's to say that none of them would have flipped out and just pulled out a weapon and started shooting. And then one of them did, absolutely validating the security guard's forcefulness.

These attacks sometimes mean that the ambulances end up bringing in injured Jazeeris, like Muoy Lim and Liz Miller. Just when they seemed to have the PJF attacks under control so they could go about their work of patient care again, we heard the screech of a rocket and suddenly there was a cloud of purple smoke. "Gas! Gas! Gas! Notional MOPP four! Notional MOPP four! I love this stuff!" Apparently mice got into the fourth years' MOPP gear in the warehouse, so they are just simulating the gas masks and charcoal suits this week.

"Notional" is fourth-year speak for "faking it," sometimes because it wouldn't be appropriate for them to insert real IV lines into fake patients, and sometimes it's because they're low on real-world litters or other supplies, and sometimes because they're too lazy or uncreative to go through with the real thing. For example, when Tyler Powel ran head-on into one of the BAS stations, the tiny security guard whose perimeter he had just breached yelled out "I notionally tackle you and zip-tie you," which seems more than cheating.

I had finally gotten released to go back when tragedy struck again. I was riding shotgun in a Humvee that John Roman was driving with Blair Laufer and Tara McClusky in the back when we spotted a groundhog crawling out into the road. John Swerved to miss it and ran into an IED. I was thrown from the vehicle and landed on my femur, which snapped and poked through my skin. Tara's arm broke her fall, also snapping on impact. Blair's injuries were all internal, but John landed on his forehead and developed a closed-skull fracture. The leg hurt (until they gave me morphine and fentanyl), but what began to terrify me was that I couldn't feel my foot anymore below the break. I did not want to lose my leg and go pirate and I let everybody know about it. I warned them about the insidous groundhogs in this country that are used to lure Humvees into IEDs. After being shot three times yesterday, to be blown up today seemed just too much. But the surgeons finally successfully reduced my fracture and put on an external fixator and gave me real-world peanutbutter cups (to help me understand for what we were fighting in the first place). While I was waiting for my evac to Landstuhl, I saw that Robbie Wetzler had been brought in, having lost his eyesight, and that Fred Nielson had been hit in the forearm and was spurting blood from his artery. And poor Scott Story--his whole head was bandaged when I saw him being carried past.

By the time I finally returned to duty, we were all preparing for the next big attack--the one expected to take out a huge number of casualties. Moulage covered my arms with abrasions--scratches from my pet tiger who was scared and attacked when the car bomb went off. Poor Meg Ginn was just a mess, but that didn't stop her from picking a fight with Anthon Lemon, who had gone completely off his rocker. I saw a gunshot on Kevin Gray's chest and worried if they would get to him in time. Fred Nielson was burned all over his face and arms--another Darth Maul impressionist. It was Liz Miller's bowel that eviscerated tonight, and Nicole Baker and Jamie Piercy whose eyes fell out.

It would have been incredibly demoralizing to have so many of us hurt or crazy, but then they sent something guaranteed to boost our spirits--reinforcements from Bravo Company, recently returned from their Kerkesner deployment. It's hard to describe what it was like to see them again. During the week of Kerkesner, our platoons had grown so close, like family. It's hard not to love someone who's had your back in a firefight, who's confided in you what the MRE did to his system this morning, who's lifted the side of the litter across from you to help bring a critically ill patient to definitive treatment. We are indeed a band of brothers now. Then, during Bushmaster this week, we'd shared car wrecks and explosions and borderline psychotic episodes and bullet sprays with other members of Alpha Company, and the family expanded to include cousins.

It was nice to have a platoon of Bravo join us, and we hugged and laughed and exchanged stories. But, having not been by our side during these critical times, they were on the outside of this net we had woven connecting each other, and they were now part of their own, separate net. I hadn't expected the distance to feel so palpable. The reunion moment gave me a Hemingway-esque glimpse into the surrealness of returning to regular life after war. Would the outside world have any sense of what we had done, of the import of what we had accomplished. I mean, who's even heard of Jazeeristan anyway? It gets, what, two Google hits? Three, maybe? We weren't even sure of the meaning of everything we'd done.

Still, we piled ourselves and our stuff into vehicles and shipped to the mission site. Even knowing we would sustain massive casualties, we were still jovial, singing classic Willy Wonka songs and joking about bringing on "notional" sunshine. It had already started to rain. A thunderstorm approached. It took one boom of lightning for the NCOs to order us back into whatever vehicles could be found, and I found myself sardined on a bench in the back of a canvas-covered Humvee, clinging to a roll-bar with Jesse Giffhorn on my lap. Never mind that we had done our SERE training and forded streams in worse than this. The vehicles raced to the barracks, deposited us in the motorpool, and headed off. I was placed in charge of eight fourth-year women and bringing them to the female barracks.

In just over an hour, the lobby of our barracks was filled with female faculty and support staff, all the MS-4 and MS-1 women who had been at Bushmaster (the fourth-years not even having material from their tents), and the MS-1s who had been brought back up from their tents at Kerkesner. A game of Catchphrase began in one corner, with participants still sporting their dangling moulage eyeballs and gunshot wounds. Hearts began in another corner. A few MREs were opened. Phones popped out and texts were passed. Arrangements were made to loan pajamas and shower sandals to those who had had to run to buses from the Kerkesner site, and I discovered how wonderfully fortuitous it had been that I had packed along a large box of the Crest single-use pre-pasted rubber toothbrushes.

And we were camp girls all over again--muddy, sticky, bruised, sore, uncomfortably crammed together, and laughing our heads off, ready to be sent out again into the rain and car bombs for a delayed or modified mass-cal. Charging to the finish line.

In the end, they brought the finish line to us. The mass-cal was called off. Someone arranged for new bays of the barracks to be opened for everyone to hunker down for the night. We started rotating through showers and packing. The cooperation came swiftly and purposefully, without whining or resistance. And then came sleep.

I can't believe how early morning came. Bravo had to take off, as did those who had been drafted to clean the actual Bushmaster site, so people started moving around in the room sometime just after four. We waited until five, then rolled out of bed, prepared ourselves, and started cleaning the barracks.

As I was making myself light-headed mopping the men's bay, the line from Richard Lovelace's poem To Lucasta, On Going to the Wars kept cycling through my mind: "I could not love thee, Dear, so much, Loved I not Honour more." We've been kinda shameless in our campaigning for honor platoon, but the promised reward seems to have progressively shrunk. Last fall, it was a ride home early from Kerkesner in a helicopter while everyone else cleaned the camp and barracks, and then all we could drink at Guapos. Then the promised helicopter bumped us off the schedule and was withdrawn. And here we are, wiping and dusting and sweeping and mopping and scrubbing and waxing barracks. Admittedly, he hasn't officially announced honor platoon, but from what we can acertain, all six platoons are currently cleaning.

And I don't even drink.

So what in the world was I doing this for? "I could not love thee, dear, so much, loved I not honor more." Certainly we were not gunning so hard for this for the praise of our peers, and, as much as we enjoy the admiration of Major Burns, that alone would not suffice. Which leaves a few options. My theory is that by now we're in it for each other, and, perhaps, in it for honor in the sense of knowing we gave it what we had. I pulled a Humvee with all the strength my quads had. (I know that because I pushed them to the point of involuntary failure.) I think all along the way we've seen windows of opportunity where we could have backed off, could have endured without enduring well, and what stopped us was not wanting to do that to the rest of our platoon because they were doing the same for us.

In the words of Dan Bailey, "It's not only been an honor, guys, it's been a pleasure."

And the Carnage Continues

Being in the field does funny things to people. I started the morning with a bloody nose, and the discovery that the drippy moulage blood tastes like peppermint when it seeps down your septum and into your lips. In related news, Tyler Powell started the morning with broken fifth metacarpals, almost exactly like Major Burns's during train-up week. It was rather unfortunate that we had to report to the same sick call, but at least Jaime Piercy, who had woken up unable to see, was there between us to distract us at first. By the time we arrived at the EMED, even that was unable to keep us apart, and we started to fight again. I probably called him some names that I would have regretted in the future, except that he deserved them. By the time the MS-4s running the EMED had pulled us apart and restrained us in zip ties (not an easy process, I assure you), my nose really needed attention, so they brought me in for an eval. Pressure didn't stop the bleeding and I squirmed too much for silver nitrate, so they had to un-cuff me to lie me down and give me IV morphine. Which was a bad idea because as soon as I laid down, the blood started filling my throat, and I started coughing and choking, a hacking fit so violent that I currently have a real-world bruise on my cheek from hitting it against the metal side of the litter. They finally sedated me (that seems to happen a lot on this deployment), anesthetized me, and cauterized my bleeding septum. It came out in the history that I was taking enormous doses of asprin to control headaches, and no amount of pressure would have made my blood clot. Also, that Tyler and I were fighting because he had slept with my boyfriend and I had threatened to out him. And we were battle buddies, too. The traitor. The punk. I can't believe he would do that to me. Even the morphine didn't really get rid of my rage, though it did take the edge off. Apparently such skirmishes were happening at sick calls all over the deployment that day.

I wasn't back on duty long before I was thrown from an exploding car and sustained a closed-skull fracture. It looked so horrible that the medics left me for expectant the first four times someone passed by me. They even left with the ambulances with me still on the ground. Nobody even bothered to examine me--they would have found me responsive to at least painful stimuli. So I had to break role and start screaming to get their security guard to notice he had left me, and then go back into my mostly-unconscious state.

It was the kind of day that reminds you of the Chinese curse "may you live in interesting times." Loren Walwyn-Tross was attacked by ninjas who almost killed him had he not been able to stumble into the BAS with the ninja star still embedded in his forehead. Later on in the day, I found his face spattered with bullets. Seamus Cobb got circumferential burns all across his torso, mere hours after an explosion that blew open his skull so bad that brain matter and bone were sticking out. The same explosion knocked out my hearing, forcing me to yell all communication to the doctors and their assistants. The burns got Dan Brennan and Scott Story also. An unexploded ordinance, part of Marion Keehn's rogue model rocket project, embedded itself in Robert Fenequito's head, which forced his eye to dangle out its socket by its nerve and artery. He was barely back at work when an explosion burned him all over the face. Kevin Gray lost an arm and had to go all around the woods looking for it. I still don't know what happened to the arm Greg Nishimura lost. Frances Rosario got an open fracture to both her radius and ulna. Nicole Baker was hit by rectal bleeding, which looked pretty similar to Jaime Piercy's exploded bladder. Dan Bailey's foot was badly mangled. Chris Oching was impaled with a chest. I was shot in the left chest on two separate occasions, once leaving me with a tension pneumothorax that took three decompressions and once leaving me with an open pneumothorax that became a tension pneumo once occluded. I was gasping from the time they appeared within hearing distance until they finally successfully treated me and just the hyperventilation was making my arms and feet tingly and numb. Jesse Giffhorn's forearm was mangled. Tara McClusky's was in a different car accident, which snapped her forearm, leaving a huge bone sticking out. She took it better than Seth Olchese, who did the same thing. Fred Nielson, may he rest in peace, lost several inches of gray matter when his head split open. Liz Miller got cuts all over her face. I didn't get all the details, but the rumor is that she provoked whoever did it. Aubry also had cuts accross her cheeks. I never found out if the two were related. Muoy Lim lost a finger, as did Heather Scheibe. Robbie Wetzler, after remaining in tact all of yesterday, was peppered today with fragments of something all over his face and arm. And John Gillis--I'll miss him. By the time they found him, he was so red and black and blistered with burns that he looked like Darth Maul in his impressionist phase. Eric Abdul threatened to kill his commanding officer because he wasn't given emergency leave to deal with his encarcerated wife. Amy Alexander's arm was pretty much destroyed. Fred Nielson's OCD hit a stage where he wouldn't even go into the commander's office because of its decor; then to top it off, he was shot in the buttock. Andrew Fisher chose the wrong time to have his bowel eviscerated--right when all the rest of us were hit by a car bomb--so whatever chance he might have had to be evacuated within a reasonable window of time to save him was lost.

For forensic purposes, I documented many of these injuries photographically. It would be disturbing and beyond the bounds of good taste to make them available here, but, if we get approval from our chain of command, we'll try to set up a restricted, by-invitation blog or photo album for the photos that would be way too grafic to leave open to the public, and those who want to see will be able to just request to be given access.

There's only so much people can take before they start falling apart, especially when they're feeling like no one is attending to their needs. When the medic finally decompressed my first pneumothorax and I could breathe again, I started to cry, and crying became wailing. I didn't want to die. I was in pain. I didn't want to leave my baby, who needed her mama. I wished I had listened to my dad and joined the Air Force instead of the Marines. I didn't want to be in this horrible country with its horrible food where people kept stepping on me and shooting at me. I was sick of being shot and blown up. And I needed pain meds. Somehow, inexplicably, giving me pain meds always diminished the wailing and screaming.

We can feel the tension building. We're trying to keep up troop morale, but we keep getting injured, which then really beats on the morale of the medical staff. You can sometimes feel their agitation. There are rumors of more car bombs tomorrow. The smoke machines and Saving Private Ryan soundtrack that come on every time Jazeeris blow up cars make it even harder for them to come rescue us. By tomorrow, we might all reach our saturation point.

We hear word of political debates on whether or not we should still be in Fort Indiantown Gap, Jazeeristan, Pennsylvania. The public is suspicious that we always seem to think going to war is worthwhile when there are penutbutter cups involved. I don't know enough about the big picture to say yes or no. On one hand, a shortage in peanutbutter cups and subsequent spike in peanutbutter cup prices would send our economy into a vicious spiral. And it's really a peacekeeping mission. On the other hand, despite our best intentions, it's not even always clear they want us here.

Tomorrow should be very telling.