Tuesday, July 21, 2009

I Would Like to Thank the Academy

That glorious sensation of clean from yesterday didn't last long. Yes, we have achieved a relative steady-state of non-stinkyness, but today we added a whole new level of mess--moulage. Moulage is French for "big, simulated-bloody mess."

Our mission for today was to get hurt. And sick. And unstable. And occasionally die. All in the name of helping the rising MS-4s practice how to deal with hurt, sick, unstable and dead people. We bussed out to the central moulage site and deposited our stuff on a series of cots under the holding area tent. We then dug through old donated cammies and each found suitable ones to evolve into bloody messes. I pulled a set of soft green Marine digies belonging to someone named Evans that looked a little bit like pajamas on me. Command Central, starring Tim Gotham, Rebecca Hardy, and Mike Cullen, would recruit us in teams of two to eight, and hand us all cards with a set injury or illness on them, including relevant medical history, precipitating factors, vital signs, and what would reasonably be expected from an MS-4 treating us. If that injury involved diarrhea, out popped a baby suction bulb and some carmel-colored dyed applesauce. If the injury involved a scrape or fragmentation wound, out popped the scar wax and small silver wads of gum wrappers. If the injury involved an arterial bleed, out popped an IV bag with a control valve filled with super-saturated red cool-aid. Then Ben Nye make-up, fresh scab, and stage blood were layered on for color blending.

But, really, an injury is only as good as the Oscar-caliber theatrical performance behind it. Which was why I was terribly disappointed that my first card was to report to sick call with ear pain and itching. But then the first set of MS-4s upon whose camp we were assigned to stumble were dreadfully disorganized, having just arrived and set up their gear when Nicole Baker with back pain, Jen Nuetzi with blaster diarrhea, Anthon Lemon with an asthma attack, Kevin Gray with alcohol-induced gastro-esophageal reflux, and I arrived on the scene. Their lack of organization slowed them down, and in short order our whining had escalated. They were still in the process of slowly attempting to effectively treat our maladies when Loren wandered up with two large bleeding wounds on his shoulder to report that he, Jaime Piercy, Andrew Fisher, and Tara McClusky had been badly injured in a firefight. Nicole and I had already turned up the griping big time because of the wait, but this time we saw our chance to put something Oscar-worthy on the table and tried to run to Loren and help our friends. They tackled me. It took two of them. Anthon would have helped me out if he weren't in the middle of his asthma attack. On top of the huge collection of meds they had already given for my ear, they sedated me and strapped me to a litter. By the time the ambulance came to pick up Anthon and me, they realized that they couldn't give away a litter to send me, so they lowered the previous dosage of sedatives until I was capable of walking. Which meant I was conscious enough for another round of freaking out when the ambulance landed at EMED. There, they seemed to have a little better idea of how to calm down a hysterical patient (or, at least, in my Method acting, I wanted to calm down because of their treatment of me, whereas the other group's had only encouraged me to escalate). Finally, they just let Anthon come and keep an eye on me, until headquarters demanded we be evacuated and returned to come be patients again.

I was quickly turned around into the moulage station, where a series of gum-wrapper foil fragmentation wounds were waxed into my shoulder and covered in stage blood. Yummy. Chris Oching had been similarly pelted, Andrew Fisher was burned all over his face and hands, and Anthon was hit in the calf. Our scenario was that we had been caught in a firefight, and were found on the battlefield. Vivina McGintley won the Oscar on that one with massive abdominal injuries. I have to say, after all our tactical movement work last week, the MS-4s come off as pretty pathetic at it. They didn't have much of offensive line, so Anthon and I, as marines, kept asking for a weapon after our initial care under fire so we could get back in the fight and fend off the punks who had attacked us. Finally, one of the MS-4s gave Anthon his rubber duckie (a big no-no), and another one gave me a 9mm caliber stick. While they ran around like crazy trying to litter-carry ambulatory patients, we fended off hostile action closing in. But as soon as they brought me back into the camp in my triage area, someone who had been on the staff at the morning's sick call took away my stick-gun because she thought I was way too unstable to be carrying one. Which left no one guarding 180 degrees of their perimeter, a fact that upset me a ton more than it upset them. My bleeding wasn't serious, so they put a clean dressing over it and gave me morphine and a pre-emptive low-dose sedative--this time not taking any chances. They didn't sedate Chris, but he also would have grabbed any weapon lying around to pull security had he had the chance.

This time, I was evacuated back to the moulage tent get a skull fracture, with drips of blood oozing beside my nose and down my cheeks and eyes. Our Humvee had hit an IED and I was thrown from the vehicle onto my forehead. With pupils dilated and unreactive, I had a hemorrhage compressing my midbrain, and had no chance of ever regaining consciousness. They triaged me as expectant and got to me last. I have to say, the secondary survey the first medic performed on me included a whole lot more hands on breasts than the one we were taught. I was torn between staying in character within my coma and reminding him that he'd already checked there. A lot. Since I was the only patient left, they intubated me, but not until after a relatively long ethical deliberation. But once intubated, then they had to deal with me, so they sent over the chaplain, who kept trying to give me a poncho. After last week, the little trickle of rain was hardly even worth noticing. He then quizzed me--in my comatose state--about what the process is to return the body of a fallen American serviceman to his or her family. "What do you make sure to include in the bag with the body?" "Air freshener."

When I was finally evacuated, I came back to find that Anthon had been sent to the real-world medical tent because he was having a reaction on the tops of his feet to the make-up remover solvents. I grabbed his stuff and Sergeant Flores and I escorted him back to the dorms. Even though I came back in time for my next assignment--loss of hearing subsequent to a cold--they had already passed it on to someone else, so I got...arterial bleeding. Yay! A spurter, with it's own little squeeze-activated release mechanism. It also came with the bonus of altered mental status. This time, rather than belligerent, I went with loopy. It didn't make them freak out nearly so much. They got a tourniquet on me right away, and were the first of three groups to see me bleeding who actually bothered to cover the wound. In a series of progressively more pleasant and competent MS-4s, I was swept up through triage, initial eval and treatment, and orthopedic surgery, which was held in this beautiful inflatable clean plastic tent.

Here at Bushmaster, they seem so much more paranoid about our safety than they were at Kerkesner--we aren't to walk through the woods without chem lights and k-pots in the dark and they are attempting to enforce hydration. And then they go and pile sixteen of us on the back floor of an unmarked white van to drive on a highway. They are also beyond paranoid about making sure they have an accounting of every body on the exercise, having us check in and out of every area we use. One gets the suspicion they've lost people before. One also mourns a little that we can't have Major Burns running this by our year--he would remember to treat us like grown-ups, and would not let us get away with some of the slackage we've seen.

After my post-op evacuation, I had a few minutes to scarf some food before I was at it again, this time with a dry cough. That one was painful to simulate, and doing it too much brings on dizziness. The faculty and fourth years kept coming back to me to tell me I could drink water. Jen got bloody diarrhea, Seamus Cobb had a spontaneous pneumothorax, and Brian Pomerantz got to attack somebody. We could see how the length of the day was beginning to wear on them. It's been kinda fun to listen to the dialogues between the faculty and students about best course of action with our various complaints. It makes me excited to start getting into Pharmacology and Pathology and clinical rotations, and not just so we can show them up in two years.

When we arrived at the barracks, there was a mad rush for the showers. We're not quite ready to sacrifice that whole clean thing so quickly just yet.

Monday, July 20, 2009

On the Jungle Gym











What is this strange feeling I have? I don't have to gag every time I catch a whiff of myself. My hair isn't encrusted with sebum and sweat and sand. There is no mud or charcoal or gunpowder or bolt grease or MRE marinara sauce encrusted in my nails or elbows or neck. My clothes are not mottled with mud and leaves and grass stains. There are no jungles of hair growing on my legs or axilla. It must be the sensation known as "clean." What a beautiful experience, this clean.

This morning, though, I took my wonderfully clean body and had to put it back into unwashed fatigues to traverse a series of Jazeeri terrain obstacles with a small band of assorted Alpha Company ninjas caught behind enemy lines with me in a region of Jazeeristan known as the Leadership Reaction Course. The PJF had exploded and booby-trapped various bridges and dams and critical molten-lava-crossing points, and we had to get ourselves and various equipment and patients to ralley points on the other side. As a platoon, we really hadn't gotten much opportunity to work with the others in our company, and it was pretty inspiring to see the rest of the talent pool we have. Ted Steelman, Becky Hardy, Angelina Ruiz, Megan Ginn, Sean McIntire, Muoy Lim, and Matt Hawks joined Liz Miller, Andrew Fisher, Kevin Gray and me in a series of teamwork mindgames in which we pitted Sean's brute strength against Becky's killer assymetrical groin stretch against Ted's invincibility. I can't claim that we always got across in time with all of our equipment and patients in tact, but we came away with the kind of bonding that really only comes from holding hands to guide one another on precarious makeshift cantilevers across radioactive lava.

The first order of business back at the barracks was a hike to the FIG-Jazeeristan laundromat to remove the foul, toxic stench from our Kerkesner uniforms. Doubling the detergent works well for this. While we were waiting, various servicemen from the post would come up to chat, always a little shocked at our generous spatterings of bruises, moleskin, and medical tape. They seemed a little incredulous that we were medical corps, and even more incredulous that we were both officers and medical students undergoing something so intense. While we were there Lieutenant Mike Cullen texted Becky Hardy to inform her that we were advised not to defecate in the barrack toilets until the plumbing problem could be addressed or porta-johns could be obtained. But, really, what else did they expect from digestive tracts so abused? The locals proved very helpful, pointing us to their secret caches of carbonated beverages, paperbacks, and foot/groin wipes. I won't name names, but let's just say certain people were very excited about that particular selection of commodities.

After laundry, we disbursed to the four winds for naps and calling families and dinner excursions. I joined a crowd of Alphaholics at the one local restaurant--a family diner known as Funk's. It was hard to tell if the food was actually excellent, or if any cooked meal would have been beloved after a week alternating white bread sandwhiches and MREs. At one point, Marion turned to Steve and asked, "You have kids, right?" "That's the seventh time you asked me that, including three on the bus from Antietam. No." "We've been trying to find the right girl for Steve for almost a year now. The problem is that he's looking for super low-maintenance. When I asked him whether that meant he didn't have to spend much money on them or that they didn't need much time and attention, he asked if it were possible to find someone that fit both." "Such a woman is very hard to find, Steve. Perhaps you could get a pet--a fish, maybe." It appears that all of the USUHS faculty and staff have been deployed out to Jazeeristan and half of them ate at Funk's tonight. The more NCOs we see wandering around, the more we wonder if they remembered to leave anybody back on campus to run anything there--the library, the clinic, admin, anything.

Marion used his iPhone GPS to land-nav us a new azimuth back to the barracks from the restaurant. It only involved crossing one small stream, maybe. We found ourselves still scanning the woods for hostile forces and scanning the ground for obstacles behind to which to obtain cover from them, even though our deployment had finished. We're told it's not PTSD unless it persists after the initial month or two. The final stretch was straight uphill, but by now the ony thing we know how to do on hills is to charge and take them by force, so that's what we did, beating the group on the traditional route by six minutes.

Tomorrow, we start support for Bushmaster. I'll also see if I can track down a heftier network to get the images up from yesterday and today. Stay tuned.

Photos, Kerkesner Day 6





































Man Who Says It Cannot Be Done Should Not Interrupt Man Doing It

Today was the Alphaholics last day on the Kerkesner side of our adventures. We awoke after the sun, packed up our stinky clothes, and scarfed down another MRE for breakfast. It's Sunday, and the chaplain was holding a non-denominational Christian service. I often find such things generic to the point of being unsubstantive, but this one was direct and uplifting. It was odd to be the only soprano voice over a crowd of basses and tenors. The seven of us Mormons in Alpha Company escaped into the bleachers for a few minutes in the afternoon to do sacrament. I have to admit, with the schedules we have been keeping this week, it has been difficult to find time to nurture myself spiritually, and the lack of that has been somewhat draining. It's not like we don't have lots of quiet time, but the kind of reflection that goes on when crouched over an M-16 in a security halt is often of a very mundane, trivial nature and usually involves wishing there were some more comfortable position in which to be crouching.

Jason Baumann and Eddie left us in the morning for an OEMS course in England. I found myself almost choking up as we said good-bye.

Our mission for the day was to defeat the other platoons. Like most missions, it began with a lot of standing around, waiting for the people on top to tell us what in the world was going on. We were still pretty high off of yesterday's triumph in the Battle of Day Five, so even when we heard the events--rifle disassembly and assembly, a patient carries relay, a Humvee pull, pugo sticks, grapling, and an MRE eating contest--it couldn't kill our mood.

We started out with a bang--Nicole Baker had disassembled her rifle and run almost three-quarters of the way down the track where Ian McDougall waited before Heather Scheibe and Jeanie Gorlin even started running. I had been a little worried when we saw how long the run was because Nicole's feet are so inflamed she hadn't been wearing shoes for the past almost twenty hours, but she still managed to blast ahead. From the far end of the road, Ian, Brian Pomerantz, and Tim Gotham waited, trying to see who had taken off. The three were convinced at first that it was Jeanie, because of how fast she was running. When they saw it was Nicole, the other two go out of the way and Ian prepared to sprint it. His rifle assembly was smooth and even, and the blank fired into the air sealed our first victory, with Brian coming in second.

The relay was an absolute killer--one huge lap around the road loop with the first quarter a buddy fireman's carry, the second quarter a fireman's carry with roles reversed, the third quarter a litter carry, and the fourth quarter a litter carry in gas masks. All of this in full helmets at noon on a dusty road. Kevin Gray, Dan Bailey, Marion Keehn, and Loren Walwyn-Tross represented Alpha Three Platoon. The run was absoultely brutal--they kept a pace that was hard for me to follow with the camera, even without taking on the weight of an extra real or fake body. Most of the platoon paced with them, cheering them on and absolutely winding ourselves in the process. The first platoon to arrive at the gas masks for some reason left their litter and mannequin, so the next did the same, and the third. Major Burns had specifically not wanted anyone sprinting in gas masks and was ticked that his instructions weren't followed, so the entire even was thrown out.

Next came my event--Humvee pull. Four men and four women, two ropes with hooks, pure bruit strength. But, dude, what other medical students can pull a Humvee fifty meters up a hill? We had Steve Colonna and Lucas Groves in front, followed by Amy Alexander and Alicia Scribner, then Dan Raboin and Jeff Strich, then Jaime Piercey and me. It took absolutely everything my little chicken legs could give to make any progress, and they began to fatigue really quickly. When our bodies crossed the white line, my foot grip began to slip, and they came out from under me a foot before the back of the Humvee crossed the line, just enough to scare everybody except me, who knew I could roll out of the way just fine and was just grateful I hadn't taken anyone else down with me. We missed first place by two seconds.

Then came pugo sticks, first to five hits. A coin-flip gave Nicole a buy for the first round, and Jeanie Gorlin battled with Alli Brinker. Mostly, Brinker just hopped around her, both playing defensive and not actively engaging, but eventually, Megan drew her in and defeated her. Seamus Cobb beat Greg Nishimura soundly, because, well, Seamus is awesome and has a little Tasmanian devil inside of him. Nicole started down against Jeanie, came back, but never fully recovered enough to beat her. I couldn't help but wonder if it wouldn't have been different had she been fresh. Seamus then proceeded to defeat Matt Brown, sealing in the second victory for the Alphaholics.

Next up were Liz Miller and Megan Ginn on grappling. I had absolutely underestimated Liz's viciousness when I had supposed that I might stand a chance against her. Holy cow. She got Megan to the point where she made gurgling sounds and stopped breathing, but Megan still wouldnt'tap out. A few ferocious scrambles later, and Liz was defeated, but not by much. Anthon Lemon represented us for the males, and started up against Mike Cullen. Now Anthon wrestled at the state level in high school, but he wrestled 103 lbs, and is currenly around 145 lbs. Mike cullen weighs about 235 lbs and has prior training in grappling and submissions. Anthon held his own, but after what seemed like an an incredibly long time, Mike finally had him in a position where he had to tap out. Megan then proceeded to defeat Frances Rosario and Mike defeated Ted Steelman, though, again, not soundly.

I don't even want to think about the MRE eating contest. That food is hard eough to choke down slowly. The entree was cheese and vegetable omlette. There were also scones and crackers and other horribly dry carbs. Robbie Wetzler and Fred Nielson didn't stand a chance against Matt Feist, who ripped off his shirt at one point and just snarfed and horked down the whole package, filled with water. Robbie snarfed but did not hork, and sometimes it came back up into the bag and he had to choke it down again. In his black warpaint, Matt was beyond ridiculous, spilling everywhere, like cookie monster, but then scooping it off the table and shoving it into his mouth. The level of disgusting was incredible. I never wanted to eat another MRE again. To pronounce his victory, Matt chased Major Burns to give him a big, wet, shirtless omlettey hug. Major Burns understandably ran. Fred was next to finish. Robbie kept trucking away, but at one point he looked around and made a mad dash to the woods to give it all back. We were proud of him for even trying. Has Jason Baumann been here, or maybe Dolo, they might have tried, but I really think Matt was pretty unstoppable at this.

After lunch, Major Burns held an award ceremony where we recognized the excellence of the cadre who had contributed to the successful week. I realized that the combination of my real-world gun bite and a bruise on my palm made it painful to clap, so I just hooted more. Major Burns read a piece about a special leadership award--an American flag--and what it represents and what it has been through. I was starting to tear up before he even finished explaining the award, and they started trickling down my face when he announced that it went to Steve Colonna. To me, there's no question that he deserves it--the smoothness with which he has run the platoon, the willingness to use the best that everyone has to contribute and to mentor and support to compensate for our weakness, the lack of desire for personal attention and glory--I've said before, but it's a joy and a comfort to follow his lead.

Then came the after action report and the buses bearing Bravo company. And then we loaded back onto the buses and left. For the next five days, we'll be at the barracks out in Bushmaster. An unsuccessful walk showed the shoppette to be closed, so we ordered pizza and Chinese, and settled in. I probably spent a half-hour in the shower. I couldn't get over how good it felt to shave my legs and actually touch my scalp. When I had to make a quick run to the garbage to throw away a soaking band-aid, I caught a glimpse of myself in the mirror. I didn't even recognize my body--the traps were too tight, and there were bumps and bruises all over the surface of my body, and my hair had become a disaster.

Tomorrow, we take on a leadership reaction course and finally get to do laundry. And tonight I tuck a clean body into clean clothes in a clean bed. Life is wonderful.

Saturday, July 18, 2009

ATTENTION BRAVO COMPANY!

Major Burns has requested that you not read this blog at all until the exercise is over. There are too many friends, family, staff, and alumni readers for us to simply restrict the privacy settings for that long. Please don't cheat your own experience and that of your classmates. Thank you.

Kerkesner Photos, Days 4-5






























My camera isn't great at low-light, but sometimes that makes for interesting special effects.

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