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In the following diary, I've attempted to bare my soul, in a cathartic attempt to share what it is to be a veteran in america.  This is my own experience.  There are points in this diary that are hard and brutal and detailed in such a way that it deserves a warning to those who suffer from PTSD.  There are things in this diary that may be triggers to you.

All that being said, as a lifelong Dylan fan, the analogy of a Hard Rain speaks to me and touches my soul.  A hard rain did in fact fall on me in Afghanistan...and it changed me forever...

Thank you for allowing me this cathartic expression of my emotional struggles.

I am a husband, a father, a surgeon... a man, to quote Frank Underwood, who’s “a white trash cracker from a white trash town that no one would bother to piss on”.  At the end of the day, there is more that defines me.  I am a veteran, a proud veteran, a war veteran of Operation Enduring Freedom in Afghanistan.  However, I am now a civilian, six months now.  My beard wouldn’t pass the muster for regs and I am so far removed from military life that the world around me is nearly unrecognizable.  But if I’m honest with myself, when I close my eyes for fitful sleep at night, the part of myself that most defines me, that both brings me pride and haunts my soul, is my service as a surgeon at a forward surgical hospital in Afghanistan.

I am the product of my rural raising in northern Middle Tennessee.  I grew up on my grandparents tobacco farm, a house that idolized the message of Jesus Christ and the example of Franklin Roosevelt.  Yet, that rural experience was rooted in the deep belief that I would rise above that existence.  It was never a choice for me whether I would go to college or not, at least where my parents were concerned.  I had a love of science from an early age, wanted to be an astronaut from as early as I can remember, and watched the Challenger explode from my home when I was sick with strep throat.  At some point, I decided, to my dentist father’s horror, that I wanted to be a physician.  He had seen that medicine was a changing landscape and didn’t want his son entering that field without a real understanding of what was in store for him.  Eventually, I settled on surgery as a career.  I had witnessed 9/11 as a medical student and in 2003, as I started residency, the invasion of Iraq occurred.  I watched the news reports of injuries and felt that I had a skill that was needed on the front lines.  My family had a long history of service to our country and I was compelled to offer my services.... as an aside, at this point, if you are familiar with the story of Ron Kovic, you know the tragedy to come, but thats a story for another time.  It didn’t hurt that my two closest friends from childhood, men whom I considered brothers, were serving as officers in the military, putting their lives on the line while I took sleepless nights of call.  So, I joined the Navy of John Paul Jones, but in 2008, when I went on active duty, I took a position caring for the Marines of John Archer Lejeune and Chesty Puller.  My life prior to deployment was a mundane day in day out life of a community general surgeon.  Yet, in the fall of 2010, I was notified that I would be deployed to Afghanistan in February of 2012.  At the time I deployed, my son was barely 18 months old, my daughters were 9 and 7.  

    I am no hero.  I did not serve with a rifle in my hand and did not put my life on the line on missions or patrols.  That was the job of the marines and sailors I cared for.  I lived at a Forward Operating Base during my deployment of seven months.  I was close, but not too close to the front lines.  If I close my eyes, I can still smell the acrid smell of the Afghanistan desert in northern Helmand Provence. In fact, there are tough days I go out to our garage and open my deployment bags to catch the smell of those moments.  

    We operated in tents.  Sterile technique was maintained but was a glorious joke.  Between sand blowing throughout the operating room and sweat from our foreheads and the sheer devastation of the wounds we cared for, there was no sibilance of sterile technique.  Sometimes temperatures pushed over 120 degrees and we still had to run heaters in the operating rooms to maintain normal body temperatures of the patients we treated. Many times it was so hot, at the end of a case I could pour sweat from my shoes. There was no such thing as “definitive” surgery at our hospital.  If you cant picture it, think M*A*S*H, except even more austere and smaller.  Our existence was one of intermittent sand storms, extreme heat, and constant casualties.  We ate glorified MREs, Unitized Group Rations,  two times a day, which were heated in a steam oven and the diversity of which were dropped by air every week.  If we were unlucky enough to have a sandstorm at the time of the air drop, well...we ate beef stew for two weeks for dinner and sausage gravy for two weeks for breakfast.  Fresh fruit and meat were a hot commodity we rarely received.  We lived imbedded with the same Marines we cared for when they were blown to pieces or shot in a firefight.  We used piss tubes and wag bags for our excrement and solar showers when our well pump crapped the bed.  It was a daily existence most Americans can only imagine, but it was one we lived daily and I would do it all again in a heartbeat.

    The first casualty I cared for was an Afghan policeman, injured in a firefight.  Nothing major, an extremity gunshot wound that we debrided and sent on to a higher level of care.  That was my first day, mere hours after landing at my temporary home.  Less than a week later, we had our first multiple amputee.  I was sleeping in my tent and a corpsman who had been on duty in the CoC, our communications center, came rushing into our tent to say that a triple amputee would be arriving at our base in ten minutes.  
    The night in Afghanistan can be so dark that you literally cannot see your hand in front of your face.  That night, we had a full moon and I had no problems seeing my way to the conglomeration of tents that made up our hospital.  When the young marine arrived, our corpsmen nearly dropped him off the stretcher from the medivac helicopter.  You see, a man who has only one of four limbs throws off the normal weight and balance of a stretcher.
    That Marine had lost so much blood he looked like pure cotton.  He had been fighting for his life during his evacuation.  He looked up and an expression of recognition came over his face.  He knew that he was amongst American medical personnel and he knew he was safe.  At that moment, his head dropped to the stretcher and he coded.  His heart stopped and he died on that table.  In that moment, we moved him into the operating room and immediately started resuscitating him.  I opened his abdomen and put a large clamp on the abdominal aorta.  Both legs had been severed at  the hip and his right arm was shredded, all that remained was his upper arm and the skin that had covered his forearm and hand. The skin that hung like a rag doll looked like it had been peeled off of his missing hand down to the finger tips, hanging limply on the stretcher with piece of bone still attached to the subcutaneous tissue.  What remained of his legs were bloody, muddy stumps of shredded meat that were quickly taking his life.  After anesthesia had successfully gotten back a pulse, we moved our clamps down to the individual arteries supplying the leg stumps.  We closed his abdomen with a temporary abdominal closure and sent him out to the next higher level of care.  The young man required massive blood transfusions along the way, and ultimately made it back to the United States.  He died of an injury he sustained to his brain from the IED blast, not from his extremity injuries. However, thankfully, he did not succumb  before his family was able to be with him and say their goodbyes.

    Over the course of the next few months, we cared for multiple Marines who sustained similar injuries.  We got very good at treating these young men and may of them ultimately survived.  One of the things that struck me during this time, we would see these young men leaving in convoys for missions.  They were strapping, armed to the hilt, and “hard core Marines”.  To a man, once they were injured, they immediately became their age.  19 year olds can only act hard and fearless for so long.  Take a man, blow him up, and he is transformed into the child who has hidden behind the mask of strength and heroism.  

    Yet, we didn’t just treat Marines or NATO forces.  Many of those we treated were Afghan nationals.  We treated young and old alike, with no question of their political allegiances.  We treated young men shot by snipers who had endemic round worms crawling out of their abdominal wounds. Young children ripped apart by IEDs, for the crime of playing in their own fields.  Old people ripped asunder by bullets in a marketplace, being caught in the crossfire.  I am haunted by what ultimately came of most of those patients.  Are they alive? Dead? What ramifications are they dealing with in their daily lives?  I am haunted by the 18 month old boy, the size of my own son at the time, that I fought to save who died on my table from a single gunshot wound.  I am haunted by the young Marines we were able to send off and made it out of the country and whether they lived or died.  While I can tell you that our survival rate for trauma increased significantly while we were there, I can’t tell you what happened to most of our patients long term.  I grieve for the parents and families of the service members who died, either under my care or afterward, but especially for those who I was the last to touch prior to being placed into a plain black bag.  One such case was a young man who was treating a marine for a superficial injury and stopped to wipe the sweat off his forehead, a fatal mistake.  A sniper used the opportunity of the pushed back kevlar helmet to shoot him in the head.  He was brought to us with a slight pulse, only moments before he was in cardiac arrest.  I opened his chest in the failed attempt to keep him alive.  I held his young heart in my hand as he died.  After the deployment, I attended the memorial service for his unit and met his parents.  I didn’t have the heart to tell them who I was or why I was there.  Maybe it was guilt over the fact that when their son was brought to me, I was enjoying an evening cigar on our flight line. Or maybe, it was the fact that I didn’t have the courage to look them in the eyes and say “I took care of your son, and I couldn’t save him”

   During my seven months, I performed nearly 150 major operative cases.  There were days that I operated so much, I could literally smell the blood on my hands.  To this day, there are moments that I’m taken back to that sweltering tent and smell my hands...knowing they are clean, but still smelling that sickly sweet smell of blood.

   When I came home, my son didn’t know who I was, my oldest daughter was ambivalent to the entire deployment and her biggest issue was that I had lost “too much weight”.  My middle child was the most touched by the whole process and asked questions that were more pointed and thoughtful than most adults.  

    Truth is, I came home and had been changed irrevocably.  I was no longer the same person.  Those who had not been touched by deployment, expected me to return and be the same as before.  Even my wife, for whom life had gone on even though I was gone, had only a single comment:  “You need to check your language.  Your filter is off.” To this day, I’m not sure she truly gets how much deployment affected me, despite her genuine attempts to understand.

    Since returning in September 2011, I have both forged stronger bonds with those I deployed with, and built barriers to those who don’t understand what we experienced in Afghanistan.  I served for two more years on active duty, completing my obligated service.  When my time was up, I ran from the Navy, because I thought civilian life offered the better opportunity.  The reality is, I am running from my post deployment self.

    Since my deployment, I’ve suffered from fitful sleep, sometimes so bad my wife wakes up and sleeps in our extra bedroom.  She never has asked many in depth questions about what I experienced and what she does know usually only comes out of my mouth during nights of heavy Jack Daniels therapy.  It is during these moments that I know I am not alone.  So many young people of this generation suffer from far worse issues related to their military service than I do.  I get to live the comfortable civilian lifestyle now, but not a day goes by that I don’t wish to return to active duty.  I miss the comaraderie and the acceptance I received by those I served with.  I struggle daily with the transition to civilian life and the feeling that I am a cog in a wheel.  Yet, even in my darkest hours, I know there are far more fellow service members who are suffering far worse.
  We have an entire generation of young men who have suffered the horrors of war.  They were a totally volunteer service who has returned home to an indifferent country and two wars that are now viewed as mistakes.  When I am around others who served in Afghanistan or Iraq, I feel an instant connection that cannot be explained.  We share stories, we connect on common experiences, we understand each other.  When I speak to non-service members, the theme is either “what a waste” or a total lack of understanding; for example, one person actually ask me if I had been in Afghanistan with “Doctors Without Borders” because they had no idea that there were military medical providers.  As for the former, I would say..Was it a waste that those young people answered the call and rose up and went and did what was ask of them? Was it a waste that I spent  7 months in what most would consider a third world hell to care for the injured and dying?  Was it a waste for a young man to lay down his life caring for a senior marine?  It is easy for those who have not experienced such atrocities to sit in the safety of their home and media studios and call the sacrifices of this generation a “waste”.  We owe it to these young men and women to give back as much as we can to care for the scars of war.  If what I contributed was “a waste”, I couldn’t imagine a better way to “waste” my life.

3:35 PM PT: I can't thank all of you enough for your amazing replies and encouragement.  Finding myself on the rec list after finishing work was pretty incredible.  I did want to clarify a few things.  First, my wife has been amazingly supportive throughout my whole post deployment period.  She has an incredible knack for keeping me grounded and keeping the demons at bay.  I should have elaborated on her support. Second, I've been seeing a great therapist who has given me some great tools to dealing with these issues without medications, thankfully, at this point.  Finally, once again thank you guys for your receptiveness to this diary.  You guys are phenomenal

3:35 PM PT: I can't thank all of you enough for your amazing replies and encouragement.  Finding myself on the rec list after finishing work was pretty incredible.  I did want to clarify a few things.  First, my wife has been amazingly supportive throughout my whole post deployment period.  She has an incredible knack for keeping me grounded and keeping the demons at bay.  I should have elaborated on her support. Second, I've been seeing a great therapist who has given me some great tools to dealing with these issues without medications, thankfully, at this point.  Finally, once again thank you guys for your receptiveness to this diary.  You guys are phenomenal

Originally posted to docreed2003 on Fri Mar 14, 2014 at 05:00 AM PDT.

Also republished by IGTNT Advisory Group, DKos Military Veterans, Military Community Members of Daily Kos, Three Star Kossacks, and Community Spotlight.

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