Afghanistan

 I wanted to go.

For the first time, I felt like I was actually doing what I signed up for—what I trained for. It was my choice. My duty. The timing was both terrible and perfect. Terrible because it gave me a way to avoid dealing with my brother’s death. Perfect because it gave me something to focus on.

Pre-deployment workups pulled me out of the hospital grind, which—honestly—I wouldn’t have handled well anyway. Grief and patient care don’t mix. Instead, I buried myself in training: briefings, physicals, paperwork, online modules… and then repeated the entire process because someone lost my deployment folder.

Rookie mistake. Always make copies. Lots of copies.

Training

 I was sent to a trauma hospital in Los Angeles for experience. Turns out, civilian trauma in LA is about as close as you can get to battlefield prep without a battlefield.

It was also where I met most of my team. Deployment medicine is basically a random draft. People pulled from hospitals all over the world, thrown together, and expected to function like a well-oiled machine.

After that was field medical training. A simulated battle environment where you put tourniquets on mannequins and actors, then hump them up a hill on a litter to a fake helicopter. Great way to see who’s in shape. Even better way to bond by talking shit about who’s not.

Then it was off to weapons training at Fort Jackson Army base on the East Coast. This was also great people watching. The only medical personnel with muzzle discipline were those who had deployed before and people from the south. Personally, I was in my element. I used to be Rambo after all.

The Flight In

Finally, we boarded the plane. Strapped into seats along the sides of a C130 with all our gear on pallets in the middle. (Were we strapped in? I honestly can’t remember. Wouldn’t have made a difference.) There aren’t any windows to look out of. Just hanging out in a big metal tube flying into the unknown. I love that part. Until the combat landing, where you basically drop straight out of the sky and pray to whatever god you used to believe in that the pilot has skills and any rocket dudes in the mountains don’t. Ok, I actually enjoyed that part too.

Welcome to Kandahar

Our indoc briefing was held in front of a wall riddled with bullet holes. The Alamo. Taliban’s Last Stand. Maybe they were trying to make a point of the seriousness of our situation, or maybe it was just because there was no conference room. Either way, it made an impression.

One of the first things we were told to be aware of was a minaret just outside the wire, overlooking the hospital, that had previously been used as a sniper tower to kill medical personnel. The minaret could have then been considered a legal target and destroyed. Of course we did not destroy it. Afraid to be seen destroying a religious structure, I suppose.

So, every day we walked to the hospital, looking for snipers in the minaret. That thing made me angry every single day. Still does, when I picture it.

The Job

There’s an interesting contradiction in combat medicine: You’re excited to do your job. But your job exists because people are getting injured. That contradiction is always in the back of your mind.

Getting a mass casualty page was a strange mix of adrenaline and dread. When the call came, I ran to the trauma bay, which quickly filled with surgeons, nurses, corpsmen, lab, admin. Everyone in position. And then—silence. When the ambulances arrived, it was quiet. Not calm. Controlled. No noise. No chaos. Just movement. Precision.

I remember the first time I prepped a patient from an IED blast with bilateral leg amputations for surgery. I’m trying, and failing, to hold the pieces of flesh together to clean it with Betadine. The surgeon said, just hold the end of the femur (which was intact). Oh. Ok. Just hold the femur. Just reach in there and grab the femur. I’m laughing now at my virgin self, but it wasn’t funny then. Looking at bits of leg afraid to touch it because I might make it worse. I might hurt it somehow when it’s already as bad as it gets. Hold the femur, Betadine everywhere. Just all the Betadine. Betadine and get the hell out of the way. Got it.

Trauma ORs are hot because prevention of hypothermia is critical. We turn off the heat as soon as the operation is over. The rooms were usually covered in blood and betadine after a trauma. Walls, floor, all the parts of the bed, and equipment, including the wheel casters. Fucking wheel casters. It took forever to clean up. When the blood got cold, it had that smell. That cold metallic smell that will stay with me forever. Just like my brother’s house.

The Ones That Stay

In my first week, there was a procession on the flightline for a Romanian soldier who died. Pretty much everyone was crying in formation. It’s chilling to watch a flag-draped coffin enter a cargo plane. And that was for someone we didn’t even know. After that, I didn’t attend any more processions. I stayed in the OR and cleaned up the blood. Weirdly, that was easier.

In terms of the quantity of casualties, our numbers were low relative to the rotations before us. But it doesn’t matter, either for the medical team, or the teammates of the fallen. We all have at least one patient, one person, one incident, that stuck with us. I have two.

One was a double amputee I treated multiple times. I still see his face. Defeated. Scared. Like he was wondering what was going to happen after he left, and if it would be worth it. Maybe I’m projecting those things from my own feelings. But his face, that look, is a permanent fixture in my mind. Not in a menacing way like some others I see. He shows up in my head at random moments. Usually when I’m being lazy. Like when I don’t feel like doing squats or don’t want to take the stairs. And my brain goes: Yeah, I bet he’d love that option.

The other was a gunshot wound to the head. Non-survivable. We took him to the ICU for his friends to say goodbye. Before we left the OR, we cleaned him up and bandaged his head. The surgeon was combing the blood and debris from his hair. I just stood there watching him, in a fog. I wasn’t in Afghanistan anymore. I was in the viewing room at the funeral home, looking at my brother lying there with the towel covering the missing part of his head. I felt weak. The surgeon asked for the bandage, and I didn’t even hear him. I snapped out of it when the anesthesiologist handed it to him. Oh, right, that’s me. Kandahar. Back to work.

The Surreal

Even the normal things had an air of the surreal. Like a sandy Twilight Zone. It was all relatively safe, and yet it wasn’t. We had athletic events outside, like 10K runs. We experienced inaccurate rocket attacks that interrupted soccer games, but didn’t actually hurt anyone. With a siren and this lovely British voice in the background saying, “Rocket…attack, rocket…attack.” This got funnier and weirder the longer we were there. I still hear “rocket…attack” when I hear a tornado siren back home.

We were told the mountains around us harbored snipers, but we had to wear glow belts. Some people chose to wear them as a sash across their chest as if to present the best possible opportunity. Just in case the snipers needed help.

We slept in a barracks which could nearly be mistaken for a college dorm room, except that there was no alcohol and we were segregated by gender. I had a small refrigerator in mine. One night, a bottle of Perrier froze and exploded. I jumped out of bed and hit the deck immediately. I don’t think I’ve ever moved that fast before or since.

There were Girl Scout cookies everywhere. People sent them in care packages. They filled the closets in the hospital and the USO. I still can’t eat Girl Scout cookies.

There were pallets of bottled water everywhere, but you had to squeeze the bottle to make sure it was sealed and hadn’t been tampered with. Took me years to break that habit. Squeezing bottles in the gas station in California, then looking to see if anyone caught me.

One night, we were playing Cards Against Humanity with a deck we found in the USO. These cards had been passed around for years, and the blank ones had some pretty interesting things written in. The chaplain sat down at our table, trying to be one of the guys, as chaplains do. Someone had to explain the term “pixilated bukkake” to him. (The answer to, “What’s the worst thing about deployment?”) He didn’t sit with us anymore after that.

We had internet access, but it wasn’t streaming quality. Once, a bunch of us girls gathered in my room to try to watch Magic Mike on Amazon, but it just kept freezing. Pixilated indeed.

I didn’t really sleep, which added to the fog. We were always on call, of course, but we’d rotate doing in-house call, sleeping in a call room (closet) in the hospital. We’d often treat prisoners. So I’d be sleeping in the call room while these guys were next door in the ICU. Under guard, of course, but it was still unnerving. Treating detainees is its own level of surreal. Keeping someone alive who would likely kill you if given the chance is a difficult paradox to tolerate. This wouldn’t be the last time I experienced this.

The whole experience was basically months of boredom punctuated with some nights by beeping pagers, blood, and adrenaline. And a generalized sentiment of what the fuck just happened? Like I said, we were never inundated with casualties, never overrun, and the only thing that blew up in my direct vicinity was a bottle of sparkling water.

So you can understand why I’d be confused about my extended, ten-year trauma response. I could not understand why I was so stuck.