Another interesting day in the Brown Zone.

The first step out of my door on each day this week has reminded me that, the mild weather of my first month notwithstanding, it is going to be very, very hot this summer. The overwhelming heat pounds me the second I go outside of my air-conditioned, 22 degrees Celsius cocoon. By midday, the weather is intolerable. I keep reminding myself that this is April, and that the peak temperatures (July-August) are still months away.

In the middle of our morning clinic, we had another blackout, and had to finish up with our patients in the dark. The TMC ended up being out of commission for about an hour, during which we sent SGT Evans over to make arrangements for a backup generator to be installed in our building. When, in the military, one makes a huge request like this, there are four possible things that will happen:

1. The person to whom the request is directed will laugh or nod politely. Either way the message is clear: Not Gonna Happen.
2. The requestee will actually get angry (either at the audacity, or the waste of time).
3. The requestor will be told, blithely, that the request has been granted, and will be given the usual reams of paperwork to fill out. He/she will complete said paperwork, and turn it in. About three months and 180 phone calls later, all hope will be abandoned.
4. The item will show up on the requestor’s doorstep, as if by miracle, within a few days of the request.

SGT Evans is our own Radar O’Reilly (although he sadly has no idea whatsoever who Radar is), and so he may just pull this one off, but right now, we really don’t know whether option #3 or #4 is in play.

In the afternoon, we had a huge group of patients who needed “LOD” assessments to be done. These amounts to a lot of medical paperwork which is done to document for a given soldier that he developed a medical problem during (and perhaps as a consequence of) his deployment. All well and good, you say, and I agree with you: a soldier who is injured in the course of his/her soldiering should, indeed, get medical and/or financial recompense from the government. Sadly, a few soldiers (a great minority, and almost never active duty personnel) use these LODs to try to extract every last dime out of Uncle Sam. I have had people request LODs for (I kid you not) hemorrhoids, heartburn, rashes that just popped up the week before, etcetera. One proud fellow claimed eight different issues (mostly musculoskeletal) which just happened to pop up during his six months of deployment, and of course had nothing whasoever to do with the fact that he is 54 years old and 50 pounds overweight. I am waiting for a soldier to attempt to claim an STD as a compensable medical problem; I’m sure it’s coming soon.

After seeing twenty-four of these LODs, my afternoon was capped off with a sadly interesting case: a very young kid who had driven his vehicle over an IED during a convoy two days before, and had been knocked out by the force of the explosion, which destroyed his vehicle. Happily, he had no penetrating trauma (thanks in great part, I am sure to the new-fangled protective devices built into many of our armoured trucks). He had been assessed elsewhere initially, and was sent home with Tylenol and the knowledge that his CT scan was negative.

He came to our clinic today complaining that he has had a headache since the event, and just did not feel right. On my exam, he had lost the ability to furrow his brow on the right side (sounds funny when I say it like that, but this is one of the tests for damage to a cranial nerve, or to the organ from which those nerves originate, the brain). He also had a slight but definite ptosis (drooping of the eyelids), also on the right side only. Finally, he had a very flattened affect, fancy doctor way of saying that he spoke in a monotone and barely looked up, as if he were hung over or morbidly depressed. These findings combined with the history of head trauma and the lack of resolution of his headache led me to believe that something more serious may be going on. We have no lab or x-rays in our clinic, and so we asked the ambulance people to help us out, and I personally delivered him to the Emergency Room at the CSH, and when our trauma guy took a look at him, he made the immediate decision to air-evac him out of theater, to get an MRI tonight.

Traumatic brain injuries (or TBIs) are a leading cause of evacuation out of theater, and often it is the lesser injuries that end up causing more long-term problems. This is because if a CT scan shows a massive subdural hematoma, it will be properly managed, and the patient carefully followed until resolution of the problem. But some of the mild injuries, which do not show up on CT, but cause persistent symptoms, can go un-diagnosed for a long time. The military has taken an aggressive stance on TBIs (and NTBIs, as well) and we all attempt to be very proactive. I would rather that this ends up being much ado about nothing and that his symptoms are simply from post-traumatic muscle spasm which will resolve neatly on its own. But there is a saying in medicine: if a doctor has positive findings every time he orders a brain MRI, he isn’t ordering nearly enough of them.

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Post-script: I made another rare trip to dinner tonight (I usually eat a PB and crackers or Hormel chicken salad at home, to spare a few calories and give me some time to write). So, guess what those aforementioned, evil, money-grubbing-Cheney-hugging faceless corporate fatcats at KBR fed your Multinational Forces tonight?

WRONG AGAIN! The crab legs were last week!

Tonight, we had surf-and-turf: a t-bone steak (a good one, medium rare, just right), plus tempura shrimp, but wait for the clincher. To top it all off, we were served

(duh duh duh DUH)

Martinelli’s Sparkling Cider!

Again, I would not joke a joker (nor a smoker, nor even a midnight toker). We had Martinelli’s Sparkling Cockamamie Cider! The grape kind! All you can slurp! And, apparently, all I can exclamate!

Admit, don’t you sorta wish you were here right now, living in a plastic Barbie house surrounded by dust, insects with teeth, and people who are actively trying to kill you? It’s worth it, if only for the sparkling cider, don’t you think?!? Bet you can’t find that in your local Safeway. (By the way: if you do find it in your local Safeway, can you send me some more? I don’t think I can go back to the Saudi cola now.)