Thanksgiving Greetings

I have started writing down little notes to myself of things that I think might be interesting to write about.  Sometimes as I prepare to write these emails I think, . . . uh nothing really different happened this week.  I often forget to mention things that are super common but might be interesting to know about if you have never been deployed or in the military.  This week my list looked like this:
                                                          Water/Smoke
                                                           Letters
                                                           Rockets
                                                           Home teacher shelves
                                                           Parable of the girl
So about water,  I previously included a photo of the trucks that drive around base pumping out the septic tanks that with 50000 people regularly need emptying.  There are trucks labeled clean water, grey water and black water.  None of the water on base that comes out of the taps is potable.  You can shower in it and brush your teeth with it but we are repeatedly warned to never drink it.  Someone also told me never get it in your eyes.  I didn't ask questions but I can tell you I keep my eyes tight shut in the shower.  So the grey water is the water that goes down the drains in the sinks and showers. Black water is the water that goes down the toilets.  If you are ever walking down the street near a black water truck and you have gum in your mouth just spit it out because if you don't it will have a new flavor after you walk by and it is not a flavor you would want to be chewing on.  The black water trucks drive their loads to a big burn pit where they are emptied into hug trenches.  After a few days the water has dried up and the leftovers are burned along with all of our other garbage.  On burn days depending on the direction of the wind the air may be filled with a ghastly smelling smoke.  I have been assured that there are no long term detrimental health effects to breathing poop smoke but then again these are the guys that lined submarines with asbestos.
    Letters.  When we receive our mail and have read the letters and emptied the boxes we have to 'sanitize'  them.  This means that you have to cut out the sender and receiver address labels and shred them and then burn them at the same burn pit the poop is burned in.  The idea is that you do not want the addresses of loved ones getting into the wrong hands.  Our garbage is handled by the local nationals and there is ample evidence that they routinely go through it.  I doubt that most of them are looking for addresses but I wanted to assure everyone out there that I properly sanitize all of my mail so write away.
    Rockets.  Yesterday at about 5:45 am my pager went off along with all the other pagers in our room.  The message read "IDF attack, take cover", this page was followed by the loud voice outside saying the same thing.  We rolled out of bed and got on our bellies.  We lay there for about 10 minutes while rocket after rocket hit the ground with a loud rumble.  All in all there were 10 rockets that hit somewhere on the base but none hit anything important and there were no injuries.  My main purpose in recounting this story is not to scare anyone but to make a point.  Once the active rocketing was over essential personnel have to report to their stations in the hospital to prepare for incoming casualties.  As an aside, I have always taken casualty to be a death but in the military any injury however minor as a result of an attack is a casualty. Anyway, we line up at the dorm building and are released in groups of five to run across the street and into the hospital.  I have talked about rocket attacks before.  It is a fairly routine occurrence.  The protocol is that you put on your body armor including your helmet before going outside.  I was surprised that about one in five people were wearing the PT uniform which is a sweat suit and nothing else.  I think that because this happens so often they have just become desensitized to the danger that exists.  They have decided not to put on their armor, reasoning that nearly always the rockets don't come close to hurting anyone.  Such was the case about a month before I got here when a rocket hit a bus stop.  Five people ignored the warning to take cover and three were killed.  In war and in life we can never forget that someone is out there looking for an opportunity to take your life whether spiritual or physical.  You can never let down your guard or leave your armor at home.  Do the little things and the big things will take care of themselves.  P.S. IDF stands for Indirect Fire.
     Home Teacher Shelves.  When we moved from Utah to San Antonio, my dad and two oldest brothers came to help drive the trucks and move us in.  We built some shelves in the garage to hold tools and camping stuff.  About two weeks after I deployed to Afghanistan I received a text from my wife. It went something like this:
---Your car has another dent in the hood.  (Last year I was in the garage trying to pull a cast iron dutch oven off the shelf and it fell 8 feet onto my new car's hood.)  The shelves in the garage fell down any your tool box landed on it.
   Most of you know that after daylight savings I am 10.5 hours ahead of Central time in the states.  When I got the message I called Cami to figure out what we could do to fix the problem.  By the time I got a hold of her our incredible home teacher, Alan Nelson, had come over and not only fixed the shelves but made them bionic.  As we enter this season of gratitude I recalled this experience.  It will ever be part of my testimony of the home teaching program of the church.  For those unfamiliar with what this is, in the LDS church each family is typically assigned two individuals who watch over that family.  They make a monthly visit, share a spiritual message and assess the needs of the family.  This is how the Lord uses others to shepherd his sheep.  I am grateful to Alan and the other great people that have looked after the needs of my family not only while I am here but always.
     The parable of the girl. I shared this experience with a couple of people earlier this week but it has stuck with me and I wanted to share it with everyone.  There was an eight year old girl brought in to the hospital by her grandfather for surgery on a tumor behind her right ear. It started out as a small minor infection easily treated in the states.  Left untreated the infection had spread and festered and created a huge mass which needed to be surgically removed.  It was obvious that she did not want to be there. She clung to her grandfather and would not let him go. When it became clear to her that there was no escaping being separated from him she made a desperate bid for freedom and leaped off of the gurney she was sitting on. The interpreter caught her and carried her writhing tiny frame into the operating room. This little girl was filthy. The kind of dirty that doesn't come off when you wipe the skin, dirt that is caked layers deep. It looked as though she was several months out from having her head shaved from an uncontrolled lice infestation. She thrashed and kicked as many of us tried to calm her down. She screamed in Dari, the dialect they speak here, "I don't want to have surgery, I just want my grandfather, I just want my grandfather!" We had no choice but to place the anesthesia mask over her face and allow her to scream and gulp down the anesthesia gas. As three of us held her down to keep her from hurting herself, she looked frantically around for eyes in which she could find solace. She didn't find any. She shook with great wracking sobs. Within seconds she was asleep. As primitively as these people live and as archaic as we find some of their customs there are strong bonds of love that connect these people together. This little girl found comfort and safety in the arms of this wise old man who had been there for her throughout her life.

As I looked at her tiny body now limp I thought of myself.  Of the tiny course alterations I have made from the strait and narrow path, things that could have easily been corrected at the outset and made right.  Left untreated they fester into character traits opposite those of God.  They become festering pustules of sin that cause us and those around us incredible pain and suffering.  We fight against the physician of our souls who knows what we need and that it will be painful but in the long term it will free us from the suffering and pain. Sometimes we kick and scream our way through life thrashing around resisting the very thing that will heal us. God is good and patient and loving. We can find safety, confidence and trust in His ever extended arms. Sometimes we just have to stop fighting and look for His face, I promise you that it is ALWAYS there.

     This Thanksgiving season I pray that you will each find yourselves surrounded by those you love.  List freedom from tyranny and oppression among your blessing.  Thank God for shoes for your feet and bread on your table.  I have been exceedingly humbled by the conditions I have witnessed here.  The poorest of the poor in America has more than 95% of the rest of the world.  It is easy to focus on that which we lack but when our hearts are full of gratitude life is better, brighter and filled with God's love.  I love you all.  Each of you will be on my mind as I thank God for my blessings.  I have so much.  

A Whole New World

     Since arriving in Afghanistan I have been reminded over and over about the fact that I am not in Kansas anymore.  Having served a mission in South America I know that different cultures have different customs and beliefs.  However, I have never experienced the differences I have seen here.   Life in Afghanistan is about survival, about living day to day.  The majority of people here live in mud or adobe huts with no running water or electricity.  Personal hygiene is non-existent.  The Afghans toil for their daily survival. In general they have no concept of time.  No one knows how old they are, how tall they are or how much they weigh.  Birthdays are not celebrated.  All holidays are religious.  There are many things about the American way of living that the locals find totally crazy.  The fact that we run for exercise is something they have no concept of and don’t understand.

     We have to do physical assessments on the patients that come in to have surgery.  The first thing we ask is how old they are.  This question is always followed by a blank stare.  They usually associate their age to some local historical event.  Most people say they are a lot younger than they look.  Most children are extremely small for their age and are malnourished.  The infant and maternal death rate is very high.  Death is something that is ever present and the people tend to readily accept the death of loved ones as God’s will.   Often we will treat children with burns or cleft palates and get them to the point where they are ready to go home.  The families are usually overwhelmed by the requirements of special needs children and will typically allow them to starve to death or in many cases they will shoot them.  This is completely crazy for us to consider but to them it is about survival and anything that threatens their ability to survive is eliminated.  There are no social programs, no government assistance that will come to these families’s aid, they are on their own. 

     We ask people about their general health and about their exercise tolerance to get an idea of their cardiac status.  The stark majority of these people have never seen a doctor in their lives and as explained before they have no concept of exercise.  We have to adjust our questions to things that make sense to them.  Instead of asking about exercise we ask about how far they can walk.  We ask about where they have pain and what their diet is like.  Often they have underlying disease states that have gone untreated for years.  Just the other day we had a patient with horrible diabetic foot ulcers.  Our orthopedic surgeons scheduled him to have both of his legs amputated below the knee.  The patient looked at them and said that he would rather just go home and die.  As I said it is a whole new world.

     I may have mentioned in previous emails that the fighting season is supposed to end with the onset of the cold weather.  It has cooled down but winter has not yet arrived.  The fighting seems to be getting more intense not less.  This past week we had patients come in from two separate IED blasts and yesterday had a convoy that was ambushed and several soldiers had some non-lethal gunshot wounds.  When American soldiers are injured we stabilize them and then ship them to Germany and from there they go to my hospital in San Antonio.  When they are Afghan troops that are injured we treat them here until they are pretty recovered and then send them to the Afghan hospital.    

     So I wanted to end this week’s email by talking about dog tags.  Every soldier in the deployed setting is required to wear a set of aluminum identification tags referred to as dog tags.  If ever there is a situation where a soldier’s life is lost the tags identify the soldier.  There are also religious emblem tags that people wear.  The LDS church created a tag that you can see in the photos on the blog.  When I first received my dog tags I had a thought.  This little piece of metal identifies who I am.  The first line is my birth name.  It identifies me as a member of the Rush family.  This is the name given me at birth by my parents.  Interestingly enough the next line is my social security number.  This number is also assigned to me at birth.  It identifies me as a US citizen and is linked to my net worth.  It is a representation of my value to society, how much I contribute into the system.  The last line is my religious preference.  On my tags it says Mormon.  The religious emblem on my tags is the temple.  I also found this to be pretty significant.  The last line shows what I believe, who I am spiritually, whose I am.  We each come from an earthly family.  Those of us who work in the US have a social security number, however; nothing gives us more worth than recognizing that we are God’s own children.  This simple truth is more important than the family we were or were not born into or our net worth.  Being a child of God gives us infinite and eternal worth and the most important thing to realize is that every living soul has the same value to God.  I am grateful for life and liberty, for my family, for agency and the atonement.  Life is so simple, don’t be fooled by the easiness of the way (Alma 37:46).  Love you all.

These are my dog tags.  I covered up my social so that I could post ithem on the internet.

This is the religious emblem that the church gives LDS service members

My new boots.

They are super comfortable and no more foot pain.

I flew this flag in my operating room on Veteran's Day.

One of the most beautiful sights a deployed soldier can see.  A special thanks to all those who have taken the time to write and send care packages.  They are so appreciated!  Since my last post multiple people have offered to send me toilet paper from the states.  While I could probably make some good money selling it, it really isn't realistic as I have no where to store it and I would have to tote it around with me every where I go.  Besides, once I develop some callouses it will be a mute point.  Thanks for the concern!

Potty Talk

Many people have written emails asking questions about every day life here in Bagram.  I am dedicating the majority of this weeks post to answering those questions.

Do you have community showers?

Luckily we do have private showers.  Each bathroom has four showers and there are two bathrooms on our floor.  So there are eight showers for roughly 140 men.   To conserve time and hot water there is a combat shower rule. The picture is worth a thousand words, mold and all.  The showers are alright but shower shoes are a must!  I am not sure that sitting on the wooden bench with your naked behind would be a good idea either.

Splinters are the least of your concerns if you sit on this bench.

Do you have normal bathrooms?

To borrow wording from our politicians, it depends on what you mean by normal.   Afghan toilets are a cross between the Asian hole in the ground you squat over and the regular American toilet.  They are about 14 inches off the ground so you end up in a modified upright birthing position.  There have been days after doing lower body workouts that I almost needed to call for backup to extricate myself from the throne.   They are very low and if you can’t complete your business in less than three minutes you can guarantee numb legs when you stand up. 

   One of the most offensive gestures in Afghanistan and in many places in this part of the world is to offer someone your left hand.  If young children show left hand dominance they are trained to use only their right hand. The left hand is considered the dirty hand.  Why you ask?  Well, it is used to clean one’s self after using the bathroom.  Why would anyone do that?  I asked myself this question when I first learned about this . . . . and then I tried Afghan toilet paper.  There are two types that I have encountered. The first is two-ply heavy duty 100% recycled tree bark that removes not only what ails you but several layers of skin to boot.  If I ever get a cold and blow my nose repeatedly with this stuff I will come home with a nose like Michael Jackson.  The second type is of the crepe paper variety 5/8-ply that ends up creating more dreadlocks than doing any good, most of the time you end up using your hand after completing the first stroke anyway.  Given these two options it is no wonder the locals just cut out the middle man and use their hand.   It is a small wonder that they sell baby wipes at the base store and they can’t seem to keep them in stock. 

How low can you go?!

Don't let the English writing fool you this stuff is horrible!

What is the food like?

   You can imagine that cooking for 50,000 people would be challenging.  There is usually food anytime you want it and usually as much of it as you can eat that being said usually one plate is more than enough.  There are five different DFACs, which is military for dining facilities.  Some people swear that some are better than others but I have yet to notice a significant difference.  For breakfast you can get powdered eggs made any way you like as long as it is scrabbled.  You also can eat as many hard boiled eggs as you would like, just plan on 90% of the egg white coming off with the shell.  You can always get turkey sausage, bacon, and biscuits with deep fried hash browns and your choice of oatmeal or grits.  They do have soy milk which is what I normally go for because the ‘cow’s milk’ is that long shelf life milk. Woof!  They usually have a pretty good selection of breakfast cereal and fruit too.

   Lunch typically looks a lot like what you had for dinner the previous day with a poor disguise.  Typically it will be a beef or lamb dish, some variety of chicken, instant mashed potatoes, a veggie, and salad with your choice of light Ranch or French dressing. 

   Dinner is the most variable although it varies in predictable ways.  Some nights you can get lasagna or spaghetti with stale toasted hot dog buns with a sprinkling of garlic powder.  Every Friday is steak and shrimp night.  I am told it used to be steak and lobster night but with the budget cuts . . . you know.   Sunday night is usually French toast night with a mystery topping.  I have had strawberries foster and have heard of bananas foster.  You can usually count on some sort of pie and some pretty good ice cream for dessert.  Occasionally they will prepare an Afghan dish and those are typically my favorite.  All in all the food is very good albeit lacking in variety.    

You are required to wash your hands before every meal, not a bad idea.

Fresh fruits and veggies are always available, they aren't always ripe but they are available.

Buckets-o-chicken

Making the rounds. 

This was one of the Afghan dishes that was pretty tasty.  Most of you know I don't eat much meat so it has to be good for me to eat it.  This rice dish had lamb in it.

My soy milk, cabbage and leftover surprise. Our typical lunch fare.

This is actually what I had for dinner tonight.  It is Sunday so we had French Toast Bananas Foster style  plus rice and red beans, asparagus, and potatoes.  Nice medley of flavors.

  

What is your schedule like?

   We have been ordered by the wing general to work 84 hours a week.  This means that you work a twelve hour shift every day or you do a 24 hour shift once a week and get the following day off.  We do the latter.  Our shifts go from 6:30am-6:30pm.  There are two anesthesia providers that cover the night shift.  Four of us are on during the day.  Usually there are between 0-6 scheduled cases each day divided between our three rooms.  You also have the potential to get trauma patients at any time.  Patients that are too complex for the smaller surrounding hospitals also come to us.  I would say that about 80% of our patients are local nationals.  We spend a lot of time during the day sitting in our small office watching TV, reading, listening to music or watching movies.  If nothing is going on we are allowed to leave the hospital for short intervals and run get a haircut or pick up something from the base store.  When our shift is over we can go work out or go to exercise classes.  If you are feeling particularly daring they have salsa dance classes, country western classes, ping pong or chess tournaments.  There are several movie theaters on base where you can watch pretty new movies.  I typically go to bed at about 9:30 so I can be up at 4:45.

This is the anesthesia office.  We had an early morning mortar attack and we all had to report in and wait for the all clear.

There is a set of bunk beds in our office for the night shift.

This is our med room in the office.

A game of Risk during some down time.  This is the hall in front of the ORs.

This is the Afghan Baazar.  It is a lousy picture. There are booths of crafts and local wares.

Walking around the hospital I discovered where they keep the search and rescue vehicles.  Certainly no messing around in this puppy.

There is a gazebo on the hospital roof where you can see the surrounding base and the mountains.  The mountain in the right side of the picture is 20,000 ft high.  

Closer shot of the mountains.

Air Rescue helicopters next door.

The flight line.

They have these huge trucks that come and pump out the septic tanks and then they burn the waste.  Pretty smelly any time you walk past them.

    

What is the church like?

   I am a member of the Kabul Afghanistan Military District.  I attend the Bagram Afghanistan Branch.  There is a chapel on base where we have our meetings.  There are two different times for sacrament meeting to accommodate all schedules, a 10am and 8pm meeting.  There is a branch president that is an American civilian contractor and both of his counselors are active duty military members.  I typically attend the 8pm meeting and there are between 25-30 regulars.  I am told there is at least double that during the morning meeting.  There are members from all over.  We have a sacrament meeting with one speaker and then have a Sunday school lesson.  On Monday’s there is a FHE group that meets.  There is a very special feeling in the meetings I have attended.  It is cool and amazing to think that the church has branches in the Middle East.  There are lots of opportunities to serve and get involved.  I am speaking on the life of Christ the week of Christmas.  I am looking forward to talking about the life of the Savior while I am living as close as I am likely to be to where He actually was born, lived and walked. 

    This experience is difficult but it is an incredible opportunity for personal growth on many levels.  I can feel myself being stretched and pulled as I grow.  I want to end with a quote my mom sent me this week. It is from Brigham Young,  he said that “the Prophet (Joseph Smith) progressed toward perfection more in thirty-eight years because of the severe tribulation through which he successfully passed than he would have been able to do in a thousand years without it."  Difficult times are a gift to us from God, they help us to progress and grow in ways that we could not otherwise.  I am grateful for this refiner’s fire.  Have a great week. Love you all. Hug a Veteran for me!