by Ray Wiss
It is known that the Taliban have numerous infiltrators in the Afghan security services, rather more in the police than in the army. These individuals will give away the plans of patrols, attacks and ambushes that we are going to conduct. This individual appears to have wanted to take a more direct approach and tell his comrades in person where to shoot. It boggles the mind that he thought he would get away with this. As soon as the helicopters landed at the FOB, the spy was arrested and carted off to jail.
I suppose we should consider ourselves fortunate. There have been a couple of incidents this year in which Afghan police have opened fire on Coalition patrols. In both cases, there were American fatalities. Also in both cases, the patrol defended itself and killed the traitor, making it impossible to question him.
I have spoken to members of our intelligence services about these incidents. They feel it is likely that the identity of these individuals was somehow discovered by the Taliban. Our enemies went on to learn where their families lived. The policemen would then have been given a stark choice: open fire on the Americans, knowing full well that they would return the fire with lethal effect, or have your family murdered.
What would any of us do, if we were faced with a similar choice?
JULY 1 | Canada Day
My Canada Day celebration was delayed by the arrival of three patients, who had the good grace to arrive sequentially rather than all at the same time. As is becoming predictable, they were all either drivers or guards on the convoys that go along Ring Road South.
One of them arrived with an injury I had dealt with on my previous tour: a small bowel evisceration. Back then, an older gentleman had arrived with one loop of his intestines hanging out and I had struggled to repair his injury with inadequate instruments and medications. Today, it was a sixteen-year-old with multiple bowel loops trapped outside the body. Fortunately, I was much better equipped this time.
After ensuring that the patient had no further injuries, I put him under general anaesthesia. I washed off the bowel with copious amounts of sterile water and checked to see that there were no perforations needing repair. Then, with far better instruments than I had on Roto 4, I extended the skin wound by two centimetres. The patient was now paralyzed by my medication and his abdominal muscles could be easily stretched. This made it simple to stuff his bowel back into his abdomen.
I then washed out his abdomen with a couple of litres of sterile water, which I suctioned out. I closed the skin with a series of sutures, and we helicoptered the patient to Kandahar. What had been a one-hour, high-stress sweatfest in 2007 now took no more than six or seven minutes.
The injuries of the other two patients were, in the context of the war zone, almost trivial. One of them had shrapnel wounds in his back, and the other had a gunshot wound in his shoulder. In both cases, ultrasound ruled out any life-threatening injuries to the thorax or abdomen. Despite the visually impressive nature of the wounds, they only required simple bandaging before transfer. Both patients, though in a fair amount of pain, were stable, but the way each reacted to the pain was dramatically different.
Have you ever heard someone describing developing-world patients in general, or perhaps Afghans in particular, as being able to tolerate extraordinary amounts of pain with little or no complaint? This is utter bullshit. Although we humans can display the most remarkable variability in shape, size, physical appearance and political leanings, our nervous systems are identical. You can get used to things like walking on gravel or running in the heat, but there is no way to become accustomed to the feeling of being ripped open by shrapnel.
I have treated trauma victims on almost every continent and in a variety of cultures. I have not noted a measurable difference in any ethnic population’s response to acute pain. Some individuals are tough, and some are wimps; the majority fall somewhere between these two limits.
As it happened, these two patients were at opposite ends of the spectrum. The one with a gunshot wound to the shoulder was stoic. When I asked him to rate his pain, he kept repeating it was manageable. I gave him some intravenous narcotics anyway, and he admitted that he felt better once that kicked in.
The other patient came in screaming and kept right on screaming, even after we had given him a generous dose of Fentanyl (a powerful synthetic variant of morphine). He then revealed something that a sizable number of the patients I have seen here have also reported: he told us he was a hashish and opium addict. This is useful information for the trauma team to have. Patients who are addicted to narcotics will need more medicine to control their pain due to the downregulation phenomenon I described in the June 17 entry. However, it is also true that addicts will sometimes exaggerate their pain to get access to narcotics.
When faced with this conundrum (Give more morphine because of downregulation? Give less because he might be lying?), it is always better to err on the side of humanity and to give the painkillers. The occasional addict cadges a dose, but everyone with genuine pain gets treated quickly and effectively.
Having said that, there is a limit to my generosity and this patient reached it. A number of things didn’t fit: the first dose of Fentanyl had had no effect, the patient’s pulse was not racing, he wasn’t sweating at all and his facial expressions . . . didn’t seem right. He kept asking for more drug, but I declined to provide it.
Whereas he might have been exaggerating his pain, he was probably being honest about his addiction. Hashish is abundant in this area. Many of our operations burn dozens of kilos of the stuff. As for narcotics, 90 per cent of the world’s illicit opium comes from this country. While most of it is converted into heroin and sold in Europe and North America, a substantial portion of the harvest is siphoned off for use in Afghanistan and neighbouring Central Asian nations. The best estimates put the total number of addicts in this region between ten million and twenty million.
The reasons for this are obvious. A small proportion of the human population has a predisposition for addiction, but this does not account for the total addict population. The majority of addicts turn to psychoactive drugs for the same reason the rest of us turn to pain medication: to numb an unpleasant stimulus.
This is the case in Central Asia. Repressive governments, moribund economies and continuing strife (both within and between the countries of the region) have left the populations here anxious and bored at the same time. They turn to cheap and readily available chemical vacations as a respite from lives that are much more stressful than any we can conceive of in Canada.
The day ended with a couple of events worth reporting. First we were visited by General Jonathan Vance, the commander of the Canadian contingent. This was a low-key thing, quite different from the visit of the CDS two weeks ago. General Vance dropped in on Major Arsenault and the leaders of the combat team for less than an hour.
I wanted to learn more about his bodyguards—elite soldiers are always interesting characters—so I wandered over to talk to the men who escort the general. They are a pretty tough bunch. They are almost all on at least their second if not their third and even fourth tour. One of them was with the Canadian infantry battalion that participated in the initial attack on the Taliban in 2001.
I did not have much time to talk to these guys, but I could tell that our commander was in good hands. This morning, his convoy easily fought off Taliban ambushers firing automatic weapons and RPGs.
The general himself fired off a full magazine at the enemy! I don’t know if this was the first time the general had been under direct fire, but you could tell his escorts were used to this. They mentioned this morning’s firefight almost as an afterthought.
The general rolled out around dinnertime and I went to catch what was, for the troops, the high point of the Canada Day celebrations: the issuing of the two beers per month that we get here. I never drink when I am on duty, but I got to enjoy the brews vicariously.
Addendum, July 19: The best part of Canada Day came three weeks later. My daughter’s daycare has been very suppor
tive of my family during my absence. They wanted Claude and Michelle to know that they were not alone in this. So they made an enormous banner, and got all the kids in Michelle’s group to “sign” it with their hands. Then they had a “red shirt day” on Canada Day, to express their support for the troops, with Claude and Michelle as the guests of honour.
Walden Daycare supports the troops
JULY 2 | Sparks
I turned fifty a couple of weeks before I got to the FOB. I like to think of myself as being computer literate, but there is a generation gap between me and most of the soldiers in this respect. Computers are something I have grown familiar with over the past fifteen years, but for the twentysomethings who make up the majority of the FOB population, computers have been a natural part of their lives since birth.
It is impossible to overestimate the importance of electronic communication for this crowd. Whether it’s e-mail, instant messaging or surfing the Net, these kids are permanently plugged in, so the impact on morale of any breakdown of our Internet connection would be catastrophic. It follows that one of the most valuable men on the FOB is the remarkably capable and good-natured Corporal Tom White. He is a twenty-three-year-old “signaller,” one of the men responsible for everything that has to do with communications (phones, radios and the all-important Internet).
In the past few days, he has proven his worth to me several times over. In what is sure to thrill my Mac-loving friends, my PC’s Internet connection broke down after I tried to upgrade Explorer. Corporal White got it running again. I will be eternally grateful to him.
From the beginning, I have called Corporal White “Sparks.” But not until today did I ask him if he understood why I did this. He did not, but he had been too polite to say so. I explained that in the early days of radio the vacuum tubes would often give off sparks, and that radio operators in the military were universally given this nickname. Corporal White went on to make me feel even older when he admitted he did not know the names of the characters in the original Star Trek TV series.
Addendum, September 9, at FOB Sperwan Ghar: My debt towards the signals people has increased. For the past several days, my personal global satellite phone has stubbornly refused to turn on. This made it difficult to keep my promise to Michelle to call her every day. It occurred to me that another Sparks might be able to help. What happened next felt like déjà vu.
Master Corporal Laszlo Pivonka fulfills the same role Corporal White did at FOB Wilson. I had run into Master Corporal Pivonka a number of times. Like his counterpart, he is always cheerful and strikes one as an all-around nice guy. The similarities with Corporal White do not end there. Master Corporal Pivonka is yet another one of those technological whiz kids who are the modern-day masters of the universe.
The parallels between these two communications gurus continued in their interactions with my equipment. Master Corporal Pivonka got a few instruments and tools, poked and prodded my phone for no more than sixty seconds and . . . voilà! It was working again.
I sat there, stunned by this miraculous change. I began to express my gratitude, but he cut me off with a laugh and a grin, saying, “It’s my business to fix shit.” When I asked him what the problem had been, he admitted that he was not sure which of the three or four things he had done had resurrected my phone. “Sometimes, when I fix shit, it starts to work by FM.” And that would be? “Fucking magic,” he replied.
Finally an explanation from a tech wizard that makes sense to me.
JULY 3 | RIP In
The abbreviation RIP has a negative connotation we all know. In the army, it has a second meaning, one that is more positive.
In two days I have to go to FOB Ma’Sum Ghar. The doctor who will be taking over at FOB Wilson arrived today and we conducted a RIP—a relief in place. She did a RIP In; I will do a RIP Out in two days. I got her settled into our shack and showed her around the FOB and the UMS.
Captain Valérie Lafortune had been assigned to KAF before this. She was one of the military doctors I trained in ultrasound last December. She asked if she could have a quick refresher, which I was happy to provide. Once again, good old reliable P.Y. stepped up as a model.
Captain Lafortune was pleased to be assigned here to replace me. For all the danger and the boredom, this is front-line medicine. When we spoke over the phone a few days ago to prepare her transfer, she emphasized her desire to see some trauma cases. I know that sounds morbid, but it isn’t. I feel the same way. Although we wish it were otherwise, we know bad things are going to happen to people. That being the case, we would prefer that these patients come to us. We came here because we believe in the mission, and this is how we can best support it.
Captain Valérie Lafortune takes over at FOB Wilson
Beautifying the UMS: burning paint to bake it into the concrete
Cute-as-a-button Captain Lafor-tune may not look the part of the hard-bitten FOB doctor, but appearances are deceptive. She is cool, collected and very competent. I was happy to leave the FOB in her hands.
She arrived as I was evacuating the day’s only casualty, an Afghan convoy guard who had been shot through the upper thigh. The shooting must have taken place some hours before because his leg was covered in blood that had dried. We had a report that he had lost a considerable amount of blood at the scene, which was believable because he was displaying early signs of shock when he arrived. Fortunately, he responded to initial treatments and he will be fine.
The day ended with a remarkable display of artistic ability on the part of Corporal Nathan Nolet, one of the combat medics. He has had no formal training; his considerable experience was gained decorating overpasses. He took it upon himself to beautify the social area of the UMS. He works only with spray paint, a piece of cardboard, the top of a garbage can and a paper plate. His creation was stunning. If you have a forklift and a flatbed truck, the above masterpiece can be yours.
JULY 4 | Abbreviated Tragedy: WIA, VSA, DOW, KIA
With Captain Lafortune having taken over the UMS, I was free to take the day off. Quite a treat—I had time to read, make additional videos for Michelle and laze around. I also had time to have one last long talk with Major Arsenault, who continued to impress me with his maturity and insight. It could have been an all-around wonderful day, but it wasn’t. The war came back to hurt us yesterday and today.
Our fallen are referred to as having been “killed in action,” which we abbreviate as KIA. In the strictest sense of the word, this is inaccurate in a small proportion of cases.
The vast majority of Canadian soldiers killed in Afghanistan have died in explosions that ended their lives between heartbeats. They are true KIA. A minority survived for some time before expiring. We try very, very hard in these cases to stave off death, even if it seems inevitable. The motto of the KAF hospital is “If you arrive alive, you will survive.” That is a promise we have been able to keep with nearly every Canadian wounded in Afghanistan. Nearly.
Canadians who are wounded are labelled as WIA: wounded in action. This gets the medevac helicopters into the air. If things go badly, WIA might get upgraded to VSA: vital signs absent. This means the wounded soldier is now in cardiac arrest. Things are grim when that happens. Soldiers are young, healthy people. If their heart stops, it is because their bodies have suffered tremendous damage and they have lost most of their blood. The chances that they will survive are slim at best. Nonetheless, the distinction between VSA and KIA is an important one. As long as we are still attempting to bring the patient back, the medevac helicopters will get to us at best possible speed in all but the worst weather. If we realize our efforts are futile and we stop trying to resuscitate the patient, they become a KIA. The evacuation then becomes a much lower priority. We may even decide to evacuate the body by road. Very rarely, a soldier survives passage through the KAF hospital only to die several days later. We learned of one such case today.
Master Corporal Charles-Philippe Michaud had been on patrol on June 23 near FOB Sperwan Ghar. He ha
d stepped on an IED that ripped off one of his legs and badly damaged his other limbs. Initial reports were that he might end up a triple amputee. Then the reports became more optimistic. He was at the Coalition medical facility in Land-stuhl, Germany, and was improving. His life was no longer in danger. It looked like he was going to keep his other limbs. He was transferred back to Canada.
This evening, we learned he had died.
Wounds this severe tax the body tremendously. Even if you stop all the bleeding, the damage is so extensive that nothing can be done to reverse the patient’s decline. A body so weakened is also easy prey to infections of all kinds.
Master Corporal Michaud will be listed as a DOW: died of wounds. It is some small consolation that he did not die in Germany, but rather in Quebec City. Although he never regained consciousness, his loved ones got to see him and to hold his warm hand in theirs one last time before he passed away.
The term KIA, unfortunately, is the one that applies to Corporal Nick Bulger, who died yesterday. He was the driver of one of the last vehicles in the general’s personal convoy, the guys I met three days ago. The other vehicles in the general’s convoy rolled over the mine without detonating it. Corporal Bulger probably thought he was safe. As the driver, he was anything but. Drivers die more often than soldiers who are riding elsewhere in our vehicles.
One thing I did not mention when I reported my conversation with the soldiers escorting the general was that they had half-bragged and half-complained that they were on the road constantly. At the time, I had been impressed. The general was not above taking chances himself.
Seen through the prism of Corporal Bulger’s death, the general’s actions seem far different to me than they did forty-eight hours ago. He could accomplish just as much, in terms of seeing the various Canadian outposts, if he travelled by helicopter. By doing so, he would expose his fellow soldiers to far less risk. As it stands, several vehicles and a large group of men are assigned to escort him around some of the most dangerous real estate in the world. And now one of them has paid for this with his life.
