View from my deck at home...

I'm looking forward to meet the tenants when I get home. My sister will be in Hawaii also, it'll make this more of a homecoming for me. I'll just have to lather on the sunblock! This island boy is white.

Almost home

Due to operational security concerns and personal matters, I've been unable to continue to update this blog. Thank you to family and friends who have supported me throughout this deployment. Coming home soon...

Day off?

A quick calculation reveals that over 7 months, there are over 60 Saturdays and Sundays... 60 days of freedom! This experience will sure make me appreciate weekends so much more.

I didn't realize it was President's Day until I received an email from my Aunt mentioning it. Funny how holidays lose their the bargaining power when you don't get a day off work!

Here's a picture of me with my 3 corpsmen, in the early morning hours out on the flightline.

Hawai'i

Not Iraq.  Definitely not Iraq.  I'm dreaming of mountains, waterfalls, lush foliage, sandy beaches, and the ocean.  In K-Bay, I was fortunate to have the extraordinary privilege of being able to go surfing on my lunch breaks!  5 minutes to change out of my flight suit into surf shots... a 5 minute drive to North Beach... grab my board and run down to the beach.  I could be in the water in about 10 minutes from leaving work!  It's a luxery I won't have for too much longer.  I still haven't received my orders to San Diego, but I don't think I'll have more than a few weeks left in K-Bay after we return.

The anticipation of surf... there's nothing quite like it.  You never quite know what you'll be surfing that day until that moment when the ocean comes into view.  For me it's usually a jog over a sandy burm in my flip-flops, past a life-guard stand, and then the big blue horizon.  On a big day, I can hear the waves crashing long before I crest the burm.  That singular moment sometimes provides elation, sometimes disappointment, but always happiness.

I've plastered the walls of my office with surfing photos, and we'll watch surfing movies in the ready room on slow nights.  Self-inflicted torture, perhaps, but it keeps us looking forward to the trip home. 

Marine tender

Marines have a reputation for being "hard"... an apt word to describe them.  Emotionally blunted, vulgar, phsyically fit, trained killers.  At least that's the usual stereotype.  They're also often teased by the other services as being a little, well, slow.  Jar head is used to describe the shape of their heads, and thickness of skull.  But Marines continue to impress me with their compassion, emotional range, familial regard, and their intellect.

 

One of the officers started an impromptu discussion today, Valentine's day, and asked a group of his Marines to think about 3 things that they love about their significant others.  You might think he'd be laughed at for asking such a corny question to a bunch of grizzled warriors, but this was not the case.  He deftly added a little humor by quickly ruling out "sex" and "her body"... and after a few chuckles, remarkably the responses were honest and revealing.  They offered answers such as compassion, independence, humor, intellect, being a good mom, to just plain "putting up with me."  Next, the officer asked, if we weren't deployed in Iraq, where we would be taking our significant others for dinner?  It made everyone homesick thinking about their favorite romantic restaurants and little hidaways.  To keep the conversation from getting too sentimental, one of the guys said he always takes his wife to Hooters... but most were honest responses, revealing a bunch of guys who miss their wives and families. 

 

I can say that at least once in three years with Marines, these hard men showed they have a soft side, in front of eachother even!  For all the boasting, swearing, vulgarity, and recklessness, there's a woman in each of their lives who they love and miss.

Siesta!

MedPageToday reports good news coming out of the University of Athens Medical School. Turns out napping at least 3 times a week for 30 minutes decreases death rates from coronary artery disease!

CASEVAC Corpsmen

Two Navy corpsmen were among those killed in the 46 crash last week.  Here's a news article I found on one of them, Petty Officer 1st Class Minjares Jr.  Notice this was from a local newspaper website, certainly not not mainstream media.

 

I finally saw the video that was broadcast initially on Al Jazeera and then on MSNBC.  I htink you can find it on YouTube actually.  If it turns out the footage is authentic, it certainly looks like antiaircraft munition of some sort.  But a stupid move on the part of the insurgents... if true, it lets us know what their capabilities are, such that we can adapt new tactics and techniques to counter the threat.  I admit there's an element of psychological warfare going on, but where we could have proceeded under the assumption it was mechanical, now we have credible evidence that says otherwise.

Monday web bytes

A lot of great posts over at KevinMD today: 

 

There's this story from the WSJ about mothers in London who schedule c-sections early in the month to secure thier spots on private school wait lists, prozac for dogs, and others...

 

Good news for the UK this Valentine's day: Viagra to be sold OTC ???

 

More trouble for the Osprey's: the Marine Corps fleet was grounded due to a computer chip glitch.  Hopefully this doesn't delay their deployment to the field.

 

Defensetech has a great post about the new helicopter threats in Iraq.

A doctor draft?

A flight surgeon buddy of mine forwarded me a link to this point paper, posted at the U.S. Medicine Institute for Health Scinces website, written by the formerSurgeon General of the Navy, Vice Admiral Harld Keonig MD (ret).

 

In it, he details the history of military physicians since World War II, and paints a particularly grim picture for both recruiting and maintaining quality physicians in the armed services.  In the wake of 9/11, HPSP scholarship applications began diminishing and culminated in both the Army and Navy missing their targets by a wide margin in 2005, a trend that continued into 2006.  This will lead to a significant shortage of General Medical Officers (GMO's), beginning in 2009.  Hey that's just 2 years from now!

 

He believes that a doctor draft is a real possibility if things do not change.

 

What caused this abrupt change?  Well for one thing, as Admiral Koenig points out, there has been a dramatic shift in healthcare since WWII, marked by the specialization of physicians, leading to less emphasis on primary care.  There are no longer career GP's, let alone career GMO's.  In the past 5 years, I've seen this military medicine follow suit by requiring GMO's to return to residencies if they want to promote.  Medical students today are focused on specializing, and do not relish the thought of a 4-5 year delay in getting on with their careers.  10 years ago they might have justified this by the opportunity to live abroad, see the world, serve their country... but these days, deploying to hostile territory in the name of a largely unpopular war (read: nationbuilding) effort, does not justify this hiatus.

 

I've got at least 8 more years minimum... my military committment isn't up until 2015!  It's far to early for me to speculate on whether or not I'll stick around for 6 additional years to get to 20.  By then I'll be a senior O-5, perhaps looking to promote to O-6, with greater potential to have some sort of influence on the future of Navy Medicine.  I think 2-3 years from now the writing will be on the wall for the future of this institution.

Irony

"I'd rather lose 200 Anna Nicole Smith's than one of those Marines."

 

A blunt statement by one of our pilots, but the sentiment is clear.  Here we are, lamenting the loss of 7 more servicemembers, including a female helicopter pilot who's personal character, values, and accomplishments put most people to shame ... and when we turn on the news, it's all Anna Nicole.  It's astonishing how much media attention this ridiculous story is generating!  Why do we have this perverse interest in the lives of famous people?

 

I'm certainly not immune to this oddity.  I'll be browsing the top stories on a news website, and I'll see some ridiculous headline about Britney and K-Fed, and I can't stop my self from clicking on the story to read it.  Human nature I guess.  A side effect of our competetive nature, the drive to be unique and differentiate ourselves from others.  But at a time when we should be celebrating the lives of true heroes, this "who's the daddy" debate is most annoying.

Prescription diet pill now OTC

Xenical just gained approval by the FDA for OTC use, albeit at decreased dose.  Via Medgadget.

Purple Foxes

In December, I took a trip to TQ for two weeks to participate in real-life casualty evacuation missions with Marine Medium Helicopter Squadron 364, the Purple Foxes.  I helped train some of the CASEVAC corpsmen back in Yuma over the summer... on their last day of classes, we had them sprint about 100 yards to two moulage patients with simulated trauma injuries.  Sucking chest wounds, through and through gunshot wounds, abdominal eviscerations, you name it.  By the light of glow sticks, they had to assess both patients quickly and efficiently, prioritizing and treating the most serious life threats first.  This was followed by litter carries races.  Two corpsmen would carry one of their colleagues, a simulated casualty, about 100 yards to a waiting "aircraft", come back, and take another one.  Litter carrying is one of those things that looks easy, but isn't.  Carrying a 180 lb person on a litter just a few yards and you feel it everywhere: your hands, forearms, shoulders, back, legs, and lungs.

 

As they finished their last day, I recall feeling so proud of them.  To me, CASEVAC corpsmen have one of the most challenging jobs out here.  I'd say it's a close second to the Marines and soldiers patrolling the streets and clearing houses.  When the CASEVAC helicopter lands to retrieve a casualty, the corpsmen leave the relative safety of their helicopter, sometimes in zones that aren't 100% secure, and they bring them onto the aircraft to administer aid to their fallen comrades.  Men and women sometimes die in their care, if they're not already dead.  It's a mission that takes a mix of hardness and compassion and bravery.  I felt honored to be among them and play a small role in their training.

 

The Purple Foxes are an amazing and storied Marine helicopter squadron.  Their efforts have saved countless lives - both American and Iraqi.  On the missions I participated in, we transported more Iraqi's than American service members.  The CASEVAC/MEDEVAC machine of the US Armed Forces is an amazing thing, and the path from the battlefield to definitive care has been recognized.  The Purple Foxes play a vital role in this path.  "Vital" sounds trite but it's accurate.  The bravery of the corpsmen notwithstanding, the pilots and aircrewmen that fly the corpsmen into hazardous landing zones, in broad daylight, each deserve their own medals.

 

I had the pleasure of meeting Capt Jennifer Harris, however briefly, when I was in TQ.  Her reputation preceded her as being a true professional and one of the best pilots in her squadron.  She had an air of confidence and leadership about her, with a warm disposition.  She was also a Naval Academy graduate, two years behind me.  While I don't remember her from school, very likely we passed each other in the P-Ways and might have been in the same classes.  As I read the news reports from her hometown, I find myself deeply affected by this terrible loss.  It's a loss to her family and hometown for sure, but also to her Alma Mater, her Squadron, the Marine Corps, and the entire country.

 

It could happen to anyone, anytime.  Our mortality is such a precious, specious thing.  She only had another week or so of flying before heading home.  I am committed to attack my job with renewed vigor... where ultimate success is measured by the absence of accidents rather than the number of kills or hours flown.

Web bytes

Good news, Gmail is now open to everyone.  No need to provide a telephone number for verification.

 

The worlds fattest countries, via KevinMd.

 

I think I would have used this online study tool extensively back in the day.

Close to Home

It's a pretty safe bet that something happened when you get a "River City" email.  When the base is in River City, all internet, email and phone access is limited to very secure channels, to control the information in and out.  I'm not opposed to such a system, not only is it smart from an operational security perspective, it also protects families from hearing bad news through the wrong channels.

 

Another helicopter crash... this time a Marine Squadron, people I know, helicopters I have flown in.

 

Naturally everyone wants to know what caused the crash.  "Under investigation" isn't good enough for the press or the public.  What's unique about mishap investigations, at least in the Navy and Marine Corps, is that in order to obtain the most accurate and honest information, all details of the incident are what we call "privileged", meaning they can only be used for the purposes of the investigation.  Having conducted mishap investigations myself, I know this to be a terribly painstaking and difficult process.  Evidence is carefully gathered and scrutinized until formal conclusions and recommendations can be made, a process that often takes many weeks.

 

We may never know the cause of the crash, but if we do, it won't be anytime soon.

 

I must take special care of the things I write, but suffice to say that we are all deeply affected by this.  Unlike at home, there's no time to take an operational pause, no time to reconcile feelings, to purge emotions.  There's only compartmentalization and continuing on with the mission...

Refueling

This was a pretty cool picture that one of the pilots took the other day.  I was outside helping to refuel the aircraft, and he took this from the right pilot seat looking out the left cabin window.

Groundhog Day!

We've got the DVD running on loop in our Ready Room... it's a tribute to a great movie and a great representation of what life is like out here. The feeling that you're living the same day over and over again is not unique to the military, by no means, but when you're deployed, every facet of life is regimented, and there's almost no variation in schedule. There is no movie theater, shopping mall, park, or grocery store. You can't hop in your car and drive somewhere. There are no weekends... the most reliable to tell each passing week was football on Sunday... so after this weekend we're liable to completely lose all sense of time and phase out of existence.

One of my best friend's birthday is today. Makes it pretty easy to remember a birthday when it falls on such a unique day. Happy Birthday Cameron! We've known eachother for over 15 years now... My family moved from Annapolis to Orlando, right before my sophomore year of high school. Not an easy time to pick up and try to make new friends... Cameron was the first person to make an effort to get to know me, we became Chemistry lab partners, and the rest is history!

"Attention Al Asad..."

The Big Voice reaches every parcel of open air in the entire camp.  Unless you're jamming indoors with your headphones on (it's not allowed to wear headphones outside), you cannot escape it.  While it's relatively rare to hear the Big Voice, with it's volume and eerie omnipresence, it's intimidating enough.  Naturally, a message passed on the Big Voice must be important, and everybody pays attention, as if they had a choice in the matter.  This is probably the safest large base in Iraq.  So when the Big Voice announces indirect fire (IDF) mortar attacks or mass casualties arriving from off base, it shatters our temporary feelings of safety and complacency.

 

I was riding my bike to the post office when I saw the Army Blackhawk land at the Surgical helo pad, and noticed the Cobra escort circling overhead... indicating this was a CASEVAC drop-off.  Not at all unusual.  If this had been a mass casualty, the Big Voice would have already prompted "All Medical Personnel" to report to the clinic.  And this was my third attempt to mail my sacred fitness report back to the States, as the lines at the post office had been incredibly long in recent days.  I had resolved to stop by to see if they needed an extra hand after I was through at the post office.  My FitRep was going to be mailed today.

 

I had been waiting in line for about 15 minutes when the Big Voice suddenly came alive.

 

"ATTENTION AL ASAD.  ATTENTION ALL ASAD..."   Every sentence is repeated, probably for good reason, but it always seems like a waste of time when you hear it. 

 

"THIS IS THE COMMAND POST.  THIS IS THE COMMAND POST.  ALL PERSONNEL WITH O POSITIVE BLOOD REPORT TO SURGICAL IMMEDIATELY...," (repeat), "COMMAND POST OUT."

 

The post office is directly across the street from Al Asad surgical.  And I'm an O-POS.  A moment's hesitation as I eyed my position in line; a glance at my watch, noting the post office closure in 10 minutes; and I was sprinting across the street.

 

The surgical center here on base maintains a few units of packed cells, which they're prepared to transfuse at a moment's notice.  This usually will suffice for the single surgical urgent patient with moderate blood loss.  But when a patient suffers massive hemorrhage, or if we receive multiple casualties at once, the walking blood bank is activated, using the Big Voice.  Due to the ready availability of blood donated by eager soldiers, sailors, and Marines, the clinic can do away with the expense and trouble of maintaining type-specific blood banks. 

 

From what I had heard, every request for blood is met with a nearly instantaneous response.  I was the third person in line.  Preceding me were two of the clinic staff - an orthopedic surgeon and a corpsman.  "Nice of them," I thought as I hastily filled out the screening form, while the hallway quickly filled up with 20 or so breathless people.  I was brought into an exam room where they took my vitals, then drew two vials of blood for "virus screening", which I presume to be for Hepatitis C and HIV.  Then I was sent back out to the hallway to wait my turn.  By this time the hallway was a zoo of 40-50 people.  One staff member's sole job was directing the human traffic and issuing instructions.  It seemed a little superfluous to me to have so many people there for presumably one patient.  But in extreme circumstances a single patient can go through many tens of units of bl ood.

 

As I waited, I caught sight of a large German Shepard down the hall.  It was one of those deployment moments where you realize how long you have been gone.  People don't keep pets here on base... you don't see any animals at all for that matter, except for the mice.  It was a military working dog, brought along by one of the Marines that had stopped by to donate blood.  He (I presume) was bewildered by all the activity.  I occupied my time admiring the large canine and scratching it between the ears.

 

When it was my turn, I entered another small room and sat down.  They pumped up a blood pressure cuff around my upper arm, wiped my skin clean with betadyne, then darted one of my antecubital veins with a gigantic 14 gauge catheter.  Five minutes later, one tenth of my circulating blood volume was conveniently packaged outside my body in a white plactic bag.  The Marine Corps Major sitting across from me was a little lightheaded... it doesn't help when the corpsmen ask you repeatedly if you're doing ok.  You start to imagine you might be feeling ill, and then your parasympathetics get even more ramped up.  My heart fluttered a couple times with worry, but a couple deep breaths and I felt fine.

 

I'm not sure if my blood was even used.  They had already transfused 3 units of packed blood to the patient, who was in the OR for some unknown injury.  They now had 4 units freshly drawn O-POS blood standing by if they needed it. 

 

The poor folks in the hallway were told to "stand-by" in case they needed more.  Some of them had been there over an hour and had nothing to show for it except their screening paperwork.  Maybe I believe my time is so precious that I wouldn't want to wait in a line for 2 hours in case I they might need me.  But around me, all I saw were patient smiles.

 

I asked one of the nurses if they always get this kind of response, and she replied "Every time."

Water intoxication

So this woman in the news, Jennifer Strange, died of hyponatremia, or water intoxication. Very sad story, just goes to show how something seemingly as harmless as drinking water can have dire consequences. Sadly, she was trying to win a Nintendo Wii for her kids in a contest.

I drank myself to relative hyponatremia a few months before deployment. It was actually part of a class on hydration I was taking to prepare for deployment. We drank a liter of water every half hour for 3 hours... Thus 6 liters of water over 3 hours. Seems easy, but it was a miserable experience. First nausea sets in, sometime during the 3rd liter... then the headache comes, confusion, lethargy, and just a general state of misery. I felt horrible by the end... was urinating about 400cc every 20 minutes, and my Sodium level was 131!

Kidney Notes estimates her sodium levels dropped to 115!

Mythbuster fans

For those champions of empircial evidence and healthy skepticism in the face of heresay and the supernatural... Here's a link to a nice summary of all the Mythbuster's Results.

It's freakin freezing in here Mr Bigglesworth

Ever use a portojohn in 20 degree weather?  The toilets in the heated outhouse have overflowed, again, so we're back to the protojohns.  Bowel habits vary, but most folks have a BM once a day.  However, when faced with the prospect of getting half-naked in a cold, dark portojohn, most people can stretch that out to once every 2 or 3 days.

The shock of your bum hitting cold plastic isn't that bad, actually.  There must be a dearth of temperature neuroreceptors in the buttocks region.  It's just annoying having to sit there in the cold, with your pants down.  There's not much you can do to keep warm in there... I guess you could do some isotonic muscle flexes, but that's only going to get you so far.  Your hands freeze too, because you can't get the job done with gloves on.  Too risky.  On a positive note, there are no flies in there when it's this cold, and the smell isn't so bad for some reason.

The flies.  In the fall, presumably to escape the cooler outside air, they assaulted our office spaces with great persistence.  With my trusty flyswatter, I would easily kill 20 flies a day.  I was deadly, but the poor flies never learned from the mistakes of their fallen brethren.  Some would be so bold as to actually land on the sleeve of my left arm.  Guaranteed kill.

The Google God says they hibernate when it gets too cold.  Those clever little bastards.  I didn't realize they slept, let alone hibernated.

Ag man.  Just finished reading "The Power of One" by Bryce Courtenay.  It was sent to me by a friend in Hawaii.  I thoroughly enjoyed it... I found myself both inspired and exasperated, but mostly inspired.  As I read one scene, I realized that it was a passage I had seen before, either on an SAT exam or perhaps in one of my high school english classes.  I've been thinking about the 'required reading' in high school in college, and wondering how much I really got out of it, at the time.

Web Bytes

Good stuff from MedPageToday:

 

  2006 Cardiology Year in Review
Big ups for Crestor, treating "pre-hypertention", and Waltzing-for-exercise in heart failure patients. Thumbs down for trans-fat, Pfizor's HDL-booster, and Green Tea. Mixed results for the drug-eluting stent debate. And intercessional prayer dealt another blow, this time for recovering bypass patients.

 

  Changes to Childhood Vaccination Schedules

• Three doses of oral rotavirus vaccine at two, four and six months to protect infants against severe diarrhea
• A second dose of varicella vaccine at age four to six years following the first dose at 12 to 15 months, or a catch-up dose for older children and adults who previously received only one dose, and
• Expansion of the flu vaccine to include children 24 months to five years old and their caregivers and others who come in close contact.
• The HPV vaccine Gardasil was approved in June 2006 for females ages nine to 26 for the prevention of cervical cancer, precancerous genital lesions, and genital warts due to HPV types 6, 11, 16 and 18.

And this is nice to see: "Diet Pill" makers finally get fined by the FTC.
 

New Years Day, Iraq

It was still dark as I made my way home this morning, New Years Day.

Above me, the black sky was lit suddenly by two small bursts of light, which fell from a point in the sky, then fizzled out quickly. Not fireworks, not here. I might even have been apprehensive about a possible indirect fire attack, but I knew precisely the source of the light. Despite a soundless, invisible sky, there was an helicopter up there, and it had just dispensed its flares. They were probably just testing their countermeasure systems, but I prefered to imagine the pilot just returned from a mission, and celebrated the New Year in his or her own fashion.

No fireworks, no booze, no raucous celebrations. Just business as usual for our Squadron, and the other units out here. Some of our pilots and crew were on a mission as the clock hit midnight, somewhere over the Iraq countryside. Most of the maintainers were out on the flight line, turning wrenches with frozen hands almost rendered useless in the 20 degree weather. Somebody's got to keep the aircraft flying.

I was in my office providing emotional support for a Marine who's wife just gave birth to his first son. These proud young men and women willingly sign their lives away to Marine Corps, but moments like this cause them to question their past decisions and reevaluate their priorities. What's worth giving up something as monumental as witnessing the birth of your first child? "NOTHING!" screams a voice inside my head... "it won't happen to me!" But here was a young man trying his darndest to deal with a sacrifice he made that tested his deepest ties to the brotherhood of the Corps.

Here's a New Year he won't forget.

Angels

Almost 3000 servicemembers killed in Iraq so far.  How do these soldiers and Marines get home?  I imagine it's a long chain of custody, that starts from where the servicemember was pronounced dead, until they reach their final resting place.

Sometimes we are a link in that long chain.  On occasion, we'll be tasked on an "Angel" flight, a euphemism for the servicemember who gave the ultimate sacrifice.  This typically entails flying from our base to an outlying base, and then returning them here.

I'll never forget my experience.  Once we landed in the zone, the procession began... 4 soldiers unloaded a litter off an armored personnel carrier, which bore the body of the deceased.  They proceeded to slowly walk through the middle of two long columns of their fellow soldiers, who were standing at attention from the moment we landed.  It looked, appropriately, like a funeral procession... only this wasn't a funeral.  The columns ended a hundred yards or so from the helo, and the detail carrying the litter continued the rest of the way on their own, fighting the downwash from the rotor.  They approached the rear of the aircraft, cautiously made their way up the slippery helo ramp, gingerly placed the litter onto the floor of the aircraft, rendered a final salute, then departed.  Once they were clear of the rotor arc, we raised the ramp while the pilots turned up the engines, and we lifted, an angel in our great metallic belly.

The crew chief and I stared at eachother a little uncomfortably during the flight.  Here lying at our feet was a Marine or Soldier, who just died probably within the past 12 hours.  What do you do?  I half felt like standing at attention for the whole flight.  My doctor instincts were strong: I had to resist the urge to check for a pulse, look at the pupils, provide comfort.  But there was nothing more to be done.

Arriving at the receiving medical facility, it was clear they weren't expecting us.  I ran out the back under the rotor arc and towards the receiving door of the clinic.  "What do you have?" asked the corpsman who greeted me, over the roar of the helicopter engines.  It was obvious he thought this was an casualty.  I'm not sure he even heard me say "Angel" but the second it came out of my mouth, he sprinted back to the clinic, holding his hands together above his head, a rudimentary "A", for all the medical staff to see.  Within a minute, there were 20 or so corpsmen, nurses, and doctors, standing at attention in two columns leading up to the rear door of the clinic.  4 of the staff donned cranials and approached the aircraft to retrieve the litter, and the procession was repeated, in reverse order.

It was just the start of this member's journey home.  And it was done with as much honor and dignity as possible, and I'm grateful to have been witness to it.

a Merry Christmas

As much as we would like to feel sorry for ourselves, we had fun in spite of ourselves.  While far from family, we were surrounded by family of another kind.  Holiday spirit was bountiful, at least for one night and one day.  A brief respite from the daily grind.

I cringed when some of the Marines filled up a kiddie pool outside with water, mind you it was 35 degrees out, and had a polar bear swim contest.  Needless to say I was standing by with my corpsmen, and we ended up calling the thing at 10 minutes.  I swear those Marines would have stayed in there till they were blocks of ice.

We are nearing the halfway point of the deployment... hope we can keep everyone motivated and avoid complacency.

Residency Bound!

The GME-2 selection list came out earlier this month, and I was very pleased to find out I was selected for Ophthalmology residency in San Diego next year!  I'm extremely happy and relieved to know what I will be doing next year.

I can't take credit for the following graphs... but they very nicely demonstrate the spread of the residency selection this year.

A word on mishaps

This is a dangerous business, and the Navy and Marine Corps spends a great deal of time and money on controls to prevent mishaps.  My one and only mishap in the past 2.5 years with my Squadron occured just 2 weeks after I checked in.  Luckily it was just a "Class C" mishap, the least severe.  But in many ways it was my baptism into the flight surgeon's world.  3 straight weeks of closed door deliberations with the rest of the mishap investigation team was a grueling, painstaking process, and that was just for a piece of engine cowling that departed the aircraft. 

I do not envy the flight surgeon who gets the call that one of his squadron's aircrafts has gone down with fatalities.  They must investigate the mishap site, sort through the carnage, perform physicals on the survivors, and assist in the collection and preservation of any human remains.  It's a sordid business. 

The constant threat of mishaps and their subsequent investigations is enough for some General Medical Officers to avoid flight surgery, and I've heard this argument to convince young military physicians to choose dive medicine over flight medicine for their operational tours.  That and many dive officers like to think they're super hard-core SEALS or something... whatever :)

Prevention.  Success is the avoidance of a negative event.  It's impossible to account for all mishaps prevented.  I'd like to think that my presence in the Squadron has made a difference, but accidents happen, despite all the training and controls that might be in place.  While flying with my unit puts my life in danger, it's a risk that my pilots and crew take daily... and it's an invaluable tool to assist in identifying potential human factors that may contribute to a mishap.  The mantra in flight surgury school was that just ONE mishap prevented, one aircraft or one life saved, makes up many thousand-fold for the cost spent on a flight surgeon's training.

Another test...

The military doctor paradox

Here's a thoughtful  little article from the NYTimes: "A Heart that Needed Fixing, a Mind that Said No".  Talk about a difficult decision.  (hat tip: KevinMD)

 

Of late I've been contemplating my role as a physician in a military unit.  In medicine and in warfighting, people lives are at stake.  In both cases, decisions are made that affect the life and death of real people.  In medicine, sometimes physicians are faced with situations in which they "let people die," as in the article above.  In these cases, there are always other considerations that somehow justify this acceptance of death, but are such that we don't dare call it murder or killing (with some rare but notable exceptions, as in abortions or physician assisted suicides). 

 

In the military, soldiers and Marines are sometimes asked to kill other people, and this may lead them to carry heavey burdens, internally weighing the ethical considerations and rationale behind their acts.  They accept this as part of their jobs, in the name of patriotism, of democracy, and the ideals of freedom... to protect our interests and to give the rest of the world a shot at the potential for happiness and success, at least as it's defined in our western society.  Moral relativism notwithstanding.

 

And military doctors face other dilemmas not encountered by their civilian counterparts back home.  What is their place in the military kiling machine?  Treating the members of their unit maintains the strength of their unit and allows it to go on with its mission, and sometimes to go on and continue killing...  Is that doing no harm?  But they're also doing harm by NOT treating anyone.  They, along with nurses and corpsmen and medics, are all issued personal weapons... what if they find themselves in a position to use that weapon, not merely in self-defense, but in a position where using the weapon would preserve the "home team's" assets?  How should one allocate resources to treat one' own vs the enemy's wounded and sick? 

 

There are some that argue that physicians have no place in the military.  I carry my 9mm pistol around with me everywhere, as does everyone else here.  And I hope that I will never ever have to use it.  But will I hesitate to use it if necessary?  How can I be sure what is necessary?  It's a lot to think about, so it's easier not to think...

 

More interweb bytes

Cellphone <--> Cancer link finds little support in this study. (via MedPageToday)

 

JSF ready for its maiden flight.  I hadn't realized how much this project has cost. (via DefenseTech)
 

 

Another very cool piece at DefenseTech about the Laser Beam pain weapon.  David Hambling makes a very strong case for showcasing this potential weapon in a reality/celebrity TV show.  I think it's a genius idea.  People submit to all sorts of ridiculous self-harm in the media today.  It would "humanize" this potential weapon as perhaps a legitimate means for riot control and warfighting, rather than have folks blow this off as just another piece of inhumane weaponry.  I'd be interested to see how long someone like David Hasselhoff can withstand this thing.  5 seconds appears to be gold standard.

around the interweb...

Some interesting things I've been saving up:

The Chainless Bicycle. (via CoolTools)

Last TO-DO's of the year. (via Lifehacker)

Make your own custom photo-stamps. (via CoolTools)

This is a wild idea that might work:  A device marketed for the elderly and/or (presumably) those not technologically inclined... plug in a regular phone jack and it prints out emails, pictures, etc.

A condition called fetus in fetu, which I certainly do NOT remember learning in medical school, in which a baby is born with a another fetus inside it's abdomen.  WHAT?

Finally, Ask.com, that other search engine, has enterred the online maps fray, with AskCity.  TechCrunch seems to like it.  I played around with it, and compared to Google Maps, I found it had faster load times, and actual drawing tools embedded, so you could circle things, draw lines, etc.  Very cool.