It rained (well showered, actually) today for the first time that I have been here. Lasted about 2 hours and amounted to no more than 1/4 inch I would say. It did get the dust down.

 

This place has the same climate and sunny disposition as Las Vegas, the fastest growing US city. If not for the minefields, I might invest in some real estate for a future retirement community. On second thought, I don't think gambling would be legal, though.

This has been a slow couple of days, thankfully. A young boy did come in yesterday with minor injuries when the goat he was tending stepped on a land mine. The goat didn't turn out so well.

 

Caught working in my reading room. Can you guess what is on the monitor to the left of the picture?

Four rockets apparently hit the edge of the base last night, but they were too far away for me to hear. I don't think anyone has been hurt by these ever. I guess that the Taliban just wants us to know that they are still here.

 

I mentioned a family that had a motor vehicle accident returning from an Iranian refugee camp last week. Everyone recovered, except for the 9 month old baby who never did wake up enough to breathe on his own. We think he had a bad pneuminia before he got to us. The mother and older sisters took it very quietly in the same manner that we have noted all families here have to hearing bad news. It is a hard life in Afghanistan. UNICEF figures record a child mortality rate of 257 per 1000 kids before age 5. The fertility rate is 6.8 children per woman. This means that each mother can expect to see one or two of her young children die before they would get to kindergarten.

Time for a tour of my radiology department. Our sickest patients come in through the ER (i.e. EMT). The CT scanner area doubles as my ultrasound exam room. Note the tiny US machine. The most essential piece of government property is my star Technologist (called a 91P), SGT M. He is sitting in my reading room ...

 

 

 A rocket landed about 500 meters north of our hut last night. It sounded different from what I expected - kind of a tinny crash, but loud. We didn't hear the whoosh of it flying over, so it must have come from the other direction. Landed in the Korean compound (they are part of the ISAF coalition). No one was hurt. And no one appeared to pay much attention. Seasoned veterans all!

It has been a busy week. A major trauma when a soldier had an accident with his hand grenade. An Afghan family (Mom, Dad, kids 6 yr, 18 mo, 9 mo as well as several aunts and uncles) rolled over in the truck taking them back home from Iran after 3 years away as refugees. The usual assortment of individual injuries from bullets, IED's, motorcycle accidents. They all fly in by helicopter just like MASH. The traumas usually arrive between 5 PM and midnight because of the travel time delay making for long days at the office. My mornings are filled with films from Sick Call. My Children's Hospital colleagues will be amused to hear that I can't get away from Fast Track ortho follow-up films even here!

 

I had a good week, too. Passed my physical fitness test with my highest score ever (278 out of 300). I also perfomed my first solo percutaneous nephrostomy with an ad hoc kit scavenged from a Cordis central line kit and a cystoscopic ureteral catheter kit (we don't have a cystoscope). The radiology section now has a new level of respect from the surgeons and nurses! The patient lost his right kidney to a bullet, and his left kidney was unfortunately obstructed by a large renal pelvis stone discovered by CT, thereby explaining his renal failure. Pictures later.

Here is our local shopping mall: http://www.aafes.com/downrange/home.htm. Select Bagram from the pulldown menu, or preview other stores across the world. Transportation to these exotic shopping destinations is free if you sign up with the Army!

This is where I live: main street, the front door, the foyer, and a 360 degree tour of the puka. I love the carpet (genuine polyester). I even vacuumed.

Like the view from my window? Check out the 4 leaf clover on the doorway over my right shoulder. (Thanks Jeanette!)

 

I saw my first fireball ever tonight! I have seen meteors aplenty, but a fireball is something else. Couldn't get a picture, of course, but check out this site for more info: http://www.imo.net/fireball/ and http://starchild.gsfc.nasa.gov/docs/StarChild/shadow/solar_system_level2/peekskill.html.

I saw this site on an NPR announcement. This soldier is making the most of his Iraq experience. I have to say that he has a lot more to work with! The only birds I have seen in this dusty valley are English Sparrows (!) and a black and white crow-like bird. See his Blog here: http://birdingbabylon.blogspot.com/.

There is high sensitivity here over publishing graphic images of trauma and concerns for patient confidentiality, so I will be very careful about uploading cases. I will collect illustrative cases for a conference back home. I think the sterility of radiographic images still tells a story but with minimal shock value, so I hope select images will be OK. For cases click here: Radiographic Cases.

We had a distinguished visitor ("DV") in the CT scanner today for abdominal pain. The department may not look like much (pictures later), but as the only CT in the country, we serve everyone from the highest ranking US citizen to the poorest Afghan villager. Democracy after a fashion.

A lot of the trauma we see is caused by landmines, a legacy of the Soviet, internal tribal, and current military involvements over the past 20 years. The insatiable curiosity of the children, in particular, makes them common victims when they dig up or play with the things. This is my favorite, a hand sized plastic "butterfly" scattered from aircraft just perfect to attract a childs attention. See Land Mines for more information.

Here is a C-17 luxury liner arriving from Germany like the one I flew on. Sixty of us were wedged around a white land rover while sleeping on the steel deck. Internal views later. Note that I have not seen a single cloud since arriving October 27, just a dusty haze. Read about Air Force aircraft here: http://www.af.mil/factsheets/factsheet.asp?fsID=86.