Archives for April 2003

Not in Your Name

A small number of people with a disproportionate access to the media have gone on record that the War for Iraq is wrong, arraying themselves against it with the catchy slogan “not in my name”. I was thinking about this the other day when Russel Wardlow posted a rant about it, which is better than I could have done:

Alright. I am fully prepared to allow for the fact that this war is Not in Your Name. Duly noted. The bombing, the soldiering, the shooting and the killing; all of these things are done with you having morally washed your hands of their responsibility. I’ll be sure to remember that.

When the people of Iraq breathe a collective sigh of relief and joy after Saddam, his sons and his cronies have shuffled off this mortal coil and ended their national nightmare, this will not be in your name.
When Iraq holds its first elections and begins to take those first tentative steps towards representative government, peace and prosperity, this will not be in your name.

I was reminded of it today, while reading a similar thought by Charles Johnson:

This moment is IN OUR NAME.
Those who sought to keep the Iraqi people in their living hell, who stood in the way of their liberation, and insisted that the US and Britain and Australia and our many other partners had no right to take action to defend both the Iraqis and ourselves: This was NOT IN YOUR NAME.
And we won?t forget where you stood, in your ignorance and fashion-driven hatred of America. We won?t forget.

I won’t forget. I hope nobody forgets the celebrity idiocy, and the fair-weather friends of the UN and NATO. I’d be interested to know the reaction of Iraqi movie audiences when they find out about it. Hollywood is probably dead there, and for quite a while. They worked hard for it, and they deserve it. French and German companies are going to get the cold shoulder, too.

Why I like the A-10

These are forwarded from a forward from a forward, but the story is, basically, a combat damaged A-10 “Warthog” comes home, saving its pilot and being able to be repaired to fight another day. It’s amazing this bird kept flying; the pilot certainly deserves whatever award she (yes, she) should get.


Notice how you never see pictures like this of damaged F-16’s limping home? So much for the ‘mud fighter’ concept. I have heard that the Air Force is again making noise about retiring A-10’s after this war; they made the same after Desert Storm, and stopped because the USMC wanted them! Let’s hope the USMC still has the budget to keep this robust and effective airplane in the active inventory.

Update: I have combined the pictures into one larger pic.

Devil Doc Delivers

From the San Jose Mercury News:

It all happened so quickly. A young displaced Iraqi woman was about to give birth, and her family had come to the Marines of the 15th Expeditionary Unit for help just after sunrise.

Fifteen minutes after she arrived by military ambulance, Navy Lt. Sean Stroup, 27, a San Jose native who serves as the unit’s battalion surgeon, was assisting Jamila Katham with the birth of her baby.

“It was great,” a satisfied Stroup said in an e-mail later that day to his parents, Steve and Robbi Stroup of South San Jose, “one of the few good things I’ve done while out there.”

Navy Corpsman with Iraqi newbornThe picture ran last week on Navy News with the caption “Chief Hospital Corpsman David Jones of the 15th Marine Expeditionary Unit holds two-hour-old newborn Rogenia Katham, daughter of Jamila Katham, 20, in Nasiriyah, Iraq.” (Looks young for a Chief, and he doesn’t have a coffee cup).

The SJMNews story seems to have come from the Marine Corps News story, which has more details.

No one would expect less from a Navy doctor. Mother and child are doing well.

via the Cellar IOTD

Letter from a Fleet Hospital

One of my Navy doctor friends has been heard from, from an unknown foreign country at war, and I have excerpted some of the letter that’s medically interesting. I have gotten his permission to post it.

“The first several days we were busy putting up the fleet hospital. It is a pretty impressive structure. It is essentially a metal frame tent system that has interior and exterior liners. The interior liner is insulated and we have air conditioning that works off and on. There are multiple generators within the camp and we have a fair amount of electrical medical equipment. The hospital also has these large metal containers that are sort of like truck trailers and in these are prefabricated structures like the operating rooms and bathrooms. Once you enter the hospital, everything is connected so you never have to leave. During the day, you don’t want to leave because of the heat outside. The people that are on night shifts are really suffering because from about 10am to 5 pm it is almost impossible to sleep because of the heat. Our berthing tents are regular tents. We can open up the flaps to get a bit of a breeze but it doesn’t seem to help that much.

My job has been pretty interesting so far. Most of the patients that we see have been seen at another lower echelon of care first so there isn’t too much primary stuff that we need to/ get to do. A lot of it is trying to figure out what they did at the previous place because often we don’t get documentation of what was done. This seems to be getting better though.

I work in the casualty receiving section which is kind of like the ER. We are a mixture of ER and Family physicians. The family physicians have been doing a great job and we (ER docs) have been trying to help them with some of the procedures that they haven’t done in a while. Other than work, there is not much else to do. They are trying to show some movies and have other recreational activities but I have been too tired to do anything else.

I eventually get back to my tent at night, read a book and then fall asleep. I try to write my letters during the day while it is slow.”

He also reports that snail mail isn’t getting there yet, but that they have email.

PE visits to soar

David Bloom was a reporter on MSNBC, and I truly enjoyed his work. He died suddenly in Iraq, of non-traumatic causes, and the current speculation (and that’s what it is, we have no proof as of yet) is that he died of a massive PE (pulmonary embolism). PE’s are usually blood clots, but can be air bubbles (diving) or fat bubbles (orthopedic surgery).

What this is going to do is again sensitize the public to the issue (which was covered extensively last year in article about ‘tourist class’ syndrome on long plane flights), and they’re going to start showing up in doctor’s offices and ED’s. Those that go to the doc’s office will most likely be referred to the ED, as we can get the workup done very quickly, so we’ll see the majority of them.

Which brings me to my rant. We (docs, specifically ED docs) have been told for the last several years that there was an epidemic of undiagnosed PE’s out there we were missing, and thereby doing harm. We, therefore, started testing scads of patients with even minimal symptoms for PE’s, and you know what? I have been surprised by an unexpected positive exactly once. Patients are either classically symptomatic or they aren’t; the classic ones need only a confirmatory test, the non-classic get the big and usually fruitless workup. I’m still testing as I did before as I don’t want to miss this diagnosis, but the ‘epidemic’ is overblown.

So, I’m getting ready for a wave of PE visits. I’ll let you know how it goes where I am.

Set Your Clocks Forward

(Public Service Announcement)

Yes, tonight you either a) lose one hours’ sleep, or, b) get to church in time to shake hands as everyone else leaves. (Sorry if that leaves your religon out, but the joke works better that way).

There is a much more interesting history to this than I had thought, and in a rare event, I must admit I was wrong! In a recent conversation with my son he was right and I was not, the idea was originally Ben Franklins’!

For an interesting and comprehensive look at Daylight Saving Time, go here.

via DavidMSC

Ask Jeeves goes to GruntDoc for the poop!

Well, not really. I was researching search words that led people to my blog, and “Green Feces” (I kid you not) was used as a search term, and guess who pops up as the number one link?
Green Feces??
This is not what I want to be known for. Sorry, no green feces here. Move along. And Rick’s link is way cooler.

200 posts!

The post below is number 200 for this blog, and that’s remarkable to me. My friend Rick had a blog long before I did, and when he would hint I needed my own I would respond “but I have nothing to say”. I figured I’d do it for about a week and then quit. I’ll still quit someday, but not until at least post 210. Hehe.

1st Marines CO Relieved (and not in a good way)

On the front page of todays’ Washington Post is one of the biggest shocks I’ve heard of so far in the war:

The Marine Corps relieved one of its top commanders in Iraq yesterday, an extremely unusual action, especially for a unit engaged in combat.

Col Joe Dowdy, USMC, was the CO of the 1st Marine Regiment which is currently engaged in combat in Iraq. According to the WP article, the Marines are being tight-lipped about the cause for the extraordinary decision, and that’s OK for the near term but not for the long term. His CO, the 1st Marine Division Maj. Gen. James Mattis will not doubt be called upon to explain his actions. It should be pointed out that this was most likely not a decision made lightly and that MajGen Mattis probably had at least concurrence with the Theater Commander before taking such a drastic step. Col. Dowdy’s career is now over, and that’s never a good thing for a Marine who has spent his whole life protecting out country.

Commanding troops in combat is the ultimate experience for a career officer, and it’s a terrific responsibility. It’s a juggling session between getting the mission accomplished (job 1) while minimizing US casualties (also job 1) and, in this war, minimizing Iraqi casualties and infrastructure damage (also job 1). Get all that done and keep your boss happy (the boss will be happy if you get job 1 done), then you’re OK. It’s possible one of these is what caused him to be relieved; it’s also possible it was personality, insubordination, or any of the myriad other human foibles. We don’t know now, and the Marines are not ever going to make a big announcement (unless they charge him with something); frankly, I can wait.

The big question I have is who commands 1st Regiment now? I sincerely hope their XO (Executive Officer, 2nd in command) is given the job, because he’s already up to speed on the situation on the ground and has a good functional knowledge of the subordinate commanders and their dispositions. That would be the best thing for the troops.

I know first hand how disruptive a CO’s relief can be, and we weren’t being shot at. Our Battalion (BN) CO was fired about 10 days before we deployed overseas for 31st MEU. The new CO was a good Marine and very sharp, but he was playing catch-up with a unit already trained and ready to go. Don’t get me wrong, our BN could have carried out any mission given it, but the communication that happens easily among people who have worked together for a long time wasn’t there.

Here’s hoping the 1st Marine Regiment is well led by their new CO. Certainly he’s aware that it’s not a permanent job.

More from Dr. Gupta

Dr. Gupta (CNN) is back forward with his Devil Docs. Interesting reading, and makes quite a point that 75% of the patients are Iraqi and they are getting the same medical care our troops get. Contrast that with how our POW’s are treated.

US Casualties being Evac’d out of Theater

I have noticed that many of the US casualties (all that I have heard reported) have ben evacuated to permanent US medical facilities, either in Germany or the US. This is probably a good idea, but it makes me wonder what the medical facilities in-country are doing?

I know we have at least one Navy Fleet Hospital deployed there (and probably a lot more), and just one is a lot of capability. It’s entirely possible that this is reporting selection bias, that the ones I’ve heard of who have been evacuated out of theater are the only ones the reporters know about, so that’s what they report. I have no idea what criteria are used to evac casulaties out of theater, and I’m sure those evacuated go through medical stabilization in one of thoes in-country facility before flying away. Perhaps these are casualties who will not be able to be returned to the fight, perhaps they have specialty treatment issues driving their evacuation.

What I do know is that from my worm’s eye view I’d like to see some better coverage of the in-theater treatment, and I’m glad they’re there.

April Fooled by Dr. Rangel

Well, the hunch was right. Dr. Rangel recently announced he was shifting his blog to Spanish to fill a void in Spanish medical blogs. I wrote about it, then added an update that, as it was written on April 1st, it could be an April Fool’s prank.

Guess what? I have just read a nice email from Dr. Rangel congratulating me for being the only one who suspected the switch wasn’t what it appeared to be. I guess I should have seen it coming, and now we all know. It’s a pretty good joke on me, and from now on I’ll never believe anything he blogs again.

Just kidding. And the sidebar link is going back to normal. Someday. Hehe.

A few weeks with the Devil Docs

I have written before about Dr. Sanjay Gupta (CNN) being with the Devil Docs, the skilled Navy Docs and Corpsmen who move and fight with the Marines, with the purpose of saving lives.

Dr. Gupta has an article about his experience in Time this week. ALthough the medical information he has reported before, the article should be read to get a feel for what it’s like to live and move in the desert. He has a video report on CNN that’s new, and I cannot watch it (Real Player hates my satellite connection).

And when you’re finished, consider: Dr. Gupta got to go back to Kuwait and take a shower, the Devil Docs are still forward, where they belong.

Smoking, Heart Attacks and Helena, Montana

In Helena, Montana, the voters went for a smoking ban in ‘public places’. This eight month ban reportedly resulted in a decline in hospitalizations for heart attacks from 7/month to 3/month. The physicians who presented this to the American College of Cardiology were apparently big proponents of the ban, which was put on hold due to a legal challenge in December, when there was a ‘possible spike’ back to normal.

Now, I’m not a statistician but I know crap when I see it. There is no reported control for out of hospital deaths, and nobody is even making an assertion that the ban changed smoking patterns, just that hospital admissions declined. Phooey on this association and its implications.

This is not to say I’m against smoking bans in restaurants. I like to smell my food, not Pall Malls, and I’d walk a mile to eat in a smoke-free joint, thanks. I will gripe about the nanny society incessantly, but will stop when it comes to smoking. I think the second hand smoke ‘research’ is poor but that’s not my objection. My opinion is that cigarette smoke is an irritant, offensive gas that shouldn’t happen around my food. Want to light up? Fine, wait two minutes after you pay the check and walk outside, light up, and enjoy. But don’t act all offended when the ER doc asks if and how much you smoke when you come in with chest pain.

I support smoking bans, but for purely personal and selfish reasons. Helena, Montana is fortunate to have had a decline in their hospital admissions for MI, but it’s not due to a smoking ban. Heck, they’re probably just dropping dead before they get to the hospital.

Dr. Bob Arnot in Combat

It’s 0100 Central time and I’m listening, live, to Dr. Bob Arnot on MSNBC reporting from a trench in Iraq, and they’re under fire. Dr. Arnot is an embedded reporter with 1/4, a USMC Infantry Battalion. They’re in Al Kut, trying to secure a bridge while fighting the Republican Guard, so they’re pretty busy. While describing the scene for the TV viewers (without video) he just called in Arabic for civilians fleeing the town to get into his trench for safety. In case you missed it he called in Arabic, and they responded, then a USMC Colonel came to make sure they (the civilians) were OK. (They were).

Dr. Bob Arnot is now OK in my book.