One of my friends from the Navy days went to the Gulf with Fleet Hospital 3. He’s an orthopedist, and was very busy there. He’s been home for a while now, and has compiled all his photos, and sent me copies. I think he took more than 300 photos, and many are terrific. I hope to dole them out here as eye candy, and so people can see how the medical part lives, forward deployed.

Update: from my friend: “The hummer was actually taken by the Opthalmologist. … He actually put my name on the picture and my partner on the passenger side. So, it is a doctored photo. It was actually some MP’s I think. Note the tear gas launchers and the NBC fittings on the vehicle.”

Ah, well, so it’s Photoshopped some. It’s still pretty funny.

Recently, I got an email from a Navy GMO, assigned to the grunts. I tried to respond to his email, but the return address is bad, so here’s my answer to his question(s):
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MSNBC – U.S. Army surgical unit saves Iraqi lives

Nice article about the Forward Surgical Team attached to the 2nd Armored Cavalry Regiment in Baghdad.

I have no idea if the associated video is any good, it wouldn’t play for me.

GruntDocs heard from again! For his prior missive, follow the link.

Things are going well here. We don’t know when we will be coming home yet as things start to wind down. Even though we got word directly form the CO’s mouth yesterday the possibilities range from not having a mission here within 2 weeks to staying here for at least 3 more months as the last medical asset in the area while all of the other assets egress. Who knows?
I will wait until someone tells me to start packing my bags.(Friend) has been busy with lots of work. The orthopedists (writer not an orthopod – ed.) have been working the hardest. We are hoping for the Humanitarian Organizations to set up shop in country because that will lighten our load significantly. Right now, we have nowhere to send Iraqis that will need long term re-hab etc.Otherwise, camp life is good. Mail sucks but thank God we have the internet to communicate with. The STPs, Surgical Companies and the FRSSs don’t have any way of communicating except for the broken mail system. The medical system is completely different now. There are no casualty clearing companies. Everything is based on these shock trauma platoons and forward resuscitative surgical suites which are staffed with ER Docs and surgeons that are located right near the front lines.

That is about all for now.

And the wind is for real.

I have gotten a couple of very touching emails from readers who are interested in knowing if I’m ‘in the field’ and if I know their loved one, and can get them a message.

No. I’m right here in the Continental US. Sorry.

Watching MSNBC, still following the Iraqi developments, I was enjoying a report about the USMC finding a orphahnge, staffed by nuns, intact and doing their job well in a difficult situation. The embedded reporter then spoke about the Marines bringing in their corpsmen, there was a blast from my past:

Petty Officer Joe Gallardo!

Gallardo was a corpsman in my BAS way back when, and he was a motivated and dedicated sailor. He spoke on camera, sounding the same as I recall, and made the Devil Docs look good. He held a child, and the reporter stated they did brief medical checks on the kids.

He’s the first person I’ve see that I knew, and it was great to see him. I’m glad for him he stayed in, and I’m glad for my country guys like Joe Gallardo are there.

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.”

The 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

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.

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.

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.

Medscape (link requires free registration) has an interview with Col. Cliff Cloonan, MD, chairman of military and emergency medicine at F. Edward H?bert School of Medicine, the military medical school at the Uniformed Services University of the Health Sciences. His CV is impressive, and he knows what he’s talking about. His experience is Army, and so’s his jargon, but the medicine is the same (though Navy Corpsmen are better trained than the basic Army medic).

Medscape: Does working in desert conditions while traveling pose unique challenges, such as maintaining a clean field during surgery, or preventing shock in injured patients exposed to extremes of heat and cold?
Col. Cloonan: Most wars are fought in uncomfortable, dirty, nasty environments, but that’s just where we operate. In Korea we had the freezing cold; in Iraq we have the blazing heat and windstorms blowing sand in your eyes. We tend not to fight wars in Hawaii.

I like this, and hope Medscape gets their in-theater doctor/reporter they want.

Dr. Sanjay Gupta reports on CNN.com that the Navy has developed and deployed a forward surgical capability. That’s great news, and I look forward to their publications in the future as to their effectiveness, mortality and infection rates. I actually would not hold a modestly increased mortality rate against them, as they’re going to get very injured combatants, the most injured of whom might have died on the way to a more remote OR.

According to Dr. Gupta:

In this mobile operating room — a tent that can be set up or torn down in less than an hour — it’s not unusual for these doctors — Navy personnel who work for the Marines Corps — to perform surgery on their enemy.
(snip)
Monday was the first time the Frontline Resuscitative Surgical Suite has been used, and doctors began treating some of the first patients coming from the front line.

Dr. Gupta did a creditable job of describing the facility but wasn’t given enough room to explain the odd title: Devil Docs?

In WW I, at the battle of Belleau Wood, not only did the USMC distinguish itself in combat, but they won the grudging admiration of their German enemy, who reportedly stated they fought like ‘Teufelhunden’, or Devil Dogs. The Marines liked the sobriquet and adopted it as a nickname, often greeting each other as such. The Devil Docs is a natural extension, applied to the US Navy medical personnel who proudly serve in the Green Machine.

It’s a terrific capability, and I hope it save a lot of lives. I’m rooting for our Devil Docs, the Corpsmen and Physicians alike.