Finally

Posted: July 9, 2013 in Uncategorized
Tags: ,

A 93-year-old retired dentist finally received his diploma from The Citadel 64 years after being pulled from college to serve in WWII. Sadly, he passed away Friday, only a week after the diploma was presented to him.

Provided by the Robert Williams family Vincent Williams (from left), 91, holds the diploma presented Saturday to his brother, Robert, 93, by a 2013 Citadel graduate, Marine 2nd Lt. Scott Holmes.

Provided by the Robert Williams family Vincent Williams (from left), 91, holds the diploma presented Saturday to his brother, Robert, 93, by a 2013 Citadel graduate, Marine 2nd Lt. Scott Holmes.

Advertisements

As of tomorrow morning I no longer owe any time to the US Army. All contracts complete, all obligations fulfilled.

A few months ago I made the decision to leave the Army. It was a tough decision to make, but in the end I have no doubt that I made the right decision. I don’t think the grass is greener on the other side…it’s just time for something different.

This hasn’t been the easiest journey… and I still am not sure if it was worth it. Three moves in five years and a year deployed… I’m not bitter, but I once I’m a civilian again I hope to spend some time reflecting and writing more about  my experience.

It’s going to be a few more months until my separation paperwork is completed and I’m actually a civilian again. I think that is when this blog is going to get really good again…

milk n' honey_big

The winter months in Afghanistan can be cold and dry. In the river valley it rarely snows and surprisingly it gets really dry. And showering with cheap body wash in heavily chlorinated water left my skin begging for moisture.

One day I had the idea to find some nice homemade soap that was good for dry, itchy skin. I found a nice lady from Michigan who had a small business named Marmalade Hills that made and sold homemade soaps online. I ordered a couple of oatmeal and honey soap bars that were supposed to help keep skin from drying out and relieve itching. Well, when this nice lady found out she was sending some soap to a soldier in Afghanistan she decided to hook a fellow up. When I received my purchase in the mail I found that she had put at least a half-dozen different bars of soap, two tubs of scented body butter, and several tubes of lip balm. It was awesome!

My elation was short-lived however. I realized that despite the sweet soap hookup, I just became a male soldier in Afghanistan that had a bunch of foo-foo girly scented soap and lotion in his room. I got worried that someone would smell the soap in my room or, worse, smell something on me. That’s how rumors get started…

So I hid that box of  soaps and wonderful potions and lotions as quickly as if someone had just sent me a box of pornography and liquor. I knew the consequences would be huge if I got caught.

I discreetly and carefully explored the contents of the box as if I was an EOD guy disarming a bomb. Some of those soaps had glitter on them. And once you get glitter on you …it is hard to get off. And if I was seen with even a speck of glitter on my skin I would never hear the end of it.  I sorted the non-glitter soaps from the glitter soaps. The glitter soaps were immediately placed in zip-lock bags and sealed off from all other non-glitter soaps. The non-glitter soaps were inspected carefully to make sure no traces of glitter could be found.

The soaps were amazing. That oatmeal and honey bar was quite nice on my skin and had almost no lingering smell afterward. I felt guilty hoarding all these nice soaps so I decided to discreetly share them with some of those in my trusted inner circle. Here is the actual email traffic that went out:

Me: “Hey guys. I ordered a bar of all natural soap from this lady’s online
store. She saw that it was an APO address and sent me a couple extra
bars of really nice soaps. If you guys want a bar just let me know. I’m
happy to share.”
KB: “So… you ordered lady soap?”
Me: “Yup. It leaves my skin silky and smooth. I’m strangely comfortable with that.”
JS: “I would love to try a bar.”
JL: ” Mike, Don’t take Percocet or Ambien then shop online.- J***”
JL: “Mike, The way I read this e-mail, it really sounds like you are purchasing [sic] women’s soap.- J***”
I won’t name any names here, but late one night there was a tap on my door. When I opened the door there was a man standing there in the shadows. He looked around to make sure no one was looking then said to me quietly ” So…I hear you’re the guy to talk to about some soap…”

I wanted to take a break from my usual writing to put some information out there about the financial benefits of the HPSP program. I know there are a lot of dental students and future dental students who read this blog so here is some information for you. And with the rising cost of dental education this is becoming more and more important.

When I was in dental school, a classmate gave me a hard time about taking the Army scholarship. He said it was financially a foolish move and that I could make so much more money in the civilian world. I explained to him that my decision to come in the Army was not about the money in my particular case, but a desire to serve. He couldn’t argue with that one, but remained adamant that I got a raw deal.

So after five years in the Army I am looking back and re-evaluating the cost benefits of this scholarship.  All non-financial issues aside, this program was totally worth it. Here is my rationale using the in-state numbers from my dental school in todays dollars.

Tuition and living expenses for 4 years: $336,131. I’m assuming a Stafford loan with the current default* 6.8% interest rate and the standard 10 year payback. Using a student loan calculator, a new dentist from my dental school would need $3,868 a month to pay that loan off in ten years. Over the ten-year term of the loan, he would pay $128,053 in interest bringing the total cost of his dental undergraduate education to $464,184.

Now lets run those numbers based on a 4 year commitment to the Army – meaning your dental school loan is paid off in four years, not ten. With those same numbers, a new dentist wanting to beat the HPSP would have to find $8,017 in his monthly budget to pay off that loan. That is $96,204 a year in student loans. That is feasible if you are a practice owner, but an associate making a generous $110,000 a year would have to live off of about $14 grand a year for four years to beat the HPSP.

So here I am at almost the five-year mark (I had a five-year commitment because I completed an AEGD). My dental school is almost paid off. I’m in a pretty good position to buy a nice practice and a nice home –  or do whatever I want without having to worry about paying that huge note if I choose to leave the military.

*Term “default” used to refer to the default setting of the online loan calculator. This does not refer to the interest rate charged to a borrower when a loan is overdue. 

20121226-175836.jpg

A lot of my significant memories from my deployment are negative ones – saying goodbye to my family, dealing with isolation and depression, facing the realities of the violence of war. But mixed in there with all the bad memories are some really positive experiences and great stories of Army Dentistry.

By far, my most positive experience in Afghanistan was my trip into the Jalalabad Market. I got an email one day from the head of our Base Defense Operations Center (BDOC) asking me if I would be willing to go on a short mission outside our base to deliver dental supplies to children in a school near the market outside our gates. Without hesitation I said: “Absolutely!”

An organization back home in the states had collected toothbrushes, dental floss, and other oral hygiene supplies and mailed them to Afghanistan. Not really knowing what to do with them, they arranged a mission to deliver them to some local Afghani children. Realizing that this was a great opportunity to win the “hearts and minds” I made a quick trip to the Public Affairs Office (PAO) to see if they had a combat photographer available to go with us. We were lucky and PAO was interested and readily willing to accompany us on our trip.

The day of the mission was a brutally hot summer day. Those of us going on the trip got in full battle rattle and met our security detail on the friendly side of the Entry Control Point (ECP). In addition to the photographer, the dentist, and the crew of 3 heavily armed and armored gun trucks, a partner team of Afghan National Army soldiers joined us to translate and provide additional security on our mission.

We had a short mission briefing before rolling out. We placed our weapons on “RED” status –meaning we chambered a round and placed our weapons on safe– and headed out the gate. This was my first time on foot outside the wire. I immediately felt like a fish out of water with a target painted on his back. I realized instantly that this was a perfect opportunity for the enemy to hit us with an IED. I imaged the headline the next morning: “An IED attack killed ten American Soldiers who were conducting a dismounted patrol in the vicinity of Nangarhar International Airport on Tuesday….”

I pushed that thought out of my mind and refocused on what was going on. Surrounded by our escorts we walked about 100 meters down the main road – Highway 1. We came upon a small market on the right side of the highway and began slowly patrolling down the narrow dirt road. On both sides of the road were shops – a shoe store, and a butcher shop just to name a few. We all waved and smiled and tried to make the locals feel like they should be happy to see us. The PAO photographer, a young blonde female Staff Sergeant, was drawing quite a bit of attention from the young men on the street. I overheard at least one marriage proposal.

20121226-180032.jpg

As we reached the end of the road we were immediately surrounded by a large number of young children ranging in age from infant to teenager. Our Afghan Army security detail yelled at the kids to stay back, and a man who appeared to be a teacher herded the children to a small clearing by a tree. With the help of a translator I gave a short class on brushing and flossing. We posed for a few photos with the kids and then started to hand out the toothbrushes and floss.

Within moments the basic discipline the children exhibited while in the presence of their teacher disappeared. They began mobbing us and grabbing the boxes. We were quickly overwhelmed with dozens of surprisingly strong children who were patting us down, reaching into our pockets, grabbing pens and anything loose off of our uniforms. Fearing a child would accidentally grab a weapon, I dumped my box of brushes and the others quickly followed suit.

As the situation calmed down we started the walk back to the base. On our way out of the market we stopped briefly at an outdoor butcher shop. The locals were very friendly and hospitable and were offering us food. Knowing that the meat had been hanging outside for hours and seeing the number of flies on the food, we thanked them and kindly declined. I always felt bad turning down food from the locals as it is considered an insult. But I would rather offend on occasion than suffer from a severe bout of food sickness. I had a policy of always accepted chai if it was offered.

It took only a few minutes to return to the gates and get back to our FOBBIT lives. Later that week the photographer burned me a CD with all of the photos she took while on the mission, some of which I have included here. That mission remains one of the highlights of my year. My interactions with the Afghan citizens throughout that year made me appreciate how similar–on many levels–all people are.

This slideshow requires JavaScript.

20121213-195413.jpg

I sat straight up in bed and looked at my watch. It was 6:17 in the morning and my heart was pounding. “What the hell was that?” I thought. It was too loud to be a controlled detonation – and way too early in the morning for anyone to be at the range.

I was staring at my wrist watching the seconds tick by. If this was an attack then the alarm should go off any second…

It couldn’t have been five seconds before I heard the alarm screaming “Initiate Force Protection Condition DELTA….” which meant something bad was happening. I was now fully awake and aware that I was not dreaming. I jumped down from my bunk and started putting on my gear. This was an all too familiar routine, but the feel of adrenaline starting to pump told me that this time it was close.

I ran down to the aid station where we started getting accountability. It was the usual post-alarm chaos…people running around trying to figure out who was missing. The only difference today was that everyone genuinely looked concerned. You could feel the tension in the air. The officers and NCO’s were on the radios trying to figure out what just happened. Pieces of information started trickling in.

Apparently there had been a large explosion at the Entry Control Point – the front gate. At this point no one was exactly sure of the details. Was this an accident? Was it a helicopter crash? Did a fuel tank explode? A lot of different scenarios ran through my head.

Then we started getting some real info. Our base had been attacked by a VBIED: a Vehicle Borne Improvised Explosive Device. Two vehicles loaded with explosives attempted to gain access to the base. The driver of the lead vehicle detonated as he entered the first gate. There were dead and wounded and they were all headed our way.

Not ten minutes after waking up and getting to the aid station did the first vehicles started showing up. The surgical team was quickly overwhelmed with patients as were our two physicians, the nurse, and the PA assigned to our battalion. I was asked to go out front and triage any additional wounded.

Moments later an Afghan Military Toyota truck pulled up in front of the aid station. There were several men in the back of the truck. Those who could walk on their own stumbled out of the truck and surrounded me. They were pointing and yelling at something lying in the bed of the truck. I looked up and that’s when I saw him.

There was an Afghan soldier – a member of the partner unit that helped guard our gate – lying face down on a litter. One of his legs was mangled and mostly amputated. His arms and shirt were up over his head. His leg wound looked like meat from the butcher: pale reddish-gray. I noticed immediately that he was not moving. I quickly jumped up in the bed of the truck to look for a pulse I knew I wouldn’t find. I pulled his hands and shirt down from over his head to gain access to his neck.

I still don’t fully understand what I saw. The best way I can describe it was that his head wasnt where it was supposed to be. There was just a flap of skin: neck and hair. What was left of his face was unrecognizable as human. What remained of his scalp was simply matted hair with blood. There was no bleeding.

Two of our medics ran up to the truck to help me.

“Put him in Expectant…” I yelled, referring to the worst of the four triage categories. I told them to help me carry him to an area we had designated as the collection point for the dead and dying. As we moved the Afghan soldier out of the truck, one of the surgeons came outside and asked where we were taking him. I told the Doc that he was dead. He quickly listened for chest sounds with his stethoscope and then nodded.

We carried his body behind a wall so that the others couldn’t see him. I told his comrades that he was dead. There was nothing we could do. I don’t think they spoke much English, but they understood. The medics placed his remains in a human remains pouch (aka a body bag) and I went back inside.

The whole aid station was chaos. There were wounded Afghan and US Soldiers in every treatment room and in the hallway. Our PA asked if I could sew up a wound on a man’s face. The blast split open his chin and would require several sutures. After gloving up, I anesthetized the area, irrigated the wound, and placed five or six vicryl sutures. Not the ideal suture material to close a facial wound, but the thread is white which was essential in the situation considering the patient’s thick, dark beard.

Later that morning our Company Commander and I drove over to the ECP to survey the damage and check on our soldiers – my dental assistant had been on guard at the gate that morning. We knew very early on that he had not been injured, but we wanted to check on him and see how he was holding up. He had witnessed the entire event.

After checking on my assistant– who was shaken up but otherwise okay– we walked down to the site of the explosion. The force of the explosion threw the engine block of the vehicle over fifty feet into a concrete bunker wall. The driver was essential vaporized. Someone later told me they found a part of his spinal column hundreds of feet from the blast. There was burnt, twisted metal everywhere.

The attack that morning left nine Afghan soldiers dead and about fifteen wounded. Two American soldiers had been wounded, but thankfully none were killed. Had the driver waited a few more moments before detonating his vehicle, many Soldiers –my assistant included– would have been seriously wounded or killed.

After the situation stabilized it was back to life as normal. I decided to close the dental clinic for the morning as my uniform was bloodied and dirty and I was a bit upset. I needed a shower and some time to regain my composure. I wasn’t hungry but my head was screaming for a cup of coffee.

The events of that morning left me bothered for a couple of days. We were less than a month from the end of our deployment and I mistakenly assumed the worst was over. The attack renewed my sense of fear and left me scared, nervous, and ready more than ever to get home safely.

20121118-214438.jpg

I don’t enjoy having conversations about Afghanistan with people who haven’t been there. It is not that I don’t want to share or help others understand the conflict or my experiences. My issue is that the stories I truly want people to understand are so visceral that words rarely due them justice. Especially when my words fall upon ears that don’t already have some basic connection to this conflict: the ears of someone who has never served in the armed forces, who has no relatives who have been to Afghanistan, who couldn’t find Afghanistan on a map.

The majority of my time in Afghanistan was divided between working hard and doing absolutely nothing. There would be days at a time where I did not see a single patient. Being frustratingly bored is what I hated the most about my deployment, but being bored is not what has affected me. Being bored is not what inspired me to start sharing my experience on my blog.

My clinic in Afghanistan was in a small concrete building near the runway on a small base close to the Pakistan border. In this building were other medical assets, to include two operating rooms and a team of surgeons. As such, the majority of seriously wounded Soldiers in our area of operations came to us for surgery. I got quite a bit of experience that year treating maxillofacial battle wounds, but unfortunately along with the split lips, broken teeth, and facial lacerations came the double amputations, exsanguinations, and other variations of modern battle-wounds that the American public has yet to see the long term effects of.

As a dentist I see bleeding and pain on a routine basis, but I am not accustomed to the level of violence and trauma that a general surgeon is. To me the images of wounded American Soldiers stand out profoundly, while to a surgeon they are likely routine and unmemorable. I hope to never again see the effects of such violence again in my lifetime, but those wounded and dying men and women that I saw will forever be etched in my memory. It is these memories that I want to share with the American public, and it is these memories that churn my stomach when I recall them.

My first exposure to the violence of this war was in the first 24 hours after arriving in Afghanistan. A suicide bomber walked onto a nearby base and the wounded were evacuated to our facility. Still, this trauma was distant, new, confusing, and as such did not yet seem real. Nine days later was when it became real to me. It was a Sunday morning and I had been called in to the clinic to see two emergency dental patients. As I was finishing, we got word that we would be receiving five incoming wounded patients. I remember feeling naively excited as our new battalion surgeon and I propped open the doors to the clinic to prepare to receive the casualties. He wanted me to stick around to triage — to sort the patients based on severity — since that was technically an additional duty of the dentist.

I recall it was a very warm April day. The sun was beating down on us while we joked, getting to know each other better. Then the first ambulance rolled up and the medics threw open the back door to get the patients out. The mood quickly changed. I ran up to the vehicle to assess the patients and to begin sorting. Thankfully there were not enough patients to really triage. There was only one that really needed surgery and a few others who were minimally wounded. But at this moment the war became real to me. I looked up and saw a man about my age with red all over his uniform, blood streaming from his face. He was shaking and violently vomiting into a plastic baggie. His left eye was ripped out.

As the year progressed and casualties mounted, I developed a bad habit of internet-searching the names of the Soldiers who died. I wanted to learn a little bit about them out of respect; and in the age of social media and online hometown newspapers, it was easy to do. Unfortunately this made the emotional burden somewhat more personal. I could no longer separate them simply as patients. They now had first names and families. Lives they had lived before the military. Wives and kids whose lives would be forever changed by their death.

One particular death bothered me more than others, probably because it was my first. He was a young Soldier whom I did not know. To this day I do not know what happened to him, but when I came around the corner of our building I saw the team unloading him from the ambulance. His uniform had been cut off by the flight medics so I could see his pale yellow skin under the hot Afghanistan sun. There was a small amount of blood on his chest but no visible trauma. Our Brigade Nurse was barking orders while doing chest compressions on him. His eyes were open but vacant. Each time she compressed his chest I could see his lips moving, un-naturally expelling air. He was dying right there before our eyes. I knew from the color of his skin that he was already gone.

He died that hot summer day in Afghanistan.

Something odd happened to me every time I saw a Soldier in the grips of death. Time slowed down and all of my senses heightened. Colors became more vivid, smells and sounds more defined. Details became more pronounced. I will never forget the smell of blood evaporating into the air under the hot sun. It is the smell of life being carried away by the wind.

Later that day I searched his name on the internet and quickly found a picture of him and his wife and children. He looked very different in life. I realized that in a few short hours that woman in the photo would get a knock on the door that would change her life forever. Her husband had been Killed In Action. Those children’s father would never kiss them good night again. A knot formed in my stomach. I thought about my own family: my wife and son, my parents. I prayed they would never get that knock.

I couldn’t get the images of his death out of my mind for days. I had a hard time sleeping at night. Every time I closed my eyes I could see his face. I can still remember his face but it doesn’t bother me as much anymore. I’m not sure if that is good or bad. I like to think that for me it is a good thing. But for history’s sake, forgetting his face is wrong.

Now that I have been home seven months, I find my mind wandering back to Afghanistan less and less often. In the fast-paced, cushioned lifestyle we enjoy in our country it is easy to forget how many are still serving in Operation Enduring Freedom. As Thanksgiving approaches this week I will take a few extra moments to thank God for bringing me home safely and pray for those who are still downrange. And I will remember to ask God to bless the families of the fallen who celebrate the holidays this year for the first time without their loved one.

It didnt take long for life in Afghanistan to become mind numbing. I lost track of what day of the week it was almost routinely. I joked with one of our Lieutenants that “every day in Afghanistan is Monday” -which was exactly what it felt like. That grumpy feeling that I have first thing Monday morning was how I felt pretty much all day every day. As the days turned into weeks, and weeks turned into months my mood just got worse.

A good friend of mine started expressing concern about my change in attitude a few months into the deployment. I’m usually a pretty easy going guy, but I had developed a very short fuse and an unpredictable temper. I hid the temper well, but my anger was easy to see. Running and working out no longer helped relieve stress and I was quickly turning into what my two year old calls a “Grumpus.” My faith in God and my daily bible readings, which sustained me for years, no longer helped. I had lost my faith as well.

About two weeks before R&R I finally went and asked for help. I set up a discreet appointment at Behavioral Health and told the doc what was going on and how it scared me. I knew this wasn’t me. The doc reassured me that this was very common and diagnosed me with what he called “deployment mood disorder” and wrote me a prescription for some anti-depressants. I hesitated at first, but eventually agreed to try the meds.

The military has done a lot to remove the stigma around mental health and asking for help. But despite all of the official roadblocks removed, there still is some reproach among your peers. The stigma may not be as bad as it was five years ago, but it is still there. The perception remains that those who seek assistance from behavioral health are somehow weaker individuals and perhaps less trustworthy soldiers. I strongly disagree and have a feeling that a lot of officers discreetly made appointments to see a mental health specialist. Regardless, I was still embarrassed. I was worried that our pharmacy tech would mention to someone that he had dispensed anti-depressants to the dentist and that word on the FOB would get out. I even hid the medication in an old Motrin bottle so my buddies wouldn’t accidentally see me taking an anti-depressant.

I took the meds for about a two weeks. I saw a very rapid improvement in my mood which I was thankful for. However, I did not like the side effects and decided to stop taking the meds right before arriving home for R&R. I knew that if I could just get home and see my wife and son for just a few weeks then all of this anger and sadness would just fade away. I was right. The break at home was just what I needed and by the time I was headed back to Afghanistan I felt like a new man.

I managed to finish the final 6 months of the deployment without any more appointments at behavioral health. The knowledge that I had survived six months in Afghanistan and only had six more to go was enough motivation for me to hang in there. When my mood started getting bad again, I would just talk with some friends. Usually a good cigar and good conversation around the fire would be enough to fuel me for one more day.

And that is how the rest of the deployment went. One day at a time. One cigar at a time.

This post was written almost a year ago and describes 3 of the most emotionally difficult days of my deployment.  I waited for the right time to post this, but the time never came. I guess now is as good a time as ever. These events are how I recall them and were written immediately after they took place:

The other night at 0130 I was awakened to the loudspeaker announcement “ATTENTION ON THE FOB: ALL B POSITIVE BLOOD DONORS REPORT TO THE AID STATION IMMEDIATELY.”  Disoriented,  I sat up and waited to hear it again, as I couldn’t quite make out what the voice said. Sure enough, they wanted all B + personnel down there ASAP. I jumped out of bed, grabbed my weapon, and beat feet the 100 meters or so to the aid station not knowing what I was going to walk into.

There was already a handful of half-dressed, sleepy-eyed soldiers and contractors waiting. People were running around, clearing chairs, scurrying about. I asked someone what was going on: “IED, sir. 5 casualties. Three are heading to the OR right now.”  They needed five units of B positive apparently.

Within five minutes I was laying on a table with a garden hose in my arm draining me of my precious B+. I hoped that my blood would somehow work miracles on whoever it was that was so in desperate need of it not 20 feet away. A few minutes later we were done, a lab tech came and grabbed the bag and ran a couple of quick tests and took that tomato colored juice bag of blood next door to the operating room.

“First guys dead.” I heard a SGT say. “They’re prepping the next guy for surgery.”

I didn’t know whether my blood made it into the first or the second guy, but I like to think my hemoglobin carried some oxygen to another man’s tissues. I hoped my blood gave at least one of them a fighting chance.

For those who don’t know me, I don’t usually give blood. I am not opposed, I just don’t tolerate it well. Every time I donate blood I experience orthostatic hypotension when I stand up and if no one is around, I hit the floor. Hard. I guess that is something you don’t grow out of.

As expected, I got very pale apparently. Someone got me a chair and some water. I downed the water and grabbed some Ho-ho’s I had stashed in the fridge. I sat in the hall for a good five to ten minutes waiting to absorb some of the fluid I just drank. I watched as they wheeled the second guy into the OR. In my head I wished them the best. I wanted to stand up and help, but I knew I would pass out if I did.

0630 came a lot faster than I had hoped. I was exhausted. I had not gotten back to bed until after 0230. I made it to the clinic around 0750 and inquired about the patients from last night. Two out of three didn’t make it through surgery. The third survived and was in our ICU recovering.

This is the third or fourth time this has happened since I have been here. I was honored to be able to help by giving blood that went straight into the operating room but I wish there was no need for the blood.  Sadly though, this is becoming my world. This is where I live. This is the crap that goes down in my neighborhood.

PART II: The following evening I was waiting in my office for a friend. We were heading up to the roof to smoke some cigars. Out of nowhere one of the surgeons from the Forward Surgical Team pops her head in and says “Im glad I found you! We have a guy coming in with a gunshot wound to the jaw. Would you mind helping us out?”

I spent three hours that night in the operating room assisting a neck dissection on a young man who took several rounds to the head and neck region. One of these bullets went in through his left parotid gland and came out on his neck about three inches below his left ear. Another bullet appeared to enter just anterior to the sternocleidomastoid and exited the back of his neck. This is the luckiest man in the world as not one of those bullets hit an artery, nerve, or vein. Just muscle. We dissected all the way down past the carotid to the esophagus and trachea. Everything was intact.

I wasn’t used to standing for so long. I hadn’t eaten much that day and at one point the pulsing carotid  became too much for me. Beads of sweat starting forming on my forehead and I felt my face tingling. I knew I was about to pass out or vomit or both. So instead of hitting the floor in the OR I excused myself. One of the nurses gave me a soda and let me relax for a few minutes before scrubbing back in.

I helped close up his neck and I closed up his facial wound myself. He is going to need some grafting to replace this half-dollar size chunk of face that was gone, but other than that he will probably be fine. I never thought my life as a general dentist would take me into the operating room to help handle gunshot wounds. I guess I was wrong.

Part III: How much trauma is going to happen while I’m writing this post? It was 2400 last night. Almost exactly midnight by my watch. I heard the door to my hut fly open and our brigade nurse speaking firmly, yet seeming to try and be quiet at the same time. I couldn’t make out what she was saying.

“Whats going on?” I asked, disoriented.

“A Chinook just crashed with 24 people on board. We need everyone down at the aid station. Right now.”

“Are you f*cking kidding me?” I replied. I hoped this was another MASCAL drill.

“No. I’m not kidding. We need everyone down there right now.”

My heart just dropped. I felt sick to my stomach. I could not even imagine what this could mean.

I was still waking up and getting oriented as I ran down to the aid station. People were running around all over the place. The Forward Surgical Team was up and their doors were propped open so I knew this was no drill (as they don’t usually participate in our midnight training exercises).  I tried to get some info from our platoon sergeant. All I was able to determine was that a CH-47 Chinook helicopter had gone down with 24 soldiers on board. No status as to any survivors, but we were preparing to receive 24 casualties.

In the middle of the night we executed our plan for a Mass-Casualty Event (MASCAL) flawlessly. I was really impressed at how everyone came together. We had over 30 litter-bearers show up just to help carry people. During a MASCAL my job is to triage the patients as they bring them to us. For an hour I waited out front trying not to vomit thinking about the horror that could be dropped at my feet any moment. Thankfully at 0100 we sent everyone packing. The had taken the critically wounded to a closer surgical team and we would not be receiving any of the urgent or surgical patients. We received several of the crash victims throughout the night, but they were stabilized and not surgical patients. Thankfully, not a single person was killed in the crash, though there were some very serious injuries.

That all happened in the last 72 hours. I spent most of Sunday sleeping. I was just physically exhausted.

One of my bosses had this idea before we deployed to send me all over the AO to do “cleanings.” In his office one afternoon, he explained to me that he understood how important that prevention stuff was and that this was his solution to how I would manage the brigade’s dental care during the deployment. “Anyway, that’s what our dentist did in Iraq” he said.

I immediately began repeatedly banging my head on his desk.

No, no I didn’t. But strangely that was my first instinct.

What really happened was a polite and respectful conversation in which I explained to him my concerns with his plan. But he was the commander and I was just his dentist. What did I know about effectively delivering dental care? My job was to do what I was told. I left his office that afternoon with a knot in my stomach and a headache. I did not want to spend a year in Afghanistan polishing tobacco stains off of teeth.

Fast forward about twelve months. There we were in Afghanistan and the impossibility of sending me out to perform dental hygiene on thousands of soldiers was finally apparent. However, in an attempt to show support for our Soldiers we came up with a compromise. My idea was to travel around to as many small FOBs, COPs, and OPs as I could with cases of fluoride varnish. I would fly out on a helicopter to some small outpost and just paint fluoride on the teeth of anyone who was willing. Unlike cleanings, this required minimal equipment and would actually be a way to quickly affect many soldiers in a short time and actually prevent dental decay. This plan also freed me up to do consultations with soldiers, medics, and the PAs while my dental tech administered the fluoride treatments.

We traveled on quite a few missions throughout the year. Some days I would leave in the morning and come back at night. Some times we would be out for days. At times, we had some very interesting experiences.

One particular trip took us to a small Combat Outpost up in the Pesh River Valley called “Honaker-Miracle.” This COP was named after two soldiers, Specialist Christopher Honaker and Pfc. Joseph Miracle, who were killed in 2007.  This base was at the bottom of a steep valley and was prone to mortar and sniper attacks. We arrived late at night on a UH-60 Blackhawk. A small element from the base operations cell was there to greet us and give us a quick situation report on the security of the area. The situation up there wasn’t very friendly.

Being one of the highest ranking officers on the COP that week, they put me in what they called the VIP suite. It was mostly a joke, but they had mints on the mattresses and had printed up a brochure for the VIP room that satirically welcomed visitors to their “Gated Community.” Their brochure offered amenities that included:

  • 24 hour security
  • Nightly fireworks
  • Spectacular views
  • Gun ranges
  • Free meals (prepared by our trained and certified culinary experts)

The VIP Suite at COP Honaker-Miracle

We settled in for the evening with the hope of seeing 50-60 soldiers the following day for fluoride. I actually got a great night’s sleep and woke up to some truly spectacular views of the Hindu Kush mountains. Around 8:30 in the morning we started taking sniper fire from up on a hill. The echo from the valley made each round sound like it was being fired from twenty feet away. Because of the sniper everyone had to stay inside as much as possible and wear full “battle rattle” when moving outdoors – helmet, body armor, and weapon.  If you needed to relieve yourself, you had to run in a dead sprint to the latrines and hope for the best.

Not surprisingly, we didn’t get too many soldiers willing to risk their life to come see the dentist that day. We spent the morning hanging out and watching movies in the aid station with the PA and the unit medics. We could hear the sniper firing outside all day. He would pop off a few rounds here and there at some unlucky soldier trying to run to the bathroom or go get some chow. No one was particularly bothered by this as it was a pretty normal event for that base.

Sometime after lunch an alarm went off alerting everyone on the COP that there was a casualty on the base: someone had been shot. Everyone in the aid station started preparing to receive a wounded soldier. My assistant and I picked up our gear and moved it out of the way. The aid station was very small, only holding a couple of desks and two litters on litter stands. The last thing they needed was a bunch of fluoride varnish and dental supplies all over the place.

Only a few moments later the back door came flying open and a large soldier came lumbering down the hall. His buddies followed quickly behind him and tried to explain what happened: he was outside trying to go get some laundry when he got hit.

The medics quickly but calmly hoisted him on a litter and began cutting off his uniform so they could inspect the wound. A small amount of blood was noticeable on his sleeve. Once exposed, a wound was visible on the lateral and medial surface of his left bicep. There was minimal bleeding and no swelling. The patient wasn’t feeling much pain thanks to all the adrenaline and was surprisingly very calm and cooperative. The PA did a thorough examination and determined that the round had passed through only muscle and had done so cleanly. There was no damage to any major blood vessel, nerve, or artery. The pulse in his hand was strong. They debated about calling a MEDEVAC helicopter to take him to the surgical team for an evaluation, but opted to observe him there instead. The risk of having a helicopter shot down was greater than the risk of this particular injury.

The medics cleaned and bandaged the wound, then wrapped an ice pack on top. They gave him some pain medications and assured him he would be fine in a few weeks. Members of the soldier’s chain of command were there very quickly with instructions to the patient: Call home, tell your family what happened and tell them that you are okay. Then they immediately started the paperwork for his Purple Heart.

After a few minutes things started calming down. I struck up a conversation with the recently wounded soldier. I told him who I was and what we had come there to do. He was surprised that a dentist was there. I asked him if my tech could put some fluoride varnish on his teeth while he was here. He agreed, and he agreed to let me photograph him.

Combat Dentistry: Taking dental to the tip of the spear

Later in the afternoon as the sun began to set, the sniper lost his ability to see his targets and he retired for the evening. The soldiers at COP Honaker-Miracle did not take the snipers attack without fighting back. They returned fire when they could and they mortared the area where they knew he was hiding. As the rounds landed on the side of the mountain some of the dry brush caught fire, gently illuminating the mountainside as the sun set over their tops.

There are not a lot of times in an Army dentist’s career when he has the opportunity to come so close to the enemy. For the most part, even when deployed, dentists rarely leave their post at the dental clinic. It is even rarer for us to travel so far forward to such a small outpost. Our experience in war is usually limited to treating dental patients in some cozy clinic all day long. I consider it a great honor that my unit wanted and allowed me to deliver dental care to the Soldiers out there who actually do the fighting in this war. As much as those Soldiers appreciated my visit, I appreciated my time with them much more.