I was interviewed by Martin Madert of the Witness to War project. Witness to War is a 501c3 non profit dedicated to preserving the oral histories of combat veterans. This is the full length version of my story about serving as an Army dentist in Afghanistan.
About once a month I get an email from a dental student or pre-dental student who has read my blog and is interested in the Army HPSP scholarship. That’s great! But almost every single one is asking how they can get out of deploying if they come in the Army.
I’m really getting tired of writing the same emails to these students. So here it is:
IF YOU DONT WANT TO DEPLOY TO A COMBAT ZONE THEN DONT JOIN THE ARMY.
It’s simple. There’s not much more to it than that. Don’t email me asking for ways to get out of deploying.
There’s a lot more to being an Army Dentist than deploying, and many never have to deploy. Deploying or not deploying doesn’t make you a good or bad soldier. But trying to avoid deploying makes you a dirtbag in my book.
The Army is not for everyone and that is okay. But if you take the scholarship and you come in the Army, then you have to accept what risks and responsibilities come along with being an Army Officer.
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.
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.
FOB Fenty / Jalalabad Air Field
It’s not easy deploying an infantry brigade to Afghanistan from Hawaii. Just getting there required a multi legged trip that turned into the most convoluted journey I have ever been on. In my mind, the logical route would have been to head west to Japan or Korea. From there one could easily fly over into Russia then down into Afghanistan. Quick and easy. Instead, we flew north from Hawaii to Alaska. From Alaska we flew up over the north pole to Germany. Then we flew over Europe to Kyrgyzstan where we arrived at Manas Air Transit Base. Needless to say, it took several days just to get to Kyrgyzstan.
Chapel-tent at Manas in Kyrgyzstan
We flew out of Manas on an Air Force C-17 after several relaxing days enjoying Air Force facilities. When we crossed into Afghan airspace the crew chief made everyone put on their body armor and helmet. That was pretty disconcerting. After about 90 minutes in the air we landed at Bagram Air Field. As we all descended down the ramp out of the back of the aircraft we were met by a gorgeous view of snow-capped mountains. It was raining and cold. It was not at all what I had expected of Afghanistan in April.
For those who haven’t visited, BAF is a complete dump and there are entire websites dedicated to humorously showing love for its peculiarities. Most guys in my unit would up spending almost a week there living like homeless refugees in overcrowded flooded tents. I got lucky and wound up catching a flight out of there after only a few hours, skipping two days worth of “vehicle roll over” training.
About five days after leaving Hawaii I finally arrived in Jalalabad via a “combat landing” in a C-130. For those who aren’t familiar with a combat landing, it’s when the pilots decide to go from being in the air to being parked on the ground in about thirty seconds. Its fun. Our plane actually landed at JAF/FOB Fenty around 2200. I will never forget my first look at FOB Fenty. I was standing under the tail of a C-130, it was pitch black and the only lights I could see were from across the runway where the main part of the base was. I was hot, sweaty, and smelly. The smell of jet fuel and burning wood filled my nostrils. Dust and dirt being churned up by the propellers stung my face. I looked out across the runway and thought: so this is my new home for a year? I couldn’t make out any buildings, just lights from windows. It looked like anywhere and nowhere at the same time.
They herded all of us together and walked us single file across the runway for accountability. My XO, who had arrived several weeks earlier, was there to meet us. She took us to the Company Command Post (CP) and had us sign in and account for our weapons. Then they took me to my room. I was pretty tired when I arrived but I had the hardest time sleeping well that first night.
I spent the year living in a one story cinderblock building. Each building had a couple of hallways with 8 rooms made of plywood. The walls went about 8 feet up but the ceilings were about 10 feet tall. The beds were mattresses on plywood racks up high with a little desk below. The guy I replaced basically got thrown out as soon as they heard I was coming and I believe he wound up sleeping on a filthy cot in the hallway the first night I was there.
My first morning in Jalalabad was an exciting one. I woke up disoriented and exhausted from lack of sleep. I took a much-needed shower, grabbed some food and then made my way down to the clinic. The dental clinic at JAF is close to the flight line and was two buildings down from where I lived. In the same building we had a surgical team with two operating rooms, a small physical therapy clinic, pharmacy, patient hold area, and admin area.
As I was walking out of my building I saw a lot of commotion by the clinic. People were running around. Golfcart-like vehicles called “Gators” were zipping back and forth. I picked up my pace a little bit and asked someone what was going on.
Entrance to our clinic and the surgical team
A suicide bomber had walked onto a nearby FOB and killed eight or nine individuals – mostly Afghans if my memory serves me right, and wounded several American servicemen and one civilian contractor. I remember seeing the MEDEVAC birds coming in for the very first time and watching as the survivors of the attack were brought to our medical facility for treatment. I went down to the flight line and helped carry some of the wounded off of the helicopters. I remember the smell of blood throughout the clinic, followed later by the unforgettable odor of the disinfectant they use to mop the floor after it gets soaked with blood. I remember the look of exhaustion on the faces of the wounded and the slow defeated way they walked. There were several patients that had to be carried in that day, but I can’t remember them distinctly now as they just blend with all the others we carried in that year after them.
Those first few days were a rapid orientation to what was going to become my world for the next twelve months. By the time our year there ended, 20 soldiers from my brigade had been killed in action and dozens more from our supporting units had lost their lives as well.
E Quad: Zero Dark Thirty
The hardest part of the deployment was saying goodbye to my wife and 15 month old son. The emotions I felt the morning I left were not of pride and excitement but of dread, regret, and overwhelming heartache. It took several weeks to get the entire brigade out of Hawaii and into Afghanistan. We left in groups called “chalks” at all hours of the day. Thankfully I had some family there to see and help me off.
My parents had flown in to say goodbye and my mother in law was there to help ensure my wife and son got back home safely. We had decided that since we had no family on the island, it was in our best interest to put our belongings in storage and fly M&G back home to spend the year with friends and family on the east coast. So on top of saying good-bye, we had to pack all of our stuff up and move out of a house. According to my wife, the hardest part of that was the days after I left when she had to accomplish the final tasks of that without my help…
We had rented a beach house on the north shore the week before I left to allow us a place to rest and relax after making the final arrangements for our departure. No one really knew when their chalk was leaving until a few hours before. When my number was up, I wound up having to report for accountability formation at 0200 (see photo of miserable guy above).
Soaking up the last of Hawaii with my boy
The night before I left I spent the evening with my little boy playing in the yard and in the hot-tub. I didn’t sleep well at all that night. I knew I needed rest so I tried to force myself to bed around 8PM. We just laid there all night. I tossed and turned until my alarm went off around midnight. I woke up, showered, and put on my uniform.
I went into my son’s bedroom and picked him up and held him for a few minutes. I kissed him goodbye, not knowing for sure if I would ever see him again. Up to that point in my life, that was the hardest thing I had ever done. I was overwhelmed with nausea, fear, and anxiety. I felt like throwing up. My family woke up with me and I said goodbye to my mom and mother-in-law there at the house. We all teared up, but it was short and sweet. My dad helped me load my gear into my car and my wife, my dad, and I drove in almost complete silence the 30 minutes to Schofield Barracks. I held my wife’s hand the entire way.
We stood there for about an hour talking. After a point, I realized we should say our goodbyes while we had the privacy. I hugged my dad, said goodbye, and asked him to give me a few minutes alone with my wife.
M and I hugged and cried for several minutes together. We kissed good-bye for the last time for what would be six months.
And then they were gone. And I was all alone with the other guys from my unit. Guns, gear, and sadness everywhere. The reality of the separation was quickly becoming real and the six months in front of me before I would be home again seemed like an eternity.
I have been thinking back a lot recently to my time in Afghanistan. I kept a journal that I wrote in every day and I also wrote several longer descriptors of several significant events throughout the year. At the time, I thought that I would never forget the details of that year. Going back and re-reading what I wrote made me realize I have already forgotten a lot of the details.
So I am hoping to begin telling some of the more interesting stories from my deployment. Some of them are funny, some of them are pretty messed up, all of them are worth sharing.
The plan is to work chronologically starting with my first few days in Jalalabad in April of 2011…
Now that I am home from Afghanistan and the dust has settled, I have decided to come out of hiding for the sake of this blog. I still want to work toward sharing my experience as an army dentist with those out there who are interested in reading.
My year in Afghanistan was long. I deployed as the dentist for an Infantry Brigade Combat Team. My brigade was deployed to a remote and violent part of Afghanistan along the Pakistani border. I was the officer in charge of a small expeditionary dental clinic that supported approximately 8,000 US and Coalition forces throughout our Area of Operations, and I was the only dentist in the AO. The majority of my time was spent seeing dental patients at my clinic. Over the year I saw approximately 1,300 patients whose problems ranged from infected wisdom teeth to trauma from IED blasts.
My dental clinic was at a larger sized FOB and co-located with a physical therapist, a team of physicians, nurses, and PAs, a preventive medicine officer, and a Forward Surgical Team (FST). As expected, the surgeons handled quite a bit of war-related trauma throughout the year. Since there was no oral and maxillofacial surgery support in all of RC-East, I had the opportunity to go into the operating room to help the surgeons repair some maxillofacial trauma. I remember assisting two of the general surgeons on a neck dissection after a guy took several AK-47 rounds to the head and neck. A bullet went in through neck and came out through his left parotid gland (one of the major salivary glands). They wanted my assistance dissecting and exploring the parotid and its duct into the oral cavity. I also had several opportunities to handle facial lacerations, and even remove shrapnel from a soldiers face after he was wounded by a mortar round.
Part of my job as the brigade dentist was to “flex forward” and support our more remote soldiers in more than twenty outposts throughout the mountains and valleys of Nangarhar, Nuristan, Kunar, and Laghman provinces. Throughout the year I traveled on 18 “battlefield circulation” trips throughout this AO. During these missions I would travel forward with my assistant to provide evaluations and preventive care to our most remotely deployed combat soldiers. My assistant and I would fly to some small observation post or outpost up in the mountains for a day or two. While my resources limited me to very basic procedures while on a mission, these trips proved to be a very valued service to the war fighter and much appreciated by their commanders. Life on these small outposts was very different from life back at my larger base. The movie Restrepo did a pretty good job detailing what life is like for these guys out at these small outposts and I would highly suggest it as a primer to what life has been like for the infantry in this war.
Life on my FOB was pretty good and relatively safe. It made me appreciate the little things we had (like flushing toilets). Although we got mortared somewhat often during certain months, I never really felt like I was living in a dangerous place. However, towards the end of the deployment a small group of insurgents did successfully mount a VBIED attack against my FOB that resulted in 9 deaths and approximately 20 wounded Afghan Forces. We took enough casualties that morning that I actually had to act as the triage officer for a short while because all of the physicians and surgeons were busy inside.
Looking back on the deployment I am glad that I was there. I’m proud to have served as an army dentist in a time of war and I am immensely honored to have deployed with an infantry brigade. I witnessed many events and ventured to many places that I will never forget. The deployment was more difficult on me and my family that we had anticipated. The year-long separation was very challenging and stressful on my marriage and my relationship with my young son. I feel we are stronger for it, but I wonder if there will be lingering effects of this separation for some time. The professional isolation was overwhelming at times, but I have no doubt it has made me a better dentist.
While my future in military dentistry is dubious, I hope that I can continue to serve as a reference to any dentist who is deploying with a brigade in the future. I hope this blog continues to serve as a source of information to all those who read it.
For the past year I have had to share toilet facilities with hundreds of other US military personnel as well as a host of Third Country Nationals and Afghans. By now I have pretty much gotten used to the odd hygiene and toilet practices of our non western partners. I was recently thinking back to when I first arrived in country almost a year ago and was exposed to the oddities of third world defecation for the first time.
I remember seeing signs “Do Not Leave Water Bottles in Here” in all the port-a-johns. Why would people bring water bottles into the port-a-shitter? Probably because there is nowhere to wash their hands. It didnt take long to figure out what was going on.
I had put these odd defecation practices out of my mind until yesterday when I was out on a mission to Laghman Province. I saw the above photo plastered to all the US toilets. I simply had to capture it and share it with America.
My favorite part of sharing toilets with Afghans and TCNs isn’t the un-flushed mounds of feces. It isn’t the piles of brown paper towels that are literally piled into miniature mountains on top of their poo. My absolute favorite part is the muddy footprints that they leave on the toilet seat after squatting on the john. It really accentuates the polarity between our cultures.
For more information on pooping in Afghanistan, please check out Tom Ricks blog here.
I haven’t written much in a while. I’m still here in Afghanistan. Still living in a 8×8 plywood room. Why haven’t I written? Because pretty much every day is the same. Every once in a while there are spurts of excitement but for the most part the winter isn’t the fighting season.
Last week I watched the movie Office Space and couldn’t help but see the similarities between the main character Peter Gibbons’ life and life on a FOB in Afghanistan. There was a scene in which Peter was in therapy because he hates his job. The conversation went something like this:
Peter: “So I was sitting in my cubicle today and I realized that ever since I started working, every day of my life has been worse than the day before it. So that means that every single day that you see me, that’s on the worst day of my life.”
Therapist: “What about today? Is today the worst day of your life?”
Peter: “Yeah.”
Therapist: “That’s messed up.”
That scene pretty much sums up my life right about now. Being here for this damn long is really messing with my head. I’m moody. I’m angry. I lose my patience quickly. I get frustrated over the littlest things. Why the hell can’t I get any sunflower seeds? (Damn you Pakistan!) Every day seems worse than the day before.
I wake up every morning pissed off. I’m angry at myself. I’m angry at the people around me. I’m angry at the Army. It is mostly misdirected anger and it usually subsides after morning sick call. But it is no way to start the day.
My only consolation is my amazingly upbeat wife who reassures me that This Too Shall Pass and that once I return to America my life will improve. She’s probably right. She has to be right. Right?
I still love what I do. I absolutely love being a dentist. I even enjoy being in the Army. I’m just tired of being at work 24/7 I guess. I miss my family. I’m ready to come home.
Army Dentistry 