Afghanistan Clinical Ops

Updated: Nov 4, 2020

So after five months in Afghanistan I have a couple stories to tell. I should mention that since some of the people I work with have fairly classified jobs, or as we call them “secret squirrels”, I changed a lot of the locations, names, etc. in anything I put on here.

If there is one thing I’ve learned over the last couple years about being special ops and working basically in the shadows is that it generally sounds way cooler than it really is. I think this goes for just about any job as a physician that seems exciting and different. The bottom line is that no matter who your taking care of, or where in the world it is, from the presidents personal doc to the super secret CIA spy doctor at the end of the day your job and only job is to take care of people and try to provide the same care as you would anywhere back home. The only thing that really changes is the scenery, which in my case meant living in a plywood palace, being on nights for five months straight and not really seeing the sun. The less than optimal living conditions were offset by getting to work with some of the most badass people on the planet, and generally a community of people that take their job seriously, deeply care about what they do, and are generally just fun to be around. I was also occasionally rewarded with some truly incredible sunrises coming over 14,000 foot mountaintops.

My main job with the help of an IDMT was to provide sick call support twice a day to a community of flyers, we also provided occasional CASEVAC support. We had a small little room with our own pharmacy inside of a larger clinic. A family doc and a handful of medics that saw everyone who wasn’t on flying status staffed the rest of the clinic. We all lived above the clinic, and over time grew to become like a big family.

The environment for the most part was pretty serious, but as anyone who knows me, I have trouble with seriousness. So we managed our share of shenanigans. One time when it was snowing I managed to convince the motor pool to give me a spare intertube that I blew up and hooked to the back of our ATV with cargo straps and went tubing around camp. Another time in the midst of our Archer TV show marathon we decided to order black “tactical turtle necks” online along with cheap black trousers and dressed up in all black with our M4 rifle, and M9 pistol clipped to our hips and went to the chow hall looking like some kind of Israeli assassination squad. As we walked to the chow hall we passed a couple pilots that I heard behind me say, “Aren’t those guys doctors?” Generally speaking having full access to Amazon and an APO address with lots of extra money from being deployed can be a dangerous thing.

On New Years Eve there was a 5k that started early in the morning when it was still dark. I wanted to dress up and just be ridiculous so I sutured blue chem lights (approximately 16 of them) to my clothes so that every limb was outlined like some raving stick figure. I also managed to affix some external speakers to my reflective belt so that when I ran everyone around me could jam out to my iPod, which played such classics like the Venga boys, and what is love from the Roxberry soundtrack.

In all seriousness though what was nice about Afghanistan was that there was plenty of medical support, if I ever had questions I could chat with the other docs, and their was a larger hospital nearby that I could send people to if needed. This or course being in direct contrast to Africa where I’m the only doc in the middle of nowhere and the only western medical facility being a quick six hour jet ride away.

As I mentioned our clinic was open every day 365 days a year, to say that the days became redundant with everyday being the exact same schedule would be the under statement of the year.  Most of the medicine was pretty simple though, coughs and colds, rashes, my knee hurts, my rectum’s bleeding (saw a fair amount of that…don’t know why, was afraid to ask too many questions). But, by far the most we did was hand out Ambien. Everyone was always shifting schedules so sleep aids, or “no-go” pills were like crack, and I was the crack king. There is a policy that flyers can’t have more than twenty pills in a sixty day period, but we saw so many people that we still managed to go through a few hundred pills a week. The funniest thing about prescribing out Ambien is how people would ask for it. I imagine it would be much the same as trying to sell crack out on the corner. There are those guys that are experienced and confident and know exactly what they want. They come into clinic and know the lingo, and it goes something like “hey doc, can I get two tickets to ride the A-train?” or “hey doc, can I score some sleepy treats?” Then there are the newbies that don’t really want to enter the room, they just kind of stand in the doorway picking at the splinter in the wood frame, or maybe staring at their feet with their hands in their pocket while under a muffled breath say something like “so…umm, I umm was wondering about this umm…to help me sleep, umm”. In time I even came to recognize what squadrons these guys flew with based on the way they asked for Ambien. If they walked in with bravado telling instead of asking me what they needed I knew that they probably had some kind of job that involved shooting things at people. These were also the guys that if they had a rash on their genital region would walk into my room and whip it out before I could even ask them what they wanted or close the door. On the other hand the shy ones often had some kind of really boring job on the back of a plane, like a sensor operator, or some kind of communications nerdiness. But, in the end I never judged, we just handed out pills, and updated spreadsheets.

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