Well, here's my first blog update on life in the AOR (Area of Responsibility - the military's term for all the Middle East deployment sites, including Iraq, Kuwait, Qatar, Bahrain, Afghanistan, Pakistan, Diego Garcia, UAE, Saudi Arabia, Turkey, Kyrgyzstan, and Uzbekistan...maybe a few more, too). I think the term Area of Responsibility is a bit ironic, in the Colin Powell sense.

I started my journey 13 Jan flying out of San Antonio to Norfolk. I boarded there for about a day, leaving on a Delta 767 chartered by the military specifically to fly to Qatar. We flew to Germany and refuelled, then left again and flew to Qatar, arriving around 11 PM. It was FREEZING there, about 35 degrees and rainy - not my idea of the desert! We unloaded and sorted our bags, then passed customs and immigration before waiting for a shuttle to take us to housing. After waiting in the cold mud for about an hour, one finally showed up. You'd think that with 20,000 people a month passing through Al Udeid Air Base, they'd have a system for this by now, a mere 5 years into the war. But no, it seems to be a surprise every time some people show up. When we got our bunks (a big tent with 30-60 guys in it) around 5 AM, we crashed for 8 or 10 hours. Next day it was a quite comfortable 55-60 degrees with the sun out, falling again into the 30s after dark. We assembled that night to fly out, and then waited about 7 hours in the terminal before getting on a C-17 Globemaster for Balad. We all strapped on our IBA (individual body armor) and Kevlar helmets and filed onto the plane. It was an uneventful 2-hour flight, at the end of which the pilot cut the engines and dove steeply, banking into a tight spiral before landing. I think we went from 29000 feet to landing in about 5 minutes.

After inprocessing (this was quicker - they seemed to KNOW that we were coming, unlike at Al Udeid), we went to pick up our bags and check into housing. I then split away, picked up my issued 9MM handgun, and joined my colleagues at the hospital for a quick tour. I already knew several of them, since I come from the largest USAF medical center, which supplies a great many of the personnel for deployments. Balad Air Base was the former Iraqi Air Force academy. Many of the concrete buildings are Saddam-era, like the indoor Olympic-sized pool and the outdoor soccer stadium, where Uday Hussein shot many of the Iraqi soccer team when they lost an embarrasing World Cup game. About 35,000 people live here, making it a small city.

The next day I started working. My first week I was assigned to the rotating duty of taking care of the ward and ICU patients. I rounded with the "Trauma Czar" (our trauma medical director, a colonel) twice every day, and ended up being in the hospital 6:30 AM until at least 11 PM every night. After I rotated off that duty, things eased up some. The Balad Air Force Theater Hospital (AFTH) began as a series of tents linked together, and moved last summer to a "hardened facility", meaning a real building. The "old wing" was a Saddam Hussein-era clinic with a 2 1/2 foot-thick concrete roof and a basement which, before renovation, still had rings in the concrete basement walls where political prisoners were shackled for "reprogramming". The buildings added onto this house four operating rooms, 20 ICU beds, 40 ward beds, two Philips 16-slice CT scanners, an ER capable of 30-40 patients during a surge, a dining hall, lab, pharmacy, chapel, and some clinic space.

My typical day is like this: I wake up around 6:15, walk to the hospital (it's about a 100-yard 4-minute walk) around 6:30, and we have a morning report at 7:15, discussing all the previous 24 hours' admissions, followed sometimes by a clinical presentation by one of the docs or a morbidity and mortality conference. We then proceed to the OR while the trauma czar convenes multidisciplinary rounds on the ward (including surgeons, orthopaedics, nutrition, psych, discharge planners, physical therapy, and nursing staff). Several OR cases are scheduled every day, usually washing out wounds, closing abdomens, skin grafting, excising burned tissue (lots of pediatric burns), etc. Daytime is usually when casualties arrive at the ER, heralded by an overhead hospital-wide page in case you missed the roar of Blackhawk rotor blades beating the air. This is the opposite of trauma in the U.S., which heats up at night. Nights are generally quiet here. When someone "sick" comes in, everyone swings into action, drawing blood, getting IVs inserted and blood transfused, obtaining a chest X-ray, ultrasounding the chest and abdomen, taking vital signs, etc. If the patient needs an operation, we usually have them in the OR (just down the hall) within 5 or 10 minutes.

At 6:30, all the surgeons wander in and we all go to dinner together, piling into the back of a pickup truck and driving to the DFAC (dining facility, in mandatory military acronym-speak). I'm the on-call or backup trauma surgeon about every third night, which means I stay here overnight. The food isn't bad (Thursday is Mongolian stir-fry night, Wednesday is surf-n-turf - good crablegs, but the "steak" resembles camel-meat predigested in a shark's stomach), and there is a good selection every night. "Family dinner" helps keep us all happy together and getting along, not an easy task for a bunch of egotistical surgeons. Afterthat, we come back to the hospital for evening rounds and maybe a movie or cards. The next day, it's the SAME THING. The running joke is that it's like the movie Groundhog Day, where every day is the same. The only thing that marks the time is what's for dinner that night at the DFAC. Today IS actually Groundhog Day (Feb 2), making it a little surreal.

Thanks to you all for your emails! The best things are letters, pictures, and emails from home.