166 Days: My Journey Through The Darkness (8 page)

13 June 2008

We had a briefing early in the morning about our upcoming mission, which was now pushed back one day because the team commander decided our pallet was in fact a necessity, and so a truck was hired to bring our MedCap supplies from TK to us. This was a huge piece of good news in many ways. During the briefing, we also discussed the route and plan of action if we did, in fact, get into contact. I would be sitting in the back of the HMMWV, which meant if something happened my job was to duck; a job I was happy to take.

After the briefing, we picked up our supplies and began to separate everything we brought for the local nationals along with what the team already had into two piles, one for each day of the MedCap. I watched one of the team guys cutting up a bunch of pieces of an old parachute and tying the ends with cord, he saw me watching him,

“Hi there, I’m Chad,” he said.

“Nice to meet you, what are you doing there?” I pointed to the pile of material in front of him.

“I’m taking this old parachute and making a hammock out of it. It beats sleeping on the ground out there…never know what may crawl into your sleeping bag and cuddle up next to ya,” he laughed.

“Oh…um…yeah that’s a good point,” I pictured myself and my new friend, the huge camel spider, spooning. Chad must have seen my face.

“Would you like me to show you how to make one for yourself?” he asked.

“Please!” I smiled. Grateful for his help making the new bed I never would’ve imagined I needed. As we talked I learned he was actually another medic on the team. He seemed to love what he did and I felt we’d be able to work well together. Our preparation of supplies took several hours and once completed, we got our vehicles cleaned and ready to go.

Vance showed me how to operate the different weapons and how to reload them in case we came into contact. He was adamant our vehicle had any and every possible supply we might need, and that I knew where they all were. He wanted me to think of each and every scenario, to prepare for the worst. As he taught me about things to anticipate, I watched the other guys slowly wrap up their preps one by one, leaving us as the last vehicle to be deemed “ready.” As I observed his attention to detail, I was comforted by having Vance on my truck because of his experience. We sat for a while together and he began to talk about some of the missions he was on the year before, which explained a lot about why he was the way he was.

“Well, last year was the hardest year of my life,” he said. “I lost a very good friend and fellow medic in a TIC” (short for
Troops in Contact
).

“I’m so sorry,” I said. “I understand if you don’t want to talk about it.”

“No, it’s ok. I think it helps when I do,” he replied.

“What happened?”

“During the TIC, he got shot in the arm and the bullet went through his armpit to his left chest, and he bled to death. I tried to stop it, but I couldn’t. He died in my arms,” he said.

It took a while before I was able to respond. “Vance, I can’t begin to imagine what it must have felt like to have a friend, so close that you called him your brother, die in your arms, and there was nothing you could do to stop it. I’m honored you shared this with me.”

“No big deal. Like I said, I think it helps,” he replied. “Last year was a very hard season for my team in Afghanistan; we were in TICs constantly, and each man on the team was driven to his very last drop of effort. It got so bad that at one point our team commander changed his whole focus from killing as many bad guys as we could to getting the rest of the members of our team home to our families
alive
.”

“How awful,” I said. I tried to understand the impact that would have on a person’s psyche; having to continuously deal with tragedy, loss, and the unknown of who the next casualty would be.

“After last year,” he continued, “I went through some very difficult times adjusting to normal life.”

“How so?” I asked.

“I would sit on the floor in my room and stare into space for hours at a time, thinking. I withdrew from friends and family and handled my pain in the only way I knew how; by myself,” he confessed.

“How did you get through it?” I asked.

“I don’t really know. I was eventually able to pull myself out of my depression, but I’m still not the same person I was before last year.”

I could see the pain and anger behind his eyes and I believed what he said earlier was true; having someone listen to what he was feeling was therapeutic for him. He explained that with everything he saw and did last year, he developed a fear of missions.

“So then why did you volunteer to go on this MedCap?” I asked.

“I had to get over my fear and address my inner devils face to face,” he explained.

We talked about family and he told me he had a son. “Would you let him join the military?” I asked.

“HELL NO! I’ve sacrificed everything short of my own life several times over for this country, and I have more than paid my own and my family’s debt to society. My son is going to live the life I gave up so that he could.” I gave him a hug and thanked him genuinely for sharing his story.

After lunch we took the vehicles out to the heavy weapons range to test fire the weapons on the HMMWV prior to our departure. I got to fire the MRK-19 (an automatic grenade launcher pronounced
Mark-19
), the .50 cal, and the M240 machine gun. My favorite was the MRK-19; it was really neat to get the chance to fire those weapons, something I likely would never get the opportunity to experience again. As we were out there, letting each vehicle test fire, I saw an Afghan man slowly approaching us. I felt a sense of fear bubbling up inside.

“Hey Chad, you see that guy walking towards us?” I pointed. “Is he something we should be concerned about?”

“Don’t worry Lt., he’s a regular,” Chad said.

“Oh yeah, that guy?” Travis, another guy on the team, confirmed. “He comes out to pick up the brass so he can sell it at the bazaar.”

I thought it was so sad he had to do that just so he could get a few cents to help feed his family. I waved him over to our vehicle and handed him a handful of the casings on our truck. He nodded and waved a “thank you” and I smiled and waved; it was the least I could do.

When we returned to base, I had a couple of patients waiting for me at the clinic. One was a little boy who had a dog bite on his ear and another was one of the cooks who had acid reflux. After I treated them I went to watch the ANA and the team guys play volleyball. As I watched the game with Megan, we couldn’t help but notice the spectators seemed to turn their attention from the game to us.

“Jenn, look at that. Can you believe this?” Megan asked.

“What is it?” I asked.

“Look at their cameras,” she said.

I looked closely and saw that the ANA guys actually had their cameras pointed in our direction, filming
us
for the majority of the game. At first it was funny, but over time it was both annoying and unnerving. We tried to ignore it, but it got to be too much. I looked at Megan and said, “You know what? Give me that.” I grabbed her camera out of her hands and pointed it right back at them. “What do you think about that!” I yelled, “How does that feel?” Megan and I laughed at our small, yet effective stance.

Sure enough, once they realized what we were doing, they got the message and stopped filming us. After the game was over we decided to play a match; minus the spectators of course.

15 and 16 June 2008

We woke up at 0100 hours to get everything together with a goal to leave by 0300. As I loaded my things into the back of the HMMWV, I looked up at the night sky and realized how beautifully clear it was. The stars were brilliant and breathtaking. I found the Cancer constellation and realized my birthday was soon approaching. I couldn’t believe a year had already almost passed from last summer.

As I stared up at the stars, I felt an overwhelming sense of peace. I felt closeness to God on a completely different level then I had ever experienced. As I stood there, I began to pray; asking not for protection, but for the strength to accept whatever my fate may be. I found myself truly accepting the fact I may not come home. I never thought I would feel such acceptance; for the first time in my life I realized I had no control of the circumstances to come; it was in God’s hands. I felt a sense of peace in that moment of realization, a peace that only surfaces when there is a true understanding of life’s circumstances being so much bigger than ourselves.

As Megan and I loaded our things we had a conversation I never wanted to have again.

“If something happens to me Jenn, I want to tell you that my wedding ring is in the top pocket of my backpack,” she said.

“Ok… Mine is in my journal, under my pillow,” I said.

“All of my stuff is still packed for the most part, back in my room at the firebase,” she continued.

“Mine too,” I replied. “Um, Megan… If something
does
happen out there… I…uh… I would want you to tell…” As I tried to tell her what I wanted her to pass on to my Greg, I couldn’t hold back my tears. She was very sweet, and since I couldn’t get the words out, she spoke for me.

“You know what I would tell him? I would tell him how I feel like I know him because of how much you talk about him, and how it is so obvious how much you love him and how much of a part of you he is.”

I nodded in thanks, reassured what she just said was exactly what I would want him to know if anything happened to me. After we finished talking we sat together in the darkness holding hands and said another prayer. It was nice having her there; after our moment together I again felt a sense of peace with whatever may be. After everything was loaded, we ate and then got all of our body armor and gear on and headed out of the safety of the gates and into the night of the unknown.

Sitting in the back of the HMMWV was kind of like sitting in the bed of a pickup truck, except of course, that the sides of the vehicle we were in were bullet proof and we had a .50 cal machine gun sitting over our heads. As we sat, and waited for the ANA trucks to join in the convoy, the team commander came over to my truck and whispered in my ear; “Jenn, promise me, if
anything
happens you will
get down
. There is nothing you will be able to do in your position with your M4, so please, just get down.”

“Ok, I will,” I promised without difficulty.

“Ok guys, get your NODs (short for night optical device, also commonly referred to as night vision goggles) on and pick a side of the terrain, I need you to be scanning for anything unusual,” Vance instructed from above. He would be the turret gunner manning the .50 cal for our vehicle.

As we pulled our night vision goggles on I said, “I’ll take the east, what do I need to be watching for?”

“Look in the crevasses and along the horizon for any enemy activity. They often ambush from positions in this type of terrain,” he answered. I couldn’t believe I was really doing this. All of the scenario training I had participated in the previous years, that I never thought I would use, suddenly all came back to me.

Our convoy was quite impressive; it was comprised of six HMMWVs and ten additional trucks driven by the ANA, which carried the supplies for the MedCap. The fact that it was so large and our vehicle was somewhat in the middle was comforting. However this comfort was short-lived. Every vehicle drove blacked out; meaning we traveled in darkness without headlights. To avoid being seen by insurgents we relied on our night vision goggles to observe our surroundings. Suddenly, out of nowhere, the ANA truck that was behind our vehicle turned its headlights on, completely illuminating our vehicle for the world to see. Vance about lost his mind as he screamed into the radio, “What the hell are you doing? Turn off your fucking lights!” We were a sitting duck, a perfect target, had someone been searching for one. We braced ourselves for any and everything. Finally after seconds, which felt like hours, the truck lights turned off. I never knew why they turned them on, but I couldn’t avoid my suspicions that it was intentional. I had been told by others that sometimes the enemy would infiltrate the ranks of the ANA. I hoped that was not the case with any of the soldiers I encountered, but it kept me on guard.

We drove on and off the road, up and down hills and narrow passes and past the occasional compounds for about an hour before we came to the edge of the Green Zone. Up until that point we had been driving in desert, the Green Zone was marked by trees and vegetation which made the area dangerous due to more strategic fighting positions for the enemy.

By the time we got there, the sun had already begun to rise and I could see farmers and their children gathering in front of their homes to watch us. I wondered what they must have been thinking, seeing us pass by with our massive convoy, weapons and gear. Looking down into the Green Zone I could see the Helmand River, which runs through a good portion of southern Afghanistan. It is known for the violence associated with the Taliban due to all of the poppy fields growing around it that were used to fund their operations. To get to our final destination for Day One of our MedCap we had to ford across the river. As we got closer Vance yelled down, “Hey! You guys need to scan the rocks and riverbed! It’s early morning and this is a prime time for an ambush to occur.”

I could feel my heart pounding and my fingers tighten around my weapon as I looked at all the rocks and caves as potential hiding places. Just to my right was a huge mountain that had on its peak a castle that was built by Alexander the Great. In any other scenario, I would have loved to get a closer look at it, but as we passed through the dangerous area, I was consumed with my duty of looking for enemy activity.

As our vehicle got closer to the river, I watched the trucks ahead of us begin to cross the water; thank God the ANA already had the other side secured. Our vehicle made the journey with no problems and once we were all across, we stopped on the river bank for “chai,” which was a tea Afghans traditionally drank. At first I was skeptical, mainly because of the water it was made with, but the team guys put my mind at ease saying they had partaken in chai many times before and had not suffered any illness. I tried it and was quite surprised at how good it tasted. It was a nice break, and peaceful watching the sun rise over the mountains. As I sat there, I realized what a beautiful country it was. Sadly, the horrible things that happened here made it hard to appreciate the natural beauty.

After our break, we pressed on for another forty minutes until we reached the compound where we would have the MedCap. I’m not sure what I was expecting it to be, but I was not prepared for what we saw. It was a building made of mud, like all of the other compounds we saw along the way, with no electricity or plumbing. The floors were covered with straw that was saturated with urine and feces, both human and animal. I found the most “private” appearing room I could to set up as my exam room. I made an exam table out of a litter and four MRE (meals ready to eat) boxes to hold the litter up off the ground. I set my box of medicine off to the side and my other supplies on a shelf that was carved out of the wall. We would see the patients with an interpreter because the locals in the region either spoke Pashto (the same language spoken in Pakistan and typically used by members of the Taliban) or Dari, a language used less often by the Taliban.

Four of us would be treating patients; I was the only female. The others were the two medics (Vance and Chad), an Afghan doctor, and Don, my fellow PA. I was there for the women, but I was anticipating a low turnout if any at all based on the briefing before we left.

“Don’t expect many female patients, their husbands rarely allow them to leave the homes,” Don had said. This forecast could not have been more wrong. There were at least two hundred women that came in the morning alone. Up to then, I had not seen any local women and now they were flowing in. It was heartbreaking to examine them; they were all covered in filth, their teeth were falling out, and they had to cover their faces when in public. I think what struck me the most about them was the sadness I saw in their eyes. I could see how tired they were from the poverty stricken lives they had led.

The condition of the men and children wasn’t much better. Most of the children didn’t have shoes and if they did they were falling apart. Hundreds of people showed up and their complaints were all the same: body aches, belly pain, headaches, colds, and fevers. Every once in a while I would see something different, but the majority was all the same. Women often complained of the symptoms of their “monthly sickness” and their babies dying shortly after birth, which was most likely due to malnutrition and dehydration. I had never seen patients before in a situation where we didn’t speak the same language. Relying on the interpreter to translate what the patients were actually complaining of, and then my instructions on how to take the medications I prescribed or specific lifestyle changes they could make to improve their conditions was challenging. I realized very quickly how much I had underestimated the importance of being able to speak directly to patients. With my patients back home, I could pick up on a tone of voice and body language much easier, which was so important in deciphering if what was being said was the whole story or not. I could watch their reactions to what I said and could see whether they understood or whether I needed to explain things more appropriately. In this situation, it was all a guessing game, a frustrating one at that.

Late in the morning I saw the two patients I will never forget. The first was a three-month-old infant girl who was so malnourished she looked like a newborn. She was deathly ill from severe dehydration. The child was lethargic and her skin turgor was unbelievable; I could pinch her skin, and instead of it bouncing back like well hydrated skin, hers stayed tented up for several seconds before returning back to her body. Her tongue was sticking out because she was trying to suckle food and it was as dry as her fragile skin. Her respirations were extremely labored and fast and I knew that this child would die if she did not get treatment. We had IV equipment, but not small enough catheters for a baby. I searched and found a 25 gauge needle and managed to get venous access and got some fluid in, but since I didn’t have a catheter, any movement could potentially rupture the vessel. As I tried to secure the needle, that is exactly what happened; the needle was moved and it punctured the wall of the vein. Just like that, I lost the venous access. I tried again on her other arm, and was unsuccessful. I gave her the rest of the fluid bolus through her rectum and arranged for a medevac to get the baby and her mother to a hospital where she could get more definitive care. As I explained the plan to the mother via my interpreter, I saw a look of fear come over her face as she shook her head. She explained if she went without notifying her husband, he would kill her. I could not believe what I was hearing. I tried to explain to her that if she didn’t take her baby to the hospital, she would surely die within the next day or two. She nodded her understanding, but insisted on talking with her husband before doing anything. She promised to come back after talking to him. She never did, and I never saw her again.

After realizing the woman would not go on the medevac, I went down to tell the Captain the news. As soon as I walked back into the compound I saw the excitement was far from over. Apparently while I was making the arrangements for the baby, one of the Afghan soldiers came running up to Megan carrying a girl over his shoulder, no more than fourteen years old, who was gasping for each breath and moaning in pain. Her husband had hit her over the head with a shovel and pushed her off of the roof in anger, resulting in her falling over twenty feet. Thankfully the Afghanistan National Police (ANP) already had him in custody when they brought her to us.

By the time I came back to the exam room, she was unconscious and unresponsive lying on the litter soaked in urine, indicating she had lost control of her bladder; a bad sign in a fall victim. After a quick assessment, Don and I quickly determined her status to be critical. We intubated her and applied a c-collar. We established two IV lines and called for a medevac; we did not have the means to do much for her in that environment and our supply of sedative drugs was very limited. It took about thirty minutes for the bird to land, and by that time her medications were wearing off and she began to aspirate. Her spontaneous respirations were causing me to be unsuccessful in ventilating her. She vomited, forcing me to extubate her (pull the breathing tube out of her throat) to prevent her from choking to death. As we carried her on the liter up the hill I realized the adrenaline was starting to wear off and my body’s fatigue was settling in. Thankfully the medevac arrived when it did and I relayed the information to the accepting medic informing him that he would need to re-intubate her. As we watched them load her into the helicopter I felt overwhelming sadness for the young girl. I later found out that she was the niece of the head of the ANP, which was a huge deal. We were reassured that her husband was dealt with “the Afghan way.” Several days later I was informed of the diagnosis of a severe intracranial hemorrhage and she was brain dead, being kept alive by a ventilator. The staff waited for her family to arrive and then eventually they discontinued life support. This was the first patient under my care who had died.

By the end of the day I was exhausted, mentally and physically. We had a meal, waited for the sun to go down, and loaded the trucks again to travel to the site of the following day’s MedCap. We traveled for about an hour and a half, which seemed like eternity. Every several feet along the way there was a detail that walked alongside our vehicles scanning the sides of the road with metal detectors and bomb dogs in search of IEDs. It seemed that we would never arrive at the next compound. I was struggling the whole journey to keep my eyes open, but I knew I had to stay awake to scan the terrain.