Deutchland

Well my time in Germany was a well needed respite from daily camp life. I was put up on the Landstuhl Army base at the local Air Force Inn where my room shared a bathroom with the patient's brother whom i had just escorted. it was not the nicest "hotel" i have ever stayed in but it sure beats a clu. I was able to get a rental car so i could explore the area some. i went out to find some nice German lunch and man was it good. Weisswurst, brezel and a bier.

On my way back to Landstuhl i found myself lost. i was driving around out in the German countryside and i really didn't care. i wasn't in Djibouti. At one point i just stopped the car and stood on the side of the road for a while. It was a gorgeous day and it was not 110 degrees outside with the stench of burning camel and goat carcass permeating everything.

Landstuhl is a quaint little town. It is probably the only German town that has two, not one, Irish pubs. I spent the night have a few beers watching the Germany Spain World Cup semifinal game. to bad for Germany.

The next day i tested my navigation skills again and drove to Heidelberg. There is an impressive ruin of a castle there. The Heidelberg schloss. http://en.wikipedia.org/wiki/heidelberg_castle

I wandered around the castle for awhile then i ran into a group of jayhawks. We talked about lawrence and basketball a little bit.

later that night i was able to find one of my favorite german meals. kasse spaetzel. it is awesome macaroni and cheese. i was able to enjoy several of my favorite beverages as well as i sat outside at a nice little table while the night closed in.

My last day i spent exploring the local castle there in Lanstuhl. it was much smaller but still cool to see.

I had my lunch up top the hillside next to the castle overlooking Landstuhl. then it was off to Franfurt to catch my plane.

BOO HOO. back to the stink and heat and filth. bye bye beir and sausage.

Medevac

Last Monday i was starting to take off my shirt so i could change clothes to go for a run. i was walking out towards the front desk to make sure nothing was going on so i could leave the clinic. sure enough an ambulance call comes over the radio but i didn't hear any specifics. just out of curiosity i asked "what was that call?" "a heart attack" he replied. i just thought he had seen me standing there and was teasing me, so i said "no, really, what was it?" "a heart attack" he replied. "great" i thought "just another routine chest pain evaluation" I was not on call so i considered just going running anyway since anyone could work up chest pain and then find me if they were concerned. but i decided i would at least stay and at least see the patient with my own eyes. i am glad i did for the second i saw his face I knew this was a real MI (myocardial infarction). I confirmed this with his ECG. I needed to get him thrombolytics to break up the blood clot in his heart artery so the heart muscle can get blood flow again. this is the only way to treat this since the nearest interventional cardiac cath lab is in Dubai about 1,200 miles away. he received the thrombolytics about 30 minutes after the onset of his pain and was pain free about 10, maybe 15 minutes he was given the medicine. the ECG also resolved nicely. the medicine was clinically successful. Now he survived the initial part and the treatment, now i needed to get him through the next several days. there is a period after a heart attack where a lot of other bad things can happen. that is why we keep these patients in an ICU setting for 24 - 48 hours and then watch them on the telemetry ward for another 3 days. Djibouti was no place for this man to be. The issue is that he is not active duty military. he is not one of the contractors that work on our base but he was a member of a group of volunteers from a town in California who get together and buy steaks, fly themselves and the steaks out to our deployed military outposts and them cook them for us on holidays. they were here for the 4th of july and he was loading luggage to go home when he had his heart attack. by the way the steaks they made were a million times better than the "steaks" they serve every Saturday on steak night.


anyway so we arranged for him to be transferred to Landstuhl, Germany. guess who needed to go with him as an escort?

They sent a C-17 with the regular medical transport crew as well as a critical care team.





So

counting myself this single patient was transported with 2 doctors (cardiologist and air force ER Dr), 3 nurses, a respiratory tech, and 4 med techs.

These are the racks for patients. they are used for storage now but this plane can handle approximately 30 stretcher patients for a flight. my patient is in the back there in the white blanket. i don't want to show any pictures of him just for privacy sake.





I rode in the cockpit for take off and landing and listened in on the headphones to all the chatter from the crew, the pilots and the tower.















takeoff



Bye Bye Djibouti

The sunset from the sky over Germany

The approach. It was honestly one of the softest and smoothest landings i have ever been on.





the off load and on to the hospital

Promotion

I was promoted to Commander on 01JUL10. For those not familiar with navy ranks, that is a lieutenant colonel in the army or an 0 - 5. i am only 2 away from becoming an admiral.

The CO came over to the clinic and we had a small ceremony right there in our ER despite my protests. i would have preferred to just sign on the dotted line.

The oath

The uniform change out

The signing

The drinking

Bryan and I

The beer i have been drinking is Tusker. It is a fine Kenyan lager that is refreshing and cool and easy to drink. its great for the heat of djibouti. there is more flavor compared to one of the american big 3 lagers. hints of caramel and biscuits with a slight palate of hops. overall it has a grainy bite to it.

work

sorry for the delay in posting. i thought i would wirte a little bit about work. we have a clinc building that is fairly well equiped but some of it is relatively old. mostly we see sick call 6 days a week. 90% of it is rouite complaints: snotty nose, back pan, rash on my foot, i cant sleep, i want to get out of work today. occasionally we see some real ilness or something wierd. i diagnosed mumps, i have seen 4 young men for swollen lymph nodes in various places that all are concerning enough for cancer to warrent a work up, and i placed my first cast.




i am currently evaluating a guy with an going liver issues that i havent figured out yet. i managed an acutely psychotic parnoid schizophrenic who was convinced all of his fellow national guard companions were out to get him. there was a man that came in and said for about 6 months he has felt like there has been sand in his eye. when we looked at his eye under slit lamp exam he had sutures that were still in his eye from a surgery about 13 months before. we took them out for him and guess what he felt a lot better. so there are some real cases as well. we see several heat casualties as you can imagine.

there are a few actual emergencies. there was a man who cut into his upper abdomen with a saw. he only cut the muscle and did not penetrate the chest or abdomen. lucky man. we keep busy at work.

this is my office and my patriotic wall:

this is the ward and some of our nurses

The OR

The ER

Ancillary servies: X -ray, lab, and pharmacy

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Now i am not overwhelmingly busy but we can be busy at times. when i am toiling away and occupied with sick call here is how bryan the anesthesiologist spends his days. chose your rate chose your fate i guess.although we stay busy with the daily illnesses and accidents our main operational duty is to be here just in case for our deployed operational personnel. we have taken a few medevacs from ships and a few from other deployed personnel elsewhere in africa but nothing major. we all here and ready to do what we need to do just in case.