by Ray Wiss
Red Ricard did an exceptional job as well. With so many casualties, they had to call more choppers than they had air evacuation medics to crew. With ten seconds’ notice, Red got his travelling medical gear together and jumped on the last chopper to escort the final batch of wounded back to KAF. The FOB medical team performed so well that they had all the patients stabilized and evacuated in forty-four minutes, an awesome performance.
The combat team here has continued to execute its tasks superlatively as well. Yesterday, Captain Vince Lussier took his platoon out before dawn. By the time they came back for a late breakfast, he and his men had once again asserted our military dominance of the area.
One Talib had been foolish enough to engage Captain Lussier’s light armoured vehicle with an RPG. The shooter had been so inept that Captain Lussier was not sure who the man had been firing at. Not that it mattered. Although he was dressed in civilian clothing, the Talib had clearly identified himself as a combatant. He was cut in half by the LAV’s 25 mm gun.
Another Talib had been merely incompetent. He had been detected by one of our troopers while setting our forces up for an ambush. A single bullet from the soldier’s rifle ended his life. One shot, one kill.
Yet another armed insurgent died because of bad luck. He was detected in an open field. Though still out of range of our personal weapons when he was spotted, he was not beyond the range of our artillery. Captain Lussier radioed his position back to the guns and, within a few minutes, the enemy soldier was torn apart by a storm of high explosive and shrapnel. Then Captain Lussier did what he has done every other time he has taken his men out to fight the Taliban. He brought them all home safely.
None of this will ever make the news back home.
Addendum, midnight: I have to jot down a few things before I go to bed.
First, we had a late-night medevac for an ANA soldier who had suffered a minor gunshot wound. The medical care was routine. All I did was give a bit of guidance to Master Seaman Cloutier; then I let him run the show. Corporal Vallières came by to help out, and I was pleased to see that MS Cloutier let him do various procedures.
“Procedures” are the things we do to patients, such as starting IV lines, packing wounds and putting different kinds of tubes into various body parts. It is emotionally satisfying to do these procedures because you can immediately see the benefits of your actions. Being the kind of leader he is, MS Cloutier saw the case as an opportunity to share knowledge and skills rather than as a chance to “put cold steel into warm bodies” himself. Within minutes, my crew had the patient stabilized. A little while later, the chopper arrived to take him away. Night vision equipment has made life-saving helicopter evacuation available to us 24/7.
I was also happy that my crew was able to handle this case with minimal supervision because of something else that was going on tonight. I was on my way, for the first time, to winning the evening’s poker game. I came back to the UMS, flashing my cash (all of thirty dollars) and telling my people that the honour of the medical section had been restored.
Only that was not true. Major Jourdain had decided to take the night off. Winning the game without him present is like coming first in the hundred-metre dash at the Olympics with Usain Bolt watching from the sidelines.
SEPTEMBER 13 | Unlucky 13
The war in Afghanistan began for Canada in the late fall of 2001. Members of our special operations forces, Joint Task Force-2, were on the ground before the snow fell. Over the next four years, our casualties were light, Then we came to Kandahar. Over the past three years, we have lost more than 120 soldiers here.
To the best of my knowledge, only one infantry company has come through a Kandahar tour without a fatality: the unit commanded by Major Cayle Oberworth and based at FOB Sperwan Ghar during the previous roto. Until today, it looked like one of the companies on this roto might be able to match that. I had served with Bravo Company at FOB Wilson, and Charlie Company here at FOB Sperwan Ghar, but not with Alpha Company.
Alpha Company has been a bit of a vagrant. Lieutenant Colonel Paul, the battle group commander, has given them a number of different tasks. The only one of these tasks that you may have heard of has been the establishment of the “model village” of Deh-e-Bagh (pronounced “Dee-bah”). It has been so successful that it motivated our commanders to implement the change in our tactics that I described in the August 18 entry.
Their other tasks took them hither and yon throughout our area of operations. They did not have a FOB of their own, but rather wandered around the battlefield looking for a job to do or a fight to pick. This obliged them to travel constantly on the roads of Zhari-Panjwayi, which means that the work they do is extremely dangerous. Alpha Company’s luck ran out today. One of their vehicles was caught by our eternal nemesis, the IED. The driver, Private Patrick Lormand, was killed.
This would have been bad enough, but as we were preparing to send our comrade home for the last time, we got word that columnist Margaret Wente had written that “our soldiers don’t get out much. They no longer chase the Taliban. Mostly, they’re trapped behind the wire at the base in Kandahar, where IEDs won’t get them.”* I cannot begin to imagine how that must have made the family of Private Lormand feel, not to mention the families of Major Pépin and Corporal Drouin, who were killed one week ago in the same manner.
This is lazy journalism at its worst. For Ms. Wente to make a statement like this, it would be necessary for her to have ignored all the news coming out of Afghanistan for the past several months. Telling her readers that we are safe from IEDs and are no longer pursuing the enemy is an astounding error. It boggles the mind that a member of the fifth estate could be so out of touch with reality.
If there is one thing the media does a good job of reporting, it is our deaths.† Of the thirteen soldiers we have lost on this rotation, all but two of them have been killed by IEDs. This death rate of approximately two per month is what we have suffered on every rotation since arriving in Kandahar province in 2006. So much for IEDs not “getting” us anymore. As for our offensive operations, this diary has reported on almost daily combat and patrolling activity. Tell me, Ms. Wente, how does that square with your statement that we “no longer chase the Taliban”?
For some reason the CF will not forcefully respond to this distortion. If asked, the CDS will disagree. But there will be no attempt on the part of the Public Affairs people to contact reporters with facts to disprove what Ms. Wente has written. Instead, the CF will take it on the chin and soldier on. I suppose that to do otherwise might be seen as interfering in some way with the political process back home.
As I am speaking only for myself, I am under no such constraints. Ms. Wente, you were way out of line. You owe every member of Task Force Afghanistan an apology.
SEPTEMBER 14, MORNING | Emergency Ultrasound at the FOB
Those who know me professionally are aware of the role that emergency ultrasound has played in my career. When I first launched the EDE (Emergency Department Echo) course in Canada a decade ago, there was already overwhelming proof that this technique benefited patients. But the evidence mattered little: EDE was an incursion into “turf” that radiologists have always considered their preserve. The political battles I have waged to overcome this resistance are legendary in Canadian emergency medicine circles.
Much of the opposition has centred on the ability of emergency physicians to use ultrasound to detect serious injuries. The fear is that essential care will be delayed and the patient will deteriorate, perhaps fatally, if these injuries are missed.* Many emergency physicians also focus on the “positive” scan—one that shows the presence of an injury, especially an unsuspected one—when they begin to explore the use of this modality. The times this happens are marked indelibly in the memory of an emergency physician: a patient arrives at death’s door and is saved only because an ultrasound scan guided therapy within seconds.
As dramatic and memorable as those cases are, they represent a tiny fraction of the ultra
sound exams performed by emergency physicians. Today I was able to use EDE in a manner that is far more common and that ultimately has far more impact on emergency medical practice.
An ANA trooper had been struck by shrapnel from an IED and had some moderate lacerations on his face. They would be a challenge to repair, but they were not life-threatening. A far more worrisome injury was a small puncture wound in his right chest, right under his axilla. Even innocuous-appearing shrapnel wounds in the thorax can lead to life-threatening conditions. That could have been the case here. The patient was complaining of pain in his right chest, and there was a peculiar finding when I examined the side of his chest wall: feeling around the wound site, I got the faint impression that there were Rice Krispies beneath the skin.
Even the most junior emergency medicine trainee would have recognized that this was possibly “subcutaneous emphysema,” or air trapped beneath the skin. In the current context, the most plausible explanation for this finding was that a piece of shrapnel had punctured the lung tissue and that air was leaking into the chest wall. If this was the case, a pneumothorax, or “collapsed lung,” was a strong possibility. It would have been reasonable to insert a chest tube and call for helicopter evacuation. But the patient’s vital signs were stable and he was breathing easily, so I elected to do an EDE instead. This test showed conclusively that there was no pneumothorax.
I therefore felt comfortable not subjecting the patient to a surgical procedure (the chest tube) and not risking the lives of one of our helicopter crews to come and get him. I cancelled the medevac, and we spent the next hour repairing the patient’s facial lacerations. During this hour, and for a couple of hours thereafter, I regularly rechecked the patient’s chest with ultrasound. All these examinations were negative. Doing all these exams in a short time allowed me to demonstrate the technique to Corporal Girard. He quickly mastered both the manual ability and the image interpretation skills required to perform this exam.
After three hours of observation, the patient was still utterly stable. It was safe to send him back to his barracks.
Corporal Pascal Girard performs an EDE
Addendum, September 15: The patient has returned for a follow-up visit. Repeat ultrasound scanning of his chest shows that a pneumothorax has not developed. “Negative” scans such as this one—scans that prove that the patient is not injured—have a great impact on the practice of an emergency physician. They represent more than 99 per cent of the EDE scans that we do, accelerating patient flow through our emergency departments and enhancing patient safety. This is where the most “bang for your buck” occurs with EDE.
SEPTEMBER 14, EVENING | My Right-Hand Man
I have not yet recognized the awesome contribution of Master Corporal Sylvie Guay. She is the most important member of my team, my UMS medic. We spent some time together at FOB Wilson when I first arrived, and she rejoined me here a couple of weeks ago.
Master Corporal Sylvie Guay, role model
When I arrived here in early August, the new UMS building had been in place for only a few days. All the gear was piled up in boxes in the corner. When Master Corporal Guay arrived, she worked tirelessly for several days to put everything in order: building shelves and labelling and sorting through a mountain of supplies.
It has been a very enjoyable professional relationship. At the end, she paid me the highest compliment an enlisted person can give an officer: she said she would be willing to come back to Afghanistan if she could be assigned to my UMS. I treasured the compliment, but told her that she was highly unlikely to ever come back here if that was the case.
What do you call a mother of two in her thirties who serves her country in war zone? “Role model” would be apt.
SEPTEMBER 15 | The Listeners
In an earlier entry I described the Taliban’s espionage network. We too spend a lot of time gathering information, making extensive use of Afghan interpreters to eavesdrop on the Taliban. “The listeners” will sit for hours on end with a radio headset, telling us verbatim what they have heard. The Taliban know this and act accordingly. Often their exchanges go something like this:
Taliban A: “Did you get the big thing?”
Taliban B: “Yeah. I got it.”
A: “Can you bring it to the place?”
B: “I have to get two guys to help me carry it. Can you send them?”
A: “Sure. I will send two guys to your house.”
B: “Okay. When they get here, we will bring you the big thing to the place we said.”
We intercept a lot of stuff like this, none of it particularly useful. But we keep listening. By doing so, we limit the enemy’s ability to communicate. They have to use such stilted code that only limited amounts of information can be passed. And there is always the chance they will slip up.
Most of this work is done by our locally hired interpreters. The Taliban routinely try to infiltrate their followers into this group. So we have people who listen to the listeners to detect when someone’s interpretation is intentionally misleading. When that happens, the interpreter is fired or, if we can make a case for espionage, arrested.
But where do we get native Pashto speakers we can absolutely rely on? In Canada. The CF places ads in media outlets that are aimed at the Afghan immigrant community. After a prolonged vetting process, an Afghan-Canadian who answers the ad can be granted a top-secret security clearance and sent to work with our intelligence people. I have met three of these individuals here, all of whom fled Afghanistan ten to fifteen years ago. They are pleased to be helping their country of birth get back on its feet. They would like to do more in the years to come.
Two of them are men with families. They are committed to the same values any other Canadian would be, including their daughters’ education. They are profoundly grateful for what the Canadian Army is doing in their native land.
Even more interesting is a woman in her early thirties. She is happy to be able to help in the struggle against the Taliban, but she also laughingly admits she took the job for that quintessential Canadian reason: to pay off her student loans and start her own small business. She is doing work that is hard (and a bit dangerous) while she is young, to get her life off to a good start.
These people came to Canada from Afghanistan fairly recently, but they have all changed considerably in the interim. The woman, in particular, has gone through a remarkable evolution in a short time. She and I have gotten to be good friends, and she has shared with me her annoyance with an Afghan man who is currently pursuing her. She tells me he is quite attractive. Unfortunately, his exposure to Canadians has not caused much evolution in his attitudes towards women. Like any good friend would, I listened supportively but noncommittally as she talked about this man’s advances. While many of the things she described would be considered very chauvinistic in Canada, I thought it was necessary for her to come to her own conclusions about him.
But then she revealed something that was so off-base that I was unable to hide my reaction. This Lothario has said he wants to marry her and that he will be faithful to her. However, on a number of occasions he has shared with her how much he enjoys the company of “white women.” Seeing my facial expression upon hearing this, my friend came straight out and asked me what I thought about this statement. I replied that, from a Canadian perspective, she would be crazy to marry this guy. She agreed.
And another Canadian is born.
SEPTEMBER 16 | Last Day
LATE AFTERNOON
The sun is going down. I am sitting beside the hilltop observation post, looking out over Panjwayi district. There was a moderate dust storm this morning, and I am concerned that the weather may worsen tomorrow. The combat team is heading out on an operation in a few hours. I hope the weather does not make us “medevac red.”
In twenty-four hours, I will be leaving the combat area. For all the danger and discomfort, the FOB has become so familiar that the thought of leaving is mildly unsettling. I didn’t feel like this the last time.
I was sad to leave my friends and worried about their future safety, but I was mostly very happy to be heading home. This time, I am experiencing something I have seen in combat veterans before.
Part of me likes being here. Life is simple. You get up in the morning. You do your job or you pass the time. Then you go to sleep. If you are still alive the next day, you do the same again. This differs markedly from modern life, in some ways you can anticipate and in one you might not. There is the meaningfulness of the work, the intensity of the emotions and the depth of the relationships—all that is to be expected. But the most striking difference, one that many young soldiers do not fully appreciate, is that there is so little choice here. You have one job to do, one place to eat, one group to hang out with. That’s it. You don’t have all the choices modern life in the developed world gives you.
I sometimes wonder if these endless choices have almost paralyzed us. We spend eternities examining various options—for a car, for a house, for a job or an outing—in the hopes of making the perfect decision. And when we finally make a decision, we often look back on it and wonder if it was the best one.
There is none of that here. Despite the risks, I have grown comfortable with the exquisite simplicity of my existence on the FOB. Fortunately, I have very strong bonds with my family and friends, bonds that more than make up for the intricacies of my life in Canada.