A Day in the Life at Craig Joint Theater Hospital (Warning: May be considered graphic)

This is the final article I wrote about Afganistan, also intended for publication in the newspaper. This is not for the kiddos.

    The alarm clock begins beeping, signaling the start of another day. It’s only been a few hours since he closed his eyes, but for Capt. Robert Austin of the U.S. Air Force, there is no sleeping in, no matter how tired he is. “Service Before Self” is one of the three key tenets of the Air Force, and this deployment has provided an exceptional opportunity to live that tenet. 

Austin, a Nurse Anesthetist deployed from Travis Air Force Base in Northern California is a Nurse Anesthetist with the 455^th Expeditionary Medical Group at Craig Joint Theater Hospital, Bagram Air Base, Afghanistan. 

He says, “On paper, we only work 8 hour shifts. I’m usually at the hospital 12-14 hours a day, minimum. So many of our patients require so much that we often have 2 providers in the room, or we are busy enough that we end up staying over to help cover the cases.” He is referring to the nearly 300 anesthetics he has provided or helped with in the past 6 months.

“My last day off was the day I got here, December 21^st,” He smiles and jokes, “My next will be the day I go home.”

The hospital cares for a large majority of the American troops wounded in theater, as well as Afghan National Police, Afghan military, and local nationals. He explains, “Bagram is the primary hub for evacuation to Germany. No matter where in country you are injured, you will most likely come through this facility on your way out.”

Accurate numbers were not available, but Austin estimates that the facility averages 10 surgeries a day, ranging from laparoscopic appendectomies and gall bladder extractions to multi-specialty, multi-hour cases. "We have specialties here that you’ll only find at large hospitals stateside. Neurosurgical services, pediatric orthopedics, vascular surgeons, ophthalmological surgeons. We have it all. Often we’ll have one surgery with 4 or 5 services scrubbed in. It can be very hectic." 

One of the surgeries that stands out in his mind is a Polish patient early in the deployment. “I started his case one evening and took it back over and finished it the next day. He was in surgery for over 18 hours. He had Ortho, General Surgery, Neuro, and I believe, Urology, all working on him.”

Such extensive surgeries are the exception, not the rule, fortunately. Unfortunately, the signature injury of the war, amputation of both lower extremities and one hand with or without groin injury are seen almost daily, and are increasing in frequency. “These patients are the hardest,” says Austin. “Usually we are not the first to see them. By the time they get to us, they have already sustained not only their original injury, but the first of what will be multiple surgeries. They are the recipients of massive transfusions.”

‘Massive transfusion’ refers to when a patient receives more than 10 units of blood products. The average circulating volume of the human body is 5 liters. 10 units of blood products comes close to completely replacing that volume. 

“We recently had a patient who had received 70 units of packed red blood cells (pRBCs), 64 units of Fresh Frozen Plasma (FFP), 21 units of whole blood, 4 10-packs of cryoprecipitate and 5 6-packs of platelets before he got to us. He had the equivalent of 14 people’s entire blood volumes for one surgery. We took him back to surgery, gave him another 8 units of whole blood, 8 pRBCs, 13 FFP, 3 10-packs of cryoprecipitate and 5 more 6 packs of platelets, or about another 4 blood volumes, just for the revision and washout of his injuries. He’s facing probably another 20 or more surgeries over the next few months, and then years worth of recovery and physical therapy.”

Austin says he wonders about how well these patients will do. “We’ll never see these guys again. I have no idea if they will recover and adjust to life without three limbs, or if they will die of infection, or what. It’s hard.”

Some patients exhibit a spirit that reassures him. “We had one guy who had lost a leg. He had to go back to surgery for a washout of his injury. After surgery he was in a lot of pain, both physically and emotionally. He was really struggling with accepting his injury. One of the ICU nurses told me the next day he was gonna be ok. I asked her how she knew and she shared a joke with me that he had told her that night. 

‘Where does a man with only one leg go for breakfast? IHOP!’ If you can joke about it, you’re probably going to be all right.”

There are other patients that Austin will never forget either, the ones who didn’t survive. Speaking of the first patient who died while in the operating room under his care, Austin says, “I carry a lot of guilt,” he says. “They died under my care. While I can know that I did everything right, that we all did, it doesn’t change the fact that we lost him. We tried until it was apparent that he wasn’t going to make it, and then we kept trying. There were four anesthesia providers working on him and six surgeons. At one point there were over 20 people in the room, all contributing to try and keep this soldier alive. He had the best of the best giving it their best, and it wasn’t enough.”

Austin says he is glad he’s going home soon. “I have been privileged to care for our troops, but it’s someone else’s turn. The cost is of caring for these boys is high, mentally and emotionally, not just for me, but for my family as well. I’m looking forward to being reunited with them, and to my upcoming PCS.” Austin will be moving to Elmendorf AFB in Anchorage later this summer.

What are the odds?

This is actually the first article I wrote, before I found out about Davin and Dan being there. This was also intended to be published as a Newspaper article

     It is approximately 6500 miles as the crow flies from Homer to Bagram, Afghanistan. That distance was bridged in an incredible way this spring. Sometime in Mid-April of this year, a chance conversation at the local CarQuest between Mariah Thomas-Wolfe and R.J. Austin led to the discovery that both of them had sons deployed to Bagram with the 455 EMDOS, serving in the same unit.
    Mariah’s son, Senior Airmen Zach Schindler is a 2004 graduate of Homer High and works in the Contingency Aeromedical Staging Facility or CASF as a medical technician. R.J.’s son, Captain Robert Austin, graduated Homer High in 1994 and is a Nurse Anesthetist working in the Operating Room inside the hospital. The two met a about two weeks after their parent’s encounter, during a IDF or Indirect Fire attack, when the CASF was evacuated into the hospital.
    “It is incredible. No matter how far away we get, I always run into somebody from home. My last deployment (To Balad, Iraq in 2005-2006) I worked with a guy from Kenai. There are a couple of docs here from Alaska as well. I am impressed with how well represented Alaska is in the Armed Forces.” says Captain Austin.

    Coincidentally, only a couple of nights before Austin and Schindler met, Capt. Austin snapped a picture. He explains, “People back home make and send blankets and pillows for the wounded troops to use on their flight out to Germany. The litters that the patients travel on are lined up in the hall a few hours before the flight. That night, I happened to notice the embroidery on the blanket said “Homer, Alaska.” I don’t know who sent that blanket, but I hope they read this article and know that it did indeed keep a wounded service member warm on a long flight, and that it cheered up another service member, seeing that reminder of home. Whoever you are, thank you.”

Anchor Point Serves

    This is an article I wrote about some of the guys and myself from my hometown. This will be the first of three articles I wrote about my deployment. Enjoy!

    Anchor Point is a town of only about 1900 people, but it is extremely well represented in the Armed Forces. This point was amply illustrated earlier this month at Bagram Airfield, Afghanistan.
    Three sons of Anchor Point, all Air Force, were briefly reunited thousands of miles from home. Davin Chesser, a Reserves C-130 maintainer deployed from Elmendorf AFB has nearly 10 years in. Dan Byrne, a first term Imagery Analyst, is deployed from Beale AFB, CA and will re-enlist while deployed. Robert (B.J.) Austin, Nurse Anesthetist, recently returned from his deployment to his home station at Travis AFB, CA. He has seven years in the service. The three attempted to meet for dinner, but due to schedule conflicts were unable to get all together. Instead, Chesser and Austin chatted for a few minutes, and later that evening, Austin and Byrne shared a meal.
    Austin and Chesser were neighbors on David Lee Street growing up, while Byrne and Austin both attended church together at the Anchor Point church of Christ, where Byrne’s dad preached. All three are graduates of Chapman Elementary and Homer High.
    While it is not uncommon for those from larger cities to run into someone from their hometown, reunions such as this must be extremely rare. “I’ve never heard of three people from the same small town all being deployed together since I joined the Air Force. I’m sure it’s happened before, but it was a real surprise to see these guys” said Austin.
    Mike Koch, U.S. Army and another former Anchor Pointer, just returned from Iraq. That is more than 2% of the entire population of Anchor Point serving overseas at the same time. The number in the service is even higher. Says Austin, “I know of at least 2 others from Anchor Point who are in the Navy, Gloria Velsko and Morgan Tracy. There are probably others on Active Duty I don’t know of, and many more who have served at least one term in a branch of the Armed Forces. VFW Post 10221 should take pride, knowing that their tradition of service to country is being continued, and strongly.”

Labels, and the impossible writing that accompanies them!

     As I was making changes to the blog this evening, I happened to notice that there are 41 links listed, each of them occurring only once. That is about to change. What follows is the Freestyle writing including 19 of the links that I have previously listed. I'll try to get the other 22 into the next post.


     When Yakob was a little boy, he wanted to be in the Union Air Force. He wanted to fly airplanes and visit far-off places like California. The intervening years had instead immersed him in a world of automated phone calls and book reviews, baby news, frustration and e-mail. Too much of which was currently occupying his phone. He couldn't even load his Bible software without it crashing. 
     "What ever happened," he wondered, "to the good old days when family sent actual letters, and actual comic books like Boy Wonder sat on actual bookcases?" Instead, as a e-news blogger trying to make a living in the brutally competitive news media, Yakob experienced daily frustration as his technology became ever more rapidly obsolete. 
    Yakob's thoughts continued as he hurried across the street, dodging around one of the many barricades erected recently. "Beards were only for old men, gaming had gone from on-line to live. Christians were a persecuted people, and few of his readers could separate fantasy from fiction. God's word was often considered a relic from 3000 years ago."
     Even the food had gone down hill. "When I was young," he remembered, "and Mama went on her diet, she never ate this poorly." Neither had he, not till the war. It was the war that changed it all. The war . . .

1,700 PS3s purchase by Air Force

     In today's news of the weird . . . check out this article, reporting on the Air Force's attempt to build THE ultimate gaming machine! I wish I could have gotten even 1 PlayStation 3. Guess Boy Wonder and I will just have to plug along with our old PS2. Do you feel sorry for me yet? 


P.S. If you click on the title, it will take you to the article. Good to know, hmm?