A Line in the Sand Read online

  Away from the city, the likelihood of suicide bombers decreases. That leaves the possibility of improvised explosive devices (IEDs) that are either remote controlled or wire controlled or that blow up when you drive or step on them. The correct term for this is VOIED—victim-operated improvised explosive device. I hate that term: it implies that it will be my own fault if I step on one of these things.

  In the end, the trip was a quiet but nonetheless unpleasant drive.

  At 1100 we arrived at the first FOB I will serve at: FOB Wilson. It lies at the northern edge of Zhari district and at about its east-west midpoint. It is the northernmost of our FOBs. It was named for Trooper Mark Wilson, who was killed in action near here on October 7, 2006.

  FOB Wilson is the only FOB I did not serve at during my first tour. Its layout is striking: whereas our other FOBs are built on heights of land, Wilson is flat. It is a big square of Hesco Bastions (gigantic sandbags) plopped down in the desert. This explains why it has been hit by only two rockets in the past three years: it is difficult for these devastating but inaccurate weapons to hit a target that is flat on the ground.

  This is not to say that the area around FOB Wilson is safe. Enemy activity is high, and one can watch Canadian and Afghan soldiers engage in close-quarters gun battles right outside the FOB’s walls. IEDs have even been placed no more than a hundred metres from the main guard post. Be that as it may, life inside the FOB walls is quite safe. Everyone walks around in T-shirts—no helmets, no frag vests, no ballistic glasses. Things are a lot more relaxed than they were at either of the FOBs I served at in 2007–08.

  As for creature comforts, things have improved considerably since my first tour. We get two hot meals a day, breakfast and supper, served in a wide-open area with handwashing stations that make it easy to be hygienic. At lunch, the cooks lay out all kinds of salads, cold cuts and warmed-up leftovers from the previous night’s meal. The grub is fantastic. No more ration packs!

  There are two “shower cans,” each with three washing machines and dryers! No more washing by hand!

  “Triple-7” in action

  We have the same kind of communications shack I remembered from FOB Ma’Sum Ghar last time, with three Internet connections (mostly reliable) and three phones (somewhat reliable).

  Right beside the Internet shack we have an amazing gym. It is named “Greener’s Gym” in honour of Sapper * Sean Greenfield, who was killed in action on January 31 of this year. There had been a gym at the first FOB I served at in 2007, but it was a dark, dusty place with only a small amount of gear. I think I went twice before deciding that pumping iron in that place was too depressing.

  And get this. There is also a “Rock House,” a wooden structure the size of a large room with a climbing wall on the outside and a music studio on the inside.

  In the UMS, the unit medical station, we have a wall of munchies, a large coffee maker (permanently filled), a toaster, a microwave oven and a fridge. And outside we have a large freezer, filled with water bottles that have been frozen—ice in the desert!

  Instead of being in a bunker with five guys, I am in a “sea can” that has three curtained-off “rooms” and a central area that serves as an office. My bed has a mattress (no canvas cot!) and my “room” has an air conditioner.

  The FOB is home to a combat team centred on a company of infantry, Bravo Company of the Second Battalion of the Royal 22nd Regiment, the “Van Doos”—the same French Canadian outfit I spent most of my tour with last time. They left for an operation this morning, so the base is deserted.

  The only downside of living at FOB Wilson is that the M777 155 mm cannons are located less than a hundred metres from my quarters. They often have to fire right over my shack. This isn’t dangerous, but the noise and the concussion wave of the shot makes sleeping pretty much impossible.

  The cannons can’t fire very close to the FOB—even with a minimum of propellant, the shells go too far. For close-in bombardment, the artillery has some 81 mm mortars. These weapons “arc” their bombs, making it possible for them to hit targets that are very close.

  “The guns” (as everyone refers to the artillery) were busy today. Before the day was out, they would fire over eighty rounds in support of Bravo Company’s operations in the Panjwayi. This was one of the largest “fire missions” executed by Canadians since arriving in Afghanistan. The combat team had encountered an unusually high number of enemy while they were on foot and away from their vehicles. They had used the artillery to blast a path back to their “leager.” * After eight years of war, it is disappointing that there are still so many Taliban targets to shoot at—another disturbing indicator that things are not going as well as we would like.

  But as badly as things might be going, I learned two things at the end of the day that convinced me we are doing the right thing here. Two things that got my battlemind to where it needed to be.

  First, on the national scale. In 2007, the Taliban burnt or blew up 130 schools in Afghanistan, while forcing another 300 to close by threatening the teachers. They also murdered at least 105 students and teachers. Convinced of the correctness of this course of action, they have continued in the same vein since then.

  If you look at everything written about Afghanistan in the news, you can catch a glimpse of this,* but it is something else to get a briefing that shows you, on a local map, all the schools that have been destroyed.

  Locally, I learned that there is an Afghan medical clinic within sight of the FOB. This is the last functioning clinic in the area. Four others farther away have closed their doors because of Taliban threats. Apart from this last clinic and our UMS, there are no health care facilities of any kind in Zhari district. This does not seem to matter to our enemies.

  Regardless of the challenges, regardless of mistakes we may have made, whatever our chances of success, Canada is in the right place. I am in the right place.

  I am here to help defeat the Taliban. Let’s get on with it.

  Addendum, June 9: Major Bouchard, ever mindful of the morale of the people in her company, called me tonight to see how I was doing. She asked how I was getting along with “the bayonets,” the slightly derogatory term used by the medical services to refer to the combat arms. I answered that I was getting along with them quite well, and I left it at that.

  If I had known her better, I would have told her that I felt I was back with my brothers, and that I saw myself more as one of them than as a member of the health services. I am a bayonet.

  Battlemind set—good to go

  JUNE 5 | The Shop

  Another night of lousy sleep, thanks to artillery fire over my head during the night and the first call to Muslim prayers from the Afghan National Army (ANA) compound ten metres away at 0430 (first light). I take over as FOB Wilson medical officer today—time to go to work.

  The UMS is across the street from my quarters. There is also a four-stretcher tent close to it that can hold four more minor casualties. All told, the UMS can handle three times more patients than it could in 2007.

  As a doctor, my first reflex was to be pleased with the improvements. I have spent a good part of my career in Canada pleading for more resources for emergency medicine, so I was chuffed to see that I would have more of everything with which to do my job than I’d had during my previous tour.

  The FOB Wilson UMS

  As a soldier, though, I was troubled. Those with access to far more information than I, our leaders and decision makers, believe that we are going to need these resources to care for a larger number of wounded. It seemed the major’s briefing two nights ago was bang on.

  The UMS itself shows the effects of the lessons learned over three years of warfare in Kandahar province. Again, I was pleased to see that many of the recommendations I made after my last tour have been put into effect. The place functions like a small community emergency department in Canada onto which the resuscitation area of a Level 1 trauma centre has been grafted. The specialized medications and gear that I’d
had to request for myself last time are already in place. The military medical staff may not be familiar with all this stuff, but at least it is here. This makes me as functional as possible, and it will give me the chance to do a bit of teaching with the person I am replacing.

  The communications have vastly improved. We now have e-mail right in the UMS, a land line to the key places on the camp (command post, district centre, etc.), and a phone that can make a call to KAF or Canada as easily as a call across town back home. We also have secure communication devices that allow us to monitor what is going on with the units in the field so that we can anticipate their medical requirements. And my desk has drawers! We had none of this on Roto 4.

  Wounded Afghans—who so far have represented 100 per cent of the casualties treated here—arrive via the main gate, regardless of whether they are military, police or civilian. This places them close to the UMS. Since they almost invariably arrive by vehicle, the warning call we get from the gate coincides with the arrival of the patients at the UMS door. For some reason, the Afghan soldiers and police rarely use their radios to alert the FOB of the arrival of their wounded.

  It is therefore not unusual for a load of casualties to arrive at the doors of the UMS with very little warning. This is not unlike what I have been dealing with in emergency medicine for over a decade now, and it is something I have had a lot of experience with in the developing world. The worst MasCal (mass casualty) incident I ever dealt with occurred during the Nicaraguan Contra War and involved eighty patients, worse than anything Canadians have had to deal with in Afghanistan.

  Rather unusually, the FOB had been covered for the past few weeks by a doctor, rather than by a PA. She has had additional training to prepare her for the trauma patients who dominate the caseload here, but she remains what the army calls a general duty medical officer, an office-based general practitioner.

  The arrival of unscheduled patients was something she seemed to have found very surprising. She kept repeating over and over, “Patients will just show up!” as if to warn me of the probability of these anomalous events. I tried to reassure her that I had lived through these events many times before. As an emergency specialist, that is what my career entails: if bad things happen to people unexpectedly, I want to be there to take care of them.

  Let me now introduce the crew of the Bison armoured ambulance based here. *

  Master Corporal Nick Beaulieu (centre in the following photograph) is the crew commander. At the age of forty-one, Nick should be much further along in terms of rank. He is not lacking in courage— he still goes out on foot patrols when the combat units are short a medic—but he is one of those guys who is more comfortable with less responsibility and therefore less authority. You get the impression he has almost engineered various disciplinary incidents—some of them quite funny—so that he will not be promoted.†

  The driver (left) is twenty-three-year-old Corporal Pierre Yves (“P.Y.”) Lavoie. P.Y. is on his second tour in Afghanistan, having been a convoy driver during Roto 4. P.Y. went down the roads of Zhari-Panjwayi—what I said yesterday was “the worst thing you can do”— almost every day for six months. He signed up for this tour two months before it was scheduled to go. Although he had never driven a Bison before, he quickly mastered the vehicle. He seems to be a natural around heavy machinery.

  The Bison medic is twenty-nine-year-old Private Dominic Vaillancourt-Larose (even he laughs about the length of that surname). Like all our medics, he is extraordinarily competent when it comes to caring for a trauma victim. Dominic is also one of the most eager learners I have ever met in medicine: he is constantly asking me questions. There is also a medic assigned to the UMS proper, but he will not arrive for another week. Currently, that position is filled by Master Corporal Sylvie Guay.

  The FOB Wilson Bison crew

  Only one trauma patient today. An Afghan convoy guard was shot through the top of his foot. Through-and-through, no major damage, but ultrasound confirmed a fracture of one of his metatarsals (the bones that connect the toes to the foot), so I sent him to KAF for an orthopedic consultation. The helicopter arrived to take him away within thirty minutes. Cool!

  There’s another positive aspect about being assigned to the FOB Wilson UMS. During my last roto, a Taliban rocket detonated about two metres from the UMS. The two medics inside were very fortunate: they survived with minor injuries.

  I like to think that this makes it unlikely the UMS will get hit by another rocket while I am here. Statistically, that is incorrect. The odds of a rocket strike on a particular spot are always exactly the same, regardless of where one hit before.

  In a war zone, superstition trumps statistics.

  JUNE 6 | “Collateral” Damage

  The jet lag was still beating me up this morning, and after a couple of hours I collapsed back into bed. The UMS is only ten metres from my shack, but I brought the UMS radio with me so that I would be immediately available. Emergency physicians never stray from their resuscitation area when they are on duty. And I am on duty here 24/7.

  That turned out to be a good move: as I was entering REM sleep, Master Corporal Guay radioed that I was needed immediately. I staggered over and was still prying my eyes open when I came to the door of the UMS. Inside, I was confronted with something that is all too common in this war. Two children, one of them eight years old and the other one in his mid-teens, had set off a Taliban IED. They were “collateral damage,” a horrible term that tries to gloss over the fact that civilians are often killed and maimed in war.

  The younger child had been hit by a half-dozen small pieces of gravel that had been thrown off by the explosion. His wounds were trivial, but he was very upset. Like most children who go through such events, all he needed was to sleep in the arms of someone who cared for him.

  The older child was far worse off. The detonation had taken place no more than three metres from him. From the pattern of his injuries, it seemed that the mine had been placed in a soft plastic container. (Plastic jugs, not unlike the things you see at campgrounds in Canada, are used by the Taliban to store their explosives.) I drew this conclusion because the patient was shredded from his groin down to his calf on both sides, but there were none of the amputations or deep penetrations that occur when the explosive is encased in metal.

  About a third of the soft tissue on both legs had been lost, giving the limbs the appearance of raw, bloody hamburger. The nerves remained at least partially intact; the patient was still moving both his limbs, although not purposefully. His abdomen and chest were untouched, but his face looked like it had been sandblasted. Both corneas were coated with grains of sand that had been forced into the tissue. His eyes must have been open when the blast occurred.

  He was still breathing on his own, but he was semi-conscious, barely moaning when I tried to stimulate him by rubbing hard with my knuckles on his breastbone. He was also in shock: we could detect a pulse in his neck, but not in his wrist or in his groin. This meant that his blood pressure was somewhere around 70/nothing.

  We proceeded with a straightforward resuscitation. We started two IVs, one on each arm, and gave the patient large amounts of fluids to bring his blood pressure back up. Meanwhile we prepared him for evacuation. Both his legs were swathed in pressure bandages and we administered two medications, etomidate to put him to sleep and rocuronium to paralyze him. Intubating—putting a breathing tube from the mouth down into the lungs so that we can take over breathing for the patient—can make patients vomit. If this happens when they are semi-conscious or unconscious, the vomit can be sucked into the lungs and choke them to death. Paralyzing the patient makes it far less likely that this will happen because the stomach can no longer contract and expel its contents back up into the throat.

  The destination for this patient was none other than Camp Hero, an Afghan army hospital that opened its doors in February 2008 and at which I had done some teaching on my last tour. It is functioning at a high level now and is accepting a large proportion
of the Afghan civilian and military casualties.

  Addendum, June 7: The teenager is dead. No life-threatening injuries were missed; he had spent too long in shock before getting to us. This delay damaged the internal organs, notably the liver and kidneys, so badly that the patient died even though his injuries had been repaired and his lost blood had been replaced.

  Events like these are so common as to be barely worth mentioning. The Taliban do not hesitate to plant their weapons in populated areas because they know our patrols go there to interact with the locals. Most civilian casualties in this war are caused by these incidents.

  Remember that when you hear about American air strikes going astray. Yes, these incidents are tragic. They need to be investigated, and we need to do a better job to reduce these casualties. But when Afghan civilians are hurt by Coalition weapons, it is because we screwed up. When they are hurt by Taliban weapons, it is a direct and predictable result of intentional Taliban tactics.

  JUNE 8 | Every Body Goes Home

  It could have been a lot worse.

  One of the platoons of Bravo Company, the company based at my FOB, had been clearing a dirt road, searching for IEDs. The four troopers who were leading the advance had come to an intersection. The road running to the left had mud brick walls on either side. Another wall of similar construction ran along the left side of the road leading straight ahead.

  Three walls needing to be cleared, four troopers. The trooper in charge directed one of his men to start clearing the left-hand side of the side road while he sent the other two to the other side. Once there, these two split up. One headed farther down the main road, following the wall on the left side. The other one, Private Alexandre Peloquin, took the right-hand side on the side road and started moving away from the intersection.