Thanksgiving Letter

I hope that everyone has enjoyed yet another turkey day, the one day at least one people pause and reflect on the freedoms and blessings that we have. For many of of it is a time to gather with family and eat until we can no longer, loosen our belts, and eat again. For others it is time of sadness and loneliness, those without anyone or much of anything in the world. It has been a while since I have written, and in that time, I have had the luxury to reflect. Djiboutians do not celebrate Thanksgiving as we do; they have other holidays, but the story of the Mayflower and escape from tyrannical Britain is unique to us as Americans, and I am thankful for that celebration and the sense of fellowship and togetherness it demands, unlike so many other days of the year.

In the past few weeks, some crazy things have been going on here, and I have elected not to write any mass emails.

Today, and everyday, I am thankful for so many things. Living in this desert has brought me into a realization, not unlike the Kubler Ross stages of dying: I have sojourned across the emotional landscapes of denial, anger, bargaining, and disbelief...and have now accepted this deployment in a strange relationship between reality and a dream. It is a paradigm shift from my norm, or at least the former life I lived before I arrived here, and as anticipated, I may not be the same when I return home to the US in April. Hopefully this experience has polished my character. It occurred to me last week, before the celebration, how much God has done to work in my life to get me to where I am today, and how many blessings I take for granted. My education is one of them.

Last week, for example, I received a patient who had been choppered off of a ship for an intractable headache and impressive neurological symptoms. He could have had viral meningitis, or a very severe migraine, or worse, a lesion on his brain. He needed a spinal tap, but before that, he needed advanced imaging such as a CT scan of his brain to rule out a bleed, or worse, a herniation of part of brainstem that might worsen and kill him if a spinal tap was performed first. As an expeditionary medical facility, we do not have access to a CT or MRI, so I needed to medevac him to the next level of care, which would be Landstuhl, Germany, an full fledged Army hospital that receives casualties from Africa as well as the other operational theatres. I ordered an urgent medevac of the patient to Landstuhl, as we had done for six other patients that same week (an unsually high volume of medevacs for us). In fact, we had two critical care patients in the same week, both intubated and on a ventilator, the only two we have had (so far) in the five months I have been deployed...and all of them came from the same ship. Very unusual. Because I ordered the third urgent medevac in less than a week, which requires a standby team to drop everything and catch a flight to Djibouit, I received a call from the flight surgeon in carge of aerovac operations. After a lively discussion, I convinced him that this patient could potentially die without this care, despite my professional assessment that it was not life threatening, yet unwilling to jeopardize my medical license and this man's life on a hunch.

The team was dispatched from Landstuhl, and the next morning, with a migraine creeping on the right side of my head, I accomapnied the flight nurses to the flightline to give report and load the patient. Landstuhl had dispatched a dozen airmen, nurses, and corpsmen to pilot a 250 million dollar C17 jet aircraft, set up like a mobile ER, to pick this patient up and fly him back to Germany, as they had done twice already that week. The aircraft was beautiful as dawn siloutted it against the runway, and I could not help but think how it reminded me of an enormous whale. As we waited for the plane to refuel, we talked about how expensive a mission like this costs- well over $100,000 to get a single patient to Germany for a CT and spinal tap. Then it hit me: that because of MY order, this crew of 12 and this aircraft were dispatched on a mission, requiring untold manpower securing last minute country clearances across hostile countries (like Yemeni and Eritrean airspaces), to take him back to a hospital in a turn around time of less than 20 hours, all costing more than I make in an entire year. Wow. That is a very humbling, and sober, realization to weild that amount of power on any given day. I am thankful for those years God saw me through medical school and residency to be able to help this man, but am equally thankful for that crew to sacrifice their time and resources to get that job done.

Now, if we can only get access to a CT scanner, I can do the spinal tap myself next time and save everyone all this trouble :) By the way, the patient survived, and as predicted, did not have a life threatening condition, but in medicine, you always have to play it safe...or you will be sorry one day.

Though days have a tendency to become routine, Thanksgiving is certainly a time for me to realize that I have the privelege of helping people who serve our country, and that I do not work long hours, and that I get paid pretty well for what I do. I am blessed with the most amazing woman in the world as my wife, a wonderful family, broad circles of close friends, some unbelievable adventures, good health, and a loyal pet ferret :)

Though I am without my wife, family, and most of my friends (I have made many on deployment) here in Djibouti, I am content. I recently fixed up my $10 mountain bike so that I can ride it more and more, and have been riding 10-20 miles everyday in the dirt and sand, hoping to accumulate about 2000 miles of riding before I leave here in April, more than I have ever ridden before in a single year.