March Madness

Well the end of March was an exciting time here in Baghdad. As you may have gathered from my last email and the news - things here in Iraq got pretty busy from the military and medical standpoint. Starting on Easter Sunday morning and really continuing until yesterday - the skies were busy with a whole bunch of mortar and rockets being launched at various places in the Green Zone and some of the surrounding FOBs. Unfortunately two civilians who work with the embassy were killed and quite a few injuries - but for the most part the attacks were thankfully poorly aimed and didn't cause any casualties. From what the rumors are, most of the firing seems to come from areas in Baghdad called Sadr city. It is mostly poor slums that are heavily controlled by Muqhtada al-Sadr and his Mahdi militia. If you have a few minutes, you may want to google them to get a better idea of what they are about. As far as I can tell, they are mostly about being a gang of criminals with really big weapons who use religion as an excuse to further their own ends violently.

Sadr city itself is only a few miles from here, making it a convenient launching point for most of the indirect fire (IDF - rockets, mortars, and artillery). There had been increased combat that was taking place there and some of the surrounding areas and had accounted for the increased patient workload with injured soldiers and local national Iraqis coming to the CSH.

The hospital was almost at capacity during the week - even with the multiple evacuations out of the hospital -both to Iraqi facilities for local nationals, and to the Air Force hospital for our soldiers to be evacuated on to Germany. We did lose a few soldiers despite some really heroic attempts at resuscitation both by my colleagues down here in the ER - and the dedicated surgeons and intensivists up stairs. Even in the midst of the dozens of tragedies that surrounded us, people were doubly affected by the loss of the troops. Due to the threat of the indirect fire, we were unable to give all of them our last respects with their angel flights. It is strange that one ceremony really has quite an impact on those that work here, and people seemed to be almost as upset about not being able to salute the fallen soldier as about the death itself.

We have since gotten back to some sense of normalcy. At least back to the way it was before last week - as I don't think we can ever call this place truly normal. We have started to be able to return to the gym which is a huge part of what we all do on a daily basis. And now we can go outside again without wearing our body armor. Last night, though, I think I gave Amy quite a scare as I was talking on the phone to her on the roof of the hospital when the alarm for 'incoming' went off and I ran inside the building and hung up the phone by mistake after saying something along the lines of "oh-s*&t". I was able to call her back a few minutes later and put her at ease. And apologize for hanging up the phone on her...

More importantly - now that we can go outside without our IBA on again - we have to get back to the important monthly grilling of steak and lobster donated by our 18Delta - Special Forces medics who come and work with us. They have quite the hook-up, almost makes me want to join the Special Operations command... Just kidding.

As for the rest of the news for the month - thankfully, the moustaches are gone. They were horrendous - at least mine was. But other people were upset about looking like someone out of a B-rated movie as well. We did celebrate St. Patrick's day - even here in Iraq we celebrated. How else, by donning stupid hats and drinking green beer. Alright it was non-alcoholic beer, but still with a little green food coloring, made it just like home.

As usual, the dining facility personnel decorated to celebrate Easter in their usual Bangladeshi style... errrrrr..... whatever that means. No one can quite figure out what kind of animal that is and what it is doing. Any suggestions?

And then finally, as a little piece of home was sent to me from my friends over at UMass - a hat from LifeFlight to remind me of better times - probably the first time one of those hats was worn with IBA on and a weapon in hand.

Back at home - Amy is trying to stay as sane as possible with the girls. She really has her hands full and is doing a phenomenal job as always. I miss the three of them (and Riley) very much and can't wait to see them. 1/3 of the way done...

Anyway, back to work for me. Hope you are all doing well. Thank you for your recent emails and thoughts, very much appreciated.

Thought I would surprise you all and write a little sooner than my usual 2 week intervals. Has been an interesting week. Started out having lunch with some members of the US Institute for Peace - led by their Chief of Mission here in Iraq and then with 4 of their employees all of whom are Iraqi and very much aware of what is going on outside the blast walls that surround the IZ. The USIP (http://www.usip.org/iraq/index.html) is the group that initiated the Iraq Study Group and essentially is a quasi-governmental congressionally mandated organization whose purpose is to encourage rebuilding and reconciliation. They work all over the world, Iraq, Israel, Sudan, etc... and seem to have a really unique and nobel mission. In addition to hearing about some of the real successes that are occuring around the country here (there are actually some good things), it was incredible to just speak with a bunch of local Iraqis voice what life is really like out there. We discussed the crushing unemployment (around 60%) and how that is driving a large part of the anger here. Also talked about some of the basics of life, they only have electricity in Baghdad for about one hour a day (so they only have water for an hour a day) - makes for some real discontent especially as it gets warmer. Under Saddam, there was electricity 23 hours a day. When asked pointedly "was it worth it", 3 out of 4 of them said yes. The fourth, definately not. He talked of the opinion that freedom is worthless without security - so with many thousands dead, he sees no reason for it. Great food, too. Made by one of the employees wife's.

That high point, was really the only good thing this week, though. As has been in the news, we lost 8 soldiers around Baghdad earlier in the week, and an upturn in casualties across the board. Saw a few of them here in the Hospital. It is humbling what these soldiers do on a daily basis and risk their lives for. I am never really one for sentimentality,and there are really places I would rather be - but it is really an honor to be able to care for these soldiers. It just reminds me every day of how lucky I am, and being here in the hospital is the least I could do

It still is a kick to the groin and very difficult to watch the Angel Flights fly out of here. I hope I never get used to it.

That's it for now.

One more month down... woohoo! Only 10ish left, but who is counting?

The big news, of course, is the moustache's for March. We have already had more than a few people drop out of the contest due to the fact that they look absolutely horrible. But I am staying strong and going for the 15 March deadline, no matter how bad I look. It is a measure of dedication to a cause to suffer through with it, but I am willing.

As most of you have probably heard, things have continued to quiet down a little throughout the country and thankfully Mahdi Army has extended their cease fire another 6 months. Hopefully this lull in violence will be a lasting thing. It is interesting that with the decrease in violence we are seeing more and more medical problems in the ER - it is almost starting to feel like a small ER back home - aside from walking around with the M-16 thing.

I recently had to fly a patient to the Air Force theater hospital about 20 minutes from Baghdad in Balad. It was quite an experience. I have flown plenty of patients in helicopters before just always in civilian helicopters, and never wearing my full ballistic armor and carrying a weapon. The Blackhawks go a heck of a lot faster and a lot lower to the ground then the helicopter back at UMass. The flight there was focused on the patient, so didn't really get to see the surroundings so well. The trip back took a little longer with a few stops along the way which gave me a perspective of what is actually surrounding the IZ and Baghdad itself. From the sky at night, it really looks like any other small city - lights on everywhere. Major difference is that the roads were not filled with traffic at night - quite literally only convoys of trucks and military vehicles moving around after curfew. Flew over "The Mother of All Mosques" - which was a really impressive site. This is an internet picture that I stole to give you an idea of what it looks like. It is in about the same stage of construction as in the picture because all work stopped during the initial invasion and now most of the construciton supplies have been looted.

Unfortunately it was at night, so no real pictures from the trip back (flashes aren't really appreciated by the pilots in their night vision gear). On the way back, we stopped at a few of the outlying FOBs to pick up patients -- made me really appreciate where I am deployed to, compared to pretty much everywhere else. Being in a real building, with streets, and even trees is world's away from these other outposts. Definately helped put things in perspective for me.

Some of you may know my friend Gary Dufresne - he recently got back from Iraq after 15 months long months over here with 1st Cavalry Division. If you come across him, please buy him a beer and have one for me - you can put it on my tab. PS - Gary you were right, Taji is a dump.

Also just got a tour of the new US embassy over here - of course no pictures were allowed, so picture if you will a small college with sandstone buildings, surrounded by 15 foot walls and patrolled by heavily armed Peruvian contractor guards. That is essentially what it looks like - with an indoor pool, gymnasium, cafeteria, helipad, fire control center - you know, the usual stuff of a college campus. They haven't moved into the compound yet - I am sure it will be quite busy when they do move in.

Other than that, passing time in the usual fashion - running in monthly races - and actually finishing them. Playing games of world domination and of course continued training to maintain our flexibility.

Hope you all are well. Until next time.

VD day

Well Happy Valentine's Day! The pics are... http://jaycosdesertvacation.bogspot.com/ The best part of Valentine's Day - is that February is now halfway over. If you don't count the rest of February, and then subtract out R&R, then can't count the month I come home - well then there are only 9 months left for me here in Iraq. That is countable on two of your own hands. Slowly chipping away...

Not all that much new and exciting here recently. The weather is warming up a bit, actually a pleasant 70 most of the time right now. From what the preventive medicine people tell me, the perfect breeding time for the next season here in Baghdad - the bug season. I can't wait. Maybe I will get some exotic disease from one of the bugs and become famous by having some rash published in some journal somewhere. Dare to dream.

We have been passing time in the usual fashion here - working, gym, sleeping, hippity-hop. Yup, hippity hop races through the ER in the middle of the night helps to pass the time, and our patients quite enjoyed the spectacle we were making of ourselves - one even joined in a race. I was unfortunately defeated in the first heat (cheated out of it more accurate), but I am not bitter as a good time was had by all.

Some of our docs here were only here for 6 months and just rotated home (not me obviously). Sad to see some of them go, not so sad about others. But it is another marker of the progress of time. The good part, though, is that in the transfer, we inherited some bicycles form the outgoing docs. So yes, put on your kevlar helmet and mount your M-16 - we went combat bicycling around the international zone. It was fun and we will definatley do it again. Besides, it does save a lot of time in getting to the PX and back.

We haven't seen anymore straws in bladders - for all of you guessing on how it got there, the soldier said he didn't know - but there is only one way for it to get there... I have gotten to see a few interesting medical things that you don't get to see back home in the past few weeks. Including a little girl who just flew to Boston on the tab of some charity to be treated at Shriner's burn hospital for 50% burns basically from her navel all the way down the rest ofher body. Hopefully she will make a good recovery and have some semblance of a happy life.

As a means of gratitude for some work that we did - one of those Special Forces medics that I talked about on the last email brought us an entire cooler filled with fresh'ish' steaks. We were able to hobble together a grill and 'acquired' some charcoal and had ourselves an old fashioned cookout. It was even complete with beer - well non-alcoholic beer. Something was definately missing without that alcohol part.

Meanwhile back home, the girls seem like they are doing well.

Sara sang me the entire alphabet last night and Naomi is now walking around and popping out some teeth and says 'Hi Daddy' on the phone (or hi doggy, can't really tell). Amy is hanging in there.

Last, but definately not least is the news of Moustache March. All the guys (and capable women) in the ER have decided that we will have a hairy upper lip for the month of March. That way we can all look like hillbilly pedophiles together. At least no one can grow a mullet... Stay tuned for the updates as they develop.

Well, it is finally almost over. The month of January that is. It is bordering on the longest month in my life. It will be a great day on the first of February, for quite a few reasons, not the least of which will be the end of the mud rain. That is one of the more endearing qualities of this place, it quite literally rains mud. The water just mixes with the dirt in the air, on the buildings, and everywhere else. Just adds to the ambience. It also means that I am less than one year form coming home. We can actually count the days on a single calendar now.

Not all that much has been happening here. Things have continued to be a much more 'reasonable' pace in the CSH. As I am sure most of you have heard, most of the fighting has shifted to the northern reaches of the country. The other 'piece' of our hospital, which is up in Mosul, has been getting busier from their usual slow pace. As it stands now, I am scheduled to head up and relieve the sole ER doctor up there in a few months so he can go home on R&R.

On the fun side, we did get some 'range time'. We spend some time in the ER training Special Forces medics and keeping them fresh on Emergency Medicine kinds of stuff. (Don't read this part Mom and Dad) In return, they 'teach' us some things and give us, well unique experiences (you can contact me seperately if you want details). It was a lot of fun and a nice diversion from the usual daily grind. Other than that, the best entertainment is the daily 'chicken dance' by the ER nurses.

Things on the home front have been a bit more exciting. Naomi had her first birthday, followed shortly by her first teeth. The girls have been giving Amy a run for her money as you might expect. Though they've been having some fun - going to the PA State Farm Show, and of course getting tooled around in the new Cohen minivan.

I guess in the side of interesting cases - we did have one soldier who had some abdominal pain - and after finding a strange looking object in his bladder on CT scan - went to surgery and found that he had a full size McDonalds straw inside his bladder. The kid denied knowing how it got there - you can leave that part to your imagination. He did say that there were a couple of nights of heavy drinking that he didn't remember what happened. A great lesson to teach our kids about not drinking too much...

Other than that, not much new and exciting on this end. Other than the great letters and care packages. All of us in the ER appreciate the extra pounds we are putting on thanks to everyone back home. They are awesome and very appreciated.

I miss all of you guys and hope you are doing well. 11 months to go...

Is it still only January?

Happy January 16th!

Wow, time does seem to go slowly over here. It is hard to believe it is still January - except for the fact that it is colder here than it is back home - oh yeah and the snow. First time it snowed in Baghdad in 70 years. It didn't accumulate at all - but still, the white stuff came down on us. And as far as I know, nobody ate any yellow snow. Although, some people were caught running around like little kids - catching snow in their mouths. Although we did have one guy slip and fall on some blue "porta-pottie" ice.

I know Amy is happy to hear that I have almost run out of places to visit in the International Zone. No it does not mean that I will be visiting places in the 'Red Zone'. Just that I will likely not be doing much exploring around here - just 2 or three places I haven't been. Then I will have nothing to do but watch movies and read in my spare time. I guess that is not such a bad thing. Just boring. Although we do have some range time coming up - always good for a little fun.

To help pass the time, we have the occasional 'VIP' come by and visit for some reason or another. They tend to want to visit the ER and see how things happen there. Depending on how you view things - sometimes a positive/sometimes a negative. Entertaining when we get a sick patient in while a 3 star general and his entourage are clogging the entrance in the ER and a lowly Captain can yell at them to leave - I was pretty surprised when it worked, too.

The overall flow of casualties has continued to drop off from what we had when we first got here (with occasional spikes)- thankfully. Although we still have job security. A lot of people back home have been asking if we had received casualties from a few days ago when we lost 9 soldiers, but unfortunately we did not as most did not survive the initial blast. It was a blow for us to get the news of their loss, as even more a tragedy for their friends and family here and back home. Another horrible reminder of what we are here to do and the horrible price people are paying for us to be here.

If you area religious person - I can only ask that you pray for those they left behind, and offer thanks for what you have.

Sorry for such a downcast email, just one of those days.

Most of you know I am not really a sentimental type person, but one of patients gave me a copy of this poem and I thought I should send it out - a little out of season - but not to bad...

A Different Christmas Poem
The embers glowed softly, and in their dim light,
I gazed round the room and I cherished the sight.
My wife was asleep, her head on my chest,
My daughter beside me, angelic in rest.
Outside the snow fell, a blanket of white,
Transforming the yard to a winter delight.
The sparkling lights in the tree I believe,
Completed the magic that was Christmas Eve.
My eyelids were heavy, my breathing was deep,
Secure and surrounded by love I would sleep.
In perfect contentment, or so it would seem,
So I slumbered, perhaps I started to dream.
The sound wasn't loud, and it wasn't too near,
But I opened my eyes when it tickled my ear.
Perhaps just a cough, I didn't quite know, Then the
sure sound of footsteps outside in the snow.
My soul gave a tremble, I struggled to hear,
And I crept to the door just to see who was near.
Standing out in the cold and the dark of the night,
A lone figure stood, his face weary and tight.
A soldier, I puzzled, some twenty years old,
Perhaps a Marine, huddled here in the cold.
Alone in the dark, he looked up and smiled,
Standing watch over me, and my wife and my child.
"What are you doing?" I asked without fear,
"Come in this moment, it's freezing out here!
Put down your pack, brush the snow from your sleeve,
You should be at home on a cold Christmas Eve!"
For barely a moment I saw his eyes shift,
Away from the cold and the snow blown in drifts..
To the window that danced with a warm fire's light
Then he sighed and he said "Its really all right,
I'm out here by choice. I'm here every night."
"It's my duty to stand at the front of the line,
That separates you from the darkest of times.
No one had to ask or beg or implore me,
I'm proud to stand here like my fathers before me.
My Gramps died at 'Pearl on a day in December,"
Then he sighed, "That's a Christmas 'Gram always remembers."
My dad stood his watch in the jungles of 'Nam',
And now it is my turn and so, here I am.
I've not seen my own son in more than a while,
But my wife sends me pictures, he's sure got her smile.
Then he bent and he carefully pulled from his bag,
The red, white, and blue... an American flag.
I can live through the cold and the being alone,
Away from my family, my house and my home.
I can stand at my post through the rain and the sleet,
I can sleep in a foxhole with little to eat.
I can carry the weight of killing another,
Or lay down my life with my sister and brother..
Who stand at the front against any and all,
To ensure for all time that this flag will not fall."
"So go back inside," he said, "harbor no fright,
Your family is waiting and I'll be all right."
"But isn't there something I can do, at the least,
"Give you money," I asked, "or prepare you a feast?
It seems all too little for all that you've done,
For being away from your wife and your son."
Then his eye welled a tear that held no regret,
"Just tell us you love us, and never forget.
To fight for our rights back at home while we're gone,
To stand your own watch, no matter how long.
For when we come home, either standing or dead,
To know you remember we fought and we bled.
Is payment enough, and with that we will trust,
That we mattered to you as you mattered to us."

Take care.

cohen

Happy New Year!

I know, I am a little behind and all. No excuses except not a whole lot to email about. Things have continued to slow down here clinically (about 30% less than what they saw last year at this time). Which is great, although there was a pretty bad attack yesterday where we lost another two young soldiers. It is interesting that now that clinically we have slowed down, the non-clinical (admin) people have been looking for things to do - making new policies, changing things around, just to keep busy and usually to the detriment of patient care. Fascinating that it happens even in Iraq in a combat zone.

Had our own little new years celebration at midnight on new years, complete with noise makers and non-alcoholic beer. Including 'beer' chugging contests and the like. I guess you make due with what you have. The celebrations in the DFAC where the same as for Christmas, so nothing new there to report.

Iraqis have a strange way of celebrating - they fire their weapons straight up in the air in celebratory fire. I guess they are so happy, that they forget that th rounds still have to come down at some point. For about 15 minutes following midnight, we heard quite a few weapons being fired. Followed by the sound of raining metal on the pavement outside and on the roof. We had been warned to expect it, so the hospital was actually on "lockdown" during the period to prevent anyone from going outside without their full IBA (Individual Body Armor). Unfortunately some of the locals didn't figure this out right away and well... back to work.

The pics above are pretty typical of our traumas, kind of like organized chaos. Actually runs pretty smoothly now - everyone knows their job and what needs to be done and just makes it happen. For the medical types, I can share pics of some of the injury at personal request. Not the kind of traumas we tend to see in the states.

For most of December, we had an AP photographer/reporter 'embedded' with us. It was an interesting experience - for one, because we could get as much information from her as she took from us. So learned a little about what life was like outside our little FOB, what the soldiers are actually going through and how the locals seemed to be reacting. It was also nice to be able to interact with a civilian in a normal manner, not have to worry about rank, and what position they are and all that. Anyway - her name is Maya Alleruzzo - and she has a fair number of pictures published (best way to find them is to look in Yahoo news images, and search for her by name - there are about 30 of her pics from the CSH published in various sources that pop up). Unfortunately/fortunately, I am too ugly for the camera and did not make it into any published ones, but many of our nurses, medics, and the two other ER docs did (Todd Baker and Marti Roellig). She gave us copies of all her pics that she took when she left and made a small collage that is below - I can send people the PDF if you can't see the collage.

The big excitement back home is that the Cohens are now a minivan family - much to my dismay - when I return I will be driving a blue minivan. Laugh all you want, but well, I would laugh at me too. But I guess it is practical and makes things easier for Amy. So we will blame it on her.

Anyway, just thought I would put the new years pics up - let me know if you can't get to them. I hope you are all well and having a great new year.

Miss you all - well, except you Yiram. Happy New Year.

cohen