The Diary

May 31 to September 27, 2009

MAY 31 | Departure

Going to war, a second time. How did I feel on this day? A lot different from the first time.

The last time I went, my preparations were rushed and my emotions were completely focused on the task at hand. Like a lot of soldiers, I disconnected from my family before I left. I particularly did not attend to my daughter very much. Michelle was only two then and not very verbal. My civilian job often took me away from home for days at a time, and Michelle’s lack of a sense of time seemed to protect her from any feelings of missing me. I thought the same thing would happen during my deployment. I was wrong. In the second week of that first tour my wife, Claude, found Michelle crying silently one night in bed. She asked her if she was crying because she missed her daddy, and Michelle nodded yes. It would not be the last time she cried during that tour.

As happens with a lot of men, my connection to my daughter deepened after she turned three and began to interact in what I considered a meaningful way. I knew Michelle would react even more negatively to my absence this time, so I took a number of steps in hopes of lessening her pain. The most helpful thing was purchasing a high-quality video camera to record myself reading bedtime stories for her. I spent the first minutes of my last day at home recording a few more.

I had been videotaping for about half an hour when Michelle woke up and came looking for me. This is her normal practice, as we both wake up earlier than Claude. Michelle and I will often spend an hour or more together in the mornings.

For a couple of months before my departure, our routine had been the same: I would put Michelle in a backpack and work out on our Stairmaster while we watched a movie. This was the only time that Claude and I would allow Michelle to watch TV, so she looked forward to our morning sessions quite a bit.

For the past several weeks, she always asked for the same movie: Monsters, Inc., an animated film whose central plot revolves around a father-daughter relationship. Michelle quickly learned that DVDs can be controlled, and she would ask for her favourite segments to be played over and over. By far the part she liked best was the ending, a rousing chase scene where the father figure struggles to save his “daughter” from an evil monster. She never seemed to get enough of that.

This scene is followed by a sad one in which the father figure must leave his “daughter” behind. Every time we viewed this scene, I explained to Michelle that her daddy would soon have to go away as well, for “a lot of sleeps.” I explained that it was okay to be sad and that Daddy was going to come back. She took this in very thoughtfully.

We had almost finished breakfast when Claude got up. Our conversation was cordial, with only a trace of the strain that had been all too evident before my previous tour of duty in 2007.

I was much more present for Claude in the period leading up to my deployment this time. I spent more time at home, and I tried to keep things as normal as possible. I never wore my uniform around the house, and I even let my hair grow longer. Most importantly, I remained emotionally focused on Claude as much as possible.

This is not to say that this deployment has been easier on her. What I am asking of Claude goes way beyond anything she imagined she would have to do when she entered into this relationship. Many of my friends have told me that their marriages would not have survived one combat deployment, much less a second.

I had finished packing the night before, so we were able to have a leisurely morning together as a family. But all too soon, it was time to put my bags in the car and head off. I spent one last minute looking around my neighbourhood before we left. Quiet, peaceful, prosperous. It seemed unbelievable that I was leaving this behind.

We first drove to my parents’ home. Claude chose not to come in, partly to give my parents and me some time to ourselves, partly because she felt it would be stressful to watch me say goodbye to them. She was right—it was an awkward moment.

My father is one of only two true pacifists I have met in my life, individuals who would be incapable of harming another human being even if they were being attacked. We have discussed the various crimes of the Taliban, and he recognizes that they are horrible abusers of human rights. It does not follow for him that Canadians in general—and his son in particular—have to go to war to stop them.

As for my mother . . . well, she’s a mom. Her spontaneous reaction, the first time I told her I was thinking of volunteering to go to Afghanistan, was: “If you do that, I’ll shoot you myself!” Although I knew six months ago I would be going back, I did not tell my parents until four weeks ago. This time, my mother said: “C’est une bêtise!” (“That’s really stupid!”). You could say that things are improving.

My mother’s initial reaction—motivated by her concern about my safety—was replaced within minutes by unconditional support. During my last tour, she e-mailed me every day and her messages were invariably upbeat and encouraging. I drew strength and comfort from those e-mails, more than my mom will ever know. I have no doubt she will do the same thing this time.*

We had a brief discussion about the mission and my role in it. It ended with my mother telling me that she would always support me, no matter what I did, as long as I always came back. I promised that I would, both of us knowing full well that might be a promise I would be unable to keep.

By the time we got to the airport, there were only a few minutes left before boarding. There is nothing good about being at the airport in this situation, so it is best if it is short and over with quickly. Claude and I shared a few more hugs and I love yous and it was time to go. Michelle was happy as I said goodbye to her and hugged her. She did not even seem perturbed when she called out to me, after I had gone through security, that “Mommy’s crying.” From where I was standing, I could see that Claude’s cheeks were dry. Michelle, sensitive as all children are to a parent’s distress, had noticed her mother’s shiny eyes. I replied to her that Mommy was crying because Daddy was going away for a lot of sleeps but that Daddy would come back. I repeated “Daddy will come back” at least four times.

After an uneventful flight to Toronto and a quick stop to get a regulation haircut, I called up a taxi company the army uses to ferry soldiers from Toronto to Canadian Forces Base (CFB) Trenton. You have almost certainly heard of this base, as it is also the place our fallen return: the “Highway of Heroes” leads from Trenton back to Toronto.

The ride to Trenton is a sombre one. You can’t help but think of the Canadian soldiers whose return to Canada was followed by a trip down this road. You can’t help but desperately wish you will not join them.

I got to Trenton in time for dinner. I reported in to the base accommodations (which were—by army standards—superb, like a good roadside motel), called Claude to let her know I had arrived, then went out for one last restaurant meal. I then went for a long walk by myself before turning in for the night. I tried to reflect on what I was doing, but I couldn’t focus.

I have given so many presentations since returning from Afghanistan that I am usually clear about why I am going back. But it is difficult to remember those motivations when I think about my wife crying, my daughter saying goodbye and the risks ahead.

I am going to war, again.

 

JUNE 1–2 | Getting to Kandahar: The Easy Way

My first flight from Canada to Kandahar had been a painful, prolonged and exhausting ordeal. Things were much better this time.

The trip began with a civilized wake-up at the unmilitarily congenial hour of eight o’clock. I threw on a pair of jeans and a T-shirt, revelling in my last chance to wear normal clothing. A short walk to the mess hall (cafeteria) next door was all that was needed to acquire breakfast. I then had to call a taxi to get from the sleeping quarters to the air terminal. And that’s where the civilian part ended. Waiting for me in the terminal were several dozen other individuals with short hair and military packs.

The plane we boarded was a gigantic Airbus model, owned and operated by the Canadian Forces (CF). When we boarded—via the forward hatch—we were met with some extraordinary institutional insensitivity. What was in the first-class section for all to see? Generals in comfortable seats? Politicians with their entourage?

Stretchers.

These same planes ferry seriously wounded Canadian soldiers home from the tertiary care hospital in Germany to which they are evacuated if they cannot be treated at Kandahar Air Field (KAF). We were on the outbound flight, so the stretchers were empty. Yet seeing these stretchers was sobering. I’m sure the administrators who organize these flights only consider the aircraft layout in terms of seating availability. They have probably never been on the aircraft itself, so they have never thought that it would be easier for all concerned if passengers entered only from the rear of the aircraft. This is not because of any discomfort I or other Canadian soldiers feel at the sight of our wounded. Rather, it is out of a desire not to intrude on them when they are so vulnerable.

After a couple of hours, I got up to stretch my legs and ran into an air force nurse named Rhonda Crew. We had worked together for a few weeks at KAF in 2008, and she had impressed me with her competence and collegiality. She was also pretty gutsy: she had volunteered to fly on the medevac helicopters, landing on battlefields to pick up our wounded. She had even been under small-arms fire during several missions. This means that Taliban soldiers were shooting at her with rifles and machine guns from a distance of a few hundred metres. As I said, gutsy.

Rhonda was in charge of the medical evacuation component of these flights. She was on her way to Germany to pick up a couple of our guys. I commented on the layout of the aircraft, and she agreed that it was far from optimal.

We compared notes about our activities since we had last seen each other, and I got updates on friends we have in common. We were soon joined by the nurse and medic who made up the rest of the medevac team. As frequently happens in our small army (including reservists, the CF has fewer than 100,000 people in uniform), we all knew people in common. The medic had served on Roto 2 and had been on the scene when Glen Arnold and David Byers, two soldiers from my part of northern Ontario, were killed in 2006. The nurse had served in the 1990 Persian Gulf War with a doctor who had been my roommate at KAF during my first tour.

The stopover in Germany lasted an hour and a bit. We all piled into a special military waiting area graced with the presence of a Subway restaurant, where I got one last dose of North American junk food. Six hours later we landed at a small, isolated civilian airport in the “host nation,” the Middle Eastern country that allows us to maintain a logistics base close to Afghanistan. After a short bus ride, we arrived at “Camp Mirage,” our pseudo-secret base in the aforementioned host nation.

Before I racked out, I called home. I had promised to call every day. To make sure that I would be able to do so no matter what happened, I had bought my own global satellite phone. Voice communication with Canada, even from here, can be a little iffy. It was wonderful to be able to simply reach into my backpack and talk to my wife and daughter. Expensive, but worth it.

With things settled back at home (as much as they could be) I was able to focus on what was coming next. “Battlemind” preparation, getting oneself emotionally prepared for exposure to combat, is an essential process for any soldier to go through. I had done very little of this before departure, for a number of reasons. As a veteran, there was no need for me to repeat many parts of the training process I had gone through the first time. Although this allowed me to spend more time with my family, it cut me off from my military brethren.

The military flight had not contributed much to my preparation. The host nation is extremely sensitive about having Canadian soldiers on its soil, so the trip is done in civilian clothing. You don’t feel very soldierly when you’re unarmed and wearing jeans and a T-shirt. And upon landing in the Middle East, the pilot wishes good luck to those who are “going up north.” No one seems to want to say “Afghanistan.”

After I got settled into my room, I went for a walk around the base to try to “get my head in the game.” Halfway around the world, alone and in the dark, having left a much-loved family behind and heading towards possible death or dismemberment, it can be hard to feel the clarity of purpose that was so strong a few months ago. The heart aches for peace and a soft, warm embrace.

JUNE 3 | Afghanistan Again

I woke up at 0900, dragged my gear over to the baggage loading area, then headed over to the weapons shack to draw my rifle, pistol and ammunition. This area is no longer a sea container but a real building; in the daylight I could see that the base had expanded considerably.

As we climbed aboard the Hercules, the transport gods (who had so cursed my last trip to KAF) smiled upon me yet again: the aircraft was only half full. There was ample room to stretch out. I tried hard not to sleep, to get over the jet lag quickly.

When we got to KAF, I went to the orderly room to get the routine in-clearance paperwork done.* I then reported to my company commander, Major Annie Bouchard, a little dynamo whom I had met during my pre-deployment phase.

Major Bouchard began by congratulating me on the impact that ultrasound has had on the ability of her medical company to provide cutting-edge emergency care. In the months before the company’s doctors and physician assistants (PAs) deployed, I had given them a basic Emergency Department Echo (EDE)† course and conducted advanced training for three of them. I had also gotten the SonoSite company to donate (Yes, donate! For use in a war zone!) three brand-new systems for the duration of the rotation for use on the FOBs, or forward operating bases. The guys I trained have been making excellent use of this gear, detecting injuries that would have been missed otherwise.

Major Bouchard then briefed me on my mission. It’s going to be a busy summer. A lot of enemy activity is expected, which we will do our best to counter. We will also continue to support reconstruction as much as possible. The “operational tempo” (military-talk for how hard we will be working) will be extremely high.

One thing hasn’t changed: this is still a civil war, and it is still the Afghans who are enduring most of the suffering. Since the current rotation (Roto 7) began in late March, only one Canadian soldier has been killed: twenty-one-year-old Karine Blais, the second Canadian woman to die in combat in Afghanistan. Casualties among Afghan troops and Afghan civilians have been high.

Major Bouchard then said something that struck me as very odd. It seems that, at the FOBs, I will be treating Afghan casualties almost exclusively. The helicopter evacuation system has become much more efficient in the eighteen months since I was here last, and wounded Canadians are almost invariably picked up from the battlefield by air medevac. Helicopters have also changed the way non-medevac functions are accomplished. Since February of this year Canada has had its own helicopter squadron at KAF for transportation and air assault missions. We no longer depend on our allies to fly us around. This should have a positive impact on our casualty rate, since most of our deaths have occurred as a result of roadside bombs striking our vehicles.

The major adroitly anticipated my next question. The Afghan army and police, she said, can call for helicopter evacuation, but to date they have not been fully integrated into the Coalition communication network. If they are not accompanied by a Coalition mentor, communication with the medevac choppers is extremely arduous. It is therefore more efficient for the Afghan forces to load their wounded, and even their dead, into the back of a truck and bolt for the nearest FOB.

I also learned that I will be joining this war very soon: I head for my first FOB at dawn tomorrow. That being the case, I had to draw additional ammunition as well as a desert-pattern flak jacket this evening. The ammunition was no problem, but getting my flak jacket proved to be a challenge because the clothing store where these items are kept is run by civilians and closes at 1800, and it was well past 2100 when I arrived. The clothing store supervisor explained that it was inconceivable—inconceivable!—that he would wake up one of his people to allow me to get the gear I needed. We had to get Captain François Aziz-Beaulieu, one of the senior officers of the medical company, involved. Captain Aziz-Beaulieu, who can bark with the best of them, resolved the problem. It seems that not everybody here accepts that we are at war.*

With all my gear collected, I went back to my room to pack. I started by loading my rifle ammunition into the (many) additional magazines I had been given. My infantry background shows when I do this. At the top of the magazine I load a few ordinary bullets, to be fired off quickly if a firefight starts unexpectedly. This gives the enemy something to think about, and gives me something proactive to do. That helps to calm you down, even if the shots are only vaguely aimed. By the time those shots are away I hope to be in good cover, trying to locate the source of the enemy fire. Once I figure out precisely where the bad guys are, I want some tracer rounds ready to go to indicate to my comrades where the enemy is. Finally, I leave my mags slightly underfilled, because mags filled to capacity are more prone to jamming.

I finished loading my two backpacks with what I would need for the next four months: clothing (which, given the heat, is pretty limited), my laptop, my DVDs and some books. I learned during my previous tour that the boredom of the FOBs needs to be countered with more than movies. After the first month, I was desperate for something to read.

By midnight I was done, and I stepped outside to call home. I couldn’t bring myself to tell Claude that I was headed outside the wire the next day. This meant that I could also avoid talking about the worst part of the next day’s activities: I will be going by road rather than helicopter. There is a convoy headed to my first FOB, and it makes more sense to send me now than to wait for a helicopter. The helicopters are so occupied with medevacs and combat operations that routine KAF-to-FOB transfers are unpredictable. It is essential that I get to my first FOB to provide coverage, so I have to go tomorrow. I will be going with the Bison (armoured ambulance) crew from my FOB. They returned from vacation today and are headed out tomorrow.

Going down the roads of Zhari-Panjwayi, the threat of roadside bombs and ambushes are ever-present. The place where most Canadian deaths have occurred.

The worst thing you can do.

After Major Bouchard told me that, she sent me to get my picture taken. I went to pack my gear instead. The picture in question is the one they show on the news when you are killed, the one with the Canadian flag off to the left. No way was I letting anyone take that picture.

 

Afghanistan’s Kandahar province, showing three Canadian FOBs

Kandahar street scene: dilapidated building . . . with satellite dish*

JUNE 4 | Back to the FOB

I woke up at 0500 and spent the next half hour finishing my packing. The Bison crew arrived in front of my quarters half an hour later to pick me up. I jumped in the back and took my usual position in the right rear (starboard) “air sentry” hatch, and we drove off to the area where the convoy was being marshalled.

The pre-convoy briefing began with a description of enemy activity in the area we will be traversing. The briefer began with a map indicating the locations where the Taliban had planted bombs or had sprung an ambush in the past week. I couldn’t believe how much activity there had been between Kandahar City and the FOB. Things were not nearly this bad when I was here during Roto 4 , a “winter tour”. There has always been an increase in the fighting in Afghanistan in the summer, and it was clear that the “fighting season” was upon us.^”

The view from Northeast Observation Post, looking south

There are a number of routes you can take to get to Zhari-Panjwayi from KAF. The one we chose took us through Kandahar City. This is a strange experience. You’re driving through a city of a half-million people that looks like many other communities in the developing world. This should be a cultural experience to be savoured. But here you’re riding in an armoured vehicle, part of a convoy bristling with heavy weapons. Every vehicle that crosses your path might contain several hundred kilograms of high explosive accompanied by an individual convinced that he will go to heaven if he blows himself up beside you. Your attention is focused on vehicles that are within fifty metres of your own. The city itself goes by in a blur.

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.

He had not gone far when the IED detonated—but far enough that his partner was shielded from the blast. The trooper supervising the team from the other side of the road was knocked off his feet and temporarily lost his hearing, but was otherwise unhurt.

His buddies rushed to Private Peloquin’s side and started administering first aid. They were joined in less than a minute by the platoon medic, who did a superb job. But Private Peloquin’s injuries were devastating. Every part of his body that had not been covered by the fragmentation vest was torn apart. He was a big man, and very strong, but he lost consciousness almost immediately and died soon after.

This is the first fatality for this FOB and this company, and everyone is taking it pretty hard. Nothing can prepare you for this, not even having gone through it several times before. Unfortunately, I am not in a position to help the troops very much. As I am the “new guy” on the FOB, it would be awkward to reach out to them. For their part, the soldiers are unlikely to seek me out for support unless they are severely affected.

Our jobs as battlefield medical personnel did not end with the evacuation of the victim. We had one more important task to accomplish. Last December, Warrant Officer Gaëtan Roberge of Hanmer (a small village in Greater Sudbury) was killed by a roadside bomb. As with Private Peloquin, he suffered devastating injuries, including the loss of an arm. The soldiers with him that day, under enemy fire, had focused on trying to save their comrade and, failing that, extracting his body. We will never know for certain if the missing limb was vaporized, which seems likely, or thrown far away. Either way, the arm never made it home.

Warrant Roberge’s parents found this very hard to accept, and complained bitterly about it in a front-page story in the Sudbury Star. This was noticed by the CF, which tries to do the best that can be done for casualties and their families. It is now standard operating procedure to ensure that all human remains are collected. The combat team commander and the medics made sure, personally, that this was done.

Sounds grim, doesn’t it? It was. But by the time Private Peloquin gets on the Hercules, he will be whole.

Through the ages and in all cultures, there are stories of soldiers taking insane risks and sometimes even losing their lives to retrieve the bodies of their comrades from the battlefield. “Everybody goes home” is part of the soldier’s code. We are taking it one step further.

Every body goes home.

JUNE 9 | Pashtunwali

Some of the injuries I treated today were due to local societal norms, so this is a good time to delve into the subject of tribal society.

Most of the population of southern Afghanistan belongs to the Pashtun tribe. This is the largest tribe in Afghanistan, comprising some 42 per cent of the country’s population. Because the Taliban are drawn almost exclusively from this tribe, some Canadians believe the tribe is opposed to us. This is incorrect: most Pashtuns oppose the Taliban to varying degrees, often with very good reason. The current president of Afghanistan, Hamid Karzai, is a Pashtun who fought the Taliban for years before 9/11. Like so many of his countrymen, he too had a family member murdered by the Taliban, in this case his father.

The Pashtuns live by a strict tribal code of honour and behaviour called Pashtunwali. There are three key elements in Pashtunwali, the first two of which are closely related. Melmastia refers to the obligation to extend hospitality to anyone who arrives in one’s home. Pashtuns will deprive their own family of basic nutrition to be able to provide a meal to the visitor. Closely related to melmastia is nanawati, which mandates that hospitality can never be denied to any fugitive.

Afghanistan’s geography has had a large role to play in this. Since the time of Alexander the Great, this area has been transited by invading armies. No one cared about Afghanistan per se. The country is mostly rocks and desert—only about 20 per cent of its land mass is arable. It is the topography of the region—the high mountain ranges of the Himalayas and the Karakoram and the deserts of what is now southern Afghanistan and southwestern Pakistan—that has funnelled invaders through here as they headed somewhere else. Depending on which way they were going, these invaders sought to reach the wealth of the Middle East, the markets of Central Asia or the ports of the Indian Ocean. Several empires were built on any one of these prizes, and those same empires often tried to conquer the other two. An area that spent most of its time dealing with foreign invaders developed a social code that supported anyone who was fleeing, since the chance that they were fleeing a common oppressor was high.

But since good-news stories never have much traction, the existence of melmastia and nanawati are relatively unknown outside of Afghanistan. And since violence gets you on the evening news, a lot more people have heard about the third component of Pashtunwali: badal—the right of revenge.

The tribe takes this so seriously that it is not an exaggeration to say that crossing a Pashtun is one of the unhealthiest things you can do on this planet. There is even an ancient Hindu incantation to the gods, asking to be saved from various natural disasters and one human one: “The revenge of the Afghan.”

You might think that this cannot bode well for any kind of national reconciliation after so many years of civil war, but armed conflict between large groups doesn’t seem to trigger an intense need for badal.

To really make a Pashtun crazy, you have to go after his zar (gold), zan (women) or zamin (land). Then you have a blood feud on your hands. In every reference I have read on the subject, the order of these three is always the same: zar, zan, zamin. First gold, then women, then land. You can infer from that what you will.

On to today’s medical misadventures. Two young men arrived with stab wounds. One had a single wound to his upper arm which, though it was squirting arterial blood, was easy to control and to bandage. The other one had three small wounds in his upper back. One of these wounds was trivial, but the other two—one on each side of the chest a few centimetres below the shoulder blade—proved to be quite deep.

A quick look with ultrasound determined that the patient had a pneumothorax, popularly called a “collapsed lung,” on the left. In this situation, air has escaped from the lung and gone into the chest cavity. This air does not move in and out of the body with respiration, and as it accumulates it can exert so much pressure that the lung can no longer expand—hence “collapsed lung.” This is a Bad Thing: the patient’s oxygen saturation (a test that allows us to determine how well the lungs are functioning) was worrisomely low.

The treatment for this condition is to make a small hole above the fifth rib, in line with the middle of the armpit, and to insert a plastic tube into the chest cavity to allow the trapped air to escape. I punched through the chest wall and was rewarded with a satisfying “hiss” of pressurized air escaping. The patient’s oxygen saturation improved.

I then switched the probes on the ultrasound machine to look for bleeding in the chest and in the abdomen. The abdomen was fine. There was bleeding in the left chest, but I already knew that—it was coming out of the chest tube on that side. I discovered that there was also bleeding on the right, caused by the stab wound on that side of the chest. Blood can do the same thing as air: if too much of it accumulates in the chest cavity, it can also collapse the lung and provoke the same kind of breathing problems. So I zipped a second chest tube into him and managed to secure it as the medevac helicopter landed.

Lots of blood, lots of life-saving procedures, everybody alive at the end. The perfect emergency medicine interaction!

The unique aspect of the case was the “mechanism of injury.” It turns out that the two patients are cousins. They live in one of the ubiquitous mud brick dwellings that house most of the population here in the hinterland. These structures, called “compounds,” are designed with Afghan history in mind: a country constantly at war prepares for defence in even the most mundane of circumstances. Each compound resembles a small fort. The walls are thick enough to stop even a modern rifle bullet, and there is often a well in the centre of the compound. Add some food and ammunition, and you are ready for a siege.

Back to our story about the cousins. The compound they live in has two doors, one on the front and one on the side. Persons exiting from the side door are in a position to look into the neighbour’s backyard for a few seconds before they turn a corner. As said neighbour is unable to afford a high enough wall around his yard, there is the possibility that his women will be seen by someone exiting from the side door. These women would be in full burka, but would be unaccompanied by a male relative.

This was unacceptable to the owner of the house in question. He had warned the cousins that exiting through their side door was intolerable to him. This intervention failed to achieve the desired result: the cousins kept exiting via their side door. Their neighbour then took things to what was, for him, the next logical step: physical violence, with at least the possibility of killing the target.

View of several Afghan family compounds
(Photo courtesy Master Corporal Julien Ricard)

Close-up of corner of compound (the well is visible)

Graduation day

This kind of behaviour will have to be moderated if Afghanistan is to evolve. While a functioning government and legal system, backed up by a professional police force, will help, the lasting solution is education. Far more than any legal means or coercive system, it is education that rids humans of their baser instincts.

More precisely, we must focus on the education of women. Those of us involved in developing-world work have known for decades that the highest return on investment comes from educating women. It is much more likely that the skills acquired will remain close to the family and village of the person receiving the training.

Addendum, October 15: Under the Taliban, there were 600,000 students and 1,500 schools in Afghanistan. In 2007, those numbers were 6 million students and 9,000 schools. Despite the Taliban’s out-and-out war on the educational system, that system has grown by leaps and bounds: in 2009, there were 8 million Afghan children in school.

JUNE 10 | The Contractor

There is a man here who could be said to be performing both the oldest and the newest function in warfare. Let’s call him “the contractor.” In reality, the contractor is a composite of a few different people who are doing the same job. I have commingled them to protect their anonymity.

The contractor is a Canadian who has had extensive military experience in the CF, both in Canada and on various deployments. He was approached by a fellow veteran and asked to return to Afghanistan to work for a private security company. He agreed. For all intents and purposes, he is a mercenary, a soldier for hire.

The Iraq war saw the advent of companies that, for a hefty fee, would take over functions that previously had been the sole purview of the military. These included perimeter defence of bases, escorting supply convoys and even limited, but nonetheless aggressive, patrolling. The rationale was that these companies could provide additional manpower right away. No need for the military’s recruitment and training cycle, no benefits or pensions to pay during and after the individual’s employment.

The behaviour of these companies has been controversial. Thanks to a statute rammed through by Paul Bremmer when he was the “administrator” of Iraq,* employees of these organizations are not subject to Iraqi law. The problems caused by granting this immunity came to the fore on September 16, 2007, when employees of the Black-water company (now re-incorporated under the name of Xe) who were escorting a convoy through Nisoor Square in downtown Baghdad shot and killed seventeen Iraqi civilians. The Blackwater men claimed they thought they were under attack. They were mistaken. The incident was investigated by the FBI, which found that at least fourteen of the dead were innocent Iraqi bystanders. Despite this, none of the Blackwater employees have faced criminal charges for this incident (though a civil suit is ongoing).

A number of these companies are now active in Afghanistan, including the Canadian entry into the market, the company that employs the contractor. He has sixty-three men under his command, most of them ANA veterans who have been attracted to this job by the higher pay.

The contractor’s men take care of the “perimeter defence” of the FOB. This means they have the relatively easy job of protecting the base from attack. They staff various observation posts along the FOB walls twenty-four hours a day. These are strong defensive structures, with excellent fields of fire that are constantly illuminated. Thus the tedious guard post duty is removed from the list of chores our soldiers have to perform while on the FOB. If we ever face more than harassing fire on our walls, the Canadians will join the contractor’s men in repelling the attackers.

I asked the contractor the obvious question: if the Canadian Army is willing to pay these individuals more than Afghan soldiers receive, why not give the same amount of money to the Afghan government to fund the training of more soldiers? This would enhance the links between the population and the government by providing more government jobs while giving us closer control over these individuals.

The answer I got was quite reasonable. The contractor maintained that many of these individuals do not want to join the army, even for better pay, for any number of reasons. The private security company therefore gives us access to men who would otherwise be unavailable. The presence of these men on the gates of the FOB frees up far better trained and equipped Canadian soldiers to go outside the FOB and take the fight to the Taliban.

There is no question this is useful. We do not have enough soldiers to patrol all of Zhari-Panjwayi while defending our FOBs and outposts. Either we hire this company or we sit in our FOBs and let the Taliban run riot.

So it makes sense. Nonetheless, there is something disquieting about the concept of privatizing war. Although I can’t quite articulate why, I think that nations need to take responsibility for everything that happens when they decide to participate in an armed conflict. Putting some of the people armed by the state in a legal environment that is removed from military discipline doesn’t seem right. I am sure these companies would claim they are not “armed by the state,” but that would be a meaningless splitting of philosophical hairs. The state allows them to be armed and is their only employer.

The first Baron de Rothschild said, “When there is blood in the streets, buy property.” Cynical, yes, but he was stating an eternal truth: there is money to be made during wars. In its purest expression, that money is made by men who are willing to soldier for a fee. Until their most recent incarnation as organized, for-profit companies, mercenaries always joined a national army. They fought, albeit for cash rather than for ideals, under the command of an existing military structure. What we are doing now separates the mercenary from the army he is serving.

JUNE 11 | The Things I Miss, the Things I Enjoy

Today is Michelle’s fourth birthday. Although we celebrated it a few days before I left, it is still the first important family event I will miss on this rotation.

I can’t help but wonder what the long-term effect of this absence will be on my daughter. I plan to cut back on my professional activities for several months after I return from this mission, to try to make up for my time away. I worry that that will not be enough.

As much as Michelle’s future emotional well-being concerns me, I didn’t have much time to think about it today. FOB Wilson sits astride Ring Road South, the main highway that runs the length of the northern edge of Zhari district. This road links Kandahar City with the district of Maywand (farthest west in Kandahar province) and Helmand province even farther to the west.

Supply convoys travel down this road to get to the Coalition outposts in the western part of the district and in Helmand province. These convoys are run by private Afghan companies that hire armed guards to ride shotgun on their vehicles. These guards, and the drivers they are meant to protect, provide the FOB Wilson UMS with a large proportion of its patients. The Taliban attack these convoys almost daily.

Today there were attacks on two separate convoys. Two critically injured men were sent in from the first attack. One of them had received a large piece of shrapnel in his lower left abdomen and arrived with very low blood pressure. A part of his bowel was hanging out of his body. He was barely responsive. A quick physical exam assisted by ultrasound confirmed that he had no other injuries and that there was serious bleeding in his abdomen. It is impossible to control this bleeding in the field, so it was urgent to get him evacuated to a surgical facility. My priorities were to get IV lines started to bring his blood pressure up with fluids, but only a little. If a bleeding site cannot be controlled by direct pressure, as is the case in the chest and abdomen, it is unwise to bring the blood pressure up higher than is needed for a safe transfer. We achieved this quickly; the medics here are slick at starting IVs.

Although this man was now stable in the cardiovascular sense (his blood pressure was okay), his diminished level of consciousness made it essential that I protect his airway before the medevac took place. The danger was that he would choke on his tongue or vomit into his lungs during the helicopter ride.

His intubation was delayed, however, by the arrival of the second patient. This man was alert and oriented and had normal vital signs, but he had been shot in the middle of his throat. The bullet had travelled down and to the right, exiting to the right side of his right shoulder blade. Ultrasound examination showed that there was bleeding into his chest cavity, so we prepared to place a chest tube. But it was the neck injury that needed attention first.

The danger was that one of the arteries in that part of the body had been partially cut. If this artery ruptures, a hematoma (large blood collection) can accumulate so quickly that the patient’s airway is crushed. When this occurs, it is no longer possible to pass a tube from the mouth into the lungs. As much as I wanted to secure the airway of the other patient expeditiously, I intubated this man first. Once he was under general anaesthesia, I was able to put the chest tube in very easily. This drained off the blood that had been accumulating in his chest cavity, preventing it from collapsing his lung.

I then returned to the first patient. Dominic the Medic had cleaned off the extruded bowel and replaced it in the man’s abdomen, then bandaged the wound. The patient’s level of consciousness was still diminished, so I proceeded with the intubation I had planned for him.

We had just gotten these two patients loaded onto the medevac helicopter when another casualty reached us from the second convoy attack. He also had a gunshot wound to the chest, and ultrasound confirmed blood and air in his chest cavity. He also got a chest tube. We called for yet another helicopter, and he was away in less than twenty minutes.

My medic team performed admirably throughout this period, and I felt as well surrounded as I am in the Level 1 trauma centres I have practised in back home. This was all the more impressive because this group had not been led by an emergency specialist prior to my arrival. They had to work more quickly and more intricately than before. Master Corporal Guay, for instance, had seen chest tubes placed during her few weeks at the FOB, but never under sterile technique. She immediately understood that this additional step would help to achieve the best outcome and figured out how to assist me with the procedure.

Later in the day I called Lieutenant Colonel Ron Wojtyk, the highest-ranking doctor of the task force, to asKAFter my patients. Ron, who is a visionary physician, had been a student of mine on a couple of emergency ultrasound courses before we deployed. He is quite senior to me in rank, but we are close in age and careers and we have become good friends. He informed me that my patients had fared well. Two of them had required emergency surgery, but both were now on a regular ward. They will all be going home in a week or so.

Ron then asked me what I thought of the day. I replied that it had been very satisfying. Again, lots of blood and lots of life-saving procedures, everybody alive and doing well at the end. It had been pure emergency medicine, and it doesn’t get any better than that.

JUNE 12 | Political Science Lesson (or, Not Much Going On)

To understand what is going on in Afghanistan, it is necessary to understand another country: Pakistan. The fates of both nations are inextricably linked.

Let’s start with a bit of geography, since politics so often derives from the land. I mentioned earlier that the Taliban are almost exclusively drawn from the Pashtun tribe of southern Afghanistan. But while it is true that most Afghans living in the south are Pashtuns, it is not true that most Pashtuns are Afghans. The legacy of colonialism here, as in so many places, has split a tribe between two countries.

All through the 1800s, Great Britain and Russia vied for influence in Central Asia (roughly present-day Iran, Afghanistan, Turkmenistan, Uzbekistan, Tajikistan, Kyrgyzstan, Kazakhstan and Pakistan). Occasionally they would invade, but more often they would try to establish alliances with local warlords through bribes of money, weapons or other inducements. This went back and forth in what came to be called “the Great Game.”

Warlords controlled one main city and the surrounding countryside. By the mid-1800s, the territory that would be roughly recognized as present-day Afghanistan came to be controlled by a single king-like entity, an emir. The British wanted to demarcate where Afghanistan ended and where their own colony of India began. Sir Mortimer Durand, at the time the foreign secretary of the British Indian government, mapped out the line that to this day is the border between the two countries. The only difference is that, in 1947, the Muslim part of India became Pakistan. So the Durand Line is now the border between Afghanistan and Pakistan. The problem is that the Durand Line followed physical features such as rivers or watersheds. In doing so, it divided the Pashtun tribe.

Afghanistan’s government, long dominated by Pashtuns, has never recognized the Durand Line. The tribe longs to be reunited in a “Greater Pashtunistan.” One could argue that Pashtunistan already exists. Pakistan has never exerted much influence or control over those of its provinces that lie next to Afghanistan. The border is a nonentity, and Pashtuns pass effortlessly in both directions.

This state of affairs served Pakistan and the United States well during the Russian occupation of Afghanistan. The Pashtun provinces of Pakistan were training grounds, rest areas and logistics bases for the mujahedeen fighters who were being armed by the CIA. The situation in Afghanistan today stems in large part from the different goals held by America and Pakistan in the war against the Russians.

The Americans wanted the Russians to hemorrhage blood and treasure. This was done out of revenge for their losses in Vietnam. Russia invaded Afghanistan less than five years after the Vietnam War had ended. America’s sixty thousand dead, many of them killed by weapons supplied by Russia, still constituted a raw wound in the American psyche. It was only much later, when the Afghans began to inflict serious damage on the Red Army, that the Americans began to think of this as a proxy war they could win.

When the war was won and the last Russian soldier had left, the Americans lost interest in Afghanistan. They had won a skirmish in the Cold War. That war was ongoing, and their attention turned to where they thought the next battles would take place. No one was predicting that within two years the stresses caused by Russia’s defeat here would provoke the disintegration of the Soviet Union.

Pakistan’s goals were radically different. With CIA money, Pakistan was training and advising the Afghans as they prosecuted all-out war against the Russians. As Muslims, most Pakistanis had no love for the atheist communists and it suited them to help their co-religionists. The war raging to the west also served to better prepare them to confront the far more serious enemy they faced to the east: India.

Since India and Pakistan’s independence, there have been three full-blown wars and countless skirmishes between these two countries. But whereas India sees Pakistan as a constant irritant, Pakistan sees India as an existential threat. A glance at the map explains why: India is gigantic. You may think of it as a Third World nation, but that would be inaccurate. It is the regional superpower. Its economy dwarfs that of Pakistan, it has five times Pakistan’s population and its army is much larger and better equipped.

The Pakistani army, on its best day, could never do more than conduct raids into Indian territory. The Indian army, on the other hand, has a large number of tanks and troops massed across the border at Pakistan’s midpoint. As the bomber flies or the tank drives, it is two-to three-hundred kilometres to the Afghan border. If Indian troops capture that central part of Pakistan, they will cut the country in half. The capital, Islamabad, would be cut off from the port of Karachi, the economic hub of the country. Pakistan would disintegrate.

This equation changed in 1997 when both countries became nuclear-armed (each detonated five warheads that year), but old habits die hard. Pakistan’s fear of invasion remains the same, even though it can now inflict such damage on India that New Delhi would never order such an attack.

This fear dictated Pakistan’s goal during the Afghans’ war against the Russians and in the civil war that followed: to establish a friendly government in Afghanistan that would give Pakistan “strategic depth.” In theory, Afghanistan would serve as a backstop for Pakistan, allowing the Pakistani army to continue to retreat westward in the face of the Indian onslaught. This would give the Pakistani army time to regroup and counterattack while leaving the Indian army at the end of a long and vulnerable supply line.

Although this has been advocated by the Pakistani military for decades, it is a lunatic concept. Afghanistan has minimal transportation infrastructure, and while the Pashtuns on either side of the border have an affinity for each other, it does not follow that the Afghans would welcome the retreating Pakistani army with open arms. The best the Pakistani army could hope for would be for a few of its members to hide in the caves of western Afghanistan. For Pakistan’s generals to cling to “strategic depth” as a matter of policy shows how detached from reality they are.

Whatever the logic of the matter (or lack thereof), that was the motivation for Pakistan’s support of the anti-Soviet resistance in Afghanistan. There is a further complication: “Pakistan” cannot be taken to mean a nation-state in the sense that Canadians use the term. Pakistan is not one country; it is three countries.

One Pakistan is run by the civilian government. It has institutions that look like our parties, prime minister and parliament. Although influenced by the Islamic character of most of its citizens, it is nonetheless nominally secular. Think of the United States before Kennedy was elected president. It was a huge deal, in 1960, for a Catholic to even run for this office, much less win it. And yet, the unbroken string of Protestant presidents elected before then would have described their country as having a separation between church and state. Religion was not an official government policy, but it informed people’s decisions. Pakistan’s civilian governments would identify with this.

Another Pakistan is run by the army. This goes beyond the regular military coups that have overthrown the civilian government. Even when it is not in power, the Pakistani army exists as a national entity unto itself. It has its own economic base: it runs thriving import-export businesses in a wide range of fields; it owns hotels and shopping malls; it runs several factories. Even more astoundingly, it conducts its own foreign policy.

The most remarkable example of this occurred in the spring of 1999. Pervez Musharraf, then the chief of the army’s land forces, decided to attack India at a place called Kargil. Only a few thousand Pakistani soldiers were involved, so this was never going to be more than a raid that penetrated a few kilometres into Indian territory. Nonetheless, it was a blatant act of war, and it could have provoked India to retaliate and perhaps have led to a nuclear exchange. Musharraf decided to do this on his own. He did not even discuss it with the then prime minister, Nawaz Sharif,* much less any other members of the civilian government.

In Canada, our country has an army. It is beholden to our elected civilian leaders. In Pakistan, as in a lot of developing-world nations, the army has a country; the elected civilians serve only as long as the army allows them to.

Finally, there is a third Pakistan. This one is run by the spies. Their organization is called the Inter Services Intelligence, or ISI. Think of this as a combination of the CIA, the FBI and military intelligence in the United States.

The ISI is a power unto itself. The civilian government (when there is one) is not even allowed to know what the ISI’s budget is. Like the army, the ISI runs a number of businesses to support its activities. And it is even more aggressive in the foreign policy arena than the army is.

During the Russian occupation of Afghanistan, the ISI controlled the CIA money that flowed to the Afghan resistance. Being largely run by Islamic fundamentalists, the ISI favoured those resistance groups who shared their theological beliefs.

This continued during the civil war that followed the Russian withdrawal and when the Taliban conquered the country. Despite the Taliban’s behaviour while in power, Pakistan did not sever its links with the Taliban until after 9/11. Even after that, the ISI continued to arm, train and otherwise support the Taliban for many years, even as the Coalition fought them in Afghanistan.

Pakistan is the piece of the puzzle that George W. Bush never addressed. Since Afghanistan is landlocked, Coalition forces have to ship most of their heavy supplies via Pakistani airports and harbours. In exchange for this access, the Bush White House ignored the overwhelming evidence that a proportion of the Pakistani military and intelligence establishments were helping the Coalition’s enemies. Instead, it kept praising Musharraf as a vigorous leader in the war against the Taliban. Musharraf would thank Bush for the compliment . . . and continue to pretend that his country was not playing both sides of the fence.

Until Pakistan is cajoled/encouraged/pressured/assisted to do its part in bringing responsible government to this area, our mission here will not have succeeded.

Addendum: The best review of the situation in Pakistan today is Descent into Chaos, a book by Ahmed Rashid, a Pakistani journalist who has covered Central Asia for two decades.* Rashid is critical of all sides in this mess. The difference, which he recognizes, is that his criticisms of the Coalition side will stimulate debate, which has a chance of leading to policy changes. His criticisms of the Taliban, on the other hand, have only led to death threats against him.

JUNE 13 | Combat Psychology, Combat Psychologist

The CF tries hard to identify those who will not be able to withstand the rigours of combat and to weed them out ahead of time. For the soldiers who make it into combat, the CF does everything it can to support them psychologically. Here’s an illustration of how far we go to make this happen.

For the past four days we have been joined in the camp by a social worker, Captain Josiane Giroux, who is posted to KAF. She has a master’s degree in counselling and does a lot of the critical-incident debriefing sessions for our troops. She will spend a week at our FOB, counselling any soldier who feels the need to talk. Her timing could not have been better. She arrived the day of the ramp ceremony for Private Alexandre Peloquin, twenty-four hours before Bravo Company came back to the FOB.

A number of soldiers, including some commanders, have come to see her. This is good to see. If our troops are no longer worried about discussing their anxieties, it means that the stigma attached to these feelings is nearly gone. This bodes well for the ongoing mental health of Canadian soldiers.

It is appropriate and indeed necessary to be tough and unemotional when the bullets are flying. To be otherwise would put oneself and one’s comrades at risk. After the shooting is over, many people will benefit from being able to vent their feelings. Often soldiers will seek out friends or trusted leaders to do so. The CF also provides well-trained mental health professionals to those who want to avail themselves of that service.

Things are markedly different than they were even ten years ago. It used to be that soldiers who admitted they were scared were seen as weaklings. Discussion of one’s fears was subtly (and sometimes not so subtly) discouraged. Like all pendulums, this can go too far the other way. One of the men on the FOB asked to see Captain Giroux, saying that he had been ordered to talk about his feelings. He had been involved with our KIA—killed in action—and someone in the chain of command thought he was doing the right thing by shoving this soldier on the social worker. I am sure the commander’s heart was in the right place, but his actions were overzealous. Some people come through a combat experience with no emotional damage whatsoever, and others are not ready to talk about their feelings. Both types of individuals should be left alone until they feel the need for help.

Captain Giroux spent some time with me discussing the relaxation and visualization techniques she uses to coax the emotionally wounded back to health. She has had good success with these techniques, but she worries about the few individuals who have not responded. I can’t blame her. When my treatments fail, my patient’s suffering has ended; when her treatments fail, her patient’s suffering is only beginning.

JUNE 14 | EOD: Explosive Ordnance Disposal

Another day of heavy fighting all around the FOB.

The Taliban managed to pull off three attacks right after we had finished breakfast, one to the west and two to the east of our position. Two of these were ambushes of civilian convoys, and one was an attack on a police substation. ANA units and our own quick reaction force headed out to engage the enemy.

The first reports of casualties came in one hour later. There was one patient with a gunshot wound from the fighting to the west, and possibly other casualties to the east. We got ourselves revved up and ready to receive them. This involved calling all the medically trained personnel on the camp, especially the combat medics who are assigned to each platoon, to join us in the UMS. They are trained to the same level as Dominic, the Bison medic, so they are superb.

The other resources available to us in a MasCal event are the soldiers who have taken a course called Tactical Combat Casualty Care, or TCCC. They can perform basic emergency procedures and, most importantly, can help us control life-threatening bleeding. They do this with a number of different kinds of sophisticated bandages, modern tourniquets and an ingenious substance called Combat Gauze, a dressing impregnated with a substance that accelerates the formation of blood clots. Using this dressing to pack a large open wound greatly decreases the speed with which the patient loses blood. Blast injuries can also give you a tremendous amount of blood loss from diffuse oozing. Combat Gauze is invaluable in these situations.

Combat Gauze has largely replaced its predecessor, Quick Clot. This was a substance we used liberally during Roto 4. It produced an exothermic reaction when it came in contact with blood or any other source of moisture. When you sprinkled it into a wound, it got so hot it cooked the torn flesh. This sealed off the bleeding vessels.

Sounds like a wonder drug, eh? It turns out to be, like so many things doctors have tried over the centuries, a beautiful theory that gets killed by an ugly fact. Since Quick Clot would burn itself into the tissues, it was often necessary to “debride” (cut away) more tissue than would otherwise have been the case. Combat Gauze has the advantages of Quick Clot without the drawbacks.

We also put the word out for two of the senior non-commissioned officers (NCOs) to join us. These two men handle the flow of information from me to the KAF Tactical Operation Centre, or TOC, which marshalls the medevac choppers and provides a summary of the incoming patients’ injuries to the receiving physicians. There is no physician-to-physician contact.

This may strike those familiar with Canadian medicine as aberrant, but in this setting it works well. Battlefield injuries, though devastating to the victim, are straightforward to manage. There’s a hole in the front and a hole in the back? The part that has to be fixed is in between the two holes. The leg is ripped off? Try to save as much of it as you can. The thorough description of the patient’s history and physical exam that is so crucial in civilian emergency medicine is not necessary here. In a MasCal, it would be an inappropriate use of my time—I have to focus on treating and stabilizing patients.

Having gotten ourselves prepared for a possible MasCal, we ended up receiving only a single casualty, a truck driver from one of the ambushed convoys. He had been shot from the driver’s side while seated. A bullet had passed through the front of his thigh and creased his abdomen. This was another one of those incidents, so common in war, that show how much survival sometimes depends on the tiniest things. Had the bullet struck him a fraction of a second later, it would have struck him at the level of the femoral artery and then ripped into his intestines. Either one of these injuries would have had the potential to kill him before he reached the UMS. As it was, all he needed were some intravenous antibiotics and a couple of bandages. We transferred him to KAF, but as a Category B (no surgery or other care needed for at least four hours).

We had finished cleaning up the UMS after the above incident when the UMS medic came by my desk and taped a “coms lockdown” sticker on my phone: all communications except those essential to ongoing operations were to cease until further notice. I looked up at the medic, and he held up two fingers. My heart sank. We go into coms lockdown whenever a Canadian is killed. This prevents the news of the death from leaking back to Canada. Cell phones and e-mail have made the world a very small place.

There is a right way and a wrong way to learn that your loved one has been killed in combat. The right way is for senior representatives of the CF to come to your home and tell you in person. The wrong way is to hear it on the news. The CF does everything it can to make sure this always happens the right way, and so far its success rate is 100 per cent.

I walked over to the encrypted communications device that allows us to watch the flow of information within the battle group. Two men killed in action: one Afghan and one Canadian.

Corporal Martin Dubé was a combat engineer who had specialized in EOD, explosive ordnance disposal. Although dominated by army engineers, this group also includes navy and air force personnel. These are clearance divers (who go after explosives underwater) and aviation technicians (who, among other unpleasant tasks, disarm bombs that fail to release from planes).

These individuals have the most stressful job imaginable: ridding Afghanistan of explosive devices. The task is almost incomprehensibly difficult. Our enemies’ main weapons are mines and other explosive-laden booby traps. Coalition forces use specialized vehicles, mine detectors and other equipment in “counter-IED” tasks. At the sharp end of the stick, we have experts like Corporal Dubé who are willing to take these things apart by hand.

Taliban mines are only part of the problem. Thirty years of war have left a phenomenal number of unexploded bombs and shells all over the countryside. Some of these explosives have been so corroded by the elements that they are harmless, but many of them are still capable of exploding if they are disturbed or handled the wrong way. Finally, there are the remnants of the numerous minefields that were scattered indiscriminately by the Russians during their occupation in the 1980s.* These devices not only impede our ability to go after the Taliban, they also inflict limb-destroying and life-ending injuries on civilians who stumble onto them.

We expend a significant amount of time and resources to rid the country of this plague. Our prime targets are the newly laid mines of the Taliban. Corporal Dubé was attempting to deactivate one when it detonated. Everything seemed to be going well, then there was a flash and a roar, and Martin was gone.

Try to imagine what his job entailed. Someone has placed a large amount of explosives in an attempt to harm Coalition soldiers and innocent civilians. That person has also rigged the explosives with additional charges so that the apparatus will explode if someone attempts to disarm it. There may also be other mines on the approach to the one that has been detected. Any one of these mines contains enough high explosive to tear a human being apart. Now imagine walking up to the device and dismantling it.

Of the many toxic byproducts of war, mines are one of the worst. The Geneva Conventions state that minefields must be well marked and fenced off. The devices must be detectable by conventional mine detectors. Most importantly, they must self-destruct or self-deactivate once their military objective has been achieved.

The majority of the mines laid in conflicts around the world were not placed according to these rules. Every year brings a tragic and predictable crop of farmers and peasants who have lost limbs or lives to these echoes of war.

People like Corporal Dubé have taken on the monumental task of ridding the world of these silent, lurking killers. For a soldier’s wages, they take on more risk in a single morning than most of us do in a lifetime. If combat infantrymen have ice water running through their veins, combat engineers must run on liquid nitrogen (–196°C).

Corporal Dubé was not based at our FOB, and his body was helicoptered to KAF. I wanted to learn more about him, but there was no time to do so. We were about to be hit by two enemies, one natural and one human, and we had to prepare for both.

First, we heard the wind pick up dramatically. I went outside and was confronted with the first full-blown sandstorm I’ve seen since serving in Afghanistan. As is evident from the following photograph, you can see this thing coming from a distance. So we had some warning, which we put to good use. We ran around securing whatever looked like it might fly off our tents and barracks, and closing whatever openings might allow the sand into our structures.

Sandstorm coming

Look at the picture again. Can you see that there is as much dark stuff coming down from the sky as is rising up from the ground? Believe it or not, in this desert region, that is rain. After we were pelted by the wind and the sand, we got drenched by a powerful downpour.

We were still dusting ourselves and drying off when I received word that the casualties from the incidents east of here were coming to our FOB. Once again, I gathered the team to the UMS. All told, I had a couple of dozen people on hand to help me. The warning had come early enough that I was able to assign specific tasks to each individual in order to improve our organization when the casualties arrived.

Then we waited. And waited. And waited. No casualties, no further reports. More than half an hour went by before we got a call telling us that the truck carrying the casualties had arrived at the gate. The driver had taken his time because they were all dead.

The dead men were civilians who had agreed to drive trucks carrying supplies for the Afghan government and Coalition forces. It is likely that they were not motivated by political convictions; they were simply trying to feed their families. And they had paid for this with their lives.

Addendum, date unspecified: I have had the opportunity to meet the rest of Corporal Dubé’s team. I will not tell you where we met, nor will I provide any photographs of them. Even these tiny hints could be used by our enemies to some advantage.

What I can tell you is that they are among the bravest and most professional soldiers you could ever meet. There is no braggadocio; these men are far past that. Discussions with them demonstrate only a cool, calm competence.

The EOD team is engaged in a very intimate war. There are probably no more than a few skilled IED men in all of Zhari-Panjwayi. When one of them rigs an IED with secondary devices designed to detonate when the primary IED is moved, he is deliberately targeting the EOD men. Similarly, the more of these IEDs the EOD men detect, disable and dissect, the more they learn about the bomb maker. This makes it easier to hunt him down and kill him.

EOD experts always refer to bombs as “devices,” a dispassionate term that matches the nature of these soldiers. Watching them take an IED apart and construct various gizmos for their next mission is like watching a skillful surgeon at work. Every move is deliberate, every action well thought out, and the “bomb techs” know exactly where they are going before they begin. It is a cerebral war for them, totally different from the primal firefights of the infantry. It is still a fight to the death.

I asked these men what drew them to a career that has so much to recommend against it, and what prompted most of them to return to Afghanistan for a second tour. They all answered with variations on the same theme. They are soldiers first and foremost. IEDs are the most lethal weapon our enemies have to use against us. More than anything, they want to defeat these devices to protect their brothers in arms.

JUNE 15 | The War Correspondent

The day started on a sombre note, with a memorial service for Corporal Dubé. Major Tim Arsenault, the senior officer at FOB Wilson, spoke briefly but well. You could tell that he was still quite upset about the loss of his own soldier, Private Peloquin, seven days ago.

The rest of the day was quiet. The main event was getting a chance to speak to the individual I want to talk about today. War zones are populated by more than their fair share of colourful characters. By far the most colourful I have met on both my tours so far is Louie Palu.

You have probably never heard of Louie, but you have almost certainly seen at least a few examples of his art. He is the most prolific photojournalist to work in Afghanistan. He was the “Canadian Photojournalist of the Year” in 2008, and his pictures have appeared in all our major newspapers.

Louie is about halfway through his fourth three-month tour in Afghanistan. Twelve months in Afghanistan may not sound like that much—many of our soldiers are on their third seven-month tour and are approaching twenty months in the country—but the two are not comparable. Our troops go through regular cycles of operations and dow ntime. Louie goes out of his way to attach himself to a unit about to get into a fight, then leaves them when they go back to their base to rest.

He has been with us for the duration of the recent operation and is now heading off to hang out with the U.S. Marines. The Marines asked him to come along with them, on an operation they have declined to describe. He has only been told to show up at KAF tomorrow and to report to the flight line at midnight. Is there anything about this that does not scream “Bad Idea”? †

†Louie Palu, war correspondent

The Taliban soldier I treated in 2007
(©Louie Palu/ZUMA Press, reprinted with permission)

I talked to him for about an hour, and we discovered the most amazing connections between us. During the first combat operation I participated in during Roto 4, I treated a Taliban prisoner who had been shot in the chest. It turns out that Louie was with the guys who shot him. He had helped to carry the wounded man back to my UMS.

I had seen a photograph of our medics treating the wounded Taliban soldier on the CBC website a few days after the operation. It was Louie who took the photo. I showed him a video of our resuscitation of this prisoner, and Louie recognized him.

As you can see from his portrait on the previous page, Louie has a feline look to his face. Whether he looked like that before he used up eight of his nine lives in this place, I do not know. It is most fitting he appears like this now. This guy has been in more firefights than any soldier I know. So far, not a scratch.

Louie was kind enough to let me use a few of his remarkable photographs for this book. The first appears on the previous page.

JUNE 16 | Zero Sweat

Canadian soldiers serving in Afghanistan carry at least one personal firearm. For most FOB soldiers, this is the C7 5.56 mm rifle, the standard infantry weapon of the CF. Specialized soldiers, such as machine gunners, tank crewmen and snipers, will carry other weapons that are matched to their particular tasks. Many of us, myself included, carry a second weapon called a sidearm. This is a Browning 9 mm pistol.

The members of the task force can be divided into two groups, based on whether their weapons will be used for offence or defence.

The infantry, the front-line soldiers, are the archetypal examples of the first group. They use their weapons to attack. I would fall into the second group. The only time I should ever have to fire my weapon is if things have gone terribly wrong and I have to defend myself against a direct personal attack. The Geneva Conventions prohibit health-services types like me from using “area” weapons, weapons that can inflict damage on a large area. This would include grenades, rocket launchers, flame-throwers and the like. Under the Conventions’ rules, I am allowed to kill the person who is attempting to kill me, but I have to do this using a “point” weapon, one that can only hit a precise spot.

Given the low likelihood that I will ever have to fire a weapon to defend myself, the CF does not expend much energy in giving me one with which I am comfortable and familiar. Rather, I am issued a rifle and a pistol at Camp Mirage from the firearm equivalent of the bulk bin at the local grocery store. The weapons are in good working order, but they need to be “zeroed.”

Zeroing involves adjusting the sights so that the weapon is adapted to the person using it. Everyone holds a rifle a little differently: our arms are different lengths, our eyes are in different places. A rifle will therefore not hit the same point when held by different people. The sights can be set to compensate for this.

I got around to this important task today. One of the platoons was running some combat firing drills, so I asked to go along with them.

I spent an hour on the range not only zeroing my weapon but also going through some of the drills with the boys. I caught a break: the last person who used my rifle must have had a body type similar to mine, because I only needed to make a tiny adjustment to the right, and my rounds started landing dead on target. I was pleased to see that, once zeroed, I was able to shoot as well if not better than the youngsters on the firing line with me. I have always been a pretty good shot, and I had practised my marksmanship a fair bit before I left.

The combat firing drills, on the other hand, were another story.

The sergeant running the show had us firing in a number of awkward and uncomfortable ways, to simulate positions in which we might end up after coming under enemy fire and hitting the deck. It was exhausting. I kept up with the youngsters . . . but only barely.

JUNE 17 | Downregulation

“Downregulation” is the process by which a cell becomes less responsive to a stimulus to which it is repeatedly exposed. An example of downregulation is alcohol addiction.

There are receptors on the outside of our brain cells to which alcohol molecules will attach themselves. Once the molecule is attached, the receptor sends a signal to the cell. This signal causes intoxication. These receptors are constantly being created and broken down.

If the cell is repeatedly stimulated by alcohol, it will start to “downregulate” the receptors, which means that fewer of them will be made.

With fewer receptors, the cell is less sensitive to the alcohol molecules.

That’s why chronic alcoholics need to drink far more than normal people to get drunk. Their brain cells no longer respond to the lower level of stimulation.

You can downregulate in other ways. Let me give you some examples.

When I got here, having my pistol on my hip was quite annoying— a big hunk of uncomfortable metal was pulling on my belt and weighing down my leg. This morning, I looked down and was almost surprised to see that my pistol was in its proper place. I no longer feel it there. Call that physical downregulation.

This afternoon, the Taliban attacked an Afghan National Police (ANP) strong point right beside the FOB. I was in the UMS after lunch when it started: three large explosions followed by a heavy volume of automatic weapons fire. The ANP counter-attacked, the Canadians drove armoured vehicles up to the perimeter and our mortars started firing bombs that were aimed to land a short distance from the FOB walls.

I stepped outside the UMS for a minute to listen to the shooting. I noticed it was much closer than it ever had been before. Then I went back in the UMS and continued reading my book.

It might seem bizarre to go back to one’s diversions when several heavily armed men intent on killing you are firing at you from a few hundred metres away. But there is shooting every day around our FOB. The Canadian and Afghan combat troopers do the job of pushing the Taliban back. They did that effectively today, as they have on all previous occasions. If there are no reports of incoming wounded, there is nothing for the medical team to do. So we tune the sound out and go on with whatever we were doing. Call that emotional downregulation.

The most extraordinary example of emotional downregulation occurred outside the walls of the FOB. When the attack started, a farmer had been working in his field a few hundred metres away. As the ANP surged out of their strong point to attack the Taliban, he raised his head for a minute or two to watch the direction in which the attack was going. Then, satisfied that the shooting was going to pass at least a football field away from him, he went back to tilling his field.

He continued even when one of our mortar bombs misfired, exploding close to where he was and scaring the crap out of a couple of his sheep (who were otherwise unharmed).

You can get used to almost anything. This man continues to tend to his crops while a full-scale firefight goes on a few dozen metres away. It is sad to think of what his life has been like, to make him so unflappable.

JUNE 18 | CDS: Chief of the Defence Staff

General Walter Natynczyk is the top soldier in the CF—he is the chief of the defence staff, or CDS. He takes a keen interest in the welfare of the soldiers serving in Afghanistan and visits the troops here every few months. He is back in Afghanistan now and was scheduled to come to our FOB today. At our regular morning briefing, the detachment commanders were ordered to assemble their people at 1300 in a large open area near the command post. The general likes to have what he calls “town hall” meetings, where anyone can ask him questions.

At 1145 I went to get some lunch, returning to the UMS about twenty minutes later. There were still at least forty minutes remaining before the general was scheduled to arrive. Wanting to be at my best, I went outside to brush my teeth, then stepped into our latrine to pee.

A few minutes later I stepped out of the latrine, toothbrush in one hand and zipper in the other, to find myself face-to-face with General Natynczyk. He already had his hand extended and Major Arsenault was introducing me, so there was no getting out of it. I tucked my toothbrush into my back pocket, took the general’s hand in my unwashed one and shook it.

We spoke for a minute or so. He was surprised there was an M.D. on the FOB, and even more surprised to hear that I was doing it for a second tour. I explained my combat arms background and he replied that going from the infantry to being a FOB doc constituted “retirement failure.” (Not bad for an off-the-cuff comment!) He then thanked me for my service and moved off with the major. The boys in the UMS had seen my move with the toothbrush and were all chuckling as I came back inside.

At 1245, we headed off to join the rest of the soldiers. The general joined us (almost) punctually,* asked us to huddle up and addressed us in French. As a French Canadian, I could tell that this language did not come easily to him—he must have worked quite hard to develop the facility he has. My fellow francophones and I appreciated his effort.

Whenever the CDS comes to visit a unit, he gives out CDS coins, large coins inscribed with his personal seal. They are presented to individuals who have distinguished themselves in performing their duties. I was pleased to see one of these coins awarded to Master Corporal Nick Raymond, one of the Bravo Company combat medics. Nick has dived into every casualty situation we have had since I’ve been here and was one of the two medics who responded to Private Peloquin. Everyone commented afterwards about how calm and competent Nick had been through this horrible event. His award was well deserved.

The general then moved off to a table that the combat team leaders had set up to show various pieces of equipment that they thought could be improved upon. They also had some gear that other nations are using which they felt was better than what we had. The general took in all these comments attentively.

Unfortunately, the items the medical team wanted him to see were not on the table but right beside it: two medic packs, one issued by the CF, and the other the one that many of our medics use. The regulation pack has one large pouch. Many of our medics, with their own funds, have bought a pack that has a large number of modular pouches inside it. When dealing with a casualty in the field, they open this pack up and instantly have a well-organized treatment area at their disposal. They can also close it just as quickly if they have to move out in a hurry.

Nick pitches the pack to General Natynczyk

Master Corporal Raymond was standing by to explain all this, but it was not obvious that the packs were part of the display. The general walked right by them and moved on to his next meeting. Nick did not feel comfortable enough to call out to him to come back.

I was made aware of this several minutes later. In a serious breach of protocol, I chased after the general, blew past some senior officer who tried to block me and told him my guys had something to show him. I added that it would be much appreciated if he would take a couple of minutes to come and talk to them. Although his helicopter was orbiting the FOB at the time, he came to the UMS and listened to Nick explain the advantages of this pack.

I made sure the general understood the most impressive thing about this pack: Nick had bought it with his own money so that he would be able to take better care of his guys. The pack in question costs $600; a medic makes about $3,000 a month.

Addendum, September 15: Going home in a few days. I have now met almost all the combat medics of Roto 7. Every one of them has bought the same pack.

JUNE 19 | Unsure About the Shura

A quiet day. There was a bit of combat activity up and down the main highway, but only one hit generated any casualties: a rocket strike that set a vehicle aflame. The four occupants, Afghan civilians employed as truck drivers for Coalition convoys, were burnt beyond recognition.

As things seemed to have wound down in the early afternoon, I took the opportunity to check out the weekly security shura (council meeting). This was attended by the Zhari district leader (a position somewhere between city mayor and provincial premier), the local chief of police, and representatives of the ANA and intelligence services. The Canadians at the meeting included the mentors we have assigned to the ANA and police, and those soldiers involved in development projects in the district.

The Afghans spoke first, giving an update on their activities over the past week. The highlight was the killing of a local Taliban leader, described by the district leader as a “beast.” Given the standards of bestiality among the Taliban, I am happy not to know what he did to deserve that title. Everyone agreed the world was a better place for his having left it.

The Canadians then passed their points, mostly administrative advice about how to obtain various items. The Afghans had recently asked for a lot of gear, particularly communication devices. There is an eternal tension in these situations. The Afghans would like the Canadians to obtain the equipment for them. The Canadians insist that the Afghans use their own resupply system so that the system becomes more efficient. We are going to leave one day, and when we do we want the Afghans to have a functional system that is familiar to them. This is something one encounters regularly when working in the developing world.

The shura

The more intriguing aspect of the shura was the performance of the translator. I have done a lot of translating, and I pride myself on my ability to provide simultaneous translation for speakers in all three of my languages. I like to watch good translators in action, but that was not the case here. Our guy was so minimally functional in English that I questioned not only his translation of what the Afghans were saying but also his understanding of what we were saying, which needed to be translated into Pashto. And yet the civilian and military leaders of Zhari district were counting on him to talk to each other.

Watching this process was disquieting. We knew as far back as 2006 that we were going to be in Kandahar province for a long time. That would have been the time to bring over a bunch of ESL teachers to KAF for four to six months to train a large number of superior interpreters. Given the importance of ensuring that allies in a war understand each other, this would seem to be a no-brainer.

This affects my work as well. I often tell medical trainees, “History beats physical exam. History and physical beats labs and imaging.” This means that talking to patients gives you more information than you get from examining them. Talking to them and examining them gives you more information than you get from blood tests and from radiological procedures such as X-rays, CT scans and MRIs. Even with all our sophisticated tests, most of our diagnoses are arrived at by talking to the patient.

For trauma care, my minimal Pashto is all I need. However, I also treat a few Afghan civilians or soldiers every day for non-traumatic ailments. If I can’t be sure of what the patient has said because the interpreter is incomprehensible, my diagnostic ability is limited. While some of our interpreters are quite good, the group includes some whose skills are clearly not up to the tasks required of them. I get the feeling that our generals do not appreciate how dysfunctional the translation service can be out here at times.

Very unusually, the day was not medically over at sundown. Our night vision equipment gives us such an overwhelming advantage in the dark that the Taliban rarely attack between dusk and dawn. FOB Wilson has not had a single trauma patient arrive after supper since this rotation began in mid-March. The case we had tonight involved another Afghan-Canadian communication breakdown, but of a more humorous nature than the one at the shura.

There is a medic attached to the ANA unit based here. If he is on the FOB when we have casualties, he comes over to help us out. He doesn’t speak a word of English, but you can’t help but like this guy. He is always smiling and eager to learn. I integrate him into the team whenever he shows up.

Tonight, as he has done on a number of occasions, he popped his head in the UMS door. He stood there with his usual big smile as I greeted him from my desk. He looked at me. I looked at him. I waited for him to clarify what he wanted, but he just stood there holding the door open. At least half a minute went by before Dominic the Medic walked over to the door and looked outside.

“Hey,” says Dominic, “there’s a stretcher out here.”

“Uh-huh,” says I, thinking that he meant the ANA medic had brought an old stretcher that he would like us to repair or replace.

ANA medic in his UMS

“I mean,” says Dominic, “there’s a stretcher here . . . with a guy on it.

And he’s bleeding!”

As the GP I replaced had said: “Patients just show up.”

The UMS team went from zero to sixty in about two seconds flat, but the wound was minor. The patient, an ANA soldier, had a through-and-through gunshot wound of the left arm that had broken at least one of his forearm bones. The bleeding was easy to control and the fracture was quickly splinted and stabilized. The problem was that the patient had been terribly burned some years ago. His arms, legs and abdomen were all horribly scarred.

This made it impossible for us to start an intravenous line. The scarred tissue disrupted his anatomy so much that my skilled medics were unable to locate a single vein. After they had tried a half-dozen times, I had a look and couldn’t see a decent option either. To be able to give the patient the pain control and antibiotic medication he needed, I would have to use a large intravenous catheter called a central line, which can be placed in the large veins in the neck, the chest and the groin.

Central lines are far riskier procedures than regular IVs. There is always the potential of hitting something you don’t want to hit. The resulting complication can be anything from an annoyance to a life-threatening event. Fortunately, bedside ultrasound can be used to identify the large vein in the neck called the jugular vein. Once you see the vein, you can put a large intravenous catheter into it with very little risk.

The medics had never seen a central line placed, much less under ultrasound guidance. After the patient had been evacuated they peppered me with questions about the procedure, so we threw a (mostly) willing P.Y. (the Bison driver) onto a stretcher for an impromptu teaching session.

 

JUNE 20 | Combat Team Commander

How much responsibility do we have in our lives? Many of us are responsible only for ourselves. Parents are responsible for a small number of other human beings, but that responsibility is almost always shared with a spouse or extended family members. Some of us have responsibilities at work. In all of these settings, the risk of injury is negligible.

I want to introduce an individual who is responsible for the lives of several hundred people twenty-four hours a day. A large proportion of these people are regularly in extreme danger.

Major Tim Arsenault, from my hometown of Sudbury, is the thirty-four-year-old commander of the combat team based here at FOB Wilson. Centred on an infantry company, the combat team also includes an artillery detachment, a reconnaissance unit, snipers, combat engineers and various logistical trades.

Canada has three combat teams in Afghanistan. The combat team commanders are the most senior officers who still go into direct combat, leading their troops forward with rifle in hand. By the time our combat mission ends in 2011, well over thirty thousand Canadians will have served in Afghanistan. Fewer than forty will have been combat team commanders.

Major Tim Arsenault, combat team commander

To say that the soldiers chosen for these positions are exceptional would be a gross understatement. Major Arsenault’s CV includes paratrooper training, Ranger training (a specialized commando-type course run by the Americans, along the lines of what you may have seen in the movie G.I. Jane), a deployment as a platoon commander in Bosnia, a stint as an infantry instructor at the Combat Training Centre in New Brunswick, and other taskings that are considered plum postings for young infantry officers. Only a few dozen soldiers in our army have Major Arsenault’s skills as a combat leader.

Many civilians reading this will have a vision of combat soldiers that is grounded in Hollywood movies. The last paragraph may have conjured up images of Sylvester Stallone or Arnold Schwarzenegger in their prime. Although some of our similarly trained officers would fit the bill, Major Arsenault runs counter to type. He has a warm and engaging personality, he is invariably smiling and he speaks softly— loud enough to be clearly heard but not a decibel more.

We hit it off immediately, but I suspect that anyone who comes into contact with Major Arsenault feels the same way. Within moments, you know that you’re in the presence of someone who is sincerely interested in you and what you have to say. You also sense that he will give you good advice, no matter what your problem might be.

In my case, that advice came with regard to my relationship with my daughter. For several days, Michelle has refused to speak to me on the phone. She is angry at me for leaving—she has been crying at night, saying that she misses me—and this is her way to retaliate. There is not much to do in these situations other than ride it out, but the pain this caused was so strong it was physical. How badly am I hurting my child?

Major Arsenault has three children himself, aged four, six and eight. His youngest daughter is the same age as mine. When I told him about Michelle’s behaviour, he replied that a father was always a young girl’s first love and that nothing could change that. It was the perfect thing to say, and the anxiety that had been building up dissipated.

Being a military leader, of course, does not only involve reassuring and encouraging those around you. There are also times when firm correction must be applied. Again, Major Arsenault’s style might not be what you expect. A telling anecdote was shared by one of the combat team’s warrant officers. He told me that the first time Major Arsenault chewed him out, it took him several minutes to realize that he was getting blasted, because the major’s voice was so calm and polite.

Another story was related to me by the social worker who visited us last week. It is a cliché that soldiers like to complain about their officers. Most of this is inconsequential bitching and must be taken with a grain of salt, if not the whole shaker. But after spending a week interviewing soldiers who may have been less happy than their comrades about being here, she had not heard a single complaint about the major. Not one gripe. She found that extraordinary.

It would be a mistake to think that Major Arsenault’s gentle manner implies that he accepts anything less than 100 per cent effort from his men. I had the opportunity to discuss a discipline issue with him, and he had no difficulty “closing the feedback loop.” I am reminded of what Andrei Gromyko said about Mikhail Gorbachev: “He has a nice smile. But he has teeth of steel.”

For the past three years Major Arsenault has been the commander of Bravo Company, Second Battalion, Royal 22nd Regiment (“The Bastards”). There is a cycle in the life of infantry units such as this. A company will be built up, function at a high level for a few years and then be broken up as veterans are assigned to different tasks. Major Arsenault took over Bravo Company right after it had gone through one of these periodic breakups. Over the next thirty months, he rebuilt the company. Then he took them to war.

The commander of “Bastard Combat Team” on the battlefield

One day, I saw him gazing into the distance in a thoughtful manner. I asked what he was looking at, thinking we would have a superficial but nonetheless pleasant conversation about the terrain. He replied that he was thinking about the next operation. It was only then that I saw he was looking at some of his men playing volleyball some distance away. We talked for a while, and he described everything he was doing to try to keep his men safe.

Major Arsenault lost a man, Private Alexandre Peloquin, twelve days ago. He agreed with me that the death of one of his men was almost inevitable. It would have been invasive to ask him how he felt about that, but I did ask him if he’d been prepared for it. Major Arsenault replied that, in spite of the foreseeable nature of the event, he had not been.

A note on a leader’s weapons. Major Arsenault has been under direct enemy fire more times than he can count. I asked him how often he had used his personal weapon. He replied that he has not fired a single shot.

This is a mark of extraordinary coolness under fire. When someone is shooting at you, there is an overwhelming desire to shoot back. The act of firing your weapon gives you the feeling that you’re doing something to regain control of the situation. It is psychologically satisfying and goes a long way towards reducing the fear you are feeling.

Every time Major Arsenault has been under fire, he has had to suppress this desire. Instead, he focuses on the evolution of the battle, directing his platoons and the various “supporting arms” of the combat team (artillery, tanks, engineers, bombers and attack helicopters).

Upon hearing his answer, I complimented him on his self-control. He modestly waved this off, saying, “My weapon is my radio.” That’s not exactly true: his weapon is his mind, the skill with which he choreographs the various elements of his combat team as they perform their intricate and lethal dance.

Speaking of his radio, I will point out that the previous photograph shows that Major Arsenault carries it himself. The thing weighs a ton, and some commanders opt to have a young soldier carry it for them. Major Arsenault may not have the Rambo attitude, but he definitely has the Rambo physique.

Addendum—Why things got worse: Major Arsenault was able to shed some light on why the security situation had deteriorated since I had last been here. During Roto 4 we had fought to establish a ring of FOBs and outposts that encircled Zhari-Panjwayi. This had spread our forces so thinly that we were tied down defending all these bases. NATO had asked for more troops to be deployed to Kandahar province so that Coalition forces would still be able to patrol between our FOBs and outposts. No nation stepped up. When last summer’s fighting season rolled around, there was nothing to prevent the Taliban from bringing more troops and equipment into the area to reassert their presence.

In what must have been a heartbreaking operation, Major Arsenault and “the Bastards” had to fight their way into an outpost we had built in 2008 . . . to dismantle it. He would like nothing better than to be able to help rebuild this country, but without security there can be no reconstruction. The priority now is to protect Kandahar City, where approximately 70 per cent of the province’s population resides. To protect the city, we have to keep the Taliban bleeding and dying in the rural areas.

The combat team’s mission statement speaks about “relentlessly disrupting insurgents.” The major is more direct: “We go out and we get into fights.”

MY FATHER

My father leads a company, but not any company
A company of soldiers who fight for humanity

When it is day time here
My father lays on his pillow his fear

When I go to dreamland at night
My father rises and faces the fight

He serves in a foreign country protecting kids
I will never meet
To make them all that they can be
He walks the land in dust and heat

When my father has to go away
His example teaches me to always pray
That the world will see a better day
And that all children will be free to play
—FLORENCE ARSENAULT, age 8, daughter of Major Tim Arsenault

Florence wrote this after her father had left for Afghanistan. She then memorized it and recited it to him over the phone one night, flawlessly. He copied it down and carries it everywhere he goes. He reads it every day.

 

JUNE 21 | Father’s Day with Nichola’s Daughters

How do modern armies kill?

Very few civilians are aware that the majority of soldiers killed in combat by modern armies for the past hundred years have been killed by cannon fire—what we call artillery. When you watch Hollywood movies, you come away with the impression that the infantry (foot soldiers) shoot each other on the battlefield. This is inaccurate. The role of the infantry is to push the enemy into a killing zone, where the artillery can do most of the damage.

The injuries produced by an artillery shell’s explosion fall into three main categories. Primary injuries are caused by the sheer force of the blast: the shock wave can turn internal organs into mush. Tertiary injuries occur when a body that has been thrown through the air by the blast hits something. By far the largest number of injuries, however, are secondary and are produced by shrapnel, the tremendous amount of high-velocity debris thrown off by these explosions.

Considerable shrapnel is produced by the shell itself. As it explodes, the metal container of the shell disintegrates into hundreds of razor sharp metal shards. Any one of these shards could do as much damage as a rifle bullet, if not more. Even more shrapnel comes from whatever was on the ground where the shell exploded: rocks, gravel, wood from trees, cement from buildings, metallic objects. Any of these things can be propelled at such high speeds that they can kill. Even “biological shrapnel,” the bits of bone and flesh thrown off when a body is so close to the shell’s detonation that it disintegrates, can be lethal.

The artillery represents the single most important weapon system in the battle group. If our troops get into trouble, the artillery can rain so much death and destruction on the enemy so quickly that it will be forced to break off the engagement. The infantry troopers here can tell many stories of the artillery saving their bacon.

Canada’s main artillery piece is the M777 155 mm cannon. It can fire shells weighing dozens of kilograms to distances of thirty or even forty kilometres. In other words, the guns here at FOB Wilson can hit anything in the Canadian area of operations in Zhari-Panjwayi. The trick lies in telling them where to shoot. That is the job of the forward observation officer, the FOO (pronounced “foo”).

FOOs perform the most critical and dangerous function in an artillery unit. They go forward with the infantry and tanks to observe the enemy and guide the fire of the cannons. This is a lot trickier than it sounds: think about trying to find a fox in the forest, but with shooting and explosions going on all around you.

It is also vital that they know where all the “friendlies” are. When a combat team of over 150 men and a dozen vehicles are scattered over a wide area, this can be nearly impossible. Yet it must be done perfectly, because FOOs can bring Armageddon down on the battlefield.

The “kill radius” of the artillery shells they fire is fifty metres, so anybody caught in the open up to fifty metres away from an explosion is at high risk of lethal injury. To do their job, FOOs must be right on the front line. They are more likely to be killed or injured than anyone else in the artillery.

On May 17, 2006, Canada lost a FOO in Afghanistan. She had been serving with the Royal Canadian Horse Artillery. On the day Captain Nichola Goddard died, she had been accompanying a unit of the Princess Patricia’s Canadian Light Infantry, the famed PPCLI. When they came under heavy fire, she drove her armoured vehicle to a point where she could engage the enemy with direct fire from her vehicle’s weapons while simultaneously calling in the “indirect fire” of her artillery battery.

Gunner Mélanie Faucher

Inside her armoured vehicle, Captain Goddard had good protection from the weapons the Taliban were using, but her field of view was restricted to what she could see out of a few small, shatterproof windows. To do her job as well as possible, she stood with her head and torso outside the vehicle. FOOs often do this in combat because it gives them better “situational awareness,” despite the risks it entails. It was this commitment to her duty that cost Captain God-dard her life. When a rocket-propelled grenade (RPG) hit her vehicle, she was struck by shrapnel fragments and killed.

It was inevitable that this would happen. Although it is a fact not widely known outside of the military, women have been in the combat arms for several years now. There are even women serving with the hardest of hard men, the infantry. They perform the same duties, take the same risks and pay the same price.

Here at FOB Wilson, three women are serving with the artillery. I asked them if they would discuss their lives with me.

Gunner Mélanie Faucher has been in the army for two years. Now twenty-five years old, she can remember being fascinated by cannons from a young age (I didn’t ask why). The artillery was a natural choice for her. She sees herself staying in the army for the rest of her career. If you think this makes her some kind of gun nut, you could not be more wrong. She exudes a warmth and empathy that is classically feminine. She does not limit this empathy to her comrades; she has been known to seek out Afghans who work on the base to help them with some of their more unpleasant tasks. She feels entirely accepted by her male companions.

Bombardier Annick Vallières

Gunner Faucher is living a very modern kind of stress on this mission. Besides worrying about her own safety, she is also concerned about her significant other. He is a sergeant in the infantry, assigned to a neighbouring FOB. They try to talk or e-mail daily, and they see each other every few weeks. They are living an experience that would not have existed a decade ago and one that most couples could not comprehend.

Bombardier Annick Vallières, twenty-nine, is back for her second tour in Afghanistan, having been here during Roto 4. She was at FOB Wilson that time as well. She admits that her first tour was a little rough because some of the men were not as accepting of her as they could have been. I would advise the men serving with her now to do their best to be collegial: you are in the presence of a tough individual.

You might think I was describing a cliché: tough chick goes into the army and becomes tougher still. As with her colleague, first impressions are deceiving. Bombardier Vallières is the mother of three children, aged nine, six and five. When I asked what her prime motivation was for being in Afghanistan, she spoke primarily of them. She wanted to show them that their mother had done something very difficult and done it well. What is parenting, if not setting high standards for yourself as an example to your children?

Bombardier Vallières’s future plans provided yet another twist. When I asked where she thought her career was headed, I was guessing she would spend the rest of her time in the combat arms. Again, expectations were confounded. In the not-too-distant future, she would like to get out of the combat arms and into an office job where she can let her hair down, wear makeup and dress in “really feminine clothing.” She may be made of titanium, but she is still all woman. Lieutenant Marie-Ève Labonté is a twenty-three-year-old graduate of the Royal Military College (RMC) in Kingston. Her father is in the military, and she grew up as a base brat; but whereas her joining the military was predictable, her path to the artillery was a bit circuitous. She started off in the navy, which she hated for a number of reasons. She accepted her current posting almost as a last-minute thing . . . and found that it clicked perfectly with her personality.

Lieutenant Marie-Ève Labonté

In her current position as a gun line officer, she records the information called in by the FOO and calculates the precise angle and elevation at which the cannons must fire to hit their target. I am grossly oversimplifying things here— the numerous calculations required involve high-order mathematics, and many factors must be taken into account. I will mention only one, to make clear how intricate this task is: the shells go so far that Lieutenant Labonté must take into account the rotation of the Earth when deciding where she will shoot. A few days ago, I spent some time in the command post watching her direct a fire mission. She seemed completely at ease with her task.

I asked her the slightly sexist but nonetheless obvious question: how did she reconcile her feminine side with her job, where her orders caused the deaths of other human beings almost daily? She admitted that she was occasionally conflicted by this, but, like me, she thinks she is saving lives: Canadians in the short term and Afghans in the long term.

Speaking of Lieutenant Labonté’s feminine side, it has had an unexpected positive effect. Her second-in-command is a warrant officer, an enlisted man with over twenty years’ experience. The way the military organizes things, the officer in command is the stereotypical father figure, stern, cerebral and somewhat distant. The second-in-command is the mother, much more aware of what’s going on in everybody’s life than the father. Paradoxically, many of the men under her command have approached Lieutenant Labonté with personal issues that they have chosen not to share with their warrant officer. This somewhat discombobulated her second-in-command, but her troops have benefited from it.

Lieutenant Labonté had finished the first phase of her artillery officer training when Nichola Goddard was killed. Captain Goddard was legendary, initially at RMC and later in her artillery unit, for her affability and competence. Lieutenant Labonté is still visibly affected when she discusses Captain Goddard. When she did so with me, we were standing outside in 40°C heat. Yet she got goosebumps.

As the father of a young girl, I can’t help but look at these proud, strong, competent, honourable women and hope that my daughter turns out like them.

JUNE 22 | A Busy Morning

Major Arsenault led the combat team out for a quick operation last night, leaving only a support staff behind. When this happens, our morning meeting is cancelled. I was looking forward to sleeping in, a hope that was dashed at 0700: the UMS medic (a somewhat immature young man who has replaced the reliable Master Corporal Guay) burst into my quarters to tell me that several ANA soldiers had been wounded by a suicide bomber. With the combat team away, there was only one other medically trained individual on the FOB. All the medics and TCCCs were with their combat units. I put out calls for all the other subunits still on the FOB to send me whomever they could spare and ended up with about a dozen people all told.

I spent some time talking to the individuals who had never done any kind of medical work before, asking them to focus on plugging whatever holes they came across. If we were to be overwhelmed with casualties, simple pressure bandages could go a long way towards saving as many lives as possible.

One of the first patients to arrive had a fair amount of blood on his upper thigh and lower abdomen on the left side. We brought him into the UMS and I attended to him first. He had a small puncture in his groin that had already stopped bleeding. I ordered his wound to be bandaged and went to the overflow tent to attend to the others. Three of the four patients there had minor wounds; the fourth had arrived on a stretcher complaining only of shoulder pain. There was no blood on the front of his shirt. His vital signs were stable, but he seemed a little drowsy. As I walked by, the UMS medic told me that he thought the shoulder might be dislocated. I put my hands on both shoulders and quickly determined that no dislocation had taken place. I then examined the patient’s back and found a tiny puncture wound in his right chest, a couple of millimetres wide and no more than a centimetre long.

The UMS medic had made the classic beginner mistake of examining only the front of the patient. The shrapnel wound, though quite small, was plain to see once we had the patient sitting up with his shirt off. His drowsiness and shoulder pain now took on a much more sinister connotation. Shrapnel fragments travel at such high velocity that even tiny ones can cause massive internal damage if they hit the victim in a sensitive spot. And the chest is full of sensitive spots.*

I took the patient over to the main UMS and examined him with ultrasound. Internal bleeding had collapsed the left lung. I put in a chest tube and drained 1,200 millilitres of blood, securing the chest tube as the medevac chopper was landing. With blood no longer crushing his left lung, the patient’s breathing and level of consciousness improved. It was not necessary to intubate him.

This process took a little over an hour, from first warning to last patient departure. All the while, we were serenaded by the longest and most intense fire mission any of the artillerymen can remember. They fired nearly two hundred rounds of 155 mm ammunition—another record—in support of the combat team’s operation, all before lunch. This led to a temporary change in Bravo Company’s nickname from “Bastard” to “Boom.”

By midafternoon, the combat team had returned to the FOB. They had been in constant contact with the Taliban, meaning that they had been in gunfights all day. Several Taliban, as many as twenty, were killed. None of our guys had so much as a scratch.

JUNE 23 | God Counts the Tears of Women

I had two patient encounters today that, had they happened in Canada, would be among the most mundane. Here, they were extraordinary.

Although we cannot begin to respond to all the health needs of the local population, we make exceptions for children, particularly if they appear to be suffering from something straightforward such as a laceration or broken bone. Around midmorning, I was told there were two children at the main gate who needed care. One of them had a facial laceration; the other was reported as being “unwell.”

The child with the laceration, a four-year-old girl, had been hit by a man riding a motorcycle. She had a deep gash on her right forehead that went all the way to her skull. She was accompanied by her twelve-year-old brother and was distressed at being surrounded by unfamiliar faces speaking an unfamiliar language.

What now? Giving this child an injection of local anaesthetic would have hurt her. Also, local anaesthetics only block the sensation of pain. The patient can still feel movement. That is why children who have received local anaesthesia continue to be upset: they can feel the doctor’s instruments moving their skin around, and they think the pain of the initial needle is about to return. This child had been through enough already. I decided to repair her face under ketamine sedation.

Ketamine is a wonderful drug that allows emergency physicians to put patients into a sleep state equal to general anaesthesia, with one major difference. Under general anaesthesia, patients must be put on a ventilator, which will breathe for them. With ketamine, patients continue to breathe on their own. Equally important, their gag reflex remains intact. Should saliva, blood or vomit somehow end up in their throat, they will still be able to cough the material out rather than aspirating it into their lungs.

The only problem with giving ketamine is that the patient has to be observed for two to three hours afterwards, and this would tie up one of my stretchers for some time. I checked to see if there was any combat activity going on that we knew of, but everything seemed quiet. So I went for it. Within two minutes, the child was out and I was able to proceed with the tricky repair of her ragged cut. With the child immobile thanks to the ketamine, this procedure went very well: I was done in less than ten minutes. We then bandaged her and bundled her into a blanket on one of our stretchers.

The surreal part of this patient encounter came a couple of hours later, when the child was awake, alert and ready for discharge. She had been brought in from her village by the police, from one of their outposts three kilometres away. She was now going back the same way, travelling in an unarmoured pickup truck with police markings: an easy, high-priority target for the Taliban. I had thought that the children had walked in from a nearby compound. It made me sick to think of the risk we were taking with this child to get her home.

While only the method of discharge was aberrant in the above scenario, the other patient encounter was incredible right from the beginning. The patient was another four-year-old, a boy this time. He was accompanied by his two siblings and his mother. And no one else.

Sleeping off ketamine with new teddy bear, and big brother watching over

This was extremely strange.

Since Roto 7 began, FOB Wilson has treated a few dozen Afghan civilians wounded by the war. Not one of them has been a woman. In one instance, an intercity bus either overturned or was attacked with rockets (the story was never clarified) and more than a dozen males were brought to FOB Wilson for treatment, but not a single woman. All the women who were injured were taken to Kandahar City so that they could be seen by a female doctor. Even if the delay this imposed did not lead to loss of life or limb, it was medically unsound. Pashtun-wali trumps medical expediency.

To have a woman not only show up at the FOB, but to do so unescorted by a male relative was a staggering departure from local norms.

The local culture encourages people to try to kill individuals who merely look at their women. Even photojournalist Louie Palu, who has seen more of Afghan culture than even two-tour veterans, had never seen anything like this.

The mother was clearly motivated by concern for her child. Nonetheless, she had to be very uncomfortable, so I tried to minimize her A woman alone unease as much as possible. I approached her as respectfully as I could, removing my hat and sunglasses and kneeling on the ground. I took a slow and careful history, spending extra time so that the interpreter got my questions absolutely right.

A woman alone

The mother told me an unusual story: her son had been unwell for three years, was not gaining weight or growing, and was always listless and asking to be picked up. I asked several more questions but could not pin down any constellation of symptoms that suggested a particular diagnosis. The mother went on to say that she had seen several doctors in Kandahar City, all of whom had told her that her son needed an operation on his heart or chest. She stated that she was unable to afford the surgery.

I then examined the child. He showed signs of mild chronic malnutrition, as is the case for many children here, but was otherwise normal. His height and weight put him right between his one-year-old and six-year-old siblings. In other words, he seemed to be growing normally, at least in terms of his familial context. As well, he struggled against me while I examined him and quickly ran to his mother when I let him go. There was no lethargy whatsoever.

The benign history and physical, in the light of a complaint of three years of “unwellness,” seemed to indicate that nothing serious was going on. I thought long and hard about what to say. I did not want to appear to blow off the mother’s concerns, nor did I want to disparage the Afghan doctors she claimed to have visited. I decided to tell her that what her child had would go away on its own, and that he would be a healthy boy in a year or two.

Then what had been astounding became mind-boggling. The woman lifted one side of her burka, exposing her left breast, and began breast-feeding the youngest child. She then reached out and touched the male interpreter on the knee to emphasize a point she was making.

Unless you have personally observed the hyper-conservative nature of even regular Afghans in this part of the country, it is difficult to grasp the import of that last paragraph. For pure shock value, this woman’s actions were the equivalent of walking in on your grandmother while she is having sex with a stranger . . . in public.

Here in rural Kandahar, another consideration made this woman’s actions even more astounding. What she did was not only shocking to local sensibilities, it was also a direct contravention of the rules of God, according to the Taliban. She could well be killed by them should they discover what she has done. When the Taliban were in power, they would beat women if a flash of ankle was visible beneath the burka.

I was still reeling from what I was seeing when the other shoe dropped. The woman asked if she could have money to help take care of the child. Now I understood what was happening. The only way this woman would have been able to come to the FOB on her own would be for her to be alone in the world. Somewhere in the twenty-one months between the conception of her one-year-old and now, she had lost the rest of her family, or what was left of it. She no longer had a husband, a father, uncles or brothers, since one of them would surely have accompanied her. She was as marginalized an individual as it is possible to be on this planet. The story about the child needing heart surgery was an attempt to tug at our heartstrings even more—not that it was necessary.

This put me in a difficult spot. We cannot start giving money to beggars who come to the FOB gate. This would guarantee a non-stop lineup of people seeking the same thing every day. But not to help someone like this would have required me to stifle my emotions more than I am able. In front of the other soldiers, I toed the party line and told everyone we could not help this woman. Afterwards, I caught up to her right before she left the FOB and slipped her a U.S. twenty-dollar bill.

BEGGARS IN THE DEVELOPING WORLD

In the 1982 movie The Year of Living Dangerously, Mel Gibson plays Guy, a reporter who is introduced to the slums of Jakarta by Billy, an Indonesian journalist. Billy (a male character played by Linda Hunt in a gender-bending role) visits a mother and two small children who live in a hovel in the worst part of the slum. He gives the mother some money, instructing her that this is to be spent on a doctor for one of the children. The child is quite ill.

As they walk away, Guy asks Billy why he bothers. There are 300,000 people in the slum; giving a small amount of money to one woman for one child will not change a thing. Billy replies that one must never focus on the darkness. Rather, you must try to “add your light to the sum of light.”

That one line inspired me as much as anything else I have heard in my life. It has guided my approach to charity in general and the developing world in particular. If you look at all the evil in the world, all the things that need to be fixed, you will go mad. It is far better to try to add a little light to the “sum of light” and not worry about the darkness.

Did I achieve that with my trivial offering to this desperately poor woman? Perhaps. The best advice I ever got with regard to beggars in the developing world came from a Lonely Planet guide I read nearly twenty-five years ago.

The guide grouped beggars into three categories. The first was adult males. These were to be avoided. They were likely to be experienced scam artists who might be setting you up for a pickpocket or something worse.

The next category was children. Although they did not pose any threat, the guide urged the reader not to give them any money. Child beggars, no matter how pitiful, are usually “run” by an adult. The beggar-adult relationship is likely to be exploitive.

The last category was women. The guide encouraged its readers to give these individuals small amounts of money. The rationale was that women were almost always begging to support their children. Their offsprings’ hunger was the best guarantee that the donation would be put to good use.

The guide suggested that it would be educational to watch what the locals did. I did so and watched a woman begging in downtown Lima for over an hour. Sure enough, passing Peruvians would regularly give a small coin or two.

Was I right to give the woman the money? Will it give her unrealistic hopes about what will happen the next time she meets a Canadian? Might it even cause her more problems, as the other villagers inquire as to her new-found wealth?

Or did I add my light to the sum of light?

 

JUNE 24 | Unfriendly Fire, Part 1: Naquibullah and the Dead Talib

MORNING

This morning I saw Naquibullah again. He is a thirteen-year-old boy, the son of a farmer who lives near Howz-e-Madad, a village about ten kilometres west of here. He was wounded by one of our tragic but very uncommon screwups. In late May, one of our artillery shells struck his home. His two younger siblings were also wounded, one of them fatally.

Naquibullah was hit by a shrapnel fragment that tore into his right knee. The injury was serious enough that he needed orthopedic surgery, which we provided at the KAF hospital, a Canadian-run facility that is the main Coalition hospital in southern Afghanistan. He was discharged the next day and returned home. Since then, the FOB Wilson UMS has been managing his dressing changes and after-care. This was his fourth such visit since I have arrived.

I first saw Naquibullah ten days ago. The wound was healing well, but he was not able to fully bend the joint. I showed his father how to do simple physiotherapy exercises and saw him again twice in the next three days. A week ago things seemed to be improving, so I scheduled their next meeting for today. The wound still showed no signs of infection, but I wasn’t satisfied with the joint’s mobility—Naquibullah could not fully extend his knee, as shown in the following photograph.

I contacted one of the military orthopedic surgeons at KAF, Major Max Talbot. Max and I did our basic medical officer course together and became fast friends. He holds the record for most time in Afghanistan by any Canadian military physician, having spent a total of over a year at KAF since 2006. He even spent a month at an American FOB that had a surgical capability, becoming the only Canadian military surgeon to have done time “outside the wire.” Max shared my concern and asked for Naquibullah to be transferred to KAF for further evaluation. This is standard. Any civilian wounded by Coalition forces will receive the best care we are able to provide. We will also pay monetary compensation for these incidents.

A victim of war

It took two hours to arrange the transfer to KAF. With the help of a very good interpreter, I took advantage of the delay to speak at length with Naquibullah’s father, Mr. Rahkman. I know what you’re thinking: how honest was this man going to be when we were treating his wounded son? What were the chances that he would honestly tell us what he thought?

It turns out that the chances were pretty good. Mr. Rahkman did criticize the Taliban severely, and said that he was happy we were here to help get rid of them. Even if we discount those words as flattery, the other things he said had the ring of truth. Although he maintained a calm and pleasant demeanour throughout our time together, he was blunt in telling us the things he did not like about us.

His complaint centred on his recent losses. Mr. Rahkman accepted that what had happened was an accident, but he was still very angry at us. He was also very critical of various branches of the Afghan government, particularly the police, who he felt were corrupt.

What struck me most about an exchange like this one was that it occurred at all. Mr. Rahkman was in a room full of armed Canadians, and yet he did not show any hesitation in criticizing his government and its allies. For a democratic society to be able to function, it is essential for the population to feel that they can voice their criticisms openly. Free societies are secure enough that their governments can take a few shots (figuratively). Things were very different under the Taliban.

AFTERNOON

This afternoon, a dead Talib* was brought to the main gate of the FOB by the ANP. For some reason, I was asked to examine the man and declare him dead. I had never been asked to do this before. I wondered whether the Canadians at the gate were also in unfamiliar territory and had reacted as non-medical people often do in these situations: call the doctor.

The Talib had been discovered while attempting to plant an IED. An alert ANA soldier spotted him and shot him once through the head, killing him. The body was in the back of a police pickup truck, along with the evidence of his crime: a 155 mm artillery shell, some wiring and a detonating device. You could tell at a glance that the man was dead, but I went through the motions of placing my stethoscope on his chest anyway. After the prescribed period, I announced that he had passed away.

The memorable part of the event came next. An Afghan policeman from the detachment based at our FOB had been kidnapped by the Taliban yesterday and executed. The Taliban and the ANP were now engaged in negotiations to arrange for the bodies of their respective soldiers to be exchanged.

There is an individual in the district who acts as a middleman in these situations. I wondered how on earth anyone would get started in such a business.

Addendum, June 27: The body exchange has taken place. Around midnight last night, the “body exchanger” came to collect the dead Talib. With the heat of the past three days, he had started to rot and stank to high heaven. I assume the police have gotten their man back as well, in a similar state.

Muslims try to bury their dead before sundown of the day they die, so it was notable that both sides were willing to neglect that covenant to be able to get their man back.

Every body goes home.

JUNE 25 | Unfriendly Fire, Part 2: Barali

Ninety-four per cent. In nearly every field, that would be a pretty good number.

Barali was the one-year-old brother of Naquibullah. He had also been caught by the blast of the artillery shell that wounded his older brother. He had been seen by my predecessor at FOB Wilson, who had noted a small laceration to a leg. There were no other apparent injuries.

Before he returned home, his oxygen saturation was checked and found to be 94 per cent. The rest of his vital signs were normal, and he seemed comfortable. Two days later he coughed up a blood clot. Then he died.

Oxygen saturation measures the percentage of red blood cells that are carrying oxygen. Anything that impedes the ability of the lungs to transfer oxygen to the blood stream will be detected by a decrease in the oxygen saturation. Normal oxygen saturation varies between 95 and 100 per cent. In other words, this child had only the subtlest indication that there might be anything wrong.

Given the history of blood clots being coughed up, it is likely that Barali had a condition called “blast lung.” The shock wave of the explosion caused a multitude of tiny rips. These rips started to bleed into the lung tissue. Barali drowned in his own blood.

His father was seen today by officers of our provincial reconstruction team. Given the proximity of our artillery strike to his home, there is little doubt that our actions at least partially contributed to Barali’s death. Compensation has been authorized.

What do you say to the man whose child has been killed by the actions of your army? How can we put a price on his loss? There are no good sides to the story, but there are two important points to make about the people we are fighting.

The Taliban place their bombs in areas where civilian casualties are almost guaranteed. When this occurs, their position is that it was glorious for the civilians to die for their holy cause. No compensation is paid.

And what do they do when our side harms civilians? The boy’s father told us that some Taliban soldiers came by his dwelling after his child had died.

He says they laughed.

Addendum, June 29 : His father brought Naquibullah back for another follow-up visit today. Max had not wanted to change anything in terms of the treatments I had prescribed, so we set him up with enough supplies for two weeks of dressing changes. Max will see him again after that.

Before leaving, Naquibullah’s father complained that word of the compensation he was to receive for the death of his son had leaked out and been broadcast on a local radio station. He fears this will attract the attention of the Taliban. I asked the translator how bad that could get. He answered: “Very bad.” I took that to mean “Fatal.”

The money that Naquibullah’s father will receive will be in the order of five thousand dollars. He has told us that he wants to use this money to move to a safer place (read: closer to the FOB). Now he has to make a choice. Accept the money and be seen as a traitor by the Taliban, with potentially lethal consequences; or stay in the middle of an active combat zone, one that has already killed one of his children.

JUNE 26 | Divine Wind in Kandahar

We captured a suicide bomber today. I’m not going to discuss how we figured out who he was, where we captured him and what is happening to him now. But the phenomenon of suicide bombing is worth examining in greater detail.

The military histories of the Western world have occasional examples of men who, in the heat of battle, have chosen a course of action that condemned them to death. The majority of these actions occurred when individuals sacrificed themselves to save one or more comrades. A soldier will dive onto a live hand grenade to protect other soldiers in the same trench. A pilot will give his parachute to another crew member, then keep his burning plane flying straight and level long enough for his buddy to bail out. A sailor will close a watertight door to prevent a submarine from sinking, even though he will be trapped in the flooded compartment.

The Western mind can comprehend this, but it cannot accept suicide as a tactic to achieve a limited military objective. You might wonder how we could ever defeat an enemy willing to do such a thing. To answer that question, we must first understand the motivation of the suicide bomber.

Many suicide bombers are not driven by deep philosophical or political convictions. On the contrary, a large number of these individuals are mentally handicapped people who do not realize what they are about to do. Many others are pressured into this role, often to pay off a family debt of some sort. These people are being used as weapons by utterly callous individuals. The only way we can stop them is to kill or capture the men who manipulate or coerce them.

The suicide bombers we need to understand are those who are of normal intellectual capacity and who are convinced of the rightness of their actions. The best explanation for this was articulated by Lawrence Wright, who wrote The Looming Tower, the best work on the origins, evolution and philosophy of Islamic extremism.* In a presentation he made in Toronto, Wright explained the appeal of martyrdom.

Consider what the life of a young man is like in a country such as Saudi Arabia, where all aspects of social life are controlled by Islamic fundamentalists. What outlets are there for these individuals?

The economy is barren. The total economic production of the entire Middle East is less than that of Mexico. If you take oil out of the equation, it is less than the Nokia phone company. There are few productive activities one can engage in.

Social interactions are even more limited. There is very little in the way of theatre, music or arts. Worst of all is the way that women have been removed from public life. There are none of the moderating influences that women exert on society, and none of the social interactions that occur when both sexes must share the public arena For many of these young men life is spent living at home, with interruptions for trips to the mosque. It is a life devoid of challenge, of any possibility of expressing oneself, of any chance of making a mark on the world.

Then along comes al Qaeda. Now, these young men can change history. All they have to do . . . is die†

This eagerness to die can make suicide bombers seem like fearsome enemies. Given their willingness to trade their lives for those of our soldiers, do these individuals represent the ultimate weapon?

There are two answers to this question. The first is that this is a war of ideas, and our ideas are more appealing to human beings than those of our enemies. As education makes our ideas more accessible to societies that breed suicide bombers, the “suicide idea” will lose its appeal.

The second answer requires a longer historical view. Suicide bombers may seem terrifying, but we have already met and defeated this enemy. At the end of World War Two, the Japanese sent thousands of young men on suicide missions. The kamikaze (“divine wind”) were given minimal flight training and then ordered to crash their planes into Allied ships.

The appearance of this new kind of enemy horrified Allied sailors: it was deeply disturbing to know that the attacks were being carried out by men who had given up all hope of survival. But the Allies quickly adapted to this new and desperate enemy tactic, and nearly all of these barely competent pilots were shot down before they reached their targets. The impact of the kamikazes on the overall course of the war was negligible.

The same thing will happen in this war. Liberal democracies have figured out how to beat suicide bombers before. We’ll figure it out again.

Addendum, June 30: It would be a mistake to think that suicide bombers always hit their targets. As with IEDs, Canadians only hear about the ones that manage to kill one of us.

You do not hear about the ones we kill or capture before they can launch their attack. You also do not hear about the times alert soldiers make a split-second decision and open fire on a civilian vehicle. In that instant, the soldier agonizes that he or she may have killed an innocent person. In the next instant, the bomb in the vehicle detonates and the correctness of the soldier’s actions is confirmed. Since the explosion has taken place a safe distance from our convoy, the media could not care less. Superb soldiering is not nearly as newsworthy as the times soldiers kill in error. The latter gets a lot of media coverage, even though it represents a tiny fraction of the times Coalition troops open fire on civilian vehicles.

The suicide bomber’s weapon

The suicide bomber’s target

Being a stickler for grammatical accuracy, I will point out that you only hear about suicide-homicide bombers. You do not hear about the times suicide bombers really are . . . suicide bombers. In the interests of “journalistic balance,” I offer one such example from a few days ago.

The first photograph on the previous page shows the remains of a motorcycle after a suicide bomber detonated himself on it.

We only found shreds of this guy. The bomber had driven his motorcycle behind the ANA vehicle shown in the second photograph on the previous page. The vehicle was shredded by shrapnel. There was no place on the vehicle that anyone could have survived.

When the suicide bomber detonated himself, the truck was empty, making him only a suicide bomber, without the homicide he had been hoping to achieve. He traded his life for a Ford Ranger.

JUNE 27 | The Elements, Part 1: Water

Let’s start with a literary installment, the first verse of “Gunga Din,” by Rudyard Kipling. This poem describes the desperate thirst of a wounded man lying in the heat. The location of the action could well be Afghanistan, since Britain fought a war in this area around the time Kipling was here:

You may talk o’ gin and beer

When you’re quartered safe out ’ere

An’ you’re sent to penny-fights an’ Aldershot it;

But when it comes to slaughter

You will do your work on water,

An’ you’ll lick the bloomin’ boots of ’im that’s got it.

The temperature in Zhari district is reported as having been 47°C today. It felt like 57°C.

I have been in the Caribbean, Central America, Southern Africa and equatorial Indonesia, so these latitudes are familiar to me. Something about this heat is different, perhaps because we are in a desert.

At the risk of sounding like a broken Canadian record, I think the heat affects you more in a desert because . . . it’s a dry heat. In other places I experienced tropical temperatures, I was either in a rain forest or close to an ocean. Here, the heat reflects off the sandy ground with such intensity that you feel it is exerting a physical pressure on you. Direct sunlight is so strong that you feel your exposed skin is being damaged from the moment you step outside.

Our water consumption is therefore a source of constant concern for commanders at all levels. Getting water from KAF to the combat troops occupies the minds of everyone. This starts with the general, who watches over the logistics of delivering over 200,000 litres of water to the FOBs every month. All this water is bottled. As is the case elsewhere in the developing world, it would be foolhardy to drink any locally found water, even that coming from a well.

At the other end of this pipeline, the corporal makes sure the private carries enough water before we head out on an operation. How much is “enough”? Combat infantrymen already carry a lot of weight: body armour, weapons, ammunition, rations and other gear. Most of them will also carry eight litres of water, contained in two large bags called a Camelbak. Counting the bags themselves, that is almost ten kilograms of additional weight to carry. When we resupply troops in the field, one helicopter’s payload might be taken up by water alone.

The goal of all this drinking is to avoid dehydration. In these kinds of temperatures and with that much weight on their backs, the combat troopers can lose several litres of water a day through their skin. At a minimum, water intake must match the amount lost through sweating. If it does not, a person can fall into a condition called heat exhaustion. In its early stages, heat exhaustion is easy to correct, by removing patients from the heat and giving them a lot of water to drink. If the situation deteriorates even further—if individuals get dehydrated and continue to work hard in the heat—they can progress to a much more serious condition called heat stroke.

We sweat to cool off our bodies. People with heat stroke either drank so little or sweated so much that they are out of water completely. The physical characteristic that confirms they are suffering from heat stroke rather than heat exhaustion is that their skin is dry rather than sweaty.

This can be life-threatening. With sweat no longer being produced, the body stops cooling itself. Body temperature, which until then remains roughly normal, rises quickly. Somewhere between 40°C and 42°C, neurological dysfunction occurs: confusion, collapse and coma. Somewhere between 44°C and 46°C, the patient dies.

It is not all that difficult to fall victim to heat stroke. Highly motivated people can push themselves hard enough to do it. I had a case like this recently.

I was getting ready to go to bed when one of our combat troopers came in complaining of a single episode of vomiting, abdominal cramping and a headache. Although his blood pressure was normal, his pulse was worrisomely elevated. He looked, to use the medical term, like shit.

Given that he had vomited only once, it was unlikely that his rapid pulse was due to gastroenteritis. He claimed to have been well until an hour earlier. He had spent the day participating in the St-Jean-Baptiste celebrations.* He mentioned that he had acquired a new camera and had taken 227 pictures that day. Upon hearing that, I asked him how much water he had drunk that day. He thought about it for a few seconds and then said, “One five-hundred-millilitre bottle of water—maybe.”

This guy had been having so much fun that he forgot to drink for twelve hours in 50°C heat. This is more common than you might think, and it demonstrates the degree to which training is contextual. Had this trooper been in the field on a combat operation, he would have remembered to drink constantly. Soldiers who allow themselves to become dehydrated on an operation will be charged with negligence: they will be punished for not looking after themselves properly.

It is a testament to the resilience of the young to see how far this man, in his twenties, was able to drive himself. It took twenty-four hours and nine(!) litres of intravenous fluid before he began to urinate normally. He was off his feet for three more days after that.

JUNE 28 | The Follow-up

The little girl whose facial laceration I had repaired a few days ago returned for her suture removal today. Once again, she was accompanied only by her brother. I noticed she wore the same dress as she had the first time I met her, but the blood stains on it had been carefully removed. It is likely her one good set of clothes. This is something I have often seen in the developing world: individuals who are dirt-poor and living in mud and thatch hovels will meet you dressed in a good shirt and pants or a nice dress. They take exquisite care of that single good set of clothes. The poor take as much pride in their appearance as anyone else.

My patient was a little apprehensive, but no more than any small child confronted by a stranger would be. You will recall that I used ketamine to put her to sleep for the repair. One of the best qualities of this drug is that it erases the patient’s memories starting a few minutes before the injection. Children who have a painful procedure done under ketamine don’t even remember the shot that put them to sleep. They have no negative memories of the hospital and are much less frightened when they come back.

The little girl tolerated the procedure well. She was even feeling confident enough to express her desire for more of the Oreo cookies that we had sent her home with last time. As you can see in the photograph above, these were provided.

Suture removal; under Oreo sedation

JUNE 29 | Operation Tora Arwa II

The past three days have been an anxious time. The combat team has been running a major operation in Siah Choy since before first light two days ago. This is an area of intense Taliban activity southeast of here. I have been closely following their progress on our various communication networks.

This was an airmobile operation, meaning that the troops attacked by helicopter. It was one of the first times an entire combat team had been airlifted directly onto a known Taliban troop concentration. The planning and coordination involved for such an operation is monumentally complex: nearly two hundred people will land, at night, in the middle of terrain crawling with enemy soldiers. They have to be ready to fight from the moment they hit the ground. The amount of detailed information Major Arsenault had to juggle in his mind as the combat team went through its preparations and rehearsals is mind-boggling.

The operation started off on a hilarious note. Major Arsenault was on the first helicopter. He got off and had only taken a few steps when he came upon a rifle, a pistol, a radio, a canteen, some food, various maps and other Taliban documents, some night vision gear, a blanket and . . . a full set of clothing.

Our enemies are not stupid. They know we are trying hard, with some success, to figure out the locations of their main commanders and principal weapons caches. These locations are vulnerable to surprise attack by airmobile troops, and any idiot can figure out which fields are big enough for several helicopters to land on simultaneously. The Taliban place observers throughout the district to warn them of such an attack. It looks like Major Arsenault’s chopper landed almost on top of one of these guys. He must have run off buck naked.

After that, things got more serious. The fighting has been fierce, and contact with the enemy has been constant. The artillery has been firing regularly, and fixed-wing aircraft and helicopters have been conducting frequent strafing and bombing runs.

Whereas the fixed-wing bombers are flown by our Coalition partners, the helicopters supporting this operation are Canadian. The combat team was flown in by our Chinooks, and strafing runs have been executed by our Griffons. The link between the Griffon gunships and the infantry is particularly strong: the door gunners are infantrymen who have taken a special course to learn how to shoot people on the ground from a moving aircraft.

Even those helicopters whose crews are made up of air force types go out of their way to help the Canadian infantry. They routinely take last-minute calls from the field and then cram their birds with whatever the combat troopers need.

One Canadian was wounded yesterday. He took a piece of shrapnel to the head. From the combat medic’s description, the wound did not seem all that serious. There had been some arterial bleeding, but this was now controlled.

Four more Canadians were slightly wounded today. They were helicoptered to KAF but were all discharged within hours with nothing more than a few sutures. The Canadian wounded yesterday was also sent back to us after some minor facial plastic surgery.

The combat team was airlifted out of Siah Choy after last light this evening. I asked to be given a heads-up when they were ten minutes out so that I could go to the helicopter landing site.

They came back to the FOB in three separate waves of Canadian Chinooks. The air was thick with dust as they came in. In the night air, the rotor blades ignited small flecks of dust, creating a twinkling effect. It was a bizarre juxtaposition of delicate beauty and awesome military power.

I shook hands with as many of the guys as I could as they stepped off the birds. I wanted to wish them a hearty welcome home and congratulate them on a job well done. They had gone into the heart of darkness for their country. I wanted to make sure they knew that I appreciated it.

Major Arsenault was the last man to get off the last chopper. The first thing he wanted to know was how his wounded were faring. I could see the relief on his face when I told him they were all fine and already back to active duty.

Addendum, June 30: This morning I had breakfast with Major Arsenault and other leaders of the combat team. As we ate, they relived the high points of the operation. It was fascinating to see the expressions on their faces as they did so. Those expressions brought back memories for me, memories that remain crystal clear even after two decades.

As a young man, Winston Churchill had spent time as a war correspondent during the Boer War in South Africa. One of his most famous lines from that time was that it was thrilling “to be fired upon without any effect.” He was absolutely right. The first time I was shot at was during my time as a medic during the Nicaraguan Contra War. After the battle was over, I experienced a feeling of euphoria more profound than anything I have experienced in my peacetime endeavours. I knew exactly why I felt this way. Several hundred people had tried to kill me, and I was still alive.

Watching the leaders of the combat team discuss the operation, I recognized that same exultation. Part of me wished I had been with them, under fire, so that I could experience that feeling again. This is not a healthy attitude. It is one I have learned to control.

JUNE 30 | Spy IQ

The most famous book on the conduct of warfare is The Art of War, written by the Chinese warrior-philosopher Sun Tzu in the sixth century BCE. His insights into the nature of conflict and leadership were so astute that they continue to be required reading in most military officer schools.

One of the chapters of the book deals with spies. Sun Tzu taught that leaders in war must tend to the development and maintenance of their espionage networks with great care. There were incalculable advantages in knowing the enemy’s strengths, weaknesses and, above all, intentions. Sun Tzu summarized this by saying, “It is better to pay one spy very well than an army cheaply.” In other words, the information gathered by a single spy could have more influence on the course of a war than thousands of soldiers could.

Let me give you two examples of Taliban espionage. Call it the story of two spies, one of them sophisticated and the other one too dumb to pound sand.

The first spy must have spent a lot of time watching our FOB, paying particular attention to the comings and goings of our convoys. After determining a likely route that one of these convoys would take, he crept up to the road one night. He followed a minuscule gully that brought him within range of our observation posts. What this Taliban spy did took a lot of guts. Had he been detected, he would likely have been killed.

Towards the end of the following day, a convoy carrying one of the senior leaders of the battle group passed right over this spot. Fortunately, the Talib’s courage and skill was offset by his bad timing. The trigger man detonated the IED between the first and second vehicle in the convoy. The explosion shattered the road and sent dust and debris fifty metres into the air and a hundred metres away. Incredibly, no Canadian was injured.

You might come away from this with the feeling that the Taliban are all incredibly clever. Let me show you how false this can be.

During Operation Tora Arwa II (described in yesterday’s entry), the Canadian combat team was accompanied by an ANP unit that was being mentored by some American trainers. During a lull in the battle, the Afghan policemen and their mentors were resting in a field. One of the policemen got up and walked towards a nearby tree line. This was strange, because it was in the direction the Taliban were thought to be. The policeman disappeared into the trees for a couple of minutes, then walked back, taking a position on the edge of his group. No more than a minute later, an RPG (rocket-propelled grenade) was launched from the spot in the tree line that the policeman had disappeared into. It exploded more or less in the middle of the combined American and Afghan troops. This was followed by rifle and machine gun fire from several Taliban soldiers in the tree line. The Americans and ANP returned fire until the Taliban broke contact and withdrew. During the firefight, the policeman who had wandered over to the tree line was observed firing his rifle well off to the side of where the enemy was. None of our soldiers were injured during this exchange.

It is known that the Taliban have numerous infiltrators in the Afghan security services, rather more in the police than in the army. These individuals will give away the plans of patrols, attacks and ambushes that we are going to conduct. This individual appears to have wanted to take a more direct approach and tell his comrades in person where to shoot. It boggles the mind that he thought he would get away with this. As soon as the helicopters landed at the FOB, the spy was arrested and carted off to jail.

I suppose we should consider ourselves fortunate. There have been a couple of incidents this year in which Afghan police have opened fire on Coalition patrols. In both cases, there were American fatalities. Also in both cases, the patrol defended itself and killed the traitor, making it impossible to question him.

I have spoken to members of our intelligence services about these incidents. They feel it is likely that the identity of these individuals was somehow discovered by the Taliban. Our enemies went on to learn where their families lived. The policemen would then have been given a stark choice: open fire on the Americans, knowing full well that they would return the fire with lethal effect, or have your family murdered.

What would any of us do, if we were faced with a similar choice?

JULY 1 | Canada Day

My Canada Day celebration was delayed by the arrival of three patients, who had the good grace to arrive sequentially rather than all at the same time. As is becoming predictable, they were all either drivers or guards on the convoys that go along Ring Road South.

One of them arrived with an injury I had dealt with on my previous tour: a small bowel evisceration. Back then, an older gentleman had arrived with one loop of his intestines hanging out and I had struggled to repair his injury with inadequate instruments and medications. Today, it was a sixteen-year-old with multiple bowel loops trapped outside the body. Fortunately, I was much better equipped this time.

After ensuring that the patient had no further injuries, I put him under general anaesthesia. I washed off the bowel with copious amounts of sterile water and checked to see that there were no perforations needing repair. Then, with far better instruments than I had on Roto 4, I extended the skin wound by two centimetres. The patient was now paralyzed by my medication and his abdominal muscles could be easily stretched. This made it simple to stuff his bowel back into his abdomen.

I then washed out his abdomen with a couple of litres of sterile water, which I suctioned out. I closed the skin with a series of sutures, and we helicoptered the patient to Kandahar. What had been a one-hour, high-stress sweatfest in 2007 now took no more than six or seven minutes.

The injuries of the other two patients were, in the context of the war zone, almost trivial. One of them had shrapnel wounds in his back, and the other had a gunshot wound in his shoulder. In both cases, ultrasound ruled out any life-threatening injuries to the thorax or abdomen. Despite the visually impressive nature of the wounds, they only required simple bandaging before transfer. Both patients, though in a fair amount of pain, were stable, but the way each reacted to the pain was dramatically different.

Have you ever heard someone describing developing-world patients in general, or perhaps Afghans in particular, as being able to tolerate extraordinary amounts of pain with little or no complaint? This is utter bullshit. Although we humans can display the most remarkable variability in shape, size, physical appearance and political leanings, our nervous systems are identical. You can get used to things like walking on gravel or running in the heat, but there is no way to become accustomed to the feeling of being ripped open by shrapnel.

I have treated trauma victims on almost every continent and in a variety of cultures. I have not noted a measurable difference in any ethnic population’s response to acute pain. Some individuals are tough, and some are wimps; the majority fall somewhere between these two limits.

As it happened, these two patients were at opposite ends of the spectrum. The one with a gunshot wound to the shoulder was stoic. When I asked him to rate his pain, he kept repeating it was manageable. I gave him some intravenous narcotics anyway, and he admitted that he felt better once that kicked in.

The other patient came in screaming and kept right on screaming, even after we had given him a generous dose of Fentanyl (a powerful synthetic variant of morphine). He then revealed something that a sizable number of the patients I have seen here have also reported: he told us he was a hashish and opium addict. This is useful information for the trauma team to have. Patients who are addicted to narcotics will need more medicine to control their pain due to the downregulation phenomenon I described in the June 17 entry. However, it is also true that addicts will sometimes exaggerate their pain to get access to narcotics.

When faced with this conundrum (Give more morphine because of downregulation? Give less because he might be lying?), it is always better to err on the side of humanity and to give the painkillers. The occasional addict cadges a dose, but everyone with genuine pain gets treated quickly and effectively.

Having said that, there is a limit to my generosity and this patient reached it. A number of things didn’t fit: the first dose of Fentanyl had had no effect, the patient’s pulse was not racing, he wasn’t sweating at all and his facial expressions . . . didn’t seem right. He kept asking for more drug, but I declined to provide it.

Whereas he might have been exaggerating his pain, he was probably being honest about his addiction. Hashish is abundant in this area. Many of our operations burn dozens of kilos of the stuff. As for narcotics, 90 per cent of the world’s illicit opium comes from this country. While most of it is converted into heroin and sold in Europe and North America, a substantial portion of the harvest is siphoned off for use in Afghanistan and neighbouring Central Asian nations. The best estimates put the total number of addicts in this region between ten million and twenty million.

The reasons for this are obvious. A small proportion of the human population has a predisposition for addiction, but this does not account for the total addict population. The majority of addicts turn to psychoactive drugs for the same reason the rest of us turn to pain medication: to numb an unpleasant stimulus.

This is the case in Central Asia. Repressive governments, moribund economies and continuing strife (both within and between the countries of the region) have left the populations here anxious and bored at the same time. They turn to cheap and readily available chemical vacations as a respite from lives that are much more stressful than any we can conceive of in Canada.

The day ended with a couple of events worth reporting. First we were visited by General Jonathan Vance, the commander of the Canadian contingent. This was a low-key thing, quite different from the visit of the CDS two weeks ago. General Vance dropped in on Major Arsenault and the leaders of the combat team for less than an hour.

I wanted to learn more about his bodyguards—elite soldiers are always interesting characters—so I wandered over to talk to the men who escort the general. They are a pretty tough bunch. They are almost all on at least their second if not their third and even fourth tour. One of them was with the Canadian infantry battalion that participated in the initial attack on the Taliban in 2001.

I did not have much time to talk to these guys, but I could tell that our commander was in good hands. This morning, his convoy easily fought off Taliban ambushers firing automatic weapons and RPGs.

The general himself fired off a full magazine at the enemy! I don’t know if this was the first time the general had been under direct fire, but you could tell his escorts were used to this. They mentioned this morning’s firefight almost as an afterthought.

The general rolled out around dinnertime and I went to catch what was, for the troops, the high point of the Canada Day celebrations: the issuing of the two beers per month that we get here. I never drink when I am on duty, but I got to enjoy the brews vicariously.

Addendum, July 19: The best part of Canada Day came three weeks later. My daughter’s daycare has been very supportive of my family during my absence. They wanted Claude and Michelle to know that they were not alone in this. So they made an enormous banner, and got all the kids in Michelle’s group to “sign” it with their hands. Then they had a “red shirt day” on Canada Day, to express their support for the troops, with Claude and Michelle as the guests of honour.

Walden Daycare supports the troops

JULY 2 | Sparks

I turned fifty a couple of weeks before I got to the FOB. I like to think of myself as being computer literate, but there is a generation gap between me and most of the soldiers in this respect. Computers are something I have grown familiar with over the past fifteen years, but for the twentysomethings who make up the majority of the FOB population, computers have been a natural part of their lives since birth.

It is impossible to overestimate the importance of electronic communication for this crowd. Whether it’s e-mail, instant messaging or surfing the Net, these kids are permanently plugged in, so the impact on morale of any breakdown of our Internet connection would be catastrophic. It follows that one of the most valuable men on the FOB is the remarkably capable and good-natured Corporal Tom White. He is a twenty-three-year-old “signaller,” one of the men responsible for everything that has to do with communications (phones, radios and the all-important Internet).

In the past few days, he has proven his worth to me several times over. In what is sure to thrill my Mac-loving friends, my PC’s Internet connection broke down after I tried to upgrade Explorer. Corporal White got it running again. I will be eternally grateful to him.

From the beginning, I have called Corporal White “Sparks.” But not until today did I ask him if he understood why I did this. He did not, but he had been too polite to say so. I explained that in the early days of radio the vacuum tubes would often give off sparks, and that radio operators in the military were universally given this nickname. Corporal White went on to make me feel even older when he admitted he did not know the names of the characters in the original Star Trek TV series.

Addendum, September 9, at FOB Sperwan Ghar: My debt towards the signals people has increased. For the past several days, my personal global satellite phone has stubbornly refused to turn on. This made it difficult to keep my promise to Michelle to call her every day. It occurred to me that another Sparks might be able to help. What happened next felt like déjà vu.

Master Corporal Laszlo Pivonka fulfills the same role Corporal White did at FOB Wilson. I had run into Master Corporal Pivonka a number of times. Like his counterpart, he is always cheerful and strikes one as an all-around nice guy. The similarities with Corporal White do not end there. Master Corporal Pivonka is yet another one of those technological whiz kids who are the modern-day masters of the universe.

The parallels between these two communications gurus continued in their interactions with my equipment. Master Corporal Pivonka got a few instruments and tools, poked and prodded my phone for no more than sixty seconds and . . . voilà! It was working again.

I sat there, stunned by this miraculous change. I began to express my gratitude, but he cut me off with a laugh and a grin, saying, “It’s my business to fix shit.” When I asked him what the problem had been, he admitted that he was not sure which of the three or four things he had done had resurrected my phone. “Sometimes, when I fix shit, it starts to work by FM.” And that would be? “Fucking magic,” he replied.

Finally an explanation from a tech wizard that makes sense to me.

JULY 3 | RIP In

The abbreviation RIP has a negative connotation we all know. In the army, it has a second meaning, one that is more positive.

In two days I have to go to FOB Ma’Sum Ghar. The doctor who will be taking over at FOB Wilson arrived today and we conducted a RIP—a relief in place. She did a RIP In; I will do a RIP Out in two days. I got her settled into our shack and showed her around the FOB and the UMS.

Captain Valérie Lafortune had been assigned to KAF before this. She was one of the military doctors I trained in ultrasound last December. She asked if she could have a quick refresher, which I was happy to provide. Once again, good old reliable P.Y. stepped up as a model.

Captain Lafortune was pleased to be assigned here to replace me. For all the danger and the boredom, this is front-line medicine. When we spoke over the phone a few days ago to prepare her transfer, she emphasized her desire to see some trauma cases. I know that sounds morbid, but it isn’t. I feel the same way. Although we wish it were otherwise, we know bad things are going to happen to people. That being the case, we would prefer that these patients come to us. We came here because we believe in the mission, and this is how we can best support it.

Captain Valérie Lafortune takes over at FOB Wilson

Beautifying the UMS: burning paint to bake it into the concrete

Cute-as-a-button Captain Lafor-tune may not look the part of the hard-bitten FOB doctor, but appearances are deceptive. She is cool, collected and very competent. I was happy to leave the FOB in her hands.

She arrived as I was evacuating the day’s only casualty, an Afghan convoy guard who had been shot through the upper thigh. The shooting must have taken place some hours before because his leg was covered in blood that had dried. We had a report that he had lost a considerable amount of blood at the scene, which was believable because he was displaying early signs of shock when he arrived. Fortunately, he responded to initial treatments and he will be fine.

The day ended with a remarkable display of artistic ability on the part of Corporal Nathan Nolet, one of the combat medics. He has had no formal training; his considerable experience was gained decorating overpasses. He took it upon himself to beautify the social area of the UMS. He works only with spray paint, a piece of cardboard, the top of a garbage can and a paper plate. His creation was stunning. If you have a forklift and a flatbed truck, the above masterpiece can be yours.

JULY 4 | Abbreviated Tragedy: WIA, VSA, DOW, KIA

With Captain Lafortune having taken over the UMS, I was free to take the day off. Quite a treat—I had time to read, make additional videos for Michelle and laze around. I also had time to have one last long talk with Major Arsenault, who continued to impress me with his maturity and insight. It could have been an all-around wonderful day, but it wasn’t. The war came back to hurt us yesterday and today.

Our fallen are referred to as having been “killed in action,” which we abbreviate as KIA. In the strictest sense of the word, this is inaccurate in a small proportion of cases.

The vast majority of Canadian soldiers killed in Afghanistan have died in explosions that ended their lives between heartbeats. They are true KIA. A minority survived for some time before expiring. We try very, very hard in these cases to stave off death, even if it seems inevitable. The motto of the KAF hospital is “If you arrive alive, you will survive.” That is a promise we have been able to keep with nearly every Canadian wounded in Afghanistan. Nearly.

Canadians who are wounded are labelled as WIA: wounded in action. This gets the medevac helicopters into the air. If things go badly, WIA might get upgraded to VSA: vital signs absent. This means the wounded soldier is now in cardiac arrest. Things are grim when that happens. Soldiers are young, healthy people. If their heart stops, it is because their bodies have suffered tremendous damage and they have lost most of their blood. The chances that they will survive are slim at best. Nonetheless, the distinction between VSA and KIA is an important one. As long as we are still attempting to bring the patient back, the medevac helicopters will get to us at best possible speed in all but the worst weather. If we realize our efforts are futile and we stop trying to resuscitate the patient, they become a KIA. The evacuation then becomes a much lower priority. We may even decide to evacuate the body by road. Very rarely, a soldier survives passage through the KAF hospital only to die several days later. We learned of one such case today.

Master Corporal Charles-Philippe Michaud had been on patrol on June 23 near FOB Sperwan Ghar. He had stepped on an IED that ripped off one of his legs and badly damaged his other limbs. Initial reports were that he might end up a triple amputee. Then the reports became more optimistic. He was at the Coalition medical facility in Land-stuhl, Germany, and was improving. His life was no longer in danger. It looked like he was going to keep his other limbs. He was transferred back to Canada.

This evening, we learned he had died.

Wounds this severe tax the body tremendously. Even if you stop all the bleeding, the damage is so extensive that nothing can be done to reverse the patient’s decline. A body so weakened is also easy prey to infections of all kinds.

Master Corporal Michaud will be listed as a DOW: died of wounds. It is some small consolation that he did not die in Germany, but rather in Quebec City. Although he never regained consciousness, his loved ones got to see him and to hold his warm hand in theirs one last time before he passed away.

The term KIA, unfortunately, is the one that applies to Corporal Nick Bulger, who died yesterday. He was the driver of one of the last vehicles in the general’s personal convoy, the guys I met three days ago. The other vehicles in the general’s convoy rolled over the mine without detonating it. Corporal Bulger probably thought he was safe. As the driver, he was anything but. Drivers die more often than soldiers who are riding elsewhere in our vehicles.

One thing I did not mention when I reported my conversation with the soldiers escorting the general was that they had half-bragged and half-complained that they were on the road constantly. At the time, I had been impressed. The general was not above taking chances himself.

Seen through the prism of Corporal Bulger’s death, the general’s actions seem far different to me than they did forty-eight hours ago. He could accomplish just as much, in terms of seeing the various Canadian outposts, if he travelled by helicopter. By doing so, he would expose his fellow soldiers to far less risk. As it stands, several vehicles and a large group of men are assigned to escort him around some of the most dangerous real estate in the world. And now one of them has paid for this with his life.

I can understand the general’s motivation. He wants the soldiers to see him on the front lines, facing the same dangers. But I am not convinced that any positive effect on morale this might have is worth the life of a Canadian soldier.

Addendum, July 6—“Know thine enemy”: In his eulogy to Corporal Bulger, the general described IEDs as the “weapons of cowards.” I will grant that I am still upset about the death of Corporal Bulger and that perhaps this makes me more critical of the general than I otherwise would be, but that was a foolish thing to say.

We bomb the Taliban from planes that fly so high they cannot be seen or heard. Those bombs are guided onto groups of Taliban walking in the dark by sensors that turn night into day. We shell the Taliban with artillery that can reach dozens of kilometres. We track them with tanks that are invulnerable to any of their weapons. Does this make us cowards? Of course not. They are trying to kill us. We are trying to kill them. But we all keep showing up. That demonstrates there is bravery on both sides, and in abundant quantities.

In war, combatants will use every advantage they can to destroy their enemies. IEDs are the weapons of the weak. Whenever one side is outclassed in raw military power by the other, it will turn to these guerrilla war methods. If it did not, it would be destroyed.

The Taliban are many negative things: fanatical, bigoted, nihilistic and sociopathic, to list only a few. They are not cowards. I hope that the general was speaking out of his personal pain and that this does not reflect his true perceptions.

A much more insightful evaluation of the Taliban came from Major Arsenault on the morning of June 30, when he and his subordinates were discussing Operation Tora Arwa II over breakfast. The major described two things the Taliban had done that impressed him.

The first was an intricate attack the Taliban launched on the last day of the operation. This attack hit all three platoons of the combat team as well as the company headquarters group from six positions simultaneously, showing that the Taliban had been able to conduct a fairly detailed reconnaissance undetected. The attack, which was initiated with a large-calibre weapon, was well coordinated and pressed home with determination as the Taliban attempted to assault our positions at three different locations. It was broken up by an even more competent Canadian defence, and the Taliban withdrew with heavy losses. Nonetheless, when Major Arsenault spoke about the skill with which the attack was executed by the Taliban leader, it was with something approaching admiration, or at least the respect of one professional for another.

He also described how the Taliban would sprint towards the Canadian lines when our artillery would start to fall among them. The Taliban soldiers know that the closer they are to our guys, the less likely we are to bomb them, for fear of a shell hitting our own troops. So they gamble that they will be able to get under cover before the Canadian infantry can shoot them. Sometimes this tactic works, sometimes it doesn’t. Even if they are not gunned down as they run towards us, they are now in a close-range fight with our troops—a fight they almost always lose.

Foolish? Irrational? Deluded? Sociopathic? Perhaps. Possibly all four. Cowards? No.

We need to accept this if we are to defeat them.

 

JULY 5, MORNING | Blasting Off from Wilson

Last day at FOB Wilson. It started off with a bang, literally.

I had taken care of Warrant Officer Serge Comeau, the second-in-command of the FOB’s engineer detachment, when he had gotten a moderate case of heat exhaustion a few weeks ago. As a thank you, he invited me to perform a BIP, or blow in place, the controlled destruction of an enemy IED that has been detected and removed. The IED in question was the 155 mm artillery shell discussed in the June 24 entry. I enthusiastically accepted his invitation. What can I tell you? It’s fun to blow shit up!

Warrant Officer Comeau, Cinquième Régiment de Génie de Combat (5th Combat Engineer Regiment), is cut from the same cloth as Major Arsenault. He is a pleasant individual who is always upbeat and a master of his trade. After the major, he is probably the most respected man on the FOB. Here’s one example of why that is so.

Warrant Officer Serge Comeau,combat engineer leader

During the recent operation in Siah Choy, Warrant Comeau helped to set up and defend a CCP, or casualty collection point. The four men who were wounded on the third day of the operation were brought to him. Before being wounded, the men had been stopped on the edge of a field. Since they were not running, they undid their helmet straps, which chafe in the heat. When they were hit—simultaneously, from a single explosion—they fell to the ground and their helmets came off. Their comrades, in their rush to get the wounded to a safe place—the CCP—did not bother to pick up the helmets.

When the wounded arrived, there was still quite a bit of shelling going on and shrapnel fragments were landing all over the place. Warrant Comeau spontaneously removed his own helmet and placed it on one wounded man’s head. That illustrates his courage, but what he did a couple of days later shows you the kind of leader he is.

He ordered every one of his men to bring a picture of a wife or a lover or of their parents and children, and then asked them to say a bit about the people in the pictures. Once everyone had finished, he asked them to reflect on how important these people were to them and how much these people wanted them to come home safely. Then he asked them to make sure they kept their helmet straps done up at all times.

Military training manuals define leadership as “the art of influencing people to do your bidding.” Poor military leaders yell and scream and threaten. Average leaders give orders without explanation. The better ones explain the reasons for their decisions. With the best leaders, followers make good decisions for their own reasons. They are barely aware they are following orders.

I have one last remarkable example of Warrant Comeau’s internal moral compass. At thirty-four years of age, he is quite young to have achieved the rank he holds. The CF has big plans for him—or rather, it had plans. Warrant Comeau has announced his intention to retire. He does not have twenty years in, so he will not qualify for a full pension. He still enjoys being a combat engineer, but he is giving it all up to be closer to his wife and young children.

 

JULY 5, AFTERNOON | Return to FOB Ma’Sum Ghar

It was with sadness that I bade farewell to Major Arsenault, Warrant Comeau, Dominic the Medic and the rest of the FOB Wilson team. Although it is “one FOB down, two to go” and a milestone in my progress towards going home, I have become attached to the people here and it is hard to leave them. It would be preferable for the departure to be quick. That would not be the case today.

The convoy I was booked on was delayed. After several hours it became evident that they would not arrive in time to take me to my next FOB, Ma’Sum Ghar. This would leave the FOB without medical coverage for a day or more; a lot can go wrong in that time, so I scrambled to see if I could hitch a ride with anybody else.

Going down the roads of Zhari-Panjwayi, as I have mentioned in the past, is not something one does lightly. So it was with some trepidation that I got on the only other convoy headed my way that day: an American mine-clearing unit tasked to perform a sweep of one of the Wilson-to-Ma’Sum Ghar roads. Since this unit was made up of eight vehicles, my arrival at FOB Ma’Sum Ghar had all the subtlety of a royal wedding. The man I am replacing, Petty Officer Martin Bédard, was duly impressed. also one of the three soldiers I had trained in advanced ultrasound techniques.

I was thrilled to see “Bed” again. He had taken my introductory ultrasound course and had been sharp and enthusiastic. He was

Looking northeast from Hilltop OP
(Photo courtesy Master Corporal Julien Ricard)

It was great to be back at FOB Ma’Sum Ghar as well. It was familiar ground and aesthetically pleasing. FOB Wilson had marvellous creature comforts (though Ma’Sum Ghar comes close), but its topography left something to be desired: it was affectionately known as “FOB Flat.” FOB Ma’Sum Ghar is built on a hill, which gives the UMS staff a spectacular view.

I was less pleased to learn that Ma’Sum Ghar was still Rocket Central, as it had been on Roto 4. Life here will be a lot more dangerous than it was at FOB Wilson. Everyone wears their full PPE (personal protective equipment: helmets, ballistic glasses and frag vests) anytime they are outside the protective walls of their bunker. The big hill we are on is an easy target for the Taliban rocket men. Being an eternal optimist, I chose to focus on the lower number of rockets hitting Ma’Sum Ghar (when compared with my last tour) as being a sign of progress. The other side was still lobbing more high explosive at this FOB than at any other . . . but less so. In a war zone, you cling to things like this.

Bed took me to see the UMS, which is vastly improved. Lieutenant Colonel Ron Wojtyk, my friend who is the senior doctor in the task force, told me this morning that the Ma’Sum Ghar UMS is the busiest one in our area of operations. The statistics Bed showed me explained why this was so: in this intimate little war, moving a few kilometres from Wilson to Ma’Sum Ghar changes the types of wounds we see.

The treatment area of the UMS

The room I share with the UMS medic

The injuries at FOB Wilson were mostly gunshot and shrapnel wounds from attacks on convoys on Ring Road South. As penetrating trauma goes, these wounds are relatively straightforward. The UMS here sees far more IED victims. The devastating injuries caused by these weapons are much more challenging to deal with. July will be hot in more ways than one.

An air-conditioned staff lounge is attached to the UMS. This place has everything the FOB Wilson “goodie wall” did, but here we have an area in which to sit and eat as well. To say that this is better than the old tent, when it is 50°C outside, is the understatement of the year.

The bunker we sleep in, which was one big room during Roto 4, is now subdivided into three rooms and a lounge, complete with TV. The TV is used to play video games far more than to watch the single available channel (CFTV—Canadian Forces TV). “Guitar Hero” and an amazingly realistic hockey game dominate.

Ghar means “mountain” in Pashto, and ma’sum means “quiet.” So Ma’Sum Ghar means Quiet Mountain. This war has its ironic moments.

THE FOB MA’SUM GHAR MEDICAL GANG

The medic assigned to the UMS itself is Master Corporal Julien “Red” Ricard. Red is a veteran, having been in Kandahar Province for Roto 3. Red’s older brother, Sergeant Georges Ricard, also a combat medic, was on Roto 2. They spent a week in the country at the same time, Georges leaving while Red was settling in.

Red was assigned to the provincial reconstruction team and spent the tour wandering around Zhari-Panjwayi. He travelled extensively and spent a lot of time on foot. This means that he was exposed to a considerable amount of risk.

Red made it through the tour without a scratch . . . until the last week. Seven days before he was to go home, he was riding in a vehicle called a Nyala. Soldiers like this vehicle because it rides high and has a V-shaped hull, designed to deflect the energy of an IED blast away from the crew compartment.

Red Ricard, Roto 3 combat medic
(Photo courtesy Master Corporal Julien Ricard)

Red’s vehicle was leading a convoy from FOB Ma’Sum Ghar back to KAF. He was the only Roto 3 soldier on board. The rest of the crew were all the members of the recently arrived Roto 4. Red had been kept back to help with the RIP.

They left shortly after midnight and had gone only a short distance when there was a bright flash of light and a loud explosion in front of the vehicle. Everyone was startled but quickly regained their composure. No one was hurt, and the vehicle was still running straight and true. The consensus was that an RPG round had barely missed the Nyala and had detonated on the road a few metres ahead of them.

As Red describes it, the soldiers in the vehicle experienced the same feeling of exhilaration I described earlier, in the addendum to the June 29 entry. They were all laughing, slapping each other on the back and giving the thumbs-up. As Churchill had said: “No better feeling than to be fired upon without any effect.”

Then their vehicle hit the IED.

When a human being is that close to an explosion that powerful, there is no sound to be heard. It feels instead like the hand of a malevolent god has reached down and snatched you upwards. For several seconds the hand has you in its grip, shaking you in a way and with a force that is terrifyingly unnatural. Then the immutable laws of nature take over and you come slamming back to earth.

The blast had been so massive that the engine block was ripped out of the vehicle and projected several metres away. The Nyala planted itself in the ground like a lawn dart. After having been thrown upwards, the crew was now slammed towards the front of the vehicle.

In what has to be the definition of a bad day, the second vehicle in the convoy then smashed into the Nyala from behind. Red and the other soldiers were now thrown backwards by the violent rear-end collision. Finally, the Nyala stopped moving. The total time from IED detonation to vehicle immobility was less than ten seconds, the longest ten seconds of Red’s life.

As he started to get his bearings, Red became aware that his right leg hurt like hell. A quick “wet check” did not detect any bleeding and he was still able to walk, so he ignored the pain and moved on. Surveying the wrecked interior of the vehicle, he could see that the driver and front-seat passenger were extricating themselves from their seats. This told him that they would be able to administer basic first aid to each other, should that be required. That was a relief to Red, because it would have been difficult for him to reach them. There were two other passengers in the rear of the vehicle. One of them was unconscious.

Over the next several minutes, Red organized the evacuation of the vehicle and the extrication of the unconscious casualty, and assessed everyone who had been aboard. He was astounded that the sum total of the injuries in his group was a fractured jaw, multiple contusions and his own hairline-fractured leg.

The wrecked Nyala

When the rest of the soldiers in the convoy had secured the area, they withdrew back to FOB Ma’Sum Ghar. Pack up, turn around and go home. That sounds simple, doesn’t it? It wasn’t.

It was the middle of the night. It was pitch black outside, with no illumination coming from streetlights or nearby dwellings. A convoy of a dozen vehicles had undergone not one, but two attacks. The second attack had destroyed one of their vehicles, damaged another and wounded five of their comrades. As bad as that was, the first attack was foremost on everybody’s mind because it was a “direct fire” attack. Enemy soldiers had had the convoy in their sights when they fired the RPG. They could still be lurking in the dark, waiting to fire more grenades into the now immobile and far more vulnerable convoy.

The first priority was to set up a security cordon so that the convoy would be able to defend itself if it came under attack once more. Only then could the wounded be attended to and the damage to the vehicles assessed. As it turned out, the vehicle that rear-ended the Nyala hit so hard that it was a “mobility kill” (in other words, a total writeoff).

It took four hours for the remaining vehicles and their crews to make it back to FOB Ma’Sum Ghar. Throughout this time, Red cared for the wounded. He had everybody conscious and mobile by the time they rolled into the FOB.

Red is not one of those laugh-in-the-face-of-death idiots who try to pretend that events like this do not affect them. He has no trouble telling you that the tears flowed that morning. He was given the choice of returning to KAF by road or waiting a little longer to go by helicopter. He chose the latter. Statistically, that was the safer choice, but it did not seem so a couple of hours later. Still shaking from his brush with death, Red experienced the FOB Ma’Sum Ghar specialty: a rocket attack.

In the end, waiting longer and sweating through a rocket attack made no difference. A dust storm blew up, which grounded the choppers. Red ended up going back to KAF by road anyway, in the back of a Bison ambulance. He slept all the way, not because he was fearless but because he was still very frightened. “The way my mind was working then,” he says, “I thought that it would not feel as bad to be killed while I was sleeping.” Like I said, it was a Bad Day.

Despite all that, Red signed up for a second tour. He has chosen a soldier’s life and a medic’s career. It is here that he can best follow his vocation and support his comrades. In doing do, he has demonstrated true courage: doing something that frightens him and overcoming that fear.

As the UMS medic, he is formally my second-in-command. That designation does not do him justice. The decisions that officers make are only as good as the implementation managed by the non-commissioned officers who are their partners in leadership. If an officer is doing a good job, it is often because he or she has an excellent second-in-command.

If all Red did was take my suggestions and turn them into realities, that would be enough. He goes well beyond that. He has that quality the military looks for in a future leader: he is a self-starter. Red is always looking for ways to improve the functioning of the UMS. While the rest of us are enjoying the down times, he often starts on some project or other on his own initiative. He has improved the storage space of the UMS, wired additional lighting and (my personal favourite) created a “Wall of Remembrance” where the pictures of fallen combat medics are displayed. He does all this with such quiet efficiency that I am barely aware the tasks are being done. I could not ask for a better man to have at my side.

Finally, Red is a professional-calibre photographer. Many of the images you will see from here on will be his handiwork.

We have two Bison ambulance crews here. One is attached to our quick reaction force (QRF)—the tanks and infantry tasked to respond to any emergency. The crew chief is Master Corporal Sylvain Vilandré (centre in the photo). At forty-eight, he is the only medical FOBbit (a hairy bunker inhabitant) in my age bracket. His nickname is “L’Père” (“Pops”), which leaves me nonplussed—I am two years older than he is. This is his second combat tour. He is built like a refrigerator—one of the strongest men on the FOB. This makes it even more embarrassing when he runs men twenty years younger than him into the ground. Despite hauling all that muscle around, he is in such amazing cardiovascular shape that he can go forever. He puts on a tough show on the outside, but he is so kind-hearted that he has been known to release mice caught in traps back into the wild.

Corporal Cynthia Bouthillier (left) is the medic. Twenty-two years old, she has already distinguished herself during an IED attack in Kandahar City. She did a masterful job of organizing the medical care of multiple victims. She has sought me out for extra teaching sessions on a number of topics. It is a pleasure to work with her.

Trooper Tony Houde (right), although thirty-six years old, has only been in the army for eighteen months. He is quiet and modest to a fault, but completely reliable. He helps out wherever he can when the casualties come in. He has three young children, and his oldest is going through many of the same ups and downs as my daughter. Like me, Tony worries about the effect his absences will have on her.

QRF Bison crew

Whenever possible, this crew gives clean bottled water to Afghan adults and candy to Afghan children. The locals have learned to recognize the vehicle by the teddy bear attached to one of its antennas. They invariably smile and wave, and even run after the Bison.

The second Bison ambulance crew is attached to the tank unit based here, a squadron of the Lord Strathcona’s Horse. This Bison is commanded by Master Seaman Richard Turcotte (right in the following photo), a thirty-seven-year-old senior medic. It may seem odd that a sailor is running an armoured vehicle crew in a land war, but the credo of the Health Services branch is interoperability: medics from all branches can perform their duties in any environment. Master Seaman Turcotte, the father of a six-year-old girl, is also a Roto 3 veteran. He has been through some harrowing experiences but remains rock-solid.

The medic, commonly called the GIB (guy in back), is Private Daniel Labonté. At twenty-three, he has a maturity far beyond his years and the same enthusiasm for medicine that I saw in Dominic at FOB Wilson. He is always asking questions and is particularly interested in knowing how to perform emergency ultrasound examinations. He is invariably in a good mood, all the more so lately since he discovered that his wife was carrying a baby girl.

Strathcona Bison crew

The driver, Master Corporal Jason Taylor, is a reservist from Prince Edward Island. Like many reservists you meet here, he comes closer to being a pure soldier than most regular force (full-time) troopers. No matter what combat or medical task we have assigned to him, he has accomplished it quickly and with little or no supervision. He is one of those utterly dependable individuals you sense you can count on in any situation. Because of that, I do not begrudge him his photophobia.*