Sep 09

Methamphetamine is a violent and volatile drug. While I may not completely understand the nature of drug addiction, the appeal of meth boggles my mind. Aside from the various psychological effects it can have, why take a drug that literally causes your body advanced decay?

It destroys the normal function of essential neurotransmitters leading to profound physical effects, raises blood pressure, and causes liver and kidney damage, uncontrolled muscle contraction, heart palpitations and dysrhythmias, as well as rotting teeth and hair loss. Then there are the effects on the brain. The decaying neurons there lead to paranoia, hallucinations, and abhorrent behavior that makes them dangerous and potentially violent.

It's always an experience attempting to take someone hopped up on meth to the hospital. It's an exercise in controlled chaos. There are anywhere from eight to eighteen people attempting to control one person who is usually screaming, spitting, biting, crying, pissing, flailing, and completely deranged.
When a user does become violent, this one person is a juggernaut. He pushes the word violent to the limit. Their physical strength peaks to superhuman levels, throwing sheriffs across the room with one hand climbing to their feet from being pinned by two plus two hundred pound grown men. Not to mention invulnerability to pain. I've seen a man take a taser to the chest and shake it off, strain against handcuffs to the point of tearing flesh, and punch into objects breaking bones in the hand and arm quite visibly only to continue punching other objects. 

We found our patient handcuffed and restrained to a chair by two sheriffs. He was screaming nonsense about alien conspiracy and how he knew the truth. Hallucinations and delusion had convinced him that we had come to take him away for experimentation because he knew too much. The maddened cries for help and curses of revenge periodically interrupted by outburst of attempts to harm us were indicative of behaviors we've come to associate with meth overdoses. 

As the emergency medical personnel entered, his drive to fight escalated as if our presence confirmed his belief that he would be taken away for torture. Bruised and exhausted, eight of us wrestled him to the gurney and struggle to restrain his arms and legs. I left my sunglasses on because it was sunny. It was a mistake, I realized while attempting to restrain his kicking legs when one heel found it's way to the bridge of my nose cracking my new and beautiful polarized Oakely's. 

He was tazed him twice to gain control to strap him down. Sedated three times. All attempts to subdue him were less effective than pure manpower to securing him to the gurney. By the time he's in the ambulance, I'm barely strong enough to hold the wheel steady, I'm drenched in sweat mostly but not entirely my own, and I'm annoyed at the crack just on the edge my field of vision. But as tired and broken as I feel, I imagine the terrible discomfort that poor bastard in back will be feeling when he sobers up and realize: it could be worse. At least I have healthy teeth.
Aug 19

Late one evening, we responded to a man who wounded his hand after a night of heavy drinking. While splinting his possibly broken hand, we attempted to unravel the details of how and why. The man was vague, said he punched something because he was angry. After seeing the wedding ring, one of the paramedics put two and two together; he asked the man where his wife was. We found her face down on the floor in an upstairs bedroom.

Medical professionals are not required to like every patient. We're simply required to give every patient an equally exceptional level of care, regardless of individual situation. Whether they are a kindly old lady or our personal worst enemy, every patient is entitled to the same quality care. Ensuring that every patient is treated equally is one aspect of patient advocacy.

A patient advocate must act in the best interest of the patient. Each medical professional needs to access state of mind in decision making situations, ensure safety, ensure that proper information is relayed regarding the patient’s condition and history, and protect the patient’s privacy.

As an EMT, patient advocacy is one of my primary directives. While vital, it is not always easy. Transporting a patient with flu symptoms that is stable and can be safely transported by car is draining (and not just on us, but Medicare too). Often a patient’s attitude can be one of hostility or anxiety. They may be drunk or high. Still other times, you may have a patient that makes it very hard to focus on putting their needs to the forefront. 

I was posed a question before I started working. “What do you do if you show up on scene and your patient just finished beating up his wife? The police want to take him someplace private to 'question' him, do you allow it?”

Of course not. As a patient advocate, you never leave the patient’s side. You can’t let any harm come to the patient. He is in your care regardless of his actions or who he is. 

My conviction has been tested. I’ve treated and transported assailants, addicts, vagrants, child abusers, spousal abusers, and diagnosed psychotics. I’ve seen people at their very worst. Not just their weakest, but at their most vicious and cruel. I've had the same man spit on me, kick me in the face breaking a very nice pair of Oakley sunglasses, and call my mother an assortment of derogatory terms; he received the same level of care as Grandma Nicey McHuggington. I would give every other patient. After he kicked me in the face, I did however, opt to drive the ambulance rather than ride in back.

You ignore your emotions whatever way you can. Some try to know as little about their personal history as you can, or block the image of them hitting their child from your mind. Some pretend the patient is someone else with a different history. You also tell yourself that when they get to the hospital, they’ll have an opportunity to change. Whatever you do, you do your job. 

Deep down there’s a part of you that wishes the child abuser resisted arrest. You think of what they do to rapists in prison. You hope the man who beat his wife goes to jail. You hope justice is done. But it never shows. They are your patient and you their advocate. And when necessary, and it can be, you offer care and safety without discrimination or prejudice.

Aug 18

Last year, when I wrote about one of my greater exploits as a Platoon Leader, in “A Tale of Two MEDCAPs,” I omitted a crucial detail: the pictures of the MEDCAP. It was only after we posted the article that I realized what an opportunity Eric C and I had missed. So we are fixing that problem today.

The Army and Pentagon still haven’t learned to appreciate the soft side of warfare. Good counter-insurgency doesn’t get the respect of the Generals; really big battles do. So when I say my greatest accomplishment might be a MEDCAP, it shows how different my perspective on operations is from higher leadership. Nonetheless I would still argue that that single MEDCAP did more than a month worth of fighting throughout our AO.

These are the villagers lining up before the MEDCAP started. The line wrapped around the building to the right for a couple hundred feet before the day was done.


This is true coalition partnership. An Afghan doctor works with an American doctor and an Afghan Army Medic to treat the local civilian on the right. The most common ailment was arthritis pain.


While the MEDCAP was treating local Afghans, the District Governor called a shura to discuss issues. Not much was decided on this day, but like all things it was a start.

Aug 04

Today we have a two for one special--two Iraq-related posts for the price of one. First, an update by Michael C on his current deployment, then a list of articles of the most important stories about Iraq.

An Update

This deployment is nothing like my last trip downrange. On my last tour, it took five minutes to get hot water in the showe (if it came), the food consisted of two warm trays of heated...stuff, and I shared a room and an AC unit that constantly broke with 8 other people. Conditions were spartan.

This deployment the water is always warm in the shower (sometimes too warm), the chow hall has a Caesar salad bar, sandwich bar, ice cream freezer, and steak on Fridays, and I have my own room and a working AC unit. Conditions are lush.

And the work environment is completely different. In Afghanistan, I executed someone else’s mission and controlled my own battlespace. This time I work for other people, but I get to choose my own work and I never leave the wire. A surreal experience.

A Second “Remember Iraq Link-Drop”

A few months back, in a bit of unintentional foreshadowing, I reminded our readers that Iraq was still relevant. While Iraq isn’t nearly as precarious as Afghanistan, as recent events have shown, Iraq is far from stable.

Recently, Violence in Iraq has peaked to the highest death toll levels in two years. The main cause--and the most worrying issue--is that Iraqi has failed to form a new government after the March elections. If the Iraqis don’t get past this political impasse, expect violence to increase.

But the Obama administration is staying the course with the troop drawdown in Iraq. Both President Obama and General Odierno have stated that we will have less than 50,000 troops in Iraq by August 31st, and I believe that.

Oh, and the new mission will be called “Operation New Dawn” which sounds like “Nude On” if you say it fast. So, on September 1st, I will get my “Nude On” with everyone else at my base.

Right on the heels of the “Top Secret America” article condemning the use of military contractors in intelligence, we find out that military contractors in Iraq have a bright future with the State Department. I wish there was a better solution than hiring more contractors (State Department security? a militarized peace corps? our military?), but it looks like Triple Canopy, Xe nee Blackwater and other security firms will remain in Iraq until at least the end of 2011.

Finally--to show that contractors aren’t the only perpetrators of fraud, waste and abuse--the Pentagon announced that it can’t account for 8 billion dollars of Iraqi rebuilding money. Sarcastic applause.

Aug 02

When I was in Afghanistan, one of my favorite tactics was giving gifts to locals. I gave away fuel, building contracts, HESCO barrier walls, stuffed animals, humanitarian assistance and security. If I could provide it, I tried to give it away. It’s the new way to wage war, but it worked. When I told this to Eric C, he remarked that simple gifts can mean a lot for people living on a dollar a day.

He’s right, but he didn’t know the corollary to his statement: a gift from someone who lives on a dollar a day is nearly priceless.

When I first showed up to Serkani District, the Taliban attacked the police (ANP) checkpoint near Pashad every other day. Insurgents would blast the checkpoint walls with gunfire and sometimes RPGs, then flee back to the mountains near Pakistan. Because of a lack of manpower, Destined Company and the Afghan National Army couldn’t do much about it.

Until we came.

As soon as 4th Platoon arrived in Serkani from the Korengal, my commander told me that protecting the ANP from these attacks was my number one priority. Attacks usually happened at dusk, so we timed our patrols for afternoon and nighttime. We also prepared to QRF (quick reaction force) if the checkpoint commander gave us a call. For the first few weeks we had some false alarms, but no action.

One night, I got a frantic call to get to Pashad. We went. Long story short, we identified and took care of some insurgents who had just shot up the ANP checkpoint.

The checkpoint commander Sayed Abudullah, my RTO (radio guy), my interpreter and I sat outside the ANP compound, next to my humvee. It was a weird conversation: Sayed Abdullah was incredibly grateful for what we had done that night; I felt like we were just doing our job. As we talked about our recent success, an ANP soldier walked up with two oranges and gave them to Sayed Abdullah. He insisted my RTO and I have one.

Sayed professed that this wasn’t much, but a symbol of his thanks. He kept repeating how grateful he was that we could hit the Taliban for him. A few months before, his son was shot in the stomach and could no longer work at the checkpoint. For him this was personal, and we had done much for his safety by finding the Taliban at night.

So I ate his orange, knowing that fresh fruit is common but expensive in Afghanistan, and small by American standards. It was delicious nonetheless. I felt honored.

Jun 07

On Friday, June 4th, UCLA's, College Basketball's--and possibly athletic's--greatest coach, John Wooden, passed away. Not just Southern California, but America felt his passing.

Why do I feel compelled to write about him at On Violence (aside from the fact that I went to UCLA)?

Any Bruin alum can tell you the impact of Wooden's legacy. The line to get his autograph was always full, either at the bookstore signing books or before college Basketball games. His picture adorns program, buildings and memorabilia. He built the athletic tradition at UCLA. Even though I never really met him, I still feel his loss like the entire community of Bruins.

More than anything, Wooden was a leader. I think every sports commentator has said this: on and off the court he embodied character. It doesn't make it less true.

He won 10 national championships, seven in a row. He won 88 straight games. Despite retiring thirty five years ago, John Wooden kept working. He published books on leadership and basketball. Wooden on Leadership has better stuff in two pages than the entire Army FM on leadership. His "Pyramid of Success" adorns classrooms, boardrooms and bedrooms around America, inspiring new generations.

And he was also by every single account a man of character. No one speaks ill of him, no one.

And I bring all this up because despite all the accolades we in America give our servicemembers, I don't think any General or Admiral of the contemporary age comes even close to this. In the World War II generation we had several generals who earned respect on a John Wooden level: Marshall, Bradley, perhaps Patton. General Petraeus is our most famous general, but will he stand out in thirty years the John Wooden has? Our Army loves "values," be they the Warrior Ethos or the Army values. Wooden created leadership through character, do our current Generals and Admirals have that character?

Maybe a comparison between the Army and Men's college basketball is unfair, but leadership is leadership, and sports is probably the closest field to war short of combat. Wooden is important to me because he was first and foremost a leader. A leader we should all emulate.

Post Script: Oh and he was also immensely quotable, so check these quotes out (they are all correctly sourced to John Wooden). And check out his website, pretty good design quality and a wealth of information.

Apr 21

I was laying prone on the rocky ground, something I hardly ever did in Afghanistan.

My heart pounded so loudly I thought it would break through my chest. I had never been more nervous. I feared for my life.

I was sitting at the rocky outcrop on the southern part of the Korengal Outpost, the KOP. Taliban swarmed up the hillside, surrounding me. The men who were with me fell back; I couldn't stem the retreat. I knew at that moment I would die on that hill.

And then I woke up, alone in my apartment in Vicenza, Italy. It was the worst nightmare I'd ever had. In my dream, I had returned to the Korengal Valley, later nicknamed the "Valley of Death." I only spent a couple months in the Korengal, but it felt much longer. The place haunted me before I arrived in Afghanistan; it still haunts me.

All these memories came back when I saw the photos of the Korengal Valley last week. Instead of US forces fighting for the population, it is now controlled by the insurgents I fought against.



The US Army, under General McChrystal, decided to move all troops out of the Korengal last week. If I am being intellectually honest, it makes sense from a counter-insurgency perspective. But while I can understand the move rationally, emotionally it just feels wrong.

So here is a collection of links about the Korengal Valley and the recent decision to pull out of the valley:

I first heard about the Korengal Valley through this Nightline piece by Sebastian Junger. I watched it in Vicenza, Italy a few days before I left for Afghanistan. This footage made the war very real, and very sudden.

Sebastian Junger's recent New York Times OpEd is probably the most thoughtful of the accounts about our retreat/retrograde/draw-down in the Korengal.

For the best images, this photo gallery by Time captures the essence of the valley very well. It was taken after Battle Company and the ROCK had left Afghanistan, but the people are still the same.

Finally, Jeff Schneider captures the fundamental conundrum of the Korengal in this piece for the Huffington Post.

Apr 12

I was in the middle of a shura in Pashad, when I received an urgent call from my Company Headquarters. Instantly my mission changed from peaceful shura to hurried cordon and search at a suspected insurgent cache. I paused for a moment to figure out my course of action, then excused myself from the shura.

Parked in front of an ANP (Afghan National Police) checkpoint, I quickly told the ANA (Afghan National Army) soldiers--our patrol was loaded with forty ANA in addition to my sixteen men--and ANP leaders we had to go. My men remounted our vehicles; the ANA did the same, just not quite as fast. I was working my personal radio to get more information, head some yelling, and I looked up.

In front of my truck, an ANA soldier aimed a rocket propelled grenade launcher at an ANP soldier about seven feet in front of him. The lever was cocked, and he was ready go.

Uh-oh. (I used different wording at the time.)

As I moved behind my truck, I told everyone to button up inside their vehicles. More ANA and ANP began to square off. The yelling got louder. At this point, my interpreter had no chance to translate my yelling. So I did the only thing I could: I hopped into my vehicle and hoped that both sides would see the insensibility of going Mexican stand-off on each other at less than ten paces (especially silly considering an RPG probably won’t even detonate at ten meters).

As my platoon watched inside our armored boxes, and a surprising number of ANA guys not even realizing what was going on, an ANA First Sergeant arrived. He restored order by slapping the ANA guy holding the RPG, and gesticulating to his men to get in their vehicles. The ANP checkpoint commander took control of his men shortly after that.

Crisis averted.

In hindsight I realize how surreal this event was. It's the equivalent of the LAPD pulling firearms on the National Guard during a riot. And from what I hear, Iraq went through similar types of turf wars. No matter, Afghanistan will have trouble as long as the Army and Police don’t get along. The only real positive note, is that the ANA and ANP leadership eventually got their men under control.

(In defense of the ANA, the Soldier with the RPG thought there were people smuggling lumber through the check point, something that is technically illegal. Konar Province has a huge problem with smuggled goods: semi-precious gems, lumber and ores. Still a weird time to start enforcing the law.)

To succeed in Afghanistan, we need security. The success of both the ANP and the ANA in achieving security will either make or break our efforts in Afghanistan. Unfortunately, I had to watch these two groups--each struggling to come to terms with their role in a future democratic Afghanistan-- point loaded weapons at each other.