#19. 100 Day Retrospect & Action Over Words

This employment contract has reached the point of one hundred days. It's time for its first leave period. This gives me a chance for a knee jerk primary retrospective.

Without anything else coming close, professionally anyway, the salient event has been the US military departing this country. What followed was an instantaneous crumbling of the coalition government and resulting sectarian violence.  Before you could say "Is there one I in Shi 'ite or two?" and " who forgot to turn the fan off because I think there are a few letters of the alphabet about to hit it"  they already had.

(editor's note: the writer would like to distance herself from any religious overtones or even undertones in that last remark. If anyone read the post "Redux: The Day the Music Died" she has learned her lesson and the current IPod is successfully in a witness protection program. )

US civilian workers checked and rechecked our emergency plans. While no one actually counted the number, I would guess the years of collective work experience in emergency medical response meetings around those tables was well over triple digits, a veritable Methusala of a working group. Just our elbows alone leaning in were weighty with experience.

However, I would also guess no one had made these plans with so few actual resources. Of course there were some basic ground and air equipment, but you just can't call the Cav anymore, like the way John Wayne did with his gold kerchief in a war far away. You can't just call air support anymore, when you need more helicopters than what we have parked and well equipped.  And it doesn't really help to tell the stories about when you were able to get all the help and resources you needed. Nice, but no help. In balance, what we don't have, at the moment anyway, is an enemy to fight. Now that should cut back on some of the bulk.

Our job now was to act smarter and leaner with less than ever before, and the plans, both large and small, had to reflect this concept. It was a little late to order "Who Moved My Cheese?" in cheerful boxes from Amazon, because the military had also left with the only mail service. This paradigm shift was like geologic plates moving below the feet of contractors left behind, with mail service being the least of the vacuum created.

I'm not the physicist to explain why nature abhors a vacuum, the phrase we were told to repeat in earth science, but the suckage here was making people feel the inadequacy of what I will collectively call "back up". Look behind you, and you either saw a T wall or the desert, depending on your vista, but you did not see your tax dollars at work in the form of military might flexing to hoist your broken bone to the nearest orthopedic surgeon. That was going to be left to our planning imaginations, and we were on it. Elbows on the table, focused, lists being made and maps being drawn. On it.

 Imagine 911 going down permanently where you live. Everywhere. And  your, say, local two bay fire station is told to come up with a plan for your entire county. That's not a perfect example, but it's probably the closest analogy between a US domestic situation and here. Your fire station is small. I'm just here to remind you. (Don't mess with my Ipod if that made you antsy. Just saying. )

The neighborhood we woke up to on December 19, 2011 was no longer a planned community with a jolly mayor and weekend softball. Instead, there was a careful recheck on the big lock on the metaphorical back gate, without a clear sense if it was to keep potential marauders out or hold us inside until the plans for movement improved. Literally, though, there were periods of no movement at all. I think "batten down the hatches" is a Navy term, but for some reason it came to mind, like the way I felt when a hurricane would take aim at the Outer Banks from the wide expanse of the Atlantic. Not many Navy men here though, mostly former Marines and Special Ops, so I may have been the only one thinking in obsolete mariner terms.

Those with recent military histories seemed to be watching the taillights fade through the dust, if tanks had taillights, and if they weren't already well into Kuwait anyway. It was that thousand yard stare, like when you need water in the desert. For a few there was a direct inverse relationship between their former military rank, number of years served, and the ability to make new plans at the tables mentioned above. There is really no other way to put it; it's as if there was a period of utter disbelief in the pullout "Can this be happening?" that would make it return to their baseline normalcy. It was never expressed that clearly, of course. It was just that through examples of then and now, the contrast became not only clear, but absolute and permanent. We would now become surfers of the contrast. And try as I might, I could not picture some of these guys in board shorts waiting patiently for the perfect wave.

 But in reponse to this observation of the men who were carefully brought into the present along with their intact intellectual skills, I would like to propose a new ICD9 nomenclature:  "folie de group think", which would follow the ever popular folie de deux.

I guess it was a different folie de group thinkers who had predicated the whole WMD phenomenon in the first place. It must be something about this land of Mesopotamia that elicits this particular folie. The antiquity? The sandstorms? Our country's sometimes inter generational executive branch of government's preoccupation with creating a solution for which there is no problem?

 But we of the heavy elbows eventually all got on the same page; these are smart guys, but imagine your entire trillion dollar tool box being wheeled away and you're left with a hammer, a Phillips head, and a Swiss Army knife with the tweezers missing. What is this --McGyver Goes to Haiti? Speaking for medical assets, plans were made, trained and tested. Then we had  several actual medevacs including a serious vehicular trauma to further challenge the plans in real time. It all went relatively smoothly, not that there were no thoughts of the Cav or air support to swoop in and provide heroics, but we managed to salvage the day anyway. Patients had good outcomes. Meanwhile, thankfully, there has been no mass casualty, although this threat is never off the planning table.

And this is how you build a new body of confidence. It fills the vacuum.

Confidence is built on superlative action, not in tabletop planning alone, comforting words or historical tales (although I love a good story.) All of us here have plenty of the latter, and most of us have met adequate measures of the former as well. Day by day, it's a standard we have to attempt. If you're comfortable with the way you are, then get used to it, because without effort there is unlikely to be any improvement. Nature doesn't seem to push things uphill.

It's the deed, not the word, that's as real as the blood pounding in your ears when you doing what you've trained to do and get it right. Only actions build confidence, both in yourself and in others. Can this country right itself? I have no idea. But those of us here are working alongside local nationals, and their numbers are increasing to 50% of this workforce . They need training and confidence. It's a model for them as individuals and for their country. There are no short cuts. And the mission is a long, long way from being accomplished.

#18. Relentless Obstinancy & The American Dream

What makes you run?

Metaphorically speaking.

What's in it for you when the person running behind you sees the full soles of your shoes and your elbows catching air? And the person in front of you suddenly hears foot steps?

What would make you chase a goal so intently that the list of things you exclude to maintain your focus is almost as long as the list of steps to the end itself?

Why do you have no answer when someone asks "Is that fun for you?"

Have you been told that this choice is crazy?

The passion of relentless obstinancy cannot be understated.  There is no substitute for desire. You can't teach it, you can't coach it, but you can spot it in someone's character and hope that person is forever on your side. It's the intangible that no stat sheet can quantify.

A person who, in the balance of things, will tip toward personal achievement over personal comfort is infinitely more likely to realize long term potential. Success and pain are not typically considered in the same instance, but that may be because the former eclipses the latter with really good endorphins, not because the path was a climate controlled walk with well lit directional arrows.

Motivation can sustain a project when raw talent without motivation will fail. A motivated person who can ultimately claim domain expertise is potentially unstoppable, and domain expertise is part talent and part determination. Therefore it's anybody's bootstrap to grab.

And you thought the American Dream had drifted back into a deep REM cycle. It never went anywhere, it's just that recently we thought we had to be asleep to have it. Time to wake up.

So what makes you run?

#17. Housemates! The Senses Get Some O.T. Duty

As the Goddesses of Residential Affairs are laughing their respective tiaras off because they think irony is hilarious, I find myself sharing a large house with four men, each of whom at various times are also my patients for coughs, colds, and muscle strains. Nice and respectful guys, certainly. Armed, trained, disciplined and fit, all of this and more when they're out in their duty personae. These are the fellows you want on your side once you leave these thick T walls that encircle us like a massive corral in the U.S Consulate.

 But having spent the years since my brothers left for college not in the company of male housemates, as a matter of understatement, I do have some catching up to do on the other than subtle ways of this gender occupies space.

It's not as if men have not made great impact on my life and the way I see the world. I just haven't lived with them. We finished our shifts, or bike rides, or dinner, and went home. Different homes. Three consecutive decades, notably, included the preponderance of men named Jeff.  Jeffs that really made a difference. In the 1980's Jeff and I pedalled our bicycles around eastern Europe when it was still the "Communist Bloc" countries. In the '90's a different Jeff was the rural paramedic that had my exposed PA backside as a solo rural ER provider; he later became key to Peacework. Then in the early 2000's, another Jeff cajoled me to invest with him in a medical practice that would allow me have the financial freedom to administer Peacework the way I wanted to. He was right.

 But any one of the Jeffs, two of whom are no longer sharing this earthly plane with us,  would have enjoyed demystifying this current situation for me. With these housemates, for instance, I can usually tell where any one of them is, and what part of the environment they are stressing, using just any one of my senses. And  admittedly, my individual senses are not really all that keen. On the contrary, each of them seems unaware of, well, most everything that involves sensory perception indoors. The duality of their perceptive skills is akin to an on off switch. It seems once they are inside these friendly homey walls, the duty persona of trained and gritty professional degrades to somewhere between Homer (the American, not the Greek) and the Hulk.

Their language often includes entire paragraphs within which not one sentence would have met the criteria for inclusion on the airwaves of 20th century network television, and even by this century's standards, only scattered sentences would make it past censors, and probably not enough to make a sensible delivery of information. Yet, when on duty,  I hear them speak on the radio, and the words sound like they could belong to Anderson Cooper at a state dinner. And we know Mr. Cooper is not profane. Not Gloria Vanderbilt's child.

This is also to note that I've moved again. This is correct: no longer in a dry CHU, where 4 others could not possibly be with me, no matter what their habits and behaviors.

I need to update the folded napkin that I keep somewhere in a piece of luggage not checked or misplaced and update

The (***drumroll****)

Movement List 2011-2012:

Sept 5: Deployment Center, Ft Worth, TX
Mid Sept: West VA training
Late Sept Early Oct: Falls Church VAWaiting Period, Best Western Variety
Late Oct; Waiting Period, PHX Home Variety
October 28: Erbil arrival, first U.S. Consulate cubby living space
Early Nov: Second Consulate room above the clinic
Late Nov: back t the U.S. for mom's memorial service
Thanksgiving Day: Move to the desert Diplomatic Security Compound and first dry CHU; a 200 acre desert site, former forward operating base
Mid Dec: Slept in my office for 10 days. Long story unfit for this space; Santa did not find me.
Late Dec: Moved into a different dry CHU
Dec 30: temporarily back to the U.S. Consulate, a 1;5 acre site

Of Course it's Temporary. Eleven moves in 16 weeks would suggest a guaranteed absence of permanence wherever I've had breakfast. The first thing I'll do when I return in March after having a break in the US is move into yet another different CHU at the Dip Security location. However, I've only actually worked in two places: the Consulate and the Diplomatic Security Compound, so that at least has provided some stability during the packing and unpacking of things. And the basic anatomy and physiology of humankind hasn't changed while I was waiting for my bags to offload. So I'm good.

I've become familiar with my patient population, and the way things work and sometimes don't work here. If you've ever familiarized yourself with a workplace, it takes at least a few days to first learn the standard operational procedures during official orientation, then a few weeks to realize the substandard operational procedures that collectively function for a place in real time, then the next couple of months figuring out how to survive without making the gap between the two any wider. Finally, if you're lucky, you may have the chance to narrow the gap to make a more workable standard all around. I'm evolving into the latter phase currently, which has little to do with who is leaving breakfast dishes in the sink in my current homey homeplace and more to do with where the medevac helicopters are parked. And if the fueling site has quality fuel for them.

With the military departing, the opportunity for the aforementioned gap to widen is tremendous. With tensions in the country being what they are, we don't want that gap to be a place we are looking way up from wondering what just happened. SO we have our work to do here to prepare for and avoid disaster. It's not just treating upper respiratory symptoms, although that may feel like your personal disaster when you awaken with a pounding head and dry cough.

That's definitely a part of my job that I break away from to package the decongestants when when I look up from what I'm doing. It's not as if our guys can run out to the local pharmacy and stock their med cabinet; they are locked down on this compound and I have a captive set of patients. They only leave to protect a person they are here to protect, not to run errands. We all share the same airborne germs more or less too.

The URIs will pass with tincture of time, according to my clinical instructor in 1992. She knew what she was talking about. A bit more time sensitive, however, here and now is our ability to respond to a mass casualty attack or to an industrial accident of any magnitude. We talk, we plan, we package gear, we train, we review the helicopters and ambulances, and we live together and have every plan to continue this way unchanged and unscathed.

I think my housemates are happy. What would be a sign? If they are indiscrimimately noisy in ways I did not even know made noise, eating well according to the dishes in the sink, smoking plenty, profanely articulate, choosing to be delightfully polite to me, whom they cheerfully call "Doc"?

Is this a good gauge to go on with the male housemates? I'm enjoying them, honestly. What a novelty; it's like a crackerjack reach -inside -whatchagot just to go outside my door. I've never lived with my patients either, although we used to joke about taking certain ER patients home. Never lived in an armed frat house, never  made a mass casualty plan that included everybody I know and nobody I didn't, and never really knew I would never go barefoot ever for any reason in a house until now.

What a unique personal opportunity as this country continues to argue  itself into new unworkable corners. Sadly, the corners include sectarian violence as witnessed by the hundred people already killed in Baghad since the new year. It could also include a possible attempt at independence by this region, Kurdistan, with unknown consequences from the southern Iraquis. It is less and less likely to include a coalition government of the sects working together that had been the attempt of the US backed effort, and crumbled almost instantly upon the US departure.

Meanwhile, in another hemishphere just half a world away: Today is the second anniversary of the earthquake in Haiti. Je me souviens. I hope you'll remember the resilience of the survivors and the strength and love so many of you have shown to help ever since that day that life changed forever.

Since the moment the dust settled, the wounded and refugees needed homes, the orphans needed feeding, and by October the cholera patients needed care. Peacework Medical and all of you generous donors and volunteers have never quit.
We're going back again in July to Ranquitte, which is Peacework's home. We have 4 spots left for 2 docs and 2 PAs:
http://www.peaceworkmedical.com/    mesi mes amis,  je t'aime toujours  pb

#16. Rousing Chorus for Spontaneous Adventure

Adventure was never meant to necessarily have a beginning, middle and end with the chance of a podium appearance if it all went perfectly well. It was never intended to fit into plans, in fact conversely, plans were made to fit as the adventure unfolded.

You can have your contingency plan, your back up, your go-to if things go wrong as the adventure reveals itself within your plans. That's the very intrigue of the element. But the surprise, excitement, fear, joy, pain and sometimes disappointment that adventure brings just happens. Nature does a fine job of behaving in an authentic way. Your model and mentor is all around you when you go out to play.

But somewhere along the way, the sight of someone sipping Gatorade with a side of chips on the sofa became less visually stunning and more a part of standard living room cuisine. I will arbitrarily tag this as the point at which spontaneous adventure ended for most of middle America.

 We turned some proverbial corner and stopped playing outdoors, and it had little to do with age and something to do with being told to wear a helmet and pay an entry fee to do this as a group and pedal there in a line. Then stop there.

Alternately, at age 10, I was building clay, cow dung, and acorn dams in the woods, and being chased by the farmer with a 12 ga., which he did indeed shoot into the air, I suppose because the dams were so effective they were ruining his ponds. I had a step on him this one particuliar day, only to make it to the safety of my home to be met by my mom, who would not let me inside due to the products listed above that were all over me. She saw the farmer coming. She used a Hungarian word that she used in times like these, always in reference to things smelling bad or going terribly wrong. This was both. It certainly felt like an adventure as I started running again.

(editor's note: the word may have been southern WVA Hillbilly in origin, or a blend of linguistic adrenaline that included the Magyar Dynasty and Almost Heaven. I never could tell the difference, but I learned quickly enough not to use these words, or say things a certain way, if I intended to be understood by a classroom of my peers. I was sent to speech therapy in first grade. This lasted one session, and I assume it was determined I was just using a playbook of word choice and pronunciation that was not quite ESL before it had a name. I tried to sound like the others. I did. I do. And when I travel I can spot a central Piedmont NC accent by mid sentence.)

Since then though, adventure became packaged like a frozen TV dinner, albeit a manly size. You're supposed to know the contents before you open the package, as if you could read the label and know what you were buying or trying to achieve. The element of mystery, of beginning the day and not knowing what could happen, had passed as the default. I call foul on this. Yellow card.

 Instead, you are now planning to go on an adventure trip as advertised. How did this planning person know in advance what would happen? You can't subcontract this to someone like a deliverable due next week. Have I begun confusing adventures with agenda items? Big difference; and if so, I was in more trouble than that day with the farmer. I'm not sure how I would pack for such a trip of promises. Oh wait, there may be a required packing list.

 Then Gatorade developed a low calorie option, I suppose, for this sofa sitting purpose, since its original purpose was for avoiding dehydration for intense athletic events lasting more than 40 continuous minutes in humid conditions. I guess it's possible to dehydrate while watching TV and eating chips, especially if you live in the desert, but we can now rest easy this won't happen. Thank goodness someone in a lab was thinking of those of us in deserts who worry about electrolyte replacement while avoiding hyperglycemia.

The fear of the unknown is the element of adventure that makes it appealing, and it's the very thing that tests you, teases you, focuses you, and may make you come back for more. Or learn to stay away. You prepare for it. You train for it. You pack for it and repack for it.

Your imagination is given the keys to the kingdom, and for this you have to prepare your mind as well:

Fear of the unknown must be the most unrelenting fear  that we can give credit to our higher thinking. Animals only fear what they already know. Desire of the unknown must be the most unrelenting desire of our higher thinking. When these two are combined, for some the calling is transcendent.

How can you plan adventure? You just can't; you only plan for it in the same way you plan for best and worst case scenarios. You can only hope to meet it where it lives and be open to the possibilities in whatever environment you've chosen. Go where you are intrigued; its best habitat. It's your energy, your desire, your willingness to make what could be bad luck into a situation that challenges you. The outcome has as much to do with attitude as  skill.

  This day will be different from yesterday, that much is certain, and that's why you go. Imagination has been given a day to roam free, and possibility is never far behind. You may not even know you're having an adventure until you are immersed in it, this thing that has gripped you and makes you use your ability and mind and body to fix it, find it, wait for it, or out run it, whatever it is that has made your day come to this moment. But it has made this one different from all the others in some way.

And you will come back for more.

#15. Viability Check

Remember the first time the oldest kid in the neighborhood got his driver's license, and not only that, you and a couple of buddies got to go for a ride?

Yesterday was something along that continuum for me. After being locked down in Chevy Suburbans nearly anchored to earth by their armor and self awareness, eighteen hours ago at dusk I had a much different ride: I was in a dark silver Mercedes rocketing through the desert, no radio chatter included.

I shared the back seat  filled with Kurdish interpretors on their way home from their work day at the compound- the afternoon commuter trip. What a difference timing, situation, and coincidence makes. The driver, also a local interpretor, had the radio tuned to a station that suited the landscape perfectly, with songs they all knew and I never would. For awhile I would be a visitor in their world, almost unnoticed with a window seat. Perfect.

Miles and miles of sand, dotted with adobe huts, sheep, and occasionally a glimpse of a hearty individual  who lives out here. There are two tiny villages between the compound and the city of Erbil. The dusty orange sunset fell behind one of these during this transit, and I saw clothes hanging to dry, and women with their ha jib headdresses tending to babies in backyards. The mud walls of their homes took on the color of the sky. The earth around them was almost indistinguishable from the structures. Only the undulating ribbon of pavement, this narrow highway, offered any real definition of contrast and border. This desert is a study in subtlety.

Meanwhile, the car was taking the unmarked road under its wheels as if it were the Autobahn, and in terms of indeterminate speed, perhaps there is this commonality. However, in regards to safety conditions, there are no similarities to be found. Unlike the Suburbans, though, the Mercedes was doing this gracefully. The driver has driven this route hundreds of times, but for me, it was my first time free of the Suburban, a tank on wheels. I had both good adrenaline and fear adrenaline, which is to say I was alive.

I owe this opportunity for the self viability check to none other than the Chain of Custody protocol for liters and liters of urine drug screening tests. The samples, which I had spent all day collecting, had to be passed off by me. And they had to be passed off in a specific window of time, and that window was closing, because they actually had to go all the way to the US during the night. It's a complicated effort to just catch a ride to the city. As I noted in a previous post, you can't just call Discount Taxi. There was security involved, and in fact security was involved in this carpool, it was just very different. I can't tell you in this post how different it was, or how it was exactly employed. But I can tell you that Mercedes was just the right car for the viability check. And wow, what a sunset. Both were just too short.

While it's good to know what you like (chocolate, sunsets, walks on the beach), it's typically easy enough to determine these things. What takes more effort is figuring out your thresholds for difficult, demanding, or downright frightening things. Or one thing that's all of these. Have you ever finished a 5K and thought "geez, I coulda jogged faster than that?"

Would you go faster the next time, or be safe and train at the same pace?

So how do you know your limits? Or learn your limits? Few do. We can be pretty certain we're nowhere near exceeding them. We have room to be more fatigued, more confused, more frightened - and still be ok. Arguably, the baseline of comfort for most of us with the leisure to read and write blogs is at least cozy.

 The 5K was just an example, but physical limits is just one type of challenge. It feels good in the short run to play it safe, but after awhile it has no real appeal of its own, just familiarity. Familiarity isn't really appealling, it's just inoffensive.  But on the other hand, if you challenge yourself to lose touch with your cozy baseline and try something new or difficult for yourself, something that challenges you, then it's like building a base for yourself to stand on. The next thing does gets easier to try.

It doesn't matter if this thing you choose to do seems easy for someone else - it's your challenge. Only yours.
Do something better, something bolder, something harder than before.
This is about you finding yourself alive. And maybe less familiar to yourself.

Happy 2012.
pb

#14. A Holiday Wrinkle and Rattle

The office holiday party just got even more difficult to organize if you're the president of Iraq. You just fired your vice president, and he departed in a foul mood. His parting gifts were of the explosive type, and he is now said to be headed north into Kurdistan.

This abrupt change of employment in highest office of this land coincided with the same day that the US military ended their own protracted stay. A war ended with nothing more than dust trails from departing people movers, and this was done in the dark of night. Both of these things also coincided with the anniversary of the day my Army uniform was summarily never worn again, the date that appears on my rather formal discharge papers, and a day that dates back to an era when Bill and Hillary slept in the same hemisphere and Ronald Reagan told the middle class to take a bow, but it turned out to be a bend.

So when a vice president of a country takes off in a foul mood with a trail of explosives in his wake, a ripple effect takes place even if you are nowhere near the sound of the blast. Suddenly Kurdistan, the safest place in the Sorority of Unsafe Travel Destinations, becomes a place where there is a hunted man being pursued by angry men.

Kurdistan had been enjoying an ambiance of safety and civility. A place seemingly achieving the day it would place a large order for safety handrails and "no cursing within 10 meters of the entrance signage", was now just like the southern part of the country: threatened, defensive, uncivil.

Here at the compound, movement changed dramatically, beyond what I can describe here given the world wide webbiness of this posting. There were some inconveniences, a little sleep loss and some plans changed. Difficulty to Deal Scale? On a scale of IPod demise being a 10? This was an 5.

Where oh where is the vice president, or for that matter, the men chasing him? A few days have passed now. If it's known, this information has not trickled down to the medical personnel, and meanwhile business has returned to normal here on the compound. When I ran the perimeter today in the perfectly warm afternoon sun, it was possible to not think of intruders, holiday parties, or politics. All good for a reset, certainly for me, and hopefully for the land I'm currently living in.

#13. Visitors, Canines, and Hoops

Did your day begin with a man entering your work space and announcing, "I'm from the Pentagon, I'm looking for who's in charge here."

If it didn't, then there are some things we did not have in common this morning. We did not share the next few moments thinking that this man looked surprisingly similar to a down sized version of Oliver North, because that's what  I did for the next moment.

I also spent a fraction of a second thinking about who the person was he may be looking for (this person in charge), simultaneously pondering the purpose of the arrival of anyone from the Pentagon, and finally in the split of the same second left before it became awkward, sizing him up as advocate or adversary.

Or was he just lost in this construction zone?

The jarring reality was that he was in fact looking for the two PAs here, and he had found us. We were in charge. We are. At that moment I was making coffee and my colleague from another company was deciding between antifungals for  tinea cruris for a patient who was listening to all of this unfold.

So I offered the small version of Mr. North a cup of coffee and introduced myself and my colleague, and he was satisfied that he had established himself at the correct place. He declined the coffee; he had a plane to catch right away. He needed to know if our equipment needs had been met by the surplus that the military had left behind. It seemed to be nothing more than a yes/no answer that he needed. A simple answer for a potentially complicated question.

His assistant was taking photographs of my office, within which there was no surplus equipment, if that answered his question, except for one filing cabinet that says "small arms" in Sharpie on the top drawer. (There are no small arms inside, just medical files, by the way.) He suggested this vast resource of equipment was somewhere else in this country, just not here.

 There was no clear way to connect the need with the surplus, not in this visit anyway, not that was shared at this time. But maybe being in charge of this office wasn't the view from which one could see the whole mystery of this potential miracle of sharing. We are not that much in charge. Or more likely, the answer has yet to reveal itself, kind of like that 8-ball game you played as a kid.

They left as abruptedly as they arrived. The morning went on with barely a wrinkle from the event, as we continue to make do with what we have. There remains no substitute for good clinical medicine and careful procurement of the medications that we can actually acquire. Working smart and lean is not difficult; being asked who's in charge before the coffee's made can sometimes be a challenge however.

Meanwhile, the desert air is so desperate for moisture that it pulls any precious drops of liquid from hair and skin before you can get back to your canned home from the shower. It's not a long distance to walk, although at daylight it may seem that way.  Just like a desert in the winter, the sun comes up to meet these sands at a freezing temperature. Then it gets better.

The absence of humidity along with the uneven, rocky surface has taken a toll on my canine patient's feet today. His pads have become cracked and nearly bleeding, even with the best of care from his handler. This happy labrador works on his feet as long as his handler will allow him too. His endurance being very nearly unlimited, however not always matched by this 20 month old's ability to focus.

I carefully check for signs of infection or foreign bodies in the fissures. There are none. There also seems to be no gait disturbance, and so no secondary pain or swelling associated with the original complaint.

For a plan, the human who lives and works with this dog and I talk about wound care. We also discuss the pad hardening spray that the kennel master tells us he can get. Meanwhile, the dog is on light duty, just like any worker would be with a short term disability. He seems delighted to have my company, and I scratch his belly to share the mutual pleasure. This is far better than billing.

The other species I treat here, the men who do security for diplomats and others, also must risk their fate in this unforgiving environment. In the case night before last, the environment was a pick up basketball game on the only paved surface known on these 100 acres. Basketball is not a sport for those with vulnerable connective tissue in their working joints.

In this case: "Did you hear that pop?!"  And for anyone in this basketball game, the answer was yes, because that's how loud an achilles tendon can be when this is its day to pop. Sadly so, this was the case, and the hobbled gentleman was brought to the clinic with a colleague on each arm and a cardboard splint already affixed on his ankle. These security guys are capable of so many things.

However, none of us here are capable of even minor orthopedic surgery. So a transfer all the way back to the US was arranged. It should be a simple surgery and a quick rehab in this healthy non smoker, but it can't be done here.

This reminded me of when I broke my bicycle chain somewhere in the Stewart Cassier Mountains of British Columbia. It is very simple to repair this, but you do need a tool that's specialized for the cause. Unfortunately, I hadn't packed it.

What followed from that tactical packing error was a 400+ mile hitch hiking adventure to the nearest bicycle shop. It happened to be in the adjacent province to the east, in Calgary, Alberta. Things you need are not necessarily close by in the western part of North America.

My cycling partner and I lashed the bikes to the back of a cab of a tractor trailer, and off we went. Calgary was an entirely different place than western B.C.. There were wide open spaces and a cowboy atmosphere. We had left behind steep mountains, ferns, creeks, and bear country. Then of course we had to bicycle back once I had repaired the chain, and experienced B.C. from east to west for the first time.

I trust that my patient with the newly repaired tendon will return to us as well. He'll have some stories from home that will include the holidays, and hopefully be prepared to shoot some hoops again. We will welcome his return. Just as we welcome strangers who stop in from the US. The coffee is on.

#12. Redux: The Day The Music Died

The thing about living in a construction zone is this: the view is always changing. And some days you are the one leaning against the shovel, while other days you are the one powering it down. Pace yourself carefully and enjoy the view for what it is. It can all change without your input or advice.

On the day I very nearly parked prose in the poetry lot regarding my little Ipod, it suddenly stopped working. Just like that, fully charged and nowhere near full of Dave Matthews et al, it drew a blank. The first or second thing that came to mind was the possibility of the aforementioned heresy and resultant remarkably efficient backlash.

No amount of rebooting, reenlisting, rekindling, LIDO DRIP STAT! would serve to re-enlighten the glow that had once come from the Nano screen . I even asked for help. Human help, like the kind I accept when I'm commonly lost outdoors. Nothing. The best and the brightest, their intel clearances and Gen X credentials put to this test. Nothing.

But within which camp had I possibly fallen heretic? Had Mr Jobs sensed my marginalized attempt at marginalized humor at his expense, with my cavalier reference to elegance meets function meets the awe of a species as we consume the manifest of his intellectual properties? Or was it the critique of Eddie's singing abilities? No one has made note of my opinion before in that department. Islamic prayers potentially, but not quite, in the waistband of my shorts? They never made it there, truly. Would any of these things serve to transition a sleek technical entertainment center into the product capabilities of a 1 oz smooth river stone?

I don't know. I'm not particularly superstitious. Well, ok, ER nurses have made me superstitious in the ER. I do believe in Mondays on Wednesdays, full moon lunacy, no tuna consumption in the nurses station, (is that superstition or just stinky?) and certain phrases you never say unless you plan to take responsibility for the metaphorical busload of patients that will be let out at triage once it leaves your naive, unfortunate lips. Woe to the soul who does that.

But other than carrying the same photo in my white lab coat when working since coming to AZ in 1996,  believing the room once designated "Trauma 1A" at the Vale is haunted, and thinking I have the spirit of a former beloved dog watching over me, there are no superstitions to complicate my crisp scientific measures.

With this change in the tunes status, now I will run the perimeter with the sounds of heavy machinery and the occasional whoop of an excited and highly trained canine. Rattle and hum with a howl. I might have missed something with the little buds in my ears...the sounds of progress and freedom in Kurdistan?

What does freedom sound like anyway? Does it ring like the song says it should be let to do? I think about comparative freedom now that I'm living within walls boasting a radius of about 1 mile, and with no liberty to leave without cause. This has initiated some inquiry from friends in the US about feeling trapped.

Do I feel trapped in my adventure? Has liberty been sacrificed for the experience? No, I can assuredly respond, there is nothing nearly so dramatic taking place. Trapped? Something sacrificed? No, but there is perspective that probably should be addressed to make some sense of it. Attitude and perspective. These are the things you have to come up with when somebody says the wrong phrase in the ER and the bus pulls up, or when you  think the walls around the perimeter should have the gaps for wildlife and joggers too. Attitude and perspective are the duo that have saved a lot of bad days from becoming disastrous long term memories.

 Inside these walls, I sleep, go to work, administer Peacework, eat three meals +, exercise, and communicate with friends in person and afar. I wonder about how different a typical day would be for me in my home in Phoenix compared to here, specifically, in regards to real  use of freedom (not in regards to seeing my dog or friends).

My point is this: Do we really use our freedoms, or do we like to carry them around in our mental pockets for use another time? I mean, how often do you spontaneously jump in a car and drive to the Grand Canyon? Or is a typical day more likely to include a drive to the grocery store and traffic anxiety? Running errands should not be confused with freedom. I can't run errands here, true, but I can plan a trip. I may plan a long bicycle journey, or hike with my dog, for instance, for a leave period if I wanted. I have lost the freedom of spontaneous travel here, but I have gained the freedom from running household errands.

Most of us live and work and fully exist in a small radius anyway. Maybe not a one mile radius with all basic needs provided, but when you really think about it, your routine is your wall. Whether your commute is a 5 minute walk or a 45 minute drive, you have made your choice as certainly as I have decided to live within these 20 ft walls for three months at a time. We are probably doing the same things every day: sleep, work, etc, and planning our next adventure between patients or whatever it is you do.

It's good to plan adventures, but it's even better to get out and enact them...even when it means living in a huge chilly desert inside a former military forward operating base. Doing this with few distractions allows me to appreciate the people I'm meeting here, and the other details in the mix around me. What I lose in entertainment I gain in the observation of everything that exists within my senses. It's not orderly, it's not pleasing to the eye, and it's not meant to be these things for any one's concern. But for now, it's home, and it's a little quieter without the music.

#11. Sounds From Without; Sounds From Within

Prayers can no longer be heard from the other side of the US grade bomb proof walls. The sounds of prayer are now coming from this side at daylight. It's because there is no one on the other side of the walls any more. Everyone who works this far out in the desert is in here with us.  We are one big group, working, living, eating, some praying, some listening. Beyond the US grade bomb proof walls, there is just the vast rolling sands that finally rises into hills just enough to make the horizon more complicated than a transverse line.

There are local prayers, however, in two varieties I can count on. First, the living voices waking me at daylight, and no longer surprising me with the deep voices that seem to go in and out of harmony. Due to this regular event, I don't need an alarm clock.

But I've also discovered them on the radio channel on my IPod. I feel like it's best not to clip this transmission inside my shorts when I run, risking heresy, even though Mr. Jobs, in his recent past life, managed to devise this clip as a most elegant and functional means of attachment. He may or may not have thought of this confluence of options: prayer and gym shorts.

However, it does seem like a place Eddie Vedder or Emmy Lou Harris could safely go. Ms Harris, whose talents with  voice, skirt and boots has transcended fashion and created a genre including these three elements. Maybe only a few of us are aware of this genre, but it's a dedicated few. Mr Vedder, arguably, may not be gifted with any of these three elements necessarily, but there is just something about his delivery. Every generation needs a poet who can't sing.

All this is to say I have moved to a new location. It's a big scratch in the Syrian where I am now, no longer a tightly packed residential community in town. It's not a place one would choose to live, but it is a place to work, and that's what brought us all here after all.

I've maintained a pen- on- napkin running count of moves since I first accepted this assignment, and it's possible there has been a piece of luggage left unchecked.

Let's review:
2011:

1. early September: Deployment Center in Texas
2. mid September: West Va for Training
3. late Sept: Falls Church, Va for waiting - Best Western variety
4. late Sept and October: Back to Phoenix for more waiting - home variety
5. late Oct: to Erbil, first living quarters for 5 days
6. the second living space in Erbil - above the clinic
7. November: Back to the US for Mom's memorial service
8. November: Moved to this new site north of Erbil - CHU life

So here I am.
I'm currently unpacked in a Container Housing Unit, which is called a CHU in military terms, named by the people who left them. This makes me an old lady who lives in a CHU. This CHU, like all its neighbors, are without running water, but do have the benefit of a US grade bomb proof wall (not to be confused with the perimeter wall) around the group of us. There are gaps to walk through, like the way the highway department accomodates for wildlife along highways. To get to the showers or toilets, which are also in these rectangular metal buildings (CHUs), find the nearest gap.

The first couple of days I was here, the walls and CHUs, having few distinguishable identifiers, were like a corn maze without anything organic involved. Not being able to see over the walls within walls provides a distinct disadvantage to anyone hoping for a visual landmark. Fortunately, there were no wavy mirrors, instead, there were individuals in vehicles who asked me if I needed a ride. I did.

One huge advantage to being here is the space. Once I figured out where the perimeter wall actually is, and yes, this took three days, I realized the 3 mile running track is a fantastic alternative to the treadmill. The treadmill, not incidentally, is in a tent with no windows, so years of dissociation while running really is paying off. Otherwise the tent gym is stuffed full of high quality equipment, pushed up against canvas walls of a 20 year old wall tent.

And I saw some of my potential patients when I was out today. These include the canines. They were practicing their skills for an exam, yet they did not appear stressed. There was lots of wagging, actually.The bomb sniffing dogs are  in my care, along with their human handlers. I watched them train together, and they are good! A tennis ball, or a Kong on the human's behalf, and the dogs will reward us with no bombs. They sit when they have the scent. We all survive to play ball again. What a deal.

After all, we are all here to work. My job is to be prepared for disaster in this huge occupational space, while sniffles and sore throat are the order of the day. I run with my cell in my pocket; I sleep with it by the bed. It's not just my lucky charm, it's my patients' only 911 service. And just like in the ER, we don't say the "Q" word...

#10. Home Is How You Make It

I spent the morning treating a young man with a painful kidney stone. (Is there any other kind of kidney stone?) He is improving.  Bronchitis season is here, with the smokers being the first wave to fall victim. The  in -house pharmacy is stacked on metal cabinets left somewhere in the abyss of design changes that occurred between post war Viet Nam and IKEA. Nevertheless, we are stocked with the standard of care for these typical maladies, and then some.

The flu vaccine never came because there is no mail delivery since the military left.  But even with no mail, a paramedic was delivered in the recent group of incoming employees, and he has both Navy and urban domestic experience. He will be joining me at the new compound;   maybe I’ll  be there by Thanksgiving.  My holiday plans have never been so vague…but on the other hand, I won’t need to worry about a guest list. We are an instant community here.

Otherwise, this afternoon included the cumbersome, albeit safe, transfer to the airport. Now I’m in the veritable belly of Lufthansa, making dinner choices and declining white wine as if this is something I do any given evening.  There’s a no alcohol policy on the compound, so the context had been temporary misplaced.  I had almost forgotten that part of an international flight. It’s nice to have choices, even if it is to decline.  I’m speeding westward to the land of infinite choices. Westward to America, like so many before me, the tired, poor, and hungry, as well as lots of earlier  direct flights this week of the well fed who paid by credit card. 

I’ve left the compound again. But this time it’s no airport drill. I’m heading to the Tarheel  State, North Carolina, to meet my whole family there and celebrate my mom’s full and meaningful life. It’s pecan season where I grew up, and that means there will be a chill in the air and leaves on the ground. And if you stepped down anywhere, and I mean anywhere, on the rich dark earth where my feet first touched this acreage, your foot would land on a pecan.  Just pick it up, find a way to crack it open (there’s a way to do this right, of course) and taste one on the reasons we were meant to eat food right from God’s earth.

There will be no desert this trip: no Sonoran, my beloved adopted home in Arizona, or the Syrian, my new workplace in northern Iraq. This dirt is the kind that does not run through your fingers or blow in the wind. The terra firma of my home is mostly red clay , with some darker peat , and in combination you can grow whatever you have a taste for.  It’s the kind of dirt that makes a damp clump when you squeeze it in your hands.

This won’t work with desert soil, although you can dig down into the Sonoran and find clumps of something. I learned these white hard spots are called colechee, although no one told me how to spell it. I’m no geologist, but by my best estimation, it’s a cross between a white flour Sunday morning biscuit that went uneaten, and the chalk your third grade teacher used if you’re old enough to have had a blackboard at the front of your classroom instead of something electronic.  This biscuit and chalk mix won’t grow anything, but it’s rocky enough to keep you from planting  fence posts, so you get the day off if that was your plan.

But with the damp, clumping soil I’m flying home to currently, anything that tastes good will grow from it. If you can dream it, find the seed and pull up what’s already propagating there and you’ll have it within the season. You like tomatoes? Just drop a few, and you’ll have what we called volunteers sprouting up before you can grab a stake to keep them straight.  Summer and zucchini squash? You better have recipes ready and friends to give the excess to, or they will take over your garden. (That is a quote from so many people I can’t even assign it to one person.)

But for now, I’m going to land in Frankfurt this evening, and begin my folie with jet lag. It’s an 8 hr layover, with a morning flight over the ocean, at which point my body reverses day for night as we overtake the sun heading westward. Unfortunately, the sun will continue on its timetable as it’s done for, say, eternity, and we will have a mismatch by eight hours when I am firmly on the birth soil. It won’t be the first time I’ve experienced this phenomenon, and I’m certain practice does not help with the outcome.

I will present the words to remember my mother’s life on Sunday. I used the time on the treadmill to find the right combination words in the right order; it’s the best time to think. It might be the only time no one interrupts me in plain sight, as if there is something sacred about a 10 minute pace, not to be broken. There is a meditative element to the repetitive hoof beat, but it’s quite a reach to suggest the sacred hand of God would be involved in a 10 min mile… maybe a lesser angel who’s free at that hour. She wouldn’t even need to hasten very quickly.

But if you’ve read this far, you may want to go ahead and see those words copied below into this post. I’ll present them in the church that she helped charter, before my large family and the members of the small church, many of whom are the people I grew up with there.  Some of these same people are also children of the charter members – our lives forever linked by the goal of our parents to create and grow this church. Those parents, many also passed on now, just wanted the next generation to have a better life, an easier road than they had. The dreams were real, and within reach.

 Wishes of parents are the same everywhere I go. The distance from Iraq is half a world away. One jet lagged initiating day of travel. But the goals of our families are the same, and when I talk to the shopkeepers about their kids, it’s no different.  Safety, health, education, it’s not different for any parent in any country where I have travelled or worked. Three stores on the compound, three dads, and all want something more for their kids than they had, now that they have survived this war.  This was the same for my mom, whose parents came from Budapest, just after World War I, with nothing of material value, but very much survivors.

The title of my mom’s eulogy is “Faith Hope Love and Joy”

Mom   -Mimi-  would be very happy today. She would be happy because all of her family is together, and not only are her children, her children’s spouses, her grandchildren and their spouses and children are here, but also because her church family is here. We have all gathered here in Griffith Baptist Church, which was her second home in Winston-Salem.

We can be certain Mom is smiling today. There was nothing more important to her than family and faith. We know this, because if you shared this church family, you heard many many stories about her children, and if you were her child, you  heard the prep for the next Sunday School lesson teaching.

It’s an enormous task to summarize a full and well lived life in the time I have today. In speaking for my family, it’s impossible to tell you how much we have loved our mom, or how much she has done for each of us. Given this challenge, I hope that you’ll reason with me that what I’m telling you is only a representation of a little lady who was always larger than life for us.

She made something of great value from little or nothing, over and over.  Resourcefulness, motivation and creation were themes throughout her life. The details are in the memories for us who knew and loved her, and these details are the treasures.

Our mother was born in the mountains of West VA to parents who did not speak English as their first language. They had come to America with a dream for a better life and willing to work hard for it. Her family was extremely poor, and with the sudden death of her father at a young age, the outlook was bad. But fate intervened, and she met the young gentleman who would become our father, Danny.

There must have been faith when she met Dan. What else could there have been?

They were just teen agers, with little else but faith to go on,their whole future ahead of them.

There was a world war breaking out across the Atlantic, and before long a young family in the making. There must have been a lot of faith to bring healthy children into the demanding environment of the hills of southern West VA. There were hogs and chickens and a cow to take care of. Dad’s breakfast had to be made at 4am before he headed into the coal mines. A vegetable garden big enough to feed them year round, and her helpers ranged in size from one pint to two pints, and had a tendency to squabble among themselves, from the stories I hear.

But what mom also had was hope. Lots of it, and it apparently sustained her well in these days. And she had the will to succeed. It would be safe to say she was driven. This was a little lady

who was never in neutral, never in reverse. She had faith and she had hope. Her faith and hope gave her an intense goal for

  a better life not only for herself and for those she cared the

most about and that was us, her family. She sacrificed for us. For this we will always owe mom a debt of gratitude.

She sacrificed not just her time, but her own comforts. Her children's needs

came before her own without a thought. Mountain life could be hard; and there were no conveniences to make it easier. But she had faith, and she had hope.

And before long, the family moved to this NC home and with it came the modern

conveniences that suburban living can bring. With it also came two more children to complete the family. Now this

home was really full of love. Faith, hope,and an abundance of love. We had these things in the home she made with dad. Her will to make this a home that we all loved to be in

was her purpose, and she succeeded in a thousand ways. We have memories of trying to fit around the kitchen table to eat. We could not. We have memories of picking up the pecans at this time of year by the bucketfuls. We did. There were Christmases when the presents wouldn’t fit under the tree, and summers trips to High Rock Lake when there was so much food and laughter.  We loved these family gatherings. There were so many people talking at once; I know I never got to complete a thought or sentence on my own – someone would complete it for me. This seemed to happen not just for me, though.

Recipes would be shared, tales would be told, Mom would often break in to “set the record straight” when the tales seemed to leave too much to interpretation. And that would only make the decibel level grow louder among the well fed crowd.

 Mom never had an alarm clock in her life, and never needed one. She just spontaneously was up and working, with the sewing machine going and pots clanging and the washing machine spinning all at once. I never needed an alarm clock either, because of her activities.  

The family was thriving. Mom was also a part of a new beginning with this

church, something that came to define her along with the family she created.

Faith , Hope, and Love

Mom's children, one by one, left the home to continue our education and start

our lives beyond the family home. Mom and Dad could not have been more joyful as each of us found success on our own. Mom never missed an opportunity to tell anyone how proud she was of each one of us, sometimes with great detail. Then, even this joy was exceeded when the next generation began to arrive. I don't know if there was anything that elated her more than those grandkids.

Faith, hope, love, and joy.

To have a life that is so easily identified by these four qualities is a life well lived. To find these qualities in the six of her children and then so clearly repeated again in the next generation is the legacy any person would want to leave behind.

What a generous gift to us all, this legacy. It’s a gift she could not have bought for us if she had saved for it her entire life, but it is valuable beyond measure.

 And we were the so fortunate to have received it,

because it was shared with us every day we were together.

It is a legacy born of selflessness. All she wanted was for us to be happy and to succeed in life. She and dad gave us the home from which to make this possible. It was not just a location; not just a street address. It was a place where the critical objectives were learned that would be the basis for pursuing our own goals. We learned to not back down from a goal, choose battles carefully, and when to tap into that intensity first witnessed in our own mother. It’s the imprint of a successful leader, an organizer, and a caregiver, who just happens to have been the one who raised you.

This was a powerful little lady who embodied faith, hope, love and joy.

We will miss our mom. But by having faith when we need it, or hope; showing

love to one another, or sharing joy, we will know she is still with us.         We will love her always.

#9. Simplicity and the Pursuit of Peacefulness

This morning I had the leisure to organize the cardiac code meds in tidy groups, and line them on a wide shelf like soldiers in review. No code cart to fuss over. This will make them handy to reach for if someone arrives with, say, pulseless V Tach and no nurse...the former being infinitely more likely than the latter in this case.

There are two experienced paramedics on this compound, and one is also the PA who is orienting me before I leave for my own clinic. However, there is no guarantee we would all be at a given emergency at once, or in any given combination. It's a one PA clinic, just as mine will be when I get there. And as often as I have regaled our profession to whomever would listen, the truth is, we do have only two hands/ten manual digits. This is a chance to use all twelve parts with new found efficiency.

The PA at this clinic is a former special forces medic and has been key to my transition into this new world that blends the threat of sudden violence with the threat of protracted boredom. Meanwhile, I continue to treat the walking well, which is what I always do. There will always be the walking well, as certainly as the seasons change, with cold symptoms, sinus pain, sore throats, and muscle aches. It's just that here, I see as many in a day as I would see in an hour in Phoenix.

The time on my hands to dust off and organize code meds is a testament to the pace. The recognition that all the grocery stores and restaurants sell the same products is a testament to the spartan simplicity. The natural creation of a routine that falls naturally into place is a reminder that we are fundamentally looking for normalcy.

It feels good to have the absence of a thousand choices for every whimsical whim perceived as a need . Better yet, the paucity of choices includes the collateral loss of the extra, unnecessary things of overstuffed living: the chattering screensaver of our time, which is TV news, for instance. It's here, but to get to it I would need to walk to the other side of the compound.

 Another example of clutter lost: vehicular traffic. Typically, you find your place in it and go - what else can you do? Here on this 1.5 acre, there is none. A convoy of three Suburbans going 15 mph constitutes traffic. I haven't heard the sound of a car horn or tires screeching since I've been here. Whether in central PHX or central Ranquitte, Haiti, the sounds that drivers and their cars make is expected and accepted as a part of life.

The little gym is a microcosm of the PHX downtown Y. It's in the same building where I live, eat, and work. I watch the sun come up while on the treadmill.  The suns sets so early these days, I return in the dark for the second half of my workout after clinic.

Did I come to Iraq or to a monastery? It's so peaceful within these walls it would be difficult to remember what has gone on outside in the past. The people I work with have the paradoxical combined effect of being kind, pleasant, locked and loaded.

Personally, the simplicity is remarkably calming. I don't miss racket that can come with the daily carrousel of choices. It's true, I may be longing for a full team if I ever use those cardiac meds I had the leisure to organize, but until that time, I'll read the news online, and forget the sound of traffic entirely. I'll match the sun's timing as best I can in the morning, just as a Spartan or monk would, and not sleep away the best part of the new day....these new, more peaceful days in a country with war wounds.

#8. The Original Multi Tasker

I was at the local airport here in this northern Iraqi town, looking inside the helicopter that would serve as our medevac unit when one would be needed for transport. The AK-47 leaning against the pilot's seat had a name tag on it that read "Chupacabra". Of course. I felt perfectly safe.

It was the first time I had left he secure compound since my arrival a week earlier. It takes a small radio controlled convoy of armored Suburbans to depart the gates, seated with armed guards, and of course a reason to go, so it's not as if you call Discount taxi and there you are, off to the airport. This particular trip to the airport was for the purpose of making a plan to move an injured or seriously ill patient to a surgeon, and this is why I had my head near the Chupacabra, peering into a space nearly as complicated as the internal organs of the human body.

That's when the call came on a colleague's cell phone: the one to call my sister in North Carolina as soon as I can. I wasn't suprised to hear this message; I knew the call was because my mother had passed that day after years of dementia and more recently, a bad fall. The inevitable had been imminent.

And I wasn't surprised that a cell call would come in on a colleague's  phone, knowing exactly who I was with, when, and where. It's part of why I can feel safe...but then, I also know the guys here who are doing the tracking. They have no agenda - just security. If, in the early part of my life I might have believed that "Jesus is watching"...well...the opportunity for symmetry here is mine to offer, but these guys are not in ecru robes, and do not come with halos of light. Ear pieces, maybe. So I won't pursue it.

My mom was the original multi tasker. She could do several things at once before it had a name, and she did this without the benefit of electronic gadgets or financial resources that would enable conveniences. She was born into Appalachian poverty to Hungarian coal mining parents.  She had an internal drive that allowed her to  never lose focus from her path, which was to build a better life for herself and her family. The six of her and dad's children, myself the sixth of these, were the extremely fortunate benefactors of this path. She mentored us to achieve by her everyday example.

The inherent lessons were these:

1. Do it yourself. No one will do it for you, and if they do, they won't do it the way you want it anyway.
2. Do not miss an opportunity. You never know if you'll have that opportunity again.
3. Share with others who have less than you do. Don't expect anything back.
4. Don't go into debt except for college or a house.
5. You need to go to church.

I carefully followed four out of five of these edicts, tripping up on the fifth one, but nevertheless spending a lot of time around remarkable individuals of faith and piety. Accordingly, I have a profound respect for religion, faith, and the power of infinite good, church walls notwithstanding. I've found religion to be not a lot unlike the alley ways of Central Phoenix just before large item pick up: there are things of immense value, placed right beside of absolute trash. Who are we to judge which is which put there by another human?  Place it in the back of your truck if you want, carry it around for awhile, and see if it changes your life for the better.

I thank my mom for providing me with the perspective needed to find authenticity in the characters among us who may purvey faith. She did this by a certain osmosis: I spent my childhood observing the others in the fishbowl of the extended church family, and I have seen the faithful at their best. Now I know it when I see it. You just do. It takes some trial and error, but what do we have but opportunity for this?

That being said, my family has asked me to speak at my mother's memorial service on Nov 20. Momentarily speechless, this in itself a phenomenom, I recovered and agreed with a sense of honor at the request. It will take place in the church she helped charter in 1956. This is the same one I was raised in,  and spent so many hours in that I could tell you secret places in every building only a child would know, or think secret. Her service will be in lieu of Sunday School that day. Oh, the many times I wanted to skip out on Sunday School...there will be happy children that day.

Meanwhile, the medevac  plan works. At 0230 hr today a call came that a man was "having a really bad stomach ache". Indeed he was. And in fact, clinically, he was having acute appendicitis. There is not lab or CT scan here, but there's a basic history and physical that can cover for these missing applications. There is also no nurse here. As I was injecting meds into the IV bag, I was thinking of the ER nurses who had done this as a reflex action, as well as my mom who had told me to "never miss an opportunity"...I'm not, mom, really, I'm not.

#7. Greetings from Kurdistan

The first sound at daylight is not that of pidgeons, roosters, or helicopters. It's not the cacophony of any sort of violence, although in this land those sounds have once bounced from the US grade bomb proof walls that encircle my living quarters. It's the sound of prayer. Ancient prayers that connect man to man and man to infinity and, with some grace, to infinite good.

I imagine these men facing east, but I can't see them, only hear their collective and melodic pleas. I can't see them because if there was not the need for the US grade bomb proof wall which I can't see over, there would not be a need for my ears to be here in the first place.

Meanwhile, I'm not sure which way my head is directed. There is not only a wall to protect me, but an absence of windows in my cubby sized sleeping space. I live in a place where safety is the order of the day. If it's not clear why something is done a certain way, its common thread of explanation is typically safety.

I wind through an older apartment style home that I share with my colleagues to get to my cubby space, and by the time I get here, my direction is impaired. Arguably, I have not been certain which way is south since I last saw the red lights of South Mountain Preserve, but that's another story. And that was last Friday.

This walled compound encircles a few blocks of a town, and whatever was located within before the wall was built is still here now, and in one way or the other, is now utilized by those with security clearances to do current business. For instance, there are the contractors that provide security from the US, and the houses we live in as small groups. We are grouped by our work detail. As the medical provider I don't have a group (more on that work place phenom later). So I live with the intel folks. The communal living concept is a lot like college, but without the alcohol, angst, or poverty.

The walls also encircled small businesses when they were erected, which of course are needed by those of us who live here: there are three restaurants and three tiny markets. Not having the liberty to go through the guarded gates to the greater world outside, this is where all food is found. The markets each have a crushing amount of inventory in a space the size of a motorcycle parking space. ...and what you don't see, the shopkeeper can get for you on the outside. See how easy that was?

In some ways the compound has contrasts and comparisons to a retirement community: Everything you need is in one very convenient and accessible space: a gym, a pool in the summer, a medical clinic. And then, of course, things you don't need in retirement are here too, such as bomb sniffing dogs, an armory, dozens of remarkably fit and trained marksmen, and a tactical command center.

Also, like a retirement community, there are veterans of foreign wars here at every corner. But instead of recalling events of 50 and 60 years ago, these men and women have memories of, say, last July, as well as recent years past. Both sets of veterans do have direct deposit checks arriving on time as well. One set is looking for the next Tea Party Meeting to complain how taxes are spent; these guys are looking for tax shelters.

Living in the compound does not have a cookie-cutter industrial feel, architecturally speaking. It's authentic; this did not come from a US issued blueprint of how to house a company in an unsafe land. Instead, it flows with the original urban landscape...right up until you hit that massive wall.

#6. That Light Looks Green....

Security clearances are not granted for any of the same reasons one may have achieved a parking spot under the awning at work ( which is the peak of the food chain in PHX). However, it was only with tremendous patience and professional reserve, that a Special Investigator endured what no man before him has ever done: he reviewed, in detail, the purpose and activities of every international trip I've taken in the past ten years. Nearly every one of these was because of Peacework Medical Projects. He did this in person with only cold water and fruit to sustain him. It took two and a half hours.

He never lost focus, but somewhere along the second hour he did seem to become a believer in the work that Peacework accomplishes. I appreciate this immensely. Not only did he accept that the work is credible, accountable, and consistent, but his expediency has hastened getting the necessary credentials to go to Iraq.

And the sooner I get there, the sooner I can set the dates for Peacework's summer 2012 efforts in Haiti. And that will be another foreign trip to explain to a future special investigator when the time comes to renew my security clearance...and that too will be special. Not spectacular, just special.

Peacework is worth the trouble. All of it, every time. It just comes in unlikely presentations some days.

It would appear that my next post will be from the Syrian Desert.

#5. Holding that Thought in my Home ER

My Home Base ER, the one I've called my own since 1999, is a special place. It's not just that I'm biased toward this irreverent, remarkably capable, uniquely challenging hotbed of mixed pathology and sociology. It really is special.

 While waiting for this Iraq contract to fall into place, I've returned for a few shifts of the experience at "The 'Vale".  We know it, love it, and sometimes less than love it, and we are fond of saying "Only at The 'Vale".

There's a reason this phrase has become commonplace. There is a reason this phrase is accurate. It seems that for every set of hoofbeats, there really is the occasional zebra, and the zebra may sometimes have a peacock riding in on its back. And the peacock may be playing a bagpipe.

Unfortunately, there is no zebra specialist on call for us. Anywhere. And no one will even discuss accepting the peacock problem without a zebra consult. The conversation ends each time before you can bring up the part about the bagpipe. (What's the bagpipe about anyway?)

This is only a part of what makes the 'Vale team so good. We overcome. Just get the zebra and peacock separate beds and figure it out.  Put the bagpipe in a belongings bag for later. The  translation phone, of course, get that out again, because this is not going to be our common language here, which is Spanish.

The peacock refuses a bed, thanks, just wants her oxycontin refilled, and a different ride home if we're keeping the zebra.  The zebra, being a zebra and not a horse, is mysteriously ill. He is his own worst historian, as if he just looked in a mirror this week and realized he was covered with alternating black and white stripes.

More hoofbeats. Horses this time. Herds of them. It's the bread and butter stuff of the ER: sore throats, lacerations, headaches, mental health crises, sprained ankles, chest pain, skin abscesses, abdominal pain, difficulty breathing, bleeding during pregnancy, drug overdose, skin rashes, fractured bones, the occasional gunshot wound, car accidents...pain, pain, pain in every way the body can hurt.

Our nurses triage and manage the flow and flood expertly. Every patient and every family gets roomed and ready to be seen by a physician or PA in a series of movements that is a coordinated dance. It may appear chaotic. It may sound noisy. But there is a willful system that functions gracefully despite superficial appearances.

Some come by ambulance to this Level II trauma center. Some come by private vehicle, and these drivers just do not check on the trauma level of the 'Vale before transport, which is why we sometimes get major trauma from the streets. This ER is a place to stabilize such a patient for further transport. Our docs do it best. Probably because they get plenty of practice.

So what about that zebra? A thourough work up was completed. With stripes growing more and more pale, he was admitted to the ICU with an anemia of unknown origin.  Lots of work to be done for his ailing animal. The ICU RN calls back to ask how we attached the nasal canula.

The peacock's pain was treated at the visit, non narcotic Rx, follow up provided, and no taxi voucher from the charge nurse. She found someone to come give her a ride. Unfortunately, there was not a chance to see which species arrived. Too busy. Hoof beats pounding.

It's noisy at shift change. There's an IPod that just met two extra powerful speakers. A patient has found the volume on the Sponge Bob channel. (He needed a chair for this.) Nurses are huddling to round on which patients are where, who is in transition, and who needs what care. They probably discuss other things too, but that's what I can relay here.

Then I hear above all of this from a registration clerk, as she pulls her chair under an open desk, "Hey, who left their bagpipes here?!"