Douglas & McIntyre

Book details:

October 2014
ISBN 978-1-77162-106-9
Paperback - Trade
6" x 9"
226 pages
200 colour photographs
Biography & Autobiography / Personal Memoirs BIO026000
$39.95 CAD

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Douglas & McIntyre


A Doctor on the Front Lines in Afghanistan

Excerpt / Additional Content

November 26 | This Is Why I Came to the FOB

The description in yesterday’s entry of the combat here was not complete when I knocked off for the night. I still needed to describe the most significant aspect: improvised explosive devices, or IEDs, which have been the cause of most of our casualties. As fate would have it, I can now speak about this from direct experience.

We had sent out a patrol in light armoured vehicles, and they hit an IED on their way back to the fob. Some of our men were severely wounded and landed on my medics and me within fifteen minutes of being hit. Forewarned of the seriousness of the injuries, we called for the MEDEVAC chopper before the wounded men got to the fob. This gave me much less time to work on them than I normally have in civilian practice. Fortunately, the combat medics had done outstanding work and had already bandaged the life-threatening hemorrhage sites. They had also administered narcotics for pain control, so the scene was far less chaotic than it could have been.

With the help of the medics and other troopers, I managed to reevaluate all the casualties, ensure hemorrhage sites were controlled and airways were protected (only one needed a tube), check their breathing, get them fluid resuscitated (started four IVs myself, more than I have had to do in a single day since med school), perform bedside ultrasound examinations on them to look for hemo/pneumo-thorax (blood or air in the chest) and intra-abdominal hemorrhage (all negative), get their spines stabilized and get them warmed up.* In less than a half hour, they were all on a chopper bound for KAF. I don’t think these soldiers will be back to active service, but they will all survive.

This was easily the most intense medical experience of my career. Until it happened, I had not fully appreciated the degree to which rapid helicopter evacuation would limit the time I would have to do my work. This realization hit me full force when, just as the casualties arrived at the fob, the combat team commander told me that the chopper would be there in about twenty minutes. There was also the unspoken, but nonetheless crystal-clear, expectation that I would not delay the helicopter evacuation of these men in any way. This did not change the fact that I wanted to ensure, as far as humanly possible, that I did not miss any serious injuries that could cause these patients harm during the transport. I had no trouble dealing with the wounds and the actual medical care—that’s what I have been doing for the past fifteen years, and it’s all quite automatic now—but I had to work faster than I ever have before. In civilian practice, I would have had twice as much time for a single patient.

The end result of this was that, as the helicopter lifted off, I was almost vibrating from the tension. Normal procedure at this point called for me to radio the KAF MMU to give the team leader there further information as to the condition of the wounded. This is exactly what takes place anytime an emergency physician transfers a patient to a surgeon: a verbal description of the case, including patient age, the mechanism of injury, the nature of the injuries, the care given to that point and the patient’s response to same. I remembered to make the call, but I was so frazzled that the only thing I could mumble out was: “You’ve got three patients inbound, two of whom will need immediate orthopedic surgery.” *

This brings us to the subject of soldiers and wounds. There are six fears that soldiers experience on the battlefield. The first five are dying, killing, sights and sounds, failure and the unknown. That may appear to be a fairly frightening and complete list. It often surprises people, therefore, to learn that when soldiers are asked which one they fear most, the overwhelming majority—more than 90 per cent of them—will name the sixth: mutilation and disfigurement.* The reasons for this are complex and have a lot to do with who soldiers are: young men, to whom physical prowess is vital. The bottom line is that soldiers are affected as much, if not more, when their comrades are severely wounded as when they are killed.†

The day’s events affected me in two main ways. The first difficult part was completely unexpected. When the combat medic called to give me his report, I could hear our soldiers screaming in pain over the radio. You may find this odd, but in a lot of years of taking calls from ambulance crews, I had never heard a patient in the background. It caught me by surprise and left me feeling a little unnerved for a few seconds, mostly (I think) because I realized I was hearing my own troops. That dissipated fairly quickly.

The second way I was affected was much more predictable and longer lasting. Seeing the terrible leg wounds on my fellow soldiers and knowing their legs might be amputated made me very conscious of my body, particularly my lower limbs. I spent a fair bit of time tonight looking at my feet and moving them around, as if to reassure myself that they still worked. I expect that will last a day or two.

I had the same reaction during the Nicaraguan war, where I worked as a paramedic. While I was there, I cared for a soldier who had had both his arms blown off to the elbows by a hand grenade. I had been in the war zone for several months by that time and had seen injuries that were far worse, including seeing people who had been ripped apart by direct rocket hits. But this man’s injuries affected me more powerfully than anything else I had seen. When he was brought in, I immediately thought: He has lost his hands. He’ll never paddle a canoe, rock climb or touch a lover again.

What can I tell you? I was twenty-seven years old—those were the things that mattered to me then (come to think of it, they still do). For a few months after that, I had a recurrent nightmare in which my forearms just faded away. I would wake up sweating and panicking and using each hand to try to find the other. Not pleasant, but it went away.*

A last personal observation. I have been a little surprised to find that I do not want revenge against the Taliban for killing and maiming our troops. It strikes me that it would be illogical to feel that way: they were having their little civil war here, and we came half way around the world to kill them. What were they going to do? Throw us a party? What I am furious about is 9/11 (and the twenty-five Canadians who died that day). I don’t buy the Taliban’s story that they were unaware of what Osama Bin Laden was planning. Even if they weren’t aware, I reject the notion that their code of hospitality precluded them from turning him over.

Even more than that, I despise the Taliban for what they are, for what they did and for what they continue to do to powerless people under their control. There is an interesting analogy to draw here with the work I do as doctor for the tactical unit (a.k.a. SWAT team) of our local police department. When the “Tac Team” goes up against a hostage-taker who is not of sound mind, they will go to extraordinary lengths to bring him or her down without the use of lethal force. And when lethal force has to be used to save the life of the hostage, these “hard men” take it very badly. A successful encounter is one that ends in an arrest or a psychiatric hospitalization, not a death.

I feel the same way about al Qaeda and the most radical elements of the Taliban. Their ideas are so diametrically opposed to anything I can imagine is rational human behaviour that there has to be an element of mental imbalance at work here. Be that as it may, they have to be stopped—and their hostages, the Afghan people, have to be released from their clutches. Their numbers and the degree to which they are supported make it necessary to use robust military intervention to achieve that. Going out regularly and killing these radicals gives time for the Afghans to build themselves up to the point where they can contain the threat themselves. When that happens, we can talk about negotiating with those insurgents whose motivation is more cultural or nationalistic. But there can be no negotiation with people as crazy as al Qaeda and the hard-line Taliban extremists, because negotiation begins with finding common ground. Halfway to crazy is not common ground. It’s still crazy.

The Foreword, by General Rick Hillier

If I have heard Canadian soldiers say, once, that they wish every Canadian, from coast to coast to coast, could spend one or two days in some of the hellholes these servicemen and women temporarily call home, then I’ve heard them say it a million times. They say it to express their frustration with the superficial concerns that Canadians are perceived to have for the rest of the world—that is, we must do everything possible to help, but not if it gets really hard or expensive or interferes with our lives—as well as their difficulty in articulating the difference between Canada and the rest of the world. These men and women who serve our country in our nation’s uniform want all Canadians—young and old, both those born here and those recently arrived—to appreciate what a great country we have, what an affluent life we live and why we have a responsibility towards those who desperately need our help, whether we find it hard or not.

Obviously all Canadians can’t visit or live in places like Afghanistan, but they can do it figuratively by reading FOB Doc. In this book, in a very real and emotional way, Ray Wiss fills the gap in our education concerning much that goes on outside our borders. FOB Doc leaves one feeling proud to be Canadian, emotional when reading about our sons and daughters who have been wounded or killed, and clear about the evils that lurk in our world—evils that sometimes need to be confronted, no matter the cost.

Ray’s description of his tour in Kandahar and of the variety of his experiences—from the trip to Afghanistan to the instant and overwhelming impact of sand and heat, his work at the Role III hospital, the vagaries of operational transport, insects and bugs, accommodation, and eating and socializing facilities—is so realistic that it puts us there, with Canadians that we know and with their friends from around the world. We are there during the boring times, in those minutes of sheer terror, at Christmas and while Ray’s comrades talk to their families back in Canada. If a picture is worth a thousand words, Ray has shown us that picture and has used the words to create an experience we all can share.

Central to this book, though, is something that is fortunately unfamiliar to the vast majority of Canadians—war and all its implications. Like Ray Wiss, surrounded by the images and stories of the men and women with him, we get to see, through his eyes, the toughness and professionalism of those Canadian soldiers, tempered by their absolute humanity and kindness. We feel, with him and with them, their pride in being Canadian, in representing in this far-flung corner of the world a country that Afghans can only fantasize about living in. We get to understand the equipment they have and use so well—not in the terms that come across on Discovery Channel, but in a way that lets us say, “Yeah, I got it.” We learn what an ARV is, and we connect with the young Canadians who operate the vehicle. We also get to feel the basic, rugged accommodations, the “bagged” meals that, although tasty, get monotonous after days of nothing else.

We come to see that human side of soldiering, when being killed or killing is something you deal with day after day. Ray unveils for us the historical truths of men and women in combat and of how they respond: with incredible skills, honed as never before in history and enabled by cutting-edge technology and with compassion that avoids hurting the innocent Afghan victims caught in a war zone, even if that compassion means letting Taliban fighters escape—knowing that they will return to attack you again.

Ray puts us in the middle of the gallows humour that develops in these environments. Instantly, we go from that humour to grief, farewells, coping and remembrance with our national treasures in uniform when they lose their lives, whether because of direct fire, faceless roadside bombs or heart-wrenching battlefield accidents. The scenes at the unit medical station in FOB Lynx or FOB Leopard, or at Kandahar Airfield during a ramp ceremony, are all too real and unforgettable. In short, Ray puts context around what many Canadians do see about Afghanistan—the return of Canadian soldiers in coffins.

FOB Doc, however, is not only about the daily life, the grind, dedication and sacrifice of Canadians and their allies and friends. It also is a picture of the very soul of Afghans, those most persecuted of people living in one of the harshest places on earth, unfortunate enough to exist at a crossroads used by invaders since time immemorial. Whether it deals with the Afghan National Army soldier’s stoicism after wounding, the humour that comes from encountering those “different” individuals that always seem to be present in a crowd, the brutal regime that was the Taliban or the pitiful existence of children caught up in violence—often without family support structures and, most sadly, without hope—this book’s descriptions and photos of ordinary Afghans are compelling. Rare is the Canadian who will not be moved by their terrible circumstances and their challenges in life. Even rarer is the Canadian who won’t compare his or her own life of ease and, yes, luxury, with that of the boy who has a burned body and who will be handicapped for life, when relatively minor surgery could have lessened the impact. This, in a country where one’s physical abilities often mean the difference between life and death!

It was easy for me, after much time in Afghanistan, to relate to the stories and descriptions in this book and to believe that Canadians would find it enthralling. So I used as a test case the reaction of my wife, who picked up the book without knowing what it was, started reading it and could not stop. She thought the book was amazing. Ray, she believed, had put a face on a country, people, mission and sacrifice in a way that brought it to life, putting into context much of what she had heard or seen elsewhere.

Ray poses two questions as he returns to Canada, to his family and their happy and complete life. Two questions that all Canadians should consider and answer. First: are the Afghan civilians—those men, women and children, hardworking, dignified and dirt poor but still with a sense of humour, hope and determination that puts others to shame—worth protecting? Canada’s government, on behalf of all Canadians, has determined that they are. Canada’s soldiers, those who bear the brunt of that determination, believe that also, and their actions—not words but actions—articulate Canada’s belief. Most Canadians agree and support that action.

The second question is a little more troubling for many Canadians. Is the Taliban so bad, so evil, that it must be confronted with lethal force? For Ray, the answer is an emphatic “Yes.” Somehow, Canadians in many parts of our sheltered society, in our well-maintained cities, snuggled inside our “cradle to grave” social care system, often too uninterested to exercise basic rights such as voting for their representatives in an election, seem to think that violent, murderous men (and the occasional woman) can be influenced, neutralized, removed or persuaded to adopt peaceful approaches through diplomatic, financial or developmental pressures. Ray strongly disagrees with this premise. He closes his diary by asking readers who are unsure about the mission or who oppose it to inform themselves as well as possible. Overwhelming proof of the immorality of the Taliban, through evidence of evil, violent actions and of the need to confront them militarily, is there for all to see. Unfortunately, for most Canadians, all they know of the mission comes from the media focus on our casualties.

Doc Wiss has lived it. And through his eyes, in his words, shaped by his evident common sense and supported by his pictures, all Canadians can live it too. Canadians can better appreciate their country, which tops the UN charts, after “visiting” Afghanistan, a country on the bottom of the charts, through FOB Doc. I encourage you to read this book, to think about what it is to be Canadian in the context of this story and to encourage your family and friends to read it. And I encourage all of you to give thanks for men and women like Ray Wiss and the comrades he describes.