War Surgery in Afghanistan and Iraq

While the U.S. government has tried its best to censor a textbook of military medicine as experienced in Afghanistan and Iraq, authors Dr. David Lounsbury, Dr. Stephen P. Hetz and Dr. Shawn C. Nessen have succeeded in bringing it to bookshelves, at least virtual ones like Amazon.com or the Government Printing Office.

In a New York Times Article on 5 August, journalist Donald G. McNeil, Jr. discusses what it took to get the book published by the U.S. Army, of all outfits. With the help of surgeon generals, the authors were able to present the book with the photos and captions they intended, acquiescing only on the issue of covering the eyes of the wounded who did not give written permission to be included.

“War Surgery in Afghanistan and Iraq: A Series of Cases, 2003-2007,” is not for the faint of heart. With sometimes gruesome photos of missing limbs, bomber's ribs sticking out of injured soldiers, blood, guts and gore, the authors have pulled together a handbook of the latest findings of battlefield surgeons in our most current conflict. Their hope: medics will hit the ground with a more realistic and accurate understanding of what to expect and will benefit from the knowledge learned by others on the front lines of how to best treat the injured. Often, the old ways are no longer the best ways, at least not with the kinds of injuries and resources available under a medical tent in the middle of Kabul or Baghdad.

I first learned of the book's publication from an email I received from Dr. Lounsbury (who contacted me based on a connection we made when I worked for conflict photographer James Nachtwey). A retired colonel, Dr. Lounsbury took part in both invasions of Iraq in the past two decades, and edited military medicine textbooks at Walter Reed Army Medical Center. According to Lounsbury, the book has garnered attention not only in the New York Times, but also NPR and the BBC. In response to the article in the Science Times section of the NYT, Lounsbury says that he agrees, "with the tenor of the article that 'Americans who choose to do so have the right to see ...the human cost of war'."

I haven't put my hands on the book as of yet, although I plan to. And to share it with as many of you as can stomach it. It's as important a tome as Philip Jones Griffiths' Vietnam Inc., if not more important, given that the warfare it depicts rages on and the book could possibly impact how the wounded - soldiers and civilians, allies and enemies - are cared for. Even better, it could prevent greater loss in the future by bringing our troops home.

Marching to Zion

Well, it doesn't get much more beautiful than this...on a bike, on foot, in a car. No matter how I took this turn, I was awe-struck each and every time.

While some of us had our reservations about heading to Mormon country in southwestern Utah on the annual Black Sheep Adventures "Epic" bike tour, we all returned to the Bay Area as Zion converts. Bryce and Grand Canyons were pretty gorgeous as well, but neither was as majestic as Zion.

Day One: Flew Oakland to Las Vegas. Laura made a new friend with the Southwest flight attendant who wore my helmet while giving safety instructions. I wore it the rest of the flight to make Bubba feel more secure for our inevitable crash landing. Drove from Vegas to Brian Head, a ski resort town at over 10,000 feet in Utah. Reluctantly saddled up to ride a 6-13% grade up to Cedar Breaks National Monument. Great wake-up for the legs (and lungs!) at altitude.

Day Two: Back up the pitch only this time at the top I managed to fall off my bike while looking back for Wendy. Proceeded to vomit. Lovely. Then we went down hill for most of the rest of the way toward Bryce Canyon National Park. Spent a number of miles on a rolling bike path below Hoodoos and red rock, past natural stone arches and beautiful cliffs.

Only interruptions to an otherwise pleasant ride: a sheep crossing (actually, that was a highlight) and an electric storm during the 18 mile climb up to Rainbow Point (okay, that was a highlight too). Nothing like riding uphill through a lightning and hail-size rain storm to feel invincible and kick ass. The nasty hot chocolate recovery drink which Becky, Pat and Laura stirred using Nutter Butters almost made me vomit a second time.



Praise the local non-Mormons at Wasatch Brewery for their Polygamy Porter and Evolution Amber. Washed down the day in style.


Day Three: You'll never guess. Back up the 6-13% grade past Cedar Breaks National Monument for another series of lovely descents to Zion National Park. Easiest riding day of the trip, with easy descent down a not-too-busy State Road 89 and the most lovely ending of any day. See this YouTube video of the road into Zion from West to East. Riding 12 miles along gently inclined road into the park was rewarded with the majestic and monolithic walls of rock surrounding us. Even the 1-mile ride through the tunnel (finished in the 1930s, amazingly) was a superlative experience. Finished up poolside at the Majestic Lodge 2-miles on the other side of Zion in Springdale, UT.

Day Four: A rest day, if so chosen. None of us did, though, with Zion in our backyard there was no way we could stay at the lodge and rest on a few days' riding. Three of us rode the 18-miles roundtrip back up State Road 9 (Zion Mt. Carmel Highway) to the entrance of the tunnel, through which bikes may not pass. Our pre-dawn ride (thanks for the company, John!) was a great start to the day.

After joining the rest of the crew for a cup of coffee, I caught the free shuttle that takes visitors back into the park and disembarked at the entrance to the Emerald Pools trail. Sometimes steep, sometimes shaded, the short 2-mile trail looped me past rocks that wept water, with "hanging gardens" of green vines and flowers thriving along the rock face. Wow. Such life in the middle of the desert.


From Emerald Pools I ran a couple more miles to the trailhead of Angel's Landing, knowing my compatriots would soon come along the same way. Slugging up 21 steep switchbacks known as Walter's Wiggles (some had to be at least 18% gradient), I got to Scout's Landing breathing hard, sweaty and dusty with disposable (!) camera in hand.


Realizing I had arrived far ahead of the hikers in the group, I took a detour and explored the 5 or more miles of the West Rim trail, looping back to Scout's Landing and getting further encouragement from the many foreign (mostly German, French and Italian) tourists who had cheered me on as I ran up the endless switchbacks earlier. Together we made the final .5-mile ascent up the cliff to Angel's Landing, proper.

Traversing a rock face with large-gauge chain bolted into its sides for hoisting only the most intrepid traveler past its sheer drop-offs to the left and right, the sheer ridge brought me, out of water but full of excitement, to a most beautiful panoramic view totally worth the work it took to get there. Topping out at almost 5,800-feet with an elevation gain of almost 1,500-feet over 2.5-miles, the trail is considered the most challenging of all in Zion, although, amazingly, one of the most popular. A couple of strangers re-hydrated me and took my photo (see here...doesn't even look real, does it?!).


As I slowly climbed/slid/shuffled back down the ridge to the landing, I passed my buddies from Black Sheep and choked down a Gu. Replenished, I ran the rest of the way back down to the valley and along the Virgin River to the visitor's center at the eastern entrance to the park near Springdale. I had time to buy some lime tortilla chips and local salsa and diet coke, and make a stop in at the photo museum. Hopping back on the free shuttle, I made one more stop - at the Human History Museum - where I found a pack of my favorite Trident gum on the floor of the theater (yummy for a dry mouth after a 15-mile run!) and watched a 20-minute video of Zion.

The crew met me back at the pool at Majestic Lodge in the early afternoon but only Fana showed for supposed water polo match. She gave me a long lesson in the sport, instead, which was fine by me! She played at Cal, has coached in California at the collegiate level, and played for a few years in Australia on their National Team. Now I can watch water polo in the Olympics and have a chance of understanding!

We ended the day with a Barbara-64th-birthday-surprise (brownie sundae) at Oscar's, a Mexican restaurant in town. Check out our series of hat photos (link below) we took while at the Majestic. The beer or the views must have gone to our heads!

Day Five: Bummer, time to put that sore butt back on the saddle and climb back up to the tunnel in Zion. We unanimously decided to start our day earlier than usual to beat any traffic riding through Zion. The plan worked and we saw only a handful of cars in our first 30 miles of the day. Kath kept me entertained on the road out, Mark came by with his usual witty remarks and nice push from behind as we made our first real climb of the day toward Kanab and Fredonia (which, BTW, is the name the group decided to give to Fred/Becky/Frecky's unborn child).

The 30-mile slow incline along 89A to Jacob Lake (elevation just below 8,000-feet) in Arizona's Kaibab National Forest. After crying on the climb from the pain that started in my left gluteus and rand down to my toes, I was beyond consolation even at the end of the ride. The rooms at the one inn in town (which also served as gas station, restaurant and convenience store) weren't ready for us, so I took a nap next to Barbara on an old sofa-chair.

Once we got settled in, the majority of us caravanned out to Marble Canyon, the Vermilion Cliffs near Lee's Ferry and the Colorado River. Rapid brown water was a bit daunting, so we drove further in and found a damned portion to wade in before chasing another electric storm (see the rainbow shot) out of the canyon and back to Jacob Lake.

Day Six: Our last full day on the bike started with a lovely climb (thanks, Mark, for making my glute capable of enjoying another climb) and sweet time-trial-worth stretches through aspen forests and green meadows. A straight-shot on State Road 67, 45 miles to the north rim of the Grand Canyon. Once there, all but Wendy decided we wanted to explore/hike/photograph and so hung-up our bikes on Fred's truck and went to play.


I couldn't leave Bubba alone for too long, so after about an hour, I climbed back into the Suburban with Fana and we became the Bubbster's personal support vehicle. She booked back to Jacob Lake, covering the 45-miles in under three hours. We all survived a stinky/sweaty/hot ride to St. George near Vegas where we spent our last night at the new La Quinta there. Opening ceremonies of the Beijing Olympics, a local beer and a filling dinner delivered by the local Pizza Hut put us nicely to sleep.


Day Seven: Having to leave the hotel by 9am to catch our flight at the Vegas airport, a few of us went for runs (I was nearly run over by semis in the dark of the morning, but joyously discovered ATV trails across sand dunes to run on once light came up) or short rides, met for continental breakfast and packed up. I slipped in my daily dunk in the pool and then away we all went. Sad!!!

Poor Fred and Fana drove the van back to Berkeley while we flew home and all took long afternoon naps before retrieving our bikes and gear from our fearless leaders. Another Epic week with Black Sheep ... until next year!
Photos of trip available on my Flickr page under the Black Sheep Adventures Collection of albums. And our Fearless Fred the Leader posted a fun video on YouTube.