Talk to Me Like My Father: Frontline Medicine in Afghanistan
In Afghanistan as well as Iraq, the military is running out of doctors to patch up wounded troops—and civilians caught in the crossfire. One doctor's frontline diary from Kandahar.
it's late january, and on my way to Kandahar I stop at a facility called Camp Mirage that sits on a clear desert highway and shimmers in the early afternoon heat. It serves as the support base for Australian, New Zealand, and Canadian forces in Afghanistan and the Persian Gulf. The camp exists, and yet officially does not: The Host Nation does not acknowledge it, forbids its mention publicly. Uniforms must not be worn off the base, nor may taxis be hired to bring personnel back from shopping trips in the closest city. Soldiers who've served their six-month tours and are at Mirage awaiting flights home affect postures of world-weary and taciturn indifference, while the 19-year-olds coming in gaze around slack-jawed.
Thirteen years ago, I was a captain in the Canadian army, a medical officer in an artillery regiment, and bored to the point of catatonia. I had enrolled for a tour of duty partly in an effort to pay for medical school, but I was also drawn to an entirely fantasized idea of distant deployments and U.N. peacekeeping, anything to get me out of dusty and predictable Manitoba, where the idea of exotic exists only in the context of dancers in Saturday-afternoon bars. As it turned out, I was attached to a base in Shilo, Manitoba, a vast, windswept expanse of whitewashed clapboard huts tossed up during World War II. I was 25 when I arrived there, and had 400 young men and a small clot of aggrieved women to care for. They were none of them sick. If any one of them had anything in the way of important illness, they would have used it to insist on a posting to a city. My day's work was done by 9 a.m. The rest of the day, I napped on my desk. Little puddles of drool accumulated beneath my chin.
Today, after years of sitting on their hands in Kabul, the nato-led International Security Assistance Force (isaf)—especially Canadian, Dutch, and British forces—has moved into the southern provinces of Uruzgan, Helmand, and Kandahar to wrest control back from the Taliban. For Canada, which closed its last military hospital in 1998, it is like nothing since Korea. It quickly became clear that uniformed personnel were too few to staff the Canadian-run combat surgical hospital at Kandahar Airfield. An appeal was put out for help. Within a few months, several nurses and doctors with whom I work on Vancouver Island had all signed up for brief rotations for the Kandahar icu. I did too.
Is There A Doctor On The Base?
10,853 U.S. physicians and dentists served in Korea, fewer than half via the "doctor draft."
30,000 U.S. physicians and dentists served in Vietnam. Only 100 had been drafted.
Today, the U.S. Army has 4,200 physicians on active duty worldwide.
There are 32 active U.S. military doctors serving the 25,000 U.S. troops in Afghanistan.
There are 96 physicians, 18 general surgeons, and 9 orthopedic surgeons serving the 146,000 U.S. troops in Iraq.
The U.S. Army has 2 pediatric surgeons.
20 children are seen at the Bagram Air Base hospital in Afghanistan each month.
The U.S. National Guard is offering health care professionals $30,000 in bonuses for three-year commitments.
Canada offers medical officers enlistment bonuses of up to $225,000.
—Nicole McClelland
I board the C-130 Hercules along with soldiers from the 2nd Battalion, Royal Canadian Regiment. There's an air of taut and humorless anxiety I do not recall from my own days in uniform. I wear a Kevlar helmet and body armor over my jeans and sweater. The other two civilians aboard are an agitated bouffant-going-gray foreign-service officer and a lithe goateed man who, when I ask him what is bringing him to Afghanistan, replies, "this and that." He could be a hairdresser or software engineer but for a certain exaggerated yet quiet intensity. He says his name is Greg. The foreign-service officer asks him how long he will be in Afghanistan. "Two, three months," he says. She nods, and begins telling animated and self-congratulatory stories of her last spell in Kabul. He listens but doesn't pay her much attention.
Three and a half hours later we begin our descent into Kandahar Airfield, a giant base from where isaf coordinates its attempts to control southern Afghanistan. It is from Kandahar that the Taliban first emerged in 1994 and where it finds succor today. Kabul is now almost safe: Girls go to school; the markets are full. In Kandahar, where the cloak of the Prophet is kept, bicyclists explode themselves next to soldiers trying to build roads.
After landing, we're ushered into a devastated hangar, where tendrils of aluminum roof sheeting hang down like crepe paper; Mars glows red between the largest of them. A company sergeant major approaches and asks who I am. "Well, why hasn't the hospital sent someone for you?" The foreign-service officer walks around in tight, quick circles asking pointed questions of her BlackBerry. "Greg" has slipped away quietly. Detecting little in my bewildered response to satisfy him, the sergeant major barks into a telephone. A few minutes later a medic arrives to drive me to the hospital. Nobody naps on his desk here.
past midnight, I'm deposited in my barracks and meet the other doctors: a mix of Dutch, British, and Canadian officers, as well as a Canadian civilian radiologist, and the icu doctor I'm replacing, John Ronald, with whom I work on Vancouver Island. After a burst of enthusiastic welcome, words run short. I've been flying for days. I crawl under my coarse woolen blanket. An instant later, I wake myself up with my own snoring.
The next morning, John shows me around the recesses of the jury-rigged hospital, part tent and mostly unpainted plywood. The toilets are in a prefab metal container. There are two operating rooms and the only ct scanner in the entire province. Within this construction-site ambience work two surgical teams: one Canadian, the other Danish or Dutch, which alternate every two to four months. Also present: British, Australian, and American doctors, nurses, and medical assistants; morning rounds have the sort of internationalist air that Madrid might have had in 1936. ncos don't bother saluting officers here—no one can figure out the myriad of rank insignia present on the base.
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I think you really missed by not posting the picture of the wounded child shown in your hard copy. I think better than the one you did use, if you could use only one. For what it is worthy.
Thank you for this beautiful, in its bittersweet way, article. You show the humanity of all those involved and the complexity of the situation. May the day soon come when there is peace in that country.
Beautifully told account of a war that is hardly covered in what our US media calls "the news," and is mostly the latest breathless goings-on of celebrities. I'm going to forward this to lots of friends as eager as I am for real news. Thanks to Kevin Patterson for writing it; thanks to Mother Jones for running all seven pages.
I think this article should be removed. How awful to read about the death of your son and what the Doctors did to him on the operating table in great detail. What the Mother and Father must be going through . Its horrible enough to loss a son over there. They do not need the details of the operating room.
hoping for the best care of our troops.
Dr.Q
The name of the wounded soldier and the graphic details of his medical treatment should be removed immediately. This is a flagrant violation of patient confidentiality and medical ethics. I will write directly to Dr. Patterson regarding this.
please remove the article on kevin megeney. the tragedy of his death hurt family enough. those details of his death does not help our grieving process.
I must say that I understand why you have done what you have done here. Of course it is your job to sell papers but have you even taken into account the family of Kevin Megeney or indeed the officers and soldiers of his unit? It has been an extremely tough time dealing with the death of such a great young person. A person who so willinging volunteered for this job to protect the values that we hold dear. I ask that you take this into account and remove such details from your article so that we can continue with our healing process!
When I read this article I was completely shocked, I can't believe these graphic details r made public. Kevin's family is suffering enough, they don't need this!! My niece is Kevins niece and a 16 yr old can get into these articles pretty easy, please remove it!!
PATTERSON: You're nothing more than a crude, insensative bastard.
You have a Nice Day,too !
Greg
My heart goes out to the Megeney Family. Having to deal with the death of a loved one is hard under any circumstance, but having read the horrific details is reliving the death all over again. DDid you consider the family when you wrote this?
Did you know before this article was published that NO ONE in Cpl. Kevin Megeney's family was aware that this article was being published?? How irresponsible of you as a "news organization" to do such a thing. Do you not investigate such things before you publish??
I also hope this doctor is dealt with at the highest level. I am not a doctor but I know about patient-doctor confidentiality. I hope his license is taken away for ever and that the family sues him for everything he has or ever will have.
I have never read your publication before today and trust me...never will again. I will also encourage others to do the same.
Shame on you...I hope you get sued too.
Disgusted.
Ed MacIntosh
I cannot believe people feel the need to print this tragic yet graphic story again and again, The family must be heartbroken, and thus feeling very betrayed, and to think all the while this sits in print someone is making money off it. Being ex- military nothing surprises me anymore. God Bless
As the co-editor of Mother Jones, I would like to make a few things clear in regards to the part of this story that involves Cpl. Kevin Megeney.
First, we sent a letter to Cpl. Megeney's parents, uncle, and sisters, ahead of publication, informing them that this 7,000 word diary of a doctor's month of service at Kandahar Air Field did contain a scene involving the tragic death of their son. That it was written by a doctor present when Cpl. Megeney was brought in for emergency surgery, and that it would likely be disturbing to those close to him. We offered to send it to them or any intermediary they would like if they thought it would be too disturbing to read it themselves. I then spoke with Mrs. Megeney by phone at length. She assured me that the family would like to see the article, and that she was a nurse and would read it before any other members of her family; she said it would help to have closure to know more about what happened. We heard from other members of the family who also wanted to read it, and some whom after they did expressed the desire to write to Dr. Patterson "to express my appreciation to him for exhausting every effort to save [him]." They asked that we link to Cpl. Megeney's memorial site, which we were already planning on doing, so our readers would have a chance to express their condolences.
As to the question of anonymity: The death of Cpl. Megeney was an extremely well covered story in Canada. There was no way to write about the incident and not have it be instantly clear to any member of his family or any member of the Canadian press, or anyone who'd followed the story who we were talking about simply by omitting his name. So we felt it would be false anonymity at best. Doctors can and do publicly talk about how patients die when the story is already in the news--consider press conferences following tragic accidents. And there was certainly nothing in this account that disparaged Cpl. Megeney, who served his country admirably and died in a tragic accident.
This was an extremely emotional story to work on. The account of Cpl. Megeney's death was particularly poignant, but there were many other stories in there of death and injury to soldiers and civilians that are hard to read.
But in our opinion for the greater public to live in denial about what happens in a war does a disservice to those soldiers who serve and the civilians who are affected.
Clara Jeffery
Editor, Mother Jones
I find it hard to imagine that the Megeney family would be anything but grateful to Dr. Patterson for fighting to save Kevin Megeney's life and writing such a poignant account of the horror of his death. Hard to read? Yes. Although the real tragedy is that these soldiers deaths are so easy to ignore. it isn't pleasant, but we all need to open our eyes and see what is going on in Afghanistan and not forget the sacrifices these young men and women make.
Hey American Canadian, STAY IN CANADA!!!
The sooner the US-led occupation troops get out the better. It's been six years of virtually no aid to Afghanistan (outside of Kabul aka Potemkim city) so even the most die-hard apologist for the Rape of Afghanistan should be able to see that the West has no benign intentions what-so-ever towards this poor blasted land. Withdraw and apologize for destroying yet another defenseless country
A very moving piece that I am glad was written and read. I'm having a hard time deciding whether or not our soldiers should be in Afghanistan, and I shrivel in horror every time a soldier is killed there.
There are so many things that are hard to understand, but I understand the humanity and pity of the author.
Thank you for sharing with us.
If honest reporting were the norm, readers would not be so shocked when faced with stories of life and death. As a culture we have dulled our senses into a tele-play stupor. Until we are willing to face the violent truths of our actions, we cannot hope to change them. Bravo for seeing and writing with clarity, the life-seeping violence, the bravery, and the gentle grief of life in a war zone.
I have a loved one whom has just left for kandahar yesterday, Although this article is very graphic and detailed and somewhat hard to read, I do have to say that I am happy to know there are doctors and medical staff over there willing to give it there all to try and make sure our soldiers make it home alive.
i think the Megeney Family should be proud to have the actual details revealed as in this article,but most of all-they should stop acting like he's still alive on his website,get over it,get either closure or get to a phsycarist's office for some counselling.
to pictou county girl,Jackie in his/her post said it all,with the family and friends comments on Kevins website,how in the world can they ever stop grieving,face it-if everyone down there stopped this talking to the dead,the Family may get what they need,maybe seeing as his Mother is a Nurse,she can realize the damage you are all doing to Her Family.
RIP
I was a close friend of Kevins. And am writing from Afghanistan. And to "Jackie" i say how dare you tell a family to get over something so tragic. It isnt something you can get over. First hand experiance tells me that it doesnt take time, and you cant ever accept it. Unitl you come to this country i think you should keep the attempts at controversy to yourself. i have no issue with the article just the mindless [deleted] people like "jackie" will write out of ignorance.
But John Williams,you have to admit-The Family does need Counselling in the worst way after reading Kevins website,to chastize the truth shows no Honour for the Bereaved.
now John-seeing as you say your a close friend,and in afghanastan,would you like to fill us in on which Other Close Friend Pulled the Trigger?
Arthur Nova Scotia, that comment was way over the line and I'm going to pull it. Please, everybody, no matter what your feelings are on this article or the war, have some sense of decorum. The family is entitled to grieve in whatever manner works for them. --Clara Jeffery, Editor
August 3, 2007
Open letter to the Canadian Forces
Re: Dr. Kevin Patterson’s article in July/August 2007 Issue of 'Mother Jones'
I am writing with regard to the ethical issue of the confidential medical information that Dr. Patterson has shared in a public forum without patient permission.
There was a report in today’s New Glasgow 'News' that:
“Lt. Cdr. Pierre Babinsky, a legal services spokesperson for the Canadian Forces, said military officials were aware of the article, printed in the magazine Mother Jones when it was published.
Babinsky said one of the investigations, conducted by military police, will determine if there were any breaches of protocol regarding information laws.”
I contend that even if the investigation shows there was no breach of “information laws” the article written by Dr. Patterson and published in Mother Jones does breach this physician’s code of ethics with regard to patient confidentiality.
Some would suggest that Dr. Patterson or the Mother Jones publication should not have used the name of the soldier in question when he wrote a detailed description of the death. This would not have made the article any more acceptable as it is too easy to identify this soldier, as well as any of the others soldiers, about whom he has written.
Perhaps the soldiers who are still living gave permission for their stories to be shared by Dr. Patterson in his writings but we know from the family in Stellarton Nova Scotia that they were not asked to give permission for the story of their son’s death to be published.
All health care professionals are bound by their particular profession’s code of ethics. All codes of Ethics hold confidentiality as a cornerstone. The details of military personnel injuries and treatments came to Dr. Patterson because he was privileged to be providing care to these patients. That privilege gives him a responsibility to hold this information in confidence and only write about these experiences with the expressed permission of patients or, if they have died, of their next of kin.
Not only is this an ethical issue it is a professional practice issue. Dr. Patterson should be reported to his professional college.
Sincerely
Cathie Watson BN MHSc (Bioethics) RN
Pictou County, Nova Scotia
cc. Mother Jones
The News
The lack of compassion on the part of Mother Jones is shameless. The point could be made without wanton cruelty. Shame for your war profiteering.
Your story honestly depicts the horror and ugleness of war.But it also depicts the fight Doctors have, to do all they can to help our boys,who become men too soon.Having three sons myself, a loss of anyone of them would be unbearable .But it would have been a little easer to know honestly that all had been done.We sometimes forget the war within a war that the Doctors and medics fight.The horrors honest reporters face when they try to answer and report about the face of war.A lot of them are young people and boys too.Please give them the the same prayers and compassion we give all in that hedious war.Like the fallen Hero reported here ,they too have parents that have read the criticism of this report.A report that was honest .The face of war is washed each day by tears of millions.Harsh judgements could possible one of the seeds that fertilized with chritizems help create the stories we read about.My prayers are with the familys but also with those who see such horror every day and help and go on.Boys yet that may die helping and keeping us informed .
Thank you, Doctor Kevin Patterson, for letting us know a bit about what the military involvement by the Canadian government, the theorists in white shirts in Ottawa, in Afghanistan actually means to the people directly involved - our young men and women.
I doubt the authenticity of this article. As a serving soldier it sounds very Walter Mitty-esque, and certain parts I know for certain to be false.
Wonderful and insightful account of the horrors of Canada's involvement in Bush's war.
Clara Jeffery: Thanks for publishing Kevin Patterson's piece. I found it very moving and informative, and extremely well-written. His treatment of Kevin Megeney's death was appropriate and very respectful of that young soldier.
I am a former Canadian daily newspaper reporter and editor. I am now a historian, one of whose specialties is military history (and who was a journalist involved in military matters)and who has personal ties with the Canadian military.
As you know, and as I experienced, with stories such as this you often get knee-jerk reactions from readers who claim to speak for "the victim" or "the family." Those reactions I have often thought were quite off-base.
Anyway, thanks to you and to Dr. Patterson, who is a very, very good writer.
The poster 'No' says nothing has been accomplished in Afghanistan. Tell that to the more then 4,000,000 refugees who have returned home; I mean they should have stayed in their tent cities right. Tell that to the millions of children, including young girls, who now have a chance at a better future through education. Tell that to the families of the over 40,000 children who didn't die last year due to the decrease in infant mortality rates; a direct result of the west's intervention. Tell that to all the children who will grow up not having to deal with the scourge of polio due to the immunization programs that we've established. Tell that to the villages that now have clean drinking water. I could keep going on and on but if you need more evidence of the good work that is being done in Afghanistan then maybe you should take some time to educate yourself.
Maybe you are you one of 'those people'. You know the kind, they don't think Afghan's are worthy of one Canadian life or maybe you believe that we live in a utopian world were there is no need for men with big guns. If you are then just say it loud and say it proud.
For now I will give you the benefit of the doubt here in that you are probably just ignorant of the facts.
P.S. Thanks for the article Mother Jones
This article tells the truth of one side of war - what injury and death are all about. The editor says that she did check with Megeney's mother and she agreed to the publication of this material.
Canadians should know the truth in all its details.
Please pull the story of Cpl. Kevin Megeney's death. The family has been through enough already. The event of his death was a tragic event, no one wants to read about it in a news article. RIP Kevin
Bob, I'll get all the double posts taken down. But it's the weekend so that might take awhile. Sorry everybody. Especially if this post appears four times. Also, just hit the submit button once.
Just a question: How come my post keeps reappearing? I didn't do that, as far as I know, and I am not computer-illiterate (but not according to my son, who works for Dell).
Hi Clara: I do hit the submit button just once. I am not so dumb or inexperienced to do otherwise.
Maybe your computer has become infatuated with me and wants to begin some kind of weird relationship.
Good luck at handling the comments on the Globe and Mail's board. You are actually getting an easy ride compared to some on those boards.
As I have said, I think you did absolutely the right thing, and I will defend you against the naysayers who do not bother to think it through.
Best wishes, Bob.
I have spoke to the family concerning this issue, and once again the media has made a complete mess. They are very appreciative for the efforts the medical team put forth to try and save their family member. The only issue concerning this article was that they would have wanted to see it before it hit the stands. THATS IT!!! They have not asked Mother Jones to pull the article and I see by peoples comments its actually the general public saying to pull the article. Not them. But the media loves to stir the pot, and in this case they did a good job. People on here attacking and criticizing the way they grieve? Why? What does it matter to anyone how the family handles their loss? Is your life going to change any? Did it make you feel good after you made your harsh comments?
This is being blown way out of proportion, and is on the verge of ridiculousness. My understanding was that this comment option was for stating your opinion on the article, not whether you agree with the way the family is grieving. I would think Mother Jones staff would agree, although by seeing how they've published comments regardless of content, it almost looks like they are condoning an attack on a grieving family. Which I would hope is not the case. I also tried to access the website moments ago, and I see it is no longer accessible, after reading this comment section, I need not ask why. Mother Jones for your magazine alone, clean up your comment section, people can agree and disagree intelligently without personal attack.
Bob
I'd explain what causes the multiple posts, but I'm afraid it might encourage some mischievous soul to use that technique inappropriately.
Insensitive beyond belief. Patterson is a smart ass with no profession ethics and Mother Jones is a profiteering rag. Hope you all read something similar about a member of your own family one day.
Hi moderator: Thanks for your response. I understand your nervousness at supplying specifics. However, I am curious. If you want to tell me, I have a hotmail email account, yeoldepoges at hotmail.com
I am very sorry that you have had to remove the link to Kevin Megeney's memorial site. I think that is tragic, and is one of the very unfortunate features of this modern communication called the Internet. I sympathize with all you who have to try to handle this.
Please keep up the good journalism that has been a feature of Mother Jones since its inception (which I am old enough to remember).
Best wishes, Bob Beal, Edmonton, Alberta.
I am a Reservist in the Canadian Infantry and I am also a 3rd year medical student; I found this story at times absolutely brilliant, starkly grotesque, depressing, and uplifting....Thank you for giving us a personal account of what it is you have experienced as a medical professional in a war-torn nation and also for volunteering to help those that need help the most, whether it be innocents, opposition fighters or coalition forces.
In my opinion, this was an excellent read.
I expect more out of Mother Jones. Sharing this story with the solider's name serves no purpose other than to further the pain suffered by the soldier's friends, family and fellow soldiers. Shame on this publication and its editors.
Martyn: Every article in Mother Jones undergoes rigorous fact-checking. Saying you "doubt its authenticity," while not saying who you are, which unit or army you serve with, nor what specifically you question is a red herring. The facts of Dr. Patterson's article is not in dispute, by the Canadian government, the Megeney family, or anybody else. If you have specific concerns state them and they will be addressed to your satisfaction. Otherwise you engage in anonymous slander and such posts will be removed. --Clara Jeffery, Editor
Dr. Patterson - Thank you for your efforts to keep our Canadian Soldiers alive in Afghanistan.
MoJo - Thank you for bringing the reality of war to light by publishing this article.
Canadian Troops - Thank you for all you do. I pray your lives are never put at unnecessary risk or taken in vain.
The Megeney Family - I am sorry you have to re-live the pain of the loss of your son. I know you are very proud of him.
Kevin - Rest In Peace my friend. I am glad to have known you.
Clara Jeffery, Mother Jones' Editor here.
Thanks Barb from Nova Scotia: I just had the link to Cpl. Megeney's memorial site pulled at the family's request. They were rightfully upset that some people here mocked their private expressions of grief there.
We'd originally put it up at their request, because we thought our readers would like to express their condolences. It's really sad that the "Jackies" and the "Irenes" of this world, whose comments have been pulled, have to act so completely inappropriately.
We've been having some technical glitches with the comments function, which is why the delay in pulling some comments and why comments were repeating. Also it's always a bit harder to monitor and get things fixed over the weekend, we're a small staff.
Everybody's feelings are running high, but I would hope that people who are actual Mother Jones readers at least would behave themselves. If people can't we'll shut down comments entirely.
Very immediate, moving, and necessary account. This is what trauma medicine is like. This is what *is* happening to our men and women in war zones. There is no offense here, only truth, and told with respect.
