The Elder · 4:22am Oct 28th, 2018
The elder arrived at our FOB two days after the suicide bombing.
His shoulder was injured in the blast, though we couldn't tell just how badly. There was a hole in it, poked by some piece of shrapnel, but the wound had already closed and there were no obvious signs of infection or disability. Instead he had an X-ray from the local hospital that showed a light smudge just a few inches beneath the skin, in the fleshy part of the shoulder around where doctors give your influenza shot.
If the image on the radiogram (that is the formal name for the black-and-white image created by X-rays) had been sharp and bright we wouldn't have worried so much. That would indicate it was metal, and metal shrapnel is generally not a problem in the human body. There are millions of people around the world with bullets or BBs or screws or what-have-you in their flesh, and they get along just fine. The human body seems to regard intrusive bits of metal as obstacles to be accommodated, rather than invaders to be fought.
But the image on the radiogram was neither sharp nor bright. It was soft, dim, amorphous. It didn't look like anything in particular. Not anything we expected: a nail or a ball bearing or fragment from a mortar shell. Just an irregular, rough tracing, like something seen under a microscope. Most likely it was a piece of the bomber or his clothing. That was something to worry about - organic materials, up to and including people parts, can cause serious problems if they become embedded in another person's body. They can cause grave infections or disastrous immune system responses. Think gangrene.
You might wonder, at this point, why an elderly Afghan male would come to a small American outpost with a medical concern, despite already holding in his hands an actual X-ray image from an actual hospital that treated him (and dozens of others) after the explosion. The busy intersection the bomber targeted was just a few blocks from the hospital. He walked there with his hand staunching the wound.
The answer is that the civil hospital in Gardez had an exceptionally poor reputation among the locals. After decades of war and corruption and emigration by any Afghan with a valuable skill, the country's medical infrastructure was in tatters. The hospital suffered from chronic shortages of everything a hospital needs - drugs, oxygen, equipment, money, electricity, but especially doctors and nurses. The few who remained did their best, and they are among the finest people in Afghanistan, but it was hardly enough. The civil hospital in Gardez was where people went to die.
So the elder came to us.
I'm not a medic. But our team's medic knew that I was qualified as a Combat Life Saver, meaning I've received additional training in how to provide emergency battlefield care. Simple surgical interventions like administering an IV or performing needle chest decompression. I'm supposed to be comfortable with blood and sharp things, and it was a slow day, and the medic was my friend, so he invited me to join them and take some pictures as he worked.
We wanted to remove the shrapnel from the elder's shoulder. It was too dangerous to leave in, whatever it was. But we had trouble finding it.
X-ray images are amazing, when you think about them. To us, who've grown up in a world where they are ubiquitous, it's sometimes easy to forget how miraculous they seemed at the time of their invention. You could literally see inside of solid objects. Entire worlds previously hidden, discernable only to those with scalpels and a willingness to destroy, could now be viewed and shared by everyone. But they are two-dimensional pictures. If the hospital had had an MRI machine it could've created a three-dimensional picture for us, but that's not what the civil hospital in Gardez had. Frankly, we were lucky to get the one X-ray. And a two-dimensional X-ray is only partially useful when exploring a three-dimensional human. We knew approximately where the shrapnel was, but not perfectly. We had to explore.
The doc started with lidocaine injections to numb the area. Then he used the thinnest needle he had to investigate the shoulder, slowly inserting it through the skin and muscle until he reached the depth where, according to the X-ray, the shrapnel should have been. But we never found it that way.
The second tactic was more straightforward. The shrapnel had, after all, carved a path through his shoulder. We should just be able to follow the wound channel until we reached it. But over two days the wound had closed, and this required opening it again.
If you saw the wound, you would never have known what caused it. It was barely more than an abrasion, a wet pink spot of missing skin the size of my littlest fingernail. Only a faint, faint red line in the center suggested there was more to it beneath the surface. So the doc got out a metal probe and began tearing the wound open again. This method, known as blunt dissection, causes far less bleeding than using a sharp object like a scalpel. Torn vasculature closes itself; severed vasculature bleeds until it clots.
The doc worked for a while, tugging the skin this way and that. It was such a small wound that you couldn't really see into it. The metal tip of the probe was all we had, and we searched through his muscle with it like a blind man tapping at the sidewalk with his cane.
Throughout all this the elder lay on his back on the examination table, naked from the waist up. It is rare to see men in Afghanistan without a shirt. Though they are not as conservative with their own bodies as they are with the bodies of their women, the men typically cover themselves from ankle to neck with a long-sleeved cloth outfit known as a shalwar khameez. Combined with their beards and wool pakols, the only skin you are likely to see of a stranger is on their hands and face.
He lay there the entire time, barely moving, never complaining. He answered the doc's questions through our interpreter. I asked if the lidocaine was helping. He said it still hurt.
At last, the doctor had to give up. He was causing too much damage with the metal probe, and either the shrapnel was too deeply buried for us to find, or it was so soft that the inquisitive tip of the metal probe could not tell the difference between it and the surrounding flesh. We bound the man's shoulder again, apologized, and told him to visit the Afghan National Army base across the way. It had surgical facilities more suited to helping him than our little clinic. Or, we suggested, he could go back to the civil hospital. We were always trying to encourage Afghans to use it.
I'm not sure what he did. After he left the FOB, I never saw or heard from him again. Such was Afghanistan.
***
As I wrote this little piece, I was struck for the first time by how distant these events seem now. Even though the war in which they occurred continues to this day, 17 years after it began, they have assumed the quality of distant recollections, more a story in my mind about what happened to someone else than something that happened to me. I will have to check my journal of the war to be sure, but I think the memory described above happened 11 years ago. And it is likely that sometime soon I will be sent to Afghanistan again, picking up where others - including myself - left off.
Something interesting will happen in 2021, assuming the war in Afghanistan doesn't come to an unexpected end. People who joined the military after the 9/11 attacks will be eligible for retirement. Soldiers will begin drawing pensions for service in a war that began before they enlisted and outlived their career.
We read in history books about the interminable conflicts of the past: think the Hundred Years' War, the Thirty Years' War, or the War of the Roses. But now we are creeping up on those dusty relics with own modern war. I wonder what future historians will call it.
I need to finish this with something about ponies, so I'll call out my friend and reviewer Present Perfect's last few blog posts about some of my Starlight Glimmer stories. PP doesn't share my love for our little horse sorceress, but the reviews are still pretty good, so I forgive him.
How ever they look at it , it is doubtful it will be favorably.
The past isn't some far away thing that happened to others, it's the present waiting to happen.
Now I know why your screen name is "Cold in Gardez."
...on so many levels.
I've been thinking a lot about what the present will look like to historians in the future. Thank you for sharing your story; it's been very eye-opening, in all honesty. I'll be there watching as we watch history unfold. I don't really know how to feel about all of this now, but I suppose I can say that it's murky and strange.
Murky and strange. What a place the world around us can be. Especially now.
Wow. Were you expecting organic material, or some non-metal non-organic building material to cause the greyish xray?
Damn it, I always wondered what they would call the afghan war. But the fact that it's going to be called by history as just "the war on terror" or "the x-year war" is as depressing as it is outrageous. At least they'll be able to tell it belongs in the club.
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I was expecting some sort of hard foreign tissue like bone, but we never found it.
'Those who do not remember the past are condemned to repeat it.' George Santayana.
Afghanistan has been the doom of many an over ambitious military campaign. The British army has been there three times in the last 200 years and come away bloody and battered each time.
I do wonder if the saying should be 'Those who do not learn from the past.....
"We read in history books about the interminable conflicts of the past: think the Hundred Years' War, the Thirty Years' War, or the War of the Roses. But now we are creeping up on those dusty relics with own modern war. I wonder what future historians will call it."
I do not believe there has ever been a true analogy of the current situation in Afghanistan.
Some historical wars have lasted longer in theory, but historical terminologies and military practices are so different from modern standards that I am not sure the examples can apply. The Hundred Years War was really a series of several wars between French factions interspersed with armistices and long periods of peace, the actual numbers of years where major military operations took place were relatively few. The War of the Roses likewise involved relatively short, sharp, campaigns interspersed with relatively long periods of peace.
In practical terms, the nearest analogy to the present situation in Afghanistan would probably be the peacekeeping and policing operations conducted by the European Empires during the late modern age. Here again there are significant differences, for one the end goal of the 18th-20th century empires are the mirror opposite of the stated US goal, being one of permanent occupation as the ends in itself, rather than being a nescessary means of generating an environment of stability needed in order to enact reform. The European never promoted concepts of equality between themselves and the conquered, and never held the view that they were liberators.
I used to work for the VA as a claims adjudicator. Now I’m an attorney that helps Vets with their appeals. If you ever have any questions, hit me up.
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"What we learn from history is that we learn nothing from history." -- Georg Hegel
Thanks. :V
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You can thank me by loving Starlight Glimmer!
Does this go for you, too? When did you join?
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It will be a few more years for me, but not many.
Do you still write much? I know you enter the Write-off but I'm curious if there's anywhere else you place your pen these days? I like reading your wartime stories too. The moments are usually so small but oddly personal and I appreciate that.
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Until 2021?
The Useless Opium War that Funded the CIA.
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More than that.
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I think I've actually written more this year than most years. A lot of it has gone into my ongoing story The World is Filled with Monsters, which is why it doesn't appear like I've written as much new material.
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Sorry I didn't realize. I'll have to read that!
Glim Glam is best Glam.
How's Star Craft Land treating you so far?
Don't you mean "horseress"?
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Hm.
Yeah, that'll work.
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She is best pony after all.
Is there something in particular that makes you think you're going back to Afghanistan? You weren't moved to Korea that long ago.
That was the hardest line to read.
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They never promoted equality, but many saw themselves as some kind of liberator. Read "The White Man's Burden" by Kipling. Also note that slavery was widespread in Africa, and it was Europeans who abolished it there. But I think they were more proud of introducing Christianity.
There was a lot of debate in Europe over the morality of colonization. The British opium war against China was unpopular at home and was very nearly stopped by Parliament. The genocide in the Belgian Congo had to be carefully hidden from the public to continue, largely through the assistance of Pope Pius X, who had a deal with King Leopold. The deal was that the Catholic Church would get to raise all of the children orphaned by Leopold's slavery and genocide, as long as Europe didn't find out. There were hundreds of Catholic priests in the Congo at the time, and not one of them ever revealed the atrocities going on to Europe.
Outside of Northern Africa and Australia, AFAIK the areas Europeans colonized were usually already divided into warring groups, or into a ruling ethnic group exploiting subject groups. Europeans would usually partner with the oppressed or weaker group, because the stronger group was less likely to partner with them, because this made the war easier to sell to the public back home, and also because crushing the stronger group would give the Europeans more power afterwards.
So the group the Europeans sided with often saw them as liberators. For example, the many Native American tribes ruled by the Aztecs saw the Spanish as liberators, which is why the Spanish were able to win. In Namibia, the Germans freed the Bamara from enslavement by slaughtering their masters, the Nama and Herero. The British freed much of Nigeria from the Hausa-Fulani, and freed much of South Africa from the Zulu. They occupied Botswana to protect the local people from the Boers (the folks who ended up dominating South Africa after the British left), and to keep the Germans from getting it so the British could build a railroad from South Africa to Zambia. AFAIK the British are still popular in Botswana.
In general, people conquered by the British had it better than those conquered by the French or Germans.
Afghanistan is more technically and morally complicated than those wars, because the locals aren't two warring ethnic groups, but one ethnic group that is itself divided within each town and village.