The close of summer...

Two weeks ago, Jill and I cashed in a gift certificate we had received from Brent and Maggie to take a cooking class called “summer dinner under the stars” at the L'Academie de cuisine in Bethesda. What makes cooking classes fun? Someone else shops for and buys all the ingredients, measures everything out and takes the dirty dishes away as we use them. We, on the other hand chop, mix, cook and eat this wonderful summer meal (BBQ Pork Tenderloin, Asian slaw, guacamole, mango salsa and white chocolate mousse). Most of the recipes seemed to be variations of Americas Test Kitchen ideas, but we still learned some good techniques and I enjoyed it immensely. And I thought Jill was going to bring the dishwasher lady home with us for the school year. I’m determined to do it again, even if it’s not until next summer.

Since June, Jill and I have been training for the Marine Corps Marathon, which is Oct. 29th. (I went for a couple of runs at Bushmaster, but at Kerkeschner they recommended against running through woods with an M16.) The long runs (Saturdays) are getting to the point where they eat up a good chunk of the time that we have together, but it’s been a lot of fun to get out and explore with her- running through Acadia National Park, in Freeport, etc. These last couple of weeks we’ve been tromping along the Chesapeake and Ohio (C & O) canal towpath (running along the Potomac) and the capital crescent trail (which runs from Bethesda down into the national mall). And we’re becoming experts on energy gel flavors. If you’re in the market we can tell you what flavors to buy (and more importantly which to avoid).

Summer certainly came to a screeching halt when school started last Monday. Based on the speed with which we’re covering material it feels like they added an extra gear to the “transmission of learning” for the 2nd year of medical school. Three days into classes I realized that if I was going to try and complete even half of the assigned reading for pathology and microbiology/immunology I wasn’t going to be able to attend very many classes. It’s felt like a difficult start in many ways. Contrasted with that, the amazing things that have been happening in our Christian Medial Association chapter at USUHS have been miraculous and encouraging. Part of my summer was making a website for our group (www.usuhs.mil/cma) and during the MS1 orientation week about one third of the incoming class has signed up to be involved with CMA; something we’ve been praying about for the last six months. Really, although it’s dense, the course work this year has definitely been more directly applicable. We were also issued (at no cost, of course) our “doctor bag goodies” (otoscope, stethoscope, BP cuff, etc) and one of our classes is just learning how to do a thorough physical exam which is practical and a lot of fun.

And then there are the memories of summer fun…

12 Aviation battalion, Fort Belvoir, VA

When I got back from Bushmaster/Kerkeschner 6 of the MS2's from USUHS (myself included) started a “summer experience” at Ft. Belvoir, VA spending two weeks with the 12 AVN unit. The unit is basically a Blackhawk squadron responsible for the Capital area military aviation functions, with attached medical, engineering, and fixed wing aircraft companies. They do everything from flying Generals around or transporting the engineering company to a disaster relief site (the pentagon after 9/11 or the mines in West VA after collapse), to search and rescue ops on area water ways. That afforded us a couple of great flights. One was in a Blackhawk to NYC to see the Statue of Liberty and Ground zero (up close, from the air) returning to VA along the New Jersey shore line (dodging kites and waving at kids) and making a stop at the hangar where the Hindenburg was built. The hangar is so big that they have these adult sized trikes to ride around in the hangar so that they can get around a little faster. Another flight was in a Huey and took us around the capital to see the monuments (see photo). Another couple of days we spent with the flight doc for the 12 AVN, seeing patients, playing basketball and eating ice cream cake.

Two more days we spent with the engineer company, during their ropes training course, learning how to tie some basic rescue knots and repelling off their 50 foot wall and their helicopter skid. The skid repel was pretty wild. You stand on this skid (roped in) and let your rope out until you’re parallel with the ground, feet still on the skid. This part is pretty similar to what you’d do on the wall, but the difference is, when they say go, you hop and drop, letting yourself free fall as long as you want, then pulling the rope behind your back to arrest the fall which makes for a very fast and very fun ride if you choose to make it that way. If you play that thing right, you can swing all over the place on that rope. Some of the guys (previously trained) would ride half way down then flip around and repel head first with a foot wrapped around the rope. The last day of our time with 12 AVN they had a battalion meeting at which we gave a sexually transmitted diseases presentation, which they seemed entertained by. At the end of the meeting, the unit commander called us up and gave us the Commander’s and Command Sergeant Major’s battle coins in appreciation for our little STD chat and for our commitment to serving the soldiers through medicine. I’m not generally a huge fan of pomp and circumstance, but it was a motivating experience to be recognized as the future of Army medicine like that. The commute was killer (55 miles each way) but the experience was certainly memorable.

Nag's Head and Field Exercises

A few days after we returned from our Road trip to Maine, I left for our two weeks of field exercises and Jill headed for North Carolina to see a good portion of her family vacationing in the Outer Banks. It sounds like they spent some wonderfully relaxing days on the beach and fishing, catching crabs and hitting the local eateries. In fact, one evening they were there the rip tide was substantial enough that a news crew came out to the beach to interview them about the water conditions. Jill snapped some photos of John being interviewed in his swim trunks.

Jill's Trip to NC

Jul 20, 2006 - 24 Photos

I remember lying in my cot under our tent about nine in the evening and the sides of the tent are rolled up because it was still almost 90. I’m holding the phone a little bit away from my ear to keep the sweat from dripping on it while I’m checking my voicemail and here’s Jill’s sweet little voice: “Hey baby, I sure hope that you’re doing ok, because it’s hot out here. I sure am glad that Sonny and Nancy put A/C in their beach house because it must have been 85 degrees out today…” I got a good laugh out of that. Actually, I really enjoyed our time out there. I missed Jill and would have loved the time with the fam out at the beach, but experiences like those are the reason that we’re here, and the military medical school. For those of you who saw the first piece that the local Fox News station did on our “boy scout camp”, you probably already have an idea what I’m talking about. (You can find the links to both stories on the USUHS homepage, or go directly to the Fox News links: Battlefield Medicine Part 1, Battlefield Medicine Part 2) I don't think that they used any of the footage from my squad in those videos, but there’s a guy making a documentary about USUHS and I may be in some of his footage. I’ll tell you when it comes out.

Operation Kerkeschner Bushmaster

Aug 5, 2006 - 15 Photos

So, the details: The first week we spent being patients for the 4th medical students (called operation Bushmaster). We would sleep (briefly) in barracks, then up at 0430, ride out to the site in a five ton truck, eat an MRE breakfast, get your wounds made up (moulaged) and rotate through these different medical aid stations. Sometimes we’d be staged out in the woods and they have patrols find us and call a Medevac, other times we’d walk into base for “sick call”- a regular doctor visit in the field. You could take a break between rotations and get a snack, read or sleep for a bit, or say have an MRE milkshake drinking competition (six shakes in less than five minutes was the camp record- and one I didn’t even attempt), and then go get moulaged again. In the evening they would start staging us for a Mass Casualty (“mascal”). About eight pm we’d hop into the 5 tons and they’d take us out into the woods, stage us and rev up the sweet sound mortar fire. We’d spend the next couple of hours being treated, evac’d, and doing after action reports (talking about what went right and what didn’t.) We’d usually get back to the barracks about 2330, shower, tick check, and lights out by 0030. The whole process actually taught me a great deal, and I know that it was big-time for the 4th years; at least one couldn’t take the pressure and became a “real world” casualty. (Anytime someone really did get injured we had to start every sentence with “real world” so they’d know it wasn’t an act.) But better it happens here, and it gets fixed now, than in the real deal when somebody’s really taking fire. There is so much that you just don’t think about until you go through the process of being a patient (even if it’s being a fake one). Things like: don’t set anybody in the sun if you can avoid it, make sure they have their gear when the evac to the next level of care, let them know what you’re doing and seeing, and even if you can’t treat them right away, make eye contact and reassure them that you haven’t forgotten about them.

I had some pretty good injuries, too. I got shot in the buttocks, had meningitis, crabs, a seizure, burns and lacerations to the back, an evisceration, and some battle fatigue where I was going psycho because all I could find of my battle buddy was his index finger and thumb. That one surprised people a little, when they’d see this very life-like bloody finger that I was holding while I rocked back and forth screaming. And I don’t mind saying that I played a psycho pretty well. Not sure if that means I’d make a good psychiatrist, or just a good psycho. The other half of the time we in the field (operation Kerkeschner) it was doing things like learning hand to hand combat and grappling techniques, repelling off a fifty foot wall, doing night and day land navigation with a compass and map, completing these obstacle courses with the rest of our squad, shooting M9’s (9mm pistols), applying the lessons from the combat casualty care courses that we had last year, starting IV’s on each other (I must have been stuck six or eight times), all kinds of fun stuff. Each activity was called a lane, and the lanes would start at 0730 and usually we were done by 2100 (except night land nav which started at 2200).

Generally, we got more sleep at Kerkeschner, but we worked a lot harder, too. For instance one evening we were driven out to this paintball course for a lane called “care under fire”. All evening we played paint ball and pretty quickly figured out how difficult it can be to communicate and get medical care to wounded soldiers at the point of injury. Even though it was only paintballs, the tactics and environment made it seem very war-like and it gave me a new appreciation for the how vital medics are in completing mission objectives. (You can see one of the paintball welts on my arm in the IV-photo.) Before and after each lane we would meet and discuss the relevance, lessons learned and so on. The entire time we were at Kerkeschner, save on the repelling wall and playing paintball, we carried M16’s; if you were ever caught without your weapon you did push-ups to get it back. And those who lost their weapons only lost them once. Each platoon rotated through the “patrol” lane; we’d walk through the woods and look for bad guys. Inevitably, we’d see a sign of chemical or biological weapons and have to put on our gas masks at which time we’d start taking fire and have to “defend our position” (which is particularly tricky because when the enemy knows we’re shooting blanks). It was only mid 90’s on the day we did it, but I’ll tell you, it should be one of the Geneva Convention tenets that no chemical or biological warfare should be conducted in the summertime within 40 degrees of the equator, because it’s just too hot to have those masks on. Every day (usually by 0800) I’d completely soak my BDU’s- like bill of the patrol cap is dripping, but it was warm enough at night that one of my two pair of BDU’s would be dry by the morning. All in all, the extra wide cabela’s cots, the sunrises, firing weapons, and the free food (all you can eat MRE goodness) made it all worthwhile. In fact, when I got back from this little boy-scout vacation, I was almost (almost) surprised that they had paid me for it. (grin)

Road trip to Acadia & days on the Cape

In end of June, after our commitments at school ended Jill and I took a 10 day road trip to Acadia National Park in Maine. On the way up we drove through the sub base where my dad was stationed at when my sister was born. Interesting place. (Love you dad, but I'm glad I joined the Army.) Once on Bar Harbor Island (which houses a good portion of Acadia National Park) we camped for two nights and stayed in a motel for three. We explored the island, by foot, car, free shuttle (courtesy of L.L. Bean), kayak, and boat and enjoyed it thoroughly. Since it was just before the fourth of July, we were still exploring during what they considered the non-peak season. And we now know why. The water is so much cooler up there that for the first several weeks of summer the warm air just makes it very foggy. Very foggy. We have some pictures of us hiking up Cadillac Mountain, and they have to put these rock piles every 20 feet so that you don't walk off an edge. Towards the end of our trip when we went on an evening Kayaking tour and a whale watching trip, we finally got some clear weather. We have quite a few photos of our kayak trip at sun down. What we couldn't capture was the phosphorescent algae in the water what would light up every time we pulled our paddles through the water. The next day we went out on a whale watching cruise and saw some puffins on one of the lighthouse islands, then headed out to a "whale park" where we tagged along with this humpback for 30 minutes, watching him blow and swim and dive about 4 times. He would take about 13 breaths, then dive for a few minutes, then come up for 13 more and dive again. Each time he dove, his tail would leave this perfect impression of smooth water on the surface. Finally, on the last dive his enormous tail fin came out of the water and splashed back in. Of course, by that time, we had used up all of the memory in our digital camera, so you'll have to trust us that it was an amazing site. The boat ("Friendship V") was pretty quick and while we were standing on the bow it got pretty cool several miles from shore, even with unhindered sunshine for the first time in weeks. See the photos below:

Road Trip to Maine

Jul 4, 2006 - 89 Photos

On the way back we decided to stop in the town that LL Bean calls home, Freeport, MA. It turns out this town, in addition to having an enormous LL Bean complex which is open 24/7- 365 days a year, is also the birthplace of outlet shops, Banana Republic, North Face, J Crew, Gap, etc, etc. Because it was a holiday weekend, and there is apparently a throng of people who make this yearly pilgrimage to Freeport for school shopping, the only reasonable room we could find was in bed and breakfast a couple of blocks from the strip. It turned out to be a lovely evening, comfortable bed and great company. To help all of you avoid some confusion that I initially had, I might add that while a lovely place, the "free" in Freeport is actually a misnomer. Nothing in Freeport is actually free. Once you get past that, it's a wonderful town.

As we were driving through Massachusetts we saw the sign for Boston and Cape Cod, and decided to go. After spending the night just outside of the Cape and the morning in a visitor's center we called some friends who we suspected would be staying with their parents (who have a place on the North side). As it happened they were just down the street from us, heading out to go sailing for the afternoon, and invited us along. Steph's parents watched their two girls while six of us (Jill, myself, Doug, Stephanie, Stephanie's sister Susan-and Susan's fiancee Dave) took out a little 19 footer. The wind was making for a lazy cruise until I caved to my habit of jumping into the water and launched off the back of the boat, apparently nudging it into a gust of wind so that when I began to swim back towards her, the boat was moving at a good clip. After several failed attempts to catch her (much to the amusement of all onboard), Doug and Dave brought her about and helped me over the gunnels. I bought him an ice cream cone later for saving my life and we still have a good chuckle when we tell the story to our classmates. That evening we ended up staying with Stephanie's mom and dad, who is also a big fan of America's Test Kitchen. Being so close to Boston (Americas test Kitchen home) he promised to give me a call if he hears that they're giving tours again. (When we were headed on our road trip, I had actually called my parents and asked them to look online for a phone number that I could call and try getting a tour while we were around.) We thoroughly enjoyed our time with Doug and Stephanie and their family, and it turned out to be a perfect end to our road trip. We had considered staying in Boston for their 4th of July fireworks display (they reserve an entire section for military members), but the next morning we decided to head home and made it in plenty of time to catch them on the tube.

PAX River

Last weekend, my former supervisor (Murray Anderson) came out to DC to present at a conference. It was good to see him and hear about what some of the old gang are up to. Since we both love airplanes, we decided to go see the new Air & Space museum out at Dulles airport. It was amazing- hundreds of full sized aircraft, engines, and weapons. I didn't know that they had a shuttle inside, and that alone was work the price for parking. Also included were the B-29 Enola Gay- which, I was reminded by Murray, dropped the A bomb on Hiroshima- a Concorde, and many, many more.

The real story this week for me was our adventure at PAX river Navy aviation/dive lab. We left very early on Thursday morning to head a couple hours southeast for the training that they require all personnel to complete before they are qualified even to ride in a high performance aircraft or start aircrew training. It included several presentations as well as a trip to 25,000 feet in an altitude chamber and some water crash egress training. A couple hours into the day we donned our flight helmets and masks, plugged into respirators and started the trip up. Once “at altitude” we took our masks off (and lost the 100% Oxygen we were breathing) and attempted to do some coordination drills (Patty cake with our neighbor). Long story short within 3 minutes at that altitude we were all getting hypoxic enough to make patty cake seem complex- and very funny. Before we all got too deprived, we put our masks back on and watched some comrades take their turn. It was an incredible experience. They brief you very well on how to clear your ears during descent, and we had ample opportunity to do so during the rapid fall back to sea level. I have a whole new appreciation for high altitude physiology.
For the next hour we remained under observation to make sure that no one got an acute case of “the Bends”- which is very rare but a necessary precaution. During that time, we took turns strapping into a fighter jet seat, getting the appropriate ejection posture and –Eject! Eject! Eject!- pulling the ring that would normally immediately subject us to about 55 G’s while it literally blasts the occupant 250 feet up from the cockpit. Even without that 55 G acceleration, it was a cool simulation. We also learned how to separate from the seat, what to pull when, how to use a parachute landing fall, then activate the beacons, life rafts, and flares.
An hour after lunch we went swimming… first in swim trunks, practicing the modified strokes that we would use when in full flight gear. (The balance, drag and buoyancy changes require some slight changes to normal swimming strokes.) After we proved we could swim 25 meters- breaststroke, tread water for 2 minutes and swim 25 meters underwater we got dressed. We put everything: flight suit, boots, helmet, gloves, harness, and tactical flight vests (with built in life preservers) and repeated the process. Although far slower and more cumbersome, we all made it. Our next training was the under water egress training. In shoulder depth water, we strapped into a seat belt on the end of a 15 foot steel pole. At the other end of the pole were 5 door levers (representing all those in use on non-experimental aircraft) and an escape hatch. The drill was the instructor would say “prepare to crash…Crash! Crash! Crash!” and push you down into the water. During the “prepare to crash” command, with our feet we would find the pole (our reference point), after we were in the water, we would grab the pole with our left hand, and undo the seatbelt with our right. Once the seat belt was off, we would pull ourselves (not kicking) to the escape hatch, operate the five different types of levers, push the hatch open and pull ourselves through- never releasing the reference point with our left hand until we were grasping the edge of the open hatch with right. The second time we did the drill, we had black-out goggles on- and zero visibility; simulating a night or murky water landing. Finally, we practiced inflating our life vests, and then using the blow valves to inflate them manually while treading water.
What a memorable day! Anyhow, now I’m signed off to ride back seat in a screamer (high performance aircraft). The rest of the week was full of classes, meetings, and social occasions. We had a big CMA meeting this week where we talked about our vision for the coming year and it was exciting to see everyone there to share it. Jill and I were on opposite schedules the last part of the week, but we’re planning to take some time tonight and tomorrow to catch up. This week’s schedule looks dense with academic work and with our biggest physiology exam a week from this Monday, we’ll all be trying to prepare. Jill works the afternoon or evening shift all week, so maybe by the weekend I will have had enough time to prepare that we’ll be able to spend most of it together. Next Saturday we’re running the “Germantown 5-miler”, a local race put on to benefit local charities. We’re excited about that as well.

Home stretch

We're half way through our spring quarter and the beautiful weather outside has made the long physiology lectures almost unbearable. The second year medical students are finishing their finals before they have a six week "break"- which will be totally consumed by studying for the USMLE step 1 exam. We, the MS1's, are taking over all the leadership roles for clubs and it seems like overnight we somehow took a large step towards that seemingly elusive date in 2009 when we'll become doctors. At the same time, I have been humbled by new responsibilities, new ways to serve, and my inadequacy to accomplish the necessary tasks. In our weakness, He is strong...

The redeeming quality of spring quarter for 1st year USUHS students are all of the Military Applied Physiology labs we do. Last week we went to the Antietam battlefield and during a several mile road march learned the history of the bloodiest battle of the Civil War. The photo at right was taken as we approached Burnside's Bridge. This week I got to participate in a Dive lab, determining the effects of water temperature and pressure on various body systems first hand. I have a new and unforgettable respect for the Navy divers. I also did an exercise physiology lab and test the limitations of the respiratory system on maximum work output. Next week I'll "ride" in a hypobaric chamber up to 25,000 feet and see the effects of hypoxia on mental function. The same day I'll get to "crash" an aircraft into an enormous pool and learn how to egress from a submerged aircraft under no-light conditions... something that I'm sure is useful to know in the event that it ever happens.

Outside of school and work, Jill and I have stayed pretty busy. Last weekend she ran the Frederick Half Marathon, which was a well staffed, smooth running event that lacked only the pre-race expo the magnitude of Seattle's. And Jill ran like a track star, smashing her time goal with sheer will. Her training partner, Maggie Feldt, and I cheered her on and watched her fantastic finish. Three other Cedarbrook guys from the "Saturday Morning Run Guys" club ran the marathon. They are good people and I've enjoyed the brief time that I've been joining them in the Saturday am's. (Matthew, John and Mark pictured at right... taking a photo break)

We have also started attending a small group on Monday evenings. Even though we just started, it feels like a perfect place to plug into God's word on a weekly basis. Youth group is getting ready to make some big changes and we're also excited about how that will change the way we are able to interact with these middle schoolers.

Our good friends the Hooks are getting ready to move to New Mexico; an opportunity we are both excited and agonized over. Their son Nathan (see photo on the left) will be staying- and we will enjoy seeing him for at least a couple more years. We were fortunate to spend Easter with them, and were once again reminded of how warm their family is. We won't count them out yet, though, Gary and Georgia won't escape with their two younger kids (Eli and Abby, pictured on the right) until mid-June.

Signs of Life

This may be the time of the year that Washington DC is most famous for. The Cherry Blossoms are in full bloom and most of the other botanical life is not far behind them.

Our great friends Jerid and Kelly came out for my spring break with their now 10 month old baby-Ryan. We had an absolutely fabulous time with them although now that they've been gone for a full week it feels a little like a blur. We tried to see the highlights of DC and, I think, succeed. I can't tell you how good it felt to see them, and spend time with Ryan. Although in hindsight, I wonder if we should have left a few of those big ticket items off our agenda so that they would have reason to come back and see us.

(Baltimore Aquarium at left- where we unknowingly violated the stroller prohibition and managed to make it to floor 2 before we were apprehended.)

And even though I had a little trouble correctly navigating us there, one of my favorites was our stop at the Cathedral. It seems like every time I come up out of the Metro, my internal compass is spinning. But, alas, we made it. The architecture was amazing- both inside and out. It was an appreciated change from the churches we live in now, whose designs are driven by our post-modern efficiency and functionality thought processes. Not to say I don't want a basketball court at our church; it was just a beautiful place to quietly remember the history and role of the church in this country.

Now, we've been back in school for a full week. In fact, I just finished our first Physiology exam. The second year students said that this quarter was easier than the last... like I haven't heard that before. Jill is actually in Seattle right now; our good friends Marcy and Patrick were married last night in a ceremony I greatly wish I could have seen. I'm sure that it won't be last of the significant events I miss because of the career to which I've been called.

Chris Ledford and I will be taking over the leadership of the CMA group. And, in fact, the hand-over for our weekly meetings has already occurred. That process of preparing to lead for the next year has made the end of this one feel close. (Even though we've still got a few more hoops to jump through.) I hope also be getting involved in the AMA group here and creating opportunities to serve the community through that as well.