Egyptian Liberation, omphalocele, and Toby Keith

You must know I've been busy since it's been 9 days since I've blogged!

I have done some interesting things in the past 9 days. For one thing, I went to the Sinai Liberation Day Celebration put on by the Egyptian forces on base. There were, of course, welcome remarks from the Egyptian commander, the posting of the colors, etc, and also a video depicting the importance of the holiday in their culture. Then came the main feature: the food! There was grilled eggplant, rice and chicken, fried cheese, and - of course - rice pudding made with rose water. It was certainly a nice departure from the same-old-same-old in the military DFACs. After dinner, the dancing started. It was hilarious! Almost all of the Egyptian military members are male, so "dancing" essentially consisted of the men standing in a circle and gyrating. Eventually some females joined them, and we laughed even harder.

A few days later, I got a page while I was running around the hospital, and it was the commander wanting to know if we could take care of a one-day old baby with an omphalocele, a birth defect in which various abdominal contents are sticking out of the belly button. It took some thinking and some discussion, but the peds surgeon, the other pediatrician, the commander and I decided that we had the resources to care for this baby.

Meanwhile, I prepared for the concert event of the spring: TOBY KEITH!! His band came by the hospital during the day, and I was fortunate to speak for quite a while with the bass player. The concert was in a large tent which surprisingly had great acoustics. Although he only played for an hour (he had been to 15 bases in 5 days, so he was probably pretty tired), we got to hear all the good songs, like "Beer for my Horses" and "The Angry American" (I wasn't leaving until I heard the latter song!). It was a little surreal, because for a few moments I actually forgot I was in Afghanistan. But then I would look around at the weapons slung around everyone's shoulders and waists .... and I would remember that this is a war zone. All in all, the concert was the social highlight of my two months at Bagram. My friend took some pictures, and I'll post them when I can.

I went back to the hospital after the concert and found the baby in the OR. The surgeon feared strangulation of the bowel, so she decided to operate immediately. I sent the other pediatrician home and waited for the surgery to conclude. I ended up waiting until 12 or 1 am, and the patient came out of the O.R. very unstable. The surgery had gone well, but his electrolytes and blood sugar were totally out of whack (for you medical folk: his initial glucose was 617 by one accucheck and 430 by the other). The surgeon and I sat at his bedside all night monitoring his condition, and by morning I felt as if I had been hit by a truck.

I completely lost the entire next day, as I was napping and covering the peds inpatients as best I could while Rob (the other pediatrician) saw the outpatients. Luckily, I went to sleep early that night because we got two additional admissions overnight who would require my full attention the following day. Rob and I are basically running a PICU with 5 patients, and we also have 2 patients on the ward (one of which was only moved there to free up a bed .... she's the girl with the devastating burns, and she really belongs in the ICU). In fact, we have more patients than the adult service has! At one point, we had 4 intubated patients and one marginal, recently-extubated patient .... so let's just say that we are very busy with some pretty sick kids. I am happy to report, though, that tonight all of the patients are off their breathing machines (including the baby) and their clinical conditions have stabilized.

Chino Youth Museum

The cousins were so excited to see Matt on Tuesday! They had something extra special planned for the kid...

Our weekly playdate had missed Cheekfeast last week due to transportation issues. To see pictures of the cousins playing at the waterpark, view album here: http://picasaweb.google.com/mtsadsad/SplashPark?feat=email#

Zach did a great job in the water and of course the girls really enjoyed themselves. I'm sure Matt would have a great time so we'll have to revisit this event especially with the summer heat we're expecting to get. James' blog mentioned 120 degree temperatures in Iraq and while we don't expect to get there, we'll still rub it in when we're splashing in the fountains with his kid.

Since the big girls are pros at daytrips, Kate and Ashley planned a special tour for the boys. Zach was excited but Aunt Shannon grumbled at getting up so early. Props to Aunt Tonya who made all the arrangements to get up at dawn and fight traffic to pick up Matt. Sidenote: I am definitely open to commuting arrangements, suggestions and/or ways to share transportation if anyone has ideas!

I heard the car ride was a thrill for Matt who was excited to see Aunt Tonya. He used many new words to describe things he saw along the way including "truck" and "car". Matt talked Aunt Tonya's ear off and she couldn't get a word in edgewise! Once we all finally got to the secret destination, the Chino Youth Museum, the kids were antsy to get out and play. This is a great museum designed for kids that is truly interactive. Here is more information about the museum: http://www.chinoyouthmuseum.com/

When we arrived the kids all split into different directions. Kate immediately befriended another little girl, Ashley went to explore the science exhibit, Matt headed for the stairs (of course) and Zach found a quiet corner to take his nap.

The museum is designed so the kids can explore on their own but moms can still keep an eye on multiple wandering kids. We explored the solar system, a playhouse, a new water stages exhibit, police and firefighters jobs, house set-up, barn with slide(!), mail system and a coloring center.

Again, I say this every time but its great to see the different developmental stages with these kids. Kate organized the tour through the different sections, Ashley used all the tools and buttons to manipulate features, Matt was so excited to experience something new he ran everywhere and really had a chance to use his new words, and Zach newly mobile walked on his own and explored simple movement tasks like opening doors and climbing.

I always enjoy going to the museum and even got in the action. Tonya did me no favors by taking pictures to capture the moment! No, I'm not sick - I just look horrible in the photos. And drumroll... here are the pictures with captions to describe the events better than I can narrate: http://picasaweb.google.com/mtsadsad/ChinoYouthMuseum?feat=email#slideshow/5329847591245060546

Four kids five and under up at dawn and overstimulated. Well, you can understand we took an early lunch at the water fountain. Kate and Ashley obviously have great motor skills and understand boundaries, Matt has good motor skills (loves climbing!) and learning boundaries, Zach is just feeling comfortable walking and can't escape so the boundaries are not an issue. But the boys try to keep up with the girls and go everywhere they do, so the aunts looked alternately like pack mules and traffic cops. Needless to say we found a quiet spot on the grass for lunch.

Again, the girls finished lunch quickly and went to play while the boys take twice as long. But this gave Matt the chance he was looking for to steal Aunt Tonya. He sat in her lap and wouldn't budge. He was very attached to her and wanted her in his sight every moment. While he has definitely bonded with the gang, the activities are still new to him and he wanted the comfort of Aunt Tonya. But poor Aunt Tonya had to manage to carry Matt (who we know is not a little waif) and contest with Ashley who was not jealous per se but was trying to figure out her role not as the baby in the mix. Despite my lamentations, it really was a fun day - and naps were had by all including the aunts!

The Message Bean

I got some good news about a week ago - from a bean plant:

The bean plant

"A what?" you ask? Yes, I didn't type that incorrectly. It was somehow written on the side of a bean seed, so when the bean sprouted, it exposed the text. I started watering it about three weeks ago, and it took around a week for the sprout to break ground, then a day or two for the husk to show with the message. Here's me with my new bean plant (it still brightens up the Engineering area even after it's delivered its message):


So this blog entry has actually been about 4 months in the making. Tita, Autumn and Matt sent me this bean plant back in December, when it was pretty cold out here, so I left the plant in the shipping materials (a can with a removable top) for a warmer time. After I had been back from leave for about a month, I stumbled on it, and eventually made it into work carrying it in my cargo pocket. It did really well under the fluorescent lights and the indoor air, which is a bit warm now despite the air conditioning. It's only the beginning of the heat - it's rumored to reach 120 degrees out here, which is basically like Palm Springs if it were on another planet.

The bean plant has garnered quite a following in the office, being the only real plant there. There are people (of course), rats, roaches, and various insects, but this is really the only plant. The first encounter with someone usually involves the bean's backstory, and I get a rash of daily status seekers, all looking it over to see if it has been attacked by insects, burned by the nearby copier, or even some who wonder if it is still there (I think they're plotting its doom). In any case, I'm sure going to miss it when it's gone. I guess I know how Tom Hanks felt about that volleyball in "Castaway" ...

Oh yeah, the message. Tita, Autumn and Matt wanted to let me know: "I love you"!

The power of family

I have always known that family was important. But I didn't know that here in Afghanistan, family is not just important, but it is crucial for the survival of children in the hospital. Not that our nurses and doctors are incapable of taking care of children; it's just that kids heal so much better when their families are present.

The 5 year old little girl with the penetrating head trauma has been in the hospital for several weeks now, and she has been getting feedings through a tube inserted into her nose. We have been trying endlessly to get her to take feeds by mouth, offering everything from applesauce to yogurt to milkshakes. Not only would she take nothing, but she would spit out the semi-solid food in disgust. She would not sip from a straw, and the only way we could get her to take any liquid was by squirting it into her mouth using a syringe. In her case, there are three reasons why she might not be eating:

(1) she's not hungry - this seems possible given that she's getting tube feeds and therefore her stomach is rarely empty

(2) she cannot eat - this doesn't seem likely given the location of her injury and the fact that she is able to swallow her own secretions

(3) she doesn't like the food - always a concern with these Afghan children; their diet is very different from the "typical" American diet we offer them in the hospital

We tried to "fix" problems #1 and #3 as best we could by offering her a wide variety of foods and slowing down her tube feeds to attempt to artifically create some hunger. But all of our efforts were to no avail; she still would only take a few ounces of liquid per day, nowhere near as much as she would need to in order to maintain her hydration and nutrition. A few days ago, it seemed that we had met an impasse.

Meanwhile, a few days ago, her uncle (who had been her guardian since a few days after the injury) needed to return home to take care of some personal matters. She was far less happy during his absence, and did not want to interact as much with the nurses. She no longer spoke or played. However, everything turned around once her uncle returned last night.

When he walked onto the ward and saw her sitting up in a chair (almost) by herself, he literally started crying. She had made a ton of progress in her rehabilitation since he last saw her. She was returned to her bed with her uncle at her side, and a few hours later the nurse went to check on her. Would you believe that there was an empty box of juice on her tray? When questioned, the uncle stated that she took the entire box - and she drank it by the straw! She was provided with a nutritional shake and a half banana, and with some help from her uncle, she took those too! Amazing.

This morning when I saw her, she was eating yogurt from a spoon. It was quite a happy sight, with her opening her mouth for more food and her uncle shoveling the yogurt in. (The trauma surgeon said that it reminded him of a little bird opening its mouth for food.) She will be transferred to a Red Cross rehab hospital today, and will follow up as an outpatient next week in order to track her weight, blood protein level, neurologic status, etc.

Thank goodness for happy endings!

Zoo Crew pictures and video

Drum roll please ...

Here are the pictures (in slideshow format) of Matt's recent visit to the LA Zoo. You'll see pictures of all of the things Tonya talked about in her post; in fact, you may consider re-reading the post to get the most out of the slideshow that follows.



Here is my first attempt at uploading video! You can see for yourself what a handful Matt is. :)

Hometown Hero 5k

Everyone, meet the next F-R-E-E T-shirt:


Last Saturday, my unit put on a 5k "fun run" called the Hometown Hero 5k. The race was held the same day in both Iraq and back in Delaware, and the times are being compiled together to determine the winners, wherever they ran. It's almost like the 15k that the 146th Signal Battalion from Florida put on a few weeks ago, except that one was a HUGE race in the US, and this one was pretty much a local event. The Delaware National Guard hosts a series of runs each year, and this one counted as one of the series.

It wasn't a particularly good run for me - I've had a couple of fairly busy weeks, and going to the gym has declined from a 4-day a week affair to a 2 or 3 days a week, even reaching a low of one day last week. Getting back into the swing of things is painful, but I only declined 16 seconds on 3.1 miles, so I guess it's not that bad. It was a lot harder to run this one though, and it was slower!

Here's me crossing the finish line:



Yes, I'm actually wearing the T-shirt for the race, which may be another reason I didn't run so fast - I already had my prize at the start of the race!!

The obligatory group photo. I'm not even going to try with the names; the people in the photo are from my unit (261st Signal Brigade). The one gentleman I would like to point out is Captain Linden Boyer, the guy on the far left, who put most of this thing together (and who I can thank for ... yes, the T-shirt :)

IED vs. chocolate bunny

Happy Easter!!

I have been waiting for this holiday to tell you the story of the chocolate bunny on my desk in the clinic, and after that perhaps you will understand the nature of this post.

Since I started work here at Bagram, there has been a slightly eaten chocolate Easter bunny on my desk. The face is bitten off, and someone had also taken a bite out of its ear. After seeing quite a few IED blasts come through the ER and onto the ICU, I couldn't help but think that my little bunny had - before I arrived, of course - suffered an IED blast. I mentioned this to one of my colleagues, and it has since become quite a joke in the clinic. Numerous patients have asked about the bunny, and I tell them that he was hit with an IED. It gets the conversation started, to say the least!

IED blast injuries are very common in theater, both for the bad guys (who often present with bilateral hand amputations and facial injuries after the blast has gone off unexpectedly) and the good guys (who are often tr avelling in a vehicle when hit by an IED near the road). Since we are the referral center for nearly all med-evac flights in Afghanistan, we see a large majority of these blast injuries on our ward and ICU. The ubiquitous nature of IED blasts makes them, at times, a source of jokes and laughs. This does not mean that the health care providers take them any less seriously; the jokes and laughs are just how we survive the day-to-day grind of caring for patients with devastating injuries.

With that small introduction, I would like to provide you with my first attempt at composing Easter songs. (Well, I didn't really compose them, but rather modified them for my current situation.) I encourage you to sing them out loud, as the beats and rhymes will make more sense that way. There is a glossary of terms and acronyms at the end of the songs for those civilians who might not be familiar with the verbiage.


Sung to the tune of "Peter Cottontail"

Here comes Peter Combat-tail
Rollin' down the convoy trail,
MRAP, HMMWV,
Better look both ways!

Wearin' all the bad-ass gear,
Minus one chocolate ear,
Helmet, M9,
Better stay away!

Takin' out the Taliban,
Knowin’ soon they'll be gone,
C4, grenade,
Soon enough you'll pay!

Teachin' all the girls and boys,
IEDs are never toys,
CCAT, dust-off,
Need them both someday!


Sung to the tune of “I’m a Little Teapot”

I'm a little bunny missin' my face.
My ear was blown off without a trace.
When I see an I.E.D
My tail does shake!
And then, of course,
A bite it takes!!!


Sung to the tune of “London Bridge”

Bunny has no face at all,
face at all, face at all.
Bunny has no face at all,
Left I.B.A.

His ear was blown off Easter Day,
Easter Day, Easter Day.
His ear was blown off Easter Day,
By I.E.D.


Glossary:

MRAP - Mine Resistant Ambush Protected (a type of wheeled vehicle used for mine sweeping)
HMMWV - High Mobility Multipurpose Wheeled Vehicle (a military Hummer)
CCAT - Critical Care Air Transport Team
IED - Improvised Explosive Device
IBA - Individual Body Armor
Dust-off - Slang term referring to the medevac hangar

(Some of you only thought I was crazy. Now you know for sure!)

Egging

We took Matt and Zach out egging in Glendora. The two boys are just like their dads and I think they hit a few of the same spots too...

Actually the cousins all went easter egging. The Easter bunny visited the Glendora apartments and hid eggs all around the gardens.

Kaitlin was a great helper and encouraged the boys by showing them where the "boy eggs" were aka the easy ones. Kaitlin was able to find even the hardest eggs in the bushes. She even took a moment out to climb a tree. In the end she became the Easter bunny and hid the eggs all over again.

Ashley only wanted to find the "girl eggs" aka the hidden ones. She especially liked the fancy sparkly eggs and the candy inside! Ashley was more concerned with finding the eggs that had hidden treats than finding the most eggs. Thankfully she shared her candy with Aunt Shannon!

Matt just wanted to run around outside and the shiny colored ovals were an added bonus. Maybe Matt didn't understand the objective to FIND the eggs; he really enjoyed emptying the basket and watching Tita try to clean up the Easter "grass" inside the baskets. Matt also enjoyed running down the small hill toward the staircase and trying to climb as many stairs as possible before someone came and pulled him down.

Zach chilled in the sunshine and watched the shenanigans happening around him. Even though Zach just learned to walk, I think he was overwhelmed with all the activity and just stayed put for most of the action. The girls were very kind and emptied their baskets out for Zach. By the end of the day he was sitting in a HUGE pile of eggs. Thankfully my kid doesn't care how much I dress him up. Chuck said not to post this picture, but I just couldn't help myself. Besides the cousins need some ammo to pick on the littler ones with. Oh don't worry James (we're stockpiling the pictures of Matt to pull out when we really want to hold something against you).

Here are a few pictures of Tita catching Matt:Unfortunately, Aunt Tonya got stuck with most of the clean-up...
After the hunt, we enjoyed a little lunch. While we were wrapping up the day and saying good bye, we were talking about mommy and daddy. Tita asked where mommy was and Matt looked at all the pictures of mommy hung in the living room. Tita asked again "where is mommy?" and Matt pointed at the picture of mommy. Then Tita asked "where's daddy?" and drumroll please.... Matt said "daddy". It was clear and distinct and an exact formation of the complete word. We were all so pleased and started clapping. But of course Matt wouldn't say it again no matter how much we begged and pleaded.

Great day

I had a great day today! But since it's 10:04 pm and I'm due back at the hospital at 5:30 am, I'll be brief by summarizing the events of the day:

(1) Slept well last night. Got up and rounded on my few pediatric patients with a positive outlook on the day.
(2) Attended rounds with the team. Helped put in a central venous catheter with one of the surgeons. She walked me through it so that if I ever had to do it on my own ....
(3) Went to the OR with one of the patients. Did the intubation, then scrubbed in for the case. The surgeons let me participate!
(4) Finally ate some breakfast - cinnamon raisin bagel with a mocha latte (=coffee with hot chocolate). Didn't get around to eating the remaining breakfast - hard boiled eggs and pear.
(5) Spent a considerable amount of time trying to figure out if my patient with the amputation has neuropathic (aka "phantom") pain. Once I determined that her pain likely is neuropathic, I spent a considerable amount of time learning how to treat it. Once I had gained that knowledge, I spent a considerable amount of time figuring out if we - given our limited pediatric pharmacy resources - even can treat it. Turns out that we can. Wrote the order.
(6) Saw a medic from my unit for chronic cough. The CO had sent her to me because she didn't feel that she was treated appropriately in the outpatient clinic. Looked at her XR and gave recommendations.
(7) Tried three time to put a feeding tube down the patient with the amputation. Had to have four people hold her down in the process. Two-year olds have mighty strength when they think that you're going to hurt them!
(8) Gathered various fruits for the patient since her tube feeds do not have enough daily fiber. Was able to locate and cut up green apples, pears, plums, dried cranberries, raisins, prunes, and dried blueberries. Served them all to the patient and implored her brother to help her eat some of it.
(9) Talked for about an hour to the PA who first treated with patient with the penetrating head injury. He was doing a routine humanitarian mission in the area when a local Afghan man brought the patient to him. He had a minimal medic bag, but was able to intubate and stabilize her before the flight medics arrived to bring the patient to the hospital. It was an amazing story and I very much enjoyed hearing it from the horse's mouth.
(10) Made some uber-ramen for dinner. I had to put it into three cups for microwaving because I couldn't find a bowl big enough!
(11) Called the pediatric neurosurgeon when one of the patient's ventricular drains began to leak (a ventricular drain is a pop-off mechanism so that some of the spinal fluid will drain off if the pressure in the head gets too high). Assisted in fixing the drain.
(12) Went back to the little girl with the amputation to find that she had eaten almost an entire pear, half an apple, and two prunes. Success!
(13) Checked the orders for all of the patients for morning labs. Don't want to miss anything or draw any labs that are unnecessary. Checked in with all of the nurses in the process (a habit I got into as a resident; I found that if I checked in with the nurses before going to bed, I could avoid getting paged overnight ....).
(14) Returned back to the barracks for a very quick combat shower and to hit the sack.

So that was my day! It was more busy than the average (mostly because I made it that way) but very rewarding and even fun!

"Your mom sends me care packages"

This must be "funny vignette day"; here's what made me laugh today ...

Some background: We live in two-man rooms here on Camp Victory, and no matter how you try, if you have a roommate, you have to resort to skills you learned when you were in Kindergarten. Fortunately, my roommate, Bob Anuszewski (a.k.a. "Ski"), and I get along just fine, so we set up our room as an open area with the beds and closets along opposite walls, giving us a living room of sorts when we aren't occupying a bed. Throw in opposite shifts, and we basically have 2/3 of the room whenever we are in it.

Along with the fortunate living situation came some conveniences we developed. For instance, since it is easier for me to drop off laundry on the way to work than for Ski (I'm on day shift) and easier for him to pick it up on the way back from shift, that's how we handle laundry. I take two bags, and he picks two up a day or two later.

We can also pick up each other's mail, which leads me to the point of the story: Ski is traveling in the North of Iraq right now, and I'm picking up all his mail. His mom unfortunately sent a lode of cookies after he found out he was leaving, and they had not arrived by the time he left. I have been photographing and emailing him the mailing labels, and when this one came in:


he told me to open it, eat my fill of cookies, save him half a box, and distribute the rest. The cookies are excellent (thanks Mrs. Anuszewski!!), and along with the other wonderful packages everyone has sent, I am running more and more on the treadmill to burn it all off.

I told the other soldiers in our section about all of this, and we decided we had to somehow poke fun at Ski because he missed the care package, leaving us here eating cookies his mom baked for "all of us" (but we all know they were really for him, she just knows better than to include only enough for him to eat ...). One guy came up with this patch from the custom patch shop:


Patches on your right sleeve are a big deal to some people out here, for various reasons. Some patches signify you served under a storied unit during a conflict (i.e. "I was in 'Nam, man!"), having many patches means you went to war many times (i.e. "This is nothing ... you should have seen it in '03!"), and having certain other ones indicates you have some special skill (i.e. "Special Forces", "Ranger", etc) - these unofficial "custom" patches are meant to poke fun at the patch-worshipers, and have a good laugh in the process.

So, after much ado, I'm going to send a thank-you note to Mrs. Anuszewski with the picture below printed out and enclosed ... and email a copy to Ski to let him know the cookies made it!

Makeup

Just a quick anecdote that I thought you might enjoy...

This morning, the nurse taking care of the 8-year-old with burns was putting bacitracin over her eye wounds and some chapstick on her lips to keep them from drying out. The little girl started saying something in her native language, so the nurse got an interpreter. She was saying that she wanted more "makeup"! This entire time, when we have been putting bacitracin and chapstick on her, she thought we were putting on makeup to make her beautiful. And in a way, we ARE putting that stuff on her face to make her beautiful. She will be beautiful once again when her wounds have healed. :)

She also requested some "sparkles", which are (apparently) an eye makeup used by Afghan women. I'll see if I can find some at the Haji market on base ...

Tech Savvy

Well dad, I know you had every hope of being the first tech-teacher for Matt. But it seems that Uncle Chuck has beat you to the punch. Cheekfeast now has his own gmail address and skype account (actually that's even more tech savvy than Chuck).

Matt helped Uncle Chuck build his own desk and set-up his own computer. Granted it is an OLD computer (I mean OLD) but it is perfect for skyping with mom. We did a little test run with Autumn but we didn't have speakers so unfortunately she got to hear us but we couldn't hear her. It was a little awkward... Next we'll try a gmail video with dad!

Zoo Crew

Written by Aunt Tonya, still waiting for pictures from Grandma Kathy ...

How many adults does it take to manage three little kids at the zoo? Well, we have answered the question: It takes no less than four! On Sunday, we attempted this experiment for ourselves at the LA Zoo. Just take a look at the supply and equipment issues: 3 car seats in one car with four adults, 1 double stroller, 3 snack bags, 2 diaper bags, 1 camera bag, 1 clothing bag with 6 jackets, 2 pillows for Ash, 2 stuffed bunnies for girls and 1 Luvie for Matt. Three stops required between Corona and LA. Upon arrival, everyone either had their hands full with a bag, a stroller or a child. Never let it be said that we do anything without being prepared!

Everyone had an incredible time, each in their own way. Kate was allowed to essentially run free. She moved from place to place without restriction ... jumping and climbing on everything in sight. Amazing to watch Kate try to read the information signs. She read by “filling in” the written words with her own facts/observations about each exhibit. When talking with her, the hippo was her favorite because she said that hippos play games by tipping over boats. (Wonder if the people that get their boats tipped on the Nile would have the same perspective.) Ashley loved the alligator family simply because she likes to play alligator games using her hands to go snap-snap.

Michael spent a good portion of the day chasing Ash through the crowd as she chased Kate. Mom, Dad or I always seemed to be chasing Matt in the opposite direction. (Note: people tend to move for a running toddler in a crowd but not for the adult that chasing them ... go figure. Just encourages the kid to run further and faster laughing all the way.) The situation became some what like herding cats. The kids would stop individually, but not collectively. A leaf here. A rock there. Muddy puddles in the garden. The list is endless.

Matt had a great time. Matt and I had to have another get-to-know-you period when we first arrived. It was too funny for words. He was happily sitting in the stroller until the flamingo exhibit where the bushes were too high for him to see. I released the front table tray on the stroller - he pulled it back in place with a frown. I unsnapped the lap restraint - he held it dropping his luvie at the same time. I got the luvie, put it on my shoulder, sat still not saying a word - he just looked at me. I sat - he looked and then decided that he could not reach luvie from his seat. He got out - I lifted him to see the birds. Issue resolved: he decided that it was much more fun to be held in my arms and be able to see the funny pink birds. Once he was comfortable being carried, we tried riding on my shoulders. He was happy as could be and sat quietly looking around until my shoulders hurt and I had to put him down. Letting Matt walk was my idea. His idea was to change this into another game of tag. Thankfully, the petting zoo was right around the corner. He did not seem to be afraid of any animal in the little zoo, even those that were twice his size. I was nervous with three kids roaming around live animals but Mike, Mom and I managed. Ash showed him how to brush the animals' coats and he did a pretty good job. No animals were harmed during this educational process. Although the animals were cool, the dirt was even more fun to kick and create dust clouds. Kate found a timid goat that she befriended.

We went on to do all the standard zoo things. We rode the tram - Ash just loves trains and sat happily. Kate sat with Mom and talked her ear off. Matt sat with Dad and me. He was so focused on watching all the new things that he sat still. Images played in my head of one or all of the kids falling off. We saw the zebras and tigers. We all had a typical junk-food lunch with not a fruit or vegetable in sight. Against my objection, Dad did make sure that Matt got milk instead of sharing my soda. We let the kids run up and down the paths and through the crowds and determine the stopping points. Ash actually found an animal that she did not like: the Kimono Dragons. Tried and tried to explain that "dragon" was just part of the name and they did not have wings to fly out of the cage. It was an attempt in vain.

We found the gorilla and young giraffe enclosure. All the kids were amazed by these two exhibits. Kate was standing at the gorilla exhibit up against the glass. Something startled a large gorilla and it charged the glass about 10 feet away from her. Obviously, Kate was then startled but recovered quickly. The funniest part was that she scolded this 300lb animal by saying "Don't do that or mommy will send you to timeout."

By late afternoon, both Matt and Ash could just go no further. The sandman was making a visit. Both opted to ride in the stroller. Binkies, luvies and pillows required. Ash's final words: "I'm not tired." Dad pushed the stroller for the next several minutes and both were fast asleep. Kate finished seeing the zoo alone which was just fine for my Prima Dona.

What did we learn? 1. Physical energy is wasted on the young - it should be given to adults, who do the majority of lifting, pushing and pulling. 2. I am old - thank God for all the helping hands. My shoulders actually hurt today. 3. A zoo visit with three kids under age five can actually be done and everyone can have a great time with precision planning. 4. The pictures will be worth a thousand words. There are enough pictures to write a novel.

Tidbits

Just a couple items of note...

Warner Insurance now stocks animal crackers. I guess Uncle Kirk decided it was time to diversify in this market. Actually Grandpa Frank takes Matt for a walk EVERY single morning and their usual route runs through downtown Glendora where they get to stop and visit Uncle Kirk. He's a softy and gives Matt his daily dose of animal crackers. Here is a pic of Uncle Kirk, Annie and Matt. The second pic is blurry but you can see Aunt Elloise in the back too.

Grandpa Frank has a new game with Matt. Matt lies on the ground and Grandpa Frank drags him across the carpet. We got to witness this last weekend. While Matt thought it was absolutely hilarious Tita was watching out for rug burns.

Zach showed off his new teeth to Matt. He now has four on top and two on the bottom. Since they are still tender, everything goes into his mouth. We watched to see if Zach would really show off his teeth by taking a bite out of Matt. But Matt is much larger than Zach and scared him away. Although Matt did seem to be pretty jealous, he did share his toys well.Lastly, Matt gave Loretta a black eye! Tita wouldn't let me take a picture of her though. She seems to be just fine. I guess Matt was a little overexcited about sharing his toys with Tita and decked her. But seriously, Matt is 1/3 of Tita's size. I think he'll be her full height by age 5. Maybe 6?

Just one more photo of Matt I couldn't resist...

McNuggets

Written by Aunt Tonya...

Got Matt in the morning from Glendora. Shannon and Zach met us at the apartment. This was the real first test with Matt on how he was going to handle outings with us. An uneventful departure from the apartment. Expected some resistance from when we left but Matt only turned back once when he realized that Loretta was not coming. Expected the possibility of tears but there were none...sighed with relief. Again, car ride and arrival uneventful. Shannon was telling the story of the boys babbling to one another in the backseat and trying to hold hands. Wish that I had been there to see it.

Ordered standard lunches for play dates - Junk food: hamburgers, nuggets, fries. Did attempt to add something healthy but the apples and milk did not really go over too well. Girls quickly ate their lunches and were off to play together and with the other kids. Should have been offended by the girls inattention but I actually got to eat my meal hot and offer a free hand to help with the boys.

The boys sat side by side in their highchairs happily eating their lunches. The casual onlooker would have smiled with amusement. Matt takes from Zach's hamburger. Zach takes Matt's nuggets. Zach tries to feed himself and then Matt. Matt eats half the fry and Zach finishes it. The boys continue with this sharing, taking and feeding behavior throughout the meal. We end the meal with Matt's face covered with food and Zach's clothes covered with food. Matt is still at the stage of testing gravity by throwing food on the floor. I had a get a broom and sweep the mess. As complicated as this sounds, it was actually very easy. Set the food down and let the boys pick and share as they went.

We had about an hour to play after finishing lunch. Zach and Matt played on the simple climbing step. Actually, a very good activity for Matt. Required using the spider-climb technique that we already were practicing. He showed improved skill at staying with the group and following one-step verbal commands. He could follow two-step commands with verbal and physical cues - this was the first time that I have seen him accomplish this. Parallel play is being extinguished and replaced by more unilateral, cooperative play. As you probably guessed, his favorite activity with me is tag. The play place is idea for such games. Babbling is being replaced with functional sign/gesturing and attempts at word formation. This week I clearly heard "this" when making a request. We had to reinforce the use of a straw using Ashley's soda as a reward.

Zach has grown by leaps and bounds. Just love this developmental stage. He was able to stand with stability but does not have the courage to take that first step. Walks requiring only one hand - used mostly for security, not support. In less than a month, he will be fully mobile. God help us all with four kids all on the move. Feeds self well and eats almost anything. Just starting to see emerging functional gesturing. Interesting to watch from afar his frustration at not being able to make his needs known. This is the precursor to first words. They will be arriving soon. He is the easiest kid to carry - light and clinging. Never had that kind of luck with my own kids. Kate was light and Ashley was clingy.

There were only three little bumps in the road. 1. Zach was beyond tired with the late hour and a tummy full of food. It is so true that kids get accident prone when sleepy. Zach took a good tumble and split his lip. The oozing blood took more than than a minute or two to stop and will certainly leave a good size fat lip. 2. Took Matt to the bathroom for a diaper change and general cleanup before returning him to Loretta. We were washing his face and hands when I made the mistake of saying something like "Wash them well. We need to go back and see Tita." Tears started to form and he said "Teet". Resolved the issue with round of "The Wheels on the Bus" and no any real crying. 3. My girlish figure just can't take much more of these junk food days. My budget can't tolerate a whole new wardrobe. What is a girl to do?

From Shannon - Sorry, we were so exhausted with the kiddos running around that I didn't have a chance to take many pictures. But I finally popped open the camera on our way home. Here are a few pics of Matt in the carseat with a belly full of nuggets...

Dodge City North

Quick quiz: What is "Dodge City North"?

A) The name of a town from the Wild West where a famous shootout occurred.

B) The title of a second-rate action movie starring Arnold Schwartzenegger.

C) A Chrysler plant that makes the new Dodge Ram 1500 pickup.

D) The aptly named living area in Iraq where James currently lives.

E) This is an April Fool's joke; why would anyone name something Dodge City North?

If you guessed "E", then you are probably thinking the same thing the people who lived in this place thought when it was officially called something else, but affectionately called Dodge City. So the story goes, this used to be the living area that got hit the hardest and most often by mortars and over-the-wall attacks. It's not particularly close to the wall anymore (the wall has been moved out over the years), and there have been almost no attacks since I arrived. At some point, though, it was bad enough that the residents nicknamed it, and the military let the name stick.

Despite the relative calm, the living areas are pretty heavily fortified with concrete barriers, and it is a lot like cabin camping in a post-apocalyptic wasteland:

Bottled water is available everywhere - you just help yourself to however many bottles you want. Of course, you are encouraged to conserve, but not at the expense of hydration. Even in the winter and spring, I usually go through two or three of the 1-liter bottles a day. All the water is purified out of the Tigris River, which is diverted to Victory Base Complex via canal, and the bottles are produced, filled, and distributed from the Oasis Bottling Plant about a 20 minute walk from my room.

This is one of the massive generators that provide power to the living areas. All of the power here is generated using fuel that is trucked in. All of the water and raw materials used on base are trucked in, and the wastewater and trash are trucked out. It's almost like we are living on the moon.

The tall concrete walls are known as "T-walls", since they roughly form the shape of an upside-down T. They are everywhere. In the beginning, there were sandbags, but as our presence grew more permanent, they were replaced by the Jersey barriers (like on the freeway), then 5-foot tall barriers, then a year or two ago, these 12-foot T-walls. As going-away gifts, units will often get miniature replicas of the T-walls and engrave something in them or mount a coin in them. The signature mark of the company that makes the T-walls is the number "77" at the top - it is even on the miniature ones they make!

Dodge City just goes on and on ... and it's one of several living areas on Camp Victory (one of 6 camps that make up Victory Base Complex)!

The structure to the right of this picture is a bunker. These are not as frequently occurring as I would think for a place called Dodge City, but they are close enough to you if you are between T-walls that you can dive into one in a pinch.