After Action Report: Lilley, Take 2

I know my silence on the web has been deafening. I haven't posted to the blog or kept in touch via email much lately, mostly because I spent the last 2 weeks downrange at my favorite little fire base on the Pakistan border. :) Yes, I had the distinct opportunity to once again visit Fire Base Lilley as a pediatrician, and this trip was even more eventful than the first!

The mission was conceptualized in July as I met the two Lilley SF medics when they arrived in Afghanistan and spent a few days in Bagram on their way downrange. Honestly, here's how it all started:

Jason (SF medic): "Hey, Autumn, what do you think about coming down to Lilley to do some teaching?"

Autumn: "That sounds good. How are we gonna make that happen?"

Jason: "I don't know. Let's looks into it."

The process of mission authorization was arduous and bureaucratic, requiring coordination at multiple levels of leadership within both my command and the SF command at Bagram. There were many times I thought, "This is never going to be approved." Incredulously, a few days before the mission was supposed to commence, we got the word that the mission had been approved at the highest levels. I was elated.

The medics and I began facilitating the logistics of the mission and planning for the training modules for the medics and local national providers. We discussed equipment and materials necessary to complete the mission, and within days transportation had been acquired. The flight out of Bagram was one day sooner than expected; although this caused me additional stress in the preparation phase (I got under 2 hours of sleep that night!), I was super excited to get down to Lilley and begin the mission.

Radio delays at Bagram caused me to miss my connecting flight from Salerno to Lilley; however, this deviation from the expected travel plan allowed me to spend a day experiencing Salerno. I used the day to further my knowledge of the resources available at the forward operating base (FOB) by meeting providers at the hospital as well as learning about the medevac capabilities staged at Salerno. It was a great opportunity to meet other medical professionals and become familiar with the medicine practiced there. Meanwhile, transportation was worked and re-worked and re-worked again; the medic at Lilley and the air coordinator at Salerno worked their tails off to ensure my safe passage downrange.

I caught a rotary-wing flight the following day to FOB Boris, a small base north of FB Lilley. I had met the doctor at Boris during my prior visit to FB Lilley, and he graciously provided quarters and other assistance during my stay there. Once again, I took the opportunity to experience as much as possible of the FOB by speaking with the medics, clinic NCOIC, and operations center. This FOB of around eighty soldiers was much smaller and more austere than Salerno, and the differences in personnel and environment were palpable. Meanwhile, I was kept informed of the tactical situation and plans by the medic at Lilley, and was picked up via convoy by the SF team in the middle of the night, arriving at Lilley around 0400. They had convoyed for 5 hours before they picked me up, so the team wasn't in the greatest of all moods, but we listened to Ace of Base in the MRAP and that seemed to make everything better. I stayed awake through sunrise in order to document the beautiful glimmers of light over the mountains of Western Pakistan.

We then settled into a solid daily routine. While not set in stone, our schedule loosely followed this paradigm:

Mornings - I saw women and pediatric patients at the Lilley local national clinic with the two Afghan providers. The SF medics joined me when possible. I encountered a wide range of complaints and diagnoses, including pneumonia, gastroenteritis, routine pregnancy, skin conditions, malnutrition, animal and insect bites, and gastritis.

Afternoons - I prepared and executed several hours of pediatric-specific training for the SF medics and local providers. The remaining time was used in organizing the clinics, conducting preventative medicine operations, and developing medical protocols.

Evenings - After dinner, the medics and I would see patients in clinic as needed. In between patients, the medics would provide blocks of instruction to train me on topics in tactical medicine. I learned about tourniquet use, building medic bags and individual first aid kits, regional and general anesthesia, acupunture, the different types of weapons used by the SF team, and so much more!!

As needed - I assisted the SF meds in other activities around the FB, including resupply missions and preventive medicine.

FB Lilley came under a rocket attack within a week of my arrival. I was headed to clinic when the first rocket hit within 30 feet of my destination; I didn't hear it nor see it, but I was told to take cover. I don't remember any of the other four rocket strikes, but I do remember the gigantic bang when the ammunition cache exploded (the explosion was estimated to equal around 1000 pounds of TNT).

With the SF medics, I treated two patients - one with a severe concussion and one with a knee sprain. The decision to medevac the patients was made, and I was given around 12 minutes to college my belongings and body armor, and be ready to board the bird. I did my best to pack for this unknown trip, but ultimately didn't do a very good job. :( Via blackhawk medevac, we went to Orgun-E for initial stabiliation, and then flew to Salerno for a CT scan. I spent one night in Salerno after the most seriously-injured patient was released from the hospital, and fortunately returned to FB Lilley the following morning within 24 hours of the rocket attack.

The operational tempo at the FB following the rocket attacks was quite high. (As well it should have been ..... the enemy has been unable to hit the base for over a year.) Once I returned from Salerno with the patient, the SF team prepared to go on a mission, and because some of their team members were non-mission-capable due to the attacks, they elected to assign me as the medical support for the FB in their absence. For 24-48 hours, I served as the only coalition medical professional at FB Lilley, which required me not only to see patients at the local national and coalition clinics, but also to keep abreast of the operational and tactical developments throughout the region. During this time, an additional three rockets hit FB Lilley, but fortunately no soldiers were wounded.

This second mission to FB Lilley was the capstone experience of my deployment. It was fun, it was challenging, it was new and different (even though I had been at Lilley before), and it convinced me that operational medicine - in some way, shape, or form - is my calling. 100% of me now believes that I'm probably in the wrong field of medicine, and that I need to change my plans and my career course. I haven't completely decided where to go with my career, but the options include intensive care pediatrics, flight surgery, public health (which will allow me to travel), pre-hospital care, operational/tactical medicine (e.g. with Special Forces), and emergency care. There are lots of options, and now I need to decide which suits me and my family best.