Life in Canada
I was born and grew up in Saskatchewan, Canada, and middle of nowhere, we always joke about that. Growing up, just part of the city, and my father had been in the army before I was born. I got my way through high school decided I wanted to focus on medicine, and I'd started doing an undergraduate degree in science and it was around that time that my grandmother had died, and I'd gotten into medical school and my dad had told me earlier on, "Oh, son, you know, think about joining the military." And I said, Dad, "I'm a lover, not a fighter. That's not what I would do."
And he had been in the army. But then getting into medical school and realising there was a bit of a price tag at the end of it all, I thought, "Well, I'm gonna look into this."
My grandmother had died and I ended up traveling overseas and meeting a lot of Australians and Americans, people from Europe, and I realised this is something I could actually do. So, when I went back to medical school, I decided to join up, that was back in 1990. Went through medical school, did some time in Ottawa, I went to Halifax and served on a ship for two and a half years, took from the west coast of Canada down to the East Coast and I really enjoyed it.
But along the journey, along my medical school journey, I met a girl from Melbourne, and she was over working for a year and after meeting her, we decided to stay together and got married over there, had a child over there and then it was time for her to come home and I thought, well, the way I could do that would be to transfer as a doctor, as a general practitioner as a family doctor.
And not really understanding the medical system here, I thought, I do understand navy. So, I started approaching that and transferred from the Canadian Navy, effectively had to get out completely, and then had a bit of a hiatus before coming over to Australia in 1998.
Transfer to the Royal Australian Navy
I will clarify a bit about the transfer bit because it was, I did join the Australian Navy before I came to Australia. But how that happened, there were two phases of that, being as a doctor, we were almost like blacklisted, you didn't really need them in Australia unless you went to certain areas.
So, the Defence Force had an agreement with the Department of Immigration to say, "Hey, we want to bring in this person." So, it was going to be relatively seamless until someone forgot to renew that contract. So, I said, "Oh, I'm married to an Australian, and we have a child. How does that change things?"
I spoke to the high commissioner, and he said, "Just send us your passport, you're immediately a permanent resident, and then I could get the ball rolling again." And then they flew an Australian officer up from San Diego, who was on exchange, to Vancouver, who signed me into the Royal Australian Navy and then I got on an aircraft, landed in Melbourne and that was my entry as a permanent resident to Australia.
So that was easy, and they paid for it all. So that was a very good thing, and I knew I had a job. On arrival, it was December, so I went to the base, met my new boss, whom you know, and pretty much identified, "Go get your uniform. We're about to go on reduced activity period" as it was known as back then, I didn't even know what that was, which meant that the base essentially went down to minimum manning and most people were on leave, but I hadn't accrued any leave.
So she goes, "That's okay, you just go on leave and you come back in January and you'll have a job." So, that transition was quite nice with a young child and finding a place to live. We were put up in a hotel, awaiting a Department of Human Services place, a DHA home, sorry.
And that was helpful to transition that way and then, really on entry, I felt very at home. The Navy, the service life, having already been nine years in defence in Canada, that was the commonality. The difference as a doctor was that otherwise as a fully qualified family physician over in Canada, when I came to Australia, my credentials had been assessed by the Victorian licensing agency at that point, but I was on a restriction of my registration until I had done the Australian Medical Council exams.
So, that was the transition for me, having been a fully qualified doctor, going to sea doing all the things you would normally do, to now being under supervision again, and having to sit exams to prove that I knew what I was doing.
So, I had to do all that and I worked out at HMAS Cerberus for essentially a year and a half while getting through those exams, working on the ward at the health centre, teaching at the medical school where we train our medics and doing a few shifts in the emergency department to understand the health system from external to defence.
So, my very first provider number was at Frankston hospital which is now where I still work as a consultant surgeon. I live down in Victoria but not quite in Frankston. So that was that was my transition, just getting to know people, having to go on all the courses, doing officer training. Having already been fully trained as an officer they gave me a bit of an out.
They call it a lateral entry officer 's course and qualified entry officer course, so smaller duration than the others and very bespoke, I was top of my class because I was the only one in it. And they gave me a tour around to Sydney and Canberra to just meet people and get a bit of lay of land and getting through all the exams, after a year and a half, I then transferred up to the Submarine and Underwater Medicine Unit in Sydney at HMAS Penguin.
Underwater medicine
The skill set I actually had in the Canadian Navy, I was an advanced diving medical officer there and I was also diving officer running my own dive team for my ship. So, when I came to Australia, that was a career focus for me and a path.
I identified that early. So, to get that, that job in Sydney, it is focusing really on Underwater Medicine, which includes anything that goes under the water - submarines and divers. So, at the Underwater Medicine Unit in Sydney, that was primarily focused on diving we had at that time the Royal Australian Navy diving school, now known as the ADF diving school.
Right next to us, we were right on the water in Mosman, and that role there was as a primary health care doctor, and there to run resuscitations for stricken divers, take them to the recompression chamber if need be. I had a group of underwater medics working with me and that was our entire focus.
We're just down the hill from the Balmoral Naval Hospital and our focus is purely on diving. The unit itself, at that stage, was the only Submarine Underwater Medicine Unit. We had a submarine escape training facility over in the West Coast and that was kind of the offset.
So, we were the bigger unit with the diving focus and the submarine escape training facility was where they did the pressurized escape training and so we needed to have doctors and medical sailors there that were underwater medicine trained to manage those people if they got injured.
The bends
The bends is really decompression illness. So, it's someone who's been at depth for a period of time, they've on boarded nitrogen during the dive and as they come up, the nitrogen bubbles come out of solution and cause problems in the tissues that the bubbles expand into.
So, they're taking on nitrogen as they come down because they're breathing gas at pressure and that's just coming into their body. So, as they come up through the water column, that then exposes or can dissipate and cause problems in the joints and the soft tissues in the spinal cord and the nerves in the brain.
So, any of these symptoms that come on surfacing, we would then identify we would assess them and decide, yes, they've had the bends or decompression illness, and we will then take them into the decompression chamber for treatment.
There are other conditions that can come through air gas embolisms that can go up, so a bubble that comes through the circulation and it can go into the brain or into the any other area and that can be related to problems in their heart where they had a hole in their heart that we weren't aware of.
These types of things can happen or a person has been panicked at depth and they 're raised to the surface, and they're holding their breath, and they overpressure their lungs and rupture their lungs and cause that, that air embolism that way.
So, there's lots of different injuries that can occur. And then just trauma in general, they could be hit by propeller, there can be shark attack, etc. So, a whole variety, venomous creatures or dangerous creatures in the sea, standard injury, but the decompression illness that we decompress are taken to the hyperbaric chamber, is what we would do to then let the nitrogen get out of their system so we can get them back up to the surface again.
Anything deeper than 10 metres is one atmosphere and if you're down there long enough, you're gonna onboard enough nitrogen that can cause a problem. So, all the recreational divers, as well as military divers, will plan their dive so that they avoid that risk.
But in the military diving and operational diving, they sometimes do have to go deeper for longer. We might use different gas mix mixes so that they can stay down longer without that risk. But that's why we have them in the Navy and why it's important for continuing to have a Submarine Underwater Medicine Unit for the Australian Navy.
Submarine escape training
In general, if a submarine is stricken, is in distress, cannot surface for whatever reason, it's had a collision, has lost power, and it's at depth, or it's had a fire, they've been in enemy action, whatever reason, and the sailors that are there cannot get that submarine to come back to the surface then they have to an escape.
They're at depth. Now they'll be at significant depth, we're not talking 10 or 20 metres, they're going to be at hundreds of metres down and for them to escape, they would go up to a conning tower, they flood that tower, they then, through the hatch, release themselves and have a pressurized suit, they'll take them up to the surface, where they can actually have a bit of breathing.
But for them, they're breathing compressed air because they're inside the submarine and they then will go up. If they held their breath, as would be the standard, then their lungs would rupture, and they wouldn't be surviving that ascent.
What we used to train was, in the water column, on how to do that, how to get into the flood chamber, don the suit to get out, and then how to go up through the water column while exhaling the entire time because the gas is expanding in your lungs. So, you just have to keep things open, let them blow the bubbles. So back when I joined that unit, that was still happening on the West Coast, and we were training people, the whole world is still training people like that.
Over time, we've identified that that still causes injury to people and it's not necessarily the thing that we need to train them to do. So now we can do that training at a very, like one metre depth, so that they're just going along the water column. They are understanding how that works, but they're going horizontally instead of vertically.
Operation Relex
That was the first of our border protection events when the potential illegal immigrant vessels were coming in through the Indian Ocean. That was in 2001. Another very significant event, of course, happened in 2001 and I was at sea during that time. But that operation, Relex, was the border protection that we see now in Op Resolute.
So when potential legal immigrant vessels are coming down, or suspected illegal entry vessels, SIEVs, we were there to stop the boats from coming through, intercepting and sending them back if we could to where they came from. For any of them coming through they would have been at sea for a varying amount of time. They may have been fleeing persecution or other areas, so they may have already had some injuries or illnesses, chronic conditions.
Obviously, in the defence force, we have a narrowed age range of people that we normally take care of, so this was an additional challenge, and why it's good to be a general practitioner and a family doctor, because there 'd be children, there would be pregnant women, newborns, there would be elderly people with significant chronic conditions and then all the risks of malnutrition, dehydration, viruses, even I suppose scurvy, but didn't see that. But any of the injuries that could occur from that time if they're in rough seas. So, we assess their health, we manage their health, and then either brought them into Christmas Island as a detention facility, and then they were managed along the political lines of the day or, if possible, we would return them to where they come from.
The Medical Officer Specialist Training Scheme
The Warramunga deployment that we talked about on Op Relex was the beginning of my transition from being a general practitioner family doctor into becoming a surgeon or orthopaedic surgeon, when I stepped off Warramunga in January of 2002, I then entered into the civilian public hospital system to enter into surgical training.
So, at that stage, I was still permanent Navy, and I was in this new program known as the Medical Officer Specialist Training Scheme that allowed for us to remain in permanent service in the three services, Army, Air Force, Navy, and we would go and try and get into a training program and if you were successful, then at the end of that training program, similar to our undergraduate program, we had a period of time that we had to pay back as a specialist and that core group of specialists at that time was an orthopaedic surgeon, general surgeon, an anaesthetist, emergency physician and intensive care physicians, those were the three in the surgical sphere and two in the critical care sphere, that was what we were training up for, for the whole of defence.
So, I was the first person that went into that training, into that program and by the time that actually got me into the program was in 2004 and that program was signed off and approved by Admiral Berry in 2001. So really, from my time on Warramunga up until completing my orthopaedic surgical training in January 2008 I was essentially in a training environment, didn't do anything other than regular communication with my chain of command, but didn't have to do any deployment.
But as soon as I finished. then I was the first full time trained specialist that had come through that training program and I had, it sounds minimal, it was 24 months of return of service obligation for that amount of time out but it was designed to be part time leave without pay which meant you could organize how much or how little you did. I chose to do two days a week in the military setting and three days a week in the civilian hospital system and that's how I divided it up.
So, I was only really getting paid 40 per cent of my wage and that meant that 24 months extended out to being about four and a half years. During that time I then began deploying quite regularly, going with exercises and operations. There was Operation Penang assist in 2009, aboard HMAS Kanimbla, after the earthquake offshore, and a lot of exercises that we just tend to do every year, every second year, Talisman Sabre, these types of things and then in 2010, I was selected, I was selected as backup for an Air Force surgical team, and I went to replace the orthopaedic surgeon at that point at relatively short notice in early 2010.
So that was my first trip to Afghanistan. I was in Tarin Kowt, didn't last much longer than four weeks, in fact I know it was actual 29 days because there's medallic recognition that happens at day 30 which I didn't achieve in that one. But that was a very first time that I had an opportunity to be the deployed orthopaedic surgeon in a war zone, and pretty much what my career had been leading up to.
So, it was a very important and transitional time as a military surgeon, and that was in 2010 … I deployed to Papua New Guinea, with the army as part of their deployed capability and on exercise, international exercise. I just continue to deploy that way, usually two or three times a year on Navy exercises, Army exercises, and then had the big call up in 2012, where I was selected to be the senior medical adviser to the Joint Task Force headquarters over in the Middle East.
So, we were running the entire Australian contingent in the Middle East, I was there as that senior doctor or Senior Medical Advisor, and later that same year, went for another four months. At the Role 3 Hospital in Kandahar. It was run by, it was NATO but it was run by the US Navy and that was a big calendar year 2012, where I spent about seven and a half months away from home.
Arrival in Afghanistan
We were there supporting the Netherlands hospital, the Role 3 hospital and because the surgeon I was replacing had been injured, they couldn't really do their role, they then had to leave the area and it meant that the other surgeon, the general surgeon had to kind of cover both aspects of surgery and it was a bit of an issue, I suppose.
So, when I came in, because of operational secrecy, we don't advertise when you're moving in and out, so they didn't know when I was coming. I flew in, in one of our military aircraft with some other people coming in, and it was very quick. To land, there's always a risk of air attack from ground to air, so you come in and dive down and you land and I'm like, "Well, this is the big deal." And you're in body armour systems, you've got all that and that wasn't unfamiliar to me but as a Navy guy, you don't tend to do a lot of that.
My Canadian Armed Forces background had me doing a bit more land-based activities in the past, so some of it was familiar but I've never been to a warzone before, so that was daunting. In fact, for my family, especially my wife at that point, we had all four of our children and that was a big deal for me to be going away at that stage with a young family.
So, it was emotionally different, but it was exciting because I knew I was going to do what I was there to do. Everyone, a lot of, well, all my colleagues in orthopaedic surgery can do what I do from a trauma and orthopaedic point of view, it's just they're not the ones that go forward and just a few of us are fortunate enough, I guess, to have that opportunity … It was a containerized hospital solution that the Netherlands ran.
We had one dedicated operating theatre that we tended to use the most. There was a second operating theatre that we could extend into. We had a very small, so it was the Australian Defence Force that provided the surgical intensive care team, but small, so one surgical team, and enough to provide intensive care for two beds and that's what we were there to do.
So, it was austere. That's what we call it when we're in the middle of nowhere, you don't have everything you would ever need but we were lucky, we had the operating theatre, we had sterilization systems, we had a good group of people working in the hospital, we had a radiographer that could do X rays and ultrasounds. We didn't have a CT scanner there, so you don't have everything you need, or that you want, I suppose, but for me as a trauma orthopaedic surgeon, I had everything that I needed to do my job.
Risk of attack at Tarin Kowt and Kandahar
There's always risks of rocket attack and complex attacks. So, there's aspects of it that are challenging. In in a war zone, we would often be required to have a weapon system with us at all times. But because we were working within the Netherlands hospital, those of us from the Australian Defence Force to work there, we didn't carry weapons, because the Dutch didn't carry weapons.
But the rest of the compound that had Australians in him kind of looked us go, Where were your weapons. So that was something also to get used to that first time that I'd had to worry or consider having a weapon with me … There were rocket attacks. I wouldn't say daily, but quite regularly.
So, we had drills, and we were used to nothing else untoward. We weren't overly busy, but we weren't not busy, if that makes sense. And we were dealing not just with military, but also with civilians from the local area. So, it gave you a breadth of experience that we didn't necessarily see in other deployments, because there was more regularity of managing civilians from the local area that had been maybe injured three or six months prior, and still had external fixation devices, so that 's rods and pins on the outside of the body that were still there, so I could manage that.
Or we'd get newly injured individuals that we would have to manage and help … We had pagers, we didn't always have phones with us, you 'd find out what you need to know. When I was there I was the senior Australian in that group of eight people, so I had a reporting requirement for anything I had connectivity with my high command in Australia, and what I found is I would learn about potential threats, complex attacks.
So, I would tell my team, "We've been told if we're going up to the hospital, we have to wear our body armour to walk up there." In some other places and times, that was standard anyway but, in this compound, it wasn't and so we did that. And my US colleagues, were looking at us going, "What are you doing?"
I'd have to brief the executive officer and commanding officer of the NATO Role 3 hospital and say, this is what I've heard, you know, behind closed doors, "This is what I've heard from my command. I'm not sure if you're getting any of those feeds from your command but I've heard that there's a higher heightened risk at the moment."
So, there were certainly times that I felt more at risk, more at threat than other deployments that I had been on and there were times that these things that happened in Afghanistan, in that base, and did happen to friends of mine while they were deployed in subsequent deployments. So, it was a bit scary.
Market at Tarin Kowt
There was a market that would come, I think on the weekendsand so just outside the gate, so we were allowed, there 'd be guards there, we would go out, they would have their wares, we could meet them and buy whatever they were selling if we were interested in that and many of the locals then potentially gain employment within the hospital or in the compound as interpreters or as service providers.
So we did get to see a few of the Afghanistan people … going out to any of the markets, you'd feel a bit more exposed, you're then outside the compound, just outside the gate but even going along the perimeter, if we would go for a run, the Netherlands, the Dutch, like their runs as well, so we do the five English mile and ten English mile runs, so you 'd be running along the perimeter and you knew that there could be snipers out there watching you, they have their scopes.
So, I guess you had that hyper vigilance and if you met people, you'd be worried about someone who was going to do you harm. So that's part of that, I guess, when you transition back into civilian life, after you've been deployed, that you have to learn to calm that suspicion a bit down, but you do have to be vigilant.
A different landscape
It was very interesting to see just sand and dust, really, it was the dust of Uruzgan … So, it was a very stark difference from what I grew up with in Saskatchewan, what I was living in, in Australia before I deployed. That was big sky.
I'm used to that from Saskatchewan, but nothing like what I saw there, and the dust got into everything and I was bit of a runner, still am a bit of a runner, not as much as I used to be, and going around and vehicles went past you, it was like talcum powder and you breathe it into your lungs. It would get into everything. So that was a bit of a challenge and a bit different.
When you're also considering, I'm there to do a job as a surgeon, we want to be as clean and as sterile as possible. It was continual that we were to be cleaning dust even though we were in containers, not tents, it was still challenging to maintain and make sure that we were as sterile as possible.
Contact with home
I've gotta say the Australian Defence Force is amazing at the amount of infrastructure they put to allow for that. They understand how important it is for people to have connectivity. My first times in the Canadian Navy, when I went to sea, it was, "See you later."
And I wouldn't have any communication, not even email until I got to a foreign port but here, in the middle of a war zone, I had computers that set us up to do Skype calls. We had telephone availability. So, you just pick a phone and dial is if you're in Australia, the area code, the number and you were speaking to your family, like it was next door, it was very impressive.
I found that my kids were probably better with me on the telephone than the video because in the video, they were at the age where they're watching themselves in the video rather than me and rather than talking with me, they were making funny faces in the video.
But now there was, it was quite good to be able to see and interact with the family from that distance and I was very appreciative, as was my family with that type of support that we got from Australia … the family were kind of used to me being away.
I found it, it's just an anecdotal story but a poignant one, when I was in the States, we were in New York, and they had just opened up the pools of remembrance, and I was there with my family and my daughter. Now how old would she have been at the time? She would have been 12 and she, we had a photo taken and she goes, "No, no, we got to take that again." And, "Why you look fine." "No," she goes, "No, I was smiling. And I shouldn't be smiling here."
And then for the younger ones, I could explain to them that the reason why dad's away, is what happened here in 2001 and that was very interesting. So, I think the family were on board with all that. But I do know what affected them by the time I came back after those seven and a half months away, for sure.
A typical day
The normal day would be a normal day, go to bed, you'd wake up, have your PT and then breakfast and meet up and do an outpatient clinic, see some of the locals, anybody that we 'd operated on that was still in the hospital. At that point, we had a few Ward areas, we would go do our clinical rounds, meet up with staff, get a briefing from the command team of the hospital as to what was expected and planned for the day.
If we had known surgical cases, we would get on and do those and that wasn't uncommon. If you had someone that was injured, you'd usually take them back to the operating theatre the next day. So, we would have those, we would then do some training and because we were working with other countries, we also had a Singaporean team with us as well, we would be interacting with them and there was the local compound.
Within the compound we had the Australian, two different groups of Australians, so we would interact with them and then the clinical people who didn't interact with them. So, Saturday was kind of like that and then after hours there might be an ability to watch a movie, get together people, play a video game, play poker.
We played a lot of poker with the Dutch and but not for anything other than fun, bragging rights. Presumably you have shift work as part of the daily routine? For the nursing and Medic staff that were caring for people overnight, they'd be in shift because I was an MO1 there was only one orthopaedic surgeon there then. I was on call 24/7.
So, I tended to do as we do anywhere, we will just work during the day. So, as kind of a day worker who's on call, someone comes in injured, there's a concern with someone who's admitted, they give you a call to come wake you up.
Deployment at UAE and Kandahar
Earlier, in 2012, having been at the UAE for that three and a half months, I had a break of about six weeks where I went back to Australia and took my family over to Canada and the States to visit my parents, my mother and to visit my brother and my sister-in-law and we did a lot of these things.
So, I had this lovely break before I went back, and all my gear was still there. I just locked it up in a cage in the UAE and I could take that forward with me to Afghanistan. So, we always stop in at that transition base on our way through to any point of deployment in the Middle East and then because, like I say, had the cage there, the person that I had handed over to in the JG7 or Senior Medical Advisor role was still there.
So, I was able to catch up with them, see how they were doing in their job and then met up with my, the group of people that I went in there with. They didn't belong to me, they were just a group of eight of us that went in. We had two anaesthetists, the general surgeon, orthopaedic surgeon, two ICU nurses and two anaesthetic or perioperative nurses that went in at that time. So, we all met up together.
If we didn't know one another, we got to know each other there and then we did our bit of our reception, staging, homeward integration training and then we went forward into Kandahar and then from there, had to be integrated and trained to enter into the US Navy led hospital.
That was the NATO hospital there. So, that was, just again, like anywhere orienting yourself, "Where am I living? How do I find my way around? Who am I working with?" and at that point, we were all embedded within our teams of our specialties. So, I was there with, I think six or seven other orthopaedic surgeons from the US Navy. So, I got to meet them.
The trauma surgeon that organized all of the surgery went there. We started meeting our teams doing some training, but it wasn't long before the first casualties started coming through and as we were there getting our IDs sorted, our access sorted, we would then observe our US colleagues, and then help them out to understand their systems because we also then were working within their computer system within their supply system, understand their surgical instruments, understand their clinical practice guidelines.
A lot of us, we had learned about those beforehand and I, because I've been the senior doc or the Senior Health Advisor bringing people in for the first rotation, I knew what we needed to know. So, I told people that I was deploying with, "Read up on these, they're on the internet.
This is how you access them. They are open access. Learn this because this is what our US colleagues are going to be working towards and we need then to be part of that team and learn those things." So, that was that transition, but we came in August, and within, you know, hours, we were there when our outgoing team was there. So, it was a handover time as well, for about a week.
So, my offsider that was an Australian orthopaedic surgeon, I got a handover from her and then we saw them at the end of their deployment, got to learn a few things from them. They would tell us their transition, what they learned during their four months there and then we just took on that aspect from there on.
Kandahar hospital
Kandahar province, it 's south of Afghanistan towards the Pakistan border. So, we were down south and next to us there was a Role 3 Hospital in Helmand province that was run by the UK or Great Britain. So, they had their hospital and we had ours.
We were the only hospital in southern Afghanistan, that had a neurosurgeon as well. That's what defined our Role 3, they were a Role 3 because of their size and scope but they didn't have a neurosurgeon with them, the British, so we would get all the neurosurgical trauma as well.
Was Kandahar a base? Kandahar was a multinational base … when I went to Kandahar, the Canadian forces had been running the hospital there before, when it was a kind of a tent and reinforced hesk of a wall place. Then when they made the brick and mortar and handed that over through NATO, it was transitioned …
It was almost better than a hospital in Australia. It was purpose built for trauma, so it was designed with the trauma flow from a resuscitation bay or emergency department, straight through, right n it next to that it had two CT scanners, they had interventional radiologists, they had then 12 bays of resuscitation and then straight through, you go directly into the intensive care unit or to the operating theatre, depending where you needed to go in and there was a general services ward, but it was, you would think you were in a hospital in Australia and when I went in there, the anaesthetic machines were the same ones that we used at Frankston hospital. It was amazing how non austere that felt, and because it was such a large facility, we had pretty much everything that we needed and more.
Kandahar base
We were in the Role 3 in Kandahar and that was the multinational base of Kandahar, but that was the province as well. I'm sure that there's a township named Kandahar as well, I didn't really get out and about much, I must say, but the base itself was massive, multinational.
Many of the countries you can think of would be there. There were nine different, I think, dining facilities you go to that had different themes. It was big, very, very big place … there was kind of almost like a central village area that had the shops, so that's where you would meet some local shopkeepers. They also had weekly markets just outside so you could go to the markets.
So, there was a lot of that, and they had fast food outlets. They had coffee shops, they had ice cream shops. It was such a big base, that one was totally different than Tarin Kowt where we had the Australian compound. Australians are great with the barbecue concept, so we had this beautiful outdoor barbecue.
They somehow brought grass in and kept it green and alive, and it was about the only grass that was around in Kandahar. So, for then inviting your coalition colleagues to come into the base you'd have to go through a process of doing so but they loved it. And so, we could invite them in for a backyard barbecue type of concept.
We had, when I was there, in that time of year we had Remembrance Day. So, I asked for representation from the US Navy members of the hospital to come in and be my guests and lay a wreath and say a few words and it became a really nice coalition interaction. So those are the things that we could do.
Recreation wise, though, to get back to that question, there are always recreation centres where you could go read, watch a movie, play cards. There was gymnasiums, multiple there, so it'd be the heavy lifting gyms and there would also be the cardio gyms, there would be gym classes, and PTIs running that.
Social interactions
With that many different nations, different languages, different expectations, and tensions, there can be issues, but I didn't see much of that, to be honest. Most people either stayed within their country, or you got to know people in a different way. There were other cultural things.
One of the things I probably shouldn't even say because my kids didn't like it, but we had a cigar club, and we'd be next to the runway. In the evenings, we'd only do it on Friday, or that was the standard thing. We 'd get what you call near beer because, of course, we're not allowed to drink and it was the near beers and we'd have pizzas and we'd be there and we'd be interacting with all the people from the hospital who weren't on shift and on call, or you could be on call, but you weren't on shift and we'd be out there engaging that social atmosphere and that was great and that translated to other deployments I did.
That became a nice way of counting off the weeks. And you could watch a movie together and have just some outdoor interaction and relaxation. I didn't see too much tension from that aspect. We worked collegially together quite well.
Working on casualties
From a health perspective, we tried to minimize that by having the clinical practice guidelines that we ran and we would have weekly conferences, not just with our hospital, but with all the other hospitals. So, from the point of injury coming in, so we try to minimize the disruptions and the lack of understanding. In the base itself. and it 's something that, I guess, not health people would fully understand but you can imagine you're going for a surgery or procedure, there's a timeframe that it's going to take, and you just get through it and it's all fine.
If you've been hurt badly, injured in a war zone, you've lost multiple limbs and you're losing blood and you just, what you need is to get someone to stop the bleeding and you need to get into an intensive care unit to be rewarmed and get your physiology normalised. When people are that badly injured, we would have multiple teams operating on them at the same time.
It wasn't do one operation, then do another operation, then do another operation, we would have an orthopaedic surgeon or two per limb. We would have general surgeons operating in the abdomen, and in the chest and we'd have the neurosurgeons working on the head and then maxillofacial surgeon working on the face, the ophthalmologist, all happening all at the same time, and we would have multiple anaesthetic teams, we have multiple scrub teams. So almost everybody.
It was a full press, full core press, the whole team was there but by doing so we were able to clean up all the debris and all the contamination, stop the bleeding, warm the patient, keep resuscitating them, give them blood, and then get into the intensive care unit.
What we could do there, it was quite incredible. You wouldn't see that, really, anywhere else. Because we were all there, we were captive audiences in a sense, but we had nothing, no other reason to be there than to do that type of work. Was it sustainable?
Well, yeah, we all sustained it but if we had to do 24/7, we wouldn't be able to. So, usually the surge of casualties came in during the day and you operate all day, and you'd have multiple operating theatres running at the same time and then you'd finish up and we'd go for an ice cream or just go for a meal and decompress for the day.
Maintaining surgical standards
We had standards that we wanted to achieve, and these are things that are in the public domain, but if we would say that we wanted to ensure that someone who's been injured gets first aid buddy care within that first 10 minutes, you know, they are going to be there. Within an hour they're at a defence facility or within two, in two hours, they're in a surgical facility, if that's what they need.
We tried to ensure that they, from point of injury to arriving at our facility was within one hour. So, we're really pushing that envelope because we knew that the sooner they got to us, the sooner we could get to fixing what was wrong with them.
The pervading statistics that I kept on hearing while I was over there, I can't validate, but this is what we were told, 98 per cent of people if they arrived to the Role 3 Hospital in Kandahar, where the pulse would survive. That's, however that is obtained, that stat, the reality was that if they did get to us, and they still did have a pulse, they had a great opportunity to survive their injuries, get home to their loved ones and that's what was our point of pride.
So, the occasional time that that did not occur, the whole hospital was in mourning because we are there to win and we are perfectionists and we want to ensure that our patients come through our system, they get treated as best as we can possibly do in our situation. I think the motto was 'best care anywhere ', and it was. It was great.
The evacuation chain
The dust off in the PJs, they would go in pick up the casualties from point of injury or they would, that was coordinated by the headquarters of Patient Evacuation Coordination Centre, would send out the rotary ring assets. If they were operated on in Tarin Kowt where I had been two years previous, we still had surgical teams there, we had surgical teams throughout Afghanistan.
They might have been a casualty that went there first, but because of the nature of their injuries, or because of the holding policy of those facilities, they were then rapidly transitioned to us because we had a large, I think it was a 30-bed ward. We had a 12 bed ICU, we had the capacity to hold those patients but even we didn't want to hold them for very long, because we would fill up. So, within 24 to 48 hours, we would have aircraft, taking these extremely injured people away through an evacuation chain that would take them back to Germany and then back to wherever their home country was.
Australian identity
I still liked the fact that I was there in Australian uniform, I think that was what an Australian soldier who was injured, or any service member that was injured, if they saw Australian uniforms there looking after them, they felt that greater level of assurance.
I touched upon being the senior person therefore I had the reporting requirements. That was then more of an issue when an Australian was significantly injured and that did happen very early on in my deployment, where I was the on call orthopaedic surgeon with the team. At that point, I think we only had five other orthopaedic surgeons.
So, there's six of us. I was on call, we've had 12, or 13, multi amputation casualties coming through that day, a bad day in the war for us and then after all that had happened, I then found out we were pretty much done, everyone was just finished and showered and getting out of there and then I got a call that an Australian had been injured and was in Tarin Kowt and was on his way to us.
So then, okay, that that's it, they're all, they all mean as much, but this one means more, because now there's an additional, this is the same uniform, this is that kindred spirit. So, from there, then was back in the operating theatre in the evening and this individual had already been operated on once, but we had to operate on him again and he we didn't really wake him up.
Went to the ICU because he was going to fly out the next day. I've subsequently met up with him and that's been a great reunion and I've been able to have him come to speak at medical conferences and that type of thing. So that was an amazing, heart wrenching, but a pride to say that I'm there on behalf of Australia and I've done these kinds of roles before but this was a special one and thankfully, we didn't get very many significantly injured Australians, but when we did, it had that additional feel to it.
Meeting a former patient
I recently was in the United States at a conference for the Society of Military Orthopaedic Surgeons, of which I actually am their international representative and during that conference, there was a group that were the trade exhibitors.
I met them at the welcome reception, I went to their booth, I went to a luncheon that they were putting on, I just kind of got to know them quite well and I identified that one, they're all veterans, and one had lost both his lower extremities, or lost one, and I just chatted to him after this luncheon and we started talking and I don't know why, maybe I had a sixth sense but anyway, we started talking and I said, "Well, where were you?" "I was so and so." "And when were you there?" and also, "So, you would have gone to the UK hospital." "No, no, I went to Kandahar." "Okay." So, then we realised, okay, that was 2012 and "I was there in 2012, was around November", he said.
So I was there. So, we were actually in the war zone in the same hospital and I'm like, "Oh, I may have actually operated on you." So, then we look at each other, start crying, big hug, get a photo. and then I went back, he was driving back to Texas, and I was, this was in Arizona, I went back to my hotel room, and I looked up my logbook and I sent him a text message.
Just said, "If you are this callsign, I was your surgeon on the day, and operated on you the next day as well." And it was like, "Blow me away." Those are the kinds of things that you never expect but he then sends me the photo of a family. He's got about 10 Kids and girls, "They wouldn't be here without you doc." And we stay in contact. It's not why I do it, but it is why I do it.
I would never expect to ever meet any of my patients again, you always hope and assume that they live productive, happy lives but in both those instances of the very beginning of my deployment, very, very early on was the Australian, whom I respect greatly, who's gone on to great things here in Australia and then, I'd never, until a few months ago, would never known this guy happened to be the last patient I operated on in Kandahar. The last day of my, I was deploying, redeploying a few days later, and I met up with him. 11 years, 10 years later. Yeah. Yeah, 10 years later, almost exactly when I met him. So, it's incredible.
Transition to home
Because I'd been deployed so much in the Navy beforehand, we'd always had these ideas of how the household ran when I was home and when I wasn't home. And having a very, very independent and capable wife who just said, "That's okay, you're not here, I'm just going to make things happen." I then came back feeling, "I'm additional, I'm getting in the way here." So those were always the transitions coming back, especially that year being away that long, it was even more so.
That year, I do recall coming back and getting back into the hospital system. So, the family reunion was amazing, and I was fine, and I didn't have any hypervigilance. I guess I'm just lucky that way, but it was going back to the hospital and doing an operation, elective operation on a foot and going, "This is almost cosmetic procedures."
And I know so many people that I've just operated on that would like to have a foot still there so that they wouldn't be worried about the fact that, for the reason that I'm doing that surgery, and that was a thing that hit me.
But the transition back, maybe I'm just lucky or stupid. I don't know what it is, but I seem to transition okay, back into it. But it was the family dynamic that I did feel, as the family learned to be without me, to come back in and slot back in to help out and someone who's maybe overcompensating and trying to help out too much, and then upsetting the balance that had already been there when I wasn't there.
So those were the types of things that were challenging … and the younger that the children are, the more that's the case, the older ones remember you better and when you come in the slot back in a little bit easier. But again, dynamics, I've got two daughters and two sons so it's a different dynamic there and the girls are older, the boys are younger.
So, all those dynamics were quite challenging, but it's a minefield, can be. So that's a terrible, horrible thing to say, when we talk about IEDs, but it is challenging, but it's something that you learn to navigate, and everyone will have their own dynamic and their own family and how that functions.
Mental health casualties
When I was in the JG 7, the Senior Health Officer role, putting my first group of Australians into that Role 3 hospital, I was concerned about how they would cope, not because of any other reason than it was high intensity, it was the type of injuries that we don't see in Australia, can be very confronting. So, I had the advantage of having senior psychologists there in the headquarters with me, spoke with her and said, "What can we do to give them a little bit more support?"
It's a four-month deployment, so we organized for a halfway through deployment, to do that. I then instituted and recommended that continue for my team and you have to remind health professionals that we are humans too, we have vulnerabilities, we need to accept the fact that we might get affected by that.
Most of us think we won't but just by sheer luck, you know, we've been able to get through a lot of that, but many of our colleagues have not and there have been times when very well-seasoned individual professionals have met with a complication or problem that has affected them for the rest of their life.
So, we then talk about that post traumatic stress disorder, that when we have a Royal Commission ongoing now about veteran suicide, defence force veteran suicide, it is telling. and I think the questions that you asked about your transition home, Australia's been very, very good at preparing people for that. They give us a ton of decompression before we come back.
We get our return to Australia, psychology screen, to identify people that are already showing signs of having issues. We require everyone to have a three month post operational psychology screen to do those things. I do think that we do a very good job of taking care of our people but there is no doubt that our people that are on the ground, especially those that are going out in harm's way outside the wire, doing the patrols, doing those special operations, things that they do, there are risks and for us as health professionals, yes, we're there, we 're maybe not putting ourselves in harm but we're seeing things that we wouldn't, we'd rather not see.
But flipping that around, we are there because we want to be there to help those people, so that would just be the thing that I would always reflect on, that service comes with a price. Sometimes people's relationships break down, their interactions with their children, families break down, they themselves become mental health casualties. It is a real thing. We do what we do, because we're there to help and to serve and serving our country is the biggest bit of pride. That's why I keep on going. This has been 33 years of service so far, I'm still going. So, it's always an honour.
Anzac Day
Anzac Day has come to mean a lot to me, but I didn't know about it growing up in Canada, I wouldn't have. I don't know, why would you growing up in Saskatchewan, so coming here the first year, I always, of course, knew about Remembrance Day but I didn't know anything about Anzac Day.
So, it was very interesting to be part of that as my first year in service, but I was, actually, I had just come off of my officer training at that stage, the first year, but fast forward, I was deployed sometimes for Anzac Day. I was deployed in the UAE for that, and then later on a deployment to Iraq was deployed with the Anzac task force. So, I've actually become an Anzac.
But the first one, it was amazing to me, the level of respect that I saw from the Australian public, knowing what had happened to service people in the US, in Australia and Canada, who'd served in Vietnam, where they didn't get recognition, that they didn't get the thanks of their country for putting themselves in harm's way and actually having casualties themselves.
The Anzac Day, I was quite amazed at the size scale of it, and the pride that I saw in the community from it, so it's something I hadn 't known about in Canada, I 'd never experienced. So, it was quite incredible. I didn't know what 'two up ' was. I didn't know any of those things.
But Anzac Day has come to mean a lot. I've met some very, very good friends, just at RSLs and we 've become, a group of four of us, from totally different realms of life, two sailors and ex-serving Army Sergeant. I think I 've gotten his rank wrong. I think he was, I think it was a staff sergeant, but we met there and we've been friends ever since and we go on trips together.
So, I think the Anzac spirit comes through, you see it on telly, you go to the marches, you go to the RSLs, you do the 'two up ', you see the camaraderie, you see the respect of the community, and it's something that I'm always impressed by.
