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German Guards©

vitomd — Fri, 24 Nov 2006 09:32:27 +0000

I know it’s over 61 years since World War II ended, but one still must exercize a certain degree of sensitivity to the fact that we are an American Army still inhabiting German soil. We occupy large parts of this country, even though we are no longer an Army of Occupation. Just between here and nearby Heidelburg are dozens of Army and Air Force Bases, Caserns, Barracks, Clinics, Depots, Commands and Headquarters, a pattern repeated all over Germany. Many German citizens work on U.S. installations in a myriad of capacities from the highly technical to the menial. Almost everyone of them speaks English very well. That includes the dozens of German locals who man the security fence that the hospital erected several months back, in more than token recognition of the worldwide span of the anti-terror struggle. In order to enter the hospital grounds proper I must present my military I.D. card to one of these uniformed German guards, who sit in little guard houses or patrol the perimeter around the clock. If I say, “Good morning,” they answer “Have a nice day!” If I say “Guten Morgen,” they still say “Have a nice day!” Practicing the sensitivity I referred to earlier, I refrain from remarking on the historical turnabout here — where the local police power exists to prevent me from entering, rather than leaving, a barb-wire enclosed facility holding hundreds of American soldiers. Thank heaven none of them is named Schultz, because all I can think of is reruns of Hogans Heroes and reading Stalag 15 in high school. If you’re thinking, who’d attack a hospital full of soldiers wounded in Iraq, you’d be thinking in pre-9/11 terms, and abiding by now possibly out-of-date Geneva conventions regarding the treatment of soldiers who, by their disabilities, are hors-de-combat. No, in fact this place is a delectable target, if only for the headlines such an attack would earn, so I only hope the lightly armed, slightly superannuated German guards are up to the task of fending off any would-be terrorists. If Charles Martel had not defeated the Muslim advance into Western Europe at Tours in 732, and had Venice, Spain and the Pope’s forces not defeated the Ottoman advance into Eastern Europe at Lepanto in 1571, we’d all likely be speaking some variant of Arabic today. From where I sit, the job of keeping Europe out of the grip of the new jihadists now seems to rest in the hands of about forty-five middle-aged German men wearing sidearms and speaking impeccible English. Gotta go.

Bullets Everywhere©

vitomd — Tue, 07 Nov 2006 09:34:29 +0000

Salzburg, Austria, lies just over the border beyond Munich, only four trains and five hours from here. They speak German there, too, so it made great sense to head toward the southeast this last weekend — no new foreign phrase book to carry around, just the same old dog-eared German one that I refer to increasingly less and less. It had snowed in Austria on Thursday, and the dirty remnants of that first Neuschnee were still forcing pedestrians to walk circuitously when I left the city Sunday evening. Salzburg, like the rest of Austria, is celebrating Mozart’s 250th birthday with overkill. Imagine celebrating the making of your favorite sweet port wine by drinking it three times a day, every day for a year. Can anything be that good? I caught a performance of Eine kleine Nachtmusik and a Divertimento by the young Meister, performed by a string quartet (plus one violin) in the same room in the Archbishop’s Residence that once heard the young Mozart himself perform. The High Mass in the Dom on Sunday morning featured an early choral composition of Mozart’s — a Mass, complete with chorus and orchestra. Mozart’s father’s and widow’s graves were hard to find in the cemetery behind St. Sebastian’s Church because of the dusting of snow, but their headstone was the only one to highlight the engraved letters with gold. The warmest part of my stay were the several hours passed in Mozart’s Growing-up House (as opposed to the nearby Birth House); the museum piped in relevant music to accompany the many instruments, scores and autographs of Wolfgang, his father, Leopold, and his sister, Nanle. Maybe this will inspire me to make the drive up to Bonn to see where Beethoven lived, or to make it as far as Leipzig, in eastern Germany, to hear Bach’s organ in Leipzig. (tbc)

Visitors©

vitomd — Sat, 07 Oct 2006 02:03:13 +0000

All hospital patients should have visitors. Most do, usually family and friends. Strangers usually come around the High Holidays, spreading good cheer anonymously by doling out seasonal songs or baskets of goodies. Pediatric wards, especially, are full of carolers, and other groups of people — auxiliaries of local police and fire houses, or fraternal organizations — passing out stuffed animals. But at least at this military hospital it’s Christmas and Channukah every day. Visitors trip over each other on their way to performing this sacred corporal work of mercy. In the last twenty-four hours alone I have seen on the surgical wards the Commandant of the Marines (the only 4 star Marine there is) with a contingent of well-wishers here to award Purple Hearts to his soldiers. I’ve seen liaison soldiers in uniforms of other countries, too, mostly Australians and Germans, visiting. This morning saw the entire 35-person Air Force entertainment troupe (“Tops in Blue”) come through to serenade some of the amputees (what’s going through their minds seeing this?). Add in the usual complement of chaplains, Red Cross volunteers, family members, military liaisons and public affairs personnel and you need a traffic manager to make rounds. Could it get any worse come December? I think I see a magician coming — gotta go.

“All Available Manpower!”©

vitomd — Fri, 06 Oct 2006 04:55:06 +0000

The hospital is practically empty today, the start of a four-day weekend occasioned by Columbus Day falling on Monday. Empty of ancillary staff and non-essential personnel, that is, but certainly not of patients. I started the day with only one patient in-house, a man whose kidney I removed on Monday last, and made arrangements for him to be flown to San Antonio, Texas, to be closer to family. But I knew my case load would grow when I heard the overhead page call for “All available manpower” to report to the Emergency Room. While not code, it is a verbal signal that another planeload of patients has just landed at nearby Ramstein Airbase, and we could expect their arrival here at Landstuhl in an hour or less. A plane arrives from Baghdad or Balad or Kosovo or Kandahar every day, if not more frequently, and it takes all available manpower to lift the stretchers off the buses and load them onto hospital guerneys. Sure enough, two of the patients were mine. One had sustained a spider bite to his privates that festered into a raging abscess which then required incision and drainage and further intravenous antibiotics. The other was a young soldier who couldn’t urinate, even though he had no history of infections or trauma. In between admissions, I saw an inpatient on the psych ward — a very manic man who spoke so tangentially that I gave up on the idea of traditional history-taking in favor of the “gestalt.” The most memorable patient of the day was a 21 year-old lieutenant shot by a sniper as he tried to help two other wounded soldiers in his unit. The bullet had penetrated his buttocks, missing all vital structures, and after exiting his thigh it went through his non-dominant left hand. This morning he was up at his sink, trying to shave, but with the bulky bandage on his hand he couldn’t open the shaving cream can or remove the cover on the razor blade, so I lent a hand. He told me the story of the ambush, and how ironic it was that the village they were patrolling was called Hit. He left this morning for the long flight to Walter Reed Hospital in Washington, where a hand surgeon awaits him. Gotta go.

Death and Birth©

vitomd — Sun, 01 Oct 2006 12:35:28 +0000

Tradition has it that general surgeons are the “captain of the ship” when it comes to coordinating care for trauma patients, especially when more than one organ system is involved. Unfortunately for many of the patients here at Landstuhl, their injuries are protean, and so there are many “captains” here, and many “ships” in need of one. As a urologists, I usually function in an advisory capacity for the general surgeons, or for the internists in the ICU, where most of the most grievously wounded are in residence. Last Friday morning began with a call from just one such person, with a most unusual request. A young soldier, who had been a victim of one of the ubiquitous IEDs in Iraq, was going to be removed from life support, and the wife was requesting that I do whatever had to be done to allow her to bear his child at some point in the future. This required clearance from the hospital commander, consultations with the Judge Advocate for U.S.Army European Command, and with the pathologists and dermatologists (who have the only supply of liquid nitrogen here). It also required speaking to the family — something I usually never do. That’s the job of the surgeon, or the head of the ICU. So I trekked over to the ICU waiting room to meet the moribund soldier’s mother and father, and his young wife, who was clutching not one but two teddy bears tightly. They were very tearful, especially when they got around to saying that it was his last wish that he have a child with her, and could I please help. So I scoured his military records, and his driver’s license, for any indication that he had ever explicitly forbidden an organ donation (which he had not), and then asked them to sign a surgical consent form. The procedure was done at the bedside, using the same tools and technique I would use in a formal operating room. The Ied had amputated one distal extremity, ironically making the surgical field larger and easier to work from. Two Army nurse lieutenants assisted, and the pathologist carted off the spermatazoon-rich epididymis for flash freezing, and later transport to America. I told the family it had gone well and they smiled and thanked me for giving them the only smile they had had since they arrived in Germany. Gotta go.

Four Friends©

vitomd — Sun, 01 Oct 2006 10:07:48 +0000

You should know who I spend my time with outside of work, the people I look for in the mess hall when it’s crowded, and the people I share a rental car with on weekends. There’re the same three who showed up at Ft. Benning when I did, and we travelled to Germany on the same plane. One is a lieutenant, a registered nurse anesthetist with whom I’ll surely work in surgery. From St. Louis, the son of a CRNA too, he’s relatively new to the Army, but was a diver for the Navy for nine years. Then there is the Nicaraguan-born, American-raised neurologist captain from Mobile. He talks (in Spanish) to his wife and daughters in Mobile at least every three hours on one or another of his cell phones. Last is the lieutenant colonel radiologist from Wichita, Kansas, who has enough years in as an enlisted soldier before becoming an officer that he acts with great authority and self-assurance in all matters. He has three daughters (3, 5 and 7) who are set to join him here in a few weeks in a rental house off base. He’s been raising them with the help of his parents since his wife, a young pediatrician, passed away several years ago of a non-curable malignancy. Together, both medically speaking and not, we have all the bases covered, and enough linguistic ability between us to travel anywhere in Europe. And more than enough jokes, old or new, funny or not, to make the autobahn ride seem not so long. Gotta go.

Old and Young©

vitomd — Mon, 25 Sep 2006 01:50:16 +0000

Landstuhl Hospital is unique among medical centers. It’s laid out in a far-flung succession of long wards and connecting hallways – a concept born out of a need to survive an aerial bombardment typical of wars fought long ago. The walking distance, say from the urology clinic to the emergency room, the operating room, the I.C.U. or the cafeteria, is vast, which may partly explain why everyone here looks so fit. The corridors are crowded with gurneys laden with soldiers on their way to the MRI or CT rooms, or with wheelchairs headed for the outdoor smoking pavilions. (Smoking is not as socially unacceptable a behavior in the Army as it is back home in California.) In addition to the wounded from Iraq, Afghanistan and Kosovo, we treat the local population of dependents (spouses with children), DOD civilian employees and the many expatriate military retirees. So it’s not that unusual to see men on the wards who are obviously too old to still be serving in uniform, and who suffer from ailments not found in the ranks of 20 year-olds. The first patient I spoke to here was a man in his 70s in a wheelchair, his left leg sporting some external orthopedic hardware and his right hand clutching a filter cigarette, blocking a back door entrance to the hospital. It being my first day on the new job, I thought it prudent not to lecture him on either of his obstructive behaviors. At the other end of the spectrum, the hospital is nearly overrun with children – from kids in strollers and in backpack carriers to preteens and teenagers. They are not patients, but dependents visiting their soldier mom or dad for a quick meal, or an after school visit. Many parents walk the hallways of the hospital, on the way to the bank, post office, laundry, cyber café, travel office or convenience stores located within the facility, with two or (often) more children in tow, explaining the high volume in the vasectomy clinic each week. All of them very well behaved in public, these children belie the “Army brat” locution that will follow them in later life. Here comes a small brood now. Gotta go.

vitomd — Sat, 23 Sep 2006 12:39:57 +0000

A few kilometers from the American military cemetery in Luxembourg lies its German equivalent. Where the American cemetery is supported by tax dollars and a Government agency, the German one is cared for by volunteers. Much smaller in size, it contains the remains of nearly twice as many soldiers as the American one, because almost 4,900 Germans lie in a common grave, the marvels of modern forensic science not being available to those who cleaned the battlefields between Hamm and Bourgogne in 1945. Instead of glistening white granite crosses, all the German headstones were of darker native stone, and, intrestingly, there were no Stars of David to be seen. Fresh flowers were to be seen on only a small handfull of gravesites, left by some still grieving relative or decendant. The vast majority of the German dead ranged between 17 (one was only 16 and 1/2) and 22 years old. There was a small chapel near the entrance, open and inviting, with a table holding a registry for visitors to sign. I saw that five other Americans had visited that day, but so also had the son and daughter of one of the dead Germans. I wondered if that dead German had ever seen his children, who today must be in their late sixties. Above their affectionate note to their dead father was another, written in a shaky hand by someone doubtless in her late eighties, that read (in German): “Dear E., This will probably be the last time I come to visit you here — your everloving sister.” An old German woman succeeded in bringing a tear to my eye when all the rows of white crosses had not. Gotta go.

vitomd — Sat, 23 Sep 2006 12:18:47 +0000

Two other medical folk who travelled over here to Germany with me last week, a radiologist from Wichita, Kansas and a nurse anesthetist from St. Louis, drove with me this morning to the large American cemetery outside Luxembourg City. This was my first visit to a national cemetery outside the United States. Over 5000 graves lie here, each marked by a white granite cross or Star of David. We chose this one because it is also the final resting place of General Patton, who led the Third Army across Europe during WW II. I had special interest in coming here because I wear Patton’s Third Army patch on my “combat veteran” sleeve ever since serving in Saudi Arabia in 1991. He died after WW II officially had ended, but his wife insisted that he be interred here, in Europe, among his troops, rather than be sent back home to California. As if to create a hierarchy of sadness among the rows of tombstones, there are twelve sets of brothers laid to rest here, side by side, and one pair of “friends,” according to the cemetery’s rolls. Two busloads of German tourists arrived as we were leaving. I turned around and walked back among them for a while, trying to understand what they were saying (What would one say here?), but they spoke too softly for me to hear. For an American, the symmetrical array of headstones –located between two flagstaffs and two sets of murals depicting the 1944 campaign of the Battle of the Bulge, during which most of these young men died — presents a powerful visual and emotional experience that can be appreciated by anyone, regardless from which city their tourbus originated. Some WW II General (it may have been Eisenhower himself) said that military cemeteries were the best argument against war that could ever be made. Gotta go.

Bad Durkheim©

vitomd — Mon, 18 Sep 2006 11:03:25 +0000

Yesterday I took three local trains through the German countryside to a quaint little village, Bad Durkheim, that was celebrating the local wine industry. Viticulture has been a principal industry of this part of Germany for a very long time, because this is the 600th-plus time the annual Fall Festival has come around. I’m impressed by that because nothing in America is even close to being that old, if you don’t count the oldest cemeteries on Long Island, where are interred the remains of people contemporaneous with Michelangelo. The “beer” tents were serving mostly year-old white wines from the region, and you had to search for an empty seat. The oom-pah bands would have passed for caractures of themselves had not the Germans been singing along so lustigly. Suddenly it seemed like 1806, not 2006. The streets of the center were deserted, and there was no litter to be seen. Only two pieces of grafitti were in evidence: one a call from some poorly-defined anarchists to end the war in Iraq, and the other, scrawled on the walls of the German Red Cross building, accusing the occupants of being Nazi doppelgangers. Many of the towns around here are named after the native healing waters (“Bad” means spa) or minerals or herbs, so I guess this is a good place for us to have our hospital. Health by proxy, if not proximity. Gotta go.