Wednesday, September 30, 2009

O'fest/Munich pics

Somehow the photos are in the reverse order that I selected. From the top:
1. View of eastern Greenland on return flight
2. Isar River, Englischer Garten, and my trusty steed
3. Bottom's up!
4. Inside the Lowenbrau haus
5. Inside the Haufbrau haus
6. Showin' my leder hosen in Marienplatz
7. O'fest crowd
8. First of many


I'm honored to have had the chance to help our wounded troops at Landstuhl. Unfortunately, it looks like more such help will be required for years to come. As our military enters its 8th year in Afghanistan and 6th year in Iraq (US involvement in WW2 was only 4 years) I think it is past time for all of us to consider what we as individuals can do for the men and women serving in the military, as well as for their families. The bigger picture, of course, is to consider what we all can do to bring these soldiers home while maintaining our national security.

An easy and worthwhile thing to do is to financially support charities such as the Fisher House Foundation ( which provides housing and support for families of wounded soldiers near military hospitals around the world (there are 2 Fisher Houses at Landstuhl). Another worthy charity is the National Military Family Association ( Both put >85% of donations into their service programs rather than administration, advertising, etc.

An important, but somewhat indirect way to support our troops and country is to become better informed about foreign affairs by listening and reading about all sides of the issue - not just listening to those you already agree with. Not only will this broaden our view of these complex issues, but it just might help restore the "civil" in our civilization. Use this knowledge to vote for those who might also examine all sides of an issue before making a decision.

Lastly, we have to think of how we can best defeat those who would harm us. Both Al Qaeda and Iran are heavily dependent on money from oil revenues. Likewise, Russia can't be a threat without oil money. If the US dramatically and quickly decreased our use of petroleum, then the funding for nefarious activities carried out by these groups would be cut off. There are obvious environmental benefits for using less oil, and potential economic benefits for quickly developing alternative energy sources. I'll test the civility of our relationship by proposing a $1 per gallon tax on gasoline as a way to accomplish this. In past wars, the entire country sacrificed for the common good - we really haven't done this since the 1940s. However, I believe this is ultimately the best way to support our military, make us safer, and keep the rising seas from covering Scuttlebutt.

On a lighter note, I'll post Oktoberfest/Munich photos later today.

Monday, September 28, 2009

The Rest of Munich

I felt a little burned out on the whole O'fest thing so I rented a bike and set out to see the city this morning. Munich is perfect for biking. The city is absolutely flat - not a single hill. There are dedicated bike lanes on the sidewalk (sometimes on the street). Lots of people are doing it, usually carrying stuff in a large basket. I first went out to the Nymphenburg Palace, maybe 8 -10 km west of downtown. Looks a lot like Versailles. Then I went 5-6 km to the former Olympic Village (Summer Games 1976), then over to BMW Welt (they seem to be promoting the SUV/sedan crossovers and hybrid engines). I continued on to the Englisher Garten, which is really just a very large, beautiful and minimally developed woodland along the Isar River. Then I rode back into the Old Town, parked the bike, and strolled around.

All of the exercise made me pretty hungry. Unfortunately, my worst (wurst?) fears about eating unknown German food were reaIized in the Victualen Markt (which is kind of like Pike Place Market). I saw a guy eating what looked like a particularly good ham sandwich, and I asked him what it was. He pointed to the menu and said "leberkase", so I went with it. It tasted sorta like ham, but the consistency was a little softer. Only after I downed the thing in just a few bites did I think to use the dictionary that I was carrying. Leberkase is "pork liver meatloaf". Although I don't think that I'll order it again, it was really pretty good, and so far I've managed to keep it down.

I have to catch a train at 0550 to get to the Frankfurt airport in time for my 1100 flight tomorrow morning. I think I'm done with Oktoberfest, but maybe I'll just wear my leder hosen around town for awhile (in Munich this time of the year it's not as crazy as it sounds...)

Sunday, September 27, 2009

Beer, Brats and Breasts

I left Landstuhl after work Friday with 4 of my new Army buddies. We drove the autobahn for about 4 hours to get to Munich. There was some construction and traffic in parts, but we still managed to get up to 200 km/hr. We had thought ahead to use Google map to get us to our hotel, but it was pretty useless, since we can't read the traffic signs. We miraculously found the hotel without too much trouble. Our good karma continued by having one of the best bars/beerhalls I've ever been to be located just a block away. The Lowenbräuhaus was rocking when we got there about 11:30. It was so much fun that we went there again after we left Oktoberfest the next night. It's a different (younger) crowd than O'fest, and the band plays much better music.

On the way to O-fest Sat morning, we bought our obligitory leder hosen (goat leather, very nice). Not cheap, but probably 75% of people (guys) had them on. The locals (all ages) wear their LH and dirndls (the low cut dresses that add at least 1-2 points to any 1 - 10 score) without any sense of irony - they are totally in to it.

We got to O'fest before noon on Sat, but the place was already packed. I briefly saw Tanner, but there wasn't room for all of us at his table - we had to move on. You must be seated at a table to be served in the beer halls. We had to go to a couple more places before we found seating for 5. After all that effort, we felt compelled to stay for awhile. Beer is served by the liter. After the first one goes down, the next doesn't look as intimidating. The food is also served in large portions and is really good.

The Germans have interesting customs. They LOVE to sing - either unintelligible Bavarian folksongs, or American rock songs from the 70s and 80s. Traditional um-pah bands are in all the halls, and the crowd seriously digs it. The other thing Germans love to do is drink beer, and the bands play songs specifically made for toasting and drinking. During band breaks, the crowd spontaneously starts singing things like "hey........ay baby, I want to know.....ow if you'll be my girl". I've probably heard that 100 times in the past 48 hours. As funny as the singing is, it is kind of cool to see people of all ages singing these traditional German songs and drinking together.

My newest best friends left this afternoon to return to Landstuhl. I'm solo till I fly Tues am. I'll try to post again tomorrow. Since I don't have an electrical converter plug for the laptop, I won't post pictures till I'm back in the States.

Friday, September 25, 2009

Goodbye Landstuhl

My last day was quiet. Many patients transferred back to hospitals in the US, and only a couple of new patients arrived.

After 2 weeks of this I believe that I can draw a few conclusions:
1. The soldiers, doctors and staff are extremely loyal, brave and hardworking. They seem to have incredibly high level of morale despite the sometimes dysfunctional military medical system and the endless procession of badly injured young men and women.
2. These military professionals will do whatever their commanders tell them to do. They might not agree or like it, but they will do it wholeheartedly.
3. The Commander in Chief, President Obama, has the ultimate responsibility for the decisions which place these soldiers in harm's way. The officers whom I have spoken with (admittedly a small sample) generally like his approach to our current international problems, and understand the complexities of the situations. They are capable of having an informed, rational, and unemotional conversation about controversial issues without resorting to name calling or hysterics.
4. We have an all-volunteer military. For many of us, it is easy to tell somebody else to take risks when we are shielded from the immediate consequences of our decisions.
5. If military personnel are disciplined enough to rationally discuss issues that directly bear on their risk of death or serious permanent injury, why can't the rest of America do the same?
6. By all accounts (including Chris's and my direct observation during our work in Pakistan in 1988), Afghanistan is a hellhole. I believe that sending more troops will only increase the work in medical facilities downrange and at Landstuhl, without fundamentally changing the situation in the region.

Since I got that off my chest, the autobahn becons and I'll lighten up by driving to Munich this evening with a group of medical residents from here. The weather is supposed to be perfect, but it probably doesn't matter. Pics to follow...

Thursday, September 24, 2009

Winding Down

It has been a little quieter for me the past couple of days. Patients continue to come in, but there hasn't been much vascular-related work. Did have an impressive bleed from an iatrogenic innominate vein injury from an ill-advised attempt a tracheostomy in a coalition hospital in Afghanistan (apparently not run by the Americans, but another unnamed European ally). The commander of Landstuhl Med Center happens to be a cardiothoracic surgeon, so he did the sternotomy to repair it (the big dog's gotta eat!).

Had a fairly interesting video conference today with the trauma teams downrange in Afghanistan and Iraq, as well as uprange at Walter Reed, Bethesda Naval Hospital, and Brook Army Med Center. They track all of the trauma pts from beginning to end. The process and logistics are impressive, but it's sometimes hard to understand the military jargon.

I'm going to get my liver enzymes warmed up tonight at "Belgian beer night" at Ramstein Air Base which is about 10-15 km away, then on to Munich and Oktoberfest this weekend.

Tuesday, September 22, 2009

Castle pics

1. outside of castle
2. Ramstein Air Base in distance - this is where the planes from downrange land
3. Landstuhl Army Hospital is on the top of the hill - you can't see it, but trust me on this. The town of Landstuhl is in the little valley
4. more castle
5. in case you missed it, I have another post from today below this one

Having a Blast

C-CAT (critical care air transport) brought in 3 new guys this afternoon with unstable spine injuries from IED blast. I've already operated on 3 others in the past week for anterior spinal fusion at the same L1 level. Apparently all these types of injuries have occurred when a heavily armored vehicle is blown up - the soldiers are wearing body armor and are strapped into their seats, but the force of the blast catapults the vehicle up into the air and the spine is crushed on their return to earth. The docs here say that we've been much busier than in recent memory. I'm in the OR almost every day, and have also put in 1 IVC filter with another scheduled tomorrow (thanks to PEMC IR staff for my training!).

I sneaked out for a couple of hours today for a hike up to the town castle, located on top of a steep hill above town. Photos to follow in next posting.

Monday, September 21, 2009

Winefest pics

1. Big cask with restaurant inside
2. Bill Pomeroy, American medical resident that came with me to fest
3. Carnival atmosphere
4. Crowd scene
5. Surprisingly good German red wine

Sunday, September 20, 2009


Not much letup in the unit on the weekend. There are both incoming and outgoing patients. Some are sent back to the States still on the vent but otherwise pretty stable. It seems like most of the incoming are from blasts (IED's) rather than GSW. I've seen a couple of vascular injuries that have already been fixed with vein grafts downrange. Today, Sunday, I explored a guy with an horrific leg injury from IED who lost his pulses during an ortho wound washout. His tibia and fibula were so badly comminuted that I exposed his T-P trunk from his lateral leg wound. Luckily his vessels were not thrombosed, but in extreme spasm - he may need an amp anyway because of the huge soft tissue defect.

On a lighter note, yesterday I went to the annual Wurstmarkt at the town of Bad Durkheim. It's billed as the world's biggest winefest, and the town has the world's biggest wine barrel with a restaurant inside. Pictures take forever to upload, so I'll post them later...

Wednesday, September 16, 2009


Here are the pictures that I promised yesterday. The internet connection here works alot better in the morning than in the evening, so I wasn't able to load them until now.

Tuesday, September 15, 2009

Busy Day

Today I got into the OR for the first time, helping the neurosurgeons with an anterior exposure of L1 vertebral burst fracture as a result of an IED explosion. Another guy in the same vehicle has a very large open wound in his calf which required ligation of the anterior tibial artery and ext fixation of a complex tib fib fx. Later tonight there reportedly is a soldier with a popliteal artery injury with a temporary intraarterial shunt still in place - apparently these injuries are usually repaired downrange so I'm not sure why he's coming here first. We'll have to operate on him tonight.

I'm really impressed with the skill of the surgeons and staff. They are extremely compassionate towards the soldiers and their families. Their enthusiasm is contagious, and it is good for an aging, somewhat jaded American vascular surgeon to have the opportunity to work in this environment.

I've attached some photos that I took yesterday. Photography is discouraged on the base, so I took a couple of hospital pics from outside the gate after a run. The hospital is on top of the steep hill in the background of the town photo. My room is on the 1st floor of the tan building - 5 windows! It is very nice, and you can see that it's been remodeled on the inside.

Monday, September 14, 2009

After all mandatory paperwork was completed this morning, I made it up to ICU rounds just as it ended. Although all 16 beds are full, curiously there are only 4 patients with battlefield injuries - others have medical problems (including a terrible - sounding thing called Crimean-Congo hemorrhagic fever) or nontraumatic surgical complications. I didn't realize that casualties from all coalition forces come here to Landstuhl, so now in the ICU there are patients from Poland, England and Uganda, as well as a couple of civilian contractors and retired military guys living in Germany. Apparently there is a population of about 50,000 military personnel and dependents in the area that are cared for in this facility.

The ICU is pretty small and predictably chaotic, with the usual assortment of doctors, nurses, RT etc, with the addition of some residents and medical students. Flights from "downrange" (Iraq and Afghanistan) come daily, but apparently nobody today needs immediate surgery. I'm carrying a cellphone in case there is an emergency. My role seems to be like a fireman: I'm not needed every day, but they say it's good to know that I'm around when a case arises.

The hospital is only 2 stories tall but spread out over a large area (thought to be more difficult to attack). Besides the usual hospital services, there is a cybercafe, food court (Burger King, Subway, pizza) and convenience store. I haven't been around the rest of the base yet, but the facilities here at Landstuhl (Army) do not seem as upscale as what I saw from the transport van yesterday at nearby Ramstein Air Base (Air Force).

If it stays quiet, I may do an exploratory running tour of the base (a 5 km course was included in my orientation papers). Unfortunately the only bike shop in Landstuhl is closed for vacation until next week - I think I can rent a bike at the Air Base, but it's a 15 minute cab ride to get there.

Sunday, September 13, 2009

With the buzz of international travel propping me up I'm sleepless in over 24 hours. Picked up by driver at Frankfurt airport - the ride to Landstuhl on the autobahn was a little bit out of my comfort zone. I don't think the boxy Ford van was designed to go 90 miles an hour, passing sleek Eurocars like they were playthings. The German driver was alternately on his cellphone and changing the radio station (which played recognizable songs by Pink, Snow Patrol and Phil Collins mixed with Europop).

After check in at base at the Landstuhl Inn (one of a chain of Air Force Inns across Germany and maybe elsewhere) I walked about 1.5 km (I'm metric now) downhill to the town of Landstuhl. A mini version of Oktoberfest was happening so I sampled a currywurst (apparently a local favorite) and a cheese crepe (OK, but not as good as the Swiss version). Luckily, beer is spoken in an international language, because I forgot to bring the German phrase book to town. I also forgot to bring the camera, so no photos today.

Tomorrow (Monday) morning I'll get checked in to the hospital, which is only a block or so away from my room. I'll post details of the 1st clinical day tomorrow.

Wednesday, August 26, 2009

A well written piece by Bob Herbert in the NYT on August 25 pretty much summarizes why I volunteered for a 2 week rotation at Landstuhl Regional Medical Center. All seriously wounded US military personnel are transported there after initial treatment in Iraq or Afghanistan. After stabilization at Landstuhl, they are flown back to hospitals in the US. The Society for Vascular Surgery has encouraged civilian vascular surgeons to assist military surgeons in the care of these wounded soldiers. I'll be writing about my experiences and, hopefully, be getting feedback from some of you reading this blog. When my 2 week rotation is completed, I'll be winding down at Oktoberfest in nearby Munich (maybe less writing during this time...). I hope this blog is entertaining and informative - your comments will be much appreciated.

Friday, August 7, 2009

Breaking the ice on the blog. I'm completing the background check and other paperwork for my volunteer position at the US Army Hospital in Landstuhl, Germany. So far the process is pretty straightforward, but I don't know many details of exactly what I'll be doing there. The uncertainty makes me a little nervous, but hopefully I'll respond well when the time comes.