Tuesday, March 11, 2008

MASH Notes

After the Mexican Manifesto, I attended the panel MASH Notes: A Military Surgeon's Videoblog from Iraq.
A United States Navy trauma surgeon shares his experience caring for combat casualties in Ramadi, Iraq during a seven month stretch of the Iraq War. He describes the challenges in caring for critically wounded American troops, Iraqi civilians and security forces, and enemy combatants in an austere environment with limited resources and personnel. All the while he is able document his combat experiences and communicate with his family and friends back in the States with a videoblog maintained throughout his deployment.

The speaker was Carlos V.R. Brown M.D., currently the Trauma Medical Director for Brackenridge Medical Center, and local Austinite. Previously he worked at an LA trauma center and was in Iraq from August 2006 to March 2007.

He'd been deployed before, but always as either a single or engaged person. Never before had he had to deal with being deployed and leaving behind a wife and three small kids. His brother, who works for Google and YouTube, suggested he set up a blog as a way to deal with the situation. The blog allowed him to communicate with his family and, as a side effect, forced him document his experience. He talked about how the blog changed his experience in Iraq.

This was very, very well presented. He's probably done this for some medical conferences as well.

First, he gave the audience a bit of a background, which was useful since most of us had not read his blog. He was deployed to a Level II medical facility Ramadi, Iraq, which is equipped to handle resuscitation, surgery, blood and transfusions, and critical-care holding. (Level III facilities are more like full hospitals, Level IV is a hospital in Germany and Level V is Walter Reed and Bethesda back in the U.S.) His presentation included images and videos from his blog, T*R*A*P*P*E*R 'L*O*S, M.D..

The experience of trauma surgery in a war zone like Iraq is very different, for many reasons. For example, causalities could come in on tanks, not ambulances and instead of getting 24 injuries in one day, as with the L.A. trauma center, in Iraq they could get 50 in fifteen minutes. In fact, they might even know when they were getting a lot of causalities if they heard an explosion that seemed louder or closer than usual. He also dealt with enormous injuries and much more severe trauma than at a U.S. based trauma center, with people sharing the same uniform as himself. He showed some very graphic images of wounds.

He mentioned that he would not have taken these videos and pictures had he not setup the blog. Now he's really glad he did since it really documented his experience. The original purpose, however, was to share his experience back home through the blog and stay in touch with his family.

He did sometime have a hard time figuring out what he could and couldn't put on the blog. To help him decide he put up only things he felt he could share with his kids. (Keep in mind that you might have different ideas about what your kids can handle.) The military knew of his blog and allowed it, and the pictures he took of injuries fell under informed consent. (Medical professionals do this all the time in order to help teach the next generation of physicians.)

He wanted to give some operative footage on the blog because it highlighted how surgery in a facility like his was so very different from how it would be done in the states. For example, having to use manual tools (a hammer and chisel to break open the sternum) rather than the tools used back in the states because of the lack of electrical power. Also, often multiple people would be operating on the same person at once. The surgeons did their own cleanup.
One of the ironies was that he was using a high tech blog to communicate, but didn't have a lot of the basics (like a blood bank) needed for the kind of surgery done. It was a very different professional experience and he was able to share that.

To deal with the situation he read, and worked out. He had a Netflix account and they deliver straight to the base! He was able to catch up with favorite shows like Arrested development and The Sopranos. But overall, the video blog was critical to maintaining his sanity while he was there. He spent the bulk of his extra time on preparing his blog. To do that he used an Internet cafe across the street. The picture is amazing, since most folks aren't used to blogging with computers covered in sand!

His "mustache contest" got the most comments of any entry in the blog. Some celebrities stopped by the facility, including a well known photographer who was kind enough to share some of his photos. His best friend John Spong came out to Iraq report on it for Texas Monthly.

After lots of pictures, videos and text, he started getting a bit creative. He put some of his pictures and videos to music, and did some special stuff for his kids to celebrate birthdays, Halloween. It made it easier for his kids to see, via photos, that he got a birthday cake on his birthday. He did video for his blog with Star Trek theme and him in a costume for his kids. The blog allowed him to participate in family events like Thanksgiving or Christmas. His voice broke talking about the pictures of Christmas.

He still keeps in touch with the people he worked with in Iraq. The only thing he didn't post was pictures of those who had died in his area during his time there, but he did show us during the presentation. He then opened for questions.

My sister is a pediatrician at Texas Children's Hospital in Houston. She'd had a chance to tour medical facilities and nearby areas in Kashmir after the earthquake in 2005. She shared her photos with my family at Thanksgiving and it was absolutely fascinating, but almost 2 years later. It's the kind of thing that would be excellent for a blog, so I was curious about whether Dr. Brown's blog had an effect on other physicians or interested them in doing the same and asked him during the Q&A. He said that, at presentations at medical conferences, there was a lot of interest but that generally they just didn't know how, so he'd be giving them advice on how to get setup and started.

All in all, a very nifty presentation.


Irene said...

What a great use of social media. It sounds like it was a good outlet for him to keep in touch with his family.

Heather Steely said...

I spent nearly six years living in Germany working at an Army post where troops were constantly deployed. I have dozens of friends and acquaintances who have or are currently deployed, most recently to Iraq, but other places as well. And it's always a bit funny to me how the military operates. If you've never read Catch-22 by Joseph Heller, I highly recommend it. The stories my friends tell are just as funny, and just as sad. Dark satire to the core. Funny as all get out, but deathly serious.

Here's the kicker: The general military (and I'm not talking Intel or special ops units, here) gets all the old equipment. Uses the old standard operating procedures. Gets all the hand-me-downs. But, even though they may be fighting a war using aged everything, service members have this amazing opportunity to use new media technology. AWESOME that they have the means today to keep in contact with friends and family while fighting a war. Talk about a morale booster!

What other generation of service members ever had the chance for video-conferencing, blogging, or e-mailing while getting mortared? Totally AWESOME.