Subsequent Events

SGT Castro and I both sustained concussions as a result of the VBIED explosion. In addition, I sustained relatively minor orthopedic injuries primarily in the form of abstract neck/back and hip pain and shoulder stiffness. Thereafter, I also had consistent foot pain, but since I was functional and felt I could perform my duties, I waited to seek treatment for what turned out to be two fractures in my left foot and a labrum tear in my right shoulder until I returned home. Aside from the minor physical injuries, upon resolution of the concussion, I continued to experience sensitivity to light, headaches, memory issues, word-finding deficits, and difficulty attending to and comprehending written information.

As health care professionals, many of you are likely aware of the generalization that “we are the worst patients.” This generalization reflects our innate resistance to “taking our own advice” and “taking care of ourselves.” While not true of all health care professionals, it is a generalization that held true in the case of Charlie, 173d ABCT. The majority of the medical company sustained some type of injury. Ironically nearly all the members of the Combat Stress and Concussion Care Teams had been concussed, and a couple members of the Forward Surgical Team sustained injuries which would necessitate eventual evacuation from theater. Some Service Members up to one mile from the point of detonation were affected by the blast. Retrospectively, I realize that most of us shortened our recovery-time and tried to stagger rare “downtime” opportunities in order to continue medical care for others.

Our Concussion Care Center did not have the capacity to treat all affected Service Members from that event. We worked with the medical company to screen and triage those who were symptomatic. We admitted to the Concussion Care Center all that we could, treated other Service Members as outpatients, guided and assisted concussion management of other Service Members who were being cared for by smaller medical assets on the FOB as needed, and sent other Service Members to Bagram for additional care.

We had the added challenge of needing to evacuate the patients from our Concussion Care Center and temporarily relocate them to a more secure area on FOB Shank. Much of the 173d Support Battalion’s Bravo (maintenance) and Charlie

(medical) company areas and many of their living quarters had also been destroyed by the blast. The maintenance company relocated off the perimeter of the Forward Operating Base. In the midst of recovering from their own injuries, the medical company was tasked to stay in place, rebuild and return to full mission capacity, and to secure their perimeter.

It was during their efforts to secure their perimeter that we noticed our Concussion Care Center was inadvertently in their line of fire. We, of course, immediately drew this to their attention, created a patient evacuation plan that was compatible with the medical company, and joined their perimeter security plan. Although co-located with the medical company, we were not officially attached to them. Fortunately, their leadership and medical staff were generous in their advocacy and support of our efforts and mission.

Ironically, the VBIED detonation itself may have been the least stressful event of my deployment. There was nothing I could have done to prevent it. It was sudden, unexpected, and over before I fully realized what had happened. However, the stress and subsequent medical and emotional challenges that occurred as a result of the events surrounding August 7 were nearly overwhelming. It was only by working together, as a unit, that we and the medical company were able to continue doing all that was required.

The lead OT in RC-East, Afghanistan was stationed at Bagram. An honorable and compassiate leader, she insightfully relocated another Army Occupational Therapist in the region, CPT Powell, to FOB Shank to assist us in running the Concussion Care Center while we recovered. CPT Powell was invaluable to our ability to continue to treat Service Members in the week that followed the VBIED detonation. Additionally, CPT Nordstrom (Army Occupational Therapist) and SFC Butch (Labrador retriever) provided animal assisted therapy services not only after this event, but also throughout their tour in Afghanistan [for more information on occupational therapy roles in Combat Operational Stress Control units and Animal Assisted Therapy see [5]). Furthermore, higher headquarters behavior health care leadership at Bagram personally helped to rebuild the Combat Stress Center.

I would also be remiss if I didn’t mention the support and assistance we received from the Navy Seabees and formerly concussed Service Members who had successfully returned to their units. We were truly blessed in every sense of the word. Not only were we receiving support in the form of Service Members (and sometimes contractors) stopping by to “see how we were doing,” they also assisted in cleanup and repair projects. Occasionally we received donations of clothing, blankets, hygiene and food items from their families back home. Often there was a “thank you” note and a brief update about their loved one. Independently of the VBIED attack, we regularly received items from corporate, nonprofit, and individual donors throughout the USA. Since many wounded Service Members came to us from the battlefield without their gear/supplies, we relied greatly on these donations to provide those who stayed with us adequate supplies during their recovery.

To the best of our ability, we provided any extra supplies to the other medical assets at FOB Shank and at remote outposts to distribute to their patients. Although unfortunate that so many came to stay with us at the Concussion Care Center, the remarkable men and women with whom we interacted restored our perspective and renewed our resolve to fulfill of our purpose there.

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