17 August 2009

10 August 2009

Coppola: A Pediatric Surgeon in Iraq

Coppola: A Pediatric Surgeon in Iraq

There's safety in thin patients

Posted: 09 Aug 2009 09:16 AM PDT

As M. and I settled in to enjoy a rainy Sunday morning with the paper, coffee, and twelve friends from the Dunkin family, she stumbled across a "Hey Marge!" story.

(If you don't know the "Hey Marge!" story, it was defined by David Lee Roth as a story on the TV so shocking that it causes one to yell out "Hey Marge!" and call in his wife.)

Apparently, a 500 pound man was arrested in Harris County, Texas, searched several times, but when he arrived at the prison he was discovered to have hidden a 9mm weapon between folds of fat.


It made me feel somewhat thankful that our patients at the combat support hospital in Iraq were too thin to try and get away with such a trick. In fact it was unfortunate that the majority of the Iraqi children we treated were in a state of malnourishment. They often looked years younger than they actually were because of a chronic want for calories.

We had procedures in place to be certain that no patient arrived at the hospital still armed with a weapon. In spite of this level of confidence and safety, our team still performed our double checks and triple checks to ensure that all staff and patients remained safe.

Early on, some of the insurgents we treated were mildly obese, but still nothing compered to the levels of superobesity we are capable of here in the US. I asked the interpreters about this phenomenon and they explained that many of teh insurgents had been active Baathist party members and enjoyed a relatively greater share of riches and feeding.

As the war progressed, and greater numbers of the insurgents turned out to be foreign fighters, this difference in body mass index when compared to Iraqi soldiers and civilians faded away.

I do recall one incident comparable to the skin-fold weapon concealing prisoner, but I experienced it years ago in the US when I was a surgical resident. The ED staff called me in to consult on a school-age girl who whose diagnosis had eluded them. Her mother brought her in because she "smelled funny" and no matter how many times she bathed her daughter, it wouldn't go away. The child was a pretty and friendly girl, but was obese to a level that threatened future health risks if she didn't get some sports and outdoors into her life. There was a smell very much like an abscess, but the child was happy and healthy with no pain or visible signs of infection. My examination of her belly must have been a bit more thorough than the ED resident's because I discovered a remnant of a tuna fish sandwich tucked into a skin fold near her right flank. When the child's mother saw it, she burst out "Is that tuna? I gave that to her over a week ago!" We were all pleased that we had found an explanation, and no serious trouble had been unearthed.

There is beauty in the women Rubens painted, but we have gone far beyond that archetype.


For both health reasons and keeping contraband out of prisons we need to find a happy medium between impossibly anorexic fashion models and superobesity.

Annoyed? I'll try and help!

Posted: 09 Aug 2009 08:33 AM PDT

Hi, Since I'm messing with the blog settings, you might end up getting the posts twice. If you are getting spammed from me, let me know and I'll try to fix it. (By the way, this means I'm officially old and can't figure out the young peoples' latest gadgets and gizmos.)

08 August 2009

Take an online trip of peace

Take an online trip of peace.

Once a coworker at the hospital in Iraq asked me, "Has Public Affairs approved your blog?"

I replied, "No, but there's nothing in there they could reasonably object to."

Shortly after that, I got a message my commander wanted to review my blog. I gathered up everything I had written and delivered it to him.

"Looks good to me" he said, "carry on!"

I heard scattered stories of troops being ordered to shut down their blogs or being disciplined for something they might have posted online. I do realize sometimes our young citizens, in or out of a war zone, post some pretty ridiculous stuff, the kind of pictures and stories that they might just find themselves explaining in a future job interview. But isn't that the spirit of freedom of speech? Our right to speak our minds is not predicated on how smart, stupid, or even outrageous the statement might be. In fact, it is most important to protect the outlandish stuff because as soon as you let one voice be stifled, we are all are in danger.

There are many military blogs I have visited. One of the earliest I read was BlackFive:


which used to give breathtaking accounts of missions from behind the rifle.

You can find a vast variety of over 2400 military blogs (including mine!) at Milblogging.com:


After reading just a few, you quickly realize how every soldier (or soldier's wife back home) has a vibrant story to tell.

I also understand that as a troop, I had willing submitted to the Uniform Code of Military Justice, which is kind of like the dress code, behavior code, and imposition on every moment of life that I was subject to when I went to a Catholic school. The difference is that the rules in school were strictly defined and interpreted by the brothers, but the UCMJ is a vast mess of contradicting regulations on such scattered minutia such as which side of the belt I was supposed to wear my hospital beeper. For better or worse, it doesn't seem like any one person actually knows all of the UCMJ, so the lawyers in the JAG can swing it whichever way they choose to argue.

For my part, I self-policed very severely and never revealed a patient's name, any interpreter's photo, or any details that could give the enemy an advantage. I suppose we had it easier than WWII troops who had the censors heavy black pen blotting out large portions of their letters.

There is a huge value in having troops on the front line able to communicate their thoughts, dreams and fears directly to the world at large. Lots of people in the US would be surprised at the low opinion many people in the world have of us, and that's just because they don't know us as individuals.


By letting the soldier have a voice, the world can see Americans for who they really are: hopeful people who fulfil their duties even as they miss their families at home.

A recent article described how the Pentagon was considering a complete ban on access to any blogging or social networking sites, even though some leaders understood the importance of maintaining these lines of communication.


While in the military, I attended Air War College, and learned the thinkers in the military realized the strategic importance of conducting Internet communication as a form of soft power. In fact it seemed as if Al Qaida had realized the value of the online channel and was using it as a means of recruitment and propaganda. I learned about Public Diplomacy, a little known and less well understood function of our State Department that aims to communicate to citizens of other nations that the USA is a land of freedom and opportunity. I also learned that it received very poor funding.


There are groups in the world, such as the Saudi Arabian Sakinah Campaign (it means "Tranquility") who scan the web for Al-Qaida activists and engage them in online communication to try and combat their message of intolerance.


Young people around the world look to the Internet for their information about the US. One interesting site I found is Mideast Youth, based in Bahrain, where young adults discuss issues from the Iranian election to the role of the US in the Middle East.


It is important that young Americans join the dialogue, and who better to represent us than our dedicated troops.

A friend in Spain gave me this saying: "Travel plants a seed of peace in the heart of the visitor and the visited." There is no reason that trip of peace can't happen online.

07 August 2009

Moving to a new Blog Site



I am very pleased to announce that I will be publishing a new book, "Coppola: A Pediatric Surgeon in Iraq" with NTI Upstream, Chicago, IL in November, 2009. If you are interested in visiting the new site, please click to:




Best wishes!



06 August 2009

The Tightrope Gets Thinner

The Tightrope Gets Thinner

M. and I were shocked to read a 25 JUL story about how an Iraqi commander ordered the arrest of three US soldiers after they killed three insurgents near Abu Ghraib. I will fully admit that it is impossible to know what happened without actually being there. But after meeting so many of these young, dedicated, professional soldiers who are serving in Iraq, and seeing firsthand the deadly injuries that they suffer, I come down 100% on the side of our US troops who have to make life and death decisions in an instant.
We read that the troops in this event were in convoy when they received contact in the form of small arms fire and rocket-propelled grenades. The troops bravely dismounted, pursued the attackers through an urban environment, and killed three insurgents. Civilians were killed in the gun battle. An Iraqi commander arrived late and ordered the troops arrested.
Here is a link to the story:


Fortunately, the following day Iraq Prime Minister Al-Maliki announced that the commander’s decision was in error and expressed his confidence in the troops and gratitude for their service.
The story is here:


I am pleased to see a general improvement in security in Iraq and fewer deaths each day. Best of all, it gives me hope that the day we get our troops home from Iraq is getting closer. But I think that we have to be very careful as we exit that these troops are not subject to second-guessing or legal action just for defending their lives.
This danger is nothing new. One soldier I know who has served bravely and has stood up to complete the mission on multiple tours to Iraq recently described an incident he experienced, very nearby in Abu Ghraib, four years ago. His troops on patrol were confronted with a vehicle speeding toward them, saw and heard gunfire and had to make a life-and-death decision. Like so many others, they performed professionally, and made the safest and correct decision, but with the full weight of responsibility and conscience. You really should read his report via the link below because it gives a rare perspective into the thoughts of troops on the scene.


Recently, my associate loaned me the book “Warlord, No Better Friend, No Worse Enemy”. It is Marine Lt. Ilario Panano’s own account of how he was accused of murder after killing two insurgents in Iraq in 2004. My wife, son, and I were captivated by the story, and again horrified that one of our troops could be put through such an experience after doing his best to defend his men.
There is an adequate summary on Wikipedia here:


Lt. Pantano’s family started the foundation Defend the Defenders. (I don’t know if they are still active)


As a doctor, I don’t have to look far to find reasons why war is so harmful to the many people young and old who are caught in its grasp. But it is important to remember that even as strong, well-equipped and professional as our troops are, we have to look out for them too and be sure that their dedicated actions are not being second-guessed.

05 August 2009

Finding my way

I’ve spent the first week of my new job going from orientation to orientation. Today was a day-long class on the electronic medical record. It’s like learning a new language. But it’s worth it to be able to leave the paper record behind. This way when a patient comes in with an emergency at midnight, we don’t have to wait until their chart is retrieved from storage. It’s great to be starting my first civilian job, but it’s been an adjustment on many levels. It still feels weird to walk around outside without wearing cover. Even at home, there are little reminders of my former military life. Every night at 2100 the church across the street chimes the hour then plays Taps. I feel the urge to stand at attention when I hear the first few bars.
I still haven’t figured out how to get around the new hospital. On the way back from my computer-based training, I got lost trying to find the surgery office. At least I ended up in the cafeteria. I’m eager to finish this training and get back in the OR. I just hope I can find it!