The Deep End

The Best Medicine: Lessons from Afghanistan

It's time to get personal at ISG. Learn some of the foundational experiences that helped shape our philosophy, mentality, and approach.

December 30, 2019


While volunteering at Craig Hospital on Bagram, I sat feeding a catatonic girl. She'd been in the hospital 2 weeks by this point and had only recently started eating.

War stories are a funny thing. They're generally purposely constructed to remind the listener that the storyteller has an image to keep up. This isn't a story about an image.

It's not a story about heroics, valor, courage, or fighting prowess.

It's just a story about life and when it's over there's no one who deserves a beer or a pat on the back. No one really wins and the story doesn't end.

It's a dry, dusty story about a dry, dusty place and how it's relevant - if it's relevant - is entirely up to you, dear reader.

That fits just fine. It's the kind of story that doesn't get told because, as veterans, we generally don't think it's relevant.

...But then again, maybe it is.


I didn't go to war for altruism. I didn't care about the Afghan people. They were just one more group of unfortunate people in a world of unfortunate people. My goal was simple: make some money, get some poor chump a replacement so he could go home to his wife and kids, and learn as much as I could about a society that's lived in a perpetual civil war for 25 years.

I wanted to see as much as I could of a society in a deep state of failure and learn to manage the problems that happened in that environment. I had some training and I wanted to put it to use. One of the niches I found was far from what I expected. For one, I'm not a medic. I'm not a doc, a PJ, or even an EMT. I've got some basics in CPR/1st Aid, a version of CLS (combat lifesaver), and the Air Force's mandatory Self Aid Buddy Care, but nothing amazing.

Medicine was a peripheral topic for me, but I knew it was important, both for fighting effectively and for assisting the injured. Strange then, that after some time living in Afghanistan, that was how I came to this story.


Abdul and Mubeen. Mubeen was an old Mujahideen fighter. They called him "Goidashiday", which meant something like lazy.

"They're not that different"... And no, I don't just mean because they also had to wear those absurd reflector belts.

I remember thinking this, sitting there speaking broken Dari while they busted my balls for my mistakes. After work, the Afghans would sit in a common spot. It wasn't far from one of the buildings I worked out of so I'd join them.

One guy, called Abdul Zawyer - we called him Z - spoke fluent English. His father was an Engineer and he was fairly well educated before the Taliban came around and shut down the schools. I offered to trade him Sprite and Clif bars to teach me some Dari, which was an easy yes for him. We'd sit in the shade and talk about work, women, life, religion, politics, and of course, the state of the Afghanistan - you know, all the stuff in the Afghanistan Cultural Awareness Guide it says to avoid.

Weeks passed, and I got to where I could string together enough words to make a crude sentence, and that made me pretty useful. In the meantime, Z got rich off Sprite. I couldn't help but wonder if that Clif bar could have helped the Pellagra that scarred his face in that common, unmistakable semi-circle that forms just off to the side of the mouth. A hallmark of early childhood starvation.

He was a good enough guy and after a while I realized something:

"This guy is my friend."

The problems we talked about weren't his alone. Many of the things that affected the Afghan citizen affected the military as well. Floods that drove hundreds of thousands of Pakistanis flooding into Afghanistan, bringing with them their Madrassa radicalism. Drought. Attacks in the area. We actually had a lot more in common than I'd have thought.

I had similar conversations with friends in the States. We were fighting the Taliban, sure, but the real victims were the ones who'd been living among the fighting that plagued Afghanistan for centuries. Who was in power at any given moment was not particularly important to the regular Afghan, unless it was his tribe benefitting. So I admitted to myself that the side-eyed glances from my allies weren't as detrimental as my friendship with Z was beneficial.

Pat Frank once wrote "Small nations, when treated as equals, become the firmest of allies." It wouldn't be long before I realize how true that was on a personal level, as well... and I'd find that sometimes, being part of a larger force didn't do much good when it comes to saving those allies.

The Hospitals

"Here, quick, put some operator stuff on before the Sergeant Major sees."

My job began to pick up after a few months, and I was sent pretty routinely to move around Afghanistan.
There were a couple benefits to this:

  • I got to interact with a wider variety of people.
  • I got to see more of the country (tactical tourism!)
  • It put me on the radar as someone who got out from time to time, and could speak, which;
  • Led to me being invited to help out at the hospitals (by a smokin' hot Army officer, so yeah, sign me up).

The hospitals however, were there own little world, and so, this is where this story gets far more personal.

Egyptian Field Hospital, Part I:

"Volunteers never come back... They all say the same thing."

I wasn't too interested in what the volunteers said or why they wouldn't return. I knew what I was after, and I'd get it. Experience.

That would mean coming back, so I grabbed a bag of milk for donation and started the walk to the Egyptian Field Hospital.

As the new guy, I had a simple job: Hold a bag of milk and wait to distribute it to the kids who's parents and family members were in the field hospital for treatment. There were probably 20 of them, dirty, dusty little ragamuffins who looked like something out of Mad Max. I stood there, ignoring warnings from the officer who organized the hospital trips that I might wanna pay more attention to the bag of milk I was holding.

"You'll wanna hold it higher" she said, but I felt pretty confident I could keep it from them.

She walked off, and they instantly went "Children of the Corn" on me; they formed a half-circle, and starting moving in, reaaaaaal slowly.

Of a sudden, one of them lunged forward, tore the plastic bag with a ratty fingernail. I'd been carrying the bag like it was a baby, and I could feel my arms hit my chest as the milks dropped out the bottom of the bag. The children dove in, dust flew. Two boys were full-tilt slugging each other in the face. A little girl sat crying with a bloody nose. All but two or three of them disappeared, the only ones hanging around were those injured or dejected.

The rest had grabbed what they could and absconded, the little devils.

Not many hospitals look like this. It looks more like an Elementary School to me.

That officer gave me the side eye (a look she'd throw  at me a few more times) and I realized that I might be able to speak a bit of Dari, but I wasn't making myself understood in that culture. Afterwards, we met several doctors who would become trusted friends and who would continue to teach us both about the practice of medicine, their culture, and share their experiences in the war.

The day ended and I was the last to leave.

It'd been a weird one but it wasn't over... This was a hospital and though I'd been dealing with the young and healthy (I think by design), I'd soon get a taste of the everyday reality of that place.

I passed a boy on a bench with his father. The boy was curled in the fetal position, shivering in pain.

The following is an entry from my journal:

19 July 20XX
I asked his father what was wrong, and he started describing it to me. I tried to consider all things, but the attendant told me it was Lymphoma and there was nothing they could do. An old Azore woman said that all they could do was wait for the boy to pass, and make him comfortable and dignified. Her eyes welled up and she put on her glasses. Naturally, I looked at the father and I don’t know why. It broke my heart. Perhaps more than anything I’ve ever experienced. He looked so lost and helpless, his boy, agonizing and no one could help. The woman said he looked to them as if they were gods, praying for an answer, for help.

In that moment, I'd found what she'd told me about. She'd said that the volunteers always say the same thing:

"I can't go back, it's too sad."

They were right.

Craig Hospital, I:
And later, we were all summarily executed for having too much fun.

After several months, I arrived at the Craig Hospital and there was a new patient. A little girl, very much catatonic. Her story, as told to me was the following:

Her father had been a local police officer (ANP), opposed to Taliban rule. He'd been murdered a few weeks before, but to punctuate that they meant business, the Taliban decided to hit a car in which the girl, her uncle, and mother were riding as well.

They opened fire with AK47's, killing the mother and the uncle. The girl caught a round to the left femur, which was blown clean in half, and another round to the head, which miraculously followed the curve of her skull. She came out of surgery with staples all along her scalp and her leg was bolted back together with steel braces.

She wouldn't speak. She wouldn't eat. She just stared at the wall. To complicate matters further, she came from a Pashto speaking district, so I was no help there. I'd found that there was a sort of strange satisfaction in helping the staff in cases like these.

Not only did I secretly hope that these children would remember Americans as good and decent, but I naively hoped it would help to change the landscape of that country. Seeing the dying boy on the bench had taught me something I wouldn't be able to put into words for years:

Everyone appreciates kindness when it's extended to their children.

Remember I said we're not too different? Imagine, if you will, living in a place where your kids are killed for retribution. They're a physical vestige of your vulnerability.

Asymmetric Warfare, Unconventional Solutions, and Hippy Shit

Given the impasse, I figured I'd try a different language all together: Music.

Sounds campy, doesn't it?

Let me be the first to say, I'm not about that 'flower-in-the-hair' caring-and-sharing life popularized by the free spirits of the 1960's. Honestly, I'm not a big fan of them. My job was to salt the earth and do whatever I could to deliver terrorists to the bosom of Allah.

On the other hand, I got thinking about how stupid it is that we pay lip service to phrases like "think outside the box", or "find unconventional solutions".

I got thinking about Europe's Dark Ages. Days of manual labor spent in the mud under overcast skies, the only sounds the rolling wheels of rusty wooden carts and the clomp of horse hooves. A world in which the commoner didn't have the faintest notion of what a "lute" was. It got me thinking of how the church and it's introduction of the chants and hymns which brought a moment of beauty to those drab, uninspired lives. Imagine stepping out of the mud and into the halls of those cathedrals, hearing those chants. It would have been nothing short of entheogenic.

Well, under the Taliban music had been forbidden. As absolutely medieval as that sounds, again, put yourself in a position where the only melodic sound you've ever heard is the call to prayer. I'm reminded of a Niven/Pournelle Quote:

"...any sufficiently advanced technology is indistinguishable from magic."

Music there was nothing short of magic, so lacking any better option, I figured 'what the hell?'

After a few days, the little girl started taking food, though she hadn't lost that vacant stare.

It dawned on me that salting the earth was a little overkill and sowing some seeds of peace was an inevitable component of even the most terrible wars.

Time does what it does
Najibullah and his father Mahibulla. Naji was burned by white phosphorus and had no skin covering his bowels, which had been laced with fistulae, allowing waste to seep into his abdominal cavity.

I'd become close friends with the officer who originally invited me to the hospital. She was right; it was sad... but it was easier to deal with as a team and we worked well together. It was a bloody summer too, which wasn't a surprise. Z had told me he'd been hearing things, and sure enough, a few days later a fuel truck detonated at the gates.

The Egyptian hospital had become beset; I don't recall the specifics of the attacks but there was a surge of injuries there. An amputation, several smaller injuries. Most of the bigger trauma was shifted to Craig and things there were grim as well.

Two boys had been shot in the throat, one teenager had been burnt to unrecognizability, and several of my friends had either been injured or had children who were sick. We treated burns, described ways to keep their kids from succumbing to infections, changed bandages for the Craig hospital's longest and most loved resident, Najibullah, and we watched as the kids at the Egyptian hospital grew organized and better behaved.

An older woman came in with a broken wheelchair and no one could really help her. The spokes had broken out from the wheel, and it wouldn't roll. I hammered it into place with a brick and zip-tied it... that woman was as grateful as any person I've ever seen.

I started feeling good about this stuff. It was satisfying some deep rumbling that had been vacant from my life in the States. I felt useful. I felt purpose.

One day Z pulled me aside and told me he had bad news. While I'd been out, a friend of ours had been murdered. Taliban thugs grabbed him while he was trying to take a Taxi and when they saw his wallet was empty, they executed him. He left behind two daughters. Z tried to describe the reason it had happened... The reason, it seemed, was that we're humans, and that's just what we do.

I'd become close with Dr. Ahmad Gemal, and he, the female officer and I spent quite a bit of time discussing medicine, politics, and the state of Egypt - his home nation. This was during a very troubling time there, and he seemed both relieved to be out of the country and concerned with his family back home.

He invited us to observe several procedures and we were invited to the UAE's Special Operations compound for lunch. Ahmad was there during an attack that hit their mosque and his eye was injured pretty bad.

During this time, he told me something. We were tending a patient who was very uncomfortable but would recover. We walked out of the little surgical hut and I asked him how he would go on treating the patient. He wiped his hands, looked to me, and told me something I'll never forget but the story would go on for a while yet before it would matter.

Craig Hospital, II:
Ashmatolla. It probably sounds like I'm making these names up, but nah, they all just sound the same. He'd wheeze when he laughed, because of the hole in his throat.

I grabbed some food to help with the catatonic girl so the nurses could get a few minutes and took to feeding her. She'd eat in a way that reminded me of how an animal grazed. As if it were just a sort of afterthought of her biological programming. She took no interest in it, but she had taken to finishing her food, which was progress.

She hadn't moved so far as I could tell. She couldn't walk, of course, but she wouldn't even move a finger. She wouldn't move her eyes. I glanced at the nurse and she gave a shrug, before walking off. They were thankful, of course, and for me what had started as a crash course in medical care had slowly turned to a sense of compassion... perhaps even affection.

Despite my initial disregard, distrust, and dislike for the Afghan people, I couldn't help but see them as people from this distance.

With my regular work shift approaching, I set the spoon on the plate, pushed the tray aside, and began to stand when felt something snag my hand... hard.

I looked down, and saw that the girl had grabbed me by the hand.

She didn't move, but she said one word; kenah. Then again... and again with tears in her eyes. I was shocked. Kenah.

She spoke. I can't remember if she moved in any other way but as she said it, her grip tightened like a ratchet. A moment of vulnerability that, once the seal was broken, took her emotional isolation and replaced it with a torrent of tears.

I stood there like the roles had been reversed. I found myself unable to move, to look away, to speak.

When I was able to, I told her in a language she couldn't understand that I'd be back.

She had begun to see me as a person, too.


Little by little, she began to talk and move. When I think of it now, I think of the boy with Lymphoma. I doubt very much she's alive, but maybe... at least she had some small comfort. Some measure of trust that this world isn't completely awful. Another name on another page in History's book of infinite dead.

In time, the girl was discharged to a man who claimed to be her uncle. Najibullah was sent home too, after several successful skin grafts. Some months after that, I'd be sent home too, as if I'd been cured and no longer needed to be deployed.

After being home a while, the female officer (who'd told me the hospital was too sad) and I realized that we'd cultivated an unbreakable bond of respect and love. We ended up married and we have our own children now. I occasionally look at them and wonder if they'll ever be burned by white phosphorus or shot and left catatonic. I wonder if an foreign military will take time feed them, if so.

On the occasions we've found to talk about the hospitals, I keep to myself when she asks what I think happened to the kids. "They're probably fine", I'll say... but I know better.

They live in a place without running water. Most of the villages don't have phones or mailing addresses. Who's doing the follow up care?

It's easy to dismiss it, or to just say "F*** it" and pour a drink.

It's easy for me to forget this is one part of a larger story and it's only a small component of what life there was.

What's not easy to forget is that there are people who caused this. Evil people.

If we accept that given a chance, we can bond with people who are not like us, who are our enemies or potential enemies, and we can overcome those things, it's impossible to forget that the opposite exists. That there are people with whom we can never reach in agreement, who will never lay down arms, and who will kill their kin - just as readily as we would give aid to those who our not our kin.

I didn't learn to do surgery. I didn't spend much time on acute trauma or packing wounds. This isn't a story about the best medical practice.

This is a story about what Dr. Gemal told me outside that surgical ward.

He said to me:

"The best medicine is a kind word."

And you know what? Sometimes I think he was right.



Oh, I had to ask around to find out kenah meant. It's from Pashto "Ken-astul" meaning 'to sit'. Kenah roughly translates to "please stay".

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