Sunday, December 26, 2010

Faithful Friend


When Jesus saw their faith, he said, “Friend, your sins are forgiven.”
(Luke 5:20, NIV)

Five words from Jesus: “Friend, your sins are forgiven.”  With that proclamation, Jesus emphatically declares His identity to the Pharisees.  They object to His claim, accusing Him of blasphemy and correctly stating that only God has the authority to forgive sin.  Then Jesus backed up his claim of being God’s son by publically healing the man of his paralysis; He showed that He has power over the body as well as the spirit.

As amazing and important as this passage is to Jesus’ identity as divine, it is the first half of the verse that stops me in my tracks.  When Jesus saw their faith.  Luke the physician, who obviously would have been interested in Jesus’ ability to heal a paralyzed man, includes a detail that is easy to read past.  Jesus forgave and subsequently healed the man because the man’s friends had great faith.  These unidentified people would not give up their quest to help their friend when they encountered a large crowd blocking the door to the room where Jesus was.  They found another way in- right through the roof. 

Jesus saw their faith and determination to help their friend, and He knew that their hearts were right- they believed that Jesus was their only hope.

In this passage we see that sometimes God takes action on a person’s behalf due to another person’s faith.  Let that sink in for a moment.  How many times have you given up on praying for a lost friend, a sick loved one, or a broken relationship because it seemed hopeless?  The door to Jesus seemed blocked?  Here we see that Jesus will reward faith.

I am humbled to think that as a physician my greatest gift to my patients is my willingness to pray for them.  God’s ability to heal and restore in response to faith exceeds anything I can do with my hands.  I wonder how many people have been cured of their disease, healed of their brokenness, or brought back into relationship with their Creator due to persistence in prayer and faith of others on their behalf.

On the other hand, it chills me to think that I might have been the only one in a given patient’s life who was willing to carry them to Jesus.  In this story, the man’s friends did for him what he could not do for himself- and it made all the difference.

(From the January 2011, Christian Beacon (www.christianbeacon.com), published as "More to the Story, Part III")

Thursday, December 23, 2010

Be Who You Are



(Published in the January 2008 Christian Beacon as part 6 of A Brain Surgeon Looks at Life)

So here's what I want you to do, God helping you: Take your everyday, ordinary life—your sleeping, eating, going-to-work, and walking-around life—and place it before God as an offering. Embracing what God does for you is the best thing you can do for him. Don't become so well-adjusted to your culture that you fit into it without even thinking. Instead, fix your attention on God. You'll be changed from the inside out. Readily recognize what he wants from you, and quickly respond to it. Unlike the culture around you, always dragging you down to its level of immaturity, God brings the best out of you, develops well-formed maturity in you.
(Romans 12:1-2, The Message)

“Hello, Governor,” he greeted me as I walked into his hospital room.  Taken aback, I introduced myself as a medical student that would be taking care of him in the hospital.  His name was Carl.  “How was the inauguration? I bet it was cold out there,” he went on.  I tried to explain to him that I was not, in fact, the Governor. 

A nurse walked into his room, carrying a tray with his medications and some water.  Carl introduced us. “Governor, this is my assistant.  She keeps trying to get me to take these pills, but I think she’s forgetting who she works for.  Do you remember the last time you met her?”

The nurse looked at me, shook her head, and deposited the tray on Carl’s bedside table before leaving the room with a chuckle.

As our conversation unfolded, I realized that Carl was incorporating everything we talked about into his personal life history.  I asked him a question about his heart, and he reminded me of the time I talked with his wife about her heart surgery.  When I told him that I like the robe he was wearing, he reminded me that I gave it to him for Christmas a few years ago.  The problem was that none of those things were true.

Over the next few days, I had the amusing and heartbreaking job of taking care of Carl. He had a severe anemia, and heart failure, and was suffering from alcohol withdrawal.  But the medical aspects of his care were not the things that make me remember him enough to tell you about him 15 years later. The fascinating part of Carl’s story is his neurological disorder: Korsakoff’s syndrome.

Carl had become so addicted to alcohol that he began to drink instead of eating meals.  Over time, most of his daily caloric intake came from alcohol.  When a person does this, he or she can slowly become deficient in some nutrients, and rarely the deficiency can become so severe that they actually develop diseases related to the lack of these vitamins or minerals.  Commonly, alcoholics suffer from anemia related to the lack of folic acid and sometimes vitamin B12 in their diets.  The rare Korsakoff’s syndrome comes from a severe depletion of thiamine, also known as vitamin B1.

Thiamine is important to the structural integrity of the parts of the brain that allow the integration of old and new memories.  The hippocampus, thalamus and hypothalamus become damaged and disconnected in a way that prevents the rehearsal of new memories from being transferred into long-term memories, and interferes with recall of old memories in an accurate way.  Practically speaking, this creates memory gaps that the person fills in with whatever is around them at that time- essentially inventing memories.  This is called confabulation, and Carl was the most textbook example of amnesic-confabulatory disorder, or Korsakoff’s syndrome, that I have ever seen.

My daily talks with Carl were funny and frustrating, entertaining and tragic.  Every morning brought a new introduction.  I was the Governor, his former neighbor, his son, his mechanic, his daughter’s fiancĂ©e.  As we replaced his alcohol with food and vitamin supplements, corrected his anemia, and treated his heart disease, he became healthier.  But his memory did not improve; the damage was done.  I couldn’t help but be overwhelmed at the sadness of this bright, articulate man whose addiction had literally obliterated his brain.

Although Carl never remembered me, I learned a lot from him.  Certainly, I never missed a question on a test about what thiamine does.  But far more importantly, I learned a spiritual lesson from Carl that I think is relevant to all of us. And like always, the amazingly designed complexity and frailty of the nervous system gave me a window into understanding life.

Carl went through life allowing every single encounter to determine the next.  He had no ability to shape his own future, because he was completely unable to know who he really was.  And in that, he reminds me of a lot of people.  How often do you have a conflict with your spouse, and then snap at your co-worker later that morning?  You are not really mad at your colleague, but rather allowing your irritation, hurt, or anger at your wife or husband to affect the way you treat someone else.

You lose someone close to you to cancer or an accident, and you become bitter, losing your joy and allowing the loss to control your mood for years.  A person goes through a major trauma and becomes a shell of their former self, drifting through the rest of their life unable to shake the fear and pain of that event.

We frequently become very pliable, bending and being shaped by the events and people in our lives in significant ways.  When we lose our compass, it can lead to tragic consequences.  The Lord tells us in Romans 12 not to conform to the world, but rather to be transformed by his word.  I love the way this passage reads in The Message, and I have included it at the top of this article.  Don’t be dragged down by the events around you; let God tell you who you are.

Carl was a helpless passenger in life at the time I met him. He had no ability to be the man he was made to be. Years of abusing alcohol had destroyed parts of his brain and wiped out his ability to understand reality.  The intricate pathways of memory his Creator had lovingly crafted had been annihilated by his years of bad choices.  He was beyond help.

But we have a choice.  We have to live in this world, but we do not have to let it determine our mood, our thoughts, or our actions.  We should be changed from the inside out by our maker, not from the outside in by other people or circumstances. 

Tuesday, November 23, 2010

Five Words

When they had crucified him, they divided up his clothes by casting lots.
(Matthew 27:35, NIV)

Some scriptures jump out and grab you.  Short sentences that contain much more than the first reading reveals.  One of the amazing things about reading scripture is that every word is alive (Hebrews 4:12).  There is no fluff, no wasted space; we have every word the God intended for us to have, and every word counts.

Think for a moment about the scripture printed above.  Matthew matter-of-factly states that the soldiers crucified Jesus, and then gambled for his clothes.  Go to your bible and read the scene in context (Matthew 27).  We are taken on a journey from Jesus’ arrest in chapter 26 to his burial at the end of chapter 27.  In verse 35, Matthew uses five words to describe the most important event in human history.

When they had crucified him.

I have a problem with brevity.  The editor of this paper will attest to my difficulty with fitting my articles each month into four hundred words.  Had I written the account of Jesus’ crucifixion, I would have wanted to describe each aspect of that day in great detail.  I would have worried that the readers would miss the importance of Jesus’ sacrifice if I failed to give enough background, enough description, and enough inclusion of events.  You would have read a graphic account of what it sounded like for those nails to pierce his skin.  I would have wanted you to feel a little sick in your stomach as you read about what those soldiers did with their whips and rods.  I would have wanted you to feel like you were there.

Matthew, writing under the influence of the Holy Spirit, makes a much more important point.  You didn’t have to be there, because Jesus was.

Five words tell the story of the redemption of mankind.  When they had crucified him. 

I want more.  God says that’s enough.  Five words cover the entire basis of hope for all of human history.

In this series we will look at several examples of biblical sentences that are much more than they seem at first blush.  The Word of God is living and active, and when we read it, we need to pay attention. I challenge you to find another book that is filled with sentences that contain as much.  Dickens or Hemingway might need hundreds of pages to tell their story.  God only needed five words to tell His.

(Five Words, by W. Lee Warren. From the November 2010 Christian Beacon (www.christianbeacon.com), published as "More to the Story, Part I")

Monday, November 22, 2010

Thanksgiving

Rejoice always, pray continually, give thanks in all circumstances…  (I Thessalonians 5:16-18, NIV) 
Thanksgiving is my favorite holiday.  Not just the food (although I do love it), but everything about Thanksgiving makes me happy.  Families reunite, relationships reconnect, and we take a moment to reflect on all that God has done.  We give thanks- for our family, our health, our successes and our blessings.

But what about the next day?

I can go through my life and think of many days when my prevailing mental posture was not one of thanksgiving.  During difficult times, do I meet my Lord with an attitude of rejoicing, prayer, and thanksgiving?  Or do I bring him a laundry list of complaints or requests?  Sometimes, I find that I will struggle to remember the last time I spoke with Him at all.

When reading scripture, we find that the Word is, indeed, sharper than a double-edged sword (Hebrews 4:12).  In I Thessalonians 5, Paul gives us one of those sentences that says a lot more than it seems to at first glance.  Read through that chapter in context, and you’ll see what I mean.  But verses 16-18 should stop us in our tracks.

Rejoice always, pray continually, give thanks in all circumstances; for this is God’s will for you in Christ Jesus.

No qualifications are given here, no options for our attitude, no exemption for certain circumstances.  When does God will for us to rejoice?  Always.  How often does he expect us to be prayerful?  Continually.  During what circumstances are we to be thankful? All.

Now, before you start writing letters to the editor saying that it’s ok for Christians to have sorrow, anger, fears, or things they’d like for God to improve, understand that I agree. The bible plainly tells us to bring all our lives before God and gives many examples of people asking God for very specific things or for changes in their circumstances (see Job and Psalms, for example). These verses, however, speak to something more related to our hearts.

God says, effectively, “I have given you life, I have blessed you with unearned salvation from your sins, hope for eternal life, and constant access to me through prayer.” He expects that to matter to us. It should change our approach to everything.

Say those nine words to yourself and watch them change your life: Rejoice always, pray continually, give thanks in all circumstances.  If we start there, we can make every day Thanksgiving.

(Thanksgiving, by W. Lee Warren. From the December 2010 Christian Beacon (www.christianbeacon.com), published as "More to the Story, Part II")



Thursday, August 5, 2010

When the Facts Shake Your Faith, Part 11, by W. Lee Warren, MD

(Note: This article will be published in the September 2010 issue of the San Antonio Christian Beacon)
Because you are my help, I sing in the shadow of your wings.
(Psalm 63:7, NIV)

 
Pursued.  Hounded.  Hunted.  David was in trouble, and not for the first time.  Years before King Saul’s vendetta had David running for his life.  Now the king, David was again being chased with his life on the line.  But this time, the pursuer was David’s own son, Absalom.

Imagine the emotions David must have felt.  Along with fear, he had to feel betrayal, anger, embarrassment, and confusion.  If ever there were a moment to doubt your faith, this was it.  How could God let this happen?

Have you ever had an enemy? Someone that just seemed to want to mess with your life at every turn?  Someone who would not stop pursuing, testing, harassing and causing you pain? The attack of another person, whether physical, emotional, financial or spiritual, can be one of the most potent challenges to our faith.

In the midst of such a battle, it would make sense to ask why, to demand that God bring justice or deliverance.  It would be reasonable to wonder if God could really care about us if He allows people to mistreat us so badly.

The problem is that life is always going to be full of enemies, because we have an Enemy that will never stop wanting us to hurt.  Remember I Peter 5:8-9: Your enemy the devil prowls around like a roaring lion looking for someone to devour. Resist him, standing firm in the faith, because you know that your brothers throughout the world are undergoing the same kind of sufferings.

If we let our faith dwindle every time an enemy appears, we will spend our lives on the run and have no effectiveness in the Kingdom, and no peace in our hearts.

A better answer is to look to David’s example.  During the worst moments, when he was in danger of being assassinated by his son, David wrote Psalm 63. “O God, you are my God, earnestly I seek you… I will praise you as long as I live… They who seek my life will be destroyed… But the king will rejoice in God.”

Instead of doubting, David held on tight.

Don’t feel singled out when an enemy is hurting you.  You’re in good company. And by the way, David was not the only Biblical example of someone being betrayed by his or her children.  When it happened to Jesus, his answer was to say, “Father, forgive them.”

Monday, May 24, 2010

The Head of Doom

Warren Innovation and Head of Doom:
Bringing Brain Cancer to its Knees


Welcome to the Head of Doom store at www.headofdoom.com!  Head of Doom is a project brought to you by Warren Innovation, Inc. and the Warren Innovation Foundation.

Head of Doom exists for one purpose: to help fight brain cancer.  The brainchild of Dr. W. Lee Warren and Warren Innovation President Lisa Warren, Head of Doom is the graphic representation of our efforts to stamp out this terrible disease. 

The first thing most people ask us is: “What in the world does ‘Head of Doom’ mean?”

Good question. 

In 2006, the www.auburnneurosurgery.com website was launched when Dr. Warren and Lisa founded the practice in Auburn, Alabama.  The key graphic feature of the website was a cartoon head that we jokingly referred to as the “Head of Doom.”  Now hold that thought- we’ll get back to Head of Doom in a minute.

Over time, as the practice grew we noticed an alarming number of cases of malignant brain cancer in the areas around Auburn, and began to discuss with epidemiologists from Auburn University the possibility of starting a research project to look at environmental factors that could be related to the disease.

A broad category like “brain cancer” contains a lot of different diseases.  But in the Auburn area, we see an unusually high incidence of one type in particular.

Glioblastoma multiforme (GBM), also known as Grade IV Astrocytoma, is the most deadly form of brain cancer.  Over the past 40 years, no significant advances have been made to offer hope for its victims.  The average survival from the time of diagnosis, despite all the treatments available for people, is about 15 months. 
During the course of his career as a neurosurgeon, Dr. Warren has seen too many people suffer and die from this disease, and we at Warren Innovation have decided to do something about it.

Here’s the problem: GBM is a relatively uncommon disease, with only about 5,000 new cases per year in the United States.  Compare that with breast cancer, which strikes about 180,000 people per year, and you’ll start to understand why no real progress has been made.  Common diseases get research dollars and lots of researchers working on them, and things get better.  Uncommon problems have small and usually poorly funded research projects, and it is much more difficult to make anything happen.

So we at Warren Innovation have One Big Idea: raise enough money to find the smartest research team with the most promising project, and fund that idea to its completion. 

Let me outline the plan for you:

Warren Innovation will donate a portion of its corporate profits to the Warren Innovation Foundation.  Other projects, like the Head of Doom Store, the Warren’s “Climbing Cures” project, Sporting events (like the upcoming inaugural Head of Doom Fun Run), etc. will raise additional funds, and we will seek donations to the WI Foundation from individuals and corporations as well. 

This money will be used to establish a grant to fund scientific research aimed at curing GBM.  Dr. Warren is assembling a team of world-renowned physicians and scientists to form a review panel, which will be tasked with choosing one research team with one project.

Once the team and their project has been chosen, the review panel will establish benchmarks and guidelines for periodic review of their progress, to ensure that the project stays on the right track.  These researchers will not have to worry about doing anything other than trying to rid the world of GBM.  Unlike most scientists, these folks will have only one mission, and will not have to worry about writing grants, re-applying for funding, or finding other jobs to feed their families.  They will be funded completely as long as their ideas are working out.  Taking the financial worries out of their work will allow them to focus on finding the answers.

Now back to Head of Doom.  The graphic is cool, and the name “Head of Doom” has a double meaning.

Imagine the thoughts that would go through your mind if you heard your doctor say that you had a brain tumor.  Certainly, brain cancer has an ominous sound to it, and gives people a sense of doom.  Head of Doom says let’s turn that around.  Let’s organize and fight this, and let our work spell doom for brain tumors. 

The Head of Doom store will feature artwork from Los Angeles-based artist Darren LeGallo (www.darrenlegallo.com), doing original pieces inspired by the Head of Doom concept.  Lisa Warren is working with other artists to develop additional pieces. This work will be available for purchase, and available on apparel and other items.  Currently these items will be sold through online marketplaces like Zazzle, but will soon be available locally and on the Internet through Warren Innovation and the Head of Doom Store at www.headofdoom.com



Head of Doom and Warren Innovation are also sponsoring runs, the Auburn University COSAM golf tournament, and other local events to drive interest, raise awareness, and raise money for the fight to doom brain tumors.

Warren Innovation is committed to helping people find the peace of mind that brain tumors steal.  Head of Doom is proud to help.


Sunday, May 2, 2010

Chapter One of "Called Out: A Brain Surgeon Goes to War." The pictures are omitted here; you'll have to wait for the book to see the several hundred photos from Iraq I have included. Enjoy.


1. Boots on the Ground

Praise be to the LORD my Rock, who trains my hands for war, my fingers for battle.
Psalm 144:1 (New International Version)

The months prior to my deployment were packed with a whirlwind of activities related to getting ready to go into to a combat theater and practice medicine for 120 days.  It was amazing to me to learn that no one seemed to know what I should expect as a neurosurgeon there.  The Air Force had always considered neurosurgery to be what they called a “fourth echelon” specialty, meaning that they intended to keep the neurosurgeons stateside and bring patients to us since there were so few of us (12 in 2004 for the entire Air Force).  The thought had been that anyone with a severe head injury in the field was probably going to die anyway, and they did not want to put us in harm’s way unnecessarily.

That thought began to evolve when the leaders of military trauma management started thinking of the combat theater like a giant trauma system for a city- coordinating all the medics and aid stations, clinics, and smaller hospitals with central control.  This created a more streamlined process for getting injured people off of the battlefield and into the proper trauma hospital quickly.  This new system proved so effective that soldiers were reaching the more capable hospitals within minutes or a very few hours and were thus more potentially salvageable.  One of the leaders who worked tirelessly to create the trauma system was my friend Colonel Donald Jenkins.  Don is a true American hero.  He’s been deployed multiple times and literally saved thousands of lives not only with his hands as a surgeon, but with his efforts to change the status quo of how soldiers are transported after being wounded.  Don is retired now and in private practice. When you hear stories of someone being saved from an injury in the Iraq war, it was Don’s trauma system that got them to the doctors who saved them. 

The result of the improvement in transport time from injury to hospital was a lot of people getting to hospitals alive with certain types of wounds and there were no specialists available to treat them.  Neurosurgery was suddenly viewed as a necessary specialty in that environment, and the Army deployed brain surgeons to Kuwait and subsequently to the Ibn Sina Hospital attached to the 31st Combat Support Hospital (CSH) in Baghdad in 2003.  Proof of concept was achieved quickly, with the Army neurosurgeons displaying amazing results at saving lives and preserving neurological function.  

For the first part of the Iraq War, the United States Army carried almost the entire load for medical care, and the amount of work necessary was very difficult for one service branch to handle alone indefinitely.  Joint Military Commanders made the decision to have the Air Force take over the hospital at Balad Air Base, and the transfer of command from the Army to the Air Force happened on September 20, 2004.   It was clear that there was a need for more than the two Army neurosurgeons in Baghdad, and since the newly-formed 332nd Air Force Theater hospital was to become the major trauma hub for all of Iraq due to the fact that the casualties already came through Balad Air Base on their way to be evacuated to Germany, the decision was made to deploy Air Force neurosurgeons to the theater.  At that time, the Australian Military was also deploying doctors and nurses to help out in the war effort, and one of the first two neurosurgeons deployed to the 332nd was an Aussie.  The other was an American named Pete Lennarson, who found out that he had to go on very short notice.  He was responsible for establishing the service at Balad, and did a fantastic job. 

The Australian surgeon had a shorter commitment than Pete, and I was chosen as his replacement.  I was informed on August 20, 2004 that I would be deploying to Iraq sometime around Christmas.  Contact information for Pete was given to me, as well as to the neurosurgeons in Baghdad.  I emailed them all, trying to figure out what was I was getting into, what I needed, and if there was anything from a medical perspective that was needed to make things better.  Pete replied briefly, basically telling me that it was extremely busy and that he got mortared a lot.  I was basically going into the unknown, and left trying to prepare as best I could.
We were given equipment lists, uniform requirements, issued body armor and helmets, and scheduled for immunizations and weapons training.  There were courses on triage, mass casualty situations, and cultural lessons on how to properly interact with Muslims.  I got terribly sick from the Yellow Fever vaccine, and mildly ill from the Anthrax and Smallpox shots.  My right arm swelled up to about twice its normal size after the Smallpox vaccination, and the bruise under it lasted until about a month into my deployment.

My shopping trips began, trying to check off every box on the list of “necessary” supplies.  We were told that we needed to take soap, shampoo, toothpaste, and other toiletries in quantities sufficient for four months.  We did not yet know that the Post Exchange (PX) on base would have everything we would need.  Further, we were issued two huge green duffel bags full of chemical warfare gear that someone in the Pentagon was sure we would need, including gas masks and syringes full of antidote to various weapons of mass destruction. 

All totaled, I deployed to Iraq with about 300 pounds of gear, more than 50% of it issued to me.  None of the issued gear other than the uniforms ever made it out of the duffel bags while I was there, and later groups would not be forced to bring in all that equipment. At some point someone realized that you could have people leave the gear in Iraq for the next person to use.  My group brought the gear in, stored it for four months, and brought it home to check it back in.  I wonder how much jet fuel the United States used just in flying all that material into and out of Iraq unnecessarily?  To add insult to injury, the week after I got to Iraq they declared the combat theater to no longer be a malaria zone and stopped making people take those horrible medicines- just after I finished taking them.

In the midst of all this preparation, my personal life was incredibly stressful and full of enormous challenges.  As I mentioned before, my marriage had fallen apart and was in its terminal stages.  My brother had become gravely ill and suffered a major stroke.  I was in the hospital waiting room with my sisters and parents during his heart surgery when I got the phone call from my Commander that I was to be deployed.  On top of all that, I had to sit for my oral neurosurgery board examination in November. 

Neurosurgery is the specialty of medicine that involves the surgical treatment of brain, spine, spinal cord and peripheral nerve disorders.  I had received my Doctor of Medicine degree from the University of Oklahoma College of Medicine in 1995, and spent the next six years working 100-hour weeks as a resident in neurosurgery at Allegheny General Hospital in Pittsburgh, Pennsylvania before graduating in 2001.  In many medical specialties, one becomes “board certified” by passing a written test or simply by graduating from an accredited residency program.  There are even a few “boards” that you can apply to and become certified by over the internet!  But neurosurgery is very different. 

A candidate for certification by the American Board of Neurological Surgery has to pass a written examination before he or she is allowed to graduate from their training program.  This test is 8 hours long and covers every scientific discipline related to the human nervous system, as well as critical care medicine and pharmacology, neurology and pathology.  This obstacle alone trips up several would-be neurosurgeons every year.  Once passed, however, you still have to complete your residency, one year as Chief Resident, and then practice neurosurgery for four years before you are allowed to sit for the oral examination.

This was always a sore point in the military.  Since most specialties allow their practitioners to be certified when the finish their residencies or soon thereafter, most military doctors are board certified.  However, most doctors in the military are only on active duty for three or four years, depending on how long they were sponsored during their training.   As an incentive to get people to receive as much training as possible, the military pays a significant annual bonus to those doctors who become board certified.  And since the thought process in the military is that everyone is equal, there is not a lot of difference in the pay between primary care doctors and highly specialized surgeons.  So the board certification bonus is a big part of your annual salary and creates an environment in which everyone takes the steps necessary to achieve that status.

Neurosurgeons, however, are not even eligible to take their examination for four years.  Thus, in the military, neurosurgeons are the only doctors that do not get to say “Board Certified” on their titles, and are among the lowest paid physicians for the early part of their careers.  This is particularly irritating since neurosurgery has the longest training program of all specialties and is generally among the highest paid specialties in private practice.  After finishing your training, you feel like you’ve really accomplished something, and then you check into the military hospital and some Colonel won’t let you operate on him because he only wants to be seen by someone who is board certified. 

That being said, in November of 2004 I was finally about to sit for my oral examination, and I was very nervous.  Imagine having 8 experts in your field sit and ask you questions for 8 hours about anything they want.  I was in a room with people who had written most of the textbooks I studied from, the men who defined the body of knowledge for modern brain surgery, and they were grilling me!  An x-ray or CT scan would be displayed, and they would say, “We have a 12 year-old girl with headaches.  What would you do?”  I had to ask the right questions in order to get them to disclose enough information to me to be able to make the right decisions on behalf of the imaginary patient.  Long story short, I passed.  But it was exceedingly difficult and I have never prepared for anything like I did for that exam. 

After getting past that hurdle, I thought that the only thing left was to get to December and the long-awaited deployment.  But on December 3, 2004, my Grandfather died.  Robert Emmett Warren, or “DaddyPa” as we called him, was 99 years old.  He was one of those foundational characters in your life; those people who you think are always going to be there.  And even though he had been sick for a long time, I saw him as the strong Oklahoma cattleman walking through a field holding my little hand when I was a boy.  He would teach me about calves and hay and bulls and business, but in a subtle way he was teaching me about life.  I never really thought that DaddyPa would die.  I guess I believed that the Lord would return before we lost DaddyPa- I just never realized how much of my world depended on the idea that he was there.  It was very hard for me to say goodbye to him.

In the days leading up to my departure, more information was released as to where I was going.  I learned that Balad Air Base was the most attacked base in Iraq at the time.  Mortar and rocket attacks were so common there that the base had been given a nickname: “Mortaritavile.”  Once I had completed packing and obtaining all my gear and my immunizations, little was left to do other than sit and think about what was coming, and my thoughts frequently turned to the various scenarios that could result in me not coming home from the war.  I sat down and wrote letters to my children, trying to give them all the instruction I could to help them grow up and know how much I loved them and to try to tell them everything they might need to know.  Those letters were left in the hands of friends who were to mail them to the children in case I did not make it back.  Writing such a letter has a way of making you think of all the things you wish you’d said to your kids over the years, all the opportunities you missed.  If you think it is the last time a person will ever hear your thoughts, you really struggle to make it count.  When I got home and re-read them, I thought of so many more things I would have told them.  Somehow knowing how far away I had really been made me realize that no letter could have been adequate.  I was very grateful that they did not have to be delivered.

While I received well wishes, e-mails, letters and calls from a lot of friends and family members, a few messages stood out as being especially memorable.  One was a precious letter from my Uncle Keefer, who was dying from lung cancer.  I have many boyhood memories of Uncle Keefer, the strong, hard-working man.  His was a generation in which men did not often show emotion, or speak about their feelings.  To know that he took the time to write and tell me he loved me and was proud of me, especially when his every breath was labored, meant the world to me.  Two other messages, however, had a very different impact on me.
The last time I went to my office at Wilford Hall Medical Center before I deployed, the voice mail light on my desk phone was blinking.  I sat down and began to clear my messages, deleting most of them since they were work-related or unimportant.  The last two got my attention.  My former professor, Dr. Takanori Fukushima, is a world-renown neurosurgeon who now teaches at Duke University.  Dr. Fukushima is an iconoclast in Neurosurgery, and remains the greatest technical surgeon I have ever seen.  He has a habit of referring to himself in the third person, and his command of English is less complete than his grasp of surgical techniques.  I greatly appreciated him taking the time to call, and was able to overlook the content of his message since the effort meant a lot to me.  He said, “Ah, Lee, this Fukushima.  Fukushima hear you go Iraq. Fukushima hope you not die.”  I hoped not, also.

The last message was from another former professor, Dr. Adnan Abla.  Dr. Abla had a lot to do with my being selected for the residency slot in Pittsburgh, and he really took me under his wing early in my training.  He is from Lebanon, and his sense of humor gave me mixed comfort in his goodbye thoughts: “Lee, it is Adnan.  I heard you are going to Balad.  Don’t worry about a thing. I have called my cousins, and they gonna cut off your privates as soon as you arrive.”  I always loved Dr. Abla, but I really hoped not to meet his relatives in Iraq!


About two weeks prior to deployment, I completed the last two items on my checklist- Humvee driving school and handgun qualification.  These two were clearly the most fun parts of the process, although they also brought some terror.  Someone decided that everyone deployed to the combat theater needed to have a “driver’s license” to operate the High Mobility Multipurpose Wheeled Vehicle, or HMMWV.  Everyone calls them “Humvees,” and they are the iconic vehicles you see in almost every photograph of the war in Iraq.  The Humvee is the “jeep” of the 21st century, and on one very pleasant day in December of 2004, I attended the training course at Camp Bullis, Texas. 

Camp Bullis is in the Hill Country of Texas near San Antonio, and contains some very rugged terrain.  We were driven down into a valley of brush-covered, rocky ground.  Erosion had formed deep grooves in the valley, and to my eye it looked impassible.   The instructor would tell me to drive slowly and climb up a hill, and I was constantly amazed at what the vehicle could do.  There were times when one wheel was completely in the air, or we were pitched 30 or 40 degrees to one side.  Still, the Humvee kept on going, and by the end of the afternoon I was convinced that I could drive it anywhere.  I felt prepared for any situation that would require me to climb a mountain in my Humvee.  And armed with my government driver’s license, I deployed to the perfectly flat desert environment of Balad, Iraq, and never drove a Humvee again.

On the other hand, the day I had to qualify to shoot the 9mm handgun was quite another story.  I had qualified once before, in 2001 at Commissioned Officer Training School.  COT, as they call it, is a 6-week long course held at Maxwell Air Force Base, Alabama.  The purpose of the school is to refresh people who have been Commissioned officers for a while but have not been on active duty due to long training programs like Medical or Nursing school.  I had gone to the “doctor” version of Officer Training School in 1991 at Lackland Air Force Base, Texas, but then done medical school and residency training in civilian programs.  By the time I graduated residency and was ready to go on active duty, it had been 10 years since I had worn a uniform to work.  COT was designed to refresh people like me and get us ready to function in a military environment, and it was a great school.

In December of 2004, I had to qualify with the handgun again, and this proved quite different than the first time.    At COT in 2001, it was peacetime and there was no thought in anyone’s mind (especially mine) that we would actually ever have to carry a weapon or think about shooting it at someone.  Especially as a physician, I could not even imagine back then that I might really need this training.  It was a fun day, and I enjoyed it a lot. I qualified “expert” and promptly forgot about the whole thing.  At the firing range 2 weeks before I was deploying to a real war with real bad guys, however, it felt very different. 

Each time I aimed at a target, I thought to myself, “This could really happen.” I could see in my mind a scenario where some terrorist was infiltrating the hospital and I found myself face-to-face with him.  In my mind, in that fictional moment, I would clear leather like a cowboy in an old Western movie, and blast the bad guy and save the base.  Then in the next thought I would see the scene again, and I would be more like Barney Fife in the old Andy Griffith show- the deputy who was so inept with his pistol that he was only allowed to carry one bullet and he had to keep that bullet in his pocket. I still managed to shoot well and qualified, but I paid a lot more attention than I had before. 

The thing that really got to me was the fact that I was being sent to a place where someone thought I might need to carry a weapon.  My life up until that point had been focused on trying to heal, to save, to repair people injured by guns and knives and the invisible bullets of disease.  Hospitals are safe places, and doctors are peacemakers, treating the victim and the perpetrator with equal application of compassion and skill.  I did not like the idea of carrying a weapon, or being in a place where I might need to use one.  I began to have dreams of the hospital being overrun with terrorists, and having to fight them off.  I wondered if, when the time came, I could actually pull a trigger to intentionally take another person’s life.  My son and I recently had this conversation as I was admiring a new handgun he purchased.  He said, “If someone was trying to harm the people I love, I would have no problem shooting them.”  While I had always shared that sentiment, I now actually know what bullet wounds look like, I know the smell of spilled blood and the look in the eyes of people as they grapple with the death that settles on them as they succumb to the bullet’s deadly purpose.  Young people have a romantic notion of heroism, and the idea of firing the weapon seems so noble that they all think it within their power.  Personally, I still don’t know.

Time would prove that my handgun would only leave its holster once in a situation where it would have been possibly necessary to use it.  But we’ll get to that story later.

After four months of preparation, the call finally came- on Christmas day.  Nate and I were ordered to arrive very early in the morning on 26 December 2004 for our flight to Al Udeid Air Base, and our orders stated that we were to be in Iraq and on-station by 29 December.  We arrived at the airport, met the Weapons Sergeant who issued us Nate’s M-16 rifle and my 9mm Beretta.  Then we got on a plane and left for the war.  In civilian clothes, we looked just like any of the other passengers on the plane.  The only difference was our destination and the fact that we had gas masks and bullets among our checked bags.

After stops in Germany at the famed Ramstein Air Base and Al Udeid in Qatar, we finally boarded the C-130 that would take us to Iraq.  All creature comforts were gone.  About 60 people were crammed into the hard metal bench seats that lined the sides of the cargo bay.  Strapped into webbing that acted as seat belts, we were sitting on top of our Kevlar body armor in the event of gunfire from below.  All our gear was loaded onto palettes and then pushed by forklift onto the airplane behind us- sealing us in by blocking the exit at the rear of the aircraft.  We were really going.  Once the door shut, the lights went out.  We were told to put in ear plugs due to the high noise level, and that we would not hear anything further for about 3.5 hours.  There were no bathrooms, there was no legroom, and there was no one on board that did not fully understand that this would be very different that any other flight we had ever taken.

At some point in the flight, the pilot began to make very erratic movements up and down and side-to-side with the aircraft.  I had been told by C-130 pilots in San Antonio that they frequently took ground fire when flying through Iraq and that they made evasive maneuvers as they began to descend prior to landing.  I was not really ready for this.  Whether or not we took any ground fire I will never know, but I do know that the pilot gave us a ride I’ve never experienced on any roller coaster in my life.  More than one person vomited, and the smell of whatever they had eaten filled the cabin, its stench magnified by being unable to see anything.

We finally landed, taxied for what seemed like a long time, and then suddenly stopped.  The engines kept running as the rear door began to lower, and we could see the headlights of the forklift that was driving on to remove the palettes of gear.  Someone climbed on board and instructed us to stand and form two lines.  We followed him out of the plane and into Iraq.  I looked down in the darkness and saw my boots on the ground of a foreign nation at a time of war.  The surreal feeling I had at that moment has never left me.  120 days later, I would retrace those steps.  But the man who left was quite different than the one who arrived. 


Email Home, Day 3

Hello from Balad Air Base, everyone! It’s Sunday morning, cold and cloudy here in Mesopotamia.

Thursday was largely uneventful, other than the two mortar attacks. Most of the mortars don’t blow up; they’re 20 year-old French munitions (another reason not to buy stuff from France) that are duds.  But, then our guys have to go out and find them and then they have these scheduled detonations every day. When you hear how much louder they are when they blow up it scares the pants off of you to think what that would have done if it had blown up whatever it landed near.

A round landed about 50 yards from my trailer the day before I got here. Nothing like that since, though.

Friday I got to operate for the first time. An Iraqi friendly was shot in the head by insurgents and I took the bone and bullets out of his brain. He’s actually doing pretty well, talking and moving all his arms and legs. He’s blind in one eye from a fragment.

No mortars Friday at all.

Saturday, we started the day with a group photo out on the helicopter pad.  During the photo a machine gun battle broke out and lasted about 2 minutes right outside the fence we were standing by. That was scary.  We had three mortar attacks and they also found a bomb outside the North gate yesterday.

There are lots of “Improvised Explosive Devices”, which we call IEDs.  These are roadside bombs the terrorists blow up with remote controls when our guys drive by. We had three separate groups of injured soldiers from IEDs yesterday. One died, DOA. He had been shot in the head after the truck got blown up. The insurgents hide nearby and shoot our guys as they climb out of their burning vehicles.  It’s terrible.

I live in a 10x10 foot trailer that’s 3 blocks from the bathroom and showers. If I were a LtCol, I would get to share a bathroom and shower, but I’m only a major. Colonels get their own bathrooms and a car.

To make a call I have to get an operator in Bahrain or Qatar to connect me to an operator in San Antonio and get them to connect me.  It takes about 5 minutes to get through, so when I get your answering machines, it’s irritating! Just kidding.

I am going to make rounds, go to church and try to call the kids today. 

I feel pretty safe; you can’t really worry about mortars. It’s like lightning. It can kill you but you can’t control it.  The only difference is that it’s kind of weird to know that when I go up on the roof to look out over the Iraqi countryside, some of those sheepherders and farmers I see are actually plotting to kill me. That’s weird. Odds are if you go up on your roof and look around you won’t see anyone who actually wants you dead.

We’re making a difference here, though.  The insurgents we treat see firsthand that Americans are not evil. We love them and take care of them as if they hadn’t destroyed a bunch of our teenage heroes.  We give them the same food, the same accommodations as or own guys. We just guard them!  I can see in some of their eyes that they know that we’re not what they thought we were.

It’s a joy to treat some of the Iraqi friendly folks, too. They are innocent victims of the bullets and bombs, and they are thankful we are here.  One of them is teaching me medical words in Arabic so that I can talk to the patients. It’s great.

Keep praying.

Anything you send that I don’t need gets contributed to the pile of stuff we send to the FOBs (forward operating bases) like Fallujah. They have a real hard time with supplies, so they want everything we can send them. It may sound bad, but those guys are begging for cigarettes, so if any of you smoke send some and I’ll pass them forward.

I love you all, and will sign off for now.

Lee
W. Lee Warren, MD
Major, USAF MC
332 EMDG/AFTH
Balad Air Base, Iraq
APO AE 09315-9997


Christian Beacon Article: Things Are Not Always as They Seem
(Published August, 2006 as “Things I Learned in Iraq, Part 6”)

He arrived in a U.S. Army Blackhawk helicopter, barely clinging to his life.  U.S. Marines shot him in the head while he was attempting to detonate a roadside bomb with the intention of killing a group of soldiers passing by.  The Marines shot him, and then Army medics brought him to the Air Force Theater Hospital in Balad, Iraq where I was the neurosurgeon tasked to care for him.

I operated on him, removing the bullet fragments and a large piece of his skull in order to allow his brain to swell without causing further injury and hopefully saving his life and his potential to recover.  This was the first time I had operated on one of the “bad guys.” A terrorist. I had only been in Iraq a few days, and was just getting used to the constant mortar attacks, waves of horribly injured people requiring emergency care, and operating in very austere conditions.

Having to take care of the enemy was at first very difficult.  I looked at this man, and everything inside me wanted to hate him.  All of us were troubled by the situation this man brought to us. We went to Iraq ready to care for injured soldiers and civilians, but I honestly don’t think that any of us were prepared for actually seeing a real-life Al Qaida terrorist and then having to care for him.  I did my job.

During the surgery, many people talked about how they wished the Marines’ bullets had been more effective, more lethal. They joked about “finishing him off” in the surgery.  I thought as I operated, trying to understand how this guy who looked about my Dad’s age could be out there trying to kill people.  He just looked like a normal man.  I guess I thought they (terrorists) would look especially sinister or have horns or something.  He didn’t. Nothing about him, other than the hole in his head, set him apart from anyone else in particular.

Over the next few days as I took care of this man, I heard a lot of people make comments about him- he was scowled at and generally disliked by everyone passing by in the hospital.  For his part, he remained largely unaware of the disdain that people had for him for two reasons: he was in a coma, and if he had been awake, he would have noticed that he received very high quality medical care and compassionate handling from everyone involved.  People did their jobs and they did them well, in spite of the fact that this man had tried to kill a bunch of our soldiers.

I got to a point in my mind where I realized that the Lord would treat the man kindly, hoping to influence him and help him.  And that’s what I did.  It wasn’t easy, but I prayed for him, and decided that maybe by caring for him in a loving way, he (and the other detainees we had by then) would see that Americans and Christians aren’t the evil people that Saddam and Osama have taught them that we are.  I thought that maybe by influencing these few patients we (the doctors and nurses) could make a difference in a lot of lives later. I don’t know if that is true or not, but I do know that we could have deepened their hatred of us and simultaneously made ourselves bitter and miserable by hating them.

Then something remarkable happened, and it changed my life.

A group of Marines came in with another prisoner.  These were some of the soldiers involved in the brief firefight I mentioned above that resulted in the shooting of the terrorist.  The Marines, however, came with more information.  It turned out that the terrorist they had in their custody was actually the guy who was trying to set up the bomb.  They said that during the battle, my patient had been shot, and was actually an innocent bystander in the matter. In the aftermath of the shooting, the Army Medics that picked the man up to bring him to me simply got the wrong story. 

Imagine how we all felt.  For nearly a week we had harbored hateful thoughts (and, for some people, evil wishes) towards this man because we thought he was a bad guy.  Every piece of information we had said that he was guilty.  We “knew” that he was a terrorist. 

I noticed that people no longer sneered at him as they passed. And as he awoke from his coma and started to recover, people openly pulled for him, prayed for him, and touched him gently as they walked by.  Even though everyone did a great job taking care of him before, there was a difference now.  He was a good guy now.

Jesus says in Matthew chapter 7 that if we judge people he will judge us by the same standards.  We are not to be in the judging business. We are to love people and try to help them.  I learned in a very tangible way that what you are told about someone isn’t always true.  I was wrong to judge him, and I am very thankful that I took good care of him in spite of thinking that he was the enemy. 

More examples of mistaken identity happened while I was in Iraq, and I got to the point where I resolved to treat everyone exactly the same and let God and the security police figure out what to do with them later.  That’s something you never hear about on CNN, isn’t it? That we take care of the bad guys right alongside the good guys?

One man was caught (and shot) setting off a bomb and brought in by the soldier who shot him.  When we got an interpreter to talk to the man, we learned that a group of terrorists had kicked in the door of his home, and held his wife and daughter hostage with a promise to kill them if the man refused to detonate their bomb for them. 

I told you that story to tell you this: even if you think you know what someone is doing or has done, you don’t necessarily have all the information about their motives.  You can’t judge them if you don’t know the whole story.

Don’t we see this every day in life?  We hear a rumor about someone and believe it, change the way we treat that person and even sometimes end relationships with him or her, only later to find out that it was just a rumor?  Judgment, gossip and slander only hurt people; they never help people.  And most of the time, what you think you know is actually either completely wrong or only a small part of the truth.  I think that’s why God equates gossip with murder and other “big sins” in Romans, and why James says in chapter 4:

“Brothers, do not slander one another. Anyone who speaks against his brother or judges him speaks against the law and judges it.” 

Think about that for a minute.  If you slander your brother or sister, gossip against them, you’re speaking against God’s word.  Choose your words carefully, friends.  You may not “know” as much as you think you know.

In my case, I had “good” information that told me I was caring for a “bad” person.  Every reasonable person there would have and did make the same judgment: this guy was a scumbag terrorist. And we were all wrong. 

Don’t judge people.  It’s a good way to hurt someone, and it hurts the Lord.  Besides, you’ll feel better if you just love everyone and try to help.  It got me through some times when I had to care for some confessed murderers and terrorists.  And I’ve been on the receiving end of people judging me when they didn’t know the whole story (any Christian who has gone through a divorce can echo this comment).  I can promise you that your witness for Christ will be clearer and more powerful if you love people and use your words to encourage them, not to spread the latest gossip.

For the record, my patient ended up doing pretty well. He can walk and talk, and he’s with his family.  I am thankful for him; he taught me that things aren’t always as they seem to be.

I learned that in Iraq.