Date: 5/18/2003
Subject: Waning months of the war

After a dog almost caused a military aircraft to crash by running across the flight line during takeoff, the Army has decided on a scorched earth policy with regards to the feral dogs. It’s understood that there was a need for management, but there rarely seem to be any half measures. Perhaps out of poverty of spirit, or out of lack of thought, but destruction always seems to win the day. It amazes me to no end that they turn to the veterinarian, who has pledged career and purpose to the preservation of animal life, with the task and expectation that he would lay down a reaper’s sickle across everything living on this captured land; to pour lime and salt onto the wounded soil and declare it sterile.

It is always the innocent who suffer most from war. I am the hand of God. And from those terrible fingers drip gallons of Phenobarbital seeking out the veins of puppies whose eyes have barely cracked to the light of day. I am the hand of death. Government Issued death. My prose may be a little heavy handed, but it seems equal to the charge. With each karmic sucker punch that the Army forces me to take in the middrift, I will attempt to heal an animal in the opportunities offered me outside the gate, and I look to the biweekly medical ventures as salvation. The occasional chance to send a dog into the endless sleep of euthanasia is an acceptable alternative to the firing squad, but I don’t have to like it.

A reservist group of engineers lounges nearby, and I went to them weeks ago in hope of having them construct a humane trap for me. I drew out the dimensions and the concept of a tiger trap, with pressure plate and a sliding door. They took on the challenge with gusto, and produced an excellent result. The idea was and remains sound. However, the trap has yet to lure in a victim. I bait it nightly with meat MREs in areas of highest complaint, but we are such arrogant creatures, we bipedal brain children. We assume everything is inferior. Imagine taking the most hardened soldier and dropping him here in this desert wilderness, without support, without equipment, without tools, and expect him to survive. Nine in ten would shrivel up from the task. Dehydrated, and starved, poisoned by their inexperience and their ignorance, we would find their corpses, fed upon by the few creatures which survive here, fed upon by the dogs.

Yet here are dozens upon dozens of large mammals, omnivorous and cunning, surviving off of the scant resources which the desert offers. Perhaps the occasional scrap of meat, or scavenged carcass, perhaps a caught lizard or sparrow. Through the multiple necropsies I find well fatted animals, with few signs of overt illness, save a chronic struggle with dehydration marking its course in the kidneys. But daily the trap is empty, and I take a quiet pleasure in what I imagine as the dogs’ mockery of me.

“How transparent,” I hear them bark, “How ridiculous these humans are.”

For me the trap will likely remain a piece in my personal mental museum. Something out of the Victorian past. I should charge admission, a dollar for adults, two bits for kids, ladies night half price.

Therefore, I am always on the lookout to practice my true craft of saving rather than killing. The Bedouin offer me that opportunity, unbeknownst to them, and through an intricate game of diplomatic wording, I placate leadership with the inferred task of seeking out potential dangers. And its not all subterfuge. In fact, there is a genuine need to understand the diseases which lurk beneath the surface, as well as to appreciate the nutritional infrastructure which these people depend on, nay, survive on. Therefore my task is tiered, with secondary purposes floating below the surface. I have taken it upon myself to look for disease in the livestock, diseases in particular which like to jump from beast to man, and as such present a genuine problem for those soldiers who might interact with the local population or their animals.

Who is to say that Brucellosis does not hide in an Iraqi ram’s sperm, and through which is transmitted to a receptive ewe? She in turn, carrying the Brucella melitensis bacterium, aborts her fetal twins which the shepherd sees and collects to discard. He then, carrying the infectious agent home on his unwashed hands, touches wife and children and unwittingly sends them into an undulation of fevers. Bang’s disease, as Brucellosis is also called, can be transmitted to a person through unpasturized milk. So the peasant Iraqi family, living literally hand to mouth has lost the economic gain of the sheep’s offspring, and has a household of stricken children.

This is no fantasy, but a simple game of epidemiology, tracking the transmission of a disease from host to host. And this is only one of dozens of potentially infectious agents which could eventually find themselves seeking out a naïve American to live in.

Number three on my orders. Zoonotic diseases. In black and white. The Cash is trying to help, in a small, slow, methodical and pinpoint manner. Begin with the village, the localized community surrounding the tribal network which is beholden to Sheik Ali. We know his allegiance, and the Special Forces have plumbed his depths. Therefore, twice a week, an assortment of clinicians load into hummers and drive out to the Sheik’s communal tent. Orthopods, infectious disease doctors, family practitioners, dentists, radiologists, nutritionists, brain surgeons, nurses and the veterinarian. We arrive en masse to a small crowd of Bedouin sporting an array of maladies, many chronic, some disabling, some disfiguring, some deadly.

The young man whose legs and arms are an eruption of lesions, massive ulcerated warts which pattern his skin in gruesome foothills of necrotic flesh. The old man, whose squamous cell carcinoma has forced one of his eyeballs out of its protective socket to hang, staring perpetually at his feet, like an appalling Halloween mask. The little girl whose wasting tuberculosis brings flecks of blood to her lips with each cough. To these, the truckloads of American professionals unload and attempt to heal what can be healed, alleviate what can be alleviated and bring pity and compassion to the universal pain of humanity.

I quietly march off in the other direction, slinging my medical pack over one shoulder, always with Masteller at my side, but occasionally with the addition of some interested human clinician. We head out towards the small banko houses, and into the arid fields, where mange ridden dogs lie on the side of the adobe walls, and herds of sheep and goats graze. Here is the communal wealth. Not locked into banks or stocks, or pieces of eight. Instead, each camel, each emaciated cow, each coughing sheep represents the work of a family and their hope for the future.

In a small corral, the shepherds bring the livestock to me to examine. I search for tell tale signs of disease, and am never disappointed. The small ruminants are wracked with coughs and bloody spittum drools from their muzzles. They sneeze blood and have mucoid discharge running from their eyes. Were it just the lambs and kids, perhaps it could be ignored, passed off as a childhood respiratory virus which would pass with age. But the adults are listless and lethargic as well. So many possibilities exist, and I run through the list of differentials in my head. But soon the scene complicates, and animals stagger, some from blindness, some from weakness.

Perhaps it is toxic, a chemical leaching into the vegetation, an insecticide, or the heavy presence of petroleum itself. Perhaps heavy metals infect the earth and are concentrated in the water or maybe it is the high salt levels, which I can plainly see in the evaporated crystallized puddles which dot the path upon which I’m walking. Maybe it is some alkaloid in the plants themselves, or a dreadful combination of antagonists, rendering a Shakespearean drama which will only unfold after many tortuous plot twists and turns.

Infectious, metabolic, nutritional, toxic. I roll them over my brain like a candy on the tongue. Infection alone opens an entire universe of possibilities. I strive to play Sherlock Holmes. “What do we notice my dear Watson?”

The animals have no veterinary care, and the management techniques are often barbaric. Ticks are cut with scissors from the animal, taking with the little arachnids a small chunk of skin. Some of the sheep look like they have some bizarre disease which is making them lose their wool in patches, when in fact it is the human interference. But let us think on the ticks. Ticks themselves are of little danger, except in large numbers, and generally to the weaker animals. On the other hand, tick saliva often carries a wonderful cornucopia of the public enemies. The causative agents of Tularemia, Q-fever, Rocky Mountain Spotted Fever, Ehrlichia, Babesia, Theileria, Anaplasmosis, Crimean-Congo Hemmorhagic fever, Trypanosomiasis, louping ill, and Lyme disease to only name a few.

Perhaps these diseases are not known as such to the reader, but their effects are all horrific, and often deadly. These names were the sugarplum fairies which danced through my head in those weeks leading up to the national boards, comfortable tags upon which a jumble of clinical signs, pathological lesions, diagnostics and treatment protocols would be built. And slowly, the rusted, unused neurons stacked like library books in dusty corners of my brain were picked up and the fog of spider webs brushed away, sparked to life by the practical, the clinical and the actual.

As I recollected, many of these diseases are fully adapted to their ovine or caprine host, but when they are inadvertently unleashed into the human bloodstream, all hell breaks loose. There are signs, subtle clues, which Holmes would undoubtedly pick up, and which I might stumble upon if lucky.

And then there are the ticks themselves. I collect them. Carefully annotating on their glass vial prisons what kind of animal they were found parasitizing on and where, the location and the time of year. I have no intent to place them on a mantle or to gaze at them in awe in a little tick farm at home, nor is there a growing tick market to be found on eBay. Instead, the ticks will be ground up and fed into a variety of DNA amplifying machines in hopes of identifying the horrors which they carry in their salivary glands, permitting me to treat according to the answers.

For now, I must guess, and must assume a combination of ills. Likely a macroparasite such as a lungworm has infested the airways. Dictyocaulus filaria and Muellerius capillaris find their way gingerly from the forgotten recesses of my mind, the vernacular of the prepubescent veterinarian. The worms will result in a bronchial infection or progress to a pneumonia. These nematodes, might set the stage or occur concurrently with the Maedi virus here in the Middle East, possibly followed by a pasturella bacterium which might jump on for the ride. The Maedi virus alone could be implicated due to the different syndromes which exist, but of course so could dozens of other necromancer disease concoctions. The virus will occasionally be seen to cause a neurologic disease which is evident in muscle tremors, circling and ataxia. However it is the possible combination of a helminth and a virus followed by the bacterium which really complicates the clinical picture. And if it is the Maedi, then there is no effective treatment.

To find answers I go to the slaughter yard. In the tradition of gratitude and honor, each visit from the doctors is met with a small communal feast, and sheep are slaughtered for the occasion. Usually it is the younger animals, as the older, tougher ewes would not be suitable for guests, and fortunately, it suits my inquisitive purpose.

The sheep are carried out one by one to Ahmed, the tribal butcher. He wears a red and white checked turban, tied closely around his head, a white, long sleeved shirt and long brown corduroys. Over the pants is a white apron, smeared with the labor of days before. He wields a long jagged, wicked looking knife, which had at one point shattered and was welded together. The abstract nature of the knife made his speed and competence seem discordant, but knife and hand are singular as he slices quickly through the lamb’s throat. It gurgles and shudders as the carotids sense the freedom from the circulatory system and send blood exploring the outside world.

Ahmed holds a bare foot on the lamb’s neck to hold it down, and the blood continues to pump as the heart slowly realizes that the game is up. A final gasp, and the eyes glaze over in death. This is repeated multiple times as enough sheep are slaughtered to feed the whole of the visiting guests. Then the animals are decapitated and the heads vanish. Ahmed lifts each lamb onto a pair of hooks, sliding the point through the Achilles tendon and begins the butchery.

He expertly skins the hanging cadaver and without aim, tosses the pelt over his shoulder. Scurrying around him are children and other quasi-outcasts who gather the refuse of his labors. With a single thrust, he opens the abdomen and spills the intact guts over the front of the hanging thorax. Used to me at this point, he stands back and allows me to examine the viscera. I look at the liver for signs of worm migration and at the kidneys and spleen, then he cuts through the diaphragm and allows me to examine the lungs. In two out of three of these younger animals, the lungs are hemorrhagic and consolidated, evidence of chronic disease along with some inhalation of blood should Ahmed’s knife have sliced into the trachea. I take small samples of the lungs which Masteller places adroitly in a small vial of formalin. These small fragments of the former life will hopefully unlock the secrets to the disease and perhaps ameliorate the lives of their extended families bleating in the fields below.

I do a perfunctory search for the lymph nodes, but am cautious not to dwell over these animals which Ahmed is charged with cleaning and preparing for the feast. He watches me quizzically, certainly amused by my delicate handling of the tissues, as if I were examining silks for purchase or deciding on the quality of a rug’s weave. Eventually, the bits of lung will be fixed in paraffin and cut to a cell thickness before being placed for eternity onto a glass slide, to be poured over by pathologists in Washington D.C., examining the disease process as it invades and destroys each cell.

I really am a Yank at heart. I’m finding that the things which I most lust for are scenes. Pastoral moments. Amish carts ambling on country lanes in Lancaster County, its rolling hills, fenced off with split post. Big, liquid eyed Galloway cattle, with their Oreo cookie coloration, watching with muted interest as I used to motor on by, feeling the brisk morning creep inside the motorcycle helmet. Mist clinging to Bryn Mawr, or the lightness of the frozen expanse of snow covering the sycamores and old oaks in sugar coated crystals.

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