The Ghost Turd Stories Podcast

GUEST INTRODUCTION: Joe served as an Air Force active duty doctor from 2004 to 2011.

He did his officer training school, or OTS, in Montgomery, Alabama.

Joe joined the Air Force because of his sense of patriotism and to avoid medical school debt.

Joe deployed to Afghanistan in 2008 where he treated US troops and Afghan nationals.

He also served as a staff surgeon during his time on active duty.

Joe's favorite part about his service in the Air Force was the people.

Joe is now an empty nester with his wife and works as a doctor at our local hospital.

PODCAST INTRODUCTION: Hello everyone and welcome to Ghost Turd Stories.

I'm your host, Troy Gent.

Ghost Turd Stories mission is using humorous stories from veterans and first responders to reduce the burden of families whose veteran or first responder committed suicide.

Ghost Turd Stories vision is to use humor from veteran and first responder stories to prevent suicide within our ranks and reduce the burden of families whose veteran or first responder committed suicide.

We hoped to attract veterans and first responders, as well as those interested in knowing more about what it's like to be in our shoes while we wear or wore those shoes.

TROY GENT: Hello everyone.

This is Troy Gent, your host of The Ghost Turd Stories podcast.

My guest today is Joe Herb.

Welcome, Joe.

JOE HERB: Hey!

TROY GENT: How are you?

JOE HERB: I'm outstanding.

TROY GENT: Awesome.

So tell us a little bit about yourself and your veteran status.

JOE HERB: Okay.

Well, I did my officer's training back in the summer.

It was in June of 2000 and afterwards, I went to medical school so that would be 2000 to 2004.

After I graduated from medical school, I went on active duty during residency and then an additional four years after that.

So a total of seven years of active duty.

I did one deployment from 2007 to 2008 in Afghanistan and separated in August of 2011 and we moved here to be near you in Utah.

TROY GENT: Alright, so you went to OTS in the Air Force.

Right?

Officer Training School?

JOE HERB: That's correct.

TROY GENT: Okay, so you went to OTS first and then went to med school.

JOE HERB: That's right.

I don't know if that's the best way to do it because by the time you get to active duty time, you really don't have active duty experience and your officer's training was four years prior to your active duty status.

So there's not a lot that you remember.

TROY GENT: So you think it'd be better to go to med school first and then OTS, that way you carry into the Air Force what you learned at OTS.

JOE HERB: It seems ideal.

My best guess though is when you enter medical school, you're on inactive reserve status so in order to get on that status, you probably have to check that box.

TROY GENT: Okay.

JOE HERB: So it's probably an administrative box but it's less than ideal.

During your medical school, you have a couple of rotations.

Usually, you have two or three where you can go active duty and try to rotate somewhere at a military hospital so that you can kind of gauge your interest and their interest in you and your interest in that program.

But I joined before 9/11 and so after 9/11, they canceled those.

Funding and active duty and the war and all that stuff was going on by then so things changed.

So I got one of those.

So I guess my point being is that you may have some additional active duty time normally that we didn't get either.

But needless to say, by the time you show up for active duty after all that, you're ill-prepared.

TROY GENT: I thought it was funny that your brother recruited you but he did not tell you what you were getting yourself into when it came to OTS.

Tell us about that.

JOE HERB: That's true.

My brother was, at the time, in the Air Force, he was an Air Force recruiter, and he was specifically recruiting Air Force physicians.

It's a scholarship.

It's a health profession scholarship.

So you get into medical school first and then you apply and that's exactly what I did.

So I got in and after you get in you say, "Well, how are we going to pay for it?"

So my wife and I thought, "Well, military time sounds good.

We'll try that."

TROY GENT: So you had the option after you were accepted to med school to then decide how you're going to pay for it.

JOE HERB: That's right.

TROY GENT: Oh, okay.

JOE HERB: I could have done it traditionally.

I could have just taken out debt but we already had two kids and I was older than most.

I was thirty.

It just sounded appealing to us.

It's even better now.

I think they pay them a stipend every month now and they pay them a signing bonus.

TROY GENT: As they go through school?

JOE HERB: Yeah, for sure, but that wasn't present for me.

But my brother was a recruiter so I applied.

I did it through him.

We were in Southern California.

He was recruiting over there so it was convenient.

When I got in, I asked him, "Well, what's going to happen at officer's training?"

And he said, "Well, for you guys, it's not that bad."

He was an enlisted guy so he said, "You guys are going to show up and they're going to teach you how to wear your uniform and salute and stuff like that and it's like six weeks long."

And so I thought, "Well, okay.

That doesn't sound too bad."

TROY GENT: That's all he told you?

JOE HERB: That's all he told me.

But to be fair, that's what he believed.

TROY GENT: Yeah, that's what he believed.

JOE HERB: That's what he believed because that's what it sounded like the pattern had been prior to my year.

TROY GENT: There was a miscommunication because he was an enlisted recruiter and really for OTS, you need an officer.

JOE HERB: No, no.

He was an officer's recruiter but the training changed.

But he was unaware and I guess all of the recruiters were unaware that that year that I went, they decided...

And I totally get it.

They thought, “These medical officers are lousy so we need to train them more aggressively”.

It sounded like what they went with was the typical inline officer's program.

Except their program is twelve weeks long and ours is six.

So trying to cram twelve weeks of training into six weeks probably wasn't going to work.

TROY GENT: Were you with the twelve group or was it a separate platoon?

JOE HERB: We were separate from them but needless to say, I had no idea what was gonna happen when I got there.

So when I walked up there that morning...

I can't even remember what day of the week it was.

I'm guessing it was Monday, but I have no idea.

TOY GENT: It was in Alabama?

JOE HERB: It was in Alabama.

Montgomery, Alabama.

I guess I was just wandering on the base trying to find out where I'd be training.

And I went to the gym.

I remember I showed up the night before training and I went to the gym and there was some guy working out there and he was a doctor.

He wasn't in training.

He was already done with medical school.

He was a radiologist.

I remember this guy, this dude looked at me and he goes, "Hey what are you here for?"

And I told him, "I'm here to do officers training for med school."

And I just still remember him looking at me and saying, "Get out now while you can."

TROY GENT: It seems so weird to me that you just kind of meandered on base cause in the Marine Corps it was like, "Get on the airplane.

Get on the bus."

Even in officer training.

Everything was as a group.

You knew exactly what group you were with the whole way.

JOE HERB: Yeah, that's true.

Well, that's the difference though.

And if we go farther down the road, when you deploy, we kind of had some people from the base but we picked up different people as we stopped along the path and then we all ended up in Afghanistan.

So Marines and Army, you guys are different.

You deploy as a whole unit.

You come home as a unit.

And I think that in a lot of ways, that's better.

But for a lot of us, we're kind of individuals out there doing a job.

TROY GENT: Okay.

JOE HERB: I didn't even think of that, but maybe the training...

TROY GENT: Is part of your training?

JOE HERB: Well, I don't know about that but they separated into flights and in a squadron for training purposes but it really wasn't defined until you get there the night before.

I'm walking out there.

I don't know what I was wearing.

Probably a pair of khakis and a t-shirt or something thinking, "Okay, what's going to happen?"

And I just remember it was hot and there was a big flat area of pavement and a bunch of guys getting yelled at and standing at attention.

TROY GENT: So you were watching this from a distance.

JOE HERB: Yeah, right.

TROY GENT: Or like as you're walking up to it.

And I thought, "I'm in the wrong place."

I remember thinking, "I think I'm in the inline officers training.

I'm in the wrong group."

TROY GENT: So you thought you were going to the twelve week thing.

JOE HERB: I thought I was gonna twelve week thing.

And so I thought, "Well, there's no one there to ask."

And so as I wandered up there, they can see that you're looking at 'em and your flight training officers kind of...

You know how they are.

They just attack you.

And you're trying to ask a question like, "Hey, where do I go for training?"

And they just start yelling at you to get in line.

And before you know it, you're in line.

And before you know it, they have the blue line, symbolic of leaving your civilian life behind and you stand at attention and they all yell at you.

And you step over the blue line and you get your head shaved.

Even as they were shaving my head, I kept thinking, "Am I in the right place?"

So my head is shaved and we're going through all this and they give you a book and you're memorizing all the things they want you to memorize.

It took me probably most of that first day to figure out if I was even in the right place.

Training after that was a lot of pushups, a lot of yelling, a lot of marching.

Doesn't sound at least like it was the status quo for the years prior to that.

So I went home and told my brother, "You were way off, dude."

TROY GENT: So you got to the group and then they pulled you in.

What were some of your most memorable experiences during OTS?

JOE HERB: What I remember most...

It was twenty-four years ago now but just a lot of pushups.

I remember that there was just absolutely nothing you can do right.

It doesn't matter what you say or what you do.

It won't be right.

For example, I go up there.

I don't remember why they were yelling at me.

There was some reason.

They could only make us do ten push-ups at a time.

You probably didn't have restrictions on push-ups.

TROY GENT: No, I don't remember any.

JOE HERB: But there was no restriction on how...

You can only do a push-up when they give you the command to go down or up.

TROY GENT: So you're holding it for ten minutes at a time.

JOE HERB: Correct.

There's no limit on how long it takes you to do those pushups.

And so I went down there for something and some guy was yelling at me and he told me to do pushups.

So when I jumped into a push-up position, my back foot landed on one of the flight training officer's boots.

So I got in trouble for that.

So I got more pushups.

So you're doing pushups but you're acquiring more.

TROY GENT: So can they make you do ten and then they say, "Run away," and then you run away and they say, "Nope, come back," and you can do ten more.

JOE HERB: They could.

I guess they could do whatever they want but mostly they just make you take forever to do pushups and then they give you more pushups.

You would always leave with more pushups than you came with.

TROY GENT: Yeah.

JOE HERB: At least at the beginning of training and you'd have to kind of work them off, I guess.

After making me do pushups really slow and multiple sets of them, then they were yelling at me for breathing too hard.

So I thought it was interesting.

There was literally nothing I could do right but I think that's the point.

They kind of break you down and try to build you up as a team and all that stuff.

TROY GENT: Did you do any weapons training in OTS or marching?

JOE HERB: Oh, gosh.

We did a lot of marching.

We didn't do weapons training then.

I had a certified nine millimeter before I deployed but I don't recall doing any weapons training but we did a lot of marching.

We marched everywhere we went.

It took a while to kind of get that down.

I'm not sure we ever did great at it but we did a lot of that.

I remember we'd go down to the chow hall.

We'd march there and we'd had a certain amount of time to eat.

TROY GENT: So everybody in this six-week class were going to be either dentists, doctors, or...

Is that it?

Just the two?

JOE HERB: Healthcare professionals.

So...

Yes, actually.

I think that would be about right, dentists and doctors or already were.

There were a few of them that came on and already were through with training.

They were already physicians.

TROY GENT: Okay.

JOE HERB: So they would come in as majors.

TROY GENT: They just decided to come in the Air Force.

JOE HERB: Right.

They might be a major because I think they would put their civilian years towards their rank at that point so some of them would be our leaders.

I was a lieutenant then during training.

In fact, one time I remember we were in the chow hall and I had my hat off.

You always have to have cover.

Right?

Everywhere you'd go.

I put a hat on, went back, we were trying desperately not to get noticed by the flight training
officers, and I could see this guy eyeballing me and I was just trying to have that hundred-yard stare and trying to pretend I didn't know.

And then there were a couple of them eyeballing me and then one of them is coming my way and he comes up and starts yelling at me and he's saying, "I'm just curious!

Are you a lieutenant or are you a captain?!"

And I'm thinking, "Why is this dude yelling at me?"

And was like, "I'm a lieutenant, sir."

And he said, "Well, then why are you wearing a captain's hat?"

So I obviously had grabbed the wrong hat so I had to go back and find my hat and just stuff like that.

TROY GENT: The camaraderie, because you were all going to become doctors or dentists, was it pretty tight-knit?

Was everybody pretty focused on helping each other and getting through?

How did that dynamic work?

JOE HERB: Our flight was good.

We were a key little flight and we had a really nice group.

Everybody was helpful.

But at the same time after completing that, everybody over the next few weeks went to medical school and I never saw any of them again.

So I don't know.

We were tight then but we didn't stay connected.

I felt really anxious because I was about to start medical school and I was kind of on a nontraditional track because I was older.

The average age for most of these medical students is twenty-three, maybe twenty-four, and I was thirty.

TROY GENT: Just after a bachelor's degree, basically.

JOE HERB: Right.

I was older, had two kids, and had committed to military time.

I'd been out of school for a while.

I hadn't been in classes and my undergrad had been done maybe three years or something before that.

I just felt really anxious about medical school and, "What if I can't do it?

What if I'm not good enough?

What if I can't get through?"

So that kind of hung over me then and then of course coming back, packing up my stuff, and driving out to Missouri.

TROY GENT: When you were in medical school, the Air Force was paying for it, you were in active reserve, so you weren't getting paid a salary.

JOE HERB: I did not get a salary.

No.

TROY GENT: So you talked about earlier how they're doing that now.

JOE HERB: Well, I don't know.

It's not a salary.

It's maybe a stipend so it's a little different.

It's not as much as a salary would be.

But I think the biggest difference for these students coming out now is signing bonuses.

TROY GENT: How did you provide for your family while you were in school?

JOE HERB: We still took out debt.

So we had two more kids in medical school.

We had four by the time we were done.

Living in Missouri was cheap.

We probably took out about twenty thousand a year or less.

I think we came out with about seventy-seven thousand dollars in debt after all was said and done.

TROY GENT: Okay.

It's a lot cheaper than what you would have paid for medical school yourself.

You're looking at like three or four hundred thousand?

JOE HERB: Yeah, probably three or four hundred thousand.

It depends on if you have a bunch of kids.

It could be closer to four hundred thousand probably.

So you at least saved yourself a lot of trouble.

You paid that off pretty quick?

JOE HERB: Well, yeah...

No, I didn't.

My interest rate was one point nine percent so I wasn't super interested in paying it back.

I had other priorities.

We didn't buy a home till we separated so that wasn't a big priority but you don't get paid a lot when you're a Captain and you've got a family of six.

You have to be careful about your spending practices.

TROY GENT: So I've heard the argument by some doctors that say, "Well, if I went in the military and had them pay for it, then I'm getting paid military salary when I could be out getting paid doctor salary if I would've done it myself and I'd just pay off the extra debt a lot quicker."'

In your perspective, are you happy you did it the way you did it?

If you take out the whole patriotism thing and all that, are you happy you did it the way that you did it?

JOE HERB: Financially?

Just from a financial perspective?

I don't know if it makes sense financially for me but we really enjoyed our time in the military.

Socially.

From the job to the training.

I felt like my training was excellent doing a military residency.

I wouldn't change any of it.

It's always hard to change something I think in hindsight but I'd say financially...

Yeah, after residency and when you're credentialed, when you're fully a licensed physician, you make more money too.

Your salary doesn't go up per se but they start to give you bonuses every year.

So it's not terrible.

During that residency time, it's pretty slim.

My son's finishing medical school and he tells me that residents outside the military are making more money now than they used to.

That's probably not true in the military but for those guys outside of the military now, the compensation is a little higher during residency and it's definitely better outside residency.

But I don't think that the gap is as big as people think that it is.

TROY GENT: Sure.

So explain now, after you went through medical school, what you did for the Air Force before your deployment and then during your deployment and how you treated people and that kind of thing.

JOE HERB: Sure.

So my residency started in June of 2004.

So you show up and I remember we had to report to the colonel that was over the residency.

I didn't have blues.

We didn't really wear blues once the war started.

By the way, I joined the year before that.

I joined in 2000 and in 2001, 9/11 happened and I remember coming out of a test and seeing the towers go down and thinking, "Oh man.

I'm gonna go to war."

And after that, we just didn't wear blues.

We just wore battle dress uniforms.

But anyway, I had to report in blues.

So I had to go buy some stuff.

TROY GENT: So blues are your dress blue uniform?

JOE HERB: Mm hmm.

It's a blue polyester shirt and blue polyester pants.

I didn't know what to buy so I went down to the store.

I arrived the day before I had a report.

I bought some epaulets and whatever I thought I was supposed to have.

In hindsight, she didn't care, but I didn't know that.

I showed up and the first thing...

She just walked up to me and she said...

And I hadn't really had much interaction since my flight training officers were yelling at me.

And she said, "You're wearing ladies' epaulets."

So I had picked the wrong ones.

So that was my first day of active duty.

TROY GENT: That's hilarious.

You had gone the day before and bought those at the PX or whatever?

The base store?

JOE HERB: Yep.

TROY GENT: Oh my gosh.

JOE HERB: They were the wrong ones.

I didn't know.

I did not know.

But then when you're a resident you start and you get your residency mates.

We started with ten of us.

So the residency is three years.

The first year is called "Internship" and then you have a second-year resident and a third-year resident.

So it was just a lot of medicine, a lot of hours.

I bet I averaged, a hundred hours a week when I was on medicine rotations, inpatient medicine.

So you get to know those people that you're in the trenches with.

Yeah, those people you get to know because when you start with those ten and then we were down to seven because we kind of washed out three of them.

TROY GENT: So they just kind of went the way of the dodo and left.

JOE HERB: Well, I don't know whatever happened to them.

Right?

I don't know.

They weren't with us.

I don't know if they went back to medicine later.

We just had a few of them where these things did not work out well for them in residency.

And that's true.

Civilian or noncivilian.

It just happens.

So we lost three.

We were down to seven but those seven people you get really tight with.

You pull for each other.

You help each other.

TROY GENT: You were with these seven people for three years.

JOE HERB: For three years.

You're working a lot of hours with those guys.

Women, we had about half.

TROY GENT: Did you have any stressful moments?

JOE HERB: Yeah.

TROY GENT: Any conflict in there?

JOE HERB: We are up in Northern California.

That includes UC Davis.

That includes Martinez County Hospital in those places and there's just a lot of intense moments in residency.

TROY GENT: So even though you were in the Air Force, you were working basically to get experience in the civilian sector.

JOE HERB: The hospital that we have is great for certain things but it can't train you in everything.

TROY GENT: Yeah, so they gotta outsource you.

JOE HERB: Right.

You gotta outsource it so they have these agreements with UC Davis and Martinez County Hospital and Santa Clara and so we go outside to get some of these other experiences.

TROY GENT: Because you guys are in your residency, is it beneficial to those hospitals to have you or is it like, "Oh, we got to train more people."

And it's like, "Eh."

So you're like in the way, maybe the first year kind of a thing, but they're training you because they have an agreement or how does that work?

JOE HERB: I don't know how it works financially, but help is help, I guess.

Interns aren't super helpful but you'd probably get more helpful for them by the time you're a second or third year.

Your first months of your first year, that's the worst.

TROY GENT: Lots of mistakes.

JOE HERB: Right.

Yeah, you say mistakes or you just don't know what you're doing.

So that's when you need the most oversight and so they're probably not super enamored about having an intern on their first month of their training and I'm sure that was the case at Martinez County.

I went there my first month and it was...

There was just not a lot of oversight so you just felt like you were on your own a lot.

I remember my first shift there.

It took me forever to work up to things that really would seem trivial to me now but I just didn't know what I was doing.

There was some guy that had a seizure so I ordered some Dilantin.

It's just anti-seizure medication.

TROY GENT: Okay.

JOE HERB: But I wrote the loading dose and he got the loading dose all night.

So instead of just once, he got it...

And this dude, when I went there...

I remember going in.

It was like July fourth or something.

I went in there because it was a holiday.

TROY GENT: This the next morning?

JOE HERB: The next morning, this little teeny dude, skinny little dude, I just see stuff flying out of his room like a mattress and he was bonkers, man.

So it's stuff like that.

TROY GENT: When did they figure that out?

JOE HERB: Oh, about when we saw that.

I talked to the pharmacist.

Oops.

I hadn't seen him out of bed for a long time, but he got up that day.

TROY GENT: How did the loading dose...

Why did that create that condition in him?

Why?

JOE HERB: Oh, it just kind of made him a little psychotic and agitated.

TROY GENT: So the loading dose would have just calmed his seizures down but it was the fact that he was getting it all night.

JOE HERB: Right.

It was way too much for this little dude.

I felt so bad.

There was a homeless shelter across the street so these homeless people would just come back and forth.

They’d come to the hospital, live there for a while, and then they go back to the shelter and the residents there knew them all by name.

There were some women there my first week withdrawing from alcohol and she just creeped me out.

I'd go in there around like four or five in the morning and she just looked like a zombie to me and she was completely out of her mind and she tried to grab me.

So it scared me.

I'd have to go do an exam on her but I kind of sneak up on her while she was sleeping and try to do my exam.

I was afraid she would just like grab me and pull me in bed with her.

So you have those experiences.

I remember my first day at UC Davis rotating over there.

The ER doc comes up to me, he was attending.

He tells me, "So there is this patient that came in and he got a foreign object in a very awkward place, obviously that he put there."

And so he tells me, "This guy has this thing in his butt and I need you to go in there and see if you can get it out."

And so I'm like, "Well, how long has it been in there?"

He says, "Like three days or something."

Obviously, he had been embarrassed and he didn't want to come in."

TROY GENT: Do they know what it is yet?

JOE HERB: Oh, does the patient or the doctor?

TROY GENT: The doctor.

JOE HERB: Oh, he knows exactly was it is.

TROY GENT: They x-ray him or what?

JOE HERB: Yeah.

Well, I think they probably had done an exam and everything's kind of worked out by then.

My job, as the intern, was to try to get it out.

So I went in there and gowned up.

I put a face shield on.

I just went in there like ready.

So I went in there and this dude was sitting there on the side.

I felt so bad for him.

Right away, the first thing he tells me is, "I'm so sorry you have to do this.

This is just something my wife really wanted to try."

I'm like, "Okay, I'm just here to get it out."

Well, I go over there and I put some of those clamps on it and I just try to gently kind of see if I can loosen this thing up and I look and it's cracked and there's tissue stuck in between it and I realized right away there's no way this thing is coming out without surgery.

So I went back and said, "Hey, I'm really sorry.

I can't get this thing to move.

We'll see what we can do."

I go back to the ER attendee.

He'd been doing that forever.

Right?

He's probably the age I am now.

And I said, "Hey, I can't get that thing out."

And he tells me, "Let me guess, he said his wife put him up to it.

Right?"

I'm like, "How did he know?"

So, yeah.

TROY GENT: Not the first time?

Yeah, well, he had seen that same variety of patient probably multiple times and they probably had the same story.

TROY GENT: So you never found out what it was?

JOE HERB: Well, I know what it was.

We all can see it sticking out.

We knew what it was.

TROY GENT: What was it?

JOE HERB: A dildo!

TROY GENT: Oh, a dildo!

Oh my gosh.

JOE HERB: It was a foreign object in an awkward place and it was pink, by the way.

Most of my time was spent doing medicine and all that and we had these trauma patients that would come in.

And one of the trauma surgeons says, "All these trauma patients are here for the same reason."

I said, "What do you mean?"

He said, "If you ask them why they're here, they'll all say…”

"I was minding my own business when these two dudes came along."

And so I thought that was funny because it's true.

Every single trauma guy I talked to had the same kind of one-liner.

"What happened to you?"

"Well, I was minding my own business when these two dudes came along."

TROY GENT: Does that mean they were lying?

JOE HERB: Well, I presume unless they are the same two dudes.

TROY GENT: So they wanted to divert responsibility to somebody else.

Was it actually two dudes?

JOE HERB: I don't know.

Maybe it was two dudes.

Maybe it's the same two dudes.

Well, I mean, if you can stop these two dudes...

If you can find out who they are, you can stop all the bad things in the world.

TROY GENT: Yeah.

JOE HERB: But the thing I thought was funny was, when I got to Afghanistan and we started seeing trauma there, you'd see these Army guys come in.

They’d have some sort of trauma from a convoy and you would say, "Hey, what's going on?"

And they'd say, "Look, we were minding our own business on this convoy."

I'd said, "Oh my gosh!

They're in Afghanistan too."

The same two dudes are everywhere it turns out.

TROY GENT: Yeah.

JOE HERB: They were in Afghanistan.

They were in Northern California.

They're probably involved...

Anyway, I thought that was funny.

Same story.

Same story.

TROY GENT: So the end of your residency is the end of your med school.

JOE HERB: Well, when med school is over, med school is over.

Residency is a secondary training for your specialty.

TROY GENT: The graduation from your residency, is that in the civilian world too or just the military?

JOE HERB: Both.

When you graduate from your residency, it's a military residency but you're completing the national requirements.

Those requirements certify you to sit on the boards to take your national boards.

So once you're done with that, they can certify that you've completed the residency.

Then you can sit on your boards, take the boards, and then you're fully certified.

TROY GENT: Okay.

JOE HERB: And so once that was done, the first thing I did was deploy and went to Afghanistan.

TROY GENT: So in Afghanistan you treated US casualties and then Afghan nationals as well?

JOE HERB: Correct and also any civilians that we harm and some charity cases.

TROY GENT: What are some of your most memorable experiences in Afghanistan?

JOE HERB: Well, first of all, it takes forever to get there.

You don't just fly to Afghanistan.

Right?

TROY GENT: Yeah, I think our transition was about six days or something, maybe five days.

JOE HERB: Yeah, you go one place and then you go to Uzbekistan or something and you sit around.

I don't honestly remember a lot of getting over there, except when we flew into Afghanistan.

At some point, the pilot says, “You have now entered the war zone.”

I was thinking, "Well, that's an interesting thing to hear. "

I had been so busy preparing to deploy and out-processing my family, I hadn't thought a lot about what I was going to do when I got there.

So I pulled out a piece of paper and a pencil and I just wrote down goals.

I wrote down fitness goals.

I wrote down professional goals.

Like, "How can I improve as a physician?

How can I make myself better?"

In other words, in all these multiple domains by being there.

And so when I landed, I thought, "Well, professionally this is a unique opportunity to be a physician in an employee setting.

I'm not a surgeon.

I'm certainly not really trauma trained but there's a lot of it there and there's a lot of physicians that are.”

After landing, you kind of march out the back.

I went and I met the...

We call them traumas zarr left over I guess from Russia, but he's a trauma surgeon.

He's a trauma surgeon.

The guy was great.

His name was Al Phelps.

He was just...

He was an awesome dude.

TROY GENT: Civilian?

JOE HERB: No, all of these are military doctors.

TROY GENT: Okay.

JOE HERB: All of them.

Most of our trauma surgeons come from Baltimore Shock Trauma.

That's where he came from.

And I told him on the first day, I said, "Look, this is who I am.

I'm right out of residency.

I'm really interested in this.

I've done some ICU stuff.

I'm interested in doing ICU medicine."

Because originally when you're assigned to go, they just kind of mix and match your talents and interests and kind of see where they can use you.

So I was going to be in clinic but he found me after the first or second day.

He came and found me and said, "Hey, we lost a guy that was going to work in here.

We're rotating him somewhere else.

Can you kind of come in and do ICU?"

And I said, "Sure."

And so he kind of showed me how he manages the vent with these trauma cases.

And so I spent my deployment working in the intensive care unit, so patients basically that are ventilated, and then the other side of the hospital.

TROY GENT: So this is after their initial treatment.

JOE HERB: Right.

TROY GENT: So they put them in ICU to like help them start the recovery process?

JOE HERB: Right.

TROY GENT: Okay.

JOE HERB: Well, because they're critically ill.

These patients all have respiratory failure, inhalational injuries, burns, something like that that might damage their lungs or they have extensive trauma so they're going in and out of the operating room every day or two to get washed out and to get other surgeries so they leave them on a ventilator.

The US troops that come in don't stay very long.

They may be there a matter of hours.

This is Bagram air base.

When they come into Bagram, they get clean lines, they get their wounds washed, they might get some additional surgery and right away they're calling up a plane to fly them out to Germany.

So they get flown out to Germany hours after they're with us and they're flown to each location by a critical care air transport team.

These trauma patients are wounded warriors.

They don't stay very long in any one facility until they're back in the US.

TROY GENT: Okay.

JOE HERB: So if they're alive, in other words, when they get to us, they're almost certainly going to make it.

Very rarely that they won't make it.

TROY GENT: Okay.

A lot of people that were in ICU we're Afghan?

JOE HERB: Yeah the ones that would stay.

Right?

So they could be Afghan nationals or civilians or they are enemy combatants.

TROY GENT: Okay.

JOE HERB: So we'd have some of those too.

And those dudes...

They'd wake up hot, man.

TROY GENT: Yeah.

JOE HERB: Like they'd come out of their anesthesia and they'd kick you and hit you and all kinds of stuff.

TROY GENT: The combatants are ready to go once they realize they're still alive.

JOE HERB: That's right.

TROY GENT: Wow.

So did you have to restrain any?

JOE HERB: Absolutely.

One of the general surgeons there...

I was standing next to him and one of these guys, one of these enemy combatants, woke up and kicked a nurse or kicked at a nurse.

I don't remember but he got a little nuts.

TROY GENT: Yeah.

JOE HERB: And he turns to me and he says, "Do you know the Hyoid maneuver?"

And I didn't know what he was talking about.

JOE HERB: Was he speaking in English?

JOE HERB: Yes.

TROY GENT: Okay.

JOE HERB: So he grabs the dude by the neck and slams him back in bed.

TROY GENT: Oh, the doctor!

JOE HERB: Yeah, the doctor!

No, not the patient.

The doctor said that to me.

This was the other surgeon that I was with.

TROY GENT: So he basically choked him out.

JOE HERB: Well, he didn't choke him out.

He just put him back in bed.

He wasn't actually choking him but the hyoid bone is the one right under here.

And that's when I was thinking, "Wow, this is a weird place to practice medicine."

You know?

You've got a guy waking up and trying to kill your nurse and you're trying to put him back in bed.

So at that point, you wouldn't need physical restraints because you have chemical restraints.

You would put them down with medicine.

So I trained in the ICU.

One of the guys I worked with was an anesthesiologist so we would mark syringes with different medications and how many milligrams per ML so you'd know when you were pushing it how much to push and how much you were giving him.

You would get some ketamine, some Versed, and some Vecuronium.

Veccheronium is what you think of as a paralytic and lasts about an hour.

TROY GENT: And then they're pretty much instantaneous?

JOE HERB: They work pretty quick.

That's right.

Yeah, it's just a crazy place, man.

TROY GENT: Yeah.

JOE HERB: My first impression though...

The first thing that I thought of after arriving and coming out of the plane and looking around is a scene from The Three Amigos.

Have you ever seen that movie?

TROY GENT: Long time ago.

JOE HERB: Long time ago.

The plot is these guys, there's these three guys and they're performers.

There's a small town in Mexico that thinks they're actually cowboys.

TROY GENT: Yeah.

JOE HERB: They're not but they don't know their performers.

They just see them on film.

So they hire them to come and fight some bad guys.

In the whole first part of the movie, they're under the impression that they are going to this small town in Mexico to perform.

This other dude shows up, Senior Guapo, and all the bad guys and they go out and they're there to fight but these other three amigos are there to perform.

And so they shoot one of them, Steve Martin, and he doesn't know he's been shot at first.

So he's upset and he goes over and starts yelling at and Senior Guapo.

And at some point, it dawns on him that the whole thing's real.

He goes back to his friends and they say, "Well, what's going on?"

He says, "This whole thing is real."

They said, "What do you mean?"

"Those guys over there, they're going to kill us."

And so I just had that scene in my mind because it's so surreal to be in an area where everybody...

I'd go down to the chow hall and there's some kid with a grenade launcher or whatever and everybody's got guns.

Everybody, right?

I have a gun!

Everybody's got a gun!

People are driving tanks and Humvees up and down the road.

And you're like, "Man, this is a weird place."

For whatever reason, that clip just kept on going through my mind.

It's just such a surreal experience.

One of the interesting things about the population there was everyone had worms.

When you think about it, most of the population of the world really has worms.

We're just not used to that.

TROY GENT: What's the percentage in America?

Do you know?

JOE HERB: I have no idea what it would be.

We don't even have those kind of worms here.

We have like pinworms.

TROY GENT: I guess we just have such access to doctors.

If we feel a problem, we go see a doctor and they take care of the worm or whatever.

Right?

JOE HERB: Bingo!

Not only that.

You can get over the counter.

You don't even have to see a doctor to treat pinworms.

By the way, everybody blames their pets, but pinworms are only passed from human to human.

Just so you know.

You don't have to blame your pets.

But over there, they have these Ascaris worms and they look like earthworms and they're super common.

The locals would have them.

We had a patient who had a gunshot wound to the belly, and a worm crawled out.

There was a small hole in the bowel that the worm had crawled out of and so that surgeon named him Braveheart the Worm.

He said, "He just wanted to be free."

I said, "Why did you name him Braveheart?"

"Because he just wanted to be free."

I had two times though...

An endotracheal tube is a tube that you put down in a patient to allow them to breathe when they're on a ventilator.

That's what the air exchange, gas exchange, air exchange goes through.

Twice I had a worm crawl out of that tube.

TROY GENT: Wow.

JOE HERB: Twice.

I haven't done a study but it's gotta be a bad sign when your parasites are bailing.

Right?

TROY GENT: Yeah.

JOE HERB: We had one tapeworm, an ostomy that just wouldn't drain, and our trauma surgeon put his finger in it and pulled out a tapeworm and it was like six feet long.

TROY GENT: Jeez.

Six feet.

JOE HERB: Yeah.

TROY GENT: Wow.

JOE HERB: Yeah, there were times when you could just scroll through the CT scan and just see worms.

So you think, "Well, what did you do, Joe, about your worms?

Right?

You were there.

Well, when we left, we all took a shot of deworming medication.

TROY GENT: Okay.

JOE HERB: It's that liquid medication called Mubenazole.

We all took a shot of that.

TROY GENT: It kills everything?

JOE HERB: Yeah, absolutely.

We thought, "Well, that was our big going out shot that we took before we left the country, was the Mubenazole.

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JOE HERB: I've never been evaluated for PTSD.

Some of my colleagues do have that.

And by colleagues, I mean physicians so I have all the respect in the world for people that struggle with it.

I'm what I would say, I was inside the wire.

You were outside the wire.

You were out there on a convoy or whatever you were doing outside the wire.

TROY GENT: We did both foot patrols and convoys.

JOE HERB: Foot patrols, convoys...

I have all the respect in the world for that.

But for those physicians who see a lot of trauma, they can have that too.

I know that one of my colleagues had dreams after he came home that he was drowning in blood.

He would have a lot of that, a lot of anxiety.

Personally, when I was over there, I spent a lot of those nights in the ICU and it just felt like somebody was always...

Well, somebody is always trying to die on you.

TROY GENT: Yeah.

JOE HERB: So you're always trying to run over there and do your best to kind of pull them back whatever the problem might be.

And so by the time I came home, I was pretty wound up.

By the time I came home, I bet I had lost thirty pounds and I wouldn't sleep more than a few hours at a time.

So I tried to integrate back into the family after deployment.

It's awkward.

TROY GENT: What was your workload like in Afghanistan?

JOE HERB: Well, you just work every day.

So you basically take care of whoever's

TROY GENT: Twelve, sixteen hours a day?

JOE HERB: Oh, well, we would work...

There were three of us in the ICU.

We would round in the morning.

Every morning we'd have that kind of structure.

After we would round, we'd do our procedures and then we'd just care for our patients and whatever we needed to do during the day and then I would cover the ICU One night in three.

GENT: So you were on a twenty-four-hour shift once every three days basically.

JOE HERB: Right.

TROY GENT: Okay.

JOE HERB: Right.

But then you would come back after that night shift and you would repeat the same process.

Round, do procedures, eat a little breakfast, manage stuff, you'd go sleep for a couple hours, and then you'd just wake up.

TROY GENT: Yeah, that's all there was to do.

JOE HERB: Nothing else to do.

TROY GENT: Yeah.

The only thing that wasn't patrolling or operational, where I was at, was just our prison gym that we made.

JOE HERB: Prison gym?

PTROY GENT: Prison gym.

JOE HERB: What does that mean?

TROY GENT: It just means you just find what you can and you create a gym out of it.

So that was our only break.

That was our only break in between operations, that and sleep.

JOE HERB: How many days in a row did you do that?

TROY GENT: Seven days a week.

JOE HERB: Seven days a week for six months?

TROY GENT: Seven.

JOE HERB: Seven months.

That's a long time.

There's really nothing to do on a day off anyway, to be fair.

TROY GENT: Yeah, sure.

JOE HERB: But you probably came back wound up.

TROY GENT: Yeah.

So you couldn't sleep more than a couple hours when you came back at a time.

JOE HERB: That's right.

I always felt like there was always something that I needed to do, that I needed to attend to.

You were just wired that way.

TROY GENT: But there wasn't.

So what would you do?

You just kind of walk pace or what would you do?

JOE HERB: Well, I would get up.

We lived on the base and thank goodness the base gym is open twenty-four-seven.

And so I'd just go to the gym at all kinds of weird hours.

I just felt really out of sorts and out of place with the family.

I would sleep for a couple hours.

I would wake up at two or three in the morning or at kinds of weird times and I'd just go to the gym because that's what I've been doing over there.

Whenever you were awake, you would just go to the gym and it was kind of a good stress relief and so I would just do the same thing.

I was kind of living the same.

TROY GENT: How long did that last?

JOE HERB: I don't actually know.

I can't recall.

I do remember that I got some leave and we went to Hawaii.

We'd hop these planes.

The Travis Air Force base flies to Oahu like every day.

And so when you're on leave, you can hop a plane.

So we have fly space available and go over there.

And so after we got over to a Oahu, that's when I finally started to unwind.

TROY GENT: Okay.

JOE HERB: For me, that's always been our healing place.

TROY GENT: Is that when it started as the healing place?

JOE HERB: That's where it started for me, getting in the waters of the Pacific.

TROY GENT: Yeah.

JOE HERB: And so just getting in there and doing some water stuff.

We love to surf, we love to snorkel, and just being with the kids, that's when I finally started to sleep longer and kind of let go of things.

JOE HERB: And you got out in 2011 and you moved here.

JOE HERB: We separated.

Well, I came back and then we still had three and a half years of activity time as a Staff physician with residents.

That was great.

The people taking care of the military people were awesome.

We loved living on the base.

We loved our training.

TROY GENT: What base was that again?

JOE HERB: Travis.

TROY GENT: Travis.

JOE HERB: So just great people, very eclectic group.

I loved the training.

I loved the people I worked with.

It was a very positive experience for us.

We considered staying, but when your kids get into high school, they don't want to move anymore and that was kind of the break point for us.

Our oldest was going into her sophomore year and it was really good for her to come here.

We had stability.

We kind of finished up with the kids.

Now that they're gone, I actually today just applied for The Air Force Reserves

TROY GENT: Oh, you did?

JOE HERB: I just did.

TROY GENT: Oh, wow.

JOE HERB: I just did this afternoon so we'll see how that goes.

I'm a little old now.

I'm turning fifty-four so I'll need some waivers.

But, yeah.

TROY GENT: So you have...

Let's see.

That's seven years?

JOE HERB: I think they would count my inactive reserves are medical school.

So I'd have eleven.

TROY GENT: Alright, well good luck with that.

JOE HERB: Yeah, we'll see how it goes.

TROY GENT: Thanks, Joe.

JOE HERB: My greatest pleasure.

OUTRO: Thank you for listening.

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