All Rileys and Friends

Hello all!

We are anxiously awaiting the framing to start on our house. The incredible amounts of rain we have gotten the last week has delayed everything, so the framing crew still has to finish up their current job before starting on ours. Building a house is a slow process but we are grateful to have a temporary home to live in for now. I have enjoyed painting and getting things updated so that we can pass this house along to some other family when our house out in Black Forest gets finished. We still mourn the loss of our home and all the trees…..it was beautiful. It is a completely different landscape now, but we look forward to all of the beautiful sunsets over the mountains we can now see.

Our family numbers have fluctuated a lot since Keyan left. Our exchange student left the middle of June and then Ben went out to Jason and Lora’s house to work. Going from 7 to 4 was strange….cooking is not such a big deal anymore! When we went to pick Ben up, Sam decided he wanted to stay for awhile, so I took one kid and left another there. Jason and Lora are great and have done a lot to help the boys stay busy this summer. Ben is not so sure about farm work, but Sam absolutely LOVED it. He is ready to move out to Ballard full time! Mara and Ben are at Girl’s Camp and Scout Camp this week, hopefully staying dry (Becky feels bad that their week away has been terrible weather wise…she knows she will hear much about it when they get home!)

We look forward to going back to Florida next week to visit Lyrad and his family and to hang out at our old stompin’ ground. This will be interesting to see if we all still love Florida as much in person as we do in our minds!

Keyan is at about the half way point of his deployment. We expect him home the first of November. He is doing great work over there in Afghanistan….he does great work wherever he is. Wish he was here with us, though….our family work is great to do, too!

Hope you all enjoy the remainder of your summer!

Ben sporting a hard earned farmer's tan

Always practicing OPSEC, the best Masked Man since the Lone Ranger

Keyan and Becky's once and future home site

Here's something to make us all proud. A great article featuring the tough decisions Keyan and his colleagues have to make in tough situations. Front page of WSJ, 12 Jul 2014.

Will a Wounded Girl Be Saved? ‐ U.S. Faces Agonizing Choices in Afghan Drawdown | Wall

Street Journal by Michael Phillips

http://online.wsj.com/articles/will‐a‐wounded‐girl‐be‐saved‐u‐s‐faces‐agonizing‐choices‐in‐afghandrawdown‐

1405117653\

Published July 12, 2014

BAGRAM AIRFIELD, Afghanistan— Keyan Riley answered the phone and reached for his green,

clothbound notebook. He began scrawling notes about the two Afghan girls whose lives had just fallen

into his hands. "5 yr." the doctor wrote of the younger girl. "40 mm grenade."

On the other end of the line was a surgeon from a Special Forces outpost in the Afghan hinterlands. The

girls had accidentally detonated a discarded grenade. The younger one had chest wounds; the second, a

six‐year‐old, was pierced by shrapnel in the abdomen.

Could Dr. Riley send a medevac helicopter, the surgeon asked, to take the girls to the U.S. hospital at

Bagram?

Dr. Riley knew the field hospital treating the girls had no CT scanner to see if fragments had nicked the

younger one's heart. But flying the girls to Bagram would fill beds he might need for wounded American

soldiers.

Such decisions used to be easy when the military here was flush with resources and eager to secure the

allegiance of local civilians. These days, not every injured Afghan will get American medical care. In the

country's volatile east, it falls largely to Dr. Riley, a 41‐year‐old Air Force lieutenant colonel, to pick the

lucky ones.

"Rightly or wrongly," he said, "people look to me like I have the answers."

As America extricates itself from the war in Afghanistan, there are hard choices to be made. President

Barack Obama announced in May he would leave 9,800 U.S. troops in the country after 2014—should

Afghanistan's next president agree—down from more than 100,000 at the conflict's peak.

The drawdown means Afghanistan's soldiers will have to fight with fewer U.S. reinforcements. The

government will have to figure out how to build roads and pay teachers with fewer U.S. dollars. And

many of Afghanistan's sick and injured will have to do without access to the top‐flight medical network

built by the U.S. over 13 years to care for victims of battlefield trauma.

The military won't say how much medical care it now provides to Afghan troops and civilians. Officers

say it has fallen off sharply since the days when U.S. troops operated roving clinics and U.S. helicopters,

red crosses painted on olive doors, picked up almost every seriously injured Afghan.

The U.S. and its allies have closed or handed to Afghan forces more than 90% of the 852 bases and

outposts they held during the war's crest. About 20 field surgical clinics remain. Helicopter medevac

units have been reduced as well, said Col. David Ristedt, the top medical adviser for U.S. forces in

Afghanistan. And fewer people work at the two top‐tier American hospitals, at Bagram Airfield, north of

Kabul, and Kandahar Airfield, in the south.

Allied personnel must treat Afghan troops in danger of losing life, limb or sight, if local doctors can't

provide adequate care, coalition rules say. Civilians injured by U.S. actions are also eligible, as are top

Afghan officials.

In practice, however, U.S. doctors often decide who gets first‐class care and who doesn't. Dr. Riley

consults with colleagues but it is his job to make the call from his small office, which is furnished with a

single bed, a metal desk, a small refrigerator, four phones, a map of Afghanistan and a novelty lamp

shaped like a woman's leg and sheathed in a fishnet stocking.

Dr. Riley grew up milking cows and picking apricots, almonds and persimmons on the family farm in tiny

Penryn, Calif. He learned early to work hard, but military life was still a jolt, he said. He recalled being

surprised to find people yelling at him when he first stepped off the bus as a cadet at the Air Force

Academy in Colorado Springs. Now he is an intense, fast‐talking surgeon on the school's medical staff,

deployed to Afghanistan for six months. Day and night, he fields requests for help from front‐line

surgical clinics.

If the injured soldier is American, or from an allied country, it is an easy decision. Afghan civilian

patients, such as the injured girls in Ghazni Province, southwest of Kabul, require him to interpret the

rules of eligibility to manage beds and lives. Half of the intensive‐care beds at Bagram are set aside for

American or allied casualties. And medevac crews are targets for insurgents, making every decision to

dispatch them a risk.

The Special Forces outpost where the girls were first treated had only one doctor and a nurse. Dr. Riley

figured the field surgeon had stabilized the older girl enough for her to survive with treatment at an

Afghan hospital.

But the younger girl, with the chest wounds, was another question. The surgeon at the field hospital had

inserted chest tubes to prevent air in her chest cavity from crushing her lungs and heart. But without a

CT scan, he couldn't know if shrapnel had scraped her heart or aorta. Such a wound could be fatal.

Dr. Riley agreed to accept her. Medevac crews got the call at 9:45 p.m. and flew about 45 minutes to

Ghazni city, where a helicopter from the outpost met them with a stretcher.

On it was a feather of a girl, with black hair. Her eyes were taped closed to keep them moist while she

was sedated. Her bearded father climbed into the helicopter and watched quietly as the flight medic, 1st

Sgt. Randy Scott, and Maj. Mario Rivera, a critical‐care nurse, knelt on the helicopter floor and worked

on his daughter. The girl's heart rate, blood oxygen and other vital signs fluctuated wildly during the

flight.

After she arrived at the Bagram hospital, a CT scan showed a fragment had punctured both of her lungs,

but missed her heart and aorta. The metal piece was still rattling around in her chest cavity.

"She got lucky, but we couldn't have known that without a CT scan," Dr. Riley said a few days later. The

girl's recovery was helped along by a stuffed dog and a DVD of Walt Disney's "Aladdin." Her father sat at

her bedside, encouraging her to blow bubbles, an exercise to help restore her lung capacity.

Abdul Rauf, an Afghan soldier, wasn't as fortunate. A gunshot tore through his bowels and hit his spine

in May, leaving him paralyzed from the waist down and unable to breathe without a mechanical

ventilator. He fell into septic shock, with a 15% chance of survival, said a doctor familiar with his case.

Mr. Rauf spent several days at Bagram—until Dr. Riley decided he was as stable as he would get without

a prolonged stay. Already occupying beds in the intensive‐care ward were a 3‐year‐old girl with shrapnel

wounds to the head and a young woman recovering from a lung operation.

Dr. Riley put Mr. Rauf on a medevac flight to the Afghan National Military Hospital in Kabul. Before the

man left, Dr. Riley met with nurses to assure them he wasn't giving up on the wounded soldier. "It is a

matter of doing the most good with the resources the American taxpayers have given us," he recalled

saying.

He said he knew the patient was "dropping a level of care." The Americans weren't sure whether the

Afghan hospital had a working ventilator for Mr. Rauf, and they didn't want to risk losing theirs by

sending it along.

Just before landing in Kabul, the medic and nurse aboard the helicopter disconnected the electronic box

that monitored Mr. Rauf's pulse, blood oxygen and blood pressure. They unhooked the breathing

machine and attached a blue plastic bag to the tube that went down the man's throat. One of the U.S.

soldiers aboard rhythmically squeezed the bag to send air to Mr. Rauf's lungs.

"It's what we have to work with," said Maj. Jason Montgomery, the in‐flight critical‐care nurse.

Back at Bagram, the decision haunted Dr. Riley for days. "During the height of the war," he said, "we

could keep people here 100 days."

Mr. Rauf, however, recovered as well as could be hoped. The Afghan army hospital put him on a

mechanical ventilator in its intensive‐care unit, and pumped him with antibiotics, said the doctor

familiar with his case. Within weeks, he recovered enough to transfer to a regular hospital bed.

"We've been at war for a long time," said Afghan army Col. Yaqub Noorzai, a urological surgeon at the

hospital. "Our doctors have lots of experience treating trauma."

In the course of a week, Dr. Riley accepted an Afghan policeman who had picked up a booby‐trapped

radio and lost both hands and an eye in the blast. He turned away a 19‐year‐old Afghan man who

suffered a lacerated spleen and a perforated small intestine while clearing mines. Dr. Riley concluded

the field surgeon had stabilized the man without the need for more surgery, but said, "If he were an

American guy I'd probably go back and take another look."

Dr. Riley faces another pressure: As the U.S. pulls back, American doctors don't want to undercut their

Afghan counterparts by taking on all of the difficult cases—even if patients would likely fare better

under U.S. care.

"It doesn't do them any good for us to take care of all of their patients and not give them the

opportunity to improve their own health‐care system," said Col. Gary Walker, commander of the

Bagram facility. Formally known as Craig Joint Theater Hospital, the facility was named for Staff Sgt.

Heathe Craig, a medic who died in 2006 when a helicopter hoist failed as he was trying to rescue a

wounded soldier.

Afghan military doctors and their U.S. advisers say the country's military medical system has improved

since 2011, when The Wall Street Journal reported that the National Military Hospital in Kabul was so

riddled with corruption that patients had to bribe doctors and nurses. Maj. Gen. Mohammad Mussa

Wardak, the Afghan surgeon general, was brought out of retirement to clean house.

Despite their hard‐won experience, Afghan hospitals aren't as good as the major U.S. facilities here, U.S.

and Afghan military doctors said. The Afghans lack doctors and nurses for adequate postoperative care.

In eastern Afghanistan, Afghan doctors and medics handle 86% of the military casualties; another 9%

qualify for U.S. treatment under the rules; and 5% are treated by U.S. doctors because Dr. Riley agrees

to accept them.

"You go to medical school because you want to take care of people and take care of everyone," said Lt.

Col. Christian Meko, command surgeon of the 10th Mountain Division, the main U.S. force in eastern

Afghanistan. "So to be put in a position where you have very limited resources and have to make tough

decisions is difficult and requires balancing compassion, eligibility guidelines, and medical judgment."

Saying no to injured children has been the toughest part of the job, Dr. Riley said. Early in May, he got a

call from a nearby Korean military hospital about a badly scalded 8‐month‐old Afghan girl. Dr. Riley

asked the hospital to email a photograph of the injuries. The gruesome image showed a child burned

over 20% of her body.

Dr. Riley brought nurses and a pediatrician into his small office. They reviewed the baby's medical

records and looked at the computer‐screen photo. They debated whether to use an intensive‐care bed

on a child they suspected was at death's door.

"What is the right thing to do here?" Dr. Riley remembered asking the medical team. "I think she'll die

within a few hours."

Dr. Riley decided to walk across the base to the Korean hospital, which handles charity cases, to see the

baby in person. He would make up his mind there, he thought. He changed from scrubs into his uniform

but caught himself as he walked out of his office door.

"This is stupid," he thought at the time. He knew there was no chance that after seeing the girl he would

refuse to treat her. He ordered her brought to Bagram's intensive‐care ward. She died that night.

"The rules of eligibility are written down," Dr. Riley said, "but how do you say 'No' to that little baby?"

All Rileys and Friends

Sunday, July 27, 2014

Colorado Rileys visiting Florida

Week in Belize

Saturday, July 19, 2014

Julie - Any day now!

Keyan and Becky Family update

Sunday, July 13, 2014

McConkies Lookin' good on the internet ...

Keyan on Front page of WSJ!

Sunday, June 15, 2014

Happy Fathers Day