I used to help down at the clinic. I'm not a doctor, but I have a strong stomach, and sometimes that and a willingness to help are all it takes. We all figured that if I was allowed to put bullets into people without a license, I should be fine taking them out again without a license, which means anything short of that would be fine too.

The doc didn't speak a lick of the local lingo, though he worked on it, and our indigenous interpreters were less than helpful with anything much deeper than explaining the difference between a maternal and paternal uncle, and why it mattered which one had come along with the sick or wounded.

Everything else was just "hurts" or "sick". And by the time most of the locals risked going to the clinic, they were hurt or sick bad enough that you could tell as much through binoculars if you had to.

Where the interpreters really shined was in helping me with the then still unfamiliar local dialect. The patients would come up with a word I couldn't get, and the terps would cycle through equivalents and synonyms until they got to one I knew.

Think about it, though: Does your stomach hurt? What about your belly? Does your tummy ache, or maybe your tum-tum? How's your gut? Your middle, your insides, your all of these, times the four or five languages spoken in the province, times weird local shit that has never been written down once in the last two thousand years. And that's just body parts.

This was in the front-facing clinic, mind you. The one we ran for the benefit of the locals. It was situated outside the front gate for security reasons, but was still under guard and behind a full search checkpoint. We also kept very good track of who came in with gunshot wounds and what caliber the hole was. Collectively, we've treated more enemy wounded than the enemy has, and a lot of places can't or won't bother to investigate when someone shows up shot, just so long as they don't openly admit to being a militant.

The "hospital" (really the American clinic, but called such to distinguish it from the clinic we ran for the locals) wasn't set up for long term care or serious illness - anything like that got forwarded direct to the big hospital at Bagram post haste, assuming you weren't a local of course.

If you were a local, you got what we could give, or you took your chances with folk remedies and Chinese bootleg medicine dispensed by a guy with a six week certificate from the Collage of Medic in Peshawar. The real bitch of it is that the certificate wasn't even genuine.

Anyway, if you were American and you were in a really bad way, you would only even be in Bagram as long as it took to get you stable enough to make the flight to the big hospital in Germany.

But the local clinic had all kinds of shit in it the likes of which the doc had never seen in 15 years of general practice in many of the most unpleasant places in the world, not to mention the usual stuff you might expect from the daily hazards of being an illiterate peasant in an isolated region of Afghanistan. So there were weird chronic illnesses that were put in long term care as best as we could manage, and there were crazy outpatient procedures done as best we could, and there was an astonishingly large amount of venereal disease, much of which was attributed locally to a neglectful tea boy forgetting to rinse the pot between batches of black and green tea.

They were half right, anyway. The tea boy was usually the main vector for the spread of infections in a given group of men, but it had nothing to do with him accidentally (or on purpose) mixing tea in the same pot. It was because they were all fucking him.

Between my official training and the crash courses I'd picked up spending my off time assisting in the trauma and burn ward in Bagram, I figured I'd do what I could with my down time on the mountain. Really, most of what we saw was regular stuff. Guy breaks his leg chasing after a goat, kid ends up with pneumonia after breaking through the ice, two brothers end up chewed up when a stray dog breaks their fall.

Some of it was almost comically brutal, like the illegal logger who got into a fight with a chainsaw. Yeah, technically, logging is illegal in Afghanistan (part of a national effort to protect the dwindling natural resources and old growth forests, and secure many, many grants from green/enviro-conscious NGOs), but that just means that there is a brisk market for smuggled firewood. And anyway, opium cultivation is illegal too, but we all know how that worked out.

He came in with most of a leg torn off, and most of the opposite arm flayed open, the victim of a faulty plastic grip trigger on a cheap Chinese knockoff chainsaw.

His group had been logging not too far from a Pakistani border checkpoint, and the soldiers there had managed to get a couple tourniquets on him so his companions could make the three hour drive to the shafakhana amrikai. Yes, we called our clinic the "hospital" to distinguish it from the clinic for locals, and the locals called the American-run clinic for locals the "American Hospital". Language is a funny thing.

Anyway, you go pick a fight with a chainsaw that fights back and then take a three hour drive over ruts and goat paths and let me know if you live through it. The guy was dead as hell when he got there, and the blood had already started to dry in the bed of the pickup, mixed into a thin slurry with flakes of bark and sawdust and the everpresent film of fine earth that covers everything.

I had to tell his friends he was dead, and they didn't want to believe it. One of them kept yelling at us to bring him back to life and making some kind of gesture with his hands.

There were bloody hand prints on his face and on his yellow kameez, and I could tell by the size and the way the thumbs were pointed that some of them were his. The others were likely the dead man's. Tears had cut long clean paths through the filth on his face, and his thin moustache was caked with muddy snot.

The same moustache, the same eyes as the dead man. His brother. His dead brother, in a culture where nothing is worth more than a brother.

As I was bum rushing him out of the clinic, I was already getting ready to call the local mullah to come take care of the body and get it ready for the drive home. It had to be in the ground as quickly as possible, preferably before sunset by local custom.

I had to frogmarch this guy away from his dead brother because I was afraid that he would, in his grief, trip over a cot or another patient, or overturn one of the irreplaceable machines - and then I realized his gesture had been the pantomiming of a defibrillator, the kind that bring people back to life in the movies.

It was always a crapshoot when women would show up. We didn't have a female doctor, or even a female med tech, and it was not often that the Female Engagement Team ("FET" for short) from down the way was around long enough for us to give advance notice to the locals. Sometimes they and their families were perfectly OK with it - the reasoning being that since we weren't Muslim, that the woman wouldn't be shamed by speaking to us. This is the same line of reasoning that, in many places, allows Western women to completely sidestep the treatment accorded to local women and be very openly and cordially treated as a man for all social intents and purposes.

Sometimes, though, it was a fucking nightmare.

There was more than one occasion when a man would show up unnaturally angry or exasperated, dragging along a woman or a girl, or both; snappy with the local staff, snappy with the doctor, and obviously lying about symptoms, or not knowing things they clearly should have.

But to simply admit his wife or daughter was sick would be to admit that he wasn't taking care of them, or that they were somehow defective, so the most common tactic was for the men to ask them what the problem was, at home, before they left; and then try to replicate the complaints as best they could when they got to the clinic.

"My stomach hurts."

Where? How deep? When did it start?

"It hurts really bad. I can't work. I need medicine to make it better."

In the real world, these are the hallmarks of a street person just looking to kill time at a free clinic, or a junkie looking to score something, or maybe even someone under duress. But on the mountain, I realized halfway through the first such incident what was really going on without having to be told.

The real patient was the woman or the girl, who were of course forbidden to speak with male non-relations, particularly foreigners.

The magic question: We can't help you without more details. Is there someone you can ask for more details? You can go outside to (air quotes) "make a phone call" if you need to, we'll wait here.

And so would begin the laborious process of the man going outside five or six times to call and ask his brother/cousin/uncle how long it had been since he had a crippling spasm in his uterus, and his wife would have to go with him, because she remembers the phone number and it's not saved in the phone.

If the only thing you have is your pride, you have to guard it well.

Sometimes I got to put my experience in the burn ward to good use. Those were the worst days.

A woman or girl would show up, sometimes alone, more often with her mother or sisters, and she would bring terrible burns with her. If we had never seen her for burns before, it would be her arms or legs. If we had seen her for burned arms or legs, it would be her hands or feet. The third time was usually her face, neck, chest, back.

You see, the older wives keep the younger ones in line by punishing them with hot oil.

They start with the arms or legs so they could still work. Then onwards to their hands and feet, so they can't work and incur beatings on top of the burns.

And finally, or maybe right off the bat out of sheer spite, they burn their faces to make them ugly - to take away the reason the man married them in the first place.

Sometimes it wasn't older wives burning younger wives. It was older wives burning the daughters of younger wives.

Once, when the FET had shown up for the express purpose of facilitating women in the clinic - prenatals were the main focus, but all were of course welcome - I found one of them at lunch broken down in tears in the smoke pit. She was wound tight, and as was common with the FETs she had not been given anywhere near the training to expect the kind of shit she was having to confront on a daily basis.

Or maybe she was one of those rare people who retained enough humanity to notice after spending a year on the mountain.

She told me, "One of the little girls kept wanting to hold my fucking hands. I thought it was because she was scared. She was fucking amazed at how smooth my fucking hands were and kept asking why I was working here if my husband was so fucking rich. She wanted to know what fucking village I was from so she could come be a fucking servant in my fucking house."

What could I do but smoke and listen, and call the dog over to cuddle with her? Cuddling with the dog always worked for me on the days when I wanted to kill and kill and kill to make the neverending bullshit stop.

But she didn't want to kill. She just wanted to go home.

"I fucking go home in a month and I've been trying to get some better fucking lotion. I've been worried my husband will notice how fucking dry my hands are. I feel like a piece of shit."

All of this is not to say that the only time we saw women was when they were bastards to each other. Oh, on the contrary; they were the exception to the domestic violence rule, and that rule is that her husband kicked the complete shit out of her. What we saw most of were self defense wounds from when the old man decided to take out his frustrations at another failed harvest or the necessity of taking out another loan to pay for cigarettes and tea.

For a while there one Fall, this one woman in particular, Fatima, came in weekly with fresh bruises and sprains. Every time, she would ask us to take her to the "special clinic". She meant the hospital. But the answer was always that there was no reason, that we had everything we needed in the clinic, not to worry, it will be just fine.

But the injuries got progressively worse, until one day she showed up with her scalp split open for six bruise-surrounded inches, completely addled and blood caked. I had to peel the silk scarf off the wound before we could even look at it, a careful and prolonged process.

She only started crying when we told her we would be happy to take care of it right here, and that (for the fiftieth time) there was no reason to go inside the base.

We'd put some feelers out based on her weird behavior the first few times, but other than the usual suspicious relations (everybody has a cousin or two in the Taliban), there was nothing definite. But after we decided to keep her overnight for observation with the head wound, she opened up to me over breakfast.

Her husband had been fucking her up to give her a reason to show up and scout the place out, and threatening to kill her if she didn't get inside to see the layout of the inside of the base.

He'd been using her as an extra set of eyes to plan an attack.

"I don't want to. I don't want to. If I come and cheat you, you will close the hospital. Please don't close the hospital, we need it too much. Please, let me stay here, I will be a nurse, or send me to jail, but don't let me spy for him."

After he got rolled up in a joint US/Afghan operation alongside a couple of known militants, she never came back. I like to think she went back to her family, but I'll never know for sure.

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