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Monday, July 16, 2012 - Road to Methodist Medical Center Goes through Afghanistan for Oak Ridge Eye Surgeon
     
    Sitting aboard the military transport plane, Dr. Dahl begins the first leg of his journey to Afghanistan where he completed a six-month tour of duty in 2009.
     
    Thomas L. Dahl, M.D., is a board-certified ophthalmologist on the staff of Methodist Medical Center of Oak Ridge. A native of Oak Ridge, he graduated from Oak Ridge High School in 1993 and received a bachelor of science degree in zoology from Brigham Young University. Dr. Dahl earned a medical degree from the James H. Quillen College of Medicine at East Tennessee State University in 2003. He served as the ophthalmology element leader at Eglin Air Force Base in Florida from 2007 to 2010 and spent six months in Afghanistan, where he performed more than 300 trauma surgical procedures. He received the Afghanistan Campaign Medal and the Army Commendation Medal for service while deployed. Dahl completed his internship and residency in ophthalmology at Wiliford Hall Medical Center, Lackland Air Force Base in Texas. At Lackland, he was chief resident, and in 2007, earned the Outstanding Resident Award. Dahl is the son of Tom and Betty Dahl of Oak Ridge. He and his wife, Hannah, live with their four sons in Oak Ridge.
     
Life sometimes takes unexpected twists and turns. When Thomas Dahl, Jr., of Oak Ridge joined the Air Force in 2000, he never expected to serve a tour of duty in a war zone. He thought he would work in a non-combat setting, complete his military service, and go into private practice as an eye surgeon, possibly in Oak Ridge. Then, terrorists attacked the twin towers and the Pentagon, and U.S. soldiers were sent to fight in Iraq and Afghanistan.

Dr. Dahl, who is now a board-certified ophthalmologist on the staff of Methodist Medical Center of Oak Ridge, was committed to serving in the Air Force for seven years in exchange for a scholarship to medical school.

“I was stationed at Eglin Air Force Base in Florida for three years. We had a full hospital with nearly all specialties,” he recalled. “I took care of a lot of retirees who had cataracts and pilots who had vision problems.”

Rumors that he might be deployed to Iraq or Afghanistan began soon after he arrived at Eglin with his wife, Hannah, in 2007. By 2008, he knew he would be sent overseas. In 2009, he began a six-month tour of duty in Afghanistan.

The hardest part was leaving behind his family, although his experience treating wounded soldiers and civilians was very rewarding. When Dahl left the states, he and his wife had four sons between the ages of six and one. “The youngest wasn’t talking when I left,” the doctor said. “When I got back, he was talking so much, all I could do was laugh.”

During his time in Afghanistan, Dahl was the only ophthalmologist for all of the NATO and Afghan forces. “I was on call 24/7 for six months and saw patients who had anything wrong with their eyes or eyelids. I operated on Americans, French, Canadian, Polish, and others,” Dahl said. “There were times when I had a week without any surgery, and then, I’d spend several days doing surgery. It came in waves.  There was a 10-day stretch I was in the OR every night.” 

He was stationed at Bagram Air Base, which had the only fully staffed U.S. military hospital in Afghanistan at the time. “We had general and trauma surgeons, a cardiothoracic surgeon, a neurosurgeon, a plastic surgeon, an ob/gyn... Other hospitals in the country basically patched up people and sent them to us.”

The hospital at Bagram was a permanent brick structure, and the main difference between its three operating rooms and operating rooms in the states was that the floor was made of plywood. “When you walked, the floor gave and made the microscope shake.”

Dahl’s patients included U.S. military personnel and their allies, “bad guys,” and people who had injuries caused by crossfire. There was a prison on base, which had full-time optometrist. Dahl saw a large number of the prisoners who had more complex ocular disease.  “Some of the prisoners looked at you like they wanted to kill you, and others were scared to death.”

Dahl’s main job was to attempt to repair severely damaged eyes.  “I mainly saw patients with ‘open’ or ruptured globes, meaning there is an open wound in the eye, usually caused by a roadside bomb.  The wounds need to be closed and made watertight quickly to prevent infection and other complications.

“There were many eyes that were not salvageable.  A blind, severely injured eye needs to be removed to save the other eye.  There is a chance that due to the injury, the board can build antibodies against the good eye.   It’s a condition called ‘sympathetic ophthalmia.’  To prevent this, blind traumatized eyes are removed within two weeks.”

Dahl tried to repair the eyes of American soldiers even when those eyes were severely injured.  He knew the likely course of future treatment and wanted to give the soldiers time to accept the fact that they were probably going to lose their eye.  With Afghan patients, he did not know if they would receive follow-up care, so he removed severely damaged eyes on the spot when necessary.

”It was impressive to see our soldiers being more concerned about their unit and getting back to it than anything else. Many of them were being sent home, though.”

Wounded Americans were transferred to a U.S. military base in Germany, usually within about 24 hours after Dahl treated them, and the Afghans were sent to Afghan hospitals.

To complete a residency in ophthalmology, a doctor must perform four “open globe” procedures. In Afghanistan, Dahl performed more than 100. He also repaired eyelids and performed various reconstructive procedures in conjunction with the ear, nose and throat specialist and plastic surgeons. “I did a lot of thing I wouldn’t have done here in the states.”

Dahl treated a number of patients for humanitarian reasons when time and space allowed. On the second day he was in Afghanistan, he operated on a teenage boy whose eyes were severely damaged when a bomb exploded. The doctor removed one eye that was destroyed and repaired the other. The teen “has pretty good vision in that eye after we brought him back for a second surgery to remove a cataract caused by the injury.” “There also was an eight-year-old boy who lost one eye when a land mine blew up in his yard. Explosions of land mines left from the war with the Russians in the 1980s happened a lot. I also treated an Afghan nurse who was partially blinded as a child. He just happened to be in the hospital on rotation to learn and needed a prosthesis.” In both cases, Dahl opened the patient’s eyelid and placed an implant in the empty socket to give the face a more normal appearance.

The incidence of eye injuries has increased with each war since the Civil War, he said. In the conflict in Afghanistan, 10 to 15 percent of war-related injuries involve the eyes.  Dahl explained that soldiers live through more blasts due to advances in body armor.  The face and extremities are most exposed and are often injured.  Also, the munitions do a better job at spreading shrapnel than in the past.

Dahl left the Air Force and went into private practice in Oak Ridge two years ago. He never considered a career in the Air Force. “The longer you’re in, the more administrative work you do. I want to see patients.”