News From the Red Desert (32 page)

She got it. She had a point to make, too.

Every mammal with ears now knew the SF unit was in the area. And so the team gathered their equipment up and prepared to march, notwithstanding it being 0300 and dark. These soldiers were always quiet when they moved, but the usual outward-focused silence was now joined by an inward one. They had worked with the colonel for five years, as he was promoted again and again. These men were proud to be in his battalion and doubly proud to be in the fire team he accompanied in the field.

Letting the general direct the field ops of the team was like letting your boss's boss move into your house and decide how the roast should be cooked. It felt strange and intrusive to everyone except the general. This was Colonel Matheson's house. They were all grateful that the general had taken charge. But they wanted Colonel Matheson back. In the meantime it was night and the path needed to be studied. And the forest listened to. And fuck only knows who else was out there—drawn by the gunfire and then the medevac. They needed to get away, and they needed to remember that they would be looked for.

When the sun rose the next morning, they were still on the move. The sky had lightened in the east slowly, and then the sun burst out all at once as it topped a ridgeline. It was cool still, but the soldiers and Deirdre were warm from the effort of walking. Every one of them was still thinking about the colonel. SF formations took few casualties—the
IED strategy did not affect them much, as they avoided roads and used helicopters to take them anywhere they couldn't walk. But most of all, because they were careful and well led. Every casualty they did take made a lasting impression and Colonel Matheson was particularly well known. Everyone knew about his faith and his seven kids. No one had ever heard him swear or seen him drink alcohol or even coffee. They had ridiculed him for his rectitude but now what they remembered was that he had never once reprimanded any of them for their language or their intoxicant use or for anything that wasn't soldiering. And that when it came to soldiering he was obsessive. He knew the state of every bit of equipment his men carried, he knew the state of their feet and of their marriages. He insisted that every plan and the fallback and fallback-back plans to every undertaking be defined and understood by all concerned. He'd kept them safe.

When the sun came up over KAF, Lieutenant Colonel Matheson was in the base hospital being examined by a Danish trauma surgeon. A Dutch anaesthetist stood by. The American OR nurses had been woken when the helicopter radioed in. They were setting up the operating room. Everyone was anxious. When Matheson had arrived he was cold from the IV fluid run into him and from the altitude the helicopter flew to avoid ground fire on the way home. Cold because he had spilled so much of his blood out of his chest and into the soil.

Problem being, cold blood does not clot. And when he arrived his blood pressure was faint and if he were less fit than he was, he would have been more distressed with such a low blood pressure, but as it was, he indicated he felt fine, even though he was far from stable. And when the nurses transfused him with four units of packed red blood cells, he indicated he felt even better. And he meant it. But his hemoglobin on arrival was fifty grams per litre, and after the packed cells, it was still fifty grams per litre. Which meant that he was bleeding fast. The tube in his throat precluded him asking questions, but he heard enough of the
conversation between the surgeon and the anaesthetist to understand.

The doctors transfused clotting proteins, more blood and platelets, and tranexamic acid but he was still bleeding fast. As he was brought to the operating room, the anaesthetist whispered, “You're going to sleep now, Colonel.” Matheson nodded. The milky white propofol slid into his arm and his eyelids sagged. The anaesthetist watched the blood pressure carefully and ran in more fluids. When he judged the colonel to be unconscious, he nodded to the surgeon.

The surgeon opened his chest on the left side, excising a rib to get better access to his wound and cranking a set of rib spreaders. He found a hole in Matheson's subclavian artery. With his low blood pressure, the pulse of blood from it welled rhythmically, rather than spurted. The surgeon clamped it and sewed it carefully. The anaesthetist continued pumping in packed cells and plasma. In a desperate effort to warm the colonel enough that he might clot, the anaesthetist put a heated-air blanket on top of him ran all the blood and fluids he was giving him through a fluid warmer.

Finally the clamps came off the subclavian artery and the surgeon studied the repair. The suturing held. The hole was mended. He was still bleeding, however, in a diffuse and generalized way from a thousand places—his stomach lining, every suture in his chest, his lungs.

The surgeon closed up the incision as best he could, dabbing constantly at his suture lines in order to see where he was placing his needle. He looked up at the anaesthetist. “This is getting worse,” he said.

“He needs whole blood,” the anaesthetist said.

“Yes.”

The military used walking blood banks—cadres of soldiers on base who volunteered to donate blood for mass casualties. They were all screened regularly for infections and unusual antibodies and in the sexless and drug-free environment of KAF this was a strategy that could be workable where in other contexts it would not be. When they were needed, the donors were called in and a half-litre of blood was taken from them and run right into the wounded.

With fresh warm blood, the battle wounded revived with unprecedented speed. Their disordered clotting normalized and their colour improved fast. Fresh warm blood contained things that the distilled and chilled product did not, and it turned out that those things were more important than anyone could have guessed.

The anaesthetist asked the lab to activate the walking blood bank. The tech hesitated, as the walking blood bank was supposed to be used in mass casualty situations. But the anaesthetist insisted: “This is Colonel Matheson.” The debate stopped and the donors were contacted.

But by the time they had come in and were giving blood, Matheson was in worse trouble than ever, the urine in his catheter bag was claret, the secretions coming from his endotracheal tube were pink and frothy, his oxygen requirements were climbing and still, and again, the acidosis was severe. The anaesthetist had heard he had seven kids.

In the café Rashid had noticed the agitation of the senior officers when they came in after the morning briefing, but there was no saying what was up with that. There never was. Agitated officers were not uncommon in the days and weeks before operations were to unfold.

Mohammed was in the back at the computer, reading the news. He had been told to google “Bagram Black Prison” and he had. But as he read the pieces that popped up, he resented having been told to do this. He shut his eyes in angry confusion. He opened them up again. He looked out at the soldiers in the café. Could any of them have been a part of such things? Hooks in the mouth? Electric shocks? How could this ever have happened?

The Danish surgeon and the Dutch anaesthetist stood at the foot of the colonel's bed and watched the ventilator wheeze and sigh. The surgeon
said, “The whole blood isn't helping. Could he have an ongoing bleeder we didn't see?”

The Dutch anaesthetist: “It's not impossible.”

“Maybe his only chance is that there is, and we could fix it.”

“He's not going to survive the trip to Landstuhl, that is for sure.”

“We're just watching him spiral, now. And we're almost out of B-pos donors.”

“He might not survive another thoracotomy.”

“He won't survive another six hours like this. His kidneys are shutting down. His acidosis is worse. Every time we draw blood everything is more deranged. Multi-organ system failure. We can't just do nothing.”