Authors: Dave Hnida
Rick was the surgeon on that day, and since I was finishing my ER shift, I scrubbed in to lend a hand. We spent six hours doing patchwork surgery to keep this kid alive, and by the time we tore off our gloves and gowns, he was barely hanging on by that dreaded medical term: a thread. The worst injury was a small, impossible-to-find blood vessel, leaking at the base of the skull. We just couldn't get to it; all we could do was hope the leak would just gradually clot over and stop bleeding. He was too unstable to put on a plane to Germany or the States for more extensive repairs, so the battle shifted to a hand-wringing waiting game. Rick and I trudged out of the OR, leaving the young soldier in the ICU nurses' able hands, too bummed out to say a word, with nothing left to do but hope he took a turn for the better and made it onto one of the nightly flights to Landstuhl or Walter Reed.
The surgery was tough, but the next task was even tougher; Rick volunteered to go outside into the dark heat and talk to the soldiers in
the kid's unit. Bearing the bad news is the most painful job a doctor has, and this task seemed to carry extra hurt. There would be tears, slumped shoulders, walls punched in anger. I just sank my head in depressed exhaustion and shuffled down the walkway, as Rick trudged in the opposite direction toward an anxious group of battle-dirtied warriors. He was hurting and so was I, but we couldn't show that hurt to anyone besides each other. Often here, a projected “never say die” attitude really meant “we're futilely trying to cheat death.” We needed to hold each other up as we staggered down the thin line separating life and death.
Sad and lonely, I thought of my family. This was one of those times all I wanted to do was hold my children tight and never let go. All four of mine were right around the ages of most of the soldiers I cared for, and every time a chopper dropped from the sky, I whispered two prayers: God, thank you it's not one of my kids coming on that bird; then quickly, Please help me save the kid who's coming in, the one who belongs to some other parent. It was true, every turn of the blades of a medevac caused my heart to ache for someone ⦠including myself.
The bright lights of the ER snapped on as I walked through the doors, interrupting the small crowd of medics watching a DVD. For the first time in days, the place was quiet. Eerily so. The medics flipped off the movie and scurried toward me.
“What's the word, sir? Is he gonna to make it? You guys were in there for a long fucking time.”
All that came out was a soft mumble, “Man, I don't know. He's oozing and bleeding from everywhere. His neck is Swiss-cheesed. But he's hanging tough.”
Our chief nurse took a tentative step toward me.
“Uh ⦠well, sir, when we cut his pants off his wallet fell on the floor. You ought to take a look.”
I shouldn't have taken a look.
Right inside the fold of the sweat-stained wallet was a photo of the
soldier and his family. He had a bright, bubbly wife with arms around two kids dressed up in their Easter best, the boy about three years old and the little girl about a year and a half. All smiling. All happy. All together.
Now things were too personal. The picture looked exactly like the ones my family took every Easter. I couldn't stop picturing my kids on respirators with missing limbs and holes in their necks. Then came snapshot images of teenagers lying on a sidewalk after being shot while fleeing a school. I shook my head back and forth, violently trying to get the images the hell out of my brain. What was going on here? I usually did a good job blocking out personal details when a life was on the line, it was the only way to ensure the psych bell didn't toll for me. That's why I made it a rule
not
to look at the names of those soldiers teetering on the line between life and death. They were “the leg,” “the pelvis,” or in this case, “the neck.” As I sank down at my homemade plywood desk to do the paperwork on the case, I avoided looking at this soldier's name. I DID NOT want to know it. But unfortunately, I did. He was “Honey” and “Daddy.” And I was one step from losing my sanity. The photo had blown a giant hole in my protective armor.
Each day, we got up, shook out our boots and uniforms to dislodge any nighttime visitors from the neighborhood scorpion or spider families, strapped on our pistols ⦠and our most important piece of a combat doctor's protective gear: mental armor. Only then could we head off and face whatever the medevacs were going to deliver to our front door. That morning had been no different, but I hadn't seen one of the worst days of my deployment coming. I never had the chance to add that extra layer of armor.
From the ER, I walked the quarter mile of sand back to my room in total darkness; my only companion the ever-present hot desert wind, whistling at me, mocking me for my weakness. The wind was right; I sucked as a doctor and was going to lose a young soldier because I wasn't good enough.
Back at my barracks, I showered for ten minutes longer than the mandated two, watching blood swirl down the drain until the water flowed clear. I felt I'd never truly wash his blood off my skin, just like I could never get the pungent odor of charred flesh to leave my nostrils; they were my scars of his battle. I finally tumbled into bed, stuck my iPod earbuds in, and turned on my nightly sleep aid, the sound of ocean waves. Tonight, though, even the rhythm of gentle surf couldn't keep me from reliving every slice of the scalpel and the tying of every stitch. What could we have done better? Though part of me knew that the honest answer was nothing, when it's your husband or dad on the table, that's just not good enough. After three nightmarish hours of trying to rest, I lurched my sleep-hungry body down the stairs and rapped on Rick's door.
“How'd you sleep, Ricky?”
With red-rimmed slits for eyes, he wearily answered, “Like crap. Harry was up all night. Billy went out at three for something. Heard a bunch of choppers. I think I had to piss six times. But no pages on the kid. That's good, but I couldn't stop thinking about the damn oozing from that neck. Let's go eat, then check him. I don't think I had any dinner last night.”
He paused as he laced his boots.
“So who's the DS of the day?”
DS. Designated Saluter. Most of the doctors outranked everyone on the base, so a half-mile walk could easily have us returning three dozen salutes. To ease the strain on our arms and foreheads, we took turns walking one half step ahead of each other so at least one of us could make it to the DFAC, the chow hall, in peace.
With the best smirk I could muster, I replied, “You are, o great son of Oklahoma. And the salute of the day is the ⦠Boy Scout.”
Five minutes and twenty three-fingered Boy Scout salutes later, we made it to the DFAC for our typical breakfast of champions: powdered eggs, rock-hard bagels, and in Rick's case, four odd-looking, soggy excuses for grapefruits. He had restarted the infamous “Mayo
Clinic Grapefruit Diet,” which Rick claimed could peel off twenty pounds in two weeks or less. You eat a ton of grapefruit for breakfast and lunch, then have an all-you-can-eat, anything-you-want dinner, and voilà , off comes the fat! The only problem is, the Mayo Clinic says the diet is bullshit, which explained why Rick hadn't lost an ounce in the month he'd been following it.
I told him, “You're a moron. The âMD' behind your name stands for Moron Doctor. Does your wife know you're doing this?”
My tirade against Rick stalled as the rest of our crew staggered in and sat down at our table. It turns out we had gotten more business, in the form of a couple of guys who ran into an IED during the night. Bernard had to play bobbing for shrapnel in some guy's arm and leg for a couple of hours, after which Wild Bill pinned together a couple of fractures. Nothing too serious.
These wounded Americans would be fine and on a plane out of here that night, but would our guy be on it, too? Did his wife get the news yet? What was the family doing now as they waited for more information? The questions ate a hole in my brain.
A quick and fortunate shift in conversation led to current events and the topics of the day, as well as the ritual passing of the bottle. Tabasco. Down the line it went, splashing its way onto eggs, sausage, toast, biscuits, even Captain Walters's cornflakes. The banter was like a rapid-fire game show as we moved from one end of the table to the other.
First up was Sergeant Everson. “Best way to win the war is send Cheney on a hunting trip with the insurgents. That is fact, gentlemen.”
Staring at the news on the closed circuit TV, Walters was next: “Scooter Libby gets pardoned. How come no one pardons me for my gas?”
My turn. “I've got some great ideas on how we can wrap this whole thing up and go home. So how come Petraeus won't return any of my calls?”
Rick sliced back, “You shouldn't have sneezed when you were
doing his vasectomy.”
Even with a mouthful of cereal, Bernard had something to say. “Did Bush do any LSD at Yale? Maybe we're here because he's having some weird flashbacks or something. I mean, this whole place is like a bad acid trip.”
Bill Stanton decided it was his turn for a morning ballbust: “Rick, do you shit whole grapefruits or just wedges?”
The jokes were as lousy as the food, but we needed the laughs to help us cope with what we'd seen the night before and recharge our emotional batteries for what we'd face in the day ahead. We finished up and took off into a world filled with swirling sand particles so dense they threatened to block out the sun. Mouths shut tight and scarves wrapped around our noses, we snapped on goggles to keep our corneas from being sand-blasted and scarred.
The trek from the DFAC took more than its usual three minutes, delayed by saluting and dodging smoke-belching Humvees and gun trucks headed out on the day's missions. No one said it, but we were all hoping the same thing: that the number that went out would be the same that came back, and that no one would be making the return trip via medevac.
We cleared our weapons of ammo, double-checked the safety levers, and entered the hospital “complex” through a small break in the massive concrete blast walls. Rick and I headed straight to the ICU, closely followed by the rest of the doctors. We were thankful for any brilliant thoughts they might have, but more importantly for the support we felt from them just tagging along. We were a tight group: when anyone had a bad case, we all had a bad case. It was shared suffering.
Our kid was still alive, barely, but alive nonetheless. The ICU nurses, whom we called the “Angels of Mercy,” had spent the night keeping him comfortable: cleaning him up, combing his hair, and talking to him. I always wondered if the near dead could hear; it was clear that the Angels didn't even consider it a question. They just whispered
and spoke to the patient as if nothing was wrong, while the rest of us hid our fears and helplessness by playing the role of tough, unflappable doctors. We made busy looking at vital signs, respirator settings, and medication dosages. Then my eyes met the small table next to the bed. There sat the family snapshot, placed right in the direct line of sight of the soldier on life support. I bit my lip so hard it bled, but was saved when someone said we needed to get moving to make it to rounds on time.
The numbers this particular day weren't too bad. Besides a few Iraqis, we had the two soldiers in from the IED blast during the night, two Americans in the noncritical ward because of constipation-
induced abdominal pain, another American with pneumonia, then our kid in the ICU. We crowded into a tight circle, which grew even tighter when it was time for Rick to explain our case, what we had done, and the prognosis: bad. The only thing we could do was watch, wait, and bite our nails.
“This GI is in bad shape. We can't fly him. He's still oozing and leaking from somewhere deep in the neck. It's coming from the base, in the back, right at the spinal cord. I can't see where. Dr. Stanton cleaned up the blown-off arm and leg. Dave and I did the best we could with the abdominal wounds. That part's stable. We'll watch him for a few more hours, then see if we need to go back in for that leak.”
You could see a lot of eyes peering at the floor before we quickly moved on to three Iraqi patients who had decided to take full advantage of our hospitality.
By then, most of us had blocked out the chatter about the Iraqis and were mentally back in the ICU, standing over the bed of our most critical patient. The pressure drove us toward a rapidly approaching breaking point; we needed a laugh or else we'd cry. Our deliverance came in the unexpected form of a wounded Iraqi policeman with the name of Mohammed Focker. Which meant the next words out of Quick's mouth were, “So how is Mr. Focker this morning? When is he out of here?”
Since “Mo Focker” was an ortho case, a straight-faced Bill Stanton formally answered, “Sir, Mr. Focker is doing well. His fractured humerus is healing and Dr. Reutlinger has signed off the case since the gunshot wound is now closed over. We are simply waiting for disposition to his family or an outside facility.”
That statement was met with a spontaneous chorus of “Focker! Come on, get that Focker out of here, we need the bed!”
Dr. Quick: “What about Focker's family?”
A quick refrain from the medical choir: “Yeah, what about Dom Focker or Woody Focker!”
Poor Mo. He was actually a very pleasant man and cooperative patient who had absolutely no idea his name was oh-so-close to an American profanity that got wheels of its own from a popular Holly-wood movie. Little did he know his name brought our dark day a few minutes of light.
As rounds drew to a close, I snuck out to check the action in the ER. My shift actually started at seven, but I usually let the nurses and medics run the show for the first hour of my shift and only page me if there was a big problem. This day, the page came early. At 7:50, we got a static-filled radio call from “Badblood,” the medevac unit that flew in the wounded. The wording was terse: two urgent litters/multiple GSW/head, which, translated, meant two soldiers in critical condition coming in on stretchers with gunshots to the head. The medics went to work setting up the trauma bays with IVs and other equipment. The lab was called and told to warm up some blood. The OR was put on alert. And pages were sent out to the day's surgeons, Rick and Bernard.