Paradise General (23 page)

Many of the medics went outside to smoke cigarettes. And as
each burst of sandy wind whipped through the dark sky, Warren Ward slowly looked up and shook his head.

The insurgent took a long time to die, maybe too long. I expected to have my ass handed to me on a plate the next day, but no one said a word. Not that day, or the rest of our days. It was the best medical decision I had made in my time at the CSH. It was also the first time in my Army career I had ever actually given an official order. I was happy about the former, proud of the latter.

Some say all human life is equal. Yet I valued the lives of my people more than that of a man who planted bombs. I hoped my people all made it home safely, and that I was, in some way, part of making that happen.

H
OW COME IT
took so much time to get the damned blood?”

The question came from one of our nurse anesthetists.

“We hurried as fast as we could. I have to account for every unit of blood that leaves the lab and make sure it's what's been ordered by the ER.”

The lab director looked hurt as she answered.

“Well, it still should have come faster,” came the reply.

“And I want to know what took so long to get the portable X-ray into position.”

That accusation arose from a different voice near the rear of the tent.

The defense angrily answered from the front row.

“It was there in plenty enough time. We were just waiting until we were cleared to enter the bay.”

The verbal pitchforks had been flying for close to an hour as we stuffed ourselves into a musty tent to dissect the worst case of our deployment: the first American soldier to die on our watch. He was killed the day before, but instead of healing, time was salt in our
wound. A day after his death, we all continued to sink deeper into the quicksand of depression.

Now came the question I was hoping we'd never have to answer, especially after busting our humps to save insurgents. How would we react after losing our first American?

Colonel Quick was a silent referee. He sat quietly at the front of the tent, rocking back in his chair, peering over his glasses as a collection of the hospital staff pointed imaginary fingers of blame around the tent. As for the doctors, we just sat there, our fingers silently pointed at ourselves yet offering nary a word aloud. In reality, there was enough blame to go around, none of it deserved. There was nothing anyone could have done to save this kid.

Ironically, the day of his death had started on a high note, with us feeling pretty good about ourselves. We were in a groove—a nice rhythm where we were working well together. We knew our jobs. Knew our limitations. And who we could count on to bail us out when we were in a medical fix. We joked at breakfast over the perks of life in the Army: free food, free drop-off laundry service, and no traffic jams; hell, we walked to work every morning. Even better was the absence of insurance companies. We lived in a world of minimal paperwork where if we wanted a test or treatment, there was no second-guessing or pleading over a telephone.

We were even getting the hang of attacking the monotony of the menu. While Rick still ate his pile of daily grapefruits, I wanted to patent my breakfast invention: “Corn Krispie Cap'n Cocoa Loops”—an overflowing concoction that, when drowned in a carton of warm Turkish milk, tasted like a bowl of dirty socks. But at least it had taste, a surefire selling point in a place like Iraq.

The rest of the breakfast discussions centered on the upcoming cases of the morning: the cleaning out of wounds in the operating room—basically a power wash of day-old gunshot and shrapnel holes; weaning some guys off ventilators to see if they could breathe on their own; and finally, trying to kick an especially nasty insurgent out of the
ICU and transfer his ass to a prison hospital in Baghdad. This guy was a real prick. He'd had several hours of life-saving surgery done by Ian and Bill but when he woke up, his thanks were delivered with a thick load of spittle in the face of the nurse trying to change his dressings. So now he wore a “spit mask”—a surgical mask taped tightly so the only place the spit could travel would be back onto his own face.

As we finished breakfast, a tug on the sleeve brought some good news: Bill said he had hustled up a couple of baseball mitts and a softball. We'd head over to an open field after lunch and play a little All-American catch.

In the meantime, we all had work to do. I wasn't on the schedule, but figured I would spend my morning helping wherever help was needed. My first stop was an overflowing ER. Every bay was filled, every curtain drawn. Mike was running his ass off, evaluating patients and flinging orders in every direction.

I threw out a generic “Which bay do you need me in?” to the room.

The answer from the middle of chaos was a classic.

“Hey, who's in Alpha, what's in Bravo, and I don't know who's in Charlie. But I don't give a damn.”

I was now working with Drs. Abbott and Costello.

The only thing in the coffeepot was the overcooked, burnt residue of the morning's brew—no one had time to make a fresh pot and a thick skin of dead coffee lined the bottom of the carafe. I poured in some water, swirled it around, and drank the foul concoction as quickly as my throat could swallow it, just in time for an Iraqi policeman to be stretchered in.

The Iraqi cops were an odd lot. By day, many played cop for the fledgling government; by night, they changed into their insurgent clothes and planted roadside bombs. They often wore a patchwork of shirts and pants; sometimes the only official piece of uniform was an armband that said “Police” in Arabic lettering. No matter, we were an equal opportunity hospital: show up at the door and you got care.

Usually the wounded came by chopper; after being shot in the chest, this guy was simply thrown into the back of a Humvee and quickly trucked over bumpy roads to the CSH. It was the kind of wound that distinguished the Iraqis from Americans; they didn't have body armor and a sniper shot was usually aimed at the chest. Americans, on the other hand, were targeted differently, with unprotected necks, armpits, and groins the targets of choice.

We hustled a soldier with a minor IED headache out of Delta bay as I took the combat medic's report. The displaced soldier looked flustered until he saw the stretcher with a bloody shirt and the chest inside it heaving for air. He scooted quickly to a folding chair at the end of the room, knowing it would be a while until his turn came.

The report was succinct with little emotion.

“Gunshot wound to right thorax. Sucking chest wound. Chest tube with flutter in place. Vital signs up and down. Some other dings and dents but nothing too serious except the chest.”

The medics and nurses went to work. After more than a year of trauma care, they had seen it all, and needed little direction. Their requests for IVs, blood, pain medication, and antibiotics often sounded more like “this is what we're doing and we're only asking because the rules say we need to.” Fine with me—it made things move more quickly and allowed me to concentrate on the big picture. I usually answered them with quick nods of the head or monosyllabic “Yeps.”

I checked the Iraqi from head to toe. The only thing I could find was a bright red eye staring at me from the right side of his chest; it was the hole where the bullet entered. When we rolled the patient onto his side, I did a quick exam—no open holes in the back, so the bullet was still somewhere deep inside. The tube in his chest acted like an oversized straw, sucking a steady flow of bright red blood out of the area around the now collapsed lung. I paged Rick and Bernard—this guy needed to go to the OR before he bled to death. I would scrub in to help.

With a deft swipe of the scalpel, Bernard opened the chest while
Rick spread the ribs to isolate the bleed. On the surface of the skin, the wound didn't look like much—but when the bullet entered the chest, it hit a rib. The bump sent the bullet tumbling, tearing and mangling tissue as it traveled deep into the lung.

“I think the lower lobe is done for, guys,” Bernard said as he surveyed the inside of the bloody chest cavity.

Rick peered into the mass of bloody tissue.

“It's hamburger, Bernard. I don't think you can isolate the bleeders.”

“What do you think, Dave?”

“Wedge resection?” I answered.

“Correct-a-mundo. We are going to turn you into surgeon extraordinaire by the time we we're done with you. Just watch your fingers now.”

With the speed of a sewing machine on steroids, Bernard and Rick rapid-fired dozens of staples into the middle of the lung, then like a Thanksgiving turkey, cleanly carved away the irreversibly damaged portion of lung.

Like two of the Seven Dwarfs, they whistled as they worked—
today's musical choice on the boombox in the corner of the cramped OR was the Eagles' “Hotel California.”

I was afraid to ask Rick what he thought the name of the song was. “Go Tell It, California” was my best guess.

The patient might not have the wind he used to while running, but at least he'd live to run again. And within the week, he'd be able to check out and leave.

When we left the OR, the war was still going on. Word filtered in that a convoy had been hit by a series of roadside bombs. Details were sketchy, we could be getting anywhere from zero to five casualties. They'd let us know.

I walked the fifteen steps into the ER and plopped down with a couple of the medics, shooting the breeze about everything from whether baseball was a dying sport to the hidden philosophies of a
rapper named Lupe Fiasco. I didn't know who or what a Lupe Fiasco was, but the medics seemed to know everything from his favorite food to his shoe size.

As we chatted, I subtly examined their faces. When confronted with the spurting blood and moans of a trauma case, they seemed old. Not older. Old. Now, in a quieter time, they looked young enough to be thinking about going to the high school prom. I wondered what they would be like when they finally went home, away from the day-to-day companionship of those who understood what they went through each day of their deployment through hell. And how their old friends back home probably wouldn't recognize, let alone relate to, them. I hoped it wouldn't be a fiasco.

Wild Bill Stanton wandered into the room.

“Dude, sounds like a game of catch is out for the day.”

“Looks that way, but let's see what this case is. Maybe we can sneak out later and unleash some wild throws,” I answered, hoping to do something
normal
.

It wasn't to be.

The next hour was like going to bed and having a nightmare erupt as soon as your head hit the pillow. And no matter how hard you tried, you couldn't wake up. Then you realized it wasn't a dream, you were actually living the nightmare.

The follow-up call on the radio seemed innocent, the metallic voice telling us we had a single soldier being flown in. He was awake and alert, though in a lot of pain from his vehicle being blown into the air. Blood pressure a little low, but stable. All seemingly routine. One minute from landing, this young talkative soldier suddenly went quiet and suffered a cardiac arrest. It happened so fast there wasn't time for another radio call. The pilots jacked the rotors and made an acrobatic landing as our medics stood waiting on the landing pad, trying to decipher the meaning of the abnormally steep bank, crazy descent, and skidding stop.

Inside, we stood waiting, expecting urgency but not emergency.

The double metal doors made a sharp bang as they burst open and struck the side walls of the room. In an instant, we were transported to the trauma
Twilight Zone
—time quickened and people's movements became blurred with speed. Yet I was still able to hear the ticking of the wall clock and clear single sentences spoken from across a chaotic room. I could even distinctly make out the sound of squealing wheels of the stretcher as it raced toward Alpha bay. The soldier on board was pure white. Yet not a drop of blood to be seen. Little specks of dirt and grass on the front of his uniform, that was all. And no pulse.

The medics frantically performed CPR as they ran alongside the stretcher. IVs were started, medicines administered, a yell for blood creased the air. There was a hint of heart activity on the monitor but still not strong enough for a pulse to be felt. Sharp commands of “Clear” were shouted as the paddles were applied to his chest. One shock. Two shocks. Then a third. A quick pause as rapid exams were done to search for some hidden clue to what caused this soldier's heart to abruptly crash. There simply wasn't time to use special scanners or X-rays—it was all gut feeling and experience to figure out why this young man was dying—and there were only seconds to get it right.

The mournful answer came quickly.

With many explosions, the problem is often what you cannot see. The pressure waves from those blasts don't always leave a mark on the outside, but can shatter bones and rupture organs on the inside. And that clearly was the case with this young soldier. As the staff rolled him on his side to examine his back, only the upper half of his body moved; his legs and feet remained pointed at the ceiling. The force of the blast had shattered his pelvis, and his spine disconnected from his legs. It was always a fatal injury.

We lost him.

You never wanted to call it quits. No one wants to be the first to say, or even think aloud, “I think we're done.” Yet, quietly, the dreaded question finally entered the trauma bay: “Does everyone
agree we can't do any more?”

It was the worst question with the worst answer. But we never stopped until all agreed. It was a rule of respect for everyone present who had worked to save this life. The answers came with curt bobs of the head and barely decipherable murmurs.

Yes. It's time.

The soldier was gently cleaned and all signs of the medical trauma we inflicted were repaired. He was redressed in his uniform. The staff lined up and stood at attention as the soldier was wheeled out of the emergency room. The last time we would ever see this soldier was during this “Walk of Honor.”