Rule Number Two

by Heidi Squier Kraft

  So strange, the things that made me long for home. Suddenly the thought of a real haircut was the most delicious I had ever experienced. I trudged down the passageway of the barracks to the head, and examined my air-dried hair in a broken piece of mirror propped up against the wall. I tucked a few stringy, sweaty strands behind my ears, put on my floppy hat, and strode out.

  One Good Eye

  An urgent call crackled through the speaker on my handheld radio. “Triage request for combat stress.” This meant possible cot-side psychological intervention for casualties. When I arrived, I found our sick call area busy, with less seriously wounded patients filling exam rooms and spilling into the passageway. In the center of the activity, Bill looked calm.

  “Let’s get these guys cleaned up,” he told one of the corpsmen, who guided three Marines in bloodstained uniforms to a cleared area in the passageway and seated them on cots. Each had been hit with shrapnel in his arms, legs, or face, but all three of them were walking and talking.

  Bill acknowledged me with a smile as he hurried back to an exam room. The power was out across the base and the hospital felt like a sauna, except in the OR, the ward, and the lab, where the backup generators ran the tiny window air-conditioning units. Bill’s blouse was off, and sweat darkened his green T-shirt and glistened off the 9mm pistol hanging over his shoulders in a leather holster.

  “IED?” I asked.

  “Yep.”

  “Just those three there?”

  “No, their sergeant’s in here.” He motioned toward the open door, hands full of supplies. He lowered his voice and leaned toward me. “He lost his eye in the explosion. The lid is intact, but the eye itself is just gone. Except for this single black rod, which might be the optic nerve.”

  I followed him into the exam room, where a stocky Marine with dark hair lay on the makeshift table. His slightly deformed left eyelid and superficial lacerations on his cheek and chin would never have suggested that the eye underneath was missing. He moaned as Bill opened his lid with gloved hands.

  “You okay, Sergeant?” Bill asked him. “I’m just taking a look here real quick.”

  “Sure,” the patient said quietly, biting his lip.

  I drew in my breath when I saw what was under his eyelid. A thin, dark stem of tissue protruded from the gaping empty socket. The Marine would be sent via urgent medevac to Baghdad to see an ophthalmologist. If it involved “life, limb, or eyesight,” the helo was here in thirty minutes.

  “Amazing, huh?” Bill whispered. I nodded as we looked at each other. Just then the Marine grabbed Bill’s wrist.

  “Hey, Doc?” he asked.

  “What’s up, Sergeant?”

  “My eye’s not going to make it, is it?”

  “I’m not going to lie to you, it’s not good,” Bill answered carefully.

  “My mom’s going to kill me,” the patient joked with a wry grin. Bill and I smiled too.

  “Hey, Doc?”

  “Yes?”

  “Is my other eye okay?”

  “It looks that way to me.”

  “Can I open it?”

  “Sure,” Bill said. “Let me get something to patch the injured one first, though, okay?” He motioned for one of his corpsmen, who moved in to place gauze and medical tape over the mutilated eye. The Marine asked for help to sit up, opened his intact eye, and scanned the passageway. He recognized the members of his fire team, who by now had their shirts off and were having their wounds dressed. He silently counted them.

  MICHAEL PHILLIPS

  He sighed with a smile, and gingerly lowered himself back to the cot.

  “Thanks, Doc,” he said, closing his eye. “I only have one good eye, but I can see that my Marines are okay.”

  HOME

  I attended Mass on Mother’s Day. During the sermon, the priest told the Marines and Sailors in the stifling auditorium that we should be thankful for our mothers and wives today. He said, “There are no mothers here, but if there were, we would ask God to protect them and send them safely home to their children.” Standing next to me, Karen exhaled sharply in exasperation and looked at me with big brown eyes. I smiled at her and bowed my head, giving thanks for my own mother and her great sacrifice for her child this Mother’s Day.

  The lines to call home snaked far from the entrance to the phone tent. I waited.

  I talked to my mom for most of my thirty minutes. She described a fantastic day, saying my dad, Mike, and the babies took her to brunch at the golf club. I thanked her for being there and for loving my babies. I told her I was okay and not to worry. I realized how ridiculous that sounded, but I said it anyway. Her voice tightened as she said good-bye and handed the phone to Mike.

  Mike told me Brian had recovered perfectly from the surgery. It really did last only five minutes, he said, and barely two hours after he had been under general anesthesia, Bri Baby was making fish lips on the glass of the hospital’s aquarium as they left. They already noticed a remarkable difference in his ability to hear.

  Brian’s wonderful baby squeals pierced the air as my parents tickled him in the background. Meg, who was sitting in Mike’s lap, reached for the phone. As he always did before he hung up, Mike told her to “say bye-bye to Mommy.” For the first time, she actually did.

  “Bye-bye, Mommy.”

  Rule Number Two

  Jason and I stood together at the front entrance to the hospital, watching as two sand-colored buses pulled up to the curb. The doors opened, and one by one, scores of men and women slowly emerged.

  They looked just a little different from most other people on our base. Their uniforms were not the new digital desert utilities worn by the Marine Corps and their Navy medical support personnel but the older tan-and-brown camouflage pattern. The men’s haircuts were just a little longer than the Marines’, the women’s hair pulled back just a little looser. Their hands were rough and tanned. Their faces were etched with the lines of years, and of years working outdoors in the sun.

  This was the Naval Mobile Construction Battalion, affectionately known as the Seabees.

  Their unit chaplain had come to the Combat Stress Platoon the day before. His eyes brimmed with tears as he begged for our help. Upon hearing the situation, Jason immediately asked our psych techs to cancel our appointments so we could accommodate four groups of fifteen to twenty Sailors each.

  It was 0800. The boots of the first group of eighteen Seabees pounded down the concrete steps to the basement of the hospital. The four of us waited for them downstairs in the whitewashed concrete room. Despite the two high-powered fans our Marines had set up for us, the temperature in the room was already intolerable.

  I surveyed the Sailors as they took seats around the circle and placed their rifles on the floor. All of their eyes appeared red and swollen. Their heads hung, and their shoulders slumped. Several of them held hands.

  “Good morning,” Jason started, his voice echoing in the large room. The hum of the fans became the only sound. He introduced us quickly and explained that their chaplain had asked us to meet them today. He turned to me.

  “First of all,” I said, scanning the circle of fatigued faces, “on behalf of my colleagues — I am so very, very sorry for your tremendous loss.”

  My words opened floodgates of emotion. Nearly half of the men and women in the circle released loud sobs, several leaning forward to cover their faces with their hands. Others embraced one another and wept. A stoic master chief spoke for the group.

  “Thank you, ma’am.” His deep voice trembled.

  “We realize that your emotion is very acute,” Jason spoke over the muffled crying. “We also know that it is very painful to speak of your grief. We appreciate your trust in us to help you move through this time.” A few of them looked at him and nodded.

  They started talking.

  Only four days prior, a group from their battalion had convoyed through western Iraq in support of the Marines’ combat engineers. A Humvee in their convoy, carrying four Seabees
, hit an IED and exploded. Two of their comrades were killed instantaneously in the blast. Another two were rushed to us at Alpha Surgical. I remembered them. One underwent extensive stabilizing surgery and was medevaced to Baghdad. The other suffered a traumatic brain injury.

  “Heidi, this Seabee from the IED attack — can you come over now and see him? I’m worried about a head injury.” Karen had rushed over to the barracks from the hospital to find me that day.

  “He is not making any sense when he talks,” she explained. “But it’s like he knows that he’s not making sense — because he is getting tears in his eyes trying to tell me something. He made a motion to me like he wanted to write, so I found him a pencil and placed it in his hand. He put it to the paper, eraser-side first. He tried to write but of course nothing happened. He just looked at me with these big eyes, tears streaming down his face. I turned the pencil around for him and tried to smile and be supportive. I told him to take his time. But when he tried to write, he couldn’t. He finally gave up, just sat and cried. I sat with him and held his hand for a while.”

  I had agreed to see him, but even as Karen and I walked to the hospital together, his medevac lifted off. Obviously, our surgeons had agreed with Karen’s assessment. He would be seen by the neurologist at Baghdad that same day and likely sent home as soon as possible. It was for the best, I thought. After all, what exactly did I think I would be able to do for him out here?

  I shook my head to clear the memory of Karen’s description of her patient’s pain and of my resulting feelings of frustration and helplessness. I focused again on the Seabees around me. One by one, they went around the circle and told us their stories.

  Most of their Seabee reserve unit had been together for over eighteen years. Their average age was thirty-eight. The unit had been divided when they arrived in Iraq. One group set up at Ramadi, a small headquarters base near Fallujah; the other at Al Asad.

  The IED attack on their convoy occurred four days ago. The very next day, still reeling from that loss, the Al Asad Seabees received more terrible news.

  While the Ramadi Seabees had gathered together in a staging area, enemy mortar shells fell on the compound. Six Sailors were killed and another thirty-two critically injured.

  The first group of Al Asad Seabees cried together. They expressed grief, anger, fear, and fatigue. They talked of survivors’ guilt. They left the hospital basement that morning emotionally exhausted, some of them physically supporting each other as they climbed the stairs.

  As they walked out, another group of sixteen filed in.

  For five hours, Jason, Petty Officer Patacsil, Petty Officer Gob, and I stayed in that basement room, our T-shirts stained darker and darker with sweat as each minute passed.

  The last group of Seabees climbed back onto their bus. We turned off the fans, closed the doors, and walked out of the basement together. Back in our little office, the four of us opened a box of meals ready-to-eat (MREs) and started trading for our favorites.* I found the cheese tortellini and traded HM2 Gob my Skittles for his M&Ms. We sat quietly, eating our brown-plastic-pouch lunches with our brown plastic spoons.

  The techs got up to leave. We thanked them, telling them to take the rest of the day off. We all chuckled.

  Jason and I stayed. The miniature wall air-conditioning unit in our office blew frigid air at our faces. We shivered as our sweat-drenched clothing now became overchilled. We sat next to each other on the hard folding chairs we had propped up against the concrete wall.

  I looked at Jason. He slumped in his chair, head leaning back against the concrete. His legs stretched straight out in front of him, tan boots crossed at the ankles. His arms dangled to his sides and almost touched the floor. He turned his head and looked at me. My posture must have looked nearly identical to his.

  “How ya doing?” he slurred good-naturedly. I managed a weak smile.

  “I feel like I’ve been hit by a Mack truck,” I stated simply. It was true. My entire body ached. Worst of all, though, my eyes burned and the base of my skull throbbed.

  “Well, if it makes you feel any better, we’ve just completed the equivalent of five hours of trauma surgery.” He smirked at me. “We just feel the pain differently than surgeons do. Their feet and lower backs hurt. Our heads hurt.” I nodded.

  “Did you ever watch M*A*S*H?” I asked him, moving only my eyes to look at him.

  “Sure.”

  “I remember this one episode. Hawkeye sees a friend of his from high school. He later operates on the friend and loses him on the table. He is distraught.” Jason nodded.

  “So after surgery, Henry comes to talk to Hawkeye. Henry tells him that when he went to school for commanding officers, he learned that there are two rules of war. Rule number one is that young men die. Rule number two is that doctors can’t change rule number one.”

  Jason looked away from me, staring at the wall ahead of him. We sat together in silence for a long minute. Finally, in an exaggerated motion, he sat up and helped me do the same.

  That afternoon, feeling useless to do anything else, I wrote in my journal about the two rules. I found myself astonished that even fifty years after the Korean War, some things still seemed very much the same. We still heard the helicopters coming, waited for them, ducked our heads, and ran to bring our patients in on canvas stretchers. We still wrote on patients’ chests with ink so their next doctors would know what we had done, and we still operated on gurneys made into OR tables.

  There were differences too, of course. With body armor that often protected our warriors from fatal torso injuries, perhaps Henry’s line to Hawkeye would be slightly different today. Rule number one might now state that war damages people. Rule number two, of course, would be unchanged.

  I was certain of one truth, though, that Henry might not have learned in his course fifty years ago: War damages doctors, too. They are damaged by rule number two.

  The House of God

  The medical officer for Naval Mobile Construction Battalion, a Navy Captain, happened to be a psychiatrist. Jason knew him from his time with the Marines, and I knew him from my aviation tours. We both liked and respected him.

  A short time after we conducted those marathon debriefing groups for his Seabees, Captain Koffman contacted me to say he would be visiting Al Asad to check on his battalion and asked to meet with Jason and me. He also invited Gary, the psychologist assigned to the Marine infantry battalion on base. Gary operated in isolation much of the time due to the frequency of his Marines’ missions outside the wire (off the base). When I imagined how difficult it would be for me if I were in his place, I worried about him a little.

  When the captain arrived, the three of us were waiting. He wore the uniform of the Seabees. We entered our small office space and closed the door, taking seats that faced each other.

  “So,” Captain Koffman began, making eye contact with each of us. “Since I was here anyway, I wanted to use this opportunity to check in with the three of you.”

  Having expected questions about the Seabees, we sat in surprised silence.

  “You’ve been here over two months.”

  We nodded.

  “How are you doing?” He spoke the words deliberately, dark eyes focused intently on us.

  We glanced at one another, shifting in our chairs. I cleared my throat.

  “Uh, well, I think we’re fine, sir.”

  Clearly unconvinced, he moved his eyes to Jason and Gary, who nodded in earnest agreement.

  “What sorts of things are you seeing most?”

  We were ready for that one. We knew the number of patients our little clinic had seen, the diagnosis categories, and our medevac numbers, which were low.

  “These Marines, they don’t want to be sent home,” we told him. He nodded.

  “So we tend to keep them out here with us.”

  “Is it mostly Marines you are treating?” he asked. “What about the medical providers with you? Are you able to help them process some of what they a
re witnessing?”

  Jason and I laughed. “They don’t want anything to do with that, sir,” Jason said. “There was one case we dealt with, a little girl. Pretty traumatic for everyone. After that, some of them asked to talk. But for the most part, everyone’s doing okay. At least that’s what they’re telling us.”

  “Do you believe them?”

  “I don’t know. Everyone seems like they’re hanging in there. It’s been a long couple of months.”

  “How are you dealing with it all?” he asked.

  Not unlike the way our reluctant patients often looked at us, we sat quietly and stared at him. Four shrinks in one small room, I mused in silence, hiding a tiny grin. Someday, I imagined, I would think back on this moment and chuckle.

  “How are the Seabees doing now, sir?” Jason asked. The captain smiled a little and took the bait, thanking us for our care of the Al Asad battalion. Happy for Jason’s skillful deflection of the senior psychiatrist’s attention, I mentioned that Jason and I had attended the Seabees’ memorial service, adding that I had not realized how much I missed our national anthem until it was played that day. I think I said something about that moment, the sudden appreciation of “The Star-Spangled Banner,” being one I would never forget.

  The captain asked about other moments we would remember. Jason and Gary paused, so I jumped in.

  I told him about Dunham. I intended my story to be brief, focusing on the fascinating clinical details about the changing status of his head injury and the strength of his spirit. But somehow it ended up about us, about our connection with our Marine, about the delusional hope that he would recover, about the crushing news of the death we all knew in our hearts was inevitable.