We talked as we passed the mug back and forth. He was a helicopter pilot. This was his fourth deployment, second to combat, and he was weary from his nonflying, twelve-hour days monitoring message traffic. He asked about the things that went on at the surgical company. He had no idea what was happening two blocks away from him on the base. Like all good aviators, he avoided the hospital like the plague. Once I started telling him about my experience, I couldn’t stop.
I told him about the sergeant with the eye injury, and about the triple amputee. I told him about Dunham. Paul did not say a word but breathed a heavy sigh.
I debated whether to continue. Today had been the worst. I looked at my boots, kicking my feet together.
“I was on duty today,” I started quietly. Paul leaned forward, resting his elbows on his knees. “I was there at the hospital when a Humvee drove up in back. One of the independent-duty corpsmen from Division got out. He looked awful. We know him pretty well. He’s brought us a lot of patients. I’ve been kind of worried about him with all the casualties their unit’s taken.
“I said, ‘Hey, Chief . . . how’s it going?’ He just stared at me. When he did talk, he sounded like a zombie, almost like he was slurring. He said, ‘We couldn’t find his . . . head . . . ’ I focused beyond him and saw two of his guys walking up to the hospital with these large plastic bags. They were bringing them in as the chief was explaining the event to me.
“Apparently the bad guys are setting IEDs now in assembly-line fashion. One guy digs holes along the road, the next guy places the explosives in the holes, and the third fills the holes back in. Today, three combat engineers got out of their vehicles at one of these holes and were planning to fill the holes in before the explosives were placed, to interfere with the process. But apparently, the bad guys put the explosives in the mound of dirt next to the hole. One of the three Marines was bisected laterally, split in half the long way. Another lost both legs and his head. That’s the one the chief was talking about. A third lost his entire abdominal cavity. There was nothing for medical to do. While I was talking to the chief, another vehicle pulled up. They had found the one Marine’s head.”
Paul swallowed hard. I felt certain I had broken every rule in the book, saying too much to a nonmedical person, especially one I barely knew. I searched his eyes and didn’t see the answer. I went on.
“This was a long day, taking care of everyone involved. By about 1700 I felt totally deflated. I went to talk to Jason — he’s my partner out here. And he’s amazing. He’s always, always here for me. So I started to tell him about the Marines and the plastic bags. But today he cut me off before I could finish. He said, ‘Heidi, what can you and I do about this? Nothing. There is absolutely nothing we can do . . . so I just can’t hear about it today.’
“I didn’t know what to do . . . he is all I have out here. I mean, he’s right, there’s nothing we can do — and it’s so hard on him, hearing about this from our patients all day — but —” I choked on the words, remembering how I fought at the time to hold back tears in front of Jason. I clenched my hands together in my lap and lowered my head as if in prayer.
“I was going to say . . .” Paul said quietly. “Everyone talks to you. Who do you talk to?”
I smiled wryly and looked up at him. “Who’s the shrink for the shrink in a combat zone, right?” I shook my head.
The plastic squadron coffee mug was empty. Paul smiled warmly at me. It was one of those genuine smiles that told me he had no idea what to say but would sit there with me anyway. I closed my eyes for a moment. They stung.
We sat in silence for a short time. Then, obviously trying to change the subject, he cheerfully suggested that we look through his movies. He had a large selection, but we agreed that none really sounded good to watch that night. I took my leave.
The Marine sentry was still keeping watch in the tower. I waved at him. He waved back.
The shrink for the shrink in a combat zone, I realized, was simply that person who understood at any given moment. In the vast majority of those moments, that person for me was Jason. And most of the time, I trust that I was that person for him.
But if I had learned anything out here, it was that everyone needs a break sometimes.
So my shrink has also been a Navy nurse ten years my junior; the battalion chaplain who isn’t even my religious denomination; and on this day, a helicopter pilot with no medical background whatsoever.
Drifting into unconsciousness that night, I thought of one of my favorite M*A*S*H episodes, the one in which Margaret and Hawkeye get caught under direct fire while helping out a small front-line unit. As the roof of the building collapses on them, Margaret looks at Hawkeye, frozen for an instant amid the roar of surrounding explosions. In that moment, she feels unconditional empathy from a person who, because of that moment in time, will be her friend forever.
I hope everyone who has ever served in any war has met at least one Hawkeye.
Woman’s Best Friend
Sometimes, when a Black Hawk with its bright red cross landed on our pad in a swirl of dust, the patient brought in on the gurney was not a Marine, Sailor, Soldier — or even an enemy prisoner of war.
Sometimes the patient was a dog.
The Marines had a large corps of working dogs — beautiful, sinewy shepherds — who aided the mission in Iraq through the detection of explosives, weapons, and bad guys. Each dog had a Marine handler, and hundreds of these duos were spread throughout the country. The good news was the dogs were treated like royalty, with guaranteed air-conditioned spaces and terrific food. The bad news was sometimes they needed a doctor.
Our veterinarian was Army Major Tim Loonan, an extroverted man with a warm, engaging grin who had once been a paratrooper. Sharing resources with our operating room and intensive care unit had allowed Tim to build a complete animal surgical suite in the basement of the hospital. He knew of my fondness for dogs, so he sent word to me whenever he had a “lover” — a working dog that adored being adored. Not all of them fit this category. Whenever a lover arrived at Tim’s shop, I found a way to spend some time in the basement, talking to the gorgeous animal while I stroked his head and kissed the bridge of his long nose. In Iraq, I developed a new appreciation for pet therapy.
I believe Tim knew how happy I was to have this unique opportunity to escape the desert for a few magical moments with his canine charges, but I do not believe I ever told him how much I appreciated his role in saving one of my patient’s lives.
Sergeant Hutchinson, a petite brunette with freckles sprinkled across her nose, was a helicopter flight equipment specialist. Like many Marine pilots and aircraft maintenance personnel, she found herself in Iraq filling an unfamiliar role — in her case, as a member of an auxiliary support battalion. Grueling convoy duty took its toll on everyone in her company. But Sergeant Hutchinson had two other problems in addition to fatigue and vulnerability. She had a history of clinical depression, and she was the only woman in her company. She came to me early in the deployment feeling lethargic, weepy, hopeless, and fleetingly suicidal.
The sergeant and I had a heart-to-heart. She did not want to be sent home. Through tears, she begged to stay. Although she worried about how she would succeed, she said she wanted to finish the deployment to prove to both her unit and herself that she could. I believed her.
Jason and I worked together, combining antidepressant medication and intensive therapy to teach her to block her self-defeating thought processes. For a while she made progress and slowly experienced more energy and increased self-worth.
Halfway through the summer, the sergeant experienced the loss of one of her friends in an IED explosion. This caused a downward spiral in her functioning that I feared pointed to her medevac. She told me her future was hopeless. She spoke of falling asleep and never awakening. She and I worked long into the evening that day, and I could almost hear her fingernails digging in as she struggled to maintain her grip on her mental health. She held on.
The operational tempo of her unit increased, and she was unable to see me for almost two months. And then one day, four weeks before we returned home, Sergeant Hutchinson strode into our office a different woman. Her hair was pulled back, her cheeks were rosy, and I think I saw a trace of lip gloss. She smiled brightly. I had never seen her smile before.
“Our unit has adopted this puppy,” she started as she sat down. I had heard about several groups of Marines finding the orphaned puppies of wild dogs on base and making them unofficial mascots, feeding them with shipments of puppy chow sent from home. “Everybody liked him, but he always came to me. He sort of became mine. Anyway, I heard that some people were sending their puppies home —” My heart sank a little, immediately worried that my sensitive patient would be devastated if her plan did not succeed.
“So I came to talk to Major Loonan.”
I smiled, proud of her initiative. “He’s nice, isn’t he?”
“Oh, ma’am, he is so nice,” she gushed. “He took a look at Cocoa — that’s what I’m calling him, ’cause he looks like the color of chocolate. Anyway, he gave him all his shots and did the operation to neuter him. And we did the worm medication, too. Major Loonan says he’s in great health.”
I had to admit I was surprised. Tim would not have gone to all that trouble if there were no chance of this woman being able to keep this dog, would he?
“He said he has a friend in Kuwait who would keep Cocoa for the six-week quarantine thing. He said I just needed to arrange to have him sent to Kuwait. So I went and talked to the C-130 squadron, and they said sure, they’d take him.”
Patients rarely truly surprise me. I sat and stared at her.
“So Cocoa got to Kuwait, Major Loonan told me, and the vet there did all the customs paperwork and all that was left was an airline ticket. So my mom and dad got that, and they picked him up at the Detroit airport yesterday. They’re going to bring him to San Diego for me when we get home.” She sat back in her chair, crossed her arms over her chest, and grinned.
“Wow.” I shook my head. “That is just wonderful news! I am very proud of you. And you must be very proud of yourself, too.”
“I am, ma’am. You know how you kept telling me to start looking at the goals I had for my life once I get home? Like, to find the things I looked forward to?”
I nodded.
“Well, I figured out what they are. Cocoa came into my life for a reason. I have to take care of him now.”
“Good for you.”
“And I’m going to apply for the working dog program in the Marine Corps,” she added. “I figure once you know what it is you love, you might as well do everything you can to fit it into every part of your life.”
I believe good doctors learn from their patients every day. But I had never expected that in the middle of the desert half a world away, a female sergeant in the Marine Corps would define a new cure for depression.
HOME
On a blistering, windy August afternoon in Iraq, when even the wispiest cloud was a distant memory, my father wrote about rain.
Yesterday was a typical summer afternoon in the South — hot and muggy. Toward evening it clouded up and before I knew it, everything was dark and a severe thunderstorm had moved in. The trees were bent over; the street was overflowing, even with those big culverts you have. Your mom and I assumed our usual places out on the lanai with the twins to enjoy the show. We all clapped for the bright flashes of light and the especially loud thunderclaps. This has become a regular summertime activity for us.
Our technique appears to have worked, because when we picked up the kids one day last week after a particularly loud thunderstorm, their teacher told us that all the other kids were afraid of the noise and started crying — except Brian and Meg. The two of them apparently stood at the window and watched the storm, with smiles on their faces.
Have I told you lately that I love you? I do, and I am so very proud of what you are doing . . .
I sat for a moment, staring at my dad’s words on the laptop screen. My children, not even two years old, might never again in their lives be upset by the sound of thunder. I wondered if I would be able to say the same thing.
The Legend of the Camel Spider,
Part II
On a scorching evening toward the end of our deployment, Katie entered the room Karen and I shared with her, holding her tiny digital camera. I looked up from my book.
“Look at my picture of what was in the shower this morning.” She held up the camera so I could view the image. I inhaled sharply.
“Oh, shit . . . is that what I think it is?” We still had not actually seen one up close.
“Yep. Camel spider. As big as my hand. And I was only wearing shower shoes and a towel! Everyone over here was gone and I had no idea what to do, so I went next door to the guys.”
“In your towel?”
“What was I going to do? I couldn’t very well take a shower with that thing in there.”
I couldn’t argue with that.
“Bill was the only one there, and he came back over with me. But he had flip-flops on too. So we found a box in the dumpster. We picked the spider up and ran outside with it.”
“Did it jump?”
“No, it just kind of sat there in the box.”
“You let it go?” I was incredulous.
“Yeah,” she said, forwarding her camera to the next picture. There was the huge creature in all its dirt-colored glory basking in the sand outside the front door of our barracks.
“What did it do?” I imagined the shade-seeking monster chasing Katie’s and Bill’s shadows at five miles per hour once they let it out of the box.
“Well, I think it might have been sick,” she said thoughtfully. “It just sort of sauntered away.”
“Sauntered.”
“Right.”
The Little Boy
As the days of deployment drew to a close, I found it more and more difficult to pray. I continued to attend Mass every Sunday without fail, but my quiet time alone with my God, from which I used to gain strength and find peace, seemed disconnected and distant. A person not often at a loss for words, I found myself speechless in my soul.
Over pancakes one morning in the middle of August, Jason told me about a patient he had seen several days before, a young Marine whose job was to man the big gun atop a vehicle. Gunners were widely known, at least in clinical anecdotes among medical personnel, as those most at risk in the entire combat environment.
“He was on a convoy recently,” Jason told me. The syrup that morning was especially thick, settling around my pancake like a clear, tan-tinted frosting. I was determined, so I cut one piece with my fork and lightly dipped it in the blob. The actual granules of sugar were visible. I must have wrinkled my nose, because Jason smiled.
I moved on to powdered eggs, looking up at Jason. He was struggling with the pancakes as well.
“So their convoy moved through a little village,” Jason went on. “The street was lined with kids who were throwing rocks or yelling insults.”
Because many of the people of the Al Anbar province, in which we were stationed, were generally hostile to Americans, the Marines did not have the same opportunities as the Army did to see the waving and cheering Iraqis that were found in other regions of the country.
The Marine had told Jason that while he manned the gun, as they moved through the crowd of children, he saw a young boy, no older than five. The boy was holding a paper bag, scrunching the top closed in his fist.
While the Marine watched, the five-year-old child raised his arm back over his shoulder to throw the bag. Of course, children had been used in this exact manner before, taught to throw hand grenades or larger explosives, often hidden in paper bags, at convoys.
I lowered my fork and watched Jason, unblinking.
“He told me that protocol for him in that situation was crystal clear. His job was to neutralize the threat to the convoy.”
I realized I was holding
my breath, and exhaled.
“So he paused. Just for a moment,” Jason said. “He paused, and that little boy threw that bag right at his Humvee.”
I gulped.
“Nothing happened.” Jason finished the story and took a bite. “The bag didn’t have anything in it.”
We lowered our heads simultaneously, looking at our unappetizing food with numb ambivalence.
“My God,” I whispered.
Jason nodded. “He came to me distraught. He had put his convoy at tremendous risk with that split-second decision to wait. He took a chance, and maybe it was an involuntary decision. But that bag could have exploded and killed Marines, and possibly other kids on the road. He knew that. He also knew that he managed, in that split second, not to kill an unarmed child.
“What was I supposed to tell him? That he made the right choice? The wrong choice?” He shook his head and lowered his forehead to his hand.
“Can you believe that these sorts of absolutely insane situations face these people half our age every single day out here?” I asked him. “Do we actually, realistically, expect them to be able to cope with this and not have any complications?”
Jason did not have an answer for me. No one did, of course, but it did feel better to say it out loud.
“What did you do with the patient?” I asked.
“Just sat with him awhile. He talked some about guilt, and some about shame. He told me he needed to be sure of what decision he would make the next time.”
“Did you send him back?”
“Of course.” There were so few we did not. Despite their intense pain in situations just like this one, nearly to the man or woman, our U.S. Marine patients wanted to stay with their units.
“After all, he was fine,” Jason mused. “Just needed to cry a little and figure it out, I guess.”
Rule Number Two Page 13
