Rule Number Two

by Heidi Squier Kraft

“You cured him in one session.” I grinned, trying to lighten the mood. Jason appreciated the effort, I could tell, but did not return my smile.

  Jason’s story followed me throughout my day of seeing patients, invading my thoughts whenever I had a moment of silence. I thought about his young patient, this warrior of eighteen who came face to face with a decision most people could never fathom. I was impressed with Jason’s clinical acumen, as always, and his understanding that the Marine just needed to cry.

  That night, as the brilliant red sun dipped below the desert horizon, I curled up on my cot in a modified fetal position. I did it on purpose. Hugging my knees and rocking slightly, I hoped that in this childlike posture I would feel something in conjunction with Jason’s story. After all, I used to feel when I was a kid.

  It didn’t work. My limbs, my eyes, and my heart felt anesthetized.

  “Heavenly Father,” I began out loud, desperate. I paused. I wanted to ask Him to take care of Jason’s patient and all other Marines in his role, and to comfort their aching hearts. I wanted to ask for His protection for the children of Iraq, keeping them out of harm’s way. I wanted to ask Him to watch over our surgical and trauma teams and to help them someday wash off the blood. I wanted to ask Him for strength for Jason, for our techs, and for me as we waded every day through the fear and grief of teenagers. I wanted to beg Him to guard Mike and my babies and bring me safely home to them.

  I knew what I wanted to say. But the words eluded me — falling, unspoken and deadened, somewhere far away.

  “Help,” I whispered to the darkening room. I allowed my eyes to drift shut and sleep to overtake me.

  I figured He knew what I meant.

  HOME

  I sat in the Internet café one evening in late August reading my father’s daily e-mail account of life in hot, humid Florida. He and my mother were tired, he wrote, but their fatigue was their own doing. After all, they had been up late every night watching the Olympics.

  The Olympics.

  I pushed my chair back, away from the laptop, and stared at the screen. I had forgotten about the Olympics. Like most Americans, I loved watching our elite athletes compete against the rest of the world for gold. Seeing them graced with flowers and medals, tears streaming down their faces as they listened to “The Star-Spangled Banner,” always made my heart swell with pride. They were their country’s heroes in those moments.

  Walking back to the barracks, I suddenly longed for the national anthem. I had not heard it played at all out here, with the exception of that one tape-recorded version played at the Seabees’ memorial service.

  I wondered about Corporal Dunham. If the investigation into his death concluded that he should be awarded the Congressional Medal of Honor, a special ceremony would be held at the White House, “The Star-Spangled Banner” would play, and Jason Dunham’s mother would cry. She would probably receive flowers, and she and his father would accept the beautiful light blue medal on their son’s behalf. Would even a tiny fraction of Americans see the president bestow the nation’s highest award?

  I am certain that before I left for Iraq I had known this would be a Summer Olympics year. But I had allowed myself to forget. It was nothing against our athletes; I felt proud of them, as always.

  They simply were not my heroes anymore.

  The Last Patient

  In the States, football season was under way. In Iraq, the only signs of autumn were high temperatures just under the summer’s peaks of 132°F. Our seabags were ready to go. Our flight home was scheduled. Most important, the members of our replacement surgical company had arrived.

  I set my radio and pistol on the desk in our small office, and HM2 Gob briefed me on the history of my final new patient in Iraq. We would turn the hospital over in several days. An air of excitement enlivened us as we marched through our final clinical days at Al Asad — as palpable as the fear and uncertainty that hovered around our replacements.

  Gob introduced my patient and left the room, closing the door behind him.

  The gunnery sergeant’s arms stretched the fabric of his desert utility uniform taut. A pistol was strapped to his right thigh. His face was sunburned and his hair was light brown, graying at the temples, and closely cut in the Marine high and tight, the nickname for the standard Marine Corps haircut.

  “Good morning, Gunnery Sergeant,” I said, extending my hand.

  “Morning, ma’am.” He gripped my hand tightly and looked straight at me.

  We both took a seat.

  “Petty Officer Gob tells me you’re experiencing some difficulty sleeping lately?”

  “Yes, ma’am.”

  “Nightmares, too, I understand?”

  He nodded.

  “Any disturbing images you are unable to get out of your mind?”

  “Yes, ma’am.”

  “What can you tell me about those?”

  His light blue eyes appeared distant and glassy. He exhaled sharply and looked at the floor.

  “I was standing in front of the exchange the night of the first attack,” he started, his voice cracking. “When that first rocket came in, right next to us really, shrapnel hit several of my Marines. I remember I looked at Corporal Overton —” He paused and looked at me. I nodded. “And he was just lying there. He wasn’t moving. I couldn’t tell if he was breathing, but I knew it was bad — there was blood everywhere. I threw him over my shoulder and carried him to the hospital — it’s about two hundred yards, but it felt like two miles. I yelled out for someone to help me, and a few corpsmen ran out, put him on a gurney, and took him inside.” He screwed his eyes shut.

  “What did you do when they took him inside?” I asked.

  “I just sat there for a while. I didn’t know what to do. It was so crazy, I felt like the only thing to do was to get back to my unit — so I left. I left him there, to —” His voice faltered. He swallowed hard and lowered his gaze.

  I nodded again. I remembered.

  I had seen Corporal Overton’s body in the basement of the hospital that night, the first of many nights during which rockets pounded our base. His boots had been removed and were neatly placed at the edge of his gurney on the dusty and cracked tile floor.

  A scratchy green wool blanket covered his body to his ankles, and his toes peeked out. A thick crimson stain spread across the floor from under his head. Upstairs, the boots of the living pounded on the tile, and voices yelled commands. Once it was determined that shrapnel from that rocket had penetrated Overton’s brain and killed him instantly, someone had carried his body to the basement to make room for other injured patients. It was battlefield medicine. Triage demanded it. We hated it.

  I refocused on the gunnery sergeant’s face.

  “I was doing fine for six months, ma’am. I didn’t really even think about it once we buried Overton. But now, suddenly —” He extended both arms in front of him, making fists with his hands.

  “I keep seeing pieces of his flesh on my uniform — and his blood is everywhere. It’s all over me — and I can’t get it off —”

  He opened his hands and turned them up. He examined his trembling fingers for a moment before lowering his elbows to his knees, and his face to his palms. He began to sob, his big shoulders shaking.

  Pulling with the heels of my boots, I scooted my chair across the dusty floor until I was sitting squarely in front of the weeping Marine. In a gesture unlike anything I have ever done in a normal therapy situation, I reached out and touched his arm. He looked up.

  I took both his hands in mine. There was nothing normal about this situation.

  “I remember Corporal Overton, Gunnery Sergeant,” I whispered to him. “We all do. His death touched us and we will never forget him.”

  He was the first Marine we had treated who was killed in action. How could we forget?

  “I am so very sorry — for your loss.”

  He stared at me. We sat in silence, battling different gruesome images of the same young man’s death.

&
nbsp; “Thank you, ma’am,” he finally breathed.

  “What you’re going through is a traumatic injury. What you endured that day, seeing your men injured seriously, carrying your Marine to the hospital — is not a normal human experience. And you dealt with it through denial for the last six months because you had to. You functioned and you did your job. Now it’s time to pay attention to it. That’s all. You are dreaming about him and seeing his blood again because your mind is trying to tell you — it’s time.”

  He nodded, searching my face for reassurance that he was not going insane. I smiled at him. He was still clutching my hands.

  “You’re going to be okay,” I whispered.

  In the beginning of my deployment, there were tears of loss. Today my eyes were dry. Early on, there was a deep ache in response to my patients’ distress. Today, my nerves were deadened.

  As a clinician, I knew that human beings develop coping mechanisms to adapt to chronic trauma. I realized that emotional numbness had become mine.

  At least my patients could still cry.

  Cheeseburgers,

  Part II

  On our last official day as the Combat Stress Platoon of Alpha Surgical Company, Jason and I joked to our psych techs that we would treat them to a delicious breakfast. Together, the four of us walked to the chow hall. Petty Officers Gob and Patacsil filled their trays and sat across from Jason and me at the long table. It was rare that the four of us sat together and looked at one another. We had simply been too busy.

  A psychiatric technician is a specialized hospital corpsman in the Navy. During peacetime, he supports the psychiatrists and psychologists of his clinic. As a member of a combat stress platoon, however, the right Sailor has the opportunity to move far beyond a support role and take on the responsibility of direct patient care. Gob and Patacsil were the right Sailors. They not only directed our team’s schedule, they conducted all of the histories for our new evaluations, carried therapy caseloads of their own, and managed all emergencies. During the entire seven-month deployment, I was paged to the hospital in the middle of the night only a few times. Gob or Patacsil always took care of things. In doing so, they took care of us.

  Jason and I told our teammates that morning that we were proud of them. We thanked them and said we couldn’t have done it without them.

  Gob and Patacsil simply shrugged. Just doing their jobs, they said.

  Then the four of us got up from the table, dumped our trays, and hiked several miles across our sprawling base to the Mortuary Affairs compound, where we would conduct our last group therapy session as a team.

  The Marines of MA had requested our return. As we all sat down, I marveled at how these same twenty-five faces around our circle looked so much calmer, so much older, and so much more exhausted than they had those many months ago.

  When we first met these men, they had been afraid. But now, on this stifling Iraq morning in late August — three days before they left for home — they were angry.

  They were angry that U.S. Marines had to die. They were angry that they were the ones to take care of mutilated bodies. They were angry that no one understood what they experienced. They expressed concern about what they should share with their families. They worried about traumatizing others.

  Finally, and most significant, they were angry — grieving, actually, although they did not realize it — that their unit was being split up to return home. They had been pulled from many different commands for this deployment. Now, as they were about to say good-bye, they realized their only solace had been in one another. The men sat around the circle that morning with the only other people in the world who understood.

  During our session, they made arrangements for their first reunion, for e-mail correspondence to a group list, and for a standing plan to check in on everyone. This was most certainly second best to being sent home as a unit and to staying together, but it was the best they could do.

  The four of us left them that morning and walked back to our barracks in silence. Although the Marines of MA had performed their jobs with honor and learned the value in trusting one another, we worried about them. They were a special group out here, exposed to chronic and unrelenting trauma. And now they were being split up, each facing the future alone.

  We wondered if others might say the same thing about us.

  Drowning

  I dreamed about camel spiders a lot. They reared and hissed and ran and jumped all around my subconscious. This particular night in late August, I dreamed I was trying to nudge one out of our barracks room with a shovel. The strategy was not working.

  The next moment, our windows rattled and the walls trembled and the foundation rocked with such force and sheer volume that I physically fell out of my cot. I landed with a jolt on the concrete deck, instantly awake. Reaching under my cot, I grabbed my helmet and clumsily strapped it on.

  “Shit!” Karen screamed from across the room. She and Katie were also getting into flak jackets and helmets. The explosions came fast and loud, as if encircling our barracks.

  “We are going home in one week, you assholes,” I said loudly to the windows. “One week. Do you hear me?” The next crack sounded farther away. From her cot next to me, Cat grinned.

  “Ooh-rah, ma’am.”

  “Cat, what will I do without you?”

  The rockets stopped. The four of us got up and walked to the head at the end of the passageway. We all wore either workout clothing or scrubs — with flak jackets and helmets, of course.

  Our watches read 0510. The women of our company stood sleepily outside their doors, waiting for the all-clear call and the accountability report from the hospital. The women of the replacement company huddled together in one corner, white and trembling. This was their first attack.

  Today, the hospital would be entirely theirs. We would turn over responsibility to them at 0700.

  None of us could return to sleep, so we started talking. Katie had been on duty last night to train the new ward nurses. When we asked her about her night, her expression remained stone-cold. Karen, Cat, and I sat on her cot around her, figuring she needed to talk.

  She did.

  Last night, on its last official day of responsibility, Alpha Surgical Company lost its first patient on the operating table.*

  Three casualties had come in at 2200. Two of them were stabilized in the SST. Both trauma teams, ours and the new group’s, were there, making for a lot of medical people in the room, but also for a lot of experience.

  One of the three patients was critical. He had been shot in the abdomen. Katie said that he came into the SST talking. He said his name was John. She held his hand and told him she was there. He kept his eyes locked on hers, and she told him not to give up. As the team worked to stabilize his wounds, his blood volume dropped and he was taken to the OR. Katie said she noticed his eyes go dull at that moment. She knew he had stopped fighting.

  She took a deep, shuddering breath and continued her story.

  He was raced to the OR, but his vitals began dropping dramatically while the chest tube was being placed. The OR team worked on and on but could not stop the bleeding. John died just after 2300. At 0300, Katie returned to our barracks to try to sleep.

  We looked at Katie. Her expression was frozen, a pale mask of numb shock. Karen held her hand.

  “Our last night. Our last patient. I watched him give up. I watched him die. There was nothing we could do. I am done. I am done with this.”

  Karen scooted over and wrapped an arm around Katie’s shoulder. Katie rested her head on Karen’s shoulder, her eyes staring straight ahead, unblinking.

  Later that morning, Debbie, our nurse anesthetist, approached me and asked if we could talk. Her bloodshot eyes told the story before she did. She said the OR staff appeared to be struggling over John’s death the night before, and she asked me to talk to them.

  Debbie and I spoke for a few minutes. She expressed the same grief and frustration I had heard from Katie. She told me she
felt out of control.

  “I told the OR team that the patient’s pulse was forty-five,” she remembered. “Then, about ten seconds later, I told them it was thirty-seven. The chest tube was almost in, and I looked up and it was twenty-seven. It was the next second that I didn’t have a pulse. I yelled at everyone that I didn’t have a pulse — I kept saying it over and over again — there’s blood all over the floor, he’s bleeding out —”

  She exhaled and bowed her head. I sat quietly with her in the shade of the building and waited. We sat together in silence for several minutes. Finally, she nodded at me, got up, and walked to her tiny room in the hospital, head down.

  Over the next few hours I talked with several of the company’s OR techs, the corpsmen who assist the surgeons. As the morning wore on, I heard the same story — about John talking, telling them his name and what happened when he was shot, his heart rate dropping, his suddenly bleeding out, his dying in front of their eyes.

  When everyone was through talking at last, I headed back to the barracks. I sat down on my cot, unstrapped my holster, and laid my pistol next to me. I took in a deep breath and released it slowly. The next breath felt shallow and tight. I immediately struggled against it.

  Suddenly, I was overcome by a sensation of actual drowning. My lungs burned and my breathing shortened and thinned. The few colors in the room around me turned to gray. I felt there was absolutely no way I could tread water for one single moment more before I went under.

  Thankfully, I did not have to. The mini–panic attack passed as soon as I realized the reason for it. I was allowed to feel everything at once. Alpha Surgical Company and the medical care of the U.S. Marines in western Iraq belonged in other hands as of 0700 today.

  It was over.

  HOME

  Kristen, one of my dearest friends from the Navy, married the love of her life over Labor Day weekend. All of the girls who had been inseparable since our time in flight surgeon school drank champagne together at her wedding in Virginia, except for me; I sat in a dusty Internet café in the middle of the desert. An e-mail from Margy described the fantastic night.