Paradise General: Riding the Surge at a Combat Hospital in Iraq

by Dave Hnida

  “Multiple shrapnel wounds. Gunshot to left chest. Partial amputation right leg. BP 90/50, pulse 150, respirations 30. Ten milligrams of morphine on board.”

  I gave a quiet nod at Twomey as the stretcher came into the bay headfirst and my eyes went to the body writhing before me. There was blood everywhere and crooked splinters of bone where a leg used to be. Easy as A-B-C, Dave. I quickly scanned the patient and forced myself to ignore the missing leg. A snug tourniquet had that problem under temporary control, but the bone splinters lying upon a blood-saturated sheet were a magnet to the eyes.

  Reciting my lessons aloud to Major Twomey, I followed the trauma protocol to the letter.

  A. Airway intact and open. No obstruction.

  B. Breathing—good breath sounds bilaterally. Trachea midline.

  C. Circulation—skin warm. Heart sounds are clear. Capillary filling less than two seconds.

  D. Deficits to neuro are none. Patient alert. Glasgow Coma Scale 15 of 15.

  The voice coming from my mouth wasn’t my own but Twomey scribbled the words onto the trauma log. I methodically moved around the stretcher. “How are our lines? Good ones? You guys are great. Check that tourniquet, please.” Keep it calm. Take your time.

  Next came a check of pulses, abdomen, and pelvic bones. My hands slid up and down every inch of what was left of the Iraqi’s limbs. My fingers rose and fell over rough skin peppered with shrapnel, and the small bumps where the tiny pieces of metal hid just under the surface.

  As I recited my findings, the noise level in the room seemed to rise to a dull incomprehensible rumble, just enough to keep us from hearing each other around the stretcher, and me from hearing myself think. I then felt the jostle of extra bodies coming to the stretcher to take a peek and a poke at the patient. I was now being pushed to the edge of the cliff and the ground below me was starting to crumble. I was going to lose control.

  Looking up, I said, “I need everyone who isn’t in this bay to button it up, and if I didn’t ask you into the bay, please get out and get behind that red line.” It was the order I had worried about, the new guy telling people to get out of his way. But it was an order of necessity; the only cure for chaos was calm, even a false calm. And I worried how it would be received coming from me. Today, the response from the uninvited was a wilted bouquet of looks—dirty, confused, and sour. But when I looked across the room at Rick and Bernard, both of whom were still waiting quietly on the spectator side of the red line, I got a pair of welcomed winks. I finished up my exam, gave a few medication orders, and stepped across the room as I snapped off my bloody gloves.

  “Rick, I think this guy needs a look-see of the belly. Feels like some of that metal is deeper than it looks, he’s a little on the rigid side. Hey, Bernard, waiting for the bus?”

  “I just was wandering by when this helicopter tried to give me a haircut. Sweet Jesus. Nice job in there, man. Say, did you eat this morning?”

  “Yes, Mom.”

  “And how much did we eat?”

  “Enough, Mom.” God, the thought of food makes me want to retch.

  Next, I walked over to Bill Stanton, who also was patiently waiting his turn.

  “Hey, Billy, I’m getting films of both femurs, maybe the left hand and wrist. Anything else right off the bat?”

  “Dude, not from a distance. Finish up the real-doctor stuff, then I’ll step in. I’m cool.”

  As the patient went off for a CAT scan and X-rays, I crawled to my desk, imitating a man who has just finished a marathon through the steaming jungles of the Amazon. I was spent and, I now noticed, sweat-soaked. But the patient had survived, I had survived, and like an animal had staked out my turf. I prayed it would be enough to get me through the bad days ahead.

  End of shift came quickly. The only patients who came through were minor—at least for me. A shrapnel wound to the hand of an American who was able to walk in on his own after a helicopter ride, a guy who got his bell rung by an IED, as well as a potpourri of cuts, scrapes, and bellyaches. Rick came by to pick me up for dinner and we decided to stop by the ICU before chow to check on the Smurf. Todd had the ventilator settings pushed to the max, yet the kid was still a dark blue. Not going to make it. Shit. As we pushed open the doors to leave, the words came out of our mouths simultaneously: Let’s stop and call home before we eat. Just a quick reassurance that our own kids are okay. The lines were short, the calls went quickly, and we left the phone tent with the temporary solace that our kids weren’t fighting the battle to stay alive in a war zone.

  Halfway through our $32 gourmet meal of dead pork chop in congealed gravy, Rick’s beeper chirped.

  “Looks like we’ve got a kid with a hot appendix. Want to help?”

  It was a no-brainer. “You bet I do.”

  I looked forward to working a scalpel; more importantly, I was eager to see just what the OR was really like behind its mysterious blanketed entry. So far, my duties had been taking place in an ER that really wasn’t too ugly or dirty, just red with blood and overflowing with tension.

  The OR, on the other hand, was the great unknown of the hospital complex. The tents and containers that made up the operating rooms had literally been shipped by boat and constructed after we captured the base in the early months of the war. For me, the fifteen steps from the ER to the OR was the medical equivalent of a leap across the Grand Canyon.

  We pushed through the dusty blanket and walked to the cheap plastic scrub sinks. A small push-pedal on the floor forced a miserly flow of water through the faucet. I mirrored Rick’s every move, and tried to work my hands into a lather with the flimsy scrub brushes.

  “Where are the scrubs?”

  “Aren’t any.”

  “Booties?”

  “Aren’t any.”

  “Lockbox for my pistol?”

  “You’re wearing it. C’mon, let’s pop the hot tamale out of this kid’s belly and go home. I bet we can do this in three minutes and thirty seconds. That’s my record.”

  A thin set of doors with small plastic windows provided the last barrier between what was supposed to be a sterile operating room and the swirling dirt of the outside world. We swung them open with our elbows and hips, keeping our hands up and away in the classic surgical pose. Gown pulled on, gloves tugged over semiclean hands, and we were ready to cut. Almost.

  “Hey, how about some music in here?”

  The surgical tech replied, “What would you like to hear, Dr.

  Reutlinger?”

  “How about some Billy Joe while we’re working.”

  My eyes peered over my masked mouth and nose.

  “Billy who?”

  “Billy Joe. I got him on my iPod. Love him.”

  “You mean Billy Joe Bob Willie or some other hick?”

  “No—B-i-l-l-y J-o-e! You know, like ‘Piano Man’ or something.”

  “You mean Billy JOEL, Rick?”

  “That’s what I said the first time. You deaf?”

  By the time I rolled my eyes from the back of my head to the patient, Rick had already made the first incision and more. I’d never seen anyone surgerize so quickly, and so well. Skin, muscle, fascia, and peritoneum expertly sliced and separated.

  “Now where is that little—?”

  The sentence was interrupted by the sudden bang and rumbling boom of a nearby shell. The scalpel in Rick’s hand swung up and cut through air, missing my biceps by an inch as the tiny OR shook and our legs staggered.

  “What in hell’s bells?”

  “Rocket or maybe an IED just outside the gate, Colonel. Had to be close.” It was the surgical tech, who’d been jostled by scores of similar blasts during his year-long deployment. He never flinched.

  “Jeez, that’ll wake the neighbors,” Rick said.

  The tech responded, “Want more anesthesia, Colonel?”

  “No, thanks, I think I’d better stay awake for this one,” came the nervous quip.

  We were only a few hundred yards from the gate, far enough to be s
afe, close enough to be introduced to the limb-tearing blasts our troops challenged every day. A big breath later, we were back at work, faster than ever. I had a hard time keeping up, especially cutting the knots Rick speed-tied as the appendix was snipped out and the abdomen closed.

  As I watched the express train of a surgeon zoom along, I realized, with the exception of the rattling blast, this operation was no different from any other. Tight quarters in a container, cheap plastic scrub sinks, packing a pistol—none of it mattered, or for that matter, was even noticed. My focus zeroed to a patient, a scalpel, and an abdomen. Once gloved and gowned, you were automatically transported into the mystical world known as surgery.

  We left the OR a little wilted, and very tired as the twenty-hour marathon of a day groaned to an end. We walked through the ICU on our way out, silently staring at the still blue body of the Smurf, chest heaving up and down as the respirator forced oxygen into his unconscious lungs. Damn.

  I don’t know if we beat the record for the removal of an appendix that evening, but I do remember the song that was blasting through the room as we finished: “Only the Good Die Young.”

  7

  THE TUG-OF-WAR

  IT WAS YET another “first day,” although this one would take place in darkness. I was finally scheduled for the night shift, which meant I had the whole day to kill before showing up for work at 7 P.M., or as my Army watch would say: 1900 hours. After more than a week of going to work in the light of day, this would be my first time working alone in the dark and loneliness of night, and I had to admit, I was more than a little skittish.

  I was gradually getting used to the blood and gore of the ER and my confidence was rising steadily with each case that rolled through our doors. But when I worked the day shift, help was only footsteps away. At night, I would be the only doctor in the hospital, and without phones, my sole tether to help was the pagers my fellow doctors kept next to their pillows.

  Although my buddies would be less than half a mile away snoring in their bunks, that half a mile would seem like a continent especially if a bird made a surprise landing or I had someone tank out in the ICU. The only three doctors with instant availability would be me, myself, and I, and the way I was feeling, that trio reminded me of the Three Stooges. As I lay in bed waiting for my watch alarm to beep, all I heard was Dr. Howard, Dr. Fine, Dr. Howard, quickly followed by a cadence of Dr. Hnida, Dr. Hnida, Dr. Hnida.

  I shook the chant out of my head and skipped down the stairs to pick up Rick. Like me, he had been wide awake for hours, reading, killing time, and watching mental reruns of the experiences of the last few days. I envied his ability to read. At home, I normally knocked off about two books a week—usually spy or adventure novels—but here I found I couldn’t read more than a sentence or two before I had to put the book down. It was a loss I would carry the entire rotation, and I mourned not being able to mentally escape each night, even for a few minutes. Rick, on the other hand, was now reading some book that claimed God was dead, or maybe never existed in the first place. The thought creeped me out and our morning together started off with me calling him a perverse shithead.

  By the time we made it to breakfast, most of the doctors and staff were already there, having a heated discussion over some obscure worthless piece of trivia. The game took place on a regular basis no prizes or reward, just the satisfaction that you knew something of no practical value. The morning’s stumper was “What is Barbie’s real name?” courtesy of Bill Stanton.

  Answers and comments flew up and down the table as we raced against an imaginary clock.

  “She’s a fucking doll. How can she have a real name?”

  “This is a bullshit question.”

  “I know this one, it’s Barbie Mattel.”

  “Who cares? She’s a little plastic doll with little plastic boobs.”

  Bill looked smugly at the group. “Barbara Millicent Roberts.”

  “You’re on drugs, man.”

  “No way.”

  “Yes, gentlemen, Barbara Millicent Roberts. And she was born in 1959, which means Reutlinger might like to date her.”

  Rick shot back, “Yeah, well, what about Ken?”

  From down the table: “Rick, she’s make-believe, for Christ’s sake.”

  With that, we carried our trays away and took off for the hospital.

  Medical rounds were held every morning at 0730 in the Ortho offices just around the corner from the OR, and even though I wasn’t formally scheduled to work until night, I still had to show up for morning rounds.

  The exercise basically consisted of all the docs, head nurses, therapists, and psych people getting together to review the progress of the patients in the hospital, look at any interesting X-rays or CAT scans, and make sure no one had screwed up in the previous twenty-four hours. Most days things were fairly painless—the main pressure was making sure we got the wounded evacuated as quickly as possible, and getting the injured Iraqis out of the gate to the local hospitals. The latter was the pressure-filled job of Arabic-fluent liaisons who worked their buddy lists to try to find a family member or a friend who would assume the care of an Iraqi we wanted out the door. As far as the U.S. Medical Command in Baghdad was concerned, an empty hospital was a good hospital.

  The numbers that day weren’t bad, only seven patients. With a capacity of eight beds in the ICU, and twenty in what was called the intermediate care ward, we could hold twenty-eight, with a special lying-room-only section for overflow crowds if necessary. We didn’t know it, but there would be days ahead when the “No Vacancy” sign lit up at the door to our CSH.

  The first order of business was to review X-rays and scans. As we crowded around a small computer, images of splintered bones underlying mangled arms, legs, and hands lit up the screen—the kind of injuries none of us ever really saw back in the States. A few murmurs and holy shits cycled through the group. We then moved on to some CAT scan images, which still looked like Rorschach tests and mud puddles to me. The realization was a slap in the face; I was still a lost soul wandering aimlessly in CAT scan land and needed to hit the CAT Scans for Dummies book harder.

  Rick’s appendix kid was doing great, and would be out of the ward in another day. And stunningly, the Smurf turned pink in the predawn hours and would be weaned off the ventilator over the course of the day. First glances didn’t show signs of brain damage; maybe the kid would luck out. In any case, his next stop would be the States and then legal charges and court-martial. As would be the case with most of our patients that summer, the former Smurf would soon be out of sight, out of mind; there simply wasn’t time to dwell on former patients, at least not while we were constantly replenished with new.

  The last American soldier on the agenda was one I hadn’t seen or heard about, a young soldier with hysterical blindness. After one too many missions swerving IEDs, this guy lost his vision. It happened a few days before and the patient was flown in from an outlying post during the night. He claimed he couldn’t see the hand in front of his face, and a bright light was only a shadow. That meant he had to be led by hand from the ICW to the latrine or to the sidewalk for a smoke. Last night, he said he wanted to be left alone while having a cigarette, and when his nurse walked away she peeked back as she rounded a corner and saw him bend over, pick up a stone, and toss it at a sign. He then flicked his butt on the ground, walked over, and ground the embers out with his heel. This twenty-four-year-old wasn’t blind but was an everyday young man who had cracked under the stresses of war.

  Now our eyes were blank and peering at the floor, confused, yet a little frustrated at the young soldier for taking up valuable resources and time, then, just as quickly, disappointed at ourselves for feeling anything but pity. He’d be shipped to Germany, and we’d never learn if therapy would fix him or if he’d be dodging mental bullets and bombs to the day he died.

  We had a few “housekeeping” items to discuss before being dismissed, the most important of which was the rumor of a big offensive sla
ted to start within days, or weeks, depending on the setting of the bullshit-o-meter. The Surge was beginning, and its opening act would start with a bang. Although we minions weren’t supposed to know details, for fear we would leak the info by e-mail or phone, it was important for the hospital to ramp up and be ready from a staffing and supply standpoint. But as far as we were concerned, it didn’t matter. There would be no extra doctors sent to help us—busy or slow we would trudge to work and do our jobs each day.

  After rounds, we ambled over to the ER for coffee, and were told flight conditions were “red”—meaning there were swirling sandstorms in the area and no copters would be flying. No business expected at least for a few hours. Which meant it was time for the morning matinee. The morning’s feature film on someone’s laptop was the medics’ favorite: Kill Bill. Male and female, the medics watched, and then rewatched, testosterone-laden DVDs with the highest violence and gore ratings.

  I knew I couldn’t go back and nap; Rick had little going on at the moment, so we decided to hike down the road and check out the PX, a small building that served basically as our little corner grocery. We didn’t need anything, but thought some window-shopping might break up the day. The store seemed well stocked, especially with essentials like toothpaste and deodorant—there was even hair dye for the female soldiers on the base, as well as, I suppose, the vain males who were showing a few gray strands. One aisle led to another, and with each came an increasingly surprising item to be stocked in a war zone. A great selection of CDs, DVDs, audio systems, video games, and video game systems. For off-duty enjoyment on a not-so-cool summer evening were barbecue grills and a variety of patio furniture, even some with umbrellas. And to help you speed off into the sunset, a separate trailer next to the PX, which housed an actual All-American auto dealership. Not that there were any cars on the lot, but you could sit and pick a sleek beauty out of a catalogue, get financing on the spot, and have that baby waiting for you when you hit the States at the end of your deployment. Just one more thing to widen the chasm separating my war and that of my father’s.