by Marc Dauphin
In spite of a record-breaking survival rate, we couldn’t save them all. Here, unable to attend the ramp ceremony for this fallen Canadian comrade, we hold our own ceremony by the taxiway as the LAV carrying the casket rolls by. In the Role 3, there were no nationalities, just a bunch of professionals from many different countries, pulling together for the good of our brothers- and sisters-in-arms.
The last one was a shocker. There’s no easy way to die, but this one was very unpleasant. He was eviscerated from the genitals up. He had probably been standing right over the device when it blew up. His guts were spilled all over the body bag, and they had busted. A few hours after his death, the stench was overpowering, even for people who were used to dealing with injured men who have done in their pants. His buddies must have had one hell of a time putting him in that bag. Nice memories from the war for them to ponder over for the next thirty or forty years.
Why is Dad having all those nightmares, Mom?
The scenario was now clear. They had stopped to investigate something fishy. One walked right by it, maybe going ahead to cover his buddies. Or maybe he missed it completely. Two of them went out and stood right over it, while the fourth one stayed behind in the vehicle, perhaps to man the communications. Then it blew.
I could imagine their screams and the panic, and the attempts by their buddies to save them. Perhaps some last words spoken in haste. Perhaps a voice profound and filled with longing for loved ones. Or surprise that it finally hit, that it was really happening, that today was the day. Maybe they were angry words about the unfairness of dying so young, or words of panic as one feels one’s life ebbing away. Or simply a call for one’s mother.
And I imagine the firefight that surely followed, amidst those calls for help, and the orders barked by those in charge trying to impose control over the chaos.
I chased away those visions of horror and walked off to fill in the paperwork as the staff zipped the body bags shut. Then, Linda and I took our hats out of our pockets and put them on. We stood at attention, and saluted our departed brothers-in-arms. On the walk back to the hospital, we did not say a single word.
I hated mortuary affairs. Maybe I had too much imagination for my own good.
C’est comme ça.
Incidents
The following incidents are unrelated, yet all of them mesh to make up an emotional tapestry. For six months we were so busy, and every day was so much like the others, that they all seemed one continuous procession of patients. And the images in my mind are all like that now: one continuous movie made from patches of all those similar days. Many I have related as if I were still there, as I felt at the time. I did ask some of my crew what they wanted me to discuss in the book. Their answers were always the same: just talk about what we did. Even when pressed, they wouldn’t go into specifics. I guess they don’t want to actively remember. So, here goes.
A British soldier, fully conscious and not in shock. His foot has been ripped off by an explosion. Miraculously, he has no other injuries. In the field, they had immediately put on a tourniquet, thus saving his life. They apparently gave him some morphine out there, but it didn’t seem to have touched him at all. As soon as he gets to us, he complains of his pain. We give him more narcotics, this time through an IV. This time, it does the job. His comment to the nurse, expressed in a fuzzy, very relieved but heavily accented voice: “You know what, ma’am? Brit morphine sucks.”
This prompted a few rare smiles.
An unannounced helo lands and the amb crew scrambles out. Is it the Special Forces again? They never give advance warning in spite of the fact that we’ve told them time and again that, if they do, it gives us the chance to get our people ready. Especially at night. Fortunately, this is daytime, and we have plenty of people available. As the staff assembles some trauma teams, the ambulance turns the corner and the driver waves us off. He signals two stretcher cases, but waves his extended fingers back and forth a few times across his throat. Heads drop. Gazes focus downward. People shuffle back into the trauma room as the ward master quietly closes the hospital door behind him. I look at the expectant, electrified trauma teams and shake my head. Nobody says a word. They wind down their expectancy and go back to what they were doing.
One contingent of Dutch nurses has been replaced by another. The new ones are quieter, more reserved, although just as professional. But the ones who are gone were absolutely crazy. They would pull a face at you behind the general’s back, while you were talking to him. Or wear their clothes backward with deadpan faces. During the quiet moments, they were always organizing photo shoots with creative, artistic elements to them, like from the roof of the hospital. Rockets? What rockets? Or ten people piled up on a stretcher. There were only about a dozen of them, but it seemed like thirty. And now they’re gone. Dan, the officer in charge (OIC) of Inpatients, or in other words, the head nurse, says, “When they came into a room, somehow the colours got brighter.” Yes, Dan. You’re right.
A bunch of Canadian, British, American, and Dutch nurses in front of our famous sign.
Mortuary Affairs again: This time it’s the body of an Afghan interpreter with the U.K. Black Watch regiment. On the body, carefully folded, is a stained, muddy, and bloodied sheet of paper. It’s one of those thin, greyish, airmail-type papers, of the kind I haven’t seen in years. On it is written, in hurried, clumsy pencil strokes, “This is our interpreter, Hamid, a decent chap and a loving father.”
I’ve seen worse epitaphs. I fold the paper and put it back into the body bag.
An Afghani man got shot in the stomach. (I don’t even remember if he was civilian or ANA.) Either way, we resusc him, then take him into the OR without going to CT. Hole in the abdomen = go straight to the OR. Yeah, yeah. Do not pass Go!
An hour or so later, the OR team comes out looking sombre, but something in their attitude is wrong. I walk up to them and they assemble before me.
“One of our patients survived,” they tell me. “But unfortunately, the other …” and they hand me this plastic box. What the …? I open it, and see that there are some worms inside. Then I begin to understand.
“The bullet entered his stomach,” explains the surgeon, “and clipped the worm in two before exiting through the back. The worm never had a chance.”
This must be the first recorded worm death by gunfire in medical history.
An empty trauma bay in the quiet seconds when a casualty has just been wheeled out and the staff hasn’t returned to clean up, to prepare it for another case. It is pleasantly cool, only around thirty-seven degrees in the air-conditioned trauma room. I am so tired that I’ll just stop here and rest on my haunches like the Afghans do. Only for a moment. In the two adjoining trauma bays, the crews have stabilized their respective patients and are talking in muted tones. This only increases the contrasting silence in the deserted space, delineated by red duct tape.
Mere minutes ago, a battle was fought here, one against death. There is a lot of blood on the floor — a few larger puddles are already starting to congeal, and next to them, a bunch of drops with splatter. Through one of the puddles, a wheel track leads away. Someone has also stepped in it; the footprint is repeated, paler and paler, in the direction of OR number 1. Already those thinner spots of blood are drying, a brownish, dirty colour. Paper envelopes for syringes lay crumpled in the blood. A wet, dirty, and bloodied sock lies in a ball next to two half-empty plastic water bottles. Two blankets, one woollen and one aluminum, lie in a heap in the corner. An oxygen mask seems to protect a ball of tape and some discarded, muddy alcohol tampons. The metallic top from a Lidocaine bottle has been squashed on the floor. On the table that the note-taker uses to rest her forearms while she does her work, some syringes filled with narcotics and paralyzing agents lie ignored, unwatched — enough narcotics to pay for a nice evening of debauchery for a few hundred people on the street. The RCMP would have a field day with our lack of security here. The ultrasound machine sits like an abandoned car, its wheels pointin
g every which way, and its probe covered in bloody, soiled, drying gel, the very picture of unhygienic. The gel tube is also messy and carelessly thrown onto the screen. One side of the machine is covered with tiny droplets of spattered blood.
The PAD clerk returns and silently starts sifting through the plastic garbage bag into which the trauma team have thrown the casualty’s personal gear. A discarded cervical collar, dusty and bloody, lies twisted next to a used central line kit in its thick blue paper wrapper: a syringe filled with blood already turning dark tells me that they were successful in hitting their target, the central vein. The disposable scalpel lies at an angle on the J wire and the large-bore catheter, a veritable minefield of potential needle pokes. Next to the garbage pail, the discarded envelope from a chest tube under the cardboard packaging in which it came. Two bloody plastic gloves, turned inside out, didn’t quite hit their target and lie draped on the edge of the green plastic bag in the garbage pail, their fingers all crumpled up in a sticky ball. The aluminum guide from the chest tube sticks out of the pail like a cane. The drawers of the equipment chest lie half open and askew, almost empty, as though some looters have riffled through them.
A trauma bay, afterward.
Another battlefield.
It has been a tough, expensive battle. At the end of the bay, the equipment rack looks almost naked with its monitor, its ventilator, and its portable suction missing.
The civilian cleaner approaches slowly, pushing his yellow bucket in front of him. He is from India or Nepal, I forget which. He stops, facing the bay, and slowly scratches his head as he wonders where he is going to start. The water in his bucket sloshes red and his dirty mop has long ago been stained a deep burgundy, turning to pink at the edges. The trauma team slowly return, carrying their equipment. They are contained, yet grinning, filled with adrenalin, and talking perhaps a little louder than usual. But not much. They are pros.
“For a minute there it was touch and go.”
“Yeah, but Captain B will save him.”
“Yeah, he’s the best.”
“I wasn’t sure I could get that tube in, but then when you took the collar off, suddenly I could see real well.”
“Yeah, well we were lucky he didn’t start to puke.”
“Especially considering all that blood he’d swallowed.”
“That guy’s lucky to be alive.”
“Yup. If Mandy hadn’t picked up right there on the tarmac that he was choking, he wouldn’t a made it.”
“Make sure you tell her she saved that guy’s life.”
As they relive their last battle, like golfers at the nineteenth hole, they and the cleaner pick up the discarded trash, empty the garbage, dispose of the sharps, and mop the floor. In less than five minutes, the bay is ready again. I have been a witness to a tiny island of grace in a sea of horror.
Darryl Tong, from New Zealand, our oral and maxillofacial surgeon during the first few weeks of our tour, informs me that he might miss daily rounds tomorrow, as he is getting up before dawn to commemorate Anzac Day, in memory of all his countrymen who didn’t make it back from Gallipoli, Passchendaele, and all those other nice places whose names are associated with horror and untold suffering.
I can only nod silently as my thoughts wander to those battlefields of northern France and southern Belgium that I know so well. I think about all those impeccably kept cemeteries with thousands upon thousands of headstones, all white, all neatly aligned as if on parade. I think of the monuments with those thousands upon thousands of names engraved in the stone, and of those whose remains are mixed up with the earth and who have no known grave.
It sure puts things into perspective. Every generation has to do its bit for our freedom, I guess. Thanks, Darryl.
A U.S. Army foot patrol has been hit. One of their soldiers stepped on a mine, and then they were ambushed. Three KIAs. More mothers, wives, and children will be crying tonight, their lives never to be the same again. The first one we get is pale. His skin is cool. His right thigh is broken, swollen, and angled slightly, though the flight med techs have done a pretty good job of stabilizing and straightening it. They were shot at continuously on the way back and the pilot had to jink and jerk the helicopter. You can’t get good footing on the floor of an evading Black Hawk.
There is a lot of dirt and rocks under the soldier’s frag vest, almost as if someone had shovelled it in there. His right arm is mangled and torn. Muddy, blood-caked, dust-encrusted, dried-up shreds of bad meat hang out from under the tourniquet and flop around as he waves what’s left of his arm back and forth in an attempt to relieve the pain. His face is covered in dust. His lips are pressed tightly together not to give in to the fire that must be ripping through his brain. Our eyes meet. I nod once to him and put my hand on his shoulder. “We’ve got you, soldier. You’ll be okay. We’ll kill your pain soon.”
I turn to the stretcher-bearers. “Bay 2.” Next.
Another one with his right arm torn away. Only two bare bones stick out from the blackened shreds of his shirt and skin. He isn’t as pale as the first one, but he is agitated. He keeps wanting to get up. His face is contorted with pain. As I evaluate him, I mentally block out his screams. Those tourniquets, when properly applied, really hurt. A lot.
The flight med tech is Canadian. It’s Eric. He stays with the soldier to keep him from falling off the gurney, but the soldier grows more agitated. Then Eric grabs the man’s shoulder and pulls sharply. I hear the brief tearing sound of the Velcro even above the helo’s turbine. Eric is holding the U.S. flag that he’s ripped off the man’s shirt. He puts it in front of the wounded soldier’s eyes. Then, when he has the soldier’s attention, he presses the flag in the soldier’s good hand, folds it over the fellow’s heart, and nods once. The soldier calms down.
Master Corporal Eric Mantha, and Master Corporal Pierre Desrosiers with Governor General Michaëlle Jean. These two flight medics are believed to be the only two in the CF to fly a whole tour on board U.S. dust-off Black Hawks. Canada is now building up its dust-off capacity. I sure hope we ask these guys for their advice. They have a lot of experience risking their lives many times a day. Governor General Jean was very nice to us. The day before she came, we had lost a number of children in many separate incidents. Her very kind words helped put things into perspective.
“Bay 3.”
Thanks, Eric.
The helicopter takes off and the next one lands. Okay, we’ve got major problems here. This one’s face and neck are peppered with shrapnel, and the man is confused, mumbling incoherently. I pry his eyelids open. His pupils are equal and react to the blinding sun. My thoughts wander briefly to the searing heat. They had predicted forty-three, but it’s in the high forties already and it’s not even noon yet. A piece of bone is sticking out of his upper chest. I hope it’s not his sternum. Instinctively, I touch it. Gently. It comes loose in my fingers and I look at it. It is a piece of long bone with some flesh and some burned skin attached.
“Looks like a piece of leg,” someone says.
Eric is back out. He sees what I’m holding and beckons me away from the casualty. “Parts of his buddy,” he whispers. “I guess I didn’t manage to remove them all,” he adds with a grimace.
I nod again. “Best not to tell him,” I say. I close my fist on the remains of his buddy.
Okay, next.
The last one is concussed. He is also confused, but fully alert. He is crying. Sometimes a concussion will do that to you. Then, seeing your buddies vaporized in front of you will do that, too.
“Okay, Bay 4. Hang in there, brother. You’re safe now. We’ll take care of everything.”
Then their medic comes in with heat stroke. That’s it for this bunch. Now I must go inside and do my real job.
She’s already four years old, they told us, yet she looks like a two-year-old back home. Someone from her family stepped on an IED. They are all dead. In Bastion, where they first received her, they took out her spleen to save her, then transferre
d her to us because we have a neurosurgeon. She is unconscious, has been since the explosion that destroyed her world. Now she has blast lung and is dying. Nothing more that we can do. She is so small in the large bed, so fragile. One of the ICU nurses picks her up and slowly rocks her, singing in her ear. I know that nurse. She has daughters of her own back home. I look at the monitor. The little heart is beating wildly, desperately, in its final desire to live on. I walk over and turn the machine off. It’s useless now, just so much plastics, metals, and electronics assembled in a very precise manner to do a very precise job. Very fancy, yet unable to stop the inevitable. Now this little girl — we don’t even know her name — is gasping her last breaths.
Then it’s over. She passes away without a fuss. The nurse deposits the little body onto the bed and gently replaces a lock of hair. There are tears on her cheeks.
I put my hand on the girl’s head. You are safe now, little one. You are back with your mother. Nobody will shoot at you anymore. No helicopters in the night to frighten you. No bearded men to threaten your father and your brothers and sisters. You are free from hunger, from ignorance, from pain. You are with your mother.
I turn away.
I’ve been going at it all night again. ANP casualties, then a kid with a shot-up face. We were with him in the OR until 0400. Then they announced more incoming. Fortunately, they sent them somewhere else. Had a bit of powdered eggs and some bacon. Thank God for bacon. Sorry, Muslims. And grits. They keep sending us grits every morning. For the Americans, I guess. Nobody eats them but me. I love them. For me they’re a real treat. I slop that corn syrup all over them and wash them down with orange-flavoured Gatorade and coffee. This is one of those mornings where I wish I hadn’t stopped smoking. A cigarette would help keep me awake. (But probably kill me in the end.)
