“Base! Get the medics out to the clinic to receive our casualties!” the voice screamed over the radio. Becky and I jumped up and grabbed our things and started to head out, all the while hearing constant gunfire and RPG explosions right outside the gate of the firebase; and right by the clinic. As we hurried out the door, one of the guys who had stayed back with us came running after us.
“Becky! Stay here! I need you to man the radios. Jenn, go down to the clinic without her, I’m heading down to the mortar pit!”
What the??? I had no time to react, I just ran across the base as fast as I could, over the rocks, praying I wouldn’t get hit as I heard the horrible booms and bangs of combat happening all around me. Once I got to the clinic, and inside the door, I ran to the trauma bays and made sure they were prepared to receive our casualties. I found myself running back and forth between the bays, frantically trying to prepare any and everything I might need, yet my emotions were so heightened, I couldn’t think straight and found myself having to retrace my steps several times to make sure I didn’t forget anything. And then….it happened. BOOM!!!
The explosion was so loud, and so close to the clinic, that it shook the entire building. In that instant; a moment that consisted of mere seconds, the most profound thing happened to me. I jumped off of the ground, with the most incredible fear I had ever experienced, and as soon as my feet hit the ground an unexplainable calm came over me. It was like someone flipped a switch in me that turned off all of the irrational thoughts provoked by fear, and turned my logic and common sense on. I remember telling myself, “Jenn, don’t do this, not now. Get it together and do your job.” That was all it took… I was in the zone. I can’t begin to explain how it felt to go from feeling I could die, to being focused on the task at hand with such clarity; it seemed I had been doing this for years. The minutes seemed like hours, but I was ready to receive whatever came through the door.
Eventually the booms stopped, but were quickly replaced with the banging on the door to the back entrance to the clinic. As I walked to the door I replayed everything I learned in my training about inserting a chest tube and controlling bleeding from blast injuries and gunshot wounds. I was ready for whatever was behind the door - or so I thought.
Expecting to see our guys when I opened the door, I was shocked to find a truck filled with local nationals who had been escorted in by the ANA. In the backseat I saw a child lying in his blood soaked clothes with his father beside him, screaming frantically at me in Pashtu to help his child. I found myself unprepared and completely caught off guard for this situation. Where were our guys? Were they a triage priority over this little boy? Where was a Terp to help me understand what they were screaming at me? I was expecting multiple gunshot wounds to the chest and a hand wound! I stumbled through my thoughts and I looked to my right and saw the HMMWVs and Kyle (my most recently acquired nemesis) standing outside. I waved him over to get some clarity.
“Where are our casualties?” I yelled.
“They haven’t made it to the base yet.”
“What about the patient with the chest wounds? Is he still stable?”
He looked at me with confused eyes and said, “What are you talking about? We don’t have anyone shot in the chest. We have a leg wound and a hand wound.” I felt instant relief despite my confusion.
“Help me carry this boy into the clinic so we can assess his wounds,” I said. Despite our previous confrontation he quickly ran over to assist. Becky quickly joined us and together we got the boy inside. Once he was on the table, I cut away his clothes and was able to see the extent of his injuries. He had a wound in his right upper abdomen from an RPG that was deep enough that it exposed part of his liver and bowel. The entire left side of his abdomen was rigid and distended leaving me to believe he had significant internal bleeding. Thankfully all of my emergency room experience surfaced and we stabilized him in textbook order. It was quite a sight to see. Becky, Kyle and I; three strangers just days ago, now working in harmony as a team to try to save this boy.
“Becky, I need you to control any external bleeding, get IV access and wait for my order for medications,” I instructed.
“I’m all over it,” she answered.
“Kyle, elevate his feet. Let’s try to keep him warm; we don’t need him going into shock or developing hypothermia.”
“No problem,” he replied, “I’m also keeping a log of vital signs every five minutes and will let you know if there is any change.”
“Great, thanks.” I said. “Becky we need to give him a fluid bolus, but it needs to be calculated on his weight.”
“Alright, I’ll get it ready,” she quickly answered and ran to the pharmacy to get the fluids. Hal came in and began to take down the necessary information for the 9-line medevac to get the boy back to the surgeons I had just left at TK.
“Just so you guys are aware, the two ANA patients are stable and ready for medevac,” Hal said.
“Ok, it was a hand and leg wound?” I asked. I looked up as I prepared the medications for the boy.
“Yes ma’am, all superficial, the bleeding is controlled and dressings applied,” he said.
“Nice work Hal.” I said.
It was interesting to watch Kyle in this situation. Mr. “Know it All” from the day before completely backed off and watched me run the show. As time passed, I became increasingly concerned for the boy due to the extent of his wounds and the high risk for infection, given the nature of his injuries. I could see his bowel was clearly perforated, which meant he now had feces in his abdominal cavity and the potential for him to decompensate quickly was very real - whether it be from respiratory distress or hypovolemia (low blood volume). I knew if we didn’t get him out soon we would be in a situation none of us wanted to be in. We managed to keep him stable and comfortable for the next hour until the medevac helicopter landed. Once the helicopter arrived we loaded him, and the two stable ANA casualties on board and it was over.
After cleaning the blood off of the equipment, putting the clinic back together, and prepping to receive whatever else was out there, we went up to the OpCen for the After Actions briefing. We sat and listened to the details of the mission and report of the estimate of the enemies killed in action (KIAs) being in the thirties. As I looked around the room at these men, I sensed relief that it was over, but the hunger for another fight was behind each of their eyes. I couldn’t begin to comprehend the mentality it took to be able to do what they did every day.
When the meeting was over, I got up quietly, walked to my room with Becky following close behind, both of us knowing what would happen next. We closed the door and collapsed in each other’s arms and I finally cried.
CHAPTER 19
Day 62
Settling In
30 June 2008
The last couple of days consisted of a lot of administrative work with the clinic. We got the patient bays organized and the pharmacy in order. The pharmacy was almost completely stocked with expired medications, so I had to completely re-inventory and organize it. Becky, the other medics and I did some brainstorming and came up with an idea to provide classes on basic medical knowledge for the general population as well as the women, specifically for female-related healthcare issues. We also decided to come up with some radio broadcasts consisting of medical advice and tips on prevention of the most common ailments for the population, such as diarrhea and dehydration. I was pleased with our ideas and was relieved we could come together as a team. Becky also had a good idea about putting a “comment box” of sorts in the clinic for the patients to put their questions and/or any information they wished to relay to us in. I hoped the ideas would be fruitful and not just talk, as so many ideas often were.
We had several team meetings as well, all of which consisted of the same theme - fighting. Over the next month it was expected there would be a lot of fighting, since it was the prime season for the Taliban, which meant I would be seeing very few “routine” clinic cases, and focusing more on
the traumas from the missions. After each of these meetings, the guys picked up and shipped out for another mission. I got so nervous every time they went out. The Taliban wanted their firebase back, and I hated being in such a vulnerable position.
After one of the first meetings, Becky and I went to our room, and shortly after Hal came running in. “Guys! We’re getting attacked! Get your gear on and get to the OpCen as soon as possible!” We rushed to get our flak vests, helmets, and weapons on as quickly as possible and ran to where we were instructed to meet. As we arrived in a state of panic we saw no one was there.
“What’s going on?” Becky asked. Suddenly we heard laughter.
“Come on,” I said. We slowly made our way back to our room. As we walked outside we heard a large eruption of laughter above us. We looked up and saw the majority of the team on the roof laughing and pointing at us. It was all a joke. The guys thought it would be funny to see us run out of our room as fast as we could in our full gear, so they sent Hal in to deliver the instructions while the rest of them waited for the show.
“Sorry guys! We had to do it! Man you should have seen your faces!” Hal laughed.
“Ha ha! Very funny!” Becky said, as we went back to our room. Initially I was hurt we were the butt of their joke, but then I realized it was their way of keeping things light, and they would have done it to anyone. I was able to see the humor in it, but I couldn’t disregard the real threat that was out there, and the potential violence that could occur. I felt very insecure about what my role would be if things did get bad. I didn’t want to engage in contact, but the reality of the situation was I might have to. Through the deployment I tried hard to stay healthy; mentally and physically, but it was not easy. Already I could see my mental well-being wavering and slipping at times. I talked with Greg about it and he agreed the journal was the best avenue for me to channel my feelings.
CHAPTER 20
Day 63
Casualties of War
1 July 2008
It was a day filled with nothing but badness all around. It started with Becky getting very sick in the middle of the night with another episode of gastroenteritis; vomiting and suffering from diarrhea all night. I woke up several times trying to help by giving her what medications I could, but she still suffered the whole night and into the day with her symptoms.
Clinic that day seemed to go the way Becky felt. The day before I’d seen a little five-year-old boy who fell approximately eight feet off of his roof. When I initially saw him he was fine, only complaining of shoulder pain, but responsive and smiling. If this were a patient I were seeing back home, I would have been able to get a head CAT Scan to fully evaluate if there was a severe head injury, but I only had his father’s words to go by and what I could see on physical exam.
“IG, tell the dad I am going to tell him what he needs to look for in his son over the next twenty four hours,” I instructed my Terp. As IG told the man what I asked him, the man nodded eagerly as he helplessly waited for instructions to help his son. “You need to watch him overnight and if he stops eating, starts sleeping all the time, or if he throws up more than four times I need you to bring him back to me,” I said. The father agreed and took his son home.
Sure enough he was back the very next day. The boy had completely changed in just one day; all of the things I told his father to watch for had happened. During the physical exam I saw something alarming that was not present the day before. In the medical world we call it “Battle’s Signs,” which is bruising behind the ear, a finding that is consistent with a basilar skull fracture. I examined the affected side of his head and discovered the entire left side was swollen and when I pushed I could feel the edema - another sign of a serious injury to his head.
“Sir, I am so sorry, but your son’s injuries are severe, and I have limited capabilities here in this clinic. I can only treat his symptoms.” The man began to cry. “If you can get him to TK or Kandahar there are much larger facilities to treat his condition.”
He looked at me with tear-filled eyes and began to speak. Through IG he said, “I have already walked for several hours to get to you. I have no money or means of transportation to get my son to those places.” I could feel my own eyes filling with tears. He went on, “Even if I did walk to TK, the Taliban would surely kill me or my son.”
“Why would they kill you for traveling to TK?” I asked.
“They know I would be traveling there for the help of the infidels,” he answered. I tried to fathom what it must be like to be in his shoes and I couldn’t comprehend it.
“IG, tell him to wait here, I will go and see if there is a way I can arrange for transportation for him.” I tried everything I could to help him, but I was unsuccessful. “Sir, I am so sorry, I have no way to get you there,” I explained.
“I know. It is what it is,” he said. I could see he had given up. I gave the boy a steroid shot, hoping to decrease the swelling and inflammation. I packed up some medicine for pain and the nausea and handed it to the boy’s father.
“We can continue to monitor the boy if you would like to bring him back, there’s a chance he could pull through this injury,” I said, as I handed the medications to the man. I knew as I spoke the words it was likely not the truth; given the environment had none of the necessary medical care available, coupled with his rapid deterioration, his outlook was dismal at best.
The man took the bags I gave him and put his hand over his heart and nodded to me. He picked up his child, turned and walked away. As he left I felt his genuine gratitude for the care we were able to provide, which made it that much harder to watch him walk away carrying his son into the abyss of Afghanistan, never to be seen by me again.
After I completed my day in the clinic, I went back to the room to check on Becky. She was sleeping finally, so I decided to check my email. While I was logged on I decided to email Don and Chad, I was thinking about how the mission they went on after we did the MedCap together. I knew they had a long week and were likely just getting back. Shortly after I sent the email I heard back from Don. I read his words in complete disbelief:
Jenn,
I just got back to the firebase and others are due here tonight. I do not know if you have heard the jacked up news; however, here it goes. We were on the combat patrol and after no sleep for over 30 hours we decided to RON [remain overnight]. When we started to get things ready to RON Travis stepped on a mine and was killed. I kept him alive for 30 minutes; however, both arms and from the pelvis down was missing. I cut him open and crossed clamped his aorta, however, he died shortly after that. I would say that out of the 27 years I have treated trauma cases, this was the most devastating. Both arms and just at the waist-line were gone. I did what I could and I am glad that Travis lived until the medevac came. I feel really bad that he died; I really tried everything and thought that he would live despite the wounds. I flew back with all four individuals to TK FST. After his death I escorted him to KAF. I still have a hard time with it. I was just done talking to Travis and was going to walk with him up front, but I went toward my truck instead and that is when he stepped on the mine. I am glad that I was there to work on Travis and direct the medics. If I was not there, I think that they all would have died because it was overwhelming for the team medics to see Travis like that and they would have been working on Travis and would not have been able to focus on the others. From the start of this mission, everyone had a bad feeling. The first night we had my truck break down and would not start. We finally got it started and Matt’s truck broke down. My truck had to tow Matt’s. We were about to head to the pass when the second truck broke. If we had gone through that night, I sincerely believe that we would have had many from the team dead. Three others were injured.
I remembered hearing chatter on the radio that a US Special Forces troop was killed a couple of days prior to the email, but I never heard who it was and I never thought it would be a friend. As I read the words on the screen I began to cry. Not Travis! Out of a
ll the guys I met on that team, he was by far one of my favorites. He was only twenty-four years old. He had a wife and a great sense of humor.
Don explained in the email that three other ANA and interpreters were injured as well, but they survived and were sent to BAF for definitive care. One lost a finger and one had over thirty fractures to his face. To make matters even worse, the next day the Battalion sent a team to retrieve Travis’s extremities and they got their vehicle, an, RG-33, stuck in a creek and three of them drowned.
I cried and cried. I felt sick to my stomach. I couldn’t get Travis out of my head; I kept seeing his shit-eating grin and joyful eyes. Why did this happen? What is the purpose of losing such a great person? Or losing the three soldiers who went back to collect his remains?
I remembered again the last time I saw him while I was waiting for my flight out at TK; I gave him a hug and heard his haunting words, “We do it because we love it; don’t worry about us.” Now he was gone. I was aware that soldiers were dying every day, but naively I never expected to be so personally affected. I, like many others, had developed a false sense of distance from the inevitable loss that comes with war. Sadly, I now had a new understanding of the reality of wartime.
Day 66
Independence Day
4 July 2008
I have to say without a doubt that this 4th of July has been the most significant one in my life. For the past twenty-seven years I enjoyed the family barbeques, fireworks and friends in the comfort and relative safety of the borders of the United States. I had no concept of the true meaning of this holiday. I had never made a sacrifice for my country and never known anyone who had given their life for it. Of course, like any red-blooded American, I celebrated it with pride, but the sacrifice behind what made the day possible was always something I read about in books, not anything that was personal. Now, I had lost a friend to this horrible war, been on a firebase that had been attacked by enemy fire, seen the poverty and the toll hundreds of years of war had taken on the country of Afghanistan and its people, and I was looking at this holiday through a new set of eyes …eyes of understanding and true appreciation.
166 Days: My Journey Through The Darkness Page 11