ZONDERVAN
No Place to Hide
Copyright © 2014 by W. Lee Warren
ePub Edition © March 2014: ISBN 978-0-310-33804-8
Requests for information should be addressed to:
Zondervan, 3900 Sparks Dr., Michigan 49546
Library of Congress Cataloging-in-Publication Data
Warren, W. Lee, 1969–
No place to hide : a brain surgeon’s long journey home from the Iraq War / Major W. Lee Warren, MD U.S. Air Force (Ret.).
pages cm
ISBN 978-0-310-33803-1 (hardcover)
1. Warren, W. Lee, 1969– 2. Iraq War, 2003-2011—Medical care. 3. Iraq War, 2003-2011—Personal narratives, American. 4. Joint Base Balad (Balad, Iraq) 5. Surgeons—United States—Biography. I. Title.
DS79.767.M43W37 2013
956.7044'37092—dc23 [B] 2013033127
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Cover design: Faceout Studio
Cover photography: Senior Airman Jeffrey Schultze, U.S. Air Force, www.afcent.af.mil
Interior design: David Conn
Printed in the United States of America
14 15 16 17 18 19 20 21 22 /DCI/ 21 20 19 18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1
To Lisa
CONTENTS
Foreword by Lt. Gen. (Ret.) C. Bruce Green, MD
Preface
1. Maintain Control, Lee
2. Just a Little Bomb; Nobody Died
3. Everywhere I Looked, I Saw Dirt
4. No Skull Bone on Left, Handle Carefully
5. For the First Time in My Career, I Didn’t Know What to Do
6. I’m Not the Only One Getting Shot at Here
7. I Can Still See His Face and Smell His Blood
8. Glasgow Coma Score of Seven
9. “Daddy, Come Home Right Now!”
10. The Iraqi Toddler
11. This Kid’s Gonna Die, and It’s My Fault
12. A Very Odd Skull
13. “Get That Cat Outta Here!”
14. The Night Vania’s Family Was Shot
15. Plugged Rockets and Homemade Biological Weapons
16. They Were Still Screaming When the Choppers Landed
17. I Saw in 2137 Everything I Hated in the World
18. We’ll All Get Through This Together
19. Purple Ink: The Mark of Freedom
20. Freezing to Death in a Muddy Hole
21. The American Soldier, the Terrorist, and the Blood Drive
22. Rose Is My Daughter’s Age
23. His Grip Loosened and His Hand Dropped Out of Mine
24. Our Next Stop Was Abu Ghraib
25. Baghdad: A Beautiful, Broken Place
26. You Got to Keep Moving or You Get Hit, Bro
27. We Have a Special Patient Here Tonight
28. Not So Good Friday
29. It’s Going to Take a Whole Series of Miracles
30. No Place to Hide
31. Saying Goodbye
32. And Then I Lost My Mind
33. Unpacking the Bags
34. Long Journey Home
Photo Insert
Afterword by Philip Yancey
Acknowledgments
FOREWORD
After the fall of Iraq in the spring of 2004, the Air Force Surgeon General determined Wilford Hall Medical Center would lead the 332nd Theater Hospital, Balad ab, Iraq. The base was the hub for logistics and air evacuation out of Iraq, and it was under fire (twenty-plus rocket attacks per week) when our medics arrived. Roughly three hundred medics, a mixture of Air Force, Army, and Australian physicians, nurses, allied professionals, and technicians required to save lives, were sent into harm’s way to care for wounded warriors and Iraqi citizens injured in the war.
As Wilford Hall Commander, I handpicked the deploying commanders, and every medic knew their friends would follow and inherit their work. It was a harrowing time. We trained for this mission for years, honing skills and modernizing equipment sets, but now friends had to leave families for four to six months to risk life and limb. I will never forget the first two rotations’ farewells in the auditorium — the dedication mixed with fear and excitement in the eyes of the medics, the tears of families, the concern of friends and supervisors seeing the deployers depart.
These medics were incredibly dedicated to saving lives. Their work with the city of San Antonio and surrounding twenty-two counties established a trauma network second to none. Before stepping into Iraq, nurses were added to the team to capture trauma data in a registry for continuous learning. An experienced trauma surgeon, the “trauma czar,” was chosen to establish the flow for casualties that would optimize survival. In the first weeks these medics eradicated a new drug-resistant bacteria that was contaminating wounds. The survival rate for casualties rose from 90 to 98 percent, and the story began to circulate: “Why do Marines carry a twenty-dollar bill in their boot? So that, when wounded, they can tip the helicopter pilot to take them to Balad.”
This book captures simply, eloquently, and passionately what it means to be a physician in time of war. Every person who goes to war is changed. My emotional response to these chapters made me pause to consider that our best efforts to support medics were inadequate. It captures the reality so many experienced and the difficulty of returning to everyday life. Over ten years of war, we safely air evacuated more than ninety thousand injured and ill from Iraq and Afghanistan — five thousand were the sickest of the sick. This very personal story captures the essence of what it takes to be a military physician and the challenge for our nation to reintegrate all who deploy to war.
Lt. Gen. (ret.) C. Bruce Green, MD
20th AF Surgeon General
PREFACE
The stories told in this book are all true, as experienced during my time in Iraq in 2004 – 2005. I obscured details in some of them, as well as the names of some doctors, nurses, and medics, to protect their anonymity. I also changed the names and identification numbers of all Iraqis and terrorists and all American soldiers with the exception of Paul Statzer, who gave me permission to use his name and story.
I changed some names for practical reasons. For example, there were three Todds with me in Iraq. To avoid having to say “Todd the neurosurgeon,” or “Todd the therapist,” or “Todd the heart surgeon,” I simply renamed two of them.
Since there were so many different people on the worship team and so many different chaplains, I combined a lot of the people into two characters — John and Chaplain W.
I am sure that some of the events I discuss in the book would sound different if told from the perspective of other doctors at the base or the soldiers or terrorists or Iraqis who were part of my story. In the chaos of battlefield medicine, it was common for us to hear from a soldier that our patient was a terrorist, or that the injuries had been caused by an IED, only to find out later that the patient was actually a good guy or that the “IED” was actually a land mine. Chalk it up to the fog of war as well as to the differences in the accounts of any two witnesses d
escribing the same event.
The dialog in this book was recreated from memory, and since it has been eight years since I was in Iraq, I am sure that some of the dialog, while true to the spirit of the conversation it recreates, nevertheless expresses it in words that differ from those actually spoken.
Finally, I didn’t include all 120 of my emails home in this book. I modified and combined some of them to make sense in the context of this book. They were also edited for grammar (somehow I managed to make a few grammatical errors while emailing from the combat zone), and names were changed where appropriate.
CHAPTER 1
MAINTAIN CONTROL, LEE
Sit on your body armor on the flight in.”
“Excuse me?”
The C – 130 pilot laughed. It was December 28, 2004, and we were in the Base Exchange, or BX, at Al Udeid Air Base in Qatar. He looked at his colleague and said, “The major here’s never been in Iraq, sir.”
The shorter one wore silver oak leaves on his flight suit — a lieutenant colonel. And like the pilot who’d just given me the advice, he also wore pilot’s wings. He leaned closer and said, “He said you should sit on your Kevlar. As opposed to wearing it. The bullets come in from below.”
They walked away chuckling, no doubt at the bewilderment on my face.
I checked my watch: 1600 hours. Four p.m. Eight hours to go.
I shrugged their advice off uneasily and continued checking off the last few items from the list of things that I’d been told — since arriving here two days before from San Antonio — I would need at my new deployment. Things that had not been on the official packing list but that others had found useful, such as earplugs for the plane ride I was waiting for.
The one that would deliver me to the war.
Earlier in the day I’d been told that my flight into Iraq would be delayed until tonight, due to a mortar attack on the runway at Balad Air Base, my destination.
Balad was also called Mortaritaville, because at that point in the war it was the most frequently mortared base in Iraq. An Army friend who’d been there had emailed me a couple of weeks before I left about dealing with mortars:
Dear Lee,
Don’t worry too much about the mortars; that’s like worrying about lightning. You can’t control where they hit, and most of them don’t blow up anyway. Worry more about the rockets.
His advice wasn’t particularly comforting.
The two pilots I’d just spoken with in the BX delivered people like me to Balad and brought us out. I decided it would be wise to heed their advice about the body armor, although I didn’t look forward to a four-hour flight sitting on the hard ceramic plates.
Later on at the DFAC — dining facility — I enjoyed enchiladas and tacos served by an Asian contractor in an Arab country. The jumble of out-of-place foods and faces struck me as funny, perhaps because I’d been traveling for two days and was filled with an equally jumbled mix of emotions. But as the time to report to the airfield approached, I stopped chuckling, regretting my decision to eat something spicy.
I wandered around Al Udeid, taking pictures of the strange sights — such as a Santa and snowman still on display from Christmas three days before. I spent a while in a lounge chair next to the Olympic-sized swimming pool, but since I couldn’t swim in my DCU — desert camouflage uniform — I grew restless and moved on, my mind swirling with questions about what I was about to experience, what I’d just left behind, and what might be left of me in the end.
A chapel with an open front door seemed like a good place to sit awhile. I walked in and took off my shades, blinking in the dim light until my eyes adjusted. There in the front, shining like Excalibur in the stone, sat a guitar on a stand, with no one around to tell me no. I played and prayed and ordered my thoughts as I can do only when there are six strings under my fingers.
Far too soon, it was time to go. I stopped in the restroom to handle an acute case of nerves. Or Montezuma’s revenge, more likely — a just repayment for my poor dining choice at such a stressful time. I washed my face in the sink and took a long look in the mirror.
My eyes held blood and tears, the result of sand in the Middle Eastern air and sorrow in my Midwestern heart. The man looking back at me didn’t fit my self-image. I expected to see a two-hundred-five-pound blond brain surgeon. Instead, I saw a DCU-wearing Air Force major about to board a plane for the war in Iraq, wearing a leather holster and body armor and helmet like any soldier in the Army or Marines, looking ready for whatever may come. I knew better: The real me was a man driven nearly to his knees by life over the past few months, and he wasn’t sure he could handle what he was about to face.
He was about to find out.
I gathered my things and myself and walked out into the surprisingly cold Qatari darkness to find the airport.
The military is infamous for its “hurry up and wait” bureaucratic inefficiencies, but I was surprised at how smoothly processing the orders of a hundred or so people and palletizing our duffel bags went. Maybe it was because I was distracted by filling out forms and helping pass bags around and checking gas masks and gear, but those were the fastest two hours I’d spent since I’d left the States the morning after Christmas. The last thing I did was sign my name on the wall of the hangar where we waited, a wall full of the signatures and call signs of hundreds of people who’d passed this way before. I found a little blank area and wrote:
Major W. Lee Warren, USAF, MC, 859 MSGS, Lackland AFB, TX. Combat Brain Surgeon.
And then it was time.
A master sergeant whose DCUs were far too starched and clean to have ever been in Iraq held a clipboard and shouted with a nasally New England accent, “Form a line, backs to the wall, wait for your name to be called.” It sounded like, “FARMA LINE, BACKS TA THA WA, WATE FA YA NAYME TA BA CAA.”
It must have been minutes, but it felt like years before I heard, “WARREN, WAYNE LEE JOONYA.”
Like the others before me, I stepped forward, made a right face, and marched to the master sergeant.
He leaned close, squinted at my dog tags, and checked my name off his list. “Gaad bless ya, Maja.”
“Thanks, Sergeant,” I said, the last words I spoke in Qatar.
I stepped out of the hangar and followed the line of people to our waiting C – 130. We filed in, followed instructions about how to fasten our belts, and were told not to use any flashlights until we were off the plane in Iraq. I sat on a hard metal bench shoulder-to-shoulder with the men next to me. No one spoke. About two feet in front of me was another bench, equally crowded with people facing us.
When we were all on board, a forklift drove on, carrying pallets of all of our gear. I watched as the loadmasters lashed down the pallets, fascinated with their skill and technique and wondering how many other people these guys had packed off to war — and how many of them had come home. When I realized that the pallets had now sealed off our only way off this airplane, I had another thought: I’m really going to war.
As soon as the door shut, the lights went out. The last thing I saw before darkness enveloped me was a stain on my DCU pants from the vanilla latte I’d spilled on my leg after I’d stopped at the coffee shop next to the DFAC on my way to the chapel. Nice, I thought, I’m flying into battle smelling of Starbucks. Very GI Joe. No wonder the Army guys make fun of us — they call us the “Chair Force.”
I’d never been in the Middle East before landing at Al Udeid, and I wasn’t impressed with its blowing sands, desert temperatures, ubiquitous brownness, and featureless terrain. But Al Udeid Air Base was the gateway to everything I would experience of war. I would land there again in four months, at the end of my deployment. By that time, my opinion of the base would have changed drastically. Al Udeid with its swimming pools, computer lounges, and coffee shops is a much nicer place the second time you land there because it’s so much better than any place you’ve been since the first time.
The C – 130’s engines roared to life, and for the next few hours I
heard nothing but those engines and my thoughts. Sleep was out of the question.
I thought about the things I was leaving behind: Three children who knew their dad was going to the war in Iraq but were blissfully unaware that their parents’ sixteen-year-old marriage was essentially over. My only brother, struggling with a life-threatening stroke. And just three weeks before, my hero — my grandfather — had died.
Flying through the darkness, I realized that I was completely unknown on the airplane. Although my name tag said Warren, and one of the other passengers was the surgical tech Nate from my hospital back in the States, no one knew me. I was part of a bay full of cargo, implements of the war machine of the United States. I was Warren, W, 45SF — the Air Force code for neurological surgeon.
I can’t adequately describe how lonely I felt then, one inventoried item in a plane full of war parts, each interchangeable when they were lost or broken or had served their appointed time. I thought about the bullets and missiles I was sure were about to blow us out of the sky, and for a few minutes I hyperventilated and thought I was having a panic attack. Then I heard an old voice in my head, telling me to get a grip.
The voice was a memory from Pittsburgh in 1996, from the operating room at Allegheny General Hospital. I was a second-year resident in neurosurgery, operating that day with Dr. Parviz Baghai, a Persian immigrant and brilliant surgeon who for some reason took me under his wing early in my training.
A man was brought to the emergency room after a car accident. His head scan showed a massive brain hemorrhage, so I called Dr. Baghai, who told me to take the patient to the OR and start draining the hemorrhage. Dr. Baghai arrived just as I was removing a large portion of the patient’s skull. Then, using a scalpel, I began to open the dura, the brain’s thick, leathery covering. The patient’s brain rapidly swelled out of the confines of his skull, something I had read about but never seen. I didn’t know what to do — the brain was squeezing out of the dural opening like toothpaste. I said, “This guy’s going to die.”
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