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No Place to Hide

Page 5

by W. Lee Warren


  It was dinnertime. Pete explained that there were three dining facilities, or DFACs, besides the small one in the hospital where I had suffered through breakfast and lunch. He offered to walk with me over to his favorite, DFAC II, which was close to the Post Exchange, or PX.

  Halfway across the parking lot we passed a set of trailers marked Hospital Personnel Only. “Those are our showers,” Pete said. “Plenty of hot water.” Things were looking up; if I didn’t mind walking half a mile in the cold morning air, I could shower without twelve naked teenage soldiers crowding me for their sixty-second cold showers. I smiled at the prospect — until it occurred to me that this didn’t seem fair. Those guys spent their day outside the wire, taking great risks to protect all of us. Why should we have more creature comforts than they did?

  “How come we get our own showers?” I asked.

  Pete pointed back at the hospital. “Trust me, there will be days when you don’t have time to walk to the other bathrooms. You might have five minutes in a whole day to clean yourself up, and things will happen to you that even a hot shower won’t wash off.” A look crossed his face I didn’t understand — yet. His eyes fell and his voice softened. “But you’ll still try.”

  We started to walk again, but we didn’t talk much along the way. A flight of F – 15 fighters took off and flew right over us, their twin engines drowning out any words we might have spoken. A bunch of clean-looking soldiers prepared their vehicles for a convoy outside the wire. Some of their Humvees had the new armor, but most of them hadn’t yet received the upgrade. I wondered if I would meet any of these young people later.

  A barrel of sand stood in front of the DFAC with a sign: “Clear all weapons before entering.” Before they could enter, soldiers were required to aim their rifles into the barrel and work the slides to ensure that the weapons were unloaded. Just inside was an anteroom where we stood in line to wash our hands before we were allowed to eat. We stepped into the main room, made of plywood and tin. Five hundred people stood in line to select their food, all carrying weapons and wearing battle gear. The servers were mostly locals, Iraqis screened by someone who’d deemed it safe to have them work for us.

  A vague queasiness worked through me as I watched a skinny, pimpled Iraqi teenager fill my plate with some unrecognizable meat-and-sauce dish. It wasn’t the food, but a deep feeling of being unsafe. I wasn’t judging the boy — but I wondered. My fear was reasonable; after all, a suicide bomber had blown up an American DFAC in Mosul, Iraq, on December 21, just nine days before. Twenty-two people had died in the attack, carried out by an Iraqi cafeteria worker.

  We carried our trays to a long table. As we sat, I noticed a wedding ring on Pete’s finger. I pointed at it. “Looks like you’ve got someone to go home to.”

  His smile said it all. “Wife and two boys. Well, it’ll be three in about a month.” His smile receded subtly. “I hope he doesn’t come early.”

  I thought about the timing of my deployment and realized that there’s never a good time to drop your life and fly off to war. Sacrifices come in many forms.

  After dinner, we walked to the PX, which is like a miniature Walmart without the elderly greeters. Pete pointed out a flagpole in front, around which a small memorial was erected. A hole in the metal post had writing above it — RIP — with four sets of initials and ranks. A mortar had killed four people here, six months before.

  On our long walk back to our rooms, Pete and I talked about our lives. He had the certainty I was missing — he knew that his wife and boys would be there when he got off the plane, knew the house would be just where he’d left it, knew that eventually they’d work their life back to normal. I didn’t know what I was going back to.

  “And here we are,” Pete said when we arrived at my metal cube. I opened the door and Pete stuck his head in. He pointed to my fold-up electric guitar in the corner, designed for travel and much less expensive than the three “real” guitars I’d left with a friend back home. “Rock and roll,” he said.

  I shrugged. “Not these days. Before med school I was in a band, the Monster Tones. Even had the mullet to prove it. I played lead and sang backup.”

  Pete laughed. “So let’s hear it.”

  “I didn’t bring an amp,” I said through a long yawn. The travel and the long walk in body armor hit me all at once.

  “Another time, then. You need some sleep. This slow spell won’t last long.”

  Pete walked off into the fading light of my second day in Iraq. I fell asleep in my DCUs.

  At 2:00 a.m. I was startled awake by a tremendous, sustained roar. The trailer shook, and my metal-framed bed shimmied a few inches across the floor, knocking a picture off my bedside table. It sounded like an airplane was flying into my room. I rushed outside and saw the spectacular sight of six F – 15 fighter jets as they fired their afterburners and streaked into the night sky. Their twin engines looked like rockets in the darkness, shooting upward until they were out of sight. I didn’t know the airfield was so close to my trailer, and that every morning at 0200 the fighters took off for their patrols.

  I couldn’t get back to sleep. Staring at the ceiling of my little metal prison, I felt so alone, so out of control. Everything about my life was out of sorts. My marriage was over, although we’d agreed not to tell the kids until I came home. I had done such a thorough job of pretending I was happy that they were unaware we’d had any problems at all. I had insisted that we maintain the charade, thinking that if I were to die in Iraq, they could hold on to their happy memories without the burden of knowing that what they believed about their parents’ marriage was a lie. Their reality was like a movie set in which I’d built scenes that looked like a normal life while backstage I carefully orchestrated their perceptions. I knew that if I survived the war, I would pay — they would pay — for this deception.

  I thought of my big brother Rob, then in a rehab facility after suffering a major stroke six months before. I had been in the hospital waiting room in Mississippi with my parents and sisters while Rob underwent emergency heart surgery. He’d had an infection that had caused his aortic valve to fail, then thrown debris into his brain, causing the stroke. During his surgery I’d gotten the phone call ordering me to Iraq.

  I had sat in the ICU, talking to him quietly and crying the first tears I’d allowed myself in years, since I had always believed crying was for people who were unable to control their emotions. But there I was, a supposedly world-class neurosurgeon, powerless against a clump of bacteria that had destroyed half of my brother’s brain. That day had begun the process of bringing together the two parts of my life I’d worked hard to keep separate for many years: my thinly veneered perfect-appearing home life in which I actually had no control, and my white-knuckled grip on the total control of every detail of my professional life. Despite many years of training and thousands of hours treating problems like my brother’s, all I could do for Rob was cry, my tears running down my face and dropping like silent silver apologies onto his paralyzed left hand.

  I walked in darkness to the hospital before 6:00 a.m. Since the base was blacked out at night and there were no city lights nearby, the sky displayed details I’d never seen before. I could appreciate individual differences in the sizes and colors of the stars and planets, and the moon seemed close enough to touch. Iraq sits at thirty-five degree north latitude, just like Oklahoma where I grew up, so the same stars and constellations had been there my whole life. But in Iraq, thousands more of the stars are visible since there is so little light pollution. Sometimes I could even see shadows on the ground from them.

  Recent rains had turned the walk into a sloppy mess. By the time I arrived at the hospital gate, my boots and pants legs were covered in thick, brown Iraqi sludge. Pete was waiting for me. He looked at my mud-covered legs and shook his head. “Now you know why they made you bring those galoshes.”

  I’d been issued three hundred pounds of gear, including a rain suit and knee-high rubber overboots, which were curr
ently in a duffel bag under my bed.

  During breakfast, an airman ran into the DFAC and stopped at our table, out of breath, her black hair in two pigtails high on the sides of her head. She grabbed Pete’s arm. “Doc, they need you in the ER. Iraqi with a gunshot to the head.”

  We ran down the hall to the ER tent. Army medics stood around a wheeled gurney, helping an ER doctor and two nurses move a man onto a bed. The medics looked like EMTs you’ve seen before, with their medical bags and blue plastic gloves. The difference was that these two young men wore Kevlar and helmets and had M – 16s slung over their shoulders with their kits.

  Pete and I stepped past the medics. The man on the bed had his head wrapped in white gauze, which was mostly red now. He had a scraggly beard, a hooked nose, and a black number written on his chest, 1901. Pete began cutting the bandage off the man’s head as he asked the medics what had happened.

  “An Army patrol came upon a group of insurgents just as they shot this guy,” one of the medics said. “Bystanders said he had refused to help the bad guys set off a bomb at our gate.”

  His left pupil was dilated, and there was brain oozing out of the hole in his forehead. There was no exit wound. The man was breathing on his own. While I was looking him over for other injuries, he reached his left hand up and smeared blood on the front of my shirt. The movement was not purposeful; he was flexing his arms in a movement called posturing. This meant his brain injury was severe and he would die if we didn’t act quickly.

  “Get him intubated and then to CT. We’ll get the OR ready,” Pete said to one of the nurses.

  A few minutes later we were standing at one of the little washbasins outside the OR. We had changed into scrubs and were washing our hands for my first operation of the war. I felt the cold chill of doubt inching through my body. How would I do here?

  A nurse had shaved and scrubbed the patient’s head; the orange iodine prep solution mixed with blood ran down onto his chest, and I remember thinking that prepped skin looks the same no matter what color it is. Pete looked up at me and motioned toward the scrub tech, the airman named Nate I’d traveled here with from San Antonio.

  “Airman, this is Dr. Warren’s case,” he said.

  “Knife,” I said, then felt the familiar pop of the steel scalpel in my left hand.

  I was surprised to find that, once my scalpel touched skin, I was transported out of Iraq and into my operating room. The setting was irrelevant. In my career I had operated on many gunshot wounds — GSWs — to the head. The environment was different, but my hands were steady and my training sound. Maybe I could do this after all, I thought; it’s the same as operating anywhere.

  Pete and I worked together well, as if we could anticipate each other’s next movement. We removed half of 1901’s skull and all of his left frontal lobe, his left eyeball, and a mushroom-shaped bullet fragment. We placed an ICP monitor in his brain, and Pete tied the knots in the sutures I placed while sewing up the scalp. Then he showed me how to put the bone flap in the abdomen.

  “We use the right side, far enough to the flank so that later in life no doctor would assume the scar was from a normal abdominal operation.”

  That made sense. If one of these patients came into an Iraqi hospital in future years sick from something like a ruptured appendix, the shape or location of the scar might mislead a surgeon into the wrong diagnosis if our scar was close to where an appendix or gallbladder surgery might normally be performed. The patients would be unlikely to understand or remember what we had done, given their condition at the time of surgery, and there would be no medical records for the doctors to use either. And since we used the left side for feeding tubes in patients with head injuries who can’t eat for long periods of time, it wouldn’t be wise to put the bone flap into the left side.

  Pete made an incision in 1901’s abdomen and had me sweep my finger through the fat down to the first layer of muscle.

  “There, just above the rectus sheath. Run your finger around to make a pocket in the fat.”

  I placed the skull flap into the pocket I had created. Pete washed the wound out and closed it while I wrapped the man’s head with gauze and wrote, “No skull bone on left. Handle carefully!”

  Pete pulled off his gloves and patted me on the shoulder. “Congratulations, Doctor, you’re now officially a battlefield brain surgeon.”

  That evening, we sat on the roof of a small building next to the hospital and looked over the fence into Iraq. I could see palm trees, the farmland, and dusty desert fields that bumped into each other here in the beginning of the Tigris Valley. In the distance, I could see Balad Village, the tiny town for which the base was named. A bunch of Iraqis walked around, looking at the fence.

  “What are they doing?” I asked Pete.

  “Beats me,” he said. He took a long swallow of a nonalcoholic beer and handed me a bottle. “No alcohol allowed on base, General Order I-A,” he said.

  I remembered the lecture about the order. Basically, you could be court-martialed if you were caught with alcohol, pornography, or in the quarters of a member of the opposite sex while in the combat theater.

  I thought about how thirty thousand mostly eighteen- to twenty-five-year-old soldiers might behave in this stressful environment during their deployments. I asked Pete, “Do you think the general order works?”

  He shook his head slowly. “Well, in my time there have been several sexual assaults on base. And a few women have had to go home because of pregnancies. Plus, the ER docs see a few drunk soldiers every month.”

  “I guess putting on a uniform, taking an oath, and going off to war isn’t enough to overcome some people’s need for instant gratification,” I said.

  Pete clinked his bottle against mine. “To General Order I,” he said.

  The “near beer” tasted like grass to me, but at least it was cold.

  Several of the Iraqis walked up close to the main gate to the base, approaching as a group until the guards raised their weapons and challenged them. They backed up a few steps and stood for a while, not moving. I saw a gunner up in the tower next to the gate, moving his rifle to follow the robed men through his scope. Finally they walked away, following the fence line closely. One of them ran his hand along the fence as he walked.

  I wondered whether they were simply curious about the American military base, or whether some of them were enemies, looking for weaknesses, plotting attacks, and wishing us dead.

  “You must have brought some luck with you. This has been the slowest time since I’ve been here,” Pete said. That night when the jets woke me up, I was in a cold sweat from a dream in which patient 1901 told me that the only reason he was shot was that we were here. “No Americans, no bullet in my head,” he said. He wore an eye patch and held up the missing half of his skull, shaking it at me. “All your fault,” he’d said right before the F – 15s saved me from whatever he would have gone on to say.

  The dream left me with a feeling of impending doom, which still hung over me as I walked to the hospital the next morning. On the way, I saw a Black Hawk helicopter pass overhead. The pilot didn’t circle into the wind like the others I’d seen land at the hospital. Instead, he flew straight over and did a very rapid descent onto the helipad. It was obvious that the patient they were bringing in needed help quickly. I ran the rest of the way to the helipad in time to see two medics unload an American soldier with his head wrapped in bloody gauze. I followed them as they ran his gurney into the ER.

  “IED hit his convoy. Two others were KIA,” one of the medics yelled to me over the roar of the rotors.

  The patient was awake, probably nineteen or so, an Army private. I removed the gauze and saw that he had a tiny hole above his right ear and a larger one above his left. Whatever had entered had gone directly across his brain. That meant disaster. He was awake, his eyes staring at the roof of the tent, his pupils dilating rapidly. The helicopter crew had intubated him during the flight.

  Pete wasn’t there yet, and it too
k me a minute to realize that everyone was waiting on me to tell them what to do. “Get him to CT scan, now,” I finally said, although I half expected someone to laugh and say, “Who are you to order us around? You just got here.” No one did, thankfully.

  The scan showed what I already knew it would. A piece of shrapnel had crossed his brain from right to left, directly across his brainstem. He was a dead man, but the rest of his body didn’t know it yet. The injury was non-survivable, inoperable. I was filled with a feeling I’d felt many times before when faced with a patient I can’t help. Powerless, impotent, stupid — and this time also angry since I knew that this kid had been murdered by some zealot too cowardly to wear a uniform and give the soldiers someone to shoot back at. After he’d set off his roadside bomb, the terrorist had probably just slunk back into the crowd and carried on with his life. Maybe he came to work at our base cafeteria; maybe he loitered around our gate.

  “What do we do, Doc?”

  I snapped out of my thoughts. They were waiting on me to decide what to do.

  “Take him to ICU and keep him comfortable.”

  He lasted about two hours.

  He was my first dead American, a type of innocence lost I still wish I could have back.

  I walked back to my room that day unable to get the young soldier’s dying eyes out of my mind. The flat world around me still seemed featureless, but now it felt sinister. In two days I’d already seen too many examples of the dangers lurking nearby. Filled with the uneasy feeling that whatever luck I might have brought with me to the war must be about to run out, I went to bed that night before darkness fell on my brown world. I didn’t yet know that tomorrow the dominant color would change dramatically.

  CHAPTER 5

  FOR THE FIRST TIME IN MY CAREER, I DIDN’T KNOW WHAT TO DO

  Just after sunrise the next day, I walked to the hospital to eat breakfast. The last bite of powdered eggs and sip of lukewarm coffee had just tumbled into my stomach when the “911” page summoned me to the ER.

 

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