No Place to Hide

by W. Lee Warren

  I watched the gate guards lift the wire and let Vania and Mohamed through. I didn’t know whether to be thankful that I’d been there to help, or ashamed that Mohamed had needed that help.

  CHAPTER 15

  PLUGGED ROCKETS AND HOMEMADE BIOLOGICAL WEAPONS

  EMAIL HOME

  Thursday, January 27, 2005

  Hello, friends.

  Yesterday was frightening, even as we saw clearly God’s hand of protection on us.

  After rounds, about forty people from the hospital gathered in front of the Porta-Potties to wait for a bus to take them to a briefing on the other side of the base. Tim and I decided that he would go this time and that I would stay in case anyone came in needing our help.

  Around 10 a.m., I was sitting at a desk by the ER when I heard a loud sound that reminded me of a bottle rocket. It was so loud and close that everyone noticed it. Then people ran into the ER saying that a large object had landed in the parking lot and made a crater.

  It was a rocket. A ground-to-ground missile had landed on the exact spot where those folks had waited an hour before. It made a twelve-foot-deep crater, but it didn’t detonate. At the same moment, at least six other rockets had landed on base — the first coordinated attack since I’ve been here. Somehow, not a single rocket blew up. The EOD troops said that the recent rain had made the ground so soft that the rockets just plugged into the mud. That’s the last time I’ll complain about the weather.

  One of the rockets landed in the housing area where our trailers are, and another outside the gym where we work out. I don’t know about the rest.

  The path of the rocket that landed just outside the hospital would have put it about thirty feet over my head when I heard it. That’s when you realize that the tent isn’t going to help you much if something huge blows up one hundred feet away. Praise God for the non-detonation.

  The Alarm Red sounded, and we spent the rest of the day in body armor and helmets as the EOD team tried to dig up the rocket so that they could move it somewhere else to detonate it. They spent hours digging, but finally decided to blow it up in the crater. First they put big concrete barriers around the hole to keep us safe.

  Some people in the hospital joked nervously, some went about their business as usual, and some were clearly very afraid. One technician hid under her desk, crying quietly. It was the first time we’ve had that close a call or an attack directly on the hospital, and it made us all remember that we are at war. At one point they lined us all up in a hallway and told us to sit against the wall. I got pretty nervous, thinking that if the rocket exploded and caught the hospital on fire, there was no way out. I had a little pocketknife with me, and thought about how I’d never be able to cut my way through the canvas in time. I decided that if I survived the day, I was going to buy a bigger knife, like the ones the Army guys were issued. The Air Force didn’t give us knives, but at least they gave us malaria pills.

  During the Alarm Red, we received a helicopter full of US soldiers from right outside the gate, victims of an IED that blew up right around the time of the rocket attacks. I can’t say much about them yet, but we were all busy for a while. Suffice it to say that I’m now convinced my new partners are at least as good as the guys who recently left.

  When the EOD squad finally detonated the rocket, it shook the whole hospital and threw mud and gravel over a hundred yards away. I can’t imagine what would have happened if that thing had blown up on impact, but I probably wouldn’t be sending this email.

  About an hour later, the All Clear sounded, and we were allowed to leave the building. I was too tired to eat, so I went to my trailer and slept for several hours, worn out from a full day of surgery and wearing body armor for twelve hours.

  Around midnight, I had to go back to the ER because a patient came in complaining of headaches. His CT scan showed a large brain tumor. Even here, illness lurks. We sent him straight to Germany.

  They installed a new gate at the hospital yesterday evening that looks a lot sturdier than the little wire gate there before. They stationed a tank out there too. I feel a little safer, I guess.

  Have a great day, everyone, and give thanks for the fact that most likely no one will try to blow you up today. Your friends in Iraq can’t say that.

  I love you all, and miss you much. Gotta run for now, though. Patients are coming in.

  Lee

  “Wake up, Lee! I need to check my email while there’s still time.”

  I looked up. Tim was standing behind me, patting my shoulder. It took me a few seconds to realize that I’d fallen asleep in front of the computer in the surgeons’ lounge after I sent out my letter. I’d never left the hospital after I came back in to see the guy with the brain tumor, because an IED attack immediately afterward had produced twenty patients for us, six Americans and some Iraqi civilians, plus a bunch of insurgents who looked like they should be on an FBI Most Wanted List poster. Tim and I had operated all night, and when we’d finally finished the last case, I’d sat down at the computer desk.

  I lifted my head and wiped a pile of drool off of the desk as I slid out of Tim’s way. “What a night,” I said.

  Tim nodded as he logged on. “I think the enemy changed the rules yesterday.”

  I plopped onto the couch, trying to decide between going back to sleep or going to the ICU to check on our patients. We weren’t going to do group rounds today because all the other surgeons were still in the operating room. All night long, in case after case, we’d seen that whoever had made this particular bomb had not been a very nice person, even by terrorist standards. We were used to finding ball bearings and metal shards in our patients after IEDs blew up. But this one had been full of razor blades and pieces of steel wire and rocks, coated with brown goo that the infectious disease specialist identified as human stool. I guess the bomb maker figured that if someone survived the blast, they might die later of infection — it was a homemade biological weapon. As disgusting and sinister as this was, it had occurred to me while I was removing a goo-coated rock from an Army private’s frontal lobe that militaries have used bacteria as a weapon for centuries. War brings out the worst in people.

  “Hey, check this out,” Tim said.

  I dragged myself off the couch and slumped over the desk. Tim pointed to the screen, which showed a photo of a pretty-girl-next-door type with a bright smile standing sideways, resting her hands on her protruding belly. “Your wife?” I said.

  “Yep. And our daughter. First kid.”

  “Congrats. When’s she due?”

  Tim’s face darkened. “About a month. We’re going to try to set up a webcam so I can see her deliver.”

  I wondered how, with twelve other neurosurgeons in the Air Force, someone had chosen to send both Pete and Tim off to war when their wives were having babies. As much as I missed my kids, and as heartbroken as I was that my family had crumbled, I couldn’t imagine being seven thousand miles away when your child is born.

  “I’m sorry, man,” I said.

  A tech from the ER ran into the room. “Two more Black Hawks coming in. Another IED. They’re about twenty minutes out.”

  “Perfect,” Tim said, typing his reply to his wife’s message. He leaned back in the chair and rubbed his eyes, yawning. He looked awful, I thought, but at least he didn’t have to wipe his own spit off the desk. I probably looked worse.

  “Hey,” he said, “we just finished our fourth crani an hour ago. If there are any heads coming in, I hope we have enough instruments.”

  “Sit tight and relax,” I said. “I’ll check on the instruments and make rounds in the ICU before the choppers get here.”

  I checked my watch as I walked to the instrument-processing area. Techs brought dirty instruments there for cleaning and sterilization. Every instrument had to be removed from its tray, washed and replaced, and then steam-sterilized in an autoclave. We had two autoclaves, and it took about three hours to sterilize a tray.

  Sergeant McDonald was washing instrume
nts. He had on hospital scrubs, size small, I was sure; he was easily three or four inches shorter than my 5'9". I watched as he nimbly cleaned Iraqi and Syrian and American blood off forceps, scissors, and clamps. When he looked up, I saw in his red eyes and distant look the same crushing fatigue and general sadness I felt.

  “What can I do ya for, Major?” he asked.

  “Just checking on craniotomy instruments, Sarge. We have more patients coming in.”

  McDonald looked to his right, and I saw a stack of eight or nine dirty instrument trays waiting to be cleaned. Both autoclaves were hissing, and the room smelled like soap and steam.

  “One of your sets is cooling off, ready to go, and one is about thirty minutes from being done. The other two, ’bout four hours. I gave my other two techs an order to get some sleep, so it’s just me for a while.”

  I shook my head. “That’s not going to work. If we have more than two patients who need brain surgery on those choppers, we’re in trouble.”

  McDonald huffed and seemed to grow taller. He squinted at me, jaw muscles bunched. Pushing up his glasses with the back of a gloved hand dripping soapy water and holding a surgical clamp, he said, “You think I can snap my fingers and make these things clean, sir? I bump your stuff to the front of the line, I’ll have ortho docs and general surgeons down my throat. Everybody’s all hot to have their stuff ready first. You guys seem to forget that when you’re busy, we are too. I’m no surgeon, but I’m busting my hump same as you. So unless you got another autoclave somewhere I don’t know about, it’s gonna be four hours.” He tossed the clean clamp onto the pile of instruments to his left, stared me down for a second, picked up a bloody retractor, and went back to work.

  I turned and left, feeling like I’d just been dismissed after a visit to the principal’s office. Until now, I hadn’t thought about the fact that dozens of people were working hard to make sure I had what I needed to save someone’s life. People like McDonald who never got to see the patients and would never be in the spotlight. But we couldn’t function without them, and they were getting mortared and missing their kids, same as me. And he was right — when we operated all night long, somebody in the instrument room was in there sweating away, washing little bits of the war down the drain to give us back the tools we needed, knowing we’d soon get them bloody all over again.

  In the ICU I saw Brad, one of the critical-care doctors, standing next to an Iraqi man I’d operated on a few hours before. The patient had a huge skull fracture from the IED blast, and when I’d removed his broken frontal bone and his destroyed frontal lobe, I had found a Dsized Energizer battery buried in his brain.

  “How’s he doing?”

  “ICP is normal. Pupils aren’t working, though. Augie thinks he’s going to be blind in both eyes from the blast effect. His labs are all out of whack too. I’ve been having a hard time getting his blood sugar under control.”

  I wondered: Why would a healthy-appearing thirty-something-year-old Iraqi have a high sugar level? “Did someone give him steroids?” I asked.

  Brad shook his head. “I think he’s diabetic. The problem we have with a lot of these patients is that they haven’t had any health care for most of their lives. Our troops are all in good shape, have their shots, go to the dentist. When one of our boys has an injury, that’s usually all that’s wrong with him. These guys, not so much. They have high blood pressure, diabetes, heart disease, abscessed teeth. We have a pretty hard time taking care of them after surgery sometimes. Check out the Godfather over there.” He pointed to the patient in the next bed.

  I looked over and saw a middle-aged man, 2115, who looked remarkably like a young, tanned Marlon Brando. He had an open belly wound and an eye patch.

  “Look at his hands,” Brad said. His knuckles were enlarged, and his fingers were twisted sideways. “I think he has rheumatoid arthritis. I can’t give him prednisone to help with that, though, because it will keep his abdominal wound from healing.”

  I remembered the US soldier from the night before, the one who had come to our ER with a headache, where I had diagnosed a brain tumor after viewing his CT scan. That soldier was on his way back to America, where whatever the diagnosis turned out to be, he would have access to every available medical technology and the best doctors in the world. He would have the highest possible chance of survival. But as I looked around the ICU, I realized that none of the non-American patients were likely to see even a family doctor again in their lifetimes.

  “That’s hard,” I said. “It’s one thing for us to save someone’s life in the OR, but trying to keep them healthy for the long term must be frustrating for you.”

  Brad nodded.

  With the Iraqi health care system in shambles, the doctor in me was frustrated along with Brad. But the “911” on my pager meant that the surgeon in me had to get back to work.

  “Showtime,” I said. “You should try to move some of these guys out, because we’re about to have more.”

  I ran to the ER, hunger pangs reminding me that I hadn’t eaten in almost twenty-four hours, and I’d been working for fifteen hours straight. More importantly, we still had about three hours before our other instruments would be ready.

  I had a bad feeling about that.

  CHAPTER 16

  THEY WERE STILL SCREAMING WHEN THE CHOPPERS LANDED

  While Brad and I were talking, an American convoy outside the wire was passing through a narrow street, on their way to deliver supplies to soldiers at a forward operating base. Insurgents had planted bombs in cars on either side of the street; they hid while the vehicles funneled through. At the right time to inflict maximum damage, one of them triggered the bombs with a cell-phone signal, and the world exploded into fire and flying shrapnel.

  After the explosion, while the dust settled and the shock faded, those who were conscious cried out in pain, terror, and anger, trying to find their missing buddies, children, or body parts. US medics, despite the danger, managed to rescue all the Americans and any other injured people still breathing.

  The victims were still screaming when the choppers landed at Balad. A multilingual cacophony filled the air as I ran down the hall to the ER.

  I heard their cries before I got there.

  All eight beds were full, but medics were carrying more burned, broken men into the overflow room and the surgeons’ lounge. Dave the Trauma Czar ran from bed to bed, trying to manage the chaos; nurses started IVs and wrote numbers on chests; and a couple of the surgeons were assessing patients. The timing was bad — the ICU was nearly full, and half of the ORs were still being used after last night’s chaos.

  The first man on my right was a Marine private, missing a leg. Whoever had reached him first after the bomb went off had removed the private’s DCU belt and used it as a tourniquet around the thigh just above where his knee would have been. That had saved his life; I could see his femoral artery sticking out next to his stark white femur, but no more blood was coming out. I put my hand on his chest and, leaning close, looked in his eyes. Dozens of little wounds covered his arms, neck, and face, and he smelled like gasoline.

  He was staring at the ceiling, eyes pale and clear blue, and I could see the tan line on his face from the sunglasses he’d been wearing that had saved his vision. I shined my penlight in his eyes. His pupils were normal. Then he startled me by reaching up with his right hand, grabbing my collar, and pulling me down almost on top of him. “My foot hurts,” he said.

  As I straightened, my right hand fell to his left side. My brain knew what I felt there before I saw it.

  I moved the sheet off his left side and saw that his left hand was resting on the amputated portion of his right leg. His foot and lower leg were still in his boot; someone at the scene had scooped them up along with the private. His knee, I guessed, was still on the battlefield.

  I turned to the nurse. “He needs ortho. Grab one of them when they get out of surgery. Get him some blood and a head CT.”

  I patted the private’s ch
est, thankful that his concussion had taken the clarity of the situation from him for now. His phantom limb pain would go home with him, along with his Purple Heart medal, but at least he was alive.

  I moved to the next bed, where an Iraqi policeman was screaming something in Arabic and struggling against two orderlies, who were trying to keep him on the bed.

  The policeman had a bloody bandage over his right eye and forehead, a long laceration on his face, and burns on his chest and arms. He was also missing several fingers. As I gave him a quick assessment, I noticed a piece of steel wire sticking out of his right thumb. I looked at it more closely — it was precisely placed surgical hardware, not the type of wire that would have come from a bomb blast. There was also a wound on the palm of his hand that looked a few weeks old, and a smaller one on the back of his hand. This puzzled me. The man had had some type of surgery in the recent past, but I was sure it had not been at our hospital.

  An interpreter named Raul arrived at the bedside to help calm the man who was now fighting three of us. As I tried to take the bandage off his head, I had to lean on his chest.

  Raul spoke to him in Arabic, and the man quieted. His eyes held both tears and rage, and his words hissed between clenched teeth as he answered Raul. The policeman gestured toward the patient directly across from him, currently being assessed by Tim.

  Raul shook his head. “This man is Jafar,” he told me. “He is policeman from Tikrit. He say the man in next bed is jihadist who set off the bomb today. Jafar also say he was off duty and in the market with his daughter when bomb go off, and Jafar watch her die from burns while he hold her hand. He ask if he can spend some time with that man.”

  Ice and fire flowed through me at the same time. Jafar’s daughter had died only minutes before, right in front of him, and the man responsible was five feet away. In Jafar’s place, I would want to have time alone with that man too. But for the moment, I had to be Jafar’s doctor.