No Place to Hide

by W. Lee Warren

  Well, you all know from the news that a lot of bad things have been happening over here. Just know that we’re all doing okay today, and that God has extended his shelter over us so far. Thanks for all your support.

  I love you all and continue to ask you for your prayers.

  Lee

  EMAIL HOME

  Saturday, January 29, 2005

  Good morning, friends.

  Yesterday was the beginning of what we expect to be a very bad weekend. Several mass casualty situations occurred around Iraq, and we were steadily busy here at the 332nd.

  I can’t say too much about the guys I took care of yesterday; they’re the guys you aren’t supposed to know about, and they are doing amazing things. I did get to operate on a guy who would have otherwise died, and we got him out to Germany last night. I think he will survive, and he could actually do okay if he’s blessed with a few breaks. The other patients weren’t so blessed.

  The mood in the hospital has been tense since that rocket landed so close, especially after all the mangled people we’ve seen in recent days. We’ve been ordered to full arms, and body armor/helmets everywhere you go. Also, tomorrow (and possibly Monday) we are not allowed to email or use the telephones at all, so all of you who assume I’ve been blown up every time you don’t get my letter, please just relax until Tuesday. If there’s no letter then, start worrying.

  Please keep us in your prayers, remember that we’re doing good over here no matter what the media may tell you every night, and that for the most part the Iraqis are glad we’re here. Pray for success tomorrow, and don’t worry when you don’t hear from me. I’ll be okay — God’s got things for me to do when I get back.

  I love you all,

  Lee

  “By published criteria, he’s unsalvageable,” I said, looking at 2185’s brain scan with Tim. We’d been working nonstop for three days, since the enemy was doing everything he could to discourage the citizens of Iraq from getting out the vote for their first democratic elections, scheduled for tomorrow. Now Tim and I were faced with a fresh batch of IED victims, and we had some tough choices to make.

  We were almost out of ICU beds, and we had several Iraqi patients on ventilators who had such terrible brain injuries that we knew they weren’t going anywhere soon. The enemy didn’t seem to care that the hospital was full — he just kept blowing things up every day. In America, we would have simply let the trauma system know that we had no beds available, and they would have notified all the ambulance crews in the city to divert patients to another trauma center. That wasn’t possible in Iraq, since we were the only hospital other than Ibn Sina in Baghdad, and Ibn Sina was full too.

  So here we stood, looking at the scan of yet another numbered Iraqi, trying to decide what to do with him. We didn’t have his story, didn’t know whether he was a terrorist, a merchant, or an Iraqi National Guardsman. We did know he was dying.

  “We can keep him alive with a big decompressive craniectomy,” Tim said.

  “Yeah, but he’s not going to wake up. Both frontal and both temporal lobes are hit. At best, he’s going to be vent-dependent, comatose, and he’ll be here forever.”

  Tim shook his head and dropped into a chair by the CT desk. “I hate this part. Your call, though. I’ve got to do the American in a minute, if he survives his open heart surgery.”

  Tim’s patient had an open skull fracture, and part of his frontal lobe was exposed. The Army lieutenant had been ambushed with his unit and had taken a bullet to the forehead, along with two that had hit him in the seam of his body armor, both of which had gone through his heart. Todd and Mike were working on him, and if he made it through that, Tim would clean up his brain. The bullet must have hit the lieutenant’s helmet first and lost some of its energy, because his brain injury was really pretty minor. My patient’s was not.

  “I hate it too,” I said, while the last few images scrolled across the screen. A sour taste rose in my mouth — the foul taste of chewing on two equally unpleasant choices.

  Back home, when I had a patient whose injuries were neurologically devastating, I would leave the choice to the family. We’re very good at keeping people alive, I would tell them, but the brain injury itself determines how much of a person we can actually deliver back to them. With aggressive surgery, I can often save someone’s life despite the severity of the injury, only to commit the family to many years of breathing machines, feeding tubes, and long-term-care facilities. Usually, families don’t want to save their relative if they’re going to be “a vegetable.” We then follow the family’s wishes and humanely withdraw artificial life support and keep the person comfortable until they pass away.

  2185 was such a patient. His injuries were technically survivable, but he was never going to be okay. The problem was that I couldn’t go out and speak with his family. I had to decide. Should I try to save him, knowing that we were already in a critical overflow situation in the hospital? Committing to surgery on 2185 would mean using one of our instrument sets, along with precious blood products and two hours of time during which anyone else who needed brain surgery would have to wait. And after surgery, he would tie up one of the ventilators, the resources of the ICU doctors and nurses, and stretch even further the limits of our ability to care for all the patients the enemy had already provided for us in the past few days.

  I walked into the scanner and looked down at the young man. He was small, probably five-six or so, and thin. His brown skin and brown hair and brown eyes contrasted sharply with the bright red blood that dripped slowly from dozens of tiny shrapnel wounds all over his head and neck. The whites of his eyes were bloodshot, and his right eye had the milky haze of an intraocular hematoma. I looked into it with my penlight, and saw a little hole in the corner, where a small fragment had entered his eyeball.

  Add blind in one eye to his list of problems, assuming he survives and wakes up.

  His left pupil was still small but did not constrict. He had not been intubated yet, since he was still breathing when he arrived at our hospital. I looked at his cracked, bleeding lips and noticed the pattern of his respiration. He took several rapid, shallow breaths and then suddenly made a faint gasp. I watched the monitor as 2185 took no breath for about twenty seconds.

  “He’s Cheyne-Stoking,” I said. Cheyne-Stokes breathing indicates a serious brainstem injury, or that the brain is under so much pressure that the respiratory drive is failing.

  2185 made a sudden loud, watery gasp. He took several deep, long breaths, the other half of the Cheyne-Stokes pattern.

  I put my hand on 2185’s chest. He was only the latest victim of this war. For a moment I stopped being a doctor and became just Lee Warren, thirty-five-year-old kid from Broken Bow, Oklahoma. I wondered about 2185’s life, his family, his personality. I wondered whether he was married, and what he thought about the war and our involvement in it, and what his last thoughts had been before that bomb had gone off. He gasped again, which shook me out of my few seconds of being just a guy watching something awful happen to another guy. I took a deep breath myself and went into neurosurgeon mode.

  There’s a place neurosurgeons are trained to reach. A mental refuge in which to hide when the decisions you’re forced to make go against some aspect of your moral code, your upbringing, your basic societal impulse to help people. We’re supposed to comfort ourselves with our knowledge of the medical literature, our understanding of things like the inner workings of the nervous system, our higher level of insight into the difference between living and being alive. That’s why some of us can seem arrogant, cold, or distant at times; we’re hiding in a place where you can’t see how much it hurts to be the one to decide when someone else has to die.

  I looked at the nurse across the table. “Take him to the ICU, give him some morphine. Keep him comfortable. Let the Czar know 2185 is not having surgery.”

  Flip the switch, write the order, move on to the next patient. That’s how we’re trained. If only it were that easy, I tho
ught.

  I watched the nurse wheel him down the hall, then turned to Tim. I needed a minute to be just another person before I had to be the impenetrable military neurosurgeon again. “Hey, since we can’t use the phones tomorrow, I’m going to try to call my kids now. I’ll come and help you with your case in a few minutes.”

  “Good. See you in a few,” Tim said.

  I walked into the surgeons’ lounge. The Christmas tree lights were sparkling away, reminding us that somewhere out there someone was probably celebrating something. I smiled at my good luck: no one was on the phone.

  I let myself get a little excited at the thought of hearing my kids’ voices. I’d only talked to them twice in the month I’d been gone from them, and at that moment I just needed to know they were okay.

  The operators took their usual five minutes to make the connections. I heard the clicking and popping of electrons in Iraq, Bahrain, San Antonio, and Alabama, and finally heard the ringing.

  My wife picked up the phone, and I heard the difference in her tone instantly.

  “Hello.”

  “It’s Lee. Let me talk to the kids, please.”

  “I told them.”

  “You told them what?”

  “About the divorce.”

  She went on to say that it was simply too hard to pretend, and she felt it was wrong to keep misleading them. I realize now that I made a huge error by leaving for the war without settling everything between my wife and me and trying to help the kids understand what life would be like after I returned home. My normal need to control everything had given way, this time, to a desire to let them believe, should I die in the war, in the fantasy of a happily married Mom and Dad. I had been wrong. That was wrong, and it made the whole situation harder on all of us.

  I heard the rustling of the kids gathering to talk to me and heard the clicking of the speakerphone.

  Mitch spoke first. He was crying. His ten-year-old voice trembled when he said, “Daddy, are you and Mom getting a divorce?”

  Kimberlyn, the twelve-year-old, was slightly more controlled, but also more angry: “Mom told us, Dad. Why would you do that to us?”

  Kalyn, age seven: “Daddy, you can sleep in my room when you get home.”

  At that moment, my most sincere prayer was that a mortar would land right on top of me. The crater in my heart was already there. An actual explosion would hurt less.

  “Guys, it’s going to be okay, I promise. We’ll get through this together.”

  I tried to calm them down, but through my tears and the shock of having to do this over the phone, I didn’t have the words. Someone behind me tapped my shoulder.

  “Doc, fifteen minutes are up. I need the phone.”

  I started to say “I love you” to the kids, who by this time had stopped crying, but the line went dead.

  I moved out of the way and fell onto the couch, crying into my hands. I was shaking, crushed that I wasn’t there to comfort my kids, hold them, try to explain it to them. Instead, I was thousands of miles away and impotent to help them.

  Suddenly, Tim was sitting next to me. He put his arm around me, and I cried onto his shoulder.

  “What’s wrong?”

  I told him.

  He listened quietly, then said, jaw muscles tensed, “Listen, I know you’re hurting, and I’m really sorry. But you have to put it aside for now. You can’t survive here if your head is in Alabama. There’s too much work to do. You’ll deal with that when it’s time, but right now you have to suck it up. We need you here.”

  And I knew he was right. No matter how much pain I was in, or how serious the wounds to my kids’ little hearts, I couldn’t fix it from Iraq. And if I didn’t clear my head and fight on, people here would die.

  But whatever part of me had left for the war thinking that my wife and I would work on the marriage when I got home died right then, and a sixteen-year-long relationship went into Cheyne-Stokes breathing. Distant thuds from another mortar attack hit my ears, sounding a little like a hammer nailing the coffin shut on that part of my life. I accept the fact that my marriage failed, and blame was to be shared between both of us. And I know during those sixteen years I wasn’t the easiest person to love. I was never home, I was too driven, I didn’t know how to fight or directly handle things emotionally. But hearing my kids ask me why when I couldn’t see their faces or hold them caught me unawares, and I was totally defeated.

  I walked back into the ICU and watched a tech turn off the monitors beside 2185’s bed. He was dead. In the next bed, still very much alive, was 2137, the blind and comatose bomber from one of yesterday’s attacks.

  At that moment, I saw in 2137 everything I hated in the world. Terrorism, war, meanness, hatred, the hatemongers who love to sow discord and pain. Icy rage crawled up my spine, and for a moment I wished I could choke the life out of him, as if that would make everything right. How can someone hate another group, another person so much that they would be willing to blow up a marketplace full of innocent people?

  I took a deep breath and loosened my grip on the bedrail. I was still shaking and would have been still crying but I was out of tears.

  The monitor showed 2137’s heart rate was way too fast. He was probably in pain, I thought.

  Therein lies the problem, I told myself. I’d always been the man to take someone else’s blows if it meant avoiding conflict or letting the other person feel good, at my own expense. And no matter how much someone else hurt me or the people I cared about, I always seemed to find myself apologizing and trying to make peace. I could never stand to let someone else suffer. But at that moment, I wanted him to suffer. As if watching him hurt would somehow make me feel better about everything, even what was happening with the kids.

  “Right now you have to suck it up,” Tim had said.

  True, 2137 was an enemy, and he had done terrible things. But it wasn’t my job to punish him. My job as a doctor was to help him survive so that others could mete out justice. His reckoning would come if he survived. And, I believed, even if he didn’t survive.

  I made the decision right then: I was not going to lose myself to this war. Not the one in Iraq, and not the one in Alabama. I couldn’t fix my kids’ pain, or even fight that battle, at least for the moment. But I could still do my job there in the dusty tent hospital with the tachycardic terrorist-turned-patient in front of me.

  “Give him some morphine,” I said to the nurse. “It’s not right to let him suffer.”

  CHAPTER 18

  WE’LL ALL GET THROUGH THIS TOGETHER

  Moments later I walked out of the hospital and looked up into the dusky red sky, my eyes still burning from having emptied themselves. A few stars were faintly visible through the dust and the blowing smoke. I coughed and wrapped my scarf around my face and walked across the lot to the bathroom trailers.

  In the mirror I saw a man I hardly recognized. For most of my life I’d been somewhat overweight, and my mental image of myself had round cheeks and a double chin. The guy staring me down had a sharp jawline, sunken cheeks, and hollowed temples — I’d lost almost twenty pounds in less than a month.

  My eyes were so bloodshot that I could see hardly any white outside the blue iris. I looked awful.

  I splashed water on my face and felt the coolness trickle down my neck under my collar. When I’d boarded the plane to leave for the war, I’d told myself that this trip to the desert might provide the clarity I’d been seeking to figure out how to deal with my problems at home. Now I sighed as I realized that not only was I out of answers, but I didn’t even know the questions.

  I shook my head at the thin, haggard man in the mirror. For so many years I had been all about work and my kids. I had defined who I was by what I did, and I’d worn that Invincible Neurosurgeon persona like a superhero costume. It was impenetrable. No one could find my hidden vulnerability, the Kryptonite that would render me just another guy with a bad marriage and no idea what to do about it. Church had been a place to smile and pretend
that I had it all together, because in my church if you didn’t have it all together it meant your faith was faulty. And because I was supposed to be a smart, professional, infallible brain surgeon, I couldn’t admit to anyone that my faith was in fact faulty. After all, I knew that I didn’t have it all together.

  In that mirror-moment, the whole jumbled, confusing mess of my life seemed impossible to figure out. I wished again for a rocket to just take me out. My dad had sold me a life insurance policy before the war, telling me how important the policy would be for the kids if I died, and as I looked at my ridiculous tri-colored eyes, it occurred to me that I was worth considerably more dead than alive. And right then, my kids might have agreed.

  I heard a noise behind me, and I kept washing my face so whoever it was wouldn’t see me looking so pathetic. A hand clasped my shoulder, and I looked up to see John, the occupational therapist who had been coming to my trailer for movie nights for the past few days.

  “Hey, man, you coming to worship practice? Starts in thirty minutes,” John said.

  I’d forgotten all about it. Greg, the worship leader, had set up a practice that night with all the new singers and musicians who had arrived to replace the folks who’d recently gone home. Pete had volunteered me for the band, and I had helped a little over my first few weeks. But tonight, Greg planned on helping the new group get itself together, and he’d all but ordered me to become the new leader.

  How can I lead a worship band when I’m not even sure what I believe right now?

  I wiped my face with a paper towel. I had no excuses. Tim was on call. When I turned around, John’s smiling face was the closest thing to a good feeling I’d had in days.

  “Sure. I’ll run by my trailer and grab my guitar.”

  By the time I reached the chapel, the team was already there. In the dimly lit tent surrounded by a five-foot-high wall of sandbags, nine people sat in a circle on the little stage at the front, talking quietly as I entered.