Greg turned when he heard me. “Hey, Lee! Glad you could make it. Come join us.”
I dragged myself down the aisle and sat in the circle between John and a tiny Air Force captain with close-cropped hair and the biggest smile I’d ever seen. She stuck out her hand and said, “Hi, I’m Shauna.”
The rest of the circle was made up of people from all over the United States. Three different racial backgrounds, seven different military jobs, and the Army, Marine Corps, and Air Force were all represented. Directly across from me were Israel, a guitar player and singer with an M – 16 and a sidearm, and Luther, a six-six giant of a man who looked a little like LeBron James, but he carried a grenade launcher and a huge machine gun. The two of them were very fit, serious men who looked like they could have delivered plenty of shock and awe all by themselves.
I was uncomfortable sitting in this circle of people who, despite their busy schedules, had volunteered to be in the church band and help other people worship. I felt intimidated by their generous spirit and, I assumed, their spiritual depth and maturity. I thought that they would take one look at me and instantly know that I’d failed in my marriage, failed to save my patient that day, and failed to know where I stood with God, or even to know for sure what I believed. At least I can play and sing pretty well, I thought. Maybe we won’t have to talk about all that other stuff.
Greg called the meeting to order, and of course the first thing he said was, “Okay, guys, let’s get to know each other. Beginning with John, tell us a little about yourselves and where you are in your life and in your faith, and about how the war’s affecting you. Over the next few months, this should be more than a band. You’ll become a family, and help each other through whatever’s going on.”
John began, and by the time we’d worked our way around the circle to me, I knew that I was in a room full of people with problems and struggles as significant and real as my own. There was no pretense, no judgment. Tears fell, hands were held, and people really opened up about their lives.
It was my turn. I had a choice to make. Continue to be Dr. No Problems? Continue to hide my issues? Or tell the truth and let myself be known?
I searched inside. I couldn’t find the energy to hide or pretend anymore. I was tired of being unknown, and less afraid of the rejection I’d feared from my church in the States if my problems were known than I was of the hollowness of pretending to have it all together. So I told my story.
When I finished, Greg asked us to stand and hold hands for prayer. Luther, the giant soldier, leaned closer and in a thunderous bass whisper said, “Doc, it’s gonna be okay. We’re here for you.” John and Shauna held my hands, and John said, “We’ll all get through this together.”
By the time Greg ended the prayer, I realized that the day’s horrible events had somehow delivered me to a place where I’d finally stopped trying to survive on my own.
As I tried to sleep that night, my mind replayed my children’s voices, again and again. I could hear their sobs, their despair. But I could not hold them and comfort them. I was impotent and absent and unable to help them deal with the worst news they’d ever received. That had been taken from me. But on that same day God had provided a group of people whose openness and love made me believe that it would all be okay — somehow.
A mortar landed somewhere close by, and the thud-boom sounds shook my trailer a few seconds before the Alarm Red sounded. I pulled the covers over my head, no longer afraid enough to bother hauling myself to the bunker.
My mind played the tape of 2137’s hatred, 2185 bleeding out, and my kids’ sobbing questions. Life-and-death decision making, damage control. Battles lost, wars still raging. Decisions to be made.
I made one right then.
I’d left for the war with my marriage in critical condition, but at that moment, as I lay in my bed in Iraq listening to a mortar barrage, it died. Last night, I was a man planning on going home to see if my marriage could be healed. Tonight, I was a man with lawyers and judges and custody battles to look forward to. I’d finish my involvement in the war and go home to a divorce. There would be no more pretending.
The enemy was bombing us again, and death hovered as thick as the smoke in the air. But Tim had told me to suck it up, and he was right on. It was my job to take care of the living.
CHAPTER 19
PURPLE INK: THE MARK OF FREEDOM
I crawled out of bed on Sunday morning, Election Day, after a night of fitful sleep. Dreams of patients bleeding out, my kids demanding answers to questions they shouldn’t have needed to ask, and enemies plotting my demise kept me from really resting, and I dressed that morning uneasy about the day.
Our commanders had told us that Election Day would almost certainly be one of the busiest days of the war, with insurgents plotting violence to disrupt the budding democracy and centuries-old battles between Sunnis, Shiites, and Kurds playing out in blood even among those glad to have a new government. No one would really be safe, neither the voters standing in lines to grasp at freedom, the workers in the polling places, or the candidates who would win the races.
That night, the news told us that at least forty-two people across Iraq had died from attacks on voters.
EMAIL HOME
Monday, January 31, 2005
Hello, everyone, from the world’s newest democracy!
By all accounts here, the election was far more successful than anyone had hoped. We were steadily busy but never overwhelmed. And while the insurgents were trying unsuccessfully to stop the election, they couldn’t stop the stork. A very pregnant woman came to the gate in labor, and the first baby ever born in an Air Force theater hospital arrived shortly after.
A man came in severely shot up and had many hours of heroic surgery. General surgeon Brett saved his leg, and vascular surgeon Todd repaired his damaged carotid artery. Joe (ENT) did a tracheotomy and repaired his face, tying off a bleeding facial artery that nearly caused the patient to bleed to death, and Tim and I took out his frontal lobe, removed bullet and bone fragments from his brain, and repaired a huge hole in his orbit that his brain was falling through. He’s awake and moving his arms and legs now, and we think he will make it.
A sniper shot a young lady after she voted. The bullet entered through her eye, went through her mouth and through two of her vertebrae. Somehow it didn’t tear up her spinal cord; she’s moving her arms and legs. She did lose her eye, but she’ll walk again.
Yesterday, for the first time in my life, I operated while armed. That was weird. Fortunately, no situation arose in which we felt compelled to load our weapons. If the fate of the war depended on the doctors and nurses shooting anyone, we’d have all been in trouble.
Today, you should thank God that you can vote in the assurance that no one will try to kill you. Doesn’t it make you sad that in America we think it’s successful if we have 50 percent voter turnout? We’re hearing that the Iraqis managed around 60 percent, despite more than twenty suicide bombings, snipers, mortars, and rockets. People here are willing to die in order to exercise their political freedom.
I love you all.
Lee
Rounds on Monday morning took a long time, since we’d performed so many surgeries over the past three days. I was alone to take care of all the neurosurgery patients, because Tim had to ride on the C – 17 to Landstuhl with an American soldier who’d been shot by a sniper. Tim thought the soldier was too unstable to travel without a surgeon on the plane with him, and the commander signed off on the plan.
The bomber, 2137, was still on a ventilator and tying up a crucial ICU bed. He was under guard twenty-four hours a day, because we were afraid that Jafar or one of the interpreters might try to kill him. I made a few notes on his chart and watched for a moment as the nurses changed his bandages. The nurses were professional, but there was a subtle difference in how they spoke to him, how they touched him, compared with patients they knew to be his victims. It was as if they feared that some of his evil might rub off on the
m.
I stopped at the bedside of 2203, an Iraqi woman who’d been hit in the head by shrapnel from a car bomb after she voted. Her ICP was very high, and her pupils were dilated. Tim had operated on her while I was taking care of someone else. Despite Tim’s aggressive care, her brain injury was severe, and she was in serious trouble.
“When was her last dose of Mannitol?” I asked the nurse.
“Six hours ago,” he said, “but her sodium level is one-sixty, and she’s dumping a lot of urine.”
I looked at the collection bag, and saw that 2203’s urine was completely colorless, like water.
“Check a specific gravity, and take her to CT stat,” I said. The urine specific gravity would tell me whether her hypothalamus was shutting down in response to the high ICP. Her sodium level was too high for me to consider giving her any more Mannitol, because at that level her kidneys might be damaged.
A few minutes later, I looked at her scan and shook my head. She’d had a massive, unsurvivable stroke, probably from clotting off one of her damaged cerebral draining veins. Despite Tim’s best efforts, her brain swelling had closed the vein and choked the brain’s blood supply so severely that it had killed the hypothalamus, as evidenced by the high sodium and urine output.
The nurse ran into the CT room with 2203’s lab results.
“Spec-grav is ten-oh-three,” she said.
I closed my eyes for a second, wanting to erase the image of the nightmare playing out on the CT scan. A urine specific gravity of 1.003, or ten-oh-three as we called it, meant that her kidneys couldn’t concentrate her urine at all. She was dumping all the fluid that came into her body because her hypothalamus and pituitary gland were failing to produce a hormone called vasopressin, one of the drugs no one thought we might need to take with us to the war.
Ten-oh-three for 2203, who would a few minutes later become Election Day victim number forty-three.
I opened my eyes again. She was probably in her early twenties. Medics had told us that she was a schoolteacher. Yesterday morning, she’d been standing in a group after exercising her newly granted right to vote. Today she was dying of the combined effects of terrorism and intracranial physiology. I thought, I hope whoever she voted for won.
“She’s going to die. Just keep her comfortable,” I said. I walked away from the ICU, unable to stand there and watch another innocent victim of the war take her last breath. I felt impotent and frustrated and angry, and I wanted to go home, hold my kids, and have somebody tell me it would be okay. But at that moment, I didn’t believe it ever would.
A few minutes later, I was standing in the surgeons’ lounge watching election coverage on CNN when I heard a voice behind me: “Doctor, if you please.”
I turned. Saeed (pronounced Sigh-eed) stood in the hallway, his head slightly bowed. He held a piece of paper toward me with his right hand; his left was held over his heart. Saeed had proven to be a reliable and accurate interpreter for us when we needed to communicate with patients.
“Please, sir, take it.” He pushed the paper toward me. When Saeed said sir, it sounded like sear. I tried to think of another time when he had spoken to me outside of taking care of patients — or for that matter, a time when I had spoken to him. Since I had arrived, I had interacted with the local nationals who worked on base only when I had to. Was it because I didn’t trust them? Or had I just been so wrapped up in myself that I hadn’t been willing to extend myself to them? But here was Saeed, speaking to me, and I suddenly saw him not as a tool to be used, but as a young man with some type of need.
“What is it?”
Saeed lifted his head, his chocolate eyes peering out from behind a permanent squint brought about by all the things they’d seen over the years. I thought, though, that behind the hardened face I recognized something close to a happy spirit.
“It is a letter, for you.”
I took the letter, handwritten in blue ink. It took a moment for me to realize that I was reading a note from an Iraqi physician.
Jassem, Age: 7 years
Dear Dr.
Can I refer to you this child who’s suffer from head injury (shell) at 9:30 AM 1/30/2005. The patient had disturbed consciousness, also he vomitize for one time. The pupils asymmetrical but reacted to light.
The wound is about 5 cm length in his right side of his head behind the right ear. There is mild hemorrhage also there is big hematoma under the scalp and piece of brain out of his wound. . .
Dr. Ali 1/30/2005
I couldn’t believe what I was reading — a detailed medical report handwritten in English by someone outside the wire — obviously a bright, well-trained physician. Saeed told me the rest of the story. Somehow after a bombing at a polling place, medics had left behind an injured seven-year-old boy. He’d been taken to one of the very few Iraqi doctors still out there working, and that doctor had kept the boy alive for over twenty-four hours.
“Saeed, where is the child?”
“He is right here in Balad, sir. Dr. Ali is my cousin. He have the boy in his home.”
We showed the letter to Colonel H, who then radioed the story to his commanders. After a few minutes, they gave orders to scramble a team. Saeed put on body armor and a helmet and accompanied a small convoy of soldiers and medics outside of the wire, putting their lives on the line to go get the boy.
Two hours later I met Jassem, a crying little boy with a blood-soaked head bandage and a filthy teddy bear. He had wavy brown hair sticking out from under the bandage and a face that looked like it had been borrowed from someone older, someone who had needed to worry a lot more than Jassem should have had to at seven. He moved both arms and both legs, squirming like my seven-year-old daughter did whenever she was at the pediatrician’s office. Except that my Kalyn had never had mortar fragments in her brain because some Muslim terrorist was trying to keep me from voting.
At the child’s bedside a man stood, wringing his hands as I approached. He had the same face as the boy, only older and more wrinkled. Probably my age, I thought, but with a difference. I’d grown up in a country where every twenty years or so we send our sons overseas to fight for certain causes. He’d grown up here, where in his teens he’d seen the Iran-Iraq War, in his twenties Desert Storm, and in his thirties American troops invade. Every day in between he’d lived under the cold reality of Saddam Hussein’s brutal tyranny. No wonder he looked older than me.
“I’m Dr. Warren,” I said, then listened to Saeed interpret.
Saeed turned to me. “This man is Hikmat. He is Jassem’s father. He say they were leaving the voting station when mortars hit. Hikmat woke up and could not find Jassem, then someone tell him that Jassem is with Dr. Ali.”
“Tell him I need to examine the boy.”
After Saeed spoke, Hikmat held both hands in front as if he were praying, then gestured toward his son and bowed his head to me. He said something quietly to Saeed.
“He say to thank you, and to please save Jassem.”
As Saeed and I had spoken to the father, the nurse had given Jassem some morphine to ease his pain. I removed Jassem’s bandage. He had an open skull fracture behind his right ear.
Ali was a very good doctor. The wound had been expertly cleaned, and the dirt and debris I’d expected to find was all gone. His scalp had several perfectly squared sutures around arteries that would probably have caused Jassem to bleed to death. I could see the boy’s brain pulsing gently through the open wound. Ali had made the wise decision to not close the scalp laceration. Undoubtedly, he had known that closing it would increase the pressure inside Jassem’s head. The mortar had basically done a decompressive craniectomy for Jassem, and Ali had been wise enough not to close it back up. I thought, This guy could teach our field medics a few things.
I told Saeed I’d have to take Jassem to surgery, and a moment later Saeed gave me Hikmat’s answer: “God be with you, sir.”
We got a CT scan: Jassem had several metal fragments in his brain, one of which had penetrated all th
e way across to the left side. The path of that piece of mortar was dangerously close to several major arteries, but somehow it had missed everything important. Jassem had survived a very close call, thanks to a lucky trajectory and the intelligence of a poorly equipped Iraqi physician who had operated on him in a house and then helped get him to me.
An hour later, I walked out of the operating room confident that Jassem would survive and probably make an excellent recovery — if no infection occurred. In the waiting room were Saeed and Hikmat, who sat in a chair praying with his eyes closed.
Hikmat looked up when he heard me enter. His eyes, which were a pale gray color I’d never seen before, were filled with tears. His shirt and pants were splotched with blood. The look on his face was familiar; I’d seen it in other waiting rooms in other hospitals. Fear, anxiety, dread of what I would say, and in the case of parents waiting for news about their kids after an accident, usually some guilt mixed in.
He stood as I approached.
I spoke and Saeed translated. “Your son is alive, and I think he’s going to be okay.”
Saeed didn’t really have to translate Hikmat’s answer, because relief and joy are universally recognizable when they wash over someone.
We sat and talked through Saeed for a few minutes. I told Hikmat all about the injury and the surgery and what would happen next for Jassem. After I’d answered all his questions, I told him about Kalyn, my seven-year-old, and for a bit we were just two dads taking a load off, sitting and chatting about our kids, although I’d never swapped kid stories through an interpreter before.
We found one of those natural pauses in conversation, where no one is exactly sure what to say next. I decided that would be a good moment for me to go make rounds and let Hikmat see Jassem. But before I could rise, he leaned forward and buried his face in his hands. For the first time, I noticed the purple ink all over his right hand, and I remembered the commander telling us that the Iraqis were required to dip their hands in ink after they voted, to make sure no one voted twice. I thought about the now-brain-dead schoolteacher, 2203, and remembered that as I’d walked away from her bedside I’d seen the ink on her hand as well, the mark of freedom.
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