Tim had just started his case, meaning he’d opened the third of our four sets of craniotomy instruments. I passed the scrub tech Nate in the hall on my way to the ER and grabbed his arm. “Nate, go find McDonald and tell him to rush the crani sets. We’ve only got one left sterile, and there are more casualties in the ER.”
“Roger,” Nate said as he turned toward instrument processing.
I entered the ER. The Czar was talking to two medics. They turned to me when I approached. “This was one nasty attack,” the Czar said.
“Yes, sir,” said a medic. “They hit one of our convoys with IEDs, and then shot everyone when they tried to get out of the burning vehicles. Our guys returned fire and by the time we got there” — he motioned to the stretchers behind him — “there were bodies everywhere.”
“Over here, Doc,” a nurse called.
I walked to her, and she pointed to two beds next to each other. An American and a brown-skinned man with 2280 written on his chest. A Marine lance corporal stood next to the American’s bed, his hands on the stricken man’s chest, his eyes closed, his mouth moving silently in what I presumed was prayer. The nurse touched his shoulder gently. “Corporal, you need to go to the waiting room now. Let the doctors do their work.”
The young man looked up at her, his green eyes showing an amalgam of rage and fear. “Yes, ma’am,” he said. “Please save Louis. He’s my best friend.”
“We’ll do everything we can,” she said, tears welling in her eyes.
The corporal stepped toward the surgeons’ lounge, then turned and pointed at 2280. “This guy shot Louis when we crawled out of the Humvee,” he said. He looked down for a moment before he continued, “Then I shot him.”
As the corporal walked away, I looked down at Louis, a strong, tall young private of maybe twenty. He had a bandage on his forehead, and when I removed it I saw a perfectly round bullet hole in the middle of his forehead. There was no exit wound. His pupils were dilated and did not react. His chances were not good.
“Take him to CT, stat,” I said.
While the medics rolled Louis to the scanner, I turned to 2280’s bed. He also had blown pupils, no exit wound, and a hole in his forehead. The corporal was a good shot.
“He needs a scan too,” I said.
Ten minutes later, I was faced with the most difficult decision — personal or professional — I’d ever had to make.
Tim was still tied up with his surgery, and it would be about three hours before we would have another set of instruments available. Neither of these two patients would survive long enough for McDonald’s people to sterilize more instruments. And both Louis’s and 2280’s scans showed injuries that could be survived with immediate surgery, but that would be fatal if I didn’t hurry.
I am trained to make medical decisions, not political ones. These two patients were about the same age, had similar injuries, and the medical issues surrounding my decision as to which of them should be operated on first were decidedly undecidable. There was no medical answer to this problem, and no military training we’d received prepared me for it. Triage was usually more straightforward, and the Americans naturally received priority in non-life-threatening situations, but this was literally a case where 2280 was going to die a preventable death if I said so.
“Lee, come on — room four is open. But we’ve got more casualties coming in. What do you want to do?” The Czar wasn’t interested in my private thoughts.
“Both beds in room four are open?” I asked.
“Yes, both beds,” the Czar said.
“Then get me one of the general surgeons, and take both of these guys to the OR.”
Five minutes later, I was shaving the Marine Louis’s head, and Chris was doing the same to the terrorist. I still didn’t know exactly what I was going to do, but I wasn’t willing to let 2280 die just because he wasn’t an American.
We prepped both men’s scalps with iodine solution and draped them for surgery. Nate opened the last craniotomy pack on his table, and a nurse connected our last sterile drill to the foot pedal so I could control it.
“Knife,” I said, then felt the pop of the steel scalpel when Nate slapped it into my hand. I held the blade over Louis’s head and said a silent prayer, as I always do just before I start an operation.
“Finished my case, I’m here to help,” Tim said with his head stuck through the door. “I’m scrubbing in.”
That solved the problem of two patients for one brain surgeon, I thought, but we still had only one set of instruments.
“Tim, we’ve got one drill, and the others won’t be ready in time to save either of these guys.”
“No problem,” he said. “Let’s just change drill bits between you drilling your patient and me drilling mine. At least the bit will be sterile.”
“Sorry, Colonel,” Nate said, “but this is the last bit in the hospital. We were supposed to get more on the resupply flight today.”
There was an uneasy pause. “Okay, guys, here’s what we’re going to do,” I said, though I could hardly believe that I was about to propose such a preposterous plan. “I’m going to start my case, and after I’ve used the drill I’m going to hand it to the nurse. She’s going to run sterile saline on it to clean it, rub it down with alcohol, and hand it to Tim. Every time I finish with an instrument, that’s what we’ll do.”
Tim shook his head slowly, his eyes scanning the OR as he tried to think of a better plan. Nate and the others were silent, as if they couldn’t believe what we were contemplating. In America, sharing instruments between patients would be considered malpractice. That day in Iraq, it was the only choice I could see.
Tim nodded. “Make it so. Scalpel.”
We both made the skin incisions and exposed our patients’ skulls, as we’d done so many times before. I used the drill to remove Louis’s skull flap, and when I was finished I handed the bloody tool to the nurse. My eyes met Tim’s when he took it from her after she’d cleaned it as well as possible.
And so it went. Four or five times during my case, when I was sure I wouldn’t need a certain instrument again, I handed it to the nurse to clean for Tim — who improvised during his case until he had what he needed. I passed off the Penfields and the Kerrisons and the Langenbecks and the other tools of our trade, and Tim’s operation got easier with each addition to his arsenal.
Louis’s brain relaxed nicely after I removed the clot, and by the time I closed his scalp, the ICP monitor read 0. He had a decent chance of surviving, although his brain injury was severe. He would most likely reach Walter Reed alive, and his family would get to see him again. That’s something, I thought.
Tim’s patient, 2280, was having more trouble. The corporal’s bullet had torn several arteries, and although Tim handled the bleeding and brain swelling expertly, 2280 lost a lot of blood. And like everything else in the hospital that day, blood was in very short supply.
“Need any help?” I asked when I stepped away from Louis’s bed.
“Not with the surgery — I’m done here. But he’ll need at least four units of blood. They’re checking with the blood bank to see what we have left.”
I walked out into the surgeons’ lounge and saw the lance corporal sitting on the couch, clutching his helmet to his chest. His eyes had softened. They now held less rage and fear and something more like sorrow or remorse.
He looked up when he heard me, the unspoken question obvious on his face.
“Louis is alive,” I said. “He has a chance to recover. That’s the best we can do here.”
The corporal nodded slowly, then looked me in the eye. “And the other guy?” he asked.
Before I could answer, the overhead speakers crackled and a voice broadcast throughout the hospital.
“Attention: This is the blood bank. We have a critical need for whole blood, type B negative or O negative. If you’re willing to donate, please come to the lab immediately. This is a critical need.”
Every time I’d heard the call
for a whole blood drive before, I’d been in the middle of an operation and thus unable to give. This time I wasn’t a candidate because I’m type B positive.
The corporal stood and stepped past me.
“Where are you going?” I asked.
“I’m B negative,” he said. “Sounds like somebody needs my blood.”
I reached out and grabbed his shoulder. He stopped and turned to me.
“Corporal, there’s something you need to know,” I said.
“Sir?”
“The blood drive is for the man you shot. The terrorist who shot your friend.”
The corporal stiffened. His eyes filled with tears. He clenched his jaw tightly and looked at his boots for a few seconds.
Then he pushed my hand off his shoulder. “Sir,” he said, “lots of people have done things for me that I didn’t deserve. I shot that man in battle, but letting him bleed to death when I have the power to save him — that wouldn’t be right. Excuse me.”
He walked toward the lab, leaving me standing in the lounge with my mouth open, wondering if I would have done the same thing.
I never saw the corporal again. A few days later, we received news that Louis had survived the trip to Walter Reed and was improving. 2280 eventually woke up, saved by Army medics and Tim’s skill and ultimately by the corporal’s sacrifice. Even though some of the instruments used during his surgery were not properly sterilized, he never became infected.
The morning we transferred 2280 to Abu Ghraib, I checked his labs and saw that his blood counts were normal, even though he’d lost eighty percent of his own B negative blood in the operating room. I knew that most of the cells contributing to those normal lab values came from the kindness of an American Marine corporal.
Over the course of the Iraq war, American soldiers were guilty of inhumane treatment of prisoners at places like Abu Ghraib, murdering civilians and children, and committing other war crimes. Those things showed up on the news, and rightfully so. I was fortunate to work in a place where most of what I saw held up to the light of inspection, but I knew some of the soldiers I cared for were not righteous or heroic in every moment of their individual wars. Even in the hospital, signs warned the women not to walk around alone at night because there had been rapes on the base. I will not pretend that everything I saw or heard about regarding our troops’ behavior was good, but most of it was. And since most of those stories don’t make the news, because human nature usually requires something scandalous to sell papers, it is my hope that the story of the corporal’s blood flowing into 2280 will resonate with anyone who’s ever benefitted from someone else’s sacrifice, especially when it was undeserved.
Show me another army in the world full of soldiers willing to sacrifice their own blood for their enemies.
CHAPTER 22
ROSE IS MY DAUGHTER’S AGE
After six weeks of seemingly nonstop trauma surgery, I was locked into a mind-set of moving fast and trying not to let the tragedy get to me. Every day someone else would come in with his or her face blown off, a spinal cord shot in half, or with some part of the skull missing.
While the war raged on around me, I tried as hard as I could to resist the emotional black hole I was being pulled toward. Every time I called my kids and heard their mother’s voice on the answering machine, and with each day that passed without an email, letter, or card from them, I felt less hopeful that I would be able to put my relationship with them back together when I got home.
I passed the downtime playing in the worship band, finding a measure of peace in helping others seek the healing presence of God. Inside, I felt like God was using me to lead others before him while keeping me at arm’s length.
Movies in my room helped us relax and forget the war for a few hours. So many people started showing up that we had to move the movies to a large tent next to the hospital. A big-screen TV and several sofas were set up, and my email network’s care packages started to include microwave popcorn and movie candy. Movie Night was now routinely attended by twenty or more people.
My daily email journal was being read by several thousand people in twenty or more states, and I was receiving three to six care packages a day, most of them from strangers. I gave away almost everything they contained. The surgeons’ lounge looked like a flea market during mail call, with folks from all over the base wandering through, picking out what they wanted, and relishing the generosity of people they would never meet.
I felt numb, my senses dulled. I was robotic in my job as a neurosurgeon and felt as if I were just going through the motions in my roles as worship leader and entertainment coordinator too. When I closed my eyes at night, I was alone in the world, so tired I could barely breathe but so afraid of the dreams I knew were coming that I tried hard not to sleep.
By week seven I wasn’t sure about anything.
I spent all of one night in the hospital trying to save an Iraqi who’d wrecked his motorcycle. After surviving thirty years in a totalitarian society and avoiding the perils of war, this man bounced his head off a highway when he hit a pothole. The road did a lot of damage, and on a day when I’d managed to save three other people from their war wounds, I lost him to a stupid motorcycle wreck that could have happened anywhere else in the world.
I walked out of the operating room at around 8:00 a.m., slammed my fist into my locker, and went to check my email. The usual hundred or so messages filled my inbox, but none of them were from the three people I most needed to hear from — my kids. I wasn’t sure how I was going to get through the coming day. I pressed my face into my hands and squeezed my eyes shut as tightly as I could, hoping to keep tears from flowing. After all, I was supposed to be Dr. Cool-and-Unaffected.
“Doc, Rose is in the clinic.”
I heard Nate’s voice and opened my eyes. He loomed over me, six-foot-one and 240 pounds. I rubbed my eyes hard and yawned.
“What?”
“That kid Rose is here with her parents. I guess the commander approved your request to operate on her.”
I walked down the hall to the clinic, then stopped just outside the door, collecting my thoughts. A few weeks before, an Iraqi couple had brought their thirteen-year-old daughter to the gate. They were related to one of our translators, Raul, and he’d told them that we might be able to help the girl. The commander gave permission for her and her mother to come in, but on that particular day the girl’s dad didn’t have some of his identification papers, and he wasn’t allowed to enter the base.
I had just said goodbye to baby Mohamed and his sister Vania, and when I came back into the hospital that day a nurse told me to go to the clinic to see Raul’s cousin. At the clinic I found a middle-aged Iraqi woman, wearing a head covering and long brown robe. She and Raul were standing next to an exam table, and when I stepped past them I saw a young girl in a purple velour dress, her dark, curly hair pulled back with little pins with red flowers on them. Raul said, “Doctor, this is my cousin Hasim’s wife and their daughter Rose. Rose began to have seizures when she was four, and Iraqi doctors have told Hasim she will die because her disease is untreatable. I told Hasim I have seen American doctors save many lives, and he asked me if you could help Rose.”
EMAIL HOME
Wednesday, February 16, 2005
Good morning, friends.
The highlight of yesterday was seeing Rose, the little Iraqi girl that I’ve told you about before. She has been having seizures most of her life and has a brain tumor that I am going to remove today. Please pray for her and her mom and dad. They are grateful for the care, but of course very nervous.
I want to tell you a little about this from their perspective, so you can see how scary and exciting this whole thing must be to them. I apologize for the creative license.
Rose was born in 1992, just as the first Gulf War began. Her life has been spent surrounded by armed conflict. She has heard horrible things said about America, the Great Satan, populated by infidels. She developed a seizure disorder at age fo
ur and lived in a culture where if you don’t have money your disease is untreatable. She became more and more developmentally delayed as the years of seizures went on, and the child whose parents say she was the brightest and fastest learner in her family became slow.
In 2003, Americans showed up in person to deliver the death blows to Saddam’s reign of terror, and the little girl again saw war, this time with tanks and soldiers instead of only bombs and missiles.
The seizures continued, and the medicine she was given to treat it seemed to cause her additional problems. Her doctors said they’d done all they could.
Rose’s parents heard that the Americans had taken over the hospital at Saddam’s old air base. From time to time, one of their friends or relatives would be injured in a bombing and receive care there. Rumors started to spread that the Americans were actually kind and compassionate.
Rose’s family had a relative who began to work as an interpreter for the Americans. One day he told them that he met a doctor who might be able to help them. They managed to get copies of her CT scans and sent them to the hospital with their cousin Raul.
When Raul showed me the scans, I asked for and received permission to invite Rose and her parents to the hospital.
Imagine how scary it must have been for them. First, on the way to the base, every time they walked past a crowd, they must have feared a car or suicide bomber. Then, walking up to the gate of an American military base during wartime, any violation of security procedures, any threatening move, could result in death.
While the guard processed the papers, they were searched and questioned, and finally only the child and her mother were allowed in. The father’s papers were not in order.
Stepping out of Iraq and into a completely unfamiliar world, accompanied everywhere they went inside the base by armed guards, the brave mother brought her child into the hospital.
It was three weeks ago that Rose and her mom walked into the clinic and Raul introduced them to me, a blonde Oklahoman who could neither speak their language nor understand their culture, dressed in the uniform of the United States Air Force.
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