I asked Rose’s mom if she minded if I examined her girl, and she consented. It must have seemed like forever to her before I finally told her that I thought we could help the little girl, as long as Colonel H approved.
I went to his office. Colonel H said we could probably help Rose, but he would have to ask his higher-ups, and that we definitely had to wait until after the elections.
Through Raul, I delivered the news to Rose’s mom: Raul would let them know when and if they could come back for Rose to have surgery.
And so for three weeks, they’ve been waiting, wondering, worrying. Two days ago, Colonel H gave me the verdict: Surgery approved. Raul went outside the wire to deliver the news to Rose’s parents.
Yesterday Rose returned, this time with both of her parents.
Rose’s father is a tall man in a turban and robe. He has a grandfather’s eyes and a soft smile. Although he carries himself in a stately, reserved manner, he cannot hide his concern or his love for his little girl; that language crosses cultures.
They listened to all I had to say, then politely asked me if I would please remember that God would take care of her. They said they did not need any more information, that they trusted me completely, and that they were grateful to be here.
The surgery starts in two hours.
For these people, this whole war boils down to someone being sent here to try to save their daughter.
Let’s all pray today that this operation proves to be more than simply a medical procedure. In a real sense, these people will judge our culture, our religion, our hearts, and our nation by the way Rose is treated here. Please pray that no one, neither the doctors nor the youngest airman, will “have a bad day” in front of them. Pray that the surgery will be successful, that her seizures will stop, that she will do well, and that the tumor is benign. Please pray that they will go home and tell their friends that Americans are good, that we care about them, that we are not to be feared.
Thank you for your support today. Most of you will see this letter after the surgery is over. Thanks for your continued prayers after the surgery, for her to have no complications, no fevers, no infections.
Thank you all for participating in this important day. I will let you know how it goes.
I love you all.
Lee
CHAPTER 23
HIS GRIP LOOSENED AND HIS HAND DROPPED OUT OF MINE
How long will it take you?”
I looked at Rose’s new scan, evaluating how stuck the tumor would be to her right temporal lobe, locating the important arteries nearby, and the nerves she would need in order to see and to move her eyes. I could visualize the tumor, the surrounding structures, and all the ways I could maim or kill Rose if the surgery didn’t go perfectly.
Colonel H’s question hung in the air, and he is not a patient man.
“Lee, how long?”
“Maybe two hours, if her brain doesn’t swell and if there’s not too much bleeding,” I said. “Could be longer, four or five hours if it’s really stuck.”
Colonel H shook his head. “That’s a long time to have both my neurosurgeons tied up. Plus an OR, an anesthesiologist, techs, and nurses.” He tapped his finger on the monitor. “And how long will she need an ICU bed?”
“Three or four days, if she doesn’t have any seizures afterward,” I said. I realized the depth of what I was asking the boss to commit to on behalf of this little girl. He had given me permission to do the case, but when I told him that I would need Tim’s help, Colonel H began to have second thoughts. I didn’t think I should do a case that serious without someone to back me up, and Tim agreed. So now, an hour before I planned to start the surgery, Colonel H sounded as if he might rescind his blessing.
He pinched the bridge of his nose and closed his eyes for a moment. “Okay, here’s the deal,” he said at last. “You can do the case. But if casualties come in, Tim breaks out and does his job. If soldiers need you, or if the other operating rooms fill up, you will close and get her out of there as quickly as possible. If it’s complicated or it’s going to take you too long, just abort and tell the family you did all you could in this environment. Understand?”
I nodded, looked back at her scan, and wondered what I was getting myself — and Rose — into.
Colonel H started to walk away, then turned back. “Lee, one more thing. Are you sure you can do this here? Because the time to bail out is before you start. No one will fault you for saying no, but if you mess this up, it’s not going to be good.”
Without giving me time to answer, he walked out of the room, leaving me alone to examine Rose’s scan — and myself. The colonel’s question summed up the situation perfectly. The issue wasn’t whether I had the skills to remove Rose’s tumor. The question was whether I could, or rather should, try to do it here.
What would my mentors do in this situation? Would they think I was crazy for even considering such an operation in a tent hospital with only the most basic equipment? But here I was, and in a room just down the hall a real little girl waited for the only person in her country willing to help her.
I made my decision.
I walked into the holding area where Raul and Rose’s parents were talking together at Rose’s bedside. “Raul, tell them we’re going to surgery in a few minutes,” I said.
In the operating room, I looked at the unconscious Rose for a second before we put the drapes over her, praying silently that her case would go well and that there would be no emergency arrival of soldiers needing my attention. I knew that if I had to stop Rose’s surgery early, I would not be allowed a second chance.
“Knife,” I said.
The surgery took about two hours. It turned out to be fairly straightforward and as easy as it would have been anywhere else, except for a couple of explosions nearby. The tumor wasn’t attached to anything important, and it came out with no difficulty.
When I placed the last stitch in Rose’s scalp, I put a bandage on her wound and took the drapes off. She was just as precious and pretty as she’d been two hours before, but I wouldn’t be able to relax until she woke up and moved her arms and legs. Even after thousands of successful surgeries, it still seems a little magical to me that we can actually go inside someone’s head and then, afterward, have them wake up and be okay. But until that moment, I remain very nervous.
After a few minutes that felt more like an eternity, Rose opened her eyes and began to breathe on her own. The anesthetist removed the breathing tube from Rose’s throat, and she coughed a little. We took her to the recovery room, and I went out to talk to her family. Although I have performed surgery in three countries and several states, this scene is the same everywhere. Though the setting was very different here, and the sights and sounds and smells were unlike any waiting room I had ever experienced before coming here, the cast was identical: a mom and a dad, scared to death. I smiled as I entered the room, and said through Raul, “She’s all right.”
I led them into the ICU, where Rose had just arrived. She was awake but still groggy from anesthesia, but when she saw her mom and dad she smiled broadly and opened wider her still-cloudy eyes. I looked on as her parents lovingly held her hands and spoke to her in comforting tones using words I did not know but completely understood. I smiled as I turned to walk away, looking back when Rose’s father called out, in English, “God bless you, Doctor.”
Unfortunately, the emotional high of pulling off a successful brain tumor removal in such an unlikely environment didn’t last long. By the end of the day, I understood what Dickens meant by “It was the best of times, it was the worst of times” — because the war was not over.
EMAIL HOME
Thursday, February 17, 2005
Good morning, everyone.
I need to thank all of you for praying for Rose yesterday.
The surgery could not have gone better. It was beautiful. The tumor is completely gone, and she is fine. Her parents are so grateful. As we speak, the tumor is on its way to Germany
to be looked at by the pathologists so that we can know if she requires any additional treatment. Keep praying — she hasn’t had any seizures since her surgery — she normally has four or five per day. Sometimes surgery makes the seizures worse for a while, sometimes it doesn’t affect them, and sometimes it cures them. Let’s pray for a cure.
The entire hospital got on board with taking care of Rose.
The anesthesia folks were arguing about who got to do her case. Practically every tech lobbied me to be the one to scrub, and all the ICU nurses wanted to take care of her.
After the great peak of joy that all of us were experiencing with the success of Rose’s surgery, we took another huge fall. Two Americans ran into two Iraqis in a head-on car crash, and one of the Americans was dead on arrival. Shortly afterward, a teenaged Army private came in with a gunshot wound to the head, and I had to pronounce him brain dead in the ER.
The elation we felt about Rose snapped us out of weeks of being emotionally numbed by the constant tragedy of the war. Seeing the young soldier die jerked us back to reality. The contrast was almost unbearable.
Tim and I put the bone back into the last patient I operated on in January with Pete. He’s made a remarkable recovery and came back to the gate to ask if we could put his skull back together!
Feeling content after seeing that case to a satisfying conclusion, I rested for the rest of the day and was planning on going to the movie at nine with a bunch of folks, but as I was getting ready to go, I was called in to help Tim in the OR.
The patient had been shot in the base of his skull, and the bullet had lacerated the major vein that drains blood out of the brain and into the jugular vein. Then it had gone on to lacerate the vein in the middle that connects to the other side, meaning that this man now had no way to drain blood out of one half of his brain, except through his wound.
He was bleeding faster than we could replace it, and he bled to death in front of us. I held his hand as the anesthesia doctors tried to give him more blood. A whole-blood drive was initiated, then stopped within minutes, as we all reluctantly concluded that he couldn’t be saved.
I watched as his pupils dilated, signaling the end of his young life. His grip loosened and his hand dropped out of mine.
We all stared at each other. It was, for us, a moment of ultimate futility — when all our equipment and our cumulative skills and experience cannot help one dying man.
The chaplain was there. He put his arm around my shoulders and asked if I was okay. He told me he would pray for me. It felt good that in this moment of tragedy, having lost one battle, he was already looking at how he could help someone else. The rest of us were focused on the battle we’d just lost; he was looking to win a different one — the battle for my morale. I can’t tell you how much that helped me right then.
I checked on Rose— she was doing great. I changed her bandage and told her mother good night (I think she understood me). Then I went for a walk in the cold Iraqi moonlight. I thanked God for the day, for the hundred-plus thousand American soldiers this day who did not die. I prayed for the three families who will learn today about their lost son or daughter. They will know by the time you read this. I can’t give you their names, of course, but all you need to know is that three families in America have received the call they’ve dreaded since the day their loved one left for Iraq. Your prayers will help them.
I went to sleep around midnight and dreamt of the young soldier’s eyes, dilating in the last moments, his grip going slack in my hand. Over and over I saw it.
A new day dawns azure blue and bright outside my window right now. New patients, hope for Rose, heartbroken families, and more bad food await me this day. I pray for all of you that today you will feel the humbling awareness that three more Americans gave their lives yesterday in the pursuit of freedom for the Iraqi people — freedoms you consider a God-given right. Never forget it. Don’t forget it when you vote, when you teach your kids history, when you talk to your friends who vote with their wallets, when you pray, when you go to the store, or when you choose where and when and if you wish to worship. Someone died for you to have that God-given right that you take so much for granted that most days you don’t think about it at all. I will never again take being an American for granted.
A strange thought flashed through my mind in the OR last night: it’s at moments like this that someone inevitably says something profound that later becomes a cliché to those not directly involved. I kept thinking of the T-shirt/bumper-sticker slogan: “All gave some, some gave all.”
It’s true. Some gave all. Three more yesterday from the US, as well as a few more Iraqis dying in their desperation to have what you already have.
I love you all.
Lee
CHAPTER 24
OUR NEXT STOP WAS ABU GHRAIB
I stood in the ICU, watching Rose sleep. I gently touched her head. One of the nurses had cut a little hole in the back of the head dressing to pull Rose’s ponytail out. A pink ribbon tied her hair up, bright against the stark white gauze. I removed her bandages, saw the small area of pale skin where I’d shaved some of her hair, and checked her wound. “Looks great,” I said to the nurse.
The labs and the monitors and the post-operative scan were all perfect. In the eighteen hours since surgery, she’d had no seizures. I turned to reach for her chart and accidentally dropped my pen. When I knelt to retrieve it, I noticed how dirty the floor was, and I thought, Wow, an ICU floor that dirty in America would be considered an infection risk. I reached for the pen, which caused my holster to shift. My handgun slid around and almost knocked the chart out of my hand.
It occurred to me that the biggest threats to Rose now were those two things: bullets and bacteria. She’d survived years of seizures from her slowly growing brain tumor, and she had come through her surgery better than I’d hoped. But infection and the realities of living in Iraq still lurked both inside and out of our canvas-walled hospital. Like all kids, though, Rose seemed content to let the adults worry about those things; she slept with a sweet smile on her face.
A master sergeant, hair in a tight bun on top of her head, walked in carrying a clipboard. “Major, Colonel H asked me to give you this. Your chopper leaves in thirty minutes.” She handed me an envelope, made a crisp turn, and walked away.
I opened the envelope and took out a folded letter. It was an order directing me to travel to Baghdad via helicopter for a meeting with the hospital commander and both Army neurosurgeons there. Pete had told me about the meeting over a month ago, and I knew that the Army was thinking of sending their neurosurgeons home, since Balad had become the primary trauma hospital in Iraq. The order stated that I was authorized to fly to Ibn Sina Hospital and return “space available” the following day. I wasn’t sure what that meant.
I ran to my room and quickly threw a clean uniform and toiletries into a duffel. I had on DCUs, body armor, and a helmet, plus I was carrying a pistol and two knives. Pretty different from how I usually go through airports, I thought.
Back at the hospital, I found Tim in the surgeons’ lounge. He looked up from the computer. “Heading out?”
“Yep. Should be back tomorrow,” I said. “Take good care of Rose for me.”
Tim stood and shook my hand. “Of course. You be careful.” He patted the Beretta in my holster. “Will you be able to use that if you need to?”
I looked down at the black pistol, then at my hands. “I hope so,” I said.
A helicopter medic walked out of the ER, wearing his flight helmet and carrying two ice chests with red crosses on them. He stopped next to us. “Are you Major Warren?”
“That’s me,” I said.
The medic set his ice chests down. “I need to see your orders.”
I reached into my pocket and produced Colonel H’s letter. The medic scanned the page and handed it back to me. “Okay, sir, let’s go.”
I followed the medic outside and down the sidewalk to the helipad. I had come this way often,
running out to find our next patients coming off the Black Hawks and Chinooks, but it felt funny knowing I was about to leave the base on one of them.
While we walked, I nudged the medic. “What’s in the coolers?”
“Blood. We have to drop it off at a couple of field aid stations. There’s been a lot of fighting around some of the FOBs lately.”
I knew that most of the patients we treated at Balad had stopped at one of these forward operating base aid stations before they got to us. Family practice doctors, allergists, pediatricians, and general surgeons were working at those stations in far more extreme environments than I was, called out of their typical practices to work in battlefield hospitals less well equipped than your average urgent care clinic in America. And they were saving lives.
The helicopter was a medevac Black Hawk. The two pilots were doing their walk-around, checking the machine for our flight. I shook hands with them, and then the medic told me to climb in and sit in the back.
“Should be thirty minutes or so, not counting a few stops,” the pilot said as I crawled back to the narrow bench seat. Most of the interior behind the cockpit was set up for transporting patients. I saw oxygen bottles, bags full of IV fluids, and a portable defibrillator. How many injured soldiers had this same crew brought to us before? I thought of all the heroic things this medic must have done on board this Black Hawk.
I slid around a metal partition and found a narrow canvas jump seat, barely wide enough for me to fit into. The seat faced forward, and there were small windows to my left and right so that I could see out both sides. I fastened the seat belt and leaned around the partition in front of me, so that I could see forward. I gave the medic a thumbs-up, and he reached forward into the cockpit and patted the pilot on the shoulder. Then he crawled back toward me and leaned over the partition. “Put in your earplugs. It’s going to be pretty loud. Don’t try to talk to me during the flight, because I’ll have my headphones on. Just strap in and hold on.”
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