Mass Casualties

by Michael Anthony

  I look over at Reto. He's scared; I can see it in his eyes. Although I've only known him for a few months, already he's a best friend. Reto, short for Retoller; he's from rural Maine, and to my surprise he did grow up with indoor plumbing. Not the redneck I expected him to be, he's actually a good-looking guy who could have been a model if it weren't for the fact that he's practically blind and wears quarter-inch-thick glasses. Reto joined the Army, specifically the medical field, because he wants to be a doctor and have the Army pay for his schooling.

  “Well, this is it. This is what we're here for.” I try to calm him down and place my hand on his shoulder. Reto looks at me; his eyes are glossy and red.

  “Thanks, man,” he says quietly.

  Reto and I hold eye contact for a second, letting each other know we're ready to do this, and together we head toward the OR. That's how it's always been with Reto and me. Even though we've only been friends for a few months, we have the silent communication down that usually takes friends years to master. It was easy for us because we are very similar and we remind each other of friends back home. Reto reminds me of my friend Sam, who wears glasses and is a hillbilly. Reto says I remind him of his friend Tom, who is tall and pale.

  The main reason Reto and I click, is not because of our strong bond with each other but because of our lack of bonds with everyone else. If I had heard one of Denti's stupid stories in the real world I would have walked away. Same goes for almost everyone else. But Reto is my best friend because I know that after this year is over he's the only one I'll be talking to.

  The OR is small. The smallest I've ever seen. In fact, every room in our hospital is small. We have everything a hospital must have — in miniature form. We have an OR (operating room), an ER (emergency room), an ICU (intensive care unit), an ICW (intensive care ward), a respiratory clinic, a mental health clinic, a patient administration section, an X-ray section, and a pharmacy. Everything you think a hospital should have — with the exception of a maternity ward.

  In the OR we only do three surgeries at a time because that's the number of beds we have. Even worse is that in one of our rooms we have two OR beds placed only a few feet apart. This means we'll often have two surgeries going on at the same time in the same room. Not the most sterile setup in the world, but we're short on staff and short on space, just not short on patients.

  The ICU and ICW can only hold sixteen patients each. This means a constant rotation going in and out. Whether the patients are Iraqi or American, we have to move them to another place as quickly as possible or we'll have no room for the incoming.

  Reto and I grab our instrument trays and place them on the back table in the OR; this is where we'll work from during surgery. The room has just been mopped. The air is hot and smells of peroxide. I feel as though I am trapped in a bleach steam room. We walk around and check all our instruments to make sure they work. First is the bovie machine. It's a blue box that we use to cauterize the skin. Check. Next are the lights and the table. Check. Check. Last is the suction. It's bulky and looks like it's from the 1970s, but it works. Check.

  Reto and I are doing our surgeries in the two-bed OR; we'll be right next to each other during surgery. Everything is set up, so it's time to gown and scrub in. The others still haven't shown up. A tall soldier walks over and tells us that since it's our first surgeries, members of the forward surgical team (FST) will shadow us. A forward surgical team is a small hospital unit trained to drop anywhere in the world and start a hospital within the hour. They have a reputation for being a bunch of cocky bastards.

  I feel like puking I'm so nervous. I can feel my heart beating faster. I want to say I'm sick and back out. I wish that I'd chosen another job when I joined up — ER or ICU or ICW — anything but surgery. I wish I wasn't so impulsive and greedy. When I first thought about joining the military I took the ASVAB test (armed services vocational aptitude battery test). I got a great score, and the Army told me I could have practically any job I wanted. I told the recruiter that I'd take whichever job had the highest bonus and the biggest kicker for school. He said an OR medic gets an eight thousand dollar bonus and a monthly GI bill kicker (for college) of three hundred and fifty dollars. He did explain what an OR medic actually does, but at the age of seventeen I was too busy daydreaming about all of the magical things I could do with eight thousand dollars. Now here I am, three years later, and I would give back every cent to not be where I am. I would pay double, triple even, but I have no choice. The money is gone, the contract signed, and I am here in Iraq preparing for surgery.

  0800 HOURS, OR

  “You amateurs! Man, they don't teach you guys anything in school nowadays, do they?” I think this guy is Puerto Rican, but his voice gives no hint of an accent. He's this bowlegged FST soldier that comes barreling into the room. His face is covered with a mask for sterility purposes, but I can see his eyes as he talks.

  “I can't believe you got all gowned and gloved and they don't tell you what has to happen.”

  Great. I haven't even started surgery and already this guy is berating me.

  “Who's Specialist Anthony?” He asks, placing his hand in his pocket.

  I raise my hand.

  “I'm going to be shadowing you today. If we're going to be working together, you've got to learn how to do business. There is one way, and one way only! that we start off surgery, and I don't want you to forget that.”

  I nod.

  The guy with bowlegs starts plugging in electronics while he's talking. “Rule one,” he's intoning. “For What It's Worth” by Buffalo Springfield suddenly blares in the background. He quickly turns it down. “Get yourself an iPod.” He's got the bass tuned exactly right now. “The last thing you want is to be stuck doing surgery for eight hours listening to some doctor talk about golf or politics.”

  0830 HOURS, SURGERY

  “What's your name, soldier?” asks the doctor I'll be working with. He's in his late fifties or early sixties. He's skinny, skinnier than I am, and slightly smaller, around 5′7″. He stands with slouch, though, and if he stood up straight we might be the same height.

  “Specialist Anthony.” I begin to gown and glove the doctor.

  “I am Colonel Jessop,” he says as the nurses wheel our patients in the room and place them on the OR tables. “There are only a few things I ask of you. Just do whatever I tell you to do. Learn quickly and give me what I need before I need it. Do all these things and we'll get along just fine. And call me Bill.”

  That's how it's always been in the OR. Even though we're in the military and Bill is a colonel, we keep it casual. When you're doing surgery and you've got a person bleeding to death you don't have time to say, “Colonel Jessop, sir, the patient is bleeding. What should I do?” You yell, “Bill, we've got a bleeder. Get down here now!” That's the one perk of the OR — the doctors and anesthesiologists, who are colonels and majors, take off all rank and relax once in the OR. It's not about who has the higher position, it's about working together as peers and getting the job done. This in itself helps ease the anxiety — somewhat. But a patient's life is still in my hands, in our hands.

  My job is simple enough. Just like Bill said, all I need to do is what I'm told and whenever possible before I'm told. Basically, it's like in the movies. A doctor yells out “Scalpel!” and then a gloved hand reaches over and gives it to him. That hand is an OR medic's hand — my hand.

  I fall automatically into surgery mode. Life or death doesn't matter to me right now. My only concern is to do my job the best I can. We're taught in operating room technician school that it's the family's job to worry; our job is to save lives. When I first had someone say that to me, I was skeptical. I thought it was just a cute saying that people in the medical field would say to one another. Then during training I had my first surgery. It was on a woman, and I was so worried about screwing up and having the patient die that I handed the doctor the wrong instruments. The patient still survived, though. When I got out of surgery, I saw her fam
ily waiting, and I felt so happy to see their relief when they heard their mother/wife had made it through the surgery. But I also felt shame because I hadn't given my best in there. I spent too much time worrying and messed up.

  Before I know it, everything fades into oblivion. I can no longer hear the music. I can no longer hear Reto's surgery only a few feet away. I can no longer hear all the beeps and buzzes from the machines. All I can hear is the voice of my surgeon as he yells: “Scalpel!” “Bovie!” “Suction!” “Suture!”

  Eventually even Bill's voice fades away. We form a flow. I am inside his head. Our surgery is an I&D (irrigation and debridement) on an Iraqi civilian injured by a suicide bomber. Bill performed exploratory surgery on him yesterday and plugged all his holes. Now we are irrigating the wound to keep it clean and removing all the shrapnel we can find so the patient doesn't get an infection. In this case, the shrapnel is human bone from the suicide bomber. When the bomber blew himself up, chunks of his bones went flying everywhere, and now they are embedded in our patient. The surgery is like any other, but the fact that we're removing human bone makes it harder. For most bomb explosions, metal is embedded in the victims and it is easily findable with an X-ray. However, with human bone, when an X-ray is done, if the shrapnel hit in a certain part, sometimes it's not possible to distinguish between the patient's bone and someone else's bone fragments.

  Everyone is too close in this room! Even under all of our sterile protective wear I can feel everyone's breath on me. It makes me anxious. I didn't go through all my training to become certified only to come here and have people watch my every move. I haven't screwed up yet, but all this attention is making me think too much, and thinking is when I get myself into trouble. I need to stop thinking; I just need to do. That's what I always tell myself since that first surgery with the woman. I don't care if the patient dies, it's only about if I do my job well. That doctor told me I was one of the best technicians he ever had. When I saw the patient's family and how happy they were, though, I felt nothing. No happiness, no shame, no pride, nothing — my job isn't to feel.

  “Hand the doctor the final suture,” the guy with bowlegs — Specialist Trask — tells me. I've only known him for an hour and already I can't stand him. His voice makes the hairs on the back of my neck stand up. He's so close to me that I can smell his deodorant, Old Spice Original Style. I long for the civilian world OR, where you've got room to move around and no one is looking over your shoulder.

  I hand the doctor the suture and he begins closing the wound. The surgery is almost over. I look down and there's hardly any blood.

  “Nice work, Anthony.” Bill looks up at me. “You don't need the FST guy hanging around you.”

  I nod my head. “Thank you, Colonel… .”

  “Soldier,” Bill says cutting me off. “I respect your bearing, but remember we're in the OR, it's Bill.”

  “All right.”

  “You got an iPod?”

  “Yes, Bill.”

  “Trask has the worst taste in music.”

  He starts taking his gown off.

  “Next time you see my name on the surgery board, sign up to work with me and bring Classical.”

  Trask is closing up the wound.

  Bill is looking at his watch.

  I am also grateful for having met Dr. Bill — actually, he's given me hope. For a while there I was starting to think that I would never meet someone I could look up to and respect, that maybe my standards were too high, that maybe Gagney, the staff sergeant in charge of the operating room (OR) section where I work, is as good as it gets.

  Gagney: late thirties. His eyes are brown, his hair is black, and on the crown of his head is a bald spot. He looks to be a mixture of Native American, Portuguese, and Italian. He claims to be none of the above and will not tell me his ethnicity. Back during our three-and-a-half-month pre-deployment training in Wisconsin, he received divorce papers from his wife and then spent twenty minutes calling Reto and me idiots because we didn't have pens on us. Then a month ago Gagney, Reto, Denti, and I were playing Risk, a game of global domination. I had an alliance with Reto and we attacked Gagney's armies. Gagney flipped out, knocked the game board over, called us all “fucking idiot cheaters,” and stormed off. I've seen him yell at a female soldier while she sobbed uncontrollably.

  This is the guy who's supposed to be, I mean is, our leader in Iraq.

  1100 HOURS, OR

  “Look who decides to show up,” Reto says.

  Almost our entire OR team is on their way in. Sergeants and specialists like shift leader Hudge — Mexican, she's as pale as I am, attractive, twenty-four years old, and married to another specialist working as a medic in our unit's ER. I know she's a strong woman who isn't afraid to speak her mind, but most importantly I know that she is very emotional. In the past few months, every time I've seen her, she has either been yelling or crying.

  What a beginning. Almost everybody is late, including Gagney, and it's only our first day at work.

  For some reason Gagney thinks now is a good time to assert his authority as the alpha male of our group.

  “Come here, sergeant!” yells Gagney to Elster, a Dominican sergeant.

  “Yes, sir,” Elster says as he quickly approaches.

  Gagney continues yelling, his voice is hard and stern like an angered father.

  “You're late! This is a hospital! This is the military! You show up late and someone dies!”

  Gagney is directing his tirade at Elster, but he looks over at all of us to see if we're watching.

  “Your tardiness could have cost someone their life!”

  Gagney starts to get into character now. His arms are flailing, fingers pointing at Elster. “Do you understand? You're staying late tonight!”

  Gagney then turns and speaks to all of us. “Go have lunch! Because starting at 1300, we're dealing with a mock mass casualty situation.”

  I don't know whether to clap at Gagney's performance or worry that it's just the beginning of a long year. I feel bad for Elster. During training in Wisconsin he got made fun of for having an effeminate voice and for listening to Michael Bolton. He also likes the Beatles; he's the whitest black guy I know.

  But watching Gagney yell at him for no reason twists my stomach in a knot. It's one thing for me to get yelled at, at least I've mastered the art of daydreaming, but watching someone else being yelled at is like watching a car crash. You feel bad and can't take your eyes off of it, but there's nothing you can do, so you keep on driving and say a little prayer.

  We all go to lunch — except for Elster.

  1230 HOURS, OR

  A mass casualty is a surge of patients coming in all at once, possibly more than we can handle. For the mock scenario, soldiers from around the base come in and pretend to be wounded. We have to act out what we'd do if the injuries were real. It usually goes something like this: The fake patients come into the ER. The doctors and medics look them over and say what is wrong with them and where they need to go depending on their injuries. The ones with small or manageable wounds are sent to the ICU or ICW, and the ones who need surgery are sent to the OR.

  During a mass casualty, however, there are also patients you send off to die. With our limited capabilities, doctors need to make tough decisions. Eight patients come in for surgery, but you can only do three at a time. That means five lie back and wait. If the wounds are bad enough, then there's nothing we can do for them, except call a chaplain to read them their last rites.

  “So you're telling me that all we can do is watch patients die?”Reto asks as we sit and wait for the fake patients.

  “Depending on their wounds, yeah,” I say. “Some of them.”

  Dr. Bill jumps in. “Say we have eight patients and three need twelve hours of surgery, but only five need three hours of surgery. Those five could die while we spent twelve hours on the other three patients. Even though we can and know how to save everyone's life, we can't.”

  I hear Gagney yelling at Sergeant
Hudge in another room. He's been like this all day, pacing back and forth yelling at people: Do this. Do that. Stop that.

  “In fact, for the real bad patients,” Dr. Bill is continuing, “it would be better for them if we just left them to die in the field. At least there they would have a quick death. All we do by bringing them back here is prolong the inevitable. It's horrible.”

  Staff Sergeant Gagney comes out of the room and sees us talking to Dr. Bill.

  “What are you doing just sitting down?”

  I look at Gagney. “We've got eight patients on the way.” The ER hasn't sent us any fake patients back yet.

  “Get your rooms ready.” Gagney is acting as if we've got twenty on the way.

  “The rooms are set up,” I say.

  “Listen, soldier.” Gagney talks over me at a volume higher than necessary. “ER might have two patients with gunshot wounds coming over. I want you gowned and gloved and sitting in that OR waiting for those patients to come in.”