Broken Bodies, Shattered Minds: A Medical Odyssey From Vietnam to Afghanistan

by Ronald Glasser M. D.

  After basic training, Tom went to four weeks of MCT (Marine Combat Training). In the Army, it’s called Advanced Infantry Training, but for the Marines, it is simply something everyone does.

  MCT was a month of weapons firing and weapons management. Tom learned how to use all the individual and crew-served weapons in the Marine arsenal. There was little joking around now, and fewer attempts at humor. Weapons are a serious business. Everyone understood that this was no longer training, but potentially life and death.

  Following MCT, Tom went on to two and a half months of tank school at Fort Knox, where he learned machinery, maintenance, and some gunnery. On the second day out on the tank course, he knew he’d made the right choice.

  The M1A1 battle tank had a 120-millimeter smooth bore cannon. The British Challenger 2 Main Battle Tank, used by NATO forces in Southern Iraq, has a 120-millimeter rifled barrel. But the rounds from the M1A1 have a higher muzzle velocity than the British cannon, leaving the gun at more than 3,200 feet per second, which meant better accuracy than the Challenger 2 up to and beyond 3,000 yards. There was simply no contest with the Russian tanks.

  The M1A1 weighed seventy tons and, with its gas turbine engine, could go through or over anything at fifty miles an hour. Whatever else anyone might think of U.S. armor, he’d definitely be the biggest kid on the block.

  There was more training, more honing of skills, along with a better understanding of what it was to be a Marine and then what it was to be a Marine at war. Tom liked it all. He liked the camaraderie. He liked the effort and being a part of something bigger than himself. He liked the sense of responsibility and even of honor. He even liked the crusty old sergeants who never married because the Corps had never issued them a wife.

  Following tank school, Tom became a member of Alpha Company, First Tank Battalion, First Marine Division. Six months after the fall of Baghdad in April 2003, he arrived with Alpha Company, First Battalion to become part of a regimental combat team designated RCT 2.

  The Marines, despite the pronouncements coming out of Washington that the war had been won, understood that the war had simply changed. It did not take a military genius to understand that when you have more casualties in supply units than in regular front line troops, you don’t have enough grunts on the ground to make the fight, much less to guard your supply routes, and definitely not enough troops to hold the peace. More than one Marine combat unit had noticed in their run up from Nasiriya to Baghdad at the beginning of the war that, as they pulled out of a town, they could hear increasing firing behind them, but didn’t have enough troops to go back and see what was going on. The war was quickly transforming itself into an insurgency even as those in Washington were landing on aircraft carriers under the banner of “Mission Accomplished.”

  The Marine Command distributed their tanks among the combat platoons, putting the tanks up front with the troops on the ground, rumbling through the streets of Iraq’s towns and villages, inching forward side by side with the grunts as they moved past roadblocks and swept through towns and villages, supplying both covering fire power to the ground units and, when necessary, immediate backup.

  The tactics and rules of engagement for an RCT (Regimental Combat Team) are as simple as they are straightforward. Ground units move forward with their tanks for cover. The tanks, with their enormous weight and firepower, keep pace with the grunts. It is an intimate and immediate kind of warfare, a dance that Tom learned to admire and then appreciate, even though it was a dance that left little room for error and absolutely none for a mistake. Marines have never been nation builders, nor are they promoters of democracy. They put themselves in harm’s way to kill people and break things and an RTC is an effective machine to do just that.

  And that is what happened during the two Battles of Fallujah, the first in April of 2004 and the second in November of that same year. In the first battle they just did it plain wrong and marines were killed.

  In the months following the fall of Saddam Hussein in early 2003, Fallujah was one of the most peaceful and pro-American cities in Iraq. In April of that year, a crowd defied a local curfew and the protest escalated, with gunmen reportedly firing on U.S. troops. Soldiers of the 82nd Airborne returned fire, killing seventeen and wounding over seventy. When there was a review of the allegations of firing on U.S. troops it was discovered that no U.S. soldiers had been killed or wounded. But after all the civilian killings the attitude towards the American troops changed dramatically. In February of 2004, control of Fallujah was turned over to the First Marine Division. In retrospect it was probably a bad decision.

  In March, four U.S. contractors were ambushed on the streets of Fallujah, pulled from their cars and killed, their bodies mutilated and burned, and what remained of the burned bodies hung from the city’s street lamps. The Bush Administration, furious about the attack on contractors, unleashed the Marines. It did not go well. Tom’s unit was not in that fight, but the Marines did what they always do, and as they fought their way into the center of the city they killed a lot of insurgents, but also apparently killed a large number of civilians even as they took significant casualties themselves.

  It was brutal street-to-street, building-to-building, and room-to-room fighting. Marines were shot at from windows and alleyways. They were shot at as they kicked in doors and hurried across intersections. The AK-47s had poor sights and so weren’t very accurate, but the RPGs at close quarters were deadly. No one, marines or insurgents, gave anyone a break. A lot of marines were shot at close range and the choppers couldn’t get into the narrow streets to get them out.

  These were the old-fashioned penetrating head and chest wounds. You were dead as soon as you were hit. The armored vests didn’t prove as effective as advertised, the Kevlar plates had gaps between them so that, if you were hit by the shrapnel from an RPG or by enough rounds, you could get pretty messed up while the blasts themselves could leave whole squads dizzy and confused. You couldn’t hear very well after one of those went off, and you couldn’t think all that well either. And the insurgents didn’t run away. They stayed and fought until they were killed. It was a mess, with the marines giving as good as they got, but it had definitely been tough going. According to some of the medics that Tom talked to about the battle, the numbers of deaths were a surprise.

  The ferocity of the battle did indeed surprise everyone, but apparently no one more than those in Washington. It was as if they hadn’t expected the damage or the casualties. The Iraqi Government, as shocked as Washington by the ongoing violence and increasing collateral damage, formally requested that control of the city be taken away from the Marines and turned over to an Iraqi local security force. There were those in the military who were convinced that the damage done to the city and the casualties didn’t fit in with the Bush Administration’s pronouncements that the war was over and the mission accomplished, so the offensive was stopped and the Marines pulled back and the city put under control of the Iraqi security forces.

  Within weeks, those insurgents who had slipped away were back in the city, reestablishing their control and a presence that continued to grow over the next few months. The dangers from this resurgent center of the rebellion became too great and too obvious to ignore, and by September of that year, the city, as well as the whole surrounding Al-Anbar Province, was again slipping away from both the Iraqis and the Americans.

  By October it was obvious that the Marines had to go back. The insurgents had weeks to prepare for the battle. Large numbers of booby traps and IEDs had been constructed and set in place, and throughout the city elevated sniper positions were created along heavily fortified defenses along the major entrance and exit routes. The Air Force and satellite photographs indicated that the return action would not be easy. But even facing the insurgents resistance during this second battle of Fallujah, the Marines did it right, with two different RCTs leading the push into the city.

  On November 7, 2004, three days after the American Presidential election, a diversiona
ry attack on the western side of the city was made to draw off insurgents from other parts of the city. The main attack came through the southern part of Fallujah. The two Marine Regimental Combat Teams, as well as a number of heavy battalion-sized Army units, along with British troops, were part of that offensive. There was intense bombing before the attack, and this time they brought up their tanks while self-propelled 155-mm howitzers fired at dug-in insurgent positions throughout the city.

  After nine days of bitter and relentless fighting, the Marine Command described actions as mere mopping up, even though sporadic fighting continued until the end of December. A total of ninety-five marines were killed and over five hundred wounded.

  But during the three weeks of the second Battle of Fallujah, the majority of insurgents were killed and as collateral damage, the city basically destroyed. During those weeks, the Marines were engaged in the heaviest and bloodiest urban combat since the retaking of the Vietnamese Northern city of Hue following the Tet Offensive. You could, following the Marines retaking of Hue, stand on the eastern shore of the Perfume River and looking out over the battered city, not see a wall left standing that was over three feet high. It was much the same in the retaking of Fallujah. Most of the city was turned to rubble but over 4,000 insurgents were killed.

  The deaths and the wounds were different from that first battle of Fallujah. The insurgents were ready. Most of the casualties were from IEDs, powerful booby-traps, and even more powerful roadside bombs. There were numbers of burns that hadn’t been seen before as Humvees and Armored Personnel Carriers were destroyed or set on fire. And there were also an enormous number of extremity wounds and traumatic brain injuries, as well as the concussive effects from the blasts, with five or six marines killed at a time and the rest of the patrol being blown apart, or coming out of those blasts deaf or blind and disorganized and confused.

  During the second Battle of Fallujah, dozens of casualties who had to be massively transfused survived because of the use of whole blood rather than plasma, reconstituted blood, or blood stored for over three weeks. Virtually all who had been massively transfused did survive to be evacuated. The military’s own data going back to Mogadishu, along with the experience of those who had to be transfused at the main military hospital in Baghdad early in the war, showed a survival rate that was over nine times as high for those casualties who received fresh whole blood compared with those casualties receiving the equivalent amount of blood divided into components or who received only red cells along with plasma or IV fluids.

  But this time the Marines stayed. The city was destroyed but it was theirs. Of the 50,000 buildings in the city over 10,000 were little more than rubble. Every home had been damaged and over three quarters of the inhabitants had been displaced, or simply forced to leave. It was victory, but a victory similar to what the historian Tacitus said of the Roman Army. “They make a desert and call it peace.”

  Peace or not, the Iraqi Government could not hold the victory. By the end of 2005, the insurgents were back in control, not only of Fallujah but the whole of the surrounding province. None of it had made any difference. But after Fallujah, the tactics of the insurgents, whether Al Qaeda, Sunni, or Shiite, changed. It was a lot easier and a lot less dangerous to kill and blow up Americans from a distance without running the risk of gunships, fighter-bombers, and artillery.

  Tom had noticed the change in their own sweeps through insurgent towns and villages. Before Fallujah, his tank moved down streets with a squad of marines going house to house to check for weapons and insurgents. One time, a squad of marines entered a house and came under fire. The insurgents were hiding in the basement, shooting up through the floorboards. Most of the squad was killed or wounded within minutes of entering the house.

  The rules of engagement had been quite clear: any tank rounds were to be used sparingly with every effort to limit collateral damage, but they were to be used. As soon as what was left of the squad exited the house carrying the dead and wounded, Tom’s tank put three rounds into the building, sending rocks, debris and shrapnel careening down the street and through the neighborhood. The rounds killed everyone inside the building. After a few minutes, the tanks and the grunts moved on. Leveling the building probably saved the marines coming up behind them, but it didn’t win them any friends on that street.

  But after Fallujah, the insurgents started placing the IEDS in the center of the road with pressure plates as detonators along the curbs. And the IEDs were bigger and more powerful. The roadside bombs had been just that, roadside bombs, when they were detonated they might blow a track off a tank or destroy one of the wheel mounts, but little else.

  Now these bombs were exploding under the vehicles. And they were clearly setting the pressure plates to by-pass the lighter vehicles and catch the heavier APCs and tanks. It was a real surprise to everyone. The first time it happened, the force of the blast was so great that it warped the six-inch steel plates along the bottom of one of the tanks. People being thrown around and the blast wave itself had wounded everyone inside. The insurgents had clearly learned something in Fallujah. Nowhere was safe anymore.

  As for dying, Fallujah had changed that too. It had been a long time since Vietnam. But there it was again: that crazy aunt in the attic, hidden away and barely discussed or even acknowledged but still able to make her presence known. The older sergeants, and certainly the field and general grade officers, would occasionally have mentioned Vietnam during training and even during Tom’s first few weeks in Iraq, but after Fallujah, it was a lot more often, if not in a slightly more hushed voice.

  Sudden unexpected kinds of dying were an almost daily occurrence now. There’s not that much an eighteen-year-old thinks, or can even say, about death. Few in an RCT ever think of deaths, their own deaths anyway. They might think about being wounded, but not being killed. When you are young and in the Marines, dying is for someone else. That is a virtue, but it is also a mistake.

  But with more and more IEDs going off in more and more towns along more and more highways and roads, friends and comrades who had been there in the morning were gone that night. That seemed wrong. Tom missed them all and was troubled that somehow he knew something important, even crucial, that none of their families knew, that no one who had cared for or loved them or waited for them, knew. It was all out of balance that he should know something so important that their families didn’t know. But with a war to fight, the real meaning of those deaths would come to him later.

  There was a grimness that settled in with the increasing casualties. Some of the grunts in the unit became angry. But the sweeps continued and more marines were killed and even more wounded, but they were also killing a lot of Iraqis. As far as Tom could see, probably as many good guys as bad guys.

  At a routine roadblock one of the other platoons had set up late one evening, a car, turning a corner, didn’t stop. It was dusk and difficult to see, but the car simply kept moving. A fairly large car bomb could kill or mess up anyone within fifty meters of the blast. There was never a lot of time at checkpoints, so when the car, ignoring the hand signals and whistles of the marines, seemed to speed up, the Humvee along with the tanks blocking the intersection opened fire. The 50-caliber machine guns tore the Toyota apart. Inside, they found a family, a mother and three young girls, killed, the fully jacketed high-velocity rounds having blown them apart. None of them knew what to do. So they left the car where it was and, clearing the checkpoint, simply kept going.

  There were weeks now, as they moved on from dawn to dusk, where one town and village merged with the next until an IED would go off and they would level a house, street, or perhaps a whole block. They began to sleep next to their tanks and didn’t shower for weeks at a time. There were days when supplies could not get through and they had to cut to half rations. There were even times when they worried about having enough gas for their tanks just to keep going. Fuel had to be trucked overland by tankers and, often those tanker convoys had been hit. There were barely enou
gh troops to do the fighting, much less guard the increasingly longer supply lines. The insurgents could hit one or two tankers, set them on fire, and strand a whole column for hours.

  There were rumors too, that the insurgents had begun hanging their IEDs from the overhead lampposts that lined the major town’s main streets and boulevards. When they blew, the explosion and shrapnel rained down instead of up, killing or wounding everyone who had started to ride on top of the armored vehicles to be protected from the IEDs buried in the ground. Tom heard that they had actually blown the heads off drivers who were using the opened forward hatches of the armor to steer their tanks and APCs. If it was true, they certainly would be killing anyone manning the 50-caliber machine guns on the top of the Humvees or any of the other 50-caliber mounted vehicles. Tom didn’t know if any of it was true, but it was enough that it might be.

  Gradually the letters home, the email and even the satellite phone calls, became the same. Despite the increasing numbers of casualties, everyone, including Tom, always said things were fine, that they were OK and that, if not quite winning, they weren’t losing either. But mostly the marines told their parents, their husbands, wives, and even their kids, not to worry.

  But the whole country seemed up for grabs. There were armed guards and militias everywhere. You couldn’t tell who was who, and certainly couldn’t figure out who was on your side and who wasn’t. Tom was sure that they killed a lot of people who shouldn’t have been killed. He was sure they weren’t making any friends. You could see it on the faces of the people in the different towns and villages they drove through.

  What baffled him was the whole security contractor thing. They were everywhere. He could understand having private contractors driving the tankers; the Iraqis needed jobs; but having heavily-armed private security guards in the middle of a confusing war only made it even more confusing. One of the older grizzled master-sergeants told him, with the usual low-keyed mixture of both hostility and indifference so much a part of a lifetime Marine NCO, that there were somewhere around 60,000 independent security guards working for a number of U.S. companies that had contracts with the Pentagon or State Department in order to protect government employees and diplomats, or for just guarding things. “And a lot of the ones in charge are ex-NCOs with a couple of years experience and why not,” he added drily, “an E-6 with eight to ten years experience gets around 50,000 dollars a year with hazardous duty pay working for the country, while that same sergeant working for one of these companies can get upwards of 150,000 dollars a year tax free. That’s O.K. pay even if you have to work all day with a bunch of macho idiots and bottom feeders.”