Like the patients I saw in Africa and Bosnia, the patients at the Hamallaj camp sought refuge from ethnic cleansing. There was a pattern to the injuries; they were inflicted by armies, militias, and criminals with an apparent goal to kill and harm as many civilians as they could. The patients in the camp told of genocidal atrocities similar to what I had witnessed in Rwanda. Some refugees told me soldiers inserted long dirty needles into the legs of their victims and scraped their bones to cause pain and infection. In the first week of providing medical evaluations for over three hundred refugees, several of them told me their captors forced them to drink gasoline; others mentioned forced fistfights with their sons, and if they refused to fight, their sons would have been killed. Serbian attackers had raped women, young and old; some of the women had been mutilated by knives drawn across their faces and breasts.
The Kosovar refugees all related stories that I had heard or seen from other refugee camps since my time in Africa. None of them, the stories or the patients, surprised me. And though I felt sorrow for them, I also felt detached. It was a skill I had developed: remain detached in spirit without being distant in practice. It gave me an edge for treating patients I knew would die.
—
While at the Hamallaj camp, I met several Albanian doctors from the University of Pristina in Pristina, Kosovo. They told us of their underground medical school for Albanian students and how hard it was to teach and practice medicine under constant threat from Serbian forces. Over the course of several months, the Hamallaj project director, Ken Isaacs, and other leadership from Samaritan’s Purse and World Medical Missions agreed to collaborate with several faculty members from Johns Hopkins Medical School in a project to establish an emergency medicine teaching program at the University of Pristina. Essentially, we followed the Albanian doctors back to their university and joined with them in teaching medicine. By July, I was asked to join the project as the in-country director in Kosovo. I would have to spend three- to six-month blocks there, teaching and treating patients.
When I returned home, I talked with Collin about the project. The opportunity to work with the staff of Johns Hopkins on such an international scale held the promise of excitement and an opportunity to be a part of rebuilding an entire medical infrastructure where one had been decimated by war. Those kinds of opportunities were rare, and I had been asked to participate. Collin had seen how much the experience in Africa and Bosnia had enriched my professional life, and regardless of the hardship the trips brought on our own family, she was inclined to support the work because she saw that by doing so, we both played an important part in responding to a critical humanitarian need. In a large way it was an extension of living a practical faith that was not bound by distance or culture. The bottom line was that we made a difference in refugee camps and war zones, and as long as that was true, I felt inclined to go and Collin felt inclined to support that work. Beyond that, there was an attraction to disaster medicine that was undeniable. I liked the chaos and the edginess of what I was doing. Collin and my kids knew it, and they allowed me the freedom to practice that kind of medicine even though the time away sometimes made it tough at home.
At the end of July, I took a six-month leave from my Iowa emergency medicine practice to take the position in Kosovo. The six months stretched to two years, back and forth, home and Kosovo; I taught emergency medicine and worked with Ministry of Health officials to establish emergency medicine in Kosovo. Dr. Julian Lis, my immediate boss at Johns Hopkins, recruited visiting faculty from Johns Hopkins and nearby medical centers. I put them on a rotating lecture schedule. In our initial two years of the project, we established an emergency medicine curriculum in conjunction with other departments of anesthesia and surgery. I met with Republic of Kosova president Ibrahim Rugova in the late summer of 2001. He signed an executive order recognizing emergency medicine as an official medical specialty in Kosovo.
During the time spent in Africa, Bosnia, and Kosovo, I developed a heart for international and disaster medicine. There was a certain intrigue and toughness that came with working in dangerous missions that required a persistent focus on rapidly changing environments. Medical equipment and pharmaceuticals were often in short supply, and disaster medicine forced a reliance on the “thinking” aspects of medicine rather than the “technological” aspects of medicine. Part of the mystique of international practice was adapting to and overcoming such shortages, making do with whatever was available. And beyond all the intrigue and personal fulfillment, there were the patients. The work I did contributed to a sustainable program of international medicine, to be sure, but the patients I tried to help—the ones at the Panzi refugee camp and the ones in Bosnia and all those in Kosovo—changed me. They reminded me of my desire to heal, to be a part of something greater than medicine or science or myself. They were the reason I had become a doctor in the first place.
In all of my refugee camp and war experiences, I learned I needed those patients just as they needed me. Their need for a doctor fueled my need to be a doctor. Everything I did for them mattered, and as detached as I had to become for professional survival, I became attached to those patients; I was the doctor who gave hope and even laughter with medicine. I lifted patients’ spirits and by doing so lifted my own. There was a feeling that unified us, patient and doctor, against whatever calamity was trying to destroy us, so in the end we all survived together.
After 9/11, every soldier, whether on active duty or in the Guard or Reserves, knew they were bound for war. The only thing they didn’t know was the timing and destination of their deployments. I knew that Iowa’s 109th Area Support Medical Battalion (ASMB) was staging for a call-up, so I volunteered for a reassignment from headquarters in Camp Dodge to the 109th because I wanted to participate in that first wave of deployments. I was fifty-three at the time and had been practicing medicine for fifteen years. I had been on first-response teams in Rwanda and Kosovo and had provided rapid and effective mass casualty intervention. That was my personal strength in the field, intervention that was quick, decisive, and responsive to a rapidly changing environment.
In January 2003, Iowa Army National Guard soldiers received alert letters announcing an imminent call-up. I showed mine to my wife and notified the hospitals where I worked. Collin reacted with a mix of emotions. I had difficulty understanding them all. She expressed what I interpreted as quiet acquiescence. I also thought she felt fear, but it wasn’t really fear at all; it was more like what you might see when a person receives a terminal diagnosis and accepts it by showing love or strength instead of panic or fright. Collin and I talked about the mechanics of deployment: how long I would be gone, how to reach me for emergencies, and how she would be notified by the Army if I were injured or killed.
A myriad of predeployment details needed to be organized: financial details such as life insurance policies, bank account numbers, mortgage papers; simple things—titles to cars, lists of doctors and pastors, and family emergency contacts. We spent hours digging through files to find the needed information, and finding each valuable piece took on the proportion of a crisis. Yet none of it was a crisis; they were things that simply needed to be done without emotion or reaction, like painting the house or doing taxes. I didn’t have a will, so we had to talk about the legal implications of my death. Surprisingly that didn’t bother us. What did bother us, though, was the need to feel that we didn’t feel, that we could detach ourselves from the impact of being torn apart by war and the possibility of never seeing each other again. And of those frightening things we hardly spoke. Instead, we tried to hold each other at night as we talked about our children and the need to love and support them during my deployment. At times we simply tried to power through the days knowing that our remaining time together was disappearing faster than our ability to grasp each day’s meaning. Too often, we were short-tempered because time ran out and preparations did not go as planned. In part, we both acted like automatons, moving without thinking and reacting to the demand
s of the military just to get through the hours. And in all of our rushing, we tried to shield our children. I gave them only the basic facts about my deployment to Iraq and tried to minimize the risks of war—as if it were something I could hide.
I talked to Justin by phone. He was living in Chicago.
“There’s a lot of moving parts in this deployment,” I said. “I want to make sure you know I love you and appreciate you. I’m not asking you to take my place while I’m gone, but if you can look after your mom and keep in touch with her, I’d appreciate it. I need to make you aware of my will and legal stuff the Army has prepared.”
“I understand,” he replied businesslike. “How long are you going to be gone?”
“I can’t say for sure, but something close to a year. I’ll try to e-mail as often as I can, but phone calls might be limited. I am so proud of you and your brother and sisters. I love you all so much.”
At home, I talked to Darren, Katelyn, and Jordan. Darren was working and taking classes at the community college. Jordan had graduated from the University of Northern Iowa, and Katelyn was still in high school. I asked each of them if they would help out while I was gone and they promised they would. I told them how much I loved them, and they said they knew and that they loved me too.
Jordan took it hardest. “Dad, I don’t want you to go,” she said with tears falling and her voice raised. “Why can’t you just stay here and work in an Army hospital or something?”
I tried to reason. “It’s not that simple, Jordan. I have certain responsibilities. Soldiers need me there.”
“Don’t soldiers need you here?”
“Oh, honey,” I said, “they all need doctors, but I made a commitment when I joined the Army.”
“It’s not fair,” she insisted as she stomped her foot. She was right. None of it was fair. Deployments weren’t fair. The disruption of families was not fair. I had no reasonable arguments as to the fairness or legitimacy of combat or my involvement in it. I could only tell my children that I loved them and valued them and would try to return as soon as I could, and that the rest was up to God and the Army.
—
On January 24, 2003, the 109th was ordered into federal active service. In the weeks following, Alpha Company and Headquarters Company of the 109th ASMB loaded onto a bus and drove to Camp Dodge for a week of soldier readiness processing (SRP), which included a week of administration checklists, legal and Red Cross briefings, predeployment medical and dental exams, and equipment and clothing distribution. In the medical lanes, dental technicians prepared a routine, forensic set of panoramic dental X-rays for each soldier. Medics drew blood samples for DNA tests to use in case our bodies needed identifying later. Army attorneys drafted wills and powers of attorney for each soldier family. Medical officers met with administrative officers to make sure their medical credentials and hospital privileges met the regulatory standards. Several times a day I phoned Collin to ask if she could find needed documents and fax them to Camp Dodge. She did her best to comply, but I could tell from her tired voice that she was frazzled.
Since I was new to the unit, I didn’t know the other medical officers. It turned out that the other two doctors who had been reassigned to Alpha Company of the 109th were also new. On the first day of SRP, I met Majors Mike Brown and Tim Gibbons. Brown was a cardiothoracic surgeon from North Dakota and Gibbons was an orthopedic surgeon from Iowa. Not surprisingly, we hit it off right away, and as typical of doctors from different branches of medicine, we started giving each other lighthearted shit about our specialties. Brown stood over six feet tall and had the feet to match his frame. He had a bit of a lanky gait and dark brown hair that hadn’t been cut in a while. My hair was just as long. I told him he looked like a woolly mammoth. He said I looked like a yak.
Major Gibbons had quite a remarkable collegiate wrestling career at Iowa State University. Brown and I joked that his low center of gravity and rather square head made us wonder about his ancestry.
“Hey, Gibbons,” I joked. “Have ’em check your DNA for Neanderthal genes.”
“We all have Neanderthal blood,” he shot back, “especially you, being an ER doc and all—too much grunt and no follow-through.”
At the end of the week I phoned Collin and asked if I could bring two colleagues home for a few days. We would be home in four hours and could she also fix dinner for us—a roast or something nice. She was silent at first and I figured I had pushed too hard; then she responded. Yes, it was okay. No on the roast. We could order pizza. I sensed her nervous tiredness through her worn voice and barely noticeable sighs. We had spent a week preparing for war, yet neither of us could fully understand the frustrations and fears and thoughts of the other.
During the week following the Camp Dodge SRP, the 109th marshaled at the National Guard armory in Iowa City for our final preparations and the loading of our vehicles and duffel bags. On Sunday, March 2, the soldiers assembled at the armory for the final time. The mission was set. Form a convoy of military ambulances, troop transports, Humvees, and trucks of various sorts and sizes and head to Camp McCoy, Wisconsin, for pre-deployment. Outside the armory, sleet and intermittent rain battered the streets. Temperatures bounced around the mid-thirties. Families of the deploying soldiers lined the nearby streets of the armory as if waiting for a summer parade. They waved American flags and makeshift signs of support for the war and the soldiers. Many signs said “God bless” or “We love you.” A few had the names of soldiers written in large bold letters. Children stood on the curbs and waved. Some of them cheered and smiled. A number of them clung to the sides of their parents. As our convoy rolled out the gates of the armory and past the crowd, I caught a last-minute glimpse of Collin waving a tearful goodbye. It was her birthday. She was fifty-three years old. My high school daughter, Katelyn, stood next to her and held her hand. I could see their faces tucked into their winter coats. I gave them a single wave, blew them a kiss, and turned my head around to watch them for as long as I could as my Humvee drove on. Seeing them huddled together in the cold, clutching each other, made me regret all the times in the past weeks I had rushed to get things done—times that contained no hint of love or patience or understanding. I had been too busy for war and now, in the literal final seconds of contact with my family, I had nothing left for them but a vanishing kiss blown through the cold and blustery air of a late-winter day in Iowa.
As the convoy proceeded out of town, it passed the headquarters of an Army Reserve unit. About thirty reservists lined the street and stood at attention as our convoy approached. They rendered a salute and held it as our vehicles passed. They weren’t salutes of protocol, as when soldiers salute an officer; they were salutes that acknowledged fellow soldiers going off to war. To me, they signified the start of my particular slice of war, as if somebody were thumbing a stopwatch. Click—go to war. I didn’t know then that nearly ten years later soldiers and their families would still be waiting for somebody to click “stop—go home.”
When our convoy arrived at Fort McCoy, we broke into platoons and moved into the World War II–vintage barracks. The fort had once served as a cold-weather training facility. Nothing there resembled the Iraqi desert—not even close. The docs and other officers of the treatment platoon were assigned to the first floor of an older barracks. Cots with metal frames and thin, gray-striped mattresses sat against the walls, about four feet of space on either side. Major Brown brought a black plastic footlocker that he had stuffed with a few books, extra clothes and uniforms, a blanket, and just stuff he thought he needed. Gibbons and I (mostly) gave him crap about his extra stuff being nonessential.
Brown gave it right back. “Look at Kerstetter. Packed like he’s going to a weekend conference.”
“High-speed, low-drag,” I replied. “You’re taking enough crap for a vacation to Disneyworld.”
Back and forth it went, all lighthearted—all the typical banter of doctors who possessed enough surgical and medical experience between them to star
t their own medical school or manage a national health care system. In a typical civilian week, Brown performed several cases of open-heart surgery and coronary artery bypass grafts. His expertise in chest trauma and cardiac critical care made him invaluable for soldiers with blast and ballistic injuries to the chest. Major Gibbons performed hip replacements, arthroscopic surgery, and orthopedic trauma surgery. Their expertise in general and specialized trauma skills brought a critical skill set to the 109th that most other National Guard medical support battalions lacked. These were not doctors looking to gain experience from a deployment; they brought their experience and expertise with them and hoped it would serve a vital purpose.
Most of the medics and admin specialists of the 109th tended toward younger and less experienced soldiers, but their senior NCO (noncommissioned officer) leadership had been in the Iowa National Guard for ten or more years. Some of the NCOs had deployed to Desert Storm. Among the medics, only a few had more than a few years of experience. Several had finished their medic training within the preceding year. They came from rural Iowa towns and from college towns like Iowa City. They played rock music on their iPods and watched DVDs on their laptops. Several had just started college at the University of Iowa or Kirkwood Community College. And they were mostly smart and fit. Two of the medics thought they could take on Major Gibbons in a wrestling match. He pinned them each in about ten seconds; then he wrestled them two-on-one and they went down in about thirty seconds. In all, the 109th was like most National Guard units. Its soldiers represented the likes and fancies of adults in their twenties and thirties. That was balanced by a much smaller, experienced group of citizen-soldiers in their forties with a few, like me, in their fifties. And at age fifty-three, I was the old man in our battalion.
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