The convoy finally started moving on some back-road route. Our driver followed directly behind the vehicle in front of him. That vehicle followed the vehicle in front of them—dark gray elephants, trunk to tail—all hoping that the lead elephant knew where the hell he was going. We took so many turns on side roads that it seemed we were lost in a maze. Nobody kept the black curtains closed. Not that it made any difference for stealth or security. Anybody five miles away could have seen our dust column rise above the twisting roads, even at night. Soldiers pulled neck gaiters over their faces, but they still breathed the dust into their noses and lungs. We listened to coughing and throat clearing and snot blowing during the entire trip.
The convoy moved so incredibly slow. I imagined that wherever north was I could have walked there faster, and certainly done so without the constant dust and the cramping that was beginning to settle in my legs and back. I had flown on plenty of C-130 flights with their tightly spaced webbed seats and had felt the stiffness of long flights, but in the rent-a-convoy, stiffness had long given way to cramping. Soldiers twisted, shifted, and adjusted. They tried to stand up to stretch their legs. After more than an hour of slow-churned dust and jostling roads and drinking from Camelbacks to stay hydrated, the soldiers needed a latrine break. The sergeant in charge radioed the convoy command with our request. Nothing doing. Keep moving.
A particularly rough stretch of road slowed the convoy to a walk. The buses lost their tight formation and the distance between each one stretched out so far that we could barely see the vehicle in front of us. Our driver veered too far off the road, then snaked back into line. We all began to sense that something was wrong and started to get nervous. We had had briefings about enemy insurgents who infiltrated the ranks masquerading as contract workers. A lieutenant shouted at the driver to stay on the road. The driver ignored his instructions or simply misunderstood them. He kept diverting from the convoy, weaving on and off the road, stalling momentarily, then jolting forward. Gibbons ordered one of the lieutenants to get a weapon on the driver. The lieutenant sat in the front row with his rifle on his lap and aimed at the driver. From the middle of the bus, I shouted, “If he breaks convoy, take the bastard out.” I meant it. I didn’t want our bus full of soldiers to show up on CNN as a newsflash. The driver may have understood that part. He quit moving off-road.
The soldiers had been hollering for an hour to stop for a break, so we radioed the convoy commander again. “No go on the latrine break. Keep moving north. Stay in the vehicles.” One of the female soldiers sitting behind me started cursing and screaming about how she was getting sick and about how she might have an accident. She needed to stop—convoy or no convoy. We kept moving—another thirty minutes of negotiating potholes and stop-and-go busing. Finally, screaming in desperation, the soldier stood straight up in her seat and dropped her battle uniform trousers and her standard-issue underwear. Shaking and crying, she pissed into plastic cups, and onto her hands, and onto the velour seats. Whatever piss she managed to get into cups, she tossed out the window. Other soldiers started yelling and cursing about the goddamned Army and the bullshit convoy. Short of mutiny, the convoy commander ordered a ten-minute stop. Soldiers dropped their uniforms in plain sight of each other. Nobody cared. Nobody watched. Nobody said anything. Everybody pissed—in a desert—heading north into war.
—
Our convoy finally arrived at Camp New York, northern Kuwait, about 0600. New York was one of several camps in northern Kuwait known as a kabal (Arabic for “fortress”) established during Operation Desert Storm as defensive outposts and later converted to staging areas and live-fire ranges for military units on the move to Iraq. A few hours after our arrival, the battalion’s leadership went off for a quick meeting with the camp commander, the “mayor.” When they returned several hours later, they told us that the camp had no information about our arrival and that they could not accommodate us in the regular billeting area. Surplus tents had been set up near the camp perimeter for National Guard overflow. They were located on the perimeter road about a quarter mile from the Patriot missile batteries and a half mile from the burn pits where the camp’s lowest-ranking soldiers had the duty of stirring fuel into sewage and burning the mixture. Adjacent to the burning sewage, piles of garbage smoldered and burned continuously. The smoke of those fires produced a stagnant haze that choked soldiers and burned their eyes. A desktop sign in one of the headquarters tents read, WELCOME TO CAMP NEW YORK.
The day after our arrival, we got our first bit of solid information about our mission status—in limbo. In the process of rapid deployment, the battalion had been separated from its equipment. Transport vehicles, ambulances, and medical supplies were somewhere on a ship heading toward a port in Kuwait. The battalion had arrived semi-ready for war without its vehicles and major equipment. The supply disconnect was the first of many. It plagued the early movements of the war when the Army moved faster than its own supply chain. In a medical crisis, the personal items in our duffels could never sustain us for even an hour of critical care. We were to wait until our equipment arrived before going anywhere.
In the interim, our battalion medical staff would relieve the Regular Army doctors and medics assigned to sick call duty at the camp medical aid station. The duty consisted mainly of taking care of the basic medical needs of soldiers, most of which could have been handled by medics. None of it required surgical expertise or emergency care. It was primarily routine stuff: sprains, minor cuts, coughs, diarrhea, aching joints, and sunburn. Sick call was not combat medicine; it was the kind of medicine that bored me in my civilian ER practice. I railed against the disconnect. I wanted to provide patient care that demanded the most of my skills. Gibbons, Brown, and I felt we would have been more useful assigned to an echelon III or IV facility (a fixed-base Army hospital or field hospital) where our skill sets could come into play. Critically wounded soldiers in Iraq needed us. We needed them, but our orders mandated that we perform sick call at Camp New York, thirty miles away from Iraq and the real war. The disparity between our medical skills and the mission needs drove us nearly insane.
Beyond the bullshit assignments, Camp New York typified an early Iraq War experience. The DFAC blew down several times a week. The large tent simply could not stand against the desert winds and the sandstorms. The camp leadership responded by setting up three medium-size mess tents. That worked about half the time. The mess staff always tried to prepare at least two hot meals per day. Fresh fruit was plentiful. Six ice cream freezers lined the edge of the mess tent. They ran off generators that kept them cold most of the time, but when the generators failed, the entire ice cream shipment melted within hours.
Hand-washing stations placed twenty yards from the DFAC entrance typically ran out of water or soap. A chipboard wooden floor loosely nailed together by government contractors barely kept us from sinking into the underlying sand as we ate. White plastic patio chairs often bent or broke from the weight of soldiers and their gear. Folding eight-foot picnic tables covered with the permadust of sand tilted and wobbled. Some of the tables collapsed during a meal, dumping trays of food on laps and feet. Soldiers tied ripcord around the table legs to reinforce them, then stood them back up. A mess sergeant tried to keep soldiers moving quickly. Chow down. No chatter. Move out. Make room for others.
And Camp New York had sand. Sand in the food, in the sleeping bags, in the latrines, in the sick call tents. Sand in underwear and socks and duffels. Sand in eyes and ears and nostrils and mouths. I felt sand on my teeth when I swiped my tongue. Soldiers coughed up sand in the morning after breathing it all night. The dust of sand made us look like light colored badgers. It blasted our goggles so that a single pair lasted about a week, sometimes two. During one sandstorm, I found a young soldier wandering around near my tent—head down, hands over his Kevlar helmet. I hollered at him to get inside the tent with me.
“Yes, sir,” he said with relief.
“What are you doing out here?” I asked.
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“Looking for my hooch, sir.”
We used sand to our advantage. Soldiers filled empty buckets with sand and kept them in the workout tent—a makeshift gym with a single set of barbells. We worked out for fifteen minutes in our uniforms and sweat like we had spent an hour in a sauna. There were no showers in the tents, of course, so we planned our workout schedule to coincide with shower day. When we finished working out, we marched to the shower point, washed and rinsed, then put on a clean uniform. It was our way of getting back at the sand.
—
The chapel was located near the DFAC. It held approximately two hundred soldiers, three hundred if everybody crowded in, not nearly enough space for a camp of several thousand. On Sunday, or any day, soldiers could attend a worship service or vespers, or just go there to pray or attend one of the briefings on combat stress relief. I attended Easter sunrise service with Major Gibbons and Major Brown and a few of our physician assistants. The chaplain used the occasion to talk about the newness of life and about how the resurrection of Jesus meant that we all could aspire to that newness. The implications were that a new life required death, either spiritually or physically. Before the service, we had all talked about our families back home, how we missed them and what we did as a family for Easter. We talked about faith and its role in our lives. We all agreed that faith kept us centered as people and soldiers, but sometimes faith was difficult to hammer out in view of the fact that if the need arose, we had to pull a trigger and kill. The sermon reinforced the idea of faith and renewal, but all three of us acknowledged that renewal for us meant taking a new role as soldiers from our typical role as doctors. That remaking was another kind of dissonance that became evident at Camp New York. And it didn’t necessarily drive us to lose faith; rather, it made us seek more grounding in faith, simply because the task of soldiering made it clear that we, like all other grunts, needed grounding in something more powerful than ourselves.
—
Within two weeks of our battalion’s arrival at Camp New York, the commander of the 30th Med Brigade, Colonel Don Gagliano, assigned me a position on his medical staff at Camp Virginia, about twenty miles away. His brigade was bound for Baghdad and he wanted a doctor with international experience in rebuilding medical infrastructure. He sent an inquiry to the units marshaled at the kabal camps to see if there might be somebody who fit the requirements. Our battalion commander told me about the need and suggested a meeting. That same day I was driven to Camp Virginia for an interview. The colonel was a physician who had spent a fair portion of his Army career as an eye surgeon but had taken on more administrative duties as a senior officer. As we talked, it was clear that he wanted to match the experience and skills of his officers with specific needs of the mission. He sought out those with expertise that he lacked and seemed at ease with acknowledging the need for other subject matter experts.
“I reviewed your file.” He looked at me over his reading glasses while leaning back in his chair. “Interesting work in Kosovo. Tell me about it.”
“That was with Johns Hopkins. We rebuilt the training infrastructure and started an emergency medicine residency. I was responsible for the teaching and its ongoing development,” I responded.
“I need someone who can work with Iraqi doctors to do the same kinds of things. It would mean less clinical work. You up for that?”
I said I was. The colonel said he would cut orders for my transfer into the 30th Medical Brigade. I would work directly for him in the capacity of what he called a medical integration officer and forward surgeon. I didn’t know all the details of what exactly that meant. Neither did he, but he assured me I would be a welcome addition to his team of doctors.
By the time I arrived back at Camp New York, the staff in our battalion office had already received orders for my transfer. The battalion commander told me to pack my duffels. “You leave tomorrow morning. It will be a good opportunity for you,” he said. I wasn’t sure. The exact nature of the mission wasn’t clear, but it sounded certain to include heavy doses of work with Iraqi government officials and U.S. Army leadership. I had expected to work with Gibbons and Brown in a trauma center somewhere in Iraq, treating the wounded and arranging medevacs. When I told them about the transfer, they both agreed that working with the brigade commander would be great and told me to keep in touch.
Within weeks we all moved north, as promised. The 109th was assigned to support the 101st Airborne Division in the northern regions of Iraq. Gibbons and Brown were two of the battalion medical officers who managed a battalion aid station and performed only sick call duties. They worked missions that went to the task of “maintaining the fighting force.” During the course of their deployments, Major Gibbons did not perform limb-saving orthopedic surgery, and Major Brown did not operate on any soldiers in need of a cardiothoracic surgeon. As they and the other medical officers of the 109th prepared for their work in the 101st Airborne, I moved north to Baghdad with the 30th Med Brigade for a different kind of medical mission. In the coming months I would find out just how radically different and life-changing my missions would be.
From the beginning of my reassignment to the 30th Med Brigade in April, Colonel Gagliano assigned me tasks that focused more on medically related leadership issues than patient care. The colonel’s West Point experience and additional training as an Army Ranger both gave him a rather distinct perspective about military assignments and their performance. There was no mission large or small, typical or atypical, that didn’t get its due consideration when it came across his desk. If a mission required even a sliver of medical expertise for its execution, he assigned it to one of his officers and told them to get it done.
Colonel Gagliano attended daily staff meetings with the Army top brass, General Ricardo Sanchez, commanding general of the Coalition ground forces in Iraq, or the chief of staff, Brigadier General Hahn, or Major General John Gallinetti. When he was unable to attend, I attended for him. It was a bit unnerving at first. The generals had all served in other wars; they had all risen through the ranks in their careers; they all knew soldiering like I knew doctoring. I was a mid-career officer, a National Guard soldier with only summer training and weekend drills to hone my military skills. Despite feeling inadequate, I quickly adapted to the role of providing subject matter expertise to the generals and their staffs.
The operational issues and missions at that level of command involved more strategic decisions than tactical actions and were never purely medical in their scope. The missions often involved working with Iraqi leaders at the highest levels of their government and required coordination with U.S. officials in the Coalition Provisional Authority. Sometimes the missions focused on high-value targets or personnel. To a larger degree than I found comfortable, the work that Colonel Gagliano did and the tasks he delegated to me required attention to political forces in play. I hated politics. It had no place in medicine, but as I would learn through my assignments, every task at that strategic and complex level of war seemed to have a political undercurrent.
—
One of those complex missions surfaced in late July. It started on Tuesday, July 22, 2003. Soldiers from the 101st Airborne and U.S. Special Forces attacked a house in Mosul, acting on a tip given to Coalition authorities by an Iraqi informant. According to the informant, the number two and number three targets on the U.S. list of the fifty-two most wanted of Saddam’s regime were hiding there. The military used a deck of cards to prioritize high-value targets in Iraq. They dubbed Saddam Hussein as the ace of spades. Uday Hussein drew the ace of hearts and his brother, Qusay Hussein, was named the ace of clubs. The reward for information leading to the capture or death of Uday or Qusay was $15 million each.
In a mission to find, kill, or capture Uday and Qusay, U.S. forces engaged in a lengthy gun battle and a missile attack on the targets’ hideaway. Soldiers finally entered the Mosul residence after hours of fighting. They found bodies presumed to be the Hussein brothers, a teenage son of Qusay, and an unnam
ed bodyguard. Once recovered, the remains were flown to a secure location in Baghdad. When I heard of their deaths, I responded like other officers, with a blend of celebration and relief. In a sidebar discussion in the operations center, I remarked to one of the aviation staff, “We finally got the bastards.”
On the day of the attack, General Hahn called me into his office and said he had an important mission for me. “You know by now that Uday and Qusay Hussein were killed in Mosul. I need you to make a positive forensic identification and certify their death certificates. You have a meeting with Ambassadors Kennedy and McManaway. Drop everything else. This is of the highest priority.”
The ambassadors were the senior leadership of the Coalition Provisional Authority (CPA) and answered directly to L. Paul Bremer, head of CPA. My first thoughts were panic. Those were immediately replaced with dread, not because I feared meeting with the leadership of CPA, but because I knew virtually nothing about forensics. Nothing. I had been trained to keep patients from the hands of pathologists. Now I was being asked to perform a forensic task and I felt out of touch with the mission and with the specialty. I couldn’t pretend to offer advice on something I knew nothing about.
“That’s not my specialty, sir,” I responded cautiously.
General Hahn’s answer was direct. “Doc, you’re the medical officer on the staff. This is your mission. Keep Colonel Gagliano in the loop. Let me know what you need for the task.”
Whenever General Hahn spoke to officers about critical missions, he shortened his sentences and put the emphasis on action. He always reminded officers that they worked at the pointed end of the spear. When he was in that mode of communication, there was little room for discussion. I hesitated to question the mission and thought it might be best to snap him a quick salute and simply get on with the task, yet I needed to make him aware that nobody in theater was actually qualified to do an autopsy.
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