Crossings

by Jon Kerstetter

  I performed all the firing drills with gusto, mentally and physically psyched up by the “kill or be killed” mantra. But after the drills were finished and I was back in the barracks thinking about my day, I sensed the abrading of one set of skills against the other: doctor skills versus soldier skills, healing versus killing skills. Yet I didn’t think of the polar differences as an unsolvable conundrum. Killing was not optional, and I had no ethical issues about killing an enemy who attacked me or my patients. I fully recognized the need to master both sets of skills. Being a combat doctor required it. But emotionally the meaning of the word “kill” carried with it all the tangible weight and moral implications of doctors training to become killers in reserve, as if killing were but another medical instrument in a repertoire of skills designed to save lives. I reasoned that in one way killing did save lives, so, ultimately, knowing how to work a weapon was as useful as knowing how to work a scalpel or a field radio.

  —

  In so many ways, combat medicine mirrored the speed and risk of close-quarters combat. Wounds hemorrhaged or re-hemorrhaged without warning, abruptly turning a stable situation into a critical one that threatened patients’ lives as surely as a bullet. Bacteria embedded in fractures and shrapnel wounds pushed patients toward septic shock. Brains swelled from blunt trauma or ballistic trauma. The swelling could make a soldier brain-dead or just dead—period. Doctors learned to react to those sudden turns as if they were shooting at pop-up targets on the range. They shifted instantaneously from one critical scenario to another, from one kind of wound to another, from one patient to several patients simultaneously, all the while focusing on the target of keeping patients alive. Interventions were rapid-fire. Quick, invasive procedures became routine. Treatment of casualties looked more like a tactical assault rather than medical intervention. Trauma resuscitations created their own violence of action, their own entry and exit wounds.

  During midsummer 2003, my team and I recovered a patient from a missile attack. He had shrapnel wounds to his chest, arms, face, and head. A large segment of his frontal and temporal skull bones penetrated his brain. It looked like a brick or a pipe had struck him on the front and side of his head. Something had sliced off the right side of his face and his entire nose and upper lip. I swept pieces of tissue and teeth and blood from his mouth with my finger. The movement was swift and forceful, and the patient responded in pain. Normally, I would have sedated him, but I couldn’t wait because he was choking on his own blood. I got a breathing tube into his trachea and attached it to an oxygen supply; then we loaded him in our ambulance and headed to the combat support hospital across the Tigris River. Surgeons worked on him for hours: chest, arms, face, and brain. I saw him in the ICU later in the evening. I wondered if he would survive the next several days. He did survive.

  I loved the speed and electric feeling of emergency and combat medicine. Something in my personality or my genetic makeup seemed to align itself with the critical demands and the imminent danger of medical emergencies. They provided a sense of excitement that fulfilled a base craving in me—the need for danger and thrill and risk. Simply put, war engaged me. I wanted to be part of its raw, savage action. I drew meaning and satisfaction from facing its challenges and had a constant desire to engage. To infantry soldiers, that desire translated into the hunt for an enemy and the blood-rushing engagement of a firefight—into that rare and exclusive thrill of facing and surviving the lethality of war. To military doctors, that translation was as intense, but we didn’t measure it in terms of the number of bullets fired or enemy killed; we measured it by the number of soldiers treated and lives saved, in the excitement of pitting medical skills and clinical speed against the life-threatening nature of combat injuries.

  In the course of my duties, I had continued to work with Dr. Bakr after our collaboration in identifying Saddam Hussein’s sons. We consulted with members of the International Committee of the Red Cross and the Iraqi Red Crescent Society to provide solutions for identifying victims buried in several mass graves in and around Baghdad. As we worked together, we developed a mutual and professional respect for each other’s expertise.

  During July, Dr. Bakr asked for military assistance to transfer unidentified human remains to a remote cemetery. The bodies had been recovered from the streets of Baghdad and were accumulating at the morgue. The institute lacked adequate cold storage and the summer heat accelerated the decay of the remains to the point where the stench of the dead permeated the nearby streets. The situation demanded an immediate public health solution.

  I arranged for an on-site visit and arrived at the institute just after noon—two Humvees and a team of five soldiers. The team secured the vehicles and guarded the forensic building while Dr. Bakr and his staff gave me a tour of the facility so I could witness the problems firsthand. Iraqi looters had ravaged the forensic labs during the early weeks of the war destroying everything: scientific equipment, medical reference books, storage bins, gurneys, and exam tables. They ripped copper wiring from the walls and wood from the floors. The institute had been the Iraqi government’s central facility for forensic pathology. The looters reduced its laboratories to shards of glass and chunks of plaster.

  I asked Dr. Bakr about the unidentified bodies. He led me to an adjacent open courtyard. There, he opened the thick, bolted doors of two walk-in meat lockers and a single refrigeration truck. Stuffed inside were over a hundred rotting Iraqi bodies. Most were young men. What I saw struck me as forcibly as had the carnage in Rwanda. I understood the absolute waste of human life and the inhumanity of war. The bodies lay on racks, uncovered. As I stared at a few bloated faces, a fly from the truck landed on my right cheek. I slapped at it so hard, I left a bruise on my face.

  There was no electricity or gas for the generators used to cool the storage units. I took one shallow breath and the smell of decay choked me. I grew nauseous and edgy, sickened like never before in my medical practice. It wasn’t just the smell that got to me; it was the sight of all those men, those young abandoned men. I felt overwhelmed, out of place. Everything I witnessed seemed to shout directly at me. Look! Here are dead, decaying men. This is part of your war. You’re an Army doctor. Fix this, deal with it, make it better: Heal it. There would be no healing. There was far more to the institute’s issue than the accumulation and decay of bodies. Humanity itself was decaying. The bodies were proof: I was the witness. I was part of the machinery that made it possible.

  I wanted to run from the images and the smells and the institute. I turned to walk away and said I had seen enough, but Dr. Bakr told me there was more. I said curtly that I didn’t need to see anymore. He kept reminding me about the lack of refrigeration and supplies. I demanded we move from the courtyard, insisting we were finished. “I don’t need to see all this shit,” I snapped. “I get it!” I could tell I had stunned him by my demeanor. He looked both hurt and surprised. And when I saw his expression, I felt disappointed in myself and guilty that I had acted so unprofessionally, so unlike a colleague.

  On the walk back to Bakr’s office, he took me on a detour to the autopsy room where he pointed out the horrid work conditions and lack of basic supplies. I pressed him to move to his office.

  “Sir, please,” he said almost plaintively. “Allow me just a few minutes. I must show you our work.”

  He impressed me as bordering on desperation. As I looked at the room before us, I realized if I were him, I would do the same.

  “Okay, Dr. Bakr. A few minutes. Nothing more.”

  He explained that the autopsy room’s air conditioner had needed repairing since the beginning of the war and that the supply of body bags and examination gloves never got refilled. The pathologists and technicians worked in stifling and horrid conditions. Dr. Bakr introduced me to the staff. Two pathologists and six technicians stopped what they were doing and stood attentively. Two overhead fans wobbled slowly, barely moving the stale putrid air of the morgue. The technicians wore black butyl rubber gloves, the kin
d you might see in a factory where workers handled chemicals. A few of them worked barehanded. They all wore gray butcher’s aprons stained with body fluids and traces of blood. Sweat rolled down their foreheads and necks. I asked one of the pathologists how many autopsies they typically performed in a day. He told me four or six, but they could do more.

  “Sir, you can bring generators and supplies?” one of them asked.

  “I don’t know. Maybe,” I responded.

  Dr. Bakr thanked me for the time I spent with the staff and concluded the autopsy tour. As we walked out, we passed a wooden table about the size of a card table. On it were two body parts, an arm with a mangled hand and a partial skull with matted hair still attached. I saw flies crawling in the hair and heard them buzzing as we walked by. I just wanted to get out of that rendition of hell with its morgue and truck and meat lockers and all their unrestrained horror.

  We finished the morgue tour and walked back to his office where his staff had prepared an assortment of fresh-baked cookies, tea, coffee, and Fanta. A gesture of civility in the midst of human depravity. In the hustle to make things just right, one of the staff forgot the ice. Dr. Bakr clapped his hands twice sternly and ordered someone to get it. Outside, the sun’s heat shimmered off roads and buildings. Within five minutes, a bucket of ice arrived and the staff served refreshments on large silver trays with white linen napkins neatly arranged in rows.

  “Doctor, please enjoy,” Dr. Bakr said to me.

  I didn’t know what to say. I had no mental capacity for tea and snacks. I hesitated, then thanked him without expression. Again, I felt guilty that I had talked to him so sternly in the courtyard. He was a colleague just trying to do his job and reach a practical solution to a real problem. I had disrespected his position and authority as the forensic director. But I wanted to finish my assessment and get out. I considered a polite excuse to leave, then thought it would be better to stay and let Dr. Bakr tell me about his plans.

  “I’ll have an orange Fanta, please, with ice,” I said flatly.

  As we discussed possible morgue solutions, it became apparent that the resources needed (ice, electricity, body bags, and disposable supplies) got bogged down in the supply chain or were never given the appropriate priority as a public health requirement. I started to get frustrated and angry, not at Dr. Bakr, but at my own superiors who had assigned me a task that went too far out of my area of expertise. The mission focused primarily on the mechanical aspects of disposing the dead—nothing more. As had been the case with the Hussein assignment, I wanted nothing to do with the dead. I could not help them. I could not fix the stench in the streets or the inhumanity of a meat-locker morgue. But Dr. Bakr had requested medical and forensic assistance from the U.S. Army. I represented that Army. Offering no solution or claiming no ability to help was not an option. I finally told Dr. Bakr that I would request a logistics team to transport the bodies to a temporary cemetery and that we could work together over the coming week to tag and catalogue the bodies. He mentioned the need to refurbish and resupply the institute. Yes, I would also put that need in my report.

  “Thank you, my friend. Thank you. Inshallah,” he said with a smile.

  —

  En route back to CJTF headquarters, my team had to stop at the perimeter checkpoint we called Assassin’s Gate. A lane of four or five military vehicles waited for their security inspection. A dozen or more civilian trucks cluttered a separate lane. The soldiers working the inspection and security detail had to spend extra time searching the trucks and their Iraqi drivers. Weeks before, insurgents had attacked the checkpoint with a truck bomb and small-arms fire. I wanted to get my team cleared without delay and had some terse words with the lieutenant in command. I could tell I still carried the anger I felt at the institute.

  After finally clearing the checkpoint, my driver and I took the main road back to my office. A dusty brown, two-ton truck had been following us. It was non-military with Iraqi markings. I tracked it in my rearview mirror for nearly a mile. The driver was approaching too close, too fast. His truck almost rammed my Humvee as we slowed at an intersection. I hollered at my driver to keep moving, but he misunderstood me and braked instead. The Iraqi truck skidded to a near collision. I jumped out of the Humvee, and advanced toward the driver.

  It took me only seconds to run the short distance. Seconds for the driver to see me charging at him. Less than a dozen feet away, I chambered a round in my pistol and aimed my weapon at his chest. I fingered the edge of the trigger—felt the mechanical tension.

  The driver was so stunned he sat in his truck like a rock—a large, hot desert rock. Over the next three to four minutes, I screamed and cursed and berated him.

  “You piece of shit! Move one inch and I’ll kill you! Hands above your head!”

  I expected him to understand every word of my ranting, to know that he teetered on the edge of his death and that I was the soldier who could push him over. He sat in that truck, that goddamned brown Iraqi truck with its Arabic marking, arms up high and vulnerable. I saw his eyes twitch and dart. He shook and blubbered like a child confronted by an abusive father. He responded to my rants by saying “Yessir, Yessir, Yessir,” to the point that it became almost comical. Some other soldiers had gathered nearby and were watching the confrontation. I could see them in my periphery and hear them laughing in the background. One of them shouted, “Get ’em, sir.” I couldn’t tell if they were laughing at me or the driver. I didn’t laugh. Neither did the man in the truck.

  The driver continued blinking and tears fell down his cheeks. I saw a tremor start in his lips and chin. Another blink followed; then there was a flurry of them, like the kind of blinking people do when fighting back a flood of emotion. To me, each blink released pieces of fear and cast them outward toward me. I had seen that fear before, seen those eyes, that blinking.

  The driver made a move to salute me Iraqi-style, right hand fixed to his forehead, and in the time it took him to move his hand from the top of his head to his right eyebrow, I reacted. My fingertip felt the curve of steel, felt the trigger tension, sensed the pressure. I breathed controlled breaths. All my weapons training came to mind—the necessary speed of assault, the use of overwhelming force and violence of action, and my instructor’s warning to neutralize threats quickly and completely.

  —

  A blink of a human eye takes three to four tenths of a second. A soldier’s reaction time to a threat should take about the same time. It’s a reflex, threat memory, trigger memory. It requires no thinking, only a reaction—the pull of a trigger. A bullet fired from a stock 9mm pistol can travel ten yards in approximately seventeen to twenty thousandths of a second—about twenty times faster than a blink. The speed and mass of a weapon’s projectile can produce enough ballistic energy to penetrate a target like a ten-pound sledgehammer crashing through an ornamental stained-glass window. Depending on whether that projectile is spinning on its central axis or tumbling end-over-end when it hits—whether the penetrated target is skin or bone or brain, a chest or a skull or an abdomen—the resulting injury pattern may be punctate or gaping, stellate or torn, with or without secondary cavitation or shearing effects. The shape and size of every ballistic injury is different, and it’s all determined within the span of a blink.

  In the heat of a life-threatening crisis, people often see their lives flash before their eyes. In the heat of that confrontation, I had flashes too, but they didn’t replay the past, they played the future. One flash showed a dead Iraqi driver by the side of his truck, me standing over him, weapon in hand. In another flash I saw a truck bomber who might have hidden explosives under his seat or behind a door panel. He may have been collecting intelligence to use later for plotting an attack. Those flashes burst forth as if set off by a trigger. They appeared and disappeared, mixed in with glimpses of the driver. Details that I had not seen at first caught my attention. The driver’s-side fender was missing. The truck was more greenish-brown than brown. The driver was a boy with
dark curly hair and a faint mustache, a boy no older than my own sons back home in Iowa, a boy who looked just like my youngest son. Both of them had those youthful troublemaker eyes—eyes that dared me or defied me. Rambunctious eyes. I locked on the driver’s eyes. A memory of my son flashed on the scene like a double exposure in a black-and-white photograph.

  I remembered my son with his troublemaker’s eyes as he sat in our kitchen in Iowa while I berated him for being off target in his high school grades. I screamed relentlessly to make a point. The point being how to survive in a world so demanding. He trembled and broke at my bellowed threats, and as he did, I suddenly heard my own terrible and unrestrained voice, as if it were a shockwave from a bomb. My son blinked back tears, but then they fell. At first just a few, and then a flow, then a whole quivering face full of them—and his voice broke like glass hitting cement. I could see his fear and pain as it fractured his silence, maybe even his spirit. Then a distance welled up between us and I walked away, sad and powerless.

  —

  That memory of my son contained its own kind of non-ballistic force, perhaps reason or love or civility. Whatever it was, however it worked, it made me hesitate just long enough to break my attention and halt a reaction. And in that moment of hesitation, I recalled how the confrontation with my son resolved to no good end and how it left me full of regret. I started to think about the impact of pulling a trigger. What good end would it serve? Did the driver, the boy, even understand that he was a threat? As I reasoned with myself, I felt more like a father and less like a soldier. I felt suspended above the war as if looking down at myself and the Iraqi boy and my son. I saw their blinking eyes, their tears, and their shaking. The tremors of one became the tremors of the other. And then I saw it with clarity; both boys were wild, unthinking teenagers who didn’t know shit about fighting a war or give a crap about encountering a soldier lost in anger over a snafued mission and a hundred dead Iraqis rotting in a truck far across the city of Baghdad. They weren’t the threat; I was the threat.