Crossings

by Jon Kerstetter

  When I consider my own crossing, I can see now that it had less to do with the hardening of my combat skills and more to do with hardening of my soul. Before the crossing, I saw the enemy simply as soldiers in different uniforms, duty-bound to wage war, just as I was. After the crossing, I recast them as the contagion of evil and I grabbed onto hate like an extra weapon, a weapon with no end to its destructive power. When I was honest with myself, I had to admit that on several occasions hate drove me and I became the kind of person I never wanted to become. And in that unholy crossing, it was as if I was no longer a doctor and war became the larger part of my life.

  From the Canal Hotel bombing to mid-December, I worked more atypical missions. None were as unusual as the forensic work I did during the Hussein case. I did some work on a mass graves project in conjunction with a team of forensic anthropologists. Our goal was to preserve forensic evidence for potential war crimes tribunals against Saddam Hussein. I worked more clinical cases in a medical aid station I set up in CJTF headquarters. I treated a few heart attacks and arranged for the treatment of many Iraqi citizens harmed by combat. At Abu Ghraib, I did a clinical assessment and recommended the establishment of a field hospital there to accommodate the many detainees.

  My tour was coming to an end in December, and Colonel Gagliano asked me if I would consider extending my tour. I said I would if he absolutely needed me for the mission, but he could see that I was tiring and he decided to let me redeploy home with Major Gibbons. The week before I left, General Gallinetti called me into his office.

  “Doc, you’ve done a great job. You should consider a transfer to the Regular Army.”

  “Yes, sir. I am considering it. I love my work here. It’s been an honor.”

  With that, we traded salutes and I left his office. I wanted to stay, but I needed to go.

  Following days of paperwork for release from the theater, Gibbons and I made our way to Baghdad International Airport and scheduled a flight back home. The route back to the States took us from Baghdad to Fort Bliss, Texas, via Landstuhl, Germany. We flew in an Air Force C-17 Globemaster with about a hundred other soldiers who were all trying to get home for Christmas. If flapping our arms would have helped our aircraft go faster, we would have done it.

  The reverse SRP, equipment turn-in, and medical screenings at Fort Bliss took just a few days. In the medical section, mental health techs gave us a questionnaire with the obvious intent of screening for post-traumatic stress and psychological injuries. Answering the questions in the affirmative meant staying on at Fort Bliss for further psychological evaluation. One of the questions asked about witnessing combat injuries or death. Another asked about exposure to firefights and imminent danger. Did you handle human remains? Did you discharge your weapon? There were the mandatory questions about feelings of self-harm and suicide. Most soldiers operated by an unspoken rule that encouraged them to minimize their responses or outright lie when answering questions related to matters of PTSD. Doing otherwise risked being labeled weak or a nut job incapable of dealing with the normal stressors of combat. Many soldiers thought that label could end a military career. Like many other soldiers, I fudged my answers.

  One of the briefings included guidance about the transition back to civilian life. An Army psychologist delivered a short lecture about how returning soldiers might react to situations at home. We would drive too fast, continue our vigilance for car bombers or snipers, let our suspicions about perceived threats run unchecked, and speak to our family using demands and military jargon. We might jump at sounds that we thought strange or too loud; some would even duck for cover or hit the dirt. For those with highly technical careers like medicine or engineering or aviation, we might find our civilian careers less engaging, even boring, when compared to our typical tasks of deployment.

  When we finished with our reverse SRP, Gibbons and I flew to Fort McCoy, Wisconsin, where we stayed two days while the staff there arranged transportation back to our hometowns. We had come full circle, from training site to demobilization site. We had made the transition from National Guard doctors to active-duty combat physicians and back, and it felt to me like we had done something of great significance, yet it seemed that we had done something so temporary and perhaps even insignificant when viewed in the larger context of our medical profession. That mind-bending kind of reflection floated in and out of a greater awareness that we were home and had survived. And arriving back at Fort McCoy in winter also reminded us of how good it felt to feel the chill of Midwestern weather and, within a matter of hours, to feel the warmth of our homes.

  —

  I went back to work in the emergency room at the Des Moines VA hospital. It had not changed. The staff worked at a pace that I wanted to crank up ten notches. They were professional and kindhearted and they were happy to have me back, but they were not in combat mode, as I still was. The typical patients demanded little of my skills. Gone was the intensity of combat and the wide range of trauma cases and tough decisions. It felt like the challenge of emergency medicine had evaporated. If a case didn’t involve trauma or bleeding, I didn’t consider it a real emergency. I still responded to cardiac emergencies with speed and professional acumen, but even those cases became less challenging than they had been before I deployed. At the end of a typical ER shift, I felt like the whole experience of practicing medicine lacked importance and vitality. I missed the military camaraderie and the invigorating combat tempo that percolated through everything I had done in Iraq, whether clinical or nonclinical. My work became bland and I slid into someone distant and useless as a civilian doctor.

  After three months of trying to cope with the drudgery of the emergency room and the VA hospital, I phoned the medical corps assignments branch at the National Guard Bureau in Washington, D.C. An assignments officer told me about immediate needs for ER docs and flight surgeons for missions in Iraq and Afghanistan. Without hesitation, I volunteered for a second tour to Iraq. The assignment was emergency medicine. Within a week I received orders to report back to Fort Bliss for my second deployment SRP. I told my wife and children that the Army needed me in Iraq because of a doctor shortage. The truth was I needed the Army with all its attendant medical complexity and the stimulation of combat.

  Out of twelve doctors going through SRP at Fort Bliss, I was one of two who had deployed previously. The entire group were reservists or National Guard physicians assigned as replacements for doctors already deployed in theater. Most of them didn’t even know to which unit they would be assigned. I knew I was going back to Iraq as an ER doctor, but nothing more. And not knowing my specific assignment left me with the same gut-churning uncertainty I had felt during my first tour when our battalion arrived at Camp Wolverine and Camp New York.

  The Fort Bliss SRP continued for three weeks before the assignments branch gave our specific deployment orders. I would join a medical group supporting the 30th Heavy Brigade Combat Team at the forward operating base known as FOB Caldwell, named after Army Specialist Nathaniel A. Caldwell from Omaha, Nebraska, who was killed in action in May 2003. FOB Caldwell was also the site of the Kirkush Military Training Base, which trained the new Iraqi Army. The base was located just twenty clicks (about twelve miles) from the Iran-Iraq border. Prior to its occupation by the U.S. Army, the camp had been an abandoned Iraqi military facility that served as an outpost against Iranian incursions into Iraq.

  If cities and bases in Iraq had opposites, Kirkush was the opposite of the geography and missions I had experienced in Baghdad during my first tour. Kirkush and FOB Caldwell had two things: sand and heat. Heat was not unique to Iraq, but the heat at Kirkush felt like it stuck in your lungs when you breathed and boiled your red blood cells. It was so remote from the mainstream Iraqi cities that it was not even connected to the national electrical grid, nor did it have a reliable water supply.

  When I arrived at Caldwell in June 2004, it gave me a different perspective of physicians at war. I had expected nearly the same experience as I had
had during my first tour, but my experience there was quite different. I spent most of my days treating common soldier injuries and illnesses, generally the kind of medical care that I didn’t like because I felt it didn’t challenge me enough. Sunburn and heat illness and even heatstroke predominated. There were too many staff physicians assigned to the camp and too little coordination to use their skills elsewhere. It seemed that we did as much review and training as seeing patients.

  The bright spot at Caldwell was meeting Major Joe Morris, physician assistant and former Marine. We hit it off right away, having a sense of humor and professional demeanor, mid-career aspirations, and a prior deployment in common.

  Joe mocked the Army slogan “An Army of One” relentlessly. As a former Marine, he found it comical. “I’m an army of one,” he would quip. “I have one sock, one shoe that fits, and I can only see one patient a day. Takes more than one to fight a war. Even a hillbilly like me gets that.”

  “I’m putting you in for a transfer to the recruiting command,” I responded.

  “Join now. Get a free desert villa and a combat bonus,” he blurted in his Kentucky accent through his toothy grin.

  Joe and I were older than most of the other medical staff and I was the new “old man” in the unit. Joe had deployed in the months prior to my arrival and had formed a Hillbilly bluegrass band complete with a washtub bass player, a fiddler, and a percussionist who played a comb and spoons. He played the banjo and could talk with a country twang that made soldiers forget they were at war in the deserts of Iraq instead of back home training in the deserts of Texas.

  When Joe and I pulled a shift together, we split our time between clinical cases and training medics. On two occasions while I was at Caldwell, we activated a trauma alert when medics brought a dozen injured soldiers to the hospital after a firefight. Joe and I dug shrapnel out of wounds and stitched lacerations on patients. A surgeon operated on one soldier with an abdominal wound. The other docs treated superficial wounds and fractures.

  The medical commander had assigned Joe the additional duty of monitoring sewage disposal. His job was to keep it safe and in line with regulations. He was the mayor of the shithole, literally.

  “Got some land for sale,” he’d say. “Beachfront property. A developer’s dream.”

  “You’re a natural at managing shit,” I would reply.

  We would laugh and carry on about how this was his real mission in life. During a lull in our hospital shift one day, we came up with a harebrained idea for a scientific paper on the theory of how fecal bulk in large populations determined the movements of primitive societies and even armies. Some of the ideas we got from a spoof academic article, “The Origin of Feces,” in the Journal of Irreproducible Results. We proposed that large populations produce enormous mountains of crap and that, once produced, the fecal mountains forced migrations and wars in a survival effort to find uncontaminated land. It was a nutty way of coping with a bizarre and yet essential assignment; fecal contamination of the water or food supply could decimate an entire battalion.

  —

  During the stretch of three months from July through September 2004, the combat action in our sector in and around Kirkush, though slow and steady, never rose to the same fevered pitch as I had previously experienced in Baghdad. When the pace was slow and the days dragged, I, like other docs, wrestled with boredom and guarded against a critical attitude. Many days I wondered if my assignments were useful and if they counted for anything that helped the cause of wounded soldiers.

  I finished my three-month assignment at Camp Caldwell near the end of September. A few days before I left, Joe and his hillbilly band performed a one-hour show for the entire camp. The show rivaled any show you might see in Nashville. Joe had everybody, including the brigadier general of the brigade, laughing and forgetting that we were at war. I never heard so much hootin’ over country and bluegrass music. The general even gave the band a standing ovation. The next day the USO entertained the camp with a salsa band from Los Angeles and a group of NFL cheerleaders. Joe and I sat in the front row near the makeshift stage in the area behind the hospital, generally acting like crazy college kids shouting and cheering at a homecoming game. He dared me to dance with a cheerleader, so, as the next song began, I got up and started to dance. I held out my hands toward one of the cheerleaders and she hopped down on the plywood dance floor. Soldiers hooted and hollered as we spun and dipped and swayed to the Latin rhythm, she in her cheerleader uniform and me in my Army uniform. At the end of the song, we took a bow and she hugged me. All the soldiers stood and cheered, and it felt like I had danced on behalf of the entire hospital staff, because in a way I had. Every soldier wanted that dance, that single wild dance that made us feel alive and wrapped us in a rhythm having nothing to do with war, yet everything to do with war. When I sat down, Joe slapped me a high-five and laughed. “I knew you’d do it.” He said it was great. It was great.

  —

  I left Camp Caldwell the next day in the early afternoon. I said my final goodbyes to the docs and medics. Joe gave me a small brown rock that he said was a petrified turd he had gathered from the sewage field. I promised to cherish it. He drove me to the Caldwell airfield, where I loaded my duffel bags into a Black Hawk helicopter and flew to LSA (Logistics Support Activity) Anaconda, also known as Balad Air Base, north of Baghdad. From there I caught a later flight on a C-130 to Camp Doha in northern Kuwait. Doha served as the Army’s hub for soldiers deploying and redeploying to and from Iraq. Upon my arrival, I checked in at the demobilization office, where a personnel sergeant assigned me to a waitlist. It would be seven to ten days before I could leave.

  I spent my downtime making calls home and writing letters to my kids. I worked out in the gym two hours each day and followed that by a fifteen-minute soaking in the shower. I would take a loofah brush and scrub my entire body several times as I watched the soapy water swirl into the drain. I imagined my skin sloughing cells saturated with dust and oil and the scent of combat that had accumulated over my time in Iraq. In the dressing room, I noticed the absence of the locker room hoopla and the snapping of towels often displayed by soldiers. Instead, the mood was subdued, not necessarily down or depressed, but unrushed and tranquil, a mood I experienced myself and felt represented a mixture of wisdom and gratitude and luck at having survived a tour of duty when others had not. I recognized the same mood in the soldier who came to the gym the same time as I did every day. He was a senior NCO in an infantry unit stationed about twenty miles from Camp Caldwell and had been in Iraq for nearly a year. He was tall, black, and muscled, with over fifteen years in the Army Reserve. He spoke in a cadence that was not hurried or abrupt, and he moved in the same deliberate, unrushed manner. He told me that during his deployment, he’d seen several of his soldiers injured and one killed in a firefight. He always sat on a locker room bench after his shower and quietly sang a hymn as he dressed, “The Old Rugged Cross” or “Amazing Grace.” Nobody interrupted him. Soldiers came and went. They were quiet and respectful, as if attending some kind of chapel service. As I listened to him, I focused on the words of the second stanza:

  Through many dangers, toils, and snares

  I have already come.

  ’Tis grace that brought me safe thus far

  And grace will lead me home.

  Hearing the words took me back to the toils of my first tour. The singing didn’t pull me down, but instead was uplifting and affirming. It made me thankful that I was safe and on the way home.

  The seventh day at Doha I received an e-mail from a captain at the medical assignments desk at the National Guard Bureau. He wanted to arrange a conference call to discuss my demobilization. That was a bit unusual, since his responsibilities didn’t focus on getting doctors home but rather on getting them to the theater. When I called at the arranged time, the colonel in charge of assignments thanked me for my last tour and then told me I was needed for an additional mission as a flight surgeon in a helicopter attack uni
t. I asked when the tour would begin. The colonel hesitated. “Well, that’s the thing, Doc, it’s an immediate need. You have to turn around from Doha and go back to Iraq. The aviation unit is en route.”

  I paused long enough to make the silence uncomfortable. There was a combat superstition that said you didn’t volunteer for missions when close to going home because it would likely be the mission that sent you back in a box. You were supposed to keep your head down and become invisible. I knew superstitions were just that, but I also knew of cases where they came true. I had already told my wife and kids I would be home in a week. What would I tell them about an extended deployment?

  “So, are you asking me if I want to volunteer for the mission?” I asked.

  Then there was a pause on his end. “Well…we don’t have any other options here,” the colonel said. “We’ve run out of time, Doc. There are literally no other flight surgeons available now. We have to assign the mission to you. You’re in place and you have the experience. The orders were cut this morning.”

  I chuckled a bit at that. “So you basically called to give me the good news.”

  “Basically,” said the colonel, returning the chuckle.

  “Okay. Just send the orders and contact information, and give me a few days to talk to my family. I think you owe my wife a letter or a card.”

  I sat for about an hour, thinking about what it meant to return to Iraq, wondering how my wife and kids would react. Mentally and physically, I had been winding down and had set my expectations for a transition home. I was tired and excited to go home, but I had trained for a mission like this and felt a burst of pride at being assigned to do it. While at Caldwell, I felt I hadn’t contributed much in terms of medical leadership. Colonel Gagliano and General Gallinetti had challenged me during my first tour to seek more opportunities for command and staff leadership. Most of the missions they had assigned me stretched my skills in nonclinical and leadership directions. In the week before leaving Caldwell, I had promised myself to be more available for complex missions and leadership positions and to enroll in the command and general staff course for mid-career officers. I just didn’t think the promise would come into play so quickly.