The airport fire control squad had contained the fires and secured the perimeter before we arrived. In the rush to control the crash site, airport security squads had removed the bodies of the two aviators in the Apache and put them in body bags. They also transported nine injured soldiers from the Black Hawk to the Army hospital at the airfield.
I needed to get to the hospital to interview the survivors and attend to their injuries. One of the airport security officers drove me. I checked in with the hospital commander and he took us to the hospital wing holding our wounded soldiers. They had all sustained noncritical burns and cuts, and had been treated by the ER staff of the hospital. I briefly examined each one and tried to reassure them they would be fine. They all knew about the fatalities and lay in their beds in various states of shock. Most of them were in their twenties, the same age as Lieutenant Michaels. And the crash shook them mentally and physically. Several of them sat on the edges of their beds staring in disbelief. Their physical wounds were minor; their emotional wounds deep. They had been as good as dead, crashing in their helicopter, and they knew it. One of them told me he felt a thud and heard the shearing of metal; then they went down. They all thought they might get trapped and burned alive. One of the crew chiefs told me how he got hung up in his harness and couldn’t escape. His struggling turned to panic. The more he fought to free himself, the more his harness snared him. He figured he was going to die in an explosion, so he finally sat back in his seat, took some deep breaths, and prayed, “God, take me home.” As he relaxed his body, the harness loosened and he managed to free himself and run from the crash. Seconds after, the helicopter exploded. As he spoke to me, his hands trembled.
I asked the hospital commander about the dead and he said they were outside in the back of the hospital, waiting for mortuary affairs to pick them up. There was no temporary morgue. I found the bodies outside the back door in body bags resting on litter stands, the Dumpsters not too far away. I felt a wave of anger that the hospital staff put them there near the refuse, but I decided to choke it back because I saw how it would make things worse for our survivors and me. I needed a sense of calm, not anger.
I had learned the identities of those killed by the process of elimination and from the information on the flight plans, but I had not seen their remains. I asked the commander if I could cross-check the mission assignments and flight logs to make the identifications, then I could sign death certificates. But he wanted me to get positive identification, which could not be done by simply cross-checking the flight logs. “We need physical confirmation,” he ordered.
“Yes, sir” was all I said in reply. I said it professionally, respectfully, and dutifully, but I also said it with dread.
I stalled the exam for maybe ten minutes, then finally approached the litter stands where the body bags rested. I could smell the residuals of smoke that clung to the fabric. I saw the large zippers of each bag and the way the raindrops mixed with soot and made tiny rivulets that ran down the sides of the zippers. I looked away—first at the sky, then at the nearby Dumpsters, then finally at the bags. The drizzle of rain was intermittent and cold.
—
I began my exam with a full-length pull of the zippers. I pinched the large tab between my thumb and index finger, grasped it firmly, and made one long pull. That was the toughest part for me. The opening triggered a wild cascade of emotions and fear. I could feel my heart beating faster; I felt a choke in my neck. I started anticipating the broken pieces I would see. As I pulled, the zipper teeth made a metallic voop that changed pitch along the length of the bag. The bags opened slightly and I had to pull the edges apart to get a better view. At first, it seemed like I saw nothing—at least, nothing that actually registered. Then in the same way that the crash site had stunned me, the broken bodies stunned me. It was like a violent rupture of all that had made sense in my life. I lost all reference to everything I had mastered as a physician. I was not a physician, not even a soldier, only a man confronted with things that even God might turn from seeing. I gasped once, hesitated, then forced myself to observe each fragment. I couldn’t immediately comprehend what I saw. (Even when I finished the exam and closed the zippers, I wasn’t sure of what I had seen.) I surveyed all the body parts, then returned to each part separately, then to the parts of parts. I wanted to rush the exam, but knew if I did, I would have accomplished nothing, so I slowed myself down and took small, shallow breaths. I moved my hands and fingers deliberately and cautiously. The truth was I couldn’t move fast. I felt caught in one of those nightmares where something evil chases you but you can only run in slow motion. The nightmare surrounded me. There was no escape. In the identifications for the Canal Hotel bombing where the task focused more on forensics, I was able to give myself at least a modicum of escape with my clinical distance and objectivity, but in this case, that distance was lost the moment I grabbed the zipper and pulled. Knowing the dead brought me too close emotionally, and as I proceeded with the exam, their personalities began to emerge from the memories I had of them. In any other professional setting, I would have excused myself from the case. That was not an option for me. As their flight surgeon, I had carried some responsibility for keeping them alive during their tour, and now that they were dead, I carried the full responsibility for their proper identification.
I looked away several times, then refocused on the exam. I ran my fingers down the inside edges of the body bags and touched the fragments of bodies. A wet dusting of soot covered the backs of my hands. Melted body fat collected in beads and stuck to the fabric of the human remains pouch. I saw patches of skin, their edges curled like the peeled edges of paint sloughed from the walls of a burning house. There were remnants of charred muscles. Bones protruded through limbs; their shafts looked like splintered sticks of wood. The legs of one body were partially denuded. In the other body, a broken femur jabbed the sides of the bag. The burned-away leather of a boot revealed blackened nubs of toes. One foot was missing. Another one faced backward, attached to an ankle by a string of tendon. Blackened ribs outlined the thorax, which vaguely approximated the shape of a person. I couldn’t immediately discern the torn stump of a neck. I carefully touched its edges: nothing came to mind. I saw no tongue—no mouth—no face.
I stopped. I sensed I had been drifting. I saw and felt nothing in particular, only the vague, amorphous shapes that lay in a bag of vinyl. I lacked a firm sense of clinical findings. I looked away, then back at the remains inside the bags. My eyes jumped from one piece of human remains to another in no particular order—because there was no particular order. My hands started moving slowly in the air, retracing where they had been. I talked to myself. Slow down. Use your training. Make your observations from what you see. You’re a flight surgeon. Make yourself do this.
I began again with my mind fixed on the protocol of a military aircraft accident investigation. When I was done, I wrote notes on a pad.
2 Dec 2004, Time 2345
POST-MORTEM EXAM.
Two human remains pouches are tagged and labeled; one set marked as A, the other as B.
Portions of limbs are missing. Traumatic disarticulation of the left arm of A. Right hand of B is missing. Left foot of B is rotated 180 degrees.
Widespread burn damage and traumatic evisceration is noted.
Head of A is unavailable for examination secondary to decapitation. Head of B demonstrates a partial decapitation. The brain is absent the skull.
Remains are unidentifiable. DNA tests required for definitive I.D.
An intact aviator watch remains in place on the left wrist of A.
Exam concluded. Nothing follows.
The words “nothing follows” got to me. I stared off into the night, into a dark fragment of time. I looked back at the remnants of bodies. The face of a watch told me a soldier’s identity. I wrote two names on tags and pulled two zippers closed. I heard their nubbed, metallic, closing sounds.
—
A day later, when the nine injure
d soldiers were flown back to Key West, I interviewed them all at length and signed an aviation medical form grounding the crew from flight duties until they were well enough to fly again. They didn’t like it and I didn’t like it, but the regs demanded it. Within a week I could sign an up slip after an abbreviated flight physical and they would be flying again, back to a busy war. I thought about things that would follow us in the wake of that crash, in the life-defining moments of war: some soldiers would go home with ugly physical scars or deep emotional wounds, a few more might not go home at all, and most would be followed by the blessing and curse of surviving it all. As for me, I would carry the memories of a flight surgeon trying to bring healing to soldiers, whenever and wherever they needed me most.
One night the first week of January 2006, during my third tour, I heard a warning signal from the base medical facility while walking from the library back to my quarters. It was an alert for an incoming medevac. I was alone on an open patch of dirt about a half mile from the hospital and could see the helicopter on approach to the landing pad. I thought we were receiving overflow from a nearby hospital in southern Iraq, so I ran toward the hospital. Udairi, despite all the advantages and roads of a fixed military facility, still had large areas of raw desert ground with holes and rocks and semi-buried remnants of steel rebar. Footpaths led from one major building to another, but many soldiers took direct shortcuts over the sand and dirt. When I heard the alert, I took a shortcut running without caution, reminiscent of the time I ran toward the FARP at Mosul. I could feel my boots give way just enough to throw me off. My feet and legs flexed and tightened to keep my balance. I should have used a pathway, walked instead of run, should have used practiced judgment instead of hurried judgment. But I was caught up in the moment, in the specter of a medical emergency.
I had run probably fifty yards when my right foot gave way as it hit the sand full stride. I heard a snap. I felt a lightning bolt of pain. My running momentum launched me through the air. In Army training, instructors taught me to bring my arms to my chest when falling and to roll with the impact. I had practiced falling—mastered the art of hitting the ground unscathed. None of that seemed to matter at Udairi. A single thought flashed as I flew through the air: This is going to hurt. I hit the ground with my arms outstretched and flailing. My left shoulder dislocated on impact and my right ankle either dislocated or broke. And there was pain, the star-seeing, breath-taking kind of pain that floods your body at the breaking of a bone or the tearing of a joint.
I lay on the ground for probably five minutes—enough time to catch my breath and wriggle to a sitting position. I cussed at myself, checked my ankle. No protruding bones. Perhaps not broken. I could not move my arm; when I wiggled my fingers and flexed my wrist, the pain in my shoulder made me nauseated. I sat in the dirt for a few minutes more, then decided not to wait for help. I grabbed my left elbow with my right hand, slowly elevated it above my head, took a deep breath, and rotated it laterally outward. Most of the severe pain stopped abruptly when the shoulder popped back into place. I wiped my brow of sweat, got to my feet, and tried to limp toward the hospital. The pain was too much. I just stood in the dirt, wanting to kick myself for being stupid and rushing out of control. The hospital had plenty of doctors and I wasn’t even assigned there. I just wanted to participate in something critical, a venue where I could feel important.
I tried bearing weight on my foot and managed about ten yards in five minutes before I stopped and just said “Dammit.” It occurred to me to sit down, but I thought doing so would minimize the likelihood of soldiers spotting me. So I stood and stared and waited. The stars, the night sky, the hospital and the tents off in the distance, all became surreal fixtures in a picture of waiting. I focused my attention on the pain, then shifted it to the hospital, then to the stars, and then back to my pain, all the while thinking how asinine it had been to run without caution where caution was essential.
A few soldiers and a lieutenant from flight ops finally drove near enough that I could flag them down. They got me into their vehicle and to the hospital. The docs and medics were still busy with the patients in the medevac. I didn’t want to disrupt the staff, so I asked the lieutenant to help me to the bench outside the front door. My pain had softened a bit and I supposed I could have sat there for a while, but if I were offered a pain shot, I might have asked for a megadose.
“Sir, we should probably get you inside so a medic can look you over,” he said.
“I’m fine out here. Just let me sit here until they’re finished with their emergency. I’ll go in when it calms down a bit.”
“Sir, we can’t just leave you out here.” He was bold for a lieutenant, and I liked that about him. “You’re supposed to check in.”
“I’m a doctor. I’ll be fine,” I responded. “You need to get where you were going. I can wait here. If you want, just let the medics know I’m out here, but tell them I’m all right.”
“Okay, sir, but we really should have someone stay with you.”
“Really, I’m fine,” I insisted. “But you’re probably right.”
One of the lieutenant’s men drew the short straw and sat with me on the bench as we waited.
A hospital corpsman came out some twenty minutes later and helped me inside to a gurney. When he removed my boot, my ankle was swollen to twice its normal size and the pain in it and my shoulder was more than I would have allowed a patient to bear without giving them a shot. When the ER doctor evaluated me, she was concerned that I had broken both my ankle and my shoulder. The X-rays showed a displacement of the bones in my ankle and an abnormality in the shoulder. She fitted me with a boot cast and shoulder sling, then gave me a shot for pain.
“I’m going to send you for an orthopedic evaluation at Arifjan tomorrow,” she said. “You need at least a CT or MRI and an orthopod to look at you.”
“I don’t have time to be injured.”
“Nobody does. We’ll make the time,” she responded as if giving me an order.
I stared at her briefly. She stared back with the kind of clinical look that meant she was the doctor and I was the patient, regardless of rank or position. And that was the hardest part of being an injured doctor; I had to allow myself to assume the role of a patient. It was unsettling letting other doctors take control.
The next day my lieutenant and I flew to the naval hospital at Arifjan, Kuwait, where an orthopedic surgeon examined me and ordered an MRI of my shoulder. The MRI showed the cartilage of the glenoid fossa broken into three pieces and the rotator cuff torn in two different spots. Two ankle bones were fractured and one of the tendons had snapped. He said I would need surgery on both and that they were operations that needed orthopedic subspecialists at Landstuhl or a hospital in the States. He wanted to transfer me to the Air Force CASF (contingency aeromedical staging facility) at Ali Al Salem Air Base in Kuwait for a medical evacuation.
“I can’t leave now,” I said. “I’m the only flight surgeon in theater. My replacement isn’t due for another month.”
“Well, you can’t walk with a busted ankle, and your left arm will keep dislocating without surgery. You could delay a few weeks, but a month is pushing it.” He seemed surprised that I resisted, yet staying in theater with an injury was not without precedent nor atypical. Sometimes it just had to be done.
“There’s just no way I can leave without a replacement. It’s not possible,” I replied.
“Okay, sir,” he agreed reluctantly. “Let’s tape your ankle. You’ll have to wear the rocker boot everywhere, even on missions. We’ll stabilize your shoulder with an immobilizer. You can’t lift and you can’t run.”
The doctor gave my lieutenant an order to make sure I came back if there were any problems. I thanked the surgeon and he filled out a medevac form authorizing my transfer. I had signed the same forms for many other soldiers over the span of three tours in Iraq and done so without realizing the full impact that single medical decision made on soldiers. A medevac order set int
o motion a chain reaction that transformed a soldier into patient—and that special category, “patient,” spoke volumes as to the abilities and future of an otherwise willing and able fighter. Purposeful and necessary in its intent, a medical evacuation always caused an untimely separation of soldiers from their missions and from the unit to which they belonged. It was a dual-edged sword. From my new patient perspective, I felt grateful that medical officers made those decisions, but I also felt the weight of knowing that a surgical medevac was de facto proof that I was vulnerable and hurt.
—
The flight back to Udairi was odd emotionally because for the first time in all my deployments I felt stripped of my rank and influence. Being designated a medevac patient made me dependent on other military doctors and on the medical system. I had always been in a position where others depended on me as a doctor; now circumstances had flipped that dependency, and the implications loomed large. Initially, I tried to pretend my injuries were little more than a nuisance. I was a doctor. I couldn’t be hurt. But my colleagues at Arifjan classified me as a medevac patient, and that changed everything. It deflated my notions of a self-sustaining flight surgeon still capable of performing missions. Despite knowing better, I wanted to minimize the fact that my injuries diminished my usefulness as a soldier.
My shoulder immobilizer proved useless. It slid and flopped around, and mostly I slung it over the back of my chair. While at lunch with the commander and other pilots the day after returning to Udairi, I reached for the salt and my shoulder dislocated again. I let out a yelp. The commander asked if I needed a doctor. “Kinda,” I answered. He knew about my fall and my evaluation at Arifjan, but we hadn’t yet discussed the details. We met after lunch and I told him the plan.
“We’ll do whatever we can to get your replacement here faster,” the commander assured me. “Have your lieutenant help you as much as you need. I didn’t realize it was that serious.”
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