Bad guys or good guys? The combat controller begins setting up his radios to be ready to call in close air support (CAS). But it quickly becomes apparent that the people on the hill aren’t shooting at them. (Later, they figured out that what the locals had done was set up a perimeter between the helicopters and the firefight that was going on.) He tries once more to get information from the barely coherent SF operator. “Are the casualties on litters?”
“Yeah, they’re all on litters,” he responds. With that, the PJs put their litters back on the helicopter, and begin moving down the road to the south.
Then they see the trucks: five, ten, as many as fifteen trucks ranging from tiny Toyota pickups to full-size SUVs. The windows are either shot out or blasted out. Tires are flattened and they’re driving on the rims. Many of them are bristling with RPGs, and people are hanging on to them wherever and however they can. And they are coming up the road toward the PJs.
Are they about to be attacked? Are these hostiles or friendlies? For a second, no one knows. Then Malone takes a cue from the shell-shocked SF troop, who doesn’t appear to be alarmed at the sight of the trucks. “I think about the training and the caliber of people that’re on the ground. He would’ve keyed back up into his war-fighting mode if these people were a threat, and he didn’t.”
Malone asks himself, “Okay, what’re we into now?” And very quickly he answers his own question. “As the trucks roll up, now we start to see every type of blast injury you could ever imagine. So we got our guys huddled together, and say, ‘How are we going to do this? Where’s the Americans?’ ”
And then they see the numbers are growing. There are a lot more than eight people. There are more than twenty. And still they keep coming.
The original game plan had been for the Army doctor on the other helicopter to triage, and the PJs would take it from there. That scheme quickly went on the scrap heap of plans confounded by reality. The American victims of the bombing are on the lead trucks in the convoy, on litters. But since the helicopter had landed a couple of hundred meters off the road on a rock outcropping, the trucks can’t be driven right up to the ramp. So the PJs begin humping the casualties from the road to the helicopter, where the physician, his medic, and the two PJs on that bird begin to care for them. Schultz recalls,
“Some guys were on litters; some weren’t. Some were on blankets, bed pads, whatever they could find to put them on. And we just started carrying, two-man carries to get them on the helicopter.
“The first ones, all in the first vehicles, were all pretty much critical, but they had been treated. They were stable, so there really wasn’t a lot to do.” All the casualties loaded on that helicopter were Americans.
After Schultz’s third carry, he ran back to the helicopter he’d come in on. Since it had landed near the road, the trucks with the remaining casualties had driven right up to it. It’s there that he encountered one of the Special Forces soldiers who had survived the attack apparently unhurt. “I had asked him what happened. He told me he thought they took a two-thousand-pounder, and I said, ‘Take care. Is there anything you need?’ He goes, ‘No.’ I said, ‘There’s a bag of body bags; do you think you’re going to need ’em?’ He goes, ‘Yeah.’ So I shook his hand and grabbed the rest of my gear and began helping with the other casualties.”
Both Schultz and Malone were struck by how shell-shocked everyone was, including the SF guys. Schultz says, “I wouldn’t quite call everybody zombies, but they were kind of in a catatonic state. Most of them were white, their faces were white, and they would do things if you told them to do it, like a tunnel vision kind of thing. I’d seen most of these people before because they’d come through Jacobabad. I recognized them, talked to quite a few of them. It was a surprise for me to see their condition. It’s things you’ve heard about before in books.”
Both PJs agree that there were SF troops around who still had their wits about them and were focused. The others were relegated to carrying litters under the watchful eye of the pararescuemen. The emotional damage done by the bomb was brought home when they saw one of the Green Berets standing underneath the tail rotor of the MH-53 helicopter. The rotor is only six feet, six inches above the ground, and he was standing on an incline. Schultz says, “An inch either way and his head would’ve been cut off.”
The Afghan victims hadn’t been triaged as well as the Americans had been. Malone instantly could see that the sheer number of severe casualties had overwhelmed the medic with the ground unit. “He’s got twenty-plus people on the ground injured, and some pretty seriously injured; then you’ve got a mess on your hands. I mean, no litters. They’re on blankets and sleeping bags and whatever. So we bring ’em up to our helicopter.”
The plan is to sort out the casualties, loading from forward to aft, least critical to most critical. That way, when they get to their transload point, the most seriously injured will be first off the helicopter, and first onto the waiting HC-130 with its high-tech casualty team and airborne operating facility. Five or six trucks filled with casualties are lined up at the ramp. Four Americans are among them. One goes all the way forward, two are on litters that are suspended on stanchions on the left side of the bird, and one critical case is put on the floor.
Then they begin loading the Afghans, many of whom are critical and have not been treated; some are still bleeding from their wounds. There are no litters left for these patients, so they are put on the floor, on blankets where they are available. It reaches the point where there is no method to the process; it is just a matter of cramming people in, some sitting up, some lying down. Then the walking wounded are moved all the way forward in the aircraft. Schultz recalls, “I think we took four or five of them, and they just had shrapnel wounds and head lacerations. And we just kept loading, and we crammed—we couldn’t have put anybody else on the aircraft. There was one person that they wanted to load but we couldn’t. There just wasn’t any room to put him any place. He would’ve been on top of somebody. And we already had people on top of each other.”
One of the last Toyotas that pulls up to their aircraft is a pickup truck. In it, they are told, is the last American to be evacuated from the site, one of the two who were killed when the bomb hit. Malone says, “When we looked down, he was in a bivvy sack, zipped up, with an American flag pinned on it.” They placed him under the last set of litters hanging in the rear of the helo, which meant that every time the PJs turned around, he was right there, under the Stars and Stripes. Though their training prepares them to deal clinically with blood, gore, and even death, that three-by-five-foot American flag gave them an unexpected and disturbing jolt. Some soldier had deliberately carried it with him into battle, and now had used it to honor his buddy. It meant something. For the next couple of hours the flag would rarely be out of their sight. Even a glimpse out of the corner of an eye was enough to stir a conscious thought. It was a fellow American soldier in that bivvy sack, under that flag. Did he have a wife? Kids? How old was he? Who would tell his parents? How would they deal with it? And ultimately, That could be me.
The thoughts process quickly. There’s no time to stop and think, to dwell on the personal tragedy, to utter a prayer, even to recognize, much less respond to, the icy blade of fear that cuts through your gut with laserlike speed, and then is gone. Because the war hasn’t gone away.
In fact, it’s gotten louder. While it should be apparent that the entire cargo compartment of the eighty-eight-foot-long helicopter is filled beyond capacity, Afghans who were not injured are trying to force themselves onto the aircraft. The PJs presume they’re relatives of the wounded, or elders from the village. But the harsh reality is there is no room for them, so amidst what Malone describes as a lot of “hooting, hollering and yelling” over the roar of the engines, they had to take four or five minutes to get them off. It was a nervous moment, acknowledges the senior PJ, who was thankful that with all the weapons available in the nearby trucks, there was no serious trouble. “That’s all we neede
d was a firefight in the back of the helicopter, while we’re just trying to get off the ground to help people.”
Ryan Schultz was the last person to jump onto the ramp as the helicopter lifted off. The fact of the matter was, he never really did make it inside the 53. “I’m literally standing bent over the whole time with my ass sticking out the back of the helicopter, trying to move around the gunner and treat patients.” All he had time to do before beginning to work on patients was shed his med ruck; the body armor stayed on. It was his second skin.
In the back of Schultz’s mind is the knowledge that they’re going to have to refuel in order to make it back to Camp Rhino, the only secure location for Americans fighting in the southern half of Afghanistan. Listening on the intercom as he works on his patients, he hears the details. “We were critical on gas when we took off, ’cause we’d dumped fuel to get in to make sure we could take out as many as we could. And as we were coming out, we hit the west side of Kandahar, and we had to refuel quickly. We were critical gas. We didn’t have enough to get to anywhere. If we couldn’t get gas, we were going to have to land.”
Did it bother him? No.
“That’s the pilots’ issue. My job is working in the back. I’m aware of it. I mean I hear it, but I don’t hear it, if you know what I mean.”
Pat Malone was not nearly as blasé about having to refuel. The issue wasn’t the refueling itself, a process PJs are notorious for disliking. It was where they had to refuel. “It’s never done under five hundred feet,” Malone says. “But if we were at two hundred feet, we’d be lucky. We were down low. We were afraid we were going to get lit up, and rightly so. We know, map-wise, where we are, but you don’t know who else is around there. We’re crossing Highway 1, which is the major communications line; we’ve got patients with varying degrees of blast injuries; they can’t go above altitude, so it’s like, ‘Hey, this is the place to be, in the dirt.’ ”
Even when a sidelong glance off the ramp revealed the shadow of their helicopter snuggled up to the 130 refueler rippling across the terrain at 115 miles an hour, Ryan Schultz insists he didn’t have time to worry about it. “Guys were throwing up all over the back of the helicopter. The two guys on the ramp were bleeding out. One guy had half his hand blown off, most of his arm blown off here on his right side. The other guy was bleeding out his leg. And I’m just going back and forth between these two guys, treating the injuries as I find them.
“The first guy I bandage up. I do a sweep and find that he’s bleeding out his hand, and I bandaged up his hand real quick. Then I roll him over and find that most of his arm’s blown off. Then I just went ahead and amputated the rest of it with a scissors.” Then he rolled the patient over and stuffed the arm underneath him.
The decision to take off the man’s arm is made quickly and clinically. “There was not much left. He had basically mid-forearm down, and then a lot of mush, and then from about mid-humerus up was viable.”
All the while Schultz is working, his patient is rolling around and is in shock. Schultz administers no morphine, no painkillers. “There wasn’t time. Pain never killed anybody. So if he’s in pain, there’s not much I can do about it, plus it’s been four or so hours; he’s still bleeding, which is a greater concern to me.”
Schultz’s attitude toward the administration of painkillers should not be taken to mean he’s uncaring or unfeeling; it would be very difficult to be uncaring about your fellow human being and sign up for a job that posits “That Others May Live” as its credo. He’s applying his training, evaluating patients, considering the circumstances, and doing what he can do to preserve life. Does he consider getting on the radio to consult with a physician at one of the Forward Surgical Teams (FST) before he amputates? Not even for a second. The decision is his to make, and his training and experience dictate that the way to save the man’s life, to stop the bleeding that will surely kill him, is to remove the arm. “A doctor may see it differently, ’cause a doctor is a higher medical authority. But they’re not in the back of the helicopter, and they shouldn’t be.”
Before he turns to the patient with the bleeding leg, he does start an IV in the amputee’s good arm. With Pat Malone holding the patient down, Schultz recalls, it was probably the best stick he’s ever gotten: an off angle, reaching across the man’s body, with the patient moving around. In this situation, satisfaction comes in small victories.
Finished for the moment with his first patient, he moves around the gunner—who has been watching the action wide-eyed—to the other patient on the ramp. This casualty has a bleeder out his leg, which Schultz initially dealt with by putting on a tourniquet. Just as he is starting to bandage the wound, his first patient unexpectedly sits up. Schultz tethered himself to a ring on the right side of the helo, but the patients weren’t restrained. A sudden lurch of the helicopter and either or both of them could be tossed from the ramp. Disaster is only inches away.
He jumps back, steps around the gunner, and grabs the patient, laying him back down. Then he calls for a cargo strap, runs it across the two patients, and ties it off on both sides of the ramp. Finally he unhooks his tether from the ring and attachs it to the cargo strap, allowing him to move back and forth across the blood-slicked ramp in relative safety. That’s when the amputee catches his eye.
“He looked at me and he started pointing to his mouth. And a guy threw me a jug of water, and I gave him a little sip, just to get his mouth wet, and that was it. He was the most critical on the plane. He looked bad. He was in shock. I didn’t know how much blood he had lost. I didn’t know what was going on internally. ’Cause he obviously took the brunt of the bomb.”
Minutes later he looks back at this patient and sees that his eyes have glazed over. He’s died of his injuries. All Schultz can do is move on with his work. He and Malone have done their best in an impossible situation. There’s nothing to dwell on.
Looking into the helo, he can see the other casualties rolling around—“writhing” is how he describes it. “But not chaotic screams. Remember, these are warriors, too. They’re soldiers.” He can also see his PJ team at work. Pat Malone is moving from the middle of the helicopter, where he’s been helping Ryan Hall treat the American soldier who’d taken a blast to his upper body and had an open chest wound, back to the ramp. Schultz, seeing that Hall has apparently done all he can for the GI, tells him to move to the front of the aircraft and help Ken Curtis with a number of Afghans whose wounds need tending. And in the middle of it all is Jason Brooks, their combat controller, acting as the pivot man, taking supplies from the medical accessory kit and feeding them to whichever of the four pararescuemen on the team need them.
Nearly an hour after taking off, they come in for a landing at Camp Rhino, a desolate place with a dirt runway that is mid-shin-deep in nothing but fine dust. Malone recalls, “When we hit that, the place went black. Right up through the cabin, right to the front, out the cockpit windows. And the patients are lying in this mess. There’s nothing you can do but try and get ’em out of the environment as quickly as you can.”
“It was the most desolate place you’d ever think of,” concurs Schultz. “It was horrible. It was the dustiest landing going into that place that I’ve ever had. I put a muslin bandage over my face, and I had goggles on, but the patients . . . The only emotion I felt was feeling sorry for them as we went in to land, ’cause the whole cabin filled up with dust. You couldn’t even see two feet in front of you and it took probably two minutes for the dust to clear out.”
Even though the Special Tactics Squadron guys who were running the field were expecting two helicopters filled with casualties, there was still a measure of chaos when they landed. Navy SEALs who had responsibility for perimeter security managed to have litters lined up for the PJs, and then helped them transfer the patients to a staging area. From there they were loaded onto a waiting J-MAU Herc, a Joint Medical Augmentation Unit HC- 130, staffed with an emergency surgery team ready to work on those casualties who might not ma
ke it to the nearest hospital in time.
With their patients handed off to a higher level of medical care, the PJs were finally able to let down, physically and emotionally. Schultz remembers them just sitting down, exhausted. Before they cleaned up, they all just went into the helicopter and sat down and ate an MRE amid all the blood and the bandages and alongside their comrade in arms in the bivvy sack covered with the American flag.
“And then after we ate, that’s when we cleaned up the back of the helicopter as best we could,” says Schultz. “Grabbed a big body bag and threw all the stuff in there, the bloody blankets. We were loading up, picking up a blanket, and the arm fell out.”
Is it comedy? Tragedy? Or just another demonstration that even in war, they’re opposite sides of the same coin? If you haven’t been there, it might be hard to laugh at the situation. But those who read this, who have been there, will understand why Pat Malone was able to say what he did to Ryan Schultz about five minutes before their helicopter was to land at Rhino. The forty-year-old senior master sergeant and the thirty-one-year-old tech sergeant were standing on the open ramp thinking about what they’d been doing together for the past several hours, and probably for the past few years. Malone looked at his protégé. He knew the younger man had to be feeling the effects of losing a patient he’d done his best to save. Console him? Hell, no. What he said was, “You’re never stickin’ me with an IV.”
It’s difficult in the midst of this kind of organized chaos for the PJs to step back and see what it is that the training they’ve received has equipped them to deal with. But the four PJs treated eighteen casualties who were brought on board more than four hours after a two-thousand-pound bomb dropped right on top of them. Seventeen of them were delivered alive to a surgical team equipped to give them their best shot at survival. By the time they got back to Jacobabad, they would have been on duty for seventeen hours.
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