Paradise General: Riding the Surge at a Combat Hospital in Iraq

by Dave Hnida

  It seemed like we drove forever. The hospital was located within the confines of cavernous COB Speicher, with the COB standing for “Contingency Operating Base”—the military’s new term for huge, monstrous, and probably-going-to-be-here-forever base. The COB was home of the 82nd Airborne’s and 25th Infantry Division’s main operations, with the 399th combat support hospital a flyspeck, but an important flyspeck, on its periphery. And as the former home of Saddam’s Air Force Academy, there were a few concrete buildings left standing after the intense bombing raids of the war’s first days. And we lucked out; one of those intact structures was to be our barracks. It wasn’t much to look at. Pockmarked by bullet holes and shrapnel, the building was the same dull brown that seemed to be the color of paint the entire country was dipped in.

  To our delight, we were handed new, unopened packages of sheets and pillowcases along with room assignments. To my further delight, I was bunking in what was called the “Love Shack,” the largest room in the building, and the only one making up the third floor. By American standards, the “large” was relative—most of the other guys doubled up in plywood-sided rooms the size of a typical bathroom; mine was the size of three bathrooms. My roommates were my fellow ER doc Mike Barron and surgeon Ian Nunnally. As we walked through the door, our sleep-deprived brains blurrily did the math: three guys plus two beds equals a big problem. Our eyes twitched back and forth, and to each other—seeing who was going to blink first. Jarhead Mike solved the dilemma. Spying a homemade plywood table, Mike plopped his sleeping bag down and was snoring in less than a minute. He slept on that rickety platform every night for the next three months.

  4

  PARADISE GENERAL HOSPITAL

  THE FEW HOURS of sleep I got that night were edgy—

  helicopters zipped through the night skies over Camp Speicher with an unpredictable regularity—each angry whirl of the blades kept me from fading into a much-needed sleep. I was disoriented but knew the hospital was close—and it seemed like every copter was making a drop-off outside my window. They must have had a busy night. All too soon, it would be my face waiting at the end of the line as the birds carried in their bloody cargo.

  I pulled on my uniform and decided to make my way over to what would be my workplace for the next few months. Breakfast was out of the question—acid had eaten a hole in the lining of my stomach and I had a bad case of the jitters. As I opened the door on to the gravel-covered compound, the heat struck like a torch and the explosive rays of the desert sun took my vision away. Jesus, don’t forget to keep water with you all the time. And get some good sunglasses. Several soldiers stared at me as I tentatively staggered across the blinding landscape. To them, I must have looked like a lost sheep searching for the rest of the flock. Must be one of the new doctors, their faces said.

  I swallowed my embarrassment and decided to ask for directions.

  “Morning, how’s it going, guys?”

  “Just fine, sir. Another day in fucking paradise.”

  “Can you tell me where the hospital is?”

  “Just behind those walls, sir.”

  I mumbled a thanks and stared at the huge blast walls less than fifty yards away.

  The short route was covered with gravel—in fact, the whole camp looked to be landscaped with the chunky gray rocks—and even at 7 A.M. the heat radiating off the gravel felt as if it were melting the rubber soles of my boots.

  As I neared the hospital, another group of soldiers came by, snapping salutes as they passed.

  “Morning, sir!”

  I saluted back as I crunched along, “Hi, guys, how’s it going?”

  In unison, they answered, “Just another day in fucking paradise. Thank you, sir.”

  It was a phrase I would hear repeated several times more that morning, as well as every single morning for the rest of my deployment: “Another day in fucking paradise.”

  Bingo! We now had an official name for our new workplace: Paradise General Hospital.

  I wasn’t sure what to expect when I saw Paradise General for the first time. I knew it wasn’t going to look like Johns Hopkins, but I wasn’t ready for a group of shabby tents hidden behind the blast walls. It made the grounds of the 4077th MASH on TV seem like that of a major medical center. Out of the five combat support hospitals in Iraq, all had regular buildings and hard roofs except one. Ours. The bulk of our hospital was made up of a group of huge green tents with an occasional connection to an old building or to some trailers you’d typically see on the back of a semi, all surrounded by ten-foot-high, three-foot-thick blast walls to protect us from the rockets and mortars the insurgents would lob onto our laps. The support staff of more than two hundred had already been in country for a year and gone through three rotations of doctors—we were their fourth and final group—so they probably were elated to see us, even if they didn’t know or trust us.

  It was key I got off on the right foot at my new workplace; instead, I stepped in a verbal pothole and fell flat on my face. As I continued my openmouthed wandering, I realized another soldier was passing as I entered through a break in the blast walls. I spied a colonel’s rank on the cap, which meant I needed to offer a salute and a greeting. Yet this superior officer had a few strands of long hair sticking out of the cap. Was this colonel a he or a she? It was like Vegas in Iraq, with 50—50 odds I’d guess the correct gender. I took a shot and bet on the hair.

  “Morning, ma’am,” I said with a confident air of respect and courtesy.

  The stunned, pissed look told me I had rolled snake eyes.

  A deep masculine voice replied, “Good … mor-ning …

  Ma-jor.”

  Shit!

  He was one of the main bosses of the hospital. And it took less than ten seconds to get on his personal shit list thanks to my blurry-eyed gender confusion. I quickly mumbled an incoherent “Sir” and took off, stumbling past a collection of dusty tents. I had just had my initial encounter with an “administrator”—which in this camp was a four-letter word, especially one small group in particular, whose specialty was manufacturing misery for the medical staff.

  The sign on the door of the ER said, “STOP! AUTHORIZED PERSONNEL ONLY!” in oversized block letters. Was I now authorized? Or did I have to wait until I went through my orientation and became official before entering the no-man’s-land of the emergency room? I took a deep breath, rolled the dice again, and pushed through the doors. It was like stepping from a serene forest into a multicar pileup. Blood, screaming, and a kaleidoscope of chaos.

  “Can I help you, sir?”

  Help me?

  “Ah, well, I’m one of the new docs.”

  “Welcome, sir, we heard you folks got in last night. Get you a cup of coffee?”

  I snuck a peek at the sergeant’s nametag—“Courage.” He was the NCOIC of the ER—the noncommissioned officer in charge. And I could use a dose of his name right now. He sat calmly at a desk despite the yelling and screaming that peeled the paint off the walls. A bloody stump of an arm hung off one stretcher, while on the next one over a Niagara of blood poured onto the floor as a group of medics struggled to cinch tight a tourniquet around where a leg used to be. The other leg pointed oddly at a right angle away from the body at the knee.

  “Sure, coffee would be great—a beer would be better.”

  In a thick New England accent he said, “I know what you mean, sir, but all we’ve got is the black gasoline—and come to think of it, foo-foo at that.”

  Foo-foo?

  I filled an empty cup and wandered down the line of stretchers toward the action—watching as IV lines were stuck blindly into the deep veins of the neck and groin and morphine injected to quiet the screams of men whose bodies had been assaulted by shrapnel. Blood flowed on the floor in a small stream, collecting in grooves and cracks of the crusty linoleum. Fresh blood has a unique smell—tangy with a bitter sweetness—and this morning it penetrated and attached itself to the deepest lining of my nose. I sipped at the coffee, hoping to w
ash away the putrid fragrance, and wound up spitting out a small mouthful in surprise. It was Almond Spice—one of the many flavors of “foo-foo” coffees favored by a crew who struggled for some sense of sensual calm in the face of daily carnage. I staggered out of the overcrowded room, fighting the rising bile in the back of my throat as I realized in a few days I’d be on the game field, not watching from the bleachers.

  Before we were allowed any hands-on work, we all had to go through orientation—starting with a day-long PowerPoint presentation and a series of briefings on the rules of the camp, rules of the hospital, lab procedures, blood protocols, schedule of religious services, all piled onto an overflowing plate of topics no one paid attention to or remembered. But one thing did stand out: it seemed almost every female who gave a lecture spent a lot of time staring at the well-built body of the gently snoring Bernard Harrison as they spoke.

  The briefings were held in a musty dark gray tent with a reluctant air conditioner, which combined with bewildered body clocks left us looking like a bunch of bobblehead dolls, lolling off to sleep, then jerking back to consciousness. Tumbling in late came Billy Stanton, who won the prize for the first to get onto the playing field. Last night, the copters I heard were ferrying wounded, and Bill never went to bed; staying up and helping the soon-to-depart overworked orthopedist with a series of amputations, compound fractures, and limbs torn to shreds by the hot fragments of roadside bombs.

  “Holy shit, dude, it was some nasty stuff.”

  He and the other surgeon had only just finished the cases I had wandered into that morning in the ER. In a place where almost everyone who came through the door had something blown off, torn off, or broken off, there was one orthopedist when there should have been four. Soon it would be Bill who was operating night and day without help.

  Next up was a quick meet with the medical boss, Dr. Greg Quick, the kindly colonel who had picked us up at the airfield the night before. Greg was an ER doc from Massachusetts who opted to spend an entire year with the 399th supervising the groups of doctors rotating through the facility. Just around the corner from the mandatory retirement of age sixty, Greg wore oversized glasses that spotlighted his quirky facial expressions, which mainly consisted of a bemused ability to raise his gray eyebrows all the way to his hairline while talking. His voice was high-pitched and he had a consistent way of finishing a statement with a rising question mark of “Hmm?” We had no clue of how bad his year had been to this point but would gradually learn how far he would go out of his way to make sure “his doctors” were taken care of, as well as keeping us one step ahead of the Army’s “stupid rule” police.

  “Your only job is to take care of patients—that’s pretty simple, wouldn’t you say, hmm?”

  He filled us in on some of the unpleasantries of our stay: we were short a surgeon and two ER docs, so we’d be pulling extra shifts. Greg’s voice was soft and cheery, as if discussing a gorgeous springtime morning instead of one with ominous clouds and deadly tornadoes in the forecast.

  Sure, Mike and Dave, we know you’re family doctors but since you each have ER experience in the States, we’re all sure you can handle trauma here—but we’ll talk about that later in private. And Dave, we know you can work a scalpel so maybe you could help out the surgeons when you’re not in the ER. And don’t worry, you’ll all have some free time—but not really—you’re technically on twenty-four-hour-a-day call every day of the deployment. Sorry, we have no phones to the barracks—we use pagers to communicate with the doctors. Going anywhere, including the latrine, without your pager is a sin punishable by screaming. We wouldn’t want that, would we, hmmm? Oh, one more, sorry, but you do have to salute outside the hospital compound—but inside we are a no-salute zone. And don’t forget to take your cap off when you enter the hospital grounds, we wouldn’t want something sucked into the engine of a medevac, hmmm? Finally, we don’t do neurological or facial surgery here—the one phone we do have has a direct connection to the Air Force hospital in Balad. They’ve got specialists—use them.

  We sat there stunned trying to soak in all in.

  A few minutes later, we broke for lunch and a self-conducted mini-tour of the camp. The blast furnace outside was actually a relief from the musty steam of the overcrowded tent. As we pushed through the flap, Bernard said, “I’ve got a feeling we are in for a fucking hell of a ride.” Grim nods all around.

  Few words were spoken as we crunched our way toward the DFAC or dining facility. We’d seen a glimpse of it last night when we arrived, but in daylight were surprised at its mammoth size: easily two football fields with seating for a few thousand. Quite a difference from the little fifty-person fly-infested shitholes that fed me during my first tour. The shiny concrete and steel DFAC was newly built and quite a contrast to our hospital of drab tents. After armed guards checked our IDs, we were directed to a mandatory hand-washing station, then finally into the DFAC itself. Stationed at the door was an enlisted soldier whose sole job was to work the “clicker,” a little handheld counter than clicked every time a diner entered the facility. And each click was $32 into the pocket of some faceless multigazillion-dollar civilian corporation. Not a bad business deal, figuring the Camp Speicher megacomplex fed more than fourteen thousand soldiers and contractors three meals a day. Do the math and it totaled a nice 1.3 million dollars a day—give or take a few hundred thousand bucks for skipped meals. Not that the service, at first glance, didn’t seem worth it—we were waited on by bow-tied white-shirted contract workers from countries such as Sri Lanka and Indonesia. But the food choices left a little to be desired. The menu moved through a three-week cycle of deep-fried, artery-clogging monotony. If something could be cooked in a deep fryer, in it went, except for fresh-off-the-grill burgers, which we suspected were actually ground camel; mushy fruit that had suffered through countless cycles of freezing and thawing on its journey to us; and honest-to-goodness stir-fry, though we were never sure exactly what was being stirred and fried.

  On the plus side were huge refrigerators filled with soda, Gator-ade, and chocolate milk, which sat on the periphery of the huge hall, right next to the plasma flat screens that typically showed sports or political programming. I grabbed what looked like a Diet Pepsi from the fridge, but a closer look revealed its foreign lettering. I think Turkish, which proclaimed “Harika Tat!” in big letters. The translation, we later learned, was “Tastes Great!” I watched Rick stuff six cans into his now bulging cargo pockets—while I was the coffee addict, his vice was consuming gallons of diet soda each day.

  We sat munching our fare at long tables with clean plastic-covered white tablecloths that were meticulously brushed of crumbs when our meals were finished. Lest you leave your sweet tooth unsatisfied, you could top off your meal with an assortment of cakes, pies, brownies, and ten different flavors of ice cream—they’d even make you a sundae if you asked. Maybe that’s what the $32 was spent on, because it sure wasn’t health food. The battle of Iraq for many rear-echelon and support troops was really the battle of the bulge—the average weight gain of a soldier serving a year in Iraq was 10.5 pounds. This was definitely not my father’s war with its K rations, nor my 2004 tour with MREs or little cans of ravioli.

  We had about ten minutes to make it back to our orientation—and that was about nine more than we needed. COB Speicher was a huge base, about twenty square miles in size—little wonder it took so long to get from the airfield to our barracks the night before. With the pounding the base had taken in the early days of the war, craters dotted the landscape. As it was slowly transformed into an American superbase, the camp now had paved roads, bus lines, and stop signs—as well as military police with radar guns who would issue a ticket to the poor Humvee driver who exceeded the 10 mph speed limit.

  Yet most of us would never see that part of the world; we were cautioned not to venture off the miniature half-mile-square section tucked into a distant corner of the base. Our little universe consisted of barracks, DFAC, hospital, gym, showe
r trailers, and latrines, so closely nestled, all could be reached in three minutes—and in the case of an emergency run to the latrine, fifty-two seconds. All routes were covered by those ankle-twisting chunks of hot gravel. We wondered how long it took them to truck it all in and where in heaven they got it from. The distance from the DFAC to the hospital was literally a gravel throw.

  As we reentered the orientation sauna tent, we were sentenced to more Death by PowerPoint—but this time we walked through slides overflowing with information we actually needed to learn: resuscitation guidelines, head trauma and blunt abdominal trauma protocols, transfer procedures, hypothermia and shock, use of whole blood and some experimental blood-clotting product with a science-fiction-type name: recombinant factor VIIa. I was blown away and panicked at being force-fed an avalanche of material—then having to know it inside and out within the next twenty-four hours. The others seemed to squirm in their seats as well. Rick gently elbowed me and whispered a reassuring, “We’ll be okay.” He was right: if we each learned the basics, then picked one topic to become expert on, we could bail each other out. But I still felt like I was now in a brave new world, and I was feeling more and more like a coward. God, please don’t let me hurt anyone.

  In walked Colonel Brent Smith, the current head of emergency services, who was slated to leave in a couple of days. Although he was supposedly years younger than most of us, he shuffled slowly and had deep crevices around his eyes that surrounded thick bags of fatigue. His tour had been rough, and a three-month collection of trauma cases deeply etched his face. Smith was loved by the staff and had a stellar reputation as a trauma doc. He spoke in a near whisper.

  “Hi, everybody. I need you all to hook up with your counterparts for right seat/left seat this afternoon.”

  Right seat/left seat was the Army policy similar to a pilot/copilot situation on an airplane. We would be the copilots until we learned how the CSH flew, then we would move into the left seat and be in charge. The normal right seat/left seat orientation takes five to seven days. We would have one with maybe a second if lucky.