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

by Dave Hnida

  The Army pissed us off, too. There was one case in particular that boiled our eggs—a day Rick had worked for hours trying to save a kid with a bad belly wound. The case was a messy one and by the time Rick finished, he could literally wring his socks of the blood that had spilled off the body and run down his legs. Since all the squeezing in the world couldn’t save those socks, they went straight into the trash, and Rick went off to meet me at chow. That’s where he was turned away: no socks, no service. And no explanation in the world could grant him a reprieve and a meal. Even: I’m a surgeon—long case—critical patient—lots of blood—you don’t want that blood in here—you stop serving in five minutes—no time to go to the barracks and get a fresh pair.

  Sorry, sir. Next time you’ll plan ahead.

  Right, and next time we’ll tell the blown-up soldier to plan ahead.

  Maybe that’s why Bill wears big rubber fireman boots into his cases—the blood simply runs off like rainwater.

  At times, a special stone in our boots was the active duty guys, a few of whom regarded us as kids with cooties on their schoolyard. Being a reservist was bad enough for some of the active duty elite—but being a reservist doctor was the equivalent of the military homeless. Holding signs on the corner of the hospital: “Will operate for food.”

  They were spit-and-polish, we were just … spit. And blood. I guess the bottom line for them was reservists weren’t “real soldiers,” and doctors, well, we weren’t even “fake soldiers,” an insult made worse by the fact most of us were handed the rank of major or lieutenant colonel simply by joining their army.

  It wasn’t all of the active duty folks who turned their noses at us; we actually got along with and genuinely liked most of the men and women who made the military their career. And vice versa. It was simply a small group, the Lord of the Rings, Iraq Edition fobbits that gave us the hardest of times. And on our base, we were overrun with fobbits.

  Though I needed a translator for most Army-speak, even I understood the term given to those who never left the safety of a base in a war zone. Most of our camps were designated as a Forward Operating Base—or a FOB. Their home-bound occupants were therefore christened “fobbits.” The fobbits would usually spend their deployments never seeing or interacting with an honest-to-goodness Iraqi. And when you did the math, fobbits made up close to the majority of soldiers stationed in Iraq. They might just as well have picked a different desert for all the Iraqis they saw.

  Tucked away in safe corners, or really the safe innards, of a large base, these soldiers just got up every day, walked to work at some office or shop, and never went outside the wire. It was like going to work back home in the States, not that their sacrifices weren’t substantial; after all, they were apart from their loved ones for twelve to fifteen months at a time. And that sucked. But when a small number of them shit on us, that sucked even more, especially for those of us who did get to see real Iraqis every day, usually bleeding ones.

  We had a small and special group of fobbits who were our designated tormentors—sort of like schoolyard bullies, or in this case, more like pains in the ass since we usually outranked them. They would confront us in the mess hall with accusations of a sloppy uniform: Sir, your pants aren’t tucked into your boots properly and your shoelaces aren’t tucked into your boots. Or would admonish us for sitting with our enlisted coworkers: Sirs, no fraternization allowed. You need to set a good example for the other troops. We’d just shake our heads and walk away.

  One day the fobbits went too far. An exhausted Ian had just finished a marathon surgery, changed out of a bloody uniform into his workout clothes, and headed to chow. As he stood in line, a group of sergeants surrounded him, saying his shorts and T-shirt weren’t regulation, and that he should leave the mess hall. After he told them to screw off and sat down with steam coming out of his ears, we could see the fobbits sitting at their table pointing and laughing at us. We decided to pay them a quick house call on our way out.

  “Gentlemen, we have sharp knives to cut your skin, thick tubes to stick up your dicks, and rigid tubes to shove up your asses. Sometimes we confuse what goes where. You ever talk to us again—even look at us again, we’ll experiment with our tools until we get it right. Now your meals are over. Get up. Get out. And say, ‘Yes, Sir,’ as you leave.”

  They never bothered us again.

  It was tougher when we had to deal with those who outranked us—so we could only make fun of them behind their backs. Like General Richard Head. He was the general you’ve probably never heard of, but General Richard Head was actually a pretty important guy in this war. A generic make-believe leader for those of us who actually got our hands dirty every day. We loved him so much we even referred to General Head by his nickname, Dick. If we ever had a bitch, moan, or complaint, it was always nice to have a General Dick Head to blame it on.

  Don’t get me wrong, the Army had some great leaders we trusted and respected. I actually liked a lot of our generals. And rumor had it, a couple even thought I was okay as well, even though during my first deployment they seemed to take great pleasure in chewing big chunks out of my ass. But the man who wore the star wasn’t always what he seemed to be, especially when his personal photographers were around.

  Take the one general who the medics told me wanted to give some medals and commemorative coins to our brave troops wounded in battle. The problem was, at the time, we had no brave troops wounded in battle. Our beds were empty of wounded soldiers; they’d either been fixed or shipped off to Germany. The only American in the ward was moaning and groaning from a recent surgery. The general didn’t care, he was going to give this suffering soldier a commemorative coin. Unfortunately, when he found out the poor kid was in pain from hemorrhoid surgery, the general wanted his coin back. Hemorrhoid Man wasn’t going to give it up without a fight, pain in the ass or no pain in the ass. The tug-of-war must have looked great on camera.

  Then there was the guy with stars in his eyes and on his shoulders who came to visit our hospital for his own photo op. We were ordered to dress nice, look sharp, and stay put in the ER. Under any circumstances, DO NOT LEAVE, you never know when he’ll walk in. But after an hour of a painfully boring wait for an overdue general, my bowels decided they could wait no longer. So I headed to the latrine. And finished up my business just in time to bump into the general as he rushed in to use the facilities. I offered him my newspaper but all I got was a scowl in return, along with a dressing-down from an administrator as I walked out of the latrine. It was the first time I’ve been yelled at for pooping since I was three years old.

  The pranks and jokes and funny stories made up a potent prescription for sanity in the land of carnage. We hoped our self-prescribed Rx would especially be helpful on our nation’s birthday. In many ways it was, but it wasn’t enough.

  When the first radio call came in, the Uncle Sam hat was flung aside, the nametags ripped off, and socks pulled out of crotches. The wrong kinds of fireworks were detonated that day, and the wounded came in wave after wave. It was one of our worst days, but it was hard to feel sorry for ourselves. The day would always be remembered by the wounded as their worst day; our job was to see them through it.

  When the birds ceased their deliveries, the staff all seemed to wear vacant eyes, slack jaws, and slumping shoulders. The room displayed its own decorations: a floor slickened by blood, the litter of discarded bandages, and a mix of shredded and blackened clothes that once were the property of our guests.

  It was not a happy Fourth of July.

  11

  ANATOMY OF A TRAUMA

  I JUST LAY IN my bunk staring up at the metal support where my wristwatch hung. A not-so-glamorous Timex sports watch—I had worn this one for more than four years, and at the bargain price of thirty bucks, I’d more than gotten my money’s worth. It’s got a lot of timers, calculators, and stopwatches—though all I used were the basic “what time is it” function and the alarm. Not that I even needed the alarm on days I was scheduled
to pull a day shift, as I always woke up early and thought about the great unknown called the ER and what surprises would be delivered by air.

  It was only 5:15 when my eyes came to life—the alarm wasn’t set to buzz for another hour and my work shift didn’t start until 7:00. I rolled over and saw Mike was already up and out—for his daily run in the cool darkness of the morning. In this part of the country, that meant a chilly 90 degrees.

  Next to my watch, I kept pictures of my family. It was only 3:15 in the afternoon yesterday for them—and I hoped they were having a decent day; I had no idea what mine would be like. Some days were quiet, others chaotic; but the war didn’t publish a schedule of the wounds that will be suffered on a particular day, and it was the not knowing that made me crazy. When I sat at my makeshift desk in the ER, I could never fully relax; it was a twelve-hour fidgeting exhibition that kept me from reading or watching a movie with the medics if business was slow.

  I started every morning with a quick prayer that I would do a good job, and most importantly, that I wouldn’t hurt anyone. I’d mumble the same prayer back home before going to work every day. A little bit of the Bible came next. I usually read from something called “The Message”—a version of the Good Book without all of the “thee’s” and “thou’s”; instead it was filled with simple language such as “Jesus told the moneychangers to take a hike.” That kind of religious talk I could understand.

  Just as there are no atheists in foxholes, I doubted there were many in combat hospitals. Not that I experienced a sudden conversion when I got here; I spent a few minutes every morning back home reading and contemplating, as well as regularly asking God to cut me some slack for not always being His most faithful servant.

  Bill told me he had found a nice, easygoing Catholic mass up at the 82nd Airborne, and each week he’d asked if I’d like to tag along. I should. But since joining the Army, organized religious services and I haven’t gotten along very well. Seems like there’s a lot of Holy Roller stuff, and I didn’t do well with praying for God to gird my loins as a warrior. Military-style “Hooah church” gave me spiritual indigestion. Yet I hadn’t been thrown into some deep morass of asking God why he allowed all this bloodshed, even with all of the gore we’ve had to wade into. After all, it wasn’t anything new—mankind has been slaughtering each other since the Stone Age when we crushed each other over the head with rocks and clubs. Except now, the rocks explode and the clubs shoot bullets. Nice to see how much we’ve evolved and become civilized; at times, I wondered if this war would ever end. No matter, Bill’s discovery sounded like a religious gold mine yet I still hadn’t gone for an injection of spirituality. I would simply continue to pray I didn’t hurt anyone.

  By the time my morning musings had ended, the clock had fast-forwarded to 0615. I shook out my uniform and boots free of any scorpions or spiders, grabbed my pistol, and headed down to pick up Rick.

  He, too, had been up for hours. We didn’t talk much about our stresses, but I knew the pressure of being chief surgeon had cut into his sleep and ability to relax.

  It was my day to run the ER; Rick was my on-call surgeon yet we didn’t have to remind each other—the message of anxiety was clear in our eyes. We had only known each other for a little more than a month, yet we were already at a point where we could read each other’s thoughts without uttering a word. We flew through our ABCs, made sure we had our gear, and then headed over for a meal of powdered eggs, which we simply pushed around on our plates. It seemed like we both knew we were in for it—how we knew I couldn’t say—there was just a vibe that surrounded us. Even the usual jokes were missing in action as we made the trek from the chow hall to the hospital.

  As I pushed open the ER doors, I mumbled a quiet “See you later.” His answer was a terse “I know.”

  I greeted my medics with a quick “How is it going, folks?”

  They replied in unison.

  “Fine, sir, just another day in fucking paradise.”

  “That it is, my young friends. Say, I think I’m going to head over to rounds for a few minutes, page me if there’s any business.”

  As I walked, I thought about our peculiar brand of work; it was unlike anything any of us imagined. The meat and potatoes of our daily life was trauma, but not like the stuff back home. There, it’s a lot of blunt injury from car accidents with an occasional hole from a bullet or blade. Here our life was pulling nails from a car bomb out of someone’s back. Amputating limbs hanging by a thread of skin. Trying to keep some guy’s intestines from spilling onto the floor as you struggled to examine him. Comforting a young soldier who can’t stop stuttering after seeing his best friend’s brains splashed throughout the inside of a Humvee.

  It could be mentally chaotic, but wasn’t the emergency medicine you’d typically see on TV with yelling, screaming, and bedlam. I learned on that horrible first day in the ER that I needed calm. So the dual rules of my desert trauma center were simple, especially for visitors who stood in the peanut gallery: Keep quiet. And stay out of my way. I had lost my medical virginity on that inaugural day when my head went spinning. It was a day that now seemed centuries old. I had changed in ways I probably wouldn’t discover until many years and miles passed between me and this hellhole.

  I sneaked into the back of rounds and looked at my friends. Rick, Bernard, Bill, Mike, Gerry, Ian, and Blockhead—I rolled a lucky seven when I was put with these guys. They were good at their jobs, they were good to the patients, and they were good to the staff. And they were good to me—all at one time or another holding me by the hand when I was stumbling.

  We all brought some piece of medical knowledge to the table, and were always willing to bail out someone who was drowning in a roiling sea of blood. At times, the group had been stunned into silence by the bodies or pieces of bodies brought to us on stretchers, yet none lost our patience or humanity. I saw my colleagues naturally laying a soft hand to the head of a scared, wounded soldier. They would kneel on one knee and gently talk the language of reassurance and confidence into the ear of the injured. And sometimes walk away with deep red indentations of the skin—a place where the frightened had latched on and painfully squeezed tight the arm of the doctor promising to aid them.

  I was blessed with an orthopedist I could call out of bed in the middle of the night to look at an X-ray I didn’t know how to read, and I worked with surgeons who never got angry when I lagged behind their rapid pace in the OR. I also learned it was not only me who had a good fairy who left food when I missed a meal, or a blanket when exhaustion struck; we all looked out for the one who needed rejuvenation. We trusted each other with our lives, as well as the lives of the soldiers we cared for.

  Rick was in the corner with his eyes pointed at the floor, brow furrowed and stressed. Not paying one damn bit of attention to what was being discussed by the group. Sweat like ice water ran down my neck—something was up. I decided I had better head back to the ER and wait for the other boot to drop. It took less than two hours of nervous toe tapping and three cups of foo-foo coffee before the morning’s call came in.

  And this is how it went:

  09:11:30 I’m asking Major Boutin why in hell we are drinking Blueberry Surprise instead of real coffee. The medics are telling dirty jokes. Sergeant Courage is outside sweeping the sidewalk.

  09:12:00 The radio crackles. A firefight has taken place after an IED attack. Estimate two urgent casualties—arrival by helicopter in twenty-five minutes. Condition unknown—so we prepare for four patients and arrival in ten minutes. Information is often muddled when called in from a thundering helicopter. The message sets in motion a frantic cascade of rushing feet, hurried voices, and upset stomachs.

  09:12:30 I ask for pages to be put out to surgeons, orthopedics, anesthesia, respiratory therapy, and X-ray. Maybe an extra ER doc or two. We’re going to need help with this one.

  09:13:00 Staff heads to trauma bays—equipment is checked and double-checked. Suction, defibrillators, emergency drugs. IVs are hun
g and ready to drip. Chest tubes and intubation equipment placed within reach. I double-check my personal gear: stethoscope, safety glasses, and a pair of gloves. Then stuff more gloves into my pockets in case things are extra bloody. I end the ritual with a quick pat-down of my shirt pockets for my emergency cheat cards. Haven’t used them yet but the day I don’t have them is the day I will need them.

  09:14:00 We go in sets to the unisex latrine. Always have an empty bladder, you never know when you’ll get the chance to go. As I stand emptying my bladder, the nurse in the stall next to me asks how my family is. Just fine, thanks. Yours?

  09:16:00 Back in the ER, we share packs of specially designated “trauma gum”—Trident or Wrigley’s to keep from getting cotton mouth. We walk, pace, and tell weak jokes. I have a crucifix in my left pocket that has been rubbed raw over the months during these walks. I pace seven steps toward the front door, then back for seven more. We all have our pre-trauma quirks—this is mine. Why seven? Mickey Mantle and John Elway wore No. 7. It has to be good luck.

  09:19:00 Like Radar O’Reilly, we sense the vibrating blades of incoming medevacs before we hear them. They are eighteen minutes early. Medics go to the helipad wearing Mickey Mouse-—eared hearing protection. The rest of us line up in our positions. I am at the head of the stretcher in Alpha bay waiting for the most critical case. I stand on the left—anesthesia on my right. Everyone in their assigned position. It’s like a football game. Just waiting to say “Hike.”

  09:20:30 Medics come into the ER. Moving fast, not a good sign. Someone shouts: “Three urgents on litters.” Sprinting medics rush in three soldiers. I eyeball the wounded from a distance … as well as the faces of the medics. Their stress tells me how worried I should be. Shit, they look as old as I feel. I hear moaning, see blood, and sense death. The worst of the three is blood-soaked and blue in color, he’s missing part of a leg and has bright white bone fragments sticking out from his arm—the fragments are pointing oddly at the ceiling.