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

by Dave Hnida

  “Crazy stuff here, too. You ever hear the one about our sunglasses? They give us X-ray vision so we can see through women’s clothes. Our bullets are radioactive and what the candy guys toss out to kids is poison.”

  The last one brought back a memory of a trip to an Iraqi school in 2004 and giving handfuls of candy to a swirling mob of grade-schoolers. They looked and acted just like American kids grabbing and kicking and fighting each other for the sweets—until their teachers scurried out.

  “Tawaqqafa! Tawaqqafa!” Stop! Stop!

  They took the candy away, told us it would be eaten later—but we knew otherwise. They were just little kids caught in the middle of a war. As we looked at the teachers in the bright sunlight, our eyes protected by tinted goggles, they turned away quickly. The men in the group thanked us and shooed us away.

  “Going to lunch soon?” Rick asked.

  I snapped back to the present.

  “Only if you drive me in the surrey with the fringe on top.”

  “The heat burned off all of the fringe. It’s a bald surrey.”

  “Then forget it, I wouldn’t be caught dead in that thing. I’ll catch you for dinner; remember I’ve got nights again.”

  As we entered the barracks, we looked at each other and rubbed our eyes. Did we just see what we think we saw? A ghostlike apparition of a nurse in a Victoria’s Secret nighty, tiptoeing down our hallway.

  “Isn’t it a little early for afternoon delight?” Rick asked.

  “I guess it’s never too early if you’ve got the time and the privacy.”

  “Hell, the high point of my day is taking a good dump. I think my grapefruits do a nice job loosening the old plumbing.”

  I just looked at Rick as we walked in the door. Sex versus poop. Which becomes more important as we age? I was afraid of the answer.

  I trudged up the stairs and into the Love Shack, said hi to our pinups, then promptly passed out from exhaustion.

  I slept the day away and when 6:30 finally rolled around, I was in the middle of a dream where I was trapped in an earthquake, and it was flinging my body like a rag doll. I was scared shitless and when I opened my eyes, they quickly focused on a hideous monster face. It was Rick, standing over my body, shaking me awake. Startled, I bit off a scream.

  “Christ, is this the face your wife wakes up to every morning? She must take antinausea medicine before bed.”

  “Hey, douche. You’ve got to be at the hospital in a half hour. Get your ass moving.”

  I was just about to yell at him for letting me oversleep when I saw a couple of containers of food on my chair.

  “I figured you needed your beauty sleep,” he said, “but then I realized you needed to wake up before next January. Your ugliness ain’t going to be cured this deployment.”

  The folding chair was overflowing with a banquet of a stewlike mixture of stringy meat on noodles, a corn dog, and a couple of sandwiches. Plus three cans of Harika Tat.

  I mumbled a thanks, then grabbed my crumpled uniform off the floor.

  “Anything up?” I asked as I shook every thread of clothing like a disco dancer on speed.

  “Not much. Lots of crap in the air so we were on red most of the day. The Tongue of Fire was extra hot so I couldn’t work out. Would have shriveled up like a dead worm on a Mississippi sidewalk. I’ll stop by later.”

  Rick said a quick goodbye to Edith, Ethel, and Isabel as he walked out the door. He never patted or rubbed their butts like some of our visitors did. He was a good husband in love and war.

  The ER was set on medium-high when I walked in. Mike had his hands full with a hodgepodge of cases; a couple of guys who were shaken in an IED blast, a young soldier with a migraine, and the mystery case of a contractor who couldn’t move the left side of his face. The diagnosis was either a stroke or Bell’s palsy. When I told Mike to shove off, he just shook his head.

  “Nah, I’m okay. Just got a little bit more to do. A couple of notes to put in the computer.”

  Even though he had every right to walk out the door at change of shift, he always stayed. Mike knew how hard it was to take over a patient in midstream and never screwed me. For that matter, neither did Gerry. It was an informal rule among us.

  Mike didn’t get out until well after eight, missing dinner. “Oh, I’ve got some energy bars to eat.” In the meantime, I just sat around with my feet up, waiting for the next new patient.

  And I waited. And waited. I hated nights like this. Sometimes I would go outside and sweep the sidewalk—a great surprise for Sergeant Courage in the morning—or go lift rusty weights and barbells at our makeshift exercise patio next to the OR tent.

  You could never relax, always worrying something bad was going to attack as soon as you put your guard down. Get lulled into a pinch of relaxation, that was the time you might screw up or make a bad decision.

  That night, just minutes after the clock struck midnight, I faced a decision that could have gone bad.

  He was an insurgent, flown in by chopper and rushed to Alpha bay by the medics. Had to be in his mid to late twenties, a hard stubble of beard on his face. A blood mustache. Clothes dirty and ragged, cut off quickly as the gurney was wheeled from the helipad to the ER, now piled in a heap on the floor.

  He seemed to be snoring, a bad sign, which usually signifies the struggled breathing of brain damage. The right side of his skull was expanding outward, giving him a cartoonish appearance. The flight medic told me the insurgent had been shot while planting IEDs. Without a scratch anywhere on his body, and an oddly shaped skull, the sharpshooter’s aim must have been true—a perfect shot to the back of the head.

  I expected a mess so I double-gloved. Gently lifting his head, I slid my hand underneath. My fingers were quickly lost in a crater of mush. As I pulled them out, a slimy mass of gray brain tissue stuck to my gloves. One of the medics got nauseated and left the room—I couldn’t blame her.

  I couldn’t find an exit wound, which meant the bullet still had to be somewhere inside the cranium, so I called in X-ray to snap a quick picture—the shadowy film showed the sharp outline of a bullet sitting smack in the middle of the brain. No way this guy was going to make it. Yet he still had a heartbeat, and as irregular as they were, breaths continued to force their way into struggling lungs. Official protocol said we had to pull out the stops and save him, or at least keep him alive until we could fly him down to the neurosurgeons in Balad.

  Following Abu Ghraib, the rules regarding the care of insurgents were increasingly strict. We were ordered to give the best of care, then our work was microreviewed after the fact to make sure. There was even a rumor that insurgents who died in our care were flown to the U.S. for an autopsy. We knew they made it as far as Baghdad, but Dover, Delaware?

  Out came the drugs, IVs with life-sustaining blood, and the imaginary book of medical miracles. The drugs were injected as fast as thumbs could squeeze the syringes, the blood poured back out as fast as it poured in, and the book of miracles had nothing but empty pages.

  “Let’s call up the birds,” I said. “This guy needs to make a quick trip to Balad.”

  We’d kept him alive just to let him die somewhere else. It was clear the bullet didn’t just plow straight into the brain—it had to hit the inside walls of the skull and ricochet like a lethal Ping-Pong ball from corner to corner, destroying brain tissue with every bounce. He was going to die—the question was when and where.

  One of the medics tapped my sleeve.

  “Sir, we’ve got to give the helicopters about a fifteen-minute heads-up. Is this an urgent?”

  The answer was obviously yes, the guy had been shot in the head.

  “No.”

  “They also say the weather is a little iffy, but they can fly in it. They’ll need two birds for this run. Plus a flight nurse for the patient.”

  “Whose turn?” I asked.

  A voice came from behind.

  “That would be me, sir.” Lieutenant Ward stood looking at me. The whole
team stood looking at me.

  “Well, saddle up and let’s prep this guy for the flight.”

  No hesitation.

  “Yes, sir.” Yes, sirs followed all around.

  Portable oxygen, monitors, and emergency drugs were bundled for the flight.

  “Let’s wrap that head up nice and tight with some clean dressings. When you’re ready, get the flight line on the phone, and move this guy down the road.”

  There was a bustle of activity. I looked at the monitors still attached to our guy. Blood pressure lower. Heart racing at 160, but still regular. Respirations labored and irregular but he was breathing on his own. He was fighting death. Hard. But he was starting to lose ground.

  Then I looked over at Lieutenant Ward. First name Warren. Great nurse, great guy. From Ohio. Three kids. He’d be rocking-and-rolling in cramped quarters with a dying insurgent, and if the guy died on the flight, it would be Ward’s head on the platter. Plus he’d be going up in sand-filled skies with lousy visibility—him and the flight crew. And then there was the extra crew of the escort chopper. They’d be thirty seconds behind in the same bad weather. Throw in the possibility of getting shot at, and the risks were enormous.

  I stepped away from the stretcher for a minute, and thought hard as I watched each member of the staff scurry to bundle up the insurgent for the flight.

  “Hey, everybody. I need your opinion.” I looked slowly into each person’s eyes. “Does everyone agree we’ve done everything we could?”

  A few seconds of hesitation with a few stolen glances at each other. Then came a flurry of head nods and positive murmurs all around.

  “Does anyone think this guy has any chance at all?”

  Head shakes and mumbled murmurs to that question.

  “Then stand down. Mr. Ward, take off your shit. Call the birds, tell them to go back to bed. This is a no-go.”

  I stepped outside and had a heated argument with myself. Another classic paradox in Paradise. The odds of something bad happening during the flight were high. And even if the flight made it safely, would Ward be delivering a dead body? But then again, the guy was still alive. And deserved care. Yet, he was going to die, neurosurgery or no neurosurgery. Then, what about the official protocol for the medical care of insurgents? Hell, screw the protocol, it was bullshit. The “cover your ass” rules of the Army weren’t worth the life of one of my people, let alone the six Americans that would make the trip. They all had families. They needed to make it home alive.

  The argument ended in a draw; there was no right answer.

  I went back inside. A couple of staff members scurried to meet me.

  “Sir, you know the rules. The protocols. They’re strict.”

  “Here’s the deal. I am the one who made this decision. No one else did. Consider this an official order: he stays. So do our people. If anyone comes bitching about the breach in protocol—send them to me. You’re all off the hook.”

  A sense of relief coated everyone in the room. They didn’t need to look up the word “futile” in the dictionary, they were seeing it in real life heaving for air on a stretcher.

  I owed the medics and nurses—each and every one. These people had given me their all during my rotation here, saving my skin more times than I’d like to admit. And I was going to make sure Warren Ward and friends made it home to their families.

  For the next two hours, we stood, sat, leaned, and watched. The insurgent slowly continued to weaken, his body surrendering to the inevitable. His pupils were fixed and dilated, he didn’t respond to anything we did. We gave him morphine in case he felt any pain on his journey to death but I don’t think it was needed. An EKG finally showed a flat line—no pulse, no respiration. We ran an extra copy to give to the authorities. Then called the morgue.

  Many of the medics went outside to smoke cigarettes. And as each burst of sandy wind whipped through the dark sky, Warren Ward slowly looked up and shook his head.

  The insurgent took a long time to die, maybe too long. I expected to have my ass handed to me on a plate the next day, but no one said a word. Not that day, or the rest of our days. It was the best medical decision I had made in my time at the CSH. It was also the first time in my Army career I had ever actually given an official order. I was happy about the former, proud of the latter.

  Some say all human life is equal. Yet I valued the lives of my people more than that of a man who planted bombs. I hoped my people all made it home safely, and that I was, in some way, part of making that happen.

  14

  DEATH OF AN AMERICAN SOLDIER

  HOW COME IT took so much time to get the damned blood?”

  The question came from one of our nurse anesthetists.

  “We hurried as fast as we could. I have to account for every unit of blood that leaves the lab and make sure it’s what’s been ordered by the ER.”

  The lab director looked hurt as she answered.

  “Well, it still should have come faster,” came the reply.

  “And I want to know what took so long to get the portable X-ray into position.”

  That accusation arose from a different voice near the rear of the tent.

  The defense angrily answered from the front row.

  “It was there in plenty enough time. We were just waiting until we were cleared to enter the bay.”

  The verbal pitchforks had been flying for close to an hour as we stuffed ourselves into a musty tent to dissect the worst case of our deployment: the first American soldier to die on our watch. He was killed the day before, but instead of healing, time was salt in our wound. A day after his death, we all continued to sink deeper into the quicksand of depression.

  Now came the question I was hoping we’d never have to answer, especially after busting our humps to save insurgents. How would we react after losing our first American?

  Colonel Quick was a silent referee. He sat quietly at the front of the tent, rocking back in his chair, peering over his glasses as a collection of the hospital staff pointed imaginary fingers of blame around the tent. As for the doctors, we just sat there, our fingers silently pointed at ourselves yet offering nary a word aloud. In reality, there was enough blame to go around, none of it deserved. There was nothing anyone could have done to save this kid.

  Ironically, the day of his death had started on a high note, with us feeling pretty good about ourselves. We were in a groove—a nice rhythm where we were working well together. We knew our jobs. Knew our limitations. And who we could count on to bail us out when we were in a medical fix. We joked at breakfast over the perks of life in the Army: free food, free drop-off laundry service, and no traffic jams; hell, we walked to work every morning. Even better was the absence of insurance companies. We lived in a world of minimal paperwork where if we wanted a test or treatment, there was no second-guessing or pleading over a telephone.

  We were even getting the hang of attacking the monotony of the menu. While Rick still ate his pile of daily grapefruits, I wanted to patent my breakfast invention: “Corn Krispie Cap’n Cocoa Loops”—an overflowing concoction that, when drowned in a carton of warm Turkish milk, tasted like a bowl of dirty socks. But at least it had taste, a surefire selling point in a place like Iraq.

  The rest of the breakfast discussions centered on the upcoming cases of the morning: the cleaning out of wounds in the operating room—basically a power wash of day-old gunshot and shrapnel holes; weaning some guys off ventilators to see if they could breathe on their own; and finally, trying to kick an especially nasty insurgent out of the ICU and transfer his ass to a prison hospital in Baghdad. This guy was a real prick. He’d had several hours of life-saving surgery done by Ian and Bill but when he woke up, his thanks were delivered with a thick load of spittle in the face of the nurse trying to change his dressings. So now he wore a “spit mask”—a surgical mask taped tightly so the only place the spit could travel would be back onto his own face.

  As we finished breakfast, a tug on the sleeve brought some good
news: Bill said he had hustled up a couple of baseball mitts and a softball. We’d head over to an open field after lunch and play a little All-American catch.

  In the meantime, we all had work to do. I wasn’t on the schedule, but figured I would spend my morning helping wherever help was needed. My first stop was an overflowing ER. Every bay was filled, every curtain drawn. Mike was running his ass off, evaluating patients and flinging orders in every direction.

  I threw out a generic “Which bay do you need me in?” to the room.

  The answer from the middle of chaos was a classic.

  “Hey, who’s in Alpha, what’s in Bravo, and I don’t know who’s in Charlie. But I don’t give a damn.”

  I was now working with Drs. Abbott and Costello.

  The only thing in the coffeepot was the overcooked, burnt residue of the morning’s brew—no one had time to make a fresh pot and a thick skin of dead coffee lined the bottom of the carafe. I poured in some water, swirled it around, and drank the foul concoction as quickly as my throat could swallow it, just in time for an Iraqi policeman to be stretchered in.

  The Iraqi cops were an odd lot. By day, many played cop for the fledgling government; by night, they changed into their insurgent clothes and planted roadside bombs. They often wore a patchwork of shirts and pants; sometimes the only official piece of uniform was an armband that said “Police” in Arabic lettering. No matter, we were an equal opportunity hospital: show up at the door and you got care.

  Usually the wounded came by chopper; after being shot in the chest, this guy was simply thrown into the back of a Humvee and quickly trucked over bumpy roads to the CSH. It was the kind of wound that distinguished the Iraqis from Americans; they didn’t have body armor and a sniper shot was usually aimed at the chest. Americans, on the other hand, were targeted differently, with unprotected necks, armpits, and groins the targets of choice.

  We hustled a soldier with a minor IED headache out of Delta bay as I took the combat medic’s report. The displaced soldier looked flustered until he saw the stretcher with a bloody shirt and the chest inside it heaving for air. He scooted quickly to a folding chair at the end of the room, knowing it would be a while until his turn came.