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

by Dave Hnida

  The report was succinct with little emotion.

  “Gunshot wound to right thorax. Sucking chest wound. Chest tube with flutter in place. Vital signs up and down. Some other dings and dents but nothing too serious except the chest.”

  The medics and nurses went to work. After more than a year of trauma care, they had seen it all, and needed little direction. Their requests for IVs, blood, pain medication, and antibiotics often sounded more like “this is what we’re doing and we’re only asking because the rules say we need to.” Fine with me—it made things move more quickly and allowed me to concentrate on the big picture. I usually answered them with quick nods of the head or monosyllabic “Yeps.”

  I checked the Iraqi from head to toe. The only thing I could find was a bright red eye staring at me from the right side of his chest; it was the hole where the bullet entered. When we rolled the patient onto his side, I did a quick exam—no open holes in the back, so the bullet was still somewhere deep inside. The tube in his chest acted like an oversized straw, sucking a steady flow of bright red blood out of the area around the now collapsed lung. I paged Rick and Bernard—this guy needed to go to the OR before he bled to death. I would scrub in to help.

  With a deft swipe of the scalpel, Bernard opened the chest while Rick spread the ribs to isolate the bleed. On the surface of the skin, the wound didn’t look like much—but when the bullet entered the chest, it hit a rib. The bump sent the bullet tumbling, tearing and mangling tissue as it traveled deep into the lung.

  “I think the lower lobe is done for, guys,” Bernard said as he surveyed the inside of the bloody chest cavity.

  Rick peered into the mass of bloody tissue.

  “It’s hamburger, Bernard. I don’t think you can isolate the bleeders.”

  “What do you think, Dave?”

  “Wedge resection?” I answered.

  “Correct-a-mundo. We are going to turn you into surgeon extraordinaire by the time we we’re done with you. Just watch your fingers now.”

  With the speed of a sewing machine on steroids, Bernard and Rick rapid-fired dozens of staples into the middle of the lung, then like a Thanksgiving turkey, cleanly carved away the irreversibly damaged portion of lung.

  Like two of the Seven Dwarfs, they whistled as they worked—

  today’s musical choice on the boombox in the corner of the cramped OR was the Eagles’ “Hotel California.”

  I was afraid to ask Rick what he thought the name of the song was. “Go Tell It, California” was my best guess.

  The patient might not have the wind he used to while running, but at least he’d live to run again. And within the week, he’d be able to check out and leave.

  When we left the OR, the war was still going on. Word filtered in that a convoy had been hit by a series of roadside bombs. Details were sketchy, we could be getting anywhere from zero to five casualties. They’d let us know.

  I walked the fifteen steps into the ER and plopped down with a couple of the medics, shooting the breeze about everything from whether baseball was a dying sport to the hidden philosophies of a rapper named Lupe Fiasco. I didn’t know who or what a Lupe Fiasco was, but the medics seemed to know everything from his favorite food to his shoe size.

  As we chatted, I subtly examined their faces. When confronted with the spurting blood and moans of a trauma case, they seemed old. Not older. Old. Now, in a quieter time, they looked young enough to be thinking about going to the high school prom. I wondered what they would be like when they finally went home, away from the day-to-day companionship of those who understood what they went through each day of their deployment through hell. And how their old friends back home probably wouldn’t recognize, let alone relate to, them. I hoped it wouldn’t be a fiasco.

  Wild Bill Stanton wandered into the room.

  “Dude, sounds like a game of catch is out for the day.”

  “Looks that way, but let’s see what this case is. Maybe we can sneak out later and unleash some wild throws,” I answered, hoping to do something normal.

  It wasn’t to be.

  The next hour was like going to bed and having a nightmare erupt as soon as your head hit the pillow. And no matter how hard you tried, you couldn’t wake up. Then you realized it wasn’t a dream, you were actually living the nightmare.

  The follow-up call on the radio seemed innocent, the metallic voice telling us we had a single soldier being flown in. He was awake and alert, though in a lot of pain from his vehicle being blown into the air. Blood pressure a little low, but stable. All seemingly routine. One minute from landing, this young talkative soldier suddenly went quiet and suffered a cardiac arrest. It happened so fast there wasn’t time for another radio call. The pilots jacked the rotors and made an acrobatic landing as our medics stood waiting on the landing pad, trying to decipher the meaning of the abnormally steep bank, crazy descent, and skidding stop.

  Inside, we stood waiting, expecting urgency but not emergency.

  The double metal doors made a sharp bang as they burst open and struck the side walls of the room. In an instant, we were transported to the trauma Twilight Zone—time quickened and people’s movements became blurred with speed. Yet I was still able to hear the ticking of the wall clock and clear single sentences spoken from across a chaotic room. I could even distinctly make out the sound of squealing wheels of the stretcher as it raced toward Alpha bay. The soldier on board was pure white. Yet not a drop of blood to be seen. Little specks of dirt and grass on the front of his uniform, that was all. And no pulse.

  The medics frantically performed CPR as they ran alongside the stretcher. IVs were started, medicines administered, a yell for blood creased the air. There was a hint of heart activity on the monitor but still not strong enough for a pulse to be felt. Sharp commands of “Clear” were shouted as the paddles were applied to his chest. One shock. Two shocks. Then a third. A quick pause as rapid exams were done to search for some hidden clue to what caused this soldier’s heart to abruptly crash. There simply wasn’t time to use special scanners or X-rays—it was all gut feeling and experience to figure out why this young man was dying—and there were only seconds to get it right.

  The mournful answer came quickly.

  With many explosions, the problem is often what you cannot see. The pressure waves from those blasts don’t always leave a mark on the outside, but can shatter bones and rupture organs on the inside. And that clearly was the case with this young soldier. As the staff rolled him on his side to examine his back, only the upper half of his body moved; his legs and feet remained pointed at the ceiling. The force of the blast had shattered his pelvis, and his spine disconnected from his legs. It was always a fatal injury.

  We lost him.

  You never wanted to call it quits. No one wants to be the first to say, or even think aloud, “I think we’re done.” Yet, quietly, the dreaded question finally entered the trauma bay: “Does everyone agree we can’t do any more?”

  It was the worst question with the worst answer. But we never stopped until all agreed. It was a rule of respect for everyone present who had worked to save this life. The answers came with curt bobs of the head and barely decipherable murmurs.

  Yes. It’s time.

  The soldier was gently cleaned and all signs of the medical trauma we inflicted were repaired. He was redressed in his uniform. The staff lined up and stood at attention as the soldier was wheeled out of the emergency room. The last time we would ever see this soldier was during this “Walk of Honor.”

  Some tears flowed. Others stood with concrete faces. His unit was outside waiting for word of his condition. It was tough telling them that we did all we could but it still wasn’t enough. We felt like failures as we watched their shoulders sag and lips get bitten. This unit had already suffered too many losses during the Surge—now came one more.

  One soldier stepped forward, shook our hands, and murmured thanks. Then he and his buddies wandered off to let it all sink in. There would be an empty cot i
n their barracks that night. Loved ones back home would have an empty room. And countless lives would forever have a big hole that could never be filled.

  The next day we got together as a group in the musty tent and beat ourselves up as we reviewed everything we had done and maybe could have done better. But in the end, though, we realized we had done everything right in a case that was destined for wrong. The angry accusations were forgiven and forgotten.

  Nonetheless, the death of the young soldier hurt with a pain none of us could put into words. We are not gods. Sometimes we make mistakes. And even when we don’t, we suffer because we are not able to undo the damage one human can inflict on another. Each of us would see this young man’s face the rest of our lives. But his family would be the ones that missed his face the most.

  The loss dominated everything we did over the next few days though we knew we had to move on without distraction. Other wounded needed us to be at the top of our game.

  Bill and I eventually made our way over to a grassy field for our long-awaited game of catch. It was much-needed therapy on our own field of dreams. For brief periods, we talked about our families, our lives back home, and how we doctors were blessed to have each other, on good days and bad. The unique smell of a leather baseball glove pressed against my nose was a welcome distraction from the pain of the war.

  Most of the time, there was a simple silence as we tossed the ball back and forth, lost in our own thoughts and questions. I wondered where the soldier was now. What happens after you die? How is his family doing? What about all their plans for the future? What were this kid’s final thoughts as he lapsed into death?

  Just thinking about it gave me a headache, but as the catch continued, my time will Bill brought serenity. It’s funny how the great American invention of playing catch is so simple and pure. It made me wonder if we should have the Shiites and Sunnis pick up a ball and a mitt, and make them play catch until they decide to stop fighting. Better yet, maybe we should have all world leaders step onto the lawn of the U.N. and toss a ball around until they solve out their self-manufactured troubles.

  The rhythmic “thwop … thwop … thwop” of a scuffed baseball smacking the web of a broken-in glove is without question a sound of peace. And our world could sure use a good game of catch.

  15

  FAMILY TIES

  IN PAST WARS, the lifeline to home was prehistoric: snail-mailed letters and packages trapped by months in transit. No news wasn’t necessarily good news, a lot of fingernails were gnawed to the nub as both sides waited for the postman to appear with the written words of a loved one.

  We were fighting in the new millennium of war; not only did we have the latest and greatest weaponry and imagery, we had the Internet and a satellite phone system to keep us in liberal contact with the home front. In the case of the 399th, we were extra lucky: the hospital had its own phone tent with a few snail-like computers thrown in for Internet access. It was cramped, it was hot, but it was ours.

  The compromise was privacy. We couldn’t help but overhear who was struggling with the strain of too many absent hugs and kisses. We Reserve docs were fortunate; our deployments were a short three and a half months compared to the ungodly fifteen-month tours the rest of the hospital were trapped in. Our interminable waits for the phones and computers were all too often uncomfortable, overhearing the latest arguments over things that probably wouldn’t have been arguments if the two sides were face-to-face. There were a lot of conversations top-heavy with quarrels and spats, many triggered by unspoken loneliness and worry.

  As we’d sit and wait our turn for the phone, we’d bury our faces in a newspaper and make believe we didn’t notice the shouting, with one side stressed over the blown-up soldiers seen that day, the other fretting over coping alone with the day-to-day troubles at home. And the younger the couple, the louder the screaming. The calls were cyclically predictable—a calm start, a raised voice, followed by a rapid escalation to a steadily increasing volume of anger and cursing. Then came a gradual easing of tensions, with softer words, and a few “I love you”s, followed by the hang-up.

  If the hang-up prematurely became a phone slam-down early in the conversation—before the “I love you”—we’d always let the aggrieved party cut in line and hop back on the phone after they had a chance to go outside and walk off their anger. The rule was simple: never leave a phone call angry.

  My daily phone calls went smoothly for the most part, with only a rare harsh word. My family had already been through a tough deployment back in 2004, so they knew the rules of the game, as did I. Keep it light and try to avoid pressuring either side about anything non-life-threatening.

  The last time I was in Iraq, I never told them about the hours spent on the road, or the shotgun that sometimes traveled with my medical pack. They didn’t hear about the rocket that landed yards away, blowing other soldiers up but missing me—until I was safe in the living room of my home. I stretched the truth constantly about where I was and what I did, but this time I knew I had to walk the straight-and-narrow road of truth; they were veterans themselves and wouldn’t be fooled. But fudging wasn’t necessary—this deployment was easier and my position on the danger scale was near zero.

  The toughest call I had the entire deployment was with my mom early one Sunday morning. It’s tough being a parent, especially when you have a son or daughter in a combat zone, and I’ve learned there’s little difference whether the child is nineteen or fifty.

  I stopped in the phone tent minutes before the start of my shift. It was still Saturday night in America, and my extended family were gathered in Wisconsin for the wedding of my niece Megan. The entire clan traveled across the country to get together for the first time in years, and I was the only one not there. I sat in the steamy tent in a rickety folding chair, speaking to each as they snuck from a rocking dance floor into a quiet closet at the banquet hall.

  As I worked my way down the line of celebrating relatives, a seeping emptiness and loneliness added miles to the thousands already separating the hall from my hospital. Then, in the middle of an emotional black hole, I was rescued by a dose of the most potent of medicines: my mom’s voice.

  She’s eighty-seven years old, and has suffered more than her share of war in her life, starting with my dad. They were married in August 1943 and he shipped out just three days later. Months were spent sitting by the window, futilely waiting for the postman to come. There was nary a word for eight excruciating months—then came two short letters, and even they were heavily censored; the first had only three words survive: Okay, love, Steve. It wasn’t much, but it was at least enough for that one day. The second letter was a few sentences longer and was sent from a hospital in Naples, where he was recovering after being wounded by artillery.

  Her youngest brother, Artie, was a soldier in Korea in 1950. He almost froze to death after being wounded and left for dead in some battle for a hill with no name.

  Her next worry was my older brother, Steve. He was in Vietnam in 1967, the longest year of her life as a mother. Steve, like many other veterans of that war, was forgotten and unappreciated by our nation. But not by the mothers who waited for them to come home.

  Then I threw her for a major loop when I joined the Army Medical Corps in 2003. She couldn’t understand why I would do such a thing at my age, asking “Didn’t I know better?” All I could say was that it seemed like the right thing to do.

  At her age, my mom isn’t as sharp as she used to be, but she knew clearly where I was, what I was doing, and had the same questions about the war as many Americans. We only talked for a few minutes; I told her I loved and missed her and she returned the sentiment, and then added how proud she was that I was taking care of young soldiers. She then handed the phone off to my sister, who told me Mom left the cramped room with a new spring to her tired steps and a peaceful calm in her eyes. I think she just needed to hear my voice telling her I was fine and I was safe.

  I wiped away a few tears. The brief
conversation triggered flashbacks of being a kid and my mom taking care of me: playing peek-a-boo, walking me to grade school, taking me for my driver’s test, and hugging me tightly at my dad’s funeral. Quick little snippets that packed a nostalgic punch. I realized, no matter what the age, sometimes a guy just needs his mom to tell him everything will be okay.

  As my sister and I talked, the tent began to shake with the vibration of an incoming bird. It was time to get back to the war and take care of some other mom’s child.

  I hoped my eyes didn’t show the redness of homesick tears. I kept my head down as I grabbed my gloves and stethoscope and headed to my position in Alpha bay.

  The stretchers carried two soldiers; both had been hit by an IED and their vehicle had caught fire after the blast. One had a wafting odor of burnt meat rising from his body. Fire not only meant charred flesh, but superheated air sucked into lungs. I now had to worry about inhalation injuries along with the burns on the skin.

  I leaned in closely as the medics cut away his blackened uniform.

  “What’s your name, buddy?”

  “Antonio.”

  “I’m Dr. Hnida, Antonio. Where you from?”

  “California, just outside of L.A. Near the beach.”

  “Kind of like here. Lots of sand, but I think you forgot to bring the ocean.”

  His mouth bent into a small, crooked grin—his teeth extra white against the smoke-stained skin of his face.

  So far so good. I needed to look at the burns a little closer, but at least I knew he could talk—and if he could talk, he could breathe—and if he could breathe, his airways weren’t fried shut. And a smile told me he wasn’t going anywhere bad soon. He’d need some surgery to clean up his wounds and a close eye to make sure his airways didn’t swell over the next several hours.

  “Hey, I’m going over to your buddy. Just tell the folks if you need more pain medicine. You’re going to be fine. Why don’t you read some old magazines from 1972 we keep in our waiting room.”