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

by Dave Hnida

  At times, the insurgents really didn’t trust or understand us. One guy had skin grafts to repair his burnt and mangled arm, and he couldn’t figure out why the newly grafted areas had a different color and texture compared to the rest of his arm. He concluded we had sewn a new arm onto his body while he was asleep in surgery. Worse, he was a Shiite and thought we had attached a Sunni arm.

  When we joked a few weeks ago about how insurgents must feel after getting a few units of good ole American blood, we also wondered if they truly understood the men and women who donated that blood.

  We typically kept several dozen units on hand, but one bad case and we’d go through blood like water. Frankly, it would have been easy to just hold all the life-nourishing liquid for our own troops and let the bad guys leak until the gauge said empty. But we never did. As an equal opportunity hospital, we didn’t discriminate on the basis of race, color, creed, or killer. The protocol was always the same no matter who was on the table—a call went out from the OR for a “blood drive” because we had someone running on fumes. And when the call went out for a specific blood type, dozens of American soldiers with that blood type showed up to donate. We never told them who the blood was for, and they never asked. Sort of this war’s version of the military’s “Don’t Ask, Don’t Tell” policy.

  When I inquired why they rolled up their sleeves to donate without knowing if they were actually saving the life of a car bomber, the answer was haunting.

  “People is people, sir. We just don’t want to know which people. I’ll go back and take a nap figuring I just helped save an American. If it’s a hajji, well, you doctors are going to have to live with that one, not me.”

  When I walked over from the ER to the ICU for a cold bottle of water, I saw the nurses working with our longest-residing guest, Awatif. She was about forty years old going on eighty. Almost a month before, she was caught in the middle of a midnight raid—the details still aren’t clear, at least to us. We didn’t know if she was running an insurgent halfway house or just relaxing one evening when a group of bad guys sprinted in to hide out.

  When we blew the house up, she blew up with it, going blind, deaf, and suffering severe burns over most of her body. The doctors had done all they could; it had been the nurses who kept her alive and nursed her back to health. As I walked in, Awatif was sitting upright in a chair next to her bed—two of the nurses were washing and braiding her hair. She’ll never look the same as she did before the blast—for that matter, being blind she’ll never know what she looks like any day the rest of her life, but the nurses cared for her and tried to pretty her up the best they could. They had to possess a deep well of humanity that helped them deal with the next hate-filled gob of spit coming from a prisoner or a quiet moan from a broken American soldier.

  Dinner that night was a happier affair. Though we wouldn’t say it, we were each watching the calendar fill up with X’s—silently counting the days until we got on the magic flying bus to take us home. We felt bad for the ones that came before us and will leave after us—our deployments were just under 120 days—everyone else, it seemed, was getting the fifteen-month special. That’s a lot of birthdays, weddings, and funerals, let alone soccer games and bedtime stories, to be AWOL from.

  In a way our deployment had been divided into three phases—the first third a time of uncertainty and nerves; the middle phase a time where we became confident in ourselves and each other; then, as we reached the final third, we walked around with fingers crossed that we’d leave on a high note. No mistakes. No bad cases. Like leaving the playground or gym, you’ve always got to put your last shot in the hoop.

  As we sat at dinner, we all noticed the empty chair.

  “Is Rick back yet?” asked Bill.

  The day before, Rick flew to the CSH in Balad to have the neurosurgeons look at his MRI, the one taken at the hospital at Benning after he had failed his hearing test. Rick thought the MRI had to be fine since the Army let him board the plane and partake of the honor of serving his country in time of war.

  It turned out Rick was the victim of a massive screwup. After the MRI was taken, it sat on the desk of a specialist who was on a lengthy vacation. It was thirty days before he finally returned and had a chance to eyeball Rick’s scan … and see a tumor sitting in the corner of the brain. When Rick got the news, he somehow kept his cool and had copies of the scan sent to some neurosurgical colleagues back in Oklahoma. They assured him the tumor looked benign and could wait until he got home in September. To play it safe, though, Rick decided to fly down to Balad for yet another opinion that the tumor could be safely left alone. Like nervous parents, we waited for word that our friend would be okay.

  “No, not back yet,” I answered. “Later tonight or in the morning. But he shot an e-mail saying the guys in Balad thought it was a lipoma. Just a benign fatty tumor that’s sitting in a bad place.”

  I thought about how much I missed my friend. But still had to laugh at how he made me laugh.

  “You know,” I said, “all that shit pouring out of his ears can’t be just wax, now I think it’s got to be fat.”

  Bernard chimed in. “Anyone who says he wants to listen to Johnny Crash or the Beach Bums in the OR has to have a fat head. That’s good news, though.”

  No question, we missed “Uncle Ricky” at the hospital, especially me. No one for me to yell at, no one to yell at me, no one to toss adolescent quips around with like we did on the rooftop the night before he left for Balad:

  “Hey, look, right next to that bright star is Uranus.”

  “I don’t see it.”

  “Well, bend over a mirror when you get back to the barracks.”

  It was like two junior-high kids dropped into the middle of war.

  Our conversation at the dinner table shifted from Rick.

  “Big day tomorrow, though. Mike gets his board certification. Ricky better be back for that.”

  Besides war wounds, butt surgery was a big-ticket item this summer. It seemed like an awful lot of soldiers got hemorrhoids, some to the point they couldn’t do their jobs, standing or sitting.

  The high number of cases was a match made in heaven. The surgeons hated doing them, and Mike loved doing them. So they let him operate on each and every hemorrhoid or ass case that came in. So many that Mike would be fully trained to perform rectal surgery when he got back home. Tomorrow he would be awarded his graduation certificate in “Official Care of Any and All Ass Complaints,” as well as being promoted from major to rear admiral. Too bad his wife and kids couldn’t make it to the ceremony.

  The final item on the dinner menu was our upcoming rooftop party: the politically incorrect “Hos and Pimps Farewell Extravaganza.” The invitation was clear: the females would dress up like pimps and the men as … women of the evening. The swankier the better. The more bizarre the better. I decided I would go as “Helga the hooker.” Rick as “Betty Boob.”

  After dinner, I went back to my room for a big project: mailing all my excess stuff home. Even though it would be weeks before I’d see my front door, it would take that long for a big box of junk to arrive … and anything I could stuff in would be less poundage to lug. I dropped in a note:

  Dear guys,

  I’m sending along some extra stuff I don’t think I’ll need the rest of my time here. A bunch of books (which I haven’t read), some spare clothing, boots, and a beat-up pair of running shoes. Sorry for the smell. Take extra good care of the Ziploc bag filled with index cards. I spent the first few nights here scribbling crib notes on them—they were my cheat sheets for taking care of the wounded. I carried them everywhere I went—the good news is I never needed them. Not even once. A couple of cards are bloody but that’s only because I used them to scribble wound locations in people who were blown into a lot of pieces—I couldn’t recite them fast enough to the nurse, so I just looked at the patients and wrote what I saw as I worked. Funny, I thought I would need these cards every single day I went to work. Never did. Put them in a
safe place—they will always remind me of how scared I was when I first got here. So when I get home and think I’m having a bad day—I’ll pull them out and get a reality check.

  I needed a break, so I walked to my locker for an energy bar and a Gatorade. As I got to the corner of my room, my body was slammed into the open door of my metal locker. A breath later came the loudest explosion I’d ever heard. I shook the blurriness from my head and waited for a few seconds. I was stunned that anything could make a concrete building shake like a rag doll. I headed outside my door onto the roof and saw that a rocket had hit yards from the building. We’d had a safe deployment with only a smattering of mortars and rockets—and most of those were duds. You’d be walking along, hear a clank and a screech as a round landed on the gravel, then skidded a few yards harmlessly to a halt.

  This one, though, carried death. When it hit, the rocket left a huge crater and set some fires. But at this point, it didn’t look like there were any casualties.

  My dad told me he hated mortars and rockets more than anything, and I understood why. There wasn’t a hole you could dig that was deep enough for protection.

  As I watched a group gather on the roof to watch the results of the fireworks show, I thought of the first rocket that zipped my scalp. April 2004. I was crossing a causeway over a small lake with a group of guys when we heard a big pop. Someone said, “Don’t worry, that’s just a mortar hitting.” We yelled a collective “Bullshit” and contemplated an emergency dive into the water when the rocket whirled overhead. The pop was actually the rocket launch and we knew it had to come down somewhere. The shell missed us, but not the arms and legs of a group of people in a small building less than a hundred yards away. I could still hear their screams. Now I watched a group of gawkers on our roof looking to see if there would be an encore. But I knew the top of a building was the last place any of us should be.

  We were saved by the chirping of our pagers: report to the hospital for accountability. Meaning, we didn’t have wounded to treat, we just needed to all make an appearance and show them we were alive. But since the rule was all helmets and body armor was to be stored at the hospital, we’d make a fast trip across the gravel and hope another round didn’t hit. Great planning. It made me beg for my old commanders from 2004, like Izzy Rommes, who really knew war.

  I finished my note before I sealed the box and headed to accountability:

  Just a couple of thoughts to end up with. I really want to say I’m sorry. I joined the Army at an old age and left you behind to worry. It’s been kind of hard on me sometimes—most of the soldiers I see are your ages. When they are lying on the stretchers wounded, I look in their eyes, and I often see one of you. Coming here was a good thing, as painful as it’s been for all of us. Thank you for that.

  I don’t think I’ve ever explained all the reasons behind my decision—you know a lot had to do with your grandfather. I wish you could have met him. A funny guy but he carried a lot of demons—sometimes I think it was my job here to lay some of those demons to rest—but you know, they don’t make shovels strong enough or holes deep enough to bury the past. Even though we can learn from the past, we just can’t undo it. We can only look forward and, even then, be ready for what life throws at us. We adjust or we spend our lives in misery complaining. As the old saying goes: Get busy living or get busy dying. When I look at all of you, I see you’ve chosen well. Stay on that path and you will change the world. Even if that world is one person. My accomplishment here, I hope, is at least one soldier, who because of me will someday have the chance to look at today and remember it as just some rotten day in the past. And a future with unlimited horizons.

  I’ve got something to give you, but it’s better hand-carried than mailed. It’s the diary from my war.

  Love, Dad

  22

  DOG KENNELS

  IF THERE WAS one thing the Iraqis were good at, it was hurting each other.

  A couple of days ago Bernard spent five hours in the OR piecing together the face of an Iraqi policeman who was pushed off the back of a moving truck by his fellow cops. The effect of asphalt on a skidding face was to pull the skin and muscle off like a Halloween mask. Hanging by a flap, you could lift the face directly over the underlying bones. It was a one-man repair job, but I kept Bernard company as he tried to make a formerly handsome guy look like a human again. A few months ago, I would have vomited at the sight, now I just stood and chatted with Bernard as if we were talking about which team had the best chance to beat the Red Sox this year.

  “I called Balad since the muscles around the eye are probably still lying on the road—but they said he’s not worth flying down. So here I am, like an old grandmother, quilting away. I just don’t know what goes where.” Beads of sweat were building on Bernard’s face from the painstaking work.

  I told him, “Actually, it looks pretty good. But Jesus, it was his buddies that did this? I’d hate to see what they would have done if they didn’t like him.”

  “You got that right. Say, need a ride back to the barracks later? We can sit in the back of the truck and talk about you busting my balls over Captain Dee. Just hold on tight when we drive, man.”

  I rubbed my still intact face and answered a quick “No, thanks.”

  Yet the Iraqi policeman was just a single illustration of the hatred that was part of daily life in Iraq. Frankly, he was a nonnewsworthy speck compared to the eight hundred who died in a series of bombings in Qataniyah a few days before. All told, more than eighteen hundred Iraqis would die during the month at the hands of their countrymen; who knew the number of wounded.

  Surprisingly, we rarely took care of civilians wounded in car bombs—a fact that seemed to confuse a lot of people back home. After a news report on some massive bomb, I’d hear “You sure must be busy.” And yeah, I was busy, but the hospital cup wasn’t overflowing with civilians. Although we did take care of the Iraqi army and some Iraqi police, we only opened our helipad to civilians if they worked with us or got caught in the middle of the crossfire—like the ancient woman Awatif. When I first got here, I thought I’d be working on Iraqis all the time, especially kids, but we were told right off the bat we had a new hands-off policy for civilians. Seemed cruel at the time, but when I went to a division surgeons meeting at the 25th Infantry back in June, that directive made sense.

  Think about it: our primary job was to care for American soldiers. And it was really hard to send helicopters, vehicles, or put troops at risk picking up wounded civilians from all corners of the country. As the commanding general of our medical brigade wisely said, “I run the world’s biggest trauma center. I don’t run a full-service hospital.”

  Plus, we simply didn’t have the room or the staff to care for the entire country’s medical needs, even when there were mass casualties. It was the ugly and harsh reality in this neck of the world. I knew it frustrated a guy like Mike, who would have liked to save the Iraqi people, but at this point I think we were just trying to save ourselves first and foremost.

  There was also the issue of getting the Iraqis to step up to the plate and run their own damn country, not just the security but its medical care as well. As we tried to get them to do so, we needed to step out of the way and force them to develop a system that was appropriate for their culture. An American-style health care system would not work here. Unfortunately, the current Iraqi civilian health care system didn’t work here, either. It sucked. But that wasn’t from a lack of trying on our part.

  One of the best examples of failure was TTH, or by its proper moniker: Tikrit Teaching Hospital, the main hospital in Saddam’s hometown. The United States had sunk more than $30 million into this place for equipment and supplies. But where that $30 million went was anyone’s guess. Not equipment or supplies. Probably into some guy’s pockets, the universal destination of much of the funds we pumped into this country.

  We called TTH and other Iraqi hospitals “dog kennels,” and for good reason—there was no nursing care. Meani
ng your family had better be around if you needed your wounds treated, dressings changed, even your Ambu bag squeezed. The family typically set up camp next to your bed and cooked your food as well. As for rules—there were none. Smoking was allowed even with oxygen running (when there was oxygen). All those cigarettes left a layer of smoke swirling throughout the wards. Bandages were reused and hopefully you didn’t get a bed stained with old, dried blood, which I suppose was better than one damp with new blood.

  Beds and basinets just sat in the parking lot, empty of patients but full of dirt and sand. TTH did have a spanking-new MRI machine and CAT scanner—but they were broken and unused—the money for replacement parts privately pocketed. The emergency crash cart had empty drawers. Bugs crawled up the walls and down onto patients. Completing the picture of a hospital from hell were the layers of dirt and mud coating the floors. The only thing missing were packs of wild dogs wandering the hallways—instead, they gathered outside and scrounged for scraps of used bandages.

  And that was the bright side of the situation—the bad was a patient had better be of the correct religious sect when going to the hospital or else the trip would be a one-way journey. We all knew if a Sunni went to a Shiite hospital or if a Shiite went to a Sunni place, it was a roll of the dice whether a patient would be assaulted or killed. So when we transferred an Iraqi out of the CSH into the civilian system, we made sure they went to the right place; it was even more important than their being stable enough for transfer. Allah help any Iraqi sent to a hospital without family, friends, or the correct religious membership card. Recently forty patients from the wrong side of the religious tracks went into the hospital in Kirkuk and were dead within twenty-four hours.

  At rounds each morning, no one was vaccinated from criticism from Dr. Quick, but it was the liaisons and translators that caught the most heat. They were the ones responsible for getting patients out the door and into the Iraqi system—as ugly as the system was. Quick wanted the Iraqis discharged ASAP, but to the right place. No sense sending a Sunni to Shiite General or vice versa—all you got back was a dead patient.