by Marc Dauphin
You’re afraid of nurses, I hear you say.
You’re damned right I am. Don’t forget: I married one. Nurses will exhaust themselves out of the goodness of their hearts for the patients and the hospital. And they’ll do it without expectation of a return. Yet, when all is well, they’ll stab each other in the back with a smile. And woe to whoever messes with them. If threatened, they close ranks real quick, and can be more aggressive than a pack of cats with their tails stuck in a door. Best to keep them happy. Especially there, since they were all armed.
Anyway, the staff would come in on their days off to give the kids some entertainment, because sitting in a bed all day long watching a procession of badly cracked up soldiers is no way to spend your time — although it does prepare you for life in Afghanistan. So the staff would sit the kids in wheelchairs and take the ones who could walk by the hand, dress them all up in their finest, cleanest Tim Hortons T-shirts (thanks, folks back home), and take them out to the runway to look at the planes. Even the old man, the juice-seller’s father, would let himself be enticed to go watch the takeoffs and landings. And yes, he did make it in time to see something. After all, it’s only a hundred yards from the back door of the hospital to the taxiway.
The juice-seller took it all in, giving his mirror-image kid brother a bunch of advice. I would have liked to know what he was telling his brother, and I guess I could have asked the interpreter to tell me, but that would have felt like prying. Even though my emotions (and the staff’s) told me he was our kid, we all knew that, at some point, we’d have to let him go.
That day of departure was the only time I ever saw him cry. He didn’t want to be transferred to the civilian hospital. But he had to go. We didn’t need to perform any more surgery on him, and he was occupying a precious bed in a military hospital, a bed that was needed by a soldier. In the last image I have of the kid, he is crying his heart out as he’s being loaded on the ambulance that would be taking him away from us, and his father is asking Joëlle for a letter from us telling the Afghans to care for his boy. After all, he told Joëlle through the interpreter, if the order comes from the Canadians, maybe they’ll listen.
I never found out what became of the boy, and I never asked. But every time I went out the gate, I looked around to see if there was a nine-year-old mirror image of him selling juice to those long lines of truckers. I never saw anybody. And that’s why I didn’t want to learn his name. And also why I didn’t want to get into his story. It wouldn’t have hurt as much that way. Oh well, c’est comme ça. We can deal with the pain later. When we get back home.
Now back to when the kid was first taken into the OR. As soon as that happened, the four Canadian casualties came in. On previous rotos, I was told, Canadian colonels and adjutants and sergeants-major would show up when their boys came in and follow them into the trauma bay area, out of concern for their soldiers’ welfare. After all, they are legally and ethically responsible for those boys. But on our roto, with double, even triple the number of casualties, we had to orchestrate the crowd. First step: none of these officers in the trauma-bay area.
Colonel Savard, my boss, explained it to them this way: “This is our battlefield, against death. We don’t go out and interfere in your battlefield. Please respect ours.”
That did the trick with most of them. And for those who wouldn’t or couldn’t understand, we could always sic Dave on them … No, Dave wouldn’t shout at colonels and generals. This was, after all, still an army, although admittedly the hospital was a somewhat dishevelled collection of crazily dressed professionals who, between traumas, goofed off in about half a dozen different languages. No, Dave knew how to use the words that would cut anybody off at the knees; words that would make the person feel real small, and very, very stupid. No general could survive that.
In an administrative way, Annie, the OC of the Canadian Role 1, was medically in charge of these soldiers. They belonged to the Canadian commander, and Annie, through Lieutenant-Colonel Wojtyk, was responsible to him for all that pertained to their health. I was responsible for the soldiers’ critical care during their time in my hospital, but as soon as they crossed the exit, and sometimes even when they were still in my hospital, they belonged to Annie. That was fine with me, as I could concentrate on what I do best: coordinating and giving care. It was Annie who called the base surgeons in Canada to tell them what to say to the families, and to help prepare the casualties’ homecoming. Same with the crew in Landstuhl. And, most important to me, it was Annie who was responsible for talking with the colonels, and personnel officers, and sergeants-major, and adjutants. Technically, I could have done it also, and I did do it when Annie was on leave, as this area was somewhat of a grey zone and had, in some of the past rotos, I am told, led to some friction between the OCs of Role 1 and Role 3. Something about territory. But Annie and I go way back, and we’re the kind of people who solve such dilemmas by saying, “Okay, you do this, and I’ll do that. Agreed?” No long meetings about insignificant shit for us. Just get the job done. It’s the result that counts. How are we ever going to get accustomed to normal garrison life after this?
Sergeant-Major Dave Marshall and I await the arrival of at least three casualties (three rickshaws at the ready). We decided to pose for posterity. If it hadn’t been for Dave’s patience, I don’t think I would have survived the tour. This is late in the roto, and the temperature outside is probably in the low to mid forties — quite balmy after a hellish summer. Our faces reveal our exhaustion. Well, mine anyway.
Major (now Lieutenant-Colonel) Annie Bouchard, OC of the Role 1. She was responsible for giving primary health care to all Canadian personnel in southern Afghanistan, and for all the medics who accompanied the troops.
Anyway, as soon as those commanders showed up at our back door, Annie kept them well behind the red lines that the previous rotos had painted on the asphalt for just that purpose. Annie kept them company. She kept them informed. And she kept them out of our way.
Anybody who observed the arrival and unloading of casualties at our back door saw just that: wounded guys being taken off ambulances and placed onto gurneys, then wheeled in to the trauma bays. Simple. And that was okay with me. The better we were, the less anybody would see of the complexity. Sort of like Tiger Woods (yeah, I still like him) hitting a golf ball: guy walks up, addresses ball, swings, ball goes 350 yards. Simple, right? Now you do it. Same for unloading and triaging — except for the little added stress that we were dealing with life-and-death issues.
Here’s what you’d have been missing:
When the choppers landed at a predetermined spot on the tarmac, and the ambulances drove up, also to a predetermined spot (sometimes even as the chopper was coming in above them — try that on a civilian airfield), they kept their rotors spinning. As soon as the casualties were off-loaded, the pilots took off and went to the other end of KAF to refuel. Hot refuelling is quite an interesting process in itself, but it’s also another story. Once that was done (the refuelling, not the story), they’d come back to our place and land to pick up their flight med techs. When many casualties came in with staggered arrivals it could cause some confusion, because we couldn’t always tell if a landing chopper was carrying incoming or just picking up its crew. Do we send an ambulance crew out or not? So we devised a hand signal for med tech pickups. You stretched your right hand in front of you, palm facing the side and thumb up, then you slowly closed your hand into a fist as if you were grabbing a glass of beer (I wish). Then, with fist closed and thumb extended, you moved your hand up. Neat, huh?
Awaiting six incoming. Weather as usual.
Dust-off landing on the taxiway. If the helicopter can produce that much dust on a paved surface, imagine what it is like out in the countryside.
The hospital had three ambulances. They were used, among other things, to drive out onto the tarmac to load casualties. All our staff who went out onto the tarmac had to pass an exam that covered driving out there, walking, radio, and hand-s
ignal procedures. Master Corporal Stryker, in addition to his other duties, was the person responsible for tarmac discipline. And the Air Force doesn’t have a sense of humour. I guess they don’t like seeing a multi-million-dollar aircraft go up in flames with its crew because it crashed into an errant vehicle. And they don’t like seeing some idiot walking into a tail rotor and getting his head sliced up like a cucumber. C’est comme ça. So, even if you were a general, if you hadn’t passed the exam, you didn’t go out onto the tarmac. It was that simple, like the little guy used to say.
Once the incoming chopper was in sight, the ambulances drove to a predetermined spot. The crew got out, opened their back doors, and stood in another predetermined position as the helicopter landed at its designated spot. At that point, if you were out there, you were basically breathing mostly dust mixed with a little bit of air, and you were deafened by the whine of the turbines and the flap-flapping of the blades as ten tons of metal, jet fuel, electronics, armaments, crew, and wounded were being kept from slamming into the asphalt by the strain on those four blades. The worse the injuries, the faster the chopper would come in and the more sharply it flared up to land. If the helos arrived with the wind at their backs, at this point, just before landing, they would hover while putting their noses sharply down, and swing their tails around before flaring, to land facing into the wind. Some of those pilots were tired. Some had just been shot at. One had even crashed into something when taking off from the pickup zone and he was still shaky when he landed. All that made for some pretty hairy landings sometimes. I’ve ducked more than once on seeing a wobbly landing. If one blade of that rotor touches the ground, pieces will immediately be flying in all directions. Mucho fasto. You better duck. It happened to my friend Pierre Voyer, who was nearly decapitated by a piece of blade that flip-flopped right over our heads.
Pierre was the deputy commanding officer, the DCO, Colonel Savard’s assistant during the mission. We go back a looong way. Years ago, Pierre had been the regular force officer at the Sherbrooke Field Ambulance where I worked, before he moved on to other jobs. When he heard that I was coming back in the CF, he vetted me to the CO — quite a risk for a guy you haven’t seen in years. Thanks, Pierre.
That day we had the close call, Pierre was at his desk in that huge semicircular tent where the HQ of the Canadian Health Services Unit was located, just behind the hospital, when he heard this ungodly whoop-whoop. It turned out a non–Med Evac helo had tried a tight landing next door and had clipped off the ends of its blades when the landing area had proven a little too tight. The ends of the blades flew right by the hospital without hitting anything. I didn’t even realize that we had escaped death that day until Pierre told me, months after we got home. Sometimes you have to be lucky. C’est comme ça. Thanks for watching over us, Mom.
Okay, so the helo had landed. From now on, because of the noise, all communication was through hand signals. Once the chopper was down, the flight med techs on board opened those sliding doors and signalled to the amb crews which casualty to take off first.
Even something as simple as sliding a stretcher off the helo can lead to bungling, even the dropping of a casualty. One day, an over-enthusiastic (non-Canadian) padre decided he was going to do his padre stuff right there on the tarmac. The amb drivers told him that he wasn’t tarmac-qualified, but he just ignored them. He was, after all, a lieutenant-colonel and the drivers were just privates and corporals. What did they know? When the padre got near the helicopter, the first two stretcher-bearers had already pulled the soldier halfway out of the chopper, and so, when the padre bent over the casualty to do his sign-of-the-cross thing, the other three stretcher-bearers thought he was actually grabbing his handle on his corner and they all pulled. You can guess what happened. Luckily for the casualty, the flight med tech was very quick and caught the stretcher before the casualty fell off. When Stryker told me about this incident, I told Colonel Savard. I guess she must have spoken with the padre’s CO because we never saw that guy in our lines again.
So everything was rehearsed, even taking the casualty off the chopper. Then, the four stretcher-bearers (plus one or two med techs if the patient was being ventilated or if IV bags were on) walked to the designated ambulance and loaded the patient on the left side. Loading was also a well-rehearsed event. You placed your hands a certain way, and lifted in a certain way. It was all synchronized through hand signals, as you couldn’t hear a conversation because of that big beast with spinning rotors right next to you. Besides, you were wearing ear plugs.
The worst casualty was off-loaded first. Sometimes that casualty was doing so badly that the amb was waved off as soon as the casualty was loaded. The flight med tech decided. His or her authority was unchallenged.
Sometimes they’d load two stretchers into an ambulance. In that case, if there was a second stretcher-bearer team, these would wait until the first team was clear of the rotor before moving in. Roto 6, the ones before us, had really drilled this into us. They were a disciplined, smooth bunch.
Sometimes two helos carried in wounded and landed at the same time. Sometimes two helos arrived simultaneously from two different and unrelated missions. In that case, the worst-off casualty may very well have been in the second, or even the third ambulance. It was the ambulance driver’s job to inform us, the unloading and triaging team waiting at the hospital’s back door, of what he was carrying. As he was driving up, he’d use hand signals to tell us how many were on board and what their status was. Then the ward master, who was the chief traffic cop, would direct the amb to the left or to the right. The ward master had a global picture of what we were expecting, so he adapted to the casualty’s needs, but also in relation with the others. Once the amb was where the ward master wanted it, he’d bang on it with his open hand as it went by, yelling “Whoa!” That, by the way, was the only yelling permitted.
On the way from the helipad, the driver signals “one casualty.” He will go on to tell us via sign language what the patient’s status is.
Unloading casualties and placing them onto a gurney was a lot more complicated than it seemed. First of all, not all stretchers were the same model. Then, some stretchers would have collapsed on the way, and the gurneys would not secure a collapsed stretcher. It took three very strong people to reopen a stretcher with a casualty on it. Even powerful guys had to get under it and use their legs to reopen it while the others pulled the handles apart. And it seemed more difficult when it was carrying a bleeding, screaming casualty, especially if the casualty was bleeding on you while you were lying on the burning asphalt using your feet to pry the stretcher’s bars apart. Well, you get the picture.
The priority of casualties could change on the ambulance between the landing pad and the triage area. The med tech in the back of the ambulance would tell us on arrival, as in, “This one first! This one first!” No questions were asked, and the patient was unloaded.
First, two supply techs would each click out a stretcher handle before grabbing it and slowly pulling the casualty out, coached by the med tech on board. A casualty with protective armour, weapon, and ammunition could easily weigh three hundred pounds, and it was not easy to slide one out by pulling on a handle, especially doing it slowly, under a baking sun, while breathing in exhaust fumes and dust. Not to mention all the noise from the chopper, the screams of pain, and the orders. I’ve seen diminutive med techs putting both feet up on the bumper of the amb and throwing themselves backward to help them start a stretcher moving. As the casualty was being pulled out, sometimes a flapping arm would catch onto the side, or a monitor would become entangled, or an IV line would hook itself. Thus, the pulling was done slowly so that any order of “Hold it! Hold it!” was immediately obeyed. Canadian ambulances were designed to offload stretchers much more easily. There is a mechanism whereby the stretcher can glide out on a rail that angles down for easier offloading. Yeah, real smart. Except for one thing: many of those casualties were in shock, or barely avoiding it, compensating with
everything they had. If you angled them down you sent what little blood they still had to their legs, away from the heart and lungs, and precipitated them into an irreversible and fatal spiral. So, no using the fancy mechanism.
As soon as the stretcher was halfway out of the amb, the two other handlers moved up and lifted it up by the sides, passing it along hand to hand until they got to their far handle, which they had to unclick before grabbing, then turn as they lifted. Sounds easy, right? Just hit the golf ball 350 yards. Simple. Then, the stretcher was deposited onto the gurney under the coaching of the crouching ward master (or Dave, during out roto, if another amb was requiring the ward master’s attention). The hooks on the underside of the stretcher had to be deposited just right or the stretcher wouldn’t be secure. Then the amb driver (usually) tightened the wheels that clamp the stretcher onto the gurney, while the PAD clerk started his thing, the stretcher-bearers were chomping at the bit, and the triage officer (that was me) determined the bay number according to his teams and the casualty’s condition.
The PAD clerk was all over the casualty, wanding, touching (The heck with the blood, dirt, puke, and the rest; I have to feel), and asking questions, if the casualty was conscious: “Any grenades? Any ammo? Any knives? Any bayonets?”