by Marc Dauphin
So we call Pierre, Colonel Savard’s deputy commanding officer (DCO), the go-to-to-make-something-happen guy. He won’t get any special bravery medal for this, his second roto in Afghanistan, although he’s been shot at multiple times, and has borne it with a cynical fatalism. He won’t get any outstanding-job-we-couldn’t-have-done-it-without-you recognition or anything of the sort, and he isn’t expecting any. He just wants to get the job done and go on home to get on with his life. He’s a no-nonsense straight-talker. And, like I said, he gets things done.
Well, even Pierre can’t get this one done. He gets the go-around, too. The big go-around. The one where he gets to talk to the Brits, the Aussies, the Dutch. The whole rigmarole. But sometimes it’s more important to be lucky than to be good.
We just shut the ward down and condemn it for the day, as the temperature, under that hot canvas, is hitting the low fifties (no kidding!). It’s way too hot even for the locals, who should be used to this kind of heat. This is when a bunch of Canadian combat engineers hit an IED. They all have varying typical blast injuries, none of them life-threatening, but severe enough for them to be sent back home. It’s late afternoon when they come in, and early evening by the time they’ve been operated on, CT’ed, and stable enough to be transferred to the ward, which, by this time, has been reopened. The temperature there is back down into the mid to upper forties. Cooler, but still very hot. But we’re running short of beds.
The engineers’ officers come in to see their guys before they leave for Landstuhl. Pierre, who hardly ever came into the hospital (he says it smells too much like blood) is here. When the OC of the engineers’ company exclaims at how uncomfortable it is in the ward, Pierre just grins.
“Let me tell you about our A/C …”
An hour later, a huge truck arrives, followed by a crane. They unload and connect the most massive and most illegal A/C I have ever seen.
You gotta love engineers.
The little fellow’s leg had been blown off during the winter and our predecessors had patched him up. Winter is usually quieter, war-wise, and they had had time for charity projects. The boy’s other leg had been mangled and had healed with a vicious, retracted, tough, thick scar, and he couldn’t straighten it out. He needed follow-up surgery, so we took him in. One bed at all times for a goodwill project. That was my compromise between the immense needs of the Afghans and those of my soldiers. Sometimes I even worked my way up to three goodwill beds. But that was all I dared spare for civilians not directly wounded by the war.
So we admitted him for what we knew was going to be a few weeks. The kid needed at least three operations. He just lay there quietly in his bed. We gave him a few toys, donated by some generous and thoughtful people back in Canada, and he accepted them without a smile. I guess, in Afghanistan, kids learn not to attract attention to themselves. So they don’t cry much either.
His father would come visit him often. The man would just sit on the boy’s bed and stare at all the activity, not saying anything. You couldn’t help wondering what he was thinking. Then, one day, there was a VIP visit. I don’t remember who it was. Maybe even the governor general. On those days, Colonel Savard, the CO of the Canadian Health Services Unit and of the hospital, and my boss, would guide the VIPs through. Sometimes there’d be cameras and reporters. Sometimes, if Lieutenant-Colonel Wojtyk wasn’t with her, I’d have to be there with my boss to answer medical questions. It’s not bad work (unless I’m busy). Hey, maybe those VIPs will be impressed with my work and order the CF to leave me my major’s stripes when I come home. Just kidding.
So it was that we had moved the kid to that tent ward we’d just opened. As Colonel Savard was guiding the VIPs through, and showing off our new ward, there was the father, so totally engrossed in what he was doing that he didn’t even notice us. The man was sitting on his son’s bed with a colouring book and some crayons, and he was patiently trying to fill in the lines with his clumsy strokes. It was obvious that he had never done such a simple activity as that. One which we take for granted in North America.
Some images stick in your mind. This is one of them. I guess it’s not easy for anyone in Afghanistan. And I am reminded that adults were children one day.
A bearded old guy just came in. Old, as in Afghani old. He’s forty-five, maybe even fifty. A bullet clipped him right under his arm. Now he can’t move his legs. As soon as they took him off the ambulance, I noticed the paradoxical breathing. That’s how a person breathes when only his diaphragm is working. Not a good sign.
The CT confirms what we thought: the bullet shattered his T4 vertebra and ripped his spinal cord to pieces. He’s paralyzed from there on down. Forever. In Afghanistan, “forever” won’t be long. Being paralyzed in this country is a death sentence. This old guy is condemned. We can’t keep him here and provide the special care he needs. There are no civilian hospitals to keep him. No wheelchairs (there are no sidewalks, the streets aren’t paved, and pushing a wheelchair in the dust is not easy). Even if we could give him a wheelchair, he would die anyway. He would eventually (quite quickly, actually) get a bladder infection and die. There is no health care here. Even in Canada, where people have an education that lets them understand our health care as being different from magic and sorcerers, and where we can teach you the principles of sterility and contamination, paralyzed people who have been trained in sterile bladder care still get infections. And if he doesn’t die right away, the man will still be a burden for his family. Sooner or later they’ll ask Timmy the Talib to get rid of him for them. Or they’ll just take him to a deserted field and leave him there. And our old man perfectly understands this. We all feel bad for him. He bears it all with such dignity. He just stares at the ceiling.
“Where do you live?”
“Far away.”
“Do you want us to call your family, to bring them to your side?”
“No. They are too far away.”
“How come?”
“I am nomad.”
The MPs come. They run tests on his hands for gunpowder residue. They are positive. This was a bad guy who had been most likely shooting at our people. We’re probably the ones that shot him.
Later on in the evening, he started to tire. The only way he could keep breathing was with his diaphragm. All his other muscles are useless, paralyzed. And the diaphragm won’t do the job alone. Not for long anyway. He felt himself going. That’s when, through the interpreter, he told the nurses about his wife and his son.
He was a nomad. He fed his family by working for the poppy growers. And this season, like all the seasons before, when the poppy season was over, the Taliban told him that he owed them money for the food they had given him. Even if he had known how to count, in Afghanistan you don’t haggle with the Taliban. So the old man did what he was told. He picked up the Kalashnikov they lent him, and he followed their leader. Then he got unlucky. Or he was simply too unskilled. Poppy pickers do not soldiers make. Even if they have their very own AK-47.
He simply had no geographical notion. He just went where they told him. And he didn’t know where it was that he had left his wife and child.
He passed away in the wee hours of the morning, at that hour when, if you are suffering, everything seems so bleak and hopeless. It wasn’t a pleasant passing. It’s never calm and peaceful to slowly smother and choke to death. We did give him some drugs to alleviate his panic, yet …
Afghanistan is not a place for the faint of heart.
I hate some of those Special Forces units. Some are gentlemen, but others act like thugs whose motto is, according to us, Deny everything, admit nothing, counter-accuse.
Such was the case with this unit.
A tractor was driving along a road and blew up. There were five men on the tractor. Two of them survived, were treated at a Role 2, and were transferred here. “Not bad guys. Just civilians,” the people at the Role 2 assured us. Just civilians, my ass.
As soon as they arrive, our interpreters hide their faces.
They know right away. It’s a Friday and, like the interpreter says, “Nobody in Afghanistan works on a Friday. It’s hard enough to get them to work any other day, let alone a Friday.”
So, what were they doing on a tractor? Besides, we found out that they were miles away from any arable field. They had supposedly blown up on an IED, yet according to the flight med techs there had been no hole in the road where they had blown up. It just didn’t make any sense. The most likely explanation is that they were on their way to plant an IED when it blew up on them. The injury pattern certainly supports this.
It’s when I see the chest film of one of them that I start to really get angry. On any chest film you get the shoulders. That means you see the tops of the humeruses. This can give you an idea about a person’s age. And this kid is no more than fifteen. More like thirteen; maybe even twelve. His bones not only haven’t fused, they aren’t even about to do so.
These are bad guys, and what’s worse, they’re using kids.
So I phone up the Special Forces and ask for their doc. I guess the lack of sleep hasn’t made me any more patient: “Tell your people that we may be ignorant, but we’re not stupid. Tell them that if they don’t send me an armed guard right away, I’m not taking on any more of your patients.”
I guess it doesn’t make for smooth inter-ally relations to talk like that, but I am not to be mollified. I won’t endanger my people for the SF’s bullheadedness, and that’s that. These bad guys don’t think anything of blowing themselves up. They certainly won’t hesitate a minute before grabbing a nurse’s weapon and going out in a blaze of glory, taking a few infidels with them. Or grabbing anything that happens to be around — an IV pole, monitor wires, the monitor itself — and use it as a weapon. Only the week before, a bad guy with a broken pelvis (albeit with an external fixator) had tried three times to get out of bed. That is, until Shrek had explained things to him. He had just picked the guy up with one hand, put him back in his bed, and, pointing with a stern index finger, said just one word: No! Fortunately, the guy had understood.
This I proceeded to explain to my colleague from the SF. (Of course, if I wasn’t so darn tired I would probably have worked the problem through and come to the conclusion that maybe some higher authority was needed, and passed the problem on to my boss, Colonel Savard, or to Lieutenant-Colonel Wojtyk. But when you’re lacking sleep, you’re not thinking straight, although you think you are.) And the bad guys are here. We need some action now on the guard issue.
Well, the American SF react to my call. They send me a lawyer-type who proceeds to explain to me that since they can’t absolutely prove that these men are bad guys, then they won’t consider them as such.
“But this is not some f---ing court of law! I don’t want to prove that they are bad guys,” I say. “I just want my people protected if they are!”
But the SF admin-type is not to be swayed. He just turns around and leaves, all calm and bureaucrat-like, leaving me to look like the agitated fool that I am.
(Fortunately, that particular SF unit left a few weeks later. Their replacements were much more professional and certainly more helpful. It got so that I had a lot of time for those guys and would go out of my way to help them. And also fortunately, for us, that day the Canadians had captured a guy after they had shot him, and we were taking care of him. They had a guard on him, and that guard agreed to keep an eye on our two Friday strollers. Still, you never really trust the SF guys.)
Three Afghan soldiers. Buddies. Two of them have shrapnel in various locations. Nothing deep, though, so we remove the pieces, stitch them up, and they are free to go. Not so their buddy. He has some large pieces deeply imbedded in his brain, in both hemispheres. Unsurvivable. We are palliating him. His comrades don’t understand why we don’t work our “magic” on him. They are getting restless. Enough so that the staff grow uneasy and inform me of this.
I wander over to the soldiers, who are their companion’s bedside in Bay 8, where we put him while awaiting the inevitable. They are dressed and ready to go, but wish to stay by their buddy’s side. That makes sense. I look over at the man. He looks calm, peaceful with his head wrapped in impeccably white bandages that the blood is only beginning to seep through and his arms calmly by his side. It’s difficult to believe that he only has minutes to live. I can understand that they don’t want to believe us. I meet their surly gazes and nod once. “Tell them to follow me.”
The ’terp, unsure of himself, glances at the weapon I carry. It is not unknown that Afghan soldiers resolve issues with their weapons. It is not frequent, thank God, but not unknown. Just a month ago we had the shoot-out at the OK Corral.
The soldiers follow me. I take them to the main radiology monitor. I retrieve their friend’s CT scan and put it on for them. In simple terms, I explain to them what they are seeing. They are impressed by our technology. They didn’t know that we could see inside someone’s head. They are especially fascinated by the way I flick the images by holding the left button of the mouse and moving it to scroll between slices, moving up and down their friend’s brain like I’d seen Denis do. They are convinced now that their friend is dying, and are no longer surly.
“Tell them to come with me.”
I take them back to their friend’s bedside. “Please say the last prayers.”
We stand respectfully. Two passing nurses join us. Thank you, ladies.
Then I tell them to put on their headgear, and stand them at attention. I also put mine on and say, “Here is a soldier who is dying so that others may live. He deserves the utmost respect a man can give another.”
I salute. They imitate me. We shake hands. I leave.
What do you say to a pilot whose bird has crashed, when he is alive and three of his buddies have died?
How come these boys are back with us again? There must be dozens of infantry companies out there. Yet it’s always boys from that one company who are in here suffering from heat exhaustion. What is it that their commander doesn’t understand? This is the third time in two weeks. He must be acting like that incompetent in Band of Brothers who had his men force march without letting them drink. Unacceptable. I tell Lieutenant-Colonel Wojtyk. He’ll deal with it.
I look at the poor soldiers. One is confused. One wants to go back because he feels he let his buddies down but he can’t stand up without fainting. Another is crying silently. It all makes for a tense scene. Fortunately, we don’t receive any casualties while we are taking care of them.
An hour later, they are in the new ward. It must be forty degrees in here. They are all eating silently, just wolfing the food down. A half-hour later, in spite of the screeching of the jets taxiing by, they are all sound asleep.
That night, Lieutenant-Colonel Wojtyk informs me that their company commander has just won himself a one-way trip back to the U.S.
C’est comme ça. Thank you, sir.
We lost a soldier. He’d been squashed by a piece of heavy machinery. His heart had exploded like an orange that’s being stepped on. When they opened his chest, a veritable fountain of blood spurted higher than the surgeons’ heads.
Captain B and the vascular surgeon, Major Brown, tried, but they couldn’t fix the unfixable. On the OR floor there is a centimetre of blood. Captain B is so covered in blood that he squishes as he walks from the OR to the TOC from where he’s called one of his friends in Bastion for advice. This friend is also a heart surgeon, and the co-author of the medical textbook we use in the ICU. They exchange a few words, then Captain B walks back to the OR to change, leaving bloody footprints behind him.
In the trauma bays, Major Brown is sitting on a chair beside Sonya, one of the orthopaedists. They’re not talking. His forearms rest on his thighs and his head hangs. I pull up a chair and sit silently beside them. They’re not discouraged. Only tired. Very tired. They haven’t slept in thirty-six hours. I’m lucky. I managed to catch two or three hours.
We just sit there, not saying anything. Sometimes, when we get a lot of c
asualties and the adrenalin is flowing, Major Brown calls for push-ups after we’re finished. To my surprise, I can do fifty now. So can Sonya. But right now we’re just too tired to even talk.
Then Major Brown stirs and gets up. “So …” He sighs.
“Yeah …” says Sonya.
I just nod. “Try and get some sleep.”
On every roto, we get one. On Roto 3 they called theirs “Red Man” because of the colour of his clothes. The instructors at the McGill Trauma Simulation Centre had prepared us for this, complete with pictures and a play-by-play analysis of how to deal with this unusual condition. During a firefight, one of the bad guys gets shot in the lower part of the face, sort of like our young kleptomaniac. Technically, it’s only a flesh wound, so it doesn’t completely incapacitate him like one to the chest or the abdomen would.
But when the lower part of your face is shot up (or “away”), you can’t lie down: you’ll choke on your blood. Besides, if you don’t have a lower jaw, there is nothing to hold the rest of your face away from your airway. So, if you lie down, what’s left of your tongue, jaw, and mouth will collapse on you, blocking your airway.
But with this type of injury, since you’re not incapacitated, you can walk away from the battle. And if you’re a bad guy, you certainly don’t want to give up. Usually it takes a couple of days for these casualties to come to terms with their predicament. By which time they’ll just show up here. And after a couple of days of drip-dripping, the front of their clothes are, well, you guessed it, caked in it.
So it is that we now have our Red Man. Yup, on every roto there is one.
We let him sit up on the stretcher, and prepare to intubate him only at the last second, just before we operate. Now this can be a hair-raising, hair-whitening experience, because once you put him under, you’re committed. So it is that I go to my office and grab my last remaining Airtraq. Just in case.