Paradise General

by Dave Hnida

  Five and a half hours and yet another cardiac arrest into the surgery, Bernard and Rick saw daylight. An artery smaller than the narrow lead of a mechanical pencil, almost completely hidden behind a piece of glistening white neck bone. Pulsing away lifeblood second by second, there was no way to clamp or tie off the leaking vessel. Then you could almost see the simultaneous light bulbs go on in Rick and Bernard. Bone wax. A few pennies’ worth of cheaply manufactured material made from beeswax. The guys cautiously wedged in a small piece, then another, and the oozing gradually … slowly … stopped.

  Blood pressure went up. Pulse rate slowed. Bingo.

  “Let’s get out of here real fast, guys,” Rick whispered, as if the evil artery might hear him and start bleeding again.

  It wasn’t a home run, but at least the kid was still in the game. Realistically, the outlook was bleak. He had brain damage, some paralysis, and was still on life support. But at least we might be able to get him back to the States where some of the super-docs could do more than we could in our little tent hospital in the middle of the desert. Back home, his wife and loved ones had no idea of the miracle that Bernard and Rick had just performed.

  We trudged together in the dark to midnight chow, no words between us, just the sand-filled wind in our faces. I thought about the three of us, strangers who by chance volunteered for the exact same deployment, were randomly placed in the same CSH in Iraq, and formed an unspoken brotherhood when we scrubbed in for our first case together. Tonight it all came together for the one case that needed a miracle. We had given it all we had … together.

  At one minute after midnight we heard, then saw, the nightly plane to America. Our guy was on his way.

  Rick finally broke the silence.

  “You know why I didn’t want to quit? The picture of his wife and kids. I don’t know if you guys saw it, but every time I wanted to just let this guy go peacefully, I saw that picture.”

  Bernard broke in. “Man, you saw it, too? I thought we were screwed. Then that picture kept on showing up in my head. It was a miracle we found that bleeder.”

  My smile was invisible in the dark.

  With my mind on his family, as well as my own, I wondered aloud, “I just hope we did the right thing. You know, that it was worth it. I hope she’s okay … and the kids, too.”

  Still thinking, I paused for a second. “I don’t know. Maybe we went too far.”

  But we hadn’t. At the same time that the plane from our CSH was taking off for home, a small group in America was getting ready for their own trip. The U.S. Army was flying the family of our wounded soldier to a hospital where they would see their husband and dad once more. We had succeeded in keeping him alive for an important, final family reunion. They now had a chance to say goodbye.

  Several days later, they turned off his life support and the family donated his organs to others in need. And we suited back up into our mental armor, waiting to see who we would work on next.

  9

  DEAR KIDS

  IT SEEMED LIKE I had already lived a lifetime of war in the course of a few short weeks. Though I tried to call home regularly, there often wasn’t the time or desire to get into the details of life. Most often a call consisted of simply reassuring the person on the other end of the line that all was well. One evening after another eighteen-hour day, I finally had the time to drop an e-mail with a few extra details of life in Paradise.

  From: david.w.hnida@us.army.centcom.mil

  Sent: 06/22/07 23:08

  To: hnidafamily2@aol.com

  Hi Guys,

  We’ve got a little break in the action, so I thought I’d drop a quick note. Man, what a few weeks. We’ve got Internet in the phone tent right next to the ER so I can just run over and type a few syllables when we hit a lull. The computer crawls so slowly, I think it operates on hamsters running on a little wheel—so this e-mail will probably take an hour to write and send. Our phone/e-mail tent is not only convenient, it’s off limits to anyone but hospital personnel and better yet, free.

  As I wrote the kids about the Internet, I thought about our first day in camp when we were almost snookered into buying Internet for our room. For a couple hundred bucks a month, we could sit in the luxury of our quarters rather than wait in line. A couple of guys took the hook and signed up—but it turned out their service is slower than the phone tent and is always breaking down. The guys peddling the service are pricks; it seems someone is always trying to make a quick buck during a war and we docs rotating through must have a “Sucker” sign stuck to our backs.

  I went back to writing, trying to hurry before the next chopper delivered some business.

  But remember, all of our phone calls can be tapped and our e-mails read, so there’s a lot I can’t say or write.

  In reality, there were bundles of things I wanted to tell them, but there were simply too many thoughts, as well as things I simply didn’t want them to know.

  Things have been steady but not too crazy. I run a trauma team in the ER and am the first doctor the patients see when they are flown in.

  And I always pray I won’t be the last face they will ever see. The haunting thought keeps me up at night. My biggest fear is having an overload of wounded come in, then having to pick the most critical and decide to let him die because he’d take too much time and resources from the others.

  The helipad is right outside the door of the ER—

  maybe a hundred feet or so—when a chopper thunders in, the whole camp shakes like a rag doll. The sensation starts in your feet, then slowly works its way up to your teeth. I’ve had a couple of landings where my mouth hurt from the jarring vibrations of spinning blades. We don’t need jeeps

  or vehicles to bring patients to us, instead we use

  large-wheeled stretchers called “rickshaws” which move as fast as the medics can push them. I have to admit,

  the injuries are a little different than what I’m used to back home.

  Like the guy who took some shrapnel to his eye, and when I tried to examine him the bloody jelly oozed down his cheeks and stuck to my gloves. Or the fellow who came in with a rib sticking out of his side—except it wasn’t his rib. It belonged to the guy sitting next to him in the Humvee when it hit an IED. I still haven’t slept through the night yet—too wound up to fall asleep or stay asleep for more than a few minutes if I finally do nod off. But at least I haven’t puked since that first day. But I have lost about ten pounds in the past few weeks; it’s called the “Scared Shitless in Iraq Diet.”

  The best way to describe where I work is to have you flip on an episode of M*A*S*H—it’s like a picture postcard. Mainly tents, a couple of beat-up buildings, even some containers, the kind you sometimes see on the back of big tractor-trailers. Very claustrophobic, in fact our OR is half tent, half container with very little room to move.

  Surgerizing in close quarters made for some uncomfortable coziness. We often wore our pistols and as we pressed against each other, would quip about our discomfort.

  “Is that your pistol, or are you just happy to see me?”

  Or in the case of our resident stud, “Oh, sorry, Bernard. I meant, is that a shotgun or are you just happy to see me?”

  Quarters were so tight, it wasn’t unusual to have the weapon leave a bruise on our legs.

  The ER is in one of the few actual buildings at the hospital. It’s a little ramshackle but it’s nice to have a solid roof over your head. Long and narrow with clanging metal doors at both ends, the wounded come in the front and are taken, the worst first, to the far end. Walk out the back door, hang a quick left, and you’re at the OR tent.

  Guys, you wouldn’t believe this, but there is no door to the OR. Instead there’s an old blanket that covers the entrance. When you sweep the blanket away and go in, you find yourself in a small tent. Straight ahead is OR number 1, to the right, OR number 2. Both small rooms are made from the containers with flimsy wooden doors separating the tent from containers. It seems like a fine, sandy
dust creeps in through every ill-fitting opening and crack. People in the States would faint if they were ever brought to this makeshift surgical suite. So would the surgeons.

  The Army Medical Corps calls our work “Damage Control Surgery.” We had another name for it: spaghetti-and-meatball surgery—a unique brand of fast-food medicine. Simply put, our job was to keep the wounded soldier alive so someone in Germany or the States could do the complicated fancy repairs. There often wasn’t time for us to do anything fancy. When a bullet or a bomb tears the human body apart, you might have fifteen minutes to isolate and stop the pulsating flow of blood from multiple wounds. Take sixteen minutes and your patient dies. Someone’s brother, sister, mother, or father is gone because you were one minute too slow. Our surgeries tend to be a sprint rather than a marathon.

  I’m adjusting okay to life in the desert, just mainly trying to get used to the heat. We hit anywhere from 120 to 135 degrees every day. But at least it’s a dry heat. Then again so is a microwave. We’ve also got this ever-present wind whipping down from Turkey. We call it the “Tongue of Fire.” It blows at a steady, scorching 20 mph and we pray one day it will just get tired and peter out. Whenever you walk somewhere, it feels like someone is pointing a giant hair drier right into your face.

  I don’t think I’ve ever had my contacts stick to my eyes because of heat, but that’s what happened the other day. The whistling of the wind is ghostlike and threatens to drive us insane. The best way to describe it is like having a medical practice on the surface of the sun. If this is a commercial for global warming I’m living in, we are all going to fry one day.

  It’s funny how we hustle from place to place. The buildings and tents are air-conditioned and we trade speed for heatstroke as we journey from one structure to the next. The one place that can get steamy is the OR.

  In the States, operating rooms were kept chilly during routine surgeries to slow blood loss. In Iraq, it’s the opposite—the air-conditioning gets turned down. The warm room helps prevent shock in a soldier who has lost a lot of blood. We’d sweat so much our gloves would

  fill to the point we could empty the liquid into a couple of coffee cups.

  You’d love the crappers here, we have a bunch of porta-johns scattered around the camp, but the best place to drop a deuce is at what’s called the “unisex” bathroom at the hospital. Unisex means just that—it’s for both males and females … simultaneously if necessary. I remember the first day I walked into the unisex. I was impressed—six stalls, no waiting. But the true meaning of the word “unisex” didn’t sink in until I sat down and was suddenly surrounded by female voices to the left of me, female voices to the right—all accompanied by the sounds that come with sitting on a toilet.

  So far in this war, I’d pooped in a barrel, a small ravine, even a sawed-in-half plastic bottle, but never in the presence of females. I was so freaked, I would have shit my pants, except they were bunched around my ankles. After the first few times, it’s become like standing and having a conversation with a neighbor over a picket fence. Talking about the weather or how the tomatoes were growing.

  “Hi, Dr. Hnida.”

  “Hi, ladies. And how are we today?”

  “Fine. Sure looked pretty nasty this morning.”

  “Yup, but the sky is clearing.”

  “How’s Colonel Reutlinger?”

  “A little grouchy. You know, he gets a lot of aches and pains when the weather changes. Then again, he can just be an ornery old coot.”

  “I’ve got some really nice salve from home that’ll make his joints feel good as new.”

  “Thanks much. I’ll tell him to stop by. Have a good one.”

  “See you later, sir. Have a nice day, yourself.”

  Flush.

  The nurses are great. Smart as can be, but soft and tender to everyone that comes through. I’ve already learned a lot from them. Sometimes I don’t know how they deal with the sadness that lies in the beds of our hospital.

  One of their stress relievers, I’d learned, was to light up. Every evening, a group of nurses would gather in some quiet place and puff away on stogies while letting their stresses drain away. The first time I spied the smoke rising from a meeting of the exclusive “Nurses Cigar Club” I did a double take. I never realized women could puff away with the skill, and look, of a bunch of bar-brawling tough guys.

  My quarters are pretty good—better than what I had last time. It’s an actual building instead of a tent, and I have an actual bed instead of a rickety cot and sleeping bag.

  The dump called my room is actually palatial by combat zone standards. The first two floors of our three-story building were once open, cavernous rooms, but add some ill-fitting plywood walls, and doors that don’t shut, and you’ve got housing. Most live two to a room with homemade wooden bunk beds and creature comforts stuffed into every nook and cranny. Not only are you squished, but the plywood is so thin you can hear a symphony of snoring, farting, and groaning when you enter the building at night.

  Some of the rooms have makeshift bunk beds to squeeze out extra room, scary tall and scary rickety. One of the ER docs, Gerry Maloney, fell out of the top bunk the other night and scared the shit out of us. We thought a rocket had scored a direct hit on the building.

  But those quarters are for the riffraff. Three of us lucked out and got the Love Shack, the only room on the top floor, and with it a patio complete with camouflage netting, sandbags to hide behind during a gun battle, and stone floors that heat up to a little under 1,000 degrees on a hot day. We’ve a bunch of pinups on the wall, put up by the original group of doctors to staff the hospital many moons ago. More superstitious than sexist, we are paranoid to take the pictures down. Every day we say “good morning” to Ethel, Edith, Isabel, and the rest of the pinup crew, then add a good-luck pat to their bottoms before walking out to face the world.

  My roommates are cool guys, one is a general surgeon, Ian Nunnally from Ohio, and a family doctor, Mike Barron from St. Louis. There’s just the three of us rather than the twelve I lived with in 2004.

  I lucked out with my roomies. We all work crazy hours so the key is keeping quiet day and night; it seems like someone is always trying to grab some shut-eye. Ian snores like a thunderstorm and likes a clean room; in fact he’s such a neat guy I think he’d vacuum Iraq, sandy desert and all. Mike is quiet as a mouse, sometimes so quiet we’ve put a mirror under his nose when he is sleeping to make sure he’s alive.

  One small problem is my bed—because it is small. The Iraqis tend to be short and I don’t fit very well at six-three on a metal bed frame made for the standard five-eight Iraqi. So I’ve stuffed a sleeping bag for padding over the metal railing at the end of the bed and let my legs hang off. I also have an easy chair, actually it’s a folding chair with no back, but a full roll of duct tape was more than enough to make a solid surface to lean back on. It’s such a piece of crap I think someone would actually have to pay someone to haul it away in a garage sale back home, but here it’s a luxury item.

  The doctors I work with are great guys, better than I could have hoped for. In fact, I don’t think I’ve ever met a better group of doctors. We get along well. As Forrest Gump would say, we go together like peas and carrots.

  My saviors, and those of my patients, came in the form of an odd mix of characters from across America. Seven other doctors who, like me, were reservists who volunteered to get the hell scared out of them. We are young and old; black and white; conservative and liberal.

  My best friend is a surgeon from Oklahoma, a guy named Rick Reutlinger. We met the first day of the deployment and have been hanging out ever since.

  It’s said that opposites attract, and that certainly was the case with my battle buddy. I lucked out when Rick plopped his ample butt onto my lap for that bus ride to Fort Benning.

  We eat together, exercise together, and perform surgery together. Like two grumpy old men, we spend most of our time yelling at each other, especially in the OR.


  “Move your finger, Dave, or I’m going to lop it off! Where did you learn to play surgeon, anyway? Where did you get edumecated?”

  “That’s not my finger, asshead, it’s his penis. Go back to that butcher’s counter at the supermarket back home. They’re asking for you.”

  Despite the yelling, there is never anger in the words. The man has a great bedside manner and truly the patience of a saint, especially when, showing my surgical inexperience, I would try to sew my glove to the patient we were trying to piece back together. (“Jesus, Dave, was you born with ten thumbs?”)

  Rick was a country-smart surgeon who knew his way around the human body better than any cutter I’ve ever met. He was named chief surgeon for good reason, and he’s the main reason I haven’t lost my mind yet.

  Another close friend of mine is Bernard Harrison, he’s a heart surgeon from Minnesota. We sometimes call him Harry.

  You could do a pinup calendar of “The Doctors of Iraq” and could use Bernard for all twelve months. The women in the camp love him; so much so, there seems to be a constant stream of females knocking on his door at all hours. But he’s never let one in; it seems he lives the life of a monk. We know that as a fact because we spy on him all the time.

  He’s also a helluva surgeon and is cool as ice. The guy became a camp legend last week when an Iraqi soldier shot in the chest came into the ER with the bullet lodged in his heart. He was a dead man until Harry cut open his chest right there in the ER, stuck a finger in the bullet hole, then calmly walked into the OR alongside the stretcher like the little Dutch boy with his finger plugging the hole in the dike. One keenly placed cardiac graft later and we had a young man who would hopefully live to a ripe old age.