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  He shook my hand. “Pete here tells me you want to be in the praise band. That’s great! We practice here on Wednesday nights.”

  I looked at Pete. He smiled and said, “Yeah, Lee can play guitar and sing, and he’d love to be involved.”

  Greg squeezed my shoulder. As he turned to walk away, he said, “I’ve been praying for a new praise band leader. See you Wednesday!”

  “You’ve never heard me play or sing,” I reminded Pete. “You’ve only seen my guitar propped up in the corner of my room.”

  Pete smiled and said, “It’s good to have something to do. You’ll thank me later.”

  During the walk back to our rooms, I received a “911” page on my beeper. That meant, “Go to the ER.” Since Pete had been up late the night before, he went to bed and I went to work.

  Awaiting me in the ER was a civilian contractor. For some reason, this mental giant had decided to wander outside when he heard the Alarm Red sirens to “see what was going on.” He hadn’t thought a helmet was necessary. A mortar landed near him, detonated, and knocked him out.

  His CT scan showed a small skull fracture and a minor bruise on his brain. His injuries didn’t require surgery, so I wrote orders for the nurses to manage him overnight in the ICU, and then I walked to the surgeons’ lounge to try once more to call my children. I got a different operator, who allowed the call.

  During the five minutes it took to connect, my heart was aching to hear their voices. Kimberlyn — nicknamed Kimber — was twelve at the time, and I could picture her blonde hair and huge grin when she would answer the phone by exclaiming, as she always did, “Daddy!” Mitchell, then ten, would be the one to ask if I was safe. Even as a small child he needed to know things like that. Seven-year-old Kalyn had been my biggest fan since the day she was born. She would tell me to come home, still not able to comprehend why I had to go. The call finally connected and began to ring. My pulse quickened.

  It went to voicemail for the second time that day.

  I looked at the Christmas-turned-New-Year’s tree, its glowing lights illuminating the back of some worn-out soldier sleeping on the couch, and I wondered if I would ever hear their voices again.

  I passed through the physical therapy clinic on my way out of the lounge. I saw a digital scale on the floor and stepped on, curious about my weight — I wasn’t eating much, and I was walking everywhere in all my gear. One ninety-seven; I had lost seven pounds in seven days. It didn’t occur to me then, but I was wearing boots. I’d actually lost over ten pounds.

  Leaving the hospital, I bumped into the sergeant who had been my chauffeur a few days before. “Been looking for you,” he said. He had my email account set up. He gave me instructions on how to use it and reminded me that every email was screened. Any violation of security could result in a court-martial.

  I went back to the surgeons’ lounge, logged onto a computer, and kept a promise I’d made to my mom a month before. At the reception after my grandfather’s funeral, Mom had passed a list around, and forty or so relatives and friends had written their email addresses down. Mom made me promise to send updates as often as I could. In exchange, the people on the list promised to send me care packages.

  I’d been keeping a journal on my laptop whenever I had time, and I had the email list and the files on a thumb drive in my pocket. I made a group email list and sent the first three letters. I included my wife on the list, hoping she would share the reports with the kids, since they didn’t have their own email addresses. The first two letters — I called them “Day 1” and “Day 2” — covered the trip from San Antonio to Iraq. “Day 3,” which I had written earlier that day, recapped the events from December 30, 2004, through today, January 2, 2005. Now that I had email, I resolved that my reports from then on would be only one day behind. Even though no one in the States would see the emails I’d just sent for a few more hours, I now felt connected to them again. I hoped that when I checked email the next day I would hear from someone.

  Soon I was sitting on the edge of my bed, taking off my bloody socks. I felt completely unsafe after the mortars and the gunfire, and I’d lost even the security of counting on my own skills. Unanchored, adrift in a sea of self-pity and fear, I thought of 1915. His charcoal eyes stared up at me, and I felt incompetent and guilty and utterly out of control. But something else was there, something hazy I couldn’t yet grasp, but I knew I had to find it. I turned out the light and let the darkness envelop me.

  Memories of the day washed through me. I remembered chapel: yelling at God and hearing the bombs. I thought of the Bible story of Job, who’d lost his kids and his fortune and finally his health. But when he questioned God, God put Job in his place: “Gird up your loins like a man; I will question you, and you answer me.” Even though I did not then (and do not now) believe that God sent those mortars to get my attention, as I lay there in the darkness, I believed that questions were being asked of me — questions for which I did not yet have answers.

  I thought about the communion service during the mortar attack, and regretted what I’d written in my email about the experience. I had described that communion as feeling surreal; in retrospect, that wasn’t right. It had actually felt very real: a room full of people united in the purpose of giving themselves for the freedom of others, but sharing a ritual remembrance of another person’s death two thousand years before. As the bombs fell and the tent walls shook, the group of strangers had been acknowledging the sacrifice of one for many, and it changed my perspective. Christian communion is a memorial to self-sacrifice, not self-satisfaction.

  I tied something together in my mind then, something I’d missed before: That was 1915’s blood on my socks, not mine. The little cup of wine represented blood shed on my behalf, not blood I had to give myself. And yet I could sit and yell at God with my skin intact and all four limbs attached and no number written on my chest. My wounds were internal, and no more important than anyone else’s. My why me? questions suddenly seemed shallow and selfish.

  Before I finally fell asleep, I had a vivid memory of a conversation during my neurosurgery training. Dr. Joe Maroon, my mentor and former chairman, taught me a principle used by sixteenth-century Italian sculptors called disegno. Dr. Maroon used the example to describe the way he sees a brain tumor or spine problem in his mind before an operation. He told me how Michelangelo could see David in the marble before he began to carve; all Michelangelo had to do was remove the marble to set David free. Before surgery, Dr. Maroon would envision the least invasive and most direct way to find the problem and repair it — like Michelangelo removing the perfect amount of stone.

  I felt myself being carved, sculpted. Pieces of who I thought I was and how I thought of my life were being chipped away. I wondered what would be left when the Sculptor was finished.

  CHAPTER 7

  I CAN STILL SEE HIS FACE AND SMELL HIS BLOOD

  The pressure wave from a powerful blast slammed into my chest like a linebacker and knocked me down just as I stepped into the common area outside the operating room. The scrub tech, Nate, who had been sitting on a nearby table, was blown onto the floor. Subsonic energy pulsed through my skull; my ears popped, and my head began to pound.

  I didn’t yet know what had happened, but I knew this: people had just died.

  In less than a week of war, I had already become accustomed to the quiet thuds of distant mortars, the slightly louder and more intense sounds of rockets, and the whizzing you hear just before they detonate. I also knew by then that most things launched or lobbed onto the base didn’t even explode — the people launching the mortars and rockets were poorly trained and using old Soviet, Chinese, and French munitions. I was grateful for the high failure rate, but the Alarm Red siren still scared me every time.

  Explosive Ordinance Detail (EOD) soldiers would go out and gather up the undetonated projectiles and destroy them in controlled detonations. The EOD troops blew them up almost daily, and those explosions were very loud, very close, and fortuna
tely usually announced ahead of time.

  But whatever had just blown up was neither on base nor predisclosed. The fence separating us from them, outside from inside, base from Iraq, was two hundred fifty yards from me, known as The Wire. There was a gate, a guard tower, and young soldiers with guns and a tank. Their job was to protect us, and I realized that someone had just tried to kill them. Judging from the force of the pressure wave that had just knocked me down, I figured things were about to get busy.

  I stood, noticing for the first time the fear that took a few seconds to register in my brain. I thought, That was really close.

  The Alarm Red siren began. Nate was still on his hands and knees. He spoke first. “Doc, I better go get the OR ready.”

  “Roger that,” I said.

  EMAIL HOME

  Tuesday, January 4, 2005

  Good morning from Iraq, everyone.

  Two hundred fifty yards from the hospital, outside the twelve-foot chain-link fence that surrounds our base, there are three checkpoints. These are designed to keep the bad guys out, and they consist of concrete barriers, guard towers, lots of men with powerful weapons, and three one-inch-thick steel cables, which serve as the gates. When the guards decide to let someone inside, they lower the cables.

  The cables are called wires, and whenever someone inside the (relatively) safe base has to venture off base, we say that they are going outside the wire.

  Trust me, you do not want to go outside the wire. But more importantly, we definitely do not want the wrong people getting inside the wire.

  They tried to yesterday.

  Around seven in the morning, a taxi brought four INGs (Iraqi National Guardsmen) to the gate. The guards let the car through the first two checkpoints. When the driver let off the four INGs, he hit the gas and tried to run through the third checkpoint. The wire stopped him, and as our guys were firing on him he detonated the car.

  Four ING guys and the driver were killed instantly, and many were injured. Praise God, though, even in this: if he had gotten past the wire, there were a hundred and fifty ING soldiers standing in formation just past the barrier beyond the wire. They would probably have all been killed or injured if he’d made it twenty yards more. Another hundred yards and he would have driven that taxi right into the hospital, and you wouldn’t be getting this email.

  Nate ran right toward the operating room, and I ran left down the hallway toward the emergency department. Others were heading there as well. As I entered the ER, the first group of patients was being brought in through the front entrance. In the midst of the chaos and with my ears still ringing, I had a passing thought: in this world, they are all patients. In the frantic moments of handling a mass casualty situation, the victims were assessed according to their medical needs; each and every one treated with the same skill and degree of effort. This had been drilled into our heads before deployment: it was not our job to judge who deserves our care. We were to treat whoever showed up, to the best of our abilities. In those minutes, they were not terrorists or insurgents or Iraqis or Marines. They were all our patients, wheeled on stretchers by medics who have to cross the wire and go out there when someone needs them. At least I get to stay inside the wire where it’s safe, I told myself.

  Casualties arrived almost immediately. Within minutes of the blast, stretchers filled the ER, the surgeons’ lounge, the hallways — even into the area where we typically stored the dead.

  On my way to the ER, I saw a nurse and a technician doing CPR on a teenage boy, 1954 written in black marker across his forehead. His gurney rested next to the Christmas-turned-New Year’s tree. 1954 looked just a little older than my son, Mitchell.

  Shaken, I paused for a few seconds. The scene seemed to slow down in time; it was as if I were watching a movie. When the perspective zoomed out, I saw utter chaos. People screaming, not all of whom were the patients. Human struggle writ large and real and here — death versus life, good versus evil, fear versus courage, twenty or more plays being acted out with their outcomes yet to be determined. Zoomed in, I saw professionals doing their jobs, excellently. Small kindnesses, hands patted, tears shed, people saved and people lost.

  My brain reminded me to move. I had work to do. I snapped out of it.

  In the hallway I had to step around a pile on the floor. When trauma surgeons cut clothing from the patients to identify their injuries, and orthopedists removed mangled and unsalvageable or already detached limbs, they were dropped on the floor to be dealt with later. I saw a man’s hand resting on someone else’s foot, neither still attached to their owners.

  Medics had delivered to one corner of the room several people who seemed to have mainly head and neck issues. Our ophthalmologist worked on a man who had been looking directly at the car when it detonated, and the shrapnel had irreparably punctured his eyes. His operation would wait until the more seriously injured people cleared the operating rooms. The ophthalmologist taped the eyes shut for the moment.

  Joe the ENT surgeon was working with an anesthetist and a tech to place a breathing tube into a bubbling redness that had once been someone’s face. They failed, and he died two minutes later. They discovered in their efforts that his trachea was no longer connected to his lungs. His suffocation was merciful, as the rest of his body was burned terribly.

  Two men in the first batch of patients were silent. In a world where most people enter our view screaming from the pain of missing limbs, ripped-open abdomens, or burned-off flesh, not talking means there is most likely a head injury. These two were mine.

  The Trauma Czar strode through the room like a general might run the front line, encouraging his troops, shouting orders, forcing decisions. He stopped next to me. “Who goes first?” he asked.

  The decision had to be made now. Time was of the essence, because our resources were limited and people were dying. I stood in the emergency department in the busiest hospital in the nation of Iraq, in trauma bay two, looking down on two badly injured men. Both had head injuries, both needed brain surgery. We had one CT scanner, and one brain surgeon because Pete had the day off. Someone had to go first, someone had to wait. I had to decide; the Czar demanded it of me.

  I hesitated too long, so he repeated himself. “I said, ‘Who goes first?’ ”

  The question hung in the air, awaiting an answer only I could give. My profession does not allow indecision.

  “Come on, Major. Make the call.”

  I was judge with gavel, executioner with axe, Roman Emperor giving thumbs-up-or-down. Someone would be given the chance to live, and someone would probably die.

  I looked down at the two men whose lives rode on my choice, 1952 and 1956. In America, triage usually means, Which not-so-sick ER patient gets to see the doctor first? I’d never been forced to make a real life-or-death triage decision before, because I’d never been in a hospital where we had limited resources before. Here, the one I chose to treat first would have a significantly higher chance of survival than the other man.

  “The guy on the left has a serious scalp wound,” I said. “He’s losing a lot of blood. Let’s get him back to radiology first. The other guy’s still awake; he can wait a while.”

  Orderlies wheeled 1956 off to the CT scanner. The scan would reveal the severity of his brain injuries and tell us whether he could be saved with an operation. During those minutes, the other man waited his turn; whatever was happening to the brain material trapped inside the confines of his skull would continue to happen until I finished treating 1956.

  In San Antonio, while my patient was in radiology for a CT scan, I would likely be in my office, reading or returning phone calls, maybe watching Sports Center. Not in Iraq.

  “Major, hold this guy’s legs,” I heard.

  I turned to see who was calling. A general surgeon was working on a man’s groin. Important parts of patient 1948 were missing; he would miss them if he survived. But he wouldn’t survive the blood loss much longer, and the surgeon needed me to hold up the legs to help him see
. 1948 was still awake.

  In my new role as leg-holder, I headed to the end of the bed. The man had not been wearing shoes when the bomb went off. His legs were obviously broken; cuts and shrapnel wounds and multiple small burns covered them. I grabbed both ankles and lifted. “Alam! Alam!” he screamed. The morphine wasn’t helping. His ankles and calves came up with my lift far too easily — his knees and thighs did not move. I heard and felt the crunching of his compound tibia fractures. The bleeding had stopped now; I carefully let the legs down and walked away, swallowing hard to keep from retching.

  Keep it together, Lee, I thought.

  Nate came in with a message: “Scan’s done, Doc.”

  I ran to radiology past a sea of brokenness, wishing I could keep running, all the way home. A young airman, her blonde hair tightly braided atop her head, sat on a desk crying, her face in her hands.

  1956’s scan showed several skull fractures and a fairly minor bruise on his frontal lobe —straightforward stuff to repair in the operating room. I figured I could get this done while patient two was scanned and prepped for surgery, assuming he needed it.

  A few minutes later I was in the operating room, trying to stop the bleeding from multiple lacerations in 1956’s scalp. At the same time, 1952 finally had his turn in the CT scanner.

  A few minutes later, another tech came into the room holding a mask up to her face. She hung the scan on a light box on the wall. “The Czar told me to bring you this scan, sir. And to tell you that the patient had a seizure and they put him on a ventilator.”

  I stepped away from the surgery table and examined 1952’s CT scan. The scan showed an epidural hematoma, a true neurosurgical emergency. If you remove them quickly enough, the patient usually recovers fully. If you don’t, they frequently die. And the difference in most cases between life and death is minutes.

  1952 had been awake earlier only because the clot was not yet large enough to compress his brain and cause the coma. When I’d seen the two patients for triage, I had been more impressed with 1956’s blood loss and his severe scalp wound, but his brain injury had turned out to be relatively minor.