No Place to Hide Page 8

  I’d chosen the wrong patient to go first. And 1952 might die because of it.

  I tried to quickly finish the repair of the skull fracture. Joe the ENT surgeon walked into the room, his hands held up in the air dripping water. He was scrubbing into my case. “Warren, I can close the scalp for you,” he said. “The other guy needs your help right now. I told anesthesia to get him ready. He’s in OR three.”

  I was shocked. A surgeon from a different specialty was going out of his way to help me. “You sure?” I asked.

  “Yeah, go save that kid.”

  I scrubbed out and ran to OR three. Someone had already shaved and prepped 1952 for surgery. I washed my hands.

  The anesthesiologist had on a lot of cologne. The smell made me realize that all I had smelled for two hours had been burned flesh, blood, and a variety of body fluids.

  The procedure went well, and once I removed the blood clot, 1952’s brain looked pretty normal. I found out later that he was one of the plotters of this day’s attack, and he’d been standing a little too close to the action when the bomb went off. He ultimately recovered enough to be transferred to Abu Ghraib. I’d saved my patient’s life, but he would not have done the same for me.

  Later, when I had time to think about it, I would be thankful for the accuracy of the gunners at the gate. They’d killed the driver before he cleared the fence, so the bomb went off outside the base, killing over twenty innocent bystanders and injuring hundreds. Army medics had risked themselves to bring the most seriously injured people to us. The rest crawled or walked off to whatever medical care they could find in their villages.

  The rest of the day was spent sorting through the remaining casualties, including a few US soldiers from another incident. The seeming chaos in the emergency department, although it never let up much, was never out of control. This was because the Trauma Czar managed it brilliantly. He was finishing his tour, so this was old hat for him by now. He and the rest of our medical crew had been here during the Battle of Fallujah and twenty other mass-casualty situations. They were seasoned; I was the new guy.

  The Czar patted me on the shoulder. “Good job today, Major Warren.”

  “Thanks, Colonel. But I made the wrong call on those two head injury patients.”

  The Czar shook his head and offered a kindly smile. “No, you didn’t. Triage requires you to go with your gut and with your eyes. Your first patient was bleeding a lot, and there was no possible way for you to know what the scans would show. Besides, you got his case done so fast the second patient was in surgery before his films even came off the printer. That was good work. Now go get some rest.”

  He walked away, leaving me for the first time in forty-eight hours with nothing to do. My sixth day in Iraq, and I’d spent it as the only neurosurgeon working a mass casualty with forty victims. Pete had been alone for over a week, so today he slept at the Czar’s command. There is only so much one person can do, he said, and he insisted we take care of ourselves.

  Only later did I realize that the Czar had called me by my name. I felt like I’d made the team, just in time for most of them to leave.

  I was walking out of the hospital when I ran into Joe. “Thanks for your help today, sir,” I said.

  He smiled and said, “That’s what we do here. If you set the right example, the next group will too. And cut out the sir stuff. It’s just Joe.”

  I hadn’t eaten in about fifteen hours, so I headed for the DFAC, thinking about what Joe had said. In a week or so, the new group would be here, and for a few days I would be the most experienced trauma surgeon in Iraq.

  That evening in my ten-by-ten metal trailer with no windows, I prayed and cried and raged into my pillow, thinking of home and the incalculably horrible things I had seen that day. I knew that the past two days had begun to crack open the person I’d been when I arrived here, pouring something into me that would bind itself to my spirit. I was being changed but was not yet sure how. I was sure of one thing: I would never be the same.

  I began to compose in my mind the email I would send to my family and friends back home the next morning. What I was experiencing here was important, and I knew that I had to find a way to do more than simply tell people what I was seeing and hearing. I wanted to allow them to see and feel and taste and smell the war and its effects on me. But I also knew that many of my letter’s recipients would forward it to others I didn’t know. So although I wanted to be very honest about what was happening in the war, I did not want to go into detail about my personal life. To be honest, I was afraid of being judged by some of my relatives and friends, since divorce is inextricably tied to failure and sinfulness for so many of those raised as I was. I couldn’t stand the thought of having to deal with emails from relatives telling me I was going to hell — especially since I was half convinced of that anyway.

  On the plane ride into Iraq I had wondered if perhaps God had given up on me. Now that I’d spent six days here, I felt like he was taking me somewhere. I just hoped to survive the trip.

  When sleep finally came, I dreamt of cracking tibias, the bubbling faceless man, and the teenager’s blank stare as the blinking Christmas tree lights cast their green and blue shadows across his eyes. Mostly, however, I dreamt of that day’s second patient, the terrorist. He told me — showed me — how the attack had been planned and carried out. He said he would do it again — it was his duty. We assessed each other in my dream. His duty was to destroy, mine to heal. He said it was my job to save him — to save him so he could kill me.

  I would have this dream for many years. As I type this paragraph, separated by years and thousands of miles, I can still see his face and smell his blood. 1952.

  CHAPTER 8

  GLASGOW COMA SCORE OF SEVEN

  I had been in Iraq almost a week, and the mass casualty situations of the past two days had rendered me weary and irritable and wondering what week two would hold. Pete led me down a hallway to a door I hadn’t been through before. A sign said “Long-Term Care.”

  “Why haven’t I seen this before?” I asked, stopping just outside.

  “I haven’t brought you here yet because none of these patients have head injuries,” Pete said. “This is where we keep all the non-Americans until they’re well enough to go home or to an Iraqi hospital, or to prison in the case of the terrorists. There’s just one guy we need to see. I’ve been rounding on him every few days. We call him G. He lives near Balad Village, and he was working for the Army as an interpreter until the bombing.”

  “Bombing?”

  Pete nodded his head. “Yeah, the bad guys apparently didn’t appreciate him helping the Americans. They bombed his house. Broke his pelvis. His lower spinal column’s in five or six pieces. We can’t fix it here. His little daughter was badly injured also, burned. She’ll survive it, though. She’s in Baghdad at Ibn Sina.”

  A surge of anger rose through me at the thought of someone willing to blow up a family. The interpreter had just been trying to feed his wife and daughter, but in his society, working with the Americans in any capacity made him a target.

  “Ibn Sina — that’s the Army hospital where our other two neurosurgeons are, right?”

  “Yep. Jeff and Don. Good guys, but they’ll be going home soon. The Army is thinking of consolidating all the neurosurgery in the country here at Balad. One of us is supposed to go to Baghdad for a meeting soon, by the way. They want us to come to them. Baghdad is safer than here.”

  “One of us? That sounded predetermined,” I said.

  Pete laughed. “Well, here’s the deal. There’s a C – 130 with my name on it headed for Al Udeid in about two weeks. Between now and then, the only way I’m leaving the ground is if a mortar blows me into the air. And besides, it wouldn’t be fair for me to go and negotiate about the future of neurosurgery in Iraq when it’s you and whoever replaces me who will be affected by the decisions made.”

  “True enough,” I said, thinking of all the different ways a helicopter ride outside t
he wire could result in my death.

  “And besides,” Pete said as he flashed a huge grin, “I hear Baghdad is lovely this time of year.”

  I shrugged and laughed, reaching for the heavy plastic drapes that separated the hallway from the ward, but Pete grabbed my arm before I could step inside. He stepped in close — close enough I could smell the coffee on his breath — and spoke quietly. “I should warn you. Most of the patients in here are hard-core extremists waiting for a trip to Abu Ghraib or Guantanamo Bay. A couple of them have tried to escape in the past. They’re not that sick anymore, and they can be nasty. One of them threw a bedpan full of urine on a nurse last week. We can’t let them have metal silverware, either, because a few weeks ago one Iranian tried to kill himself. Be careful.”

  My skin tingled. I wasn’t used to being around dangerous people.

  I stepped into the ward and saw twenty or so men on green cots, all staring at the ceiling or sleeping. Unlike the regular wards, none of them had IVs or monitors. Most of them had on casts, bandages, eye patches, or other accoutrements of the injured. It could have passed for a convalescent ward in any VA hospital in America except for the canvas walls and the fact that most of the patients were chained to their beds. Not to mention that there was a skinny Army private with an M – 16, a holstered 9mm Beretta, and full body armor guarding the room.

  Pete pointed to the first bed on the left. “That’s G, the interpreter we need to check on.”

  G lay on his left side, facing away from us. A nurse was behind him, changing a bandage on the man’s back. He was so thin I could see the individual vertebrae in his tailbone. I thought about the story Pete had told me, how G’s family was attacked because of his willingness to work with us. I tried to put myself in his place, wondering how I would feel.

  We stepped around the bed and looked at G, whose eyes were closed. I could see the pain on his face while the nurse packed gauze into a wound in his pelvis. I wondered how bitter he would be, how angry that his little girl was harmed, his own life jeopardized for trying to make a living.

  Pete smiled and placed his hand on G’s arm. “Good morning.”

  G opened his eyes and looked up. The grimace he’d been wearing morphed into an enormous smile, and he spoke in perfect English.

  “Peter! My friend.”

  “G, this is Lee. He’s a neurosurgeon, like me.”

  “If you are like Peter, then you are my friend,” G said.

  I was amazed at the gentle spirit and positive energy that flowed from the kind eyes of this broken man. He had every right to be angry, even hostile. After all, our presence in his country had led to the attack on his family. But G showed only gratitude.

  We talked to G for a while. Pete had to go to a meeting to begin the process of going home in a few more days, so I stayed behind to make rounds and handle anything that came up. I told G I would check on him later, then went off to the ICU.

  As I walked around the hospital, I noticed that everyone seemed tense. Like Pete, all the other doctors and staff were almost finished with their deployments. Surgeons who had never bothered to wear their armor even when Alarm Reds happened suddenly sported their gear. No one wanted to get this far and then get blown up only a few weeks before heading home. I sensed that they were emotionally done with the war, that they’d soaked up all the terror and tragedy they could hold, and they were hanging on for dear life until the end.

  I was walking to the hospital DFAC to get coffee when my pager went off. The screen said “911,” so I headed for the ER.

  “Twenty-year-old Army private,” the medic said as he and his partner lifted the stretcher from the gurney onto the ER bed. “Tank gunner, hit in the head when they ran over an IED. He’s GCS eight, breathing on his own but not talking.”

  GCS meant Glasgow Coma Score, a standardized assessment of someone’s level of consciousness. The score is calculated by adding up points for the patient’s eye opening, speech, and movement. A dead person gets one point for each, meaning the lowest score possible is three. Eight means you’re almost in a coma. The soldier’s brown eyes looked through but not at me.

  “Private, I’m Dr. Warren. What’s your name?”

  No response.

  His breathing was shallow, slow. I felt his pulse, also too slow.

  I removed the bloody gauze from his head. He had a tiny, jagged laceration in front of his right ear, just below where his helmet would have covered. I put on a glove and felt inside the wound. There was a hole in his skull, and my finger slipped into it. Brain material covered my fingertip when I pulled my hand out of the hole.

  He still didn’t move. I reached into his armpit, grabbed a bit of flesh, and pinched him firmly, a standard examination technique to assess someone’s level of consciousness. He extended his arms rigidly, bending his wrists toward the bed. I pulled a penlight from my pocket, flashed it in his eyes. His pupils did not constrict. I ran the GCS scoring system through my head: four points for his eyes being open, one for not talking, and two for extending his arms.

  “He’s not GCS eight anymore, Captain,” I said to the ER doctor. “More like seven. He’s getting worse. Better get him to the scanner.”

  We rolled through the waiting area on our way to radiology. Several filthy, haggard soldiers had wilted onto the couch. The smoky smell the injured private reeked of was magnified. These were his guys. I made eye contact with a staff sergeant, who raised his eyebrows at me. “You gotta save him, Doc,” he said. “He’s going home next month.”

  The CT scan was worse than the one of the other American I’d lost two days before. This private’s brain was full of blood, and I could see a path of destruction across the screen ending at a chunk of metal lodged inside the left side of the private’s skull.

  “It’s unsurvivable,” I said, after mentally running through the criteria to diagnose brain injuries that never respond to surgery. “Take him to the ICU and let his buddies see him.”

  A few minutes later, I walked into the ICU and approached the private’s bed. His sergeant and a couple of other soldiers had their hands on him, praying and talking quietly to him. I put my hand on the sergeant’s shoulder. “I’m sorry,” I said.

  My words felt so inadequate.

  The private stopped breathing a few seconds later. His captain held his hands while he died. Tears flowed, and not just from the soldiers.

  A chaplain entered the room and prayed with them. I excused myself and walked down the hall past the ward where wounded soldiers waited for their evacuation to the States. The lucky ones, I thought.

  Then I silently chastised myself for thinking how lucky it was for someone to have only lost a limb or an eye.

  Later that day, I saw an Iraqi man whose house had been accidentally hit by a mortar. He was brain dead on arrival, and all I could do was close his eyes. The man’s house wasn’t far from our base, and the mortar that killed him had most likely been aimed at us. I shook my head as I walked away, wondering what it would be like to grow up in a country where you had to worry about things like random bombs hitting your house.

  Pete came to my room that night, bringing his friend Brian, a physical therapist who was also in his last few days in Iraq. We watched a movie on my laptop, and before they left I realized how for the hour and a half the movie played, I hadn’t thought about the war at all. I had a new trick.

  After Brian and Pete left, though, the war crashed back in. Every time I closed my eyes I saw the death and destruction I’d witnessed over the past few days. I tried to remind myself that I was a professional, that I’d seen plenty of people die before, some of them people whose injuries or disease exceeded my ability to save them. But this was different.

  Although I’d seen many tragic deaths and many very broken people in my career, I had never made rounds in a hospital ward in which armed soldiers guarded the patients, lest they rise and attempt to kill the doctors. And I had never operated in a tent, in a desert, in a war in which bombs were falling, with di
rt on the floor and dust in the air, where I couldn’t trust the availability of the instruments and supplies I might need to finish a case. Most of all, although I had certainly had another person’s blood on me before, I had never had all of it.

  When I managed to force those thoughts out for a moment, sleep was no safe haven. Nor would it be for years to come. I’d only been in Iraq for a few days, and as terrifying as those days had been, I knew it was going to get worse.

  EMAIL HOME

  Thursday, January 6, 2005

  Good morning, everyone, from LSA Anaconda!

  I don’t think I’ve explained this before, but Balad Air Base is a part of LSA (Logistical Support Area) Anaconda. It’s a huge Army facility that serves as a hub for resupply to the FOBs (forward operating bases). The kids here go outside the wire every day in convoys to take stuff to the forward troops. They are in great danger.

  IEDs are usually made from old artillery shells. The bad guys bury them in the road or hide them next to the road and detonate them remotely. Then when our guys crawl out of their burning vehicles the terrorists shoot at them. The guys here at LSA Anaconda deal with that every day.

  Which brings me to our subject for today: Yesterday I witnessed an amazing act of kindness that really touched me.

  We didn’t have any serious casualties or mortar attacks yesterday, and we were all sitting around waiting for something to happen when someone ran in and said that there were tanks in the hospital parking lot.

  I grabbed my helmet and armor and ran outside. Two enormous M1A1 Abrams tanks drove right into the lot. The crews got out and gave us all a tour of the machines, allowing us to take pictures and ask questions.

  I asked one of the soldiers why they were here. He said that they were from the same unit as the private I told you about yesterday who was killed.