Thirty seconds. They sit in their little green Gator medical transport at the
edge of the helipad and wait. Two young men, blue hospital scrubs, trainers
on their feet, helmets.
They should be here soon. Private Bowie Sessions glances at his watch. A
minute passes.
Always the same routine. The radio receiver crackles: “Choppers incoming, ETA
thirty seconds.” They grab their helmets, wipe the sweat from their brows,
feel the tightening in the pits of their stomachs. One of them starts the
motor, his buddy jumps up alongside. A tight curve to the left, away from
the gate, accelerate past the smoking area to the helipad. Turn to face the
hospital, motor idling.
Five minutes. Still nothing. Sessions’s gaze takes in the sandy-coloured
landscape.
Over there, behind the white hospital, surgeons suck on their evening cigars
on the roof of the staff living quarters.
Over there, in the shadow of palm trees, the morgue’s refrigeration units hum
quietly.
Over there, to the east of the Tigris in Baghdad, a pillar of smoke is rising
– a car bomb or artillery fire.
And now, coming from beyond the row of containers surrounding the helipad, a
familiar swack, swack, swack.
The first thing you make out is the red cross on the jet-black belly of the
Black Hawk.
The two choppers approach from the north over the canteen. A cloud of dust is
thrown up by the vortex and sweeps into the faces of the nurses. The men
grab their helmets and get out of the Gator to wait behind the concrete
barrier.
The helicopter wheels touch down on the asphalt. The flight medic swings open
the sliding door and gives a thumbs up.
The nurses run through the gust, necks hunched into shoulders, scrubs
flapping. Sessions grabs hold of the stretcher, his companion taking the
other end.
The men stagger with their load to the tractor’s platform. The medic jumps in
clutching his helmet. Sessions steps on the gas. All you can see of the
patient is a bloody hand poking out from the blanket.
At the ER, everything is ready. The previous patients have been moved to CT
scan and from there to an operating room upstairs. Blood has been swept from
the marble floor, bandages and bits of tubing dispatched to the garbage bin.
The nurse in charge, Captain Sophia Li, has written the details on a
whiteboard: “VBIED. Traumatic amp/RLE.” Car bomb, left leg severed.
They carry the stretcher to room 1. The curtain is drawn closed. The nurses
take hold of the edges of the blanket and lift the wounded man onto the
examination table.
The flight medic turns to the duty doctor, Lieutenant-Colonel Paul Benfanti.
“Iraqi policeman . . . roadside explosion . . .”
“Okay. We need an interpreter!” The blanket comes off. The extent of trauma is
immediately evident, but nobody says anything.
A crushed little finger is the least of the man’s injuries. His left arm hangs
limply because of the massive hole in his wrist. The right leg is attached
below the knee by less than an inch of skin. The left leg still dangles by
virtue of a few fibres of muscle, but the skin is already a deathly yellow.
“He’s had a bad day . . .” “Scissors please.” A quick snip. The leg comes off.
Someone opens up a red garbage bag.
On the second floor in operating room 1 seven professionals prepare for the
task ahead. Scalpels flash, rubber boots squeak, and country rock rings out
from speakers attached to an iPod.
“I shoulda been a cowboy . . .” There’s a crush in the room. The nature of the
patient’s wounds means that in addition to the nurse, the scrub tech and the
anaesthetists, there are four surgeons present, two for each limb.
“Dr Aydelotte, do you need the saw?” “I shoulda been a cowboy . . . That
song's been going through my head all morning.”
“Gigli or electric saw, doctor?” “Let’s have both.” The lift bell rings. The
doors open with a thump. ER nurses push the Iraqi policeman in and tip him
from excrement-covered sheets onto the operating table.
“Where’s the armrest?” “Sergeant Settles, have you seen the armrest?”
“We’re keeping the arm?” The middle of the patient’s torso is covered with
drapes, the bandages are removed from his extremities, and cleaning
commences. A nurse lifts up the ragged leg. Another nurse wipes the stump
with a cleaning solution until the skin is golden brown. Then the left arm
is placed onto the armrest and the crushed wrist is disinfected.
Major Jayson Aydelotte glances at the left leg, which is flopping on the table
like a cracked prosthesis. “Okay.”
“We start there?” “Might as well.” The nurse hands over the electro-cutter.
Aydelotte pushes the electrode into the muscle. There is a dull hissing
sound as the electric current burns away the tissue from the stub.
A pungent smell fills the operating room.
“I shoulda been a cowboy . . . I should’ve learned to rope and ride . . . Say
yeehaw . . .”
And so it goes on. There is hardly time to clean the tables in the emergency
room before the radio crackles again. The medics sprint to the Gator,
adjusting their helmets, and soon the buzzing of the Black Hawks is heard
again.
The columns on the whiteboard are filled with details. “GSW abd.” “IED,
shrap-nel/face.” Patient sent for scan, next one in, whiteboard cleaned. A
quick hamburger lunch standing up, then the clatter of the next air
delivery.
Two American soldiers have their skin speckled with shrapnel and dirt.
An Iraqi soldier spits blood into a bowl – a sniper’s bullet has entered
through his cheek and exited from under his chin.
An elderly woman, a gaping shrapnel wound in the back of her head, hisses out
insults when the nurses try to undress her for examination.
Bloody body armour and hastily cut boots pile up on the floor in the
reception.
Gunshot wound, chest. Left arm amputated. Punctured eye.
Iraqi soldier, bullet hole in lungs and trachea. Needs red cells and frozen
plasma. Condition: critical.
Young woman, age 27. Bullet penetrated base of skull behind right ear.
Conscious but vomiting. Transfer to neurological hospital if survives.
Patient. Injury. Procedure. Tube into mouth, drip into vein, waste matter into
red bag. And so the hours go by.
As dusk falls, the canteen opens. Fried chicken and pasta salad are ladled
onto plastic plates. The day shift will rest on full stomachs.
BEHIND the hospital, beside the morgue, an orderly lights the incin-erator.
Piled up in pushcarts, garbage bags fly into the flames. Tubes, bandages,
masks, gloves, lifeless tissue and shattered bones burn to ashes and rise up
in a plume of smoke between the palms. The smell is heady, but no one
notices it.
Off duty, they wear black shorts and grey T-shirts, and rifles are slung over
their shoulders.
At work you nurse the patients, at leisure you nurse the stress. That’s what
seven months have taught them.
Each has his own way. One runs around the helipad until he can’t breathe,
another is hooked on pea-nut-butter cookies, a third punishes a pingpong
ball until his arm drops.
In a third-floor supply room, nurse Victor Settles plays Beethoven’s Moonlight
Sonata on a keyboard.
Every month nurse Jake MacGre-gor runs a race around Saddam Hussein’s former
palace. Most of the route snakes between 13ft-high blast walls, but at one
point you can see a sliver of Baghdad in the distance. That’s the high point
of the run.
At night, the lights are on. On television, the army shopping channel chatters
away to an empty corridor. Stretchers screech against the floor as a sweaty
medic hauls them back to the helicopter.
In operating room 2, an American soldier’s leg is amputated from the thigh.
The saw bites away at the bone until the flap is large enough to cover the
stump. Nobody says a thing. The iPod plays U2.
Second floor. A long, silent corridor. The American soldiers’ rooms lie to the
right of the reception, beyond intensive care. The Iraqi patients sleep at
the other end of the corridor: women, children, policemen, soldiers and
wounded insurgents, eyes blindfolded, handcuffed to their beds.
Four years ago, when the hospital was called Ibn Sina and was still Saddam
Hussein’s private clinic, ordinary people were not treated here. But then
there was no war either.
There are only 74 beds. Nobody stays here for long. The Americans continue
their journey onwards after a few hours. Those who have got off with only
superficial wounds return to war after a moment’s rest. The seriously
wounded – missing legs or arms, burnt or paralysed – are shipped off at
night by helicopter, flown to an airbase north of Baghdad and transferred
home by way of Germany.
The Iraqis leave in the morning. They are packed into military ambulances and
driven through the heavily fortified green zone to check-point 1. There they
are lifted out into the heat alongside the barbed-wire fence, flies buzzing
around their wounds, and Iraqi nurses transfer them, groaning, to local
ambulances.
An American soldier waves them on. The ambulances jerk into motion, and the
wounded disappear behind the blast walls to the red zone.
On a table half way along the long corridor there is a stack of Bibles. A
young woman sits in a small office with a book in front of her. Clutching a
crayon, her hand moves confidently over the page, and a strawberry-shaped
house is given a bright pink surface.
Private Kelley Cox has been colouring books since she was a kid. In this work,
the best time for Strawberry Shortcake and Muppets is at night. Then there
is nobody about to sneer at a 23-year-old woman looking vaguely silly and
concentrating earnestly on Miss Piggy’s frock.
A touch more there; that’s it. A gentle hand colours in the strawberry leaves.
When the phone rings, the chaplain’s assistant puts her crayons and books into
a drawer, takes a Bible and walks down the stairs to attend to the dead.
In quiet moments she sometimes finds herself wondering how she ended up here –
what has become of the world when a business major finds herself bidding
farewell to body bags in Iraq.
Her home town has never seemed so far away. Flomaton, Alabama, has 1,200
inhabitants and a ramshackle downtown area full of churches and gas
stations. Everyone knows everyone and it’s no place for a recently divorced
young woman to escape her past. For Flomaton’s youngsters, the army is a
good alternative, a new start.
Cox selects a new crayon from the box. There should be a yellow sun above the
strawberry house.
THE call comes early in the morning. Cox walks downstairs. The deceased is
ready on the table in a body bag.
A four-year-old girl has been shot in the stomach. The nurses have tried to
resuscitate her in vain. This is a bad moment, she can see it on the faces
of the night shift.
The orderly pushes the cart out through the back door. Cox walks behind him.
The morgue is at the end of the alley. Inside, they turn the cart around.
When the girl’s face is pointing towards Mecca, Cox pulls open the zipper
and places a Koran on the girl’s chest.
“Dear Lord, give the parents of this child the strength . . .”
The door slams closed behind them. The orderly pushes the empty cart, Cox
following on behind.
The days are all the same, only the injuries change. Nobody follows the news.
The results are there to be seen on the ER table.
When an Iraqi man in a suit, his pink shirt in shreds and face covered in
blood, walks in, nobody asks what has happened. Suddenly there are 10 men,
and the day shift finds out that a bomb has exploded in the Iraqi parliament
just over a mile away. But there is no time to think about it, for a
writhing patient, his face scorched black, has just been lifted onto the
examination table.
Outside the room the line grows longer, the cries for help grow louder and
shrapnel wounds bleed onto the marble floor. Along the wall, there is a row
of black shoes, in one a mobile phone, in another a wad of bloody dinars.
The worst thing is inactivity. Sometimes they wait behind the reception for a
whole shift doing nothing. The first hour slips past by joking around. Then
tension sneaks into their voices. They start taking glances at the radio.
When the whirr of a helicopter is heard far off, their muscles tense. But
the call never comes, and the whiteboard remains empty.
The hours go by. Lunchtime has been and gone, the examination rooms swept
three times over.
Almost unnoticed, their minds begin to dull the memories of the previous
emergency. For a moment life feels different – normal. Then they remember
where they are. And the waiting continues.
Still, you mustn’t hope for a busy spell. It’s an unwritten rule. You can’t
even think: “If only something happened.” And you can’t tempt fate. You
can’t say: “It’s a quiet day.” Unguarded pronouncements are all too often
followed by an emergency.
MAJOR Brian Krakover’s first thought is: he’s my son’s age.
Krakover walks behind the stretcher-bearers to the examination room and draws
the curtain closed behind him. You have to fight off your feelings. The duty
doctor may not have a lump in his throat.
The boy is perhaps four, thin but not stunted. His eyes follow the doctor’s
movements vigilantly. He doesn’t cry, but when the doctor touches the hole
on his side he says: “Ouch.”
Somebody has scribbled some information in Arabic with a felt tip pen on the
child’s brown chest.
“Medic, what happened?” “We drove into an ambush in Fadhil, sir. The little
guy was standing on a roof watching. Who knows what hit him . . .”
“Where are the parents?” “There was no room for his mother.”
A nurse sticks a drip into the boy’s arm. A pulse oximeter is attached to his
finger to follow the amount of oxygen in his blood. Someone tucks a toy duck
under the boy’s arm.
“Looks like it grazed the abdominal wall.”
“Scan and then upstairs?” Krakover thinks of his three-year-old. When he
returns from Iraq they’ll go to Disneyland.
“Yes. Have to open him up.” Operating room 1. The nurse proffers a cutter.
This time the only sound accompanying the operation is the swishing of the
surgeon’s gown.
The boy’s stomach opens up readily. The surgeon sticks both hands into the
cavity and starts to examine the organs one by one. The left lobe of the
liver. The ventricular fundus. Flexura lienalis. There it is. The scalpel
cuts off a piece of the small intestine that a stray bullet has grazed.
The room’s swinging doors open with a thump and a wounded American soldier is
wheeled in, his side dripping blood from a gunshot wound. The nurses lift
the big man onto the operating table opposite the boy.
The surgeons begin to open his stomach. The bullet has pierced the large
intestine and hit the man’s spine. The soldier is paralysed.
In the evening a warm breeze rocks the helipad palms. The Black Hawk’s flying
lights send white lustrous swathes onto the asphalt.
The hospital staff stand at the edge of the field, the duty staff in their
blue jackets, the off-duty doctors and nurses wearing shorts.
A Gator leads the procession from the morgue to the chopper. A soldier walks
in front of the tractor.
A bell rings out four times in the dark. The departing man is from the navy.
Hands rise in salute.
“Commander Phillip Murphy-Sweet departing!”
The escorts grasp the body bag by its straps. The bag disappears into the
helicopter’s open door.
The whine of the turbines intensifies. The swirl of dust brushes the faces of
the onlookers, who stand rigidly to attention. Whipping rotor blades lift
the Black Hawk into the air.
Behind the palaces, in Baghdad, flares flash in the sky.
Patient. Injury. Procedure. Check pupils, ready a drip, fill out the forms.
A quick puff in the smoking area, then another rush.
A dusty Humvee speeds in through the back gate. In the ER they can tell from
the howling motor that the arrivals are in a hurry. The nurses rush out into
the yard.
The vehicle stops, brakes screeching. The armour-plated left back door slams
open.
“F***! Open the goddam door!” An American medic runs around the Humvee and
sets about wrenching open the other back door. A nurse tries to help but the
soldier pushes him aside.
“F*** off!” Eventually they get the door open and start to pull the wounded
man out. He is big, the doorway is tight, and the stretcher tips.
“F***!” Stretcher inside, patient on table, curtain closed. Nobody has time to
ask what has happened. Expressions are tense.
A nurse cuts the soldier’s boot-laces with scissors. The feet are pallid.
Sergeant Richard Baldwin climbs onto a stool beside the table. Hands one on
top of the other, and resuscitation begins. One, two, three, four, five . .
.
The medic swallows back his tears. “He was conscious, but then . . .”
Underneath the wounded man blood from his pelvis seeps on to the floor.
The nurses change shifts. Resuscitation continues: five, 10, 15 . . .
A Belmont machine pushes blood into the veins and straight through the wound
onto the table. The soldier dies.
The men sit in the hospital chapel on green plastic chairs, helmets under
arms, dirty and broken.
Nothing could be done. The doctor’s words are calm and assured. They nod, but
the doubt remains.
What if they had got the Humvee door open faster? What if the stretcher hadn’t
fallen?
They stand up. Rifles clank against body armour. As they walk out they pass
the drawings taped to the chapel walls.
American families have sent self-made crosses to support their countrymen. On
one picture someone has written in crooked handwriting an old verse:
America, in God we trust, we fear no tyrants horde: There’s light that leads
toward better deeds than conquest by the sword; Yet our cause is just, if
fight we must until the world be free Of every menace, breed or caste that
strikes at Liberty.
In the morning the sky is red. Nobody knows the reason. Perhaps heavy rain has
lifted dust from the ground. Maybe a sandstorm is coming. Iraq’s nature is
capricious.
In the hospital ward the little boy lies on his back in an armchair, popping
mint candies into his mouth and watching cartoons on DVD. The wound in his
stomach is sore, and he can’t stand up without bending.
An Iraqi woman dressed in black walks in. Her eyes take in the boy. Her hand
goes up to her mouth. The nurses realise straight away who the woman is.
They call for an interpreter.
The mother moans. Her tears come unbidden. The boy says nothing, but a grin
spreads across his face.
“You can hold him if you like,” the nurse says.
The interpreter translates into Arabic. The mother shakes her head.
“No, no, he’s sick!” The woman strokes the boy’s forehead. Then she covers her face again. A muffled voice asks the most difficult question: “Will he still
be a normal boy?” The following morning they walk out through the front
door, the black-hooded mother, the crouching four-year-old.
After security they turn left, walk around the blast wall and step onto the
street. The sky is cloudless. They sit in the back seat of a taxi. The
driver starts the engine. The boy clutches his treasure to his chest. In the
bag there is a colouring book and mint candies.
On the other side of the hospital in the ER reception, the radio crackles.
“Choppers incoming, ETA 30 seconds.”
The medics grab their helmets. The green Gator is waiting, nose facing towards
the gate. The men climb up into the front seat, the key turns in the
ignition.
On the helipad the Black Hawk’s wheels touch down on the asphalt. The sliding
doors open. The medic shakes his head, there’s no hurry.
The body bag thumps onto the Gator’s platform. The tractor circles around to
the morgue, where a doctor is waiting.
The zipper opens with a squeak. The doctor looks at his watch. A nurse records
the time of death.
© The New York Times Company 2007
