BALAD, Iraq — The mood changed fast at the U.S. military’s largest hospital in Iraq. An hour after a pancake breakfast for departing nurses, a medic radioed in over the roar of his helicopter: All the facility’s skilled hands needed to be ready immediately for a mass casualty crisis.
Within minutes all medical personnel on this sprawling U.S. air base, home to some 25,000 U.S. troops, were summoned to the hospital — a level of readiness needed only three times in the last five months.
Insurgents had overrun a checkpoint, killing at least eight Iraqi soldiers and wounding about 40 two days before Christmas. Inside this stretch of interconnected tents spanning 35,000 square feet, nurses replaced cushioned chairs in the chaplain’s sanctuary with stretchers, transforming it into an overflow treatment room.
For American doctors and nurses assigned to the Air Force’s 332nd Expeditionary Medical Group, the incoming patients were the latest in an unrelenting stream of U.S. and Iraqi casualties, victims of a conflict that fills their hospitals with over 1,000 admitted patients a month, some 400 of whom require surgery.
Helicopters stream in with wounded
Iraqi patients, many of them soldiers — their wounds wrapped in white gauze, some hobbling on crutches — watched as the first of a stream of Black Hawk helicopters branded with red crosses slowly descended toward this hospital at the Balad air base.
Inside the facility, duties were scribbled on pieces of tape and stuck to nurses’ scrubs to help doctors identify personnel. One tag on the chest of a stocky young man read “Manpower,” one who can carry in patients or equipment.
Over the next half-hour, 17 soldiers — all requiring surgery — were rolled in on stretchers, some with wounds ghastly enough to startle even veteran surgeons. One man with bewildered eyes came in with flaps of skin and muscle hanging from where his lower jaw had once been; others with multiple gunshot wounds cried for their fathers.
“It’s weird, the ones that hit you,” Maj. Julia Woodul, a nurse, said of the hospital’s patients, about 70 percent of whom are Americans.
“Maybe it’s the ones with the color of my son’s eyes,” she said. Or maybe it’s the ones who come in holding Saint Christopher medals or crosses that you have to pry from their hands.”
The atmosphere remained tense as the hospital braced for the arrival of 19 more Iraqi soldiers from the same attack.
And this was a relatively calm day in Iraq.
Still, the chaos brought back memories of the last catastrophe, on Sept. 29, when three car bombs just beyond the base walls killed more than 100 people in this predominantly Shiite Muslim city 50 miles north of Baghdad.
That attack took place on the first day of work for several of the doctors. Each would perform or assist on hundreds of surgeries during a four-month tour.
“You don’t see anything, anything like this at home. This is like a trauma fellowship,” said Lt. Col. Eugene Ross of New York, an ear, nose and throat specialist who would later operate on the Iraqi soldier with the shattered jaw. “You leave here a different doctor than when you arrived.”
Triage in surgery
Whenthe victims began pouring in, one of the military’s three neurosurgeons in Iraq, Maj. Gerald Grant, was performing nerve transplant surgery on an Iraqi with a gunshot in the leg.
Only a few feet away, another soldier in grave condition waited for Grant’s skills. Surgeons flipped the skin of this patient’s face over his skull so Grant could piece together facial bones crushed by a roadside bomb.
Grant tried to wrap up the transplant surgery, peering through powerful lenses strapped around his head to guide his careful stitching, when a third patient was placed on an operating table beside him. The temperature rose above 100 degrees.
Later, with the facial reconstruction only partially complete, Grant and other doctors aborted the procedure to free up a bed for others with more severe injuries. The wounded would fill all six operating tables for seven straight hours as every available doctor treated multiple patients.
“Things move fast around here. You don’t have time to hold everyone’s hand and be sympathetic,” said Grant. “I try to detach myself. It’s not possible to be emotionally involved with everyone, or else it’d get in the way of your job.”
Many of the victims have wounds that likely would have been fatal in previous wars. In this medical age, and because of the skill of the 50 doctors, surgeons, and specialists here, 96 percent of their patients have survived.
'It's all up to Allah'
Word eventually spread that the 19 additional wounded soldiers had been diverted to another facility, a rare moment of relief for the dozens of medics who waited outside with stretchers and wheelchairs.
But the medical need was greater than just the victims of the morning ambush. Throughout the day, dozens more arrived, including a comatose Iraqi soldier with a gunshot wound that tore into his right temple and seared diagonally across his brain.
Although the man had only a minute chance of survival, Grant led a team that removed a swath of his skull to allow his brain to swell without building pressure inside his head. The medical team placed the piece of his skull in his abdomen to preserve the bone’s blood vessels so it could be reattached later if the man survived.
The next day hospital officials searched for the unidentified soldier’s family so they could make a decision about the man, who remained in a coma with his swollen brain now covered by a temporary seal. It was Christmas Eve, and a half-dozen carolers dressed in bright red sang Christmas songs to the dozens of American and Iraqi patients in the hospital.
As the carolers rang out “Hark, The Herald Angels Sing,” the unknown Iraqi soldier lay silent except for a heaving respirator. Some Iraqi soldiers looked up and smiled at the carolers; most were lying quietly on their sides or backs.
“His prognosis is not good. We’d like to bring his family here to make a decision about his care,” Grant said, speaking slowly. “Sometimes the Iraqis just look up to the sky and say it’s all up to Allah.”
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