On the roof of the Baghdad combat hospital during a quiet evening, the medical team comes to unwind. With no alcohol in the war zone, cigars are a big part of the social ritual.
"It's a little slice of heaven," says one man. "A small slice."
It is a moment to escape all the trauma they treat every day.
Back home in Virginia, Darryl Pugh is a general surgeon.
"We never saw anything like this when we were training in the United States," he says. "There have been a couple of times when I have had to step back and say, 'How am I going to deal with this?'"
The seasoned staff is a mix of active military, reservists, and National Guard. Still, the severity of the casualties tests even a 20-year veteran Army nurse like Col. Sharon Williams.
What inner resources does she draw on to deal with it?
"Probably just spirituality, prayer, a lot of prayer, a lot of friends, close friends," she says. "And you know, this is my family here now, and we just kind of draw on each other. I just know I will never forget this for the rest of my life.
Music is one way Dr. James McLane of Honolulu unwinds. When he's working, he thinks a lot about reuniting the wounded with their families.
"If I just get someone home long enough for their family to say goodbye, so they can see them again, it's worth it, worth every bit of it," he says.
Inevitably, there are a few who don't even live that long.
"It's a part of your family that dies," says medic William Wilson from Tupelo, Miss. "It's not just a fellow soldier. And this is your brother, your uncle, your cousin, people you eat and live with every day."
We weren't allowed to photograph it, but every time an American service person killed in action is transported out of here on a helicopter, the entire hospital staff lines up to show its respect. It's called an "angel flight."
After so many injuries and a lot of angel flights, the staff which rotates through for six months or a year starts to think of home.
"When I leave the Army, I am going to find a small children's hospital that does not do trauma," says McLane. "I promise you that. If I never do trauma again after this it won't bother me one bit."
But while they are there, they do their jobs with dedication and compassion.