The first time Jose Ramirez saw a human body ripped apart by a rocket, it took hours for him to regain his composure. Nothing in his training as a Navy medical corpsman had prepared him for the sight of the dead Marine brought in September to the military field hospital outside Fallujah.
"I walked around in shock," said Ramirez, 26, of San Antonio, a Navy petty officer third class attached to Bravo Surgical Company. "I've seen people die before on the emergency room table. But what I was trying not to do, what I was trained not to do, is look at the patient with tunnel vision. It reminded me that I had to get prepared."
Two months later, when the first wounded American and Iraqi troops arrived at the hospital after storming Fallujah, Ramirez had braced for the worst.
"It doesn't hit me when I'm working on a patient. But after we're cleaning up, and I see the blood on the floor or I see someone bagging a piece of arm or leg, I know it's going to be in my mind for the rest of my life," Ramirez said.
Fifty-one U.S. troops have been killed and 425 wounded since the ground assault on this insurgent stronghold began on Nov. 8. Although U.S. commanders say they control the city, Marine units are still going door to door to root out the remaining fighters, sometimes with deadly consequences.
Medics at the Bravo Surgical Company's field hospital, where all the battlefield dead and wounded are brought, said the injuries that troops sustained in the Fallujah fight were unusually devastating, most of them the result of close-range explosions.
"They're just horrific injuries," said Chief Petty Officer Damon Sanders, head of the shock stabilization team. "We saw an increasing amount of shrapnel wounds. Typically there are one or two people who take the brunt of the blast, and the rest of the guys take shrapnel."
Sanders, 36, of Temecula, Calif., said the injuries sustained in Fallujah were more severe than those typically suffered in Iraq, largely because the insurgents had been in control of the city for months and were ready to fight.
"It's when you're waiting, you give the enemy time to set up," he said. "When they're running, they can't do as much."
'It blew up behind me'
Marine Lance Cpl. Davi Allen said he saw little action in the first days of the Fallujah offensive. But last week, after the city had mostly been secured, he and his platoon -- part of the 1st Battalion, 3rd Marine Regiment -- were clearing houses in one of the northern neighborhoods that troops swept through at the start of the offensive. After going through about 50 houses, Allen, 21, of Cloverdale, Ore., was looking around the small living room of a residence when he heard gunshots coming from the kitchen.
He looked over and saw a grenade roll into the room. The house's windows had bars on them, and the grenade was too close to the doorway for Allen to make a run for it. He said he had no choice but to ride it out.
"I balled myself in the corner and waited," he said. "It blew up behind me."
Two Marines were injured and one was killed in the attack. Medics brought Allen to Bravo Surgical with 24 pieces of shrapnel in his backside. One of the corpsmen who treated him was Ramirez.
When Allen recounted the tale last weekend, he was standing outside the hospital, sipping a soda. Ramirez dashed by to help carry an injured Iraqi detainee to a waiting ambulance, then came over to talk to Allen. They share an interest in rap music, the two said, and Ramirez repeated a promise to bring Allen some music.
"I knew eventually I'd get hurt," Allen said, cuts still visible on his hands and arms. "I was lucky just to get a grenade. I just want to go back home and see my wife."
Ramirez said the hospital prepared for large numbers of wounded troops before the battle began. But he and his colleagues did not prepare for what he called "the walking wounded." At the last minute, the corpsmen set up a tent to deal with patients who were not brought in on stretchers. Another tent was set up for Iraqi detainees. That freed up some space for the seriously injured, he said, but so many were carried in that a lounge had to be turned into a triage room.
"When they told us we'd go into Fallujah, many of us thought we'd see gunshot wounds, but not people with limbs already amputated due to the blast," Ramirez said.
He spent a lot of time reassuring troops that they were getting the best care possible. "There was one soldier, and I needed to put an IV in his arm," Ramirez recalled. "He was really nervous, and I told him, 'Look man, you just survived a blast.' "
'Almost like a machine'
Sanders said the hospital staff worked around the clock during the height of the battle, particularly as troops pushed into Fallujah's southern neighborhoods and confronted a hard core of better-trained insurgents.
There are days, Sanders said, that he and his crew will never forget.
"You're seeing your brothers come in, but you can't see them. You're almost like a machine," he said. "The history we've gone through here will forever make us family. If we see each other 10 years from now, not a word will have to be spoken."
During a recent break, Ramirez imagined facing his mother and what he would say to her. He joined the Navy 8 1/2 years ago to become a medical corpsman after her breast cancer was diagnosed. A single parent, his mother raised him to be the best at what he did, no matter what path he chose, Ramirez said.
"I would honestly be afraid to go back home and tell my family I didn't perform the best I could," he said. "I couldn't look my mother in the eye."
In the distance, but close enough for the ground to shake, an explosion thundered, sending a dark mushroom cloud toward the clear, blue sky.
"We'll know soon enough if it was incoming," Ramirez said, stretching his legs. "I will shoot if I have to. I have shot at people, but that's not what I'm here for. I'm here to save lives."
A few minute passed, then a half-hour, and no ambulance raced to the door of the hospital.
"There's just one thing I want you to know," Ramirez said, before turning to walk away. "There is a corpsman in the memorial of Iwo Jima. He's a pharmacist mate, second class, John Bradley. He was there in the fight. Most people don't know that."