In a Tent Hospital, A Close-Up View Of Attacks in Iraq Doctors Face Rising Toll Of Badly Injured Troops
By YAROSLAV TROFIMOV Staff Reporter of THE WALL STREET JOURNAL
BALAD, Iraq -- Shortly after 11 a.m. last Thursday, the crackle of the radio brought the first of the day's bad news to the U.S. Army's 21st Combat Support Hospital.
"Two U.S. soldiers injured," a helicopter pilot said on the radio. "Six minutes to landing." An armored ambulance Humvee rushed to the nearby landing pad.
As the chopper's blades churned up sand and dust near the field hospital, the ambulance driver and the pilots unloaded a stretcher carrying the more severely injured soldier and ran back to the Humvee. Sgt. Chuck Bartels, a reservist, was still clear-headed despite his injuries. His face was bloody and swollen, one of his arms was a mess of torn flesh.
"We drove on that road a hundred times -- and nothing happened before," he said in the ambulance. "I don't know how they got us." With Sgt. Bartels during the bumpy ride was Maj. Beverly Beavers, the hospital's operations officer, who tried to comfort him. "Chuck, I'm glad you're still talking," she said.
The emergency room was an air-conditioned tent decorated with Halloween skeletons and drawings mailed by children from the U.S. Doctors and nurses quickly converged on Sgt. Bartels, 25 years old, and his injured buddy, Sgt. Jared Myers, 23.
In this part of Iraq, deep in the so-called Sunni Triangle north and west of Baghdad, the attacks on American soldiers have become so frequent that emergency medical procedures are now almost routine. Medical personnel here -- one of four such U.S. facilities in Iraq -- have to deal with the biggest influx of military casualties since the Vietnam War. The Iraqi campaign has been producing far more fatalities and nonlethal casualties than the Persian Gulf War in 1991, the Balkans action in 1999 and the war in Afghanistan since 2001.
In a White House press conference Tuesday, President Bush conceded the rising violence, but vowed that the U.S. and its allies would persevere. "Iraq is dangerous, and it's dangerous because terrorists want us to leave, and we're not leaving," he said. (See related article.)
While attention focuses on the number of American soldiers killed in Iraq -- 115 by enemy fire since Mr. Bush announced the end of major combat on May 1 -- the military doesn't generally publicize the more-frequent incidents in which soldiers are wounded. According to a tally kept by the U.S. Central Command, as of 7 p.m. on Oct. 27, the U.S. military had sustained a total of 1,737 nonlethal casualties from hostile action in Iraq, including 1,186 since May 1.
The toll includes American casualties in the rocket attack on Baghdad's Al Rasheed hotel on Sunday, and U.S. military police killed and wounded in suicide bombings that devastated four Iraqi police stations across Baghdad the following day. October has been the bloodiest month for U.S. troops in Iraq since the occupation began.
Advances in medical care and bulletproof vests allow more soldiers to survive the kind of injuries that would have killed them in past conflicts. But the recent switch by Iraqi insurgents to powerful roadside bombs as their main offensive weapon has raised the number and severity of wounds even for those with high-tech protection. These bombs are usually rigged artillery shells that, hidden in vegetable crates, bicycle baskets or simple debris, can be detonated close to their target and shower it with shrapnel.
"Since May, the number and the rate of casualties has increased," says Col. Doug Liening, commander of the 21st Combat Support Hospital, which also operates a facility in the northern city of Mosul. "People in the United States do not appreciate what's going on here." In peacetime, the 21st Combat Support Hospital is based at Fort Hood, Texas, as are many of its personnel currently in Balad.
For many doctors and nurses, the daily gore makes it hard to sleep at night. "It's like a horror movie," says Capt. Nancy Emma, 49, a nurse for 16 years who worked on Sgt. Bartels in the emergency room. "I served in a trauma unit, I saw death in the face -- but nothing like here. And those who live, you've got to wonder how they are going to make it back in the States."
After the emergency room, Sgt. Bartels was wheeled into the operating room. His buddy Sgt. Myers, who received shrapnel wounds in his right arm and face, called his family back in Kansas as he waited to be treated. The two sergeants, reservists attached to the Fourth Infantry Division, were driving from a meeting at the town of Baqouba's agriculture ministry office. They accompanied a civil-affairs officer, Capt. John Teal, who was filling in for their usual captain, on leave in the U.S.
Sgt. Myers asked nurses what happened to Capt. Teal. No one could muster the courage to tell the sergeant the captain was dead, instantly killed by the roadside bomb that went through their unarmored Humvee.
After Sgt. Bartels' surgery was over, he was wheeled into an intensive-care tent and put on a cot next to an 8-year-old Iraqi girl being treated for massive burns. A large, muscular man, the sergeant was called up just as he was finishing his work for a master's degree in Russian studies at the University of Kansas. The operation had left his right arm just a short bandaged stump. Pieces of flesh were missing from his face.
The orthopedic surgeon, Lt. Col. Kim Keslung, sat down after the surgery and sipped Kool-Aid. Her desert-tan uniform was stained with blood. "His nerves and blood vessels were just shredded. There wasn't anything to fix in his arm," she said. "He'll have to adjust to his new life."
Like most doctors and nurses here, Col. Keslung preferred not to venture outside the confines of the Sustainer Air Field, the sprawling base where the hospital is located. "I don't volunteer to leave because I've seen what happens outside," she said.
Many doctors and nurses, deployed to Kuwait and then Iraq, have been overseas for more than 400 days in the past two years, which is considered the upper limit on such deployments. Few expected to deal with such a steady stream of casualties more than six months after the fall of Baghdad.
It was a mistake to discount the Iraqi resistance, Col. Keslung said, adding, "If someone invaded Texas, we'd do the same thing."
As she spoke, new patients arrived at the hospital. Another remote-controlled roadside bomb had exploded near a Humvee that was leading a convoy 10 miles outside the Sustainer base. The blast made the windshield cave in, but it went off too early to inflict serious injuries on the three military policemen from Rhode Island inside the car. They had ringing in their ears, which a doctor said would go away in a week or two.
Specialist Kindre Marines, the gunner who stood on the Humvee, says he saw the blast's flash and instinctively ducked inside before he was hit by the wave of shrapnel. This may have saved his life. After being examined, the soldiers went back on the road.
In the intensive-care tent, Sgt. Bartels woke up. He had known right after the bomb attack that the captain was dead, and he praised Sgt. Myers for driving on to the safety of the nearest U.S. base with a piece of shrapnel the size of a pocket watch lodged in his arm.
Sgt. Bartels spoke in a clear voice, without betraying emotions. "We never even had a close call before," he said. "You just drive around -- and next thing there's a boom, and your life changes." Just before going to war, Sgt. Bartels had a job interview with the State Department, and was expecting a posting with diplomatic security in Moscow. That's not a job he could do without an arm, he said matter-of-factly.
Sgt. Myers, a phlebotomist in civilian life, learned that Capt. Teal, 31, was dead. A few tears fell from his eyes. Sgt. Myers was the driver, while the captain sat in the passenger seat. The agriculture official whom they were supposed to see in Baqouba wasn't there when they arrived; a rich businessman, he was traveling to Canada. On the way back to the base, just before the blast, Capt. Teal complained about the trip.
"Then there was a big puff of dust, smoke and a sharp pain in my arm," Sgt. Myers said. The radio was fried by shrapnel, he said. The captain, who sat between the bomb and Sgt. Myers, took the brunt of the explosion. "If Capt. Teal wasn't there, I would probably have died," the sergeant said.
The civil-affairs team has been lobbying for months to get armored vehicles -- equipment they lack because, in conventional war, civil-affairs teams are supposed to be operating far behind the front lines.
It was dark outside as Lt. Col. Trip Buckenmaier, an anesthesiologist from the Walter Reed Army Medical Center in Washington, walked into Sgt. Bartels's tent and offered him a new procedure that would take away the pain. Col. Buckenmaier pierced the skin atop Sgt. Bartels's shoulder and then tried to locate with an electric stimulator the nerves responsible for the hand and the arm.
As the sergeant's body convulsed, the surgeon kept talking: "Chuck, I know you don't have a hand, but can you feel your fingers moving? Now? And now?"
After finding the nerve, Col. Buckenmaier inserted a catheter linked to a pain-killer dispenser that Sgt. Bartels could control with the other hand. This procedure -- tried on battlefields for the first time during the Iraqi campaign -- allows patients to stay conscious and in control while disabling only the nerves that produce pain from injuries.
"We're kind of pushing the science right now," Col. Buckenmaier said. "War tends to do that." He hadn't finished the procedure when an assistant walked in to say that choppers were bringing in a new load of casualties.
Around the stretcher bearers in the emergency room, doctors and nurses huddled again, both those on duty and those, in gray army T-shirts and black shorts, who were supposed to be resting for the next shift. A Fourth Infantry Division base had just been shelled with mortars in Baqouba. This shelling, like the mortars that rain almost every night in the Sustainer Air Field, is usually inaccurate. But when the attackers manage to hit the base camps, they can cause serious damage because soldiers inside the perimeter don't usually wear helmets or body armor.
Almost 20 soldiers were injured in the Baqouba attack Tuesday night, but only three seriously enough to be brought to Balad by helicopter. A piece of shrapnel had carved out part of one soldier's face and lodged behind the eye; he had also received severe shrapnel wounds in the back. A nurse picked up his blood-soaked ID card to fill in a report. Two other soldiers, a male and a female, had sustained less-serious wounds.
In the morning, Sgt. Bartels and Sgt. Myers prepared for their flight to the Landstuhl Army Medical Center in Germany, the first stop for wounded American troops evacuated from Iraq. Air Force flights to Landstuhl leave Iraq almost every day. Sgt. Myers's parents were already on the way there. Sgt. Bartels, given his injuries, was likely to be transferred quickly to Walter Reed. Col. Buckenmaier told the sergeant he could call the colonel's wife in Washington if he needed any help while at Walter Reed.
That morning, two soldiers were killed and several wounded in a mortar attack on a base in Samarra, less than 20 miles north of here. "This has been a typical workload," said Col. Carol McNeill, the Balad hospital's chief nurse. "We're getting smarter, but the bad guys are getting smarter too."