Combat Doctor Read online

  Then came the hardest part of it all: not to let that big old surge of adrenalin carry me away into a state of euphoria. Concentrate on your duties, Marc. It didn’t help that the soldier’s CO, some U.S. Army colonel, walked up to me and squeezed my arm with tears in his eyes. “Cool as a cucumber, doc. Thanks.” Well, maybe I imagined the tears, but the guy sure was emotional. I guess it’s not easy to watch your soldiers get injured or killed, especially if it was you who sent them out into harm’s way. Hey, don’t worry, Colonel. It wasn’t you. It was them damn Taliban and their friends the Wahhabi fanatics that started it. After 9/11, we should a nuked … well, that decision is way above my pay grade. And it’s probably why I’m not a general. Or a prime minister.

  That was the night before. By the next day the soldier’s CT had revealed nothing that required an operation, he was in the ICU, and the plan, no doubt, was to try to wake him up that day. Well, I knew enough and didn’t feel that I needed to stick around for rounds. So I made my way out to the ward, where I exchanged a few friendly insults with Jimmy, the day nurse. He used to be a private in my reserve unit while I was a major. Now he was a registered nurse and a captain. I was told that when we got home I was to be downgraded to captain because when I transferred from the reserves to the reg force, they made me a captain. I was a major only as long as I was in Afghanistan. Nothing personal, they told me. It was just the system.

  C’est comme ça.

  Satisfied that all was well, I made my way back to my office, stopping along the way to grab a bottle of water and a Danish. Like every morning, I poured in two teaspoons of orange Gatorade powder and drank it while reading my emails. They say routine gives you a sense of security. Dave walked in. His office was behind mine. He gave me his news after doing his version of rounds: the oxygen concentrator that was threatening to go on the fritz was now repaired. It was a faulty bearing and they had changed it. The electrician was coming that afternoon to change the inlet box, or whatever it’s called. The one we had was rated somewhere around 340 amperes, but the day before we were pulling 450 out of it. He couldn’t understand how we hadn’t blow the whole thing up. Or set fire to the hospital. I involuntarily gazed up at the plywood ceiling, the plywood walls, the plywood floors. Jesus, it wouldn’t take long to burn the whole thing down. I wondered if we’d all have time to get out. I suppose I’ll get to find out if a rocket ever hits us.

  Well, once the box was replaced, we should be okay. “See if we need to clean out those A/Cs again,” I said.

  Dave nodded. There was so much dust floating around that the air conditioners were forever clogged up, and thus, less efficient, therefore pulling more amperes. Not recommended in fifty-degree heat. Well, at least we wouldn’t conk the power out all the time. It had happened three times in the past week. Always around 1500 hours. The last time, the OR staff had to finish operating with flashlights. No big deal, they said, although it would make dramatic stories in the media. But it was the blood fridges I had worried about. It was incredible how quickly the building would heat up once the power was out, and with it, the blood fridges. I didn’t want to lose those hundreds of units. It would have been a disaster, not just for us, but for the whole war.

  Absentmindedly, I hacked up some more of that Afghan dust. There were rumours floating around that the dust was 50 percent fecal material. They had been disproved, but it still felt like you were breathing in shit — and then coughing it back up.

  Dave looked at his watch. It was time. I made my way to the coffee room/nurses’ lounge/doctors’ lounge. I called it the bullpen, because no matter what hour of the day or night you checked in, there were always at least a couple of specialists snoozing there, or typing out reports on the hospital’s only two common computers, or reading last week’s paper from New Zealand or Liverpool or Ottawa or Springfield, or checking their email on the unit’s only internet computer, or just shooting the shit. I always felt like I’d just need to pop my head in and yell, “I need a surgeon!” Sort of like when the manager signals for a right-handed reliever. Sonya, one of the orthopaedists, an ardent photographer, once took a picture of three of them sleeping on the couch and the easy chairs, and she printed it with the caption: “Per minute cost for a surgeon in a War Zone: $$$$$$$$$$$$$$. Comfortable chair/couch: $0 (second-hand). Having a well-rested specialist at a moment’s notice: PRICELE$$.”

  I still cherish it.

  The room filled up rapidly. The military is like that. People are on time. The “grand rounds” started at 0830 sharp, always the same way. Rob, the assistant chief of nursing, another huge man, and a good comrade, would tell us the joke of the day and get cheered by the guys and booed by the women. That day it was something about a fellow arriving home and telling his wife to fill up her suitcases because he’s just won the lottery. And when she asks him if they’re going to the mountains or to the sea, he quips back, “I don’t care. Just as long as you’re out of here by 1700.” When the booing died down, we all looked at the board as the physician in charge of each patient told us the plan for that patient for that day.

  When we first got there, the attitude had been relaxed; but as the pace of operations picked up, and we started breaking all previous casualty records, I applied pressure to get patients out as soon as they didn’t absolutely need our care.

  For our wounded soldiers this was no big deal, because we’d fly them out as soon as they were stabilized and there was a plane available. They generally didn’t stay more than twenty-four or thirty-six hours, and sometimes they were out in even less. But civilians would stay for weeks because the Afghan health delivery service was out. Conked out. On the fritz. Kaput. You transferred patients to the local civilian hospital (always during the daytime, as the road was unsafe at night — actually it was unsafe at any hour, but hey, those people lived here. They had to get out sometime) and those patients had better be able to eat on their own. Oh, and have someone to take care of them as the nursing staff there wouldn’t help them get up, wouldn’t help them change, wouldn’t change their dressing, wouldn’t take their vital signs. I was told they liked to watch Indian soap operas. For Afghan National Police (ANP) and Afghan National Army (ANA) soldiers, it was easier. Just a few kilometres outside the gate, at Camp Nathan Smith, they have this wonderful new hospital called KRMH (Kandahar Regional Military Hospital). It was all made of concrete, the corridors wide and the rooms spacious. The concrete part was important because that meant it was rocket-proof.

  We were supposed to move in to a brand new concrete hospital, but its construction had been delayed. Not by the builders, but by some bureaucrats. My bosses told me it was okay to tell that story. You see, it’s a NATO hospital, so, to allocate the necessary funds, it takes a vote — a unanimous vote. Apparently, there was a delegate at the table who was all pissy at Canada for not voting for some other project, so he vetoed the allocation of NATO funds for our new hospital and delayed its construction for a year. That’ll teach those upstart Canadians. I hoped we didn’t burn down before we had the chance to move into the new building. Both for his sake and for ours. It’s a good thing I didn’t know all this at that time. It might have kept me from being nice to the French (whom I like very much — hey, there are assholes in every country — but still, I’d hate to meet that guy who was playing with our lives). Yeah, he was from France, but I’m still happy we were nice to the French docs and nurses in Kandahar. They were good people.

  Back to the Afghan Army hospital. Even though their nurses liked Indian soap operas too, at least they could handle vented patients in their ICU, so ANA and ANP could go out faster. We had even invented a system (credit should go to Rob, the assistant chief of nursing — he of the jokes) where, as soon as we’d stabilized a patient in the trauma bay, Bam! he was out the door to the ANA hospital without even being admitted to ours. We called them Monopoly patients, as in “Go directly to the ANA, do not pass Go, do not collect $200.” Of course it skewed up our stats, as the numerical system in place only counted ad
missions, but the chief PAD clerk found a way to keep track of them for our purposes. Hey, I wasn’t looking to build up our stats, but if we did the work, we should get the credit for it. The way the Americans calculate the stats, they take into account only the trauma admissions. If we did that, we’d have been counting only a portion of the traumas we actually had. In the summer of 2010, for instance, it looks like they had double the traumas we had in 2009, but in actuality, they were leaving out a lot of traumas from 2009 that didn’t collect their $200. In the 2009 general’s report, they talk about 950 admissions for our roto. Imagine what that score would have been if it included the ones that weren’t admitted. And those were major traumas. Minus a few “shot in foot” and appendices. Still, it made for a lot of traumas.

  During rounds, I didn’t listen much to the docs. I already knew what they were going to say. What I was concentrating on was the mood. It was my company. I was responsible for everything that went on in it.

  After the specialists did their little thing, the OIC Inpatients would go around asking each section if they had anything of interest for the group.

  “Dental?”

  “Nothing, sir.”

  “Mental health?”

  And so on.

  When it was my turn, I’d tell them about some new routine to be implemented. Some mornings, I’d give out certificates to departing docs, and there were a lot of those. They’d book in, work like crazy for fifty-nine days, and then they’d be out. See you around. Hasta la proxima, baby. Thanks for coming out. Neeext! I hated it.

  Getting used to a new specialist was like changing horses partway through a race. Those people were good, but they all had their quirks, each of them different. Once you’d get used to one, you didn’t want to change him or her and have to break in a new one, because we sort of had to acclimatize them. The system had changed from the last time they deployed: they all told me that. They all said they were happy it was different — but maybe not at first. So there was a breaking-in period where they had to get used to the fact that the chief of surgery ran the show and the players were just that: players. Simple cogs in the big machine. It was all about teamwork. They understood that intellectually, but these docs are trained to be independent, free thinkers, and autonomous, which is the way you want them to be back home. But there, it’s war surgery. And that implies a boss who can tell you, “No, you’re not going to repair that guy’s face/femur/kidney/(fill in the blank) right now. You’re just going to stop the hemorrhage and then we’ll stabilize him in the ICU. And only when I tell you to, will you work your wonders on this soldier.”

  Well, to tell the truth, the chief of surgery did say it in a nicer way, but it was just as authoritative. And that was the way it was. Although we defended freedom of thought and speech back home, that unit ’tweren’t no democracy. But it worked. And war surgery is about that: damage control. No fancy stuff. So the newly arriving specialists had to get used to the idea of having a boss. For most it was easy, but I did have to soothe a few bruised egos. That was my way of having them do something that went against the grain. Soothe them. I was the good cop.

  Then, on rounds, if I didn’t have any great breaking news, I’d shut up. I did most of my small talk one-to-one. Then, the OIC Inpatients would ask the task force surgeon if he had anything to say, and he usually did. Intelligence mostly. Just to remind us that outside the wire there was a whole other world. A whole world of war. He saw the big picture. Sometimes Lieutenant-Colonel Wojtyk would talk about ethics. He was responsible for a lot of difficult decisions we had to make, and he had a clear, incisive picture of what to do. Me, I was more focused on the day-to-day hospital stuff.

  Then the OIC asked the CO if she had anything to say. That morning she said, “There will be some Australian journalists filming us this afternoon. They are aware that they cannot film the patients’ faces or the interpreters. Please give them your cooperation, but if you don’t want to appear on Australian TV, feel free to inform them. There will also be a team from Radio-Canada this morning, that’s the French-speaking Canadian TV.” Somebody behind me murmured, “Jesus. Frickin’ Hollywood here.”

  I couldn’t really blame him. The week before it was ABC and Bob Woodruff and the next week it was to be CNN with Sanjay Gupta, the guy President Obama wanted for Surgeon General of the United States (and who refused!). Oh well, if it was busy we’d just ignore the Aussies, and if it was quiet, I could talk them up. The tricks with TV reporters are: one, if you want a good shot, be nice to the cameraman — he’s the guy who can make you look terrible or very good; two, always have a message or two and make sure they’re repeated and hammered home. For the rest, it’s the usual stuff: don’t stray into unfamiliar territory, and remember that, while you’re allowed to have an opinion about anything, you’re just not allowed to voice it on camera (or off, for that matter). This wasn’t about me. It was about the unit and what we did for the casualties. If the unit looked good, then I’d look good. And maybe make it back up to major. Just kidding.

  Okay, after the meeting I was off to the TOC for the meeting of the unit (the CUB, or commander’s update brief). You see, our hospital was part of a larger Canadian unit, which comprised a Role 1 (see Appendix A), a Role 3, the detachment in Camp Mirage, and the one at the OMLT (operational mentoring and liaison team — they accompany the Afghan Army and train them). The Role 1 people were responsible for the health services to all Canadian personnel in Afghanistan. But they also staffed out all the medics to the units doing the fighting. That’s a hell of a job. And that was where we lost the most medical people, out there in the heat carrying all that materiel, and fighting. It was a miracle they could even manage to stand up with those thirty-five, maybe forty kilos on their backs. Even more sometimes. Those guys and girls are the real heroes. TV shows generally only saw what we did at the Role 3, but nobody ever talked up the medics from the Role 1. And they deserved to be in on the “glory.”

  Major (then) Annie Bouchard was the OC of the Role 1, perhaps a hundred personnel, give or take. And then there was a doc and some med techs with the OMLT, pronounced “omelette.” (Yeah, yeah. Omelette: To be, or not to be? I’ve heard it a hundred times.) These med techs would go out with the ANA and coach their medics in their work. Then we had a detachment in Camp Mirage. That was an undisclosed location somewhere (over the rainbow) in the Middle East. And since it was in a Muslim country (that narrows it down, doesn’t it?), they couldn’t be seen helping us, the infidels, take on their Muslim brothers, no matter how bad these brothers were. So we can’t write about where it was, although half the Canadian population knows, and probably all Al Qaeda, and the Taliban too.1 And the half of the Canadian population that doesn’t know where Camp Mirage was probably doesn’t give a damn in the first place.

  So our CO was in charge of all these different pieces. I just happened to be in charge of the biggest piece, personnel-wise, the hospital, with about 225 people at that time. (Technically, some people, like the Australians and the U.S. Army types, didn’t “belong” to us, but they worked there all the time, which made me responsible for their actions. So I count them in too.)

  Well, every morning the Canadian commanders of the medical unit had a meeting at 0845, and, as usual, I was late. (Did I mention that military people are always on time? Maybe that’s why I’m being downgraded to captain when I get home. Just kidding again.) That meeting was top secret. We talked about the bad guys, and about our ops, and about our unit in relation to the bigger unit, and all kinds of admin stuff. Oh yeah, and we synchronized our watches, too. They do that in war movies a lot. So I guess if you’re in a real war, not a Hollywood one, you have to do that. “In exactly thirty-seven minutes, it’ll be 0944. Got it?” And then Brian always called out my name. As in: “… in ten seconds, it will be 0846 … five, four, three, two, one, mark!”

  “Marc?” It was very considerate of him to address me personally. And since I had bought my watch in a German airport when my other one broke down
, and the instructions were in Japanese only, well, I didn’t know how to reset it. So it didn’t really matter to me. I just remembered how many minutes I was off from the real war time.

  Colonel Savard told me later that it was a running gag to synchronize our watches, and that the only reason they did it was to rib me for always being late. But I don’t buy that. I couldn’t have been late more than two-thirds of the time.

  And finally, after all that, my day would start. I’d normally go to my office and send some emails to my OICs informing them of all the new stuff we had just learned. But that morning I couldn’t. Some U.S. Secret Service types wanted to see me to set up a visit by a VVIP — probably some U.S. senator or a three-star or even a four-star general. (“Excuse me sir, but with all those stars on your uniform, are you an astronaut?”)