Combat Doctor Page 7

  So I set him up with Dave. (Thanks, bro.) Then that nurse came in. I looked at my watch. She’d been up all night, and by that time it was almost 0930. She just wanted me to know how upset she was that she wasn’t going to get her medal at the same time as the others because it hadn’t been ordered on time. Well, it was the admin that dropped the ball on that one. Because she wasn’t in-theatre at the time they ordered those medals, they forgot about her and, so, hers would be in late. Not very much I could do about it. Contrary to most hospitals, which are supposed to be self-contained, this one, for some weird reason only the planners in Ottawa (you know, those people who know everything so that they can tell you how to do your job?) understand, this hospital didn’t have any admin component. Even Annie’s Role 1 had an admin officer and a clerk. But me, I had to rely on the people in headquarters who were already overwhelmed with work. Hell, those guys worked late every night and they still couldn’t keep up with all that was asked of them. Besides, I had no authority over them. Nor over the PAD clerks, nor over the TOC people. If I only had a secretary, it would have made my life a lot easier, what with remembering all those departing people and all those reports. I could do the work, but I would get so caught up in the medical side of things that a lot of the admin part got forgotten. My nurse didn’t make a big fuss over her problem, but it was important for her that I was aware of the situation. I looked at her. She was practically sleeping on her feet. She was a good woman. And a hell of a nurse, too.

  I patted her on the shoulder. “Get some rest, Captain. I’ll see what I can do.”

  Then the chief surgeon walked in. You couldn’t invent him if you wanted to. He was a fairly big man, and burly. Oh, did I tell you, he’s American? Yup, U.S. Navy. A captain, too. That’s Navy captain: four stripes to my two and a half. The man was generous to a fault. Anything that was his was yours. He smoked cigars and chewed tobacco. And freely distributed both to all. Along with his view of the world. He is conservative and irascible. He didn’t mince words, which sometimes got him in trouble. Yet he was the one who counselled me to prudence when I would fly off the handle and want to go after whomever it was who got my back up. He’s an extremely intelligent man, and by far the best surgeon I’ve ever met in almost forty years in hospitals. Yet, in spite of outranking me by two ranks, he’s always been nothing but loyal and supportive, even when my decisions went against his energetic recommendations. He’s a real soldier, even though he’s in the Navy. I would not have survived the brutal pace of the roto without him. (When I left Afghanistan, I did so without thanking him because I didn’t want to get emotional in front of him. So thank you, sir, for your unstinting support. Thank you for your loyalty. Thank you for being the surgeon that you are. Thank you for being you, and for being there for me. For us. For the soldiers.)

  That day he was going out to the market, the one the Afghans had installed inside the wire for those of us who couldn’t go out very often. They sold everything there, but mostly carpets, pashminas (cashmere scarves), and those pirated movies that a guy with a camera smuggled out of the theatre — the ones in which you suddenly see some person silhouetted against Harry Potter’s face, getting up and walking out in the middle of the movie.

  “I’ve got my cellphone if anything shows up,” he told me.

  I waved him off. “Nothing’s going to happen. I feel it in my bones. It’s going to be quiet.”

  He jumped at that, startled. “Don’t say that word!” he hissed.

  “Nah,” I protested. “I’m not superstitious. Here: Quiet. Quiet. Quiet!”

  He left, shaking his head and muttering imprecations against me.

  That was the last quiet that came out of my mouth that day, or any other day for that matter. I heard the crash in the TOC almost at once. Some smart guy programmed the main battle computer to sound an explosion whenever there was something significant happening. It must have been mind-numbingly repetitious to the Tacos, but to me, across the hallway, it was a signal, a very handy one. I crossed over to where there were already four or five people standing staring at the giant screen. There must have been more crashes while the door of my office was closed, and that was why I didn’t hear them. I sidled up to the group and somebody said, “Suicide bomber, north of here. Up to now, seven U.S. casualties.”

  Shit. It was supposed to be a quiet Saturday.

  “ETA?” I asked.

  Brian shook his head. “They’re all confused up there, and the info is contradictory. Even the number of casualties is not certain.” I looked at the screen where the lines were scrolling very fast, and read a number, a mission number. Regional Command South, RC(S), was desperately trying to get a handle on the situation. They were spooling up a pair of helicopters as I read the screen. I could just imagine the crews running to their machines, throwing their gear inside, clipping full magazines on their weapons, and arming them. Don’t forget the safeties, guys. Their adrenalin must have been pumping like mad.

  I turned to the map. I figured they would bring the worst-off ones right to Qalat, which was closer, and where they had a Role 2 (see Appendix A). But then, Qalat didn’t have a whole lot of blood. If any one of those soldiers was bleeding a lot, he might be better off coming to us right away, even though it was farther.

  On board an 82nd Combat Aviation Brigade dust-off Black Hawk, Master Corporal Pierre Desrosiers, a Canadian flight medic, is bagging an intubated casualty while a U.S. flight medic reaches for drugs to keep the patient stable.

  Photo credit: Master Corporal Pierre Desrosiers.

  “I’ve got a mission for us.” It was Brian, who was busy copy-and-pasting the details of the mission from one screen to another. After that he’d print it out for the trauma team leaders.

  “How many?” I asked.

  He shrugged. “Looks like seven, but …” He shook his head, annoyed at something.

  “What?” I asked.

  He grimaced without stopping what he was doing. “It’s not clear whether it’s the same incident.”

  No way something else just as bad was happening at the same time.

  “It’s gotta be them, Brian.”

  Brian muttered something about confusion between a Bravo mission and a Charlie mission. Well, I couldn’t wait. If we were going to receive seven casualties all at once, I had to supervise the assembling of the trauma teams. I left the TOC.

  In previous rotos, they would have called a “Mass Cal” (mass casualties) for seven simultaneous casualties, but it was a testimony to how much the hospital had grown that it didn’t even cross my mind to do so. Supervising seven trauma bays was going to be a bit of a challenge, I knew, but I’d done it before.

  I stopped by my office and grabbed my red baseball cap with the “Canada” logo. Will Patton, my predecessor on Roto 5, is six-seven, so he didn’t need to wear a cap to stand out in the crowd. I’ve never seen any pictures from his roto. I wonder if he wore a cap anyway, when multiples came in. I put the cap back to front because the visor got on my nerves. I felt shut in with something over my eyes. So that became my trademark. When the OC had his red cap on backward, we were expecting trouble.

  When I got to the trauma bays, the place was almost empty. Julie arrived. She’d be in charge.

  “How many?” she asked in French.

  “Seven at least.” I tried to appear calm, though my heart was already starting to feel the adrenalin. I forced myself to calm down, not to fidget, not to dance from one foot to the other, or bend my head from side to side to get the cricks out of my neck, like before a hockey game, when they’re playing “O Canada” and you’re standing restlessly at the blue line. Julie just nodded.

  “We’ll have to get more people in,” she announced with finality. Yeah, more people.

  “All right, both permanent trauma teams, one surgical team. Tell the second one to stand by. Then get some TTLs, and some nurses, and med techs.”

  Julie just looked at me.

  “Sorry, Julie. You don’t need me to tell you
what to do.” I walked away. Still, she needed my authority to call in both trauma teams at once. Yeah, big authority. As if I’d refuse to call in the second trauma team with seven coming in.

  Well, I’d better call my chief surgeon in. He’d be just peachy, as if by saying the word quiet I had personally sent in that suicide bomber. Oh well, c’est comme ça.

  Slowly at first, then faster and faster, the trauma bays filled up as the teams assembled. One of the dedicated trauma teams arrived with bleary eyes. They’d been up most of the night with the other casualty, the guy with the foot, who didn’t actually need them. But the people in the field called him in as an Alpha, the highest possible priority. In such cases we didn’t second-guess the guy at the front who makes that call. We just acted accordingly. Besides, we’d much rather have them over-call than under-call. That had happened the week before when some Bravos had been called in, and two of them died before arriving here. Some Bravos.

  The PAD clerk arrived with his walkie-talkie and his clipboard and grabbed a handheld metal detector. He would have a heck of a job. Not only did he have to be positively certain of the identity of those we would be treating, but, in addition, he had to make absolutely sure that the casualties were not wheeled into the trauma bays carrying loaded weapons, magazines, or grenades. He also had to check them for booby traps. The Taliban are not above wounding a civilian before placing a live hand grenade underneath. Turn your casualty over, and Boom! Do not pass go …

  “What did you do in the war, Mom?”

  “I was an admissions clerk.”

  “So it was a safe job, then.”

  “Yeah, real safe, son.”

  I attracted his attention with a flick of my chin and raised my eyebrows. Translated, this meant, “What is the latest news from the TOC?” We learned to economize on words there. He answered “At least five Alphas.”

  Jay-sus! Five Alphas. What a quiet Saturday!

  I walked the trauma bays, trying to memorize who would be where. I didn’t have enough Trauma Team Leaders (TTLs). Then two USAF flight surgeons showed up. One was assigned to the crews of an evac chopper squadron, the Pedros, so he’d heard the call on his own frequencies. The Pedros are an interesting bunch. They are trained to rescue USAF pilots downed behind enemy lines, so their medics are called PJs, or parachute jumpers. Those guys are among the bravest people in the world, their courage acknowledged even by elite units. Their emblem is two green footprints, in homage to the HH-3 helicopters used in Vietnam, called “Jolly Green Giants.” In Afghanistan, the PJs served as flight medics.

  A USAF parachute jumper with his physician after a mission. The temperature is probably in the mid forties Celsius (over a hundred Fahrenheit). Note the amount of ammunition they have to carry. These guys mean business.

  All trauma bays full. In spite of the pressure, everything is calm. And probably quiet. That’s the way I liked it.

  The other surgeon was his friend who worked with the A-10s. Those planes from the late seventies still amaze me. Built around a Gatling gun, they fly slowly in spite of having two jet engines. The A-10 was built to bust Soviet tanks in Central Europe. A one-second burst of its gun can wreak havoc. A few years back, one of them mistakenly shot at our guys before realizing his mistake. In one second he killed one and wounded about forty. It was a sad day for Canada. Vince was their flight surgeon, a real nice guy, and a good ER doc.

  So okay, now, with those two, I had six TTLs. I needed one more. I looked at Dave, who just nodded. He knew I’d much rather have him as a traffic cop, but he was really happy to be doing some “real work.” I can’t blame him. Looking at it from his point of view: he was a trained PA — which would you rather be, traffic cop or TTL?

  The chief surgeon arrived and, as predicted, gave me the dark look. In spite of what was happening, I’m still not superstitious. So I just shrugged but managed to appear sufficiently mortified. The walkie-talkie grizzled. I turned to the PAD clerk. “ETA five minutes,” he announced.

  I turned to the trauma bays and lifted my right hand with five fingers extended and pointed to my watch. Then I motioned to the TTLs to assemble.

  “All right, people, listen up. Seven, of which possibly five are Alphas. U.S. servicemen. Suicide bomber. That means a lot of ball bearings, and also body parts from the bad guy. So check every hole. That is all.”

  Best not overdo the pep talk. Those guys were all pros. And it was time for me to go outside.

  The heat hit me like a sledgehammer. The sun blinded me. Jay-sus, what a country! It must be …

  “Forty-two in the shade,” announced one of the supply techs, finishing my unspoken sentence. They had an electronic thermometer. They’d heard my lame joke too many times for me to say it. But they just grinned as if I’d said it for the very first time. They were a good bunch, those supply people. Whenever we were expecting casualties, they came out of their tent and volunteered to be stretcher-bearers. Never a peep out of them, yet, with no training, they faced the worst traumas you can imagine. It must have taken something out of them. Lately I’ve been looking at the gazillion pictures we took during the roto, and in some of them the faces show the strain. I guess we all paid the price.

  “What did you do in the war, Dad?”

  “I was a supply tech.”

  “So you didn’t see many horrors, then.”

  “Hardly any, son.”

  I picked it up before the others, a low thump-a-thump buzzing sound.

  “Here we go, people, here we go.” I opened the hospital’s double doors that we kept closed till the last minute to try to keep the cool inside. I had time to go back in to check on my people. I didn’t need to say a word. The trauma teams all went into their respective bays. That’s one thing we did: I didn’t care how you dressed, but when there were casualties, everybody stayed in their place and nobody yelled or got excited. Not too much wandering around. We all respected this. Amazing, considering what a heterogeneous bunch of originals we were.

  The first chopper arrived. From inside the hospital I recognized the sound of a Black Hawk. Good. I hated it when a Chinook brought in casualties. Although those big birds could haul a few dozen wounded at a time, they took forever to unload, and they kicked up such a cloud of dust that we had to close the hospital doors whenever we heard that casualties were coming in on one.

  Time to go out again. I looked around the triage area. Everybody seemed to be in place. Dave was not in the triage area outside: nobody had shown up to take the seventh trauma bay, so he had to fill in. I bet you he was pinching himself, trying not to grin. Well, I didn’t have to worry about him: he was one of the best. Back home, he trained young doctors to handle traumas. He had also scored 100 percent on a recent paediatric advanced life support (PALS — don’t you just love acronyms?) exam.

  Meanwhile, Andy, the ward master, would handle traffic in addition to his regular duties (ambulance traffic, unloading, supervising the medics in the trauma bays, making sure there are enough supplies in the bays). He would be a busy man.

  The choppers came in fast and over-flared as they landed. That was a sign there must be someone critical on board. From the triage area, we couldn’t see the unloading of the casualties. There were some concrete barriers between the landing area and the triage area, just like there were all over camp. Something about limiting the amount of damage and the number of casualties. I should know. The first week I was there, one rocket blew up just a few dozen feet from me, but all I got was thrown to the ground and a little dazed. It had landed on the other side of one of these barriers. Like I always say, it’s more important to be lucky than to be good.

  After what seemed like forever, the first ambulance slowly rolled off the tarmac. Two of the helicopter-unloading medics were running behind it. Not a good sign. The ambulance driver raised four fingers and mimed two walking and two stretchers. Not too bad. Andy pointed to the place where he wanted him to stop.

  Then the ambulance passed us, Andy bellowed “Stop!” and
I just glimpsed the face of “Young Andy,” the usually impassive British driver. He looked stressed out. I didn’t have time to think. I was the first one to look into the back. I always did the same thing: as the ambulance came to us with its back doors open, I always touched the light blue fire extinguisher bolted onto the open back door. Sort of like when a goalie touches his posts. Some kind of stupid ritual, I guess. Usually, as soon as I did this, the ambulance would stop and I’d turn the corner and look in. But remember: I’m not superstitious. Besides, it’s bad luck to be superstitious.

  If ever there was an Oh shit moment, that was it. Not only were there no U.S. servicemen on the amb, but it was filled with civilians — children. On the jump seat at the front of the box was a woman holding a screaming baby that looked like it was all pockmarked by shrapnel. She was desperately trying to pull a veil over her face, and I could only see one of her terrified eyes. On the stretchers were two little forms covered in aluminum blankets, in spite of the heat. Remember the death-triad (Appendix C)? Hypothermia, hypocoagulability (your blood won’t clot), and acidosis will make you circle the drain. The problem with those children was that they only had one leg apiece. By some stupid trick of mind, my memory recorded the scene very clearly, and my astounded brain noted that one has lost his left leg, and one his right, which made a symmetric picture. All of this took less, much less, than one second. Well, at least we knew what happened here. This was no suicide bomber.

  The flight medic, to be heard above the sound of the whining turbines, hollered “This one first! This one first!”