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Saturday, March 10, 2007
War through the front door
The Atlanta Journal-Constitution
Baghdad, Iraq - The call crackles on the radio just before 1 p.m.
Casualties coming in by road.
Several children.
Mortar attack.
“Here we go,” says Staff Sgt. Tristan Hartfield, swinging his nurses into action. The soldier from Savannah had predicted things would get busy around lunchtime; he knows the rhythms of bloodshed in Baghdad.
Minutes later, the silence along the corridors of Ibn Sina Hospital is shattered by screams. The wounded: six children, two women, two men.
Fayad is only 3. His fragile little body is speckled with shrapnel; his head lacerated by shards of metal.
The young Iraqis are quickly strapped to gurneys and hooked up to mobile medical monitors that read vital signs. Blood pressure. Pulse. Heart rate. The emergency room fills with twinkling orange lights and the beeping sounds of monitors.
This is Baghdad’s busiest hospital, built by Saddam Hussein. The staff sees horrific injuries two or three times a day — the kind you’d see at Grady Memorial Hospital maybe once in three months.
One child has a fragment in his spleen. Several have abdominal and head injuries. Mohammed, 14, has shrapnel lodged deep in his left arm.
Hartfield, 31, has seen the unthinkable during his six months in Iraq with the 28th Combat Support Hospital, housed at Ibn Sina. Bodies burned beyond recognition, limbs blown off, eyes blasted from sockets. Blood. And more blood.
Near the front desk, remnants of a soldier’s body armor sit on the floor. Earlier in the morning, he was treated here for third-degree burns on 80 percent of his body.
That’s the effect of a remotely detonated IED, an improvised explosive device, a term for makeshift bombs so common in the news that it no longer registers with many Americans. And shrapnel? It can slice open the body and make meat of a human being.
Hartfield, in charge of the enlisted emergency room staff, had to put a 4-month-old infant into the morgue once. He works at lightning speed to make sure he won’t have to do that again today.
GSW spells relief
1:30.
The staff is still busy tending to the Iraqi children. At the front desk, Hartfield puts down the phone.
“We got two more coming off a bird,” he yells.
“What is coming off the bird?” asks Maj. Chris Hoyt, a general surgeon.
“Sir, I don’t know yet.”
Minutes later, Hartfield finds out. “We got an interpreter with GSW [gunshot wound]. U.S. male with GSW.” They’re coming by helicopter.
GSW spells relief to Hartfield. “That’s nothing,” he says.
Not like the soldier who came in this morning. He is fighting for his life in another ward. The doctors give him a 50 percent chance to survive if he does not develop any complications. What usually kills burn victims is infection.
The sounds of the Black Hawks get louder and louder. Hartfield’s staffers run out with gurneys to the landing pad and wheel in Pfc. Jared Isbell, 21, of the 10th Mountain Division and an interpreter from Somalia, Ahmed, 20. (His full name is being withheld for security reasons.)
Doctors determine that Isbell’s is a flesh wound that won’t require surgery. But fresh white bandages on Ahmed’s right leg turn crimson within seconds. He begs Hartfield for water.
“I can’t give you water in case you need surgery,” Hartfield says.
He disappears, then returns with a few wet cloths and places them on Ahmed’s parched lips.
“I’m here for you, man.”
War is an equal opportunity destroyer. As doctors and nurses, the staff in this hospital consider themselves equal opportunity healers. Every patient receives the same quality of care.
Upstairs in the intensive care unit, an insurgent with an amputated right leg lies shackled to a gurney, gasping for life with the help of a ventilator. The man tried to attack American soldiers in a Bradley Fighting Vehicle.
He is treated like any soldier, though every nurse and every doctor here wonders if they are saving a man who will one day return to the streets to kill their brothers in arms.
‘He just wants to go home’
Hartfield runs among the three trauma rooms, now brimming with patients.
He wags a white beanie baby, a winged dragon, in front of the howling 3-year-old, Fayad.
“He just wants to go home. Right, baby?” Hartfield says.
“I don’t blame him,” says pediatrician and anesthesiologist Col. Jim McLane. “So do I.”
Hartfield sits down to wash Fayad’s head wounds with saline. He thinks of his own children, Keaton, 7, and Kaydence, 15 months, and how he will never get this time back to spend with them.
He and his wife, Trelease, have made a life for themselves in Fayetteville, N.C., home of Fort Bragg. Hartfield is known as the joker in the trauma center — the one who keeps everyone laughing through the most trying times. But his smile fades as he says he missed his daughter’s first birthday.
Fayad is about the same size as Kaydence, though he is almost two years older.
“These guys are a lot smaller than their age,” he says, gently rubbing Fayad’s head. For the first time, the child stops crying.
Outside, in the hallway, Staff Sgt. Joshua Campbell paces back and forth. He wants to know how Fayad and the other kids are doing.
Two hours ago, his patrol had just finished clearing a block in al Dora, a neighborhood racked by sectarian violence in southern Baghdad. The children were standing along the road waving to the soldiers.
That’s the first mortar fell and scared them away. But they didn’t run fast enough to escape a second blast.
Campbell, 24, of the Kansas-based 13th Infantry Regiment, has brought soldiers into the combat hospital before. But never any children.
Campbell’s own son, Blake, turned 2 the previous day. It was the father in him that rushed Fayad to a Humvee.
“I know this kid’s a fighter, he says. “He punched me in the mouth when I was carrying him.”
Hartfield rushes past Campbell with Fayad on the gurney. The nurses wheel him to the elevator and to the second-floor intensive care unit. At the end of a hall in the ICU, they lower Fayad into a crib.
While the toll of dead and wounded soldiers is closely tracked — more than 3,100 U.S. soldiers have died in Iraq; 23,000 have been wounded — everyone debates how many Iraqis have suffered. The United Nations estimates that as many as 35,000 Iraqis died in 2006 alone.
But Hartfield doesn’t care much for statistics. They are just numbers until you see what a combat wound looks like. Until you smell burning flesh, body fluids, drying blood and explosives. Those are the smells of Ibn Sina.
A Purple Heart, just in case
It’s almost 3:30.
The badly burned soldier awaits a chopper ride to Balad, an air base north of Baghdad. From there he will be transported to the burn unit at Brooke Army Medical Center in Texas.
He is wrapped in foil to keep him warm on the ride. Without skin, his body cannot hold heat.
Before he is taken out, the soldier is awarded his Purple Heart. Just in case.
The goal of the 28th Combat Support Hospital is to treat people with fresh trauma and stabilize them until they can be transported to more permanent facilities. The hospitals here have life-support gear so advanced that some of it is not yet available in the United States.
At one time, the hallways of Ibn Sina displayed photos of Saddam Hussein. The Iraqi dictator built this hospital for use by his family and the Baath Party elite. It’s within the heavily fortified “Green Zone” and now serves as the emergency hospital for the U.S. military.
Iraq has several such hospitals, all of which are overseen by the 3rd Medical Command based at Fort Gillem in Forest Park, outside Atlanta.
The mantra here is simple: golden hour, platinum 15.
Medics on the battlefield have 15 minutes to stop the bleeding. The paramedics have an hour to get patients to the hospital. At a regular hospital, Iraq’s wounded might not survive, but if they make it to Ibn Sina, they have a good chance.
In Vietnam, it sometimes took 40 days to return a wounded soldier home. Now critical patients are back on U.S. soil within 72 hours.
Not a day goes by when the 28th Combat Support Hospital doesn’t see its trauma rooms fill up. Hartfield has seen as many as 38 patients in 12 hours.
“It’s sobering,” says Col. Harry Snowdy, 58, an orthopedic surgeon from Augusta.
Snowdy was in the Army Reserve for 26 years and had his own practice in Augusta. He gave it all up to work at Ibn Sina. He wants to be able to say: “I did my part.”
He once watched a helicopter lift off with a dead American soldier. He never stands outside anymore.
Quiet, but not for long
In the operating room, Snowdy asks his assistants for a fresh X-ray before he begins operating on Mohammed, the 14-year-old brought in with five other children. Snowdy wants to see if the metal fragment embedded in his arm has moved.
Then he washes Mohammed’s arm with a mustard-colored Betadine solution and begins to cut.
The boy has a fracture, too, but the priority is to get the shrapnel out. The staff can’t afford to tie up the operating room for long. Someone else could come through the doors to the trauma room even as Snowdy operates.
The surgeon digs deeper into Mohammed’s arm.
“I don’t see it,” he says, ordering more X-rays.
After 10 minutes of struggle, Snowdy pulls out the blade-like shard.
He saves it to give to the boy when he wakes up.
It’s past 5 p.m. when the pace finally slows. With little Fayad in good hands in the ICU, Hartfield has returned to his post downstairs. He inspects a mobile medical monitor and goes over the shift change this evening.
He enjoys the lull in activity. He knows it won’t stay quiet long.
In six months, Hartfield is scheduled to return to America and work at Fort Bragg, where he will snip bandages and fix twisted ankles.
He will go home to Savannah — maybe sit on the beach at Tybee Island with his family and eat a lot of seafood. Oysters on the half-shell are his favorite.
At Christmas, he won’t have to look at the dozen bloodied uniforms, cut from wounded soldiers, that surrounded the tree at the combat hospital last December.
Here, Hartfield goes to sleep thinking about what the next day will bring. He can’t know yet the fate of the patients he has seen today, or what the war will deliver tomorrow.
When he gets “back there,” to America, he worries that Iraq will haunt him, that the numbness bestowed by the daily grind will wear off. That when it gets dark and quiet, memories of Ibn Sina will lurk like ghosts.
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Breaking bread
The Atlanta Journal-Constitution
Louie Favorite
Lunch earlier today in a village near Tal Afar included chicken with couscous (foreground) and chicken with rice. The bowls contain a tomato-potato soup that doubles as a dipping sauce.
Ayn ash Shababit, Iraq - The feast was laid out on plastic tables. Chicken and rice, couscous, potatoes in tomato broth, chunks of onion and flatbread.
The soldiers of Company H, 121st Infantry (ABN)(LRS) look forward to these Iraqi meals whenever they visit this village, about 15 miles from Forward Operating Base Sykes.
The food served in the Sykes chow hall is good but variety is the spice of life.
In Iraq, as is the custom in most Eastern cultures, visitors cannot leave without sips of chai and a full stomach. It’s considered rude to refuse.
The Georgia soldiers oblige. Not that anyone would want to refuse meals here. In the past, the villagers have slaughtered a lamb for the feast.
The Georgia men are covered in the large, round pieces of flatbread. A debate erupts on which nation has the best bread.
We eat with some of the village leaders. They are all men. The village sheik was noticeably absent — he was attending his brother’s funeral.
I am the only woman at the table, the only woman seen in public. This is a conservative Shiite village and not a single woman was out of her house. I wonder who prepared the tasty meal.
It’s a glorious day, not a cloud in the sky. There’s a view of the Sinjar Mountains as the backdrop. A few bottles of red wine and for a moment, it could have been Tuscany — except the gunfire at the checkpoint down the road.
