One day in a doctor’s life at the 399th Combat Support Hospital in Iraq.
By Dave Hnida | We longed for a beautiful sunrise or sunset, yet on most days in the desert the sun either rose or fell like a window shade—rapidly, with little time for enjoyment. This day would be no different. When we stepped out into the swirling wind called the Tongue of Fire, we couldn’t see three feet in front of us. The floodlights were still on and would remain on through most of the morning, at least. Bad dust storms, so Paradise General would be on flight condition red until the haze evaporated.
I’d been in desert sandstorms before, but few like this. I felt like I inhaled a playground of sand before we’d walked halfway to the chow hall. And my face was raw as the fine particles blistered the skin from my face and blasted their way into every crevice of my body. Rick and I didn’t even bother to try to spit a few syllables; we just tucked our chins and forged onwards, head down into the wind until we eventually reached our destination. We stood for a few minutes, shaking our bodies of sand like a wet dog that has just come out of the rain.
Most of the guys were already eating by the time we walked into the cavernous hall. Jokes, insults, and BS were flying like the sand on the other side of the walls. We’d been together for a more than a month and a half, and were getting along well. No one wanted to kill each other, at least not yet, and I didn’t think we’d ever see the day we would. Each of us knew we were in a fix, and unconsciously recognized the only way to survive our time here was to hold each other up. Left alone, we would become the walking psychologically wounded.
Even better, we genuinely liked each other, which is rare for a bunch of doctors—a group notorious for huge egos and horrid social skills.
When we crossed the gravel-strewn field to the hospital, we heard the crackled sound of “Big Voice.” Just like on M*A*S*H, there were giant loudspeakers attached to poles high above the ground: it’s how we got announcements and important information. However, our Big Voice was hoarse—we couldn’t understand a word coming from it. It sounded like a broken drive-through speaker at a fast food joint.
We stared at the pole, then each other.
“I think either we are about to get mortared … or salsa lessons have been pushed back a half an hour tonight.”
Nonetheless, we quickened the pace, eyes and ears peeled to the sky. The only things we saw were unexpected patches of blue. That meant a day of work. It turned out to be one filled with some of the oddest cases of my war.
The first was a 22-year-old soldier with a cough that just wouldn’t quit. Ordinarily we’d have told him to shove off and go to sick call; the ER wasn’t the place for him. But something just didn’t look right. A pleasant cherubic-faced kid with the weak sprouting of a grown-up mustache, his skin carried a paleness that shouted illness.
A chest X-ray, then a quick CAT scan of the chest gave us the reason: the huge clusters of lymph nodes signified cancer, in this case, a lymphoma.
He took the news he’d be flying to Landstuhl, and then the States within 24 hours, without much of change in expression.
“Sure beats hell doesn’t it, sir? Here I am in Iraq, and I got cancer. Wait until my mom hears this one. At least I ain’t going to get blown up. That’ll make her happy. But geez, cancer?”
I’d sat and had “the talk” with dozens of patients and their families when bad news needed to be delivered, but this was a first for me. You simply don’t think cancer is going to attack in a war zone. But it did. And this young man needed the same tender kid gloves any wounded soldier would get. We talked for more than an hour as we waited for the travel arrangements to be made.
As we finished, I felt the vibration of our first incoming of the day. A chopper was furiously beating the air as it hovered over the helipad. I scooted inside and quickly donned a pair of goggles and gloves. Our patient was an Iraqi soldier, and he left a trail of blood as he was wheeled in.
The flight medic told me the soldier had been in a complex IED attack—first blown up, then shot as he crawled and squirmed out of the smoking vehicle.
“He’s got open wounds all four extremities, facial lacerations, and multiple puncture wounds to the torso. And double-check the groin—it’s starting to seep blood. Ten milligrams of morphine on board.”
Ten milligrams and still moaning, to the point no one could hear themselves think. I asked the flight medic, “How long ago did you morphine this guy?”
“Ten mikes.” That was more than enough time for some relief to kick in.
I shook my head.
“Give him five more milligrams IV. Then let’s get the translator in and figure out what we’ve got.”
I ran through my exam—step by step as always. In the meantime, the medics performed their usual rituals of IV lines, medications, and clothes cutting.
One had just snipped away the patient’s shirt and pants when he noticed an expanding stain of blood on a pair of underwear that looked unchanged for weeks.
“Hey, Dr Hnida, this guy’s got a problem down south,” he said.
I mentally said, “Shit,” then pulled down the underpants. The IED fragments had done a clean amputation of the left testicle and nipped part of the shaft of the penis. No wonder he needed more morphine. There probably wasn’t enough morphine in the world for this guy. I think every male in the trauma bay unconsciously bent at the waist and went knock-kneed.
“Folks. It’s gone, as in clean gone. Sorry for the thought, but double-check the clothing so a bloody ball doesn’t fall out and roll across the floor.”
It didn’t. The testicle was nowhere to be found, and was probably still lying in some reed-filled field next to a roadway miles away. Probably to be eaten by some birds. The thought made me queasy.
But our Iraqi policeman/soldier was just happy to be alive. Through the translator, he said he would gladly trade his testicle for his life any day. Good perspective.
We had expected a not-so-busy day but things were hopping, and we were a little bummed—sort of like kids who think they’re going to wake up to a blizzard and a day off of school, yet when the morning comes, not a flake has fallen.
But that didn’t mean we couldn’t have our cake and eat it, too. It was my birthday. I hadn’t told anyone except maybe in passing many weeks before, but the date became an imprint in someone’s mind.
One second the ER was empty, the next it was filled with marching people singing “Happy Birthday.” Bill Stanton was to thank, or blame. He and a couple of nurses in the ICU had gotten some cake mix from home, stirred it up, and baked it in some little plastic play oven. It was jelly-like and undercooked in places, rock hard in others, but it was real honest-to-goodness birthday cake.
The party ended, not with a whimper, not with a bang, but the whirling of incoming aircraft.
Up next were two guys who had been on the receiving ends of bullets. One walked in; the other rolled in via stretcher but was alert and stable.
The walker was a piece of work. He’d had his body armor off and took a glancing sniper shot to Satan—meaning a $500 tattoo of the devil on his upper back had taken the brunt of the bullet, shearing off most of Satan’s pitchfork. The soldier would need a little repair work from us, then some follow-up body work down at Mr. Mohammed’s House of Tattoos.
Devilman’s buddy was a little quieter; he’d taken a slug to the upper thigh and was bleeding like the proverbial stuck pig. As I did my exam, something seemed weird—I just couldn’t put a finger on it.
The bullet wound was deep and stuffed with some sort of a cottonlike material I’d never seen before. Then I saw the cotton had a piece of string attached so I pulled. It was a tampon. It seemed many soldiers had been buying tampons at the PX, and then bringing them out on patrol to supplement their first-aid kit. Whatever weird looks these guys must have gotten at the checkout counter, buying a box of Tampax was well worth it. The tampon had done a great job slowing the bleeding and helped save the soldier’s life.
He needed to go to the OR to have the thigh repaired, but first needed his tank topped off.
“Sorry buddy, you’re going to need a little bit of blood before we take you in to the body shop,” I told him as I threw the tampon into the trash.
“Yeah, blood. Like the commercial says: Blood. It does a body good.”
He started to get a few tears in his eyes. I think the realization he’d been shot was finally sinking in.
I leaned over and tried to speak quietly into his ear. That’s when it hit me. The weirdness. The odd thing about this guy. It was more than the tampon. It was the fact that he smelled. Really smelled. But the fragrance wafting from his body wasn’t the usual unwashed sweaty nastiness—it was really nice.
“Hey, man. Don’t take this the wrong way. But you smell really good. What do you do, put on aftershave every day?”
His mood brightened.
“Oh. Sorry. I’m kind of a Dial soap guy. Or use whatever samples I can rip out of magazines. What are you wearing?”
“Allure by Chanel,” he answered. “It’s full-bodied, but not overpowering, you know what I mean? A touch of wood and a hint of spice. About 40 bucks for a small bottle and worth every drop.”
I wrinkled my nose as I unconsciously sniffed my stained armpit.
“So tell me, do you usually go out on patrol smelling like a holiday in Paris?”
“Well, man, I mean sir, it’s like this. I’m just one small piece of a big machine. I can smell bad and look like shit just like everybody else, or I can be my own man by dressing up. And since I can’t dress up, I’m going to smell good. Plus, if I get killed, I’m going down with style.”
For the next ten minutes, I got schooled on the latest in style and grooming from a twenty-something fashionista. By the time we were done chatting, I realized I’d never be a poster boy for classy—but the units of blood were in, and the Army’s fashion plate was calm. He wound up doing great, and looked great while doing it.
The docs ended the day the same way we started it, gathered around the table, pushing food around plates, and seeing if salad dressing on potatoes would fool the palate. It did, a little.
Like a family supper, the meal essentially revolved around questions like: “And how was your day, honey?” Or “did anything interesting happen at the hospital today?”
The answers were flat and quick—and normal for our typical day.
“Ah, not much. Kid who shouldn’t have cancer has cancer. Couple of guys got shot. Iraqi dude had his nut shot off. The usual.”
Dave Hnida C’76 is a family physician in Littleton, Colorado. He volunteered for two tours of duty in Iraq. This essay is adapted from Paradise General by Dr. Dave Hnida. Copyright © 2010 by David Hnida, M.D. Reprinted by permission of Simon & Schuster, Inc.