The Wall Street Journal
October 29, 2003
IRAQ IN TRANSITION
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^1.)
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.
[medic]
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."
Write to Yaroslav Trofimov at yaroslav.trofimov@wsj.com4
URL for this article:
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Updated October 29, 2003
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