For returning medics, trauma of their own

By John Aloysius Farrell
Denver Post Washington Bureau
Friday, March 19, 2004 -

CAMP ANACONDA, Iraq - Spec. Travis Wilson, an emergency-room medic at the 21st Combat Support Hospital, is guiding a handful of young soldiers newly arrived on this sprawling military base.

"Over there's the incinerator," Wilson tells the group of replacements, who have been in Iraq for just a few days. "If you have any body parts, limbs or arms from the operating room, take them there and light it up."

There is a gasp from among the new arrivals. One soldier rolls her eyes and turns away. Several shudder.

"Yeah," Wilson says grimly, acknowledging how the horrific becomes routine in war. "Good times."

The doctors and nurses of the 21st Combat Support Hospital are heading home. After nearly a year in the war zone, the 240-some Texans, Coloradans and Missourians of "the Cash," as they call their mobile hospital unit, have handed their duties to the 31st Support Hospital, a replacement outfit.

Last month's transfer was emblematic of what is taking place in Iraq these days, at the one-year mark in the war. In a monumental movement of soldiers and materiel that will last until May, entire divisions - some 125,000 troops in all - are returning to the United States. They are being replaced by 110,000 new arrivals.

Commanders must ensure that the hard-won lessons of the occupation are conveyed by experienced units to their untested replacements. And for the homecoming veterans, there's the challenge of re-entering a civilian culture that's largely oblivious to what they've endured.

"No one will understand," says Col. Carol McNeill, chief nurse for the 21st Combat Support Hospital, "when we tell them about mortar rounds landing a hundred feet from our tent, or guys coming in all blown up, or locking and loading our weapons when we leave the compound, chambering a round and shooting it at people.

"And we will stop talking because it will be so frustrating. So that is going to make it hard to cope."

35,000 patients treated

The doctors and nurses and support personnel of the Cash got here in April in convoys from Kuwait that closely followed the U.S. military advance on Baghdad.

They were among the first Americans to arrive at this abandoned Iraqi air force base, then inhabited by snakes, scorpions, turtle doves and feral dogs.

They practiced medicine in tents, dug holes for latrines, ate cold, packaged meals, and came under nighttime rocket and mortar attacks. They washed the blood from the dead faces of comrades, and saved the lives of Iraqis who had done the killing.

They saw 35,000 patients - Americans and Iraqis - of whom 1,400 required emergency surgery. If you were a wounded U.S. soldier, and you made it to the doctors and nurses at the 21st, the odds were better than 10-to-1, they say, that they would save your life.

"These people have done a tremendous job helping our soldiers survive serious wounds," says Col. Richard Heitz, the commanding officer of the replacement unit. "It's time for these people to go home. I am the cavalry - the reinforcements come to relieve them."

When they reached the heart of the hazardous Sunni Triangle in April, the members of the Cash thought they would be home in a few months - by the holidays,

for sure. The toughest duty was turning away the Iraqi civilians who showed up at the gates, asking for medical treatment for their children.

But on the evening of July 3, things changed.

"I had just finished taking a shower," says Maj. Beverly Beavers. "We heard the first impact, and then the second impact was probably 20 seconds behind it."

The camp was under mortar attack.

"We were looking at each other trying to figure, what is this? By the time the third round hit, we all knew. Within 10 minutes they were bringing the casualties into the ER.

"We ended up evacuating six of those guys. In the next six weeks, we had dozens more. We have now had more than a hundred."

Hopes of going home withered in the heat of the Iraqi summer. As the attacks went on, U.S. casualties mounted and the temperature soared well above 100 degrees.

"It became obvious in June and July that there was not going to be an immediate happy ending for all this," recalls Col. Doug Liening, the 21st's commander.

"I cannot describe to you what it is like here in the summer, only to be told you are not here for six months, but for a year.

"To be honest, it seemed like a very dark period."

'I just wanted to leave'

The toll of Americans killed or wounded climbed, peaking in October and November. Anne White, a 62-year-old operating room nurse, recalls lying in her bunk, hearing helicopters arrive with wounded, and being paralyzed by "extreme anxiety."

"I just wanted to leave," White remembers. "But I couldn't, of course."

Sometimes, the U.S. combat patrols would bring in, along with a wounded or dead GI, the Iraqi attacker as well.

"By God, you just want to beat the hell out of them," Wilson says.

"You've got an American in one bed who just died and the Iraqi who is responsible for it on the other bed. And this Iraqi probably is so scared the way everybody looks at him.

"But he gets treatment. He gets to go to a cot. He gets three square meals a day. He gets to be warm. He gets to joke around with his buddies, the other prisoners."

The emotional discord, Wilson says, "messes with your head."

He found himself in a rage one time, pummeling a dead Iraqi's body.

The Cash coped. It got a boost when a few dozen soldiers from the Colorado-based 10th Combat Support Hospital, which was being sent home from Kuwait, volunteered for combat hospitals in Iraq.

"Those were the guys who stood in the gap," says a grateful Liening.

As summer turned to fall, the soldiers at the Cash sought ways to break the routine. Maj. Randy Cassels, who runs the emergency room and is an avid outdoorsman, helped rescue a nest of baby owls. On Halloween, Spec. Felicia Lemon showed up for work dressed as a Dallas Cowboys cheerleader.

Some had Internet sex with lovers back home; others found partners on the base. At times, one medic says, "this place was like ' General Hospital."'

The good times, however, were fleeting.

"When they are home, a year from now, they will say this is the greatest thing they have ever done," McNeill says of the soldiers she led. "But right now it is so raw and it hurts so bad and they are so tired. You can't go to sleep without seeing some of the horrors that you see when the patients come rolling in."

When fellow Americans die in the emergency room or on the operating table, "you cry," Wilson says. "You try not to do it in front of anybody. But people know, when you come back in, you were outside shedding a tear."

Turning over the scalpel

Finally, the word is passed and orders cut. The Cash is going home.

The replacements from the 31st Combat Support Hospital arrive to watch and learn.

"This is my first arm," says one young soldier from the 31st, turning away from where an aged Iraqi man is lying on the emergency room table, his severed arm beside him. He had been caught at night with an automatic weapon and was wounded by a U.S. helicopter crew.

As the moments pass, with doctors and nurses from the 21st looking on, the newcomers nervously and inefficiently prep the man for surgery.

"This is chaos," murmurs Col. Robert Lyons, the surgeon who heads the Cash medical staff. He whispers to a colleague from the 21st: "Dave, why are they making this an emergency when it isn't one?"

The newcomers "will master it," Lyons says. "They are all smart people. And then it will be Groundhog Day: every day the same. They will see more dead people here in a year than they will their entire lives."

Indeed, two nights later a mortar attack claims two American lives. A third soldier is brought in, his leg shattered by shrapnel.

The surgeons operate with handguns strapped to their hips. Their combat boots are slowly stained by the soldier's dripping blood. He loses his leg, but survives.

The 31st got its own welcome from the Iraqi insurgents.

"What was that?" Liening barks.

He was standing at his post in the command center when a dull boom interrupted the evening routine. The code word for a mortar attack is quickly passed

- "Thunder! Thunder!" - and everyone heads for shelters.

Seven rounds hit. Finally, there is no all-clear siren, just whispered word that danger has passed. For the next few days, few newcomers venture anywhere unarmed.

On the eve of going home, the soldiers of the Cash have time to reflect on the American experience in Iraq.

Liening and Lyons are convinced that the invasion has helped deter terrorism.

"They took two of our buildings; we took two of their countries," Lyons says.

"This has to make these countries think," Liening says. "We used to be on the East Coast, waving at them. Now we are right at the border saying, 'Hi. Here we are. This is us. We are just going to stay here for a while."'

But some are not so sure.

"I hope we made a difference," says Capt. Eric Ritter, a nurse anesthetist at the Cash. "I hope that being over here, being away from my family, and the soldiers that have died, I hope have died for a reason.

"We are trying to make this country better. But then we get mortared. We get somebody who gets killed. And you just get to the point where you don't care anymore. And that is sad."

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