So since we last ‘talked’ we have had a lot of rocket
and mortar attacks on the base.  Nothing close, but
the command increased the threat level so we all had
to wear full armor and weapons loaded all week.  Made
going to the gym and chow a hassle.

Worked a shift in the ER Tuesday.  We had 2 patients
right away, both were Iraqi soldiers.  One had a AK-47
wound through his knee, he did OK, but had to go to
surgery.  What a mess, the AK-47 packs an incredible
punch.  The M-16 does not cause as much damage as far
as I can tell, (you will see below in the next story).
The second patient was shot in the right flank and
the round exited right below his heart (close one!).
He was in a lot of pain, but his vitals were stable.
Ultrasound of his abdomen showed a lot of blood, he
got a CT scan and the bullet went through his liver
and out his stomach and just missed his heart.  The
exit wound was huge.  I should have taken a photo, but
was too busy.  He went to surgery, not sure how he
will do, will have a long recovery.

Last night I went on a night HH-60 Blackhawk mission
transporting two intubated Iraqis (soldier and
civilian), one shot in the head and the other with
multiple IED  injuries, both post-operative.  Had to
sedate one of them in flight and suction his tube out
because his oxygen levels dropped.  Try that at night
kneeling on the deck, wearing all the gear that you
will see in the photos, it was tough!  When we got to
Baghdad, I ran into a doc I knew from Darnall named
Todd Baker, cool.  We transported two American
soldiers back home for prep and transfer to Germany en
route to home.  Both with IED injuries.  They were
more scared of the night flight than of their
injuries.  They did OK it was great to help them out
since they are risking their lives out there.

As soon as we landed and took our patients in, a truck
brought in 4 enemy combatants whom our forces had just
engaged.  They were VERY seriously injured.  There
were only 2 ER Docs and I was just standing there in
my flight gear when they rolled in.  I took one of the
patients and started working on him.  No one even
asked who I was, we all just worked together to get
the job done.  He had around 10 M-16 wounds all over
his body, chest, back, abdomen, shoulders, arms, legs.
The entrance and exits were about the same size so he
had roughly 20 or so holes in his body!  I had to
intubate him while he was coughing up blood, then put
in a central line in his groin for blood and IV fluid,
then a needle in his chest to relieve pressure then a
chest tube.  He went to surgery, and from what I heard
he is still alive.  The other guys are alive too
although I did not work on them.  We used 12 or more
units of blood on them and it took us an hour or so in
the ER, while the Americans I just transferred were
watching and waiting.

It was a surreal situation to say the least.  Here we
are working as hard as we can to save the lives of 4
enemy ‘soldiers’ who were just shot trying to kill our
soldiers and 2 wounded American infantrymen who were
watching and waiting their turn for help.  They said
they understood, but I wonder what they really
thought.  None of the health care providers said
anything about working so hard to save the enemy
patients, except the Iraqi translator who called them
‘garbage’ and said we were wasting our time.

I have spent a lot of time last night and this morning
trying to wrestle with the emotions this event has
generated.  I know that in a perfect world a doctor is
supposed to treat everyone the same and try and save
every life, not to just try and save the ones you want
to.  There is no doubt that I saved that guys life
last night, he would have been dead in minutes without
all the tubes and blood my team put in him.  I am not
saying that lightly or trying to impress you, what I
mean is that now he can live to fight again.

What if saving him allows him to kill someone else.
We are talking about an enemy that intentionally kills
women and children and sets traps/IEDS for medical
personnel.  Not to mention the resources we are
denying our own service members such as blood and
supplies and OR time.  It is a difficult concept and
one that I will have to work with.  I am going to talk
to some of the other surgeons and ER docs who have
been here longer to get their thoughts and I will
share them with you.  Should be interesting.  Either
way, at some point I am going to have to come to terms
with it because it is no longer a theoretical
discussion, but a reality.  My boots still have his
blood on them and his face with the look of contempt
in his eye is burned into my mind.  War is strange
place to say the least.

Well if you made it this far, please enjoy the

photos, most are from my helo flights.  The
photo of the patient in the ER is the enemy combatant
I was talking about.

I hate to sound like a broken record, but WOW another
ridiculously busy week+.  I am late on my weekly
update because of some big events.  Be sure to look at
the photos, some gross ones and interesting ones.

Since my last email, I went on a UH-60/Blackhawk helo
medevac mission from Balad’s Combat Support Hospital
(CASH) to Baghdad’s main civilian hospital.  A Iraqi
national was injured and on a ventilator.  There was
some small arms fire which again was not very close.
The pilots say it happens about every other landing in
that area. After we landed, we transfered him to an
amoured ambulance and then convoyed to the hospital
which is off the airport.  Nerve racking just waiting
for the IEDs to off, but nothing happend.

A couple of days later, I was working in the ER with
my medic SGT Munoz when a suicide bomber ran into a
group of 8 soldiers on patrol outside our gate,
taliking to civilians, women and children and
detonated his vest.  The children where killed and a
women and the 8 soldiers where seriously wounded.
Because it happend so close, we only had about 3
minutes warning that the were inbound.  3 docs, 8
critical patients arriving all at once on 4
helicopters.  They rushed in put them in the trauma
bays and ran out.  My first patient had burns and
lacerations to his face, blast injuries to his right
shoulder and both legs.  He need blood and IV fluid to
bring his blood pressure up, he had lost a LOT of
blood.  We stabalized him and sent him to CT/xray.
The second soldier had several medium sized blast
wounds to his arms and legs and minor cuts to his
face, was stable but acting very violent and had to be
sedated.  It turns out that he had a brain injury
called a subdural hematoma.  He went to surgery to
have it drained.  He is doing fine.  The other
soldiers xrays/CT’s where negative, but he need
vascular surgery.  However 7 of the 8 guys needed
surgery right away and there were not enough people to
start the operations.  I volunteered to start the
operation till the vascular surgeon could get there.
The anesthia back-up doctor put him under while I
scrubbed in and began cleaning out the wounds and
temporarily clamping and tieing the vasular injuries.
The staff was very helpful since I can’t remember all
the instrument and tool names.

I pulled out several pieces of bone and meat that were
part of the suicide bomber.  (See the photos.)  Teeth,
bone and a finger joint.  Very disturbing.  When the
surgeon showed up we put the femoral vein and
saphenous veins back together and debrided the wounds.
I sewed up his face last and he went to the ICU.  The
next AM he went to germany and was awake before he
left and doing well.

Whew.

Last night I got in about midnight froma 2 day, 6 leg
mission on the UC-35 jet to Baghdad, Kuthar, United
Arab Emmaretes, Kuwait and back.  We stayed in Dubai,
UAE.  Very nice.  Beautiful hotels and good food.  We
were escorting 2 General Officers.  I got a coin from
a Brigadere General, which is cool.

So far Iraq is fascinating.  I am hoping to get to
meet some locals when it is not busy to get their
insights into our mission here and I will share it
with you.  As of right now, I am working in my clinic
all day, flying different missions and volunteering
with the ER and medevac, so I have been crazy busy.

Be sure to look at the photos, some good ones.

WOW has it been a busy week.  We had a mass casualty or MASSCAL this week.  A truck of Iraqi soldiers was hit and rolled over, ejecting the people in the bed.  Several other vechicles where also involved as well as a pedestrian was run over.  My 3 medics and I grabbed out gear and ran to the hospital.  They put us right to work, I was sent to the treatment area and the medics heloed unload the helicopters.  I had 3 immeadiate aka critical patients, one with a broken left shoulder and arm as well as multiple lacerations/abrasions, another with a broken pelvis, femur, tibia/fibula and facial lacerations and the pedestrian that was ran over.  He had to be intubated, central line and blood as he was bleeding in his belly.  He went to surgery and survived.  The other 2 eventually went to ortho surgery after I cleared their other injuries.  Good stuff!!

I spent the rest of the week doing flight physicals and catching up on the stuff that was no done the last 3 months the unit did not have a doctor.  Lots of admin and tracking people down who where late in shots/vision/hearing, etc.

I got to spend my third birthday since joining the Army in the field.  My first was in basic training in 1992 and the at NTC (National Training Center, Ft Irwin, CA) in 1994, then here in Iraq.  The day started out pretty boring until about 6:00 pm…..

One of our unmanned aerial vehicles crashed on takeoff, the details are classified but needless to say it was a long night.  We had to go out to the scene and take photos, measurments and then take the operators/crew to the lab to draw blood and urine for alcohol and drugs.  Then today, I had to interview all 9 of the crew and take their histories over the last 72 hours.  My job is to decide if there were any human factors, such as health, fatigue, chemicals that could have contributed.  I have to sit on a board next week to present my findings.  I will send some photos once it is unclassified.

I have been on several flights allover Iraq.  We skirted the Iranian border, check the photos and landed in North Iraq, lots of mountains scary approach and then flew to Baghdad at night.  Saw several tracer rounds being fired, but none even close.  I think they shoot at the sound, but by then we are long gone.

Have been working out everyday, losing weight and toning up and eating good

Have a happy Thanksgiving and talk to you next week.

My daily routine looks like it will be; 6:30am wake up, clean up go to the office to see sick call, walk to the chow-hall for breakfast (pineapple and yogurt with juice). I see patients on appointment till around 1230, eat lunch (a sandwich), see patients or admin stuff. Go to the gym/run/swim. Eat dinner (chicken, meatloaf whatever) back in the clinic, more admin. Then I watch TV, or play Xbox till around 9pm. Go to my trailer (Trailer trash!!) and watch a movie or read a book. Not too bad.

We got hit the other day. I didn’t hear it, but when I walked back too my room that evening, everyone was watching the smoke from the fire it started (see photo). No one got hurt. Here’s the cool part, we can tell which way the attack is from (radar) and dispatched aerial recon vehicles from our unit and hanger. We found the guys loading a mortar for some more shots and the predator took them all out with a Hellfire missile, we watched the video feed at the next meeting. That’s the unit I am taking care of…..finally a satisfying job.

talk to you next week.

Anyway, my room is a small trialer, across from some showers and toilets in another trailer. I have a small clinic in the hanger and the ER is across the street. I’ll post some pictures soon.