The Tragic Bonds of War

There is silence tonight in the hospital. It is a silence made denser by the hearing protection we put on as the helicopters approach the landing zone. We knew the "Angel Flight" was landing, not because we could hear it, but because of the vibrations that were coming up through our feet and into our chests.

Here at the 86th Combat Support Hospital in Iraq, we see death every day. Those who die, even here in a combat zone, die with a piece of us. They take a piece of our lives with them. We can work to fight the inevitable—for minutes, for hours, for days. But in the end they all take something of us with them. The Iraqi children who are burned by a kerosene heater, the mother who is shot by an unseen enemy, the contractor whose life is taken by an anonymous mortar, the soldier who dies fighting for her faraway home.

Today they took a lot of us with them. When I got the telephone call that backup was needed in the ER, I figured it would just be a routine procedure: someone injured, resuscitated, packaged and sent onward. We are not supposed to think, to dwell on who is in front of us—we think instead about what is in front of us: a collapsed lung, an amputation, an evisceration. It is not the soul we think about, it is the body and the injury. This is what we are trained for. The radio lets us know what is coming—"Talon Medic, this is Med Flight—two mikes [minutes] out for two urgent surgical after IED blast and one critical with face and extremity injuries. How copy?" We get into the usual positions, one doctor in the back room for the "less sick," one with the main trauma beds. There is a whirlwind as the flight medic comes through the blue curtain that serves as a door. "U.S. soldier involved in IED blast, prolonged extrication, weak pulse, unable to obtain BP, unresponsive ..." he continues. His voice fades into the background din and the sound of the rotor wash as I look over and see my nurse step back and suck in the air around her.

The patients enter our ER as a number, then become a soldier, a civilian, a mother or father, but in the end they evolve into their injury. This one was different to Ann. He came in as a number, then evolved into a soldier, then a lieutenant in the Third Infantry Division, then a classmate, then a friend. He wasn't a shattered pelvis, a retroperitoneal hematoma, or even a traumatic arrest. He had been a college friend, and he was trying to take a large part of her with him.

In the ER, we did what we do. We put two lines in and replaced the blood he was losing. We placed a tube into his trachea and replaced the air he was not breathing. We compressed his chest to replace the heart that was not beating. And we opened his thorax to clamp the vessels that were not sealing. In the operating room, they opened his abdomen and found a body whose blood was not flowing. And that could not be fixed.

There is no ability to change nurses here, but I don't think Ann would have left her friend's side if told to do so. As I ordered the course of treatment—"Another round of epinephrine, another four units of blood and FFP ..."— she never hesitated, but fought for her friend as hard as she could. She did not want to give up that piece of herself. In the end, he took it from her.

Every time a patient dies prematurely, whether in a hospital in the United States or in a combat zone, we all feel we have lost a piece of something. Here, when a soldier dies, that piece is a lot bigger. That person is no longer a number or an injury, but a soldier, then a kid down the street, and then a father who will no longer be home for dinner. As soldiers, we all have an extra bond with these patients. I can visualize their parents or spouse watching as the chaplain and casualty officer walk up to the front door, hoping for a mistake, knowing their dreams and hopes are shattered. I can only imagine what is taken from those who know and love these fallen heroes.

It's 3 a.m. on the hospital landing zone. A full moon and the green lights inside the Black Hawk illuminate the black body bag as it is secured. Attention is called, and even though we in the ER do this all too often, there is scarcely a face whose tears do not reflect the moonlight. The silence grows loud again as the helicopter powers up and departs into the night with one of our fallen soldiers—our lieutenants, our classmates, our friends, our Angels.