1. Cotton, Sandra LTC


Even after a second tour of duty in Iraq.


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It had been a fairly quiet day for a war zone, so quiet that I was volunteering in the ED of the Air Force Theater Hospital. Two soldiers arrived on backboards after being hit by an IED (improvised explosive device); both had lost consciousness temporarily, received multiple soft-tissue injuries, and suffered damage to their hearing. Seeing the hint of terror in their eyes, I broke the ice by saying, "I'm not usually on the ground here-I'm a flight nurse volunteering here tonight. I just hate it when they shoot at us like that!!" Both cracked a smile, and I knew I was in. "So you guys got hit by an IED?" And as they told me the story of their latest evening in Iraq, they stepped onto the road to recovery.


Now in my 32nd year of service in the Air National Guard, I've had a relatively safe life as an aeromedical evacuation nurse. I served from September 2005 until January 2006 in Balad, about 35 miles northeast of Baghdad-an almost bucolic site compared with a lot of places in Iraq and Afghanistan. These young men had been on patrol in Baghdad, and only the small size of the IED and their body and vehicle armor spared them from more serious injuries. They received the best ED care: scans of the head, neck, and spine; chest X-ray; blood and urine analyses to evaluate for internal bleeding; analgesia; and state-of-the-art nursing. Compared with many IED victims whose limbs require amputation or whose internal injuries require surgery, these "boys" got off easy, and they knew it. Both grew animated as they described the vehicle they'd been in and how they'd gotten out alive. A stroke of fate let them live to talk about the attack.


Their physical recovery took about a week, but they required neurologic and psychological evaluations before they could be deemed fit for duty. One of them told me it was the second time he'd been hit by an IED, and despite his tough talk, it was clear that he wondered how much longer his luck would continue. Both men, particularly the one who'd been hit before, developed an angry edge that intensified during their stay in the ED. Soldiers like this are not uncommon. Despite their fear and anger, they wouldn't shirk their duty.


Once I got over the initial shock of the heat, dust, and relative austerity of this war zone that would be my home for the next four to six months, I wondered why I hadn't gotten here sooner. As I walked into the Air Force Theater Hospital, the largest established since the Vietnam War, I saw that in spite of the conditions, nothing less than miracles take place here. Lives are saved, limbs reattached, eyesight restored. This was what I had trained for throughout my military career.

FIGURE. On the ramp ... - Click to enlarge in new windowFIGURE. On the ramp of a C-130 cargo plane, Lieutenant Colonel Sandra Cotton, center, speaks to a nurse from the Contingency Aeromedical Staging Facility in Balad, Iraq, where some injured soldiers are held before being flown out of Iraq for further treatment.Courtesy of Major Robert Couse-Baker, Chief, 332 AEW Public Affairs, Balad Air Base, Iraq

I arrived in Iraq in September 2005 as the flight commander for aeromedical evacuation operations in Balad-an experience I often describe as "the best worst job I've ever had." The soldiers I served beside and cared for on missions provided me with a sense of duty that, for the first time, made me understand what it means to lay down your life for the person next to you. I knew that this sense of pride and camaraderie could only be had with this job.


While Balad was safer than other forward operating bases in Iraq-at least at that time-the daily mortar attacks made working conditions challenging. It is easy to understand how Balad came to be called Mortaritaville. Another difficulty I had not anticipated was the condition of the medical equipment. It was not designed to work reliably in the hot, dusty, inadvertently abusive conditions it was constantly exposed to aboard the aircraft. One soldier who had burns over more than 70% of his body "woke up" during transport to the aircraft when his IV pump failed. The image of his agony is something I will take to my grave.


When I first returned home some five months later, I needed to talk about my experiences with almost anyone who would listen: family, friends, colleagues, and a small group of Iraq War veterans who took me into their meetings at a local outreach center. Their support was invaluable as I transitioned from Iraq to home.


I recently returned to duty with the same squadron in Balad, this time as an active flight nurse. I hold to the philosophy I first brought here some 15 months ago-an apolitical belief that our soldiers deserve good care. To question whether the United States military should be in Iraq does me no good. It's important to me to take the focus off of wartime politics and place it instead on the soldiers who are here. Whether I am volunteering in the ED or rigging a plane for a mission, I approach each task with the same vision.


We often hear the expression "One team, one fight." To the outsider it may sound like empty military bravado, but it's not just sloganeering; it's a reminder that in the military we are all in this together. Our soldiers-who go back into battle after a second IED hit and test their luck again-deserve the best we can give them.