Colleagues, Iraq, Trauma, War injuries



  1. Goforth, Carl RN, MSN, CCRN


A personal account of a U.S. Navy nurse's experiences with a victim of trauma in Iraq is presented.


Article Content

"Two wounded inbound. Improvised explosive device attack. Mikes (minutes) unknown," the army trauma coordinator says. The surgical team runs to the operating room (OR) to turn on the lights, start warming fluids, start the oxygen generator, and warm up the anesthesia machine. Then we sit and wait with a mixture of anxiety and dread.


"Headlights coming down the alley," yells one of the surgeons. A Humvee skids to a halt, and 4 soldiers jump out and start pulling out a casualty. Medics and the surgical team jump in with a litter to carry our patient to prevent extending any injuries. The backside of "Charlie Medical" explodes into chaos as the soldiers start telling us what happened as we rush the casualty into the receiving bay. I am standing in casualty receiving and start to follow our patient in when I am frozen in my tracks. He is so black from dirt and mud I cannot tell if he is wearing a uniform. Only the whites of his eyes give away the location of this face. My initial thought: has to be an Iraqi civilian. This leaves me confused because the report was 2 army soldiers. Another quick survey leaves me stunned and breathless as I do not see anything below the upper portion of his thighs. There was nothing to see but volumes of empty space and bits of ragged flesh.


The field medic is on his heels, and he looks as pale as a silver-lit moon. His uniform is also caked with dirt and mud. Sweat is streaming down his face into his eyes, but he does not even notice as he blindly bumps into Charlie Medical staff as he runs into the trauma bay. The chaplain is right next to me and asks him if he is the medic. He gives us a blank head nod as he tries to push past us. We quickly thank him for doing such an outstanding job of getting his patient to us, and the chaplain takes him aside to console and comfort him.


With the field medic safely placed with our chaplain, I follow on the heels of the litter bearers into the OR. Staff streams in to assist as I position myself on the soldier's right flank and establish intravenous access while simultaneously putting on electrocardiogram leads and pulse oximetry. I swiftly scan the room to see if crowd control is needed and spot an unknown visitor wearing a tan flight suit with no identification. I quickly walk over, introduce myself, and request that he immediately identify himself. "Company commander," he says. Letting my guard down as we talk for a bit, I ask about our patient as our anesthesiologist intubates and the 2 general surgeons don sterile garb. "Just married a few months ago while on leave. Such a good guy." He says. What to say back? We both stand in silence for a few moments. I ask him if he is okay with staying, and he seems fine, so I direct him where he can stand out of the way as I go back to work.


The orthopedic surgeon and general surgeon are working on the extremities simultaneously. An hour is spent meticulously debriding both thighs, tying off vasculature, and completing bilaterally the above-the-knee amputations. Another flight nurse and I take great care to "package" him up for the MEDVAC flight to Al Asad and start administering intravenous midazolam (Versed) and fentanyl as another trauma victim cycles through our OR.


His unit: their love for him is unquestionable. His buddies press into the OR the second we finish damage control surgery on his upper thighs. The shell-shocked medic should be given credit for saving this soldier's life. When tourniquets would not control the profuse hemorrhaging, he quickly just started adding more tourniquets until it would stop.


The soldier's battle buddies are in the OR, and they look like zombies. They are standing around our casualty, touching his arms and chest, although they themselves just emerged from the trauma bay with patched-up extremities from the same blast, and they refuse to leave his side. Just standing there with hollow eyes and mouths stuck permanently in "O" position. Eric, one of the team's anesthesiologists, talks to them about how well their brother in arms did with the surgery, but they are visibly upset with themselves as if this were somehow their fault. Eric gives one a bear hug, reassuring them they are not to blame for the senselessness and randomness of war.


With the evacuation mission requested, it is time to transport our casualty a few hundred yards to the flight line. The evacuation medics assist us in transporting the casualty from the OR to the medical evacuation pad. We not only have the patient intubated, paralyzed, and sedated in a litter, but we carry around 80 lb of flight and medical equipment: 2 oxygen tanks and regulators, a physiological monitor, a transport ventilator, suction unit, fluids, blood, and a transport bag laden with supplies for every possible contingency. The men who just emerged from battle with him insist on handling the litter, and we let them. No, more accurately we are honored to let them be the litter bearers back to the Humvee for the short ride to the helicopter pad.


I help Mark, another en-route care nurse, load our casualty into the Humvee and turn to run ahead to the evacuation pad. As I turn, I suddenly come to a screeching halt again for the second time tonight. The soldier's entire unit is lined up and at attention along the route to the helo pad. As the Humvee slowly pulls away, they render colors and salute their wounded brother. I was so proud of them all and knew that they would see one of their own through anything. With the air heavy and charged with emotion, I find myself stumbling because this time it is my turn to be blinded by tears as I try to make it to the landing area before the Humvee.


They all march in unison behind the Humvee to the evacuation pad and help us load him onto a Blackhawk helicopter specially outfitted for medical evacuation missions. We all stand together one last time as the Blackhawk spins up rotors and gently whisks the casualty to a level III hospital at Al Asad. Not a muscle twitches until Blackhawk and patient are out of sight and rotor chop fades into the night.