View Full Version : Operation Iraqi Freedom: a surgeon's perspective

11-08-03, 06:56 AM
Operation Iraqi Freedom: a surgeon's perspective
Submitted by: MCB Camp Butler
Story Identification Number: 2003115211627
Story by Navy Capt. Stephen F. McCartney

CAMP OKINAWA, Iraq(Oct. 31, 2003) -- With no television, usable phones, internet, and mail being essentially non-functional for the most part, we only knew what our intelligence briefs had confirmed. War was imminent.

Convoys had been driving by Camp Okinawa for three days without a break. Marine Corps generals were dropping by for "tours" of our hospital more frequently. I believe it was for that last minute "warm fuzzy" of knowing we were ready for their soon to be bleeding Marines. I made sure we had enough type O blood on hand, our walking blood bank was ready to make up for any shortfalls and our anesthesia machines were stocked with enough Forane for unlimited use.

The first of 36 scud missile attacks, with speedy runs into 8-foot deep bunkers occurred the night before. Gas masks on, gas masks off when the "all clear" signal was given. Don't run in the pitch dark or you will impale on an angulated tent stake aiming at your lower abdomen. Know the password of the day or the sentry will shoot. There were no misconceptions now as Chinese Seersucker II and Korean missiles were impacting a few miles away. Our Commanding General told me that it took 123 seconds for a scud missile launched in Basra to impact at Alpha Company. My desire to appear "in the know" was slightly less than my desire not to terrify the company, so I never shared that bit of information until days later.

The first CH-46 helicopter arrived in the morning with several wounded. An Iraqi officer with a large open defect behind his knee from a USMC M-16, he was white as a sheet and tachycardic, but I saw a clear save here if we could get some blood into him. Multiple IV attempts by the best of all of us failed and as we exposed the saphenous vein for cannulation, he arrests and dies from prolonged hemorrhagic shock. In the same ambulance is a young USMC officer. He is dead. Shot through the abdomen exiting in the lower back. I have to enter the ambulance to record the injuries. I have seen plenty of dead, having trained in a trauma center. But this is a "good guy", not a gangbanger. It isn't exactly right. Now it is he and I inside the ambulance, and it is very quiet. I will have this discussion with myself many times in the next few weeks. The C-130 planes are now transporting in wounded as well as helicopters. It is controlled chaos. Calm determination describes our hospital company. All committed, all somewhat numbed. No one complains--they just work. They all have the same blank look on their faces. They all remember the young officer. There is no more rationalizing, no more denials ... this is war. No one falters. A group of young Marines and a Navy corpsman arrive. All have leg injuries from landmines. The corpsman was blown up running to the aid of one of his injured Marines. Their muscular legs are horrifically deformed and shredded full of holes. Under the tent lights the shrapnel glistens and reflects from inside the wounds. The Marines are quiet. Answering questions polite and dignified. Even their injuries and pain doesn't keep them from saying, "Yes ma'am, no ma'am" or "Yes sir, no sir." The general surgeon meets with the orthopedist for an ad hoc discussion about immediate amputation versus limb salvage in some of the cases present. I started this policy a few weeks earlier to make sure all amputations were deemed the best option with the agreement of at least two surgeons. Two Marines and the Navy corpsman leave the resuscitation area for the OR for amputations. All wounds are left open. Four hours earlier in southern Iraq a smoke break in the cab of a 7-ton USMC truck is interrupted by an RPG hitting the three Marines inside. Two arrive with shrapnel in their eyes and neck, but not serious enough to warrant immediate surgery. Their master sergeant has open head wounds , skull fractures and is not arousable. He is intubated, bleeding profusely from the head and face he is taken to surgery. The bleeding is stopped and he is taken directly from the OR, while still intubated, to a Blackhawk helicopter. He sees an Army neurosurgeon within 2 hours and undergoes more surgery. We hear later he survived. A helicopter drops off several USMC ambushed while taking an Iraqi surrender. Nine of their fellow "devil dogs" are dead. An RPG has killed a corpsman from our hospital during battle in Iraq. Many people know him from San Diego. He had two children and a wife. He was twenty-six. Alpha Company begins to hurt. The numbness disappears quickly. A friendly fire injury brings in more young Marines. One Marine escaped three burning vehicles only to be badly injured later. He gets an exploratory lap, a colostomy and debridemant of large buttocks and flank wounds from 30mm cannon prior to medevac.

An Army soldier arrives after being shot through the left thigh and has no pulse. I joked with him about checking for proper HMO authorization. He laughs loudly. As we leave for the OR, a young Marine behind me is being lifted by the stretcher-bearers for a journey to surgery as well. He looks down from the stretcher at the large puddle of his blood underneath and apologizes to the nurse for leaving a mess behind. He says his mother taught him to always clean up after himself. Looking at his face it is clear it could not have been all that long ago. He appeared barely 18. I asked myself "Where do these young men come from?" "What makes them able to do this?" "How does the Marine Corps find them amongst all others?" At this point I took my one and only trip to the "time out" box to take some deep breaths out in the cool night to regain composure before surgery.

The soldier's artery is grafted and regains it's pulse and he is evacuated one hour after surgery. The other young man loses his leg at the knee at the same time as a Saddam Fedeyeen arrives.

The incoming patients continued for five to six days. As the war moved North, Bravo and Charlie surgical companies were inserted into Iraq and our activity lessened. We received many walking wounded and some that were operated upon by our sister companies.

The horrific injuries, unannounced arrival of dead soldiers and Marines, and emergency surgeries stopped almost as quick as they started a week earlier.

Tired young men crashed their large trucks. No one wore seat belts as there was a morbid fear of being trapped after an RPG attack failing to extricate. Weapons were at the ready but hard to use when confined by a seat belt. Some were just careless. I quietly yelled and screamed at these young men, their mangled bodies, for getting through the war and dying in a careless accident. Seeing the carnage still occurring after combat operations ceased was very difficult for Alpha Company. We thought we had been issued a free pass, or "get out of jail free" cards by late April but it was not to be. Painful, albeit, irregular events plagued us. The Combat Stress Team and chaplain worked 24/7 dealing with the many heroes of Alpha Company. The performance of so many young people was so remarkable but it is ludicrous to think that anyone got off without taking serious emotional and spiritual insults. Some had never seen a dead body, much less someone their own age. Many of us with children had to sort out what we did and the permanent images we have recessed in our psyche. The uninvited replays will be an unwelcome feature we all have to deal with. We dealt with it privately early on. Small groups formed up to discuss things, in most cases indirectly. No one wanted to awaken the sleeping monster yet, just whisper a bit and get some relief and sleep. One day we all apparently had the same epiphany and to my knowledge we haven't spoken of the most painful events ever again. There just wasn't anything else to say. Words can't describe the feelings so it's best to not speak about it anymore. Perhaps later the words will come. I feel everyone's journey will be different.


Navy Capt. Stephen F. McCartney, left, a Santa Monica, Calif., native, and Navy Lt. David Callaway, revascularize (put an artificial graft) the destroyed femoral artery in the leg of an Army soldier, while supporting operations during Operation Iraqi Freedom. Photo by: Courtesy Photo