National Geographic : 2006 Dec
personnel to civilians and insurgents, are helped here by some of the best trauma teams in medicine. The hospital treats hundreds of patients each month. It does not mirror the sleek, high-tech civilian institutions in the U.S. or Europe. It is battle-ready and rough, the rooms cluttered with equipment, some of it aging. Occasionally, the electricity fails. But then, war medicine is not civilian medicine. It's dirtier, faster. The wounds are worse, the patients at greater risk. Here medi cal teams cut, crack, and inject where their civilian counterparts might pause and worry about lawsuits. Ibn Sina is designed for life saving procedures, not the long recoveries required by amputees or burn victims. The mis sion is simple: stabilize patients, ship them on to facilities equipped for longer term care. "There are no litigious restrictions over here," a lieutenant colonel who is also a doctor tells me. "People play fearlessly, and when they play fear lessly, they make fewer mistakes. It's a dose of reality you'll never forget. The surgeons, nurses -never in the rest of their lives will they be who they are here." The 10th arrived here in October 2005 to replace another CSH unit at the conclusion of a year-long tour. Few of the 10th's nurses or medics had ever seen the chaos of big trauma. Many are in their early or mid-20s; some had cared previ ously for cancer patients or the elderly. Iraq was immediate, terrifying immersion. Lt. Col. John Groves, 42, head ER nurse, trained in some of America's busiest trauma centers, including Miami and Honolulu. He is a short, friendly man, a career soldier who, if prompted, can talk into the night about past cases and calamities, the mutilations of this war. He is a self-described steel-mill kid from Indi ana, and on his desk lie photos of the 20 or so head of cattle he keeps on his new farm in Kansas, where he plans to retire. Groves is a father figure to his young staff. He watches them carefully, knows their strengths, their weaknesses. He remembers thinking not all of them would last. 88 NATIONAL GEOGRAPHIC * DECEMBER 2006 "So many were timid, they didn't know what to do. It was a hard adjustment, and not every one is cut out for this kind of medicine." Groves was ready to reassign several nurses to other wards. Lt. Riane Nelson was one of them. She is 24, a tall round-faced blonde from San Diego with blue-green eyes that shift color depending on the scrubs she wears. From the time she was eight, she wanted to be a nurse. She lived then in Greece, where her parents worked as missionaries. After college, she joined the Army. She didn't have any trauma training before she arrived in Iraq. Nelson grew up an athlete. She knew what it meant to work hard, play fast. But she struggled with the crushing pace of the trauma room, the weight of decisions made amid blood and fad ing lives. She forgot things, made mistakes. She began, she says, to crack. Then, slowly, the weeks of panic yielded to smoothness. She remembers when the conversion came. VALENTINE'S DAY, 2006. Nelson hopes for a slow shift. But somewhere in Iraq, an Army convoy hits a roadside bomb and a medevac helicopter rushes in a seriously wounded soldier. The sit uation is going badly. The soldier arrives medically dead. A tourni quet encircles the right leg. Below the tourni quet, the limb hangs by threads of flesh. The femoral artery is like a severed hose. There is the coppery smell of blood. Nelson stands at the head of the bed, feeling for a pulse, giving directions. Medics slice away the remains of a uniform. Nelson realizes her patient is a woman. She has no pulse, she is drained of blood. Nelson orders someone to begin CPR, even though in her experience it has never saved anyone. A doctor calls for drugs: atropine, epinephrine. Nelson injects them into the woman's body. Finally, she feels the weak flutter of life. "After about five minutes of CPR, I felt a carotid pulse," Nelson later wrote in her journal. "We double- and triple-checked to make sure we weren't just so hyped up that we were feeling our own pulse in our fingers."