Curled up in a blanket, Spec. Paul Augustine of Chicago was stirring slowly. The medication was beginning to fade, and pain was shooting up a leg that had been sprayed with shrapnel.
“I’m surprised it took so long,” the 24-year-old South Sider said of the grenade that caught up with him after nearly a year in Iraq. He and three others from the 2nd Platoon, 4th Battalion, 27th Field Artillery were wounded in an attack the night before in a dangerous stretch of West Baghdad.
In the next hospital room was a young private who had frozen during the attack. While others in the platoon ran, Augustine paused, grabbed him and was racing with him for safety when the second grenade hit them.
“He’s been in country only two weeks. I have been 10 months,” Augustine explained, saying he did what he did without thinking.
Caring for injured soldiers is routine business for the 28th Combat Support Hospital, the Army’s largest, busiest and most specialized hospital in Iraq.
But little else has been normal for the hospital in a conflict that has dragged on and turned into a guerrilla war that is far more brutal than many hospital staffers had expected.
Indeed, among the hospital’s more than 350-person staff there is a great awe and sadness over the way roadside bombs packed with nails, bolts and rocks mangle young, healthy bodies.
They are struck by the bombs’ ability to maim and blind. While soldiers’ torsos are protected by the latest armor — a marked advance over previous conflicts — their arms and legs and faces often are not, leading to a number of amputations and facial wounds.
There is a strong sense at the hospital about the need to make do, to improvise, to scrape by when resources dwindle. Sometimes when blood supplies run short, for example, someone will even step aside from a surgery, and a replacement will step in, so they can provide the needed blood.
The 28th C.A.S.H., as it is known, also cares for Iraqis — friends and foes, young and old, a nuance that sometimes both surprises and confounds its staff.
Many are Iraqis who work with the U.S.-led coalition forces or private companies tied to the interim authority, Iraqis who were injured accidentally by U.S. troops or who innocently fell victim to the violence of the conflict.
Or they are Iraqis injured while trying to kill Americans, like the 14-year-old who was shot as he was about to throw a grenade at troops. He lost both his legs in the confrontation and now is recovering at the hospital.
It’s not unusual for an injured soldier to wake up in a recovery bed beside someone who may have been trying to kill Americans soldiers not long ago. Those patients will remain at the hospital until they are healthy enough to be transferred to a prison.
Most of the time staffers race from one crisis to another at the hospital, which moved in August from a windblown desert campsite to a small, three-story hospital in the heart of Baghdad. It had exclusively served Saddam Hussein’s relatives and Baath Party elite.
That was not the pace, however, during one recent 24-hour spell. Still, despite the quiet — a word that hospital workers superstitiously do not invoke — there was a sense that at any minute a radio call would come from an in bound helicopter or Humvee filled with wounded.
To be sure, the calm did not relieve the burnout that Dr. Ben Gonzalez, 41, the head emergency physician, was feeling.
He was sitting in a small room just off the emergency room area. It’s where he works, and frequently sleeps, crawled up on a cot shoved behind a screen. In the corner is a violin that he plays sometimes for leisure. His favorites run from classical to Mariachi music.
“I’m tired. I’m talking about a real tiredness,” said the soft-spoken physician, originally from Mesa, Ariz.
A first-generation Mexican-American, Gonzalez teaches trauma care to other physicians back home in the U.S. as well as serving as assistant emergency room chief at the military’s Walter Reed Army Medical Center in Washington.
But all his training could not help him overcome the tiredness that he said has come from working seven days a week for weeks on end — a fact of life for the hospital’s emergency room physicians.
It’s the same feeling, he said, that briefly caught hold of him last summer. He has steadily complained about the situation to higher-ups, he said, but nothing has changed.
Among everything else, he knew he was sliding into a burnout, he said, because he had not kept up his journal, something he rarely neglects. It always has been his way to deal with his feelings.
On June 23, for example, he wrote about a young medic from California whom he had encouraged to learn more about medicine. He saw the medic that day, but the young soldier’s face had been blown away by a rocket-propelled grenade.
“A wave of sadness swarmed over my body as I began to feel the tears pool in my eyes,” he wrote. “Then frightening flashbacks of all the faceless soldiers and civilians that I had taken care of during this war flashed through my mind. I couldn’t stop the horrific pictures.”
Just as he was going over his diary, Capt. Zenia Tabakman, 33, the emergency room’s head nurse, came by, carrying updates on a patient.
A tall, easy-smiling woman, she was serving at the hospital at West Point until five months ago. A native of Uzbekistan in the former Soviet Union, she came to the U.S. in 1991 with her family, refugees fleeing anti-Semitism.
Her emergency room experience in the U.S. did not prepare her, she said, for some of the wounds and injuries she has witnessed in Iraq. At the same time, she has felt a “sense of responsibility” that has driven her in the most trying moments. It was a responsibility, she explained, like the one that had led her to sign up for the military.
“It was something I wanted to do, because I wanted to pay back the country. I kind of felt obliged,” she said matter-of-factly as someone called from across the emergency room.
A surge of patriotism
At the emergency room desk waited a medic, Spec. Tab Law, 24, of Rock Falls, Ill. Before signing up for the military nearly two years ago, he had been a union carpenter. But a surge of patriotism after the Sept. 11 terrorist attacks and the desire to do something different had driven him, he said, to the military.
Though he talked with the savvy of a battle-weary veteran, the tall, blond medic admitted that he never had imagined the kind of human devastation he would see in Iraq.
“There are a lot of people who can’t handle it, and so they move to the wards,” he said. “Me, I put it in the back of my head.”
“I would definitely say that I’ve aged,” he added with a shrug. “I’m a lot more responsible.”
Just down he hall, Lt. Col. John Uriarate, 49, a social worker and one of a seven-person mental-health staff, suggested that Law’s change of mind was nothing unusual. During the Vietnam War years Uriarate saw many young men who became older-seeming men because of what they had been through, he said.
But there are other changes that worry him.
He worries about soldiers so driven by their jobs that they ignore their own wounds. One was a supply truck driver who had been through so many roadside bombings that he was on the verge of losing his hearing, Uriarate said.
Nonetheless, the soldier refused to quit, saying he feared that badly needed supplies would not get through to the soldiers without him, Uriarate said.
And he worried about doctors who disconnect from their feelings so they can push themselves to deal with the “horrific situations” they face — the carnage and non-stop pressures. Ultimately, however, some of them have a hard time reconnecting with families and friends, he said.
Because the emergency room is within earshot, Uriarate often strolls down to talk to soldiers waiting for an injured colleague.
“My job,” he said, “is to meet them and say, `Tell me what happened.'”
Often, he said, they will blame themselves needlessly for their colleagues’ injuries.
Hours later, several solders were camped out on the edge of the emergency room. Three of their platoon members had been hit by grenades. So, too, had been an Iraqi woman, whom they brought along for care. It was near 9 p.m.
They were another platoon from Augustine’s regiment, and they had been hit about the same time as his was the night before.
“I can’t even count how many times I’ve been here,” grumbled Sgt. Gregory Jackson, 36, of New Orleans, leaning up against the wall, his helmet and flak jacket sitting on the floor nearby with the other soldiers’ equipment.
Several platoon members raced upstairs, meanwhile, to see how Augustine was doing. “Hey!” they shouted upon entering his room. “We got hit again!”
He told them he probably would be evacuated to Landstuhl Regional Medical Center in Germany for more treatment. There was some concern about shrapnel that had torn through his leg and struck bone.
By 11 p.m. the platoon’s wounded soldiers were treated, and their cohorts were told they soon could go back to their base.
“See ya tomorrow night,” joked an emergency room crew member.
The young are not immune
On a second-floor wing, 10-year-old Kasim Muhammad Khalaf was sitting at a nurse’s station. Because he rarely sleeps more than a few hours, the nurses let the child stay up with them. He had been walking in downtown Karbala several weeks ago when a barrage of powerful bombs went off, ripping open his stomach and seriously damaging his eye. Thirteen people were killed and dozens wounded.
Kasim specifically remembered two blasts and how they had thrown him to the ground.
U.S. medical workers quickly transported the boy to the 28th C.A.S.H.. But it took a while before officials could find his parents. Once they did, however, the family has made the trip to Baghdad several times, hospital officials said.
“I am Kasim. Mister, what your name?” the youngster said as he reached his hand out to Dr. James Jezior, 40, the hospital’s deputy commander for clinical services, who was reading through a pile of medical records at the nurse’s station.
The doctor shook his hand, smiled and asked how the youngster’s bandages were doing. The boy seemed bothered by them, the doctor said, and then went back to reading records. It was close to 11 p.m. Jezior, an urologist from Walter Reed, had been on the job since early morning.
The calm held through the night, so in the early morning 1st Lt. Marisol Melendez, 34, of Canovanas, Puerto Rico, had a few minutes free from her duties as a nurse in a third-floor intensive-care recovery room.
This is the time, she explained, when she searches for stories from newspapers in the U.S. about the people who have died in her unit. Without the stories she knows them only as names, and she wanted to know more, she said.
Until a few days ago she kept an article posted on a small bulletin board about one death that had especially touched many in the unit.
It was about Staff Sgt. Kimberly Voelz, 27, of Carlisle, Pa., a bomb-disposal worker who had died Dec. 14 after being wounded by a roadside bomb that she had been called on to defuse.
Her husband, Staff Sgt. Max Voelz, who also works with explosive devices, had rushed to the side of his wife, marking a rare occasion when a victim has had a family member on hand.
At first she had seemed likely to survive her severe injuries. But within hours she died, making her one of only a handful of female U.S. soldiers killed in the conflict.
“The hardest thing was that he was holding her hand when she died,” Melendez said.
