Saviors with scalpels
South Sound medics in Iraq ensure 96% survival rate at Balad Air Base
SEAN COCKERHAM; The News Tribune
Published: May 7th, 2006 01:00 AM
Balad Air Base, Iraq - Maj. Brett Schlifka of Puyallup was up all night in this tent hospital that nurses describe as "'M*A*S*H' on steroids."
The neurosurgeon from Madigan Army Medical Center had been operating on a U.S. soldier shot through the jaw. The next morning, he was getting ready for surgery on an Iraqi who lost his eye to an improvised explosive device.
Schlifka said he heard the Iraqi might be an insurgent who had fallen victim to his own bomb. That's one of the tough parts of his job.
"I don't take care of people who are trying to kill me back in the States," Schlifka said.
In Iraq, he also faces daily mortar attacks, a never-ending stream of gunshot and blast victims, and the emotional gut punch when the American soldiers he considers family die of their wounds.
Schlifka is among dozens of doctors, nurses and air crews from the Puget Sound area who are links in the medical lifeline for soldiers wounded in Iraq.
Medics from McChord Air Force Base help pick up troops and take them for surgery at the Air Force Theater Hospital at Balad, about 50 miles north of Baghdad.
This is the hub for treating battlefield casualties from across Iraq. All soldiers with head and neck injuries go through here. So do any others whose injuries are so severe they require evacuation to Germany.
"Nowhere in the world do you get the level of injuries you see here," said Col. Donald Taylor, the hospital commander who comes from Lackland Air Force Base in San Antonio.
A team of McChord medical specialists at Balad prepares the patients for evacuation out of Iraq. Other McChord medics and nurses often go on the life flights.
They are part of a medical airlift system the Defense Department calls unsurpassed in the history of war.
Maj. Ken "Rhino" Winslow, a McChord reservist nurse from Issaquah, helped bring wounded soldiers to Germany over the past several months. Winslow, based in Germany, would ride the planes to Iraq and back.
"From the time you are hurt on the battlefield in Iraq until you get to the continental U.S., it is 24 to 36 hours," he said. "If you were severely wounded in Vietnam, it was two weeks."
Winslow works in civilian life as a nurse practitioner in the emergency room at Snoqualmie Valley Hospital. He's proud of his contribution to the wartime medical airlift.
But like other McChord reservists, he said the duty takes a psychological toll. It has made him a different person. He doesn't know how to answer when people ask what it was like.
"Let's see, I was wearing body armor and a helmet and saw kids with arms and legs blown off," he said. "How do you express that?"
Tears and white knuckles
Master Sgt. J.P. Wirth, an Air Force Reserve flight medic from McChord, travels in C-130 aircraft throughout Iraq to pick up wounded soldiers in regional centers like Mosul and Talil.
"We get fired at when we fly, and we could get shot down," Wirth said. "But that's nothing compared to the guy in the ditch."
Wirth, who's been away from his job as a Seattle firefighter since 2003, said the focus is on safely moving the patients and managing their pain.
"A large number of guys, they will be denying their pain," he said. "But they will have tears in their eyes and will be gripping with white knuckles."
Wirth often takes patients to the hospital at Balad Air Base, a collection of more than 30 connected tents and a few trailers in the heat and dust of a former Iraqi air base.
There is no indoor plumbing. But hospital staff said they can do just about anything a major U.S. hospital can do, except heart transplants.
A bone saw is always buzzing in the tents.
The hospital sees more than 650 emergency patients and performs more than 450 surgeries a month. The wards are mostly filled with Iraqi soldiers, police and civilians.
They lie listlessly in hospital beds, some with horrible burns and abrasions. After treatment and triage, they're released or sent to Iraqi-run hospitals. They are rarely evacuated on American flights to Germany.
About two-thirds of the patients who come through are U.S. troops, with the occasional Brit or other coalition partner, but the Americans normally spend less than 24 hours here before being evacuated. They often are unconscious the whole time, brought in on helicopters, planes or convoys from the battlefield.
Hospital staff must remove stashes of ammo from the patients - including the single bullet that many soldiers tuck away to shoot themselves with if things get too bad.
Unlike anything in the U.S.
Balad is where ABC News anchorman Bob Woodruff and his cameraman, Doug Vogt, were taken after being severely wounded in a bomb blast near Baghdad in January.
Schlifka, the neurosurgeon who lives in Puyallup, was part of the team that worked on them. He said the journalists got no better or worse treatment than the average GI.
"(We) did not know who these guys were when they came in," Schlifka said. "I only found out who they were when I spoke with my wife later."
The surgeons often see multiple penetrating brain injuries a day. They routinely perform craniectomies, in which they remove part of the skull to relieve swelling of the brain. Woodruff, who was hit by a roadside bomb while standing in the hatch of an Iraqi army vehicle, apparently underwent such a procedure.
Schlifka is a burly man whose hospital screen saver has pictures of his beloved mastiffs, Baloo and Thor. He said the surgeons are close-knit, goofing around and playing practical jokes to relieve the constant stress. Little attention is paid to rank.
They kick back at "the Swamp," a building at the rear of the hospital, where doctors grill, watch movies and smoke cigars when not in surgery.
Nurses said the surgeons working at Balad will lecture at medical schools for years to come on the injuries they saw in Iraq and the innovative ways they put people back together.
An estimated 96 percent of the troops who make it from the battlefield to Balad survive.
Lt. Richard Stevens, an intensive-care nurse and a 1987 graduate of Peninsula High School, said this is a medical experience unlike anything he could get in the U.S.
It's hard, though, to see 20-year-old kids with limbs blown off. Sometimes the insurgents responsible for those injuries are in the hospital's operating room right next to the soldiers whose lives they shattered.
"For me, those insurgents get the minimum care - nothing special," Stevens said. "I have an awful hard time taking care of those guys."
Doctors and nurses at Balad say it's their duty, like taking care of murderers in hospitals in the U.S. They take some consolation in knowing the insurgents go to prisons like Abu Ghraib after their treatment at Balad.
Next door to the theater hospital at Balad is the 446th Aeromedical Evacuation Squadron from McChord. The reserve unit gets patients ready for the airlift from Iraq to Germany. A Washington state flag hangs on a wall.
They arrived in Iraq more than three months ago and have a few weeks left. They landed at 9 a.m. one day and had their first mission the same evening.
The pace hasn't let up. The unit has adopted the motto "Semper Gumby," emphasizing the need to always be flexible.
The crew of about 70 from McChord tries to bring some normalcy to the wounded who come straight from the desert battlefield. There are donated civilian clothes, a Playstation 2, television, magazines and books.
The McChord reservists, some of whom are carpenters, even built an outside deck, a basketball court, a fire pit and a barbecue area for the walking patients to use.
"This is like being a mom of the sons I never had," said Lt. Col. Karen Winter, a nurse from Lakewood.
Winter tries to get the injured soldiers to open up. It can be tough. Last week, she said, a Marine who had just graduated from Lake Washington High School in Kirkland came through. The young man had serious leg damage from a rocket-propelled-grenade attack. His buddy died trying to resuscitate him.
"He said he wanted to cry but just couldn't," Winter said of the survivor.
A nurse at Madigan back home, Winter said she loves helping soldiers. But she doesn't think anyone will leave Iraq without some form of post-traumatic stress disorder. The sound of a truck backing up reminds her of the alarm klaxons that signal incoming mortars at Balad.
"I feel like I want to dive to the ground," she said.
Maj. Diana Hunt of Seattle, a critical-care nurse who works for Airlift Northwest, said it hits her hard to see how young the wounded soldiers are. Most are between 18 and 25. Hunt said she thinks, "What if this was my kid?"
"I try not to let things get to me," Hunt said, her voice breaking and tears coming to her eyes. "But some things have gotten to me here."
The McChord medical team makes sure patients are ready for the 51/2-hour flight from Balad to Germany.
They have to consider the movement of the plane and what altitude it should fly; there can be problems with brain and eye injuries at high altitudes.
Another big consideration is taking care of the pain. The most serious patients are sedated.
"One of the most important things for us is that they don't remember the experience," Hunt said. "It's very stressful and very traumatic."
One night last week, the McChord crew was getting ready to evacuate one soldier with a spine injury from shrapnel and several with relatively minor ailments.
The patients, other than the one injured in combat, slept on cots in the darkened waiting room until the flight left around 4 a.m. About an hour before the flight, McChord medics drove to the hospital to pick up the soldier with the shrapnel wound.
The soldier was angry and drifting in and out of consciousness. He complained bitterly whenever he was moved and kept asking for "Excedrin Migraine."
All the patients were quiet as medics loaded them aboard the C-17 for the trip to Germany. Their stretchers barely moved as the jet roared off from the desert war zone toward the sanctuary of Germany.
In-flight nurses stood by in what essentially was a flying hospital, checking the soldiers' vitals and asking them how they were doing.
Spc. Brandon Lander, evacuated on a stretcher after falling from a guard tower near Muqdadiyah, seemed in awe of the care he was getting. Soldiers are used to being tough and self-reliant.
"I don't think the Army could do enough to award the medics," Lander said. "It is just absolutely incredible patient care."
American, Iraqi use languages to form bond
Balad Air Base, Iraq - Lt. Richard Stevens, an intensive-care nurse who grew up in Gig Harbor, spends a lot of time helping Iraqis hurt in the war.
So Stevens turned to an Iraqi interpreter at the Air Force Theater Hospital here to teach him Arabic.
"I've tried to learn a few simple words and phrases from him," said Stevens, an active-duty nurse normally based in Hawaii. "Like 'This is going to hurt' and 'I'm sorry.' I say 'I'm sorry' a lot."
"He's awesome," said the interpreter named Faraj, a man with a quick smile and ready laugh. "He's a good student."
Like most native interpreters who work for coalition forces in Iraq, the interpreter knows that having his identity blown could get him and his family killed. He is taking a huge risk by working for the Americans at Balad Air Base, about 50 miles north of Baghdad.
His family lives in neighboring Balad, a city of about 80,000 on the banks of the Tigris River in the heart of the Sunni Triangle.
He is well aware of the dangers when he leaves the base every month or so to go see his family.
"The bad guys have eyes out there, especially the taxi drivers," he said. But he said it's not helpful to dwell on the risk.
"You don't think," he said. "You just go."
He said his interpreting job is the only way to keep up his English, which he studied at an Iraqi university before the war. He's clearly comfortable and well-liked by the U.S. medical staff.
Stevens knows firsthand the dangers that interpreters face. The nurse used to be stationed in Tikrit in a unit that hired two Iraqi brothers as interpreters. The insurgents kidnapped the men's sister.
"They got back a body," Stevens said. "That kind of hardens your resolve."
Sean Cockerham: 253-597-8603