Being There: Ramadi 
Carlos Brown Is a Hero (No Matter What He Says)
I’ve known him since the seventh grade, when he was awkward, obnoxious, and unpopular with the girls (okay, we both were). He always said he was going to be a surgeon, and when the Navy sent him to Iraq, I flew there to see him. I watched him work around the clock to save soldiers and civilians, Americans and Iraqis—even insurgents. Through it all, his mission never changed: Ignore the politicians, take care of the patients, kick butt at PlayStation, and get home safely.
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“You don’t understand how they can talk the way they do about killing and their hatred for the enemy—not the Iraqi people but the enemy. But this is a Marine Corps rifleman. His job description is to kill people. And when I got over here and saw the stuff that happens, I understood. He’s out on patrol, his buddy gets blown to pieces, and now he’s got to go out there again. I imagine there’s a lot of anger after that.”
As a one-of-a-kind asset in Ramadi—there is no other trauma surgeon, no one else who can do his job—Carlos was at little risk of having to use his combat training. But he quickly got up to speed on the blown-to-pieces part. In his first four months here he amputated two dozen limbs, more than he’d done in five years at L.A. County. “I wasn’t used to the acuity of combat trauma. In L.A., I got low-velocity gunshot wounds, stab wounds, and car crashes. That’s my bread and butter. People at home don’t get blown up by IEDs, they don’t get shot with rockets.”
The upside of combat surgery is that his patients are usually in top physical shape, and they never come in inebriated. And Carlos has the benefit of the walking blood bank, something no stateside hospital would ever allow. When there’s an immediate need for a lot of blood, a request is made over the camp-wide PA. It’s not unusual for fifty donors to show up and all the blood they give to get used. The availability of fresh, warm blood—which clots better and carries more oxygen than stored, refrigerated blood—saves lives in Ramadi.
Another big change is working on the enemy. Occasionally detainees arrive in blindfolds and handcuffs, escorted by troops who are armed to the teeth and understandably wound up. The mood in the trauma room changes immediately. Carlos’s job is to treat whoever comes in. One of the first such cases was an insurgent who’d been shot through the belly. Carlos operated and saved his life, but when the patient came to, he started acting aggressively. The Marines who’d brought him in quickly restrained him, despite Carlos’s explanation that this was common for a patient waking up from anesthesia. Annoyed, Carlos asked an interpreter what the patient had said. The interpreter translated: “Untie me and I will slit your throats. I want to kill all of you.” Carlos said he lost a little naiveté on that one.
Easily the worst part has been being away from his family. He left for Ramadi in August, meaning he missed Tyler’s first day of preschool and Madison’s at kindergarten. Trevor is a national-caliber golfer, and his dad is his caddie when he’s home. Though Carlos’s younger brother set him up with a blog that allows the family to post video messages to one another, that was a sorry substitute at Thanksgiving and Christmas. Debbie started a strenuous early-morning exercise program, fortunately able to share parenting duties with Marisol, at least until the elder Mrs. Brown began to have medical problems. A tree fell on Debbie’s car, and winds blew down the backyard fence, all while she was trying to find a buyer for the house.
These are the things Carlos thinks about while he’s cooped up in his hooch, the walls plastered with life-size posters of the kids and artwork from them and their classmates. A resilient window unit keeps him comfortable, but it doesn’t blow loudly enough to drown out explosions in town or howitzer fire from camp or, least of all, daydreams of home.
The war has changed him. “I’ve cried in the trauma room here, which I never did at home,” he said. “It’s for soldiers and Marines who died before they got to the hospital and we couldn’t get them back. That’s excruciating.”
He’s going to church now. He’s told his mother and brother he loves them more times during this separation than he had in his whole life before. And he’s looking at his job differently now too. “Coming in here to a casualty and cutting off the same U.S. military uniform that I am wearing—it’s just overwhelming to see that uniform lying on the gurney. When I see Iraqis, it’s like patients back home, and my job is to give them the same care I would if they were family. But when a warrior comes in, that is family.
“I would never want to do this to Debbie and the kids again. But if the government told me to come back, I’d be here in a heartbeat to take care of these young Americans. These guys volunteered to come over here and die for us, and I volunteered to come over here and not let them die.”
The Team
MOST SUNDAYS ARE SLOW DAYS at the hospital, especially when it’s cold, so on those evenings, the surgical team convenes to review the week’s cases. They meet in a small, bare space between the OR and the trauma room, Carlos standing at the back wall with a laptop and slide projector and the team stretching out in front of him in folding metal chairs. He conducts things casually; since he’s generally the quickest study on the team, it appears only natural when they follow his lead. When they looked at him to start the meeting I attended, he nodded at me, telling them, “All right, guys, we’ve got a tape recorder rolling this week, so let’s be on our best behavior.”
It was well-placed advice. The surgical team, five naval officers and three enlisted sailors, is very much a group of guys removed from their wives and girlfriends. Functioning somewhat independently of the rest of Camp Ramadi, including to an extent the soldiers of Charlie Med, they became fast friends, capable of approximating a locker room wherever they assembled. And no place is sacred. During one operation, Clark leaned down to peer into a small entry wound in an IP’s side just as one of the OR techs was starting to wash out the exit wound. Clark was hit square in the face with water and blood. The requisite “money shot” joke came from the other side of the table.
And if you thought “That’s what she said” was dead as a punch line, you’ve clearly not played Madden NFL on PlayStation 2 with a hoochful of naval officers in a while.
The team turned down the testosterone for the meeting. They sat scattered around the room without regard for rank. Clark sat sideways in his chair, leaning against a wall and sipping a can of Diet Coke. A barrel-chested, 36-year-old Army brat, he’s the team’s stickler for detail and protocol, making him the favorite target for ribbing. In front of him was his chief antagonist, Petty Officer David Leyva, 24, a reformed L.A. gangbanger with a bulldog build and Aztec warriors tattooed on both biceps. Leyva is the tech in charge of the operating room, but he has value well beyond his military training. He created an informal supply route with nearby Camp Taqaddum, built individual hooches in the enlisted men’s quarters—a large room known as the Man Cave—and constructed a foot pedal for the sink where the surgeons scrub. But most impressive, he once whipped Clark in a postoperative wrestling match.
The team’s anesthesiologist, 36-year-old Lieutenant Commander David Junker, from Washington State, sat behind Clark. Responsible for intubating patients and keeping them asleep during procedures, his job is akin to a triangle player’s in a symphony. He sits quietly through most of the performance, but once each half hour he gets up and does something really important. When that comparison was made one day in the weight room, he caught endless grief. But as Carlos later explained, out of earshot of Junker, the anesthesiologist had saved more patients than anyone else on the team. “We’ve had guys come in with their faces shot off,” said Carlos, “and Junker has found an airway every time. I don’t know how he does it.”
The guys in the rest of the chairs were generally quieter. Lieutenant Junior Grade Richard Whitehead, a physician’s assistant from Mississippi, sat on the front row next to Petty Officer Tony Rogero, an administrative clerk from the South Texas town of Mission, and behind them was another OR tech, Petty Officer Hugo Loera, from Southern California. Next to Loera was Lieutenant Junior Grade Marko Radakovic, a Los Angeles flight nurse with the team’s most dangerous job. When a casualty’s injuries require immediate transport, Radak-ovic flies with him. He stands over the patient the entire trip, fastened by a long belt to the helicopter’s ceiling like a Cirque du Soleil acrobat in a formless tan flight suit. If the pilot has to fly creatively to avoid attack, the belt is meant to keep Radakovic from sailing out the open tail of the bird.
The team remained focused through most of the presentation, listening respectfully as Carlos pulled up pages on his laptop and discussed each operative case in a quick couple of minutes. The week had been relatively quiet. An American soldier hit by sniper fire, an IP who’d shot his own hand, and another IP who’d been shot through his pelvis by a buddy who’d been horsing around. All had moved on and would ultimately be fine.
Then Carlos addressed Rania, the three-year-old girl who’d died of a cerebral hemorrhage. In technical detail he described her wounds and treatment, saying what she had needed was immediate brain surgery, though even that might not have saved her. The 45-minute helicopter ride probably ended any chance for survival. “At home you don’t send a three-year-old with a huge hole in her head anywhere,” Carlos said. “Unfortunately, here we can’t do anything, and she has to be transferred.
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