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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It is easier to understand the destruction of a human body than the destruction of a city. To fully comprehend a town in ruins, you need a before-and- after shot, some solid reference to what was once there. Or at least a tour guide, someone to walk you through the remains of a neighborhood and tell you how tall the buildings used to be, who lived there, where they worked, and where their kids played.
You don’t need that with a body. When you see a person carried into an emergency room on a stretcher, his pants ripped at the knees like cutoff shorts and what appears to be piles of ground chili meat spilling from the tattered cloth, you know what is gone. You know what a leg is supposed to look like.
These are the things you think about in a place like Ramadi. I spent the last two weeks of January there watching a lifelong friend from Austin, Navy Commander Carlos Brown, perform trauma surgery at a military hospital. He took in casualties almost every day, Americans and Iraqis, warriors and civilians, alone and in groups up to sixty. They suffered from wounds caused by accidental gunshots and stray mortar fragments and homemade bombs that were packed in lorries or buried in the ground and ruthlessly calculated to hurt as many people as severely as possible. Carlos had been in Ramadi for four months at that point, his time spent continuously on call for critical care and thus split between saving lives and missing his own family back home.
As I watched him operate day in and day out, two thoughts, two seemingly contradictory ideas, kept coming to mind. The first was an unexpected realization of how resilient a body is. When a doctor performs surgery, he does real violence to a person. Take an amputation. With the patient unconscious, the mangled limb is lifted from the table and tied to a length of gauze that is fastened to a hook in the ceiling. The arm or leg is stretched out and cleaned with a thick, mustard-colored antiseptic that is painted on with sponge brushes. The dead flesh is cut off with scissors, the bone is sawed with what looks like a carving knife, muscle is scraped away from the bone with a chisel, and veins, arteries, tendons, and nerve endings are clipped with an electrocautery tool that fills the room with a flinty, campfire smell. What is left is then washed with a device that looks like a cross between an electric eggbeater and a water pick, every bit of the stub getting sprayed and scrubbed before the surgeon takes a curved needle and a strand of silk thread to close a flap of flesh around the nub.
When you watch all this, you instinctively wince. Then you marvel at the beating our bodies can take.
The other idea runs the opposite way, to the fragility of life. When a surgeon pulls a mortar frag that’s a quarter of the size of a postage stamp out of a casualty’s chest, announcing that this tiny piece of metal has opened the soldier’s aorta and that he probably won’t make it, you start to think about how dumb luck can be. You try to picture the attack in your head. You see a group of soldiers walking down an empty dirt road strewn with debris and lined with crumbling brown buildings. There’s a small cardboard box lying on the ground that they don’t notice, and it explodes in a ball of fire. You slow down the scene to find that one piece of frag as it floats through the air, sailing toward the soldier on a line that happens to run right through the armhole of his body armor. It pokes through three layers of shirts, piercing the skin and slicing through the bright-red meat underneath to clip the front side of the thick, white artery and come to rest against the soldier’s sternum.
Viewing the scene is like watching the Zapruder film each November, hoping every time that the outcome will be different. But it never is. In the scene in your head, the soldier always leans exactly the wrong way. If he’d moved a hair’s breadth in any direction, he would have been spared. But he didn’t, and he wasn’t.
Still, picturing it this way helps just a little. It lets you get your head around the event, gives a little logic to how this death happened.
It tells you absolutely nothing about the reasons why.
CARLOS AND I WERE HALFWAY through our first day together in Iraq before it mattered where we were. I arrived at his base, Camp Ramadi, shortly after three that morning, on the third Tuesday in January. The place was cold and covered by a fat layer of mud that refused to let go of your boots. When I knocked on the door of his “hooch,” a military term that avoids the leap in logic necessary to call the place where a serviceman stays “living quarters,” he’d mumbled a groggy, “Hey, Spong,” as if I was waking him up for an exam when we were roommates in college.
When he turned the light on, I saw that all the Carlosian trademarks were in place: the forehead, the chin, and the pigsty room, with piles of dirty clothes and stacks of papers and books dotted by half bags of Doritos and Diet Coke empties. The only noticeable effect of his deployment was that the clothes on the floor were tan desert cammies. Once he’d finally shaken the sleep from his head, the rest of Carlos emerged, the shrill, cackling laugh, the excited declarations of the obvious, and the incessant stream of questions that typically had no answer. In this instance, the flow was the same exclamation and query over and over: “I can’t believe we’re in Iraq together! What are we doing here?”
Carlos Brown is one of the oldest friends I have, a relationship dating back to our middle school days. As kids we were joined by a shared desire to gain attention from pretty girls and avoid it from bullying jocks. We were also, unfortunately, possessed of an awkwardness that made both impossible, though Carlos was never quite willing to admit it. Now we were in Iraq, he a top-knife trauma surgeon in command of a naval surgical team and I a journalist ostensibly there to report on the war. But mostly I wanted to hang out with him.
He walked me from his hooch across a muddy two-lane road to his hospital, which I’d initially mistaken for a tin-roofed bus barn, and deposited me in a room for some much-needed sleep. Four hours later we were in the chow hall for breakfast, and our conversation picked up right where it always does, 25 years in the past, leapfrogging right over his time in country to revisit the true landmarks of our lives, like our first beer bong and a couch we once took to South Padre for spring break.
After breakfast, Carlos gave me the nickel tour of the base, sliding through the mud in the surgeons’ SUV past long tan tents half the size of a city block and rows of two-story barracks that looked like cheap apartments. The parking lots and roads were filled with armored vehicles, some on tracks and some on wheels, and everyone we passed was carrying a machine gun, none of which qualified for inclusion in our conversation. We stopped by brigade headquarters to find the two press officers I’d been e-mailing en route, partly for a briefing on the mission in Ramadi and partly to prove to Carlos that their names really were Major Slaughter and Major Player. On the way out, we found a note on the SUV informing us that we had parked in the brigade commander’s parking space. The last time we’d gotten a note like that the parking spot had belonged to the principal.
Back in Carlos’s hooch the discussion finally moved on to our year as roommates at the University of Texas and an evening when I’d peed on his leg at a Dwight Yoakam show. Then we heard a knock on the door.
“Sir,” said a woman in green Army camouflage as she came in the room, “we’ve got an Iraqi civilian with a wound from indirect fire coming in.”
“Thanks. Call Clark and Junker,” he said, referring to Lieutenant Commanders Christian Clark and David Junker, the orthopedic surgeon and anesthesiologist who assist Carlos. “They’re at the gym working out.”
“Roger that,” she said and walked out the door with us close behind her.
On the way over, Carlos explained what was about to happen. “Did you notice that she didn’t say what part of the body was injured? We never know what we’re going to get, how many, or what’s happened to them until they get here. If it actually is a wound from indirect fire, it’s probably going to be mortar frag. If it’s to a civilian, you just hope it wasn’t one of our mortars.”
On a covered concrete slab in front of the hospital, five soldiers from Charlie Med, Camp Ramadi’s medical support unit, were waiting for the casualty. The sun was out, and the mood was loose, though the weather was still cold enough to see frost on the soldiers’ breath as the bunch of them milled around.
Carlos pulled me aside. “This is one of the few times I still get nervous,” he said. “Iraqi patients usually get brought in by IPs, Iraqi police, and they come in here in these big white pickups with blue doors and a loaded machine gun mounted in the bed. And they wrap their headdresses around their faces because if anyone recognizes them on the streets, they’ll probably get killed. And of course somebody’s just been wounded, so they fly in here screaming, and it’s just disconcerting. One of the first things you learn when you’re little is that a man in a mask with a loaded gun pointed at you is a bad guy. We’ve never had any trouble, but it just feels weird.
“See what I mean?” he said as a Dodge pickup slid to a stop in front of the slab. Sure enough, an IP with his face covered was standing at a machine gun directed over our heads. He was barking at two policemen crouching beside him. The Charlie Med guys took a couple steps toward the truck, expecting the two IPs to pick up a stretcher. But the pair stayed low. I looked at Carlos, who flashed a helpless, here-we-go smirk as a fourth IP stood up in the bed. He was holding a small girl wearing a pink dress, and the entire right sleeve of his blue shirt was purple with blood that had run from her head.
“All right, everybody,” said Carlos loudly but calmly. “It’s a child. Let’s get her inside.”
The IP was led into the trauma room, where he laid the girl on a table and backed away as the medical team flowed in and around her. Her eyes were open, but she was barely conscious and never once blinked. The team moved efficiently, ten people bouncing from the table to stations around the room, cutting her clothes off and getting an IV started in her thigh. At the head of the table Carlos trimmed the girl’s hair away from the wound, then instructed the group to roll her so he could clean blood from her back and check for more injuries.
By then Clark and Junker were in, still wearing workout clothes, and Clark stuck with Carlos as Junker placed a plastic oxygen mask over her nose and mouth. She groaned softly as Junker asked one of the techs to find a pediatric airway kit. He needed a tube small enough to fit in her throat, and that was a problem. The hospital was intended for adults, and care for children always presented a challenge. One of the nurses put a pulse meter designed for a man’s finger on the little girl’s left big toe.
An interpreter hustled to the table. He’d found the girl’s father and learned that she was three years old and asthmatic. She’d been playing in the courtyard in front of her home with a couple friends when a mortar landed nearby. Her friends were dead.
Once Junker had the girl intubated, Carlos leaned down to look at her head.
“A small amount of brain is coming out of a hole in her skull,” he said. As terrible as that sounded, it was actually good news to me. I’d seen a clump of something on the floor at Carlos’s feet that I was hoping wasn’t brain. It turned out to be a small bundle of pink plastic balloons decorating the barrette she’d had in her hair.
Soon Carlos had stapled her scalp and bandaged her head. Then he followed the interpreter through the crowd to her father. He was easy to spot, a small man with a mustache in a plaid flannel shirt standing in a daze outside. To the interpreter Carlos said, “Tell him I’m Dr. Brown and that his daughter has a significant head injury, so we’re going to fly her by helicopter to the hospital in Balad for brain surgery. And ask him if he has any questions.”
The father never looked at Carlos or the interpreter; as the translation came, he kept his own unblinking eyes fixed on the hospital door. When the interpreter asked for questions, the man asked only if he could fly with her. Carlos said of course and then put his hand on the man’s shoulder, “We’ll do all we can.”
After Carlos had checked on the preparations for the girl’s flight, we trudged through the mud back to his hooch. He untied his boots, then grabbed a bag of chips and sat on his bed. After a couple minutes he asked me, “Was that the first time you ever saw me work on anybody?”
I told him it was.
“Hmm,” he said as he took off his glasses and rubbed his eyes. When he’d put them back on he continued. “It’s weird. When Iraqi adults come in, they scream bloody murder. But the kids are almost stoic. They’re so quiet.” Then he finished his chips without saying much else.
The next morning, Carlos checked on the girl’s status on a classified Web site where he could look up every casualty he’d sent through the military’s medical system. She was the last patient he’d seen and the first one listed. The main page gave just her name and condition: “Rania, deceased.” She’d died in Balad on the way to the operating table.
You didn’t need to be Carlos’s best friend to know what he was thinking. All you had to do was look up at the pictures of â€Šhis own three kids posted on the walls of his hooch. It was suddenly, heartbreakingly plain where we were.
The Most Dangerous Place in Iraq
TAKING ITS NAME FROM THE ARABIC word for “ashes,” Ramadi was destined for tragic distinction in this kind of war. It sits seventy miles west of Baghdad on a spot where the Euphrates River was once crossed by a Silk Road trade route, an ancient supply line from the Mediterranean Sea that now carries foreign fighters and arms. In 1869 the remote Turkish government formally established the city as an outpost for controlling, or at least monitoring, the various desert tribes that still dominate the region. More hopeful to the United States, in September 1917 Ramadi was the site of one of the final victories of British general Stanley Maude, the commander of the Mesopotamia Expeditionary Force who drove the Turks from Iraq during World War I, ending nearly four centuries of Ottoman rule. Though Maude died of cholera shortly after his men took the city, his campaign pushed on to the west and the north, beginning four decades of informal British colonial rule.
During Saddam Hussein’s reign, the city fared relatively well. It was the capital of Al Anbar Province and the southwestern point of the Sunni Triangle. Its half a million residents, practically all Sunni Arabs, were either loyal Baathists or people with a talent for feigning loyal Baathism. Saddam maintained a base for his Republican Guard there, making for a significant military population that shared the city proper with a sizable middle class. Self-sufficient tribes controlled the outskirts of town, headed by sheikhs who lived in a manner that ran from mansions and Benzes to mud bricks and donkeys. Through cash payments to the sheikhs, Saddam had ensured their allegiance. But after the overthrow of the dictator and de-Baathification, the soldiers lost their jobs, the tribes lost their incentive to obey the law, and the middle class lost its sense of security.
That mix made Ramadi one of the war’s instant hot spots, but the city grew into something more in late 2004. Nearby Fallujah filled the headlines that spring and summer, after the lynching of four American contractors prompted a brief end to efforts to take that city. When Fallujah finally fell in a bloody November sweep, few noticed that many of those foreign fighters not yet ready for martyrdom had moved thirty miles west, to dig in at Ramadi. With no sectarian tensions to split their attention, the burgeoning insurgency could focus on killing Americans and anyone who cooperated with them. Ramadi became known as the most dangerous place in Iraq, on some days accounting for nearly half the insurgent attacks in the entire country.
But last May, the 1st Brigade Combat Team, 1st Armored Division, rotated in at Camp Ramadi, the forward operating base, or FOB, that coalition forces occupied in Saddam’s old Republican Guard facilities. Under the subdued command of Army Colonel Sean MacFarland, the “Ready First” intended to take the offensive, but it opted against the kind of massive show of force that had cleared Fallujah. I spoke one afternoon with one of MacFarland’s battalion commanders, Lieutenant Colonel V. J. Tedesco III, of the 1-37th Armor, an earnest soldier who, among other things, taught military history at West Point after fighting in the first Gulf war. “Instead of lining up and marching in a wave from one end of the city to the other, killing everyone who hates us,” Tedesco said, “we chose a slower, methodical approach.”
The plan was specifically tailored to fight an insurgency, and its essence was to win the city in sections. The military calls it an inkblot strategy, and the first dot is the combat outpost, or COP, a large house or group of homes seized by U.S. forces to serve as a base of operations in a given area. From there, the warriors—as the soldiers and Marines who do the actual fighting are reverentially known—fan out through the neighborhood on daytime patrols and nighttime census operations, cordoning blocks and entering homes one by one to photograph male family members, search for weapons, and attempt to gather tips. In its first six months in Ramadi, the Ready First established eighteen COPs.
“The key is the people,” Tedesco said, “showing them a positive future and getting them to invest in it. So when we go in, we pull the family to one side while we talk to the men. We give the kids candy and school supplies, and we give the moms sugar. If your objective is only clearing houses, you can do a lot in one night. But if you carefully go in, you can build relationships.”
Of course they also killed bad guys, and though Tedesco is prohibited from saying exactly how many, he gave an approximation that sounded insightful: “Hundreds and hundreds and hundreds.” His battalion, responsible for one quarter of the city, lost twelve of its own.
Slowly, parts of Ramadi started coming around. Foreign fighters had long intimidated the city with public executions of policemen and their families. When the Ready First stepped up Iraqi police recruitment as part of the COP plan, the insurgents stepped up the violence, but this time it backfired.
Last August insurgents murdered a sheikh who’d encouraged his tribesmen to join the police, and significantly, the killers hid his body, preventing his tribe from honoring the Muslim tradition of burial within 24 hours. Locals were furious. Tribesmen quietly started to cooperate with coalition forces, and highly prized insurgents occasionally turned up dead in the streets. In September a group of sheikhs aligned to form the Al Anbar Awakening, pledging to defeat the insurgents and send even more recruits from their tribes. Applicants went up from thirty a month last spring to eight hundred in December. Ramadi wasn’t safe, but it was starting to look safer.
“When we first got here, coalition forces could only operate in Ramadi at enormous effort and risk,” Tedesco said. “We would have to fight our way in, and then we could not stay very long. Now there is no place in my area that I will not go.”
There was guarded optimism on the FOB when I arrived in Ramadi. The Ready First was preparing to rotate out, and the counterinsurgency plan was viewed as moving slowly to success. In closing remarks to his platoons, Tedesco noted with pride that the inkblot strategy was now going to Baghdad. “When they talk about ‘the surge,’â€Š” he said, “they’re talking about what you have done here.” The public affairs officer who briefed Carlos and me said that insurgent attacks were down precipitously, citing impressive percentages, though he refused to give hard numbers. When Carlos asked what accounted for the decrease in casualties at Charlie Med, the officer said, “The short answer, sir? We’re winning.”
Carlos, who had initially insisted I not leave the FOB, started encouraging me to do so. He wasn’t allowed to go “outside the wire,” as the military called it, so when I ended up making two trips to one of Tedesco’s south-side COPs, it was partly to satisfy Carlos’s curiosity.
Both times I left the FOB in a convoy of Humvees that headed out on a desert highway and then took dirt roads marked by Bradley tanks at each end. The city felt deserted, the streets covered with water and debris and lined by windowless courtyard walls. Occasional date palms and fig trees peeked over the walls, and behind them rose homes, none more than two stories tall, though some clearly had been.
The architecture was boxy desert Arabic, the color of the earth, signified by columns and arches, lattices and porches, and arabesques ringing rooflines. The side streets and alleyways were blocked off by concrete barriers and tangled rolls of concertina wire, and every now and then I saw kids on the other side playing soccer and riding bikes as small groups of men and women gathered to watch. Brief moments of color appeared as well, too muted with dust and faded by the sun to be described as bursts: old reds and blues drying on clotheslines, stacks of green sandbags, and the red-black-and-white Iraqi tri-color at IP stations, but mostly the anonymous hues of trash blown against the walls or caught in the concertina. Everything else seemed brown and gray and in pieces.
An Unending Series of Slights
FEW THINGS IN LIFE GIVE ME as much pleasure as explaining Carlos the little kid to those who know him only as the renowned Dr. Brown. Nowadays he’s actually got a little George Clooney to him, standing a handsome six feet tall and a sturdy 185 pounds, with a noble Spanish jaw and deeply self-assured, dark-brown eyes. His story, of course, begins somewhere else.
Carlos Vidal-Ribas Brown was already crowing about becoming a surgeon when I met him in 1979 on the first day of the seventh grade—not that anyone was listening. He showed up at our lily-white middle school in West Lake Hills all forehead and mouth, the new guy with the funny name and the mom who yelled in Spanish at his Little League games. He was a year young for our grade, scrawny, hyper, and inexplicably brash. Questions spewed out of him in a high voice that jumped an octave when he got excited, the leaps usually prompted by something like an increase in the market price of one of his baseball cards (“Did you see that Ozzie Smith’s rookie card is at twelve dollars? I’ve got thirteen of them!”) or his scoring higher on a test than everybody else (“I got a ninety-eight! What did you get?”).
He was born in Washington, D.C., in 1967 and moved to Austin after spending his younger years in Honduras, Ecuador, and Virginia. But his name and that history barely hinted at how exotic his story really was. His parents met in Langley, Virginia, when Marisol Vidal-Ribas was teaching Spanish to CIA agents and brooding Glenn Otis Brown was one of her students. She was a tall, barefoot gypsy daughter of Catalonian aristocracy—her father had been president of the revered Fútbol Club Barcelona, Spain’s version of the New York Yankees—and he was a high-level spook with a master’s degree in English who had cut his teeth in “the company” playing jazz piano as his cover in Holland.
But all that meant for Carlos was that his mom stuck out in our Waspy environs like paella in a Luby’s line and that his dad was gone to places unknown for six months at a time. Carlos quickly fell in with the guys that I ran with, an odd bunch who occupied that social no-man’s-land for kids with no meaningful adolescent currency: no athletic skills, no musical talent, no three-figure allowances. Carlos was the guy who never acknowledged those deficiencies, who’d spend hours figuring his Pony League statistics and then announce at school, “If I get four hits in my next five at bats, I’ll get my average up to .386. That’s what George Brett is hitting.”
We became even closer in college, when the rest of the guys went away to school and Carlos and I stayed at UT. Weekends began around lunchtime on Wednesdays, the next four days devoted to keeping a beer buzz and chasing girls. Like all lifelong friendships between guys, the relationship was an unending series of slights. Every unlikely girl who showed an interest in one of us would soon be subjected to advances from the other. Our friendship was based on a policy of mutual assured goofiness; if a girl let one of us make time with her, she was clearly desperate enough to go out with the other.
More-serious endeavors worked their way into the party. We coached peewee basketball together for two seasons, until Carlos had to buckle down with his premed classes. When my parents split up during our senior year, Carlos started inviting me to family dinners with his parents and his younger brother, Glenn. Then Mr. Brown died, in 1990. Now the man of the family, Carlos asked me to deliver a eulogy, more an indication of how much we’d come to need each other than any talent I’d shown.
And at some point in there, he became as cool as he’d always thought he was. After graduation I’d summered in Waco. (Don’t ask.) One weekend I came home to find him driving a 300ZX and working as a lifeguard at a fancy country club that I’d never even been to. He’d weighed just 150 pounds when we got out of high school, but now he was filling out a closetful of Polo button-downs. He bought a nice watch and started wearing cologne.
He took a naval scholarship to attend the University of Texas Medical Branch, in Galveston, then graduated with honors. He moved to California for a surgical internship at the Naval Medical Center in San Diego, where he fell in love with and married Debbie Sicher, a pretty neonatal ICU nurse from Chicago with the saintly patience to endure all his questions. While she was having three kids—Trevor, now nine; Madison, six; and Tyler, four—he moved into trauma care, and the family relocated to Los Angeles, where Carlos went to work at the L.A. County medical center, one of the busiest trauma facilities in the country. Still a Navy doc, he was also writing papers and winning teaching awards. He became an international authority on the effects of obesity on critical trauma care.
Discussing that evolution was a favorite topic in Ramadi. “I was always arrogant,” he joked one afternoon. “I just never had anything to be arrogant about. And now I don’t have to be. Now I have a great wife, great kids, and a great career. I’m more comfortable being Carlos Brown than I was fifteen years ago. I think when you find your way in life, you don’t have to be cocky.”
I pointed out that he’d just referred to himself in the third person.
“No, I didn’t,” he fired back. “When?”
“You just said you’re comfortable being Carlos Brown.”
“Dammit,” he said, cackling. “Don’t put that in the article.”
“Okay, no problem,” I said.
He enjoys being at the top of his world, as he well should. But it would be a mistake to say he’s never looked back. Every time we’ve talked on the phone he has asked about life back home, what our old friends are up to and how the city is changing. Last spring, Austin’s Brackenridge Hospital approached him about taking over its trauma program. The job that was offered to Carlos entailed operating, teaching, and researching, and he’d oversee trauma care for eleven Central Texas counties—all in his hometown.
This was what he was talking about way back in the seventh grade, what he’d been working toward his entire life. He accepted the position, agreeing to start in October 2007. But before he could come home, he had to finish his commitment to the Navy. And that meant surviving six months in Ramadi.
THE HOSPITAL AT CAMP RAMADI is run by the 501st Forward Support Battalion’s C Company, a unit that is better known by the name that appears on white signs with red crosses and directional arrows posted all over the FOB: Charlie Med. Roughly a hundred men and women make up the unit, most of them in their twenties and early thirties, about sixty of whom are classified as combat medics. The balance are a handful of physician’s assistants and nurses, a couple of mental health counselors, a dentist, various support staff like administrators and ambulance mechanics, and three actual physicians: two pediatricians and a neurologist, who function as general practitioners. Their main facility, like most of the larger buildings on the FOB, is a simple one-story structure of about 20,000 square feet made up of a crowded seven-bed sick bay, several hooches for the medical providers, and a cavernous patient-hold area with a concrete floor where as many as forty patients can rest before returning to duty. That large room is where much of Charlie Med living is done. A significant number of staff are always on duty, and the younger soldiers while away the slow periods the way young people do, goofing and flirting, typically loudly, reciting lines from the newest Net-Flix arrivals and speculating about the party they’ll throw when they finally get home.
The mission is to provide all the health care needs for the base, which mostly means easy cases like colds and pulled muscles. The drama comes each day when the war breaks out. All of Ramadi’s critical battle casualties come to Charlie Med, the good guys and bad guys and innocent civilians. The unit itself is not equipped for trauma surgery; Carlos’s team is an attachment and technically not part of Charlie Med. But in late 2005, a naval surgical team went to Ramadi at the start of a series of mini-offensives in anticipation of a high number of casualties. When the expectations were met, simple supply-and-demand analysis mandated that a team stay on. Carlos’s guys rotated in last fall, and when trauma cases come in, they take charge. It’s during those instances when Charlie Med soldiers go from being “fobbits”—the COP warriors’ nickname for FOB residents—to heroes.
Trauma care in Ramadi begins where it does in all armed urban conflict, out in the streets. The military categorizes that as Level 1 care, and it starts almost as soon as a warrior goes down. When a squad of soldiers heads out on patrol, walking down alleyways or kicking in doors, a combat medic goes with it. (Or, in the case of the Marines, a Navy corpsman.) If the enemy makes contact, if an IED blows or a firefight breaks out, the medic is there to scoop and move the casualty and then tend to the simple ABCs: airway, breathing, and circulation. As often as not, that all takes place while the fight is still on, in the shadow of a Bradley firing its big gun. The medical decisions are quick and crude. One baby-faced Charlie Med medic put it thusly: “If he’s got open intestines or his heart’s out, we move on to the next guy.” The casualties who still have a chance are loaded onto the medic’s ambulance and moved to Charlie Med, typically arriving in less than twenty minutes.
The Charlie Med trauma room provides Level 2 care. Situated across the slab from patient-hold, it looks as if it was built in a hurry and outfitted with furniture and fixtures from a third-world Container Store. The interior walls, shelving, and countertops were all fashioned out of two-by-fours and three-quarter-inch plywood. Three casualty stations are on the left as you enter, not really beds but waist-high box frames on which the stretchers are laid. Industrial shop lights hang from the ceiling over each bed, square lamps with black-metal-mesh faces on retractable orange arms. Thick electrical cords run from the lamps to the walls.
The room feels busy even when it’s empty. Olive-green strips of vinyl hang on all available wall space with three horizontal rows of clearly labeled pockets holding necessities: gauze, scissors, syringes, needles, scalpels, sponges, rubber gloves, central line kits, slings, splints, Ace wraps, burn dressings, and operating kits. On one counter sits an ultrasound machine that looks like an old green-screen Apple computer with a microphone attached, and in the corner stands an X-ray camera at the top of a two-wheeled dolly that can be shuttled from table to table.
If surgery is necessary, the patient is carried up a narrow passageway and through two offices to the larger operating room. A table sits in the middle, with another in the left corner, and scattered around the room are stools and two rolling tables for the techs to load with surgical instruments. The walls are white, but almost everything else in the room is a soft sky blue or silver. There’s a thin, light-blue rubber pad on the floor to make standing for long periods bearable, and rows of polished instruments that look almost chromed sit on blue sheets that cover the tables. When the patient is opened, the parts of his body not worked on are covered in thin, blue paper sheets, and the docs work in blue gowns and gloves. The only things interrupting the blue are the surgical caps—Carlos’s is burnt orange, with a UT Longhorn on the front—and the blood. It’s in bags hanging at the head of the bed and in pools on the floor.
The job of a Level 2 surgical team like Carlos’s is not to fix patients but to save them, to get them stable and on to a Level 3 facility for definitive care. When a medic reaches a casualty in the field, he asks himself if the soldier is dead or not. The first assessment for Carlos is if he’s dying or not. Carlos takes off the dressing and explores the wound. If the patient was shot through the belly, Carlos opens him up from his ribs to his groin and surveys the damage. He’ll stop the bleeding with clamps and an electrocautery tool, basically a small soldering iron. With the blood out of the way, he’ll check by sight and feel. He’ll stick his arms in the belly up to his elbows and root around as though he’s searching for a pair of socks in a full duffel bag. He might remove some stomach and cut out some intestine, but if he has to disconnect the two for some reason, he generally won’t take the time to hook them back together. That happens at the next level of care. Then he’ll wash out the wounds, but often he won’t even close his incision. He’ll stuff it with gauze and then put sheets of blue plastic over that to keep in the heat on the flight out. To stay warm in the helicopter, the patient goes in a body bag, a sight that terrifies the soldiers who are waiting for word on their buddy. Charlie Med calls the bags “hot pockets” when they’re used for this purpose.
The system is based on the allotment of time and resources. Carlos is wanting for both, especially when multiple casualties come in at once. His team has only two surgeons, himself and Lieutenant Commander Clark. The hospitals they send patients to, in Balad and Baghdad, each have seventeen surgeons, including all kinds of specialists and subspecialists. They do the actual repair work and then send the American patients to a military hospital in Landstuhl, Germany, and ultimately home.
Dave Vazquez, a pediatric surgeon who worked with Carlos in San Diego ten years ago, was deployed last fall to Balad. It was a busy time in Ramadi, and a great many patients went directly from Carlos’s table to Vazquez’s. “We routinely saw people with absolutely fatal injuries that were going to live because of what Carlos had done,” he said. “I remember one patient with horrible injuries. Both legs had been amputated, and he had multiple open fractures to his arms. His genitalia was mush. He was just a mess. As soon as he showed up, we had eight people operating on him at the same time, two orthopedic surgeons, five general surgeons, and a urologist. Carlos had essentially operated by himself. And considering his injuries, the guy was in fantastic shape.”
“Untie Me and I Will Slit Your Throats.”
FOR PEOPLE THE AGE OF CARLOS AND ME, joining the military had nothing to do with going to war. We became aware of the world as the last troops were leaving Vietnam, and as we grew up, things like the draft and dying for your country were altogether unknown. We registered for Selective Service on our eighteenth birthdays conscious that our signatures didn’t have to mean anything and certain that anybody who tried to explain conscription to us had fallen from a time capsule that had been shaken too hard. Oliver Stone’s Vietnam nightmares had nudged John Wayne’s World War II heroes completely out of the cultural discourse. The images of war that we saw were either surreal or all too real, and always damning. The Deer Hunter. Apocalypse Now. Platoon. Full Metal Jacket. For us, war was Vietnam and Vietnam only. A mistake. And one that would never be made again.
When Carlos accepted his naval commission, the harm he saw in his way was his own impatience at waiting ten or fifteen years to start his career. “I joined because I needed something to pay for my education,” he said. “I had some kind of military-ish memories from being a child in D.C., and I thought serving my country was an honorable thing. But when Desert Storm started, I was a second-year medical student, and it was over before I interned. I was a battalion surgeon with the Marines in Okinawa in 1999, but we were not at war.
“And then I went back to California and just being a surgeon. It was a job.”
When his deployment became inevitable early last summer, Carlos talked to colleagues who’d already been to Iraq to get some idea of what awaited. It sounded like fiction. A friend from medical school had accompanied the Marines during the initial push into Baghdad. He described the life of a battlefield surgeon, of having to set up a tent and be ready to operate in less than an hour, of sleeping under the stars within a mile of the fight and moving his cot to the far side of an armored vehicle to feel safer. When he finished with patients, he’d write a shorthand description of their injuries with a Sharpie on their bodies for the docs at the next level of care. When he performed amputations on Iraqis, he’d leave the severed limbs under their cots so they could take them when they were released. That was part of his understanding of the Muslim faith. And most counterintuitive for a practitioner of the healing arts, he’d had to train a gun on people.
Since Carlos was going to work on a FOB, his experience would be different, but the Navy made little distinction in the two weeks of training drills he attended with his team at Camp Pendleton, near San Diego, last June. The first week was medical, making sure everyone knew the equipment and how to set up a tent, then running them through mock mass casualty, or mass cal, events. The second week was war training, officially known as rear-area security. “It was combat for noncombatants,” Carlos said. “Land navigation, learning how to set up a perimeter, how to set up and fire a machine gun. Do you know how long to hold a trigger for a sustained burst? You squeeze it, say, ‘Die motherfucker die motherfucker die,’ and then let go. If you want a short burst, you just say, ‘Die motherfucker die.’ It was stuff like that.”
This was all foreign to Carlos. “We had a sniper talk to us about killing people. He said when you shoot somebody’s head off, it just explodes in a pink mist. You see a guy, take a shot, and boom, pink mist. I guess that’s their term for a head shot.
“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.”
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.
“But the interesting thing,” he continued, “is that a doc in Balad told me that they are going to start treating Iraqi patients to an Iraqi standard of care.” Clark and Junker perked up on that point, one that Junker and Carlos had explained to me earlier. Iraqi hospitals don’t do much in the way of long-term care. Breathing tubes are typically removed the day after surgery, and patients who can’t breathe on their own are allowed to die. To preserve resources—supplies, time, and manpower—Level 3 American docs would start working within those same limits, meaning they would no longer treat Iraqi patients who had that kind of prognosis. The implication was that Carlos needn’t send any more casualties like Rania.
Junker thought out loud. “It seems like we’ve been sending a lot of patients who will be extubated the next day, who by the Iraqi standard are going to die. Is that worth it? I agree we should still do everything we’re doing, but some of these cases use a lot of our resources.”
Clark spoke up. “We could run into the problem where we don’t have the ability to treat other patients.”
Carlos shook his head. “I have a hard time with an American hospital being the first level of care that a family sees, and we say, ‘Yeah, there’s nothing we can do.’ So many dead people come in here, and we have to say that so often anyway. This girl was clearly alive when her dad brought her in. Now, what if she comes in with four other patients? Okay. Then she has to wait. But we didn’t burn up a huge amount of resources on her. So I think we press on.”
There was no further comment, and with the serious topics exhausted, the team retired to another night of PlayStation.
THE SUN WAS OUT AND THE GROUND finally dry when Carlos and I dropped off a week’s worth of laundry at the cleaners after Sunday mass. We were walking back to his car when Carlos’s cell—what he calls the Bat Phone—went off with that distinct Cingular theme song, which Carlos hadn’t figured out how to reprogram. “For the rest of my life I’m going to be hearing people’s phones go off with that ringtone,” he said, fishing the phone out of a pocket on the side of his pants, “and I’m going to think something terrible just happened.” He looked at the phone. “Dammit, I hate that song. Hello?”
He stopped walking and put a finger to his free ear to listen to the caller. “I’m just at the cleaners,” he said. “I’ll be there in two minutes.” Then he shoved the phone back in his pocket and started hustling to the vehicle. “A car bomb went off at an IP station. We’ve got eighteen casualties coming in.” He punched the gas to get the car on the road, cruising past many more joggers than usual on the quarter-mile drive to the hospital. “My guess would be they’re coming to help out at the hospital,” said Carlos, as I listened to the announcement coming over the PA: “We need all available litter carriers and interpreters for medical assistance immediately.”
The scene when we arrived looked like utter chaos. Framed by the hospital on the left and a row of four IP trucks idling without drivers to the right, the slab was a blur of green camo and gray Army workout gear, almost everything moving except for a dozen bloodied Iraqis on stretchers on the ground. At least one hundred Americans had converged, some standing over patients but most in motion, carrying bodies from the trucks to the slab or going back to the trucks to get more bodies. People ran in and out of the hospital, taking patients in and returning with supplies to set up improvised triage stations: saline bags, blankets, big metal oxygen bottles with masks and regulators, sawhorses to make the stretchers into tables, chairs for patients who came in on their feet.
The slab was packed like an elevator at lunchtime, with people squeezing past you. Sounds wove in and out of one another, engines running, nurses barking vital signs, metal tanks dropping on concrete, docs announcing the urgency of patients’ conditions, and always the undertone groans of dazed Iraqi casualties. The wounded had swollen faces, almost all still conscious and coughing, covered in dirt and ripped clothing or, if their clothes had already been cut off, with little crimson pockmarks where frag had entered their bodies. Over the din a car horn blasted, and in the driveway, Charlie Med’s first sergeant, Donald George, held a walkie-talkie to his ear with one hand and reached through a truck window with the other, screaming for the drivers of the pickups to get their vehicles away from the slab. He had more ambulances with more wounded trying to get in.
Carlos went first to find Clark and Junker. The casualties had started arriving as soon as the call came in, and the two docs had been floating through the incoming, determining who needed what until Carlos could take over. The earliest report had been ten IPs hurt, but the first bunch alone had contained more than that. By the time Carlos arrived, a second wave was being unloaded and George’s third wave was waiting. The estimate of eighteen that Carlos had received was meaningless.
That posed a problem. The doctors’ first job in a mass cal is to prioritize the injured. Patients with no threat to life, limb, or eyesight get sent to patient-hold to wait to be treated. Those with immediate needs go into the trauma room for resuscitation, evaluation, and possible surgery. And those with injuries that would require an inordinate amount of time and resources are categorized “expectant.” They’ll be treated only after the others are stabilized. Usually they are moved out of sight and made comfortable while they die. The determinations are relative; a severe head wound who comes in alone gets the attention of the whole team, but one who comes in among five others might get no attention at all. There was the difficulty. The ten beds in trauma and the sick bay had been filled in the first wave. George told Carlos to expect the wounded to keep coming.
Carlos sent Clark to ride herd over patient-hold and asked Junker to go to the trauma room and start necessary intubations. Then Carlos went from table to table making quick decisions and moving on. At table one he looked at the physician’s assistant directing the four other providers working the patient. “He’s got a head wound and he’s not responding?” said Carlos. “He’s expectant. Let’s get someone on this table we can work on.” The Charlie Med pediatrician running table two said his patient had blunt trauma wounds to his chest and thighs, but X-rays were negative and an ultrasound showed no internal bleeding. “Let’s get him ready to evac,” said Carlos. And so on through the hospital.
A more vexing problem emerged. Almost every Iraqi brought in had difficulty breathing. In patient-hold, men were sitting against the walls passing breathing masks back and forth. These were casualties with no obvious injuries, no bleeding or broken bones, no soot or singes on their faces to indicate smoke inhalation. Word spread through the hospital that the truck that had blown up had contained chlorine tanks to maximize injuries. On the slab, interpreters were telling patients to try to breathe slowly. A number of Iraqis were sitting up on their stretchers and vomiting over the side.
Nothing slowed down, but a sense of order emerged. As you looked from station to station, you noticed that one person was in charge of each table. The fifth time the guy with his T-shirt on inside out and backward ran by you, you noticed he was dropping off oxygen bottles at different tables. Groups of soldiers gathered with stretchers at either side of the slab, not milling about but standing in formation. Amid the commotion in patient-hold, a walking blood bank got started, and away from all the activity, across the driveway in front of the Charlie Med garage, an area was dedicated to expectants. Four IPs lay there, covered in blankets on stretchers on the ground, while a chaplain and a corpsman tried to make their last minutes peaceful.
After an hour and a half the tide of incoming abated, and Carlos got Clark and Junker and headed to the operating room. He’d identified four operative cases and sent for the surgeons who work at the FOB’s detainee facility to help out. His own team moved quickly, with none of the usual joking around. The first patient had frag wounds to his chest and abdomen. In no time Carlos had him open and his bowels out on the table. The patient was bleeding from a hole in the spleen, so Carlos took it out, and then he and Clark ran every inch of intestine through their hands as if they were looking for knots in a rope, checking for hematomas as they fed it back inside. With that patient stable, Carlos moved to the other table, only to cut that patient open and find no internal injuries. While Whitehead sutured that patient shut, Carlos moved back to the first, who’d started bleeding heavily into the drainage tube coming out of his chest. Blood vessels were damaged on the left lung, and when Carlos opened his chest, he found blood bubbling on the lung’s surface, making a sizzling sound like butter burning on a griddle. “His lower lobe is destroyed,” said Carlos. “He’s not doing very well.” Then he removed the lobe and called for another patient.
The next casualty had a frag wound to the right side of his neck. Earlier, in the trauma room, Carlos had stopped his bleeding with an improvised fix, inserting a small balloon in his neck and blowing it up with a tube intended for a urinary catheter. Now with the balloon out and the neck opened, the patient began bleeding profusely. His carotid artery had been hit. The typical solution would have been to insert a temporary shunt and let the Level 3 surgeons do the actual repair. But the damage was too close to the aorta to patch it like that. By this point, the other surgical team was working on an abdominal wound on table two, and Carlos got one of the doctors to come pull two inches of vein from his patient’s thigh while Carlos and Clark opened his sternum. Then Carlos grafted the vein onto the artery, a simple thing to say but the kind of procedure that would have the halls of any stateside hospital buzzing the rest of the day.
It was nearly five-thirty when he finished the graft, five hours after he and Clark had scrubbed in for surgery. Outside, things had finally slowed down. Radakovic was preparing to fly to Balad, and the patients who could fly without him were already gone. Rogero told Carlos that dinner, burgers in Styrofoam boxes from the chow hall, was waiting in the Man Cave.
First Sergeant George stopped in to nutshell the day for Carlos: 16 IPs killed at the scene, 59 casualties brought in to Charlie Med, 38 evacuated immediately to Level 3, 4 operated on, and 17 sent back to duty. And the hospital had gone through all 120 oxygen tanks it had on hand, plus 20 donated by an aid station at a COP in town and 40 more sent down from the hospital at Camp Taqaddum.
Junker walked up as George was finishing. “A civilian is coming in hit by an IED. I think it’s unrelated to all this.” Carlos winced and then waited. Ten minutes later, four Marines brought in a sixteen-year-old kid, still conscious, with his right hand attached to his elbow by just two thin, white tendons. In between was nine inches of rotting ground chuck. The OR was set up immediately.
“Today has hurt,” said Carlos as he rescrubbed. “It’s just been awful. I mean, you read about this stuff and then you’re in the middle of it. Somebody drives a truck through a wall and explodes it? Then sprays everybody with gas? That’s just evil.”
It took a little over an hour and the last two units of blood from the walking blood bank to get the kid’s hand off and close up the nub. When they were finished, Leyva started putting the unused supplies back on the shelves while Loera took the dirty instruments to the sterilizing machine. As he usually does, Carlos mopped the floor of the operating room. He said he’s not sure why he feels as if he ought to do it, but he does. It helps him wind down.
Then, while most of the team headed to the Man Cave for cold burgers, Carlos went to his hooch to lie down.
No Place for Politics
FATHER DENNIS ROCHEFORD is the reason Carlos has been attending Mass voluntarily for the first time in his life. With a high-and-tight flattop over his round face and a slight Boston brogue, he presents a Capra-esque version of a Catholic Marine Corps chaplain. He’s 58 years old and a Vietnam veteran, and his openness in talking about his pre-priestly life—the men he killed, the woman he almost married—gives him a special bond with the warriors. They stop him for short visits when he carries his tray through the chow hall, smiling like high school kids greeting their church youth group leader.
He closes each service with a simple thought, “Please take care of one another,” and he includes in each week’s bulletin a prayer he writes himself. When I went to Mass with Carlos during my first weekend in Ramadi, the offering was titled “A Warrior’s Prayer for the War in Iraq.” One line leaped out: “Teach us all to walk humbly with you, so that we may be worthy to conquer all insurgents and those opposed to our noble cause.” I later asked Father Rocheford if he wasn’t assuming a great deal with his characterization of the fight. With no hesitation he explained how I was missing the point.
“When you consider the ‘noble cause,’ ” he said, “think about this: There is no greater love that the world has ever seen than the willingness to lay down one’s life for a friend, and that’s what the soldier and Marine do every day. I don’t get into arguing with folks about whether we should have been sent here or not. When you put on that uniform, you are a man of nobility because you are willing to shed your blood and give your life, not necessarily for the politics of the Iraqi war but for your brother soldier or Marine.” His voice dropped to a whisper. “And that is so noble.”
As Rocheford explained, the warrior’s primary concern is protecting his comrades, and that unity is the essence of military service. It’s drilled into your head at boot camp and reinforced every day by a base full of people wearing the same clothes and haircut. It’s in the military language of acronyms and euphemisms that dizzies civilians. At Camp Ramadi, it’s recalled whenever a soldier has to stop on the way into the chow hall to fill up a sandbag that will go to a COP and protect the fighters who stay there. Rocheford relied on it when he was a grunt and now stresses it as a chaplain. It explains how he was able to kill and why he’s at peace with it now. North Vietnamese stormed his position and attacked his platoon. So he killed them. A peacetime cynic might call it brainwashed conformity, but in wartime it fills the space in a soldier’s mind that would be given over to worry for his own safety. The implication is that if he’s got someone else’s back, then someone has his.
That idea is seldom the point of news stories from the war. Back home Iraq is a political issue, and so much reporting reflects the nearly universal view that we shouldn’t be here. It’s the prism through which events are seen and news is related. Last winter the Columbia Journalism Review ran a piece titled “Into the Abyss,” an oral history containing 47 war journalists’ accounts of the conflict. Among its 10,000-plus words of brilliant detail on the horrors of war were just two paragraphs that put soldiers in a positive light. One applauded their discipline while another called them “essentially humane. . . . A huge majority of them are good men trapped in an impossible situation.” Much more space went to the things warriors do wrong, the cultural taboos they violate by wearing their boots into people’s homes, the fact that they say “fuck” all the time and spit snuff juice everywhere. And even that was overshadowed by the remainder of the piece, descriptions of the unthinkable, like the unforgivable treatment of Abu Ghraib prisoners and the heartbreaking deaths of civilians.
“Good news?” asked a correspondent from the Christian Science Monitor. “My first inclination is to say, ‘What fucking good news?’ The violence and criminality of Iraq has only grown in the three years that I’ve been here. And there is not an honest metric that shows anything but that.”
Discussing the media in Carlos’s hooch one night, Major Riccoh Player, the public affairs officer, asked for a little bit more. “If somebody’s going to do a story on a carful of civilians who got killed at a checkpoint, that’s fine,” he said. “But include something in there about how the shooter had been on duty for eight hours and a car bomb had gone off at that gate the day before and killed his buddy. You don’t have to tell a good news story, just tell the whole story.”
Player’s job is to think about such things. Most soldiers don’t have that assignment or feel any such need. They see some war coverage when they go home on leave but little in country. Their time in Camp Ramadi’s Internet cafes is spent on MySpace and e-mail. “If I want to know what’s going on, I just stick my head out the door,” said one.
“The guys carrying the weapons don’t care about politics,” explained Junker. “It’s about taking care of each other and watching each other’s backs. That’s one thing that’s amazing here. Some guy will have a bad injury and the only thing he’s concerned about is his buddy in the next bed.”
That togetherness became the answer to many of the questions I posed. Whenever I asked soldiers how they dealt with fear or the difficulty of fighting an unpopular war, the answer was always the same. “You don’t really think about that,” they said. “My only concern is taking care of my buddies.” When I talked to tank battalion commander Lieutenant Colonel Tedesco, I asked him for examples of heroes serving under him. He responded with parables about unity.
“One of my sniper teams was attacked by the enemy,” he began, “and a sergeant led two Bradleys in to get these guys out. The lead Bradley was hit by an IED and destroyed. The sergeant pulled the wounded soldiers off that Bradley, threw them in his own, and then continued on, not back to the COP but on to the sniper team. He got them out of the house they were in, and while he was driving away, he got hit by an IED that destroyed his Bradley. He then took all the soldiers who were still alive, set up a defensive position in a nearby house, and ran up the street to link up with elements coming to assist them. That sergeant has been approved for a Silver Star.
“A Humvee coming down to one of my COPs was hit by an IED and destroyed. Three individuals in the Humvee were killed and their bodies were on fire. A first sergeant from the COP came out with a fire extinguisher and a spray washer and stood under enemy fire to put out the flames consuming their remains. He couldn’t live with the fact that their bodies were burning.
“A corporal in a truck hit by an IED picked up the wounded driver, threw him over his shoulder, and ran two hundred yards down the street to get him to an ambulance.”
The lieutenant colonel could have gone on all day with stories of soldiers trying to save other soldiers. “It’s absolutely humbling to lead men like that,” he said. “And it’s in every one of them. These guys are just like every guy you went to college with, and they all have the capacity to do valorous acts like that.”
His stories weren’t good news by any estimation. Nor were they stories that I’d ever read.
“A Whole Other World”
ARMY FIRST SERGEANT GREG SHANAHAN is a solidly built, 34-year-old Tulsa reservist adept at blending into crowds. He’s got blue eyes that don’t reveal much when you first meet him, a low voice that makes him sound as if he’s letting you in on a secret, and a baby girl back home named Emilie whom he’s spent a total of three weeks with since she was born last August.
In Oklahoma he’s a regional general manager for Consumer Source, which publishes free shopping guides for cars, homes, and apartments. In Ramadi he’s the top sergeant in an Army civil affairs company, in charge of six 4- to 8-man teams that work, as the motto goes, at winning the hearts and minds of the people. Clichéd or not, it’s a vital role in a counterinsurgency, entailing everything from paying rent to Ramadi residents for seized property to providing the populace with some of its most basic needs, like blankets and sugar.
“Most local support for the insurgents is given out of fear,” Shanahan explained. “They will beat people’s feet, run power drills into their heads, or shoot them and leave them in the street to make a statement. Now, some people come in and say right to our faces that they wish Saddam were still in power, though they still want to get paid for damage to their house. I tell my men this is going to be frustrating, but we’ve got to be as sincere a help as we can. If it’s about to rain and a guy’s got bullet holes in his roof, he needs somebody up there fixing it without getting shot. If a home had all its windows broken in a gunfight out front, we’ve got to decide what to do about that.”
The meeting and greeting of locals occurs at civil-military operation centers, or CMOCs, located at the COPs. Carlos had suggested that I go outside the wire, so on my last full day in Ramadi, Shanahan took me to a weekly open house at a CMOC on the south side of town. The daily battles had already begun when our convoy arrived at eight-thirty that morning, and gunfire could be heard in the distance as Shan-ahan’s team—four civil affairs guys, a handful of warriors on security detail, and another handful of Iraqi soldiers who were stationed at the COP—set up laptops inside. It was freezing in the CMOC, a garage with concrete floors and walls that had been subdivided with plywood into small offices.
Business began at nine o’clock sharp, and ten men and women from the neighborhood had already assembled outside the maze of low concrete barriers out front. With a sentry leveling an M16 at them, the Iraqis walked one by one to the interior gate, stopping halfway and raising their arms to show that no explosives were strapped to their bodies. Most of the visitors were women in long black abayahs and hijabs who carried white flags—pillowcases attached to broom handles. They were familiar with the routine, coming each week to ask for money, be politely declined, and then leave with sugar and whatever new carrots the CMOC was dangling. This week they would walk out carrying fifteen-pound boxes of sugar on their heads and red Nike book bags over their shoulders.
Others in attendance received more-careful attention. A man whose home had been converted into a COP last summer came in to sign a twelve-month lease. While he was collecting nearly $10,000 in cash, Shanahan stuck his head in the room and nodded for me to follow him.
“You’ll want to see this guy in the other office,” he said quietly. “He’s making the Iraqi army guys go crazy.” Sure enough, an interested audience had formed around the man in the adjoining room, including four soldiers interviewing him, three more than the number attending to the homeowner. Unlike the other Iraqi men, who all wore blazers, sweaters, and mustaches, this man had on a dark dishdasha and wore a long black beard. “That kind of traditional look is more common with fundamentalist Islam,” said Shan-ahan, “somebody who might be studying to become an imam.”
While the man’s ID card circulated around the room, he explained through an interpreter that he’d come on behalf of three families in his building. An American tank parked outside their door shook their windows when it fired, and they frequently heard bullets bouncing off their roof. The families had asked him to make the Americans aware that they were there. A civil affairs sergeant pulled up a satellite map on his laptop and identified the building, then made a note of the request. Then he photographed the man, double-checked the name he provided against his identification, and thanked him for coming by.
The next man came in to lobby in English for a neighbor, a widow whose family had been forced from their home after it was shot up in firefights. Now she wanted to go back to fetch some personal things and assess the damage.
A sergeant looked up the location and frowned. “For one thing, there’s water everywhere,” he said. “That whole area is a mess. It looks like New Orleans.” The Iraqi shrugged. “And bad people have been in that house,” said the sergeant.
“That’s what I want to talk to you about next,” the Iraqi replied. He’d seen someone who wasn’t from the neighborhood hanging around the block. Sometimes the stranger went into the mosque next to the widow’s house and sometimes into an abandoned school across the street.
The sergeant looked at his laptop. “We’ve taken fire from those buildings.”
“That’s what I’m telling you,” he said. He described the man, but when the sergeant asked if COP fighters could visit his house, the Iraqi balked. “We can easily make it look like we weren’t invited,” said the sergeant. The Iraqi said he’d need to think about that, then shook the sergeant’s hand and walked out of the office.
That was the last customer of the day, and Shanahan’s team was all smiles as they relaxed over an MRE lunch. They’d wanted to show the positive side of the counterinsurgency, and the day had gone well. One team member told a story about a tribesman who’d shown up at another CMOC to ask if he could graze his sheep in the lawn just outside. When he was told that that wouldn’t be the safest thing for the herd, that his sheep would be in a line of frequent fire, he’d asked if he could send his wives to pick the grass and take it back to his home. “This really is a whole other world,” said Shanahan.
The team grew subdued as they reassembled the convoy to head back to the FOB. A saying in Ramadi is “Complacency kills,” an idea soldiers keep in the front of their minds anytime they move outside the wire. As we left the COP, the mood stiffened more. A voice on our radio said the south route was “black,” and the line of Humvees immediately stopped. I was one of four guys in the last vehicle, and we watched as each Humvee in front of us turned around. Our driver was noticeably ticked; a U-turn in Ramadi is a tense proposition. I asked what exactly “black” meant.
“The route’s closed,” said the driver. “Something must have happened.”
“Something like an IED?”
“Could have been anything,” he said.
We took the north route to camp, a shorter drive but one described as more kinetic, a fact that was reflected in the landscape. Walls were pockmarked by gunfire, and cinder blocks showed behind gaping holes in the plaster. Instead of driving straight out of town, we were rolling through an area where more people lived, past shuttered storefronts and taller buildings with whole sides missing, exposing abandoned rooms like the back of a dollhouse. There was some foot traffic at an open grocery, men in dark tracksuits who stopped walking to watch us go by. Cars coming from the opposite direction pulled off the road and waited, following the protocol that kept them from being mistaken for a suicide car bomber and thus getting shot.
Talk in the Humvee had stopped. The driver seemed to fret while the gunner spun slowly in the turret above me. Twenty minutes later we were back at the FOB, and the driver remarked that he was surprised we hadn’t made any contact.
Two Black Body Bags
I GOT BACK TO THE FOB at four o’clock and headed straight for Carlos to tell him about the trip. He wasn’t in his hooch, so I went over to the hospital, only to find the trauma room empty. But outside the operating room, Radak-ovic was sitting in his flight suit working on the laptop. That could only mean that he was e-mailing Balad and getting ready to fly. I asked if the team had had customers.
“Yeah, Americans. I’m taking the two of them out. Commander Brown is finishing up with them now.” He nodded at the closed double doors without looking up from the computer.
I scooted past Radakovic to grab a hat and mask and go into the operating room. While I was tying on the mask, Carlos came out. He looked exhausted and empty, the way he always did at the end of a particularly brutal day. I expected him to pull up a chair and tell me how things had gone. But instead of stopping and saying anything, he kept walking to me. Then he put his arms around me and started to cry. “Thank God you’re okay,” he said.
I tried to hug him back but felt too confused.
“We got a call around noon about an IED that hit a Humvee,” he said after he let go. “All they said was that it was Americans and two had been killed. I was convinced it was you. And then the wounded came in, and you weren’t one of them. I thought you were dead. I kept asking myself, over and over, ‘What have I done?’”
I stared at him for a second. He looked lost, and I tried to move the conversation forward. “How are those guys in there?”
“They’re going to make it. One’s a broken leg, and the other’s a broken arm. They’ll be fine.” Then he said, “Shit, I was scared,” and walked back into surgery.
Once the patients were moved to the landing strip and Carlos had finished mopping the floor, he asked me to wait for him while he went to his room. He said he had to go to the morgue to identify the cause of death of the two other soldiers, but before he went he wanted to change into his uniform. “It’s just an administrative task, but I always put my uniform on for it,” he said. “They deserve that.”
On the walk over he told me what he knew of their deaths. Apparently two IEDs had gone off, one that disabled their Humvee but didn’t hurt anyone and a second one that was detonated after they got into the street.
The morgue was around the corner from Carlos’s hooch, a small wood-frame building that I’d never noticed. The inside looked a little like the surgery room, the same bright lights, the same soft-blue floor. But there were no hooks in the ceiling over the beds and no clutter of tools on the walls or counters.
Two black body bags sat on tables in the center of the room, and the attendant opened them one at a time. At first the contents looked like piles of bloody fatigues waiting to be laundered. All that was left of the soldiers were torsos. It took a moment to find their heads, but following the plackets on their shirts up to their collars, I saw what was left. There was nothing behind their faces, no eyes, no teeth. The soldiers’ skulls had been blown out of their heads by the force of the explosion.
Neither bag was open for even a minute. As Carlos and I walked out, he stared at the ground. “If there’s any comfort, it’s that they didn’t feel anything,” he said.
Dinner was quiet. There was a Madden football tournament scheduled for the evening that had dominated conversation the past four days. But Carlos was going to pass on that to attend the Heroes’ Ceremony for the dead soldiers. He’d described the ritual in an e-mail back in September:
The soldier’s entire company (~200 troops) lined up in ranks outside the morgue, then came to attention and saluted. The doors of the morgue opened, and four young soldiers slowly carried out the body of the dead soldier and carefully placed him in an ambulance. The ambulance proceeded to a landing zone with the company following closely behind on foot. Out of the night sky dropped two helicopters, completely blacked out. They landed with a gust of wind, sand, and debris. Once again all came to attention and saluted as the soldier’s body was loaded onto the helicopter. The helicopters left in the same darkness they had arrived. I hope it is something I won’t have to experience often, but it was one of the most amazing nights of my life.
Carlos and I went to attend the ceremony a little before eight o’clock, and the path in front of the morgue was filling with soldiers. Then Carlos’s Bat Phone rang. Another American casualty coming in.
“You ought to stay here,” said Carlos.
“No, I’ll stick with you.”
The ambulance pulled up to the slab as we got there. Four medics carried a young blond soldier in, conscious and appearing okay in the front but with blood showing on the back of his uniform as they placed the stretcher on the table. The team moved quickly, cutting off his clothes and pulling off his boots. A nurse called out his blood pressure, “Fifty-four over thirty-eight”; another worked to get an IV in his arm. Clark went to the foot of the bed and asked the soldier to wiggle his toes. Only the ones on the left foot moved.
“We’ll get some morphine in you soon, and it’ll stop hurting,” said Clark, “but right now I need you to tell me if you can feel me touching the bottoms of your feet.”
“On the left foot.”
Moving his hands to the top of the feet, Clark asked, “What about now?”
“Only the left.”
Clark and Carlos looked at each other as Clark moved his hands to the tops of his ankles and said, “What about now?”
Before he could answer, Junker spoke up from the head of the table, where he’d just connected a bag to the IV. “You’re going to go to sleep in a second so we can get to work on you, okay?”
Then Carlos said, “Someone please check the blood supply.”
“Do we have the right kind, Carlos?” asked Junker.
“O positive,” said Carlos. “Got it today. Radakovic, get the blood going. I need a blanket, somebody.”
When the blanket arrived, the team rolled the kid on his side to put it underneath him. That’s when time stopped.
Nobody said a word or even looked at one another. From the small of his back to the tops of his thighs, there was nothing but a gaping hole so red it looked black. You could see through to the front of his hips. His colon fell onto the table.
Time started back up. “We’re going to need a walking blood bank,” said Carlos. “Ten units.”
“That’s not going to be enough,” said Junker.
“Twenty units,” said Carlos. “And get me some towels and clamps.” As he stuffed the towels into the hole, Junker left to help ready the OR. “We’ll be up there after the chest X-ray,” said Carlos. And then to himself, “His back looks shattered. His pelvis is gone.”
There was little talking while Carlos and Clark scrubbed. A crowd started to gather in the operating room. The soldier’s company was on hand, some in the hospital, some on the slab. Others wandered over from the Heroes’ Ceremony, which had been delayed by high winds. First Sergeant George showed up, as he always did, to watch the team operate. Brigade Commander MacFarland came in for a while, visiting briefly with George in the back of the room. A new Catholic chaplain had rotated in for Father Rocheford, a tall guy who stood by the door, never talking to anyone or taking his eyes off the table. Fully 25 people stood in a half circle around the surgical team while they tried to keep their patient alive.
Carlos barely had his gloves on before he’d opened the soldier’s belly and gotten his intestines and stomach out and set them on his chest. There wasn’t much to work with. He patched a hole in the aorta and closed off his pelvic arteries, veins, and inferior vena cava. After two hours and thirty units of blood—three times the body’s normal volume—Carlos had him stable enough to fly to Balad.
“That casualty was a reservist,” said Clark a while later, as we watched his buddies mill around on the slab. “Reserve units are actually even closer than regular Army units because they’re all from the same town. A lot of them probably grew up together.”
I left him to find Carlos. He was sitting on his bed with his back to the wall. He’d worn the same drained expression since I’d seen him outside the operating room seven hours ago.
“What did you think of that, of those guys today?” he asked. “Those are truly the most heroic figures I see here. I mean, they’re just young guys, just starting their lives, you know? They haven’t done anything yet. Yeah, they’ve served their country, and that’s a great accomplishment. But they haven’t gotten to enjoy their own families, raise their own kids.”
He looked at the posters his mom had sent him of his own three children, then turned his head to the laptop on his desk. “With the slow month I naively thought maybe it was getting better here. That may have had more to do with the weather than anything else. The mass casualty two days ago and now Americans get hit with an IED again? I don’t know when it ends. It ends for me in March. But I don’t know where it ends in the bigger picture.”
He ran his hand over his buzz cut. “You know, people say the surgical and medical guys here are heroic, but we’re just doing our jobs. These guys put their lives on the line every single day, all the time. They’re heroes. And that’s where all the politics is a bunch of bullshit. It doesn’t matter if Bush wants the war and Clinton and Pelosi don’t. That’s irrelevant. These guys died doing what they were told to do. Obviously I’d love it all to end today; we leave, and Iraq’s a happy place. That’s not going to happen.
“The only political thought I have is I hope these guys died for something. If they died for nothing, then that’s a crime. But if something good comes out of this, then the death is part of their job, and they did it well. And I tell myself the sacrifices the war fighters make are for something, that something will change, that there will be some benefit, long-term, for civilization or humanity or Iraq or our country”—he paused for a moment—“or something.”
I LEFT RAMADI LATE THE NEXT NIGHT, after lucking into a spot on the standby list for a helicopter flight to Camp Taqaddum. The wait was four hours, but that was no bother; the priority passengers were three hundred or so soldiers who were rotating out, including the men and women of Charlie Med, their fourteen-month deployment having finally ended.
Carlos and the surgical team remained another six weeks, a period that ended up being as busy as any other time during their stay. In the three weeks after I left, two more mass cals came in, both from coordinated attacks involving multiple car bombs. One explosion was so great it blew the doors open on the Man Cave, and Carlos thought initially it had occurred on the base. It was actually at an IP checkpoint several miles away, and it caused 16 Iraqi casualties. The other mass cal featured 22 wounded, all Iraqis and more than half of them children, including a three-month-old boy whom Carlos operated on and managed to save, though he gave the credit to Junker. During one 12-day period in the middle of February, he operated on 21 patients. The monthly average had been between 25 and 30.
Carlos left Camp Ramadi on March 8, but military life being what it is, he didn’t get to California for another week and a half. On Monday night, March 19, after four days of scheduled and scratched arrival times, the whole family—Debbie, the kids, his mom, and brother Glenn—picked him up at Camp Pendleton. Their celebratory dinner was at the nearest McDonald’s, where for the first time in Brown family history, the kids spent so much time climbing on their dad that they left their Happy Meal toys sitting on the table.
They arrived in L.A. just before midnight to discover that friends had hung “Welcome Home!” banners all over the house and tied yellow ribbons around every tree in the yard. It was a sentiment Carlos appreciated, even if it left him a little uneasy. To his mind, the heroes were outside the wire, the warriors who risked their lives to keep him safe. But just as he had to get used to grateful praise in Ramadi, he’ll have to endure it now that he’s back. As soon as the sun was up the next morning, the doorbell started ringing with friends and neighbors and, to Carlos’s astonishment, complete strangers who had just happened along, all stopping in to say thanks.