• A Vermonter offers firsthand view of war in Iraq
    By CAPT. EDWARD G. GYUKERI JR. | November 12,2006
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    Shortly after boarding our troop plane in Texas, members of Task Force 399th Combat Support Hospital were cautioned to settle in for what would ultimately be a 19-hour flight to an intermediate destination in Southwest Asia: Camp Buehring in Kuwait one of the final staging areas for coalition forces (primarily American) en route to the war. As our 767 left the ground, out came a range of soldiers' comments, from the obscure, "Here goes nothing," to the downright hawkish, "Let's go get some." Boots were unlaced, uniforms loosened. Here and there, lights came on and books came out. Nearly everywhere around me, soldiers had MP3 players and iPods in hand, heads nodded rhythmically. From some of these devices came a faint glow that, in the darkness of the plane's cabin, painted soldiers' faces in shades of light and color. The observation was to be my first appreciation of the fact that this war, in many small and few big ways, is like no other. Late that night, we stopped at a major airport on the East Coast to refuel and stretch our legs before beginning what was to be the longest leg of the journey. Some of us took the opportunity to call home a final time from American soil. Those of us who normally would have avoided calling home at such a late hour (so as not to wake our children) made an exception to the rule to hear those young voices another time. And so we did. Finally, happy and yet sad again, we were back in the air, closer to accomplishing what we had set out to do: serve as the only Level III trauma center in northern Iraq. Or so we thought. Our first patient Two hours off the Atlantic coast, the 767 hit turbulence. The attitude and altitude of the plane changed so drastically in such a short time that the flight attendant, evidently worried that the unbuckled, sleeping soldiers might be thrown from their seats, stood up to shout over the loudspeaker that "all passengers should be firmly buckled in their seats." At that moment, the petite woman was tossed into the air and thrown to the deck by the turbulence. On the way down, her head struck a nearby shelf. She let out a scream before losing consciousness. Almost as quickly as it had started, our bronco ride came to a halt, with the pilot announcing he had climbed to a higher, calmer altitude. Seconds later, another flight attendant called out: "Is there a doctor or a nurse on board the plane?" Unbeknownst to the civilian flight crew, there were more than 50 doctors and nurses flying with them. A handful of caregivers as many as could fit into the airplane galley treated the injured flight attendant. Within a few hours, we were at Logan Airport in Boston. The flight attendant was removed from the plane in a cervical collar and on a backboard and taken to Massachusetts General. (Several hours after our trip resumed, we learned the patient was doing well and was grateful for the in-flight care she had received.) Because we had used up fuel on this return trip, however, arrangements had to be made for us to stay another night in the United States. For me, it was a fitting way to begin this overseas tour back in New England. In the moments before I fell asleep that night, and in the hours before we left Boston the following morning, my mind traveled down the streets in which I had played (when the children of Dorchester could do such a thing), and up the streets of Roslindale where my wife, Jeanette, and I had pushed our young sons in strollers. But that was then. Camp 'Boring' After a brief stopover in Europe, we landed in Kuwait City. Upon disembarking from the plane, I recalled a line from Neil Simon's play "Biloxi Blues": "It's hot! It's like Africa hot!" It was not a temperature a New England boy was used to. We crawled into the bowels of the plane to retrieve our duffel bags and load them on waiting trucks. Then we boarded buses but were warned to keep the curtains closed tightly. Despite being in friendly territory, buses traveled in a tactical manner: maintaining a safe distance from one another, traveling in alternating patterns, swerving in an apparent random fashion, or speeding up and abruptly slowing down. We were targets. Despite the fact security vehicles were in the convoy with us, things felt a bit less secure. We arrived at Camp Buerhing at 2 a.m. We hastily unloaded our gear and moved into big, white tents to sleep. We made those tents our home for a few days "to adjust to the time change, acclimate to the weather and to hydrate." (For the record, we never did acclimate to Kuwait. We merely endured it.) There was a new moon that first night. It was 89 degrees. We spent more days at Camp Buerhing than any of us care to remember, I supposed. For sure, no one was in a hurry to rush into the mouth of the lion. But having made up our minds that we were here to do good for our fellow servicemen and for those Iraqis allied with them, we were eager to get on with the mission. Watching "dust devils" duel it out in the Kuwaiti desert was not among the reasons we were there. We would remain in Kuwait until final preparations were made for the proper handover of the hospital occupied by the 47th Combat Support Hospital an active duty unit out of Fort Lewis, Wash. About a week would pass as we waited for the command cell of each unit to tie up logistical loose ends associated with hundreds of soldiers and millions of dollars in equipment and supplies. In that week, we made the best of the situation. We attended classes on improvised explosive devices. We learned about managing a burn or trauma patient, massive fluid resuscitation of a patient in shock and, on the emotional level, dealing with soldiers in crisis. And we drank a lot of water. We had among us chest surgeons, two orthopedic surgeons, an obstetrician/gynecologist, a dentist, a few family practice doctors, a handful of emergency medicine specialists, a pulmonologist, and a psychiatrist, to name but a few. We had 10 nurse anesthetists like me. With too much free time on our hands, some of us volunteered to help out in the troop medical clinic at Buerhing, which was being operated by a group of medical personnel from the U.S. Navy. It was there that I was told that, on average, two servicemen a day were being sent by helicopter elsewhere for complications related to heat exposure some arriving with core body temperatures reaching 105 degrees. These patients would then be packed in ice, started on intravenous fluids, given acetaminophen, and hastened to the rear. While we were there, we saw young Americans training for the trip north. Some of them lurked among the tents, dressed in full combat gear, in 110-plus degree heat. They practiced tactical movements, speaking only with hand-and-arm signals. They passed quietly among the tents as if traversing buildings in a city block, clearing each building of danger, and covering one another as they moved. They were slick, well-rehearsed. They were too young, in my opinion, to be that good at what they were doing. I hoped then and I pray now as I write this that their silent rehearsals serve them well. It's 'go time' After 10 days of doing our best to occupy our time, I returned to our tent in the Kuwaiti desert to hear a friend say: "Gyukeri, you're in stick number two. Formation's at 12:45 a.m. You fly out at 3." I could feel the excitement in the tent as those around me quickly stuffed gear into duffel bags. This was it. I tried to pack my stuff in a logical manner, putting what I would need least in the bottom of my bags, leaving coveted space at the top for those items I might wish to get to first: ammunition clips, chemical gear, first aid supplies. When I was in the infantry, we did nearly everything according to a published standard operating procedure. We used to joke that if there was a way to do so, the Army would develop an SOP for using the bathroom. (Trust me: It's in development.) SOPs exist for a reason. They help to remove a great deal of guesswork. In times of untold stress, they free your mind from having to deal with neuron-wasting minutia of life. For example, when I was a grunt, we would according to the SOP pack our extra ammunition in a specific pocket on our rucksacks. The logic was that if I needed more ammunition and my "buddy" was dead or wounded, I could reach into his ruck without thinking and reload quickly. None of the doctors or nurse anesthetists I watched that day seemed to be following an SOP. Perhaps it was excitement, but more than likely, it was anxiety. Whatever logic there was to be applied to packing our gear seemed to be left to each soldier's discretion. And, I suppose, it created guesswork. Why we're here Shortly after receiving orders to move out, an informational briefing was held. We learned where we were headed, what we could expect and what the place looked like. (For the purpose of protecting those with whom I serve today, and those who have been entrusted to my care, I only will elaborate upon those bits of information that are of no tactical or strategic value.) Paying tribute to the historical lineage of the 399th Combat Support Hospital, whose roots began in Massachusetts, we were split into two groups: Lexington and Concord. My group (Lexington), the larger of the two, would be headed to Forward Operating Base Diamondback, which is located in and around the airport of Mosul, Iraq a city of approximately 1.7 million people. Those assigned to Concord would be spending time approximately 140 miles to our south. Their smaller and more modest hospital is located in Tikrit a bastion of Sunni loyalty and birthplace of Saddam Hussein. Our area of responsibility is the entire sector of Iraq north of Baghdad. Our responsibility ends at the borders of Syria to the west, Iran to the east, and Turkey to the north. Task Force 399 soon would become the sole health care provider for 25,000 U.S. troops most of whom are from the US Army's 25th Infantry Division from Hawaii. We also would be caring for two divisions of Iraqi soldiers and countless Iraqi police and civilian contractors (primarily Americans). We would do our work from a facility that in the size of its staff and the real estate it occupies is roughly equivalent in services to most of the rural Vermont hospitals in which I have worked. In addition, we were told, there was no burn center in Iraq. There never has been. The word is that one is being constructed by the Iraqi government in the town of Irbil approximately 50 miles from Mosul. Until such time as one is built, however, that responsibility will fall to us. Eighty percent of our patients are Iraqi soldiers. Since much of the civilian health care system is incapable of handling combat-related trauma, the Iraqis will remain with us until discharge or they can return to military service. When given the choice, most of them seem to feel safer convalescing in a U.S. hospital. And there is the fact that Mosul is a big and concentrated city. As in previous wars, identifying one's enemy is not easy. Occasionally, an Iraqi citizen will appear on our doorstep. We also treat them. Ironically, we are responsible for treating enemy Iraqi insurgents. The rules of engagement for American troops in the theater of operations clearly state that having surrendered or having been captured all enemy combatants become our responsibility. Period. I knew this to be true from years ago, as part of my training. However, upon hearing it again, I thought how glad I was to be where I was and not out in the arena of combat itself. Let's roll One day, we were told we would move by tactical convoy from Camp Buehring to Camp Virginia (Kuwait), where the Air Force took us to our final destination. After hours of waiting, some of us volunteered to help strap our gear to pallets for the trip north. Riggers told us what to do, and being soldiers we followed the instructions. Frankly, we were pleased for the opportunity to do something. Nine hours passed as we waited, being told repeatedly not to go far, our plane was leaving any minute. I cleaned and re-cleaned my pistol. Then I cleaned two nurses' M16s. I didn't ask them; I just did it. Then "ALL RIGHT! LET'S ROLL!" came the order. We hopped on buses around 10 p.m. In what felt like seconds, we were at an airfield, and we walked onto the flight line and into the cavernous bay of a C130. Our gear, strapped to the pallets, already had been placed in the cargo hold by forklifts. We shuffled through the darkness of the night, forming parallel lines of soldiers facing one another, with our gear in the space between us, just inches from our knees. I gave myself a last-minute equipment pat-down: helmet, weapon, ammunition, goggles, ear plugs, barf bag. Good to go. Cargo planes are not padded or insulated like commercial airliners. Every whine and hiss of the engine, transmission and hydraulics resonates throughout the C130. The crew asked for and received the "thumbs up" from everyone on board. In an incredible surge of noise and raw energy, we rolled toward the sky. In the snap of a finger, I felt the landing gear retract below me. I saw mechanical parts move in sync with what I felt below my feet. The stink of jet fuel circulated around us. "Here goes nothing," I thought to myself. The flight to Mosul was loud. I thought about the path that led me to that moment, the purpose for my role in this hospital, the people I would soon be caring for. I thought about the good I hoped to accomplish. About 20 minutes south of Mosul, a light flashed on in the cargo bay, and the flight engineer yelled "Get ready!" This was our warning that the pilots would soon begin a series of aerial gymnastics known in aviation parlance as "evasive maneuvers." The rest of the descent was a carnival ride of twists and turns, rolls and drops and gravity-defying tricks that tossed us around like bobble-heads in camouflage. The purpose of these maneuvers, of course, was to present a challenging target to anyone on the ground who might try to shoot at us. (Cargo planes and, in particular, slower, propeller-driven cargo planes like a C130, tend to be relatively easy targets.) In the big scheme of things, I did not mind being tossed over and over again out of my seat and up against my shoulder harness. Nor did I mind being slammed back into my seat, seconds later. (For the record, none of us needed the barf bag.) After an abrupt roll to the left, the pilot quickly righted the plane to a straight-and-level flight. An instant later, the wheels slammed onto the runway. We lurched to a halt. No sooner had the plane stopped when the flight crew shouted for us to get off the plane as quickly as possible. We hustled off and into a maze of cement walls and bunker/barriers. When it was my turn to check in, I stepped up to the sign-in roster and showed my military ID. After checking my name off, the sergeant looked up at me and said, "Welcome to Iraq, captain." Capt. Ed Gyukeri of Weybridge is serving with Task Force 399th Combat Support Hospital in Mosul, Iraq, since September. Anyone wishing to contact Capt. Gyukeri can do so through Herald City Editor Steven Pappas at steven.pappas@rutlandherald.com.
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