Talk to Me Like My Father: Frontline Medicine in Afghanistan
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The Afghan soldiers left in our care are preposterously stoic men. They are quite aware of the future an illiterate, legless man faces in that country. And yet they only ever thank the people caring for them. They make it clear that their preference is to leave the hospital as soon as possible, and when the women nurses and medics give them bed baths and change their dressings, their discomfort is evident. Their use of narcotics postoperatively is half of what such patients in North America require. And these are Afghans—men who might know the pleasures of the poppy.
Coalition officers who train ana soldiers believe them to be motivated and brave fighters. "Sometimes a little too brave," an American major from New Jersey tells me over lunch, "in that if you wait for the artillery and air support to do their work, you don't always have to run right at the guy shooting at you. But they have fight in them, all right." A Canadian captain tells me he thinks the media overemphasizes Afghans' ambivalence about the war. "I keep reading how they're just doing this for the money, and that they go over to the Taliban all the time. But that's not what I see out there. The anp is different. They're mostly village bullies who get into the anp to shake down everyone else. The villagers are pretty leery of them. But the ana soldiers could teach our guys about bravery and cool thinking under fire."
No one holds the Afghans in greater regard than the American Special Forces soldiers who fight with them. These are strange-looking men: densely bearded and copper-colored from the sun, some dressed in Afghan clothes and carrying AK-47s rather than M-16s; when they speak with American accents I always start. If the mercenaries are reluctant to talk about who they are and what they do, Special Forces make them look absolutely voluble in comparison. They rarely come to our hospital when injured—except after the helicopter crash—but they are adamant that the Afghans they fight with receive the best-quality care. After I help resuscitate a man who took rpg shrapnel in his leg, one Special Forces soldier tells me, "You should have seen him running right at them, rounds falling all around him, like he didn't even notice." I don't know what to say so only nod. The American continues, "Will he keep his leg?" I say that I think he will. There is more emotion in his curt nod of response than I can adequately describe.
These Special Forces soldiers—and in addition to the Americans there are French commandos; British Royal Marine Commandos and Special Air Service soldiers; Canadian jtf-2 special ops soldiers; and New Zealand, Australian, and Danish commandos on base—live in their own compound. (One can imagine the fracas that would result from any mention of Cheese-Eating Surrender Monkeys there.) On Sundays the Special Forces host their own bazaar, and allow regular personnel inside—though a Dutch colonel surgeon discovers the no-photography rule is taken quite seriously when his camera is confiscated. Their inner sanctum seems not much different from any other part of the base—just as dusty, just as prefabricated. But the sense of apartness these men give off is as strong as it is in the dfacs, where they either eat alone or with one another, speaking in low voices and seeming to suffer the proximity of others only with reluctance. They would prefer, one senses, to rid themselves of the need for food as they have the need for every other soft, urban decadence.
The day their helicopter crashed, the less seriously wounded Special Forces searched for any officers or ncos who might know the fates of their platoonmates. I watched one sergeant dissolve into sobs, great heaving gasps, when he learned who the eight dead were. The Special Forces soldiers seem so far into the military they come out the other side, and express a degree of emotion, if only about one another, that no other soldiers in my experience do, emotion that would be much more normal in the civilian hospital I work in, on a Saturday night after a lethal and beer-fueled car crash.
on the evening of March 6, four Canadian infanteers run in through the emergency entrance carrying a fifth. "Gunshot wound," they yell, as they heave him onto a stretcher. Corporal Kevin Megeney's uniform is soaked with blood where the bullet has entered his right chest, just below his armpit. His eyes are wide open and his pupils fixed and dilated; there is no pulse. One of the men who brought him in says, "We were just walking by his tent and heard the shot. Sounded like a nine millimeter. No idea what happened." I open his mouth. His tongue and throat are flaccid and it is easy to see the vocal cords; I pass an endotracheal tube through them and into his trachea, and begin bagging him.
"We need a surgeon here right now!" I holler as I grab a central line kit and begin probing his groin with a needle, trying to find his femoral vein. Lt. Colonel Dennis Filips appears and yells for a thoracotomy kit as he sprays iodine solution over Megeney's chest. He takes a scalpel and runs it between the soldier's ribs from his sternum around to his back. Megeney's lungs bulge out of the incision, inflating and deflating. Liters of clotted blood fall out of his chest in one gelatinous heap. There's so little blood left in his vessels that no bleeding is evident. Filips saws through the sternum, and extends the incision around to the right chest; this is called a "clamshell" incision and is done only in emergencies. It exposes the contents of the chest completely; surgical residents trying to sound hardened call it "opening the hood." Filips tries to find a bleeding vessel to repair, while I attempt to get my needle into his femoral veins, which are collapsed flat. One of the nurses finally gets an IV started in his arm; 10 units each of blood and plasma are ordered from the lab. Filips finds the bullet hole in Megeney's inferior vena cava and aorta—the great vessels leading directly in and out of the heart. There is no cardiac activity at all. The lab tech arrives with armloads of packed red blood cells at the same time I manage to get a line into Megeney's femoral vein. Filips says, "He's been pulseless now for 20 minutes. We should stop." The room freezes as we all realize he is right. Megeney's entire blood volume has fallen out on the floor.
Photographs By: Kevin Patterson
i wish you you could help in locating my father