This story first appeared on the TomDispatch website. The text of this piece is an excerpt, slightly adapted, from Ann Jones's new book They Were Soldiers: How the Wounded Return from America's Wars—The Untold Story, just published by Dispatch Books/Haymarket Books
In 2010, I began to follow US soldiers down a long trail of waste and sorrow that led from the battle spaces of Afghanistan to the emergency room of the trauma hospital at Bagram Air Base, where their catastrophic wounds were surgically treated and their condition stabilized. Then I accompanied some of them by cargo plane to Ramstein Air Base in Germany for more surgeries at Landstuhl Regional Medical Center, or LRMC (pronounced Larm-See), the largest American hospital outside the United States.
Once stabilized again, those critical patients who survived would be taken by ambulance a short distance back to Ramstein, where a C-17 waited to fly them across the Atlantic to Dover Air Base in Delaware. There, tall, multilayered ambulances awaited the wounded for the last leg of their many-thousand-mile journey to Walter Reed Army Medical Center in Washington D.C. or the Naval Hospital at Bethesda, Maryland, where, depending upon their injuries, they might remain for a year or two, or more.
Now, we are in Germany, halfway home. This evening, the ambulance from LRMC heading for the flight line at Ramstein will be full of critical-care patients, so I leave the hospital early and board the plane to watch the medical teams bring them aboard. They've done this drill many times a week since the start of the Afghan War. They are practiced, efficient, and fast, and so we are soon in the air again. This time, with a full load.
Two rows of double bunks flank an aisle down the center of the C-17, all occupied by men tucked under homemade patchwork quilts emblazoned with flags and eagles, the handiwork of patriotic American women. Along the walls of the fuselage, on straight-backed seats of nylon mesh, sit the ambulatory casualities from the Contingency Aeromedical Staging Facility (CASF), the holding ward for noncritical patients just off the flight line at Ramstein.
At the back of the plane, slung between stanchions, are four litters with critical care patients, and there among them is the same three-man CCAT (Critical Care Air Transport) team I accompanied on the flight from Afghanistan. They've been back and forth to Bagram again since then, but here they are in fresh brown insulated coveralls, clean shaven, calm, cordial, the doctor busy making notes on a clipboard, the nurse and the respiratory therapist checking the monitors and machines on the SMEEDs. (A SMEED, or Special Medical Emergency Evacuation Device, is a raised aluminum table affixed to a patient's gurney.) Designed to bridge the patient's lower legs, a SMEED is now often used in the evacuation of soldiers who don't have any.
Here again is Marine Sergeant Wilkins, just as he was on the flight from Afghanistan: unconscious, sedated, intubated, and encased in a vacuum spine board. The doctor tells me that the staff at LRMC removed Wilkins's breathing tube, but they had to put it back. He remains in cold storage, like some pod-person in a sci-fi film. You can hardly see him in there, inside the black plastic pod. You can't determine if he is alive or dead without looking at the little needles on the dials of the machines on the SMEED. Are they wavering? Hard to tell.
The CCAT team has three other critical patients to think about. They are covered with white sheets and blankets, but it's easy to see that the second patient is missing both legs. His right hand is swathed in thick bandages, almost as fat as a football. His face is ripped and torn so that his features appear to be not quite where they belong, but pushed up and to one side—his nose split and turned askew. He's sedated and on a ventilator meant to assist his breathing, but his chest convulses as he struggles with the job.
The respiratory therapist hovers, checking monitors, adjusting a breathing tube, and the man quiets. But not for long. The IED blast that took off both his legs above the knee bypassed his pelvis to slam into his chest. He must have been doubled over, crouching, when he walked onto the bomb. The impact damaged his lungs in ways not yet fully understood, so that now when he breathes on his own, every breath costs him more than he has to give.
The CCAT team confers. To stop the convulsive effort to breathe, the doctor can paralyze him and let the ventilator do the work of respiration, but that means removing from his intestine the feeding tube pumping in the calories he needs to heal these catastrophic wounds. It's a fine line, and the team walks it for the next hour until it's clear the man needs rest more than nourishment. Then the doctor administers a drug, the body grows still as stone, and the soldier inside sleeps softly while the ventilator steadily breathes in and breathes out.
Patient number three is breathing on his own and fast asleep, a saline drip feeding into his arm. He looks okay, but for the flattening of the blanket under the SMEED. He's lost both legs, but both below the knee. He has his hands. He has his junk. Of these four patients, he's the one the military and the media will call "lucky." But the doctor doesn't call him that. He says, "You can't assess his injuries in comparison to those of other soldiers who happen to be on the same plane. You have to assess them in comparison to who he was before." He is a boy who used to have legs and now he doesn't.
The fourth CCAT patient is a darkly handsome kid who lost both legs to an IED. His right arm ends in a bulbous bandage, but something about its shape suggests the hand might still be all there. He's conscious and breathing on his own, vaguely gazing at a thin woman in blond boots and a light jacket who stands next to his litter and clutches at the rail as if to hold herself upright.
She was called to LRMC because her son was close to death, but she is now taking him home, what's left of him, alive. In the dim light, she looks dazed, but she leans over him and speaks into his ear and soon he sleeps. The doctor tells me that the boy, a Marine, lost one leg below the knee, and the other very high up—too high for him to wear a prosthetic leg.