It's an around-the-clock fight to save lives at Iraq combat hospital

By Theola Labbe
The Washington Post

	LUCIAN PERKINS / THE WASHINGTON POST A doctor holds a patient's hand during surgery at the 28th Combat Support Hospital.
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"Oh, I'm doing dandy," the soldier said as he lay prone on a green Army litter, his tone dripping with sarcasm but not bitterness. Two medics wheeled him into Trauma Room No. 2, where everyone seemed to exhale with relief at the soldier's sense of humor. The ER staff, dressed in boots, camouflage pants and scrub tops, worked crisply but without the urgency that accompanies a patient near death.

"We're going to expose you, OK?" said Maj. Jason Boardman, a general surgeon from West Point, N.Y.

"I was born naked, it's OK," the soldier quipped. He turned his head to the side and told an administrator his name. VanBuren. Matthew. 21, from Kansas City, Kan. A private first class with the 1st Armored Division's HHC 2nd Battalion, 6th Infantry Regiment, a cavalry unit.

Using dull-tipped scissors, Lt. Hope Simmons, 25, a nurse from Tampa, Fla., carefully cut through the uniform pants. "Ow. If you press on my thigh again, I'm going to punch you," VanBuren deadpanned.

Soon VanBuren was naked except for a thin blue gown draped across his private parts. The medical staff pored over the rest of his body. Hot shrapnel from a roadside bomb had gouged the underside of his left thigh, leaving a hole the size of a grapefruit that oozed blood and flesh. On his lower right leg, another shrapnel wound was bleeding. His right shoulder was injured, but it was not clear how seriously.

"Just sit back and relax," Boardman told VanBuren. "We're going to do all the work."

Since the largest U.S. Army hospital in Iraq opened its doors on April 10, nearly all U.S. casualties have passed through its first-floor emergency room. Some come already dead. Some arrive with one arm instead of two, a shattered leg or a face wiped away by an explosion.

Assaults on U.S. troops have reached as high as 45 a day, although the frequency has dropped off in the past couple of weeks. For the staff at the 28th Combat Support Hospital, located within the U.S.-led occupation authority's headquarters at one of former president Saddam Hussein's palaces, that often translates into a dozen patients a day.

About 70 percent of the hospital's patients are wounded soldiers; the rest are Iraqi civilians and prisoners, along with a small number of U.S. civilian contractors, said Maj. Mark White, director of patient administration.

The number of soldiers treated for serious combat injuries is not publicly disclosed. Instead, the hospital releases statistics on patient admissions — a total of 1,659 U.S. soldiers through Oct. 30. The combined number of U.S. soldiers and Iraqi patients admitted per month has increased since September, and this month was expected to reach about 400, White said.

Soldiers stay here for up to two days; those with serious wounds requiring further treatment are sent on to Landstuhl Regional Medical Center in Germany and, if necessary, to Walter Reed Army Medical Center in Washington.

"They come in here saying, 'Did he make it? Did my driver make it?' " said Lt. KomKwuan Pholtavee, 24, an ER nurse from Bellmore, N.Y. In their haze of pain and fear, she said, "I've had soldiers think that I'm their wife."

The worst that Maj. Michael Hilliard, 33, an emergency physician, saw back home in San Antonio were car-crash and gunshot victims. Here, he estimates he has treated the broken bodies of more than 1,000 U.S. soldiers.

"The injuries are horrific," he said. "They are beyond anything that you see in a textbook, and they are the worst that I have ever seen."

Twenty-four hours in the hospital's emergency room with soldiers stripped of their uniforms and gritty exteriors revealed the physical and emotional toll.

Hospital operates in clinic once used by Saddam family

	LUCIAN PERKINS / THE WASHINGTON POST Maj. Fred Brennan, left, Lt. Hope Simmons, left center, and Maj. Jason Boardman, far right, examine a soldier hurt by a roadside bomb. Such wounds are typically caused by rocks or nails packed into the improvised explosives. Boardman tells patients, "Just sit back and relax. We're going to do all the work."

The ER night crew came on at 6 p.m. Some had finished up an unusually flavorful Army rations dinner of chicken fajitas. Others silently watched movies on a laptop or read e-mail.

The staff was clustered around the nurses' station outside the ER, in the back of the ground floor of the three-story, 76-bed hospital that was once the private clinic for Saddam's relatives.

Around 8 p.m., the radio crackled.

"EMT, this is China Base," said a soldier at the center, using the hospital call sign.

"China Base, EMT," replied First Lt. Chris Haese, 33, an ER nurse from Brillion, Wis., who was listening for radio traffic.

"Air evac coming in. One litter, urgent, IED shrapnel," the soldier said.

A medical evacuation helicopter was carrying a soldier seriously wounded by shrapnel from a roadside bomb — in military speak, an improvised explosive device, or IED.

Haese made a quick check of the supplies in Trauma Room 1. Simmons, the ER nurse, pulled on white rubber gloves and went through the ER's double receiving doors to wait. Three medics from the ER put on green helmets and climbed into what resembled a golf cart, then sped out of the hospital's black rear gates to pick up the patient.

The vehicle returned minutes later, a soldier hitched to the front. He lay on a narrow green stretcher, wrapped in a blanket. A resuscitator covered his nose and mouth, and the helicopter medic pumped the balloon to assist the soldier's breathing. The sky was black, but outdoor lights flooded the hospital's back parking lot.

"On the count of three," one medic said. "One, two, three!" Up went the soldier from the stretcher and onto a narrow wheeled cot. Blood had pooled on the black backboard left behind.

With a short run, they wheeled the patient into the trauma room. Hilliard stood at the head of the cot while the rest of the staff crowded around the sides, hooking up IVs, touching every inch of the soldier's body in a search for wounds and signs of life.

"Does he have a pulse?" Hilliard shouted. He turned around to reach for a sonogram that would show heart activity. "There's no pulse, no pulse!" a nurse responded.

The helicopter medic, still in his flight suit and helmet, quickly briefed Sgt. Dylan Jones, 26, of Philadelphia, the night medic in charge of operations. A roadside bomb had exploded in Sadr City, the Shiite Muslim slum in northeastern Baghdad. "I gotta go pick up another one," the medic said, and rushed out.

Flying shrapnel from the explosion had breached the soldier's skull and spattered blood on the right side of his face. Hilliard checked the extent of the injury.

The crisp, hurried movements of the trauma team slowed. Boardman, the general surgeon, ripped off his white latex gloves and walked away, muttering expletives.

Drops of dark red blood pooled on the white marble floor. The remaining staff peeled away from the soldier's bedside. Pvt. Kurt Frosheiser, 22, of Des Moines, Iowa, was dead.

It was 8:17 p.m. Maj. Benjamin Gonzalez, 41, of Mesa, Ariz., assistant chief of emergency medicine at Walter Reed Army Hospital, now the chief of the Baghdad ER, was the first to speak.

"We've got another one coming in about three minutes," he said.

Victim had just arrived, 'fresh out of basic' training

	LUCIAN PERKINS / THE WASHINGTON POST Spec. Ronald Dekker leans in close to encourage fellow platoon member Pfc. Matthew VanBuren the day after VanBuren was wounded and another soldier killed by a bomb in Baghdad's Sadr City.

Another patient dead, thought Maj. Fred Brennan, 38, a soft-spoken, bespectacled sports doctor from Fort Belvoir, Va.

"It's never easy to see it," Brennan said. "It's a very fine line for us between compassion and being hardened to it. You can't dwell on it for very long because it gets to you. We feel for him."

He sighed. "But if you dwell on him, you can't do your job."

VanBuren, the chatty soldier from Kansas, came in by ambulance, unaware that Frosheiser had arrived moments earlier. Both men were victims of the Sadr City bomb; VanBuren had been driving the Humvee when the explosion happened. He worried about his friend and feared the worst.

"God, I hope he's going to be OK," he said as he lay prone.

An Army chaplain quietly slipped into the trauma room and asked VanBuren if he could pray with him. He agreed. They clasped hands.

"My buddy Frosh, he was fresh out of basic," VanBuren said. "He got to the unit about a week ago, from Des Moines." He started to cry.

"I was teaching him my job so that if I got hurt, he could take over for me," he said, the tears sneaking out from the corners of his bright blue eyes.

"He was a good guy and a good soldier. I didn't want for him to die."

The commander of the hospital, Col. Beverly Pritchett, 46, from Buffalo, N.Y., came into the trauma room to survey the scene, as she often does after a soldier's death or other serious incident.

Pritchett walked up to VanBuren in Bed No. 4, introduced herself and shook his right hand. She stroked his bare left shoulder.

"I'm going to take real good care of you," she said. "Just take some deep breaths."

"My mother, she's going to kill me," VanBuren said.

"No, she's not going to kill you," Pritchett answered softly. "She's going to be so happy that you're alive."

By 1 a.m., the ER was quiet. VanBuren was upstairs having orthopedic surgery to remove a shrapnel fragment embedded in his right leg. A corporal who had lost two inches of bone in his arm from another roadside blast was sleeping off his surgery. A soldier from the 82nd Airborne Division was in the ER operating room, while his commander sat outside, blank-faced and nervous. The ER staff settled back into the nurses' station and began to play cards.

"This is an average night; this is not even a busy night," said Simmons, the ER nurse.

A jagged piece of metal carries memory of a friend

	LUCIAN PERKINS / THE WASHINGTON POST Hospital chaplain Rod Mills comforts a wounded soldier who was brought to the emergency room after his Humvee hit a roadside bomb on Nov. 8.

Morning brought fresh faces, the day shift. The wait for patients resumed.

On the third floor, VanBuren lay on a hospital bed, surrounded by seven of his buddies. They had brought him a pair of spurs and a certificate honoring his bravery.

Spec. Ronald Dekker, 21, from Tucson, Ariz., stood at VanBuren's bedside, listening. VanBuren told him he'd be leaving for Landstuhl in 24 to 48 hours.

"It'll be two to three weeks before I can be on my feet again," he said. Both of his legs were wrapped in white bandages.

His X-rays lay at the foot of his bed in a yellow envelope. The soldiers took them out and held them up to the light, curious to see the piece of shrapnel embedded in his leg bone.

The surgeon had given VanBuren the jagged bit of metal, which he kept by his bed in a plastic cup with a lid. It was a jagged piece of artillery shell the size of half a pinky. VanBuren planned to keep it, melt it down and make it into a medallion he'd wear around his neck.

"It's all I have to remember my friend by," VanBuren said. He started to cry. Dekker reached down and gave him a hug.

Frosheiser had arrived in the unit about eight days before he died, VanBuren said. Because they both hailed from Midwestern cities and shared a love for the Kansas City Chiefs, VanBuren had taken the young soldier under his wing.

VanBuren recalled one Friday, usually a maintenance day for the trucks, lamenting the need to change a mirror and look at the transmission. VanBuren left for two hours on a mission, and when he came back, Frosheiser had put in a brand-new mirror, serviced the transmission and put in fluids.

"He knew it had to get done, and he got it done without being asked," VanBuren said. "I decided right at that point that this guy could be an excellent soldier. He needed someone to be there for him and teach him the ropes."

Staff Sgt. Darrell Clay, 32, from Fayetteville, N.C., also thought someone should show Frosheiser the ropes.

"We were training them how to drive around Baghdad, Iraqi culture, what to expect during Ramadan, just getting them up to speed pretty much," he said, speaking softly in VanBuren's cramped hospital room.

VanBuren was the driver. Clay sat in the passenger seat. In the rear, a private sat in the right seat and Frosheiser in the left. The gunner peered out from the top.

"We were moving at a pretty fast clip," VanBuren said. "Then, all of a sudden, there was this nasty sound and smell of smoke and explosives. I couldn't hear much out of my left ear."

Clay told VanBuren to hit the gas. "My plan was to haul ass to get us to Assassins' Gate," VanBuren said, referring to the main gate of the U.S.-led administration headquarters in Baghdad.

"You did the right thing," Clay said.

That whole time, VanBuren said, he didn't hear a peep from his friend, who had slumped over in his seat.

Capt. Joel Raoelina, 37, of Logan, Utah, the chaplain of the battalion, stood in the corner of the room, listening, never chiming in. He had rushed to the 28th Combat Support Hospital the evening before to see VanBuren. Then he stayed with Frosheiser's body in the hospital morgue.

At the end of the afternoon, VanBuren's company commander, Capt. Jonathan Redmond, came by. The soldiers in the unit cleared away so VanBuren could talk one-on-one with Redmond, the most senior officer in the room. Soon he hugged VanBuren and walked away. The rest of the unit followed suit, also giving hugs and filing out.

"I love you, man," Dekker said.

"I'll see you in a few months," VanBuren replied.

Redmond stood in the hospital hallway, the soldiers milling around him. "That kid's a hero," the commander said. "Let's pin the medallion on him, send him home and get him back in the fight as soon as he's ready."

Maj. Jason Boardman, the general surgeon from West Point, N.Y., is the younger brother of Seattle Times Managing Editor David Boardman and a 1988 graduate of Bellevue High School.

Copyright © 2003 The Seattle Times Company