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It’s a dry heat. – Vita Crux

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I’m sorry but at 130° it doesn’t matter if it’s wet, dry or otherwise; it’s just bloody hot. It’s stifling, constricting and oppressive and it is every day in the desert. Imagine that blast of heat when you open the oven door to retrieve the thanksgiving turkey, but coming from all directions, not just the rush of hot air into your face. Don’t get me wrong, there are beautiful places in the Middle East, but across the plains it is hot, dry, dusty and dirty.

This day begins just like any other day, set up the clinic, take sick call, requisition supplies, and keep up with the paperwork. The average day is simply mundane, not like the constant adventure that you see in the movies. Half way into the morning there’s a pounding at the door, there has been an incident, they need a medic. The mundane day turns to chaos in an instant. Grab the kit, grab the vest, grab the weapon, head out the door, and flip the sign.

“Medic Out”

I’m by no means an old man, but this is clearly a young mans game. As I run across the compound to the helipad in blistering 130° heat, carrying all that gear, it reminds me I should be more committed to “cardio” in the mornings.

The blades on the helicopters are already spinning up, and the members of the team are assembling. There is a quick briefing on the tarmac before we get underway. A convoy, traveling down route Irish, was hit by an IED (Improvised Explosive Device). There is a ground team on the way, and we are being deployed for air support and MEDIVAC.

We load up, and are quickly underway, the helicopters lifting slowly into the air, tilting ever so gently forward, shifting into formation, pushing ahead toward the incident. The trip is oddly serene, its quiet over the radio headsets and the city beneath seems eerily calm. Each member of the team is likely mulling over our different rolls and jobs, preoccupied in our own little worlds, the only sound is the constant deep pounding of the rotor over head. There really isn’t much to talk about anyway, we’ve all been here before, we are all “seasoned” at what we do.

We bank to the left toward the incident, quickly closing in; the weapons are charged, and the side doors opened up.

Every incident is unique, as we fly over, there is smoke slowly rising from several of the vehicles in the convoy. It appears the IED was set off in the middle of the convoy. There is one HMMWV at the lead that is parked side ways, with the soldiers positioned to return fire, a couple of them have started moving back toward the damaged vehicles. One tanker is over turned, on fire, the main source of the rising smoke. Another HMMWV on its side just off the roadway. A second tanker, with the wheels blown away from it, is sitting with the cab ground into the pavement and the tank twisted around sideways. Two more tankers are piled into each other like a wreck on a highway at home. And the last HMMWV turned sideways in the road with those soldiers moving forward to the injured.

The headset interrupts my thoughts, the decision is to make a touch and go, where the helicopter touches down for a moment, we get off and then the helicopter takes off again circling above, waiting for us to return. The helicopter descends, the skids hit the pavement. Everyone is off in an instant, moving forward to the mangled vehicles and injured personnel.

Then it hits, all hell breaks loose. There are dozens of them, pouring over the embankments at the side of the road and running toward us. Not soldiers, just men with guns. Lots of men, lots of guns. Im not sure if you could see it or hear it first. But there is definitely a hail of bullets coming toward us. Glass shatters, there’s a constant pinging of bullets off the metal of the vehicles behind us, in front of us, all around us. They are coming from all directions. A steady stream of bullets, you can see them, hear them and feel them as they slice through the air all around you.

Do you remember that scene from Heartbreak Ridge, Clint Eastwood fires on his platoon during training and says, “This is the AK-47 assault rifle, the preferred weapon of your enemy. It makes a distinctive sound when fired at you”. Well, it does!

Suddenly the calvary engages. There is a rain of bullets from above as our gunship circles around and unleashes the twin M60’s. The horde of men scatter and seek cover from the gunship, still firing at us, but sporadically, giving us the chance to seek cover, to move forward toward our objectives. We fan out to cover as much ground as possible, to reach as many injured as possible.

I meet up in the middle of the mangled convoy with a couple of the soldiers from the forward HMMWV. We quickly exchange notes. I let them know there are ground reinforcements a few minutes out, we have one EVAC helicopter and one gunship for cover. I point to where the EVAC is supposed to retrieve us, its just off the side of the road, behind a berm, in a small clearing. One of the soldiers tells me that there are two more soldiers stationed at their HMMWV, they count 3 dead in the second overturned HMMWV, and one wounded. The cab of the first tanker is demolished, and on fire, 2 dead. We agree to move to the other tankers, then back to the overturned HMMWV for the other injured soldier.

Peering out from behind the rear of the tanker, bullets are again hailing toward us, as the horde of men has some reprieve from the gunship above as it circles around for another run. The forward and rear HMMWV have also opened fire with their top mounted M60’s, keeping the horde from moving in on us, though not keeping them from firing at us.

We move forward, returning short burst of fire, dodging between the mangled vehicles, ducking, sliding, running, stopping, and firing. It seems like an hour to move 10 feet. The gunship is back overhead, “unleashing the rain”. We move a bit faster as it is now their turn to seek cover. I see one of the tanker drivers crawling out and dropping to the ground. He can move, so he doesn’t need me right now, I point at him and one of the soldiers takes off toward him to bring him back to the rendezvous point. The other soldier and I move forward again, while we can. We take cover behind the next tanker, that’s where we see the other driver and his copilot, they’re fine, but unarmed and scared.

I look for the gunship, it’s circling around again. When it gets overhead, the truck drivers and soldier can move to the rendezvous point. I can move to the HMMWV, get the injured soldier and follow them to the rendezvous point. Brilliant plan. The HMMWV is only 30 meters away, note to self, DO CARDIO!

There’s the gunship overhead, we split, soldier and drivers head back to the meet point, I head to the HMMWV. Even with out the extra cardio I seemed to cover the distance in a few seconds, perhaps adrenalin is as good as cardio. There he is, lying on the ground propped up behind the tire of the HMMWV. He’s conscious, M16 in hand and returning fire when he can. That works, he can shoot, I can drag, and we can get off the road where I can look at him. It’s almost psychic, he just gets it when I reach for the drag handle on his vest and point toward the side of the road…

Insert slow motion scene here…

In reality I know it was only a few moments, but it replays as if it was a slow motion scene in a movie. Grabbing on to his vest, I turn to start moving toward the side of the road, and there he is. A kid really, no more than about 16 I’d guess, with a gun. I had holstered my weapon, so I could drag the soldier, and he was firing the other way. So there we were, face to face, about 20 feet apart. The look on this kids face was surprise, maybe shock, I don’t think he expected to come around the HMMWV and find us there. Then, in a moment, his expression changed to a look of hate. Perhaps all of the propaganda, all of the indoctrination, or some lingering atrocity that caused him to join the Jihad in the first place had been summed up into one piercing look of hatred.

He fired.

I wasn’t counting at the time, but three rounds hit me, square in the center of my chest. It knocked me to the ground, pulled the breath out of my lungs, and hurt like a son of a bitch. Thank god for kevlar! There was a moment of stunned disbelief, for me, and apparently him as he just stopped and looked at me. Perhaps questioning if I was dead, perhaps setting his sights on the soldier behind me, either way he had just stopped. Then he slowly began to raise his weapon, maybe a conditioned response. I didn’t really think at the moment, I didn’t plan, I didn’t have a “Matrix” moment of supernatural training. I simply drew my side arm and fired. His head snapped back, and he fell to the ground. There was no joy, no revelry, just the simple fact that he was dead.

The soldiers voice woke me from my haze, “are you ok?”. Time resumed to normal speed, as I rolled to my knees, pealed the top of my vest back and looked at the shirt underneath, no blood, I can breath, I can move, I’m Ok. I reach for his vest again and we resume our journey, sliding past the young man I had just put into a grave.

At the side of the road, ducked down behind the berm I was back to myself. Looking over my patient, his leg was mangled from the shrapnel coming through the side of the HMMWV, I tied a tourniquet around his thigh to control the bleeding. His arm had some shrapnel imbedded in it, but just a few pieces. Hmmm, where else would you say just a few pieces of shrapnel? And he had a nasty gash just under his helmet. Overall he’s good to travel.

One of the other soldiers came back from the meet point to help get us back over there. When he arrived, he looked at me funny and said “hey doc, your hit”. I looked at my chest again, looked at him, and he shook his head, pointing at my arm. Sure enough, there was a slash through my shirt and blood trickling down my arm. Looking at my arm, it was just a graze, perhaps a fourth bullet?

We were ready to go, the gunship was swinging over again, and I could see the EVAC swinging in to land at the meet point. As the M60’s on the gunship opened up again, we both took hold of the patient and started to run toward the helicopter that was approaching for a touch down. Timing was once again perfect, we arrived, just as the skids touched the ground. We all loaded up, and lifted off again.

The trip home was uneventful, routine really, I was back to doing my job. Bandaging, splinting, IV’s, medications and notifying the nearest CSH (Combat Support Hospital).

It wasn’t until the job was done that I had the opportunity to think. This wasn’t the first time that I had taken a life, and sadly it wouldn’t be the last. But this time, it was more personal. I was face to face, just 20 feet away. He was a kid. He was the same age as the kids on the soccer team I had coached at home. Wincing with each breath from the bruises on my chest, the dull ache in my shoulder from the now sewn up hole, and the flashes of todays events interrupting my thoughts, I had to ask, is it worth it?

There is an insane amount of money to be earned as a contractor in the desert. The job is usually very simple, providing routine healthcare for who ever shows up at the clinic door. There is the odd charm of practicing medicine with out the encumberments of insurance and restrictions of the American healthcare system. You simply treat people. You care for their maladies regardless of who they are, how they can pay or what their status is. Your job is to make them well and get them back to doing what they need to do. It might take 5 minutes and a few Ibuprofen, or it could take an hour of just listening to and discussing the problem of the day. It is truly free form medicine. You may need to be the scientist, physician, or counselor; what ever it takes.

Then there are days like today. The realization sets in. No matter the satisfaction you get from truly practicing medicine. No matter the ridiculous amount of money you can make. Is it worth trading your life for? The odds are that one of those bullets will hit their mark, and you won’t be around to spend the money. But more importantly, is the impact that days like today will have on your life, and it won’t be a life any more. You will end up mired in the memories and internal conflict born from being forced to make choices that no one should have to make. All politics and justifications aside, medicine is about preserving life, not taking it. And what is more, life is about living wether you are an aging American medic or a kid who should have a soccer ball, not a gun.

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Thanks !

Thanks for sharing this, you are awesome !