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Ground Zero, Iraq

International | MILITARY: It's a guerrilla war out there, and nearly all of that trauma passes through the hospital doors at Camp Anaconda

Issue: "Lord of the Rings," Dec. 20, 2003

DEC. 8 AT THE ARMY'S 21ST Combat Support Hospital was tree-lighting day. But it didn't end on a festive note.

Doctors, medics, and other personnel were having a relatively light day with no incoming wounded. "We never use the Q word around here"-meaning quiet-said Col. Carol McNeill. "Then it's sure to change."

During the lull the hospital chaplain, Capt. Dallas Walker, gathered the medical team to light the Christmas tree. Men and women, doctors, nurses, medics, and administrators clumped into the intersecting tent between the trauma tent and operating rooms to sing "White Christmas" and "Jingle Bells."

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Hospital commander Col. Douglas Liening stepped up to turn on the lights-a ceremony timed to coincide with the Christmas tree lighting at Fort Hood, Texas, the unit's home base. Chaplain Walker ended with prayer: "Father, we do thank You for this life that You've given each one of us. Now continue to protect us and watch out for us. And be with our dear loved ones back home."

Then it was back to work. At 6 p.m. the radio crackled to life: "Medevac, medevac, medevac." That was the first alert that wounded soldiers would be arriving soon.

This hospital is the Army's largest medical facility in Iraq outside a field hospital in Baghdad. Located near the town of Balad, halfway between hot zones at Tikrit in the north and Fallujah in the south, the 21st CSH-known in Army lingo as "the cash"-absorbs much of the war's trauma.

Medical staff here have seen more than 14,000 patients since the hospital opened at the end of April. Those include victims of combat, accidents, and general medical cases ranging from asthma attacks and hives to pneumonia and heart attacks. The 84-bed facility is a revolving door: Patients are treated quickly and returned to duty; or, in trauma cases, stabilized so they can be transported to the Army's full-fledged medical center at Landstuhl, Germany.

The hospital takes up one quadrant of Camp Anaconda, at 15 square miles the largest U.S. base in Iraq. The hospital runs on 300 active-duty personnel. They work 8- or 12-hour shifts but in reality are on call 24 hours a day.

Lt. Col. Kimberly Kesling is currently the only orthopedic surgeon on staff-and seven out of every 10 surgical procedures are orthopedic. Physicians frequently show up in off-duty shorts and T-shirt to don surgical gloves and go to work. Inside the windowless maze of tents, it's hard to know whether it's day or night. And, anyway, the lights are always on.

Why would physician specialists choose Army life? "I know this is where God wants me," said Col. Russ Martin, a general surgeon. "Pay for Army doctors is not the same as private physicians, but it is very good, very comfortable."

Col. Martin, director of resident training at the Fort Hood hospital, volunteered to deploy for Operation Iraqi Freedom because he knew there was a shortage of field physicians. "I don't see a lot of friends out there [in private practice] happy, and I am very happy with what I am doing."

At 7 p.m. more details trickle in. A Stryker, the Army's newest fighting vehicle, has rolled into a canal. Three urgent-care gurneys are prepared in the EMT (or trauma unit). Medics peel off sweaters, laugh, and sing instructions to keep tension at bay. "It's about to get hot in here," said one.

A nurse arrives with, "Who, what, when, and where?" She rubs sleepy eyes and departs after sizing up the staff level and concluding she won't be needed.

Then the final radio call: one minute out, but only one patient, in stable condition. There's no time to wonder about the changing numbers or the delay in arrival. The chopper has touched down and the ambulance flashes its headlights into the gravel path by the EMT door. An officer rolls out its back doors ahead of the litter. "Stryker vehicle rolled over into a ditch of water. It's on its head right now," he says.

The victim is conscious and moving. Once on the table, medics and nurses crowd in, slice open his pants and shirt, and go to work. His temperature is good and in a matter of minutes he is upright, wretching.

But the news coming through the ward isn't good. Two soldiers in the Stryker remained trapped under water too long. They were dead on arrival. A third was given CPR for 40 minutes before he also died. After the survivor is stabilized and X-rayed, one of the attending physicians will head outside to pronounce the fatalities.

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