The 28th Combat Support Hospital in Baghdad's Green Zone is the busiest military trauma center in the world. Casualties can arrive with as little as a one-minute warning.
"Probably about 95 percent of our casualties come in by air," said Maj. William White, the head nurse. "Since the surge started, we are seeing more coming in by ground."
Since White arrived in October, the hospital has treated close to 9,000 trauma patients. Iraqis, both friend and foe, are treated here, but mostly American soldiers and Marines have passed through its doors.
Just after noon on the day "Nightline" visited the facility, a convoy pulled up to the entrance. An Iraqi mother had waved the convoy down as it passed by. The day before, her daughter had been bitten by a black scorpion and now the 8-year-old girl was unconscious and struggling for breath.
While doctors and nurses worked to insert a tube to help her breathe and an IV line to deliver fluids and medication, White and his staff were alerted that a helicopter was now on its way. All that was known about the wounded U.S. soldier on board was that a roadside bomb had blown up his legs.
'We Are Going to Do What We Can'
Second Lt. Mark Little is just 23 years old, college educated, the youngest of eight children and the only one of his siblings to join the military. He was helping to deliver supplies when his Humvee was struck. This was the fourth bomb he had been hit by since arriving in Iraq in May. Until today, he had escaped serious injury. When he arrived at the hospital, the lower part of his right leg was gone and the lower part of his left leg was barely attached.
Little was semiconscious, but White spoke to him to help put his mind at ease.
"Mother and father — I bet they are pretty proud of what you are doing," he told the soldier.
He also tried to keep Little informed of what was happening around him.
"The name of the game here is we are going to get a CAT scan. And then see if we can get an O.R. opened up right away and fix you the rest of the way up. OK?"
Little weakly asked about his legs.
"We are going to do what we can to fix your legs up as much as we can," White told him. But he didn't sugarcoat the lieutenant's situation.
'Nothing Could Ever Prepare You for What You See Here'
"You know the deal, right?" he asked.
Little managed a joke about not having to run any more two-mile training runs. White agreed with him.
"Tell them if anything happens, you need the bionic legs. Six-million-dollar man."
But then Little asked the question that so many soldiers ask when they come through these doors.
"At this point you're pretty … certain I'm not going to die, right?"
White assured him in as matter-of-fact a way as possible, jokingly telling Little that he'd already completed his statistics for the month and that he's not about to change them.
"The guys coming in are going to be scared," White said. "You're not gonna lie to him. But at the same time you're gonna say to him, 'Look we're gonna do everything we possibly can.'"
White has served as an Army nurse for 16 years. Even though he worked in many military trauma centers in the United States, White said that the majority of the cases he sees are "your chest pains, your abdominal pains, your child fever works-ups." He added, "Nothing could ever prepare you for what you see here."
White transferred Little's treatment to Rick Rooney, a staff surgeon who would oversee his care in the operating room.
Coping Day to Day
"There are two priorities. The first is to save lives, so you want to make sure he's stable," Rooney said. "Then from an extremities standpoint, you try to salvage everything you can."
In the case of Little, the doctors decided to remove the lower part of his remaining leg.
Rooney, a West Point graduate, sees cases like Little's day after day. Even coming from a family of surgeons and specializing in traumatic spinal injuries back home in Texas doesn't shield him from the effects of what he witnesses every day.
"One of the frustrating things is that you know as a physician a lot of times you're used to succeeding," he said. "Here a lot of the time what they hand you is a patient that's been devastated. There's no win. You lose and you lose and you lose and you're just not used to losing. It just sucks."
Like everyone who works at the hospital, Rooney finds ways to cope.
"Exercise. So a lot of us exercise. A lot sleep. Some people eat, some people don't sleep very well. There are probably a lot of people on antidepressants. You know if they didn't have 'general order No. 1' which is 'no alcohol,' there probably would be a lot of drinking," Rooney said.
When White has a free moment, he checks on the patients who have come through Rooney's emergency room. The young scorpion bite victim is now in intensive care, but with anti-venom administered White was hopeful they would see a turn around in her condition during the next few hours.
White also checked in on Little who was now out of surgery, but still not awake. He would remain in the clinic for only a few hours more. The goal was to get patients stabilized and moved out as quickly as possible to U.S. medical facilities in Germany, and eventually the United States, to continue their treatment.
Little's commander, Lt. Col. Mark Weinerth, and a few fellow soldiers also arrived to check on his condition. They approached the bed cautiously and quietly pinned a Purple Heart medal to Little's pillow. A chaplain offered a brief prayer.
"We bless this soldier," he said. "We thank you father for his family back home. Continue to be with this soldier, continue to bless him. In His holy name we pray. Amen."
Weinerth asked the nurse how the medics did treating Little in the field.
"They did a great job," White assured him. "They did everything perfect. They saved his life."
Weinerth was also thankful for the work done by the staff at the hospital. "You guys are incredible up here."
White returned the praise.
"You guys have the hard job," he said. "You are out there every day. Not us."
Tragedy Hits Home
But even in this Green Zone hospital, there have been sustained attacks and personal losses. In July White and the staff tried in vain to save fellow nurse Maria Ortiz, who had walked out of the hospital just as mortars began to fall. Ortiz, who was supposed to be married when she returned from Iraq, was the first army nurse killed by hostile fire since Vietnam.
"Anyone who has ever taken care of someone who they were close to, someone they've worked with, and they've actually had to then work on them — it's a different ball game. Totally different ball game," White said. "Even though you attempt to focus on injuries like you do on 8,000 other cases you've done, when it's somebody you know, that you really know, and you know they're counting on you to save them, you know it's a different ball game."
The relentless pace in the hospital rarely allows for a moment of reflection. Back down in the emergency room, White treated another Iraqi child who had been brought in by the U.S. military. The 2-year-old had been accidentally scalded with boiling milk two days before.
Her mother took her to Iraqi doctors, who bandaged her wounds but then sent her home. A massive infection had now set in. Despite a team of doctors and nurses working to save her life, their efforts proved no match for the infection that overwhelmed her little body. White wrapped the body in a blanket as the devastating wails of the baby's mother filled the hallways.
For White and his staff, the death does not offer a moment to pause. Already there is news that several "walking wounded" soldiers are on their way, expected to arrive in minutes and fill the trauma beds of the emergency room. Some of the soldiers do indeed walk into the trauma center, but some of their injuries are life altering. The mouth and lower jaw of one of the soldiers has been reduced to a gaping bloody hole. Another has deep gashes in his legs and groin. Whatever encouraging statistics there are from the surge that point to fewer deaths and fewer wounded, at the combat support hospital they never stop coming.
But for the men and women who work in this hospital, there is some solace this day with the recovery of a young girl from a potentially deadly scorpion bite, and knowing that the staff has done its best to start Little on his long path to recovery from devastating injuries.