Harrowing Work: The Amazing Fight to Save Lives in War, An Excerpt from Men's Health

Men's Health magazine reporter Bob Drury spent months embedded with the medics of the 54th Medical Company, based out of Fort Lewis, Wash., and stationed at Balad Air Base, 42 miles northwest of Baghdad, Iraq.

Here is an excerpt from an in-depth article he wrote for the magazine, which can be read in full at: http://www.menshealth.com/iraq

The call comes in at 1330 hours one recent hot, dusty afternoon in the heart of the Sunni Triangle. Ambush. A Humvee, call sign Hardrock Six, 3rd Infantry Division, hit flush by a rocket-propelled grenade. Two soldiers are down, one "urgent," one "priority." Urgent means loss of life, limb, or eyesight; priority means loss of blood. Precisely 5 minutes later, our UH-60 Black Hawk medevac lifts off from Balad Air Base, 12 miles away. It soars over the blue-tiled roof of the mosque personally designed by Saddam Hussein, banks left, and within seconds clears the concertina wire surrounding Logistical Support Area Anaconda.

"No matter how many times you do it, you still pucker once you get over the wire," says one of the helicopter's pilots, Chief Warrant Officer Lance Duensing. Duensing is handsome, square-jawed, towheaded -- not quite a buzz cut. He looks as if he'd prefer to be flushing quail near his home in the East Texas hill country. The pilot in command, Chief Warrant Officer Jackson Wood, his sunburned face as taut as a clenched fist, throttles the aircraft, the rotors drown out conversation, and we hurtle at 145 miles per hour toward the evacuation, or dust-off, site.

Near the Tigris River, the dull, silvery brown talc of the Iraqi desert turns greener, wetter, burgeoning into lush fields of corn and melon linked by irrigation ditches. Rows of date palms sprout in symmetrical patterns on both sides of the emerald waterway, each tree capable of concealing a man with a Kalashnikov assault rifle or a shoulder-mounted rocket launcher. All eyes are outward except those of Specialist Elizabeth Shrode, the flight medic, who's busy arranging the blood supply and bandages. She rechecks the oxygen tanks. Beside her, crew chief Brandon King fingers his M-16 and scans the terrain below, his toe tapping nervously on the armor-plated floor.

From the rear seat, I steal another glance at the medic. Her brown hair is pulled back in a tight bun, and beneath her flight helmet, her dark eyeliner flatters an oval face with sharp, high cheekbones. Rifling through her first-aid kit, she appears the picture of serenity. I turn back toward the window. I pretend to be searching for snipers. It's an act. I am scared.

The 'Golden Hour'

This is a story about a pipeline. It begins with a bullet, a chunk of shrapnel, a percussive blast attempting to suck the life out of an American soldier somewhere in Mesopotamia, and culminates on a forested hilltop in Landstuhl, Germany. It is a story about the men and women who make this remarkable medical pipeline flow -- the pilots, medics, surgeons, mechanics, nurses, and litter bearers who reclaim the lives of young American soldiers who, if not for their care, would die on a battlefield far from home.

War may be the best teacher of war, as Clausewitz observed, but, from Gettysburg to Khe Sanh to Samarra, it has also been an unparalleled teacher of medicine. The rescuers in this story are aided by great leaps in modern technology, the conflict in Iraq having been the proving ground for a number of medical innovations: robotic prostheses for amputees, pills that read soldiers' vital signs, computer chips that pinpoint wounds, vacuum-sealed sterile pressure bandages, operating-room laser technology, and even a new form of antibacterial gauze with a veneer of Vaseline. All are very likely to be put to use in civilian emergency rooms across America someday.

But the primary components of this pipeline are the wisdom and heart, the dignity and valor, the expertise and dedication, of its practitioners. In many ways, this is a horrific story, as all narratives of violence visited upon youth need be. War, for all its lies, is about the truth, and no matter your view regarding the necessity or prudence of the invasion of Iraq, the fact remains that in a distant desert land, our country's soldiers are being torn to pieces at conveyer-belt rates. They would not make it home alive without this pipeline, which starts in the "golden hour," that first 60 minutes after a soldier is wounded in action, when life and death literally hang in the balance.

It starts with the medics in Balad.

In military circles, the phrase "tip of the spear" is much overused, yet it describes perfectly the medics who have rescued most of -- as of this writing -- the more than 16,000 U.S. servicemen and women wounded in Iraq. During the Vietnam War, it took weeks to move a wounded man from the bush to a hospital in the United States. Today, a soldier seriously wounded in Fallujah can be whisked to the Iraqi theater hospital, transferred to the American-staffed Landstuhl Medical Center in southwestern Germany, and taken to National Naval Medical Center in Bethesda, Maryland, or Walter Reed Army Medical Center in Washington, D.C., within 36 hours.

The medics at the mouth of this pipeline hail from the 54th Medical Company, out of Fort Lewis, Washington, and they're stationed at Balad Air Base, 42 miles northwest of Baghdad. This is the nexus of America's medical presence in Iraq. Located in the parched province of Salah ad Din, it's a former Iraqi Air Force base. It was captured by U.S. forces in 2003 and -- with its two parallel, 11,000-foot runways -- has become America's air hub in the region. The site is dusty and gritty and rocky and hot. Only a few scraggly eucalyptus trees, their leaves caked brown with sand, disrupt the endless horizon.

Working at 'Mortaritaville'

The base, dubbed Mortaritaville, is attached to LSA Anaconda, the U.S. Army's largest support base in Iraq. The combined, enclosed outpost, spread over an area with a 12-mile circumference, is fortified against bombardment by hundreds of asymmetrical rows of concrete blast walls, 12 to 20 feet high and 2 feet thick. They snake through the camp abutted by huge, mantrap-sized, cardboard-lined metal baskets filled with dirt, called Hesco Barriers. Roughly 20,000 soldiers and 2,800 airmen, as well as a smattering of civilian contractors and Department of Defense operators, are garrisoned there. (Members of the U.S. Air Force, man or woman, pilot or mechanic, are officially known as airmen.) They bunk in thin-skinned metal "hootches," similar to the containers that transport merchandise on ships. Each is large enough for two bed frames and two aluminum wardrobes; a few are double stacked. Though surrounded by sandbags piled 5 feet high, they offer little safety from a direct hit by a rocket or mortar, which are lobbed over the wire nightly. "Raining iron," the soldiers call it, and smile.

The neighboring Iraqi town of Balad is the heart of the remaining Saddam loyalists in Iraq. Thus, the base has a Fort Apache feel to it. Its ready-alert status requires every soldier and airman to carry or wear the bulky 4-pound Kevlar helmet and 35-pound armor-plated vest ("battle rattle") at all times, be it to the chow hall, the makeshift gym, the basketball courts, or the latrine in the middle of the night.

The 54th Medical Company's flight crews are constantly in the air, averaging 25 dust-offs and medical-supply runs a day. They take pride in the fact that they are the only medevac choppers in theater to fly without escorts. A half dozen of the 54th's Black Hawks are stationed at Balad -- another half dozen are spread about the theater at smaller forward operating bases -- and can cover a 50-mile radius ("60 to 70 in a pinch," says one pilot). They do not lack for business.

The aircraft, configured to carry up to six litters, have been modified into flying emergency rooms, set up for any medical contingency one might encounter in a bloody war. Their holds are crammed with oxygen tanks, blood packs, heart-rate monitors, chest and intubation tubes, pressure infusers, splints, defibrillation paddles, drugs of every stripe. It is not unusual for medics to pick up a wounded soldier at the point of impact and begin measuring his heart rate with a portable electrocardiogram machine or sedating him with a Valium infusion as the helicopter races to the field hospital.

But the bulk of a medic's work is done on the ground. It is too often sad and bloody and dangerous, all at the same time. One morning, soon after my arrival in theater, a med-evac call came in after another Humvee attack in a nearby village, this vehicle blown onto its side by an IED, military shorthand for the ubiquitous improvised explosive devices that, along with suicide car bombs, have become the weapon of choice for the Iraqi insurgency. Two GIs were seriously wounded -- one thrown clear by the blast and unconscious, the other, a turret gunner, pinned beneath the vehicle, his legs crushed.

The medics from the 54th arrived within minutes, only to discover another, unexploded IED -- "about the size of a case of longneck beers" -- planted 4 feet from the still-smoking Humvee. The scene was so fraught that ground troops setting up a perimeter around the wounded men did not dare venture closer than 50 yards for fear of being blown to hell themselves. The medics charged in, literally stepping back and forth over the live bomb as they worked. One tended the unconscious man, pounding his chest and administering mouth-to-mouth resuscitation, while the other attempted to extricate the gunner. Their efforts were for naught; both soldiers died at the scene.

Afterward, back at the air ambulance company's headquarters, the mood was somber. I watched as the medics blamed themselves for taking too much time to remove the turret gunner, and for failing to summon a backup medevac to pick up the unconscious soldier while they worked. One medic wept in fitful, silent heaves, surrounded by his buddies. The other went off to sit alone in the sand and pound his forehead.

Captain Michael Myers, another Black Hawk pilot, sidled up to me. We stared silently at the disconsolate medic sitting apart from everyone. "We all need time alone sometimes," he said, softly.

To read the full article, go to www.MensHealth.com/iraq