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Rule Number Two
Lessons I Learned in a Combat Hospital
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One of the toughest lessons of her deployment was perfectly articulated by the TV show M*A*S*H: “There are two rules of war. Rule number one is that young men die. Rule number two is that doctors can’t change rule number one.” Some Marines, Kraft realized, and even some of their doctors, would be damaged by war in ways she could not repair. And sometimes, people were repaired in ways she never expected.
Rule Number Two is a powerful firsthand account of providing comfort admidst the chaos of war, and of what it takes to endure.
Table of Contents
Reading Group Guide
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The people, places, and events described in this book are based on my recollection of them, to the best of my memory's ability.
With the exception of Corporal Jason Dunham, the name—and all identifying characteristics—of every patient described in this book has been changed.
An incredibly intense and special bond exists between Marines and the Navy medical personnel who serve with us. The medical officers and corpsmen, our beloved docs, are not graduates of Marine boot camp or combat training. They are medical professionals with brief orientations—a whole eight days—to the operational environment. The Marines protect them like the royalty they are. They handle everything from preventive medicine, routine sick call, and dental care to emergency response and surgery. They bind our physical wounds and just as surely salve our mental casualties. They share our risks and revel in our successes. They weep with us, often for us, over our losses.
This is the story of one deployment of one medical officer—a mother and the wife of a Marine—who also happened to be a Navy psychologist. She was deployed to Iraq to care for the Marines and the medical personnel.
It is a very personal story, but it is also the story of all the men and women of the Navy and the Marine Corps in Al Anbar province in Iraq. Behind the newscasts and the headlines lie the real lives of the warrior class of America, many now on their third or fourth tour in Iraq. Rule Number Two is the story of the strong men and women who are doing the nation's bidding so that others may pursue their lives undisturbed.
W. C. Gregson
Lieutenant General (Retired)
United States Marine Corps
Pagers have come a long way. When I was an intern ten years ago, our beepers produced a horrible, shrill sound—unsuitable for the human ear and audible to anyone who happened to be within a half-mile radius. By January of 2004, when I served as a staff clinical psychologist at Naval Hospital Jacksonville, my pager seemed downright polite, its muted singsong alert barely perceptible across the room.
Even that benign tune, however, sounded harsh and annoying in the middle of the night—exponentially so if I was on vacation.
My mom and dad had traveled from California to spend postholiday quality time in Florida with their fourteen-month-old twin grandchildren. I took five days off—in truth, largely to spend an entire week watching my parents watch my children.
One night during their visit, the peal of my pager awakened me at 0300. I staggered to the kitchen, splashed water on my face, turned on all the lights, and dialed the number displayed on the beeper. The resident in the emergency room told me about one of my patients, a very young Sailor who was about to become a very young single mother. At twenty-two weeks pregnant, she had experienced dangerous preterm labor, and as a precaution she had been admitted to a civilian hospital that would be able to care for a premature baby.
As the resident's voice rambled on, I sank into a chair at the kitchen table and lowered my forehead to my palm. I was always striving to separate the feelings of a clinician, who made decisions rationally and calmly, from those of a woman and mother, who sometimes did not. This became more challenging at 0300. Inhaling deeply, I closed my eyes and counted to five, slowing my heart rate before exhaling. With a sense of renewed control, I decided to visit my patient in the hospital the next morning, and I returned to bed.
Four hours later, I woke out of fitful, anxious dreams about my babies with the sense that I could not ease their pain. Pain about what, I could not remember.
The obstetricians controlled my patient's labor, and her baby remained safely in her womb. Relieved, I left the hospital midmorning, arriving on base in time for a farewell luncheon for our department head, Captain Goldberg. The four psychologists in the department, who had become one another's trusted friends both in and out of the hospital, looked to the captain as a protector and role model. We would miss him terribly.
At lunch, Captain Goldberg talked about how the new conflict in Iraq might affect us. He had been with the Marines when they had pressed to Baghdad less than a year earlier. Home for seven months now, he still seemed far away sometimes.
"I pray that this war will not place any of you in harm's way and away from your families," he said, making eye contact with each of us. "There is no indication this will occur in the near future—but if the unexpected happens, I have faith in all of you, as psychologists and officers."
As we filed out after lunch, each of us stopped to say a personal good-bye.
"If I am called, sir," I told him quietly, "I will do my best to make you proud of me."
I drove home along the river. Feeling connected with God as I gazed at the sun sparkling on the water, I said a prayer for the men and women of this war. I thought of my father and his service in the Navy during both the Korea and Vietnam conflicts, about which he never spoke. I wondered if our Operation Iraqi Freedom veterans would come home to a different world.
I almost didn't hear the singsong tune of my pager over U2's "Sunday Bloody Sunday," which I always turn up too loud.
"You've got to be kidding me," I mumbled to myself, rolling my eyes at the sight of our department phone number on the display. I picked up my cell phone and dialed.
"Heidi?" Our new department head, a lieutenant commander psychiatrist, answered the phone directly. "I was the one who paged you."
"Hi, Elissa. What's up?"
"Are you driving?"
"You should probably pull over."
"Elissa, what's going on? Is everyone okay?"
"Everyone's fine. But you should pull over."
"Okay, okay." I found a place to park along the riverfront road, under an ancient Florida shade tree whose leaves had been taken by winter. The afternoon sun already felt like spring.
I turned off the ignition and waited, my heart thumping audibly. She cleared her throat.
"Okay, I'm just going to say it. I got a call from the front office today. You have eleven days to report to Pendleton. Apparently, the West Coast psychologist who was supposed to deploy with First FSSG* has been pulled to do a float on a helicopter carrier. You're going in his place."
I sat in silence.
I pulled into my garage with no recollection of the drive home. I sat motionless, staring at the dashboard for a few long minutes, and then I forced my muscles to move, gathered my things, and opened the door.
My mother and Meg, holding hands, emerged in the hall. My baby girl smiled when she saw me, her huge green eyes bright. I could hear my dad's animated voice as he read to Brian in another room. I crouched down, and Megan let go of her grandma to teeter across the ceramic tile into my outstretched arms. She circled my neck with tiny, warm hands.
I held Megan tightly, tears flooding my eyes and spilling down my face. Looking over her shoulder, I met my mom's concerned eyes.
"Oh, no," she breathed. "Did something bad happen to your patient's baby?"
"No," I whispered, kissing the top of Meg's bald head. I shook my head and inhaled deeply.
"They're sending me to Iraq."
I was not the only medical person who had been plucked from a stateside hospital to join the people of Alpha Surgical Company at Marine Corps Base Camp Pendleton as they prepared to deploy. In fact, only a handful of the personnel were actually organic to the overall medical battalion in peacetime; the majority of us were pulled from major Navy medical facilities to augment the mobile field hospitals.
I was, however, one of only two people who arrived at Camp Pendleton that first day, to find that Alpha Surgical Company had already left for Iraq.
Captain Sladek, a hematologist/oncologist in his twilight tour before retirement, and I had both been given erroneous reporting dates by our parent commands.
Upon the discovery that our unit was gone, the two of us were informed that we would prepare for deployment and travel into the theater with the personnel of our sister company, Bravo Surgical, which would be based at Fallujah. Once we arrived in Kuwait, we would be transported to Iraq to meet up with the company to which we actually belonged.
The captain and I began the transition process together, enduring countless questions from everyone we encountered regarding why our names were not on the lists they had in front of them at the moment. We sat in the back, stood off to the side, and giggled at the fact that since no one knew we were there, no one would know if we disappeared. And yet there we stayed.
And there we sat, together on metal bleachers with Bravo Surgical, on the first of eight deployment training days at Marine Corps Base Camp Pendleton.
We were eighty Navy medical people—surgeons, physicians, psychologists, anesthesia providers, dentists, podiatrists, nurses, and hospital corpsmen, most of whom were based out of either Naval Medical Center San Diego or Naval Hospital Camp Pendleton. For the majority of us, this was our first experience preparing for combat operations of any kind, and we felt awkward and hesitant in the company of thousands of intense Marines.
In the week that followed, together we hauled empty seabags to fifteen different warehouses on base, methodically filling them to their brims with heavy combat gear. Together we donned gas masks and practiced in the gas chamber. Together we learned how to dismount a vehicle if a convoy was attacked and how to assist the Marines in the protection of that convoy. Most of us managed to deny we would need that one.
Together we were issued 9mm pistols and thirty rounds of ammunition.
At the end of the eight days, everyone wept or whispered good-byes to their family members who had come before the sun rose to see them get on the bus. Everyone, that is, except Captain Sladek and me, whose families were across the country. I carried a farewell card from Mike, my Marine officer husband, in my cargo pocket. He wrote that he and my twins would be fine. He told me there were people who needed me more than they did right now.
So I stepped onto that bus with eighty people who swiped at tears and waved through the windows to their children. I put on my sunglasses, although it was still dark, and leaned my head back on the seat.
Several long and cold February flights later, we arrived at a base in Kuwait, a huge staging area for troops entering and exiting Iraq. For a little less than a week, close to a hundred females crammed into one tent, tucked our seabags under the cots that were lined up wall to wall, and attempted to find a way to pass the time.
It was during this week that I met Sandy, a pediatric surgeon with Bravo who had a two-year-old daughter. We became inseparable, talking about our children, our husbands, and our apprehension about what might lie ahead of us in Iraq. Several female Marine officers with cots nearby felt sorry for Sandy and me, I think, and they helped us learn to quickly clean and check our weapons. We washed our socks and underwear in the sinks in portable shower trailers since word to ship out could arrive at any moment and there was no time to use the laundry service. It was dark and very cold, and the wind howled at the canvas of the tent as we slept.
No one slept very well.
And then one day, when Sandy and I returned from breakfast, a Navy Chief met us at the entrance to our tent.
"Lieutenant Commander Kraft?"
"Yes." I hadn't met her before.
"I'm Chief Edmonson with Alpha Surgical. We've been waiting to get the remaining members of the company together before we make our push into country. We've got everyone now." She grinned at me.
"You ready, ma'am?"
It was a loaded question, of course. I had been sitting here in the sand of Kuwait doing nothing for six days. And yet now, faced with the moment I would actually load both seabags on the Humvee that would take us to the transport plane, I suddenly felt completely and totally unready.
Almost twenty-four hours later, our tiny group of stragglers arrived at Al Asad Airfield in Iraq in the chilling dead of night, and we hitched a ride on a Humvee to get to the hospital. Someone directed me to a dark room in which I was to drop my bags and find an open cot. I fell asleep with my boots on.
The light of day introduced me to the people of Alpha Surgical. When all was said and done, they had been in Iraq only about two weeks longer than Captain Sladek and me. I looked around, observing this newly founded band of medical and nurse officers and hospital corpsmen; I also observed the small group of men and one woman we came to call "our Marines." (Our Marines drove ambulances, operated radios, orchestrated communication, and arranged logistics for the unit—and they protected us.) I realized that, although it would have been nice to have been with all of them during those extra two weeks, it actually wasn't necessary. They were just like the people I'd met from Bravo: they had been mixed together, shipped across the world, and were now expected to function well as a mobile field surgical company in combat.
Somehow, despite the odds, we did. The infinite light brown dirt and rock of western Iraq quickly covered our boots. The first helicopter landed in the dust behind the hospital, and the first patients were hauled to our operating room. In those moments, we were transformed into a strangely familiar family, with serious personality conflicts, outright yelling matches, and seven-month grudges.
Yet we understood one another when it mattered. That's all our Marines knew. They knew they could count on us to take care of them. And somehow, even before we really knew them, we knew they would take care of us too.
Before the dawn of my third morning in country, I emerged sweat-soaked from vivid, disturbing dreams. I felt disoriented and nauseated, and a searing pain ripped across my shoulders and left arm. My head throbbed and my teeth ached. Frightened by the pain, I sat up, trying not to notice the walls shifting around me. I closed my eyes in an attempt to ease the dizziness and process the many sensations. The pain radiated from my left deltoid muscle, and suddenly I knew: it was the site of my smallpox vaccine, administered in Kuwait five days before our flight to Iraq.
I scanned the dark, windowless room. Five cots, five women, and ten seabags were crammed into a tiny exam area. Our assigned living quarters were still occupied, so we all lived in the hospital for our first weeks at Al Asad.
None of my sleeping roommates stirred as I swung my legs over the side of the cot. I squeezed my flashlight with one hand and, by its blue light, rummaged through my bag with the other. I found my shower gear and tiptoed out the door—so dizzy I almost fell, twice.
The shower in the hospital was located in a long, thin space with no lights, next to a broom closet. Just inside the door, a duct-taped X covered the bowl of a sink that had a long crack through its pedestal base. Beyond it, a small dressing area with three rotting wooden shelves on the walls led to a small square of tile flooring. A ceramic-coated hole in the tile functioned as a toilet, its flush handle protruding from the wall. A large plastic trash bag was crumpled in the corner, a repository for used toilet tissue, which the pipes could not handle. Most of the commodes at Al Asad were holes in the ground with bags next to them, but this one was special. It had a removable rusted metal grate cover, on which we were supposed to stand while the showerhead trickled water on us—and into the toilet.
I laid my flashlight on a wooden shelf to light up the shower area and immediately wished I had stayed in the dark. As soon as the water flowed, gigantic mosquitoes emerged from the grate and hovered around my head. Some things are better not seen.
Like my smallpox injection site. I gingerly removed the gauze that covered the wound and moved my arm into the light.
"Ohhhh," I groaned, looking away. The vaccine site, which I strove to keep clean and covered while it scabbed over, appeared bright red and angry. White fluid drained from its multiple punctures. Crimson tentacles stretched in all directions from the wound, going up my shoulder and across my chest, and also down that arm. I touched the surrounding skin with my right hand. It was hot.
The cold water felt wonderful on my flushed face. I washed the wound as well as I could, cringing through the pain. Slowly, clumsily, I dressed, fever and chills hitting me in alternating waves as I laced my boots.
I walked into the passageway and found a chair in the waiting area outside the exam rooms used for sick call, the nonemergent medical care we provided to the base. Today, I would be the patient. I sat and waited.
The sun rose and the people of Alpha Surgical Company rose with it, preparing the hospital for the day. Sometime after 0700, my friend Bill, one of two physician assistants in our company, left the call room and walked down the hall to set up his morning clinic. I raised a hand in hello.
He took one look at me and stopped walking.
"Wow, you look horrible."
"Thanks." I managed a smile. "I feel horrible." I peeled back the sleeve of my T-shirt and lifted the bandage.
Bill exhaled in a low whistle. "It's impossible to keep wounds clean out here. That looks bad." He ushered me into an exam room. My temperature had reached 103°.
Bill wrote me a prescription for antibiotics and ibuprofen. I smiled my thanks and moved to the small room we called a pharmacy, where one of the techs quickly filled a small Ziploc bag with pills.
"You're going to need to take the day off, by the way," Bill called over his shoulder at me as he entered an exam room.
"Thanks, I think I will." I downed two pills with bottled water and re-entered my temporary room, which was now empty. I collapsed on my cot, boots still laced and pistol still secure in the holster that hung from my shoulders.
My eyes flew open to the sound of pounding on my door.
"Lieutenant Commander Kraft? Are you in there?"
"Yes." My voice sounded unfamiliar. I cleared my throat and sat up. "Come in."
A corpsman from the ward opened the door and poked his head in the room.
"The CO [Commanding Officer] sent me to find you, ma'am."
I had no idea what time it was. I quickly ran a hand over my hair, which had dried postshower into clumps of matted curls as I slept. Thankfully already dressed, I stood—fighting dizziness—and followed him out. He starting jogging and looked back at me. Every cell in my body screamed in protest, but I caught up. He talked, out of breath, as we ran.
"Four Marines just got here—their vehicle hit a land mine out on a convoy. One has a pretty bad injury to his face. Dr. S. is not sure if he's going to be able to save his jaw, but he's going to the OR any minute to try. All four are still in the SST [Shock Stabilization Team]."
"Okay…" I waited.
"The reason we need you is that this colonel just showed up, their battalion CO, I guess. He's standing outside the SST. He's crying, ma'am. And he won't leave. Our CO told us to call you."
I stared at him.
"And this requires psych because…?" I mumbled sarcastically to myself. If one of us was going to be called every time someone cried in the hospital, this had the potential to be a very long deployment.
We arrived in the passageway outside the SST. The door to our makeshift emergency room was open, and scores of people wearing gloves and surgical masks moved around inside. Above the general hum of the voices of our SST personnel, another sound emerged.
A Marine was screaming.
His voice echoed through the passageways of the back of the hospital, a tortured cry made more heartbreaking by virtue of the fact that this nineteen-year-old man probably had never allowed himself to cry, let alone scream. Worse, his cries were contagious. His comrades had seen the gruesome injury to his face, and they heard his agony. They responded by calling to him, trying to drown out his shouts with their own words, support directed at him and exasperation directed at us.
"We're right here, Miller."
"You're doing great, buddy."
"Can't you give him something?"
Three Marine Corps officers hovered in the doorway of the SST, close enough to hear their men in pain but helpless to do anything about it. Two, identified by gold oak leaves on their collars as majors, appeared uncomfortable and slightly nauseated. The colonel stood between them. He was impossible to miss.
At least six-four, he towered over everyone around him. His dark hair was peppered with silver. He turned in my direction, and I could see that his blue eyes were bloodshot and his cheeks tear-streaked.
A litter team exited the SST and carried the Marine past the colonel, and he clearly saw the extent of the man's injuries. He watched as the stretcher turned the corner to the operating room.
The colonel turned to face the wall and placed a palm against the concrete, arm straight. He slowly lowered his head, and his big shoulders trembled as he began to sob.
I moved toward the three men, struck by the fact that both majors kept their distance from their leader but still watched him intently and with genuine concern. And suddenly I understood. Their concern was not for him.
As a commanding officer, the colonel was responsible for the welfare of these Marines. Several had been injured, one critically, and he could not change that. He was not in control, and control was usually the one thing he always had. He would have preferred to be injured himself rather than hear one of his men scream in pain. His anguish was palpable.
But he was not supposed to show it in public.
He wiped his eyes with his sleeve and turned to walk into the SST. I moved in front of him, blocking his entrance.
"Sir," I said, extending my hand. Surprised, he stopped and looked at me. "I am Heidi Kraft."
He shook my hand. The two majors approached out of curiosity.
"Why don't we just move over here, gentlemen." I turned them as a group and herded them toward the open door of the waiting area, away from the SST. One of my psych techs, Petty Officer Gob, stood nearby. I mouthed the word Kleenex to him, and he disappeared. The colonel hesitated, looking back toward the SST, where the moans of his Marines could still be heard.
"Please, sir." I locked eyes with him. The majors were already in the waiting room. "Please, come with me." Reluctantly, he followed me.
As we entered the waiting room, my face was on fire. I felt weaker every moment, my knees threatening to buckle beneath me. I handed the colonel a roll of toilet paper and sat across from him, leaning forward so that I could speak quietly. The majors sat across the room.
"Sir, I am one of the combat stress people here. Our surgical team asked me to help get you information. I will find out how your one Marine is doing in surgery and get you a status report on the other three." He nodded, tearing off some toilet tissue to blow his nose.
"When can I see them?" he asked.
"Once they are stabilized. Not before."
He lowered his eyes. "I understand."
I moved my face closer to his, my voice nearly a whisper. "Sir, I want you to know that my team is here if any of your people should need us."
He looked directly at me. I was certain he could hear the hammering of my heart and that he knew I had trouble focusing on his face. Please, God, don't let me pass out here in front of this colonel, I thought. A brief look of understanding crossed his face. He nodded.
"Thank you, Heidi."
On any other day, he probably would have called me Lieutenant Commander Kraft or, much more likely, Doc. I smiled.
- On Sale
- Oct 24, 2007
- Page Count
- 256 pages
- Little, Brown and Company