Originally published April 13, 2007

It begins with the sound of Black Hawk helicopters.
They come in low over Contingency Operating Base Speicher, banking hard toward the wind sock that flies just outside the 399th Combat Support Hospital. As they descend to one of four landing pads, a four-person “landing team” waits with a wheeled gurney.
Dust swirls everywhere. The medic aboard the helicopter motions. The landing team, goggled and ears covered, runs toward the chopper.
Out, ever so carefully, comes a litter bearing the latest victim of the war outside COB Speicher’s gates. Expert hands secure it to the gurney. Then, in unison, the team fast-walks across the tarmac and through the swinging white doors to the 399th’s emergency medical treatment unit.
Tuesday evening, after two days of relative quiet here, a Black Hawk appeared, carrying a young American soldier who had just been shot by a sniper.
Then, less than an hour later, two ambulances careened into the circle next to the helipad, bearing two Iraqi army soldiers – both severely wounded by an improvised explosive device while patrolling through the nearby town of Door.
Then, on the heels of the ambulances, another helicopter touched down with a third Iraqi soldier from the same bomb.
Suddenly, the emergency room, which had sat quiet all day, was packed with doctors, nurses, medics, X-ray technicians and all the others whose job here is to stop death in its tracks.
Scissors cut through bloody uniforms. Fingers tapped dirty forearms to locate veins for intravenous lines. Four-person trauma teams called out vital signs and described injuries while nurses wrote in charts and doctors conferred on who needed surgery and how soon.
The noise level rose, but plateaued just below bedlam. Everyone, with the exception of the patients, was moving – yet no one collided.
Sgt. Tim Verreault of Auburn, a medic in the 399th’s emergency medical treatment unit, was asleep when the radio call on the wounded Iraqis came in. Sprinting from his barracks, Verreault arrived two minutes before the ambulance, gulped down a cold cup of coffee and went out to meet the patients.
What he saw stopped even the veteran medic short. One of the Iraqis, his body shattered by the improvised explosive device, had no lower face left.
“It looked kind of horrific,” Verreault, 30, said later.
Enough to get in the way of his job?
Verreault, who would lean over the soldier for 20 long minutes, pumping six units of blood and 2 liters of saline solution into his veins as the rest of the trauma team prepared the patient for surgery, shook his head.
“I treat it like a really long, bad run – like a marathon,” Verreault said. “It hurts, but you disassociate the pain and the discomfort and just get on with putting one foot in front of another.”
Running toward the horror – these days in Iraq, it’s a way of life at a combat support hospital.
Of the five combat support hospitals, or CSHs, scattered across Iraq, two are staffed by members of the 399th.
One is here at COB Speicher, where about 20 of the 217-person hospital staff come from Maine. The other is west of Baghdad in Al Asad, where an almost identical detachment recently opened a new CSH to help with the growing number of wounded there.
Beyond the five CSHs, there’s also an Air Force-operated hospital to the south, in Balad. All head and neck traumas end up there, as do patients requiring evacuation to the Army’s Landsthul Regional Medical Center in Germany.
The CSHs treat everyone: American soldiers. Members of the Iraqi Army and police. Iraqi civilians injured in military operations. Even insurgents.
“You step in this room, you leave your emotions at the door,” said Derek Bisson, a 21-year-old surgical technician from Hollis who worked on two of the cases that came in Tuesday. “We put insurgents back together – even people who have killed our soldiers, we fix them up.”
That may sound strange to Americans back home who can easily visualize U.S. troops killing insurgents, but can’t fathom U.S. medical personnel saving their lives.
But to a person, here, they say it doesn’t matter. A life is a life – and the mission of the 399th CSH is, after all, to save lives.
“They come through that door, they’re patients like everybody else,” said Lt. Col. Ted Koutlas, a pediatric heart surgeon from Greenville, N.C. – and a proud member of a four-person surgical staff that saves close to 97 percent of the patients who enter the 399th’s two-room operating theater. Typically, the doctors rotate in and out for 90-day deployments. Koutlas is a month into a second- straight volunteer hitch.
Does he worry, as he puts a detainee ahead of a U.S. or Iraqi soldier in the triage line because the detainee’s injuries are more severe, that he might get vilified by the newspaper bloggers or talk- radio reactionaries back home?
Koutlas, who enters every operation in the knee-high, black rubber boots his mother sent him so he could keep the blood from staining his standard-issue desert boots, shook his head and smiled.
“I’m not a talk-show host. I’m not a politician,” he said. “I’m a surgeon.”
Besides, there’s one other big difference between Koutlas and all the second-guessers safe behind their telephones and keyboards.
“They’re not here,” Koutlas said.
Sgt. Charles Pierce, 28, of Farmington was here, there and everywhere Tuesday evening.
A radiology technician who sees this as a future profession in job-strapped central Maine, Pierce made a
beeline to the emergency medical treatment unit, his portable X-ray machine in tow, at the first sound of the choppers.
There, while medics lifted groaning patients up onto their sides, Pierce deftly adjusted the bloody linens and slipped X-ray films under the wounds for quick internal pictures. Grabbing the exposed films and dashing back to his office, he quickly developed them and downloaded them to the hospital’s computer system.
Within minutes, the surgeons were taking their pre-operative look- sees.
“It takes a little while for you to deal with it,” Pierce said. “It’s not like we show up here and say, ‘Oh well, that guy’s face is missing.’ The first time you see it, it can be a shocker.”
And now, seven months into his 12-month tour?
“You start to realize you’re just doing your job and what you do and what you see is part of what keeps soldiers and keeps Iraqis alive while they’re here,” he replied. “Something gets missed, and they might lose their life.”
Tuesday’s carnage cost one life – an Iraqi lieutenant who was pronounced dead at the scene of the roadside bomb attack and never made it to the 399th.
The U.S. soldier, whose unit asked that he be neither interviewed nor identified because of the sensitivity of his mission, survived 2 1/2 hours of surgery to repair the damage done by a sniper’s bullet that had entered his back, come out his chest and then shattered his elbow. By Thursday, he was en route to Landsthul via Balad.
The “man without a face,” as the most gravely wounded Iraqi came to be called around the 399th, had two legs amputated during three hours of surgery and may well lose his left hand. He was evacuated to Balad immediately after his operations.
Another Iraqi soldier, who suffered several shrapnel wounds to his arms and legs, made it through more than an hour of surgery and, by Thursday, was back in the operating room.
And the third Iraqi patient, whose name is Ali Muhammad, needed no surgery at all for his broken clavicle and multiple shrapnel wounds.
He lay in his bed just before his discharge Thursday, mourning the loss of his lieutenant – “he was like my brother” – and marveling at the treatment he and his comrades received here.
“They did their best and they treat me in a good way,” Muhammad, 23, said through an interpreter. “They don’t distinguish between American Army and Iraqi army. They treat them the same way. Any people who come in here, they don’t care about the nationality, language, religion. I would like to thank the nurses, but I don’t know their names.”
A four-year veteran of the Iraqi armed forces, Muhammad said he will return to his unit as soon as his healing allows – if not sooner.
Why the hurry?
“When you join (the Iraq army), you don’t think about death or injury,” he said. “You put all this stuff aside. You think about the good things.”
What good things?
Muhammad looked around the place that stares down tragedy daily but can do precious little to stop it. Then he stared without expression at the translator as he passed on the question.
You think about what good things?
“Protection,” Muhammad finally said. “I think about protection.”

Additional Photos

Staff photo/Shawn Patrick Ouellette Lt. Col. Kent Kosmatka of Illinois works with the injured U.S. soldier in the Emergency Medical Treatment Unit at the Army Reserve's 399th Combat Support Hospital in Tikrit, Iraq.

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