Dr. Robert Thaxton, an emergency room doctor at the hospital at Balad Air Force Base north of Baghdad told me his simple truth about practicing medicine in an environment where 20 or more horribly injured people often suddenly appear at once.
"You just learn to deal with the basics: I gotta stop the bleeding, I gotta put an airway in, you don't need any of the fancy stuff. And in reality, you learn that you don't need a lot of the fancy stuff a lot of the time. Stabilize the patients. Keep them alive. Get them home.”
Even though the medical care for U.S. soldiers and Marines in Iraq involves an astounding array of sophisticated technology, Thaxton’s observation summarizes the philosophy of the battlefield medicine that is saving so many lives. In "Wounds of War," I try as best I can to tell the stories of the intensely dedicated doctors, nurses and medics who work toward these simple goals.
In previous conflicts, the wounded piled up in hospitals near the battle zone. The great innovation of this war is moving them out in a big hurry on the gigantic C-17 cargo planes converted to flying ICUs. The next levels of care beyond just stabilizing the patients takes place at Landstul Regional Medical Center in Germany; and even more of it at hospitals in the United States including Walter Reed, Bethesda Naval Hospital, Brooke Army Medical Center, VA hospitals and other facilities.
But if the care is so good in the battle zone, why has there been a scandal about the care back home? The best answer, I think, is that saving a life is indeed simple compared to the complex, frequent needs of the wounded when they get back. The military designed a magnificent system of keeping people alive, but did not plan for the long-term care of so many who are so severely injured. The body armor and the skills of the medics in the battle field often leave people alive with horrific wounds including amputations and brain injuries.
Since I visited Iraq I have kept in touch with many of those soldier and Marines whom I first met when their wounds were fresh. They often describe the convoluted system of “medical hold,” where they can be required to appear at formation everyday at 6 a.m. and have nothing to do for weeks or months on end while they wait for overwhelmed case workers and officers to get them transferred to the care they need. The Congress and a commission appointed by the president are looking into these conditions. Let us hope the government comes up with the necessary resources so that the long term care ends up being as good as the battlefield medicine. It is not going to be simple or cheap, but the wounded that sacrificed so much deserve nothing less.