At U.S. Hospital, Reflections on 11 Hours and 91 CasualtiesBy CHRISTINE HAUSER
MOSUL, Iraq, Dec. 28 - The bearded man was lying on a stretcher on the floor of the American combat support hospital here. He was not moving and did not speak. A quick search revealed a personal detail - he had a wedding ring in his pocket.
There was little else about the man, a casualty of the suicide bomb attack at the base here last week, that Second Lt. Shayla Henderson-Young, 23, knew when she first went to his side. Her vigil with him on the trauma room floor lasted about two hours, until she and others carried him to a quiet hallway where he took two final, gentle gasps of breath.
"The only time that his face ever moved was when he took his last breath," said Lieutenant Henderson-Young, a nurse.
"When I first saw him lying there, I knew he was going to pass, and I was hesitant," she said. "I am not very good with death. But this is what I am trained for."
On Dec. 21, Lieutenant Henderson-Young and other men and women at the 67th Combat Support Hospital took in 91 casualties in 11 hours from the suicide attack on Forward Operating Base Marez, the largest number treated at any military hospital in Iraq at any one time during the current conflict, according to hospital staff members. Twenty-two people died in the attack, 18 of them Americans.
So many were taken to the hospital that at one point the wounded and dying, some with makeshift tourniquets and bandages, filled the parking lot as trauma and operating rooms inside overflowed, according to doctors, nurses and other hospital staff members interviewed about the events of that day.
The conference room was turned into a blood donation center. Pharmacists prepared drips. The hospital's kitchen staff pitched in, gathering blankets. Armored combat vehicles served as ambulances, ferrying the wounded to the hospital.
At the height of the influx, the building came under fire. Mortar shells rained down on the compound, one of them striking the roof.
Those waiting outside tried to get into the hospital, but the hallways were already filled with people lined up, side by side and pressed against the walls in an effort to keep the aisles clear for staff and stretchers.
Nine surgeries were carried out in a small operating theater, while 10 more had to be performed outside the operating room, according to figures on a Web log kept by the hospital's doctors. They occasionally ran short of supplies.
Of the 91 people taken to the hospital, at least 17 were dead on arrival and 5, all with nonsurvivable wounds, died shortly after entering, according to doctors.
"Their deaths seared Dec. 21 into our souls," said Lt. Col. Todd B. McCaffrey, commander of the First Battalion, Fifth Infantry, at a memorial on Tuesday for three of the dead: First Sgt. Paul D. Karpowich, Sgt. Julian S. Melo and Sgt. Darren D. VanKomen.
For Maj. Mark Framstad, one of the doctors at the hospital, work that day started routinely just after 7 a.m., when he checked on a patient with a foot infection.
Around 12:15 p.m., a message came over Major Framstad's radio that the Marez mess tent had been hit by a mortar shell. Doctors went to the emergency room, expecting maybe 10 to 15 patients.
The first casualty was an Iraqi soldier. Efforts were made to resuscitate him, but he died from severe head injuries. Another early arrival was an American. He had no identifiable external wounds, but had such devastating internal injuries that he, too, died.
Before he knew it, Major Framstad was writing the time of death on the bare chests of the casualties in felt-tip pen. "Things were moving so fast we had no charts," he said.
"We have been here a year and this was the worst attack in terms of number, but maybe not by severity of injuries," he said. "I don't think you can plan for what happened. It was overwhelming."
As the wounded poured in, five-ton trucks, Strykers, Humvees and other vehicles brought more. Firemen, civilian contractors and medics from smaller clinics on the base arrived to help patients in the parking lot. Maintenance workers held IV bags.
"And that's when the graveyard started to build up," said Col. Mary Clark, a nurse, referring to a section of the parking lot where the dead were laid out.
"The body bags started here and just kept going," she said, gesturing from one corner of the lot to the other. "It was so fast we couldn't get them into body bags."
The hospital staff is accustomed to handling severe injuries caused by mortar rounds and by roadside bombs, one of the biggest dangers in the Mosul area.
But signs emerged that this was no typical attack. Doctors found wounds that were perfect holes, similar to those from gunfire. Surgeons extracted ball bearings the size of chick peas, which had been embedded in the bomb as shrapnel; some casualties had burns.
"We were asking ourselves, 'Was there also gunfire at the mortar attack?' " Major Framstad said. "It was a little strange."
Lieutenant Henderson-Young arrived at the hospital after being summoned for emergency duty. "I saw rows of body bags outside," she said.
Like the others, she jumped right in, hooking up IV drips for one patient, trying to control bleeding in another.
Soon, she was instructed to take on a task she knew would end in death. She was told to tend to the man lying motionless on the hospital floor with such devastating head injuries that he was "expectant," meaning that he would not survive but that his heart and lungs had not yet stopped.
Sitting or kneeling on the floor, she held his hand, gave him morphine, pressed bandages on the shrapnel wounds on his head and adjusted his blanket to keep him warm.
"I wanted to make sure that when he did pass, he didn't pass in pain," she said.
He was lying on his back. His face was tilted to the right, away from Lieutenant Henderson-Young, and his eyes were closed. She figured he was in the Special Forces, because he was dressed in civilian clothes and wore a holster. He was carrying identity cards, but his unit was not clear to Lieutenant Henderson-Young, and the hospital declined to release the man's name.
Lieutenant Henderson-Young spoke to him, even though she knew he could not hear or answer.
"I told him everything will be O.K.," she said.
As sun dipped low in the sky, she saw signs of the inevitable.
"Once his pulse hit the 80's and started dropping I knew it wasn't going to be much longer," she said. "I could see the pulse in his neck start to get slower.
"When we knew he was getting close to passing away we took him to a hallway where no one else was around," she said.
She and a medic who had also stayed with him, Pfc. Rachael Moore, found a private area around the corner from the trauma room.
He took two gasping breaths, and died in a place called Charlie Hall.
Jason P. Howe/World Picure News, for The New York Times
Copyright 2004The New York Times