■ 1500 HRS
I examine a group of soldiers who are ready to redeploy back to their home station. They have been in Iraq anywhere from 10 to 12 months and are here for a mandatory post-deployment health assessment (PDHA), which requires a face-to-face encounter with the clinician. The PDHA is designed to screen soldiers for disease, illness, or injuries that may have occurred during their deployment.
This group, Desert XI, is a military transition team that helps train the local Iraqi and Afghan populations. The teams are typically made up of 10 to 14 soldiers from different job specialties and locations who are trained to be advisors. This particular group was based at the infamous Chemical Ali's house. Their common complaint is that the chemical fumes from the basement were so strong that no one could enter the area. Months earlier, a mass grave had been discovered in the front yard. The soldiers wanted to document that they had been exposed to fumes from burning trash and oil refineries or possibly chemical weapons that might pose long-term adverse health effects.
The consistently humid air in southern Iraq creates a thick early morning fog of burning trash fumes and the smell of oil refineries that burns your eyes and nostrils. Some soldiers present with asthmalike symptoms after trying to exercise. It makes me think about how awful it must be to grow up in this kind of pollution and what the long-term effects of exposure to these toxic fumes will be for us.
1700 HRS
After sending up reports and sitting through the unit's battle update briefing — a biweekly meeting that helps the commanders and staff catch up on the latest changes — I find myself once again dreading my impending shift in the ER. I make my way to the dining facility and eventually back to my hooch to get ready for my long night.
■ 2000 HRS
The night starts out quietly. The medics are meeting for the first time. Some have just arrived from the States and have been in country for less than a week, and others were brought in from all over Iraq to help beef up the base's medical capabilities. Most are new graduates of medic school and have never been deployed to the combat zone.
■ 0400 HRS
It's Sunday morning, and I am nearing the end of my shift. I have used the precious time to catch up on some paperwork. Suddenly, radio chatter begins: "Roger. We are in flight to your location." The ER phone rings, and a medic relays the call, "Sir, we have two casualties. One is urgent surgical and one is priority ... both gunshot wounds ..." At once, everyone is alert and looking at me. I sit up and tell the medic, "Call the surgical team, lab, and x-ray. NOW! One of you stay next to the radio, the rest come with me."
The medics follow me into the trauma room, which is a tent across from the ER. Our "hospital" is a bunch of tents hooked together. I start assigning the medics to different tasks. "I want everyone to put on a trauma gown and gloves." All the medics are very quiet, intent on not looking like they just graduated from medic school. They are wide-eyed and their faces look expressionless, but they move with anticipation; each movement is deliberate, as if they are on the edge of panic. I then point to different medics, "I want you to check the monitors. You get the fluids ready. Get this place cleared and ready to accept patients."
At that point, the overworked FST starts to filter in; surgeons, nurses, x-ray, and lab all quietly get their equipment prepared for the incoming patients. The patients, having arrived by helicopter, are soon transferred to the care of the trauma team. Everyone works diligently to stabilize the patients. I step aside and head back to the ER clinic, which is much quieter, and watch from a distance while the others work on the patients.
■ 0800 HRS
My relief has arrived, and I put on my protective vest and helmet, grab my pistol, and head for the door. The fatigue sets in again as the adrenaline wears off. Another day gone by brings me another day closer to home. JAAPA
Shawn Buller is an aeromedical physician assistant with the Army National Guard and was deployed to Iraq at the time this article was written. When not on active duty, he practices emergency medicine in Charlotte, North Carolina. He has indicated no relationships to disclose relating to the content of this article.