Originally published in Synapse on 14 April 14, 2005.
Dr. Robert Dean, currently a clinical fellow in the Urology Department, served for 12 months as an Army surgeon in Iraq. Along with 32 other physicians, he staffed a 296-bed Combat Support Hospital. Dean shares his experiences as a military soldier and surgeon during wartime.
What are some of the main medical problems you saw in Iraq?
Well, any time you have soldiers out in a hazardous environment, in addition to trauma you have illnesses, heat casualties, infections, like leishmaniasis, and even just diarrhea. The changes in the food and climate would cause people to get multiple GI symptoms. We treated a lot of people for dehydration. As a urologist, I saw a lot of kidney stones. That was probably the number one urology thing. But we also saw kidney trauma, bladder trauma, testicular trauma, and penile trauma. And then guys would come in with testicular pain. When I think about it, blunt trauma to the groin was pretty common, so we saw many scrotal hematomas.
What was the most challenging aspect of serving as a physician in Iraq?
The medicine is pretty much the same as what you would do anywhere else. The operations are the same. You have to be a little bit more adaptive, potentially more creative. I think the biggest medical challenges were getting used to some different equipment, getting used to dirty wounds and having to care for that. Sand was everywhere, so you had to be very careful about contamination. And wound care was a little different. But we were fine for supplies. Medically, there weren’t that many challenges.
How about personal challenges?
The biggest challenges that all of us faced were being away from home and the uncertainty of the whole environment. Obviously, the unexpected could always happen because you were in a war zone. Also, you just didn’t always know how the war was going to go and what was the next step, there were plans, and we were privy to some of those plans, but plans can change easily. One of the hardest personal challenges was not being able to control your life as much as you are used to.
Was it tough seeing soldiers wounded so badly that you couldn’t help them?
Oh sure. Even if I did trauma in an American city, which I don’t, you have to get of into a new frame of mind, a new attitude. So yeah, I saw more death during that year due to trauma than I have at any other time in my medical experience. It takes some adaptation to get used to seeing mutilated bodies — soldiers and also injured Iraqis. That you can’t really rationalize. I mean one would think, “Well this guy is dead because he was driving a hundred twenty miles per hour on the highway.”
You can’t really do that in a war zone because you have no control. I mean, here is a young soldier who is 21 years old and who should be home, in Missouri. Instead he has a weapon in his hand because that was what he was told to do and he thinks it is the right thing to do. And unfortunately, he ends up dead. So at times it’s hard to rationalize.
What were your interactions with soldiers like?
Actually, you know, soldiers love to see their doctors because it’s a touch of home. And the nurses — they probably like to see the nurses more than the doctors. After living in the field with only male soldiers, it is very refreshing to see a female face. We have female doctors, so they probably like to see them as well. Basically, the hospital is a caring environment. We’re not there telling them to shoot at anything. We’re not telling them to fill sandbags. We’re just saying, “Take it easy — let us take care of you.”
So they love coming to see us. They don’t love the reason they’re coming, like a gunshot wound to the leg. But once they hit us — it’s amazing — you can see the element of fear just leave them. They would realize where they were, and they would calm down and ask questions. Their first question was always, “Is my buddy OK?” Then they would ask about themselves.
How was the morale of the soldiers?
It was good. It was the beginning of the war. There was a lot of support from the United States for the troops, maybe not necessarily for the political endeavors. But we all felt like the United States was for us, the soldiers. We wanted to do this mission and be done with it. If you think about it, the invasion phase went fairly quickly. With that behind us, people were pumped up. But then the insurgency started, months later, and morale took a little hit. And everyone was a little upset.
But when they caught Saddam Hussein it was a joyous day. My hospital unit in Tikrit was only three miles from where he was captured. The soldiers we supported were in charge of the raids leading to his capture. So of course, my whole compound, our camp, was extremely happy.
How about the morale of the physicians? Did It mirror the morale of the soldiers?
We’re soldiers too, so when the Army did something good, like finding Saddam Hussein, which was our mission, our goal, we knew we were a part of that. We’re not the team that went in and drove him out of the spider hole, but we are the team that was helping the soldiers stay healthy during that time. So yeah, we were pretty elated when that happened.
The hospital staff, and most soldiers in general, are creative people. So when Christmastime came around, we somehow found a Santa suit or made one. We celebrated the holidays as best we could, to keep up morale. Email was a big blessing. It was the first time ever, I think, that we could use email so much and so easily from a war zone. You could keep contact with friends and family in the United States. I even did instant messaging from time to time.
So you had Internet access in the desert?
We had satellites that could connect us, mostly so we could be connected with the hospitals back in the states for patient care. Of course, we could use the Internet for personal time too — we were allotted a certain amount of time per day.
How about telemedicine?
There was a ton of telemedicine. For example, we would take photographs for lesions on our patients and email the photos back to the dermatologists at Walter Reed Army Medical Center in Washington, DC. They would say whether we were seeing leishmaniasis or whether it was just cellulitis. For some of the injuries, we would take a photograph and send it back to Walter Reed as part of the patient’s history. The doctors at Walter Reed could then see the initial injuries. A photo paints the story better, and it becomes part of the patient’s history. In the OR, we would take pictures, then burn a CD, and send it back with the patient. This all aided in patient care, I am sure.
Obviously, we didn’t have dictation services — our medical charts were in doctor’s handwriting...it was sometimes better to just quickly type a narrative and e-mail it to one of your friends at the other hospital so they could have it when the patient arrived. We trusted that more than we did typing and printing — of course, we didn’t have a lot of printers, and the sand would just destroy the printers. They didn’t last very long.
Can you talk about your interactions with the Iraqi people?
Most of the people that I would see were injured or wounded Iraqi people. They were extremely appreciative, even the POW’s. I took care of several of the higher-ranking Iraqi army people who had urologic illnesses. I think that they were amazed that we would take the time to try to figure out how to make their lives better. Also, families would bring their children to us to treat. They were always very happy to see us.
I did interact with the Tikrit Teaching Hospital, which was about five miles away from where I was stationed. I met the residents in Surgery and Urology. They gave me a tour of the hospital, and I got to see their OR’s. I met their attending urologist — we talked about cases. He even consulted me about some cases, and I would take them into my hospital and do the surgery. It wasn’t that they couldn’t do the surgery — it was a time of flux for them. Their medical supply, their ability to take care of patients, was very much weakened by the war. They weren’t looking to me for expertise per se. It was because I had the equipment and the nurses.
I even offered to do surgeries with them in their hospitals. That never came about, because of timing. I had a mission – I had to be at my hospital, so it was hard for my commander to let me go for a day. If a wounded soldier came in I needed to be there. Although at Baghdad, the U.S. Army doctors interacted quite a lot with the Iraqi hospitals. I was even flown to Baghdad to give a lecture to the medical students at the Baghdad University hospital. So we had a close working relationship with the Iraqi medical community.
Having the perspective of living in Iraq, what do you think about the future of that country?
I think it’s very bright. I think the elections showed that. It says a lot about a society that is willing to stand in line for hours at the risk of death to vote for their next parliament. Also the Iraqi people have a very strong history of being able to adapt and overcome. Also, they have the second largest oil reserve in the world. So they will probably have a strong economy soon. But it’s not an easy road. No change in government is. There are very few societies that have gone through a drastic change in government in such a short period of time.
What you don’t hear in the news media is the fact that more schools are open now, the roads are better and safer, that there is more oil being produced now than even during the period of Saddam Hussein’s regime. The water supply is much more stable. There is now satellite television everywhere, which was against the law just two years ago. They are learning English at an amazing rate.
How about medical care? Did you feel like you had the supplies you needed to do your job?
You always want the best equipment. If I had my way, I would have had an MRI machine in the desert (laughter). Every doctor anywhere wants the best stuff. But we had enough. We did some pretty amazing surgeries with the things that we had. You saw the picture of the cystoscope (an instrument used in bladder procedures) being used to scope someone’s knee. So we made do with what we had.
I don’t mean to say that we did substandard care. We didn’t — we did very good care. Some surgeries may have taken a little longer because we had to sew things more than we could staple things. Some equipment wasn’t available all the time. But once we realized that we needed something, they got it to us.
For example, the weather got colder during the winter months, and we didn’t have bear huggers, or warming blankets for patients postoperatively. That was quickly discovered. We order it, and they send it to us. We had all the equipment that we really needed, but you still had to really good care of it.
