AFF's Doublethink

Date: 4/20/2003
Subject: Healing in the Aftermath

Friends and Family,

Communications are terribly difficult to access, I quite feel like a British Colonial soldier in the Sudan, mail filtering in once in a blue moon, completely disconnected from the reality of the world.

Please write, and when you do, use the following address. Stop writing before June 15th, as I will be hopefully on my way home. CPT Eric Lombardini 43rd MED DET (VS) (FWD) LSA ADDER APO AE 09331

I sat under my false bough of camouflage netting which I pretend are tree leaves. The soft wind of Iraq blowing gently over the landscape and with closed eyes I could be anywhere. I had washed in our field expedient shower, made up of plywood and bits of canvas, using cupfuls of water to rinse away the days of grime and dust. Feeling refreshed, I drank my morning coffee, German grounds I had gotten from some passing soldiers, traded for some local maps. Brewed dark and strong, strained through used filters, I started the day with the ritual of forgetting the surrounding chaos. On my lap was the strange choice of reading of a biography of a war surgeon. Somewhat like taking travel brochures to the mountains while sunning on the beaches of the Caribbean, but ironically, the words of a colleague enduring and surviving bring a somewhat tenuous solace.

An entomologist with whom I had worked at Fort Polk had swung through on her way to Baghdad, where she was going to be choosing a site to set up a forward hospital to support the ongoing humanitarian and reconstruction effort. I intended on showing her the few sights of this part of Iraq in between my own duties. I needed to check in with all of the military dogs to check their hydration. I had been battling stress induced colitis in all of the Air Force dogs, and was just recently getting them under control, while suddenly, the Army dogs were breaking with similar symptoms. So after a quick run through of the kennels and rounds with the kennel masters, I jumped back into the humvee to head outside of the perimeter with Major Caci and some of her colleagues.

I am located just next to the Ziggurat of Ur, a structure built 2,300 years before the birth of Christ. Daunting to see this massive pyramid which can only evoke awe. In its shadow are the foundation of a palace and a huge necropolis. The latter being a city dedicated to the dead, and as you walk through its cavernous length, you look down at the bones and shards of pottery sticking out through the sand. An amazing place. The Euphrates had once flowed over this area, but the passing millennia had changed its course, leaving only evidence of its waters in the shells which stud the ground acting as erstwhile jewelry to the Sumerian dead.

The noon sun rose over our heads, baking us in our kevlars and flak vests. I had a mission scheduled for one o’clock which I was loathe to miss, so I rushed the end of my tour guide duties and got my charges back inside the protection of the gate.

I was going to be joining the hospital commander and some of his senior clinicians in a reconnaissance mission of some local villages to see what we could offer. There are so many animals here…Sheep, goats, cows, camels, donkeys, horses…so much potential work. Our convoy left out with the requisite force protection vehicles: armored military police with fifty caliber guns mounted on their transport, and we lumbered down
the roads into an area of green that I had seen from atop the ziggurat, but until today had not been to. We crossed over ponds and small rivers, likely all effluent from the Euphrates, dammed up near Baghdad. Here the desert turned into a garden, wheat fields and palm trees dancing gently in the wind, such a dramatic change in the muted colors of Tallil. Birds surfed above the wheat heads, as the crops moved in waves with the warm wind.

In the middle of a dry stream bed lay two burnt out hulls of former soviet tanks, excess following the fall of the Iron Curtain which had been sold to the Iraqi regime and destroyed by flights of the A-10 “thunderbolts”, aptly named “tank-killers”. We drove into the main square of the sedentary Bedouin village, where a huge tent with open sides was set. Inside, woven rugs of reeds were laid, covered by thick oriental rugs. We removed our combat boots and entered under the smoky eaves. Inside a stone stove heated giant brass teapots, and a man in pantaloons squatted over a silver handled pan filled with coffee beans which he constantly stirred as he warmed them over coals.

Sitting around the entire outer rug were men. Each wearing a different turban, here were the accumulated power of the Bedouin culture in the region. Our host, the sheik, was a portly man with a thin moustache and a white turban topped by a black woolen circular rope. He wore a golden shawl over his white robes and his browned skin showed the passage of time and the elements. We assumed the place of honor at the head of the tent. Here we sat, careful to keep from showing any of our neighbors the soles of our feet, and graciously asking after the health of each of the forty or fifty men. The formalities continued with this ritual of politeness.

To my left was Lieutenant Colonel Weina, an infectious disease clinician, and to my right sat a Special Forces soldier, who was coordinating the meeting. I was along to quietly observe and d raw out the needs of the community. I did so subtly over the poured sweetened, triple brewed tea which was offered to us before all others. “Shukran”, thank you. Over and over. Honor is interwoven with civility, no subtle reminder that civilization was born here.

We chatted in circles through interpreters, dancing on the periphery of topics without addressing specifics. Then came the coffee. The warmed beans had been ground into a fine form of espresso, and a communal cup was passed to each of us in turn. We would have the cup filled, raise it to our lips, and drain the hot liquid, offering out the cup for a second pour. After which we would shake the cup back and forth in our right hand, which was the sign that we had had enough and were passing it on to our neighbor. This was followed with continued conversation.

The hospital commander was the center of the sheik’s attention, while we represented his royal court, his highest officers, his entourage of faithful soldiers. We were his council, each the leading specialist in our field, and as such remained silent unless addressed directly or to answer a peripheral question as to our capabilities.

After an hour of formalities, the sheik showed us his grandiosity and generosity in feeding the entire gathering. Large beaten tin and pewter plates were brought before groups of us, heaped with rice and the abdomen and hind legs of a ewe. Skinned and well cooked, we feasted on the meshwi of mutton, using our hands and sharing the plate with four or five others. Opposite me sat two elders who dug their fingers into the teaming mutton with abandon, digging out the choicest morsels for me. These were placed in front of me, and each time I filled my mouth, a new pile of the warm, succulent meat found its way before me. Plates were carried out to our foot soldiers manning the vehicles and maintaining a vigilant guard over us. The sheik also offered us his own protection as Arabs mixed throughout the company carrying kalijnikovs and AK-47s turned out to be his personal guard. Food signaled the end of diplomacy, and simple conversation replaced the official procedures. We would return and stage a bi-weekly clinic, and I would come back to offer my services as a veterinarian, or barring that, to perform human medical work, in the form of basic sick call and wound management.

After eating, we stood and exited the tent, washing our hands as bowls were brought to us to rinse in. We moved over to an abandoned school that would serve as the clinic, and the human clinical staff organized needs with the tribe’s pediatrician, a middle-aged woman who wore the traditional Muslim head covering, but addressed us with authority and purpose, speaking at times through the interpreter and at times directly to the commander. I chose to avoid filling the crowded room with yet another craning-necked body, and sat on the stoop with a combat photographer and several children. They constantly rattled off questions in Arabic that neither of us understood. Little by little, the three or four turned into thirteen or fourteen and I drew a camel in the dust, pointing to it and then to me, saying “doctor”. Eventually the light of understanding was shed on my pantomime and they all smiled broadly, listing off the variety of animals I might be able to help. Then each needed me to have a photograph taken with each, and each showed me their personal ailments.

I never was sure if to them I was simply a doctor and veterinary or no mattered little, or if this was simply a different form of polite conversation. At one point, a small man, with several gold teeth pointed to the round bullet hole in his robe at the point of the scapula, where a rectangular bandage covered his shoulder blade. He drew a picture of the former dictator in the sand, and showed me his wound again, saying “Saddam, Saddam”. He then made a gunshot sound, and stamped on the drawing, sending up a small cloud of dust.

Throughout all of this, a small boy named Hassan stood quietly at my side. He smiled constantly, asking me question after question. He always remained inches from my pistol, making me acutely aware that I was carrying a loaded firearm mere inches from his hands, a fact which made me extraordinarily conscious of the proximity of so many of the men in our little grouping.

Finally, the meeting broke up and we headed back to the vehicles. Hassan stayed closely heeled to my side, staring up at me. He pointed admiringly at my watch and then looked away shyly as if embarrassed by his desire of the shiny object, guilty of want. I thought for a second, and then undid the wristband, taking his left hand in my right, I fastened the watch around his wrist. It hung in oversized proportion on his thin arm, but the beamed smile which I received in recompense outweighed the watch’s weight in gold.

Dear God the heat. The four of us are sitting in our small tent, baking. Quite literally. A meat thermometer reads one hundred and ten degrees, and the schmall screaming outside makes it impossible to find an escape. Instead, the dust finds its way inside, like an insidious invader, it pours in. Waves and waves, creating miniature sand dunes on our inert selves.

Masteller, who had managed to fall asleep, wakes to the horror of having been buried alive. We are corpses, resting fitfully in our mausoleum. The desires for home and the pleasures therein have taken on mythic proportions. We weave our homecoming into an intricate tapestry of want. Food dances around the tent in a mirage of cold pleasures. Sergeant Hill speaks wistfully of walking around her home in her nightgown, after spending a time soaking in the sterility of the bathroom; or perhaps she will take her husband to a hotel and live on air-conditioned room service.

On my small portable compact disc player, Irish folk music wails out of pipes and fiddles, and evokes in my mind the forgotten smell of grass and trees. How I long for the soft feel of Yankee grass, wet with morning dew under my bare feet. I will sit on the edge of the Sassafras river, wearing a swim suit or perhaps nothing, and watch clouds roll by without the threat of a choking sand storm. Thinking of nothing, I will stare at the rippling waters and then silently slip into their embrace like a seal, luxuriant in my nakedness and the blessing of the cool waters.

Disease has struck the camp, and in the dreadful manner of a plague is sweeping through us like a scythe through harvest wheat. It is believed to be a Norwalk like virus, a nasty bug which is rendering entire companies of hardened soldiers useless, as they vomit up their soul, retching dryly as their stomach attempts to invert itself. The virus is transmitted through a handshake or a touched surface. It likely also travels on fly’s wings and as such we are all doomed to fall to its irrepressible strength, a victorious army laid low. The transmission is the simple fecal oral route, meaning that the poor sanitation measures seen throughout the base are to be our downfall.

The foul pits into which we defecate, the lack of hand washing stations, the constant sweating, the infrequent showers and our sardine close quarters all are a recipe for an disease outbreak reminiscent of the middle ages. I know how they felt in Europe during King Arthur’s reign. I’m living it now. The Crusader metaphor is only too true. Choking dust and dysentery. The virus is actually sweeping through the naïve soldiers theatre-wide, and initially was a huge headache for me as I had to assure myself and assuage others that the diarrheal and emetic causing illness was not food related.

Twenty-eight containers of MREs had gone missing. This in and of itself would have been irrelevant, what was the loss of a few thousand of the prepackaged meals within the scope of the tens of billions of dollars being funneled into the war effort every month. Had it simply been the irrelevant cost of the food, I wouldn’t have lost a single minute of sleep. However, sometime in the past year, certain lot numbers, relating to the production dates of a specific ingredient in the meals had been implicated as potentially being contaminated with Salmonella, and as such had been recalled. The only problem was, two ships had been loaded with thousands of containers, containing hundreds of thousands of the meals and these vessels where floating around the gulf waiting to land in the Arabian Peninsula in order to download their cargos in support of our troops.

Ok. So we meet the ships and begin the Herculean task of checking every lot in every container. On the same order as cleaning out the giant stables in a night. Again, not really a concern, except for those containers that suddenly began to travel Northward without being checked. Twenty-eight. Several thousand cases, maybe ten thousand individual meals. We’ve not found them, not that we haven’t looked. Every truck that downloads in Tallil is searched for the missing lots by the food inspectors. Even if they did debark and somehow escaped our scrutiny, it was only the non-dairy creamers which were under suspicion and only in a very few lots, so the likelihood of the infernal twenty-eight actually containing the MREs in question was monumentally low, and that one of the meals actually containing viable Salmonella organisms was even lower, much less that a soldier would use the non-dairy creamer in one hundred and ten degree heat made the chance of infection almost nil. However, the public impression and fear dominates and it is our job within the Veterinary Corps to protect the food. As such, we are like bloodhounds sniffing for our quarry.

Now, with the level of security that we bring to the dinner table, I should be comfortable, that none of the suspect MREs have made it into Adder, but the problems began when the public and press got wind, and immediately assumed that the viral disease was due to the food. Soon, commanders were baying for blood, ignorant in the mob mentality and content to remain so. They screamed that they were betrayed, that their soldiers struck down by our disease-laden hands. That we rode astride the maggot infested steed of disease, next to boredom, death, famine and war. And thus began the intricate game of damage control.

Detailed explanations of the two separate issues, the virus, and the contaminated food were put before the journalists rolled into tasty morsels for their cannibalistic pleasure, and I hoped to seduce their favors and thus quell the growing flame of fear. To stop the viral spread, I could offer little advice, and we four, thus far spared, expected to fall victim at some point, failing to protect ourselves from an inadvertent handshake, followed by a touching of the face, or setting a hand to a door or tent flap, where a thousand hands had passed, or even more innocuously, succumbing to the fecal footprints of a simple fly walking across the expanse of our sleeping faces. To that inevitable end, we had strategically placed metal pails at the foot of each cot, ready for the inexorable wrenching of the gut, screaming us awake at three am to erupt in sickness.

This was a true enemy, and though I sanitized my hands dozens of times each day, the eventuality of the encroaching illness seemed insurmountable, and I would ultimately fail. But the Salmonella held little true danger, and to punctuate the issue as I spoke to the reporters, I dramatically pulled a packet of the non-dairy creamer from my breast pocket, tore open a corner and with a flourish, poured it into my morning coffee. Letting the whiteness spread in swirls through the dark, steaming daily ritual, I drank deeply in accentuation of my conviction of safety.

Patients continue to flow in despite the fall of Baghdad. Parts of An Nasariyah were still without power and the water mains were full of holes. Initially it was believed that the damage was due to bombing runs accidentally digging deeper than expected, or also the possibility of sabotage, but as the engineers set to the task of repair, it was soon realized that the citizens of the city, frustrated by not having running water in their homes, were setting out to fill their needs. To do this, they would go to the streets, with pick axes and crowbars, hammering away at the metal piping until it burst, releasing its liquid wealth. This was occurring independently throughout the city, and the engineers were hard pressed to patch the holes at the rate they were appearing.

With intermittent power returning to the hospitals, and the promise of clean water to follow, the pieces were being picked up and slowly joined, all the king’s horses and all the king’s men, striving together to fit the jigsaw puzzle of Humpty Dumpty into a recognizable infrastructure capable of supporting the medium sized city. The local medical care had been in disrepair before the regime change, and with the war draining all the available medical supplies, as well as the looting and general lawlessness, the urban dwellers found themselves with nowhere to turn but the Cash.

United States wartime policy is to treat life, limb and eyesight injuries in any patient, but chronic cases began to clamor for aid at the front gates. It is much to expect a young man or woman to fight and survive a war, but it is something altogether different to ask them to lose their heart and compassion when faced with genuine suffering. The guards began to call in for medivacs, ground and air, to bring in the civilians. The horrible, weeping lesions of leischmeniasis and leprosy, ancient orthopaedic injuries which had healed poorly, diabetics, hypothyroidism, kidney disease, congestive heart failure and hepatitis, as well as the odd congenital abnormality.

Sufferers who had been desperately jostled through the Iraqi system saw a potential haven in the military. The hospital staff were hard pressed in their balance of duty and ethics, and began to accept those who might be treatable. The surgical patients were a possibility for a quick fix, but the chronic cases would be problematic. Every soldier wants to go home. Without exception. There is none of the former British imperial fervor in the American forces, simply an unquestionable want to be reunited with everything that symbolizes home. Wife, children, baseball, apple pie, mom, McDonalds (and in my case a glass of scotch).

Nothing remained in their hearts of the glorious expansion of the American Empire. Much as France might believe otherwise. And as for the hospital and supporting units, in our hearts, our bags were packed, goodbye Iraq, Adieu. So. No time for the chronic patients, they would have to be dealt with by the local system. Therefore, we needed to fix the Iraqi medical organism, and fast.

Medical maintenance was sent in to look at the technology, and the humanitarian aid was supposedly slowly flowing in. As the military policed the streets, and the post war chaos slowed, we all ardently hoped for stability. That did not eliminate the burden of the necessary patients, both military and civilian, and slowly our eyes were shedding the veil of war into a realization of the horrors inflicted before we arrived.

One woman in particular will always burn my memory with her phantom. She should be dead, and likely has wished to be, however, she has regressed now into a state of semi-consciousness. We shall call her “Fatima”, however, I imagine that she has forgotten her own name. Fatima has scars on her wrists and along the lateral canthus of her lips extending around her cheeks. These are from chronic rope burns, bondage as a captive, although the face scars are darker and far more ghastly. These were formed over years from the placement of a rope gag, perhaps to stifle the screams as she was raped, repeatedly, likely thousands of times over fifteen years in a Sunni prison. She is twenty-six, and was incarcerated at the fragile age of eleven. She is malnourished, and acts like an animal, harboring her food and wolfing it down in dark corners. She shies away from all men. And Fatima is pregnant.

The bile in my throat mixes with the suppressed anger, creating a cancerous shriek in my larynx, and I cannot stay on the ward for long. The nurses treat her with absolute compassion, keeping all the male staff away, and allowing her slow, subtle moments of calm, perhaps the first without terror in well over a decade. She stares ahead, incapable of speech, a mind abandoned. Somehow she has survived, perhaps even wants to survive as only an animal can, the genetic drive to continue against all odds, even though she has no concept of a better life that the torment which has been her own since she was a prepubescent girl.

In the pediatrics ward another victim lies in need of urgent treatment. This patient is a four month old baby, horribly burned over two months ago, before the start of the war. She stares with unblinking eyes, asleep or awake, with the red, blistered, seeping, unhealing proud flesh lying in broad patches over her face and much of her body. She cannot blink as she has no eyelids left, nor can she suck, as her mouth will not close without lips. Both eyelids and lips were charred away in the burst of flame which destroyed her. I can only conceive of the trauma. Unlike Fatima, this child never even had time to realize happiness before descending into an eternity of hell. She stares eerily outwards, like a skeletal thing, forever disfigured. She will likely embrace the veil and burkha which hides the face of the women, her only solace from the stares, the startled glances, the pity tempered with disgust which the streets of An Nasariyah would offer. Should she survive.

Sometimes it is just the raw emotion which slams the breath out of you, and shakes your being with the enormity of pain. I was standing with Major Christine Edwards at a British chemical company bar-b-que, while ribs and sausage char on the grill and Elvis croons over a radio, begging us to love him tender. We talk around Iraq, skirting its suffocating place in our current existence, avoiding its presence in everything from the grit on our teeth to the lackings which were our present burden.

Christine was the Cash’s clinical dietician, a job which saw her on the wards daily preparing special diets for the patients. Clear liquid broths for the surgical patients, formula for the babies, high caloric diets for the walking wounded, culturally sensitive diets for all of the Iraqis, regardless of injury. She would serve them from steaming kettles of rice and chai, which I had acquired from various locations on post for her use. Food is a softener, it breaks the hardened shell of those whose grief and pain might otherwise turn them into stone, victims of the Medusa of war.

One such instance dealt with a father. I never knew his name. The man had tried to run a checkpoint with his wife and six children. As he did so, the children waved toys out of the windows. The marines panicked in the mounting darkness of dusk and lit the sky with a storm of bullets. M16 rounds tore through the speeding vehicle, shredding the tender lives of the man’s wife and children. All told, his wife and three of the little children died instantly. He himself was hit and along with the survivors, was taken to the Cash for emergency treatment. Another daughter was critically wounded, and was barely hanging on. She survived surgery, having sustained multiple gunshots, but succumbed to the weight of life and ease of death the next day in her father’s arms. She was buried by the hospital on the base, with a headstone to mark her untimely grave. Over a week later, while the man convalesced, Christine was passing through the prisoner wards with her fare of rice, lentils and chai. She had become friendly with the man, especially as he had started to help her with a malnourished orphaned baby girl. He held the child constantly, referring his grief into the positive role of protector and father to an innocent who had neither. Christine happened to be carrying a folder in which she had tucked photographs of her family and children. She set it down, unthinking, next to the man’s cot. He glanced over, and in seeing the uncorrupted unity of her family, complete with small children, he burst into tears and sobbed openly, washing over us all with his anguish and heartache.

These are the truest forms of horror.

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