Mass Casualty

Training for Eternity

By the time I got back to our compound it was all over the news. It seemed like the thing had just happened when in reality I had been neck deep in it for several hours. And there it was on TV. Frankly, it’s kind of a blur.

The day began early as I didn’t sleep very well last night. Once I was awake I decided not to just lay there and stare at the darkness so I got up, got dressed, shaved and headed into the TOC, the heart of what goes on. In the TOC (Tactical Operations Center) they monitor several different radio nets to keep abreast of what is happening in the area. It’s the place to be if you want up to the minute information. When I arrived it was fairly calm. I made small talk with the guys there and sipped that first cup of morning coffee. The day was clear and there was very little going on, or so it seemed. A very short while later we received the initial reports. In this area there are several “camps” or “posts” that house the various combat and support units that do the day to day fighting and working around here. The first report said that a mortar had just hit one of the nearby chow halls during the middle of lunch (I’m on GMT so my morning is actually the middle of the day). It’s called a MASCAL or Mass Casualty event and it’s where the rubber meets the road in military ministry. They said there were approximately 10 casualties. That was the extent of it so I kind of filed it away in the back of my mind and continued to sip my coffee. The next report wasn’t so good. 10 dead and approximately 50 wounded. They were being transported to the Combat Surgical Hospital down the street. The Chaplain at the CSH is a good guy and I knew he’d be in need of help so I woke my assistant and we rushed to the hospital. I didn’t expect what I saw.

The scene was little more than controlled chaos. Helicopters landing, people shouting, wounded screaming, bodies everywhere. As the staff began to triage the dead and wounded I found the chaplain and offered my assistance. He directed me to where he needed me and I dove in. I would be hard pressed to write about every person I had the opportunity to pray with today but I will try to relate a few.

I found “Betty” on a stretcher being tended by nurses. I introduced myself and held her hand. She looked up at me and said, “Chaplain, am I going to be alright?” I said that she was despite the fact that I could see she had a long road to recovery ahead of her. Most of her hair had been singed off. Her face was burnt fairly badly, although it didn’t look like the kind of burns that will scar. What I do know is that it was painful enough to hurt just by being in the sun. I prayed with Betty and moved on.

“Ilena” (a made up name. She spoke very softly and had a thick accent so I couldn’t really hear her) had been hit by a piece of shrapnel just above her left breast causing a classic sucking chest wound. The doctors said she had a hemothorax (I think that’s what they called it) which basically meant her left lung was filling with blood and she was having a very hard time breathing. For the next 20 minutes I held her hand while a doctor made an incision in her left side, inserted most of his hand and some kind of medical instrument and then a tube to alleviate the pressure caused by the pooling blood. It was probably the most medieval procedure I have ever been privy to. In the end she was taken to ICU and will be OK.

“Mark” was put on a stretcher and laid along a wall. A small monitor on his hand would tell the nurses when he was dead. Even a cursory glance said it was inevitable. Mark had a head wound that left brain matter caked in his ear and all over the stretcher he was lying on. I knelt next to Mark and placed a hand on his chest. His heart was barely beating but it was beating so I put my face close to his ear to pray with him. If you’ve never smelled human brain matter it is something unforgettable. I had something of an internal struggle. He’s practically dead so why stay? He probably can’t hear anything! A prayer at that point seemed of little value. But I couldn’t risk it. I prayed for Mark and led him in the sinners prayer as best I could. There are few things in this life that will make you feel more helpless. After that, I needed some fresh air.

I stepped outside and found the situation to be only slightly less chaotic. The number of body bags had grown considerably since I first went inside. I saw a fellow chaplain who was obviously in need of care himself. I stopped him and put my arm around him and asked how he was doing. A rhetorical question if ever I asked one. He just shook his head so I pulled him in close and prayed for his strength, endurance, a thick skin, and a soft heart. Then I just stood and breathed for a few minutes.

Regardless of what some may say, these are not stupid people. Any attack with casualties will naturally mean that eventually a very large number of care givers will be concentrated in one location. They took full advantage of that. In the middle of the mayhem the first mortar round hit about 100 to 200 meters away. Everyone started shouting to get the wounded into the hospital which is solid concrete and much safer than being in the open. Soon, the next mortar hit quite a bit closer than the first as they “walked” their rounds toward their intended target…us. Everyone began to rush toward the building. I stood at the door shoving as many people inside as I could. Just before heading in myself, the last one hit directly on top of the hospital. I was standing next to the building so was shielded from any flying shrapnel. In fact, the building, being built as a bunker took the hit with little effect. However, I couldn’t have been more than 10 to 15 meters from the point of impact and brother did I feel the shock. That’ll wake you up! I rushed inside to find doctors and nurses draped over patients, others on the floor or under something. I ducked low and quickly moved as far inside as I could.

After a few tense moments people began to move around again and the business of patching bodies and healing minds continued in earnest. As I stood talking with some other chaplain, an officer approached and not seeing us, yelled, “Is there a chaplain around here?” I turned and asked what I could do. He spoke to us and said that another patient had just been moved to the “expectant” list and would one of us come pray for him. I walked in and found him lying on the bed with a tube in his throat, and no signs of consciousness. There were two nurses tending to him in his final moments. One had a clipboard so I assumed she’d have the information I wanted. I turned to her and asked if she knew his name. Without hesitation the other nurse, with no papers, blurted out his first, middle, and last name. She had obviously taken this one personally. I’ll call him “Wayne”. I placed my hand on his head and lightly stroked his dark hair. Immediately my mind went to my Grandpa’s funeral when I touched his soft grey hair for the last time. And for the second time in as many hours I prayed wondering if it would do any good, but knowing that God is faithful and can do more than I even imagine. When I finished I looked up at the nurse who had known his name. She looked composed but struggling to stay so. I asked, “Are you OK?” and she broke down. I put my arm around her to comfort and encourage her. She said, “I was fine until you asked!” Then she explained that this was the third patient to die on her that day.

“Rachel” was sitting in a chair with no injuries. She was worried about two friends that had been moved to other hospitals in country. So we prayed.

“John”, a First Sergeant, asked me, “How does my face look?” knowing he had been badly burned and would probably have some scaring. He was covered in blood, pus, and charred skin so I said, “First Sergeant, you look better than some people I know back home.” He laughed and we prayed.

One of the many American civilian workers had been hit in the groin. He was happy to be alive and even happier to be keeping, “all my equipment.” It was a light moment in a very heavy day.

As my assistnt and I walked away at the end of the day I saw another chaplain and a soldier standing among the silent rows of black body bags. The soldier wanted to see his friend one more time. We slowly and as respectfully as possible unzipped the bag to reveal the face of a very young Private First Class. His friend stared for a few seconds then turned away and began to cry.

The last count was 25 dead, and around 45 wounded. Nevertheless, our cause is just and God is in control even when the crap is a yard deep. I’m where God wants me and wouldn’t change that for anything, even if it means death. After all, “to die is gain”.

Post Script: all patient names are ficticious.

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