Cleaveland: Doctor's book exposes cost of two wars

Cleaveland: Doctor's book exposes cost of two wars

September 24th, 2009 in Health

Media coverage of American involvement in Iraq and Afghanistan focuses upon issues of strategy, cost, and political implications for wars have been underway for eight years.

Fewer reports document the challenges to military personnel in those difficult terrains. We forget the individuals who each day fight the small scale but deadly battles and patrol towns and countryside where hidden explosives or snipers can abruptly kill and maim. Many military men and women have served multiple combat tours. Members of reserve and National Guard units have been repeatedly pulled from civilian homes and jobs for incredibly difficult assignments.

A quietly profound book by Dr. Heidi Squier Kraft, "Rule Number Two: Lessons I Learned in a Combat Hospital" (Little Brown and Company 2007), makes these wars very personal. The title is drawn from an episode of M*A*S*H. "Rule No. 1 is that young men die. Rule No. 2 is that doctors can't change rule number one."

Lieutenant Commander Kraft, a Navy clinical psychologist and mother of 15-month-old twins, was part of a psychological support team sent to Western Iraq in 2004 with the Alpha Surgical Unit, which was responsible for 10,000 Marines. Navy personnel traditionally provide all medical support for their Marine comrades.

In addition to occasional mortar fire, Dr. Kraft and the members of the Alpha One team had to deal with blinding sandstorms, temperatures that reached into the 130s, prolonged power outages, mosquitoes that swarmed from shower drains, scorpions, giant spiders, and dangerous, nighttime convoys to outlying posts.

Some of Dr. Kraft's patients had sustained severe wounds including loss of limbs. Some had been in vehicles in which the person next to them had been killed or badly wounded.

On one occasion reservists had to deal with the sudden loss of a colleague of many years. Marines assigned to prepare bodies of Marines killed in combat struggled through 12-hour shifts in their grim work. A colonel wept as he saw the extent of wounds inflicted upon one of his men by a land mine.

While at the bedside of a young corporal in the "expectant" tent where Marines with overwhelming injuries incompatible with survival are triaged, Dr. Kraft encountered Corporal Jason Durham. Despite severe brain injury, he responded to her question with a squeeze of her hand. She elicited other signs of higher brain function. He was rushed into the treatment area and stabilized for evacuation by helicopter to a military hospital in Baghdad. Corporal Durham died of his injuries following transport to a hospital in the United States. He had been wounded as he fell upon a hand grenade to protect his Marine buddies. His family accepted his Congressional Medal of Honor from President Bush in a 2006 ceremony at the White House. Dr. Kraft attended the presentation.

Many patients had no visible wounds. Grief and anger at the loss of friends, overwhelming depression, manic outbursts, unending stress in a combat zone -- all these took tolls on young to middle-aged men and women. Members of the medical team suffered as well as they coped with surges of casualties.

Dr. Kraft does not hide her own vulnerability. After returning home from her seven-month assignment, she is gripped with fear as she begins her first day in clinic. A young, Marine, trained as a psychological technician, comforts her, "It's OK if you're not OK."

Dr. Kraft intersperses messages from home and family throughout her narrative. The contrast with daily life in Iraq is startling, yet comforting as she keeps track of her family and they of her. Her fine memoir reflects the enduring nature of love and compassion in a setting that is almost unimaginable.

Semper Fidelis -- always faithful -- is the motto of the Marine Corps. It should be our motto also as we consider our continuing indebtedness to the men and women of our armed forces.

Contact Clif Cleaveland at