365 Days (2 page)

If the cases are not critical, the patients go out the next morning on one of the routine chopper runs. The burns go to Kishine; the head and spinal-cord wounds go to the neurosurgical unit at Drake. Ojiie for the most part only takes orthopedic cases. Zama takes them all. The 406th medical laboratory is attached to Zama, and it can do anything from blood gases and fluorescent antibodies to electron micrographs and brain scans. The medical holding company is there too.

The Army likes to pride itself that no one hit in Nam is more than ten minutes away from the nearest hospital. Technically, they’re right. Once the chopper picks you up, it’s a ten-minute ride to the nearest surg or evac facility, maybe a bit longer if you’re really lit up and the med evac has to overfly the nearest small hospital and go on to the closest evac. But the choppers still have to get in and get the troopers out. By the time you’ll be reading this, over 4000 choppers will have been shot down. More than one trooper has died in the mud or dust waiting for a med evac that couldn’t get in, and there is more than one case of medics having to watch their wounded die on them because they’d run out of plasma and couldn’t be resupplied.

If the wounded get to Japan, though, they’ll probably live; the survival rate is an astonishing 98 percent. Part of it is the medical care and the facilities in Nam—the incredibly fine care and dedication that go into it. But mostly it’s the kind of war we’re fighting.

An RPD round travels at 3000 feet per second; a 200-pound chicom mine can turn over a 20-ton personnel carrier; a buried 105-mm shell can blow an engine block through the cab of a truck; a claymore sends out between 200 and 400 ball bearings at the speed of 1000 feet per second. For the VC and NVA it’s a close-up war. There is nothing very indiscriminate about their killings; it’s close-up—booby traps and small arms, ten meters—and they’re looking at you all the time.

We had a patient shot through the chest. He was in his hutch when he thought he heard something moving outside. He sat up; the moonlight came in through the door, cutting a path of light across the floor. Sitting up put him in it. The gook was waiting, lying on the ground, no more than two meters from the door. He let off a single round that ripped through the trooper’s chest. As he fell back the VC put his weapon on automatic and shot the shit out of the rest of the hutch.

If you’re going to die in Nam, you’ll die straight out, right where it happens.

If you don’t die right out you’ve got a pretty good chance; the evac and surgical hospitals do anything and everything. They are linearly set up: triage, X ray, preoperative room, OR, recovery. They are marvelously equipped—twenty seconds from triage to OR—and staffed with competent doctors, who, no matter what they think of the war, do everything they can do for its victims. Indeed, there is nothing else to do; it’s not France. Even if you have time off there’s no place to go. The 12th evac has six operating rooms and three teams of surgeons. In Nam, if they take you off the choppers alive, or just a little dead, it may hurt a lot, but you’ll live.

During Tet, the 12th did seventy major cases a day—everything: wound debridgement, vessel repairs, tendon repairs, abdominal explorations, ventricular shunts, liver resections, nephrectomies, burr holes, chest tubes, amputations, craniotomies, retinal repairs, enucleations. Sometimes, even now, they’ll have to do four or five major procedures on the same patient. Age helps; the patients are all kids who up until the time they were hit were in the very prime of life. There isn’t one who is overweight. None of them, if they smoke, has smoked long enough to eat up his lungs. There are no old coronaries to worry about, no diabetics with bad vessels, no alcoholic livers, no hypertensives. Just get them off the choppers, intubate them, and cut them open. Then they are sent to us here in Japan.

There was a tennis court here once, near the lab building. During the Tet offensive, the fence was torn down and the asphalt used for another helipad. Tet has been over now for some time, but nobody’s even thought about putting back the fence. No one mentions it; it is just understood that the court stays a landing pad. It is the way the Army handles its concerns; each individual, of course, handles it his own way. Grieg’s developed an ulcer, Dodding is letting his hair grow, Lenhardt sends every patient he can back to Nam; he does it even if he has to extend their profiles 120 days. He’s sent troopers back to the paddies with thirteen-inch thoracotomy scars and bits of claymores still in their chests. But he believes in the war and the sacrifice, in the need for making a stand and dying for it if you have to.

Peterson sends everyone he can home, or used to, until he began finding them showing up again in his ward five or six months later. “One laparotomy per country,” he’d say. But the Army feels differently, and so there is a pretty good chance that by feeling sorry for these kids and sending them back to the States he’s killed a few. A tour in Nam for an enlisted man is not considered complete unless he has been there ten months, five days. It’s considered good time if you are in a medical facility even if you spend your whole tour there—the Army simply counts it as Vietnam time. But if you are in a medical facility, discharged and declared fit for duty, and have served a combined time, either in Nam or in a hospital, of less than ten months, five days, you go back into the computer and if the Army still needs you, you get spit back to Nam. Not for the rest of your tour, but for a complete new twelve months. There are fellows who have been there for a year and a half. It’s the Army regulations, and at the beginning Peterson, who thought being an Army doctor was different from being an Army officer, simply didn’t spend the time to learn the rules. And so for months he’d profile guys back to the States, where they’d be discharged from the hospitals and returned to Nam.

He tries to hold them now; if they’re getting close to the ten-month, five-day deadline, he’ll try to extend their profiles thirty days to keep them in the hospital over the deadline. It doesn’t go over very big with headquarters, but he’s the Doc and you don’t need a panel for a thirty-day extension of a temporary profile. You can fool around with the Army if you want and do it very effectively without having to go outside the system; it’s all there and ready to use in that formal structure written down in the AR’s, which, if definitely applied, would be impossible for anyone to work under. But you have to care, really care, because the Army doesn’t like to be fiddled with. You can hold onto patients and refuse to discharge them, clogging up beds in the evac chain. You can put any cold or runny nose you see, no matter what his job, on quarters until every unit commander is screaming. You can demand that the most rigorous rules of hygiene be enforced and drive the senior NCO’s crazy. You can ask for a consult on every case, or simply be slow in your dictation until the personnel office is frantic.

The Commander is ultimately responsible for all, and when the patients start piling up at Yokota and the Air Force generals begin to complain, it is he who must answer. At Kishine there was a commander who insisted, despite formal complaints, in interfering with the doctors to the point of demanding that only certain medications be used. He ordered that the “foolishness” be stopped, and everyone obeyed. They discharged their patients, but with a note on the chart that the discharge was under protest, against their medical judgment, and only done under direct orders of the hospital Commander. Everything was put on him, and if indeed anything went wrong anywhere—if a patient died on a plane or even spiked a fever after he’d been discharged, if a cold became pneumonia, if a wound became infected—it would be he who was held responsible. Faced with the possibility of disaster, of being made responsible in fields he really knew nothing about, the Commander backed down and finally left everyone, except his own adjutant, alone.

As a military physician, how you feel about the situation depends on how you look at the war—and, of course, the casualties. Lenhardt, for instance, sees nothing wrong with the war; he says it’s better to fight the communists in Vietnam than in Utah. If you see the patients, broken and shattered at eighteen and nineteen as something necessary in the greater scheme of things, then there are no complaints. But if you see these kids as victims, their suffering faces, burned and scarred, their truncated stumps as personal affronts and lifelong handicaps, then you may take a chance on doing what you think is right.

Peterson and Grieg were two of our general surgeons. Hubart and Lenhardt were the other two. They took call every fourth night, and the nights they were on they took all the admissions that day. If they got really bombed, the others just stepped in with them. During Tet and the time the 101st went back into the Ashau, they all came in.

Peterson was on night call in the hospital when the AOD received an emergency call from the Kanto-based air command at Yokota. Because of an accident on the runway, an air evac from Nam scheduled early that morning would have to be diverted to the Naval air station at Atugi, about two miles from Zama. Atugi’s runway is shorter than Yokota’s, but the pilot had radioed that one of their VSI on board was going sour, and there was some concern whether he would get in country alive. The Air Force and the pilot were willing to take the chance on Atugi, and Atugi agreed. For those flying in Nam, the war doesn’t end with the coasts.

The plane landed a little after midnight. It came in under the eerie light of the airstrip with power on, flaps down, its wings almost forty-five degrees to the winds. Touching down on the very edge of the runway, the pilot dumped the flaps, and with the aircraft settling heavily on the concrete, slammed on his brakes, screeching the plane down the runway. Halfway down the strip the brakes began to smolder. With the plane streaming smoke he pulled it into a tight half-turn, and by applying power, skidded it along the edge of the runway until it came to a stop fifty meters from the end of the strip.

The patient was carried to a waiting Navy chopper, which ten minutes later was coming in over the administration building. The usual approach was out over the open fields to the rear of the hospital and then back in again to the landing pad. This pilot took it right in, barely clearing the roof of the building, rattling the windows the whole way in.

Peterson was waiting with the medic near the edge of the pad. The chopper had barely touched down when the crew chief jerked open the door. The inside of the chopper was covered with blood. In the dim half-light of the landing pad it looked like drying enamel.

Peterson and the medic started running onto the pad at the same time. Hunching over to clear the swirling blades, the crew chief helped them into the chopper. The wounded man, his head hanging limply over the edge of the stretcher, was still lashed to the sides of the chopper. Blood welled up from under his half-body cast. Grabbing the top of the plaster cast, Peterson tore it off. A great gush of blood shot up, hit the roof, and then dying, fell away. He put his hand quickly over the wound and pressed down to stop the bleeding; he could feel the flesh slipping away from under his hand. Taking a clamp out of his pocket, he took his hand off the wound and, with the blood swelling up again, stuck the clamp blindly into the jagged hole, worked it up into the groin, and snapped it shut. The bleeding stopped. The chopper, still running, was vibrating around him.

Covered with blood, Peterson yelled to the corpsman to get some O-negative and to call the operating room. Then, with the crew chief, he carried the soldier off the chopper and gave him the first four O-negative units right there on the helipad under the landing lights. By the time they got the patient up to the OR he had some color back.

Peterson operated for two hours. He had to expand the wound, ending up with an incision that ran twelve inches from the front of the patient’s thigh, right under his groin, and back around the sides of the leg. When he had cut out the infection and cleaned what he couldn’t cut, he had a decent view of the area and carefully went after the artery. Dissecting down through the leg’s great vessels and nerves, he found a medium-sized branch of the femoral artery, right above the bone, with a small hole in its anterior surface, and tied it off.

The pathologist from the 406th came in; they had used up all the O-negative blood they had, but it wasn’t enough. Half an hour later, a chopper carrying all the O-negative blood at Kishine came in, and two hours later one came in from Drake. It took ten units of blood, but the leg stayed on.

Ten units of blood, though, can do strange things to you. It dilutes normal clotting factors, so that even while you’re getting blood, you bleed. Before Peterson had tied off the vessel, the trooper began to ooze from the edges of the wound, then from his nose and mouth. While Peterson worked, Cooper, the head of medicine, opened the blood bank and gave the patient units of fibrinogen and fresh frozen plasma. The bleeding was held in check enough for Peterson to finish up and close the wound. He left the patient to Cooper, and since it was too late in the morning to go to sleep, he went to the snack bar and had some coffee. An hour later he began his morning cases.

Five days later they moved Robert Kurt from the ICU down to the medical ward, where he became Cooper’s patient. Peterson had checked him every day while he was in Intensive Care and continued to check on his wound even after he had left the unit. Kurt was quite a bit older than the average soldier, much more alert, and certainly more interesting than the usual adolescent corporal who came through the evacuation chain. He told Peterson he’d been drafted when he had dropped out of his first year of graduate school. It wasn’t that he hadn’t wanted to go on, he said, it was just that he was getting tired of going to school and wanted to be free for a while. He had taken a chance, and the Army got him.

Two weeks after the operation, Peterson came by and found that someone had put an 101st Airborne patch on Kurt’s bed frame.

“You’re kidding,” he said, staring at the patch.

“No,” Kurt said, shrugging. “I figured since I was in it, I might as well really be in it. Besides, I wanted to be with guys who knew what they were doing. I didn’t know,” he said, smiling good-naturedly, “they would be goddamn crazy.”