(This is a photo of me being carried off the battlefield and to the MEDEVAC. The Author of this article is the soldier located the furthest to the left. In the rear, with a baseball cap on, is one of the interpreters.)
Everyone has a different perspective on the battlefield. The way I view something may be completely different from how another person views it. After I was wounded one of my favorite things was to have my teammates talk about the day from their perspective. This account is from “Tiberious”, one of the medics on my team.
On 25 September 2011, our Team entered a long valley in Northwest Afghanistan to conduct a clearing operation with our Afghan counterparts. Just before the sun came up elements of our group came under intense enemy fire. On this mission I had been assigned to escort the Command group and the support personnel that accompanied them. From my vantage point I heard explosions and gunfire along with the radio chatter that comes with troops in contact. I scurried back and forth along my line of troops making sure there was security covering the areas we had already been to. I did not want the bad guys to come up behind us through the maze of twisty roads and trails that zigzagged through the village.
A few hours into the running gun battle we took our first casualty of the day. I heard over the radio that an Afghan Commando had been wounded. While my fellow medic was working to stop the bleeding and save the Commando’s life, teammates rushed to find a suitable place to land a helicopter amidst the gunfire a few hundred meters away. As I heard all of this over the radio the situation near me suddenly grew very tense as an Afghan male rounded the corner and approached the Commandos just in front of me. The Afghan soldiers shouted and used hand signals to tell the man to stop yet he kept walking towards us. The first thing on everyone’s mind was a suicide bomber. The Commando directly to my left, in a clear and definitive warning, raised his rifle just like we had trained him to do. I heard the safety click off as the rifle came up. He was giving the man one last chance before firing. It worked. The man stopped in his tracks and began following the instructions of the soldiers that approached in order to search him. As I processed the scene in front of me I realized I had heard the Commando’s rifle click off of safety but had never heard it click back on. Just before I turned to remind him to turn his safety back on I heard it.
My head swung left to see a cloud of dust erupting from around the Commando’s right foot. He immediately dropped his rifle and began hopping on one leg. He had shot himself in the foot. It would have been hilarious if we weren’t in the middle of a firefight. In my disgust and anger I made him wait as I called a Commando medic over to treat him. He was in no danger of dying but the bullet through the foot was definitely painful. This man was lucky we had already requested an evacuation because he would now get a ride out as well.
As the Commando medic treated the gunshot wound I called over the radio to let my Commander know we would be adding a patient to the helicopter that was already flying towards us for the more seriously wounded Commando the other medic’s group was carrying towards the pickup area. I ran over to our all-terrain vehicle to use it as an ambulance to bring my wounded Commando to their location. Here things got difficult. Because of the layout of the village, there was no direct route from where I was to the spot they had identified as the helicopter landing area. In order for me to drive the Commando who could not walk, I would have to leave the village and come back in closer to my teammates. I knew we had flooded the valley with our forces but they were all elsewhere as I drove my slap-happy patient out of the village towards where I could find a hole in the wall as close to the pickup zone as possible.
After what seemed like ten minutes of driving around all the while hearing gunshots snap overhead and crack on the other side of the village I saw the other group waiting for the helicopter to come in. I made contact with their security element and drove as close to them as I could get. I helped the Commando with the wounded foot hobble over to the group and linked up with the other medic to see if he needed any help. The other medic had blood up to both elbows and a patient wrapped up in a blanket that had been suspended between two sticks; with all the technology we possessed they had moved the wounded Commando in a Civil War era litter. He had started an IV and was in the process of telling his wounded Commando to not eat the oral pain medication as the wounded man had already received two shots of morphine and had chewed up a pain lozenge instead of letting it soak into his tongue and gums. I felt guilty seeing all the work he had done getting his patient stabilized and moved to where a helicopter could safely come pick up the wounded Commandos while I had simply yelled at my patient and given him a quick un-guided tour of the outskirts of the village on our drive over to meet the group.
We heard the helicopter was inbound and prepared to put both patients on the helicopter. At this point my Team Sergeant noticed my wounded Commando for the first time. He half asked/half yelled at me why he hadn’t been notified there was a second wounded Commando. My Captain had heard the call and added the second man to our request but in all the confusion and effort to move the first wounded man not everyone had heard my radio call. When I told the group the man had shot himself in the foot everyone took a deep breath and while not exactly breaking out into outright laughter there was a lightened mood with smirks popping up among the men, even the Commandos. The helicopter came in quickly thanks to a well-placed smoke grenade and we provided security all around the pickup area. Both patients were quickly loaded and we made a verbal handoff with the flight medics to let them know which patients had which injuries and what medications had been given. Once the helicopter took off we took a minute to regroup and reorganize. Our Team Sergeant then pushed us back to our positions to continue clearing the village.
Later in the afternoon our lead elements had begun to take accurate machine gun fire from a stand of trees to their front-left. I was approximately 300 meters behind our front with the command team ensuring our rear security. I had taken a couple Commandos ahead of the command team to clear a compound big enough for all our personnel to move to once the Captain decided to move closer to the fighting. We had cleared our second building when I heard what I thought sounded like, “garble, garble, I’ve been shot.” I literally stopped in my tracks and listened. This hadn’t happened yet on this trip and I was hoping I had heard wrong. A couple minutes later Kevin called out that yes, in fact, he had been shot and needed help. If hell breaking loose can be a semi-controlled process, this is what happened next. I told the other American I was with that I was headed forward. I ran to the ATV and bumped into the Captain who was already headed towards Kevin. We raced as far forward as the ATV could take us and then jumped off to make it all the way towards where my teammate lay on the ground with a gunshot wound.
Going through the medical course the first thing they preached to us about treating patients in the field was security, security, security. As we got near Kevin’s position I had to consciously slow down to take in a big picture view of what was happening. I could see him lying on the ground with an American over him. The Captain beat me to the scene and had already started the process of requesting a helicopter. Our Team’s first medic had run through an open field being fired at the whole way. Our communications specialist had come from his position and taken charge of pulling security to our front. Simply put, he started shooting back and telling others where to shoot.
I dropped my aid bag next to Kevin and demanded to see his wound. They pulled off the dressing they had begun to apply and I saw the perfectly round gunshot wound to his lower abdomen. I pulled an abdominal dressing from my bag and handed it to one of our support soldiers. The beauty of special operations medicine is that the medic is responsible for training his teammates. I was responsible for what they could and could not do medically. In this case, I simply handed a non-medic a dressing and said, “Put this on.” Because my team’s medics had trained these men I knew it would be done mostly correct even in a stressful situation. This left me free to talk to Kevin and confer with the Captain and the other medic about how we were going to move him to the helicopter while also updating them with a status report of his injury. I found out from asking Kevin that his hip was probably broken and that he had slight internal bleeding. I knew he had neurological deficits but didn’t believe it was in anyone’s best interests to explore beyond the initial question of, “can you feel this or wiggle your toes.” Kevin was hurt bad but I knew that as long as we could get him out quickly he would be okay.
Once they had started dressing his wounds Kevin began asking for pain medication. I knew from the location of his wound and how he held his leg that there were broken bones. I grabbed an opiate lozenge and taped it to his finger. Flashing back to earlier in the day I yelled at him, “Don’t bite it!” I grabbed a litter and instructed the guys to load Kevin into it as I prepared to give him a shot of antibiotics. While this was happening I kept overhearing parts of the radio traffic about our new helicopter landing area and where we were going to take Kevin after he was loaded into the litter. We were all fully loaded and would be carrying a large man who had been wounded. I wanted to minimize our movement for multiple reasons. From what I could gather from the radio traffic we were going to carry him forward because there was an area of low ground that would be shielded from enemy fire. As time went on I became increasingly frustrated because I knew that every piece of ground I had just crossed was free of enemy fighters; we had just cleared it by moving towards Kevin.
Eventually we packaged Kevin up and prepared to move. I confirmed that we would be moving a couple hundred meters to a known open area and would wait for the helicopter to come and pick up Kevin. I disagreed with the direction but had been focusing on making sure that Kevin was as comfortable as possible so I was not completely sure of the suitability of the area we were headed towards. The moment we picked Kevin up to move was a moment I had dreaded through two years of training. I picked up my teammate and prepared to carry him to safety; I failed from the first lift.
With all the shifting around while we prepared to move I assumed that one of the men standing near me would help lift Kevin in the litter. I was staying where Kevin could see me and thought there was someone lifting his head. When I gave the count to lift, “1-2-3 lift” Kevin was left hanging head-down and was actually the one to say, “Hey, someone might want to get my head.” I looked to my right and felt an instant pang of guilt as he hung uncomfortably low with his head in the dirt happily sucking his opiate lozenge. An interpreter quickly moved to grab the strap nearest Kevin’s head and we began what seemed like a mile of movement to get Kevin to an area clear enough to land a helicopter.
A Commando dragged Kevin behind the house he was standing next to when he was shot. We had received enemy fire throughout his treatment and preparation to move. As soon as we stepped off I called for covering fire. We were walking across open ground with a clear field of view to both enemy and friendly forces. The second time I called for covering fire my request was met with a cacophony of machine-gun and individual weapons fire. A Commando machine-gunner blindly fired his weapon towards the enemy. Our support personnel picked out targets and conserved ammunition while allowing us to cover the open ground. We hit our first obstacle and my heart dropped. We were going to have to carry Kevin, broken hip and all, over a dirt wall about five feet high. I pushed the men over as fast as I could while making sure that Kevin was as comfortable as possible and that his wound’s dressing was holding.
Due to the site selection of the helicopter pickup area we ended up carrying Kevin in a circuitous route laterally, towards, away from, laterally, and finally away from the enemy fire. After what seemed like twenty minutes we got onto level open ground that was shielded from enemy positions. I called a halt to movement and rechecked Kevin’s bandages. He had endured the movement and we simply had to wait for helicopter support to get him out. In the meantime I focused on what I had been taught, “Never stop improving.” I checked, rechecked, and thought of anything else I could do in the short time we had to wait. The antibiotics I had mixed up for Kevin were still in my pouch. We had 120 men on the ground and I had a limited supply of IV fluid. Kevin did not lose enough blood that I felt an IV to support blood loss was warranted. I had mixed his antibiotics in such a way that would give him a shot in the leg and arm by using a numbing agent to ease the pain of the injection. I did one last check before giving Kevin the shot and saw that in my haste to treat his wound while updating my Commander and directing the litter team I had grabbed the wrong vial of medicine. Had I given Kevin the antibiotics without that one last check I could have put him deep into a surgical plane of anesthesia without any respiratory support and he might have stopped breathing. I hated the minute training steps I was forced to endure during training but they had saved a man’s life on the battlefield. I leaned over Kevin and told him I wasn’t going to give him the antibiotics (to my chagrin this was one of the first thing he told the doctors upon landing at the hospital). We could hear the helicopter and I didn’t have time to mix up another batch.
As my teammates called in the helicopter and marked the pickup area I focused on getting Kevin ready to fly. Although it was over one hundred degrees I wrapped him in a thermal blanket commonly used for hypothermia. He had lost blood and we had stripped him of his body armor. What had been the sweat of hard work and heat had now turned to the sweat of pain and fear. A trauma patient in this situation can easily become hypothermic. I did one last check on Kevin before the helicopter landed. I knelt down to listen to him and reassure him that he was going to be okay. We were soon engulfed by the cloud of dust created anytime a helicopter lands in a dirt field. Visibility was limited to the ground directly to our front; verbal communication was limited to yelling into the man’s ear next to you. I urged the litter team towards the sound created by the helicopter and we ran up to a closed cargo door. In our urgency to get Kevin loaded as quickly as possible I had not heard the order from the pilots to load Kevin into the left side of the aircraft. The flight medic slid open the right door and we put him on board. I immediately found the other flight medic and passed on Kevin’s injuries and any treatments I had given.
Special Forces medical training had prepared me for any patient I may have come across. I could apply tourniquets, place needle thoracenteses to treat a pneumothorax and prescribe antibiotics to treat a tropical disease. Nothing can ever prepare someone to see a friend and teammate fly away in a helicopter while you remain on the battlefield. There is a sense of a mission unaccomplished; we had entered this valley as a team and would leave without one of our own. While I knew Kevin faced a long and difficult road to recovery I had to turn away from his fight and continue with my own. Immediately after watching the helicopter takeoff I called out on the radio that I would be replacing him as the element leader for his Afghan Commandos. I had been in charge of the security element for the command group all day but would now take Kevin’s assault element and continue their mission. I handed my responsibilities off to another team member and found Kevin’s Afghan counterpart. We had trained and rehearsed so well that I knew every team member’s role in the mission and fell into Kevin’s like I had been doing it all day. I transitioned from being a medic treating a wounded teammate to a combat leader, pushing the men to continue fighting through the difficulty of another day in Afghanistan.
I continued pushing the men forward through the setting sun, looking for Kevin’s attackers and only found a ghost town. The valley had been deserted. Soon after the sun set we received word that our ride out of the valley was headed to pick us up. We stopped, set up security, and prepared to move 117 men back home. We had taken three casualties. I had treated two of them yet hadn’t faced the toughest medical challenge of the day. Once we stopped moving I suddenly felt a huge urge to sleep. I had not had a good rest all day. I had been forced to transition from the relatively easy job of escorting our command element to carrying a wounded teammate under fire to leading a group of Commandos while clearing a remote Afghan village. The stress of the previous 24 hours suddenly forced my eyes closed. I tried to make a good show of telling the guys that Kevin would be okay. Based on his injuries and how stable he remained I knew he would live but I also knew he was seriously injured. I quietly told my leadership what I had seen and what I thought his injuries truly were. While waiting for our helicopters to come pick us up they congratulated us on the job we did to evacuate Kevin. We had endured a long hot day of fighting and everyone was tired.
As I lay on a dirt street surrounded by snoring men I went over my actions again and again. I knew, deep in my heart, that I could have done better. I was mad at myself for almost pushing the wrong drug but glad that I had done that last check even if it meant Kevin didn’t get antibiotics as soon as he could have. I was ashamed that I had left Kevin dangling head-down in my haste to carry him to safety. I knew I was better than that and Kevin deserved better. Above all that I felt guilty. I was still walking. I hadn’t needed to be carried anywhere that day. Kevin was physically the strongest member of our team. At home he ran our run routes twice a day for fun. He even set up a rowing machine in our office so he could exercise while we went about our daily tasks. I felt guilty that someone like that was now facing the task of overcoming a massive injury.
After returning to our camp everyone rushed to find out Kevin’s status. He was still in surgery but stable. It wasn’t until a couple days later that I finally managed to track him down in the hospital in Texas. I used Google to get the phone number to the hospital and played twenty questions trying to find out if he was in fact a patient there. I found out what floor he was on and called the nursing station. I didn’t have patient access (they had no way of confirming who I was) but I left a phone number for them to pass to Kevin. Not more than five minutes after hanging up with the hospital the phone in our office rang. Kevin happened to be awake in the early morning hours and had called me right back. It was great to hear his voice and I hope he was happy to hear from us as well. It would be another four months until I saw him face to face. Unfortunately that meeting took place as we prepared for the funeral of a fallen teammate.
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