They Call Me "Doc"

When word about medical work in Iraq circulated, my interest piqued, butterflies danced in my belly, and I quickly applied. But when I got off the phone with the recruiter, I knew only that I would be providing medical aid to unnamed clients in Iraq and that the work might involve combat and was definitely unsafe – I really had no idea what I was getting into. I prayed that I would not become another gruesome photo or 15-second video clip for rest of the world to gawk at and my mother to cry over forever. As I packed my bags, stuffing in a rosary and prayer card, I practiced the Act of Contrition.

Baghdad

Travel to Baghdad took almost three days. My first assignment in Baghdad attached me to a Weapons of Mass Destruction (WMD) collections team with a well known technical company. The paramedic that took me under his wing taught me how to urinate in a military plane, consult physicians via satellite phone, kill scorpions, evade snakes, start an IV without a tourniquet in a moving Humvee leaning over a live machine gun, staple head wounds in the dark without antiseptic, where to sit in a helicopter for the best digital pictures, and how to convey to (and convince) a sick, Arabic-speaking Iraqi man that he needed IV fluids.

As I adjusted to camp life in Iraq, I prepared myself for the worst type of trauma and remote medicine. However, the most common ailments I treated were bug bites, diarrhea, seasonal allergies and mild allergic reactions, ingrown toenails, chronic back pain, kidney stones, joint injuries, athlete's foot, a slew of dermatologic issues, sunburn, and the omnipresent Iraqi patient with all of the above. Despite my tired objections, the army and all in between called me, the medic, "Doc."

My convoy experience showed me how the army puts itself at risk every day. After a full mission brief, description of the combat environment and details of our objectives, we practiced. Circling the base in vehicle formation, simulated attacks by mock enemies, and mock casualties boosted our confidence to deal with emergencies in real-life situations. The rehearsals emphasized the chaos that result from roadside attacks and actual combat.

Boy burned by old rocket fuel

The Egyptian Clinic

While waiting for patients in Baghdad, I volunteered my time with an Egyptian physician who taught me about the culture of the Arab peoples and medicine in the developing world. He worked at a small, ill-equipped clinic that had been set up in the entranceway to one of Saddam's opulent palaces. Everyday the Egyptian clinic saw countless patients, with all types of conditions – ranging from those caused by poor health standards and lack of primary care, which had resulted from years of sanctions, to those caused by violence in many forms, including attacks against the coalition forces.

In the Egyptian clinic, I learned and practiced wound closure, gastric lavage, antibiotic therapy, tropical medicine, surgical ingrown toenail repair, abscess incision and drainage, ongoing deep wound care, antibiotic therapy, vaccination surveillance, and malaria prophylaxis. I offered my services in exchange for conversation, free tea, and the chance of a lifetime.

Tikrit

My work in Baghdad suddenly halted in spring 2004 when I was assigned to a post in Tikrit, in "safer" northern Iraq, where I would be providing medic services for explosive ordinance teams, which were eliminating old Iraqi munitions. As our convoy left the green zone, we took small arms fire to the rear of my vehicle. I then realized that someone wanted me dead. Now, this realization hits me every time I roll out of a camp's gates and pass the barbed wire that provides a shred of safety. Reciting the Act of Contrition helps.

Outside Tikrit Clinic

As we zoomed north on the main supply road, Iraqis at the roadside waved in welcome. People think of Iraq as endless desert, but as we rode north, the terrain slowly evolved into arable land with irrigated fruits and vegetables. As we wove in and out of traffic to avoid being an easy target, I could see the water-fed olive groves and tall, bushy grapevines. The Fertile Crescent is alive and well.

In Tikrit, building a workable patient area challenged my thriftiness and creativity. Drug inserts in German, Italian, Russian, and all languages but English made the triage of assorted medicines an education in pharmaceuticals. Cotton swabs from new medicine bottles doubled as applicators for topical antiseptic and old IV sets did double duty for eye irrigation. But still I had it easy in my North Americanized atmosphere. Other coalition and Iraqi-based clinics took mortar raids and always housed some dead.

Non-compliance is chronic in Iraq. Patients face death if caught working with the coalition, or with coalition medicines and signs of treatment. The insurgents kill more Iraqis than they attack coalition forces. I wake every morning to new challenges and new patients.

Stitching up a patient

Due to a security incident that occurred months prior, the day laborers live on site. The day laborer camp is a microcosm of Iraq – Sunni, Shiite, Kurdish, and Bedouin – all living under the same tent. Besides simple differences and small gang fights, the old tribal conflicts still exist. One patient particularly haunts me, a 14-year-old boy who had been repeatedly raped, and for whom codes of silence and ancient forms of retaliation would take precedence over healing. But for the most part, the men of the varied religious sects and ethnic backgrounds seem to work and get along in a state of uneasy peace.

In summary, my experience in Iraq as a paramedic has been challenging and rewarding. I have learned about clinical medicine and I have learned about myself. I have also learned that I have a world more to discover.

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