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  • Triage
  • Jon Kerstetter (bio)

October 2003, Baghdad, Iraq. Major General Jon Gallinetti, U.S. Marine Corps, Chief of Staff of CJTF7, the operational command unit of coalition forces in Iraq, accompanied me on late-night clinical rounds in a combat surgical hospital. We visited soldiers who were injured in multiple IED attacks throughout Baghdad just hours earlier. I made this mental note: Soldier died tonight. IED explosion. Held him. Prayed. Told his commander to stay focused.

In the hospital, the numbers of wounded that survived the attacks created a backlog of patients that required immediate surgery. Surgeons, nurses, medics, and hospital staff moved from patient to patient at an exhausting pace. When one surgery was finished, another began immediately. Several operating rooms were used simultaneously. Medical techs shuttled post-op patients from surgery to the second-floor ICU where the numbers of beds quickly became inadequate. Nurses adjusted their care plans to accommodate the rapid influx. A few less critical patient beds lined the halls just outside the ICU.

The general wanted to visit the hospital to encourage the patients and the medical staff. We made a one-mile trip to the hospital compound, late at night, unannounced, with none of the fanfare that usually accompanies [End Page 61] a visit by a general officer in the military. After visiting the patients in the ICU, we walked down the hallway to the triage room.

One patient occupied the triage room: a young soldier, private first class. He had a ballistic head injury. His elbows flexed tightly in spastic tension, drawing his forearms to his chest; his hands made stone-like fists; his fingers coiled together as if grabbing an imaginary rope attached to his sternum. His breathing was slow and sporadic. He had no oxygen mask. An intravenous line fed a slow drip of saline and painkiller. He was what is known in military medicine as expectant.

Some of his fellow soldiers gathered at the foot of his bed. A few of them had been injured in the same attack and had already been treated and bandaged in the emergency room. These fellow soldiers stood watch over the expectant patient. The general and I stood watch over them. One soldier had a white fractal of body salt edging the collar of his uniform. One wept. One prayed. Another quietly said “Jesus” over and over and kept shaking his head from side to side. And another had no expression at all: he simply stared a blank stare into the empty space above the expectant patient’s head. A young sergeant, hands shaking, stammered as he tried to explain what had happened. The captain in charge of the expectant soldier’s unit told the general and me that this was their first soldier to be killed—then he corrected himself and said this was the first soldier in their unit to be assigned to triage. He told us that the soldier was a good soldier. The general nodded in agreement and the room fell suddenly quiet.

The general laid his hand on the expectant soldier’s leg—the leg whose strength I imagined was drifting like a shape-shifting cloud moving against a dark umber sky—strength retreating into a time before it carried a soldier. And I watched the drifting of a man back into the womb of his mother, toward a time when a leg was not a leg, a body not a body, toward a time when a soldier was only the laughing between two young lovers—a man and a woman who could never imagine that a leg-body-man-soldier would one day lie expectant and that that soldier would be their son.

As I watched the soldiers at the foot of the bed, I noted their sanded faces, their trembling mouths, their hollow-stare eyes. I watched them watch the shallow breathing and the intermittent spasm of seizured limbs and the pale gray color of expectant skin. I took clinical notes in my mind. [End Page 62] I noted the soldiers—noted the patient. I noted all the things that needed to be noted: the size of the triage room, the frame of the bed, the...