A Doctor At War

From Baltimore's urban battlefield to the Iraqi war zone

Sun Special Report

August 05, 2007|By Article by Abigail Tucker | Article by Abigail Tucker,SUN REPORTER

Balad Air Base, Iraq -- The boy was dying much faster now. His blood pressure had skyrocketed, and his pulse was in the 180s. Standing at the foot of his bed, Dr. Heather Cereste could see his heart shudder in his skinny chest.

His father seemed to sense what was coming. It was past midnight, Heather would later recall, and he was still at the bedside of his 6-year-old, who had been shot in the head while playing outside his Baghdad home. The father had been waiting this way for several days, dressed in the same black robe, stroking the boy's shaved head or resting his own head on the child's legs. The ventilator keeping the son alive beeped and sighed; often, the father wept.

A few phrases of translated Arabic - "don't touch"; "show me"; "I'm sorry" - were posted on the hospital's walls to help the American doctors communicate. But even if Heather had spoken the language, she wouldn't have known what to say.

Such moments were the hardest part of life in the tent hospital at Balad Air Base, where mortar shells fell almost daily and fighter jets roared overhead.

In the intensive care unit, Heather encountered the worst of what war could do to a human body, saw toddlers with crushed skulls and young soldiers blown apart.

Now, watching the father mourn his still-breathing son, she knew that war also destroyed souls.

For the hundredth time, she wondered what she was doing here, 40 miles north of Baghdad, in a giant tent filled with beds. How could she practice medicine when so many of her patients were past healing? No matter how good a doctor she was, she could not save this child or soothe this father. Nothing could have fully prepared her for such a place.

And yet, she had seen tears like the father's before. They belonged to a woman named Mary, on the other side of the world. They had met months before and 6,000 miles away, in a hospital where Heather trained to treat the injured in Iraq.

To prepare her for Balad, the Air Force had sent her to Baltimore.

She hadn't known much of anything about the war wounds of children when she arrived in Maryland last fall. Thirty-seven-year-old Heather Cereste was, by specialty, a geriatrician. Back home, at an Air Force base in Texas, most of her patients were in their 80s. Heather was accustomed to dementia and broken hips, to the tissue-thin skin and breakable bones of the very old. The bulk of her knowledge of combat medicine came from M*A*S*H reruns.

But soon, by January, she would be in Iraq. She needed to get all she could out of these three weeks at the University of Maryland's Shock Trauma Center, where she would work with a team of doctors to learn emergency medicine skills. She had never been to Baltimore before. She wondered whether it was like a war zone, the way people said.

Shock Trauma, she knew, was home to one of America's busiest emergency rooms and that it had been training Air Force medical professionals since the beginning of the war, about 30 people each month: nurses, physicians, physicians' assistants, medical technicians and chaplains, many of them bound for the Middle East.

The majority came from small bases, where the closest they got to trauma experience was bandaging sprained ankles, or from specialty backgrounds like Heather's.

Along with a high patient flow and the best equipment, the hospital - which takes the worst cases from across the state - offers an unusual number of "analogous wounds," injuries that look and feel and bleed like those sustained in combat. Gunshot wounds, largely a result of inner-city violence, are the leading cause of death at Shock Trauma. A high percentage of the victims are fighting-age men.

"The reason why we chose Baltimore was, they came in with the highest bid on bodies," Maj. Jeffrey Ball, one of the Air Force administrators, told the military doctors that first day, in a windowless hospital conference room.

It saddened Heather that the people of Maryland would be standing in for the casualties of war. How could violence in an American city even come close to what was happening in Iraq?

As she toured the hospital's figure-eight-shaped floors, though, she was grateful for whatever experience Baltimore could offer her. She was not at all ready for what lay ahead in the desert, where she would be stationed for four months or more.

During a break, she squinted at her reflection in a bathroom mirror - angular face, glasses, a mass of curly brown hair - but she didn't see a combat doctor. She saw a geriatrician who was out of her depth.

It wasn't only that she lacked the skills to do this new job. She also needed strength to witness the horror of war and to face the human misery that followed.

Without it, she knew, a doctor could be traumatized, too.

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