by Keith ‘Doc’ Raymond

*Author’s Note: This is non-fiction. The names and locations are changed to preserve privacy. As they used to say in Kandahar, ‘you can’t make this shit up.’

Helmand Province, Afghanistan in the Spring is not much different from any other time of the year, except for the lack of mud and ice. The near vermilion sand goes everywhere you don’t want it to now that it’s dry, and the camel spiders are out. Massive things we only saw in horror movies back home.

Gunnery Sergeant Ramp had Corporal Donovan in tow as he went for his morning constitutional. Everyone had a buddy per the Base Commander’s orders after the Taliban attack two days before. They nearly overran Forward Operating Base (FOB) Victory, but the Marines drove them back.

“Fine dining it is not!” complained the Gunny.

“Beats MREs.”

“But not by much. At least we have porta-potties. By the way, what is that guy doing staring into the hole?”

The two Marines stopped to focus on the guy on his knees, bowing to the plastic god. A large hose snaked from an idling truck under the guy’s arm into the ‘collection.’ Problem was neither the hose nor the guy manning it moved. Typically, he’d sweep it around, and the hose would pulse with ‘debris.’

“Maybe he spotted another body in there, like they did at FOB Baker down range,” the Corporal answered. 

“I don’t know. We better check.”

“Okay, Gunny.”

Civilian contractors provide support and logistics at the FOBs and the primary bases. Despite the worker’s coffee-colored skin, the man’s arms looked pale. They couldn’t see his head. Ramp approached, but the contractor didn’t move. Of course, the suction on the tube masked his approach.

“Hey, you there, you okay?!” the Gunny shouted.

No movement.

Stepping in, he shook the guy’s shoulder. There was a drunken, unintelligible response in Hindi. “Corporal, give me a hand with him.” 

They dragged him out of the porta-potty and laid him on his back. The Gunny checked his pulse. It was weak and thready. He pulled his walkie from his belt and called for the medics.

***

I was working sick call in the clinic tent at the FOB. We were busy, more so than usual, because they didn’t post physicians at the FOBs. Typically, it’s a lone paramedic, but they called me out to help after the attack. Doctors rarely went outside the wire. This was an exception.

The FOB had a lot of troops with minor injuries remaining on base, while the critically injured were aerovac’d out. The paramedic’s walkie-talkie crackled several times, then a voice came through. It was the shout from the porta-potties on the other side of the base.

The paramedic joining me for this mission yelled, “I call dibs on the Fifty Cal up top.”

“You know how to handle it?” asked the other paramedic, permanently stationed at Victory.

“Sure, fire, and they forget.”

“I’ll stay here guys and work sick call, bring ‘em back. Preferably alive and with no further casualties!” I requested.

They took off in the makeshift ambulance, actually a Humvee with a stretcher and supplies. A normal ambulance wouldn’t be armed, but these weren’t normal times. It was war. To the enemy, a red cross or red crescent gave the ambulance a target they could aim at. 

I forgot about them as I attended the sick call in a red Hawaiian shirt, just like Hawkeye from the show MASH. I was just finishing up when the Sat phone rang, and a fax spit out of the machine.

“Did you get it?” asked Mark, the Victory paramedic, when I answered. “It looks all wrong.”

“What?”

“The EKG.”

I tore it off from the fax printer and scanned the sheet. It looked wrong to the untrained eye. Then I answered, “Switch the leads to the right side of his chest. That’s where his heart is.” 

I walked out of the tent and looked at the horizon while holding the phone to my ear. It had been nice weather up to that point, but out beyond the FOB was a wall of swirling sand heading our way. A full-blown tempest straight out of a thousand and one nights, and no magic carpet to escape it. I heard the fax activate again inside the tent.

“Mark, you still there?”

“Yeah Doc. What do you think?”

“You have goggles with you? Sandstorm coming in.”

“Shit! What about the EKG?”

“Wait one…” I walked back into the tent and removed the new EKG from the fax. Whoever it was clearly had a myocardial infarction (a heart attack) in progress. But then I saw the age. The guy was only twenty-five years old!

“Looks like an MI, Mark. Is this a soldier?”

“No, a contractor like us.”

“Is he fat, diabetic? Check for a Medic Alert bracelet.”

“Already did. He doesn’t have one, and he’s skinny as a rail.”

“Better get him back here before the storm, Mark.”

“Roger that.”

***

They didn’t make it. The wall of sand struck the base hard. Visibility went nearly to zero. It was red soup. Without goggles the particulates would blind you. I only had wrap-around sunglasses, and a bit of sand got in my eyes.

A half hour later, the makeshift ambulance arrived from a trip that usually only took five minutes. One of our patients was just finishing flushing sand from my eyes with a liter of saline. The relief felt fantastic, but my conjunctiva was angry red.

“What took so long?” I asked Mark naively.

He and the other paramedic were huffing and puffing as they set the stretcher down on our trauma bed. The guy had an IV line in place, fluids running, and was conscious. Mark ignored my question. “I gave him three nitro. Said his chest pain is down to two.”

“Well done, guys.”

Despite limited equipment, I placed a twelve lead EKG, connected him to the monitor, placed defibrillator pads to his chest, and added a pulse oximeter and a prayer. The young Indian’s eyes fluttered open. “Thanks Doc,” is all he said.

“Let’s start a nitro drip and titrate to control his BP and pain. Do we have morphine?”

“You bet,” Mark answered. 

“Let’s give him two milligrams IV and repeat every fifteen minutes until he is pain free,” I ordered. Looking down at the patient, I asked, “What’s your name?”

“Rudra.”

“Mind if I call you Dre?”

The guy nodded more than necessary as the morphine went to work.

“Dre, do you have any heart problems?”

He shook his head in that non-committal Indian way.

“Did you know your heart is on the right?”

Same response. Then the lights went out, both above my head and in the patient’s eyes.

“Pulse ox dropping,” said the other paramedic. Fortunately, it ran on a battery.

“Mark, do we have a generator?”

He nodded and went out into the storm. 

“Prepare to intubate,” I said to the other paramedic.

“Blind?”

“No other option. So…” 

We were bagging him with the endotracheal tube in place when the lights came back on. Dre’s color was much better. Pulse Ox was back to normal. New EKG showed the damage. Anterior inferior wall injury.

Mark said, “I missed the good part.”

“Not yet. Does that ventilator work?”

“Sure. Until it doesn’t. We need to get him to Bastion Hospital up at Camp Leatherneck. I’ll call for a helicopter.”

“How bad is it out there?” I asked.

Mark ruffled orange sand from his brown hair, then pushed curls back from his forehead. “I had to open the driver’s door and look down at the ground. Only way I knew where to go was to follow the tire tracks to get here. Couldn’t see out the windshield.” 

I took a peak out the tent flap. The sun turned the sandstorm into a red fog, inundating the base. It was eerie. I pinched my eyes shut, afraid more particles would fly in them, and dropped the flap. 

“I have the Guardian Angels on the Sat phone, Doc.”

“Air Rescue. Lieutenant August, how can we help?”

“Can you fly?” I asked.

“The sandstorm has blanketed the region, but we can fly. It will be dangerous, but that’s what we are here for. How many casualties, Sir.”

“Just one. Twenty-five years old with an MI. Wait one…”

I faced a dilemma. The air rescue helicopters flew with a crew of eight. Would I be willing to risk eight lives to save one?

“Belay that, Lieutenant. I can’t risk you flying him out now. If he survives while we wait out the storm, can I arrange transport then? Either in the morning, or as soon as the weather clears? I’d appreciate it.”

“Thanks for thinking of us, Sir. You’re on the schedule. Good luck. Out.”

The paramedics looked at me. I answered their unasked question. “Let’s hope he makes it. I couldn’t risk the flight crew. Plus, if they crashed in the storm, I’d be responsible for nine lives. We’ll each take a shift watching over him. Bag him if the power goes out again.”

“Roger that,” they said at the same time.
                                                                        ***

The next morning, the Black Hawk landed at FOB Victory and took him to Bastion. From there Dre was air lifted to Mumbai where he underwent cardiac surgery. I heard a week later, when I was back in Camp Leatherneck, he made it. The cardiologist at Bastion told me he not only had a right heart, but all his organs were reversed, known as Situs Inversus Totalis. Fairly rare.

Of course, Rudra wouldn’t be returning to Afghanistan, but he and his family sent me their gratitude. I related their sentiments to Mark, who received a commendation for his actions during the firefight. The other paramedic, named Penelope, picked up the nickname Fifty Caliber P after that.