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Under a dim bedside lamp in a hospital ward in Landstuhl, Germany, 1st Infantry Division Specialist Shane Salter sobs for his dead sergeant, whose hand he clutched in a morgue in Iraq just five days earlier.
At 22, Salter, from Walla Walla, Washington, is so young that he called 29-year-old Sergeant Kyle Childress "Grandpa." "He always took care of me," says Salter, who lost two fingers when his platoon burst into a bombmaker's house near Samarra one night and was met with a torrent of machine-gun fire. As Childress fell, Salter emptied his M-4 rifle into the dark. The return fire raked his chest; his life was saved by his bulletproof vest. "For 48 hours after that, I was a train wreck, dumbfounded," he says, weeping softly in his four-bed hospital room.
In many rooms along these long hospital corridors, soldiers tell similar tales of grief and pain. Across the hall, Sergeant Chris Chilles, 28, a California National Guardsman, says he was standing in the gun turret of his Humvee near Mosul a few mornings before, thinking about the Philadelphia cheesesteak he would have for lunch, when a roadside bomb exploded in front of his vehicle. The massive blast ripped through the Humvee, throwing Chilles to the floor. "It was like a plank hit me across the back," he says. The shrapnel tore two holes in his lower back and ripped through his abdomen, narrowly missing his vital organs — a "miracle shot," says Chilles.
Two years have passed since U.S.-led coalition forces stormed into Iraq and ousted Saddam Hussein. Since then, the Landstuhl Regional Medical Center, the largest American military hospital outside the U.S., has been the war's emergency room. Set in rolling hills some 120 km southwest of Frankfurt, Landstuhl is about 3,500 km from the combat in Iraq. But 20,000 soldiers have been airlifted here; of those, about 5,000 are classified as combat injuries, though the 141-bed facility also treats the psychological wounds of war, such as depression and post-traumatic stress syndrome.
In any other war, the most grievously wounded men at Landstuhl would have been killed, having bled to death on the battlefield or succumbed in a hospital to wounds so severe that their armor could not protect them and doctors could not save them. In World War II, 1 in 3 wounded soldiers died; in Vietnam, 1 in 4. In the Iraq war, the rate is 1 in 8. That remarkable statistic is due in part to the doctors and nurses at Landstuhl, who've transformed what was once a sleepy military hospital into a top-line trauma center.
As of last week, just over 1,510 U.S. military personnel had died in Iraq and 11,344 had been wounded. The Pentagon does not keep count of dead or wounded Iraqis. Human-rights groups and Iraqi health officials have tried to estimate the number of Iraqi deaths, but the figures vary wildly, between 15,000 and 100,000. No one is sure of the number of Iraqis who have been wounded. Injured Iraqi soldiers remain in Iraq, but in addition to U.S. troops about 112 soldiers from 37 other coalition countries have been flown to Landstuhl for treatment.
Every war mutilates in its own way, and Iraq is no different. Americans soldiers are surviving battles that still kill thousands in less well-equipped armies. Only 16% of American injuries in Iraq have been from bullets, according to Pentagon statistics. But the amputation rate of injured Americans in Iraq is 6% — about double that in previous wars, mostly because soldiers' ceramic-plated vests and Kevlar helmets still leave limbs vulnerable. These soldiers might have died in past wars, when bullets and shrapnel hit their unarmored torsos. While more and more soldiers are surviving battles, though, doctors have uncovered a new phenomenon among those who return: traumatic brain injuries caused by explosions that damage neurological fibers. Some soldiers have come home completely intact, only to suffer memory loss, dizziness and insomnia, even sometimes losing the ability to walk and recognize their loved ones.
This is a side of the war that is largely hidden, grinding on almost entirely out of view of television cameras and press conferences. While the Pentagon names each dead soldier, few details are released of those injured, and no photographer is permitted on the tarmac when the casualties from Iraq are unloaded at Ramstein Air Base near Landstuhl. For these soldiers, Landstuhl is a brief hiatus, perhaps a week or two before they are dispatched home or returned to the war. Here, they are neither liberators nor occupiers, neither vilified nor celebrated. They are simply patients, struggling to come to grips with their wounds — and to start the process of healing.
Their tales are as old as war itself. But Landstuhl is unique because getting here fast from two time zones away can mean the difference between life and death. "If they can make it back to Landstuhl, their chance of survival is really good," says Lieut. Colonel Warren Dorlac, an Air Force trauma surgeon who has spent the past seven months operating on wounded soldiers at Landstuhl. "These guys are surviving incredible amounts of trauma, and they're doing well."
Armored vehicles and protective gear mean that killer head and chest wounds are far less likely than in the past. Portable blood supplies and blood-clotting powders to pour into wounds have reduced the death toll even further. But many of the men and women who pass through Landstuhl owe their lives to the Critical Care Air Transport Teams (ccatts), the flying intensive-care units that treat the troops as they are lifted from the battlefield by helicopter to a combat hospital within minutes of being hit. From there they are flown six-and-a-half hours to Landstuhl. "None of us have ever taken care of this large an amount of Americans injured in conflict," says Air Force Colonel Tyler Putnam, one of Landstuhl's trauma surgeons. "This is unlike anything we've ever experienced, or maybe will ever experience again."
Few doubt that the evacuation system has saved soldiers' lives. But it was born out of a bitter failure — the Oct. 3, 1993 debacle in Somalia. There, 18 American soldiers died and some 80 were injured while pinned down in a hostile corner of the capital, Mogadishu, with no way out. Just two days earlier, a U.S. medical team had flown out of Somalia to Landstuhl with a planeload of injured servicemen, leaving behind a skeleton staff in the 40-bed battlefield hospital. "There was no system to fly critically ill people in the air; we had to create it on the ground," says Colonel John Holcomb, one of only two Army surgeons left in Somalia that day, which was memorialized in the film Black Hawk Down. They performed 34 surgeries in a nonstop 36-hour stint.
Haunted by the event, Holcomb and others began pushing for change. Army and Air Force commanders together argued that the military needed a joint medical strategy
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Today, the Air Force has about 110 active-duty ccatt teams, many of which have logged tens of thousands of kilometers shuttling between Baghdad and Landstuhl. The aircraft are fitted with the same kind of sophisticated medical equipment that would be found in any high-tech ICU, and a doctor, nurse and technician are aboard each flight. Holcomb says the greatest medical achievement in the Iraq war has been how fast injured soldiers are moved to safety. "The rapid evacuation of casualties is stunning," he says.
At first glance, Landstuhl doesn't seem like it could play a key role in any war. The complex of low-slung buildings and neatly manicured pathways, set on a forested hillside above a small town, looks more like a country retreat than a set from M.A.S.H. Taken over by the Americans in 1951, the hospital was regarded for years by military doctors as a quaint backwater, out of touch with both Pentagon politics and the cutting-edge research of combat medicine. Dorlac says it was "a 9-to-3 life," a place where staff took weekend ski trips in the Alps and enjoyed a few sleepy European years. Putnam, the Air Force trauma surgeon, says he dreaded his deployment here in 2002, thinking he had been handed a term in exile. "It felt like a small community hospital when I got here," he says. "They were focused on outpatients. There was very little war-related treatment going on."
In the summer of 2003, with staff reeling from the flood of patients following the U.S.-led invasion, the hospital received another jolt to its system: Colonel Rhonda Cornum. Her appointment as head of the hospital was a sharp break after 50 years of all-male leadership. Her combat credentials were impeccable, however. As a flight surgeon on attack missions during the 1991 Gulf War, Cornum's Black Hawk 214 was shot down over southern Iraq. Five of the eight people aboard died, and she ended up in enemy captivity, with both arms broken and a bullet in her shoulder. During her eight days as a pow — one of only two female U.S. prisoners in that war — she was kissed and groped by an Iraqi soldier in the back of a truck. Cornum opted to keep quiet, but when she yelped in pain from her injuries, the soldier stopped.
The incident made her an instant celebrity in the U.S. — living proof that even under the worst circumstances, American women were fit for combat. But Cornum, 50, says she put that "in pile B" of what she endured, compared to the hellish pain of her wounds and being almost bombed by U.S. jets strafing nearby targets. Being 36 at the time, with a toughened hide, helped. "I'd dealt with a number of people who'd died in helicopter wrecks before," she says, sitting on a couch in her office, which is decorated with certificates from marathons she has run and photographs of her previous military units. Still, her capture left her with a sharpened sense of what might torment the young soldiers — many barely out of high school — lying in Landstuhl's wards.
Under Cornum, the hospital has been thoroughly modernized. Today's combat doctors are likely wired to e-mail and cell phones. Holcomb, who now heads the Army's Institute of Surgical Research in Fort Sam Houston, Texas, says he routinely gets an e-mail "from some doctor in a tent outside Fallujah," saying a soldier has been burned in an explosion minutes before, and is being flown by helicopter to the combat hospital in Balad. An hour later, a physician in Balad calls Holcomb, saying he's putting the patient on a plane to Germany. At that point, Holcomb can dispatch a burn team to Landstuhl to bring the soldier back to the Army's specialized facility in Texas. "He's here 24 hours after being wounded," he says with amazement. Landstuhl is now a crucial stop-off point, where the details of each injury are compiled in a dossier that's carried to military facilities in the U.S.
But sometimes the system can be chaotic, say Landstuhl's doctors. "Half the time the records at Landstuhl don't make it back to guys in the U.S. who are taking care of them," says Dorlac. Landstuhl's surgeons are often left to decide a soldier's fate themselves: whether to return him back to the war after being stitched up, or send him back to his base, or home.
Partly with Cornum's coaxing, U.S. military commanders in Europe have begun requiring every soldier returning from Iraq to consult a psychologist for post-traumatic stress syndrome. Cornum, who previously led the 28th Combat Support Hospital in Bosnia, has also hired several trauma surgeons and critical-care nurses and added operating rooms to the icu. "It's a completely different place now," Putnam says. He ranks Landstuhl as "a world-class trauma center," with top-of-the-line equipment. Landstuhl's eight operating rooms are busy most days, with doctors performing 25 to 30 procedures, including neurosurgery. Physicians set bones and clean out wounds, and carry out a lot of amputations.
From within the trauma wards, Landstuhl's doctors and nurses have had a close-up view of the war's mayhem, almost as intense as in Iraq itself. After being wheeled through Landstuhl's doors one snowy morning in late January, Brent Jurgersen, 42, a first sergeant from Low Moor, Iowa, was rushed into an operating room, where surgeons amputated his left leg at the knee. The day before, as Jurgersen led his Humvee through a village near Samarra,
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Days later, doctors in Iraq e-mailed surgeons at Walter Reed to say that Jurgersen had flatlined twice in the field hospital in Balad, before being flown to Landstuhl. Like many other soldiers who've landed here during past two years, it was not Jurgersen's first evacuation. Last June, he survived a bullet that pierced his tongue and lodged in the back of throat. He spent more than three weeks recovering at Landstuhl. Jurgersen, tall and powerfully built, insisted on returning to Iraq to complete the 1st Infantry Division's yearlong mission, which ended last month. "My husband's never not finished anything in his life," his wife, Karin, wrote in an e-mail a few days after his leg was amputated, adding that when he heard Time had seen him arrive at Landstuhl, "he asked that you don't make him a hero."
Attached to the e-mail were photos of Jurgersen, leaning on a walker in the passage of the Walter Reed Army Medical Center in Washington as he began learning how to manage with one leg. Last month, he insisted on flying back to Germany to welcome home his soldiers from their year in Iraq. Last Thursday, he was back at Walter Reed, being fitted with his first prosthesis. But Jurgersen — already an aging soldier — is focused on a single goal: returning to his command. If doctors declare him fit for duty within a year, he could head back to Iraq. A precedent has already been set by Captain David Rozelle, a 33-year-old amputee who lost his right foot after his Humvee rolled over a land mine in Iraq in June 2003. He headed back to Iraq earlier this month to command a 3rd Armored Cavalry Regiment troop.
Aside from those daily slow-drip shrapnel and bullet wounds, there are the times that Landstuhl's doctors call simply "surge modes" — stretches of up to 24 hours when they perform nonstop operations. Like military historians, they can rattle off without pause the war's bloodiest events for American soldiers, when casualties spilled into the passages: the bombing of the U.N.'s Baghdad headquarters in August 2003, two major offensives against Fallujah last spring and fall, and the devastating suicide bomb in a dining hall in Mosul last December.
Month after month of seeing planes arrive loaded with fresh casualties has also sharpened the cynicism of many staff. Some say they are wary of the upbeat assessments given by politicians. Major Kendra Whyatt, Landstuhl's head orthopedic nurse, says she was from the start skeptical about the reassuring tone in Washington. She watched President Bush on television nearly 23 months ago as he declared major combat in Iraq over under a mission accomplished banner onboard the U.S.S. Abraham Lincoln off the coast of California. She quickly dismissed the rhetoric. "The life we live and the life Americans believe are two different things," says Whyatt, 37, who's been an Army nurse for 14 years and moved to Landstuhl with her three small children in 2002. "There are still casualties coming from Iraq, whether or not the incident is newsworthy."
Scores more casualties have arrived at Landstuhl since Chilles, Jurgersen and Salter were admitted to the hospital back in January. Back home, Chilles' breakneck evacuation from Iraq seems unreal to him now. "I spent nine days in the hospital and traveled about 8,000 miles, just so I could sit with my dog and watch some TV," he e-mailed from Modesto, California, from where he shuttles to local military facilities to have his shrapnel wounds cleaned and dressed. "It isn't the way I thought I would be spending my 28th year of life. But I guess it's better than no life at all."
- VIVIENNE WALT | Landstuhl
- Fewer U.S. troops are dying in Iraq compared to previous wars, in large part due to the rapid evacuation of casualties to the U.S. medical facility in Landstuhl, Germany. TIME visits the hospital where wounded soldiers come to heal