FACT

A REPORTER AT LARGE

THE CASUALTY

by DAN BAUM

An American soldier comes home from Iraq.
 
 

When people talk about the Army being good for a certain kind of young man, it's boys like Michael Cain they have in mind. Tall and lean, with a sweet smile and doll's eyes, Michael spent his high-school years searching fitfully for the disciplined achiever within him. His home, a converted schoolhouse that his parents rented amid the dairy pastures and cornfields outside Berlin, Wisconsin, was a loving if unruly place, noisy with two little sisters and cluttered with the winter coats, boots, and other items it takes to keep a family going in the rural Midwest. Michael's mother, Charlene, a sturdy woman with a broad, pretty face, earned most of the family income as a clerk in a Winnebago County mental-health clinic, forty-five minutes away. His father, Kenneth, a heavyset former machinist disabled by back pain, kept llamas in the back yard as a hobby. Michael loafed through school in his early teens, playing sousaphone in the marching band and clowning around in class. He liked to watch professional wrestling on TV. In his junior year, though, he found himself thinking that Berlin, population fifty-three hundred, looked small. Envisioning a career in computers, he bore down on his schoolwork and got decent grades, but then he seemed to lose interest in the prospect of going to college.

Graduation, in 1999, marooned him. Having no clear idea what to do, Michael took a job stocking shelves at Wal-Mart. Within months, the thrill of adulthood had faded to a dreary routine of unpacking boxes under fluorescent lights and, after hours, gazing into the PlayStation 2 upstairs in his bedroom. In May of 2000, Michael drove forty minutes to an Army recruiting station in the Oshkosh City Center shopping mall and got the paperwork to sign up for a four-year hitch. Charlene first heard of her son's plans when he came home that night and asked for his birth certificate.

Charlene thought the military would be too tough for her easygoing son. "You hate having people tell you what to do," she told him. Though Michael was nineteen and parental consent wasn't required, the recruiter drove out to the Cains' house to sit at the kitchen table among the canned goods and wrestling magazines and show her on his laptop the range of Army opportunities. "Are you sure you want to do this?" Charlene kept asking Michael as the recruiter, in crisp dress greens, sat stiffly between them. The laptop glowed with images of men flying helicopters and driving tanks. Less than a week later, Michael Cain was at the induction center in Milwaukee with a gym bag in his hand.

To Charlene's amazement, Michael thrived under military discipline. The unity of purpose, the clarity of authority, and the hard physical work all gave him hope of becoming the man he wanted to be--serious, competent, respected. His biggest gripe in calls home was that other soldiers were insufficiently respectful to the drill sergeant--a complaint that left his mother speechless. His score on the Army entrance exam wasn't high enough to get him into electronics, but it qualified him to be an "eighty-eight mike"--a truck driver. For Private Cain, barrelling along in a thirty-eight-thousand-pound transport at highway speeds was more fun than arranging displays of toaster ovens. He twice wrote to his recruiter, describing how he was getting his "ass kicked" so hard he'd lost twenty-eight pounds, but also to thank him for helping him "fulfill a life long dream, being an american soldier!!!" After basic, he was sent to Vicenza, Italy, and spent two years driving trucks and taking parachute training in order to get his jump wings. The Army worked its traditional alchemy. Michael rose smoothly to the rank of specialist and was sent to Fort Hood, Texas. He met an attractive woman named Leslie Lantz, who worked at a Denny's restaurant in the nearby town of Killeen, and they began seeing each other. On April 'st of last year, Cain departed for Kuwait, and left in her care his most precious possession--a new Dodge Ram pickup.

Two decorations hold particular fascination for soldiers who are shipping out. The Combat Infantryman Badge, or C.I.B., is awarded for spending at least sixty days under fire. The Purple Heart goes to soldiers wounded by enemy action. Together, they mean that a soldier has experienced the essence of warfare. What soldiers want when they envision the Purple Heart is to get shot, patched up, and returned to their platoons in one piece. When Cain left for Iraq, he knew he'd get his C.I.B. But he also boasted to his mother that he'd win a Purple Heart.

Assigned to the 299th Engineer Battalion in Tikrit, Cain took command of a Heavy Expanded Mobility Tactical Truck--or "hemmit"--a monstrous land schooner that rides on eight four-foot-tall tires and hauls everything from gasoline to tampons. The battalion was comfortably billeted in an unfinished palace that had belonged to one of Saddam Hussein's brothers-in-law, with rows of Army cots spread out under soaring arches. Twice a day, Cain and Specialist Keisha Duff, a twenty-seven-year-old eighty-eight mike from Humboldt, Tennessee, drove rations and water to soldiers camped two miles south on the four-lane road the Army calls Highway One. Cain impressed his company commander, Captain James Blain, as a particularly enthusiastic soldier, always ready to grab an M249 machine gun and volunteer for dangerous missions. Cain, the Captain wrote me, "was ready to rock and roll," and was in the process of being promoted to sergeant. The unit never had quite enough water. But for that--and for having to wear a sixteen-pound flak vest, web gear laden with ammunition, and a four-pound Kevlar helmet in the hundred-plus heat--Cain considered Tikrit easy duty, with plenty of time to watch movies and play video games. He liked hanging around the battalion aid station, a tent with a couple of gurneys, swapping CDs and DVDs with Private First Class George Blohm and Private First Class Jeremy Brown, a pair of "ninety-one whiskeys"--medics.

August '0th was a Sunday. At 9:40 a.m., Duff took the wheel of the hemmit and Cain the shotgun seat. A Humvee mounted with an M"49 led the hemmit out of the palace compound, and another fell in behind. The vehicles lumbered up the short gravel road to Highway One. A hemmit's cab extends several feet ahead of the front tires, and Cain recalls it swinging out over the blacktop of the highway as the truck made its turn. It is his last memory of Iraq.
 

Medics Brown and Blohm were sitting in the aid station when their master sergeant ran in to report a possible casualty out on the highway. Medics no longer wear big red crosses on their helmets; during the Second World War, they suffered high losses because they were easy to pick off. Nowadays they look and dress like other soldiers, down to the weaponry, and address each other as "soldier-medic," with the emphasis on "soldier." Their primary mission is that of any warrior, which, as the Soldier's Creed puts it, is to "engage and destroy the enemies of the United States of America in close combat." Often the first thing a medic will do for a wounded soldier is shoot back, in order to protect him. Brown grabbed a rifle and a thirty-pound aid bag, Blohm took a stretcher, and together they raced toward a greasy cloud of smoke rising up from the highway.

They could see at once that the hemmit had hit a mine; the enormous right front wheel was gone and the cab was crumpled. Blood, shiny oil, and bright-green engine coolant made a mess on the tarmac. Soldiers had ringed the scene and were pointing their rifles into the desert; mine strikes are frequently overtures to ambush. Keisha Duff had been thrown clear of the driver's seat and was being rolled onto a stretcher. Jagged chunks of the cab were embedded in her arm, and she had a bad burn under her flak jacket. Screams echoed from the hemmit's twisted cab; Blohm glanced inside. "Oh, shit," he remembers thinking. "It's my friend." In addition to having to duck and return fire while administering aid, combat medics, unlike their civilian counterparts, often find themselves wrist-deep in the hot ruined flesh of their best friends.

Cain's right leg was a mangled slab of splintered bone and stringy red muscles; Blohm knew it couldn't be saved. Both knees were visibly dislocated. The left thigh was twisted at a bad angle, indicating a broken femur, and the leg appeared both seared and flayed. Cain was shrieking in agony and panic. Brown, the senior medic on the scene, climbed up into the cab with him.

The clock was running fast on what medics call "the golden hour"--the first sixty minutes after injury, when timely treatment can determine whether a soldier lives or dies. As recently as the Persian Gulf War, in '99', the most highly trained medics were held behind the front lines at battalion aid stations. Front-line combat medics had neither the training nor the equipment, for example, to insert an airway tube into a patient's throat. And, while they carried I.V. bags of plasma, they knew little of medication beyond morphine. Modern desert warfare involves such swift travel, though, that soldiers in a forty-m.p.h. Bradley fighting vehicle can quickly move beyond the reach of an aid station. And, in the kind of "asymmetric warfare" the Army finds itself conducting in Iraq, there are no "lines" anymore. In the nineteen-eighties, the Army Medical Command decided that every soldier would carry his or her own wound dressing; today, it is a big cotton pad that can absorb about half a litre of blood. Each thirteen-soldier squad has at least one "combat lifesaver," a soldier with additional first-aid training who carries tourniquets, extra dressings, and maybe a few I.V. bags. Field soldier-medics like Brown and Blohm get the same level of training that used to be reserved for rear-echelon sergeant-medics--sixteen weeks of advanced first aid, drug mathematics, and training in invasive procedures like airway and nasal-gastric tubes and urinary catheters. One medic is usually assigned to every twenty-five-to-thirty-man combat platoon.

Brown resisted the impulse to move straight to the glaring red wounds, and instead snapped into protocols. Doing his best to ignore Cain's shrieking, he did an ABC check on his friend--airway, breathing, and circulation. Then he, Blohm, and two other medics lifted Cain out of the shattered cab and laid him on a litter. Cain wasn't in danger of bleeding to death; the bubbly, malodorous burns caused by the blast had cauterized his arteries. Though the pain was obviously horrible, Brown gave Cain no morphine, because he knew that he would be heading for immediate surgery and wanted him lucid enough to sign surgical-consent papers.

Soldiers speak to each other in a stream of acronyms and abbreviations that are incomprehensible to civilians but essential when shouting complex information over the din of battle. After the ABC check, Brown and Blohm ran through dcap-BTLS--an inventory of deformities, contusions, abrasions, punctures/penetrations, burns, tenderness, lacerations, and swelling. Then they palpated Cain's body in a limb-by-limb tic, or a search for tenderness, instability, and crepitation (bone grinding on bone). They did a CCT, checking for color, condition, and temperature of Cain's skin; and a PMS--pulse, motor, and sensory--check. They found no circulation in the right leg and a weak and inconsistent--"thready"--pulse in the left.

Cain was writhing and crying, and as Blohm and Brown worked they tried to calm him with stock assurances--"You'll be fine," "Everything's O.K."--and jokes about attractive women soldiers in the battalion. When they finished checking vital signs, they turned to Cain's obvious injuries, wrapping what Blohm called the "mush" of the right leg in bandages, splinting both legs. Supporting their friend's head, they rolled him on his side and discovered that his left buttock was half torn off, the flesh laced with rough bits of the truck cab.

An M''" personnel carrier-cum-ambulance--a steel box on tracks-- rumbled up. The medics loaded Cain aboard, and started an I.V. of lactated Ringer's, an electrolyte solution. An Army chaplain slipped in beside Cain. With Blohm holding the I.V. bag and Brown driving, they sped for a landing zone where a Black Hawk helicopter was waiting to take Cain to the "8th Combat Support Hospital--the modern-day equivalent of a mash unit--in Baghdad. Thirty-four minutes had elapsed since the mine blast. Blohm was twenty-three years old. Brown, the senior medic, was twenty-four. Cain was twenty-two.

When an American soldier dies in Iraq, newspapers publish the name. When a soldier is wounded, the incident, if reported at all, is usually an aside. Names are rarely given. The wounding of Michael Cain wasn't newsworthy; a search of wire-service and Times stories for August 11th and 12th turns up little mention of the attack; the Associated Press reported that "four American soldiers were wounded in guerrilla attacks, including two at the Baghdad University complex and two others in Saddam's hometown of Tikrit. One U.S. soldier died of heat stroke and another was found dead in his living quarters on Sunday, the military said." The day after Cain and Duff were injured, the Times reported that Americans were suffering Iraq-war "news burnout."

The Defense Department publishes an online tally of American servicemen killed and wounded in Iraq, updating it every few days. As of February 25th, four hundred and forty-nine had been killed and two thousand four hundred and twenty wounded by hostile fire. The ratio of wounded soldiers to killed is higher in this war (a little more than five to one) than in the Second World War and Vietnam, probably because of body armor and advances in battlefield medicine. (In the Second World War, the ratio was a little more than two to one; by the time of Korea, it had risen to three to one, where it remained until last spring.)

By most American soldiers' accounts, the Iraqis are lousy shots. In any case, they know that the Americans are wearing body armor. Rather than trying to pierce shielded torsos with bullets, the Iraqis increasingly rely on blowing off the Americans' unprotected arms and legs with explosives: car bombs, mines, rocket-propelled grenades, and "improvised explosive devices," which are often old artillery shells that have been buried and then detonated from a distance by some kind of cheap commercial electronic device--a garage-door opener, say, or the joystick of a ten-dollar radio-controlled toy car. As of January 9th, sixty-six service people--almost all of them Army soldiers--had suffered amputation of a hand, a foot, an arm, or a leg. Of those, ten had lost more than one limb.

Cain was injured by an Italian plastic anti-vehicle mine about the size of a tin of butter cookies. (His friends found pieces of the mine afterward.) It would have been easy for someone to feign a flat tire and bury the device quickly in the soft sand at the point where Highway One and the packed-gravel road to the palace compound meet. Apparently, the hemmit did just what the saboteur was hoping. It cut the corner a hair too sharp and depressed the mine's detonator.
 

Kenneth Cain was at home when the call came from Fort Hood, two days after the blast. Kenneth is stout, with a big white beard that makes him look a little like Santa Claus. He called Charlene at work. The first thing she heard when she picked up the phone was her husband weeping. Then he told her that Michael had been seriously wounded.

Cain was lying in a coma at Landstuhl Regional Medical Center, in western Germany, where all Iraq-war casualties are taken. Doctors had amputated his right leg below the knee. The condition of the left leg was uncertain. Cain also had a smashed jaw, a broken thumb, a broken arm, and a wound on the back of his head. He'd lost a lot of blood. During the Second World War, families were lucky to get a telegram days or weeks after a son or a husband was hurt. In this war, the Army kept the Cains informed hour by hour; a major at Fort Hood called them five times in two days. Charlene was even able to speak by telephone with the doctor who was treating her son; she learned that they were about to try turning off life support, leaving it in place in case Cain didn't respond. When she called a second time, a nurse told her they'd switched it off and he'd started breathing on his own. The Fort Hood major was working on getting the Cains plane tickets to Germany when they learned that their son was being flown to Walter Reed Army Medical Center, in Washington, D.C.

Cain remembers none of this; other soldiers say that the trip from Landstuhl to Walter Reed is grim. Litters are loaded into the fuselage of an Air Force transport, which is made of aluminum and tends to be chilly. The roar of the engines barely masks the moaning and crying of the wounded. When a soldier dies en route, his body is simply covered with a sheet.

Walter Reed is a vast campus of red brick buildings in north-central Washington; its centerpiece is the main hospital, a gigantic edifice, which opened in 1977. It's a surprisingly cheerful building, with wide, airy halls and a determinedly upbeat staff. On August 17th, Cain opened his eyes. Finding himself in a hospital bed, he believed that he must be dreaming. A nurse asked him if he wanted anything. "McDonald's," he told her. Then his eyes travelled over the machines and tubes, and he said, "My mom and dad." As it happened, they'd just arrived.

Kenneth and Charlene had been flown to Washington at the Army's expense. They were shown to a room on Ward 57--the orthopedic ward, where amputees go--and found Michael with his head arched back in a high cervical collar. A tube full of "disgusting green fluid," as Charlene recalls it, ran from his nose. His thumb was in a cast, and a three-inch round scab covered the back of his head; a catheter snaked from under the covers, and an I.V. was attached to his arm. Charlene had to tell her son that his leg was gone. He glanced at the end of the bed, where only one foot tented the blanket, then stared at the ceiling for a long time. When they pulled back the covers, Kenneth and Charlene found that Michael's right leg ended in a bandaged stump. His left leg looked as though a dog had been chewing on it: long, crosshatched crimson scars ran up its sides and back. An instrument that Charlene called a "cheese grater" had been run over the skin graft, leaving a pattern of holes that allow the skin to expand and to cover the wounded area. A metal contraption that looked like a miniature offshore oil platform rose out of his left hip, and a big square of skin had been peeled from his upper thigh to provide a graft for the stump. Cain sent Kenneth and Charlene down to the gift shop for a disposable camera and had them take photographs of his gruesome injuries. He pasted them into a flowered "Special Memories" album that he has titled "My Accident in Iraq."

Outwardly, Michael was still Sergeant Cain, telling his parents he wanted only to go back to the 299th in Iraq. (Keisha Duff did in fact return to active duty in Iraq.) He felt responsible for his men. "War's war," he told his mother. "This one was a good thing; it gave people their freedom." But when Charlene told him that his cousin was thinking of joining the Army, he asked for the phone so he could talk him out of it. "He's crazy," Michael said. "I wouldn't let him go. He could end up like me."

continue to part two