$INV: “I’ve been to war, twice. Iraq in ‘09 and Afghanistan in ‘11. I am just a fucking ER doc.” | Jan 2020


1/ I’ve been to war, twice. Iraq in ‘09 and Afghanistan in 2011. I am just a fucking ER doc. But it was there, in the deserts far,far from home, that I made my bones as a newly board certified ER doc. It is around that time, I think that I lost my capacity to feel joy. 

2/ Being in war is a strange place. As an ER doc, I wasn’t out kicking doors or taking small arms fire. I was back in base at the level 1 trauma center, waiting for the wounded to pour in. As far as safety went, I was about as safe as you can get there. 

3/ Safety is relative. Because we were frequent targets of mortar fire in Iraq, mostly rockets in Afghanistan. My base in Iraq got shelled so often, it was dubbed Mortaritaville. In fact 1 missed me and my buddy by just a couple of minutes of us standing right where they landed. 

4/ That was my 2nd day in country, in the middle of the most hellacious sandstorm you could imagine. We were not prior service, we were science nerds, avoiding active murder by chance. This was a lot for us compared to our prior experiences. 

5/ My first overnight shift was quiet, until the 4 blackhawks landed outside and rushed several soldiers to the trauma bay via Hero’s Higway. My patient was a young man from west Texas, stationed in northern Alaska. Both his legs were gone, shredded. One above the knee,one below. 

6/ His tourniquets were causing much pain and had been up for a couple of hours. I loaded him up with pain meds and we chatted to take his mind off the destruction that had been wrought on his once Adonis-like body before he went to the OR to clean him up. 

7/ he told me of his fondness for living up there near the arctic circle. Surprised me for a west Texas boy. He told me of his fun snow shoeing, skiing and all the other athletic endeavors he had picked up. We held hands, me blocking the view below me until he went to the OR. 

8/ I went to my office, put my hands in my head and cried. Maybe for the first time as a physician. I cried for him, I cried for me and the long 7 months stretching out in front of me where I would witness the brutality of a war that I had once backed that I was starting to Q. 

9/ And I went back to work. And I saw them again, and again, and again. Night after night 6 -7 nights a week for months on end. My life was mostly utter and complete boredom punctuated by minutes to hours of sheer adrenaline. When they come, they all come together. 

10/ For all but a few, that’s what war is, boredom, but knowing that shit could hit the fan at any second. And that if you didn’t perform at peak when called, that someone would die. And often, they would die even despite all you did. 

11/ No matter your job, that’s what it looked like for all of us. We tried to completely relax, but when death could come from the sky at any time, or a foreign officer could turn on his troops and shoot down anyone in his vicinity, there is no REAL relaxation. 

12/ Your world has been shrunk to a 2-3 block radius. You will trudge the 2 minutes to work and back many times. Then 2 minutes to the gym tent. Then 2 minutes to the chow hall. Overandoverandoverandover. For 6-12 months. Your bed is in a plywood room that measures 7.5×7.5 feet. 

13/ And then we come home to regular life. Which is in some ways harder to adjust to than it was adjusting to over there. There is no routine. Here, you have to think about others than your own grind. People want you to smile and be happy. You’re kids want you to pay attention. 

14/ You’re wife wants you to pick up some slack,but has new routines doing everything the way she wants and there is friction when you don’t do it, as there is when you try and change a well set routine. You must work, which for me is still in another ER,wading through death. 

15/ And so you put your game face in and try to fake it till you make it. And occasionally even miss the place you hated, the place that changed you, the place that robbed you of feeling joy. But the routine makes sense, the work is important, and you take care of only you. But. 

16/ but- it’s hard. You’ve been home a year, and you are already on a calendar marking your upcoming trip to do it all over again, in a distant, probably worse location. The anxiety needles at you, distracts, and pulls you further into your head, and away from your family. 

17/ And this is one of the ways war changes us. It steals our joy, but somehow makes us want to come back for more. Despite it all. 

18/ I’m hearing people clamoring for war all the time. They talk a big game, and seem to get a thrill out of the carnage that they watch from 1000s of miles away. But they forget the 19yo private, the 32 yo Sgt, the 38 year old major that are getting it done. 

19/ They thank us, but they bite for war-hawks that want to put us in harms way for various, often very murky reasons. Before you get hung ho for war, consider that the human costs aren’t only tallied in death or injury but also in destroyed families and the theft of joy. 

20/ Not sure where this came from tonight. Probably the Iran thing, and all the back and forth on twitter. Makes me so damn tired. And that old pre-deployment anxiety is still fluttering down there, somewhere in the dark recesses of my mind. Thanks for reading my longest tweet. Every injured soldier in theater was transported through Hero’s Highway which separated the helipad from the trauma bay.


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