On a dusty road in the middle of nowhere, Afghanistan, an IED explodes under a U.S. Humvee. It’s an ambush: rocket-propelled grenades, rifle and machine-gun fire rain down from the nearby hills.
U.S. troops fight off the attack, but several are wounded. Medics tie tourniquets; buddies apply bandages and radio ahead as they speed to the closest coalition hospital.
After that, all the soldiers can do is pray before handing their shattered friends over to the team of doctors, nurses and technicians waiting to deal with the true cost of the war in Afghanistan.
Some of those who treated such soldiers now walk the halls of Jacksonville Naval Hospital every day, in medical scrubs or in uniform.
Their skills were forged through treating some of the most horrific injuries humans can suffer.
Thanks to their expertise and medical advancements, many who would’ve died in years past survived. In fact, if U.S. military personnel made it to the hospitals in Afghanistan or Iraq, they were nearly always saved.
“When we knew we had a group of casualties coming in, everybody, and I mean everybody, runs to the hospital, and we all had our roles,” said Cmdr. Treva Poerschmann, an operating room nurse at Jacksonville Naval Hospital who served in Afghanistan.
The road there first took her through what was then the National Naval Medical Center, now Walter Reed, in Bethesda, Md.
“When I was at Bethesda, I took care of the wounded who would come back from Iraq and Afghanistan,” she said. “I think my experiences at Bethesda helped prepare me because I knew what kind of injuries I was going to see.”
But something else affected her as much as the injuries.
“I have to tell you what helped me at Bethesda is the guys with those kinds of injuries are so … I’m sorry,” she paused as her blue eyes welled up with tears. “They and their families are just so upbeat and just getting them home …”
Capt. William Todd also worked at Bethesda. A veteran orthopedic surgeon, he is now head of Jacksonville Naval Hospital’s surgical department.
He remembered one Marine, whose legs were blown off in an IED attack, who was not so upbeat.
“His legs were blown off and his arm badly mangled and he lay in his bed day after day,” Todd told a group at the Pentagon recently. “I began to question why we were doing this; were we depriving this once-proud Marine of his final dignity?”
Then Todd visited the man’s room on the final day of a long weekend shift and saw the Marine’s son guzzling milk.
“I’m going to drink all my milk so I can grow up to be big and strong and become a Marine,” the boy told the doctor. “Then I’m going to give my dad one of my legs so we can be the same.”
Shaken, Todd turned away and the Marine in the bed gave him a thumbs-up.
“I questioned something his little boy never did, and I was wrong,” Todd said.
A miracle of survival
Petty Officer 2nd Class Justin Purnell, a surgical technician at Jacksonville Naval Hospital, was at Bethesda, too. He and Todd worked together on the USNS Mercy, a Navy hospital ship, when it deployed to Haiti after the 2010 earthquake.
Todd considers the hospital ships his niche. He’s performed surgeries in 16 countries.
The Mercy was Purnell’s first time on a hospital ship.
“We had about 24 hours’ notice and were told, ‘Pack a sea bag,’ ” Purnell said.
The Mercy arrived just days after the massive quake; Todd was the only orthopedic surgeon among the rescuers.
“My first day was 47?1/2 hours,” Todd said. “Then lay down for a couple of hours and then it was 46 hours.”
The patients began as a trickle, but soon the trickle became a flood.
“It was eight weeks doing nothing but things I’d never seen,” Purnell said. “It was war injuries, crush injuries on a humanitarian scale that no one had seen before.”
That experience would serve Purnell well the next year in Kandahar, Afghanistan, when a Taliban rocket hit dead-center of the U.S. chow hall right at dinnertime.
“Whenever that mass casualty thing came through, the whole hospital stood up,” he said. “This was our first mass casualty with people coming in one after the other.
“Some people just had scrapes, but others were a lot of bowel injuries from the shrapnel.”
Through some miracle, no one died in Purnell’s Afghanistan initiation, he said.
In the months to come, that would change.
Some saved each other
“[Afghanistan] was definitely a hard experience, and of course you would have people pass before they made it to the OR, and we would always see them off properly,” he said. “It was hard, some of it, of course.”
But many were saved.
Cmdr. Poerschmann was at the same NATO hospital in Kandahar in 2013.
“If you hit our hospital door there in Kandahar, you had something like a 98 percent chance of living and getting back to the states,” she said.
She gave a large part of the credit for that statistic to the Navy corpsmen, Army medics and others in the field for their work to keep soldiers alive long enough to get them to the hospital.
“Probably the hardest to see were the guys who came in and had a traumatic amputation of the leg and an amputation of the arm at the same time and that is just …” she hesitated, clearly emotional. “I give all the credit to those guys in the field.
“If they hadn’t come in with tourniquets on, they’d have never made it.”
Though what Poerschmann, Todd and Purnell have seen has forever changed their lives, all of them said it was an honor.
In fact, Todd said witnessing the cost of war is important in itself — even for his own children.
“When they would come for their visits to see their doctors, in the lobby they’d see people with missing extremities,” he said. “There is no question at all that it’s important for them to understand that.”