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CAMP SPEICHER, Iraq — Working at a hospital in northern Iraq is like being “emotionally naked,” Capt. Roger Boutin said.

“We’re confronting a lot of fear in this job,” said Boutin, assistant officer in charge of the emergency room at the 399th Combat Support Hospital at Camp Speicher.

The Army Reserve nurses, doctors and medics all have stories to tell about patients that stick out in their minds the most.

For Sgt. Esmeralda Briones, 27, it’s a young Iraqi girl who had both legs amputated. She kept pushing the sheets down, covering her body to prevent anybody from seeing what she looked like.

To cheer her up, Briones painted the girl’s nails in a glittery shade of her favorite color, purple.

“We were pampering her a little bit,” Briones said.

For Capt. Michelle Jacobs, an ER nurse, it’s a woman who came in with two children. All three were injured by shrapnel and the mom started crying when her 2-year-old daughter was wheeled into the operating room.

Jacobs starting crying, too — the only time since she’s been in Iraq.

“That was my falling-apart moment,” she said. “The hardest thing is you can’t talk to them and tell them they’ll be OK.”

The majority of the patients who come to the hospital are Iraqi.

The 399th, a reserve unit out of Massachusetts on a one-year deployment, offers Level 3 care, which means they basically do everything but open heart surgery or neurosurgery, according to Lt. Col. Mike Nott, a registered nurse in civilian life who is doing administration in Iraq.

The hospital seems to know only extremes. It’s either completely quiet or slammed with patients.

“Trauma is like bananas,” said Col. Brian Campbell, chief of professional services. “They come in bunches.”

An empty intensive care unit last week at the 399th Compat Support Hospital at Camp Speicher near Tikrit. The hospital seems to only know extremes — either completely quiet or overloaded with patients. Spc. Alison Yager, a nurse, cleans her weapon during a slow night in the intensive care unit with no patients. Maj. Ted Koutlas, right, a cardiothoracic surgeon from Greenville, N.C., inspects an X-ray of a soldier’s foot in the operating room before cleaning out the bullet wounds. At combat support hospitals many of the doctors work outside their specialty, chipping in wherever they’re needed. Maj. Ted Koutlas, left, and Maj. Dickson Schaeffer inspect a soldier’s bullet wounds to determine what type of operation he would need on his foot. Schaeffer said to his colleagues, “I wonder what the first words out of your mouth are after getting shot in the foot?”

Spc. Katherine Duff, 24, of Randolph, Ohio, in the green shirt, gives CPR to an Iraqi soldier as staff members with the 399th Combat Support Hospital rush him into the emergency room. The soldier, who was brought in by helicopter with his wounded brother, died in the emergency room. Col. Steve Allerding, left, a family practice doctor, confirms a patient's stability during a "tail-to-tail" operation at Camp Speicher near Tikrit. A tail-to-tail is when a medevac helicopter drops patients off at a hospital about halfway to the final destination for another helicopter to pick up and take the rest of the way. That way a medevac crew and flight nurse will be available for the entire trip from say, Mosul to Baghdad. The hospital staff changes out the equipment and ensures patients are stable before sending them off for the second part of the trip. Patients are wrapped in modified body bags for the ride to keep them warm and prevent hypothermia.

Capt. Chris Kretschmeyer of Cleveland prepares to go on a medevac flight with four patients being taken to Balad. Kretschmeyer was the on-call flight nurse when a “tail-to-tail” came into the hospital. Being a flight nurse “tests your nursing skills,” he said. “You can’t see, you definitely can’t hear and there’s limited room to move around the patients.” Medics with 399th Combat Support Hospital rush a patient out to a helicopter to be taken to Balad for further treatment. During a "tail-to-tail," a patient only spends about 10-20 minutes at the intermediate hospital.

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