On Call in Hell

Then I heard the voice of the Lord saying, "Whom shall I send? And who will go for us?" And I said, "Here I am. Send me!"--Isaiah 7:8 Richard Jadick was bored. The Navy doctor was shuffling paper while Marines were heading out to Iraq. Once, many years before, Jadick had been a Marine officer, but he had missed the 1991 gulf war, stuck behind a recruiter's desk. Now he was looking forward to leading a comfortable life as what he called a "gentleman urologist." Jadick, with a Navy rank of lieutenant commander, was 38--too old, really, to be a combat surgeon.

But then a medical committee searching for help came knocking on his door. Because of an acute doctor shortage, they were having trouble finding a junior-grade Navy doctor to go with the First Battalion, Eighth Marine Regiment (the "1/8"), to Iraq. Jadick at the time was one of the senior medical officers at Camp Lejeune, N.C. "Who could we send?" they asked. Jadick thought for a moment. "Well," he said, "I could go."

His friends told him he was crazy, and his wife, a pediatrician nine months pregnant with their first child, was none too happy. But in the summer of 2004, five days after the birth of his child, Commander Jadick shipped out for Iraq. On the plane, he sat behind a gunnery staff sergeant named Ryan P. Shane. A 250-pound weight lifter, the massive Shane turned in his seat to look at Jadick. Slowly taking the measure of the 5-foot-10, 200-pound Jadick, the gunnery sergeant said, "So you're our new surgeon. That's one job I wouldn't want to have with the place where we're going." That night Jadick e-mailed his wife, "What have I gotten myself into?"

The place they were going was Fallujah. In Sunni territory west of Baghdad, the city seethed with insurgents. Jihadists had strung up the burned bodies of American contractors in the spring of 2004, and chaos had reigned ever since. By November, the United States was tired of waiting for the enemy to give up or clear out. "Over the past five months, [we] have been attacked by a faceless enemy. But the enemy has got a face. He's called Satan. He lives in Fallujah. And we're going to destroy him," said Marine Lt. Col. Gary Brandl on the eve of the attack. Jadick's regiment, the 1/8, was ordered to take what was, in effect, the Main Street of the city. For Jadick, who speaks in a gentle, matter-of-fact voice, occasionally strained by memories of the men he saved and lost, it was to be a journey to the other side of hell.

The night before the assault, Jadick hopped into a command Humvee taking a reconnaissance mission from the headquarters base outside the city. He wanted to --see what he was up against. In treating traumatic injuries, there is something known as the golden hour. A badly injured person who gets to the hospital within an hour is much more likely to be saved. But Jadick knew that in combat the "golden hour" doesn't exist. Left unaided, said Jadick, the wounded "could die in 15 minutes, and there are some things that could kill them in six minutes. If they had an arterial bleed, it could be three minutes."

Jadick knew that helicopter evacuations were out of the question: there was too great a risk the choppers would get shot down. Casualties would have to be driven out of the city. It took Jadick 45 minutes to drive from the base hospital, where he would normally be stationed, to the city. Not close enough. Jadick wanted to push closer to the action.

Jadick, along with 54 Navy corpsmen, his young, sometimes teenage medical assistants, moved to the edge of the city as the assault began; the night sky was lit by tracers and rocket fire. The next morning a call came over the radio. A Navy SEAL with a sucking chest wound needed evacuation. A weapons company was heading in to rescue the man. Lacking much military training, doctors normally stay back in the rear area. But ex-Marine Jadick decided to go to the fight. As shots rang out around them, the weapons company ran and dodged down narrow alleyways toward the building where the SEAL lay wounded. Jadick was armed only with a small 9mm pistol. He thought: "If anyone actually gets close to me, I'm going to have to throw it at him." He felt slightly ridiculous, remembering a "MASH" episode in which Alan Alda tried to scare away the enemy.

In the rubble of a shot-up building, he found the SEAL conscious but bleeding badly. "Get me out of here," the man said. Helping to carry the man on a stretcher down the stairs, Jadick could hear rocket fire and shooting. The air was thick with fine dust and a familiar smell: cordite, from gunpowder. He had smelled cordite before at rifle ranges, but never like this. "It just hung in the air," he recalled.

The radio squawked. Two Marines had been wounded in an ambush in the center of the city. Jadick wanted to get his wounded SEAL back to base camp. But the voices on the radio were insisting that the two men down in the ambush were in even worse shape. It was Jadick's call. He loaded the SEAL into an armored ambulance and set off in the vehicle toward the scene of the shooting. He could hear the firing intensify. Jadick wondered, anxiously, if a rocket-propelled grenade could punch right through the ambulance's metal sides.

The ambulance stopped and Jadick peered out at the first real fire fight of his life. There were not two wounded men, but seven. As a middle-class kid growing up in upstate New York, Jadick had avidly read about war, and even applied to West Point. But he flunked the physical--poor depth perception--and went to Ithaca College on an ROTC scholarship instead. He had served as a communications officer in the Marines, but left the corps after seven years, bitter that he had been left out of the fighting in 1991. Attending medical school on a Navy scholarship, he had never seen or experienced real war--the kind of urban combat that can leave 30 to 40 percent of a unit wounded or dead.

"I can't tell you how scared I was," he recalled. "My legs wanted to stay in that vehicle, but I had to get off. I wanted to go back into that vehicle and lie under something and cry. I felt like a coward. I felt like it took me hours to make the decision to go."

But he got up and went. He felt as though he were "walking through water." Desperately seeking cover, he ran to a three-foot wall where the most badly wounded soldier lay. He lifted the man over the wall to safety. "I put him down on the ground, and he was looking at me," Jadick recalled. The man had a gaping wound in his groin. Jadick tried to "pack" the wound, stuffing sterile gauze packages into the hole torn by an AK-47 round, but he couldn't stop the bleeding. Jadick was forced to make the first of a thousand wretched decisions. "I knew I had six other people that I had to work on. So I don't know..." Jadick paused in the retelling. "I stopped and went on to someone else." It was Jadick's first experience in battlefield triage--forget the mortally or lightly wounded, save the rest--a concept easier to philosophize about than to practice.

Bullets were hissing around him. Afraid of dying, more afraid of failing his comrades, Jadick managed to treat the wounded, to stabilize them and stop the bleeding. As he began loading men into the ambulance, an RPG screamed in--and glanced off the roof without exploding. A second RPG slammed into the wall next to them; it didn't go off, either.

One of the wounded was Ryan Shane--the massive gunnery sergeant Jadick had met on the plane. Shane's abdomen was all shot up. Jadick was unable to lift him, so the sergeant had to crawl into the ambulance by himself. "I made room for him underneath the stretchers," Jadick recalled. But he had to turn away another Marine who had been shot in the foot. There was no more room.

As a urology resident at an inner-city trauma center in Baltimore, Jadick had spent a three-month rotation handling gunshot wounds. But the inside of the darkened ambulance, bathed in red light and blood from the wounded, echoing and rattling with the combat close by, seemed far away from the sterile, scrubbed world of a hospital ER. Working with a medic, Jadick pumped Hespan (a clear blood expander) into veins and tried to pack wounds. One --man was dead already. His body, on the top rack, was bleeding all over the patients below him and Jadick, too--"down my neck, everywhere," Jadick recalled.

Jadick was covered with gore by the time the ambulance reached a transfer point. People standing around the medical tent were staring at him, so he rubbed sand on his uniform. "It made it go dark," he said.

It was not yet noon on Jadick's first day in combat. A Humvee rolled up and a big, husky young Marine from Louisiana, Joel Dupuis, jumped out and began rambling on that his friend, Pvt. Paul Volpe, was going to die. Jadick ran with Dupuis to find a young Marine slumped over on the back hatch of the Humvee. Hit in the thigh, Volpe was "fluorescent-light white," recalled Jadick. His pulse was thin and weak; shock was setting in. Jadick figured the Marine had lost more than half his blood.

Jadick looked at Volpe and thought of the Marine who had died and bled all over him. "I can't let this happen again," he thought, "or there's no point in me being here." Turning to a young Navy doctor, Carlos Kennedy, Jadick instructed, "Pack him like you've never packed a guy before." Kennedy used his boot to stomp in the gauze stuffing. Meanwhile, Dupuis, who was a corpsman, found a vein to insert an IV, and a liter of Hespan started pumping into his unconscious friend.

"All of a sudden, it was the most amazing thing," recalled Jadick. "It was like Frosty the Snowman come to life." Volpe opened his eyes, looked up and asked what was going on. When he saw Dupuis's anxious face, he joked, "I'm all right, I can see your ugly-ass face."

Jadick felt the need to get still closer to the battle. Even though Volpe had reached Jadick's aid station on the edge of the city, the Marine had almost died. In effect, Jadick wanted to set up an emergency room in the middle of the battlefield. Loading up two armored ambulances, he convoyed into the city in the dead of night to establish an aid station in the prayer room of an old government building. The night was quiet, save for the drone of a C-130 gunship searching for prey. Jadick and his men found some metal plates in the street, cleaned them and draped them with sterile gauze as trays for his scalpels. They stacked sandbags by the windows. As the sun rose, the silence was broken by sniper fire.

The casualty runs began arriving in the morning, depositing their grisly cargo. Bodies stacked up. At times Jadick couldn't sterilize his instruments fast enough. "You'd just have to throw some alcohol on the stuff and use it again. I didn't get a chance to wash my hands a lot. I wore gloves as much as possible, but they'd get all torn up and my body would just get covered in blood." Jadick was still afraid. "We were still getting shot at, and there were mortar attacks. But now it was OK somehow. Maybe I had gotten used to it, or maybe just calloused."

Kneeling over a wounded Marine, Jadick was startled to see a muzzle flash from a water tower about 50 yards away. He could clearly see a sniper, his face wrapped in cloth. For a moment, Jadick, the former Marine captain, replaced Jadick, the Navy doctor. A truckload of Marines had just pulled up. "Please go kill that guy," said Jadick, and their commander sent them out to silence the man. Jadick had a fleeting struggle with the Hippocratic Oath ("Do no harm") but thought, "At some point, it's either kill or be killed."

Jadick grew close to his young corpsmen, who were frightened, like him, but cared for the wounded like brothers. "If it would help, they would hold a guy's hand. They did those things to provide comfort, and they weren't afraid to do it. That's not something I taught them. They just did it," Jadick said.

Sometimes the corpsmen behaved like the 18- and 19-year-olds they were. Jadick was miffed at one young clerk, in charge of keeping proper records, who had apparently wandered off. Unable to find the man, Jadick began cursing him, when the clerk appeared around the corner. "Where were you?" Jadick angrily demanded. "Well," the clerk said, "some guys were trying to come across through the open gate, so I shot them." Jadick laughed as he recalled the story. "That's a pretty good excuse, so I'll let you go this time," he told the man.

On the third or fourth night, a vehicle pulled up with a badly wounded Marine named Jacob Knospler. A corporal with a rifle company, Knospler had dragged the shot-up Gunnery Sergeant Shane out of harm's way a few days before. Now, fighting house to house, he had been hit in the face with grenade shrapnel. There was a hole where his mouth and jaw had been. He was conscious and crying and trying to paw at his face. "We had to hold his hands and give him a lot of morphine, as much as he could tolerate," said Jadick. Unable to put a breathing tube down his throat, Jadick worried that Knospler would gag and suffocate on his own blood, tissue and mucus on his way to surgery. He jumped into the ambulance with the wounded corporal and, working with a female medic, kept suctioning the man's horribly wounded face. After 30 minutes, they arrived at a transfer station to hand him over to a new doctor. When the doctor saw the wound, his eyes bulged. "Are you going to be OK with this?" asked Jadick. The doctor said yes, and Jadick headed back to the inferno.

That was a bad night, Jadick recalled, but not the worst. A Marine came in shot in the head. Though he was still breathing, his skull was fractured and his eyeballs were hanging on either side of his face. When Jadick removed the Marine's helmet he could feel the plates of the man's skull moving. There was a distinctive, nauseating smell--of gray matter, brain tissue.

The man died, and so did many of his wounded comrades. But there were some remarkable survivors. A Marine walked over to Jadick and said, "Doc, I've got a headache." Jadick saw with a start that there was a hole in the guy's helmet. Gingerly, Jadick removed the helmet--and saw that a bullet had, in effect, scalped the young Marine, separating a flap of skin at the hairline, but not penetrating his skull. "You're pretty lucky," Jadick said. As both men laughed, Jadick stitched him up. "You don't need to be here anymore today," he told the man, and sent him to the rear.

The laughs were few and far between. A Marine arrived with a chest wound. Jadick had seen the man, Lance Cpl. Demarkus Brown, a few days before, when he showed up with a lip sliced by shrapnel. "Doc, do I get a Purple Heart for this?" Brown had asked. Jadick had assured him that he would, sewed up the lip, and sent him back to the fight. Now the man did not seem too badly wounded. He was breathing and his eyes were open. Still, Jadick was unable to get a breathing tube down his throat. For a moment, Brown seemed to perk up when Jadick inserted a needle in his chest for a tube, but suddenly the blood began to pulse out. A major blood vessel had ruptured inside him. The man's blood pressure was so low that Jadick couldn't get an IV line working.

Jadick talked to the man. "C'mon, Brown, don't give up on me," he gently pleaded. The young man died. He had been an especially well-liked leatherneck, tough but cheerful. "To this day, he's the kid I can't get out of my head," said Jadick, as he was interviewed two years later for this story. "It was one of those things..." Jadick paused and began to weep quietly.

For 11 days, Jadick worked night and day at his forward aid station. In late November, as the area around the government building quieted, Jadick moved his team to an abandoned pickle factory in an industrial area where fighting was still going on. The weather had turned bit-ter cold, so the corpsmen dug holes in the floor and built fireplaces out of rubble. Jadick worried that the IV fluids might become so chilled that the wounded would go into hypothermic shock. To try to warm the fluid to body temperature, corpsmen had the idea of taping pints to their legs and carrying them inside their cargo pockets.

The wounded kept coming. One hero was Matthew Palacios. Injured, he saw a grenade land beside him. Somehow, he had the presence of mind to fling it back, saving the men around him. Increasingly, the wounded were Marines ripped by booby traps and suicide bombers. The KIAs (Killed in Action) were so mangled that Jadick decided to build a morgue, so his young corpsmen wouldn't have to see the shattered bodies piling up.

The one injury Jadick did not see much of was posttraumatic stress disorder. One Marine had to be sent to the rear, and plenty of men complained that they didn't want to go back out and fight--but they did. The PTSD, Jadick knows, will show up for some men only after they're back home, safe but haunted by flashbacks and memories. "We all had PTSD at some level," said Jadick, who nevertheless has not sought treatment.

By mid-December, Fallujah was secured. It had been the worst urban fighting involving Americans since Vietnam. At least 53 Marines and Navy SEALs died, as did something like 1,600 insurgents. By mid-January, Jadick was home: there was an opening for a urology resident at the Medical College of Georgia. Jadick was eager to see his baby daughter and wife.

Jadick was awarded a Bronze Star with a Combat V for valor. (The medal, pinned onto Jadick in January, is the only Combat V awarded a Navy doctor thus far in the Iraq war.) His commanding officer, Lt. Col. Mark Winn, estimated that without Jadick at the front, the Marines would have lost an additional 30 men. Of the hundreds of men treated by Jadick, only one died after reaching a hospital. "I have never seen a doctor display the kind of courage and bravery that Rich did during Fallujah," said Winn. Jadick still owes the Navy a couple of years as a doctor. He's thinking of staying in beyond that. "Being a battalion surgeon is one of the greatest jobs there is," he says, in his low-key way. "So, sure, I would do it again, yeah."