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Author Topic:   The third rule of war
Tal
Member (Idle past 4193 days)
Posts: 1140
From: Fort Bragg, NC
Joined: 12-29-2004


Message 1 of 24 (215579)
06-09-2005 8:56 AM


Warning: Tough read and a bit long.

Dear Dad,

The first rule of war is that young men and women die. The second rule of war is that surgeons cannot change the first rule...

We had already done around a dozen surgical cases in the morning and the early afternoon. The entire medical staff had a professional meeting to discuss the business of the hospital and the care and treatment of burns. It is not boastful or arrogant when I tell you that some of the best surgeons in the world were present - I have been to many Institutions, and I have been all around the world, and at this point in time, with this level of experience, the best in the world are assembled here at Balad.

LTC Dave S., the "Trauma Czar," and a real American hero is present.
He has saved more people out here than anyone can imagine. The cast of characters includes two Air Force Academy graduates, Col(s) Joe W. and Maj Max L. When you watch ER on television, the guys on the show are trying to be like Max - cool, methodical, and professional.
Max never misses anything on a trauma case because he sees everything on a patient and notes it the same way the great NFL running backs see the entire playing field when they are carrying the ball. Joe is an ENT surgeon who is tenacious, bright, and technically correct every single time - I mean every single time. The guy has a lower tolerance for variance than NASA. LTC (s) Chris C. was the Surgeon of the Day (SOD), and I was the back-up SOD. Everyone else was there and available- as I said the best in the world.

As the meeting was breaking up, the call came in.

An American soldier had been injured in an IED blast north of here, and he was in a bad way with head trauma. The specifics were fuzzy, but after three months here, what would need to be done was perfectly clear- the 332 Expeditionary Medical Group readied for battle. All the surgeons started to gravitate toward the PLX which is the surgeon's ready room and centrally located midway to the ER, OR, and radiology. The lab personnel checked precious units of blood, and the pharmacy made ready all the medications and drugs we would need for the upcoming fight. An operating room was cleared, and surgical instruments were laid out, the anesthesia circuits were switched over, and the gasses were checked and rechecked. An anesthesiologist and two nurse anesthetists went over the plan of action as the OR supervisor made the personnel assignments. In the ER, bags of IV fluids were carefully hung, battery packs were checked, and the ER nursing supervisor looked over the equipment to make sure all was in working order and the back-ups were ready just in case the primaries failed. The radiology techs moved forward in their lead gowns bringing their portable machines like artillery men of old - wheeling their cannon into place. Respiratory therapy set the mechanical ventilator, and double checked the oxygen. Gowns, gloves, boots, and masks were donned by those who would be directly in the battle. All of the resources - medical, mechanical, and technological that American technology can bring to the war were in place and ready along with the best skill and talent from techs to surgeons. The two neurosurgeons gathered by themselves to plan.

LTC A. is a neurosurgeon who still wears his pilot wings proudly. He
used to be a T-38 instructor pilot, and some of the guys he trained to fly are now flying F-16's right here at Balad. He is good with his hands and calm under pressure. The other neurosurgeon is Maj W. a gem of a surgeon who could play the guitar professionally if he was not dedicated to saving lives. A long time ago, at a place on the other side of the world called Oklahoma, I operated on his little brother after a car accident and helped to save his life. The two neurosurgeons, Chris, and I joined for the briefing. Although, I was the ranking officer of the group, Chris was the SOD and would be the flight lead. If this was a fighter sweep, all three of those guys would be Weapons School Patch wearers. The plan was for me and the ER folks to assess, treat, and stabilize the patient as rapidly as possible to get the guy into the hands of the neurosurgeons. The intel was that this was an IED blast, and those rarely come with a single, isolated injury. It makes no sense to save the guy's brain if you have not saved the heart pump that brings the oxygenated blood to the brain. With this kind of trauma, you must be deliberate and methodical, and you must be deliberate and methodical in a pretty damn big hurry. All was ready, and we did not have to wait very long. The approaching rotors of a Blackhawk were heard, and Chris and I moved forward to the ER followed by several sets of surgeon's eyes as we went. We have also learned not to clog up the ER with surgeons giving orders. One guy runs the code, and the rest follow his instructions or stay out the way until they are needed.

They wheeled the soldier into the ER on a NATO gurney shortly after the chopper touched down. One look at the PJ's faces told me that the situation was grim. Their young faces were drawn and tight, and they moved with a sense of directed urgency. They did not even need to speak because the look in their eyes was pleading with us - hurry. And hurry we did. In a flurry of activity that would seem like chaos to the uninitiated, many things happened simultaneously. Max and I received the patient as Chris watched over the shoulder to pick out anything that might be missed. An initial survey indicated a young soldier with a wound to the head, and several other obvious lacerations on the extremities. Max called out the injuries as they were found, and one of the techs wrote them down. The C-collar was checked, the chest was auscultated as the ET tube was switched to the ventilator. Chris took the history from the PJ's because the patient was not conscious. All the wounds were examined and the dressings were removed except for the one on the head. The patient was rolled on to his side while his neck was stabilized by my hands, and Max examined the backside from the toes to the head. When we rolled the patient back over, it was onto an X-ray plate that would allow us to take the chest X-Ray immediately. The first set of vitals revealed a low blood pressure; fluid would need to be given, and it appeared as though the peripheral vascular system was on the verge of collapse. I called the move as experienced hands rolled him again for the final survey of the back and flanks and the X-Ray plate was removed and sent for development.

As we positioned him for the next part of the trauma examination, I noted that the hands that were laid on this young man were Black, White, Hispanic, Asian, American Indian, Australian, Army, Air Force, Marine, Man, Woman, Young, and Older. A true cross section of our effort here in Iraq, but there was not much time to reflect. The patient needed fluid resuscitation fast, and there were other things yet to be done.

Chris watched the initial survey and the secondary survey with a situational awareness that comes from competence and experience.
Chris is never flustered, never out of ideas, and his pulse is never above fifty. With a steady, calm, and re-assuring voice, he directed the next steps to be taken. I moved down to the chest to start a central line, Max began an ultrasonic evaluation of the abdomen and pelvis. The X-rays and ultrasound examination were reviewed as I sewed the line in place, and it was clear to Chris that the young soldier's head was the only apparent life threatening injury. The two neurosurgeons came forward, and removed the gauze covering the soldier's wounded head, and everyone's heart sank as we saw the blossom of red blood spreading out from shredded white and grey matter of the brain. Experience, told all the surgeons present, that there was no way to survive the injury, and this was one battle the Medical group was going to lose. But he was American, and it was not time to quit, yet. Gentle pressure was applied over the wound, and the patient went directly to the CT scanner as drugs and fluids were pumped into the line to keep his heart and lungs functioning in a fading hope to restore the brain. The time elapsed from his arrival in the ER to the time he was in the CT scanner was 5 minutes.

The CT scan confirmed what we had feared. The wounds to the brain were horrific and mortal, and there was no way on earth to replace the volume of tissue that had been blasted away by the explosion.
The neurosurgeons looked at the scan, they looked at the scan a second time, and then they re-examined the patient to confirm once again. The OR crew waited anxiously outside the doors of radiology in the hope they would be utilized, but Chris, LTC's A. and S., and Maj W. all agreed. There was no brain activity whatsoever.

The chaplain came to pray, and reluctantly, the vent was turned from full mechanical ventilation to flow -by. He had no hint of respiratory activity, his heart that had beat so strong early in the day ceased to beat forever, and he was pronounced dead. The pumps were turned off; the machines were stopped, and the IV's were discontinued. Respectful quiet remained, and it was time to get ready for the next round of casualties. The techs and nurses gently moved the body over to the back of the ER to await mortuary services. And everyone agreed there was nothing more we could have done.

When it was quiet, there was time to really look at the young soldier and see him as he was. Young, probably in his late teens, with not an ounce of fat anywhere. His muscles were powerful and well defined, and in death, his face was pleasant, and calm. I am always surprised that anyone still has tears to shed here at Balad, but thank God they still do. The nurses and techs continued to care for him and do what they could. Not all the tubes and catheters can be removed because there is always a forensic investigation to be done at Dover AFB, but the nurses took out the lines they could. Fresh bandages were placed over the wounds, and the blood clots were washed from his hair as his wound was covered once more. His hands and feet were washed with care. A broken toenail was trimmed, and he was silently placed in the body bag when mortuary services arrived as gently as if they were tucking him into bed.

Later that night was Patriot Detail - our last goodbye for an American hero. All the volunteers gathered at Base Ops after midnight under a three-quarter moon that was partially hidden by high, thin clouds. There was only silence as the Chief Master Sergeant gave the Detail its instructions. Soldiers, Airmen, and Marines, Colonels, Privates, and Sergeants, pilots, gunners, mechanics, surgeons, and clerks all marched out side by side to the back of the waiting transport, and presently, the flag draped coffin was carried through the cordon as military salutes were rendered. The Detail marched back from the flightline, and slowly the doors of the big transport were secured. The chaplain offered prayers for anyone who wanted to participate, and then the group broke up as the people started to move away into the darkness. The big engines on the transport fired up, and the ground rumbled for miles as they took the runway. His duty was done - he had given the last full measure, and he was on his way home.

The first rule of war is that young men and women die. The second rule of war is that surgeons cannot change the first rule. I think the third rule of war should be that those who have given their all for our freedom are never forgotten, and they are always honored. I wish there was not a war, and I wish our young people did not have to fight and die. But I cannot wish away evil men like Bin Laden and al-Zarqawi. These men are not wayward children who have gone astray; they are not great men who are simply misunderstood. These are cold blooded killers and they will kill you, me, and everyone we love and hold dear if we do not kill them first. You cannot reason with these people, you cannot negotiate with these people, and this war will not be over until they are dead. That is the ugly, awful, and brutal truth. I wish the situation was different, but it is not. Americans have two choices. They can run from the threat, deny it exists, candy coat it, debate it, and hope it goes away. And then, Americans will be fair game around the world and slaughtered by the thousands for the sheep they have become. Our second choice is to crush these evil men where they live and have the political will and courage to finish what we came over here to do. The last thing we need here in Iraq is an exit strategy or some damn timetable for withdrawal. Thank God there was no timetable for withdrawal after the Battle of the Bulge or Iwo Jima. Thank God there was no exit strategy at Valley Forge. Freedom is not easy, and it comes with a terrible price...I saw the bill here - yesterday.

The third rule of war should be that we never forget the sacrifices made by our young men and women, and we always honor them. We honor them by finishing what they came to accomplish. We remember them by never quitting and having the backbone and the guts to never bend to the yoke of oppression. We honor them and remember them by having the courage to live free.

This one was a little long, but thanks for listening, I needed to say it.

Love,

Brett


Replies to this message:
 Message 2 by Silent H, posted 06-09-2005 2:30 PM Tal has responded
 Message 9 by CK, posted 06-10-2005 1:56 PM Tal has not yet responded
 Message 12 by mikehager, posted 06-10-2005 4:03 PM Tal has not yet responded
 Message 16 by crashfrog, posted 06-10-2005 7:34 PM Tal has responded

  
Silent H
Member (Idle past 4336 days)
Posts: 7405
From: satellite of love
Joined: 12-11-2002


Message 2 of 24 (215663)
06-09-2005 2:30 PM
Reply to: Message 1 by Tal
06-09-2005 8:56 AM


rule #4: We do not let the memories of soldiers' sacrifices be used to justify poor decisions by policy makers including the very wars they may have died in.

rule #5: We make sure not to debase our reason and resort to hyperbolic and stock dilemma commentary such as...

I cannot wish away evil men like Bin Laden and al-Zarqawi. These men are not wayward children who have gone astray; they are not great men who are simply misunderstood. These are cold blooded killers and they will kill you, me, and everyone we love and hold dear if we do not kill them first. You cannot reason with these people, you cannot negotiate with these people, and this war will not be over until they are dead. That is the ugly, awful, and brutal truth. I wish the situation was different, but it is not. Americans have two choices. They can run from the threat, deny it exists, candy coat it, debate it, and hope it goes away. And then, Americans will be fair game around the world and slaughtered by the thousands for the sheep they have become. Our second choice is to crush these evil men where they live and have the political will and courage to finish what we came over here to do.
... which not only leads us needlessly into giving up our freedoms to tyrants but also to having to face the first rule of war.

I have no idea if that was a real letter or not. That I just heard that opening line on M*A*S*H* a week ago makes me wonder, but regardless IRAQ HAD NOTING TO DO WITH 9/11 OR AL-QAIDA!!! We STRENGTHENED ZARQAWI'S PRESENCE IN IRAQ and GAVE AQ A NEW PLATFORM TO ATTACK US TROOPS! Thus the message was as phony as a 3 dollar bill.

While I agree that... now that we are in... we must see the job through in Iraq, that does not in any way justify us having gone there in the first place. If this letter was a private moment of reflection from a soldier to a parent, then so be it. That it is apparently being used... by you... to push a belief that we only have two choices: follow Bush or die like sheep, is simply using the memory of dead soldiers for your own advantage.

Shame on you.


holmes
"...what a fool believes he sees, no wise man has the power to reason away.."(D. Bros)

This message is a reply to:
 Message 1 by Tal, posted 06-09-2005 8:56 AM Tal has responded

Replies to this message:
 Message 3 by Tal, posted 06-09-2005 2:58 PM Silent H has responded

  
Tal
Member (Idle past 4193 days)
Posts: 1140
From: Fort Bragg, NC
Joined: 12-29-2004


Message 3 of 24 (215670)
06-09-2005 2:58 PM
Reply to: Message 2 by Silent H
06-09-2005 2:30 PM


I'd rather fight them over there than have them over here.


"A good plan executed today is better than a perfect plan executed at some indefinite point in the future."
- General George Patton Jr

www.1st-vets.us


This message is a reply to:
 Message 2 by Silent H, posted 06-09-2005 2:30 PM Silent H has responded

Replies to this message:
 Message 4 by Silent H, posted 06-09-2005 3:51 PM Tal has not yet responded
 Message 5 by Alexander, posted 06-09-2005 11:26 PM Tal has responded

  
Silent H
Member (Idle past 4336 days)
Posts: 7405
From: satellite of love
Joined: 12-11-2002


Message 4 of 24 (215684)
06-09-2005 3:51 PM
Reply to: Message 3 by Tal
06-09-2005 2:58 PM


I'd rather fight them over there than have them over here

1) Asymmetrical warfare means that there is no such thing as a frontline, and so you can find yourself attacked at home just the same if you have troops in "their country" or not.

This point was made by Rumsfeld early on, I believe before 9/11, when he was discussing the future of the military. I actually agreed with Rumsfeld on many points of criticism he had regarding Clinton's handling of the military. Now it seems I am a radical for believing Republicans were right? Hmmm.

2) Iraq was not in any position to get over here, much less be over here, so much the less "fight us" over here. Afghanistan makes sense, Iraq did not at the time and still does not (given your rationale). The only reason we have to be there now is to make sure it doesn't get even worse, since we screwed the whole nation.

3) I'm glad to see you didn't bother trying to defend your tacky use of a dead soldier to further your own political beliefs. I'm disappointed to see you didn't make an apology.

This message has been edited by holmes, 06-09-2005 03:53 PM


holmes
"...what a fool believes he sees, no wise man has the power to reason away.."(D. Bros)

This message is a reply to:
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Alexander
Inactive Member


Message 5 of 24 (215768)
06-09-2005 11:26 PM
Reply to: Message 3 by Tal
06-09-2005 2:58 PM


That is really the lamest knee-jerk reply you could possibly have given. What the hell does that mean? Did you fire a single neuron considering whether a vapid sound byte like that means anything? My guess is no!

Al Q. and friends have a practically infinte recruiting pool stretching from the pillars of hercules to the jungles of Indonesia. They can send retards from the slums of a few dozen countries to blow themselves up outside our checkpoints from now till the end of time. What is to stop them from simultaneously dropping a vial of sarin on the subway in Manhattan? Or infecting a new recruit with smallpox and walking him around Grand Central until he collapses?

Before you question my patriotism or party affiliation, let me say this: I was in downtown Manhattan the day of September 11th, and I was very happy to see taliban heads being smashed in Afghanistan. I just wasn't convinced to turn my brain off to rational discourse and tune instead to poorly conceived propoganda. You can do better, maybe.


'Most temperate in the pleasures of the body, his passion was for glory only, and in that he was insatiable.'

This message is a reply to:
 Message 3 by Tal, posted 06-09-2005 2:58 PM Tal has responded

Replies to this message:
 Message 6 by Tal, posted 06-10-2005 9:14 AM Alexander has not yet responded

  
Tal
Member (Idle past 4193 days)
Posts: 1140
From: Fort Bragg, NC
Joined: 12-29-2004


Message 6 of 24 (215835)
06-10-2005 9:14 AM
Reply to: Message 5 by Alexander
06-09-2005 11:26 PM


Sounds like you guys got it all figured out.

Run for President.


"A good plan executed today is better than a perfect plan executed at some indefinite point in the future."
- General George Patton Jr

www.1st-vets.us


This message is a reply to:
 Message 5 by Alexander, posted 06-09-2005 11:26 PM Alexander has not yet responded

Replies to this message:
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 Message 8 by Silent H, posted 06-10-2005 11:43 AM Tal has not yet responded

  
nator
Member (Idle past 686 days)
Posts: 12961
From: Ann Arbor
Joined: 12-09-2001


Message 7 of 24 (215849)
06-10-2005 10:21 AM
Reply to: Message 6 by Tal
06-10-2005 9:14 AM


From lame to lamer.

This message is a reply to:
 Message 6 by Tal, posted 06-10-2005 9:14 AM Tal has not yet responded

  
Silent H
Member (Idle past 4336 days)
Posts: 7405
From: satellite of love
Joined: 12-11-2002


Message 8 of 24 (215876)
06-10-2005 11:43 AM
Reply to: Message 6 by Tal
06-10-2005 9:14 AM


Sounds like you guys got it all figured out.

I found it easy at the time, having read history on the area as well as public information regarding the issues at hand. This included some info from top US intelligence people who were critical of statements being made by the Bush administration.

It has since become impossible to figure out except by those who refuse to acknowledge reality. Bush himself has admitted mistakes were made, and that means he and his crew made them, not his opponents.

The real question at this point is why haven't you figured things out by now? Hindsight is 20/20 unless you have taken the term literally and jammed your head up your...

Run for President.

But performance and intellectual ability and even principles, can't guarantee a victory. We saw this with the 2004 election. A sound victory in debates got spun as a reason to despise and doubt the victor, and traditional conservative principles were spun to be weak hippy pacifist tripe.

In any case, these short bursts have done nothing to either suggest you have things figured correctly, nor make up for having used a dead soldier for your own political ends. Then again you callously use the tragic murder of thousands for your own ends within your avatar so I guess it is just par for the course.

Too bad about them facts, huh?

This message has been edited by holmes, 06-10-2005 11:45 AM


holmes
"...what a fool believes he sees, no wise man has the power to reason away.."(D. Bros)

This message is a reply to:
 Message 6 by Tal, posted 06-10-2005 9:14 AM Tal has not yet responded

Replies to this message:
 Message 10 by Chiroptera, posted 06-10-2005 2:09 PM Silent H has responded

  
CK
Member (Idle past 2644 days)
Posts: 3221
Joined: 07-04-2004


Message 9 of 24 (215907)
06-10-2005 1:56 PM
Reply to: Message 1 by Tal
06-09-2005 8:56 AM


The third rule of war is...
quote:
History teaches that war begins when governments believe the price of aggression is cheap.

This message is a reply to:
 Message 1 by Tal, posted 06-09-2005 8:56 AM Tal has not yet responded

Replies to this message:
 Message 14 by Phat, posted 06-10-2005 7:18 PM CK has responded

  
Chiroptera
Member
Posts: 6914
From: Oklahoma
Joined: 09-28-2003
Member Rating: 3.4


Message 10 of 24 (215914)
06-10-2005 2:09 PM
Reply to: Message 8 by Silent H
06-10-2005 11:43 AM


quote:
But performance and intellectual ability and even principles, can't guarantee a victory. We saw this with the 2004 election.

And the 2000 elections showed that having more votes doesn't count, either.


This message is a reply to:
 Message 8 by Silent H, posted 06-10-2005 11:43 AM Silent H has responded

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Silent H
Member (Idle past 4336 days)
Posts: 7405
From: satellite of love
Joined: 12-11-2002


Message 11 of 24 (215939)
06-10-2005 3:09 PM
Reply to: Message 10 by Chiroptera
06-10-2005 2:09 PM


having more votes doesn't count, either.

Oh, I was just hoping that was part of the "9/11 changed everything", and we'd never see it happen again. Was that naive of me?


holmes
"...what a fool believes he sees, no wise man has the power to reason away.."(D. Bros)

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 Message 10 by Chiroptera, posted 06-10-2005 2:09 PM Chiroptera has not yet responded

  
mikehager
Member (Idle past 4983 days)
Posts: 534
Joined: 09-02-2004


Message 12 of 24 (215958)
06-10-2005 4:03 PM
Reply to: Message 1 by Tal
06-09-2005 8:56 AM


Third rule?
Okay, the first rule of war is "Never get involved in a land war in Asia." The second, and only slightly less well know, is "Never go up against a Sicilian when death is on the line."

What would be a short version of you third?


This message is a reply to:
 Message 1 by Tal, posted 06-09-2005 8:56 AM Tal has not yet responded

  
EZscience
Member (Idle past 3670 days)
Posts: 961
From: A wheatfield in Kansas
Joined: 04-14-2005


Message 13 of 24 (215996)
06-10-2005 7:04 PM


Tal's letter writes:

I think the third rule of war should be that those who have given their all for our freedom are never forgotten, and they are always honored.

I think this raises a very interesting point in the context of this disputed war. Even if one feels that a particular war is unjustified (was it really about 'our' freedom ?), should this diminish our respect any for those who have died obeying their duty to government and country? I suggest not. But it does make their demise seem a little more tragic and unnecessary.


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Phat
Member
Posts: 13945
From: Denver,Colorado USA
Joined: 12-30-2003
Member Rating: 1.4


Message 14 of 24 (215997)
06-10-2005 7:18 PM
Reply to: Message 9 by CK
06-10-2005 1:56 PM


Re: The third rule of war is...
Tal,quoted by Charles writes:

History teaches that war begins when governments believe the price of aggression is cheap.

In terms of "cheap" vs expensive...In the third world, life is seemingly cheap...at least from our perspective. Al Queda thinks little of sending countless bodies to be blown to smithereens while the U.S. goes to great lengths to preserve our soldiers...even if it means killing a thousand of the enemy. We are expensive with our war, however...we will sacrifice a generations social welfare to finance this war. We spend billions yet lose hundreds in csualties. They would sacrifice millions of lives for their ideals and yet are unable to spend more than several million dollars max to do so.

This message is a reply to:
 Message 9 by CK, posted 06-10-2005 1:56 PM CK has responded

Replies to this message:
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CK
Member (Idle past 2644 days)
Posts: 3221
Joined: 07-04-2004


Message 15 of 24 (215998)
06-10-2005 7:24 PM
Reply to: Message 14 by Phat
06-10-2005 7:18 PM


Re: The third rule of war is...
Well you should have told Ronald Reagan about that. :)

This message is a reply to:
 Message 14 by Phat, posted 06-10-2005 7:18 PM Phat has not yet responded

  
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