At Frontline Hospital, Afghan War's Toll Is Deeply Felt

As fighting season begins in Afghanistan, the Kandahar Airfield hospital will likely triple its trauma cases.

Mockenhaupt apr25 p.jpg

Peter Andrews/Reuters

KANDAHAR, Afghanistan -- By 7 a.m., the first patients of the day were slid off the medevac helicopters and wheeled into the trauma bay at the Kandahar Airfield hospital in southern Afghanistan.

"I've got a wedding ring. Make sure my wife gets it," Staff Sergeant Jeremy Breece said. His face was streaked black and green with camouflage paint, and smeared with dirt from the explosion. "I need to call her and let her know I'm okay." A tourniquet squeezed each thigh. His legs ended just below the knees, still covered in shredded pantleg. The trauma team -- a doctor, two nurses, and two Navy corpsmen -- cut away his uniform and checked for other wounds

"How's Pops?" Breece asked, before a nurse sedated him.

Specialist Adam "Pops" Castagna, one of the oldest in the platoon at 37, had been walking just behind and to the left of Breece when the blast hit his torso and face. Now he lay on a gurney eight feet from Breece, groaning. "I can't breathe," he said. "My stomach is killing me." Though he had no visible injuries other than cuts on his face, an ultrasound showed blood filling his abdominal cavity. The explosive force had ruptured several organs. Fifteen minutes after arriving at the hospital, Castagna was wheeled into the operating room, where surgeons sliced open his abdomen and searched for source of the bleeding.

Thirty minutes later, Breece entered a neighboring operating room. Surgeons tied off blood vessels and cut away torn and shattered skin, muscle, and bone. They cleaned out dirt and shrapnel from his flesh and muscle and then sewed his legs shut.

For the hospital staff, a mix of Americans, Canadians, Dutch, Belgians, Australians, and French, such injuries are common fare, and their frequency is increasing. From the slow winter months to the height of summer fighting season, daily trauma cases typically triple between January and July. Military leaders expect the same this summer as the Taliban fight to reassert control over areas where coalition forces made significant gains over the past year, and to retain areas where they still hold sway. The steady climb in casualties has already begun. The hospital, just one of many NATO medical facilities across Afghanistan, saw in a single April day: gunshot wound; IED; gunshot wound; IED; IED (two victims); suicide bomber (six victims); IED.

The cases are often more complex than those seen in civilian trauma centers in the U.S. Here, a single patient could have multiple amputations, shrapnel wounds, burns, internal bleeding from concussive force, and a brain injury. But survivability is high, in large part because of the fast and frequent use of tourniquets in the field. Once considered a last resort, as the loss of circulation can kill limbs if tourniquets are left on too long, they are now cranked onto arms and legs immediately, and helicopter medevacs can have patients at the hospital within a half hour of injury. Of those brought into the Kandahar Airfield trauma bay, 97 percent live.

Which leaves the 3 percent.

Two days before Breece and Castagna were brought in, the doctors, nurses, and corpsmen stood at attention and saluted as a flag-draped body bag was wheeled outside and loaded into a van bound for the mortuary. The soldier had arrived with a channel carved through his brain by a bullet that had entered his right temple and exited the left. His brain swelled, squeezed the brain stem, and stopped his heart. The staff watched in silence as his life ebbed. They had dealt with this before, patients too far gone, and knew they would again. "You feel like you weren't even given the chance to give them a chance," Lieutenant Commander Ron Bolen, the trauma-bay department head, said afterward.

Coalition soldiers, mostly Americans, comprise half the patients. The majority stay in Kandahar less than 48 hours before making their way to home countries. Americans are flown to Bagram Airfield outside Kabul, then to Landstuhl Regional Medical Center in Germany. Those with lesser wounds recuperate there and return to duty in Afghanistan; the rest continue on to military hospitals in the U.S.

Afghan patients stay at the Kandahar Airfield hospital longer, often for weeks, until they are well enough to be transferred to local facilities, where the care is earnest but decades behind. The Afghans are evenly split between security forces and civilians, with the occasional insurgent. Of the civilians, half are children, a surprise to many hospital staff who arrived here assuming they would mostly treat wounded soldiers. Some have been hurt in car wrecks and falls, but many are battle casualties, like the2 -year-old boy hit in the left arm with a bullet, now asleep in a tiny wheelchair, a blanket across his lap. Or the brothers, 3 and 6, peppered with shrapnel, resting on adjoining beds. Or, in the back corner of the intensive-care unit, a boy, 7, whimpering softly as a nurse changes his dressings. An IED tore open his stomach, took off his left leg below the knee, and killed his four playmates.

Presented by

Join the Discussion

After you comment, click Post. If you’re not already logged in you will be asked to log in or register with Disqus.

Please note that The Atlantic's account system is separate from our commenting system. To log in or register with The Atlantic, use the Sign In button at the top of every page.

blog comments powered by Disqus


The Absurd Psychology of Restaurant Menus

Would people eat healthier if celery was called "cool celery?"


This Japanese Inn Has Been Open For 1,300 Years

It's one of the oldest family businesses in the world.


What Happens Inside a Dying Mind?

Science cannot fully explain near-death experiences.


Is Minneapolis the Best City in America?

No other place mixes affordability, opportunity, and wealth so well.

More in Global

Just In