A Surgeon on the Front Line
As an orthopedic surgeon at the 86th Combat Support Hospital in Baghdad, Army Maj. Merritt Pember saw his mission as keeping grievously wounded soldiers alive until a medevac could fly them out for further treatment. Baghdad ER, a documentary that premieres on HBO on Sunday, May 21, details the experiences of Pember and his colleagues. U.S. News spoke with Pember, 33, now at Fort Hood, Texas.
You chose orthopedics, which is not a specialty for the faint of heart. How was your first day in the emergency room in Iraq?
As strong as I thought my stomach was, I don't think that anything can prepare you for the first patient in a war zone. The velocity of the wounds over there is just so much more dramatic. It creates devastating injuries. The first patient I had was a double amputee; he lost a leg and an arm. The other leg had a compound fracture of the femur, and the other arm had a terrible wrist fracture. Just the look of it makes you step back. As the war goes on, unfortunately, you get used to what rolls in the door day after day.
People think of amputations as a primitive form of medicine. Had you done them back in your hometown of Lubbock, Texas?
Yes, but the majority I'd done in the civilian world had been on diabetics. As for traumatic amputations in young people, it's an extremely rare event. But in Iraq, probably 80 percent of the injuries involve orthopedics, because you have the body armor and the helmet, and what's left unprotected are the extremities. It's not a clean cut; they're shredded and as dirty as dirty gets. You can't make the leg look nice and pretty. The dissection is unfortunately already done for you, and you have to decide how to make it as best you can.
That's got to be hard.
It's certainly depressing. There was a 19-year-old marine I remember well. You amputate both of his arms, and you watch him walking out of there without both of his extremities. I suppose that's better than being dead, but it doesn't leave you feeling that you've done him a great service.
The survival rate in this war is the highest in history, largely because of improved body armor. But in fact, many of your most valuable tools in Iraq were surprisingly low-tech. Why?
Tourniquets are incredible lifesavers, especially with already amputated extremities. All the medics have them, and all of us have them. It's a quick fix, and that's what you need to get someone to a combat support hospital. We didn't have the fancy new tools, but you don't necessarily need them for acute care. You need a "squirt gun" to wash the dirt out, and a knife and a saw.
You often treated Iraqis, even if they were insurgents who were injured while fighting Americans. What was that like?
Anybody we injure, we take care of them as well. You're obligated to treat them the same as anyone else. Once when I was working in Mosul, the enemy was rushed over. We performed heroic measures to save him; he actually coded a couple of times and survived. He woke up and was irate--and still hated Americans. It's frustrating to go through all that and know they still hate you. But I think it speaks volumes about Americans that we treat them better than they would be treated in their own country. It was a challenge, but they got outstanding care, whether they deserved it or not.
advertisement
