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Trauma unit is Iraq war's version of MASH

FORWARD OPERATING BASE SPEICHER, Iraq—It's the beginning of the work week in northern Iraq, and Greg Beilman is pretty sure that someone is getting hurt.

"It's Sunday. They're blowing themselves up," Beilman predicts.

He knows that because it's his job to patch up the people caught up in this country's violent insurgency.

In civilian life, the 46-year-old Army Reserve colonel is a trauma surgeon and critical care doctor from Minneapolis, Minn. But for the last three months, Beilman has been a surgeon at the 228th Combat Support Hospital stationed near Tikrit.

The CSH—called a "cash"—is this war's version of a MASH unit. When soldiers get wounded in combat, the first doctor they'll see will be someone like Beilman. He'll perform the operations needed to keep them alive for the next 72 hours until they can be sent to a hospital in Germany or the United States.

At about dinner time, as predicted, two men who are part of a private security company convoy arrive at the hospital's emergency room. They were caught by an insurgent's bomb hanging from a highway overpass.

One guy from Oregon took a piece of shrapnel near the shoulder blade. The other, a Jordanian, got his hand torn up in the blast.

The shoulder injury is superficial. But Beilman and the hospital's orthopedic surgeon, Major Matt Kelly, spend the next three hours operating on the Jordanian's hand.

It's often a lot worse.

"You usually get two, three, four patients from each of these IED (improvised explosive device) blasts, ranging from minor, like this guy, to half a leg hanging on," Beilman says.

The previous Sunday night, for example, Beilman fought to prevent an Iraqi soldier from bleeding to death from a leg wound. Beilman gave him fresh whole blood donated from a couple of U.S. soldiers, blood platelets flown in from another U.S. hospital and the latest blood clotting drugs. He lived.

"We spent four hours after surgery pouring this stuff into this guy," Beilman says. "I ended up sleeping in here that night."

Beilman is here because his fellow soldiers are "children of America and they deserve good care when they put themselves in harm's way."

But the biggest chunk of Beilman's time is caring for other countries' kids.

Most of his trauma patients and the ones with the worst injuries are Iraqi soldiers and police, foreign contractors and private security employees working in the war zone, Iraqi civilians caught in the crossfire and insurgents who sometimes are hauled to the hospital by the same soldiers who shot them up.

"They just get brought here and we take care of them," Beilman says.

Monday morning, Beilman starts checking in on patients in the hospital's 20-bed intermediate care ward.

It's about two-thirds full of Americans and Iraqis. Most of the Americans are recovering from surgeries for ailments such as appendicitis and hernias.

American body and vehicle armor is "one of the real successes of this war," according to Beilman.

"The body armor is blocking those fatal shots to the chest and abdomen that used to kill these kids in Vietnam," he says.

Most of the Iraqis are recovering from war wounds.

"I'm good. Thank you," says an Iraqi patient, putting his hand over his heart as Beilman examines his leg wound.

The Iraqi was attending a wedding of a Ministry of Interior official. A suicide bomber blew himself up at the wedding, and another insurgent shot people as they fled. The gunman was wounded and he ended up at the hospital too.

"We had to keep the family of this guy from taking the other guy out," Beilman says.

"We did like 10 operations on him, and got him well," he says of the insurgent. "The last couple of weeks it was a fascinating experience. He was pleasant. He was worried about his wife and his family. He was asking me about my children. And this was an insurgent who was shooting down women and children at a wedding party where his partner has just blown himself up in a bomb. It was hard for me to comprehend."

Beilman says he knows other people have a hard time comprehending why he heals the enemy.

"My brother-in-law says `Why are you taking care of them?'

"As a doctor, my job and my purpose is to care for the patient, whoever they are, in a compassionate and caring way. That's the doctrine for the U.S. Army Medical Corps," Beilman says. "Ethically, I would have trouble with it any other way. Especially with the abuses we've heard about in Abu Ghraib and elsewhere. I have to be able to look myself in the mirror every night."

Some of Beilman's problem's are mundane: a U.S. soldier complaining about hemorrhoids. Beilman says it's really an anal fissure, and he suggests an operation called a sphincterotomy.

Then a call comes in on the radio. A patient with a gunshot wound is being flown in.

As he waits for the helicopter, Beilman, who watched M(ASTERISK)A(ASTERISK)S(ASTERISK)H reruns going to college in Kansas, explains why he likes moments like this.

"The experience of doing surgery in a war environment will make me a better doctor," he says. "Some doctors love a controlled setting. Trauma surgery is the complete opposite of a controlled setting. You have to be good at thinking on your feet. That's one of the reasons I like it."

He hears the roar of a Blackhawk landing, and people start rushing into the emergency room.

"Here we go," he says.

A blood-soaked gurney comes in with a helmeted helicopter crewman pumping a ventilator bag. The patient is a 16-year-old Iraqi.

About a dozen people crowd around, doctors, nurses, medics and an interpreter. They start examining him, connecting tubes and wires, giving him blood and oxygen.

They roll the patient onto his side, and Beilman sees a hole in the teenager's back about the size of a tennis ball.

He peers at a tiny hole beneath the collar bone. "So this is his entry wound? It can't ... it can't be. It's way too small."

"We need to explore the wound in his back," Beilman says.

The operating room suite is a prefab modular unit hooked up to a tent. Before he scrubs for the surgery Beilman puts on knee-high black rubber boots.

"When you have a big, bloody case and you're going to make a mess, you put these on," he explains.

"Who shot him up?" someone asks. "One of us," Beilman replies. "He was driving too close to the convoy and they shot him."

The patient is lucky. He lost a lot of blood initially, but he was given good initial care before he arrived at the hospital. The bullet missed his ribs, his heart, the large blood vessels, his esophagus and spine.

"Looks like the bullet went in and blasted through his lung and blasted through the hole in his back," Beilman says. But "the lung will heal itself."

It's only 12:30 p.m. when he finishes up and thanks everyone in the operating room. There's still that sphincterotomy in the afternoon. And in the days ahead more gunshot wounds, hernias, spider bite infections, bomb blasts, colon cancer operations.

"I've got job security," he says.

He takes off his surgical gown. He asks a technician if he can bring her a sandwich. Then he puts on his pistol and helmet so he can walk across the base to get lunch.


(c) 2005, Knight Ridder/Tribune Information Services.

PHOTOS (from KRT Photo Service, 202-383-6099): USIRAQ-DOCTOR


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