By Tom Philpott: Military Update
Before he returned to active duty last year, Army Reserve Maj. Donald W. Robinson was a civilian trauma surgeon at Cooper Hospital in Camden, N.J., a city so violent it’s known as the “murder capital” of America.
Nothing Robinson saw in Camden, however, came close to the horrors he and his surgical teams with the 86th Combat Support Hospital faced in Baghdad, from last December through July this year.
“I expected to see a lot of penetrating trauma because those were the reports coming out of Iraq,” Robinson said in a phone interview from his current assignment at Fort Benning, Ga. “When I got there I was taken aback. This was penetrating trauma to the nth degree. It was massive. The tissue destruction was like nothing I’d ever seen before.”
Robinson, 43, said he hasn’t talked with surgeons from the Vietnam War but he has read about the battlefield injuries they treated. He believes the wounds being suffered daily in Iraq, mostly from large improvised explosive devices, are unlike anything seen before in a war.
“It’s just hard to explain the amount of destruction with an IED,’’ Robinson said. “Imagine shards of metal going everywhere. … Add the percussion from the blast. Then put someone inside a Bradley Fighting Vehicle and add fire to it and burning flesh. A person inhales and (suffers) inhalation injury. … They didn’t have that in Vietnam, not all that together.”
Major Gen. George Weightman, who oversees Army medical training, said the military has come to recognize that medical personnel in Iraq who treat severe wounds are high risk for post-traumatic stress disorder.
“We refer to that as compassion fatigue,” Weightman said. “How many really banged-up, mangled bodies can you take care of before, all of a sudden, you just get numb or can’t handle it anymore?”
Robinson and the 86th were assigned to Ibn Sina Hospital, a modern facility originally built for Saddam Hussein’s army. On his first day, still feeling jet lag, he walked into the emergency room at 9 a.m., as five trauma patients were arriving. It was his first experience with IED victims.
“In all honesty, it just looked like destruction,” Robinson said. “Blood everywhere. People were screaming. It was chaos.’’
Robinson, chief of surgical and critical care for the 86th, and a doctor who was showing him around, each took a patient into surgery.
“That day seemed like it never ended because, after that, another patient came in and then another and another. The next thing I knew it was 12 o’clock at night. … I went to sleep on the floor. … Woke up the next morning about 6 o’clock and it was the same thing, and just kept going.”
He operated on almost 400 patients over the next seven months. The key to trauma surgery in that environment, he said, is discipline and training. And teamwork, he said, was never more critical than in Iraq.
“I understood it, having worked in a trauma center, but I really understand it now. And it has to be the whole team, firing on all cylinders. When you do that — anesthesia to techs to nurses — you save lives.”
Robinson said 70 percent of his patients were IED victims. Eighty percent were Iraqis, military and civilian. All got the same quality of care, he said, but emotionally it was hard not to react to severely injured Americans.
“It hurt me to see my Marines and my soldiers get hurt,” said Robinson, former surgeon for 7th Special Forces Group. “Sometimes I had a hard time with it. I didn’t punch too many walls but … I think I punched a wall twice. You get frustrated.”
Before surgery, Robinson said, he would reassure every patient, kneeling down to “whisper in their ear, ‘Look, my name is Dr. Robinson. I’m your surgeon. We’re going to get through this. Don’t worry. I gotcha.’ ’’
When a patient died, Robinson said, his staff knew to leave him alone. He would find a quiet place, sometimes the hospital roof, and say a prayer.
“I wished I could have called that person’s mom or dad to say, ‘You know, I’m the one who took care of your son, and I want you to know that we did everything possible to save his life.’ I wish I could have done that for every single soldier or Marine or airman.”
Robinson frequently counseled young medics and nurses, worried about how they were coping with all the trauma cases. In Iraq he was too busy to weigh the effect on himself. At home, however, he had difficulty sleeping. For two weeks he slept on the floor so as not to disturb his wife, Shari. He had nightmares, recalling the many amputations he performed.
Rather than dreams of helping patients, his were filled with the horror of their injuries. “It’s almost like you know you can help the person, but it’s just the intensity of what this person has gone through, and will have to live with. I would go to sleep and I would see that.”
In our hour-long interview, Robinson never mentioned his phone calls home to Shari “just to unload,” as she described it. During those calls, Shari said, Don was particularly troubled by the many children he treated who had been burned or had lost limbs. The Iraq experience made him miss his own children deeply, son Kimani, age 11, and daughter Karina, age 3.
Robinson, who soon will be training other trauma surgeons for Iraq, thought about getting counseling but he now feels he’s doing OK, and able to talk things out with Shari and his pastor, “a good support system.”
Before rejoining the Army, Robinson knew his pay would fall by a third and that Iraq would be dangerous. So Shari would ask: Why do it?
“Simple,” Robinson said. “I think I can save lives. If it was my son over there, I would want me taking care of him. That’s the bottom line.”
Tom Philpott can be contacted at Military Update, P.O. Box 231111, Centreville, Va. 20120-1111, or by e-mail at: