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November 1, 2008
A Warning, a Blast, a Fight to Save an Afghan Life

By C. J. CHIVERS
COMBAT OUTPOST LOWELL, Afghanistan — Jamaludin, an aging Afghan cook, twisted and writhed on the green stretcher. Blood ran from his mouth and nose. Medics had cut away his clothes, revealing puncture holes where shrapnel from a Taliban mortar round had struck him minutes before.

Capt. Norberto A. Rodriguez, an American Army doctor, listened through a stethoscope as two Army medics and a Navy corpsman inventoried Jamaludin’s wounds. There were holes on his back, neck, buttocks, left leg and beside his right eye.

Jamaludin, who like many Afghans has only one name, had been made wild by fear and pain. But for some reason he could not speak. He shook his head, sputtered and vomited blood. “Oh no, no, no,” Captain Rodriguez said, and quickly rolled him to his side.

The patient had heavy internal bleeding and was choking on his own seepage. The captain needed information. Was it shrapnel, a shock wave or both that had ruptured him inside? Jamaludin was near death. They were racing against time.

“Hey, can you ask these guys if he got blown, if he got thrown?” the captain asked an interpreter, to relay the question to the knot of Afghan men gathering outside by the body of another man, who had been killed and was now covered with a sheet.

The captain pushed his hand into Jamaludin’s mouth. He would keep this man alive. “Don’t bite my thumb,” he said, as much to himself as to a patient who spoke no English.

Jamaludin’s jaws clamped shut. “Ahhh,” the captain said, fighting to keep his hand there until suction and a breathing tube could be snaked down.

Combat Outpost Lowell is a company-size American and Afghan position in Nuristan Province, near the border with Pakistan. Far from view and named for Jacob Lowell, an Army specialist killed in the province in 2007, it is meant to play a remote role in the counterinsurgency efforts in Afghanistan, disrupting the Taliban and foreign fighters on a route to Pakistani tribal areas, and tying up Taliban forces far from more populated areas. It is one of the United States’ most forward positions in a war now in its eighth year.

Isolated, ringed by forested ridges and under such regular fire that helicopter pilots prefer to avoid flying here, especially by day, the outpost imposed an unforgiving condition: anyone injured would have to wait for an evacuation. It was up to Captain Rodriguez and a team of trauma medics to keep Jamaludin alive.

On this October day, the Taliban began firing mortars about 10:30 a.m. An American Army sergeant’s voice had crackled over a loudspeaker. “Incoming! Incoming!” it said.

Somewhere high overhead, an explosive 82-millimeter mortar round was in a free fall.

The soldiers of Apache Troop, the cavalry unit in the First Infantry Division that is assigned here, had scrambled to slip into flak jackets and helmets and waited for the round to come down. It exploded near an ammunition bunker with an earth-shaking roar.

Marine Capt. Markus Trouerbach, 40, the officer assigned to train the post’s Afghan soldiers, uttered an unprintable word. “That one was real close,” he added.

In the mountains ringing the outpost, he knew, the Taliban mortar crew had found the range.

The loudspeaker repeated the warning call. Another round was inbound. It was a teardrop-shaped steel canister packed with explosive putty, weighing perhaps seven pounds.

It screamed in and detonated beside a bunker used by the post’s local guards, blasting shrapnel deep into two Afghan men.

The guards’ second in command, Nezamudin, was killed outright, smacked by shrapnel in the neck and face. Jamaludin, the cook, a man with a nearly atrophied leg and a thick red beard, fell stunned to the ground. Blood rushed from his wounds.

If there is any universal and binding compact among military men under fire, it is this: If you are hit, we will come to get you. Among units that endure, it is a pledge more inviolable than law. And it comes with a corollary. You will do the same for me.

As soon as the word came over the two-way radio that the Afghans had been hit, Petty Officer Third Class Ramon G. Gavan, 23, Captain Trouerbach and Gunnery Sgt. Daniel P. McKernan, 36, grabbed their weapons and nodded knowingly to one other. They checked their helmets. They were on tight.

Within seconds, they were sprinting in the open across the outpost, where they met Army Sgt. Michael S. Ayres, 24, a scout, and a group of Afghans, who had slid the broken men onto litters and began to make their way to the doctor, who was in an aid station inside a tiny stone building.

“Incoming! Incoming!” the loudspeaker said.

The Afghans and Americans all dived to the ground and waited for the next shots to end. Then they were up and running again, carrying Jamaludin, who was semi-fetal on the litter, moaning.

It would be more than an hour before a helicopter could get here, if it could run the gantlet of fire. Could the trauma team keep the grievously wounded Afghan alive?

As Captain Rodriguez assessed him, Sgt. Zackary Filip called for help. “They need to call a medevac,” he said. “They need to call it now. Urgent.”

Sergeant Filip’s hands were covered in blood. He said he had always worn rubber gloves; on this day, there had been no time. He had been applying pressure to Jamaludin’s wounds and bandaging him. Now he began taking the patient’s pulse.

Petty Officer Gavan inserted an intravenous line in each of Jamaludin’s arms and cleaned the clotting blood on his face and beard, and leaned in to examine his ruined right eye. “I’m sorry,” he said. “I’m sorry.”

He prepared an oxygen line, and turned to an Afghan interpreter. “Tell him this will help with his breathing,” he said.

Jamaludin started to fight, tearing at his intravenous lines and oxygen mask. The captain and the corpsman tried to pry his hands free. They handed a syringe to a reporter, and asked him to inject its contents into an intravenous bag; it contained morphine.

Then they injected Jamaludin with ketamine and versed, two sedatives, to calm him down.

When he stopped swinging his arms, they inserted a breathing tube, and soon were helping him breathe again with the oxygen mask.

A change came over Jamaludin swiftly. Bleeding from the eye, nose and mouth, naked and sprawled across the messy litter, he was relaxing. He began to look restful. His oxygen level climbed to 94 from 80. One hundred is the maximum score.

Captain Rodriguez, 32, started to seem confident. A few minutes before, Jamaludin was near death. Maybe he might make it.

First Sgt. Douglas K. Terrell, 36, the senior enlisted man in Apache Troop, stepped into the room. He looked at Jamaludin. He was curled in a pool of blood. But he was stable.

“Can we get an E.T.A. on the bird?” the first sergeant asked into his radio, trying to determine when the helicopter could arrive. The answer came back: 45 minutes.

Captain Rodriguez looked up. “How many,” he asked. “Four-five?”

The first sergeant did not want to leave the helicopter exposed on the landing zone. He wanted everyone ready to rush the patient outside early.

“Go with about 40,” the first sergeant said. “At max.”

“He’s going to roll in here,” he said. “But I would tell you all right now,” he nodded, “be prepared.” The implication was clear: When the helicopter arrived, the Taliban would be firing.

He turned to the Afghan interpreter, Rahatullah. First things first. He wanted Jamaludin to hear encouragement in Pashto, his native language. “Tell him we’ve got him,” he said. “We’ve got him.”

Petty Officer Gavan, his face glistening with sweat, was on his knees, trying to reach the injured man in other ways. He clutched Jamaludin’s left hand with both bloody gloves, kneading his fingers, coaxing him to fight.

Sergeant Filip had a moment free, and he scrubbed Jamaludin’s blood from his fingers. “I hope he doesn’t have anything,” he said. Sweat dripped from his forehead and rolled off his nose. “I didn’t have time to put gloves on,” he said. “You have to stop the bleeding however you can.”

Forty-five minutes passed. No helicopter. Jamaludin was kept alive by another medic, Specialist Jeremy W. Wright, 20, who kept him breathing by pumping an oxygen bag. Jamaludin’s stomach rose and fell.

At about minute 65, the rotors could be heard in the valley. By then the medics and Captain Rodrigiuez were running with Jamaludin, now bandaged and strapped onto a litter, back across open ground.

The first sergeant had been right. The Taliban were waiting. As the medics loaded Jamaludin onto the helicopter, the mortars started again. The first round landed wide.

The loudspeaker was barely audible over the roar of the Blackhawk’s rotors. “Incoming! Incoming!” it said.

As Captain Rodriguez and the medics ran clear of the rotor blades, the helicopter shuddered, rose and lurched forward to gather speed for the run past the hills.

“Get down!” Captain Trouerbach shouted. “Get down!”

Everyone bounded from bunker to bunker back to the aid station, where for a few minutes the medical team, now with nothing to do, circled and paced. Jamaludin’s soaked clothes and bandages were knotted into ugly clumps on the soiled floor.

Sergeant Filip stepped behind a screen and prayed.

The silence had come suddenly. The helicopter was gone. The mortars had stopped again. Captain Rodriguez leaned onto his desk. There have been dozens of mortar attacks here since Apache Troop arrived four months ago.

His voice was almost a whisper. “I don’t know what to think,” he said, unprompted, looking up toward the sky that they fell from. “I’m happy to wake up every morning.”

An hour or so later the call came in. The helicopter had reached the next base. Jamaludin was in surgery. He was alive.


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