A soldier’s story

A letter from Iraq describes one incident in the work of an ophthalmologist serving in Operation Iraqi Freedom.

Issue: December 1, 2005

ByScott D. Barnes, MD

A note from the editors:

The following letter from an ophthalmic surgeon serving in the U.S. Army in Iraq was forwarded to Ocular Surgery News by several readers. We asked Lt. Col. Scott D. Barnes for permission to reprint his letter to give our readers insight into the experiences of U.S. medical personnel serving in Iraq. The letter has been edited slightly from its original form.

To all:
I flew into Baghdad, Iraq, at the end of August from Fort Benning, Ga., by way of Atlanta, Baltimore, Germany, Italy and Kuwait. Everything was smooth until the night flight over Baghdad in one of our large transport helicopters. It could have been any routine night flight in a Chinook that I have taken except for the tracers from ground fire coming up at us. Just a little welcome-to-Iraq present.

We hit the ground, and I had about 6 hours of orientation at the hospital before my first surgical case. And they simply never stopped coming. The work is great and terrible at the same time. The level of injuries and the concentrated amount is nothing I have ever seen. I will have seen more trauma here in a few months than I probably will see in the rest of my ophthalmology career.

The little girl (21 months old) was one in whom Dr. Barnes did an upper/lower lid release with full thickness skin grafts about 6 months after her initial facial burns and grafts.	A corneal transplant is performed by Dr. Barnes (in the white hat), and an Air Force surgeon (in the multicolored hat).
A handheld slit lamp is used to examine an Iraqi patient who suffered 25% total body surface area burns over his head and upper body.	Blood supply shipment arrives by air transport. Images: Barnes SD

For the most part, my days start at 6:30 a.m. and end around 10:30 p.m. or later, unless I am up through the night with a surgical case. That happens one to three times a week. Fortunately, the bad guys don’t do a lot of fighting at night, but some of the evening cases can stretch into the early hours.

I am convinced that I am here for a reason. I can see it on the faces of some of the soldiers and the Iraqi civilians on whom I operate. At home, I usually downplay my background and education, feeling that it is more a blessing from God than anything I really earned. But over here I have been a bit more liberal in telling these scared soldiers and their concerned commanders that they have a Harvard-trained cornea specialist working at putting their broken parts back together. I know that it is God who does the actual healing, and I am also very liberal with stating this, and telling people that sometimes He chooses to do this by working through my hands.

I’ve seen faces change and voices become more confident when they know that I am here for them. I tell them that I volunteered to come over here because I want to be the guy standing in the door to meet them when they get broken. I wanted to be a part of the greatest altruistic humanitarian effort that I believe any warfare has ever seen.

We have medics who ignore bullets flying overhead just to get to a casualty; we have medevac pilots who will rush into a hot zone and won’t leave “until [they] have your wounded;” we have corpsmen and orderlies who run out to the bird and transport the patients into the bays of the emergency room where medics and ER docs work tirelessly to diagnose and stabilize the patient; and then we have the OR techs, nurses, and surgeons who work all hours to mend the broken parts, followed by the awesome nurses who continue that healing and work to mend the broken hearts of young guys whose lives have changed in an instant.

I have never been involved with anything in medicine as incredible as this operation. The cause is noble, and the people are the greatest team of which I have ever been a part. We have Harvard-trained orthopedic surgeons, interventional radiologists, cornea specialists, laparoscopic fellowship-trained general surgeons, fellowship-trained trauma surgeons, pulmonary intensivists, gynecology oncologists, plastic surgeons, oral-maxillofacial surgeons, dermatologists, vascular surgeons, neurosurgeons, neurology intensive care specialists, CT scanners and MRI scanners. We have residency program directors and department chiefs all working together here.

Why do we have all of this? Because these young heroes who go out on combat patrols night after night are putting their lives on the line doing their country’s bidding. You can’t put a value on such high-priced real estate (the soldier), so we make sure that if they do break, they can count on having the best there to try to put them back together again.

I cannot imagine anyone not wanting to be a part of this operation. I only wish that I didn’t have to be away from my family to be part of it.

We care for more Iraqi civilians, military and police than U.S. military. We also provide state-of-the-art medical and surgical care for enemy combatants. We have an entire combat support hospital set up just for detainees. Can you imagine that? One minute they are shooting at us, trying to kill us, and we capture them and immediately begin to minister to their injuries and illnesses.

We are making a difference in the lives over here. But working on the heroes comes at a price. It is difficult to see all the pain and suffering. The loss of limbs, eyes, and life can be overwhelming at times. But we have saves in the midst of the losses, and we continue to pour our hearts into every patient because we don’t know who will make it and who will not.



Soldiers lined up in the parking lot waiting to donate blood or watching over their buddies’ gear while they were donating blood.

I have many stories both of losing and winning. I want to share the story of a young sergeant with nearly his whole pelvis shot away. He had such massive blood loss that he should have died before getting to the OR, but he didn’t. He kept living as we kept working on him, and we were running out of blood to transfuse into him. But his heart kept going. We found guys outside and told them we needed blood, and fast. Soldiers started lining up to donate blood in our parking lot. Sergeants were going up to men who weren’t even in this guy’s unit, telling them that a young sergeant was fighting for his life and needed their blood. They started calling their buddies located at bases close to the hospital and told them to get their backsides over here ASAP because a fellow soldier, who most of them had never met, was going to die without their blood. Soldiers started pouring in, asking no questions except where do they go to give blood. They didn’t know this guy, they just knew that another brother was in trouble and needed their help. They lined up in the parking lot, and when their turn came they had buddies watch their gear and weapons while they went in to donate. No questions, just soldiers doing what they thought was part of their job.

About 60 to 70 guys ended up donating. In the United States, when a patient requires 6 to 12 units of blood, that is considered a massive transfusion, associated with a high rate of death. This young hero required 207 units of blood (yes, you read that correctly), and he lived. He was flown back to the States, and back at Walter Reed Army Medical Center he is alive and off the ventilator.

I still cannot write about this without getting choked up. To see the sacrifice of the solders, the surgeons, the field medics who initially treated this young guy.

This story should help make it clear why I consider serving over here to be the greatest honor of my professional career. I get to see the real heart of the American soldier and the American military medical team, and they are as gold.

Stories like these can be seen throughout the theater of operations.

May God bless you as He does me every day.

For Your Information:
Scott D. Barnes, LTC, MC, USA, was among the earliest of the Army’s refractive surgeons. He managed the Army Special Operations refractive surgery program and is now chief of ophthalmology and refractive surgery in the busiest center in the Department of Defense at Fort Bragg, N.C. He can be reached at this mailing address: LTC Scott Barnes 10th CSH (TFN) APO AE 09348; e-mail: scott.barnes@iraq.centcom.mil.