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A Different Operation For U.S. Doctors in Iraq
Severe Cases, Grueling Hours Are Norm

By Thomas E. Ricks
Washington Post Staff Writer
Wednesday, February 1, 2006

BALAD, Iraq, Jan. 31 -- Maj. Hans Bakken and Maj. Brett Schlifka were bone-tired as they sipped bad coffee from foam cups on a chilly morning in a U.S. military tent. The men, both neurosurgeons, had worked on two serious head wound cases the previous evening and then, after going to sleep about midnight, were awakened at 1:30 a.m. to treat a soldier flown in with a gunshot to the head.

The night before that, Sunday, they operated on ABC News anchorman Bob Woodruff and his cameraman, Doug Vogt.

"They all get the same quality of medical care -- a soldier, an Iraqi, a journalist," said Schlifka, a big-armed man from Philadelphia.

They didn't want to discuss specifics about Woodruff and Vogt. "We can't give you any details" for privacy reasons, said Bakken, a native of Decorah, Iowa.

But they did talk plenty about who they are and what they do in this, the Air Force Theater Hospital, which recently was designated as the medical receiving center in Iraq for the handling of all head and neck wounds by the U.S. military. The wounded ABC journalists were flown here by helicopter from Baghdad. They were eventually taken to the National Naval Medical Center in Bethesda, where a doctor said their prognosis was "excellent," according to news reports.

Back home, Bakken said he saw "maybe half a dozen" gunshot head wounds in six years of practice. Here, about 70 miles north of Baghdad, he handles one or two "penetrating brain injuries" a day, either from gunfire or roadside bombs.

The two neurosurgeons also have become experts in particular varieties of head trauma. The majority of head injuries they saw in the United States involved external trauma, but most of their cases here involve penetration of the brain. What's more, the pistol shots they generally saw in the United States were far less lethal than higher-velocity rifle shots that traverse the skull and are nearly impossible to survive, they said. Also, their patients here arrive with far more complex wounds than the typical victim back home. Bomb victims arrive with eardrums blown, cheekbones smashed, eyes ripped apart, as well as deep brain injuries.

The extraordinary becomes routine. "I would say without exception almost everyone who has a penetrating injury has a craniectomy," said Bakken, referring to the operation in which part of the skull is removed to relieve swelling of the brain. Other military officials here have indicated that such a procedure was performed on Woodruff, who along with Vogt was injured on Sunday in a roadside bombing near Baghdad that caught them standing in the open hatch of an Iraqi army armored vehicle.

Understanding the effects of roadside bombs -- what the Army calls IEDs, or improvised explosive devices -- is an art in itself. "The shrapnel pieces from an IED seem to do more damage than a bullet," Schlifka said. The velocity of the fragments varies much more than do the velocity of bullets, and the greater the velocity, the worse injury to the brain, he said.

Working with another Army doctor, Maj. Gerald Grant, Schlifka and Bakken are still learning about blast effects -- the unseen damage caused by pressure on the brain, in which some people appear unhurt by a bomb attack only to suffer headaches, disorientation or lapses in short-term memory later on. "We see a lot of guys that are in a Humvee. They get knocked out but they, quote, don't sustain any serious injuries, unquote," Bakken said. Then when that soldier gets back to his unit, he doesn't feel quite right, but his problems are hard to discern except by those who already know him.

But the doctors have also learned to limit their intervention. They said they don't necessarily try to extract every piece of shrapnel from a head wound, because digging deep can occasionally do more harm to the brain than good.

The men are clearly proud of the quality of the care they provide, working in tents connected by a plywood corridor while Army UH-60 Black Hawk helicopters are landing just a few feet away. "I think we provide Level 1 trauma care comparable to any center in the United States," Bakken said.

He said he also likes the clarity of purpose involved in his work, with little time for administrative work or patience for bureaucratic obstacles. Bakken and Schlifka are Army officers, but said they are working in an Air Force facility with almost no friction or rivalry. "This is kind of a rank-free environment, and almost a service-free environment," Bakken said.

Bakken appeared to have little interest in discussing his brush with celebrity for having treated Woodruff and Vogt. He joined the Army last year at age 37 specifically to serve in Iraq, abandoning his private practice in Tacoma, Wash., and obviously taking a huge cut in pay.

He has no complaints. "They're paying me plenty," he said. "I'm a single guy." He and Schlifka are uncomfortable with being cast in any special light. Every night they see soldiers who they say made far greater sacrifices.

"I'm just another 61 Zulu," said Bakken, using the military classification for a neurosurgeon. (The infantrymen on which he operates, by contrast, are "11 Bravos.") "Just an asset. There are no prima donnas here."

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