lay motionless on the ground.
More help arrived within seconds as army Special Forces officers, some of them with advanced training in battlefield trauma, sprinted from buildings across the compound at the sound of the explosion, rifles and medical kits at the ready. Their snap assessment was dire in the extreme. The blast victims were so scattered and debris covered that it took minutes to find them all. Six were clearly dead, including the driver, and multiple victims had sustained life-threatening injuries, including penetrating head wounds. The CIA medic checked the badly wounded again as the soldiers applied field dressings and tourniquets. Without immediate surgery, five would die within minutes, he concluded. Matthews and Hanson were among them.
From the airfield across from the compound came the whine of a helicopter’s engine roaring to life. A Russian-built MI-17, property of the Afghan army, happened to be at Khost at the time of the bombing and was immediately pressed into service. A world-class battlefield hospital lay just a few miles north of Khost City, in the U.S. base known as Camp Salerno, but the only way to reach it quickly was by chopper. On many an evening, the CIA officers had watched from Khost as specially equipped Black Hawk helicopters rushed American and Afghan casualties to the base from firefights all across eastern Afghanistan. On this night, the incoming wounded would be Khost’s own.
Once airborne, the MI-17 could make the dash to Salerno in less than five minutes. It was a lucky break, the CIA medic thought as he helped load the stretchers into aircraft.
But would it be soon enough?
Army surgeon Captain Josh Alley was nearing the end of his shift at the Camp Salerno Combat Support Hospital when the word came of an incident at the CIA base across town.
“Chapman just got a direct mortar hit,” one of the medical officers called out as he rushed down the hall. “We’re getting an unknown number of casualties.”
Alley, a veteran battlefield physician who had served in Iraq, changed into his surgical scrubs and started to wash up as details of the attack began trickling in. The first reports had a mortar round striking the CIA base’s gym, news that hit close to home for Alley, who used Salerno’s fitness room almost daily. Like its CIA neighbor, the Salerno base was a frequent target of rocket fire.
Minutes later the doctors learned of the suicide bombing and rushed to prepare trauma beds for as many as six patients. A small team of technicians assembled at each station and listened for the rumble of choppers approaching.
The first casualties arrived at dusk. In the landing zone just steps from the hospital, one of the doctors set up a hasty triage, eyeballing wounds and sorting out the priorities by a numbered code.
Two patients were rolled into the surgical prep area, and Alley was questioning one of them, a man who was badly wounded but conscious, when another doctor called out to him with a more serious case.
“She’s got a chest wound,” the doctor shouted.
Alley rushed over to look. On the operating table was a young blonde wearing a red tank top and necklace. He judged her to be twenty-five or perhaps younger, and she had no pulse. Alley was used to seeing American soldiers and ordinary Afghans with frightening wounds. He had performed hundreds of hours of what he called meatball surgery, picking shards of shattered bone from legs that had been blown apart by land mines, but this beautiful, intact young girl was a first. Alley found the pea-size opening in Elizabeth Hanson’s chest and decided to immediately operate to explore what could be extensive damage within. He cut quickly through bone and muscle and then, with his finger, found the aorta, the main artery leaving the heart. It was flattened and empty. Desperately, he began squeezing and massaging the woman’s heart while an assistant inserted a tube into the opening in her chest. The tube filled instantly with bright red blood, a sign of massive internal bleeding.
He had run out of options. A single piece of shrapnel smaller than a marble had shredded the veins and arteries closest to her heart and snuffed out her life.
“Does anyone know her name?” Alley called out. No answer.
There was no time to think. Another patient was brought in, this time an older woman in cargo pants with extensive injuries from shrapnel. Like Hanson, Jennifer Matthews had stopped breathing during the short chopper ride from Khost, but Alley would try to save her.
He assessed quickly. Shrapnel had torn away a large chunk of the woman’s neck. One of her legs, just below a field tourniquet, had been nearly stripped of skin and muscle, exposing the bone. A small piece of shrapnel had penetrated her abdomen, and the wound had swollen in a way that suggested internal bleeding. Alley pressed an ultrasound probe against the woman’s chest to get a look at her heart. It was motionless.
He couldn’t fix this.
The frantic efforts continued for hours without letup. Working in tandem with another surgeon, Alley patched up severed veins and mangled legs. He treated, as best as he could, a young officer who had a piece of shrapnel lodged dangerously in his brain. All the others were stabilized and placed on helicopters for the one-hour flight to the U.S. military’s Bagram Air Base near Kabul, where other doctors would take over.
It was late when the last of the wounded had cleared out. Alley went outside and, drenched with sweat from the adrenaline and the eighty-five-degree operating room, sat in the cold for a few minutes. Other bodies, those of fallen CIA officers who had been instantly killed in the explosion, were still arriving, to be brought to Salerno’s morgue. Among the remains, he learned, were a few fragments of Humam al-Balawi, collected, he presumed, for DNA testing.
Alley gnawed on a Popsicle to soothe his parched throat. More than 90 percent of the American soldiers who made it alive to his field hospital ended up surviving. At Khost that evening, Alley knew, each of the dozens of factors that were subject to human control had worked perfectly, from the first aid by battlefield medics to the availability of the helicopter to the presence of a first-rate surgical team less than five minutes from the scene of the explosion. Everything had gone right, and it still had not been enough.
He thought again about the two civilian women he had been unable to save. He still didn’t know their names. Were they aid workers? Journalists? Each day brought a fresh dose of human suffering to his operating room, and he was used to dealing with it and pushing on. But war was usually men fighting men. This felt different.
More helicopters were heading to the landing zone now. Alley got up and turned to go back to work.
16.
FALLEN
At the moment of the bombing—it was still early morning in Washington—Michael V. Hayden happened to be in Langley visiting his old office. The former CIA director had been asked to give a policy speech in Pittsburgh, and he wanted to do some research. It was usually quiet at headquarters between Christmas and New Year’s, although this week was far from usual. There had been a near disaster on Christmas night when a Nigerian youth named Umar Farouk Abdulmutallab tried to blow up an airliner over Detroit. The case, like so many others lately, made no sense. How does a smart, highly educated kid from a wealthy family decide to kill himself and a couple of hundred strangers with a bomb hidden in his underwear?
Hayden finished his work and decided to check in on some friends on the executive floor. Director Leon Panetta was away for his holiday vacation, and so was Hayden’s old deputy, Steve Kappes, so he headed down the hall to say hello to Mike Sulick, the man he had promoted to run the agency’s Clandestine Service. At that moment two other managers were walking out of Sulick’s office. They looked sick.
“It’s really bad,” one of them said. “Seven officers are dead.”
The men had just broken the news to the most senior officer in the building.
Details were still coming in, and already a feeling akin to shell shock was spreading through the executive floor. Hayden, unsure of what else to do, wandered over to his old office and found Panetta’s chief of staff, Jeremy Bash, on the phone with his boss in California, relaying the latest updates.
The first reports had arrived at Panetta’s Monterey, California, home just before 5:00 A.M., with a rap on the director’s bedroom door by a member of his security detail. One of his aides urgently needed to speak with him on
