The bomb had exploded underneath one of the back wheels, setting off the gas tank and the jerrycans of fuel. Flames arced up toward the sky as the truck jumped, equipment flying everywhere, and Carlos, in the turret, launched straight up. His arms spread out, hands clutching empty air, as his body twisted. Then he fell back down, landing on the front of the truck. I was too far away to hear anything, and even if I’d been close, the machine-gun fire would have covered over the sound, but in my memory of it I always hear the thud.
I ran across the field, the machine-gun fire around me not quite registering, reached the truck, and hauled Carlos, heavy with all his gear, to the ground. His uniform was on fire and I burned myself trying to smother the flames. Rounds started cooking off in the burning truck. Inside were more than twenty thousand 7.62 rounds, ten thousand 5.56 rounds, as well as rockets, mortars, recoilless rifle rounds, and grenades, all of which would soon be exploding.
I grabbed Carlos around the underarms and started hauling him to an irrigation ditch about ten meters away from the truck, just by the side of a marijuana field. As I pulled, an explosion in the truck sprayed us with hot frag. I kept pulling. My lungs burned, and my blistered hands screamed at me. Machine-gun fire raked the open spaces around us. We reached the ditch and collapsed in, but it was barely eighteen inches deep.
“FUCK!” I screamed, then rolled over to assess Carlos, who looked up at me calmly, not in shock.
“Benjy,” he said.
I looked back to the truck, ablaze. Behind it, just up the hill, a dark figure. The explosion must have blown Benjy through the driver’s door and into the hill, saving his life. Out of the corner of my eye I saw Jefe sprinting his way toward Benjy. He moved fast for an old man.
“Leaking from the hip, bro,” Carlos told me.
A piece of frag had punched through his hips, shredding his stomach and intestines, spraying splinters of hip bone throughout the abdomen. Clearly the major injury. I scanned the rest of the body. One leg, shredded, bent horribly, bleeding profusely. Due for an amputation at some point, if he survived. I quickly applied a tourniquet, easy. He had burns to his face, hands, unimportant. The patient—not Carlos, but the patient—had sustained a hell of a blow. In an hour or so, systemic inflammatory response would hit. The bowel and abdominal wall would swell, oxygenation would drop, and the patient would need massive fluid resuscitation and possibly inotropic support. He was in the Golden Hour, and I started packing the hip and abdomen, trying to keep the organs sterile and on the inside, trying to give him the best chance of surviving those sixty minutes.
Packing from without is creating a sandwich, I could hear the instructors at Special Forces Medical Training Center telling me, packing from within is filling a cavity. Two layers of pads on either side of the liver, supported by the abdominal wall and the diaphragm. My heartbeat had kicked into fifth gear but my movements were controlled, or something beyond control, past clenched-fist bare-knuckled will and toward a natural set of movements flowing from the training, bypassing language and thought as my chattering brain whined on, reciting injuries and treatment options, but the voice increasingly distant as my hands worked.
“Are you in pain?” I asked.
“Yes,” he said. “Hip, stomach. Jesus. Leg. Right leg. Face.”
His beard was smoking. So was mine.
“Okay, okay,” I said. “I got you.”
You have to ask about the pain. Carlos’s pain—when talking to him about his pain he was Carlos again, not the patient—it would be the life kind of pain, the kind that from this point would ebb and flow but never quiet. Asking about pain at the site of injury is a way of treating that chronic pain. They’re not sure how it works, other than that it does. Perhaps since pain is emotion plus sensation, reflecting care and concern and the promise of help to the patient somehow changes the equation. So we ask about the pain, and so I asked about the pain, and Carlos tried to tough it out.
“Stop the bleeding first,” he said. I guess he thought I was going to bust out the drugs.
I grinned at him. “I don’t tell you how to do your job.”
I moved from the liver to the right gutter. Packed it. I shifted, put my left hand above the spleen, pulled it toward me, packed above the spleen, moved to the left gutter, then the pelvis. Noted accumulation of blood from a mesenteric bleeder. I stopped that with a finger. Then I used a clamp. I didn’t like the blood flow. I pulled the stomach down, pushed two fingers past it, slippery, rubbery, until I could feel the aorta. It pulsed under my fingers. This is life, I thought. I looked at Carlos’s face, which was pale, serene. I compressed the aorta manually.
Jefe arrived at the ditch with Benjy, who saw how shallow it was.
“Are you fucking kidding me?” There was a stench of vomit. He’d probably puked over himself from breathing in the toxic smoke of the truck.
Taliban were shooting at us directly now, bullets slicing through the marijuana over our heads.
“If I get shot in the ass . . .” Jefe said as he pulled off Benjy’s body armor, checking him head to toe.
“Benjy’s fine,” I said. “Carlos is in the Golden Hour.”
“CASEVAC is twenty minutes out,” Jefe said.
Huge explosions roared in the hills. The Canadian Leopards opening fire. Azad Khan appeared at my side with a stretcher. I could have kissed the ugly bastard. We got Carlos on the stretcher, started moving. Jefe helped Benjy to his feet
