Duty, honor, compassion

A doctor in Iraq

In 2001, after the 9/11 terrorists attacks, Dean Winslow, MD, scrapped plans to retire from the Air National Guard.

Leslie Williamson

“I just didn’t feel like it was the right thing to do,” says Winslow, a Stanford infectious disease expert who has served as a flight surgeon in the Air National Guard for the past 26 years. “All of us knew that the global war on terrorism was starting. I felt like I should at least make myself available.”

What started in his youth as a love of flying airplanes, Winslow’s dedication and service to the Air Force has morphed over the years into something else entirely. This past summer he found himself in a Baghdad hospital, one day signing the death certificates of U.S. soldiers, the next treating insurgents who may have caused those deaths — and, as a member of the Air Force, feeling honored to have been given the opportunity to serve in this way.

“As a Christian, I have very mixed feelings about war,” says Winslow. “But I’m very proud of the Air Force. Their three core values — first, service before self; second, integrity above all; third, excellence in all we do — I actually think that is a good philosophy of life, a goal worthy of all human beings.”

A clinical professor of medicine and co-director of the infectious diseases fellowship training program, Winslow has served several times in Iraq and Afghanistan on stints with the Air National Guard. His most recent tour was in 2006 working 69 days as an emergency room physician at a U.S. Air Force hospital in Baghdad.

“Part of the reason I agreed to go back to Iraq last summer was that I have children the same age as the soldiers,” says Winslow, 54, who is also chief of AIDS medicine at Santa Clara Valley Medical Center. “I wanted there to be some experienced, gray-haired doctors available to treat the soldiers.” Stanford Medicine writer Tracie White spoke to him about last summer’s tour working in a Baghdad hospital saving the lives of U.S. soldiers and, on occasion, saving the lives of their enemies.

Body bags

Serving in a frontline hospital in a war zone, I was often called to the morgue next to the flight line at Baghdad International Airport to pronounce death on casualties — coalition soldiers or American civilians — brought in from the field. It was the responsibility of the ER doctor on shift to examine the remains and sign preliminary death certificates.

The saddest part of the job was seeing young people about to make their final trip home — in a flag-draped casket.

On one occasion there were three young soldiers killed in the same attack and brought in together. Their bodies were pulled out of a Humvee that had been incinerated by an IED — an improvised explosive device. I remember rolling up the sleeves of my flight suit, putting on a pair of gloves and carefully combing through the burned flesh of what used to be human beings, trying to find these kids’ dog tags to make it a little easier to identify them.

I remember another soldier who was killed by a very powerful IED. He had massive injuries to the skull and face, and his left arm had been severed. The mortuary affairs sergeant and I pulled his wallet out of the pocket of his dust-covered uniform. I know both of us got tears in our eyes as we looked at a photograph of his wife and twin baby daughters. In situations like that, you often don’t have to say anything. It’s unspoken, but shared emotions.

As a doctor, I’m used to the unpleasant smells. I’m used to treating all kinds of injuries. But here was a feeling of just overwhelming sadness.

Apache down

In the spring of 2006, a U.S. Army Apache helicopter was shot down about 10 miles south of Baghdad, and the next day a video image was posted on an Islamist Web site of the insurgents dragging the burned body of one of the American pilots from the aircraft wreckage.

The following day a U.S. team was sent in to recover the crew members’ remains. It was with a mixture of anger and sadness that I completed their death certificates, realizing the unbearable grief that these brave young men’s families would experience for years to come.

About a week later, an Iraqi Army Special Operations team of 12 soldiers or so, along with a U.S. Navy SEAL adviser, raided the home of one of the insurgents who was videotaped shooting down the helicopter.

There were about five insurgents in the compound, so it was a pretty vicious firefight. This insurgent, apparently the one shown on video, came around the corner. The SEAL drew his 9-mm pistol and shot him in the thigh. Then he ran over, packed gauze in the insurgent’s wound and placed a tourniquet high up on his thigh, saving the life of someone who moments before would have taken his own.

The SEAL was telling me about this a few hours later, about 7 a.m., at our hospital as our surgeons were amputating the insurgent’s leg. The gunshot had transected the insurgent’s femoral artery. By the time the patient arrived at our facility he had lost a lot of blood and was in severe hypovolemic shock. My young colleague, Chris (then an active-duty Air Force captain, now doing a dermatology residency), did a fantastic job resuscitating him by rapidly inserting a second IV line and pumping in blood and saline solution.

The insurgent lost his leg, but his life was saved.

Saving the enemy

Treating insurgents during my latest deployment was most confusing for me as an American and as a doctor.

It was common for captured insurgents to be brought to our facility when the level of care needed surpassed what could be given at the coalition detention unit’s medical facility. This happened a few dozen times.

Most of us have turbulent feelings about treating insurgents. You know that many of the people you’re treating were responsible for killing countrymen. You are, of course, required by the Geneva Convention and the Law of Armed Conflict to provide treatment. Not once did I hear a soldier question our policy of medical care for insurgents.

Despite the horrible things the insurgents had done, they’re human beings and worthy of treatment. If you come from a basis of love, which I try to do, and set that as a goal for yourself, you realize that hating your enemy only gives the enemy more power.

The insurgents were brought to our facility wearing handcuffs and blindfolds. Some were foreign fighters. Some were homegrown Iraqis. When the detainee was wounded while being captured, we would often learn from the MP guards what the insurgent had done. Often it was planting IEDs, or having a cache of weapons and IED-making materials or ambushing coalition troops.

We had discretion as to whether we would remove their blindfolds. If we did so, we could remove our nametags to prevent the insurgents from identifying us. There was legitimate concern on the part of some of our personnel that if the insurgents knew your name, they could target you, or even target your relatives back home. I agree it’s remote, but since 9/11 it’s not entirely beyond the realm of possibility.

I would always order the blindfolds removed. I made the conscious decision that I wanted these men to see my face and to know my name and to know that I was not afraid of them, nor should they fear us.

I only speak a few words of Arabic; however, I would greet them in Arabic, “Salaam aleikum,” which means “Peace be upon you” and introduce myself. I wanted to make sure that the insurgent, my patient, knew that no matter what they had done, they weren’t being judged, at least by me, and that they were being treated with the same standard of care any American soldier would receive.

Every one of these insurgents, even those who had done some terrible things just a few hours before, would turn to me before being taken away and say, “Thank you doctor, for your kindness. May God’s blessing be upon you and your family.”

You could almost see it in their eyes, the cognitive dissonance. They’ve been taught by their culture to hate Americans. Yet here’s an American, face to face with them, who is treating them kindly. It’s very difficult for them to reconcile the two.

I wanted them to see both the kindness and the strength of Americans. I wanted them to know who we truly are.

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