The struggle to save a dying Marine in Iraq

CAMP TAQQADUM SURGICAL, Iraq (AP) - The chaplain assigned to the medical camp was drafting a homily. The heart surgeon was using the quiet spell to edit a medical paper. The medics chatted over lunch.

Twenty miles (30 kilometers) away, on the desert plain outside Fallujah, an insurgent's bullet tore through the body of a young Marine.

Less than a half-hour later, Camp Taqqadum Surgical's men and women were waiting as a roaring helicopter landed at their patch of sand-colored tents.

And so began an urgent, hour-long effort to save the life of Lance Cpl. James W. Higgins, 22.

For the 75 Navy doctors and medics here, it was in many ways just a normal case -- one of the roughly 100 seriously wounded Marines and Iraqi soldiers and civilians they see each month from this section of violent Anbar province. They stabilize the wounded, who then are taken to larger U.S. military hospitals.

But when a 22-year-old man is fighting for his life, nothing is normal.

"I always go at it with the mind-set that we can save this person," said Cmdr. Subrato Deb, 42, a heart surgeon who was part of a team of roughly 15 doctors and medics who would work on the Marine over the next hour.

"For me, mentally, that's how I prepare myself," Deb said a day later. "We always give them the benefit of the doubt."

The team knew as Higgins arrived in the summer heat that the injuries were bad. He was an "urgent surgical," the most severe category.

His heart had stopped while he was being carried onto the helicopter. Medics were pumping his chest as the chopper landed.

The Marine would begin to suffer brain damage after just five minutes without oxygen. As the helicopter landed, medics rushed him by gurney into the hot and crowded surgical tent.

The first step took only 60 seconds — a "clamshell" procedure that entailed cutting the Marine's sternum and pulling open his rib cage.

Inside, the surgeons found terrible damage.

The bullet had pierced the right side of Higgins' back, searing diagonally across his body before leaving the front of his chest.

His diaphragm had been torn off. His liver was damaged, one lung had collapsed and his right chest cavity was full of blood.

Worst of all, the bullet had clipped the right atrium of his heart in two places, letting blood build up around the heart's muscles.
Doctors found a blue, bulging sac with a silent heart sitting inside.

The surgeons had to do two things immediately and simultaneously — get the heart beating and stop the internal bleeding.
Three pairs of hands plunged into Higgins' chest and abdomen.

Deb drained the blood around the heart, then raced to sew up the first hole. Then he noticed the second hole was much bigger - about the size of a dime.

With time running out, he resorted to a technique he later described as "a little bit outside the realm of standard practice."
He asked a surprised medic for a urinary catheter. Instead of sewing the second hole, Deb used the catheter balloon to plug the wound. Then he used the catheter tube connected to a unit of blood to directly pump warm, fresh blood back into the Marine's heart.

"That's what really got him kind of responding," said Capt. H.R. Bohman, the senior surgeon at the facility, who — as Deb worked — was trying to stop the internal bleeding.

But the young Marine's heart still was not beating.

The job of massaging it back into a rhythm fell to the closest pair of available hands — those of Lt. Cmdr. Barbara Drobina, an emergency medical doctor who had never done such a procedure before.

"I had no choice," Drobina said later. "Not a whole lot of us had done it."

It was a delicate task: taking the heart between her two hands and gently and firmly pressing. Too much pressure could damage the heart. Too little would fail to force it into beating.

"Am I doing it right? Am I doing it right?" Drobina remembered asking Deb repeatedly.

Then a monitor began showing a heart rate. Drobina could feel the rhythm in her fingers.
"Yeah, just keep doing what you're doing," said Deb, focusing on clamping the rest of the wounds.

Praying for Higgins

In the background, Navy chaplain Lt. Wilfredo Rodriguez had pulled out his prayer book and was silently reading.

"Of his great mercy, may he forgive you your sins, release you from suffering and restore you to wholeness and strength," he mouthed.

Then the chaplain stepped in to help.

The surgeons already had stapled closed the hole in Higgins' lung and wrapped his liver in gauze to stop the bleeding. They had clamped his aorta to send all available blood to his brain and heart, not his lower body.

And they were pumping in blood, urgently, unit by unit — 18 in all.

"I figured I could pump blood and pray ... I said, 'Hey, looks like you've been holding that bag of blood for a long time. Can I chime in?"' recalled Rodriguez.

He took the dark-red bag from a doctor who had been holding it and kept it high above his head.

Five minutes passed — five minutes in which the Marine's heart beat.

Then it stopped again.

Hoping for miracle Drobina was drenched in sweat. She had been massaging the heart for more than a half-hour.

"The following day I was sore. But no, I wasn't tired (then). They kept asking me if I wanted relief, and I'm like, 'No, I'm fine,"' she said the next day.

She kept on massaging. But this time, it wasn't working.

The heart would not beat. Except for the five minutes when the Marine's heart had stirred in Drobina's hands, it had been still, without a heartbeat, for nearly an hour.

The surgeons knew the end was near.

"It crosses every doctor's mind — if we give it five more minutes, maybe there will be a miracle. That's the hardest part for me — letting go," Deb said the next day.

But in the end, they let go.

The doctors, speaking among themselves, unanimously agreed that nothing else could be done.

"We just say, 'OK folks, we're going to let this patient go now. Stop all resuscitation.' Everyone steps back. And that's usually when the chaplain steps in," Deb said.

The doctors and medics took their hands away from the Marine's body. Covered in dark blood, they bowed their heads. Rodriguez began reading aloud — the "Commendation of the Dying."

"Into your hands, O merciful savior, we commend your servant," he read. ".... a sheep of your own fold, a lamb of your own flock ... May his soul and the souls of all the departed ... rest in peace."

Instead of referring to the Marine as a patient, the staff would now call him an "angel."

The doctors began to slowly move away and the medics moved in to clean the body and stitch the wounds together.

Outside the tent, Marine Sgt. Timothy Cord, 22, pulled out a body bag. He loaded his M-16 rifle and stood guard beside the body — a Marine tradition of respect for the dead.

That night, Higgins' body would begin its long flight back to the United States. And the staff at Camp Taqqadum would wait for their next patient.

Even veterans like Bohman, who has served three tours in Iraq and worked more than 25 years as a surgeon, call such deaths difficult to accept.

"The only way you can personally live with it is a really strong belief that this is not all there is," said Bohman. "I believe in most of these guys, that they're in a better place than we are."

Some take comfort in the idea that those who die here have, at least, had access to some of the best medical care in the world.
"It's almost as good, if not better, than what somebody would get in a big city," Deb said.

But some find the deaths and the work here so troubling, they try to shut out any feeling.

"I try not to look at the patient's face. I try not to look at any details," said Gina Ortiz, 21, one of the medics. "I don't want to remember it. I try to block all that out."

As the young Marine's body was taken to a morgue, Deb headed to take a shower. Bohman prayed with the chaplain. Drobina went to the camp gym. Cord went to his room to play his guitar.

"You can't linger on ... because five minutes later another person might come in who needs your undivided attention," Deb said. "You have to be mentally ready to deal with that."

(Lance Cpl. James W. Higgins died on July 27, 2006.)