Fighting For Life

“They do a great job of scaring you 80 hours a week,” says 2nd Lt. Kristina Rustad, second year student at Bethesda’s Uniformed Services University of the Health Sciences. The most frequent worry, she says, is that “you’re not working hard enough.” Rustad is preparing for a career in military medicine, and she’s attending the school that Congress, in 1972, established as the “West Point” of military medicine. Today, reports Terry Sanders’ documentary Fighting for Life, a quarter of all active duty military doctors are USU graduates. And today, many of these graduates are headed to active theaters in Iraq and Afghanistan.

It’s worth remembering, today (8 April 2008), when General David Petraeus and U.S. Ambassador to Iraq Ryan Crocker testify before Congress regarding “progress in the war in Iraq,” that military medicine is ever difficult — and it is particularly difficult now. Though technologies have advanced and more injured troops survive than in previous wars, the lack of organization, funding, and equipment repeatedly leaves practitioners facing impossible decisions.

Sanders, who also made the excellent documentaries, Maya Lin: A Strong Clear Vision (1994) and Return with Honor (1998), says that he conceived Fighting for Life as a look at USU students. The fact of the current wars changed the film’s shape and expanded its focus. Shot over two years by Sanders and a four-person crew, the movie offers a variety of images and raises crucial questions. Classroom sessions show students taking notes during lectures and dissecting bodies (“We teach them respect for the cadaver,” says one instructor). Training for the sorts of triage and “worst case scenarios” doctors will encounter in a war zone, students make their way through drills that include people made up by “casualty simulation artists,” the patients’ fake-bloody effects created and “treated” in “moulage tents.”

All their dedication and long hours can only begin to prepare graduates for what they confront in the Middle East, however. Lt. Col. Paul Pasquina (USU Class of 1991, now director of Walter Reed’s Amputee Program, puts it this way: “There is nothing normal about war, there’s nothing normal about seeing people losing their limbs, seeing your best friend die.” Fighting for Life underscores the startling strangeness of the doctors’ daily work, in Iraq (specifically, the Air Force Theater Hospital in Balad, which takes American and Iraqi casualties, as well as occasional mortar and rocket attacks), at the Landstuhl Regional Medical Center in Germany (“Our ICU is basically active 24 hours a day, we are the funnel for all patients coming out of both theaters, in Afghanistan and Iraq, and then they get spread out from here”), and at American treatment and rehab institutions.

The scenes in Iraq are, predictably, the most harrowing. Lt. Col. Cathy Martin, Head Nurse at the Intensive Care Unit in Balad, says, “We’re getting all the multiple blast injuries, so we’re seeing quite a few head traumas, chest trauma, and multiple extremities traumas, where there’s quite a few traumatic amputations and vascular injuries involved.” If these soldiers would not have survived in previous wars, now they are numerous, and sometimes overwhelming. Though the film does not take an overt stand for or against the war, it makes plain the costs in human dimensions, the physical and psychological injuries, the damage done to troops, their families, and their doctors and nurses. Other costs are filtered through moral questions. Lt. Col. David Benedek lectures his students at USU concerning the reports of abuse (and cooperation in same by medical personnel) at Abu Ghraib: “We as physicians,” he insists, “cannot be combatants. We ought to be in the business of healing.”

Even apart from such well publicized dilemmas, the daily work of doctoring is daunting. Those who do it make life and death decisions regularly. As Lt. Col. Warren Dorlac puts it, “Until this conflict started, the idea of service over self was just words. It has nothing to do with what you think of the president or the Congress.” Rather, he says, “The fact is that we’re there and those are our families, those are people’s children. The devotion for me is not so much my country as these soldiers and marines, seeing what they sacrificed.”

For all the concentration on U.S. injuries and struggles, the film does show Iraqi cases, including three-and-half-year-old Omar, with wounds all over his body, and Captain Furat, who arrives at the facility in Balad after being shot 12 times while at home visiting his family. Described as a “soldier’s soldier,” the captain is overcome when he’s told he “probably” won’t walk again, and can’t imagine that he can “still do good things for his country.” His doctor tells Furat, “It’s not gonna be the life you planned, it’s gonna be a different life. People still need you, whether you can walk or not.” Furat begins to cry, and begs the doctor to kill him.

If such scenes are daily occurrences for the medical personnel in country and back in the States, they remain devastating. While the documentary shows a range of experiences, cutting back and forth between the university and the hospitals and trauma centers, it finds an especially poignant (and, as Sanders reports, unexpected) focus in 21-year-old Army Specialist Crystal Davis, from Camden, South Carolina. The movie picks up her story when she arrives at Balad, following an IED attack. She’s joined by her brother Stan, also serving in country, and, after initial treatment for “open fractures, large wounds,” and a missing foot, she makes her way to Ramstein and then the U.S. (her thumbs up to the camera as she’s loaded, on a gurney, into the giant plane taking her and other patients to the States, is both gallant and heartrending) As she works her way through surgery, rehab, and prosthetics fittings, Davis is consistently stalwart. “When I signed up,” she says, “I signed up to make it a career and I’m not letting this stop me.”

Still, it’s impossible not to see in Davis’ story the reflection of so many stories, her life changed forever, her efforts to meet all kinds of unanticipated challenges. “Never in a million years,” says Davis, “would I have thought I’d be injured.” And yet here she is, picking out her “final foot” and making plans for a future transformed by trauma. Her medical treatment is good, her family is supportive, and her own courage is remarkable. One of her doctors, Major Tom Kolkebeck, sums up, “I have a tremendous amount of respect for the people we’re treating. This is war, unfortunately.”