Beyond the Battlefield

Gazing out at the horizon, I do my best to soak in the last rays of light in what was an all too brief sunset. Dusk remains the only time of day that is truly beautiful these days, with darkness blotting out the destruction of war, and the little remaining light still encompassing the beauty which once was, over the coastline of Gaza.

As the light fades, I turn away from the view. Our force is preparing for an unusually risky operation deep behind enemy lines, and my thoughts are troubled. I’m intensely focused on the mission at hand, a high-stakes intelligence-seeking mission which will hopefully provide actionable intelligence for hostage rescue, but I can’t shake the thought which I’m sure many share – a mission of this type is almost guaranteed to cost us in casualties.

As I make my way to my quarters, a number of men passing by give their hellos, some verbally, some with a simple nod. As the war has progressed, I’ve been feeling the weight of responsibility heavy on my shoulders, performing as the Spec-Ops Combat Physician within my unit, or by my more widely used title among the men – “doc”.

Each and every one of the potential casualties will come under my care at one point or another throughout the "chain of care". From combat medic to paramedic, the combat physician, and ultimately -the evacuation forces – each a link in a chain which brings our brave soldiers home to their families.

In my quarters, I lay out my Tactical Med-Kit. Over the last few months – the kit has become an extension of myself. Each item meticulously placed, with hours of thought and planning devoted to its accessibility and ease of use when called on to save a life. The life-saving blades, medications, bandages and tubes are ordered just so, to allow for the systematic work of a combat physician in the field.

My eyes scan the various pouches and pockets, knowing that I could easily locate any of my tools in the pitch dark, with a single hand. First and most critical – hemorrhage control! The number one killer of a soldier on the battlefield.
Then Airway… Breathing… Circulation… The ABCs of Tactical Combat Casualty Care. Each pouch with its life-saving potential, designed to address a particular injury or life-saving procedure.

Satisfied that all is in place, I turn my attention on gathering the paramedics and medics, as I brief them for our upcoming operation. Good solid men. The very best. And all experienced veterans at this point. They’ve all seen action, treated men under fire, lost friends.

Looking into their eyes, my apprehension turns to calm.

I know there’s nowhere I’d rather be than shoulder to shoulder with these fiercely devoted professionals, going on this particular mission. I'm exactly where I need to be, doing exactly what I was always meant to do.

The force begins movements toward our objective. As we close in on the structure, shots ring out, our force has been exposed. I hear short clipped chatter over the coms, a man is down, the medic nearby already providing care.
We're asked to move in for medical extraction. As we sprint into the alleyway, I see small puffs of dirt kicked up from bullets shot our way. As a few men return covering fire, we duck into the structure with the injured soldier.

I kneel by his side and a quick scan reveals a penetrating wound through his right chest. A bullet entering just above the soldier's bullet-proof ceramic vest, with a downward trajectory and an exit wound in the back. It's a serious injury, one which can easily kill a man. But for now, the patient is conscious, with labored breathing. I take the soldier's vitals: tachycardic 132, saturation 86%, blood pressure holding at 110/75, rapid breaths at 30 per minute.

I pause for a split second and quickly decide that the best option is to extract the patient ASAP, as opposed to providing additional care in the middle of a battlefield.
We load our patient onto our armored vehicle and begin movement towards the border. As we drive, I start transfusion of "whole blood", given the patient's vital signs and injury mechanism.

Just a minute or so into the transfusion, I can see the blood pressure dropping, as the patient loses consciousness.
I rip open my kit and make clear my intentions to my accompanying medic. "Chest Tube" is all I need to say, as I throw the medic the appropriate detachable pouch from the tactical med-kit.
We've practiced this particular procedure countless times in training, but this will be our first time working together as a pair on an actual patient in the field.

I make my incision over the appropriate anatomical landmark, and insert the tube. It's a relatively extreme measure to provide a field operation under non-sterile conditions, but the patient is unstable and in bad shape.
Just as I'm completing the procedure, the patient wakes up and weakly complains about his pain. His complaints are music to my ears, as I prepare an ampule of morphine with a reduced dose, to take off the edge without compromising his blood pressure.
We reach the landing zone with our precious cargo slowly but surely stabilizing, and by the time the chopper touches down to evacuate the soldier, he's well enough to impart his thanks to the team.

It's early morning as the chopper lifts off over the horizon, the Mediterranean waves beneath.
Turns out I was wrong, dawn can be just as beautiful as dusk.

The writer is Dr. Captain M, MD
a Spec-Ops Combat Physician in the IDF, currently serving in the Israeli-Hamas war.