Morgantown, West Virginia, United States
|US Army Blackhawk medical evacuation helicopter|
With so much intentional killing and death in war, one might think that an occasional accidental or natural death would go unnoticed and uninvestigated. This was not my experience. In war, killing and death are often viewed through a blameless lens. However, accidental death may receive greater scrutiny and is more likely to have blame assigned. In the military, someone is always responsible and accountable. That someone is usually a unit commanding officer.
One chilly winter evening, I was called to casualty receiving. A Blackhawk helicopter had just brought in a dead U.S. soldier. I was called not because this soldier had been killed as a result of combat action, but had died as the result of a tragic accident.
As I looked upon this soldier’s grey and ashen body, the cause of death was immediately evident – severe blunt force trauma to the head. His eyes stared blankly ahead, his pupils fixed and dilated. The skull was severely misshapen, reflecting multiple displaced skull fractures. Near the left ear, the skull had been split open and brain tissue was exposed. Small amounts of cerebrospinal fluid were dripping from the nose and ears.
“What happened?” I asked one of the physicians in casualty receiving.
“We are not sure, Sir. The flight medics on the Blackhawk did not know the details.”
The soldier belonged to an Army National Guard armor battalion. His death had occurred at or near the Port of Shuaiba, about forty-five minutes by ground travel from U.S. Military Hospital Kuwait at Camp Arifjan Units flew to Kuwait and then joined up with their equipment at the Port of Shuaiba before heading north to Iraq. Equipment was off-loaded from cargo ships by personnel specially trained for that complicated and potentially dangerous task, then placed in a marshalling yard to be picked up by the units.
Within an hour, several members of the deceased soldier’s battalion began to arrive at the hospital, including the unit commanding officer. The scene was chaotic and emotional. National Guard units are close-knit, like family. National guardsmen often serve together in the same unit for many years. Between the tears, they were struggling with how they were going to explain what had happened to their deceased friend’s wife and small children. They were going to war in Iraq and already had lost one of their own, just by collecting their equipment in Kuwait.
From what the soldiers were saying, it seemed the injury occurred at twilight while the soldier was in the gunner’s turret of a moving HUMVEE and his head struck the gun barrel of a tank. This seemed like an accident that should not have occurred and that some safety procedures had likely been ignored.
Soon after, a couple of CID (Criminal Investigation Division) agents showed up in casualty receiving. They began questioning medical personnel as to the cause and manner of death. They collected the names of witnesses to this death from members of the unit, including the names of personnel that were in the tank and the HUMVEE. They did not speak to the dead soldier’s commanding officer. I realized immediately what was transpiring, and so did the commanding officer. I recognized the look of fear and resignation in his eyes. His fate was already sealed and would depend on the facts as they were sure to emerge. There was nothing that he could, or should, do at this point. He had to just wait and let the investigation run its course. If this soldier’s death was the result of inadequate or improper training or supervision, this commanding officer’s superiors would be so informed. A superior’s confidence in a commanding officer’s ability to lead is a prerequisite to obtaining and retaining command.
Even natural deaths can occasionally evoke blame. Several months later, that same look of fear and resignation would be evident in my eyes. I had again been called to casualty receiving for a soldier who had not been intentionally, or even accidently, killed. This soldier was a major and also the chaplain on the general’s staff. He had collapsed while jogging and could not be resuscitated. The general was already there when I arrived. The look in the general’s eyes suggested not only sadness, but also anger. I did not understand. Nor did I understand why CID agents were there questioning the soldiers that had witnessed the chaplain’s collapse and accompanied the chaplain’s body to casualty receiving. The CID agents did not talk to me; neither did the general.
Several hours later, I understood. The medical brigade commander, my boss, told me that a medical officer had witnessed the chaplain’s collapse and that physician had then just turned and walked away. That doctor, whoever he was, had committed a serious crime under the UCMJ (Uniform Code of Military Justice) – specifically an Article 92 violation (dereliction of duty). My boss told me that he hoped that physician was not one of my sailors. Not half as much as I hoped that physician was not a member of my unit. However, the odds strongly favored that the physician was one of mine since virtually all of the physicians at Camp Arifjan belonged to my unit. Moreover, I had not conducted any training on the legal, moral, or ethical responsibility and duty of military medical personnel to render aid. I had never even considered such training necessary. It had never occurred to me that military medical personnel would not do their duty and not render aid. I was more than a little worried, but it was too late to do anything about it now. I would just have to wait and see what developed.
About two weeks later, I learned from my boss that CID had identified the culprit doctor. He did not belong to my unit, but was an Army physician transiting Kuwait on his way home from Iraq. I felt relieved. I felt guilty. One distracting comment from my boss, a comment that ultimately had nothing to do with me or any member of my unit, had for two weeks made me experience more concern for my unit and myself than for the dead chaplain. Fear of the blame game has a powerful psychological effect.
I would never learn what, if anything, happened to the armor battalion commanding officer or to the physician that had turned and walked away after witnessing the chaplain’s collapse. I did not need to know.
Towards the end of my rotation as commanding officer of US Military Hospital Kuwait, an unexpected death occurred that evoked a more proactive response on my part, again out of fear. I was called early one afternoon and informed that a nineteen-year-old soldier had collapsed in a dining facility at one of the outlying camps and could not be successfully resuscitated. Nineteen- year-old kids do not frequently drop dead. I headed immediately to the TMC (Troop Medical Clinic) at that camp.
I went to the TMC OIC (Officer-in-Charge) to get a first-hand report of what had transpired. Apparently, this young soldier was eating his meal when he stood up, made a motion with both of his hands toward his neck, and then collapsed to the floor. An Army emergency medicine physician and two of my Navy corpsmen were sitting at the same table and witnessed this event. A Heimlich maneuver was immediately performed, but no food was dislodged. No pulse was present and CPR was immediately begun. No resistance to lung expansion was noted with mouth-to-mouth respirations. He was transported to the TMC as CPR efforts continued. He was immediately intubated and no upper airway obstruction was found. Initial electrocardiographic activity was present, but no blood pressure could be obtained or pulse felt. He could not be oxygenated despite receiving 100 percent oxygen. Resuscitative efforts continued for forty-five minutes before the young soldier was pronounced dead. I also learned that this young soldier had returned from R&R (rest and recuperation) leave from the States just hours earlier and was awaiting transportation back to his unit in Iraq.
I obtained statements from witnesses at the dining facility and personnel involved in the resuscitative efforts at the TMC. I sent my report and those statements up my chain of command. I was concerned that a large saddle pulmonary embolus, occurring after that recent trans-Atlantic flight, might explain what had occurred and account for the described observations. However, my opinion did not really matter. What would ultimately matter would be the results of an autopsy performed by the Armed Forces Medical Examiner System at Dover Air Force Base. I just collected names and statements that could later be independently checked and verified if necessary. I was responsible and accountable for the resuscitative efforts, including any deficiencies, involving this young soldier. I had not detected any. I received a thank-you for my report, but heard nothing else. I did not need to know. For me, the best response was no response.
Amazingly, because of the potential for blame, some deaths not due to acts of war were more firmly ingrained into my memory than some of the gruesome war deaths. I still have difficulty with this seeming paradox of war – blame for accidental, and even occasionally natural, death; and lack of blame for intentional killing.
JACK RIGGS, MD, is a professor of neurology at West Virginia University. He spent 29 years in the Navy Reserve before retiring as a captain. He served almost one year as commanding officer of a combat support hospital in the Middle East.