Dr. Jon Heavey: Battalion Surgeon in Iraq
Content Warning: this episode includes graphic descriptions of wounds and combat, as well as strong language.
Dr. Jon Heavey is an emergency room physician on the front lines of the battle against COVID, who began his medical career as a battalion surgeon with the 101st Airborne Division in Iraq.
Read Jon’s 2012 article “An Unbearable Price” in the Dartmouth Alumni Magazine for more about his service as battalion surgeon.
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Warriors in Their Own Words is our attempt to present an unvarnished, unsanitized truth of what we have asked of those who defend this nation. Thank you for listening, and by doing so, honoring those who have served.
Today, we’re hearing from Dr. Jon Heavey, an emergency room physician who began his medical career as a battalion surgeon with the 101st Airborne Division in Iraq.
Even for a podcast all about war stories, Jon’s stories are intense. You’ll hear some graphic descriptions of wounds and of combat, as well as some strong language. If that’s not something you want to hear, you might want to skip this episode.
Dr. Jon Heavey: We were in Iraq with the first 502nd Infantry, 101st Airborne, and we were operating in some fairly dicey areas, Kadhimiya, Shula, up by Sadr City Area. Yeah, that day the convoy actually got hit right as they were coming back into our base with an IED that obliterated at least one Humvee, if not two. Thankfully I wasn't in that convoy, but I heard the blast. You pretty much know when it's going to be “go time” and “oh, shit, what's happening?” So just based on the proximity of the blast and the concussive wave and what was happening, we got prepped and we knew that badness was on its way in. The one gentleman in particular who I ended up seeing later at Walter Reed, he had shrapnel deformities. There was a popliteal artery. He was concussed severely, he didn't know exactly where it was, although, to the Army's credit, he still knew how to say, sir, which is always remarkable to me when somebody can't remember their name, but they'll say, “sir”.
He was in a pretty rough spot. When you're in that kind of proximity to a blast, you also are at risk of developing something called blast lung, which is a secondarily somewhat delayed presentation, but you get pulmonary edema and respiratory distress from the concussive waves and the air pressure of the blast. So when he came in, we knew he was in a rough spot. He would be medivaced to a higher level as quickly as possible. We were at a Level One facility. While we had initial resuscitative equipment, we didn't have an operating room per se. We didn't have sterile field, we didn't have things of that nature. So, frankly, the NCOs and the medics and the team that was working with, those guys are ... They're the miracle workers. They're the A-team, and I'll never forget Tyrone Logan was running with Kap over his shoulder through gravel that had to be foot, foot and a half deep, just like a fricking superhero. When I saw him with the body draped over his shoulder, I thought, “oh, shit. Here we go. Let's figure out what we can do here.” He was in rough shape and the guys did what we do for trauma patients, and it was obvious that he was probably in the toughest shape of anyone who was surviving.
He was bleeding out from the popliteal artery and was altered mentally. He didn't know where he was. I wasn't sure if he was going to be able to protect his airway. I was concerned he was probably going to develop blast lung in short order. All those things are just clinical medicine. I think the part that really gets you is you were just at the dining hall with this guy, bullshiting with him and watching AFN on TV. Now here he is with his life on the line, and thank God for the NCOs and for everybody, the PAs and folks who were mobilizing the helicopters, come in to get him out to the operating room. We tourniqueted him as rapidly as possible, which is a big change from the standard civilian resuscitative - acronym used to be ABC, airway breathing circulation, and Iraq really changed that, it went to CABC, meaning circulation and hemostasis first so people don't bleed out, and then airway breathing. Anyway, I'm rambling a bit, but I'll never forget, we got the tourniquet on him and he's screaming in agony because the tourniquet, it hurts like hell. You're threatening his limb by cutting off the blood supply.
Then we packed the wound with HemCon and some other hemostatic agents. You don't have a chance to numb anything up. So, here he is getting these hemostatic agents shoved straight into his body and he's still conscious. We were wrestling with, how do we - do we protect his airway now and put them down into a medically induced coma? Or is that something that we wait for the medevac? Anyway, this is all more clinical details than anybody would really be concerned about, I just remember the way he looked and I was scared to death he was going to die. That's what it amounted to.
KH: When you say hemostatic agents, you're talking about taking your fist and jamming a pack of something as deep into a wound, as close to the ruptured artery as you can, right? I mean, you're making it sound a little more sanitized and sterile than it is in real life.
JH: Yeah, no, it's ugly. Those agents oftentimes have a heat component to them for the coagulation, so after you stuff it in as hard as you can and you're holding pressure on it, you can often smell the blood as it's cooking and the tissue that's cooking around it. But that's what has to happen so that - he ended up surviving and actually kept the leg, which was amazing.
I was working back stateside at Walter Reed and was just in the ER one night and the guy came in and he said, he was having pain in his leg and he was having some other issues, and I didn't actually even recognize him at first. He had probably put on 25 more pounds of muscle. He looked fantastic. Last time I had seen him, his head was shaved and he was ghost white. He was on the verge of dying and he was screaming and it was utter chaos. Then, as I'm looking at him and I'm looking at his wounds, I thought, “Well, that's weird. This injury looks exactly like the one that we packed at Justice” Then I took a look at his name tag, and I said, “oh, wait, I think this is Kap.” I started asking, I said, "Wait a minute, were you a FOB Justice?" He's like, "Yeah, yeah." I was like, "Did you get blown up right outside the fucking gate?" And he's like, "Yeah, yeah, that was me." I said, "Oh my God, dude, here we are on the other side of the world. I was your battalion surgeon that day." I mean, he was obviously in extremis and completely concussed. He had no idea who I was. Yeah, I'll never forget it. It was the most amazing moment I've ever had.
The vast majority of the time, you're not really challenged in terms of thinking through what's the right thing to do in any given circumstance. That being said, you will on occasion encounter challenging situations where you have to think through, okay, what's what's the right thing to do here. For instance, I recall seeing an enemy combatant in Iraq and he had been shot in battle and was brought to our base as a casualty of the battle, and he had a very serious gunshot wound in the chest. Had we not intervened, he almost certainly would've died. The medical hat in me, at that point was pretty clear. We got to take care of the guy and do everything we can to try to resuscitate him. That being said, it's not always an easy thing to sort of separate yourself from the emotion of that moment, knowing that this individual very well may have just taken the life of one of my dear friends.
It is a different series of consequences for you when you're treating your friends. For instance, in residency, it's more of a job, frankly, you're working long hours and you're getting terrific training. But then, when you know the person in front of you, it changes your perspective on the situation because you aren't detached like you normally would. It's not just “throw in a couple chest tubes and intubate the patient and move on.” That's a person you know in front of you looking up at you with their life on the line. That definitely ups the stakes in a big way. At the same time, it was also probably the most fulfilling medicine I ever had the chance to be a part of.
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Now, back to Warriors in the Own Words.
JH: There was a major convoy on its way through some sector in Baghdad and anybody who's been on one of these convoys know that once it's rolling, it ain't stopping for shit, and that includes when a motherfucker jumps out with an AK-47 trying to shoot at some massive piece of machinery, like an M1 Abrams, or whatever, is in this convoy. If a civilian hears about an AK-47, you're like, “holy cow, an AK-47”. Over there, it's like, what is this idiot doing?” The convoy director, it's like a nuisance for him. He's like, “Damn it, dude. Just go home to your wife and kids and take your AK away. We don't want to have to deal with you.” He kept persisting with small arms fire and blah, blah, blah, blah. We took him out. They killed him. Then the convoy proceeded as convoys do. They just ran over the dude over and over and over again, which is probably a violation of the Geneva Conventions, but who really knows in that sort of setting, and he became known as Pancake Man. It became a part of the lore that, “hey, if we have to call in a raid on this house, or if we're doing this operation, well you go two clicks east of Pancake Man.” It's not like he got ODOT out there to clean up the mess. It’s just totally morbid and disgusting. I am embarrassed as a human that you laugh at it, but at the same time, it's like, I don't know how you're supposed to react here. It was like boredom that this guy brought an AK-47 to try to kill people. Then it's like, “Dude, just go away. We don't want to bother you. You're being a little bit of a nuisance here. Just go away.” Then, “well, sorry, I guess you're making your decision here.” Anyway, yeah, that's Pancake Man.
At the end of the day, no matter how much the cynical humor gets you through things from time to time, I really think that there was a sense of idealism for what people were trying to do, and they were generally trying to do the right thing. You start to realize the scope of what's going on over there and you recognize, “wow, even though I'm in the middle of this, I have such limited capability to actually influence a positive outcome here.” But that being said, I know my guys in the platoon were very dedicated to bettering the lives of the people around them. One of the things that we tried to do is we took on this notion of the MEDRoe, or the medical rules of engagement, which were quite restrictive. You basically couldn't intervene in certain situations unless there was acute loss of a life, limb, or eyesight involved. Unfortunately, that translates at the ground level to “well, wait, we got a kid who was in proximity to a blast who has severe burns and disfiguring burns all over their body.” The first do no harm is, “well, yeah, you got to get the kid help.” I mean, that's a point of the mission here, right? Hearts and minds extensively, that's what we're here for. What could be more critical than taking care of a wounded child? The combat support hospital did in many cases work around that to make these sorts of things happen. But the fact of the matter is that there were just such massive issues that you had to take it one step at a time for what you could do within your sector to try to impart a positive impact and that's why we created the foundation that we did and why we started just evacuating some of these kids when we could.
The military is a massive machine that is designed for destruction. The State Department, on the other hand, has resources for reconstruction. You fall in the mix between those two within medicine where you come in with this idealism that you think you're going to be able to help a whole lot of people and then you realize, “holy cow, this is such a blunt instrument from a policy perspective that the Iraqis who get caught in between in their day to day existence have some really terrifying outcomes that happen.” That creates a real conundrum from an ethical perspective and from a medical perspective.
I remember the visual of my buddy's body just being severed in half. You see plenty of trauma as a civilian ER doc, or you think you see plenty of trauma, but you never know who the person is in front of you. As I sarcastically said, at the time, because I had to go in and declare mechanisms of death, this gets back to the black humor. Like, what the fuck do you want me to say his mechanism of death is? Blown to fucking shit, like severed in half, his leg up in a tree and his arm across the base? Mechanism of death. Yeah, blown the fuck up. I just always picture some bureaucrat somewhere who's just got to fill out the SGLI forms, or whatever's involved. I'm supposed to calmly write in exsanguination, or blast trauma, or some scientific sounding term. I always wanted to just call it what it was, obliterated, fucking eviscerated with his brain gelatin exposed. There's your mechanism of death. Exposed brain gelatin. How about that? It is what it is. It's a part of the job and it was, I think, in many ways the single most important thing that you had to do. This is somebody's loved one, and not only is it someone's loved one, you have the thought in your mind of, “Jesus Christ, they don't even know. They don't even know that the worst news humanly possible is about to come their way on the other side of the world.” The news that they dread. We try to figure out, how do you make a rational decision for the family then? Do you keep the parts of the uniform that are charred and soaked in blood and human flesh? No. No, I don't think they'd want to see anything like that, but it's not ... Who am I to say? This is their loved one. I think it was probably the biggest, I don't want to say cherished, I'm having trouble coming up with the right word for it, but it was the most serious responsibility that we took, because these were our brothers in arms, and we knew that their families were going to be hurting in an awful way.
That day in particular, it had been a rough week. We had had a lot of brownouts, which is sandstorms coming in, and when brownouts happen, the protective eyes in the sky aren't anywhere near as effective. We used to have different mechanisms, whether they were predator drones, or these sort of Goodyear blimp looking things that were bulletproof that would fly up over the sector and keep an eye out for bad actors. Anytime there was a brownout, you knew you didn't have Big Brother watching out for you overhead, and the casualty rates would go up. We had had a number of brownouts that week, and we had lost a couple of guys during the week. That day, in particular, I just remember hearing a dull thud off in the distance. I can't tell you how fucking sick of that sound I am, because you know what it is. There isn't a fucking thing you're going to do about it. As much as you like to think that you can train with all these medical techniques to resuscitate someone and whatnot, when the IED goes off, you're dead instantly. It's pretty rare where there's somebody who was not in proximity enough to be instantly killed. When you hear this dull thud off in the background, you just think, “oh, shit, who was that?”
I'll never forget that one of the guys that was killed in that dull thud was just this prince of a kid. I mean, a kid. Honestly, I don't think he even shaved. He had just turned 18, and I'll never forget, he had talked to me during basic about an advanced surgical training program at fricking Northwestern University. This is one of the top medical training programs in the country, fast tracks you to a surgical career. He was already thinking, “okay, hey, how is it that I could use my time here in the military, get in with the GI Bill, stay focused on becoming a doctor and getting into this top-flight program?” It was such an aspirational inspiration that he had this outlook and this upward trajectory for his whole life laid out in front of him and then just one dull thud, and he was blown the fuck up.
It used to be our job to go out into the canister, the railroad canister. I don't even know what to call it, a refrigerated bin. It looks like the things that you'd see on a big shipping freight or a railroad bed car. We had one that had a generator running 24/7 to keep it cold. That's where we kept the bodies. We cynically called it the death bin because everybody knew that's where the bodies are. We go in and try to figure out who they were. That was always a conundrum, too. Guys used to fricking joke about it, "If I get blown up, put Tyrone's dick on me, all right? I want to go out with style." How do you say that? So you piece the bodies back together as best as you can, you declare a mechanism of death, something other than blown the fuck up, pneumothorax, or I don't know, traumatic brain injury, or these other things. Yeah. I remember wishing, just wishing with all of my Irish anger, just pissed me the fuck off, that there were these rich old men back home making bank off of war while my buddy, I don't know if I can say his name, but Albert Benton was his name. So, there I am looking at Benton's body trying to declare his mechanism of death, knowing full well that there's however many old rich dudes making money off of his death, and it just filled me with rage. Because they, those policymakers, those contractors, those people that are part of this big giant machine, they need to spend some quality time in the death bin. Not in terms of being injured, that's not what I mean. I mean, they need to spend a moment in the death bin so that they can see what these decisions look like for the young men who carry this out, who carry out the mission, and whose lives can get snuffed out in an instantaneous blink of an eye.
I also remember, when we took mortar fire that day, I was really confused from mortar fire. I know that sounds weird, but from a sensory standpoint, it happened almost in reverse. You see in a movie that there's some big explosion and everybody sees it and then this wave, and they duck to get out of the way and everything. It's a bunch of nonsense. I was coming out of the shitter. I was coming out of the shitter and I heard some sound overhead, and had no idea what it was until I felt heat and the pressure wave from it. Then I looked up and I saw this huge ball of flame. Then I heard the explosion from it. The explosion was last. It was like it unfolded in reverse. It just makes you think like, when your time has come in the bad luck lottery in a combat zone, your time has come. There's no anticipation. There's no way of knowing. It's instantaneous, and it just comes out of nowhere. I oddly try to take some solace in Benton's death knowing that he didn't see any of it coming. He didn't, hopefully, experience pain in any significant fashion beyond a nanosecond of the dull thud. Anyway. Yeah, I'll never forget that death bin. I'll never forget the gratitude that I have for the boys and the men who served over there and kept me safe. I'm grateful every day for all the blessings that are in my life thanks to the sacrifice that they made.
But at any rate, yeah, the transition back is a challenge for everybody. I think as a doc, I had resources and blessings in my life that were a lot more supportive than a lot of the guys that I was over there with. But yeah, it's definitely a difference. Within medicine, a simple example, you go from taking care of your young buddies with blast trauma, who you're working to resuscitate and get back into a living that they can exist with, to civilian emergency medicine, which is often an 80 year old coming in from a nursing home who thinks that Nixon's the president, and you got to sort of adjust your mindset for what you can do, and you get nostalgic for the time that you had with your friends. The things that you've been through over there together, as battle buddies and brothers in arms, you've literally risked your lives together, and that sort of comradery, I think, is a once in a lifetime type experience. I mean, that's why my dad was ... He was a swift boat guy in Vietnam. I'll never forget, we visited his battle buddy for 40 plus years, and that sort of closeness, there are some areas of civilian life where you go through things together and you do feel a bond, but there is something about literal life and death situations where you know that you have to rely on that person with your life where there's just no way to recreate that.
KH: That was Dr. Jon Heavey. Jon is now an emergency room physician, serving on a different kind of frontline in the battle against Covid-19. To hear him talk more about that experience, tune into his episode of our other podcast, Burn the Boats.
Burn the Boats is an interview podcast, where I talk to political leaders, activists, and other history-makers about current events and difficult decisions. You can find it wherever you’re listening to this episode today.
Next time on Warriors in Their Own Words, we’ll hear from Col. Bill Gara. Col. Gara was the commanding officer of the 1st Engineer Combat Battalion of the 1st Infantry Division, from North Africa to Omaha Beach and the Battle of the Bulge.
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Warriors in Their Own Words is a production of Evergreen Podcasts, in partnership with the Honor Project. Our producer is Declan Rohrs. Senior producer is Isabel Robertson. Audio engineer is Dave Douglas. Special thanks to Evergreen executive producers Joan Andrews, Michael DeAloia, and David Moss.
I’m Ken Harbaugh and this is Warriors in Their Own Words.