Gifts of the Heart. Hassan A. Tetteh

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      IN THE FALL OF 2011, HASSAN AND I LIVED AND worked side-by-side in an austere United States Navy, Role 2, Forward Resuscitative Surgical Suite in Afghanistan. Our time there transformed us, both as surgeons and as men, and forged a lasting friendship and exchange of ideas that helped to inspire this book, Hassan’s first novel. This book is not an autobiography, but the protagonist shares many of Hassan’s fine qualities. Both men have a deep gratitude for the freedom and opportunity of the American Dream, a nuanced understanding of their cultural heritage, a poetic eye, and a surgeon’s steady hand.

      Prior to our deployment, I was stationed in San Diego as a Navy orthopaedic surgeon, specializing in sports injuries. Hassan worked as a Navy cardiothoracic surgeon at Bethesda/ Walter Reed. Hassan’s soft-spoken, well-spoken, bespectacled presence was a welcome contrast to the bluster and fluster of our six weeks of “training” at Camp Lejeune. We joined a group of surgeons, nurses, and corpsmen setting up tents, trialing gas masks, and firing assault rifles in the stifling humidity of a Carolina summer. We were all wary of what we would face in Afghanistan over the next seven months, and we were all homesick after fresh farewells to our families.

      It took over ten days and a combination of civilian and military aircraft to get to our assigned forward operating base (FOB), in a particularly “kinetic” corner of the Helmand river valley of Southwest Afghanistan. We clambered out of the belly of our massive transport helicopter, struggling under the weight of our combat gear, onto the rocky airfield and dragged our bags towards the medical tents, just visible over the HESCO barriers. We were all cursing the blistering heat and dust and the fact that no one had come out to give us a hand with our gear, when we saw the Army DUSTOFF helicopters coming onto the base low and fast.

      The existing Navy Surgical Team, that we had come to replace, cleared us to the side. Their corpsmen sprinted out to the Blackhawks and came back carrying a limp and mangled body. The Marine’s legs were gone, and what was left of his thighs was beyond recognition, a tangle of ripped, burned, bloody muscle and bone. We stood there, frozen for that split second, by shock, horror, and fear. Then, abruptly, the Marine sat bolt upright and glared at us, before collapsing into unconsciousness as he was rushed into the tent. Hassan and I struggled out of our flak jackets and Kevlar helmets and pushed inside.

      I will never forget our “operating room,” an old, sagging GP tent with just enough space to accommodate one litter stand, an anesthesia machine, and basic surgical equipment. No matter how much we cleaned it, dust found its way into and onto everything.With all the lights on, it still felt dark, and the temperature rarely dipped below one hundred degrees. Our patients came to us straight from the battlefield, in severe shock from the massive blood loss of multiple amputations. We operated, two surgeons on each side of the table, in a race to definitively control bleeding. The anesthesia team used rapid infusers to replace volume, often using fresh, whole blood from a “Walking Blood Bank” of Marines and Soldiers, eager to help us by donating their own blood on the spot.

      The urgency and austerity of the surgery was a shock to all of us, but especially to Hassan, whose cardiothoracic training and practice emphasized elegance, precision, and technical perfection. After a few cases, we had all accepted the brutality and frugality of battlefield surgery. We had no choice; lives were hanging on the balance. We focused on cheating death. We counted on each other and clung to our Faith. We never lost a patient in the tent. If they came in with a pulse, they left stable and strong enough to begin the many stages of their MEDEVAC homeward.

      Some patients died just before the courageous Army DUSTOFF crews could get them to us, and we tried everything we could to bring them back. Hassan opened their chests, guiding us through cardiac massage and advanced resuscitation. But their wounds and blood loss were non-survivable. Our “Hero” patients were meticulously prepared and their bodies were draped with our Ensign. We all lined the honor guard procession from the tent to the flight line, standing at attention until the helicopters lifted away to the south.

      In between cases, we fought off the anxiety and anticipation of the next trauma arrival with exercise, conversation, reading, and prayer. Access to the Internet was limited, so Hassan and I leased a small satellite system from a British vendor at the closest big base, and spent the better part of a week crawling around on top of the Quad containers behind our medical tents, running cable, tracking satellites, and tuning our dish. Our WiFi was a huge morale booster for the whole medical team.

      When Hassan was selected to leave early, we all felt a great loss. I knew him well enough by then to empathize with his quiet quest to integrate the varied challenges of his deployment to the Helmand. On the day before he left, Hassan shed some dusty tears as we shared memories of our patients and considered the magnitude of their sacrifices. We prayed that they would find the courage and determination to heal from their wounds.

      We have since returned to our busy surgical practices in the Navy. We have both seen our patients on campus, and many more like them, bravely learning to walk again, this time on state-of-the-art prosthetic limbs. We are grateful to know that our early hours with these Warriors in our small tent gave life to their remarkable and inspirational work of recovery.

      Nunc Coepi

      Now we begin...

      Christopher B. Dewing, MD

      San Diego, California