Radiologists Answer Nation's Call on Iraqi Battlefront
When America goes to war, its radiologists never hesitate to answer the call — even when that call comes at the most unexpected moment and entails considerable personal risk.
Radiologist Lt. Col. Veronica J. Rooks, M.C., got the call last August. That's when her supervisor, Col. James A. Breitweser, M.C., who has served in both Iraq and Afghanistan, asked the 13-year Army veteran to leave Tripler Army Medical Center in balmy Hawaii, for a three-month tour of duty at Forward Operating Base (FOB) Diamondback in war-torn Mosul.
In a matter of days, the lieutenant colonel would be transported halfway around the world, where she was expected to instantly make the leap from pediatric radiology to trauma radiology in a wartime setting — having no prior experience in a trauma center. As her C-130 transport touched down on the tarmac at Mosul, Rooks, 43, was feeling a little bit nervous about the tremendous responsibilities that lay ahead.
"What went through my mind as I headed out was, 'Am I going to be able to do this? Am I going to get the job done or let my soldiers down? Am I going to be safe?'" she recalls. Rooks had already received a week-long briefing on the snipers, suicide bombers, pitched gun battles, improvised explosive devices (IEDs), and occasional beheadings that plagued Mosul, an ethnically diverse city of 1.7 million located some 250 miles northwest of Baghdad. But any illusions of safety she might initially have felt inside heavily fortified FOB Diamondback were shattered on Day Three.
Remembering a 3 a.m. wakeup call courtesy of an incoming insurgent mortar round, she says, "The loudspeaker sounded, 'Bunker! Bunker! Bunker!' We all ran out of our metal CHUs (contained housing units), jumped into our mortar bunkers, and that's when it went through my mind: 'Wow, we are actually getting bombed.' When we heard the clinking of mortar chunks hitting the sides of our CHUs, that's when I realized, as my heart is beating a million miles an hour, 'This is real.'" But jumping into bunkers, she soon discovered, is standard operating procedure at U.S. installations all across Iraq and Afghanistan.
Of greater concern to Rooks were her patients. "One of the things I did not anticipate was seeing so many civilians and children. I expected to see the U.S. soldiers. I didn't expect to see so many Iraqi soldiers, but it was the Iraqi children that were the most unexpected," says the pediatric radiologist and mother of three. "I didn't expect to see children with head injuries or missing limbs or abdominal trauma. And some of the soldiers are so young that I looked at them and thought, 'Wow! How can this be happening? They are just children themselves.'"
Rooks quickly discovered that war-related blast injuries go beyond the trauma typically seen by civilian radiologists. Normally, you don't see missing limbs, bodies peppered with shrapnel, or intestines blown out of abdomens by roadside IEDs," she says. It was of some comfort to her to see soldiers wearing body armor, which protected covered areas. Among her patients were American and Iraqi soldiers fresh from military operations.
Rooks describes her combat support hospital (or CSH, pronounced "cash") as "a sprawling, one-story fixed facility that American forces had been able to modify to accommodate the needs of a hospital. The unit had 6 ER bays, 3 OR tables, 20 ward beds, 12 ICU beds, and a medical complement of 22 physicians, including surgeons, anesthesiologists, a pediatrician, a family medicine nurse practitioner, a dietitian, and a physical therapist.
"The imaging capabilities were very state-of-the-art," Rooks says. 'We were not lacking in that regard. There are other units that do not have full radiologic capabilities and that could use more bandwidth, but we even had a 16-slice CT scanner located on site."
Call coverage was simple. As her CSH's only radiologist, Rooks was on call 24/7. She recalls with a chuckle, "I didn't work shifts, because I never didn't work. We had morning rounds at 7 a.m., then clinic typically didn't end until around dinnertime, and then I was on. In fact, I was 'on' basically the entire time I was at FOB Diamondback. Trauma cases could materialize at any time — morning, noon, or at 3 a.m. Whenever something happened, I was paged. But there was no place to go anyway; I never left the FOB."
Throughout, Rooks had an extra measure of safety nearby — an unloaded Beretta 9 mm, which she carried 24/7. "We as physicians are noncombatants and protected by the Geneva Convention, but hold a sidearm to protect our patients, should the need ever arise," she says.
One thing Rooks and FOB Diamondback's medical team could not escape was Iraq's broiling heat. A hot day would see the mercury spike well above the 120-degree mark. "At times, I could only walk 10 steps before resting,' she says. "Luckily, we always had a buddy we could rely on to make sure we were okay."
She maintained contact with her family by e-mail and telephone. Her husband — a nonmedical civilian professional — "never let me know how worried he was until I came back," she says. "His support was amazing."
By October, Rooks was packing up and heading out. "I was ready to come home," she says, "but I also felt guilty leaving, because there is so much more to do; I had so much more to give."
Reflecting on her three-month tour, she says, "I had a fantastic experience and was proud to be there and proud of everyone who was and is serving us. I treasured the opportunity to practice medicine in kind of the right way — in a nonmanaged environment, just being part of a health care team that was so essential. I worked with some of the finest, most selfless physicians I've ever met. The camaraderie really kept us going during a challenging time."
She says the most striking difference between civilian and battlefield radiologists "is the commitment one has made to his or her country, which is the motivational factor that allows you to do what you need to do." Asked to imagine what it might be like to serve as a radiologist in Mosul for three or four years straight, she responds, "I don't think I could under those circumstances."
Today Rooks is back practicing pediatric radiology at Tripler Army Medical Center. On occasion, she speaks to groups about her experiences in Mosul. She values the opportunity to contribute and has a clear message for her audiences. "I think we need to be very thankful and show gratitude toward those men and women who have answered the call," she says. "The biggest thing we can do is to support them — in whatever way you go about showing your support. "