Carl Nolte, Chronicle Staff Writer
Sunday, July 13, 2008
Supplies and equipment are loaded into the C-17 Globemaster before the wounded are brought on board at Bagram Air Base. Photo by Carlos Avila Gonzalez / The Chronicle
It is just after midnight. Afghanistan is thousands of feet below. The big C-17 Air Force Globemaster has flown nearly halfway around the world, all the way from Travis Air Force Base in California, for this moment.
Now the plane banks to the right, sharply, and starts down, spiraling into the deeper darkness. The passengers - soldiers and Air Force personnel riding in back with a cargo of medical supplies - put on body armor. The crew loadmaster, a slender female master sergeant named Jennifer Lepore, straps on a 9mm pistol.
This is a wartime landing, no lights. The pilot and co-pilot wear night vision goggles. The angle and the method of approach to landing and taking off at Bagram Air Base below are a military secret, but in back, the passengers can tell the descent is much steeper than that of any commercial jet airliner. It is like winding down a long, steep hill at high speed in a vehicle with no windows.
The plane, which is as big as a Boeing 757, lands and taxis on the runway for a long way. The Russians built this airstrip when they invaded Afghanistan 30 years ago; the Taliban and other Afghans fought over it later. At one time it was littered with broken planes.
The rear ramp opens and it is suddenly chilly. There is a slight breeze, a full moon.
The crews have to hurry. The wounded are waiting. The plane has to leave while it is still dark. It is dangerous for planes like this to land or take off in daylight.
Air crews from Travis - reservists mostly, citizen fliers from California - make this run an average of once a week, to bring the casualties, the maimed, the walking wounded, from Afghanistan or Iraq back to Germany, and then to hospitals back home in the United States. They are proud of the mission. They say that more than 90 percent of the wounded who make it to an aircraft in the field survive.
It is the highest survival rate for wounded personnel in any war.
"It is an honor and a privilege to do this," says Col. Chris Dunn, a critical care physician from Redwood City, a reservist with the 349th Air Mobility Wing at Travis.
On the ground
There is short pause, time for a quick walk over to the operations center for medical evacuation. It's a plywood building, called a B hut, and inside it looks like somebody's mountain cabin, big chairs, places to sit around, telephones, desks. Master Sgt. David Baker is in charge here. He doesn't wear body armor but he has two pistols.
"Attacks are constant here," he says, "but we are ready for them." The attacks seem to be picking up - that day a suicide bomber hit down south.
"In Vietnam," he says, "it took 20-odd days to get the injured back to hospitals in the U.S. Today normal is less than 72 hours. One patient injured in Iraq got back to the U.S. in 21 hours."
Outside the air base, it is pitch black despite the moon. The base is in a high valley, surrounded by mountains. "It's beautiful here," says Air Force Capt. Toni Tones, who arrived in winter when the jagged, snow-covered peaks of the Hindu Kush range glinted in the daylight. "It's gorgeous."
After a bit, ambulances drive up. They look just like school buses, except that instead of seats they have places for litters.
Four airmen carry each litter from the ambulance to the plane, slowly, carefully. The wounded don't move. Their faces have no expression; there is a man in a neck brace, another with a leg and his left arm bandaged. Six litters are carried aboard.
There are also six ambulatory patients. One has what they used to call in Vietnam a thousand-yard stare. A female soldier is among them; she has a ponytail and wraps herself in a blanket decorated with angels. She says nothing.
There are three Air Force nurses and four medical technicians aboard to take care of the patients. "We move 1,000 people a month," says Lt. Col. Jim Coen, who commands the medical unit that flies with the injured in and out of Iraq and Afghanistan. "We are a mix of National Guard and Reserve; in my unit we have cops, we have firemen, and we all love doing it."
In his other life, Coen, who is 56, is a personnel analyst for the city of Los Angeles.
"We are not here to argue the policy or the worthiness of the war," he says. "I don't think arguing about the war is helping. Helping the kids who got hurt is the mission."
He never talks to civilians about what he does when he goes back home to Southern California. "If I were to tell them about a double amputee who got burned and needs help, what would I say? I don't talk about it. When they ask where I've been, I say Germany, which is true."
The doors close, the body armor goes back on, the plane takes off.
The injured
The crew had rigged up American flags in the cargo area and they flutter when the plane climbs, twisting its way into the sky. The log shows C-17, tail No. 6162, assigned to the 60th Air Mobility Wing, Travis AFB, has been on the ground in Afghanistan for two hours and 35 minutes.
Is that cost effective? "Some missions we do for a single guy," Coen says. "For a single one of these kids."
They are not all kids. Once the plane takes off, Jerry Patterson, an Army warrant officer, sits up on his litter. He's got one arm and one leg bandaged, and scabs on his forehead from flesh wounds. His back is peppered with little puncture wounds made by shrapnel.
He is 46, from Utah, a reservist who is a computer programmer in civilian life. In the Army, he is in an intelligence unit.
"We were out in a small town, gathering intelligence, you know, trying to find out who was who, sorting them out." He likes Afghans, "very friendly people," he says, with a tradition of hospitality.
But there are also some of those the military calls "the bad guys."
Some of the bad guys fired a rocket at the soldiers. Missed them, a long way off target. So they went into a brick building. Another rocket, missed again.
"We thought we were invincible," Patterson said. "Nothing is gonna happen to us. They are not gonna get us, we thought.
"Then I heard the whistle of the rocket. I thought, 'This is gonna be close.' "
There was an explosion. Smoke everywhere. "Everything turned upside down in a matter of seconds," Patterson said. He thought later it must have been one of those 107mm Chinese rockets. He thought it was good shooting: one shot long, one short, one on target. "You hear that rocket coming and your heart stops," he said.
Two of Patterson's men were killed instantly, nine were wounded. Two men were completely unscathed.
""I came out of there, blood running down my face, on this bad foot, just blood all over. The combat medics were at work in the hallway. If it weren't for them, some of the men would have bled out. Bled to death."
Patterson was bandaged at an aid station, then flown out. When he was ready to go, the men in his unit came up to shake his hand. "They walked right by those medics," he said. "The medics were amazing. They saved lives. I'm sorry I don't know their names."
The C-17, now a flying hospital, flew on, over the Hindu Kush, the Caspian Sea, the Balkans, to Ramstein Air Base, Germany, a seven-hour flight from a war to Landstuhl Regional Medical Center, the biggest military hospital outside the United States.
The hospital in Germany
The plane landed at 8 on a bright, sunny morning. Landstuhl is a pretty little town in the Rhineland, houses with red roofs. It looks just like Mill Valley, except for the ruined castle. The church bells ring out the hours. It is a million miles from Afghanistan.
At the hospital, Capt. Erika Cisneros, 27, an Army nurse from Baldwin Park, a Los Angeles suburb, says patients are still scared when they get to Germany.
"The first thing we tell them is that they are safe. They are in Germany and they are going home. We listen. We give them as much time as they need to be angry or be sad. And we help them through it.
"We had a patient who was heavily sedated. He had come from Iraq. He woke up in the hospital. He kept asking me if he still had his legs. He wouldn't look. He wouldn't look down.
"He must have asked me 17 times, and I had to tell him every time he had lost his legs.
"That was a year ago. And I said to myself, 'Why do I keep doing this?' "
Cisneros answered her own question. "Because I can help."
The man in the neck brace who was put aboard the plane in Bagram is awake now. He is 2nd Lt. William Ortega, born in Colombia, lived in New York City, joined the Army in 1996, served as an enlisted man and then got a commission. He's been in the Army 12 years.
He was in a truck convoy in Afghanistan when an explosive device went off. He injured his neck and has burns on the side of his legs.
"I am a platoon leader," he says. "I want to be with my soldiers. We are close, close, like a brotherhood." He says his men - all from the 101st Airborne Division - are all very young. Ortega is 38. "They call me Grandpa. It is an honor to lead men like this."
Jacob Brittain, 21, a private first class in the Marines, was ready to go home, first to a hospital, then to Frankfort, Ind. A roadside bomb got him. His left heel was shattered. "Afghanistan is a dangerous place," he says. "You don't know who's who."
It took only 10 minutes for a helicopter to pick him up, which sounds fast. "It seemed like forever, it does. You are in a lot of pain."
He always wanted to be a Marine, he says. "Some people want to be an astronaut, or a fireman. I wanted to be a Marine."
Would he go back? "Absolutely, I am 100 percent sure."
It will take awhile, though. With luck and therapy, he thinks he can walk again in a year.
The Travis plane took off from Germany on Sunday afternoon bound west across the Atlantic for Andrews Air Force Base. This time there were 17 litter cases, eight ambulatory patients and five in critical condition.
One man had lost his left arm, another his right. One man's leg was shattered. Another had severe brain injuries. A team of critical care medical personnel hovered over them for the nine-hour flight to Andrews, which is near Walter Reed Hospital in Washington, D.C., and Bethesda Naval Hospital in Maryland.
The doctor
Critical-care doctor Chris Dunn, 56, is a colonel, who joined the Air Force Reserve when he was 50. He was too old to join, so he had to get a waiver. In his other life, he has a private practice in Redwood City and is on the staff at Sequoia Hospital there.
He has two sons who are Air Force pilots. "I wanted to help," he says, so he joined up with the 349th Air Mobility Wing at Travis.
Born and raised in Seattle, he went to Stanford as an undergraduate and to Stanford Medical School. The Vietnam War was on during his undergrad days; he registered for the draft but got such a high number he was never called.
He is tall, slim and fit, with gray hair. He has a lot of credentials. "But that is nothing compared to the honor and privilege of helping 18- to 25-year-olds who are the boots on the ground," he says.
For two months on this deployment, he has flown with the critically injured, a Sunday flight to Andrews in Maryland, Monday back to Germany. He has been across the Atlantic more times than he can remember, helping the patients westbound, sleeping on the floor of the plane eastbound. Sleeping on the floor doesn't bother him; he has backpacked in Yosemite and has a good air mattress.
His patients don't know him; they are critically ill - "in very bad shape," Dunn says. "You take them to a larger hospital where the technology and care will be good. Where they can be close to their families. We are one link in a chain of survival."
At Andrews, a crew of air men and women were on hand to take the litters off the plane. The man with the brain injury was flown by helicopter to Walter Reed.
The C-17 took off from Andrews AFB bound for California on Monday. From the cockpit, one could see the Washington Monument, the Capitol, all the sights.
The plane arrived back at Travis Monday afternoon.
"I see this as a mission to help people," said Lt. Col. Michael Casebeer, the pilot.
The mission had taken a week and C-17 No. 6162 had flown 40 hours in the air, 20,233 miles.
For more pictures and video from aboard the C-17 Air Force Globemaster, go to sfgate.com
Medical personnel tend to combat wounded in the cargo area of a C-17 Globemaster as they are transported from Bagram Air Base in Afghanistan to Ramstein Air Base in Germany for further treatment. Photo by Carlos Avila Gonzalez / The Chronicle
Online resources
To see a video of the medical evacuation flight, go to sfgate.com.
E-mail Carl Nolte at cnolte@sfchronicle.com.
