A new mash for a new millennium

Intensive training for handling wounds prepared Air Force Major John C. Lundell, M.D. ’94, for the casualties he might encounter as a battlefield anesthesiologist. But in the weeks after Lundell arrived at his post in a tent hospital at the Baghdad airport in early July, his caseload resembled family practice more than trauma medicine. At Camp Sather Lundell treated several patients who were dehydrated and some who had blood in their urine, sutured cuts inflicted by can tops and pocket knives and took care of an airman having a heart attack.

All that changed with the bombing in August of the United Nations office in Baghdad. Since then, his wife Andrea L. Lundell, M.D. ’94, reports from their home in Texas, he has treated both soldiers and civilians, Americans and Iraqis, some with severed limbs or serious burns resulting from the ongoing violence in Iraq. And it turns out that at Brooke Army Medical Center in San Antonio, where she is chief of cardiothoracic imaging, she has treated patients her husband stabilized in Baghdad. “A lot of the bad cases end up coming here for further work,” she said.

In e-mail messages to Yale Medicine in July, Lundell reported that when he was not working shifts, he kept busy playing bridge with tent mates, washing his clothes and reading novels, the Book of Mormon and the hymns he’d loaded onto his Palm Pilot before leaving his home base in Texas. When he couldn’t sleep, his cycle disturbed by the rotating shifts, Lundell sometimes hung out at the hospital, chatting with those on duty or with other restless airmen who had drifted up to the hospital tent. Twice a week, Lundell could count on phoning his wife and children, 5-year-old Madeline and 3-year-old John W.

Lundell said he felt safe where he worked, well inside the base for 1,500 Air Force personnel. He went to Iraq as part of what he calls “a lean, mean wound-fighting machine,” a five-person mobile field surgical team that also includes a general surgeon, an orthopaedic surgeon, an emergency medicine physician and a critical care nurse. With equipment they carry in 70-pound backpacks, the team can assemble a portable OR in less than two hours. Their supplies can see them through 10 life- or limb-saving operations. The team can also collect fresh blood from any service member whose blood type, printed on dog tags, matches the patient’s.

A week before his departure Lundell explained that his team is trained to treat patients during “the golden hour of trauma,” when the team has the best chance of saving a life by controlling bleeding—which causes about half of combat deaths. “The old system of dragging them off the battlefield and shipping them off to an Army hospital took much more time. …We can pack a spleen or amputate a leg,” he said. Now the team can stabilize patients before sending them on to a larger hospital.

Team members do face limitations. For instance, they can’t use all their fluids on a single patient, even if a life depends on it. “In a level one trauma center, where we have basically unlimited resources, there’s a better chance of saving someone that is severely injured, but in the field there would be nothing left for the nine other patients we’re supposed to treat,” says Lundell. “Sometimes you have to make tough decisions and decide who is going to be treated expectantly, meaning comfort measures—mostly analgesia, morphine.”

The possibility of letting a patient die “is something we’ve had to think about. ... That would be rough, because we’re trained to not let people die. We’re trained to save lives.”

Lundell’s role in the mobile field surgical team brought him what he jokingly calls “my 15 seconds of fame.” In May, he appeared in “Blood on the Battlefield,” a National Geographic Explorer documentary on battlefield medicine. Lundell’s 15 seconds (actually more like 30) showed his team practicing setting up an OR and then operating on “victims” hemorrhaging fake blood. Lundell and his team members actually learned most of what they know of trauma care by treating real-life victims at Wilford Hall Medical Center on Lackland Air Force Base in San Antonio, where they were stationed before going to Iraq. Lundell said taking care of people injured in drunken-driving accidents kept them “up to speed in dealing with people who are bleeding to death.” In Baghdad, the team is working as a “building block” for a hospital staff of about 25. They work in a 20- by 70-foot air-conditioned vinyl tent with a wooden floor.

Lundell supported the U.S. invasion of Iraq, likening it to surgery. “You really would rather not operate on people. An operation is a controlled injury, controlled trauma. But if you have to operate, you want a finely honed instrument. The military is the knife. You have to cause injuries, but hopefully it’s for the greater good. … Certainly I regret some of our troops having to pay the ultimate price to free the Iraqi people, but I do support the president.” He says that his wife agrees, then adds: “I don’t know how our support would change if something were to happen to me. It’s not something we have much control over. We do our best to do what we signed up to do.”

Doing what they signed up to do has made life for the couple unpredictable since September 11. Both were in the Air Force and were periodically “at risk” for deployment, potentially at the same time—in which case the children would have stayed with relatives. The pressure eased in July 2002, when Andrea completed her three-year Air Force obligation and began a civilian job at Brooke Army Medical Center. Both husband and wife, who met as first-years at a volleyball game on Harkness lawn, took part in the Armed Forces Health Professions Scholarship Program. The government paid their medical school costs and provided a salary for John’s fellowship year in cardiothoracic anesthesia. In return, the Lundells spent a year in service for each year of support they received: she for three, he for five.

Andrea Lundell says she is coping with her husband’s absence, expected to last four months, by keeping the big picture in mind: “I try to remember that there are many other men and women over there who are making sacrifices, too, and there have been many others who have in the past. … I keep a positive attitude.” She feels supported by colleagues at Brooke Army Medical Center. “A lot of people over there know what it’s like to have somebody go.”

When John Lundell completes his Air Force service in June, he expects to go into private practice to maximize time with his family. “I like doing and I like teaching. If I can find a place where I can teach some and do, then I’ll be happy.”

Lundell is grounded by his faith as a Mormon, which is “part of the fiber of my being. It helps me feel prepared for whatever may come.”