After weighing anchor in January 2003, the hospital ship USNS Comfort left Baltimore, Maryland, and slowly chugged across thousands of miles of ocean to its final destination in the Middle East. What the Comfort lacks in speed (and firepower), however, it makes up for in size and advanced medical technology: the length of almost three football fields, the bright white hospital ship has 1,000 patient beds, twelve fully equipped operating rooms, full state-of-the-art radiological capabilities, several labs, cat scan machines, and two oxygen-producing plant systems. In early March, just weeks before the launch of Operation Iraqi Freedom, forty-eight-year-old Commander Edward W. Jewell said goodbye to his wife Clara and left their home in Washington, D.C. to fly out to the Middle East with most of the Comfort's other medical staff. Jewell specializes in diagnostic radiology and was sent to the Comfort for a two-month deployment to evaluate x-rays and determine the severity of internal wounds sustained by American forces. In the early period of the war, however, Jewell—and many of the other doctors and nurses aboard—began to wonder if they were going to care for any troops at all. The following excerpts are taken from almost two months worth of journal entries that Jewell wrote aboard ship and then edited later. (Please note: Some of the entries describe in explicit medical terms the wounds sustained by patients brought to the ship.)
March 27 — Q: The Comfort is a large non-combat hospital ship protected by the most powerful Navy, Army, and Air Force in history. What is there to be afraid of? A: Everything. Danger is all around is. We are really very close to the action. At times we see oil fires near the shore. However, we cannot really see the combat. We are not afraid of the Iraqi military. If they try to fire a rocket at us it would be easily shot down by artillery on the ground, aircraft, or by naval gunnery/rockets. However, we believe there are mines in the Gulf. Purportedly, small boats have approached the Comfort several times. When this happens we call in a helo and launch our small boat to run them off. How can we possibly see one of these things in the dark? I think it would be very easy for a terrorist to attack this ship with an explosive-laden small boat. Very easy. The Comfort is the slowest ship in the water. We couldn't outrun a rowboat. Huge red crosses on our sides and decks mark the optimum spots to aim a torpedo or rocket to sink us. As a non-combatant ship, Comfort is, of course, unarmed. Would the Iraqis attack a hospital ship if they could? Why not? In their view, they were invaded by mercenary infidels who deserve no better. A surgeon/buddy of mine, Mike from Massachusetts, thinks an attack on our ship is a near-given, with a 50 percent chance of success. However, he is a proctologist and Red Sox fan and naturally pessimistic.
March 28 — Sickening sight: a helicopter's down-wash blows a stack of letters overboard. Who knows what was lost? Last letter to save a troubled relationship? A fat check? Notice of tax audit? We'll never know. That's war. Receiving mail makes people feel so good they are giddy. Some share the letters they received with other crew members. People are so starved for contact with the outside world they are happy to read letters written by people they have never met.
The doctors are all bored from underutilization, but the surgeons seem particularly restless. There are so many of them and not enough cases to fill the time.
The Army helos cannot fly patients out to us in bad weather. The visibility has been poor the last three days, with choppy seas. We were to have received twenty or thirty new patients but they never made it because of the weather. This will all change markedly very soon. A new scheme for casualty movement has Comfort playing a more pivotal role. Two all-weather CH-46 Marine helos will be permanently assigned to us. They will be bringing patients to us who have had only basic stabilizing medical care, or none at all, coming directly from the battlefield. We hear they will be mostly Americans.
Rumor is an Iraqi speedboat loaded with explosives was intercepted today. It is believed it was headed towards one of our ships, maybe us. I notice today there are more grey-hulled (regular Navy) ships protecting Comfort. I hope it stays that way.
March 29 — Old Navy jargon "belay my last," meaning disregard my last statement, applies to my commentary from yesterday. We got creamed with fresh casualties last night, thirty new patients, both sides, all needing immediate and significant intervention. The injuries are horrifying. Ruptured eyeballs. Children missing limbs. Large burns. Genitals and buttocks blown off. Grotesque fractures. Gunshot wounds to the head. Faces blown apart. Paraplegics from spine injuries. The number of X-ray studies performed last night in a short period of time is so great it causes the entire system to crash under the burden of electronic data it is being fed. Miraculously, Cathy and John are able to reboot it. We nearly lost the entire data base in the computer. That is, every X-ray ever done on this system. Every one. That would have been a major catastrophe.
Our patients are mostly Iraqis. Along with their combat wounds, they are dirty, undernourished and dehydrated. One rumor says we will treat all the wounded Iraqi EPW's (enemy prisoners of war) for the duration of the war and these are the only patients we will see. If true, this would, in effect, make the Comfort a prison hospital ship. The corpsmen on the wards have to guard the prisoners and keep them from communicating with one another to prevent rebellion. As medical people we are trained to care for the sick; it is difficult to stay mindful these patients are the enemy and could fight back against us. The thought of a violent patient rebellion is most disturbing. We have no Marines or other armed guards to protect us. I fear a rebellion could mount if we take a sufficient number of prisoners and nurse them back to health.
April 4 — A.M.: We will be taking on fuel, food, supplies, mail(?), and off-loading garbage most of the day. This will limit opportunities to bring on new patients and pave the way for an easy day. We hope.
P.M.: Well, no mail but they did bring in eight more Iraqis, so I had a busy afternoon and evening. Worst case was a middle-aged civilian female shot in the head. Her CT scan showed major brain damage and her prognosis is very dim. Nonetheless, they chose to operate on her. She will do not well.
So far, 60 coalition fatalities, 12 of which were due to friendly fire.
April 5 — The Saturday entertainment is karaoke. I usually like it, but tonight it's not for me. The room is hot and crowded, and the whole event just too loud for me. I step out for air. On deck is a different world. For safety we are on "darken ship" status now. This means no external lights and all windows are covered to block light transmission. The goal is to make the ship invisible or nearly so to evil-doers trying to locate the ship in the dark. It does actually work. The night is moonless, skies only a slight haze. It is very dark outside. So dark my eyes need ten minutes to fully accommodate. There is a magnificent display of stars tonight, reminiscent of what you see in Utah. Most everyone is at karaoke, only a few souls on deck. It is very peaceful and quiet. The night has a misty, impressionist feel. People moving about in the night are just vague dark shapes. Voices are low. Boys and girls being what they are, couples are forming on Comfort. They drift into obscure corners. Ghost-like green blobs of fluorescence rise and fall in the water. Jellyfish. Thousands of jellyfish, they drift and bob around the ship. Tossed cigarette butts arc orange like small meteors towards the ocean and silently disappear. Solitude. I watch the stars until my neck hurts. Someone is singing in the dark in a beautiful, strange language. He tells me it is Hindi, and he is actually practicing for karaoke. I hope he wins.
April 7 — Unusual experience today. I visited the inpatient ward holding the Iraqi EPWs. I accompany one of the internists on his rounds. This doctor created a niche for himself by volunteering to serve as the attending physician on the prisoner ward. The experience will be unforgettable for him—and be a unique item on his curriculum vitae.
The prisoners are kept on a separate ward, deep in the bowels of the ship, for security reasons. Escape would be difficult. The prisoners are kept well away from the crew and American injured. The location is kept obscure. There is concern for the security of the prisoners. Lawyers run everything now, and we actually have a lawyer on board whose primary job is to ensure we comply with all tenets of the Geneva Convention. There are press on board all the time.
The ward is real creepy. Burly armed guards keep a watchful eye on the prisoners. There is an interpreter on board most of the time. The prisoners are not allowed to talk to one another. Some are strapped down to the bed. There is an isolation room for the unruly. Medical attendants have to remove their belts (before entering the ward) and empty their pockets of pens and other sharp objects (remember Hannibal Lecter). All sharp objects are kept in the center of the ward. Their food is cut for them, and they eat with their fingers.
Most of the Iraqis show real appreciation for the care rendered them. I would love to talk to them about family, etc., but we have been firmly warned not to do this. Standing Orders: "Go about your business, avoid interpersonal contact." It is contrary to our training in medicine not to show at least some warmth towards the patient, but these are our marching orders. The prisoners are a sad lot. It is easy to forget they were the "enemy." I feel for them. Most were not real soldiers, just conscripts forced to fight for the Big Lie, Saddam Hussein. Some of these guys however were Republican Guards, some of the feared Feddayeen suicide commandos. In general, the prisoners are badly wounded. They look defeated and glad to be out of combat.
April 11 — The number of patients coming aboard Comfort is simply out of control. Like MASH, we have grown to hate the rumble of helos on the flight deck, since it usually means another load of Iraqi patients. Today we received at least 35 more pts. New in the last 24 hours is a big influx of sick and injured children. We have only one doctor with residency training in pediatrics. Some of the kids are very ill. One was DOA from drinking kerosene. "They" are sending everyone here. We don't know who "they" is, and no one seems to have a handle on where these patients come from, when they are arriving, or who is sending them. We take them all and do our best. Patients are beginning to die because their injuries are so severe and they are getting to us too late. They are not just injured, but injured and sick with major complications. We are just swamped. Today's rumor says since the patients are non-combatants, we don't merit more security. Because we don't need (and therefore won't get) more security troops, there is now no limit on the number of patients we can take on (!). The ship is starting to run out of supplies, like antibiotics and IV bags.
There is no long-term care-plan for all these patients, and the ones who survive will need long-term care. Where will they go? Who will care for them after we leave? We have become deeply involved in a humanitarian crisis we will not be able to extricate ourselves from.
April 12 — It had to happen. Boys and girls together. Sex. People are having sex on board, and rumor has it finally somebody(s) got caught. It may have been more than just a couple. A ménage a trios had been the subject of rumors for some time and they were finally caught "en flagrante." They were sent to captain's mast, a form of internal Navy investigation and trial where the accused Stand Tall in front of The Captain to answer allegations. Mast is swift and final. They get to the point quickly and mete out punishment on the spot. Whatever punishment was assigned here is unknown to the crew. Most of the men just want to know who the girl(s?) were!
Rumor has it (there's always a rumor) the command will start a special night patrol looking for people having sex. How will the patrol function? Will they use night vision goggles? Will they take photos for documentation? What will the arresting agent say on discovering a violation: "Put the weapon down and come out with your hands up?" According to sea stories, sex on board became a major disciplinary problem on the hospital ships during Desert Storm. The Comfort was known as the "Love Boat" by the rest of the fleet.
April 15 — Tim and John were up all night helping with a Marine who was run over by an 18-wheel truck in an accident. Amazingly he lived despite a crushed pelvis and massive blood loss.
My concern about war in Syria is tempered by the realization that fighting a war in summer here is a near-impossibility. However, the rhetoric is building, and the language and accusations are about the same as with Iraq 4-6 months ago. Civilian Iraqi patients are being allowed to move around the ship more (with escort, of course) as their conditions improve. I saw a teenager today smiling and shaking hands with everyone. As he bent to tie his shoe, his sleeve slid up. I saw he had a tattoo on his upper arm. A fresh Marine Corps "Globe and Anchor." Wow! Hearts and minds, indeed.
I helped diagnose a testicular cancer yesterday on ultrasound. This was our second of the war. The man underwent orchiectomy emergently. Today I looked at the specimen with the pathologist. As a teaching experience, I brought along our ultrasound tech who had helped with the scan. The tech was really just a kid, a raw-boned youth with pimples from the outback of Wisconsin. He got queasy at the site of a testicle on a cutting board and fainted. I had forgotten how shocking these experiences can be to the uninitiated. That was dumb of me.
April 17 — We began in earnest to discharge stable EPW patients from the Comfort. Close to 30 sent back today. Sent somewhere. Sadly these guys don't realize they are not being repatriated. For security reasons they cannot be told where they are really going. Looking at these pathetic-looking fellows, it is easy to forget they were the enemy, and many probably still wish us harm. According to an ICU doctor, one of the most timid-looking teenage patients is actually an identified terrorist. Another patient awoke from surgery disoriented to place; he asked if he had been sent home to Syria! Apparently many anti-American Syrians had joined Saddam's army to fight us. In a Pavlovian way, the patients now associate the presence of the Big Nurse Administrator with the Clipboard with imminent departure of fellow Iraqis. As soon as she sets foot on the wards they circle their arms overhead like helo blades in motion and make woop-woop sounds. They know helos are in-bound for evacuation.
April 21 — Comfort receives a visit from CENTCOM, the name for the headquarters group for the entire war. A group of their medical admin bureaucrats, primarily Army, are on-board to give us an overview of the medical situation in Iraq and Kuwait. We hope to hear something concrete about our own status—what is planned for us, how can we off-load our patients, and mostly, when can we go home? Instead of insight and clarity, we got more obscuring mud in the eye. The formal presentation is tiresome, trite, and uninformative. It takes 15 minutes to get the PowerPoint working. The speaker uses too much Army-specific jargon. He talks at length about Army groups that are going home. It goes on for 45 minutes. He lays out timelines for certain objectives that go well into July. We wonder if that includes us. He admits the Comfort is the most stable, established, and productive medical unit in theater. The hospitals in Iraq have been looted and are barely functioning. The fleet hospitals are operating at much lower capacity than we are. We may never leave.
A Q&A session follows. The discussion is as overheated as the room. Several doctors are really pissed over how hard we worked and how we got stuck taking all the EPWs. Pointed questions regarding why we got so stuck with so many patients go ignored or glossed over. It is explained the Iraq casualties were put on helicopters by well-meaning, altruistic US troops, even though they were told not to do this. They offer no explanation for why all the Iraqis ended up in our hospital. They thank us for all our hard work, tell us they "feel our pain," and say war is hell. It is not convincing or reassuring to us. These guys all look rested, tanned, and painfree to us.
The meeting ended inconclusively. We are no clearer on finding out when this will be over for us. If anything, the Army brief made it appear we may be here for a long time to come.
As the fighting intensified in Iraq, the Comfort took on more and more wounded U.S. troops and would ultimately care for hundreds of American casualties. Six months after Dr. Jewell returned home, he officially retired from the Navy. But he continues to work for the military as a civilian doctor.
Excerpted from Operation Homecoming by Andrew Carroll, editor. Copyright (c) 2006 by Southern Arts Federation. Reprinted by arrangement with The Random House Publishing Group.