There are days when the world just doesn’t seem to work right. The little girl I was taking care of with the gunshot wound to the abdomen died this afternoon at 1700. I’m still at a loss to understand how she died, or even the fact that she is gone at all. She was improving. She made it through the night and was stronger when the morning came. I operated again and reconnected her intestines. I was able to close her belly and get her back to the ICU. I showed her mother the surgical wounds and explained what each tube was for. The girl was breathing well. When she heard her mother’s voice, she opened her eyes and seemed to recognize her. It was a big step forward to have her belly closed again. I allowed a glimmer of hope that she might soon be breathing on her own.

I returned to the OR to work on a middle-aged woman who has large wounds across her buttocks, abdomen, and back from gunshot wounds. She has been in the hospital a few weeks. It was amazing she was still alive with what she has gone through. She was injured at a security checkpoint. As she approached it, she didn’t stop at the no-fire line. When the guards fired a warning shot, she accelerated, and the soldiers fired to stop the car. It seemed like all of us had operated on her at some point during her stay. I trimmed dead tissue from her wounds and sewed her muscle back together.

Before I finished the operation, I was called emergently to the ICU. The little girl had lost her heart rate. None of the doctors or nurses could figure it out. As we gave her CPR, we checked her breathing tube, her intravenous catheters and her medications. We looked for bleeding and collapse of her lungs. For a time that seemed like an eternity, we tried every option we had to attempt to restart her heart. I didn’t want to give up. She wasn’t supposed to be dying. She had made it through the most dangerous period. This was such an unanticipated and tragic turn of events. Eventually, I had to stop our efforts and declare her dead. As I did the final examination to look for any residual sign of life, I looked at her swollen eyes and purple lips. The team around me was in shock, but I knew they were looking to me because she was my patient. There was nothing I could say to them, so I thanked them for doing everything they had done to help the girl.

Two translators were waiting with the girl’s mother in the boarders’ room. Translator N. told her the low news I carried while translator M. hugged the mother and let her cry on her shoulder.  Yesterday her husband died of gunshot wounds, and now I was telling her that her daughter was dead. The nurses and Colorectal Surgeon J. helped me clean the girl’s body, wrap her in a white sheet, and bring her to her mother to hold. I said my peace, answered her questions as best I could, and went back to the operating room.  I go on, but ask myself, how can I?

Later that night, I wait for the helicopters to liftoff the helipad. I cross the helipad and enter the compound of the old hospital. I pass by the ruins of the tents, just a few frames, canvas and sandbags. I climb to the roof of the old Swamp and gaze out over the wire. The lights of Balad blink in the distance as deuce and a half trucks drive by on Victory Loop. I let Iraq know what I think of it.