Volume 56, Number 3 - Summer 2010

 

By Peter Bretan Jr., MD

by Dr. Chris Coppola, 265 pages, NTI Upstream, $25.

Dr. Chris Coppola opens Coppola: A Pediatric Surgeon in Iraq with a quote from Lincoln’s Second Inaugural Address:

Lincoln’s timeless words express what U.S. military surgeons do in Iraq, not just for our soldiers, but also for the children who require life-saving surgery. Coppola states that the children of Iraq must be saved because they are the innocent bystanders of a cruel war. 

Bystanders are often the victims in Iraq. “Al Qaeda fighters … opened fire in a crowded public area,” Coppola writes, adding that the newly trained Iraqi Army “returned firepower with a sense of panic … completely unloading their weapons in a haphazard manner. Many of them would crouch down behind cover, such as a vehicle, then hold their weapons over their head and blindly spray bullets in the direction from which they thought they were being attacked.” 

In the midst of this incoherent backdrop of brutal injustice are the generous and altruistic acts of kindness of Coppola’s life-saving surgeries. These acts not only elevate the profession of medicine, but also improve the standing of all Americans in this controversial war. 

Coppola, who was deeply inspired by the patriotism of President Reagan, chose a career as a U.S. Army pediatric surgeon. His book is divided into three major sections: his first deployment to Balad Air Base in Iraq, from January to May 2005; his “reconstitution time” at home in San Antonio; and his second deployment, to a newly expanded and modernized Balad Air Base, from September 2007 to January 2008. 

Coppola’s character changes during this time period, transformed by the intense events he chronicles. He seamlessly blends stressful and critical situations with background facts that help the reader understand this most difficult war in a broad and balanced perspective. The death rate for wounded soldiers, for example, has decreased steadily since World War I, when the rate was 80%, to World War II (60%), Vietnam (33%), and now Iraq (3%). Much of this decrease can be attributed to a new generation of military trauma surgeons.

As a pediatric surgeon, Coppola is part of a cohesive surgical team. During his first tour, he serves in a crew of 12 surgeons, including several general, orthopedic and neurosurgeons, as well as individual ophthalmologic, ENT, urologic, and maxillofacial surgeons. In one incident, Coppola assists a neurosurgeon with an Iraqi pediatric patient who has sustained a gunshot wound to the head. The procedure requires an open craniotomy, and Coppola has to take care “to avoid suctioning up normal brain tissue” during the debridement. 

Coppola recalls “soldier’s sweat under layers of armor in the Iraqi’s 130 degree heat” and is stricken by the death of a female National Guardswoman. He writes, “I’ve treated many women who have suffered non-combat trauma before. Some made it, some did not. But I cannot wrap my mind around the cold reality of a woman being killed at war.” 

Conflicts are numerous for Coppola. As a military surgeon at a combat support hospital, his first responsibility is to troops injured in the field. However, in treating children, he makes decisions to prioritize their care, at times soliciting the participation of other staff members. In the case of a child with biliary atresia, for example, Coppola finds a way to perform the surgery successfully, despite tense arguments to let the child die of a “non-combat” surgical disease. 

Despite saying “We’re not winning, we’re not losing,” President Bush inaugurated the Surge in 2007, ordering the deployment of more than 20,000 soldiers, and extending the tours of 4,000 Marines, to provide additional security to Baghdad and Al Anbar Province. Coppola notes that while the Surge has been beneficial, it has inspired a countervailing effect on Iraqis: “Now that Al Qaeda can’t get to the troops easily, they’ve been targeting civilians. It’s frightening.”

Coppola points out that the Iraqi Medical Association prewar membership was about 34,000. By April 2006, 2,000 members had been killed, 250 kidnapped, and 12,000 had fled the country, leaving less than 20,000 physicians. This is but one of many statistics that Coppola shares. Here’s another: only 1.5% of the U.S. population is in the Armed Forces, but 67% of our $1.1 trillion budget goes to National Security and Defense. 

Military lingo runs throughout the book. A “combat shower” is 30 seconds to get wet and lather up, then 60 seconds to rinse. A military base is called “Mortaritaville,” and an oxymoron is “Army Intelligence.”

This book is a must read, not just for physicians, but for the general public. As a physician I was humbled by the grace and humanitarian acts that a fellow surgeon exhibits in war. We should all be proud to have Dr. Coppola as a colleague and fellow American. h

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