The following is an excerpt from “Bones One Zero,” the memoir of Army combat medic Reuben Ryan.

THE TOUGHEST MAN

“Bones One Zero, this is Bones OPS,” It was our Operations SGT at FOB Taji, SGT Graham.

“Bones One Zero,” CW3 Bottolene replied as our Blackhawk headed back south from Balad after completing an Urgent MedEvac.

“Bones One Zero, we just got another Urgent nine line, what is your fuel status?”

EZ instantly replied internally that we were a go, and it was confirmed by the Co-Pilot, Dahlen, both performing fuel calculations every few minutes, as per Dustoff standard operating procedure. Refueling takes time away from the mission. Knowing how much we have, divided by how much we burn, is critical.

“Roger, we are good, send the 9 line.”

“Roger, sending,” SGT Graham sent the grid over the message system.

“What is the nature of the injury?” I asked Mr. Bottolene

“Bones OPS, Medic wants to know what the injury is.”

“Roger, gunshot to the face,” The message was confirmed by Mr. Bottolene, but the cabin got silent for a couple of seconds, which seemed like an eternity. Then, as if on cue, the two pilots started working in a beautiful chaotic rhythm. Mr. Dahlen flew in the right seat, took the controls, nosed the aircraft over, reaching max speed, bringing the aircraft around to head right for downtown Baghdad. I watched the buildings near Samarra looking for any incoming fire, watching the spinning rotors come down in front of me as we began our turn.

Mr. Bottolene was in the left seat as the Pilot in Command; his hands moved everywhere inputting grid coordinates, flipping switches and turning dials, making the proper calls to all of the different air controllers involved for our route. Both of us backseaters stayed silent and hung out the left and right windows, scanning. I was on the left, and EZ was on the right.

Baghdad was a crazy place to fly at night, the glow of the city could be seen from thirty miles away. That’s great for the pilot to aim for but once you come to the city, it can be overwhelming. Our MedEvac Blackhawk was not the only thing in the air, especially over Baghdad. At 500 to 1000 feet we have to not only find the street to land on, but also contend with Kiowas, Apaches, observational balloons and those damn pesky drones being flown by some guy back in Nevada in the same flight suit I was wearing, only without the heat, smell of fuel, sweat, and dried blood that leaves the familiar metallic taste.

“Roger,” I said over the mic. My heart started to pump, and I could feel the adrenaline course through me. It felt great and sobering at the same time; I was ready. I began to think about the wound and possible interventions I would have to do. The questions began to surface in my head: What type of round hit him? How big might the hole be on both entry and exit wounds? Airway compromises? Neurological problems? My game plan formulated as we rocketed to downtown Baghdad. I decided that if it were a simple through and through that I would take him to the Combat Support Hospital in Baghdad, call sign China Dragon, but if there was a neurological issue I was going north to Balad.

“EZ,” I said when there was a break in radio traffic “We are probably going to be busy on this one, I might need your help, clear the pan on your side when I get out, OK man.” The ‘pan’ was the litter pan in the cargo area of the Blackhawk; it could be configured to hold four litters. We had it set to carry two where the top one someone could sit upright on. When not loaded down with patients, we pile the monitors and my aid bag on it.

“Roger will do,” EZ replied, I could hear the anticipation of the oncoming mission in his voice, he lived for it. EZ was not an ordinary Crew Chief. While he was rough around the edges; he loved his job as Dustoff Crew Chief. Whenever I needed help, especially with multiple patients, EZ was always there. Countless occasions you could find him wrapping wounds, bagging a guy, or just reassuring a patient that is having the worst day of their lives.

Our Blackhawk rockets past our base at Taji, having multiple aircraft being rerouted so we could have a straight shot to the patient. A brief bit of friendlies passed beneath us and then back into the darkness and rows of palm trees and huts, back into the breach. The Taji flame was out our left side about ten clicks out, the oil refinery with a lone exhaust pipe that is a small smoke plume but a huge flame at night with NVGs.

Mr. Bottolene announced he was going to be inside looking at charts and inputting grid coordinates in the GPS, so I announced I would pick up the scan over his area. I could see the large glow of lights in the NVG’s of Baghdad. The place was hopping. Thousands of cars and people were moving below us as we stayed above and flew in at blistering pace. The crew was up and ready; all senses were up. Mr. Bottolene was had just finished one airspace call and gave me the green light to call the squad that was hit. Right as I was about to make the call out of a dark spot I saw a blacked out Kiowa in a heavy bank on its left side sliding in our direction from the left about ten feet below us, obviously in the middle of a turn, the bottom of the aircraft clearly visible.

“Climb! Climb! Climb!” I said over the mic. Mr. Bottolene was ahead of me by a half second and quickly made the adjustments. Depending on angles and attitudes, aircraft with no lights can be washed out over a large city, a close one.

I flipped all my communication pin switches down except for the one I was using to drown out the other radios and then called out to the squad. I called out twice and got the response; I informed them that we were one minute out and to be ready. They acknowledged, and I flipped the pin switches back up and was bombarded by radio calls in my ears; Baghdad was a busy place tonight.

I saw the IR strobe down below the squad threw into the street, and then the squad and patient came into view. There was a team of guys there around him as we made a low pass and did a hard 180, dropping in quickly as Bottolene dropped the hawk from the sky, the twin engines screaming as we slowed, shooting back forward and down (it really is a cool maneuver and a lot more fun when you are hanging out the window looking forward). It must look cool from the ground to have the large Blackhawk shoot out of the darkness and be on the ground so rapidly.

I was already unhooked and hanging halfway out the window as we came in from thirty feet. When the wheels touched I announced, “Left Rear is off!” disconnected and scrambled around the nose. I ran twenty yards to the group of soldiers crouched behind a wall. Guns were up in every direction.

“Hello Gentlemen, how we doing?” I asked, trying to get to the patient. He was sitting on the ground with his back against a wall, leaning forward, with a pool of blood between his legs. He was a skinny guy, maybe 160 pounds soaking wet. His helmet and body armor were off, and he was wearing army combat shirt that was completely soaked with blood. His Medic, a pale-faced kid who couldn’t be more than nineteen, was telling me his vitals while I was checking him out.

“Gunshot wound to the face entering his right cheek and came out below near his neck,” the Medic said, as he pointed, my surefire moved over his wounds. His eyes were open and alert.

I was on my knees in front of him and looked him in the eye “My name is Ryan, I am a Flight Medic, I am here to get you out!” He nodded.

“You are going to be OK, we are going to fly very fast,” he nodded again.

“OK, I am going to need four!” I yelled out, and guys swarmed to pick him up.

“Prepare to move!” the Team Leader yelled over the Hawks motors; guns were up and pointed in every direction. I looked past the wall and saw EZ outside the bird, weapon locked in his shoulder, scanning around and waving us in hurriedly. I turned to the victim’s squad who were looking at me. I nodded, and the Team Leader yelled out, “Move!”

We moved in a quickly controlled movement to the bird. As we approached the bird, I ran ahead and hopped in the cargo door, so I could help slide and secure the patient inside. The Medic leaned in the cargo door as EZ tried to close the door.

“Take care of my guy!” the young Medic yelled out.

I nodded and stuck my hand out, and we shook. I hooked up on comms, announcing I was back on. EZ hopped through the window and hooked up.

“So, are we going to BIAP?” Mr. Bottolene asked calmly as if we were on a road trip.

“Negative, get me to Balad sir, the Neurosurgeons are there. Get me there as fast and as low as possible!” I said as I knelt before the patient, who was sitting up in the pan. I wanted to go low to keep any pressure off a head wound; this was going to be a crazy flight. I heard the radio traffic of the pilots talking to the Chase bird that was doing a wide circle high in the air waiting for us, informing them that we would be going to Balad.

The pilots were ready; backseaters were up. Bottolene keyed up and said “Torch,” the signal that we will lift off in exactly five seconds; there is no chatter so everybody can be ready. I leaned into the patient and yelled to hang on. I put a hand on the top of his thigh and another hand on his shoulder to steady him; a second later the bird was off, nose down and screaming into the night. We rose quickly, judging by the shapes of the buildings quickly falling beneath us. I saw flashes on my right as I knelt before the patient, the Blackhawk shot flares out the right side at a couple of hundred feet, EZ gave the all clear, saw no smoke trails; it was time to race the Reaper.

We made a couple of banks to the left and then steadied out. I continued to plug the entry wound on his cheek, but my main focus was the exit wound on his neck. It was gushing, and I was afraid that he might have nicked his carotid artery, or possibly his jugular. It was so dark that I could barely see anything, let alone the color of the blood, but the familiar metallic smell permeated the cabin as the rotors spun. I had my lip light from my mic boom going over the wounds, but the green light was not that effective. The little green light was the only option since we were blacked out and flying so low.

I continued to put pressure on his exit wound while I got the monitors hooked up to detect any drop in blood pressure or oxygen in his blood. The monitors were a constant feed of information and critical in the back of a noisy, cramped aircraft. It took about ten seconds to get the initial read, relaying that his pulse was 150. I had to calm this guy down quickly, but it is a little hard when the patient just got shot in the face. Just then I had an epiphany, I grabbed my stethoscope from my outer pocket of my aid bag, I rarely used it because of the noise of the aircraft, but I thought I might try to reverse it. I took the ear pieces and put them in the soldier’s ears and grabbed the round piece that is normally put on your chest and put it up to my mouth. I talked slowly and asked if he could hear me. He nodded instantly and gave me a thumbs up. I watched his pulse drop down to 90, then about five minutes later was down in the 70s. It worked. I told him that I was going to check him for secondaries and to relax. Quickly I grabbed my trauma sheers and began to cut and rip his blood-soaked combat shirt. While my hands ran over him, I felt scars and went in for a closer look with my lip light. There were cuts and scars, but no active bleeding. He had equal rise and fall of his chest, so I concentrated on the gunshot wound.

While we raced through the darkness I reached down to my right to get another bandage when EZ came over the mic, “Ryan, you ain’t gonna believe this.”

I kept reaching to my right, away from EZ, for a bandage and keyed up to answer, “What?”

“Watch this,” EZ replied.

I had the bandage and turned around. EZ asked the guy through gestures if he was OK. The guy raised both arms and did a double biceps pose, or ‘Gun Show.’ I sat back on my heels, smiling and motivated. Here is this young kid who was shot in the face, showing no fear. As a former Ranger, that shit pumped me up; the Reaper wasn’t getting this one.

I kept him relaxed and kept reassessing his injury. I kept checking for anything else that could pop up in case he went into shock. I got a second line in him but did not push a second bag. I waited for him to go down at any time, but he did not, this guy was a warrior. When we were five minutes out, I made the call to the Balad Combat Support Hospital located at a massive Air Force base, but because we were so low, and for some atmospheric conditions, we were unable to get a clear connection. After a few tries, and four more minutes, I got to them.

“Arrowhead ED, Arrowhead ED this is Bones One Zero.”

“This is Arrowhead ED,” the answer was almost immediate.

“Roger, Bones One Zero is a flight of two UH 60’s in route to your location with Urgent MedEvac, break,” I paused for a moment, “Vitals are as follows, Pulse 76, BP one20/76, SPO2 98, Respirations 16. How copy, over.”

“Bones One Zero, good copy, what is the nature of the injury?” the operator said in a nonchalant manner.

“Gunshot Wound to Face, ETA 30 seconds, Bones One Zero out!” I said as we rocketed across the runways low and fast making a hard left bank, leveling out and cruising down Main Street past the last blast walls. I grabbed the SGT and told him through the stethoscope to hang on, that we were 30 seconds out. He nodded and gave me a thumbs up. Looking up ahead out the window, EZ and I helped the pilots clear the last blast wall before the hospital LZ. The hawk slowed, below us there were a large number of people, triple the normal amount, standing at the edge of the hero highway with others running up. GSW to the face draws attention I guess.

EZ and I cleared Mr. Bottolene down. I swung out the window as we landed and called myself off. The cargo door slid open easily. The young soldier scooted over to the edge of the pan opting out of riding a litter. The enormous gaggle of Air Force personnel, comprising the makeshift litter team stood still in their tracks as he hopped down. The warrior slung his arm over my shoulder. I took one arm and grabbed the hand that was on my shoulder while holding his IV up and put my other one around his waist as we walked past the Air Force crews. They were all standing in place with one girl covering her mouth with shock; her eyes were glassy in the dark. As we walked out of the rotor disc area under the Hero Highway, I leaned in and told him quietly that he was the biggest badass they had ever seen. A couple of Ugandan guards stood silently in shock, holding the double doors open to the ER as we went by. The enormous trauma room that could hold thirty patients was empty. The Lead Doctor stood in the center and the end of the room, like a gunfighter at high noon. Behind him, different trauma teams were standing at the ready. No one said a word as we approached. I believe everyone was in awe of this badass soldier before them. Everyone sees bravery at different times downrange; this moment before them was a true example of what a warrior is.

The young SGT was laid down on an upright cot and was immediately treated by a team of Nurses and a Doctor. I gave my report to the Doctor, who would point at a different team behind him as I spoke, letting them know to advance. The crews worked fast on him as I stood at the end of his bed. His head was up, and he kept staring at me. I took off my helmet and looked back at him. The pain was beginning to hit him, the adrenaline wearing thin. I tore my patch off my helmet and made my way through the people and firmly placed it in his hand. His fingers closed around it and my hand, and he looked at me. Seeing him in the light for the first time and taking in his appearance it was a little chilling. He was drenched in blood from his nose down. His jaw had swollen, no doubt shattered from the impact, but the swelling would hopefully keep everything intact for surgery. He was now in Balad, and Air Force hospital with the best facilities in the theater, and a four-hour direct flight to Landstuhl, Germany.

I had to step back while they worked him and I said, “you’re going to be OK now, they will take good care of you,” he nodded slightly. I put my sweat drenched helmet on, and when I looked up, he was giving me a single gun show. I smiled and walked out knowing that I met the toughest man in the world.

As I turned to walk away, a Nurse stopped me and asked if I was ok. I said yes and gave her a quizzical look, she pointed at my chest and my body. I looked down at my hands and gear, and I was drenched in his blood. I grabbed some cold water bottles for the crew. While I was in with the patient, EZ relayed the ‘gun show’ story to the pilots. We took off to the refueling point at Balad so that both aircraft could top off; we were bingo on fuel. The refueler looked at me like I was from Mars; it took me a second to realize it was the blood. I gave him the gun show under the spinning rotors as we fueled, he didn’t get it.

After shutting the bird down back at Taji, and restocking the gear, our crew walked into Ops only to find CPT Poling, our team site XO holding the phone to his ear answering, ‘yes sir’ a lot to a very angry and irate person on the other end of the phone. I could hear his voice from five feet away. CPT Poling was trying to relay the patient info to the other party about my patient, getting repeatedly cut off. It was the soldiers Commanding Officer, who had flown to the Baghdad Hospital to meet his wounded soldier, only to find out he was not there. I could see the frustration in Poling’s face and walked up quickly to take the phone.

“Sir, it was my call, I will talk to him,” I said calmly and CPT Poling, who announced to the CO who I was and told me it was Major So and So.

After seeing the bombardment, CPT Poling was going through I decided to go on the offensive, taking charge of the call. The worst thing that could happen was to get busted. CPT Poling had a lot more to lose at his level, but I was proud that he was trying to defend me.

I put on my deep ‘Old Man’ voice that comes with 37 years, and began, “Sir, this is Doc Ryan, I am the Flight Medic that treated your man, after I arrived on the scene and saw the entry and exit wound, I began to worry about possible neurological issues, so I decided to go to Balad. Under any other circumstance, I would have gone to BIAP; I apologize for any inconvenience to you sir.”

There was a brief moment of silence, and he was as calm as ever. “Oh no problem, I didn’t know the extent of the injuries, and I hopped the first bird to BIAP. How is he?”

“Good sir!” and I proceeded to tell him of the treatment, and the fact he gave us the gun show which brought a laugh.

“Take care Doc, and Doc.”

“Yes sir,”

“Thanks for taking care of my guy.”

“Sir, you got some tough guys, and if you get the chance, tell the Line Medic he did a good job, he was worried.”

Later that night, we smoked a Cohiba, relaying the story to the others back at the pit. The gun show story became legendary throughout the deployment and a new standard for me in what ‘tough’ is.

Four days later I was back in Balad and shut down for five hours because of a sandstorm. SGT Northrup and I decided to walk around the hospital and see how the Air Force lives. We made our way through the enormous hospital with every modern convenience and found the ICU. We walked in to touch base with the staff there to check on some our soldiers we brought in. We wanted to know if they made it or not. As we stepped in, I looked at the sea of beds and saw the warrior. He was sitting up in bed, typing on a laptop. He was clean, with fresh stitches on his cheek, and a heavy bandage on his neck. The SGT looked up and stopped what he was doing, a knowing look. I walked over and extended my hand. He tried to stand up, but was still in pain, so I urged him to sit down. Nate and I talked to him, although it was hard to hear everything he was saying, with his jaw wired shut.

I looked down at the table beside him, there were nine coins beside his bed, and three that I could see had General’s stars. Who was this guy? I thought. I looked back at him, and we finished with the pleasantries and asked what happened that night. It is a rare opportunity for a Flight Medic to get the exact story of what happened with a patient, let alone see the guy after we treat them. Usually, when we are called, they are so bad that they are going home.

The SGT relayed to me what had happened. He was a Squad Leader, in charge of a General’s Personal Security Detachment, or PSD. The General was going downtown to meet with an Iraqi General at a restaurant that was owned by the brother of the General. The SGT soon realized they would be there for a while. He walked up to the HUMVEE and grabbed the radio, as he told the other trucks to spread out he turned his head and BAM! Had he not turned the round from the sniper was going to go through his ear. The SGT said it felt like he got hit in the face by a hammer. He went down, and we were called.

Nate and I stood silent, listening to him. I asked him about the other scars when I was doing a blood sweep of him for secondaries. The young SGT smiled and said that this gunshot was his fourth purple heart, he was 24 years old. I looked at Nate, and we both knew we were standing in front of a true badass.

I took all that in and asked when he was leaving for Germany. The young SGT looked up at me and said he wasn’t.

“My guys need me; I need to bring my soldiers home.”

I stood there in silence; there was nothing left to say. I shook his hand and got up to leave.

“Doc,” he said through clenched teeth.

I turned as he stood and shook my hand again, looking me straight in the eyes.

“Thanks, Doc.”

Nate and I walked out of the double doors; I looked down in my hand. I opened up my fist and saw his Combat Infantryman’s Badge. Dustoff.