Operation Iraqi Freedom 155

Chapter Six

Operation Iraqi Freedom

In June 2001, the Army’s personnel system sent the next commander to the 

212th MASH for a 2-year assignment. Lieutenant Colonel Kenneth Canestrini 

had joined the Army as an enlisted soldier, then earned his college degree and 

rejoined as a Medical Service Corps officer. Canestrini had specialized in hospital administration, but also had 2 years’ experience with deployable hospitals 

as executive officer of the 115th Field Hospital. After arriving at the MASH, 

Canestrini announced a simple goal: the unit would become trained, equipped, 

and deployable. He later recalled:

My focus was to be a medical unit that could move from Point A to Point B, set up on the 

battlefield, and provide combat health support in an austere environment. I looked at the unit 

and said, “OK, what can we do to tighten up, get everything squared away equipment-wise, 

supply-wise, and then bring real world training in to the medics?” 

Had we deployed within the first six months, I doubt we could have met the requirement [that 

developed in Iraq]. The mission changed on us, we had an unplanned 4-day convoy operation. 

When I took command our equipment just wasn’t maintained to the degree that it needed; it 

wasn’t there yet. All of the checks and functions and training things that we did in the unit during 

that 18 month prep period insured that I could operate by myself for two weeks without support.

Also arriving about the same time were new senior medical officers, including a deputy commander for clinical services (DCCS; Lieutenant Colonel John 

McGrath), an executive officer (Major Ronald Krogh), and a chief nurse (Major 

Suzanne Richardson). Compared to normal personnel rotations, this new leadership was unusually stable as the MASH went through the usual individual, 

group, and unit training. 

The next deployment was scheduled for September 2002, a 6-month rotation 

supporting the remaining US troops in Bosnia. However, Al Qaeda’s terrorist attacks of September 11 changed the plans. Intense international diplomatic pressure on the Taliban, governing Afghanistan and protecting Al Qaeda, failed to 
156 Skilled and Resolute

obtain the surrender of Al Qaeda leaders, and a US-led military coalition began 

operations in Afghanistan to topple the Taliban and capture Osama bin Laden 

and other Al Qaeda leaders. The US operations, called Operation Enduring Freedom, involved relatively few ground troops and thus required relatively little 

hospital support. Despite being the Army’s most mobile hospital, the 212th was 

not sent to Afghanistan, and a warning order to prepare for deployment was cancelled in April 2002. When the order was cancelled, rumors arose that the 212th 

had been selected for unspecified operations elsewhere. All Canestrini could tell 

his troops was to watch the news and be ready to deploy. 

Negotiations with Iraq

The 212th’s soldiers watched the uncertain progression of US-Iraqi negotiations through 2002 into what became Operation Iraqi Freedom. They could not 

be sure what they might be called upon to do, nor when anything might happen. 

They followed the news about Iraq and the military preparations should negotiations fail as US Central Command (CENTCOM) expanded military support 

facilities in the Persian Gulf. CENTCOM had been refining plans for Iraq since 

late 2001; changes would affect what troops to send and also when to send them. 

In outline, the operational plan shaped up as a ground advance from Kuwait into 

southern Iraq, possibly combined with a thrust through Turkey into northern Iraq; 

this would first isolate Baghdad and Saddam Hussein’s regime. If necessary, the 

city of Tikrit (Saddam’s hometown and a stronghold of the Ba’ath Party) would 

also be surrounded. With the regime cut off from the country, operations would 

continue, breaking down Ba’athist control and freeing more of the country. Resistance was expected mainly from Ba’athist organizations and the Special Republican Guard, while the Iraqi army was expected to put up little resistance.

In early 2003, with the diplomatic situation unclear, the Army had to make 

decisions that locked it into a particular course of action. Units were being 

mobilized from the United States and Europe, and combat troops flowed into 

Kuwait simultaneously with support units. Secretary of Defense Donald Rumsfeld had overruled the military’s standard deployment system that tried to give 

units at least 2 months’ advance notice. Feeling it hampered diplomatic options, 

Rumsfeld did not want an all-or-nothing approach. Instead he retained control 

over “force packages,” smaller numbers of troops to gradually escalate the pressure. While deployment preparations are always disruptive, at the unit level 

this new system added to uncertainty. Amid all the uncertainties, from whether 

there would even be a war to what units would be needed and when, plans for 

the 212th MASH remained undetermined. Canestrini kept his troops informed 

of the big picture, and everyone knew that V Corps’ high-readiness hospital 

might be needed. On January 14, 2003, the 212th got deployment orders, and the 

equipment had to be at the port of Rotterdam in only 3 days.
Operation Iraqi Freedom 157

Readiness

A unit’s readiness for war is a balance of staffing, training, and equipment—

each important, intertwined, and in constant flux. Instead of the often-cited 

“hurry up and wait” situation in the Army, the MASH’s deployment process was 

a case of “wait and hurry up.” The diplomatic uncertainty brought delays, allowing the soldiers to take normal leave and holidays at home, but also causing a 

great rush in the few days available to assemble troops and load equipment after 

receiving the deployment order.

Personnel

Units in Germany are on a 3-year personnel rotation cycle, so roughly onethird of all soldiers are within 6 months of arriving or departing. Some soldiers 

in the 212th were scheduled to leave the unit but opted to stay for the deployment, feeling they owed it to the unit. Sergeant Shamika Cheeseborough shared 

her thoughts: “Me being the only quartermaster equipment repairer and working 

with dolly sets for three years, why would I leave the unit now? I thought, ‘I 

can’t leave, because I’d been working with these people for three years and we 

have a pretty good rhythm and we know what to do.’” (As the 212th deployed, 

the Army did not apply stop-loss and stop-move policies, the orders that held 

individuals in the Army or in a particular deploying unit, which would later be 

controversial.) 

Unfilled positions in the unit were filled by transferring soldiers from other 

units, called “cross-leveling.” Since the MASH was the only hospital deploying from Germany, it could borrow personnel, mainly from the 67th CSH. It 

also received two doctors from PROFIS who worked in Washington, DC, at 

Walter Reed Army Medical Center. Most Army doctors and nurses are assigned 

to a fixed-facility hospital and train only a few days annually with their field 

unit; for the 212th it was the other way around, and clinical staff spent much of 

their time at Landstuhl Regional Medical Center, a few kilometers away. Unit 

leaders paid attention to how PROFIS personnel would integrate when they arrived; to facilitate integration, the MASH brought its clinicians in for battalion 

runs, professional development work, and other activities. Lieutenant Colonel 

Alfonso Alarcon, an orthopedic surgeon, thought this policy contributed to efficient teamwork. However, unusually, the two doctors from Walter Reed, who arrived February 1, had never before visited the unit. Cross-leveling also occurred 

within the unit; the 212th was over strength in the laundry and bath section, so 

one of the sergeants who had served in the infantry was reassigned to overseeing 

force protection training, such as guard duty, security for convoys, and protecting the hospital when it was operational.

The MASH was also augmented with individuals and several small teams 

who provided specialized nonmedical support. An additional warrant officer 
158 Skilled and Resolute

brought maintenance experience to keep the generators running, but a medical 

maintenance team was considered unneeded and declined. A signals team would 

travel and work with the 212th. An air evacuation liaison team was also added, 

as well as a casualty assistance team to coordinate notifications to units and 

families, but a mortuary affairs team was not attached.

In the MASH, many specialties were filled by only one or two soldiers, and 

a single medical emergency could send the command scrambling for replacements. The 212th had to deal with losing its DCCS, arranging his replacement, 

and also filling some other staff positions. The emergency room doctor broke his 

arm in January 2003, but did not take himself off the deployment roster because 

he thought his arm would heal in time. He had pain and limited motion for 6 

weeks, but he judged he was not a risk to others for that period, and once healed 

he would be extremely useful—not least because he was in charge of the chemical decontamination team. However, a pregnant physician had to be replaced 

because pregnant soldiers are not allowed to deploy. 

Few units have no soldiers who want to avoid going to war by reporting a 

medical problem, or claiming to be conscientious objectors, or taking some 

other administrative route. In these cases there is little that commanders can 

do except work with individuals and ultimately proceed with legal action under the Uniform Code of Military Justice, if necessary. Most such soldiers are 

eventually discharged, leaving unfilled positions in their unit. Fortunately such 

problems were rare for the 212th, whose men and women were ready and willing to go. Chaplain David Bowerman specifically noted that nobody in the 212th 

came to him seeking reasons not to deploy. As company commander, Captain 

Sean Farley dealt with the personnel problems, hearing concerns from many but 

losing only two soldiers. 

There were days that I just beat my head against the wall. We had redone our family care 

plans for a command inspection in November. They looked really pretty in the files. We even 

called and confirmed all of it, so that way when brigade came down we’d say, “We did all of 

this beautiful stuff, our family care plans are perfect.” It wasn’t 24 hours after the deployment 

order that people started coming in with family care issues. 

We had two soldiers that ended up getting in trouble because their family care plans 

totally broke down. In the end there was no way to resolve it and they ended up having to get 

expelled from the Army. We thought about it and decided one was a good NCO; we’d keep 

her to help the rear detachment. So she volunteered. We kind of held the paperwork back. I 

don’t know how the legal beagles would have liked that, but we kind of held the paperwork 

back and did it when we got back to Germany. But our focus wasn’t on the UCMJ; they 

weren’t bad troops. They did have some extensive issues on the outside with taking care of 

the family, and their family care plans didn’t work. I don’t think it was their fault, but all of a 

sudden people were saying, “Wait a second, this is now a reality, I can’t do this.”

To be deployable, troops need to be medically ready, including all vaccinations mandated by the Department of Defense and satisfactory dental health. 

All troops had to go through the predeployment procedure. The Soldier Readiness Process (SRP) screened troops for physical conditions, medications, im-
Operation Iraqi Freedom 159

munizations, and a number of administrative factors including life insurance and 

whether they had completed their wills. The SRP depends on the information 

entered; if troops want to deploy, they can leave out information or down-play it 

to their doctor. Major Tou Yang, the 212th’s pharmacist, felt that troops were not 

rigorously screened and deployed despite needing hard-to-obtain medications. 

Another part of the predeployment process was obtaining personal equipment, 

not just desert uniforms but also the items normally kept in unit stocks such as 

chemical protective suits and weapons. The initial issue of uniforms was on 

January 21, a week after the deployment order arrived.

Training

Canestrini focused on training the entire unit. Surgical exercises run at Miesau 

showed the unit could operate as a hospital. Personnel were also trained to function as a military unit, including providing security and driving in convoy. When 

the Army shrank in the 1990s, all units, including medical units (which per the 

Geneva Conventions can carry only light weapons), became responsible for 

their own security, in contrast to previous eras when medical units might have no 

weapons, or only one weapon between two enlisted soldiers. Before receiving 

the deployment order, the unit had finished an exercise in erecting the hospital, 

then packing up, driving 230 miles overnight, and reestablishing the hospital 

and establishing guards, which proved to be valuable training for the wartime 

mission. As Captain Farley noted, the process involved more than taking items 

out of a warehouse, packing trucks, and unpacking in a field.

Equipment

Given the short notice to deploy, there was virtually no time to address gaps. 

Some of the MASH’s equipment, such as the laundry washer, was new; some 

was about to wear out, like the dryer; most was in adequate condition. The 212th 

kept sufficient stocks of almost everything except medicines because many 

pharmaceuticals are perishable. A unit deploying got medicines, x-ray film, and 

other perishables from warehouses, then received blood in theater. However, it 

was common for some items to be in short supply before deploying, so units 

often arrived overseas expecting to obtain missing items in theater. Canestrini 

decided to take as many medical supplies as possible, squeezing in more than 

the authorized amount. The basic load was 3 days of supplies, but Canestrini 

deliberately tried to pack for 15 days.

Units have an annual budget to cover all their routine equipment and operational and training needs; extra money becomes available when a unit receives 

deployment orders. Regardless of how much a unit buys, it has to transport it, 

which limits both space and weight. The MASH leadership had taken a calculated risk in 2002, spending most of the fiscal year 2003 money by January 2003, 
160 Skilled and Resolute

which would have left them without funds through the end of the fiscal year. Major Suzanne Richardson summed it up: “OK, we’re spent for the year. There isn’t 

any more money for the entire FY, so if we don’t get deployment orders we’re 

not going to be doing anything at all.” Spending the money early proved to be 

the right decision, especially because the deployment order left only 3 days to 

order, receive, and pack equipment. However, the time available could be used 

to obtain a mixture of crucial medical supplies and items that would make life 

easier in the field, such as hand-washing sinks. 

New equipment can be a mixed blessing. A new item could be useful, but 

might be complex, bulky, or expensive when compared with the adequate older 

items. Major Ronald Krogh, the executive officer, laid out the problems:

Getting this new equipment added a biomedical maintenance trail that we weren’t prepared 

for. It added several different burdens. One was to do the initial technical inspection on 

the equipment before they put it into use. Second, everything we do goes back to the “100 

percent mobile” idea and all of the new equipment needed space too. Then if you get new 

equipment, you want to turn in old equipment, but the medical logistic system in theater 

was not mature enough to be able to take the equipment we wanted to turn in, so we were 

stuck with old and new. But you’re not going to look a gift horse in the mouth, we’ll take the 

equipment. We made it work.

Items were still left behind. Some equipment was so new that nobody knew 

how to repair it if it broke; leaders decided to take older but more familiar equipment. The chief wardmaster, Sergeant First Class Zimbalist Hester, also recalled 

taking some older equipment when newer items were not functioning. Some 

doctors found that preferred equipment, or medicines for their specialty, was left 

out or in short supply. Cardiothoracic items were not stocked because Lieutenant 

Colonel John Cho had not had an opportunity to visit the 212th. On the other 

hand, an unauthorized chest of pediatric equipment had been packed because 

some nonstandard equipment was justified for treating civilians.

Shipping Out

The MASH had a total of 37 vehicles, 32 trucks (most towing trailers or containers) and 5 HMMWVs. Trailers carried cargo, generators, and water tanks, 

while the containers were of two types. Many were ordinary cargo containers to 

protect equipment from the environment; others were more specialized expandable containers, with sides that could drop down to form a wider floor, and roofs 

and sides that could be extended to form a tightly enclosed space. The operating 

room and pharmacy, for instance, were in expandable vans.

With only 3 days to obtain necessary supplies, equipment, and parts, then pack 

it all up, fill in all the necessary paperwork, and get the vehicles to the port for 

sea movement, the command group doubted it could accomplish the task. Fortunately, a recent decision had kept most material stored in the MILVANs rather 

than on warehouse shelves. The MASH borrowed a dolly set from a neighboring 
Operation Iraqi Freedom 161

unit that was not deploying, but maintenance had kept the rest operational. However, the 212th had to rely on its own people to sort out paperwork. They had to 

document what hazardous materials (HAZMAT) were in which vehicles (which 

changed with loading adjustments), then secure and label it properly. Different 

types of HAZMAT required separate checklists, and it required patience and 

perseverance to get the inspection crews to use the right lists and approve the 

loads. Since the MASH was the first unit to deploy from Germany, the clerks had 

no recent experience, which slowed the process. 

When the vehicles were loaded and checked, they went through three assembly areas, then by barge down the Rhine River to Antwerp, Belgium. There, three 

MASH soldiers drove them onto the ship headed to Kuwait, but had to offload 

and then reload the ship when the initial loading plan proved to be unbalanced.

Medic Tashiana Graves reflected the uncertainty facing all the staff at the 

point of departure:

I think I was as prepared as I was going to be. They prepared us to the fullest of their capabilities. But nothing can prepare you for war. There are things that you can’t really train on, 

and we learned that as we went on. I didn’t know if I was going to come home. I didn’t think 

about death too much because if you think about that, you’ll probably go crazy.

Arrival in Kuwait

The MASH traveled to Kuwait in two groups, an advance party of 10 that 

gathered, inspected, and repaired the vehicles, and the main body a few days 

later. The advance party included Sergeant First Class Travis Otis, the NCO 

in charge of maintenance, and a few mechanics and drivers. They found the 

MASH’s vehicles scattered among several acres of other vehicles; Otis’s tools 

arrived late, and he lacked a rental car to help the search, but e-mail ensured that 

documentation arrived. Through hard work, most of the vehicles were running 

by the time the main body arrived, despite a shortage of spare parts. He recalled:

I was at the motor yard where our equipment was staged, just going through checking every 

vehicle, finding any deficiencies I could that would disable the vehicles. I had one mechanic 

with me. We were just trooping the line, taking the equipment one-by-one. If you would, 

imagine a big junkyard where all of our vehicles were stowed. Not just our vehicles, but 

vehicles from other units. I had identified our equipment and where it was located so I could 

at least have a plan when [the main body] arrived. And they just appeared, jumped in the 

vehicles, assisted us lining them up, and probably within one hour those vehicles that were 

not disabled were lined up ready to move.

The main body arrived on February 14 to a short briefing instead of a comprehensive reception process. They joined the advance group and headed to Camp 

Virginia, located in the desert about 12 km north of Ali al Saleem Airbase in 

central Kuwait. Administrative arrangements were problematic despite using 

computers and electronic identity cards; some pay and tax cases were still being sorted out after Baghdad was occupied. The Army had maintained facilities 
162 Skilled and Resolute

and support units in Kuwait and the Persian Gulf since 1991, but although these 

facilities could support roughly a division, in early 2003 there were at least three 

times that many troops in Kuwait with more arriving. The support infrastructure 

was not expanding fast enough; the Department of Defense’s priority was for 

combat rather than support units. Supplies also faced paperwork problems, and 

staff had trouble obtaining supplies that should have been available in theater. 

Not only were some medical supplies slow to arrive (although such key items 

as x-ray film and laboratory chemicals did arrive), but common items including 

sandbags and boots were hard to come by. Company commander Captain Sean 

Farley had to write six memos to get a soldier boots that were only a half-size 

too small, and heard a supply soldier say, “We will be glad when you leave.” 

Map 6-1. Kuwait, showing military installations, 2003. Camp Udairi was renamed Camp Buehring 

in 2004.

APOD: airport; KCIA: Kuwait City International Airport; SPOD: seaport

Map courtesy of the US Army Combat Studies Institute, Fort Leavenworth, Kansas.
Operation Iraqi Freedom 163

Supplies were landing at Doha, and the 212th had to send vehicles daily to collect supplies. Both Farley and the supply officer, Captain Stephan Porter, commented that there were not enough logistics personnel to manage the increased 

number of units and quantity of supplies. The central receiving supply point 

was unable to inventory everything, and units collected pallets without the usual 

checks. Items shipped to the 212th were taken by other units, and at times the 

212th picked up the wrong pallets as well. The medical logistics base in Qatar 

Figure 6-1. 212th soldiers playing cards to pass the time, 12 March 2003. “It was just really remarkable, I thought, how modern-day conveniences followed us out there. I remember 12 years ago [in 

Desert Shield], if you got a newspaper or a magazine that was two months old, you were lucky; it 

was like gold. Here you had the Internet, and you had newspapers and magazines—I wouldn’t say 

up to date, but within about two or three weeks, and they had a relatively nice setup. I remember 12 

years ago you had to be bused everywhere. If you wanted to get a phone call, you had to be bused 

someplace and wait two or three hours in line, and if somebody didn’t pick up the phone or the phone 

was busy, you had to get back in line. I think our unit was really great; we had our own internal 

phone system and our own Internet. We didn’t have to wait on somebody else’s stuff. They were really great about having movies for us out there. Somebody had a laptop with DVDs and they tried to 

make it as pleasant as possible. The unit I was with before didn’t have movies, we didn’t have modern 

conveniences.” —Captain John Keener

Photography courtesy of the 212th MASH.
164 Skilled and Resolute

was using a different computer system, which caused some problems. More 

troublesome was a period of “fill-or-kill” supply orders, when items would be 

provided if available but the remaining order was canceled. Without being able 

to back-order items, the 212th sent troops to Doha every day to check.

Three days after driving to Camp Virginia, the MASH was ordered to Camp 

Udairi. Both were nondescript areas of Kuwaiti desert, but Udairi was 30 km 

closer to the Iraqi border, where the MASH was poised for movement into Iraq 

should diplomatic negotiations collapse. Units were arriving continuously, causing moves and adjustments. The MASH troops had to leave their initial billets 

in large semipermanent tents after 10 days when another unit was given higher 

priority. Canestrini was given a patch of desert, and the troops dug a sump for 

wastewater, then set up their own tents and facilities. In the new quarters the 

212th had its own showers, laundry, air conditioning, satellite television, DVDs, 

and Internet connections. With dust, dirt, sandstorms, and boredom, life was not 

luxurious by any means, but it was far better than conditions for the infantry in 

2003, and also better than during Operations Desert Shield and Desert Storm. 

The War Plan and Consequent Preparations

The Coalition revised its operational plans several times while the 212th was 

in Kuwait. While each revision caused the MASH to reexamine its plans, the 

war plan ultimately simplified: the 212th would move forward with elements of 

the 3d Infantry Division, establish the hospital at Logistic Support Area (LSA) 

Bushmaster southwest of Karbala (close to other support units), and treat casualties from fighting near Karbala and Baghdad. This was the classic MASH mission, straight from the doctrine manuals: drive forward, then establish a surgical 

hospital to support combat operations. This could be repeated as necessary if 

the combat troops got too far ahead for the wounded to be transported promptly 

back to the MASH. However, the attacking Coalition force would not be particularly large, and there was a substantial chance that Iraqi elements would be 

able to sneak through the cordon and attack the supply routes and units in the 

rear areas. These Iraqi elements were small units, but likely to be Fedayeen Saddam, hard-core members of the Ba’athist Party and fanatically loyal to Saddam 

Hussein. They were expected to employ hit-and-run or suicide tactics and to 

be heavily armed, more heavily armed than the MASH. Serious resistance was 

expected at the narrow Karbala Gap, possibly including chemical weapons. The 

high casualty predictions were a concern for a 36-bed MASH, so a contingency 

plan was devised: a 25-bed ward for minimal and intermediate care patients 

would be created, staffed mainly by licensed practical nurses and medics, with 

additional support to be provided by registered nurses, if necessary. 

A key task was picking the personnel for the HUSF, which Lieutenant Colonel Canestrini had merged with the advance party to create the initial operating 

capability (IOC). The IOC was responsible for picking a hospital site and setting 
Operation Iraqi Freedom 165

out stakes to indicate where everything should go. The IOC not only had surgical capability from the HUSF, it also had some ICU beds to hold postoperative 

patients. The HUSF needed meaningful surgical capability, but the rest of the 

MASH had to stay capable if the IOC took casualties. Canestrini accepted the 

risk of putting some people with unique skills, such as the orthopedic surgeon, in 

the HUSF, while medics and nurses were chosen to balance medical and military 

skills for such tasks as setting up tents. Captain Terrence Mark, the HUSF’s head 

nurse, recalled that the plans had been finalized in Germany but not yet tested. 

The final HUSF included 17 soldiers with two 5-ton trucks, a generator, and one 

Map 6-2. Outline of the scheme of maneuver. 3d Infantry Division was the southern/western thrust, 

and the 1st Marine Expeditionary Force was the northern/eastern thrust.

Map courtesy of the US Army Combat Studies Institute, Fort Leavenworth, Kansas.
166 Skilled and Resolute

MILVAN. The advance party squeezed 13 soldiers into two HMMWVs, making 

a total of 30 soldiers in the IOC.

The whole unit trained for the long drive ahead; many soldiers were trained to 

drive the trucks and tow trailers, and officers were shown how to help the drivers repair vehicles and perform basic maintenance. Major John King, a nurse 

anesthetist, enjoyed doing vehicle maintenance and also driving with night vision goggles. Drivers towing ISO shelters rehearsed lining up and dropping the 

shelters for the DEPMEDS tents to properly attach. Major Jeffrey Hermann, an 

obstetrician/gynecologist, remembered: 

You had to do practical training. We would take the master drivers, get vehicles and attach 

dolly sets to them with MILVANs and drive over the sand. They would purposely find routes 

that were not particularly friendly, so we could experience some of the maneuvers that you 

would have to use to get around and not get your vehicle stuck or jack-knifed, which would 

be horrendous in a large convoy.

Medical training was also necessary, and not just for the doctors and nurses. 

Everyone learned how to carry a patient on a litter, learned which litter team they 

were on, and was warned about the scenes they might see, including a slide show 

of wounds. As Major Suzanne Richardson described it, “Hey, this is what you’re 

going to see. It’s going to be gross. It’s going to be brutal, but we want to tell you 

now so that you’re ready for it.” 

To improve teamwork, Colonel Ismail Jatoi, the DCCS, directed the clinicians 

to give classes to each other in their areas of expertise, perhaps burn treatment, 

chest trauma, or abdominal wounds. On alternate nights operating room rehearsals were conducted with the enlisted technicians, some of whom were quite 

junior and had not worked during major surgeries; this increased confidence and 

teamwork. Military necessity, largely the likelihood of large groups of wounded 

arriving at once, led to training for medics in tasks they did not perform in garrison, such as inserting a chest tube to expand a collapsed lung. Clinicians also 

discussed triage priorities and worked at the 86th CSH, which was treating patients at Camp Udairi. 

The physicians planned to treat patients conservatively, as described by the 

chief of surgery, Lieutenant Colonel John Cho: 

What’s the conservative play for an injury? The conservative play is taking out a spleen and 

not trying to save it. The conservative play is taking out a kidney and not trying to save it if it 

doesn’t look like it’s salvageable. The goal is to save the soldier’s life. We set our thermostat 

to conservative play; aggressive operation if there was an indication for surgery, not sitting 

on any patients by placing them in an observation status, and using the air evac system aggressively to get folks back to a higher level of care. It seemed to work out great, and that 

plan was laid out during the training we had in Kuwait. 

Another discussion was how to treat prisoners. Early plans called for wounded Americans to be sent to the 212th and wounded POWs to another hospital. 

However, it appeared impractical to send the wounded from a single firefight to 
Operation Iraqi Freedom 167

different hospitals (which would require more ambulances or helicopters, causing longer time before treatment and thus greater risk of death for some), so the 

212th made plans to treat wounded Iraqis the same way it would treat wounded 

Americans. The ethics were clear, as were the requirements of international law.

A topic receiving little attention was what would happen after the defeat of 

Saddam Hussein. V Corps had focused on combat operations, and the first order 

to Canestrini to consider post-hostilities operations arrived only 2 weeks before 

combat began. Major David Vetter, the internist, had experience with humanitarian operations and led the planning, which, given the unit’s personnel and 

transportation constraints, consisted primarily of pre-ordering supplies.

The belief that Iraq had chemical weapons was one of President George W 

Figure 6-2. Training on convoy procedures. “We had to deal with the threat of having our convoy 

ambushed. So we had a full afternoon where some of the NCOs set up a rock map showing us how we 

would deal with a situation like that, and what we were expected to do in the various scenarios. And 

then we went out and put it into action. We hopped in the back of trucks, wearing gear, calling out 

gas alerts, popping on the mask and putting your face in the sand with your weapon drawn, getting 

ready to handle whatever it is that they were testing us on, whether it was an ambush or an obstacle 

in the road.” —Major Jeffrey Hermann

Photography courtesy of the 212th MASH.
168 Skilled and Resolute

Bush’s reasons to attack Iraq, and the military planned for the possible use of 

chemical weapons. Major Hermann recalled: 

We had people, including the 30th Medical Brigade Commander, come in and tell us that 

they were anticipating a 70 to 80 percent chance of coming into contact with chemical or 

biological weapons on the route that we were taking. They actually pointed to specific locations that they thought this might occur.

Lieutenant Colonel Canestrini recalled the information he received: 

In some of the briefings I had with the Corps commander, Lieutenant General Wallace left no 

doubt that there was anticipation that the enemy would slime us. NBC was a real potential 

and possibly going to happen. The assessment was probably not initially, but that once we got 

close to the Karbala Gap, the concern was going through the Gap, because of the channeling 

of the forces through there, that the unit would be slimed.

However, Canestrini declined to take chemically protected DEPMEDS tents 

because they were too bulky to move with the available vehicles, and the MASH 

had to be completely mobile to accomplish its mission. Emergency room physician Major David Wolken, in charge of nuclear-chemical-biological (NBC) 

training, recalled a shortage of decontamination supplies and the purchase of 

liquid bleach to fill the need. He attempted to assuage the concerns of the soldiers assigned to his decontamination team about the risks from contaminated 

patients by discussing the medical properties of the chemicals (mustard gas, for 

instance, is used against some cancers). Staff Sergeant Viet Nguyen noted that 

normally NBC stood for “nobody cares,” and routine training was unpopular. 

“But because of this war, and everybody knowing in their heart they’re going to 

get deployed, and the good possibility that chemical warfare was going to happen in the Gulf, everybody wanted to learn, and took it seriously.”

The Convoy Into Iraq

Orders arrived the night of March 20–21 to finish packing and move to Tactical Assembly Area (TAA) Las Vegas. Adding to last-minute nervousness was an 

alert as an Iraqi missile flew over Camp Udairi and was shot down by a Patriot 

air-defense missile. No damage was done beyond lost sleep, but MASH soldiers 

donned gas masks and chemical suits, staying in the suits for the next several 

weeks because of the threat of chemical weapons. TAA Las Vegas became a 

parking lot as units waited to pass through gaps opened in the berm that marked 

the Kuwaiti border. Few soldiers could sleep as they waited, and most fidgeted 

and joked; mechanics patched two leaking radiators. 

The trucks rolled north on the afternoon and evening of March 21 with two 

or three personnel in each cab: a driver, a truck commander (the NCO or officer 

responsible for the vehicle, who acted as another set of eyes and relief driver), 

and possibly a passenger. Some vehicles had passengers in the back, cramped 
Operation Iraqi Freedom 169

Figure 6-3. 212th convoy waiting to move from Camp Udairi, March 21, 2003.

Photography courtesy of the 212th MASH.

for space amid rucksacks and weapons. At halts, passengers were responsible 

for security while the drivers and truck commanders checked over the vehicles 

or rested. 

The convoy plan called for the MASH to move in two parts: the IOC started 

first, the main body would follow. The MASH would travel with elements of 

the 11th Aviation Regiment, moving first across hard-packed desert, then along 

major highways on the south bank of the Euphrates River (bypassing the cities of 

An Nasiriyah and As Samawah), before setting up in the desert south-southwest 

of An Najaf. Convoy support centers would provide fuel, food, and latrines. The 

MASH’s wrecker would be the last vehicle, stopping to help any broken down 

vehicle; it could tow one vehicle, but if another broke down (or the wrecker crew 

could not fix a vehicle too heavy to tow) the vehicle would be left behind for another unit to fix. At the 30 km/h planned speed, a limit imposed by the MASH’s 

10-ton forklift, the convoy should have taken less than a day to arrive at its destination. Strip maps were issued, showing the route to be followed but not the entire area; if the convoy had to change routes, it would be operating without maps.
170 Skilled and Resolute

The convoy plan did not last long. Changes started with a slight delay for the 

212th waiting to cross the Iraqi border. Then the combat troops took more time 

than anticipated clearing Iraqi resistance. The Iraqi 11th Division, located near 

An Nasiriyah, was expected to surrender before the MASH arrived. However, 

no one discounted the chances of individuals or small groups sniping at the 

highways or setting up ambushes. Resistance centered on the cities, as expected, 

but small Iraqi parties also left the cities to attack supply routes. As a result the 

main supply route was soon blocked, and the 212th was held up (along with 

many other units) outside An Nasiriyah. Fighting could be seen, ranging from 

artillery fire to tracers; the MASH would be at great risk if the Iraqis had artillery 

to shell the road. Some combat units of the 3d Infantry Division tried to open 

the road by sweeping for Iraqi groups, while other parts of the division bypassed 

the resistance and continued heading north. Sergeant Shannon Malloy recalled 

an episode along the road:

They started yelling for us to get out of the vehicles because we were taking sniper fire from 

somebody in a field. So we all cleared out of the vehicles, got in a prone position and we 

were watching the field to see if we saw anything. . . . So two in the morning, no map, on the 

side of the road, pulling security. My platoon sergeant, who’s on the staking team too, came 

up to me: “How many rounds do you have?” I’ve got 120; that’s a two-minute firefight. I’m 

thinking if an Iraqi squad comes, pretty much we’re dead tonight.

Map 6-3. Schematic of the planned route to Rams.

Map courtesy of the 212th MASH.
Operation Iraqi Freedom 171

As support units jostled up the roads, stopping and starting depending on 

the latest reports about whether the road was clear ahead, they encountered 

danger. The 507th Maintenance Company drove into a suburb of An Nasiriyah, made a wrong turn into the main part of the city, and was attacked by 

Iraqi forces. News of the ambush and the capture of American troops spread 

throughout the theater. An increasing number of ambushes caused V Corps 

to divert units from the intended main supply route. The 212th had to make a 

U-turn, then pick up another road farther west in order to move north along a 

reasonably secure route. At times the MASH passed combat units, which led 

some personnel to think they were ahead of the combat troops. However, the 

3d Infantry Division was moving its brigades on different routes for different purposes, and the 212th was always behind the forward troops. Along the 

way, the MASH treated two soldiers injured in a vehicle accident. Because 

the 212th needed to stay packed up for movement, the doctors checked the 

patients and cleared them for helicopter evacuation back to a hospital in Kuwait. 

The convoy plan was abandoned because of these delays. Some units had already been scheduled to travel on the roads that all units now had to use; traffic 

piled up, speeds dropped, and tempers rose. Movement was stop-and-go, day 

and night. Drivers had trouble staying awake. As fatigue mounted, officers had 

to end a halt by moving along the convoy and banging on doors to awaken drivers. Captain Nina McCoy, a nurse, recalled how disorienting the night driving 

was, especially while fatigued: 

Being kind of in and out of sleep, I never got the feeling of moving. It felt like we were 

moving but we weren’t moving. It’s just the red dots moving, like being in a video game. 

There were red dots in front of you, and you don’t want to get too close to them, so you’re 

always going to like go back and forth, getting closer and farther away from the dots in 

front of you.

The unit had trouble staying together as vehicles squeezed between other 

trucks, bending mirrors and scraping MILVANs. At least once the driver training in Kuwait paid off: Captain Gary Ruley recalled that his truck almost flipped 

over on soft ground, but the driver had been trained how to react and prevented 

the accident. 

There was little interaction with Iraqis. At times the 212th drove through villages. Some Iraqis gave thumbs-up signals and shouted “Bush,” while many 

were subdued. Although the MASH was moving through an anti-Saddam part 

of Iraq (in the 1990s Saddam had violently oppressed the southern Shi’ites), 

harmless-looking civilians might be scouting or concealing weapons. Troops 

had been told not to hand out rations because it would encourage Iraqis to approach Americans, increasing the risk of misunderstanding or an accident near a 

vehicle; however, some of the civilians were so destitute that troops tossed them 

MREs. Moving to Objective Rams, which became LSA Bushmaster when it was 

occupied, ultimately took the 212th over 3 days. 
172 Skilled and Resolute

Supporting the Fighting Troops: The 212th at Bushmaster

At Bushmaster the MASH needed to switch gears and run a hospital in a war 

zone. Priorities had to be balanced amid the demands of combat: while some 

soldiers were pulled away to defend the perimeter, the hospital had to care for 

however many patients arrived, whenever they arrived, without overloading the 

staff. Moreover, the lights had to stay on, food had to be available, and vehicles 

needed maintenance in case headquarters ordered another move forward.

Arriving and Establishing the Hospital

The IOC arrived before dawn on March 24 and waited a few hours as troops 

from the 3d Infantry Division cleared Iraqi forces from the area. Then they 

checked that they were in the right place, making sure a large expanse of empty desert was where 30th Medical Brigade intended them to be. Sergeant First 

Class Tony McDonald recalled, “The area looked like the surface of the moon; 

nothing as far as the eye could see, might as well have been in the middle of the 

Figure 6-4. Front gate of the 212th at Logistic Support Area Bushmaster.

Photography courtesy of the 212th MASH.
Operation Iraqi Freedom 173

ocean. Very little vegetation, very little of anything other than brown.” Once the 

location was confirmed, the advance party began setting up the HUSF and also 

setting down stakes and cord to mark where the remaining parts of the hospital 

would be established. The HUSF was only a few tents, and it went up fairly 

easily in 2 hours despite rising winds. When the main body arrived, the HUSF 

was ready to receive casualties, although none arrived. (Once the main hospital 

arrived, the HUSF became the EMT.) 

The main body showed up around dusk and Canestrini decided to let his people sleep rather than immediately setting up the hospital. He deliberately took 

the risk of a minimal security force; a few soldiers were put on guard duty and 

everybody else went to sleep. On the morning of 25 March the work began to 

set up the bulk of the hospital. As Sergeant First Class Tony McDonald recalled, 

“We got up and went to work hard and heavy establishing the hospital. It goes 

in a certain priority. The EMT goes up and a certain portion of the operating 

room goes up, and one of the ICUs. ICU2 goes up first and that’s because it’s 

designated to take patients first. So that was established. Then the other two 

ICUs came within the next day or so after that.” Instead of a military compound 

with a variety of support units providing a perimeter, the 212th found itself in a 

section of open desert, 6 or 7 km from the nearest unit, with an impassible quarry 

in between. 

Unfortunately, the wind intensified until a massive sandstorm, reputedly the 

worst in 40 years, forced a halt. Visibility dropped to inches, and even night vision goggles were useless. Major Scott McDannold was out with the field sanitation team building latrines:

It was a wall of sand coming towards us. We were maybe 20 steps from the closest tent. 

We started packing our stuff up and then within ten minutes it was dark from sand. We held 

hands. I had a compass with me and before it went perfectly dark I got a reading on where 

the closest tent was and, using my compass, over a period of 15 minutes we walked 20 steps 

and found the tent.

We all got into the tent and got accountability for everyone. It was loud. I remember 

at one point just yelling, “Hello,” and not being able to hear anybody around me or see 

anything. It was like you were on Mars or something, just incredible. I got the idea I should 

go to the hospital and let people know that we were OK. So with my trusty compass off I 

went. Now, it’s maybe 40 steps, and I’m trudging along and the sand was blowing so hard 

that my compass started to act up because it was getting jammed, so I’m messing with that. 

I went about 60 steps and I started thinking, “If I miss the hospital who knows where I am?” 

I’m by myself, debating whether I should turn around or not. It was so disorienting. I had a 

compass, I’m good at that kind of stuff, I didn’t really feel like it would be a problem, but I 

learned pretty quickly it could be. I ended up at the guard post at the front of the hospital; I 

had actually missed the hospital and went maybe 20 yards in front. There were a bunch of 

guys in there, just kind of hunkered down, and it started to rain mud. 

The storm went on into the 26th, and two female soldiers got lost while heading out just a few meters for a latrine break. The MASH wrecker was sent out, 

with its lights flashing as beacons; then troops went out with flashlights and 

yelled, without results. HMMWVs with GPS were sent out. Parties went out 
174 Skilled and Resolute

with compasses to move in square search patterns without results. None of these 

methods worked and the soldiers were lost, without their weapons and gasmasks. 

Shortly they would stumble into another American unit 7 km away, unharmed. 

The uncertainty about the fate of the lost soldiers may have contributed to 

concerns about the security of the MASH. The various US units at Bushmaster 

were widely spread out, and since few were combat units there was relatively 

little combat power. Initially there was no quick reaction force (QRF) to respond 

to attacks. At a time when the main supply route from Kuwait was being attacked, V Corps believed there were no troops to spare as a QRF at Bushmaster. 

The bottom line was that the 212th had to provide its own security. Varying 

numbers, at times the majority, of the enlisted soldiers were put on guard duty, 

feeling nervous in an area where armed Iraqis roamed and with a nearby unit 

reporting its perimeter probed. Canestrini later acknowledged anxiety among his 

Figure 6-5. Troops sheltering in a tent as the sandstorm intensifies. “I’ve set up Combat Support 

Hospitals as the Chief Wardmaster in ice. I’ve set them up in rain. I’ve set them up under slightly 

windy conditions. But I have never set one up under conditions such that at two in the afternoon it 

was pitch black because there was that much sand blocking out the sun. With three feet from me and 

you, and you holding a chem light, I can’t see you.” —First Sergeant Robert Luciano 

Photography courtesy of the 212th MASH.
Operation Iraqi Freedom 175

“battle-focused, scared soldiers” but thought they were always ready to engage 

an enemy. As Staff Sergeant Melvin Diggs commented, “Even though we are 

a hospital, we’re soldiers first. No matter how you look at it, you’re a soldier.” 

Sergeant Shannon Malloy said, “We had to be operational, because we were 

told the 3d ID was waiting on us to go in and engage that Iraqi division and they 

couldn’t do it until they had hospital facilities set up.” On the other hand, Major 

Jeffrey Hermann perceived more risk:

I relayed some of my concerns to Col. Canestrini and he and I had to eventually agree to 

disagree about what our unit’s capabilities were. I have tremendous respect for what he did 

as the leader of the organization, but my perspective at the time was that we had a fairly soft 

unit and very hostile environment, and that if we wanted to stay intact and do our job—which 

is why we were there—that something had to change, either more security or retreating at 

least back behind a secure line. 

Lieutenant Colonel Canestrini knew the MASH was a “soft” target. Unknown 

to US commanders, an Iraqi patrol had noticed the arrival of US units at BushFigure 6-6. Sergeant Okraku on guard duty.

Photography courtesy of the 212th MASH.
176 Skilled and Resolute

master and reported it to the commander of the II Republican Guard Corps, commanding the defenses south of Baghdad. However, a combination of Coalition 

deception operations that implied a thrust from Jordan, Special Forces activity 

west of Baghdad, and Saddam’s preconceptions caused the information to be 

ignored. Canestrini also evaluated the resources he had: the rifles and pistols 

of the MASH, the few automatic weapons of the signals team and air evacuation team attached to the MASH, and the weapons of the 30th Medical Brigade 

headquarters element that was with the 212th. Canestrini contemplated requesting permission to relocate closer to other American units, but doing so would 

require about a day of taking tents down, packing and moving, then re-erecting 

the MASH. During that period the MASH would be unable to treat any patients; 

it could not accomplish its mission. Canestrini decided to stay put, finish setting 

the 212th up in its original location, and let other units, en route, thicken the 

perimeter around the MASH. 

Security and operation of the hospital were both vital. Colonel Ismail Jatoi felt 

that the assignment of enlisted personnel to security duties did not interfere with 

running the hospital. 

The rest of us basically pitched in and pulled up the slack. . . . I think that’s one of the things 

that you learn when you do field training exercises; as a physician all of us kind of asked 

ourselves, “Well, why am I doing this, this doesn’t pertain to healthcare, or it doesn’t pertain 

to surgery, or whatever?” but it does out in the field. There, you’re not going to be doing just 

surgery, you’re not just going to be doing nursing care, or devoting your time to cardiology, 

or whatever your field may be. You’re going to broaden your repertoire and do other things 

that you’re not generally accustomed to doing.

Over the next 5 days the situation improved. Other units arrived and strengthened the defenses. V Corps also found troops to establish a small QRF for Bushmaster, and the advance of US combat troops around An Najaf made it harder for 

Iraqis to slip out for attacks. Even then, the QRF might need 10 minutes to arrive, and a determined attack could significantly damage the 212th in that time. 

Canestrini later reflected on why he had pushed his soldiers:

V Corps is getting ready to go and fight. I know that the Corps can see with their night vision 

goggles, they have the capability to engage the enemy. So I said, “No, we’ve got to keep 

going because the battle’s going to start.” So that was it, we’re going to get this hospital up 

no matter what it takes. . . . So we pushed on. We motivated, got things going, and when 

that first chopper set down, we brought in our first casualties, and those EMT doors popped 

open. I said, “That’s what it’s all about, right there, the whole Army Medical Department and 

healthcare system that we provide. Are you at the right spot? Are you there to treat the soldier 

and take care of him?” And we were there.

Triage and Surgery

Patients started arriving almost as soon as the hospital was operational, and 

arrived at any hour of the day. Most arrived by helicopter, with the landing zone 
Operation Iraqi Freedom 177

about 300 m from the EMT. If several helicopters arrived at once, one might 

land closer and one set down around 50 m away; the rotor wash threatened to 

knock tents down. After patients were offloaded, two or four people carried the 

litters to the EMT. The ground at Bushmaster had a hard crust over soft, powdery sand, but the crust quickly broke under vehicle traffic, and the wheeled litter carriers had to be hauled over the ruts several times between the landing zone 

and EMT. It was fatiguing work, especially with chemical suits on. Sergeant 

Shamika Cheeseborough of the Support Platoon mentioned another aspect:

Maintenance people, we really don’t see blood and naked soldiers. . . . So when they come 

in you want to just throw your guts up, that’s how gross it was to me. A lot of soldiers said, 

“I don’t want to do this again.” We had to suck it up and go out there and get those patients. 

You have to do this, because that’s what you signed up for.

Once patients were into the EMT, their assessment and treatment began. Major David Vetter, the internist, summed up:

Figure 6-7. Patient brought to the EMT.

Photography courtesy of the 212th MASH.
178 Skilled and Resolute

A fair number of our patients had been seen already at the forward surgical teams, had some 

stabilization care done, some initial wound dressings, but we needed to reevaluate everybody 

in the EMT. They would arrive there. We would get the x-rays we needed. We would get the 

lab tests we needed urgently. We would do whatever stabilization care was needed. That was 

primarily done by the trauma teams, the nurses, the emergency physician and family practice 

physician and myself sometimes when we had heavy patient volumes. From there the “urgents” would go back to the operating room. The less urgent patients would go back to the 

intensive care units to await room in the operating theaters. 

The physician in charge of the EMT was Major David Wolken, and he described his role:

I was a traffic cop that knew something about who was dying and who wasn’t. Really, it’s 

simple, simple stuff; it doesn’t take rocket science . . . it takes being able to recognize goFigure 6-8. Treatment teams working in the EMT. “Going over the emergency room and watching 

these guys work was some orchestrated chaos. But it was kind of a beautiful thing to see, all at the 

same time. You literally had to be there to appreciate it. You see the blood just everywhere. Every 

gurney has someone that’s critically wounded, injured. It’s fortunate that we have training mechanisms in place Army-wide, because at a point you click into what you’ve trained and respond and 

you don’t actually think about what it is. You just execute.” —Sergeant First Class David Harding

Photography courtesy of the 212th MASH.
Operation Iraqi Freedom 179

ing to die/not going to die. Airway/breathing/circulation stuff is a second look. . . . As a 

physician, at first being a rookie to the emergency room and having lots of folks coming at 

you quickly, you’re trying to micro-manage, and you’re trying to deal with everybody. You 

wanted to be the doc that signed everything versus being the doc that triaged everybody, and 

got them in the right hands. So I went quickly to that second role, which is really all I needed 

to do. If it was something life threatening, yes, you treated that.

While the individuals working in the EMT had the requisite medical skills, 

they had to learn the details. They might not realize that an item was already in 

the treatment kit and call for another. But they quickly learned, and the enlisted 

personnel proved they could handle much of the work. Captain Jay Rames, an 

EMT nurse, recalled:

We’d run by the table and ask [the medics], “Hey, do you need anything?” “No.” “OK.” The 

wounds that we were seeing started to become the same. Traumatic amputations, and fragmentation wounds, and washouts, and that sort of stuff all becomes pretty easy to deal with, 

so they were doing a great job. 

For almost 3 weeks most shifts were busy enough that days became a blur 

rather than a clear timeline. 

Equipment worked well; the biggest problem ended up being broken wheels 

on various carts. Carts had small wheels, rather like grocery carts, which jammed 

and broke from moving back and forth on the uneven floor. Chief Wardmaster 

Zimbalist Hester related that, in general, “the medical equipment held up in the 

environment, no problems.” 

EMT staff found that communications were not as good as in training or in 

peacetime hospitals; sometimes there was little information about the number 

of patients and their conditions, sometimes there was no warning at all of an 

inbound helicopter. More warning would allow a faster response and a chance 

to alert the right clinical personnel. There was a quick adjustment to getting 

minimal information; as Lieutenant Colonel John Cho said, anything more than 

notice that a helicopter was inbound was “a luxury and not mandatory.” Major 

Wolken agreed: “Information is not really that important. You just take care of 

the guy that gets in front of you. We’re reacting to the situation, and you just do 

your job.” 

Between batches of patients, staff restocked supplies and tried to clean up, 

preparing for the next casualties. Specialist Sarah Hoffman recalled she had 

“never been a real big fan of seeing a lot of blood anywhere, but I’ve scrubbed 

my fair share off of the floor now.” It was impossible to match the cleanliness 

standards of a hospital in the United States, but the 212th was in a combat zone. 

Wolken recalled:

You started to realize hospital inspectors aren’t around, especially from an EMT standpoint. 

Until the end of the war we were shaking all packages [clearing dust] before we would open 

the bandages. It was literally a quarter inch of dust and dirt on there, and you realized that 

this not going to be like we’ve ever experienced it before. We felt it throughout the entire 
180 Skilled and Resolute

war, because we set it up in dirt, and you just can’t get rid of that. That was really tough from 

a physician’s standpoint. We just couldn’t get rid of the dirt.

During MASCALs, personnel had to be called in from all around the MASH, 

pulled from all sorts of duties to carry the litters, and pulled from the wards to 

help in the EMT. The MASH soon found alternatives to frequent MASCAL 

calls, because MASCAL procedures woke up all sleeping personnel who needed 

rest for their own shift and also pulled guards off the perimeter. As Dr Cho 

noted, the MASH had to sustain its operations in a marathon rather than a sprint. 

Major Richardson, the chief nurse, described the decisions:

We had rehearsed, in all of our field training exercises prior to deployment, that if we get 

more than six patients we would call a MASCAL. Well, when you don’t know what’s coming in, it may not be a MASCAL; we can’t necessarily do it by the numbers. Even when you 

get six urgent patients that need significant care, you don’t necessarily need a MASCAL for 

that. The first time we got notification that we were getting six patients in at once, the DCCS 

called a MASCAL. Colonel Canestrini said, “Whoa, wait a minute. We need to stop and we 

need to look at this as a team.” He really settled us down into a process where we assessed 

the situation before we ever thought of calling a MASCAL. Ultimately we realized we didn’t 

ever need to call them. We had focused teams that we could identify and pull folks from to 

help with patient care, and even on the nights that we had 56 patients in house we didn’t call a 

MASCAL. We progressively woke folks up and brought them in as we needed them, instead 

of having an entire hospital sitting and waiting for stuff to happen. I think doing that without 

too much fatigue saved us.

The 212th saw 701 patients, admitting 394. Sixty-six percent of admission 

were American and 34% Iraqi, but only 74 Americans (28% of admissions) had 

battle injuries. The orthopedic team was extremely busy, with 132 procedures on 

74 patients, mainly washouts, but also 17 external fixators and 4 complete amputations. There were only 55 abdominal and thoracic procedures for 33 patients, 

with 11 thoracic procedures, 2 neck explorations, 16 abdominal procedures, and 

24 washouts. The orthopedic workload was so high that other surgeons began 

doing minor orthopedic procedures so Dr Alarcon could focus on the complicated patients. As he noted, “Certainly there’s an element of working in an austere 

environment that changes the way you practice surgery or medicine. Speaking 

for myself, we have a lot of luxuries in civilian practice. When I put a metal 

frame on somebody’s leg or thigh, I have the luxury of having a portable x-ray 

machine that shows me the bones and shows me how to put it together and all of 

that. Over here I was doing it by feel, no x-rays, and no way to assess whether 

the setting of the bones was perfectly straight. I had to do it all by feel, and after 

putting on 17 external fixators you get pretty fast at it.” Most wounds were from 

bullets and shell fragments, and the goals are easy to describe on paper but complex to perform under pressure: remove the projectile, control bleeding, debride 

dead tissue, and wash out the wound to remove foreign material that could cause 

infection.

In addition to the wounded, there were non-battle injuries, mainly accidents. 
Operation Iraqi Freedom 181

Some of the American patients were accidental woundings from an American 

weapon discharging. One soldier was clearing his pistol but shot himself in the 

foot; a squad automatic weapon (SAW) burst of 20 rounds hit three Americans 

in a building. Usually the soldiers said whether the wounds were from friendly 

fire, although there was never documentation. Captain Ruth Roettger-Lerg said 

it was usually obvious whether it was an accident or a combat injury, but it was 

seldom clear which accidents might really be self-inflicted wounds.

There were also sick and combat stress casualties. Among the medical cases 

were appendicitis, kidney stones, and diabetic reactions; patients went to the 

closest hospital, whether or not it was titled a surgical hospital. Some of these 

the MASH could cure, most it could treat, and it could certainly coordinate any 

evacuation needed. By doing so the MASH returned soldiers to duty, or at least 

let combat units focus on their mission. 

Lieutenant Colonel John Cho was a thoracic surgeon and chief of surgery. He 

was involved in two of the more complex cases, a vascular repair and open-heart 

surgery; both patients were Iraqis.

We had a 41-year old Iraqi first lieutenant who had an injury to his right popliteal fossa area, 

behind the knee. He had total disruption of his right popliteal artery and vein. I took the vein 

from the opposite leg, reversed it, and essentially created a new popliteal artery. We reconnected his vein using an additional piece of vein. This removed the need for an above-theknee amputation. We gave this patient a world-class repair. My feeling is if he came to an 

Iraqi hospital, he would have had an above-the-knee amputation. But he was with us in the 

MASH. We had the surgical capability and we gave him the Cadillac operation. That particular soldier had five procedures performed on him, and that was during a phase when we were 

busy. But we never really had anyone who was in extremis waiting for an operation, extremis 

being life, limb, or eyesight. Besides, the operation didn’t take that long, only four vascular 

anastomoses and no cross-clamp time to boot; it’s not like I was doing heart surgery. This 

was essentially peripheral vascular surgery that was performed in an expeditious manner. But 

we also had the right equipment, right suture, and right personnel.

I thought another guy was in his 50s. He was a 66-year old Iraqi who was in a minivan 

and drove through a checkpoint with other family members. It was my understanding that 

two days prior some Iraqis had faked surrendering at a checkpoint and killed three of our 

Marines. So when this gentleman and his family went through the checkpoint without stopping, our soldiers fired on the van and we received the casualties. I was actually putting a 

chest tube in this patient’s niece when Dr King called me over and said his patient was moving, had a pulse, blood pressure, and then suddenly stopped breathing. I took a quick look 

and I made an assessment that the patient might have a tamponade as there was a penetrating 

injury in his left front chest. One also has to worry about tension in the chest. Dr King put 

a needle in on the right side. I went ahead, performed a similar procedure on the left. There 

was no improvement. I proceeded with a left frontal thoracotomy and my suspicions were 

confirmed. The patient has a pericardial tamponade. I opened the chest and found an injury 

to the left ventricle. The blood and pressure in the pericardium was relieved and with a little 

cardiac massage and a simple stitch the heart function returned. We took this patient directly 

back to the OR. The gentleman also had an injury to his right upper extremity and to his left 

leg. Dr King, Dr Morton, and I participated in his care. I went ahead and closed up his chest, 

put a couple of chest tubes in and he was doing fine. I also performed a laparotomy as he 

had a penetrating wound to his abdomen. I fixed the small bowel injuries and proceeded to 

close him up. Upon doing so, I got word from Barry Vance (our CRNA) that the patient lost 

pressure and pulse. Did he re-tamponade? I had loosely re-approximated the pericardium so I 
182 Skilled and Resolute

wasn’t completely certain. I opened the left chest again and found no re-tamponade. I started 

cardiac massage and continued for about 35 minutes. We couldn’t get him back. About the 

time we called the code, the initial lab values came back. His hematocrit level was 17 in the 

EMT; normal is around 44. So this 66-year old gentleman might have had a massive heart attack. It’s not something that a patient his age, with extensive penetrating trauma, can recover 

from. But that did not stop us from trying to do everything we could for him. I think I was 

quoted in the papers saying, “Well, we didn’t care who he was; we just wanted to take care 

of him.” I think that was our mantra and we truly felt that way. If someone makes it into the 

hospital, it’s our goal to preserve every life that we can. Everyone worked hard on him. It was 

a bit frustrating. Life is precious. We didn’t like the fact that we lost the patient. I think at the 

end of the day, when we looked back, we found solace in knowing that we did everything 

possible for this patient.

Captain Anthony Rhea, an EMT nurse, handled one of the amputation patients 

before he went into the OR:

I remember one soldier whose vehicle was hit by an RPG. The report was that he was an 

amputation. When he came in, that’s how it appeared. He had a tourniquet on his upper right 

Figure 6-9. In the OR. Left to right: Captain Vegter, Majors Vance and McDannold, Captain Breeding.

Photography courtesy of the 212th MASH.
Operation Iraqi Freedom 183

arm and it looked like his arm was missing from the elbow down. But as you started taking 

care of him and looked closely, his hand was still there. You could still see fingers. The x-ray 

confirmed this; somehow the explosion, instead of blowing his arm off, just accordioned it, it 

just made his arm half the length. Of course, with that much damage, you’re going to have a 

lot of bleeding and a lot of mangled tissue. To the medic the initial reaction is, for all practical 

purposes, “This is an amputation, throw a tourniquet on to control the bleeding.” From the xray that they took of it, you could just see all of the bones just broken and folded up like a fan.

On his left hand he had a shrapnel wound that went right across his knuckles, and his 

pinky, middle finger and his fourth finger were all still attached, but there was just so much 

damage that when they took him to OR they had to amputate the rest of his right arm and they 

amputated those three fingers. So all that the soldier was left with to go home with was the 

thumb and his index finger. He was one of the more serious American casualties that I saw.

Surgeons were only part of the OR team; Major John King, a nurse anesthetist, described his role in two surgeries:

I did an emergency exploratory laparotomy for Dr King on an Iraqi who had been shot 

through the abdomen. There were a lot of considerations. He was kind of obese, and he 

bled out a little. That case actually went well, although we always enter any case thinking, 

“What’s the worst that can happen?” You can have a healthy 20-year old who’s having a 

toenail removal, and you’re thinking, “What’s the worst that can happen to him? I better be 

prepared for that.”

Ten minutes before the end of this case, Dr Cho came to me and said, “Now I suppose 

you’re going to be doing my chest case next.” I go, “What chest case?” “Well, I’ve got an 

open chest case.” I go, “You told me at the beginning of this case you weren’t going to do 

that guy.” Dr Cho said, “Well, I changed my mind.” So now we have an emergency chest 

case to do, he’s going to open up the chest, and there are a lot of anesthesia considerations 

any time you have an open chest. The lung dynamics change once you separate the ribs and 

open up to atmospheric pressure. 

So after I woke the exploratory lap patient up and brought him to the ICU, I quickly 

walked over to the bedside of the thoracotomy patient and saw that he was lying in a puddle 

of blood. So I quickly did a management assessment on the fellow, looked over his labs, and 

he was an Iraqi gentleman who spoke no English. With the sense of urgency that Dr Cho gave 

me, I went to the blood bank directly, got an emergency release for two units of O-positive 

blood, ran back to the ICU, hung that first unit of blood, went to the OR, spent five minutes 

getting my area ready with the other unit, walked back to the ICU, personally brought the 

patient into the OR. By the time we had him on the table the first unit of blood was in. I hung 

the second unit of blood so that would be going. The second unit of blood was running at 

the time I was inducing anesthesia. I felt good that, number one, the turnover time was less 

than 20 minutes from the time I woke the first patient up until the time the second patient 

was on the table and getting anesthesia induced. You’d have to work in an operating room to 

appreciate just how darn fast that is.

After I’d induced anesthesia, intubated the patient, Dr Cho runs in and says, “He’s going 

to need blood,” and I pointed to the second unit that was almost empty, and said, “Well, he’s 

gotten two units already.” It’s always nice to hear surgeons say, “Wow, that was fast,” but it 

wasn’t without some effort on my part. That was very challenging. That was a very challenging case, the two very urgent emergency cases back-to-back.

Some of the most critical patients were burn patients. There were only a few, 

but they were urgent and needed special care. The largest group was the result 

of an enemy shell; it was early morning and the soldiers were undressed and 

washing. Experienced physicians could still be surprised by burn patients. Major 
184 Skilled and Resolute
Operation Iraqi Freedom 185

Lieutenant ColonelVetter recalled:

Another patient that impressed me was the first burn patient I took care of. This particular 

soldier had about 70 percent body burns, but I was very impressed at how calm he was, talking, awake, conscious. He wanted to know for sure if he was going to be OK. We thought 

he probably would be, although his burns were very serious. I remember holding his hand 

to kind of reassure him. His hand was so cold and so moist; I never felt anything like that 

before. And then all of the skin of his hand just sort of came off in mine. But a very calm patient, very cooperative. Unfortunately he died shortly after he left our facility, on the MEDEVAC flight out.

Major King helped as well.

We had one fellow who had like 60-80 percent of his body burned, a devastating wound and 

he was developing a hemopneumothorax, blood and air into his chest cavity. Dr Cho placed a 

chest tube in, and as soon as the chest tube was in you heard the gush of air and he lost about 

maybe a liter of blood. I’ve done bedside chest tube placements and, boy, they hurt. Patients 

scream. The doctor will numb it with a local anesthetic as best they can. So this man who 

was developing the hemopneumothorax really did receive a lifesaving procedure, but he had 

devastating wounds on his body. He was so cheerful. 

Dr Cho said, “We have to put a chest tube in because your lung is deflating, and we have 

to reinflate it so you’ll breathe better.” He went, “OK, let’s do it.” Dr Cho put a little numbing 

medication on, put the chest tube in. Patient never groaned, never winced, never blinked. So 

I was thinking, “Man, that numbing medication really works.” I asked him, “Did you feel 

that?” The patient goes, “Hell, yes, I felt that. It hurt like hell.” Even though it hurt like hell 

he didn’t scream or cry. He knew it had to be done in order for him to live. 

He didn’t survive. They gave him close to 100 percent chance of not surviving his injuries. He also had a lacerated liver and spleen, other injuries that, even without the burns, 

probably would have been fatal. But during that short time in the ER when he was alive, he 

was talking to us. “Do whatever you do.” We had to do a head-to-toe assessment, so we had 

to move him on his side which must have been painful for him. 

The 212th had to adjust to battlefield conditions, just as generations of surgeons had before. Dr Jatoi reflected:

 Dr Alarcon was probably the busiest because he was the orthopedic surgeon. We needed 

his expertise in a lot of things. But general surgeons can get into that mode as well, because 

a wound is a wound. You clean it, and you go ahead and evacuate the patient for definitive 

care in the rear. So a lot of those things the general surgeons were able to deal with, with 

him looking over and saying, “Yes, that’s fine. You can go ahead and do that.” We’re used to 

civilian settings where we do very detailed histories, and physicals, and so forth. When you 

get out in the field you don’t have time for that, you basically have much abbreviated forms 

and documentation because you’re getting huge numbers of injuries coming in at one time, 

and you’ve got to move them quickly. 

Another adaptation was wartime priorities for operating on patients. It was 

not an option to hold a patient for several days before deciding whether or not 

Figure 6-10 (at left). Lieutenant Colonel Canestrini’s note card about the burn patients.

Photograph courtesy of Lieutenant Colonel Kenneth Canestrini.
186 Skilled and Resolute

to operate. With only three operating tables and 36 ICU beds, the 212th faced 

an unpredictable flow of patients. Delays before operations reduced the capability to handle more patients. That unpredictable flow of patients also caused the 

doctors to review their operating strategies. If a long operation that might or 

might not salvage more of an organ or limb occupied an operating table, newly 

arrived critical patients could not receive care. The physicians had discussed 

the subject in Kuwait, and continued reviewing priorities and policies in Iraq. 

Another departure from routine was driven by diagnostic equipment. With x-ray 

and ultrasound equipment limited to preserve mobility, the MASH surgeons had 

to operate on more patients. Dr Booker King, a general surgeon, described the 

results:

My first casualty was a US soldier that had a gunshot wound to the neck, on the right side. He 

came in, was pretty stable, but had an obvious entrance and exit wound. We made a decision, 

me and Dr Cho, took him to the operating room and explored him. It was a negative exploration, but I think it was something that needed to be done, because if he actually had an injury 

then he would probably die later. In a medical center you have the ability for CT scans and 

other things. . . . But it was our thinking that we needed to be aggressive and explore these 

wounds because we didn’t have the equipment to say whether this guy had an injury or not. 

Explorations were about half and half; some of them negative, some of them positive. 

I think the most important thing I learned was that you’ve got to be aggressive and you 

can’t be afraid to take a patient to an operating room. There were a few patients I personally 

wavered on, and ended up taking them to the OR, and they ended up having injuries that 

would have been missed. Probably would have been catastrophic, because the critical patient 

you can pick up on easily. These were more subtle patients. I think in that environment you 

have to be really aggressive in terms of who you operate on. X-ray won’t necessarily tell you 

everything. We had a little portable ultrasound; that won’t give you all of the clues. You’ve 

just got to go on your overall feeling and say, “Hey, I think this guy has an injury and needs 

to go.” You can’t be afraid to do that.

A key to keeping the hospital functional was keeping the surgeons rested. Colonel Jatoi had initially wanted to be briefed on all incoming wounded, but after 

being awakened three times in the first 2 days, he realized how fatigued he could 

get and stopped that requirement. Work schedules and call schedules also were 

discarded when they proved both unnecessary and unworkable. American forces 

with night vision goggles operated at night, and thus many wounded arrived 

at night. But wounded arrived during the day as well, so the surgeons rested 

when they could. The internist, Dr Vetter, handled most postoperative care and 

discharges, leaving the surgeons to handle surgery, something Dr King thought 

was an excellent example of teamwork. The gynecologist contributed where he 

could, mainly in abdominal cases, but he also participated (under supervision of 

a thoracic surgeon) in chest surgery.

Supplies dwindled as the initial stocks were used and resupply was delayed, 

but care was always at a high standard. Some of the first-line items ran out, but 

there was always a backup, for instance, reusable anesthesia equipment instead 

of disposables. Surgeons had to be urged to scale back; there were many pro-
Operation Iraqi Freedom 187

cedures where two surgeons were not necessary. OR nurse Captain Dale Vegter 

recollected: 

To their credit they wanted to help out. But they would disagree with us, and we would disagree with them sometimes, about the need for some of them to scrub in, the need to conserve 

the surgical gowns, gloves, what have you.

 Dr King remembered using staplers several times on the same patient despite 

the risk of contaminating a wound in one area with bacteria from another area, 

an acceptable risk. Sutures were also conserved, and when only one surgeon 

Figure 6-11. Preparing a patient for surgery. “The anesthesia equipment is outstanding. The ICU 

equipment is outstanding. The operating room equipment, the instruments are great, but we don’t 

have a lot of it. We don’t have bone saws, so we used a specialty knife that you use to cut through 

the bone. Twice I had to cut through the bone in the midline area, and I did that without the use of a 

bone saw. It was an acceptable solution. In the event of trauma, you do what you can to make things 

happen. It would have been better to have some of that additional equipment, it may be helpful, but 

it didn’t affect the end result. In the intensive care unit the equipment was new, the ventilators, the 

Propaq monitors. It was just like being in the ICU at Walter Reed. For me, I was very pleased with 

that. The standard of care was met.” —Lieutenant Colonel John Cho

Photography courtesy of the 212th MASH.
188 Skilled and Resolute

was necessary, only one would operate, which doubtless helped reduce fatigue 

and increase rest. When disposable gowns ran out, cloth ones were available, 

which required the laundry to function. That led to two more effects: the laundry 

soldiers had less time available for guard duty, and the laundry needed water so 

showers were curtailed for a few days.

On the Wards

After EMT and surgery, patients were moved onto the wards. The MASH had 

three 12-bed ICUs. ICU1 was intended for medical patients, ICU2 for surgical 

patients, and ICU3 for both medical and surgical Iraqi patients, so only one 

ward needed guards. Since the numbers of patients fluctuated greatly, the plan 

had to be flexible. Some nurses in each ward thought they had the more interesting patients: Captain Gregory Hubbs thought that the surgical patients were 

more important, while Major Rhonda Newsome remarked that the non-surgical 

patients could talk about their experiences. Most of the nurses had already seen 

wounded patients from Afghanistan at Landstuhl.

There were strong bonds of duty and loyalty among the enlisted soldiers. 

Medics from the 212th were frustrated when they were on guard duty and not 

helping patients, and Captain Joe Wilson answered their concerns by saying they 

were helping by guarding everyone. Wilson was also touched that, when cots 

had to be brought out to prepare for an influx of patients, some patients helped, 

knowing that soldiers from their units would be occupying them. Patients felt 

strong bonds to their buddies still in combat as well. Captain John Keener recalled a platoon sergeant whose unit was ambushed:

He had all these young kids and he was trying to organize them, getting off the vehicle and 

into fighting positions, and he extended his arm, meaning “move forward,” and when he did 

that, he got shot through the elbow, and he was very distraught. He said, “Have you heard 

anything about my soldiers or anything? I’ve got to know. I’ve got to know.” We couldn’t 

calm the guy down. He was just so worried about his soldiers, and he didn’t want anything, 

any pain medicine. “No, if my soldiers don’t get pain medicine, I don’t.” I said, “Well, we 

don’t know, but we’re pretty much the only hospital around, and they’re not here so they’re 

probably OK.” He didn’t want to eat regular food, he wanted to eat MREs because that’s 

what his soldiers were eating. He was there overnight, and he got evac’ed back to Kuwait, 

and the very next day all his guys came in, some of them injured. Not really with lifethreatening injuries, but the poor guy was pretty much up all night. He was very emotional, 

worrying about his soldiers, and he missed seeing them by a few hours.

Captain Hubbs had two patients experiencing two aspects of group loyalty:

We had a guy that was in an ammo carrier. They’d done their mission during the day and 

were all excited about it, I think four of them in the vehicle. Well, they were driving and they 

drove into a ditch, and all of these thousands of pounds of ammo started to fall. One guy tried 

to catch it, but he couldn’t do it, it just buried them all in ammo. Then the worst part was it’s 

under water. We took care of a guy whose legs were crushed, which is bad enough, but he’s 

dealing with the shock of his buddies being there and then, all of a sudden, now they’re gone. 
Operation Iraqi Freedom 189

That was pretty tough for him.

The fighting spirit of some of the guys was amazing. We had one guy come in; a bullet 

went right through his arm, through the other side, didn’t hit anything. He said, “Got anything broken?” “No.” The next morning, “Hey, I want to go back to my unit. I want to get 

back there up to Baghdad.”

American patients seldom stayed at the MASH more than 2 days before they 

were evacuated to Kuwait. Most went by helicopter, but C-130 flights could fly 

large groups (over two dozen) at once. At first an air ambulance company was 

based next to the 212th, and it was easy to coordinate with them; their flight 

Figure 6-12. Dr Jatoi briefs Lieutenant Colonel Canestrini, with Majors Linck and Richardson in the 

background. “Every night that we were out there at Bushmaster I made it a point to go around in the 

evening, full Kevlar and flak jacket, and walk through the wards. Colonel Jatoi was available and 

we did patient rounds. I would go through and he would give me an assessment, in layman’s terms 

to some degree, “This is what we’ve got.” I knew what was going on in that facility, if they had any 

issues, but primarily it was so that the American soldiers could see a commander. That made a big 

difference. The American soldier that’s in the bed liked seeing a commander. They appreciated the 

fact: here’s a soldier coming through who’s a commander and he’s assessing, checking, and making 

sure I’m taken care of. Even though Colonel Jatoi’s doing what he’s supposed to do, and it’s clinically correct, they just like to hear that there’s some type of a report, that someone is checking on my 

care.” —Lieutenant Colonel Kenneth Canestrini

Photography courtesy of the 212th MASH.
190 Skilled and Resolute
Operation Iraqi Freedom 191

Figure 6-13 (at left). One of Lieutenant Colonel Canestrini’s note cards for daily briefing. “Lieutenant Colonel Canestrini is an MSC officer and I’m a clinician. But we had a very good relationship. 

When it came to clinical kind of questions, he would defer to the clinical side of the house. When 

it came to a lot of these operational issues, which I really didn’t have that much experience with, 

he was far more familiar. One of the good things that I like about him is that he basically had the 

willingness to incorporate the clinicians into the decision-making for how things should be managed. I think for that reason things worked very well, so I don’t think there were any real problems. 

I know some people have said it’s very different for a non-physician to really command a hospital, 

and I didn’t find that to be true. I found that it was very easy to work with an MSC commander. In 

fact, he had a lot of expertise in a lot of those things, because I was just brought on as a DCCS late. 

It was something that I really had to kind of defer to him on. I think the relationship worked out very 

nicely.” —Colonel Ismail Jatoi

Photograph courtesy of Lieutenant Colonel Kenneth Canestrini.

medics also helped at the MASH when able. Later that unit moved forward and 

coordination declined. Captain Gregory Hubbs helped with evacuations from 

his ward and recalled:

The air ambulance company was almost embedded with us; that was great and worked very 

well. When we needed to move patients, they could work something out. They could work 

within their sleep-rest cycle and all of that kind of stuff. It didn’t work so well when they 

weren’t with us, because we didn’t have communication and [the second unit] didn’t work 

as well with us. 

Captain Nina McCoy, a nurse, briefed her patients on what they would be 

experiencing:

I would tell all of the evacuating patients, “OK, this is what you should expect. It’s a twohour trip back by helicopter. After an hour they’re going to have to stop to refuel. You might 

get air sick. It’s going to be dark. Do you need anything?” 

One little guy said, “I need my wallet and my St. Christopher.” So I went to look for it, 

came back, “I can’t find it.” He said, “Ma’am, I don’t care about my wallet. I can replace all 

that, but I need to have my St. Christopher’s medal.” So I went back and asked Smitty, one 

of the PAD guys. He says, “Ma’am, why didn’t you come and ask me first?” So he had his 

dog tags with the medallion, but he didn’t have his wallet. I went back; he’s like, “Oh, thank 

you.” You could just tell that this was the only thing that was going to get this poor kid back 

to the rear with his peace of mind intact.

Reacting to Deaths

Only one person, an Iraqi civilian, died at the 212th, but a number of American dead were brought to the hospital. Some had been killed in action, others had 

died in accidents. In theory a Mortuary Affairs unit rather than a medical unit 

should have received them and gone through the somber last steps: emptying 

pockets, inventorying possessions, closing the human remains pouch, and rendering honors as the remains were evacuated to the rear. However, there was no 

Mortuary Affairs unit forward, and the MASH had the only refrigerated trailer 

available. Some dead soldiers were flown to the 212th on the same helicopters 
192 Skilled and Resolute

as their wounded comrades. Sometimes it was not clear if an arriving patient 

was dead; some wounded died on the evacuation helicopter, and the triage teams 

worked on them before realizing there was nothing anyone could do.

For many in the MASH, it was their first time seeing a dead body. Sight was 

not the only stressful aspect: many commented on the smell, and on cleaning up 

the blood afterwards. There were cases where the MASH was also treating the 

wounded buddies of a dead soldier, adding to the strain on everyone. Having a 

chaplain and a psychologist in the unit helped; they could talk with soldiers and 

help them decompress. The chaplain helped by delivering rites appropriate to 

the soldier’s religious preference.

Specialist Sarah Hoffman was one of the trained behavioral health personnel. 

Her training helped her understand and cope, but she too reacted to the first body 

that arrived.

I never saw him, but I saw the litter that he was on, and that was one moment that I honestly 

thought, “I don’t know if I can handle this.” I was outside cleaning litters so we could have 

Figure 6-14. Major Newsome and Captains Wilson, Prieres, and Fry bring a patient for helicopter 

evacuation.

Photography courtesy of the 212th MASH.
Operation Iraqi Freedom 193

some for the next people, and that’s when they brought that one over and set it down next to 

me. The litter was completely covered in blood and had a green blanket on top of it that also 

was completely saturated in blood. I got over it, but that sticks out in my head. That was one 

of those days where you think, “OK, I don’t know why I’m here.” But I got over it, and kept 

doing what I had to do.

I had a confrontation, sort of, with one soldier who actually carried the body to the refrigerated van. He was angry, and that’s how he was dealing with it, and I was upset because 

that’s how I was dealing with it. So when we kind of ran into each other, it didn’t really 

work out too well. But we sat down and talked about it and got over it together. But that was 

definitely an emotional day for a lot of people because it was the first one we got, and a lot 

of people hadn’t been exposed to that. 

Specialist Tashiana Graves, a medic, described her reactions:

When I saw my first death I really didn’t know how to handle it, because I hadn’t ever seen 

anything like that before, and it looked like something straight off the movies, ten times 

worse. We had a pregnant civilian, we had a 15-year old girl there with her sister who was 

like 24, and they had gunshot wounds, and stuff to the chest, and everything. Then we had 

this old guy, and his arm and stuff was blown off, only hanging from a piece of skin. He had 

holes in his feet and legs and stuff, and, I don’t know, the sounds of everything and the smell 

of everything, the smell of the flesh, it just really got to me within a couple of minutes. I 

didn’t want to cry right then and there, so I just had to step away and go back to my ICU and 

go in the back room, and I cried for about half an hour. A couple of people tried to come up 

and hug me, but I didn’t want a hug. But afterwards I talked with those people. A couple of 

people came by to see me afterwards. It was just something that I had to get over. It was my 

first time seeing it and I really didn’t know how to deal with it right then and there.

Captain Arthur Finch, the psychiatrist, described the effect of starting to treat 

a patient, only to discover he was dead:

Some of the most poignant incidents were when we got our first American DOA. He died en 

route and it was a very somber moment because one of the doctors didn’t realize that he was 

dead yet and started working on him and had the whole team working for probably a couple 

of minutes before they realized the guy was actually not responding at all. The impact of that, 

psychologically and emotionally, is pretty intense on most folks as they had to transfer the 

body to a body bag and escort it out of the emergency room.

The other hard part about that is he was part of a Bradley crew that was continuing to 

receive treatment, there in the emergency room, while all of this was going on. Those guys 

were pretty shaken up, understandably, and having to work with them and talk to them over 

the next couple of days while they were there kind of gave you a real feel for what these guys 

go through up there on the front line. It was pretty humbling to talk to them.

We had to deal with that three or four times, where the medics and doctors were working 

on them and lost them en route. It was always a kick in the stomach when those folks showed 

up, because once we get them we can usually keep them alive. But if they don’t come in alive 

we can’t do anything for them, and it’s very sad.

Colonel Jatoi described the differences for the younger troops and how the 

leadership responded:

A lot of the very junior enlisted were probably having the hardest time with KIAs, because 

they’re young, they’d never had much experience in a major trauma center. A lot of us, espe-
194 Skilled and Resolute

cially trained surgeons, had seen lots of deaths in the emergency room and the trauma room. 

During my training I saw a lot of people come in who died. But for the very junior people, 

18, 19 years old, all of a sudden they’re seeing this for the first time. They’ve got no real 

extensive medical background. On top of that, they’re in the middle of the desert. They’re 

away from the loved ones. But nevertheless I think they did fine.

We did spend some time talking to them. You need to talk and communicate. You need 

to go up to somebody and say, “How are you doing?” “Any problems, issues?” “Have you 

heard from your family?” and so on and so forth. Let them air their feelings, and kind of talk 

things over with you. I think all of us basically stepped up to the plate and did a little bit of 

mentoring at that point. Especially in that setting, when you’re out in the field and you’ve 

just seen somebody—they’re wearing your uniform, they look like you, they’re your similar 

age group—also you see them dead; it’s not an easy thing.

Combat Stress Control

Lieutenant Colonel Canestrini augmented the MASH with two behavioral 

health personnel. One was a psychiatrist, Captain Arthur Finch, the other an 

enlisted behavioral health technician, Specialist Sarah Hoffman. Beyond the 

Figure 6-15. The MASH’s refrigerated van.

Photography courtesy of the 212th MASH.
Operation Iraqi Freedom 195

two behavioral health staff, the MASH had a chaplain. Canestrini expected the 

MASH would receive some combat stress patients and reckoned the combat 

stress control detachments assigned to the divisions and brigades would be busy 

enough with their normal work. Finch and Hoffman had no formal duties in the 

hospital. Finch moved around as needed, through the EMT, the wards, and wherever the soldiers were, talking and listening. He was also called in from time to 

time when doctors and nurses thought someone needed his help, and moved to 

other units to observe potential patients. Hoffman worked in the EMT section 

and also on the wards, informally screening patients and also being available for 

a quiet word.

Leaders in the MASH watched to see who was stressed beyond the normal 

strains of working in a hospital in combat, and talked with their people, arranging a chat with the chaplain or the professionals as needed. Captain Finch found 

that soldiers were not totally overwhelmed but only stressed about a facet of 

their duties; the MASH leadership could frequently shift those soldiers to other 

duties.

There were few pure combat stress patients, soldiers who just could not handle combat and broke down. Instead most were already wounded and reacting 

to their wounds, some already experiencing flashbacks. Colonel Jatoi remarked 

that the clinicians were too busy with their normal duties to try to help combat 

stress patients, and both the combat stress personnel and the chaplain were very 

important elements. Nobody can quantify how effective it was to have behavioral health help in the hospital, but it apparently helped some patients and staff. 

Canestrini thought taking the two behavioral health soldiers to Iraq was thoroughly justified:

Their contribution was great. But in addition they really helped the staff out. They were on 

the spot. [Finch] really made a lot of evaluations in the emergency room which he was not 

used to doing. He’d been used to being with the soldiers. He clearly saw a need for his ability 

to work as health staff and also help the soldiers as they’re going through a traumatic period.

Captain Finch actually treated the MASH’s first patient.

That first morning we also took our first casualty, ironic in my mind because our first casualty 

was a psychiatric case. He came presenting with atypical chest pain. The EMT took him and 

did all of their poking, prodding, x-rays, and everything else, and then shrugged and said, 

“We don’t see anything wrong with him.” It ended up he was having panic attacks. So the 

first case that the MASH actually had was a psych case, which I guess is a good way to start, 

because they don’t require a lot of nurturing at that point. We ended up just putting him to 

work, we had him help us set up tents. He was a medic so he knew a lot of medical stuff, 

so we put him to work and about 48 hours later he decided he probably wasn’t as bad as he 

thought he was and he went back to his unit.

Having Specialist Hoffman in the EMT section was probably the very best thing that 

could have happened, because that meant that I had an insider in the emergency room, working with the patients as they came in, helping to identify who were combat stress type casualties. Most of these guys were combat injuries of some kind or another, but a lot of them were 

experiencing the combat stress reactions that come with those. So being able to have her 
196 Skilled and Resolute

in the emergency room, actively part of the team that was working, but also being my eyes 

and ears on who needed to be talked to later, was much better than just me trying to stand 

around like a vulture figuring it out in a crowded and busy emergency room, which never 

would have worked. To our knowledge it has never been done before, but having [her] in the 

emergency room, we identified soldiers that were exhibiting initial signs of acute stress reactions, kind of the precursor to posttraumatic stress disorder. As we identified those patients, 

we went one-on-one and had debriefing sessions with each of them. I have no numerical data 

that says that’s a good idea, but it seemed like the thing to do at the time and so we gave it a 

shot. We were trying to give them a heads-up, let them talk about their experience, these are 

guys that we’d watch sleeping and they’d jump awake, and you asked them what was going 

on. “Oh, I can feel the bullet still going through me.” They would sit down and talk to us, 10, 

15, 20 minutes about what had happened to them. We’d just let them talk and then ask how 

they’re reacting, try and let them know that that’s a normal reaction, not pathological. Trying 

to give them a heads-up that if it’s still happening two months from now to get some help 

because we can fix it early, but later on it’s really hard to fix. Hopefully the 9 or 10 percent 

of folks that might end up with PTSD from a situation like this, maybe we caught a few of 

them. We’ll never know.

As a therapist you’re used to dealing with intense conversations, and these were as intense of conversations as I’ve ever had. A crew chief for a Bradley sobbing for an hour while 

he tells his story because two of his guys are dead, and him feeling very responsible for that 

and very guilty that he’s the one that survived and they didn’t, and knowing their families 

well back home, and what they were going to do without their Dad there anymore. Very, very 

intense and emotional moments. I’d never seen anything like it. So it felt helpful in the moment. We ended up seeing over 350 people in that two-week period.

Dealing with Iraqis on the Wards

A large number of the 212th’s patients were Iraqis. Under the Geneva Conventions an army has to treat any enemies it takes prisoner. In addition, CENTCOM had a theater-wide policy of treating local civilians at risk of losing their 

life, a limb, or their eyesight, while lesser injuries to Iraqis were to be treated by 

the local healthcare system. V Corps planned for Iraqi patients to be evacuated 

to an element of the 86th CSH outside Tallil, about 60 miles into Iraq, and the 

212th had been told that it would be treating American soldiers.

Almost immediately, however, Iraqi patients arrived. They were evaluated 

and treated just as any other patient would be; it turned out they were captured 

soldiers and had to be treated. Adding complications, they arrived shortly after a 

group of American wounded, and the Iraqis may have been involved in the fighting that wounded those Americans. There was little planning on how to handle 

Iraqis, and procedures changed as the 212th gained experience. Iraqi men had 

to be treated as prisoners of war—searched, restrained, and guarded—whether 

they were in uniform or not, because Saddam’s Ba’athist and Fedayeen fighters did not necessarily wear uniforms. Also, most Iraqi men claimed, regardless of circumstances, they were not soldiers. Even those wearing combat boots 

claimed to be farmers or shepherds. Searching patients sometimes delayed their 

treatment so that everyone would be safe. When patients arrived by ambulance 

the ambulance would be stopped at the gate so there was no chance of a suicide 

bomb. As Major Richardson noted, “If we had suspicious people coming up, 

they were going to get shot.”
Operation Iraqi Freedom 197

If the guards judged it necessary, prisoners were tied up and/or blindfolded. 

Sergeant Joseph Filipiak, in charge of force protection, recalled no incidents 

with prisoners. Saddam’s anti-American propaganda had included dire warnings 

about Americans executing prisoners, and many wounded men probably denied 

they were fighters in hopes they would be spared. Almost all lost their fear as 

they were cared for. Dr Vetter saw a pattern: “For the first twelve hours or so 

they were a little apprehensive, then when we would feed them, and give them 

water, and treat them like human beings they really became appreciative.” Even 

a sergeant major from the Republican Guard, an elite Iraqi unit, realized that 

everything he had been told about Americans was a lie.

At first Iraqis and Americans were mixed on the wards, but that caused concerns among wounded American soldiers who did not want Iraqis on the same 

wards, and it also increased the number of guards needed. 

Figure 6-16. Specialist Tomokane on guard in ICU3. “We had no incidents with EPWs. EPW guards 

were another five to seven people you’d have to give up every day. We had guards on them tight. We 

treated them just like we had to by Geneva Convention rules, but we let them know we weren’t being 

friendly. We’re going to treat you, you’re going to be fine, but this attitude can’t happen. We had to 

watch these people. Especially Fedayeen, which we knew were die-hards. But we had a few who 

we just had to put in their place, just let them know what’s going on.” —Sergeant Joseph Filipiak

Photography courtesy of the 212th MASH.
198 Skilled and Resolute

Many MASH soldiers had mixed feelings about treating Iraqis. There was 

compassion for hurt and scared people of whatever nationality, yet the 212th 

were Americans supporting American soldiers. Senior leaders in the MASH had 

the chaplain lead two sessions to explain and discuss the medical rules of treatment, explaining them and giving younger soldiers (and those not from medical 

backgrounds) the chance to learn them and ask questions. Those sessions largely 

cleared the air. Major Stephen Linck, in charge of ICU3, set the tone for his 

soldiers and for the prisoner patients. The soldiers had to do their best, and the 

prisoners were told they were prisoners and could be shot if they tried to escape 

or overpower the guards. Leaders also rotated staff so that nobody had to care 

for Iraqis all the time, and both the chaplain and the psychiatrist visited daily to 

observe if any of the soldiers needed relief. POWs were eventually transported 

back to other Coalition hospitals, but Iraqi civilians had to be returned to the 

Iraqi civilian healthcare system. Some patients healed and they could simply be 

released to relatives, but MASH staff scouted a hospital in the city of An Najaf 

for the several dozen who needed further care.

The Iraqi civilian dead posed another challenge. Chaplain David Bowerman 

admitted there was little he could do beyond using the Chaplain Corps’s ecumenical handbook. There was no civilian government to receive them, and it 

took days to find somewhere to return the remains. At times the family could not 

be found, and there were also problems finding home villages. 

Language was a major problem. An interpreter, Nasir al Nasir (called “JJ”), 

arrived after a few days, and was invaluable, but he could not be everywhere. 

“JJ” was a Kuwaiti high school principal who had studied in the United States 

and volunteered as a translator after seeing a newspaper advertisement. His family was worried, but he felt he owed the United States both for liberating Kuwait 

in 1991 and for his education. He did not have a medical vocabulary, and would 

sometimes editorialize. After one patient was giving a lengthy description of his 

problems, JJ commented, “This one, he talks more than your grandma.” Eventually flashcards were written for common questions.

Cultural differences, especially about male and female roles, caused some 

problems. Male prisoners, even with their hands bound, did not necessarily want 

female medics to help them go to the bathroom. Female patients had a chaperone 

present when a male physician examined them, because all the 212th’s doctors 

were male.

Specialist Tashiana Graves worked on ICU3 and described the practical problems:

It was pretty difficult at first dealing with the EPWs, because, for one, they didn’t speak our 

language. They had religious barriers. They were screaming and hollering, and we really 

didn’t know how to ask them what exactly was wrong with them, or what could we do for 

them because we couldn’t understand them. We did get an interpreter, but he wasn’t on the 

floor all the time, so when he left, we were basically on our own to try to figure out what was 

going on with the patients. They would get upset with us because they would want food or 

water or something like that, and if they had to go to the OR, or anything, we couldn’t give 
Operation Iraqi Freedom 199

them food or water, and we couldn’t explain that to them so that they could understand. So 

they would get angry and everything. After a while we got pretty much used to taking care of 

them. We even made flashcards, Iraqi writing on the back and English writing on the front, 

so the major questions that we needed to ask them, we could just show them the card. If they 

could read it, they could answer yes or no to the different cards. That made it a little easier. 

We started learning what certain words meant.

First Lieutenant Molly Shifferd, a nurse, recalled other problems:

I did not have any problems with being a female healthcare provider in a male-dominated 

Iraqi culture. I think the people who worked in the EPW ward had some problems, but I 

personally didn’t have any problems. When it was a trauma, it was a trauma. If I needed to 

put on a Foley catheter, or if he needed to urinate or something, they would do it. I don’t 

think they were any more uncomfortable than an American male would have with a female 

dealing with that.

Now sanitation was a problem for me. The little children all pooped in my tent. They just 

walked on to the back of the tent and I walked back there and there were little piles. Things 

like that were a challenge. I tried to teach them how to take medicines, “Every six hours you 

need to take the medicine,” but eight hours would go by. The females would never ask for 

food or water for them, I really didn’t see a lot of initiative. So I definitely had my doubts 

about whether the instructions would be followed.

Some Iraqi civilians came to the MASH because it was a nearby hospital, and 

American healthcare has a worldwide reputation. However, under the life/limb/

eyesight rules, few patients could be accepted. The MASH, as a small hospital, 

also lacked capabilities (such as a neurosurgeon) to help some patients. One 

young girl had spinal injuries; her family brought her to the 212th and Canestrini 

tried to find proper care, but had to send her back to the available Iraqi hospital 

because the MASH could do nothing. Civilians also came to visit family members. Some were admitted, but a prisoner’s family had to be turned away. 

Supporting the Hospital

It takes more than doctors and nurses to run a hospital. The rest of the unit, 

from pharmacy to nutrition care, to the motor pool, to guards on the perimeter, all contributed to the 212th’s success. Generally the auxiliary functions ran 

fairly smoothly, although they were certainly busy. When the fighting wound 

down, Canestrini told many of the officers, “I want you to get out there and 

walk around and grab a mechanic, and grab hold of a laundry and bath guy, and 

a supply clerk, and an admin guy. All of those guys that have been guarding the 

perimeter every day the last 19 days, or the guys that are hauling water for you. 

As you sit here and do the glory mission and feel good about yourselves, go out 

there and hug those guys. They too need to feel needed, because they’re doing a 

very important mission.” 

Working conditions were hardly ideal for pharmacy, lab, or x-ray. In Germany, 

the decision was taken not to bring all the ISO containers, but to save shipping 

space and work from tents. The sandstorm wrecked those tents, and a sleeping 
200 Skilled and Resolute

tent was appropriated for the pharmacy. It could be hooked into the DEPMEDS 

equipment, and thus the temperature moderated, but it had about one-quarter the 

normal amount of space. Thus most of the medications were kept in storage, and 

only the most commonly used ones were kept adjacent to the EMT. Medications 

were mixed as needed rather than made up in advance because the MASH was 

moving patients out frequently and it made little sense to make an IV that might 

not be used. Dust also made it difficult to keep IV solutions sterile, but constant 

cleaning overcame the problem. Pharmacy staff also had to improvise, for instance on pediatric supplies. When a child needed antibiotics, Sergeant Shannon 

Malloy worked with a doctor: they crushed penicillin tablets to make a suspension, then added Kool-Aid to make it palatable. Major Tou Yang, the pharmacist, 

had to remind physicians that tests required finite resources, including reagents 

that might not be in stock; Yang felt that doctors ordered tests that might not 

affect how a patient was actually treated at the MASH. Pharmacy technicians 

normally worked beyond the pharmacy, not just bringing items to EMT, OR, or 

wards, but treating patients; one pharmacy technician inserted a catheter. Pharmacy stocks of some common medicines (for instance, ibuprofen and antifungal 

creams) dropped because medics came to the hospital to get more supplies, and 

Yang had to limit his sharing. He also commented that resupply was poor: over 

200 items were ordered and about 10 resupplied, and most of those were only 

partially supplied. Occasionally some items arrived in super-abundance, for instance morphine, which was needed and used, but Malloy remarked that the 

roughly 10,000 doses received were far more than needed. Part of the resupply 

problem might have been poor communications because the computer systems 

were not well coordinated. Canestrini felt the frustration as well: “We are out 

on the battlefield; we are the point of the spear for the whole Medical Department right now. I should not have a problem with getting medical supplies.” 

The MASH always had acceptable replacements for short supplies at hand, and 

patients were never put at risk. 

Over time, the 212th always had enough supplies although some reserves 

grew perilously low. Transportation was the real problem: the theater had plenty 

of stock, but there was not enough transportation to move everything forward. 

Blood supplies traveled through a separate supply chain (mainly moved by the 

helicopter ambulances when they were flying forward after dropping off wounded), but other medical supplies competed for space with all the other supplies 

the troops needed. However, while the MASH left some supplies behind by 

deliberate choice, taking more than 3 days’ worth of basic supplies proved vital. 

The Nutrition Care Department prepared special meals for patients. Some patients were on liquid diets, soft foods, or other special meals, and there were 

special ration packs for them with soups, nutritional supplements, and substitutes. Iraqis had Islamic dietary restrictions, and department staff were able to 

substitute kosher meals. Sergeant Albert Gaskins recalled that trying to identify 

items that a child would like from among the various items available caused 
Operation Iraqi Freedom 201

some concerns. Again, supplies ran low but did not run out. 

Refrigeration was a concern not just for the pharmacy but also for laboratory and x-ray: many drugs and reagents and some machines were temperaturesensitive. Another concern was the number of enlisted technicians that were 

needed for guard duty, but that problem improved over time as other units filled 

in around the MASH’s perimeter. Sergeant Mario Rivera-Mendoza, NCO in 

charge of the laboratory, commented that the experience his soldiers got working at Landstuhl paid off, because the lab was able to function short-handed.

The Patient Administration Division (PAD) was in charge of logging in arriving patients, keeping their records, and sending medical files with all discharged 

patients showing their condition and the treatment they had received. PAD was 

also responsible for performing medical regulation (arranging the transfer of 

patients between hospitals), and of taking care of patients’ personal effects. 

Standard procedures were for a patient’s unit to keep his or her equipment and 

weapons, but in the rush of combat, procedures were sometimes overlooked. 

Sometimes units also recognized that their wounded soldier was not going to return to duty and decided to ship all his or her equipment back on the MEDEVAC 

helicopter. That caused backpacks and other gear to accumulate at the MASH 

because helicopters heading back to Kuwait would not take these items. Personal effects were put in a locked MILVAN until there was a lull, and weapons 

(and other sensitive items) were turned over to an appropriate unit. 

A PAD clerk was part of the standard reception of patients, getting identification and then creating a medical record and a tag. Many patients arrived 

with only minimal information. As Captain Sean Lankford, the PAD officer, 

noted, units in combat often had better things to do than fill out forms, especially 

for Iraqis. Lankford had previously conferred with the clinicians about what 

forms would be used, pruning out ones that were not absolutely necessary and 

standard. By switching to standardized forms he was able to reduce his space 

requirements from a filing cabinet plus five footlockers of material to a compact disk and blank paper for the printer. There was no copier, so the 212th did 

not attempt to create complete patient records. Patients arrived with negligible 

paperwork, and the MASH documented the care it gave, then it sent that paperwork along with the patient. There was neither time nor personnel to do more. 

The Air Evacuation Liaison Team located with the 212th helped coordinate 

evacuation flights on Air Force fixed-wing aircraft and helicopters. V Corps had 

decided that helicopters would be the main means of evacuating casualties, and 

most patients were flown out by Army helicopter ambulances. Back in Kuwait 

the PAD section had contacted the Theater Patient Movement Requirement 

Center and checked exactly what information was needed to get a flight, which 

proved invaluable. Helicopters might be available as promptly as 15 minutes, although 60 to 90 minutes was more common. Such delays allowed time to gather 

all paperwork and personal items. Sometimes nurses had to accompany seriously injured patients; the nurses would return on another helicopter. Weather 
202 Skilled and Resolute

was the biggest problem; when sand and dust were blowing, helicopters and 

aircraft were unable to fly patients out, but patients could still arrive by ground 

vehicles. It was during a sandstorm that the MASH had its highest number of 

patients, almost twice as many as it had beds for, but since most were not seriously injured it was only a problem, not a catastrophe.

The PAD section also had the responsibility for getting in touch with the units 

of wounded soldiers, to let them know their comrade was safe and being cared 

for. Lankford tried, but communications were often poor. If the weather allowed 

radio or telephone contact, the combat unit might be moving, or a message 

might get through to a battalion but not get to the wounded soldier’s platoon 

within the battalion. A casualty liaison team had joined the 212th in Kuwait, but 

it arrived with no warning and it had never worked with a hospital, so it was only 

moderately useful.

The 212th also needed food, water, and non-medical supplies. Inside the 

MASH’s perimeter were a few other small groups: a signal team, an air evacuation liaison team, and the forward headquarters of the 30th Medical Brigade, 

which was with the 212th for several days. As other units arrived, they tied their 

Figure 6-17. Major Yang at work in the temporary pharmacy tent.

Photography courtesy of the 212th MASH.
Operation Iraqi Freedom 203

perimeters around the 212th, freeing up some of the MASH’s guards. Those 

soldiers then became the work detail, maintaining sanitation, collecting trash 

and trucking it out of the compound, stringing more barbed wire, and doing the 

dozens of other chores. 

The motor pool performed maintenance despite a virtual absence of spare 

parts. Since the MASH might, at any time, have to move forward to support 

combat operations farther north, the motor pool had to keep vehicles ready. By 

using stockpiled parts and scavenging non-functional vehicles at a cannibalization point, the MASH maintenance team kept its vehicles running. Cannibalization led to theft; a nighttime roving guard was instituted after the starter was 

removed from a MASH truck. The generators were running constantly, using 

more oil and air filters than normal, and some air filters had to be cleaned and 

reused rather than replaced.

The operations section tracked and coordinated all the unit and hospital functions so that resources could be shifted around within the 212th. “Ops” also 

had to know what was going on outside the unit, not just in the cluster of support units at Bushmaster but also in the 30th Medical Brigade, to keep abreast 

of what it might want the MASH to do next. This meant meetings, constant 

phone or radio calls, and monitoring headquarters websites to stay informed 

and to pass information along. Unfortunately, communications were frequently 

a problem. The 212th usually had contact with higher headquarters, but weather 

could knock communications out or lower the quality of the connection, and 

the MASH switched between various systems. There was tactical satellite radio, long-distance radio (which required so much auxiliary equipment that units 

tended not to use it), and satellite telephones. A signal team from Germany had 

been identified to travel and work with the MASH, but another team was substituted instead; it was trained and equipped, but for several weeks in Kuwait it 

lacked identification codes to log into the network.

A much bigger problem was computer links. Many Army systems rely on 

computer networks that worked well between bases and for units with highspeed connections, but not all units had the necessary equipment. The MASH 

frequently either lacked computer connection or had only a very slow connection. Secure military systems often provided slow access, while the civilian Tachyon system provided fast but only unclassified access. Headquarters 

sometimes assumed units received something as soon as it was posted on the 

command website; units with spotty communications, or on the move, might 

not receive the news, and headquarters tended not to follow up and make sure 

information was received.

Life in the Desert

Being busy distracted soldiers from the living conditions; Specialist Meghan 

Slater recalled a week or more without more than 2 consecutive hours of sleep. 

There were nine sleeping tents, divided between officers and enlisted personnel 
204 Skilled and Resolute

Figure 6-18. Working in the Tactical Operations Center at the 212th.

Photography courtesy of the 212th MASH.
Operation Iraqi Freedom 205

but not by sex. Each person’s living space was only about 4 by 8 feet, and that 

space had to hold a cot, footlocker, dufflebag, rucksack, body armor, and personal items. For the first few days everyone had to sleep in chemical suits and 

body armor, then just the chemical suit, and ultimately that could come off. The 

air conditioners were needed for the hospital, so sleeping tents got quite hot during the day. In fact, many soldiers stayed in the hospital during the day and slept 

on the floor or in unoccupied beds because it was more comfortable than the 

sleeping tents, and also closer to work when the next group of wounded arrived. 

Powdery dust got everywhere. 

While there was plenty of food, there was not much variety. For roughly a 

month only MREs were available, and while nutritious, they quickly grew boring. Troops knew that other units and contractors had better food, which was 

an annoyance. Sergeant First Class Angel Zepeda, NCO in charge of nutrition 

care, recalled the first hot meals were a huge morale booster. He did his share 

of wheeling and dealing to trade what arrived for what his customers wanted. 

Drinking water was not a problem, but the laundry section had first priority 

for bulk water for the 10 to 15 bags of laundry generated every day. The soldiers 

kept the old washing machine going (although the dryer never worked), washing 

sheets, blankets, and hospital gowns. Clothes were washed when the hospital’s 

needs had been met, and showers were taken if water was still available, generally every 2 or 3 days. The only recourse was baby wipes and hand sanitizer. 

The MASH’s latrines were the envy of many other units. The field sanitation 

team had bought toilet seats in Germany and built a wooden frame in Kuwait. 

Covered with canvas and set over a deep trench, it was one of the nicest latrines 

in Iraq. A helicopter once landed just so the crew could use the MASH’s latrines. 

Despite the flies around the latrine, the MASH did not have trouble with diarrhea 

or upset stomachs because the soldiers followed simple sanitary steps, including 

using the hand-washing stations purchased just before deploying. Sergeant Michael Cheeseborough was a medic assigned to work on a ward, but an additional 

duty was field sanitation:

I barely worked on the floor, I barely did patient care. I was mainly the sanitation guy. I had 

to take care of the hand washing stations, the latrines. At first it was a pail latrine, but we 

didn’t really like that idea. It was really messy because when you had to dump it, you had to 

find a place to bury it, and it was a lot of stuff. So we had engineers come out there and dig 

these really deep, roughly 10-ft holes. Then we took the toilets that we had constructed, set 

them over those holes with support beams, and we had some of our timber hold the cover 

for it. It worked out really well, because everybody liked it. A lot of people from different 

areas came and used it.

The latrines did not take care of all waste: the Army had contracted for Kellogg, Brown & Root to dispose of medical waste, but the pace of operations 

meant the 212th had to cope themselves. They burned not just bloody bandages 

but amputated body parts, and buried non-flammable items (such as needles) to 

reduce the risk of infections.
206 Skilled and Resolute

To keep the soldiers informed, Canestrini held a daily briefing for unit leaders, who could then pass information along. The first sergeant did the same for 

senior NCOs. Major Linck thought that passing information along eased everyone’s minds and quashed rumors, while Sergeant First Class Tony McDonald, a 

medic, thought he got a lot of information but the situation changed so quickly 

it was soon out of date. Canestrini passed information back to the Family Readiness Group in Germany. Security put limits on what he could say, but he tried to 

call back at least once a week (while e-mailing more often) and keep the families 

informed about what was happening. 

Dogwood, Baghdad, and the Return to Germany

The 212th had moved to Bushmaster to support the ground assault through 

the Karbala Gap and subsequent combat operations around Baghdad. Its future 

movements would be determined by the course of the ground campaign. As 

events transpired, Baghdad was quickly isolated from the rest of Iraq, and the 

Army began probes into the city on April 5. The probes found weak resistance 

and grew more aggressive, driving into the city and staying there. It was clear 

that the Ba’athist regime could not hold the city. There was no formal surrender 

or even a clear fall of the regime, but the toppling of Saddam Hussein’s statue 

in Al Firdos Square on April 9 was effectively the end of the ground campaign 

to take Baghdad.

Because of the rapid collapse of Saddam’s regime, there was no second phase 

of the ground campaign for the 212th to support. The MASH spent roughly a 

week at Bushmaster after Baghdad fell, with fewer patients coming in as combat 

became sporadic. By April 17 the 212th was ready to move, but V Corps seemed 

to have no plan for the next phase. The MASH was ordered to load up, preparatory to moving. The destination was first Mosul, but it was rapidly changed to 

Balad, then Ibn Sina hospital in downtown Baghdad, or Baghdad airport. The 

mission was equally changeable, perhaps working as a hospital, but the 212th 

also was warned it might be needed for hospital assessment missions in Baghdad, something it had not planned, prepared, or trained for. Rumors also circulated that the MASH might go home, since there were several other Army hospitals in Kuwait that had done less in the maneuver phase. Canestrini recalled 

the brigade commander slapping him on the back and saying other units would 

do the remaining work. While higher headquarters considered various options, 

MASH soldiers caught up on sleep and readied their equipment. 

Assessing Iraqi Hospitals

The 212th moved from Bushmaster to LSA Dogwood, located in the desert 

roughly 30 miles southwest of Baghdad. Even as it moved, the 30th Medical 

Brigade was changing the MASH’s mission. It was not going home but would 
Operation Iraqi Freedom 207

stay at Dogwood and send hospital assessment teams into Baghdad. Small teams 

of two vehicles and about six personnel were to visit hospitals and clinics, talk 

with the Iraqi staff, and assess the facilities and their needs. The teams were neither providing any assistance nor promising anything; rather, they were “showing the flag,” demonstrating American interest in the Iraqi healthcare system and 

gathering information.

This mission was controversial among MASH staff. They sensed risk on the 

chaotic streets of Baghdad, and it was hard to see any particular results from 

the hospital assessment visits. They had no training in hospital assessments; the 

information generated no visible action or results; and the assessments gradually became predictable since almost all Iraqi hospitals were short of electricity, water, money, and security. Iraqi reactions varied. Some were happy to see 

Americans, some were indifferent, and some were angry. The MASH soldiers 

were traveling with ambulances, and the Red Cross markings seemed to reduce 

tensions. The troops were under orders not to hand out food and water, which 

many Iraqis sought, to avoid having vehicles swarmed and surrounded. Major 

Figure 6-19. MASH personnel visiting an Iraqi hospital.

Photography courtesy of the 212th MASH.
208 Skilled and Resolute

Jeffrey Hermann, the obstetrician-gynecologist, remarked that he did not volunteer because colleagues who were going into Baghdad reported little point to the 

trips. However, the Army needed a thorough assessment program and wanted to 

generate goodwill and support through meeting Iraqi healthcare professionals 

and the Ministry of Health. Canestrini requested a written order to make sure 

his commanders had thought the mission through, then got volunteers to do it. 

When his soldiers reported the risks, he verified that higher headquarters still felt 

the risk was worthwhile. Hospital assessments would remain the MASH’s main 

mission for several weeks, with daily trips into Baghdad. Ultimately over 50 

hospitals would be examined, plus other medical facilities. Major David Vetter 

led most of the assessment missions.

We left Baghdad airport, drove into the city, a very eerie place at that point. A city of several 

million people and we drove around the city for hours. There was sporadic gunfire everywhere, buildings still on fire with secondary explosions, but we saw absolutely no Iraqis 

driving anywhere in the streets. Actually, I don’t remember seeing a single Iraqi civilian in 

the entire city the whole day we drove around. The first hospital we looked at was on the 

grounds of one of Saddam’s palaces. There was a statue of Saddam outside of the hospital, 

and a Republican Guard uniform abandoned at the foot of the statue, along with the black 

boots that you saw everywhere. 

No one was in the hospital, most of the windows broken. But we were struck by the 

equipment we found there. It was really a state-of-the-art facility. For example, there was an 

Excimer laser machine for doing Lasik eye surgery. From patient records, up until the middle 

of March they were doing corrective eye surgery there. There was a CT scanner, MRI scanner, surgical rooms with operating microscopes, corneal scanning machines, hearing booths, 

pulmonary function testing equipment, really everything you could want in a hospital. There 

were private ICU rooms, everything in very good condition, with air conditioning. So it was 

obvious that Saddam and his family had pretty good medical care at that facility. We left 

there and went to some of the other regime-associated hospitals. Saddam Cardiac Surgery 

Center, which is the only center in Iraq for cardiac surgery, things like congenital heart defects, valve replacement surgery. Since that hospital was also associated with the regime, and 

outside of the protection of the palace compound, it was totally destroyed by looters. All of 

the equipment burned, medical supplies scattered all over the place. Actually it was sad to 

see the country lose an asset like that, which may take years to rebuild.

At the first public hospital we visited the docs there had not yet returned to work. There 

had been a lot of looting there also, air conditioners stolen, parts of MRI and CAT scanners 

stolen. Anything that looked like a computer or a monitor ended up being stolen from most of 

the hospitals. They’d seen patients during the war, had a lot of dead bodies brought into the 

hospital, and those they just buried in a shallow grave in the hospital courtyard. They showed 

us the identification cards for all of those patients, a dozen or so. They had a little bit of war 

damage. On the third floor of the hospital an Iraqi army or police unit had set up, so US soldiers had targeted that floor of the hospital, pretty much destroyed it. Destroyed the hospital 

generators in that vicinity. But, overall, in Baghdad I was surprised at how little collateral 

damage there was. I think our government obviously took a lot of care to avoid targeting 

any of the infrastructure, the hospitals. Also I was surprised to see how much damage Iraqis 

themselves did to the hospitals. The hospitals would have been able to function immediately 

had it not been for all of the looting and the vandalism that occurred.
Operation Iraqi Freedom 209

The Return to Germany

The 212th’s leaders paid attention to “redeployment” (the Army’s term for 

return to garrison) opportunities, and did their best for their own people, also 

bearing in mind the value the clinicians had for the Army’s hospital system and 

the number of other medical units available in Iraq and Kuwait. MASH personnel left Iraq in batches. First a few surgeons left because the Army could use 

them at hospitals in Germany or the United States. Then it was reasonable to 

send the bulk of the remaining clinical staff back so they could resume work 

at Landstuhl. At that point the 212th could not operate as a hospital, so it made 

sense to send it back, although a small team stayed behind to travel back by sea 

with the vehicles and equipment. Coming back as a unit would have allowed a 

ceremony, but it could have taken weeks to arrange. 

There were a number of administrative steps to go through, and some bottlenecks, but the soldiers were excited to be going home and solved the problems. On the way back to Germany, Lieutenant Colonel David Bitterman took 

command on June 2. The trip started by road, south through Iraq amid local 

factions violently settling scores. There had been administrative hassles both 

leaving Germany and arriving in Kuwait; now there were administrative hassles 

getting out of Kuwait. There was a rigorous customs inspection for all individuals, and equipment and vehicles also had to be screened for contraband. For 

instance, Sergeant Michael Cheeseborough was delayed as customs inspectors 

went through clothes, books, and CD cases. Few units had left the theater, and 

there were conflicting lists of what needed to be done. Major Troy Mosely, the 

new executive officer, recalled looking at requirements from various sources, 

assembling them onto one master list, then determining what had to be done 

when and assessing available resources. Once vehicles and equipment had been 

cleared, fuel tanks were emptied to avoid explosive vapor in confined space on 

ships, and exteriors were cleaned. Since everything was dusty and dirty from the 

desert, cleaning required high-pressure hoses and there was only one wash rack. 

Originally the MASH was to have 2 days to wash up, but when another unit was 

moved up the priority list, the 212th had to finish in a single day. The trail party 

spent the next several weeks getting paperwork sorted out to finally load the 

equipment on a ship.

Troops also had to go through various steps, for instance what Specialist Hoffman described as a quick behavioral health debriefing, about what was a “normal” experience versus what warranted professional help. As she pointed out, 

“A lot of people saw things that they never thought they would see, and dealing 

with some of the visual stuff that they had been exposed to, that’s the main thing 

really.” The main body flew out on a plane shared with a Marine Corps unit. 

Meanwhile, the trail party stayed behind, working with soldiers from the 10th 

CSH, a unit that had not gone into action but was now helping out-process other 

units from Kuwait.
210 Skilled and Resolute

Sources

Background came from Gregory Fontenot et al, On Point: The United States Army in 

Operation Iraqi Freedom (Ft Leavenworth, KS: Combat Studies Institute Press, 2004) 

and Kevin Woods et al, Iraqi Perspectives Project: A View of Operation Iraqi Freedom from Saddam’s Senior Leadership (US Joint Forces Command, Joint Center for Operational Analysis, 2006); specifics of the diplomatic/political road to war came from 

speeches by President George W Bush on the White House website and from Bob Woodward’s Plan of Attack (New York: Simon & Schuster, 2004).

Information on the 212th is based on interviews with a majority of unit members as 

listed in the appendix. Unit files include the modified Table of Organization and Equipment, the after action review, several briefings, and e-mails with unit personnel. Major Ronald Krogh, Major Suzanne Richardson, Lieutenant Colonel Kenneth Canestrini, 

Captain John Keener, and First Lieutenant Molly Shifferd shared their journals and diaries. Clinical data came from Captain Arthur Fry and Lieutenant Colonel John Cho et 

al, “Operation Iraqi Freedom: Surgical Experience of the 212th Mobile Army Surgical 

Hospital” (Mil Med; April 2005: 268–272). Photos were taken by various unit members 

and provided by Captain Nina McCoy and others.

Copies of this material are on file in the historical research collection of the Army 

Medical Department Center of History and Heritage, Fort Sam Houston, Texas.