Face to Face
Combat Surgeon
By Scott D. Smith
Orthopedic surgeon Paul Huddleston, M.D., extended his tour of duty in Iraq when he realized the soldiers whose lives were on the line needed his skills.
Two days before his 22nd birthday in 2003, Jeff LaMont, a native of Blue Earth, Minnesota, had a bad feeling as he climbed down from his tank at a checkpoint near the Syrian border.
Within moments, a car came rushing at LaMont, a tank driver with the Army. A gunman fired, hitting LaMont first in the abdomen. Then, as he fell, a bullet hit his right hand and another tore through his right ear.
His sergeant immediately called for a Black Hawk helicopter, which airlifted LaMont to the 945th Forward Surgical Team at Al Sad airbase about 100 miles west of Baghdad. It was there that he met 37-year-old orthopedic surgeon Paul Huddleston, M.D.
Huddleston remembers standing at the head of the young man’s bed as he was being prepped for surgery. He asked the soldier where he was from. Revealing a certain boyish shyness and struggling to speak because of his pain, LaMont was reluctant to answer.
“You probably don’t know, sir. It’s a small town.”
Finally, LaMont told Huddleston he was from Blue Earth. Huddleston, who practices at Mayo Clinic, responded enthusiastically, saying he knew exactly where that was because he lived in Rochester. “At that moment, his eyes opened wide, and I could see—and this is my perception—that he relaxed a little,” Huddleston says of the young man. “And if I hadn’t taken care of one other person in the whole deployment, it would have been worth it because I helped some kid from Minnesota who was 6,000 miles away from home in the middle of nowhere.”
For Huddleston, who joined the Army Reserve while doing an orthopedic residency at Mayo Clinic in the 1990s and now holds the rank of major, going to war was all about helping patients and fulfilling a family legacy. Not one to dwell on the politics surrounding the decision to invade Iraq nearly three years ago, Huddleston considers himself a doctor, not a fighter. And it’s his commitment to patching up soldiers such as LaMont that sealed his decision to stay in the war-torn country after his assignment was up in the summer of 2003.
Doctors who serve in the Army Reserve usually do 90-day stints when deployed overseas. But when Huddleston learned that the Army Medical Corps was having difficulty filling positions in his specialty, orthopedic surgery, he agreed to extend his stay. Altogether, he spent seven months in Iraq. “I thought of myself as just a visitor in this giant morass, but [the soldiers] were there and in it up to their eyeballs,” he says.
A Slow Start
Huddleston was not sure what to expect after he got his orders to ship out to Iraq in January of 2003. The United States had not yet launched its attack on the nation. His surgical team was to follow rapidly advancing soldiers and stabilize lethal wounds before injured soldiers could be transported to Army hospitals in Iraq or Germany.
Originally, the team was supposed to follow U.S. forces as they invaded Iraq. However, Huddleston and his 20-person unit ended up watching the start of the U.S. invasion on television, while waylaid for more than a month at Fort McCoy in Wisconsin because of Army bureaucracy.
That delay was tedious and stressful for the surgeon, who had to leave behind his wife, Jeanne, an internal medicine physician at Mayo Clinic, who at the time was director of the hospital medicine residency, and their two young children. “You weren’t home and you weren’t there. … You were in purgatory,” Huddleston says of the wait.
Finally, the team, which included four surgeons and eight nurses, and was commanded by Maj. Mark Sawyer, M.D., a fellow Mayo surgeon, boarded a military cargo plane in early February for the 14-hour flight to Germany. “Every inch was filled with equipment, so I slept underneath a Humvee,” Huddleston says.
Huddleston’s unit traveled first to Kuwait, where they joined thousands of other soldiers at Camp Virginia. There they again waited for deployment. “Each step of the way, you’re passed off from one command to the next, and they have to figure out what to do with you, and that took three weeks,” he recalls.
The Army ordered Huddleston’s team to follow the more than 5,000 soldiers of the Third Armored Cavalry Regiment from Fort Carson, Colorado, as it advanced through Kuwait into western Iraq. By that time, the lion’s share of the fighting in the area was finished. The team lived out of trucks during the two-week trip, sleeping on the ground, on cots, or in vehicles at night. Caked with sand and dirt and with no way to bathe, he and his fellow soldiers battled the heat during the day. The highest temperature Huddleston recalls seeing while in Iraq was 136 degrees.
The surgical team and the cavalry regiment eventually settled into an abandoned Iraqi air force base close to the town of Hit, just west of Ramadi and Fallujah. The cavalry regiment was in charge of keeping the peace in this part of the Sunni Triangle, which later became a center of insurgent activity.
Although the base itself did not come under direct attack during Huddleston’s tour, he faced danger when he left the grounds. At times he would fly in helicopters with soldiers being transported to hospitals. “On helicopter rides you could look out and sometimes see muzzle flashes. Anytime you were in a helicopter or in a convoy, you didn’t feel safe,” Sawyer says. In addition, Huddleston spent a few weeks as a replacement surgeon at an Army hospital in Bilad, which was under mortar fire while he was there.
Throughout April and May of 2003, the unit worked to convert a dust-covered, abandoned office building into a make-shift hospital. Using equipment they had brought with them to establish two mobile surgical units, they transformed a cafeteria kitchen into an operating suite. Initially, the base had no running water. All that was available was the water that the Army brought with it.
The suite was eventually equipped with a diesel generator, six oxygen concentrators, four mechanical ventilators, a level-1 infuser, lights, a heater, and two portable operating beds. Electrical power was so erratic that the team relied on its own generator during surgery.
Over time, the conditions improved and, eventually, power and water were restored to the building.
However, one important tool, an effective air conditioner, never arrived.
Scott Jensen, a reservist and surgical nurse at University of Minnesota Hospital Fairview, was at Huddleston’s side during every surgery. Jensen recalls one 12-hour session during which they operated on soldiers injured in a car accident. “It got up to 120 degrees, and Dr. Huddleston was just sweating away. … You have never sweated that much in your life,” Jensen says.
Huddleston says the work was much like that done by the surgeons of the fictional 4077 on the television show M.A.S.H. But, he says, “I can assure you no one was making whiskey in the back tent.”
Glue of the Unit
Though he didn’t brew hooch, Huddleston did do what he could to keep up morale. He helped make a par-three golf hole at the base. He brought along his laptop, which he used to play an eclectic collection of music, mostly rock, whenever he operated. Huddleston “was a lot of the glue that held the unit together,” says Sawyer, who explains that Huddleston’s upbeat personality and commitment to the cause helped the group function as a team. Jensen felt the same way. “He can put on his game face, and he also knows when its time to kick back and relax,” he says of the orthopedic surgeon.
Huddleston is an affable, confident man, known for working and playing hard. At first glance, he seems as if he’s made for the military. An all-state football player and shot-putter for his high school in Smithville, Missouri, a bedroom community outside of Kansas City, he maintains his muscular build, keeps his hair closely cropped, and drives a black and chrome Hummer with an Army Reserve bumper sticker on the tailgate.
Despite those trappings, he admits that it was surreal for him to stand in the deserts of Iraq, wearing fatigues, while holding a rifle, when back in Minnesota he doesn’t even hunt. Furthermore, he’s no fan of jetting around in cars, trains, planes, and boats, all of which give him motion sickness.
“I guess if I wanted to be the Rambo type, I would have gone off and joined the Special Forces. But that’s not me,” he says.
Huddleston’s inspiration to serve in the military came not from Hollywood but from his father, Harvey Huddleston, M.D., a surgeon and southerner. Originally from Mississippi, the elder Huddleston spent 24 years in the Army Reserves and served in the first Gulf War and in Vietnam. “There’s a lot of that southern mentality in Paul in a good way,” says Christopher Bennett, M.D., a physician at Northwest Family Physicians in Crystal, who went to medical school at Mayo with Huddleston. “He has a sense of duty to family, friends, and his country.”
Meatball Surgery
That sense of duty was what took Huddleston from the operating suites at Mayo Clinic, where he relies on fluoroscopic imaging devices that allow him to see inside the body when performing intricate spine surgeries, to the improvised operating rooms in Iraq. There he performed what the Army calls “meatball surgery,” just the basics needed to save a soldier’s life.
After an injured soldier was airlifted to the base by helicopter and brought into the hospital, Huddleston and other members of the forward surgical team would stop the bleeding, stabilize broken bones, remove shrapnel, and debride damaged and dead tissue surrounding wounds. They would then apply bandages, administer antibiotics, and transfer the soldier to one of the Army’s two full-fledged hospitals in the cities of Bilad and Baghdad.
During this war, the Army transfers soldiers to better hospitals more quickly than in previous conflicts. “You could go from my operating room to Walter Reed Army Medical Center in five days,” Huddleston says, noting that this was very different from the Vietnam era, when wounded soldiers stayed in country for months.
Huddleston’s time in Iraq was defined by long stretches of downtime punctuated by intense activity, when he had to function as both emergency operating room physician and intensive care physician. He performed an average of one major surgery a week.
Once they learned Huddleston was an orthopedic surgeon, other physicians soon started referring soldiers with sprained ankles, dislocated shoulders, and a variety of skeletal injuries to him. And when he saw the demand, Huddleston hung out his orthopedic shingle and started a musculoskeletal clinic, staffed seven days a week.
Although Huddleston says he treated horrible wounds caused by gunfire or explosive devices, many of the injuries the surgical team treated were not the direct result of enemy fire but of the inevitable accidents that occur when one combines thousands of men, constant movement, and heavy equipment.
For example, the day before Huddleston left the country, a helicopter tire exploded and blew the hands off the mechanic who was working on it. Huddleston operated and helped stop the bleeding. “But what do you do then? No hands. That was a tough case because he also had a head injury.” As was the case with most of his patients, Huddleston never saw the man again—a fact that was unsettling to a surgeon used to explaining procedures to patients at length prior to surgery and following up with them afterward.
Another unfortunate case involved a lieutenant who caught his wedding ring as he jumped off a truck. The ring “degloved” his finger, tearing all the skin off. “That particular type of injury, a degloving, almost always results in an amputation,” Huddleston says. Though the officer did have his finger amputated, he returned to duty two weeks later. “I was impressed over and over with the dedication of these people,” says Huddleston of the soldiers.
Huddleston’s saddest memory, however, is of a soldier for whom he could do nothing. An improvised explosive device hit the vehicle the soldier was riding in and flipped it over. An Iraqi national found the soldier and other members of his unit beside the road, loaded them into his pickup truck, and drove them to the U.S. base.
One of the soldiers died during the trip; another soldier whom Huddleston won’t forget wailed in the background about the loss of his friend. “He was dead. He was gone, and there was nothing I could do for him,” he says.
A Grateful Mother
But Huddleston could comfort Jeff LaMont, who two years after being ambushed is still recovering from his injuries, including one to his brain caused by the shot he took to his ear. LaMont, who lives with his mother in Blue Earth after being discharged from the Army, continues to improve but is unable to work.
Sheryl LaMont says she would one day like to meet Huddleston and the others who treated her son to express her gratitude. They “gave me my boy back,” she says.
Huddleston might need to hear that kind of encouragement right now. Last month, he was put on notice that he might be sent back to Iraq. He says he and his family have decided it is a cause they again are willing to support, even though they know it may mean spending time apart. Each family has a notion “that there’s something that is worth sacrificing for, and for us it just happens to be the servicemen and women of our military,” Huddleston says. MM
Scott Smith is a staff writer for Minnesota Medicine