The surgery, which took several hours, required doctors to replace roughly half of Mahaffee's blood supply. Capt. Ronald White, the anesthesiologist, used blood tests to monitor Mahaffee's clotting capability, which remained normal. But he injected two more doses of Factor VII to be certain. The bleeding never got out of hand, and doctors said the drug made the difference.
Within hours of his surgery, Mahaffee was awake in the hospital's intensive care unit, unable to talk because of his breathing tube but scribbling notes on a clipboard of white paper to his friends and the hospital staff. A page taped to a machine behind his bed, said simply: "Thank you."
To Capt. Matt Lawton, a friend who had gone through training with Mahaffee and went to his beside, he scrawled: "Tell the guys I'm OK." To others in his unit he wrote: "This job is not done." On yet another he scratched: "Hold all calls."
"That's the way he is," Lawton said. "Being funny and thinking about everyone else."
A 36-year-old lawyer from Gurnee, Ill., with a wife, two young children and a successful general law practice back home, Mahaffee never imagined even eight months earlier that he would be working for the Army in Iraq. He had finished his stint with the Army in 1999, retiring after eight years in the Reserves, and he hadn't drilled or worn a uniform since.
But in October of 2005 he came home from vacation to find a FedEx package from the Pentagon calling him back to service. Like many retired soldiers, he was still part of the Individual Ready Reserve, a limbo status that allowed the Army to reactivate him. The program is so rarely used that few soldiers give it much thought, but the Army, suffering a desperate shortage of junior officers, summoned him out of retirement.
His wife and colleagues say he never complained, figuring he'd been trained by the Army and wouldn't turn his back when they needed him.
"He should have just been in the military anyway, to tell you the truth," said his wife, Jennifer. "He was worried about his law office, and about leaving me and the kids, but I don't think he was worried about himself. He supported the president and the president's decision, and said, `OK. This is my job.'"
Mahaffee left home on Jan. 8, headed for the Army Training Center at Fort Jackson, S.C., and then to civil affairs training at Fort Bragg, N.C. The local newspaper ran a photo of him kneeling down in the airport, looping his arms around his 5-year-old daughter, Adelia Rose, and kissing her goodbye.
"The Army talks about this warrior ethos, of never quitting, of putting the mission first. And to most people I'm sure it's just something written on a little card they give us," said Maj. Lisa Forsyth, who served with Mahaffee in Iraq. "But you look at Shane, he's it."
Like Lufkin, Mahaffee and Berry flew out of Baghdad within a day or two of their injuries, first to the U.S. Air Force Theater Hospital in Balad and then to the Ramstein Air Base in Germany for transfer to the Landstuhl Regional Medical Center.
Most casualties spend only a few days at the hospital in Landstuhl; when relatives try to visit, the Army tells them not to bother. If family members are encouraged to come to Germany, it usually means that the patient is too unstable to fly, which is almost always bad news.
Jennifer Mahaffee was told not to come. Her husband had been progressing well and was scheduled to fly to Washington soon after he arrived in Germany. But the day he was to leave, a blood clot lodged in his healthy lung.
The clot deprived him of adequate oxygen and forced his doctors to get "aggressive" with artificial respiration, according to Air Force Maj. Tim Woods, the surgeon who treated him at Landstuhl. With his condition listed as "critical but stable," Mahaffee's wife, his father, and his mother and stepfather were soon on their way to Germany.
Trauma specialists know that clots in the lungs, called pulmonary embolisms, sometimes afflict severely injured patients. But the clots typically travel to the lungs from the veins of the legs - a condition called deep vein thrombosis, or DVT. Doctors in Germany had checked Mahaffee's legs for DVT with an ultrasound machine, but the results were negative. So the source of his pulmonary embolism was a mystery, Woods said.
But others say multiple doses of Factor VII would be a leading candidate if they were trying to determine the source of blood clots in a patient.
"When you give a patient a powerful clot-promoting medication, you may well induce a clot some place you don't want one," said Dr. Rodger L. Bick, a University of Texas blood specialist.
Mahaffee was unconscious as his family gathered around, alternating shifts between the lobby and the chairs by his bed. He remained on a breathing tube, but doctors were encouraged by his condition and offered hope that the tube would be removed.