ABOARD THE USNS COMFORT - "Flight quarters, flight quarters, all hands man your flight quarters!" bellowed the loudspeakers on this hospital ship - three football fields long - as a helicopter delivering two injured Americans yesterday prepared to land.
With that, scores of doctors, nurses and corpsmen rushed to the ship's emergency room, moving X-ray machines, intravenous bags, portable monitors and plastic tubing into place. To one side, a phalanx formed around a surgeon at a light stand who was studying CT scans that showed up ahead of the patients.
"He's 12 hours out?" Cmdr. James Dunne, the surgeon, asked while looking at images of an injured skull. "He's on fentanyl?" he said, referring to a painkiller. Elevator doors opened and out came corpsmen carrying the injured on stretchers.
"The other guy, he was given one dose of steroid?" Dunne asked, flipping images of a spine onto the stand.
Dunne, a general surgeon from Bethesda Naval Hospital and a recent surgical fellow at Maryland Shock Trauma Center, ran to the bay where one of the men lay. "Start the chest X-ray on this guy," Dunne called out. A technician wheeled over a machine, swinging the camera arm over the patient.
"Oh, X-ray, X-ray, X-ray please," Dunne yelled.
Half hidden by a steel partition, Dunne could be seen leaning over the patient's face. "Relax, it's OK," he told the soldier. "Relax, relax."
After two days in which the helicopters that ferry the wounded were grounded by sandstorms in Iraq and the Persian Gulf, clear skies made for a busy day on the USNS Comfort, the 1,000-bed floating hospital from Baltimore that provides the most sophisticated care for injured troops this side of Germany.
Before the arrival of these two Americans, helicopters had delivered about 20 patients to the ship yesterday. Many were injured Iraqi soldiers, and two were Iraqi civilians - a man, who may not have been hurt, and a boy, perhaps no older than 8, who had suture marks across one side of his head.
In preceding days, at least 20 more coalition troops, Iraqi soldiers and civilians were delivered here.
The Navy has accepted reporters aboard the ship, showing them facilities that range from blood banks and operating rooms to the flight deck and decontamination room, which would be used if chemical or biological weapons are unleashed. Yesterday provided the first glimpse, however, of the organized frenzy that unfolds in the moments after patients arrive.
It was for moments like this that Dunne, 38, came to the gulf. Though he treated plenty of gunshot victims from the streets of Baltimore, Dunne said he had never before seen people as brutalized as those injured by the weaponry of war.
Simply put, the bullets are larger and faster than those he is accustomed to back home. They blast through flesh, shatter bones and send shock waves through soft tissue that create holes of unimaginable size. Shrapnel from exploding metal leaves random sprays of destruction. And battlefield wounds, often contaminated with dirt, shredded clothing and debris, pose a real risk of infection.
"I think once this is all over, it will probably hit me," said Dunne. "I've had to teach myself to turn my emotions off. Otherwise I'll lose concentration. ...
"But until you really see this - well, it's really impressive," he added. "It's easy to underestimate. You just can't visualize this until you really see it."
Years ago, when he started his education as a doctor, he didn't imagine joining the military, much less operating on a hospital ship. In the second year of medical school at the University of Illinois, Dunne found himself running out of money and listening to a recruiter who explained that the Navy would pay a year's tuition for every year he gave afterward.
After medical school, he trained at Bethesda, which has provided about three-quarters of the 1,100 people working on this ship, and stayed as a general surgeon. He worked on hernias and gallbladders, operated on patients with breast and colon cancer. Dunne could have quit after three years, but he liked the Navy life. He lives in Rockville and has a wife, Kate, a son, Bryan, 2, and a daughter, Lauren, 3.
He entered a surgical fellowship at Shock Trauma, and in 2000 and 2001, he developed skills that have repeatedly been called upon in the past week.
Besides treating accident and gunshot victims, Shock Trauma cares for people afflicted with a quickly fatal condition known as necrotizing fasciitis, caused by what are often called "flesh-eating" bacteria. When an area of skin has been traumatized, bacteria can invade and produce a severe infection, releasing toxins that destroy skin, bone and everything else in their path. Sometimes, amputations are necessary.
In hopes of avoiding that, surgeons remove dead tissue and then some, and take the patient back into the operating room two or three times more to make sure the disease hasn't advanced.
It is not clear how severe the wounds were on the soldier and marine Dunne examined yesterday. Reporters were whisked away after the medical teams started working on the two men, and no information was released about their condition.
Dunne had had some slack time over the past couple of days when patients weren't being shuttled into the operating room. Then, the helicopters started landing. One after the other.