UNC Surgeon Reflects on Combat Medicine in Iraq and Afghanistan

November 9, 2014
Amy Alger, MD reviewing Military Trauma Triage and Mass Casualty events with their Afghan Medical colleagues during one of many trainings.

Amy Alger, MD reviewing Military Trauma Triage and Mass Casualty events with Afghan medical colleagues during one of many trainings.

When acute care surgeon Amy Alger learned about the shortage of trauma care available to injured soldiers as they left the battlefield, she felt compelled to join the army. She has since been deployed to Iraq and Afghanistan, and the experiences have not only challenged her medical skills – they have broadened her perspectives on the military and on life.

“I was drawn to trauma – to taking care of the sickest patients in the hospital and trying to make them better,” explains Amy Alger, MD, trauma and critical care surgeon at UNC Hospitals and a Major in the U.S. Army Reserves. “The care for every trauma patient is different. It’s that diversity that makes me want to keep learning, prevents me from feeling complacent and forces me to stay on top of the current literature.”

Amy Alger, MD, works on a patient in the operating room on base in Afghanistan.

Amy Alger, MD, works on a patient in the operating room on base in Afghanistan.

Alger came to Chapel Hill in 2011 from Brigham and Women’s Hospital in Boston, where she graduated with the hospital’s first class of acute care fellows. Being first, trying something new and challenging herself are central components of her medical experiences. The central New York native took an uncommon route to residency by attending medical school in the Caribbean, and while at Brigham and Women’s, she participated in the Emmy-nominated television documentary series Boston Med. But nothing she has done in her career compares to the challenges she faced when she enlisted in the Army and served as a trauma surgeon in Iraq in 2010 and Afghanistan in 2013.

“I wanted to broaden my experience,” she says of her decision to serve. “Combat medicine, military medicine, is an entirely different world. It challenges you at a completely different level. You may be asleep and then all of a sudden you’re running an eight-patient mass casualty within 60 seconds. It’s something that I read about but never fully understood until I got there.”

Alger’s decision to enlist was rooted in a long-held desire to serve her country. Her great uncles served in World War II, and her father was in the Army. She was living in New York City during the Sept. 11 attacks, an experience she carries with her today. Then, six years later, while talking to friends who were serving in the conflicts in Iraq and Afghanistan, she heard accounts of the effects of the Army’s shortage of trauma surgeons on injured soldiers.

“I was giving care, in some cases, to gang members who didn’t want my help and who threatened to hurt me,” she remembers. “We were providing some of the best care in the world to some of the most troubled people in Boston, yet our soldiers were having a hard time getting coverage. I wasn’t married and I didn’t have kids, so I felt that joining was the least I could do to help.”

Preparation for Alger’s first deployment began in 2009 with basic training at Fort Sam Houston in San Antonio, Texas. She was the only female trauma surgeon in the unit.

“It was me and a bunch of guys,” she laughs.

Alger with CPT Barakat, former UNC emergency medicine resident, on base in Afghanistan.

Alger with CPT Barakat, former UNC emergency medicine resident, on base in Afghanistan.

Several months later she went to Camp Ramadi in Anbar Province in Iraq. It did not take long for her to develop an even greater reverence than she already had for injured servicemen and women. She recalls feeling uncomfortable when the first words many of her patients were able to utter were expressions of gratitude for their care.

“I felt like I was the one who should be thanking them,” she says. “I was the one who was fortunate to be there helping them – that’s why I joined.”

During her civilian medical career, Alger has treated critical injuries caused by car accidents, gunshots, stabbings and burns and treated emergent conditions such as perforated bowels and twisted intestines. But none of the injuries she saw in Connecticut, where she did her residency, or in Boston or Chapel Hill, compare to what she treated overseas.

“Some of the soldiers arrived with the worst injuries I can possibly describe,” she says. “And the first question they ask after they’ve been treated is always, ‘When can I go back and join my unit?’”

Alger’s deployment to Camp Ramadi came during the drawdown of forces – she was not there during the height of the conflict. With fewer soldiers being injured, she occupied free time by creating a course to help train Iraqi residents from Baghdad. She quickly discovered how few resources the residents had to work with in their everyday clinics.

“They’re just like medical residents in the U.S. – they’re overachievers and Type A personalities,” she says. “But they would come to base and see an endotracheal tube for helping the patient breathe and say that they only sometimes have access to the equipment. This is an essential piece of equipment – how do you care for patients when you only sometimes have access to it? It was a challenge, but we had to create courses that would minimize the use of equipment.”

Alger often reflects on her experiences working with Iraqi residents. One resident told her about his favorite place to get away: a remote area in the mountains. He loved going there because he didn’t have to take his weapon with him when running errands like grocery shopping. Other residents explained that they lived in constant fear of bombs going off.

Alger and Kryno, a MWD (Military Working Dog) she treated while in Afghanistan. Kryno needed stitches while the veterinarian stationed on base was away and Alger was able to take care of the patient.

Alger and Kryno, a MWD (Military Working Dog) she treated while in Afghanistan. Kryno needed stitches while the veterinarian stationed on base was away, and Alger was able to take care of the patient.

“It was humbling listening to their stories,” she says. “We were trying to teach them trauma care, and they were concerned about dying on their way to work.”

As she had done at Camp Ramadi, Alger created a medical training course during her 2013 deployment at Forward Operating Base (FOB) Shank, a U.S. base located in a Taliban stronghold in eastern Afghanistan. There are fewer doctors in Afghanistan than in Iraq, so she taught Afghan National Army medics burn and mass-casualty treatment. At FOB Shank, her Forward Surgical Team triaged injured soldiers, taking care of life-threatening injuries before sending them for higher-level care at a military hospital at Bagram Airfield, the largest U.S. military base in Afghanistan. But the working conditions in Afghanistan were much more challenging than at Camp Ramadi.

“It was quite dangerous,” she says. “Every day we received incoming rocket attacks and indirect fire. We’d hear the siren and have to get down because rockets had been loaded with shrapnel, which was injuring or killing soldiers. I don’t think any of us were prepared for that. We envisioned being in more of a safe bubble. In Iraq, we’d hear bombs going off in nearby cities, but I never felt I was in imminent danger….Taking care of patients in those conditions – putting on your Kevlar and blocking out what was going on around you – was difficult.”

One of her fondest memories of patient care occurred when a German shepherd named Kryno, a bomb-sniffing military working dog, showed up with facial lacerations that needed washing out and suturing. The veterinarian at FOB Shank was covering another area at the time, and care fell to Alger’s unit. With no experience treating lacerations, Alger contacted her twin sister, Kristen, a plastic surgeon who was working at Albany Medical Center.

“I called her and asked what she would use to sew up a large, gaping laceration on the face and including the eyebrow,” she says, a wide smile forming on her face.

“Just use a small nylon or prolene,” Kristen responded.

“Would that work on a dog as well?”

Alger laughs when thinking about Kristen’s reaction: “What? A dog? Wait, did you just say a dog?”

Today, Alger monitors conflicts throughout the region as closely as she can and understands that she may be deployed again at any moment. After recently becoming a mother, she is grateful for the home she found at UNC Hospitals and the UNC School of Medicine, where she is an assistant professor of trauma and critical care surgery. As she prepared for her deployment in Afghanistan last year, she was touched by how supportive her colleagues and the institution were, not only of her service, but also of the service of her husband, an intel officer in the Army whom she met while traveling through Raleigh-Durham International Airport in 2010.

“When I came here it was like the clouds parted and the sun was shining,” she says, remembering how complicated it was to deploy from Boston in 2010. “I received an incredible amount of support from Human Resources as they helped with all the implications of deployment. While overseas, colleagues emailed me asking how I was doing and seeing if there was anything they could do to help, and I received care packages. My colleagues in the division even watched our house for us and mowed our lawn because my husband and I were both deployed at the same time.”

With many faculty members in the Department of Surgery who have been or are members of the armed forces, the process of assisting Alger as she transitioned from her role as faculty member through military service and eventual return to the department was smooth.

“We are all very proud of her commitment to providing excellent surgical care to our military, especially in the front lines as she has done,” says Dr. Anthony Meyer, chair of the Department of Surgery. “Our faculty help support them by covering care of the patients at UNC while they are deployed. We all see the importance of Dr. Alger’s efforts and cannot thank her enough for her commitment.”

Alger’s experiences overseas have broadened her perspective in many ways. Little things that may have seemed important to her in the past, she says, no longer are. Instead, she makes sure to value her time with her husband and stepdaughter, spending time outdoors with them as much as possible. Although her roles now range from new mother and trauma and acute care surgeon at UNC Hospitals to military trauma surgeon in the U.S. Army Reserves, she recognizes that the combination of her skills and her willingness to serve make her a tremendous asset to the military. But she’s quick to point out that the military has been an asset to her.

“Wherever we have soldiers, we need medical support,” she says. “This has been a really different experience for me, but one that’s incredibly rewarding.”

Story by Zach Read – zachary.read@unchealth.unc.edu