PUBLISHED IN GQ // JULY 2008
The City of Broken Men

There’s a hospital in Landstuhl, Germany, where every American soldier injured in Iraq and Afghanistan is brought, treated—if only for a few days—and then sent home.
Devin Friedman follows the story of a planeload of men and their week in this miraculous netherworld between war and peace, life and death

PICTURE A METAL CAN, like an empty coffee can, and the bottom of this can is lined with copper, and above the copper is an explosive charge, and when someone throws this device at the rear wheel well of an American Humvee in Mosul, the charge detonates, the blast element melts the copper, and the copper launches from the can with enough heat and force to pierce the Humvee’s armor plating and pour
into the interior of the vehicle. This is called an explosively formed penetrator, this device.

It is an adaptation of pretty simple technology to suit the conditions of this particular war, and it has changed the course of events profoundly. The copper blob, soiled by accel-erant and blasted metal, flies past Sergeant Cooper in the rear seat, embeds some small bits of shrapnel in the driver, Sergeant Hudson, and pierces the engine block, igniting a fire that inside of five minutes will engulf the vehicle. Between the wheel well and the engine block, though, this molten copper also blows through the left leg of a guy named Michael Brown, a private first class with the military police, out of Hawaii.

Immediately, Michael can’t feel anything below his hip. He looks down and sees his boot, and inside that he sees his green Army-issue tube sock, and inside that he sees -brilliant red flesh and then two white circles of bone, one smaller than the other, that have never been exposed to light or air. The lower part of his leg hangs by a piece of skin. The phrase bridge of skin appears in his mind. His blood is emptying out and pooling beneath him.

Before the Humvee incinerates, Brown’s team leader pulls him out of the vehicle and onto the hot greasy asphalt, where he continues pumping out blood. Then this contractor lady, a former bodybuilder named Miss Dee who helps his unit train Iraqi police, is standing over him. She shoulders him and takes him to another truck. He hears air support arrive, helicopters. The ride out is the longest five minutes of his life, and after that, a gap in the tape. Later, he wakes up without a lower leg, at the combat hospital in Mosul, which he remembers as a face or two and a dirty plaster wall. He is awarded a Purple Heart by his lieutenant colonel and he does his best to appear dignified or at least coherent. Some time passes; they load him onto a plane or maybe a helicopter—it has to be a plane, but it sure feels like a helicopter—and take him to Balad. Then, once again, he’s being shipped out.

Inside of forty-eight hours, Michael Brown is strapped onto a stretcher, hanging like a shelf off the fuselage of a C-17 transport plane. There’s a guy stacked above him and another below, plus two rows of men on gurneys in the middle, and across the way a guy who has a stump where his hand should be and two others where his legs should be, all the nurses in their flight suits crowding around that man and saying, What’s your pain level one to ten and Put this pillow under your leg and Can you take a big breath for me?—Mike Brown feels bad for staring, but he does and he thinks, Man, that guy is really fucked. And then he feels the pressure of the plane accelerating down the runway, lights extinguished to protect against attacks, the plastic tubing connected to everyone tilting toward the vertical, and they’re up, the slurp of wheels sucked back into the belly of the plane, grinding through the dust higher over the dead earth that is most of Iraq, a few orange fires smeared onto the black. A little while later, the pilot comes on: “We have just left Iraq,” and a muted little cheer goes out, Michael Brown noticing how small he feels away from his unit, to whom he feels deeply connected, away from his family, shivering with the cold of blood loss even beneath the eighty-five blankets he’s wrapped in, heading “to Germany,” though the geographical nature of the place he’s not sure about, the plane moving past invisible black earth and over some black meaningless sea, he and these eighteen other compromised bodies that he’s never seen before and will not see again, all bound for a place that is only in between.

It’s not like Michael Brown is the first guy to get hurt in Iraq. He’s not even the first Michael Brown to get hurt in Iraq. The Michael Brown in question was more or less the 44,360th person hurt badly enough to be evacuated out of Iraq or Afghanistan. And every one of those men and women take this flight, out of Bagram or Balad.

In the morning, the big gray plane begins its slow fall from the sky, dropping into the thick, damp air over Germany, groaning again with fractional g’s that yaw the metal fasteners on the gurneys and pull at the plastic tubing, until it’s reeled in by the brick-straight runways of Ramstein Air Base, where buses wait to take them to an ugly little hospital on top of a hill in the Rhine Palatinate Forest. It is called the Landstuhl Regional Medical Center, itself a reengineering of pretty simple technology that has changed this war profoundly, and for the past five years the only hospital in the whole complex, dysfunctional, miraculous, weirdly pedestrian American military medical system where absolutely every hurt man who doesn’t die spends time.

* * *

IT IS EARLY STILL, 7 a.m., and outside the front doors of the hospital is a wintry mix of cold mist and German Weltschmerz, if that means what I think it does. The bus, with its shipment of injured people, appears at the end of the asphalt drive. It draws closer, begins to back up to the hospital entrance through a cloud of its own vaporous exhaust. Inside, in the lobby, there are maybe thirty hospital sta waiting, and they start to move toward the door. There are people in Army fatigues, Navy fatigues, Air Force uniforms, people in scrubs and white coats who would look normal in any hospital. There are lots of young people who joined the military after the war began and have never been to the places the injured are coming from, and a fair number of gray-headed folks who’ve been called up from the reserves. They are mostly women, a lot of them stout in those Army shirt-tunics with the pixelated camo they use now, and many of them a light brown, belonging to an emergent -American post-black ethnicity, a majority with their hair harnessed vigorously. Their faces are placid, and they seem to say without speaking: I will take care of you, but I’m not going to cry or anything. There is no more sense of urgency than in a crowd waiting out a break at a pharmaceutical conference. This is routine, this delivery of the wounded. It occurs once or twice a day, as it has just about every day for the past five years.

The bay doors of the bus open, and the first stretcher appears. “Careful,” a voice from inside the bus says, “watch the O2 tank on this side. It’s strapped but not tight to the leg—it’s very painful.” A man, his face a steamy plastic mask, is lowered from the bus, onto a waiting gurney, laid over with one of the quilts the Girl Scouts and Boy Scouts and VFWs and other organizations, o∞cial and not, send over. Then a chaplain, an upright German national with a pink face and a gray mustache, takes the patient’s hand and leans down and says with some gravity, “Welcome to Landstuhl Regional Medical Center. Thank you for serving your country. We want to serve you now.”

They appear one at a time, the second one is breathing on his own, the third is holding a stued penguin, the seventh is a black man torqued between two steel plates to keep his back immobilized, with zero body fat and veiny biceps and some kind of red mandala tattoos on his shoulders, his head somewhere inside the aluminum sandwich, his arms moving but maybe not his legs. I wonder if he’s terrified; I am terrified thinking about being inside that thing with no idea what has happened to me. Among those who are unloaded is Mike Brown. They seem exotic here in this little German hamlet on top of a hill, excreted from the bus while still in their dusty combat fatigues, their standard-issue boots with actual Iraqi dirt caked onto them, like seeing people getting off their flight from Cancún in the dead of winter still in shorts with sunglasses on their heads. One of the nurses, a guy from the Inland Empire, Southern California, says, “You can smell the war on them.”

Without a lot of fanfare, they disappear to their designated spots in the hospital, wheeled by nurses and orderlies carrying printed instructions. Each is brought to the room he’s been assigned, issued hospital pj’s, tested for brain injury, visited in a timely manner by one of about fifty representatives of the active combat units that will arrange for gear and personal eects to be sent on to wherever is appropriate, issue them $250 allocated by Congress, as well as a phone card to call home. More or less the same routine experienced by the 44,000 people who have come and gone before this shipment here at the busiest trauma hospital in the world, the single experience every injured U.S. serviceman and woman shares. None will stay more than two weeks, and almost all will be gone again in three days.

* * *

LANDSTUHL IS the central hub in a military medical system developed for the wars in Afghanistan and Iraq. If you are in the military and you get hurt, and if you don’t die immediately, you are treated by a field medic, and if you don’t die then, you’re brought to a forward surgical team, which is basically a doctor operating out of the back of a truck, and if you don’t die there, you are taken to one of a half-dozen CASHes (the next generation of the MASH field hospital) in Iraq or Afghanistan and from there to the large brick-and-mortar hospital in Bagram or Balad, where you are readied for the flight to Germany. Everyone hurt badly enough to leave his unit goes to Landstuhl, where he gets preliminary care, undergoes surgery, receives medication, waits out his fever, goes through a course of blood thinners, etc., and then gets triaged back out—the burn victims lighting out for Brooke Army Medical Center, the wounded Army to Walter Reed, the wounded Navy to Bethesda, the less injured to any of a dozen smaller, less specialized places.

In the afternoon, fog pushes against the windows along the white corridors. It’s easy to get lost in this hospital, under its low ceilings, in its fourteen identical wings lined with framed reproductions of Frederic Remington paintings—the Rough Riders falling bloodlessly on San Juan Hill. It could be a hospital in Fort Wayne, Indiana, the sound of squeaky white shoes on linoleum, the grim fried chicken and canned green beans turned out in the cafeteria, the cryptic medical messages chiming in over the PA. Except for the Army captain trussed in white bandages, a glossy red spilling down his arm from where the skin on his chest was incinerated in a blast. Except for the 350 fresh Navy reservists in forest camo from Illinois, standing in groups of three and four in every hallway you look down, women near 50 with spray-sti hair and lipstick and flat accents, men with baldy pates who look like dentists. Except for the security check at the fortified entrance.

All the wards are lined with little white rooms, and inside those rooms are patients, pallid heads on white pillows. Everyone’s the color of chicken skin. And they mostly have this arch to their forehead, the manifestation of a very poignant inner moan. You pop your head into the doorway and they look at you like you are on a TV show broadcast in Urdu. John Crosser is racked with fever and infection, lolling around his bed, his broken leg immobile, his blown-up arm. Derena McCray sits in his bed while a machine bends and unbends his leg, and his wife, a little Italian girl he met at a club near his base in Italy just before he shipped out, looks at a magazine through sunken eyes. At this late date, people are getting cycled through Landstuhl more than once. Because there are not, relatively speaking, that many men and women in the combat sections of the armed forces, and because the tours are so long (in the Army they’re fifteen months) that it seems like almost everyone deployed to a combat zone has already survived something. The primary objective of Landstuhl, as it is written in the manuals, is to preserve the fighting force, get people back to their units downrange.

In the surgery wing, there’s a break room where three or four men are eating a casserole out of Tupperware. One is a doctor visiting as a representative of the American College of Surgeons, a certain Dr. Sise from Scripps Mercy Hospital in San Diego.

“I saw more in the first two days here in terms of the severity of injury than I will see in three years in my trauma center,” Sise says. His eyes are clear and his black hair is responsibly cut. He has cried a few times since he’s been here, but while he talks, what he betrays is a certain excitement about just how interesting the injuries he has seen are. These are inventive injuries, things never before conjured by the human mind. Not a lot of gunshot wounds—if you get shot at, either they miss you or you’re in a coffin flying to Delaware. It’s more like wiring from bombs embedded three inches deep in soft tissue. Organs seared by Humvee door hinges still scorching hot when they violate the abdominal cavity. “The blast injuries are like nothing I’ve ever seen before,” he says. “There’s a guy right over there, ICU, who had his testicles blown off, the flesh in his inner thigh, his anus, just sitting in a vehicle that got blown up. I saw one the other day where inside his leg there was a cavity basically the size of one of those small Nerf footballs, twelve inches long by six inches deep of just mangled muscle. The shock wave of the blast had damaged the muscle and then the debris had been forced up inside.”

Landstuhl was a normal hospital before these wars began, dedicated to treating the ordinary medical problems of the enlisted men stationed nearby and the veterans who decided to stay in Germany. If you aren’t one of the people who undress the wounds, it still seems like a regular hospital. And while it seems normal, orderly, pedestrian for the people working here, Landstuhl has actually become a complex, exceedingly dynamic system, thanks to some pretty special circumstances—a jet-powered war fought by a wealthy country not very close by, with outposts in friendly lands halfway between home and war. Thirty trauma patients arrive one day; twenty souls are outbound the same day. Twenty-three incoming tomorrow; thirty-two checking out. The motion contained here is extraordinary—not just the 40,000 patients processed through here but the roughly 10,000 doctors and nurses and orderlies and enlisted men who have passed through, none staying more than three years, most considerably less than that.

* * *

A MALE NURSE wheels Michael Brown into the operating theater. Brown is all bristly brown brush-cut hair and yellow skin, deposited in a pocket of white sheets in a bed ratcheted so he’s almost upright. He’s on plenty of morphine and something called a nerve block that they use for amputations, since basically all of the nerves in a given appendage are severed, if you can imagine that pain. He’s kind of smiling, struggling through the pharmaceutical fog to be a part of this tableau—the young black tech arranging shiny metal cutting tools, the meso-morphic male nurse hauling in jugs of saline and Betadine prep, four or five other people moving in and out of the room with a sense of single-mindedness. They start to hook up the surgical apparatuses to Michael Brown without letting him know exactly what they’re doing or
really even looking at him, which doesn’t appear to bother him at all. He looks more like someone who’s about to watch a surgery than someone who’s about to undergo one. Before they lift him onto the operating table, he recognizes me as the guy in his room who asked him to sign a release so his medical history could be written about. “Are you going to tell my story in specifics?” I say I don’t know, maybe. He says, “Why mine in specifics?” I say I don’t know; you’re here right now and I’m here right now, I guess.

The nurse anesthetist, a woman named Captain LaFleur, pulls up a stool next to him and starts talking to him like they’re old friends while she readies her gauges and bottles and tubes. She’s treating him with a special dignity. She takes a syringe and injects it into a port on Michael Brown’s IV.

“Okay, Mike,” she says. “I’m giving you some Versed. It’s like Valium.” Then she leans in so only Brown can hear her and says, “Thank you for serving, you’re very brave, thanks for protecting us.”

“Thanks for taking care of me,” he says.

She asks him to count backward from a hundred. At ninety-four, she tapes his eyes shut with clear tape. She tells everyone in the room she’s going to intubate; she needs quiet. Then the surgeon, Dr. Sigmond, enters wearing a mask. Sigmond is a trauma surgeon from Philadelphia, about 35, arrived not one month ago. He talks loudly and walks with a swagger. He has some tattoos on his upper arms that say things in Japanese. Someone somewhere puts some loud methy white-people music on the speakers. The procedure they will perform is to wash out Mike Brown’s amputation, check the health of the wound, trim out any dead tissue. It’s Sigmond’s fifth such wash-out since Monday.

“Must be amputation week,” he says.

Then, piece by piece, Mike Brown begins to disappear. They put a blue curtain up between his face and the rest of his body, then a blue sheet is laid over his lower torso, his good leg is covered with another blue sheet, then his compromised leg is laid over still another brilliant blue sheet and propped up with a blue towel and lit with huge overhead lamps. The only thing left is that single leg, pale and hairy and bright, with a crude seam where his calf used to be before the introduction of the exploding coee can—if someone were to walk into the room right now, he may not even know this was a leg at all.

Sigmond asks for the music to be turned down and says, “Okay. We have Michael Brown. DOB 23 August. This is a wash-out for a below-knee amputation. Everyone agree?” Everyone agrees, the music comes back up.

When Sigmond slits open the incision with a knife, a new world is revealed. Red, brilliant, wet, confusing, without discernible form except for a thick ring of white fat below a layer of skin, and some white bone. They wash it out roughly with a plastic saline-sprayer–suction machine that looks like something you’d buy on TV to detail your car. They poke and prod the muscle with an electrified wire to see if it contracts, if it’s alive, and you can smell burning flesh, which doesn’t smell any different than burning hair. If any tissue is dead, it’s sliced off, like cutting the cooked layer of gyro meat.

Brown will have three surgeries before he leaves Landstuhl (and then four more when he gets to Walter Reed). They do some of the high-wire, complicated surgical procedures here—reapproximating colons, repairing arteries, installing shunts in the skull—but mostly what they do is take men to the operating room, remove their dressings, open up their wounds, clean them out, and perhaps most important, trim back the dead tissue. This is one of the major surgical weapons employed here at Landstuhl. The technical term for it is debridement, a procedure that’s been widely used since the end of World War I. It involves cutting back (i.e., slicing o) tissue in a devastating wound, cutting away anything dead or dying, cutting back more than one might logically eliminate, so that it doesn’t get infected, so that healthy tissue has a chance to grow back, so you incrementally, incrementally, incrementally increase the chances of a full recovery.

Which is basically the medical theory of Landstuhl in a nutshell.

WHEN THE United States invaded Iraq, there was an ad hoc process for the movement of the wounded, a case-by-case system adopted from the civilian world and previous wars. In the intervening years, a new structure has accreted, and Landstuhl has become the main transit station in a complicated military FedEx system where the injured are freight. In the grass next to one of the hospital buildings is a series of trailers that is the nerve center of this system, called the DWMMC, which is pronounced dwimmick and stands for Deployed Warrior Medical Management Center.

The DWMMC is where the military tracks every wounded person from the moment they get to a combat hospital until they’re sent off to a hospital in the U.S. It’s administrated by a surgeon named Captain Miguel Cubano, a man in his late forties with a big, strong face, no-bullshit metal-framed glasses, and neatly trimmed nose hair. He is originally from Puerto Rico, a product of the military who also holds advanced degrees from Johns Hopkins. He explains the way the system works. Usually within about four hours of a serviceman like Mike Brown being injured, someone downrange sends the DWMMC an electronic message—a so-called patient movement request. A virtual profile is created. Almost every hour, messages, called traces, are generated as the patient, undead and moving inexorably toward Landstuhl, works upward through the system. Digital X-rays and doctors’ comments are attached. When the patient gets to one of the two big air bases that are departure points for all flights to Landstuhl, his name appears on the white marker board in the main o∞ce of the DWMMC. Flight manifests are assembled, changed, notated on this marker board—how many ambulatory patients will be on each flight, how many intensive-care patients, the time of wheels up in Iraq or Afghanistan and the time of wheels down at Ramstein. The DWMMC receives updates in-flight—patients crashing on board, hemorrhages, what have you. As patients get closer to Landstuhl, people in these trailers have medicines pulled, schedule specialist appointments, set up surgeries. Captain Cubano, here at the single narrowest spot in the system’s funnel, where every data point passes by one at a time, must then make sure that every single patient gets cycled out again—sent to the appropriate hospital given his or her ailment and hometown, etc.—inside of two weeks so there will always be space for the next busload.

“The number of patients coming in at a single time would overwhelm a civilian hospital,” Cubano says. “Eighty percent of hospitals would be overwhelmed by one bus with thirty patients. You don’t see that except in a mass-casualty exercise. We have a mass-casualty exercise every day; that’s our joke.”

This system has made it possible for the U.S. military to push survival rates to unheard of percentages. It is the positive story of the war. Ten percent of those with serious injuries die, compared with 28 percent in Vietnam, 34 percent in Korea, and 30 percent in World War II.

“I would look at the speed we operate at—in the previous conflicts many of the casualties remained in-theater for a lot longer,” Steve Flaherty, M.D., the chief of trauma of Landstuhl, says. “During Vietnam it was more than a month before servicemen were sent out to longer-term facilities. Casualties are coming to us much faster. And that has never happened before.”

America has gotten better at war—maybe because we have had more practice, or a more industrialized approach, a taste for it, what have you—than anyone else. Part of that approach has been to work on what you could call a killer app. Let’s call it: the Theoretical War with No Downside. A war that will be quick, beautiful, with very little dying on either side. Dying, after all, is the major downside of war. Precision armaments would reduce death on the receiving end. Overwhelming force would keep injury to a minimum on the American end. And for those who were hurt, all but the most drastically compromised could be saved with a system that would involve discipline, technology, and a serious premium on speed. Get the man with the blown-o leg to a safe, prepared hospital before he can change out of his boots. It’s not about inventing new medicine; it’s about adapting existing technology, getting the wounded the medicine we already know about before they die. And the system has worked exceedingly well.
In the past five years, the Landstuhl-based system has become the most high-tra∞c, semipermanent, extremely expensive transglobal ambulance system in history. Fourteen flights per week to and from Landstuhl, for a grand total of 3,800 flights since 2003. You could argue that the greatest advance in the care of the wounded has been the simple application of money. The U.S. government can be accused of cutting corners on armored vehicles or body armor but not on this medical system. It’s been reported that it costs $10,000 per person for the medical flight from Iraq to Landstuhl, and as much again to fly from Germany to America. The budget of Landstuhl is double what it was before the war. A state-of-the-art prosthetic leg is $100,000, not including teaching someone how to use it or all the surgeries and physical therapy you get before and after. There are some estimates that say it costs the military as much as $1 million per seriously injured serviceman to get someone from Iraq to Walter Reed and out into the world again. And that doesn’t include what we pay to take care of them in the future.

THE BLARNEY STONE is an Americanized Irish pub in the cobblestony section of Landstuhl, the little German burg where every shop window bears a sign welcoming the American soldier, his American dollar, and his American English. Parts of the town are pretty in the European way, with stone buildings casting romantic old-world charm over the citizens. Other parts are defined by beer warehouse stores. Next door at the Ramstein Air Base, they have their own Chili’s and a half-built mall that looks airlifted from Charlotte, North Carolina. In the Blarney Stone, there’s a karaoke machine in the corner going full blast, so that you can’t even make out what song is playing.

Dr. Sigmond, who performed the wash-out on Mike Brown, is sitting before a very tall beer with an enlisted man who works with him. Sigmond’s got big brown eyes and a high lineless forehead and talks like someone whom people are paid to listen to. One of his Japanese tattoos means something like “The samurai is the first to suffer anxiety for the people and the last to feel pleasure.” Irony quotient appears low. I start things out on an ass-kissy note, or so I believe: What a mistake it was to shift traditionally military operations into the private sector. The contractors—like, you know, Blackwater—lack that higher, more noble directive that the military is meant to operate under. The Army doesn’t spray civilians with bullets and then drive off toward safety down the wrong side of an Iraqi boulevard—

Sigmond locks eyes with me and says, “I am not over there, with guns pointed at me and bombs going off and IED attacks, so I think those forces, whether it’s Blackwater or the military, need to do whatever is necessary to keep themselves safe and achieve their mission. And they should never, ever be questioned or doubted.” I fear he might aikido my ass right there.

Then he says, “I am really glad to be able to talk to you. It is an honor and a privilege to treat these men and women. They are my heroes, I really believe that. They’re why I get up in the morning. In my civilian job as a trauma surgeon, I treat people who don’t care about the people who treat them. I treat a lot of people who are responsible for their own injuries, because they were with the wrong people or they were stabbed dealing drugs. But this is totally different.”

We join up with another table of people, some nurses, some surgical techs, a young physician. A girl from Ohio, a private first class stationed at Landstuhl, is turning 21 today. She comes over and sits on the physician’s lap and says, “I always knew I was going to marry a doctor.” The doctor orders up two oatmeal-cookie shots. He tucks her shot in the waist of his jeans. She takes it no-hands, drinks it, then swivels around and puts her butt out. “Don’t I have a nice ass?” She disappears when she hears that her boyfriend, who’s been banned from the bar for fighting, is waiting for her outside.

Sigmond’s friend, a surgical tech, is talking to a woman (we’ll call her W.) who also works in the OR. W. is in a revealing dress, holding a big beer in toward her body like it’s a baby under threat of violence. She smokes a cigarette and rolls her eyes a lot.

“I bet you’re just going to interview General This and Colonel That,” she says. “They don’t know shit. They don’t scrub in every day. I’ve been here three fucking years.”

There’s an awkward silence, and I say, “You guys are doing great stuff here.”

W. says, “I know. I don’t need you to tell me that.”

The birthday girl comes back, looking for her doctor friend.

“You know whose birthday it is, too?” W. says. “That guy who got his nuts blown off. He’s 21 years old, sitting in the intensive-care unit. His penis was what they call degloved. The whole top layer of skin was blown off. Happy birthday, right?” Tears well up in her eyes, and she tries to hide them with the back of her fist. She doesn’t pretend to hide them; she genuinely seems pissed that she’s crying. W. doesn’t want to be laying claim to the pain of these people. I remember talking to a vascular surgeon who came here unpaid, and while he found the work totally satisfying, he still felt somehow that the war was a total mystery to him. Sigmond’s friend (he doesn’t want his name printed) says, “There’s a disconnect between soldiers and the people who are taking care of them. The soldier will look to see if you’ve got a combat patch. They see I have one, so sometimes that helps. But they also know I’m not there. So we’re all kind of outsiders.”

The truth is that the men who come to the hospital on those buses, they mostly seem so far away that you can barely see them. You can walk into the wards and turn on your tape recorder and talk to them for an hour or so while they fight to pay attention to you instead of whatever significant pain they are in, you can watch them in the operating room while they lose consciousness, you see what they look like and try to understand the events that brought them here and imagine what all that must be like. But what happened to them happened to them, and though you are in the same physical space, you may as well be on the phone to Mars. W. and her friend, they are saying that the folks here at the Irish pub know what it’s like to work here, to lay hands on the catastrophically injured. But even they do not really have access to them.

It’s not that it doesn’t get to you. It’s not that, going through the paces of your day here at Landstuhl, you don’t occasionally get emotionally torpedoed. One woman, sweet-faced, who worked at the Fisher House, which puts up the families of injured soldiers who make the trip to Germany, and sometimes the soldiers themselves if they’re here for an extended stay, was working one evening, around dusk. She walked outside to find a soldier smoking a menthol and listening to an iPod, crying. “Not like a few tears,” she says. “He was crying like my own child cried when he was 3 years old.” When she asked him why, he said it was because he was afraid to go back to Iraq but was too ashamed to let anyone know. Or another story: This chaplain named Ronald Pettigrew, evangelical, black, impenetrably chipper, is called by Jesus to sit at the bedside of a bilateral amputee who can’t speak because he’s got a breathing tube down his throat, and after some time he tells Pettigrew he wants to hear his wife’s voice, and Pettigrew calls her for him, recites into the phone whatever the soldier writes on a marker board: I'M SORRY, I LOVE YOU. When he got off the phone, he wrote the word RING.

“He wanted his wedding ring,” Pettigrew says. “I called back downrange. Got his wedding ring for him.” Or: A young nuclear-medicine tech, bright-eyed, very polite, hails out of Columbus, Ohio, tells a story where one night, when it’s late and the hospital is quiet, he gets orders to perform a brain scan, a final test to make sure there’s no brain activity before they take a young man off life support, and he sits with this still-warm human with white bandages around his head and wires strung out from his extremities as his brain scan comes up cool and empty. “And the parents are outside the o∞ce,” he says, “in the middle of the night in Germany, holding hands.” Or: The surgical tech at the Blarney Stone talks about when he sat with a guy from his best friend’s unit who’d had his face blown off—“mushroomed” is how he describes it—sat and talked to him for hours and hours while he was in a coma as a favor to his friend, so the guy would know he wasn’t alone. But that’s the experience of caring for them, not the experience of being them, a truth that makes almost everyone here feel weirdly guilty and helpless.

And the fact is that even the injured themselves don’t feel a real connection to their own injuries yet, still don’t exactly know what happened to them, still feel more sorry for people they see across the plane from them than they do for themselves.

In the morning, Mike Brown will be moving again, in a plane, wrapped in blankets, strapped onto aluminum, up over the Ramstein bowling alley and the Ramstein Chili’s, out over the vineyards and the cities of Germany, over borders and oceans toward home, on to the next phase of the system. If it’s true that we could end this war in the next year, it won’t be long until this place, as it’s imagined now, is gone. It will become an artifact. Maybe a stop along the evolutionary trail of the wartime medical system, or maybe something that was dreamed up and then went away, no one the wiser, just some people without legs who remember it in a haze, some no-nonsense women with sprayed-sti hair who were here for a year and then returned like from a fugue state to Fond du Lac, Wisconsin.
Captain Miguel Cubano of the DWMMC explained it as he sat under his diplomas and plaques, describing the system he oversees.

“The whole idea of it is that it’s going to be mothballed,” he says, clasping his strong, cologned surgeon’s hands before him. “It goes into a crate that says BREAK OPEN IN CASE OF WAR, and then this just becomes a sleepy military hospital again.”

POSTSCRIPT
Two months later, I wouldn’t have recognized Mike Brown if he’d been sitting next to me on a flight to Dallas, because whoever I met at Landstuhl was not the same person. Here in the dim living room of the Fisher House, in the Walter Reed Medical Center, Mike Brown appears vigorous, outspoken, not at all ashen. He’s seated on a floral couch with his wife of two years, Kim, with one eyeball on his infant daughter, Alyssa, big-eyed and downy-headed, with a snot bubble emerging from the concretized-mucus shell of her nose. The guy’s eyes are bright. His skin is the color of the living. He is short and thick and upright and clothed, and you can see what he really looks like: a guy who could have been the starting fullback at a small high school. “You get a lot of benefits if you’re injured,” Mike Brown says. “We got put up here for free. We don’t have to buy any necessities—milk, eggs, cheese, whatever you can imagine, they just give you! And the Army gives you a minimum of $50,000 for insurance. Double amputee would get $100,000.”

Mike doesn’t remember Landstuhl well. He doesn’t remember landing or being on a bus or that he was in the ICU. He doesn’t remember how many surgeries he had or who his surgeon was. “It felt more like I was in America,” he says. “Seeing all those people in uniform and everyone speaking English.”
He’s eager to show me the rehab center at Walter Reed, over in one of the main buildings, which looks like a replica of Independence Hall built in the ’60s. I’d seen specials about these rehab centers on CNN and the evening news—this has always been an attractive place to the media, with its daily miracles, its focus on our American ingenuity and basic human decency—but it’s still overwhelming to see it in person. It’s like a state-of-the-art gym built for and populated entirely by a race of people with bodies slightly different from ours. A white man in Army shorts does leg raises, his calf missing its skin, so you can see the muscle, fully articulated like an anatomical drawing. Another man, on the floor, raises a plastic ball using an arm with the skin peeled off and replaced by netting, like a mesh laundry bag. Two guys barely old enough to shave play a tile game like Scrabble, one with a hooking prosthetic arm and the other with a hand sewn together smaller than it should be. Men like beta versions of robots lurch down the rubberized track on complicated metal legs while a black Lab in what looks like a photographer’s vest trots alongside them, tongue lolling.

Things have basically gone as well as they could have for Mike Brown. He’s not dead. His amputation is below the knee—way easier to walk on than if it were above. It’s taken him half the time to recover and learn how to walk than it does most people. He thinks he’s got a beautiful scar. He’s worried he could develop a painkiller problem, with all the Percocet they’re giving him, and he’s freaked out about what happens when he leaves here. He doesn’t know what his daughter is going to think when she looks at him. “What happens when I’m the only one with the metal leg and people are like, What a freak?” he says later, when we’re eating lunch at the Cheesecake Factory, where he and his wife like to go when they feel like a piece of vanilla-macadamia-nut cake as big as your face.

Personally, I don’t really think that’s going to happen. I think it’ll more be like: He’ll get treated differently. He’ll be on the outside of normal society, which the military already is. It’s something none of these guys really understand yet, in my estimation. Mike Brown is not at war and he’s still not, two months after his injury, really back home yet. When he moves out of the Fisher House, when he has been processed through Landstuhl and Walter Reed and rehab, when we’ve given him all that money can buy until he’s out of the system and we’ve all gone headlong past the war except for the stories about how vets are homeless or committing murders or getting divorced or suffering from a weird lung disease or something, when he’s out on his own, that’s when Mike Brown will know what happened to him. Landstuhl, and the system connected to it, is the maximization of what we’re capable of doing for the injured on a large scale, and it’s not feasible to maintain that care as the timeline gets longer for people like Mike. It’s kind of dazzling: We can send you to a broiling desert across the world to fight precision battles in a country you know nothing about; and we can beam you up when you’re hurt and put you down in the middle of Germany, rebuild your leg, get you free cheese and $50,000. But there are some things we just can’t do. And what it is we couldn’t save Mike Brown from is what he’ll find out next.