The mortar exploded less than six steps away, shooting a piece of shrapnel deep into Doug Fry's neck, where it cut through two arteries and lodged between his vertebrae.
Lying beside the blast hole, covered in his own blood and unable to feel his arms or legs, Fry figured he was about to die in Iraq. He closed his eyes, thanked God for his short life and tried to pass out.
The number of U.S. troops killed in Iraq and Afghanistan likely will surpass 3,000 by the end of this year.
But for Doug Fry and thousands of other wounded troops, many of whom likely would have died in past wars, better armor and advanced medical procedures have made the difference between going home on a medical evacuation flight or going home in a box.
They're getting home. Alive and fast.
•••
During the Vietnam War, wounded troops often lingered for weeks before returning to the United States. Today, the injured can be treated in stateside hospitals within days.
That, doctors say, also is saving lives.
Meandering between rows of stretchers in the cavernous, cold and deafeningly loud cargo bay of a U.S. military C-17 Globemaster, Fry is nodding his head as if listening to a slow song with a deep beat.
"I'm trying to loosen things up in there, but it's killing me," he says, rubbing a spot on his neck just behind a half-dollar-sized gash, now patched with black stitches and medical tape, where the mortar fragment pierced his skin just days earlier.
Fry's journey began in Balad, about 50 miles north of Baghdad, where the U.S. Air Force Theater Hospital treats all troops in need of medical evacuation from Iraq. From Balad - or its counterpart facilities in Afghanistan — the flying hospital ships make a stop in Ramstein, Germany, to drop off patients at Landstuhl Regional Medical Center.
Now on the nine-hour leg of the trip that will take him from Landstuhl to Walter Reed Army Medical Center, where he will be treated further before returning to his family, including a 5-year-old son, in Oklahoma, Fry has no illusions about his fortunes.
"I should be a dead man," says the former recruiter, who tried out his Midwestern drawl on potential soldiers in Utah before returning to "the real Army" a few years back.
The headstrong soldier already despises the relationship he has developed with his pain medication.
"I've taken more shots and pills in the past week than in my entire life," he says. "I feel like a junkie. And I hate it."
Still, he knows, it could be worse. The two soldiers lying in the back of the plane are a silent reminder of that.
As Fry wanders close to this flight's most critical patients—both breathing at the mercy of a ventilator, lying under a web of tubes and wires and beside dangling, bloated bags of morphine, blood and urine—he bows his head and murmurs a short prayer.
"I'm alive by the grace of God," he says. "These guys deserve to make it, too."
•••
David Norton wears the military insignia of a major on the shoulder of his dark green flight suit, but he often feels out of place in uniform.
He hates this war. Doesn't understand the justification for it. Can't stand the casualties created by it.
"But my part of this, I can understand," says Norton, a fast-talking Virginian who did part of his medical residency at LDS Hospital in Salt Lake City. "I understand that it's my job to keep these kids alive."
The continuum of care he's part of begins with medics on the battlefield and ends with stateside specialists. In between, scores of doctors, nurses, medics, aircrew members, pilots and ambulance drivers will have a hand in each patient's treatment and travels.
But at 30,000 feet, and especially as the medical evacuation missions stretch out over the Atlantic, Norton feels very much alone.
"Out over that ocean, there is no place to put this plane down," he says. "It's humbling because you realize you don't control as much of this process as you wish you did."
And at the moment, Norton is feeling very humble.
Both of his patients are unconscious. One will lose his left leg. The other, a 29-year-old Georgian named Tom Hawthorne, has suffered some brain damage, though at this point the extent is unclear.
Hawthorne is starting to show some promise, however—producing so much urine that medics make frequent trips to the airplane lavatory to empty his bag.
It's a good sign, Norton says. The kidneys are a barometer of sorts for critical patients - when they're working properly, the body is on the mend.
"It's nothing I'm doing," Norton says. "That's him, fighting to stay alive."
•••
Norton can't prove it, but he likes to believe Hawthorne's slow progress has something to do with the woman who has, for days now, been at his bedside.
Told by military officials that if she hurried to Germany she could be with her son—possibly for his final hours—Yong Hawthorne caught the first flight to Europe.
"When I first saw his face, I could not even tell that he was my son," she says.
Preoccupied with her son's medical care while at Landstuhl—his face is smashed, one lung is collapsed and he is blinded in one eye—Yong Hawthorne didn't have time to learn much about how he was injured.
"Just something about a truck crash," she says. "There were many soldiers injured, maybe some killed, I just don't know."
As space and circumstance allow, the military permits family members who have traveled to Germany to fly home alongside their loved ones. So now, nestled between the airplane bulkhead and the stanchion holding her son's stretcher, the tiny woman—a gas station attendant in Hinesville, Ga.—strokes her boy's matted black hair and sings softly in his ear.
"Mama is here," she serenades. "Your mama is here for you."
Tom Hawthorne breathes heavily. It's unclear whether he can sense his mother's presence, though she chooses to believe he can.
"I saw him cry, one tear," she says. "And when I stroked his hand, he grabbed my finger."
A green "fasten seat belt" sign on the metal wall lights up as the aircraft bumps along, over the clouds, above the ocean. Yong Hawthorne returns to her seat, a less-than-comfortable folding nylon chair, and tries to rest.
"I haven't slept very much," she says. "When I do sleep, it is more nightmares." But being awake is no better. "My entire life, this is a living nightmare for me," she says.
•••
To be certain, this is a surreal situation. Patients—some in military fatigues, others in fleece pajamas—sleep on stretchers and take short walks along the center of the cargo bay. A few are eating cookies, each with a tiny American flag stuck in the middle, served by a perky medic named Andrea Essig, who is wearing a shiny red streamer in her hair. Reggie Brown, a sharp, animated nurse who works on Norton's critical-care team, is doing push-ups in the back of the plane. A few soldiers, those whose injuries were not severe enough to warrant a stretcher, sleep on bright orange folding pads on the metal floor.
Yong Hawthorne pulls a quilt around her shoulders. It's cold in the Globemaster's wide-open bay. Her son's torso is uncovered, and she's worried about his comfort.
"I hope that he's warm enough," she says. "He doesn't deserve this. He is such a sweet boy."
There is no lack of patients on these flights, which occur several times each week.
"We've never been completely full, but we're often pushing it," says Michael Morrow, who earned his nursing degree at Westminster College, in Salt Lake City, 10 years ago.
Flight doctors must clear every patient for travel, but a lot can happen in the five hours it takes to reach Germany from Iraq and the nine hours it takes to get from there to the United States.
Last flight, Morrow says, a patient wounded in a roadside bomb explosion nearly flatlined.
"By the time we'd landed, we had brought him out of it," he says, "but those were some tense moments."
Most of the patients aren't in such dire shape.
"We actually get a lot of sports injuries," Morrow says. "Guys who sprain their ankles playing volleyball or whatever."
Only about a fifth of the 5,805 patients transported on these flights in the past nine months were wounded in combat. Many of the rest are returning sick, rather than injured.
Flight medics say they see plenty of ailments that probably don't warrant evacuation at all.
"It's amazing how many medical problems get better, right away, once they know they are going home," says Constance Griffin, a flight nurse. "What can I say? I wouldn't want to be in their shoes. If I'd been through what they have been through, I can't say what I might do."
•••
Shawn Echevarria never imagined he would be in this position.
He joined the military last year, knowing he would be sent to war - even hoping so.
"But now I guess I've just seen too much," says the lanky young soldier from Michigan.
For most of his flight Echevarria sits propped up against the trembling airplane wall, hands folded, silently staring over the top of his wire-rimmed glasses, seemingly right through the rack of stretchers before him.
His injuries, like those of many others who have been evacuated from Iraq and Afghanistan, aren't visible from the outside.
"Personality disorder, they told me," he says.
More than a thousand soldiers were discharged from the Army in 2005 with that classification, which used to be called a Section 8.
The medicine Echevarria has been prescribed seems to be making a difference, but not enough that the Army will let him return to combat, he says.
Sometimes, medics say, the psychiatric patients are so bad off that they must be led into the plane under guard and closely watched during the flight.
"We don't let those ones get close to the emergency exits," one medic says.
•••
The Globemaster touches down—an amazingly soft landing for such a gigantic airplane —at Andrews Air Force Base in Prince George's County, Md. It taxies past several smaller jets, blue and white and marked in black capital letters, "UNITED STATES OF AMERICA."
Andrews is home to a vast number of government jets, used by politicians and bureaucrats in nearby Washington, D.C. The base's most famous tenant, Air Force One, is also here. But military officials say any evacuation flight takes top priority on the runway.
Most patients will spend at least a few days at nearby Walter Reed. Some, especially those who have lost limbs in combat, will spend months there. A small number will die there.
Other flights go on to Brooke Army Medical Center, where the military's most severely burned patients are treated.
And then the plane will return, its cargo bay full of helicopter rotor blades, spare Humvee tires or other supplies needed for the war, its seats filled with passengers on their way to the battlefields.
The gear will be offloaded. The passengers will disembark. A new row of stretcher stanchions will be erected. And another group of patients will be lifted aboard.
"They'll see us," says medic Stephanie Miller, "and they'll know they are going home."
