If Afghanistan is hell, home is heaven to this Blackhawk pilot. A former Sacramentan offers his first-person wartime account.

In his downtime from flying, Paul Graham helps out in surgery. Seen here in scrubs, Graham is a surgical technologist in the civilian world.

In his downtime from flying, Paul Graham helps out in surgery. Seen here in scrubs, Graham is a surgical technologist in the civilian world.

Photo By SGT. Zachary Carpenter

Currently serving in Bala Morghab, Afghanistan “the middle of nowhere, northwest side,” Paul Graham, 35, lived in the Sacramento region from 2000 to 2005 until he was deployed to the Middle East as a combat engineer. He now lives in Reno, Nevada, with his wife Holly and their four children, Keenan, 15; Jonas, 10; McKenna, 8; and Ava, 6. Graham—a surgical technologist in the civilian world in addition to being a helicopter pilot in the National Guard—hopes to return from Afghanistan in time for Christmas.

It’s July 13 in the evening and the smell of Kandahar, Afghanistan, is making me almost dry heave. See, when the forward operating base was built here, it was fairly small and the sewage pond was just outside the wire. That was 2001. Now, 10 years later, the base has grown, and the army never saw fit to move the pond. So the cesspool now sits in the middle of the base, bubbling like the La Brea Tar Pits. The transient quarters are in the middle of the base just downwind of the pond.

I walk into the VIP quarters and search around … no beds anywhere. The transient tent is suitably named Hotel California.

It’s huge—as large as a football field. A wall in the middle of it separates the VIPs from the other transients. I’ve never considered myself a VIP, but if it means a more comfortable circumstance, then I’ll take it.

I’m smoking a little more than normal. Maybe the tar and nicotine scent will block the fecal matter that’s hanging in the air. The smell is so bad that when I breathe in through my mouth, I can taste it. I go around back, hoping that side isn’t full. I haven’t slept in 48 hours. I enter the Hotel California again; there must be 200 sets of bunk beds. The bunks are a foot-and-a-half apart. It looks full. I start searching rows, hoping for somewhere to pass out. There’s one next to the wall. There’s an air conditioning duct directed at my face as I stand next to the bunk. Of course, the air conditioner is broken and it’s hot air blasting me. This particular air conditioner is also three times louder than the others. Super loud, three-foot-diameter hair dryer on steroids, unloading shit particles at point-blank range.

I’m happy to have found a bunk and throw my bags on it, claiming it. I turn to go outside for a smoke and squint my eyes as I go through the wind tunnel. Standing here, I can’t help but think of what a horrible trip it’s been, getting back to hell. It’s at least 24 hours in the air, and then there are refueling stops. In Kuwait, you may have to wait one, two, maybe three days to catch a C-17 into Kandahar.

Kuwait sucks. If Afghanistan is hell, Kuwait is purgatory. There are tons of people, but you don’t know anyone … crowded, but lonely. We’re all waiting to go to heaven or hell. Either way, we eagerly await our chariot. Purgatory is hot … 120 during the day, and it doesn’t cool at night. Someone stole my new iPod and Android phone there. I’m still pissed as hell about it. I wouldn’t be so mad, except that the Android doubles as my camera and was filled with all of my photos from the R&R trip to the West Coast that I just came back from. I hate myself for trusting people. I hate that I will keep trusting them. I wish I’d have downloaded those freakin’ photos.

I’m so upset. But I don’t have anyone to complain to, so I smoke angrily and watch the sun set behind the veil of dust and poo. The rays filter to pinks and purples, and I smile because the sun is right now rising in heaven—home. I’m finally going to sleep. I got a shower first, thinking that it would make me feel better.

A wounded soldier is transferred in Bala Morghab. A medevac helicopter takes off in the background.

PHOTO courtesy of paul graham

Sleep. Wake up. It’s 4 o’clock. My hip is killing me and my arm is asleep. I’m on this mattress that’s just springs covered with stripped ticking. I didn’t even notice how horrible it was when I went to sleep. I turn to my other side and close my eyes. I notice there’s something in the back of my throat. I try to clear it and realize that it’s my uvula. My uvula is the size of a boxer’s speed bag.

I’m fully clothed. It’s 4 a.m. The right side of my body is numb and aches. The poop hair dryer-from-hell continues to blast, my clothes are soaked in sweat, and I can’t swallow due to largest-uvula-in-the-world syndrome.

So I turn on my headlamp and start to read. The only thing that’s been good on this trip, so far, is The Girl With the Dragon Tattoo. I start burning through pages for some much needed relief. I get up at 5, pack my few belongings and go to get coffee. I have a 6 o’clock show at the flight line for a plane to Shindand.

I’m going to spend a few weeks in Shindand, another FOB not far from the border with Iran, flying with the assault dudes so I can build some flying hours. See, Medevac is awesome. It’s the only flying I’ve ever wanted to do, but there’s one drawback … wait around, wait around, wait around … fly as fast as you can … wait around, wait around and wait around some more. A Medevac pilot can end up with less than 100 hours of air time in a year. The assault guys also do a lift mission, dropping off and picking up people and supplies from all of the remote FOBs. The assault pilots can get anywhere between 600 and 1,000 hours in a year. For a seasoned pilot this doesn’t mean much except a sore ass, but for a new pilot like myself, I’m not even able to get looked at for a job in aviation until I’ve logged at least 500 hours, probably more like 1,000. I have around 270; hence, why I’m going to fly with these dudes for a few weeks.

I hop on the company’s bus. Written in the dirt on the window it says, “bang bus.” The Sergeant that picked me up is in good spirits; I give him a big smile and tell him how much I appreciate him and what he does. I’m at the flight line and I notice that my book is missing. I left it. I read almost all of it during this trip, and I only have 30 or 40 pages left. I beg the Sergeant to go back for it. He does it begrudgingly. He pulls up just as I’m going into the secure waiting area. I give him a hug and he looks at me like I’m crazy.

Paul Graham stands in front of his aircraft. For medevacs, the motto is “wait around, wait around … fly as fast as you can … wait around.”

Photo By Sgt. Kevin Imhof

I get into Shindand around 10:30 a.m. I call the company and ask for a ride. When I get over there, I ask where I can put my things. Finally I’ll have a room to put my stuff and I can try to get some sleep. “No, we don’t have any rooms. Wait … you’re staying here?” At this point, I’m starting to get pissed off. They had just given the last room to Sergeant What’s-His-Nuts, who got himself in trouble at another FOB and got sent here so they could keep a closer eye on him. I’m standing with my bags at my feet watching him move into the only remaining room.

“We have a bed in the open-bay barracks.” Seething, I turn and leave without acknowledging that they’ve even been talking to me, my bags strewn all over the ground.

It’s my wife Holly’s birthday. “Remember to call her” … is my mantra.

I wander around, get some food, watch The Time Traveler’s Wife, and feel like I’m him except not as cool. The trip I just got back from was amazing. Two weeks with my family. I close my eyes and remember my kids running on the beach, my wife kissing me, looking into my eyes and holding me, our souls happily intertwining. So many great memories of heaven—family and friends—it makes it all OK. I just noticed my uvula isn’t swollen anymore.

I’m walking back to the company area to get my bags when I see the med birds take off. I’m back at my bags and watching the helicopters disappear in the distance. I see Major B standing next to me and I say, “I’m going to go introduce myself to the people over at the hospital.” In my downtime I’ve been working in surgery up at Bala Morghab, where I’ve been flying Medevac for the last five months. I go into three different tents before I find the right one. There are so many people that I don’t know where to begin. So I just start going up to the first officers that I see and introducing myself with my credentials, “Hi, I’m Paul. I’m a scrub in the civilian world. You guys need any help?”

A few weeks before writing this story, the author spent time “in heaven” on leave with his wife and children in Janesville, a small town 80 miles north of Reno. Left to right is Ava, 6; McKenna, 8; wife Holly; Jonas, 10; Keenan, 15; and Graham.

Photo courtesy of Paul graham

The first few hard bars have a glassy look to their eyes and say, “You’re a what?” I just push past them, mumbling, “Never mind,” and go on to the next. Finally someone says, “Oh, let me introduce you to Captain Curry. He’s our operating room nurse.” I explain to him who I am and what I do for a living back home. Captain Richard Curry has intense eyes; he’s a stout man in his early- to mid-40s. He has dirty blond hair and looks to me more like the supervisor of a construction crew than an O.R. nurse. I finish with my spiel and stand there looking at him. He just says, “Come with me,” in a Texan accent and starts walking away. He’s explaining to me over his shoulder that they have one good tech, but he’s on leave, and the two that they do have here are “dumb,” in his words.

One has only done sterile processing—cleaning the instruments, organizing them and then sterilizing them. The other’s been in the motor pool since graduating scrub school a year ago. Neither one has ever scrubbed a trauma. Richard walks me into the O.R. and introduces me to the two he was just talking about, and then starts outfitting me with crocs, scrubs and protective glasses. The number of causalities they’re expecting keeps increasing … first it was two, then four, now six.

Slipping into the ER, I can see that it’s hopping, with six casualties. There are crowds of medical personnel around each patient, all barking orders, pulling bandages off or putting them back on, starting IVs or hooking up monitors. There’s blood the length of the tent, some new, some old … drips, splashes and smears.

I’m bored and go back into the O.R. Maybe with all the trauma there’ll be a surgery or two. A Lieutenant Colonel comes in and tells me to start opening two tables, then asks me who I am.

She’s an older, black woman with kind eyes and short hair slicked down to one side. I explain why I’m there, and she looks at Captain Curry who gives her a nod of approval. So I direct one of the other techs to open one of the tables while I start on mine.

The first patient has a femur fracture, and I take it. The ER crew suspected some arterial damage but the ortho doc and I are looking at it, and it’s clear that there’s only some venous damage and a lot of blood coming from the bone itself. I’m glad. Trying to do vascular surgery with an orthopedic surgeon is a nightmare. We put on an external fixator (large pins in the top and the bottom of the femur, then special clamps that hold carbon fiber rods and lock in place securing the femur in a traction position). The surgery goes well, even though I haven’t scrubbed one of these ex-fixes in a while. We also treated the patient for compartment syndrome … basically, large cuts on either side of the thigh, opening the fascia. Doing so alleviates pressure that can build due to swelling and bleeding, if not treated it could strangulate the leg, killing it. We just need to dress the leg and put a couple of pins in the wrist. I’ve already washed the wrist out.

Graham, seen here in the cockpit of a Blackhawk, has logged around 270 hours of flying. He wants to log many, many more.

Photo By CW4 Bernard Catanzorito

“Graham, Graham, we need you over here.” I hear the Texan accent coming from across the room. I’ve never scrubbed out of a case before it was finished. “Graham, really, I’m not kidding. You need to get over here.”

I look at the ortho guy. He says, “They need you more than me, I guess.” I break scrub, walk over to the sink, wash my hands, head over to the Texan.

The next thing you know, I’m standing there staring at this volcano. We’re watching it quake, waiting for it to explode. The fear we feel is a toxic vapor that we breathe out and share with one another. We can’t wait for it to erupt on its own. We must act! The volcano is located southwest of the iliac crest. The crater on its peak was formed by a 7.62 mm Kalashnikov round. The number 10 blade cuts though the mountain, unleashing the inevitable eruption.

Blood … more blood than I’ve seen come from anyone … ever. My eyes meet the surgeon’s. This is the first time we’ve met, and it’s for less than a second. Within that moment, we share our terror, our hope and our willingness to fight for life.

I shove a sponge into the wound to buy us a few seconds while we figure out what to do. We have to find the artery, but there’s so much blood that it’s impossible to see. I pull the sponge and the surgeon starts feeling around, trying to find the artery and plug it with his finger. The incision is three inches and the blood comes like a bathtub faucet. We look at each other again and read each other’s minds … this guy is going to die.

The suction is shitty and even a good one couldn’t keep up with this flow. Plus, the kid from the motor pool is the one manning it, and he’s a deer caught in the headlights.

Another sponge is in. The doc slides his hand down the top of the sponge. “I think I feel it,” he says. “See where my hand is?” I grunt a yes and slide my hand behind his, replacing his finger with mine. I feel the hole … it’s big … 2 1/2 centimeters, but at least the artery isn’t completely severed. The surgeon pulls the sponge from under my hand. The bleeding is still there, but not with as much violence as before; however, the quantity is still there. Crap, the vein is cut, too. We repack it under my hand, and the surgeon decides to make the incision bigger.

I start calling for the things that we’re going to need in the near future … prolene, silk ties, the shunts, vascular clamps and loops. I’m trying to set this stuff up in some kind of order in the extended stretch position … my right middle finger plugging the artery, my left hand working feverishly on the table behind me, loading sutures and unstringing instruments.

We pull the sponge and I find the vein with my finger. It’s huge. My index finger tip almost fits inside of it. It’s quite the trick to move your finger and then have the doc get a stitch in the vein before the cavity fills with blood and you lose sight of the needle. We stitch the vein and the doc cuts the carotid shunt (basically, a plastic tube), and rams it into the femoral artery, tying it in place at both ends with the silk ties. The bleeding has stopped and we all blow out the breath that we’ve been holding for the last 45 minutes.

I look at the surgeon, my endorphins kick in and my mood is elevated to an all-time high. On instinct, we hold up our right hands and do a monstrous high five. I almost broke into a little dance.

I still don’t know the surgeon’s name, and it doesn’t really matter. We close quickly and dress the wound.

A quick look at the room in Shindand, Afghanistan where this story was written.

Photo courtesy of Paul graham

An hour later at 10:30 that night, I’m trying to scrub the dry blood off one of the rungs of the litter stand/O.R. bed. The endorphins have left, and I’m stuck with a body that no longer wants to cooperate. I finish with the blood and go to the back to change into my other clothes.

The Texan cherub is talking to me and thanking me for my help. I explain my new living conditions and that I’m about to go move my stuff and get a shower.

“You mean they don’t have a room fur yuh? That’s bullshit,” Richard says. Then he starts ordering the other two scrubs, “Go git me two of those egg crates, a sheet set and a pilla.” He again tells me to come with him and I do as instructed.

The room is bigger than any I’ve seen since I’ve been in this country … all of 7 feet by 8 feet. I mean, it’s still crappy plywood walls and a horrible mattress, but I’m a happy camper. A huge grin comes over my face. Some people would want a certificate or some tin or cloth, but I’m happy with this as my award.

It’s morning and I’ve slept. All is right with the world.

Oh, my God, what time is it? I didn’t call Holly.

It’s 9 in the morning here. That means it’s 9:30 at night the previous day back home. I get up and hurriedly start getting dressed. I can still catch her before she goes to bed.

I can hear Richard talking to the other guys in the common area of the tent. “If Graham wasn’t there, that guy would’ve died.”

I liked that. But I never feel that I do enough. I know it must sound crazy after stories like this. But I never feel like I’ve done enough. There’s something more.

There has to be something more.