A day in the life of a Medevac pilot serving in Afghanistan

This is the first in a series of three stories by the author. Currently serving as a medevac pilot 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.

I’m sitting in my 6-by-6 room built of plywood and 2 x 4s. It’s one of ten in this

“Alaskan Tent,” which is a 20 x 35 foot Quonset hut-type structure. The wobbly ¼-inch walls of this room were clearly thrown together by people who’ve never worked in the construction trades.

Damn. This is freakin’ boring. I don’t want you to go to sleep … There were just two explosions in the distance. That isn’t very exciting either, but I figured I’d put it in here since it just happened.

7 June: We go on shift at 3:30 p.m. and stay on First Up for 24 hours. As we’re about to come on shift, a call comes in. Gunshot wound to the shoulder. The crew prior to us takes the call at about 3:10. They spin up and go after the soldier. A short time later they return, sent back by the ground troops because the Landing Zone is too hot. Troops say they need a night extraction. So I sling my gear over my shoulder and trudge to the gator (a six-wheeled go-cart with a truck bed), drop my gear (a survival vest, bullet proof vest, rifle, Aviator helmet bag, and a go bag with all the treats I would need if I was able to evade after a “hard landing”) in it, and go out to the bird.

The Blackhawk’s blades are still slowing, but the breeze they produce does nothing for the heat. It’s 117 degrees. We get to the aircraft and stage it as we always do, and do it fast, so if the guy with the GSW to the shoulder can’t wait until night, we’ll be ready.

At 3:42 p.m. we get a call that there’s another soldier shot, this time in the abdomen, at the same location, and one killed in action. We’re still at the aircraft, and I throw my gear on and immediately start flicking switches. The Auxiliary Power Unit screams to life and I go through the start-up. At 3:45 we’re ready to go and waiting on launch approval. Forty minutes later, 4:25, and we’re still waiting, melting in our seats.

Our command has told us it’s too dangerous to go in without Apache support. But we do have a chase bird equipped with guns, so we’re frustrated. Plus the abdominal wound patient is one of our own Special Forces guys.

After the 40 minutes, we’re told that there’s been another casualty and that the soldier with the abdominal wound has expired, but the Apaches are almost on scene.

I’m sitting here like a kid in the back seat—Are we there yet?—except my phrase is, “Why the fuck can’t we go.” A few moments later, we receive approval and immediately launch. Of course, after waiting all that time at fly (engines full throttle, ready to go), I’m more than eager and jerk the collective with my teeth clenched.

There’s an aluminum box for our extra helicopter blades resting next to the helo. When we take off, the lid catches air, flips wildly in the turbulence, and clangs back to earth twenty feet away. Good thing no one’s running on the track, because it could easily kill them. It’s a big lid.

The site is only 20 kilometers away. I give her everything she has and we’re there in what seems like seconds. The ground personnel tell us to hold to the north as they’re trying to coordinate how to get all the casualties into one suitable location. The radios are overwhelming. Thank god for Bernie; it’s a good thing I’ve got such a calm, competent pilot-in-command handling that.

A couple minutes later they give us a new grid and say that one patient is there and another a few hundred meters to the north and that they’ll pop smoke for us. They also inform us that when they’d come in that morning, they’d received rocket-propelled-grenade and small-arms fire and that there’s really nowhere to land since there are boulders everywhere.

On our way in we tell chase that they’ll come in and pick up the dead after we’ve left with the wounded. They also have some goodies to drop off for the Special Forces guys. We circle around from the east for an approach to the north (winds have been predominantly from the north) and as we come around, we see the smoke and turn toward it.

On our approach we start noticing a lot of people with AK-47s on the hilltops, and some in the village, none of whom are wearing uniforms. The crew immediately starts chattering about the possible enemy and the upcoming landing. They were right about the boulders, so I come to an eight-foot hover. My crew says that there’s a boulder underneath us but if we slide right, we can possibly land. Then they say, “Hold where you’re at. The ground troops are already under the disk.” So I hold the hover while a huge Special Forces guy clean-and-jerks the wounded G.I. on board. We have our fueler, Shawn, in the back, and he and the crew chief, Dan, pull the wounded soldier in, shut the door, and clear us forward.

As we pick up, there’s a plume of green smoke a couple hundred meters to our twelve o’clock in a dry riverbed. I tell Kevin, our medic, to stay outside, meaning that he shouldn’t start working on the wounded soldier yet.

We come into the riverbed and it’s dusty but not “brown out.” We’re more worried about the ruts and ditches in the riverbed. I set down with only the tail wheel and the left wheel down and hold the right one off the ground. I don’t want to deal with doing a slope landing and figure we won’t be down that long. I’m right. And off we go.

I ask the crew if I have room to maneuver since there’s a threat, and Dan says,

“Do your thing.” So I get up some speed and start careening though the hills. Once we’re at altitude, we do a slow orbit, waiting for chase to pick up the KIA, and then start heading back home.

After we’re back, I walk over to the Forward Surgical Team (FST). They’re working on one of the patients, performing an exploratory laparotomy, and, being a surgical technician in civilian life, I desperately want to scrub in and help. But the area we were just at is popping off and I know that it won’t be long til we get another call.

The surgeons are asking if they can get someone to scrub in. “I can,” I say, “but I may have to leave at a moment’s notice.” They reply that they need someone for the next hour or two, so I leave feeling defeated.

I need a shower even though I’ve already had one earlier in the day. Our shower is an outdoor one made with 2 x 4s, plywood, and a 500-gallon tank that we “acquired.” All of the pipes and parts were found around the Forward Operating Base, minus the inline heater. This shower is our pride and joy. After some food and a shower I’m watching the movie, The Professional. I’d watched it a long time ago and had remembered liking it. Unfortunately, what I hadn’t remembered was the creepy sexual undertones between the hitman Leon and a 12-year-old Queen Amidala.

After that, we line up to pay our respects to the dead soldiers. This is the fourth time in the few months we’ve been here that we’ve had such a ceremony. It’s an honor but it’s not easy. Shove those feelings into the locker to deal with later so we can do our job now. No time to dwell on mourning, but I can’t help it. And now my mortality is center stage.

Back inside to start some Grisham book that my Aunt Joyce sent me.

9:34 p.m.: “Medevac, Medevac, Medevac.” Off to the races. It’s 75 yards to our bird. My headlamp bounces like a pinball as I jog. The path is loose river rock in various sizes from pea to bowling ball, so a sprint will surely mean a sprained ankle if not a concussion.

I get to the aircraft and start slinging on my bulletproof and survival vest. Dan announces that the gust lock (a device that prevents the blades from turning) is pulled. I jump into my seat and flick the battery switch. A blue light bathes the cockpit. I’d come out earlier and set her up for night flight. We’re off, going back to the same area, except to a different LZ, and now it’s night.

The moon’s a waxing crescent and the skies are clear. I notice I’m getting a little more altitude than I want but I’m correcting as I fly. We have word there are two critical and two minor injured soldiers, so we’ll take the critical, while chase, outfitted with medical gear and our senior medic, Mark, will take the other two.

We decide that we’ll approach to the north since that’s where the winds were out of earlier, and hope that the long axis of the LZ will also be oriented in that direction. As I approach the LZ, we all notice it’s tight: trees on both sides, and parts of it are terraced. At 10 feet we brown out, losing site of the ground. I pull pitch and announce, “Go around.” I feel the senior pilot Bernie pull back slightly on the cyclic and, as we pop out of the dust cloud at 50 feet, I can see that we’re barely clearing a large tree in front of us. I turn right, climbing and accelerating, the terrain jutting up on both sides.

In the calmest voice I can muster, “Guess it’s a dust landing. We’re going to have to come in fast.” There are a couple ways to combat dust: either come down fast vertically, or keep your speed up horizontally and outrun it. Whatever you do, you have to get the power in early. If you pull any power at the bottom you are screwed. A dust landing into a confined area—I’ve never done that before. I mean, sure, during flight training we practiced, to a point, minimal ground run, but not trees on every side and a partially terraced area.

Of course, right now I’m not thinking about that. Just clear right, coming back around. The Intercom System starts getting super busy. The crew is trying to make sure I put the bird where she needs to be.

Kevin, the Medic, tells me, “Go right.”

“No, don’t go right,” Dan responds. “Hold altitude. Crossing the tree now. Clear down.” We’ve found the spot.

The crew chief continues, now calling out the dust conditions. “Dust at the tail (10 feet off the ground), dust on me (3 feet off the ground), dust on you (tail wheel is on the ground).”

Poof! We’re blind, front wheels just off the ground.

Suddenly: “Go around!” Bernie shouts.

I yank the stick, pull the guts out of her. We have a 40-foot tree in front of us and we’re 10 feet lower than the last time. Just as we clear the cloud, Bernie says, “You had it! I’m just gonna keep my mouth shut this time.”

Somehow I’m not rattled.

“Let’s let the dust settle for a minute and we’ll go back in,” Bernie says.

A minute later we come back in, same chatter on the ICS, except this time I’m determined to put it down. We find the spot again, just barely. The tail wheel comes down on the lip of a terrace and slips off as we continue forward and down, giving us a small jolt.

As the dust clears, Kevin gets out on right-hand side to go find the wounded soldiers. Meanwhile, on the left side patients have been carried onto the terrace and are being thrown on.

Where’s Kevin?

Shawn is on this flight again. Everyone likes him. He’s one of those goofballs who walks around wearing only flip-flops and his towel over his shoulder. His way of letting off steam and getting a reaction. He’s a real professional and has five Military Occupational Specialties, and I hadn’t realized that one of them was Medic. He starts assessing the casualties and treating them.

All we can think is, “Where’s Kevin?”

Thirty seconds can be an eternity.

“There he is!” He found the other wounded and is staging them for the chase bird. Kevin hops on and away we go, straight up, clearing the tree, then snaking to altitude. We complete one orbit as chase lands to pick up the other two, and drop off more goodies. Of course, Jason, the pilot of the chase bird, sticks the landing the first time.

We were Warrant Officer Candidate School classmates. Go green class! Just as I look down and see the big plume of dust as the chase bird puts down, I hear Kevin say, “Holy shit!”

This is very unlike Kevin, who’s seen the worst of it while we’ve been here and has always “kept his cools,” as my instrument instructor pilot Mr. Blade used to say.

“What’s up, Kev,” I ask.

“I just put my finger into this guy’s skull.”

“We’re heading back,” Bernie says.

I make the call to chase that we’re not able to wait and are heading back. Again I push ol’ 438 to her limit. I start slowing back about three kilometers out and that’s just not early enough; still at 150 feet and 60 knots when we get to the FOB. I say I’m going to do a quick circle to the north to lose the rest of this altitude and airspeed. I can see

Bernie’s head shake in disapproval, and I feel like I’m back in flight school. We land and the FST meets us with their gator. Back at Reggie’s Place. It’s our 20-by-10 shed, named after some guy named Reggie who cut his finger off building the place. It has all our snacks, toiletries, games and movies. We kick back and talk shit about the day’s events.

11:59 p.m. on 7 June: A call comes in to transfer 3 of the 6 patients that had come in and we scramble out to the aircraft once more.

We’ve flown this route many times over the last couple of months, and just two days prior, flew it in the worst conditions I’ve ever flown in, “red illum” (meaning, the moon angle or brightness is such that it provides no help) with poor visibility. The chase crew had a hard time that night, too. Everyone in their bird, that night, had some sort of spatial disorientation.

At 11:59 our moon has set and we’re embarking on another red illum trip, but since we have three critically injured patients, we take another ship. So now instead of two crews battling Spatial D, we have three.

Bernie asks if he can fly. Like I’m going to say no to the man who has more time flying a helicopter than I do driving a car. “Of course. I’ve been being a stick-pig all day.”

Thank god the visibility’s clear. There isn’t any light to help us except the stars, but without the haze it makes for a comfortable and enjoyable flight. I get to play PC and make all the radio calls. The place we’re going to, where we do our transfers, would be a little sketchy if it weren’t for the fact that we’ve flown in there 50 times already. It’s a fairly small village, and the runway is literally the main drag of the town. When we come in, the Spanish, who are in charge of this area, close the street and post guards. We land and transfer our patients to the other hawks. They take off, transferring the wounded soldiers to a larger facility that can treat them.

We go get gas, then take off. I’m flying on the way home and it’s amazing the difference two days make. I can actually see ridgelines and the ground most of the time. Now, don’t get me wrong. Six months ago, flying like that would have scared the hell out of me. But after the other night, it’s almost comfortable.

We land and shut down, securing the bird.

I try to rest but still can’t sleep. Back on Reggie’s porch, still recapping and laughing through gallows humor. I wouldn’t call it hollow laughter. More like laughter echoing through hollow chambers.

I fall asleep at 3:00 a.m.

6:57 a.m.: I’ve fallen asleep with my clothes on. That’s good.

“Medevac, Medevac, Medevac.”

Disoriented, clumsy but quick, into my boots, and out the door. Searing heat and blinding light punch me in the face. I hold my arm up, trying to block some of the rays. I haven’t laced my boots and my heels keep slipping in and out as I trot across the river rock.

“Gust is out,” Dan yells. How the hell does he keep beating me here? Blackhawks have a unique smell: burlap, motor oil and anxiety. It’s funny how this random shit wanders through my mind.

The P is screaming; Bernie climbs in and hands me the coordinates and information for this mission. We call this info pack a nine-line. I try entering it into the GPS, but the screen won’t brighten back up from the night before. See, when we fly at night, to keep our eyes adjusted to the dark, we dim all of our instruments down.

Instead of wasting time, Bernie tells Jason that he’ll lead while we troubleshoot. Chase flies fast and we skim the hilltops. We come to a FOB that I’ve been to many times before and could have found without the GPS. Just as we are on final approach, the GPS brightens up. We land. Kevin puts on his witch doctor mask and does his dance, and we’re home before we know it.

To nap or not to nap, that is the question. The patient’s pretty bad off. After surgery he’ll need to be transferred.


9:36 a.m.: Here we go again. Transfer our patient at the usual “tail to tail” in the little village.

Back home, just in time for lunch, then off shift at 3:30 p.m.

In summary: Five calls, six patients. Two deceased. 7.3 flight hours. 117 degrees. 24 hours.