Bend ER doc returns from trauma work in Iraq

‘You just can’t believe what we’ve seen’

By Tara Bannow, The Bulletin, @tarabannow

Sitting in a coffee shop last week, Dr. Cornelius “Woody” Peeples suddenly found himself uncomfortable with the serene stillness that draws people to Bend. It was a characteristically chilly spring morning on the west side, silent save some cars passing by, the occasional goose honking overhead.

It was nothing at all like Mosul, where Peeples had just spent a month amid violence and death.

“Bend is so quiet,” he said. “It’s like going from ‘Mad Max’ to ‘Downton Abbey.’”

Peeples pulled up a short video on his laptop shot from an abandoned home in Mosul where he treated patients.

The video pans over what looks to be a post-apocalyptic cityscape. There are buildings in shambles, billowing black smoke, graffiti and near-constant automatic gunfire. Iraq’s second-largest city is the site of a massive, monthslong battle as Iraqi forces and their allies, including the U.S., strive to liberate it from the militant Islamic State, which took control in 2014.

“You just can’t believe what we’ve seen,” Peeples said.

The emergency physician arrived there in early March. He volunteered with NYC Medics, a nonprofit aid group formed in 2005 by a small group of New York paramedics that’s known for its ability to be nimble and thrust itself in the middle of action rather than in areas of relative safety.

He learned about the group from a friend he met in Sierra Leone, where he volunteered at the height of the Ebola epidemic.

Peeples and his team provided emergency trauma stabilization to soldiers and civilians alike. His patients — sometimes arriving by the dozens after mortar blasts — showed up with missing limbs, gunshot wounds and broken bones. One patient who’d been tortured by IS showed up with all of his ribs broken and his teeth pulled out.

Often, the team treated families that had been shot by IS snipers as they tried to flee the city. Peeples recalls a mother and son brought in after a mortar round crashed into their house. The mother was screaming; Half of one of her legs had been torn off. One of the son’s feet was hanging by a thin piece of flesh.

“I will never lose the images of these people,” he said, “and that’s just one hour of one day. There were many, many other people. Some who came in and died in my hands.”

Gregory Davenport, a physician assistant from Shelby, North Carolina, who worked on Peeples’ team, said it took him days to adjust to the number of gunshot wounds and blast injuries the clinic was seeing.

“The initial shock of the mass casualties that came in was, I would say, heartbreaking and overwhelming,” he said. “I’ve got 25-plus years of ER experience and all I could do was just stand there and try to think.”

‘We cannot stand by’

Groups such as Doctors Without Borders have set up hospitals in and around Mosul, but they can be anywhere from 20 minutes to three hours from the battle’s front lines, Peeples said.

Peeples and his team, by contrast, try to post themselves as close to the action as possible to provide immediate trauma care — stopping blood flow, controlling pain, placing chest tubes — to people who would likely die otherwise. Often that means quickly setting up and breaking down makeshift clinics in abandoned homes or other buildings as they follow the front line, which is currently moving north along the Tigris River.

The majority of combat deaths are immediate, Peeples said: Someone is shot in the heart or has a severe head wound from a blast. A smaller proportion of combat deaths — about 10 percent — happen later on. They were survivable.

“They die but don’t necessarily have to,” Peeples said. “Those are the people we’re targeting to try and save.”

Once patients were stabilized, they were taken to hospitals in the back of vans being used as ambulances. The transfers were very unsafe, Peeples said, showing photos of vans covered in bullet holes. One van had a baseball-sized hole where a 20-millimeter shell had entered just above the wheel on the front passenger side, narrowly missing a passenger’s legs.

The battle to retake Mosul by the Iraqi military and its allies began in October. It is supported by roughly 5,000 U.S. troops, mostly by providing training and other logistical support, then-Pentagon press secretary Peter Cook told reporters at an Oct. 17 news conference.

Cook emphasized the difficulty of the military operation, the most significant yet in Iraq, due to the up to 5,000 IS militants in Mosul. Other organizations placed the number even higher.

“We know that they’ve had two years to dig in, to build defensive systems, to plant (improvised explosive devices), to do what they can to make life more difficult for the Iraqi security forces, certainly to make life more difficult for the people of Mosul,” Cook said.

NYC Medics sent its first team of volunteers to Mosul in February. Within the first two months, the volunteers had treated 438 people, a spokesperson for NYC Medics wrote in an email. The organization plans to keep volunteers there at least through August. Since forming more than a decade ago, NYC Medics had been responding to natural disasters such as earthquakes. Iraq is its first war zone.

“We cannot stand by while people die because the appropriate medical care is not available,” Kathy Bequary, the group’s executive director, wrote in a statement.

‘Hiding amongst civilians’

In Mosul, IS fighters live alongside civilians and often use them as shields. If families try to flee the city, militants shoot them. They also don’t wear uniforms, so it’s nearly impossible to tell which side someone is on, Peeples said.

“They’re fighting in a cowardly way,” he said, “Hiding amongst civilians. If they fought in a conventional war, they would lose.”

The United Nations estimates 400,000 civilians are still trapped in the western part of the city amid the fighting. Iraqi forces have overtaken the eastern side, and civilians are beginning to move back.

Peeples studied Arabic for the past couple of years, enough to be able tell patients the important things: You’re in a safe place. You’re protected. You’re not going to die. The keys on his laptop keyboard have Arabic letters on them.

He won’t soon forget the look he would see on the faces of bomb blast survivors.

“They are completely blank,” he said. “They’re dead but they’re alive. They just stare into the distance and you cannot get their attention.”

The same went for children. Peeples initially was struck by the fact that, even after witnessing horrific violence, they would never cry. They would just sit on the exam table, wide-eyed, and stare.

“Their eyes were like glazed over,” he said. “We couldn’t get them to react to anything.”

When it comes to kids, Peeples thinks it’s more than just shock. War has been their entire lives. Nearby automatic gunfire in the U.S. would prompt any 5-year-old to duck into a doorway or hit the ground. In Mosul, he said, they don’t stop playing.

In a country that knows nothing but war, Peeples isn’t optimistic that Iraq will be able to regain a sense of normalcy. War creates a war economy. Changing that would require a re-education of the entire society, he said.

“They will become the next generation of people who know nothing but war,” he said.

There is still hope, however, and it lies in unconditional kindness, Peeples said.

Good care in tough places

Peeples’ ability to stay calm and collected during intense moments served as the “cornerstone” of the team’s success, said Davenport, a dean at North Greenville University and a disaster medicine instructor.

“He was the air traffic controller, and I’m the pilot who is kind of freaking out because I’ve got a malfunction on my plane,” he said.

It’s the type of environment Peeples, who turned 51 in Mosul, has sought throughout his career. On top of his already fast-paced job as an emergency physician at St. Charles Bend, he has served as a medic on a tri-county police tactical team for the past 15 years. That means he’s in charge of treating patients who are injured during arrests of extremely dangerous people, including hostage situations, barricaded suspects and active shooters.

Until a year ago, he served as medical director for Des­chutes County Search and Rescue, which rescues hikers injured in the wilderness.

“The challenge is to bring really good medicine to very difficult places and to take care of people who need it in places where other people either wouldn’t or couldn’t do it,” he said. “That’s always been my focus.”

That said, Mosul took it to another level. Everyone on the team had their own way of coping. For some, it was joking around. For others, smoking. For Davenport, it was looking at family photos. Peeples exercised.

There weren’t distinct hours when volunteers were on and off the clock. They could sleep, but had to wake up at any moment if a patient was brought in.

“In a war that doesn’t discriminate between a combatant and a civilian, it also doesn’t discriminate between daylight and nighttime,” Davenport said.

Both Peeples and Davenport said they hope to return to Iraq.

Peeples’ wife, Dr. Fran McCabe, is also an emergency physician at St. Charles Bend and a colonel in the U.S. Air Force. They have two sons, ages 18 and 19.

Peeples said he went to Iraq in part to show that Americans do care, that they don’t all view the Middle East as a place to be avoided. He also wants to dispel the misconception that everyone there is hateful and radicalized.

“I did not meet a single person there that showed any animosity or anything other than gratefulness toward us,” he said. “There is no massive, anti-U.S. sentiment that I experienced while I was there.”

— Reporter: 541-383-0304,

tbannow@bendbulletin.com

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