Thousands of American and Iraqi casualties have been treated at the American military hospital in Balad, Iraq. Many of the recent casualties were Iraqi police and soldiers. But the hospital also treats civilians and even insurgents, offering the same care that an American soldier would receive. A doctor oversees operations in the emergency room at the American military hospital in Balad, Iraq. It is the busiest military hospital in Iraq, seeing hundreds of patients a month from all over Iraq, both military and civilian. 
ROBERT SIEGEL, host: More than 2,300 American troops have been killed in the war in Iraq, and 15,000 have been wounded. Many have been grievously disfigured by roadside explosives and car bombs. Those who survive arrive in daily, often hourly helicopter loads at the U.S. military's medical center in Balad, north of Baghdad. NPR Pentagon correspondent John Hendren recently spent several days there, and he has a report. A note: This report contains graphic descriptions that some listeners may find disturbing.</s>ROBERT SIEGEL, host: JOHN HENDREN reporting:</s>ROBERT SIEGEL, host: When you arrive at the U.S. military hospital at Balad, you start here, on a bustling helicopter pad on the U.S. military's busiest air base anywhere. Then you roll under the canvas of a tented emergency room where thousands of wounded American and Iraqi troops have come this year. Some days there are more than two dozen. On a recent day, not a particularly busy one, there were 14. Typically more than half are Americans, like this 101st Airborne Division soldier stifling the sting from a hole in his right leg.</s>Mr. PATRICK MEYER (101st Airborne Division): My name's Patrick Meyer(ph).</s>HENDREN: What happened to you tonight?</s>Mr. PATRICK MEYER (101st Airborne Division): We had a gunshot wound, and I was just doing my part of the role, doing my job.</s>HENDREN: Increasingly, as Iraqis move to the vanguard of confrontations with a persistent insurgency, the patients are Iraqi police and soldiers.</s>HENDREN: Four Iraqi soldiers are carted in from a seemingly unending caravan of Black Hawk and Chinook helicopters, their figures riddled with shrapnel from a rocket-propelled grenade attack.</s>HENDREN: When things are serious, and they usually are, patients in the ER are rolled the hundred yards down to one of the shipping containers that serve as operating rooms at the far end. That is where an Iraqi police officer ends up after a local hospital botched a surgery to repair the damage from an insurgent's bullet. His American surgeon, Army Major S.P. Bowers, says the injuries are often extensive.</s>HENDREN: Major S.P. BOWERS (U.S. Army surgeon, Iraq): The constellation of injuries is unlike anything we've seen. Every once in a while, a patient will have what we call the Balad special, which means that we'll have sometimes three or four surgical teams operating simultaneously. So we have to all cooperate with each other and stay out of each other's way and everything.</s>HENDREN: Less than an hour into his surgery, the operating room gets crowded. Next to the Iraqi policeman who's been shot by an insurgent, the nurses roll in a suspected insurgent apparently shot by an Iraqi policeman as he tried to plant a roadside bomb. Beneath blindfolded eyes and plugged ears is a grimace of agony. Urologist Jay Bishoff(ph) shows how a bullet designed to rip through flesh has torn a fist-size hole in his leg and shredded his genitals.</s>Dr. JAY BISHOFF (U.S. Army urologist, Iraq): And this is a serious injury. I think there a lot of places where they'd go ahead and just amputate this. But we treat all the patients the same. And if this was an American soldier, we'd give him a chance to save his penis. And we're going to give him that same chance. So we're going to do all the reconstruction just like we would any other patient.</s>HENDREN: Major Steve Resnick, a Reservist surgeon from Kansas who's come to the OR to observe, says the patient could have it worse.</s>Major STEVE RESNICK (Army Reserve surgeon, Iraq): This guy, unfortunately, because of his, you know, the environment in which lives, the country in which he lives, he'd never have a quality of surgeon that he, that he's getting exposed to today.</s>HENDREN: Do you find that ironic?</s>Major STEVE RESNICK (Army Reserve surgeon, Iraq): Tremendously ironic. Somebody who is experiencing the best the U.S. has to give after trying to create more death and dismemberment.</s>HENDREN: Most urban ERs deal with a lot of blunt trauma. But here the surgeons try to repair bodies riddled with shrapnel and bullets. Those with the worst wounds are called Humpty Dumpties by a staff that can't always put them back together again. The patients who survive, and more than 96 percent of those who make it to Balad do, end up down the hall, in an internal care unit. Major Beth Ivers, a Reservist nurse, gives a tour, stopping at the bedside of a wounded Iraqi.</s>Major BETH IVERS (U.S. Army Reserve nurse, Iraq): His injuries are the result of an IED explosion. He was literally peppered with shrapnel down the entire left side of his body, from his head to his toe. He has wounds, as you can see, in his face, which go all the way down the side of his body. This gentleman did lose both of his eyes in this explosion. So he will no longer be able to see, obviously.</s>HENDREN: Some of the medical staff have made considerable sacrifices to get here. Major Hans Bachen(ph) is a neurosurgeon who gave up a lucrative practice in August and joined the Army for a fraction of his salary.</s>Major HANS BACHEN (U.S. Army neurosurgeon, Iraq): I was in a private practice in Tacoma, Washington, and it just wasn't what I was interested in doing. And wanted to do something that I thought made more of a difference.</s>Major HANS BACHEN (U.S. Army neurosurgeon, Iraq): I realized shortly after joining that it just didn't make me want to come to work in the morning. The salary wasn't enough.</s>HENDREN: Some days here, there is little reward. In the four days after the torching of the Shiite Shrine in Samara set off factional violence last month, the staff at Balad lost several badly wounded patients. The nurses in particularly took it hard.</s>HENDREN: Lieutenant Colonel Susan Jano remembers one soldier in particular.</s>HENDREN: Lieutenant Colonel SUSAN JANO (United States Army nurse): The guy from the chopper crew just, like, walked out with this soldier in his arms and just handed it to one of the pad folks. And when they turned and ran, his foot fell off. And, so when they got him to the emergency room, they had worked on him and he had a, the patient expired in the emergency room. And then they had to go back and look for the foot.</s>HENDREN: Major Linda Stanley recalls two soldiers killed by a roadside bomb.</s>Major LINDA STANLEY (United States Army nurse): I cleaned a trail of blood from the ER to the OR and actually, I thought to myself, somewhere in the states is a mom or a dad that has no idea they lost their son tonight. And, uh, there's just a lot of death, and people dying here.</s>HENDREN: Lieutenant Colonel Paulette Shank(ph), a nurse anesthesiologist, says a spontaneous grief counseling session began with a nurse who was haunted by a fallen Marine.</s>HENDREN: Lieutenant Colonel PAULETTE SHANK (United States Army nurse anesthesiologist): She can't sleep at night. She hasn't been able to get through one night yet since that one night where you had three deaths.</s>HENDREN: And then you heard the next person who talked about her husband's in the theater here, and her son has just enlisted and will probably be coming over shortly. The next one talked about the fact that her husband would worry too much if she ever shared the stories of what happened here, so you don't want to tell your husband or your wife at home what you just experienced, because there's nothing they can do.</s>HENDREN: It was interesting because we started with a box of tissues sitting over on the table, and the next thing I know that box went from one person to the next person, to the next, and there wasn't a dry eye in the circle before we ended.</s>HENDREN: The surgeons also band together, coping through a community governed by ritual. They gather Thursday's for Mongolian BBQ at the mess hall. They lounge between procedures on a patio they've dubbed The 19th Hole. They watch light films like Fletch in a housing trailer they're not supposed to have. They've registered it under a bogus name. And they park their dirt bikes at the swamp, a shack behind the hospital where they nap and puff the odd cigar. But sometimes, says Bachen, death breaks the routine.</s>Major HANS BACHEN (U.S. Army neurosurgeon, Iraq): Every time someone dies in the operating room it affects me pretty profoundly, and I don't try to cover that up. I mean, people around me know that I'm very upset. And my simple way of thinking about it is, you must have some kind of a tank, like, for emotions that, like, you can shunt things over there for a while, but it gets filled up. And eventually it has to go somewhere. So, the way I deal with it is I, I experience the emotions at the time and at later times, and I don't try to push them away.</s>Major HANS BACHEN (U.S. Army neurosurgeon, Iraq): I think that if you had cases like this and you were not extremely sad, and frustrated, there's probably something wrong with you.</s>HENDREN: On this day, the wounded policeman and the insurgents survive, and are rolled out of the OR as another copper-load of patients touches down.</s>HENDREN: John Hendren, NPR News.