His surgeons were confronted with a difficult decision. The shrapnel would have killed Foster if it had penetrated another few millimeters. Trying to remove it surgically might also kill him, or leave him with serious neurological complications.
Foster could hear the surgeons discussing whether to try to go after the shrapnel. They mentioned the risk of a stroke or hematoma. Foster understood his medical situation. He was the convoy medic, and he had been a hospital nurse before joining the Army two years earlier.
Foster sat up. "All things being equal," he told the doctors, "I'd strongly request that you take it out."
Maj. Greg Wiggins, a neurosurgeon, and Maj. Chris Connaughton, a general surgeon, decided to try to remove the object through microsurgery. The shrapnel had left a remarkably clean wound track. The entry was a perfectly round hole surrounded by a circle of pink welts on Foster's sunburned neck.
In the operating room, Foster joked with the anesthesiologist just before he went under: "If I say, 'Bartender, round two,' hit me again."
One of the surgeons held the wound open with a retractor while the other probed inside with a hemostat. There was a sucking, gurgling sound. Suddenly, Connaughton withdrew the hemostat. Its jaws held an ugly piece of gray shrapnel.
"Nice," Wiggins said.
The two surgeons bumped fists in celebration. They were just five minutes into the surgery.
They flushed the wound, cauterized it, tucked a flap of skin back over the hole and packed it with gauze. It was over. One of the nurses rinsed blood off the shrapnel with peroxide and dropped it into a plastic pill container as a souvenir for the wounded medic.
Foster was promised another souvenir the next day. Lt. Col. Keith Knudson, an F-16 pilot, visited the ward and promised Foster he would drop a bomb on his behalf. The pilot was providing close air support for Foster's airborne unit.
That evening, Foster received an e-mail photo showing a 500-pound bomb marked with a message: "Return to Sender. Yours Truly, SPC Corbin Foster, 101st Airborne."
The next night, medics carrying a critically wounded Marine burst through the rear doors of the trauma room. The young man was unconscious. A roadside bomb had lacerated his spleen and broken his left leg in two places. He was in shock and losing blood.
Surgeons at an aid station had removed the Marine's spleen. They also had stapled his bowel to limit the damage there, and had packed his abdomen with dressing to control his bleeding. The two wounds on the Marine's leg were still bleeding despite a tourniquet and heavy bandaging.
Maj. Alan Murdock, the chief trauma surgeon, examined the wounds. He ordered the Marine taken to the operating room. Murdock had been at the hospital only two months, but he had treated enough critically wounded soldiers and Marines -- and emergency room patients at trauma centers in the U.S. -- to recognize instantly that this man was near death.
The Marine's blood pressure had dropped precipitously. His pH level -- the acid-base ratio in his bloodstream -- was 6.6. As his muscle and other tissue died, his blood grew more acidic. A level under 6.8 is usually fatal.
In the operating room, Murdock turned to three anesthesiologists and two surgeons gathered with him around the surgical table.
"If he survives, it'll be a miracle," he told them.
Murdock, 37, has lost count of the number of surgeries he has performed in Balad. He struggles each time to maintain a professional detachment, to separate his emotions from his intellect.
"I try not to think about the patient being a person sometimes," he said later, as he recounted details of the Marine's surgery. "If you're thinking about him as somebody's son, you know, it's very difficult to try to be emotional and yet take care of the patient. It's not possible."
The Marine was being kept alive by cardiac stimulants dripped into his system through a catheter inserted into the vein beneath his collarbone. Murdock ordered blood and fresh-frozen plasma. Doctors and nurses bolted from the room to fetch the fluids from an adjoining tent.
The blood and plasma were run through a machine that warmed the fluids. The Marine continued to bleed, and the doctors and nurses kept running down the corridor for more blood -- 10 units in all. Murdock added a clotting factor to slow the bleeding.
Over the next 90 minutes, the Marine fought for his life. An older man, or any man not as superbly conditioned as this one, Murdock thought, would have died by now. He was surprised the Marine had survived this long. His pulse and blood pressure would inch upward for a few moments, then crash back to critically low levels.
