The Marine had a heart rhythm, but it was disorganized and soon degenerated into ventricular fibrillation. Murdock and the other surgeons took turns performing intermittent CPR, each man grunting as he compressed the chest. They watched an arterial monitor, which showed the Marine's arterial line rising with each compression but then falling right back when each round of CPR halted.
The doctors carried on for many long minutes, compressing the chest and pumping in more warmed blood and fluids. Still, the Marine was not able to sustain his blood pressure or pulse. Medical technicians rushed into the room with fresh lab results on the patient's blood, and each time the numbers were worse.
The surgeons reviewed their efforts. They analyzed the lab numbers one more time. They looked at the monitor. It showed a flat line. There was no pulse.
It was Murdock's call.
"Is there anything we're missing?" he asked the surgeons and anesthesiologists. "Is there anything else we can correct?"
Each man shook his head.
"Unless anybody objects, the best thing would be to call it -- and not continue any further care," Murdock said.
The doctors and nurses peeled off their gloves and scrubs and walked from the room, beaten and drained. Murdock felt miserable and empty. He went to fill out the death certificate and recorded the cause of death: hemorrhagic shock.
The medical technicians stayed behind, surrounded by deflated blood bags and discarded dressings. They gently wiped and cleaned the body of the young Marine for his funeral, for his family, for everyone who had tried to save him.
Lance Cpl. Ryan Buchter, the Marine injured by a grenade, had an air tube down his throat as he lay in one of the Balad hospital's trauma bays. Bandages obscured his nose and eyes. There was tape below his mouth, and the last four digits of his Social Security number were written in black ink across his forehead. He was in shock and still bleeding.
Doctors ordered digital X-rays, then decided that Buchter's leg needed a "washout and redress" procedure to keep the deep wound free of infection, a leading complication in the deaths of troops in Iraq's septic environment. Buchter was rushed into surgery.
Lt. Col. Jim Keeney, an orthopedic surgeon, irrigated the 15-inch leg incision and packed it with gauze. He excised decaying tissue from Buchter's right hand and removed shrapnel from his nasal cavity.
There was a low whirling sound as a "wound vac" pumped blood and fluids from the wounds to help them drain. The fluids gushed through a plastic tube and emptied into a plastic container on the floor.
The surgeon and nurses worked methodically, exchanging instruments and cutting rolls of gauze. Buchter, swathed in blue surgical drapes, his leg tied to the ceiling with muscles and tendons exposed, seemed more like an object on an assembly line than a strapping former football player.
"You always have to remember that this is a person you're working on," Keeney said as he operated, "and what you're doing right now will affect him the rest of his life."
Nurses wrapped Buchter's wounds with fresh dressing, then wiped blood and rust-colored antiseptic from his face and leg. They untied his leg and rolled him toward the intensive care ward.
Buchter remembered nothing of the surgery.
He had suffered serious muscle and nerve damage to his leg, Keeney said. The shrapnel had probably reduced the strength of the limb by half, he said, but Buchter might be able to rebuild it through months of physical therapy.
"The good news," the doctor said as Buchter's gurney disappeared into the next tent, "is that he'll keep his leg."
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About This Series
More than 17,000 American troops have been wounded in Iraq since the U.S. invasion in March 2003. This series, which began Sunday, tells the stories of five men injured during the same week last November. Reporter David Zucchino and photographer Rick Loomis followed them through a system of military medical care more advanced than in any previous conflict. Loomis also contributed to the reporting.
In Tuesday's Times: Back home.
More Online
Find Sunday's installment, an interactive photo gallery and a reader forum at latimes.com/wounded.
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On the Web
Hear the voices of the wounded and of the medical crews working to save them. See an interactive photo gallery. Share your thoughts at a reader forum. All at latimes.com/wounded.
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(BEGIN TEXT OF INFOBOX)
In harm's way
The 16,653 Americans wounded in Iraq from March 19, 2003, to Feb. 4, 2006, were most often white, active-duty enlisted men younger than 25 in the Army. Those wounded:
Service:
Army 65%
Marine Corps 32%
Navy/Air Force 3%
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Sex:
Men 98%
Women 2%
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Rank:
Enlisted 94%
Officers 6%
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Age:
24 and younger 48%
25-30 22%
31 and older 20%
Unknown 10%
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Race:
White 62%
Black 9%
Latino 6%
Asian/Islander 2%
Other 21%*
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Component:
Active duty 74%
National Guard/Reserve 26%
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* Multiple races, American Indian, Alaska Native or unknown
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Source: Department of Defense.
