Location: Bowdoin / Magazine / Features / 2009 / Dr. Jonathan Martin

The Education of Dr. Jonathan Martin

Story posted February 24, 2009

Author: Mel Allen
Photography: Jonathan Martin

So, which story to start with?

We could begin with this one: young, handsome man with goals and drive makes good. His name is Jon Martin, a high school Nordic ski racer from Rumford, Maine, one of the state’s best. He comes to Bowdoin in 1988, even though his father, brother and sister all attended Colby. Freshman year, he joins a Mountain Infantry National Guard unit from his hometown. He makes friends with members of the Army biathlon team and he’s hooked.

“I had no world view then,” he says now. “I thought the Army was a great way to get to my goal of ski racing.” One weekend a month he trains with his unit. “We were infantry on skis in winter,” he says. The Army offers financial help through college and when Jon, a biochemistry major, decides to be a doctor, through medical school too. Eventually, the Army gets itself a skilled neurosurgeon. A good deal for all. And Jon gets to see how far his ski racing can take him— almost, not quite, to the Olympic biathalon in 1994.

Or do I start where so many stories must about soldiers and Iraq— the morning of September 11, 2001? On that day, Dr. Jonathan Martin, having graduated from the University of Vermont Medical School, and having trained in civilian and Army medical facilities around the country, is a junior resident neurosurgeon at Children’s National Medical Center, a civilian hospital in the nation’s capital. He’s studying a case when the anesthesiologist bursts in. “`Some idiot flew into the World Trade Center,’ he said. “And then a few minutes later a second plane did, and it’s a clear day outside,” Jon remembers. “We were watching on television when the tower collapsed. And then the Pentagon is on fire.”

When the United States invades Iraq in March 2003, Jon Martin is chief resident at Walter Reed Army Hospital in Bethesda, Maryland. The stakes, everyone believes, couldn’t be higher. Jon is living in the suburbs with his wife Amy, a radiologist stationed at Andrews Air Force Base. “We had a lot of faith in Colin Powell, and we felt obviously the government must have had information we did not know,” he says. He sees the first wounded soldiers a few weeks later. “Helping them made you feel you were doing something good,” he says. “We were all feeling good. It’s May. It’s `Mission Accomplished.’ They were clearly the bad guys, and we went in there, and we were going to be greeted as liberators on the streets.”

In 2004, Jon is assigned to Tripler Army Medical Center in Hawaii. “The Army said, ‘OK, you’re trained, now go out and do something.’ It’s the first time I’m completely running the show, and that’s a little intimidating.” In Hawaii, the war grows closer, more personal. Marines from a nearby base leave for war, and when one does not return, notes come home from their daughter’s elementary school: a child has lost a father. Jon knows a Navy Seal who dies in Afghanistan. “Now the war is part of the fabric of my life,” he says.

In time, Jon Martin comes to believe that “bad information led to poor decisions,” but still, “I felt personally invested. Did you ever see Blackhawk Down? There’s this great quote from one of the soldiers. He’s loading up his ammo. Someone says, ‘Where are you going?’ ‘I’m going back out there,’ he says. ‘We still have men out there. It don’t matter about anything else. It’s the guy to your left and the guy to your right. And that’s it.’ And that’s true. That’s true,” Jon says.

But let’s begin right here, 8 a.m. on a spring day, 2008, in a shining hotel room 35 floors above Chicago, with Lake Michigan sparkling to the north. Major Jonathan Martin, still based in Hawaii when we spoke, has flown through the night, arriving at the hotel at 1 a.m. He has already been to the gym to work out. He’s attending a meeting of the American Association of Neurosurgeons. Some 3,000 are here, but few have seen wounds like Jon Martin saw in the spring and summer of 2007. Then he was one of two neurosurgeons at the U.S. Air Force Theater Hospital at Forward Operating Base Anaconda in Balad, Iraq, some 40 miles north of Baghdad. A base he says that is as secure as one can be in Iraq; but despite that, a base where he was wounded from a richocheting bullet fired from snipers outside the walls. He is youthful, handsome, and trim at 37 with his Hawaii tan, dressed in short sleeves, casual slacks, sneakers. He is father to two little girls, Elsa and Kate, whose photos fill his laptop computer screen when he turns it on.

Inside his computer are photos of what can happen, he says, “when flying shrapnel hits flesh.” Hard photos to look at. Harder to ignore. “I understand how powerful these pictures are,’ he tells me. In Iraq, he was part of the 53rd Head and Neck Trauma team. He operated on Americans and Iraqis, friendlies and insurgents. And too many children. He wants people to know a deeper reality than what they see on the news. “I felt strongly coming back and talking to my non-military friends. The war is totally abstract to them. Not real. But it’s real. Go to Walter Reed hospital today. The wards have so many guys, one prosthetic limb, two prosthetic limbs. Horribly disfigured. So many there with traumatic brain injuries. Kids. A whole generation. Again. And it’s terribly sad.

“I’ve got to be careful what I say here,’ he says. “It doesn’t matter. I’m getting out soon. But know that nothing I say reflects the official policy of the U.S. military. These are my own thoughts.”

So we start here, with what Dr. Jon Martin saw and felt, and how he has changed, he says, forever. He speaks softly about hard things, telling a story that begins on the April day in 2007 when he boards a plane in Hawaii, on his way to war.

“If every American could see an image of a `Fallen Angel’ drill at our hospital after the death of a U.S. soldier with the room at attention while he passed through. I’m not sure what would happen” –Dr. Jonathan Martin

He knows there is no certainty he will return. Not in a land with hidden roadside bombs. Not at Base Anaconda, nicknamed “Mortaritaville,” because as the main logistical supply base for the war it is too tempting to ignore. Nearly every day enemy shells fly over. He feels the same anxiety any soldier feels when leaving for combat. “What does everyone fear the most?” Jon says. “It’s the unknown. So you take out more life insurance.” When he leaves Hawaii, he writes letters to his daughters, aged five and two. He sends them to a friend, to be read if he dies.

Elsa,

….Despite what I viewed as a doomed military mission in Iraq, my role as a provider caring for soldiers and wounded Iraqis was one that I welcomed, and felt destined to play. At the core of my character, I felt I needed to go…. I wish that I could see you, hold you, as you read this. Someday, you will have children, and will understand the joy that snuggling your child can bring to you, the rapture of seeing your child succeed where they had previously failed. You provided me with some of the happiest memories I had in life, and my love for you extended beyond words. I hope that you see in yourself all that I saw in you; nothing you could do in life could make me more proud.

To Kate he added,  

….As my youngest child, you hold an incredibly special place in my heart, Kate. My last night with you in Hawaii…you had a bit of a cold and snuggled deeply into my shoulder— a sensation more wonderful than anything in the world; you will know what I mean some day. As I close, I ask you to do something special with the profound qualities that you possess—that you will live a life that will provide you with true happiness as only you can define it. Know that more than anything, I wish I could have been there to enjoy it with you, if only for a moment…”

He lives squeezed inside a trailer compound on a 20-square-mile base, along with 25,000 men and women, a vast, sprawling town, with its own surreal middle-America strip mall ambience. Soldiers return from dangerous missions and dust choked convoys and head to Burger King, Subway, Pizza Hut, and Popeye’s. They play miniature golf, swim in the two pools built by Saddam when the base was the Iraq Air Force Academy, work out in the gym. But there is this too: heat unlike anything most soldiers have ever known, the acrid smell of diesel and jet fuel, the constant din of fighter jets and transports, the pall of smoke from the burn pit. “The insurgents who are still alive after all these years of war are so smart,” Jon says. They can use anything to make bombs. Anything. You can’t leave them anything to use.”

And there is also this: the whirring thunder of the helicopters flying right over the hospital, then setting down, then the rush of stretchers. This is a battle zone hospital, one built hard and fast, a series of linked tents and trailers. He feels he has been dropped square into M.A.S.H. many wars later. Despite makeshift air conditioning, the temperature inside reaches 100 degrees; at times, doctors and nurses pass out. Yet inside these steaming tents and trailers is one of the world’s busiest, and most effective, trauma centers. “To an outsider it might have looked chaotic, but everyone had a place,” Jon says. “My longest stint was 24 hours straight. You just do it. You just keep moving. Maybe you’re fatigued. Maybe you’re moving slower, maybe your judgment isn’t as good as it was, but it’s better than anyone else’s.”

He expects his skills to be tested every day. What he does not expect is the war he finds. Or the war that finds him. In this war only one in three of the people he treats will be an American soldier. If wounded Iraqis knew the right people, or else had been injured as a result of an engagement where U.S. troops were involved, they could be sent to Anaconda. When he tells about his days at Anaconda so many of his sentences begin this way: I will never forget.

“…There was a young American soldier who came in with his eyes welded open, looking around with 100% body surface burns. It wasn’t a neurological problem, but I was down there seeing someone else. The kid is awake, and he’s going to die, and there’s nothing you can do. Zero. And his arm is like this, fused. He can’t move it because the skin is contracted down. The I.C.U doctor just sat there and held his hand the whole time…”

“…There was a 14-year-old girl who had a penetrating head injury from shrapnel. She had charged the gate at one of our bases. A 14-year-old girl running up to this huge concrete barrier where there was a mounted 50-caliber machine gun, and she ran right at the gate firing an AK-47. I remember thinking ‘what could she have possibly been thinking?’ I asked her, ‘you ran at the gate firing. Why?’ And she looked at me, and she looked at the interpreter, and she said, ‘my mother is dead, my father is dead, my brothers are dead. And it’s your fault.’ That shut me up. What do you say? What can you say?

“…A man and his son had been sitting in an open air market. Just sitting there setting up for the day. They didn’t hear the shots. It was a random shot, and it hit his son. The boy is brought to us. The father says, ‘Help my son.’ There was nothing I could do. Nothing. I had to talk to him through an interpreter. The locals understand God’s will, but this is his only son. I can’t imagine….

“A two-year-old kid gets hit by a Humveee, okay. They bring him into the emergency room, dead, eviscerated. And you’re sitting there, and just leave him alone. And you don’t think about the morality of it. You can’t. If you dwell on it all the time, it’s bad. So you compartmentalize things, you have to, or you can’t go on….

He’s serving in an Iraq where the health system has been reduced to shambles, where nearly every doctor with the means to get out, got out. Where Baghdad’s teeming central hospital, Medical City, has become a hospital without hope. “The Iraqi health care is horrible. Horrible,” Jon says. “The people you read about who are injured when a suicide bomb goes off at a mosque or a market, they don’t have a chance.”

In a war waged in a country with a non-functioning health system, triage principles—to treat the person who is sickest with the most salvageable injuries— are tested. “When I look at triage,” Jon says, “my decision to treat somebody is different for an Iraqi than it is for an American. It has to be, because if you’re an Iraqi, and you get shot in the head, here’s what we have to think: If you’re not able to get off a ventilator quickly, we know they don’t have ventilators at Medical City. So, say I’m operating on an Iraqi, and he’s on a ventilator and he’s not doing well. We can only keep them 14 days. So, after two weeks, that patient gets put on a helicopter and gets sent to our people in Baghdad. In Baghdad, they give him a ventilator (for the trip to Medical City) and they put the patient in an ambulance—no medical attendant, mind you—and the driver drives to Medical City. Well, the reality is maybe the driver takes the ventilator and sells it on the black market, takes the patient and dumps him in the Tigris.”

“Strong stuff,” I say.

“It’s real stuff. It’s real stuff. We had patients who came in with their kid in their arms, and we start treating them and we say ‘OK, we have to send you to Medical City’ and they say, ‘No, you can’t do that. You don’t understand. I’m a Sunni, and if I go up there my neighbors will say I’ve gone to the Shia for help, and they will kill my family here, and when I go to Medical City, they’ll kill my child.’ Those are things I never even thought about before I went over there. Hundreds of thousands of Iraqis have died over there—that’s the estimate I’ve heard. There can’t be a household in that country that hasn’t been impacted profoundly by this war. I can’t believe there’s a single one. And I sit there and say to myself, ‘and I didn’t vote in the last election? Wow. I’m an idiot.’

Inside the coolness of a Chicago hotel room, he pulls down the shades. Scenes from the war he knew, inside the tent hospital, and later inside a newly built concrete hospital, fill the computer screen. “This is what a busy day looks like,” he says. “We could have six operations going at once.”

He shows me a photo; I do not at first understand what it is—an arrangement of objects on a table: bolts, nails, rings, bullets, shards of metal. Then he tells me. “This is all stuff we pulled out of peoples’ heads,” he says quietly. There is a photo of a two-year-old girl, who will live, her father beside her, whose relief is all but unbearable to see. “He was incredibly grateful,” he says. “A lot of Iraqis are unhappy with us being there, but these kiss our hands and feet.”

There is a photo of an X-ray. It shows a gunshot wound to the head of an American soldier. “I never should have operated on him” Jon says. “I have regrets. I thought he could be salvageable. Today, he’s blind, doesn’t understand speech, doesn’t speak. His family is facing a lifetime of caring for him. As a neurosurgeon, the quality of life that is left is so important. Sometimes, if you think someone has an injury that is not recoverable, you don’t treat, and people get upset. But when you know what the consequences are for someone it makes you think. If that were my son, I couldn’t say don’t treat. This was really a hard one”

And here is a photo of one of the hardest ones, the back of a seven-year-old boy. “You can numb yourself but you can’t numb against kids caught in the line of policy,” Jon says. “He had been shot through the chest; the bullet went through his back. He came to me with three stitches from the Iraq health care system. Spinal fluid was pouring out. His spine was unstable. We operated on him several times. We knew he wouldn’t walk again. He had a breathing tube. We knew he’d die within a week of leaving us, so we kept him from leaving. He stayed with us 28 days. The nurses really cared for him. He became their pet. But then finally we had to send him to Medical City. We had nurses break down. We tried to get him off a ventilator and respirator but we couldn’t. He had no chance once he left us.” Jon stops talking for a moment. “The alternative is not to treat them,” he says. “He dies then of course, but nobody grows attached.”

The time goes slowly watching these images. There are so many more. Finally he reaches the end. He clicks out of the program where the images live, and there, again, is his daughter Kate, all smiles, filling his screen. “There are so many people who’ve done what I’ve done.” He says. “I don’t want people thinking I’m special or a hero. I’m not. The experience was very important to me. But I want people at Bowdoin to know there are folks who went to Bowdoin who were impacted by this war. And for a bunch of smart people who tend to get involved in politics as Bowdoin grads do, just to think really carefully about policies that impact a whole bunch of people in ways that aren’t shown on CNN.”

In the fall—now last fall, by the time we go to print—he will leave the Army and move to Connecticut to become a pediatric neurosurgeon at Connecticut Children’s Medical Center in Hartford. “I love the military,” Jon says. “I’ve been in the military my whole adult life. It’s not what’s going in Iraq that’s causing me to get out. It’s we’re beating the drums. Is Iran next?” He will move his family to a small town, he says, because “I want a place where I can be involved. I believe one person can make a difference.” And on the day he starts his new life, he knows that another doctor thousands of miles away will be trying harder than seems humanly possible to stop the bleeding, in a man, or a woman, or a child, somewhere where the bleeding never stops.

If every American could see an image of a ‘Fallen Angel’ drill at our hospital after the death of a U.S. soldier with the room at attention while he passed through. I’m not sure what would happen.
— Dr. Jonathan Martin

enlarge this imageClick image to enlarge…

Air Force Theater Hospital located on Logistical Support Area (LSA) Anaconda, May 2007., Jon Martin '92 preparing for a trip to Baghdad, June 2007., Board showing OR cases for June 30, 2007., Jon Martin '92 "treating a casualty in the ER with my partner LTC Teff, May 2007.", On call surgeons waiting for casulties during the heat of the day June 2007., Dr. Jon Martin '92 after a long night on-call, June 2007., Last night in Iraq, August 2007., Craniotomy for gunshot wound to the head, May 2007y 2007., Jon Marting '92 "working on a casualty in the OR in concert with our team Otolaryngologist LTC Mark Gibbons, July 2007." ,