LCDR Donnelly Wilkes: Battalion Surgeon on the Front Lines in Iraq

Ken Harbaugh:

I’m Ken Harbaugh, host of Warriors In Their Own Words. In partnership with the Honor Project, we’ve brought this podcast back at a time when our nation needs these stories more than ever.

Warriors in Their Own Words is our attempt to present an unvarnished, unsanitized truth of what we have asked of those who defend this nation. Thank you for listening, and by doing so, honoring those who have served.

Today, we’ll be hearing from LCDR Donnelly Wilkes, a Navy surgeon deployed with a Marine Battalion. Dr. Wilkes served two combat tours in Iraq in 2004 and 2008, and was awarded the Navy Commendation Medal with Valor for his actions in the Battle of Fallujah. A photo of Wilkes and his team huddled around a fallen soldier went on to become a Pulitzer Prize winning piece and a Life Magazine cover.

LCDR Donnelly Wilkes:

I left the service, the United States Navy, as a lieutenant commander in 2009. I served for a total of seven years on active duty and for approximately a year and a half of that, there were two combat tours in Iraq.

When I was accepted to Tulane Medical School, one of the Navy recruiters got a hold of me and said, "Hey, you got some big bills coming your way. Why don't you look at the Navy helping you pay for it?" And he encouraged me to apply for the scholarship so I did, and I was accepted and then the Navy offered to pay for all of med school in turn for seven years of active duty service. That was pre-9/11, I had always kind of had visions of joining the military and decided that the life suited me and so I signed up in the Navy as I entered medical school.

There's a few caveats though. Every month, one month of each year of medical school, the military students are pulled from their normal duties and they are sent off to various training institutions. So for example one of the first was out to Newport, Rhode Island, to the Navy's version of bootcamp for officers and so I would go out there for six weeks during med school. Learned to put on the uniform, military history, and learned how to be a Naval officer. Another month in my third year, I'm sent out to a combat casualty field medical course to learn how to practice field medicine and understand military environments.

So they're kind of indoctrinating you as you go forward, and then day one of graduation, right after we had our ceremony in New Orleans in a downtown theater, about 15 military students are ushered off to the side into a little room, you are seated, you've got orders in front of you, a Naval officer comes in, you all stand, you take the oath, and you are commissioned as lieutenants in the United States Navy. And so things change rapidly as military medical students and from there they continue to change more rapidly and I'll cue you in as we go forward on how that worked.

My military Naval career that I had envisioned and been told about from the Navy recruiter was going to be vastly different than what I thought it was and that's because September 9/11 2001 was just right in my rear view mirror. So the world was changing rapidly, things were escalating in the Middle East already, and I was getting orders to Camp Pendleton, California, which is where one of the residency hospitals is for primary care medicine and that's the field I was going into.

So within just a couple weeks after graduation, I am out in Camp Pendleton on a Marine Corps base, working at the Navy hospital as a resident, but I know things are continuing to escalate in the Middle East and within one year of that, just still being a baby doctor, I am plucked out of residency and given orders to join a Marine Corps battalion and head to the Middle East.

It was a little bit of a mixed bag. I certainly knew that I was going to be entering uncharted waters for me personally, emotionally and physically, but I never could have envisioned what lay ahead for me. The level of trauma, the proximity to the battle that I would be involved in, despite my military training, despite intel briefs, things like that. Nothing could have prepared me for what I ultimately would encounter in Fallujah.

So when we arrived, and my battalion, we went to Okinawa for a few months to do some urban combat training to get the Marines ready for what it would be like in Fallujah and the surrounding cities in the Al Anbar province. But when we arrived there, which was roughly March of 2004, it was still the Wild West, and I say that because we roll into Kuwait by jetliner and the whole battalion is stationed in Kuwait for three weeks, we prepare for our convoy, and then the convoy rolls out. It's 50 to 75 vehicles with everything we need to sustain that battalion being mobile. Everything from bullets to Band-Aids, and then for three days, we drive north, right up into Iraq, and one of the first sights and sounds that I remember telling me that it's the real deal is I wake up in the middle of the night and the convoy is heading towards the oil rigs that Saddam had lit on fire and they're burning dark in the night like these incendiary little evil flames.

So that's when it really hit me full circle where we're headed, towards that environment, and then after three days, we make it to our fort operating base just a couple miles outside Fallujah. And to give you the lay of the land, it really happened pretty quickly after we got there. Within 24, 48 hours, mortars are hitting right around our FOB, our forward base, not far from the outer walls. I instantly realized how proximal we are to some of the worst cities in Iraq, in the Sunni Triangle area, because we're getting mortared almost every night and some of them are close enough to kind of rattle your bones. And then within just a week or two, the Battle of Fallujah, the orders are passed down that we're going to go head on with the insurgency in Fallujah and that my battalion is one of two battalions that will lead the charge, and those orders come directly from General Mattis who flies in and we have a late night meeting with him and the officers and he gives us marching orders into Fallujah.

So as we're hammering out the battle plan with the battalion commander and the company commanders, they know that this is going to be a big, full-scale assault into Fallujah, going into about 20,000 embedded insurgents within that city. And they know that there's going to be a lot of combat trauma, so we're trying to figure out what's the best way to manage that situation and get Marines to care quickly. Initially they wanted me and the other doctor in the battalion to be mobile and kind of move into the injuries that are inside the city. We made the point that that didn't make as much sense as having one stable battalion aid station that's really proximal to the front lines, and so that's what we agreed upon and so we ultimately then moved the battalion aid station just outside the city lines to a field battalion aid station and that's where we decided to receive combat casualties.

There's many factors that just come into play that you can train for but ultimately you have to go through it and experience it to fully understand what it's like. So the analogy I'll give is it's like ballet with a bull, combat trauma, combat medicine in general. In other words, it's like you're in this rodeo, you're this cowboy, you're strapped onto this machine, this bull that you can't control but you have to learn to live within it, to work within it, to even understand it in order to control it, and in order to operate efficiently within that crazy environment.

So what I'm really getting at is you've got things like heat and your flak jacket and your Kevlar helmet on your head and dust that's incessant all around you and getting in the way of everything and then you've got mortars and rockets in the background and sometimes as we were treating injured Marines there would be the battle in close proximity, not far from us, or mortars hitting pretty close to really rattling our cages, and in a normal environment, let's say an emergency room, even the busiest one in the world, it's controlled. Let's put it that way. You've got nurses, technicians, you've got blood tests, you've got invasive monitoring that can give you lots of information on how to treat that patient. You've got all kinds of helping hands. In the field, you've got great corpsmen and some Marines protecting you and other than that it's just you and your wits and your medical skills and you've got to make decisions on the fly and you're going to make mistakes sometimes, but you have to just go with it, forgive yourself and move on. Because the next trauma victim might be right behind the first one. So it's just an unforgiving environment is really how I put it and things change constantly and you just have to be willing to go with it and use the skills that you've trained for to get through.

Most of the combat trauma from Fallujah was a lot of gunshot wounds and then mortar wounds, everything from light shrapnel to more penetrating deep shrapnel and then sometimes big open wounds from rockets, from RPGs, rocket-propelled grenades, and sometimes just more traumatic gunshot wounds. So on a typical day, we're just a few hundred yards from the battle which we could see playing out a lot. We were at a position called the cloverleaf which was right underneath a freeway overpass. We had some dirt barriers around us but that didn't protect us very much. They'd still lob in mortars and a couple times rockets hit right under the overpass, kind of close enough to knock us on the ground, and sometimes we'd get radio notification we've got victims coming in. Other times, a Humvee comes out of nowhere, right from Fallujah, screaming towards us, we wave them down. Marines come out of the back and start bringing out injured Marines.

On one particular day, kind of right at the height of the battle, this was probably April 8 or 9, they bring in four wounded Marines. A couple of them have shrapnel and gunshot wounds to their extremities. One Marine has a massive head wound and it was an open wound, it was pretty horrific just to look at it and I couldn't believe this man was still breathing.

So we have to triage the lesser victims to make sure that they're stable, not bleeding out, which, they were okay, and then we would go to work on the most severely wounded Marine. He's got blood running down in his throat, he's coughing it up, he's losing his airway because of all the blood and I didn't know how he was alive but we knew we were going to do everything we could to keep him alive because his Marines are looking on, and shouting from the sidelines. So it's chaotic but then my corpsmen knew what to do. We kind of get people pushed aside so that myself and my other doctor, Cormac O'Connor, can go to work. We stopped the bleeding in the head wound and then we have to cut a surgical airway, which is a very technical procedure to do, even in an emergency room, but we go to work and just to give the real basics, it's a small incision near the Adam's apple, then you have to open that up, you have to find the airway, insert a little stilette that allows an airway tube to go over it into the airway and then you hook up a bag valve mask, try to secure that around his neck and you provide artificial respirations through that airway by squeezing the bag into his lungs.

We got it, it was very difficult and that kept him alive, and then we were able to get a medevac, a Humvee to take him to the next level of care which was a few miles away. Unfortunately that man died, but we did stabilize him to get to a surgeon and give him the best chance, and so that's just one example of a moment in time that I'll never forget.

Yeah, the corpsmen are my right and left hands when I need them, and the great thing about them is, about all of us really, is you can't really tell just from a glance a Navy corpsman from a Marine. We wear the same uniform, we're all part of the same unit and have a common mission. There's corpsmen embedded with the companies and they're out in the field and they're the most immediate point of care for an injured Marine, and so there's a number of them in each of the companies that provide that field care and they're highly trained field medics and they saved a lot of Marines. And then the corpsmen that work with me are the ones at the battalion aid station, and they're helping me from everything from patching up gunshot and mortar blast wounds to caring for some Marines with combat stress, who have been brought back to the aid station because they may have been paralyzed at one point or another from being able to carry out their orders. That didn't happen a lot, but a few of them.

And the greatest thing about the senior corpsmen, the one who have been in the field before, who have seen combat before, is there is just some elements to living within a Marine Corps battalion that were foreign to me. It's this completely foreign world, I was a hospital doctor until I was stationed at Pendleton, and so just some parts of the culture or just like, "Hey Doc, let me help you with your gear." Simple things that really can go a long way, those senior corpsmen who have had years in the Navy were just invaluable to me in helping us perform our jobs.

I give the Navy and Marine Corps a lot of credit for training. When I look back and I look at and understand the level of training that they provided me before heading into combat, it's really good. They've got field courses and trauma labs and things like that and working on animals for example, in other words, dead pigs. We put airways in them, we do cut-downs. So a lot of that was designed to help me thrive in a combat environment.

With that said, it's been ... I think one of the unique parts of my story is that it's been a while since military physicians have been this proximal to combat, and even in Iraq, the Battle of Fallujah was unique, it was the biggest battle of the whole ten-year war, it was the most violent and there was just a handful of us as close to combat as we were, so that was shocking. Living for two to three weeks in the field and being that proximal to the battle, like I said, didn't expect it. It was surprising. I didn't know or understand what it was like to have a mortar or a rocket land within yards of you and knock you off your feet and know that that was meant for you, to kill you. Just being real candid, I had to make peace at one point with where I was, because I was asking God some serious questions about, "Man, how did I end up here?" I knew I joined the military and I had a job to do and it was the life I chose, but it was difficult to reconcile with the proximity to the battle and the trauma and the death that we were involved in. And so I had to make peace with that, and I did, and when I was able to do that, it allowed me to go forward and finish my deployment and my mission with accepting my fate, good or bad, and that means life or death, really. So that evolution happened throughout the deployment and helped me persevere.

Me and my corpsmen, we all worked together and to give you an example, there was a Marine that came in one time and he had such life-threatening wounds that the question popped in my head of what can we do for this person? We knew the quality of life was going to be next to nothing, even if they did survive. So the question was do we proceed with all-out efforts. Well it only took seconds and the answer was yes, we will proceed with all-out efforts because everybody there, his fellow Marines, deserves to see nothing less and that's what they want to know every time.

But you know, you could miss something. You could miss a pneumothorax which is air trapped around the lungs from blunt chest trauma, and misplacing that needle into the chest to release the pneumothorax, those kinds of things. But that's what I mean when I say if you miss something, you just have to be able to know that you're doing your best and move on and continue treating the other Marines around you and be okay or forgive yourself if you make a mistake that clearly was out of your control.

We've learned a lot in military medicine. We've taken a lot of knowledge and examples from prior wars, from countries like Israel, who see some of the worst combat trauma routinely because they're often in a constant state of war, and we've used those things to advance our medical capabilities in the field and take them closer to the battlefield than they have ever been before. So some of the advancements that I was able to take advantage of were things like QuikClot, which is a powder that you can use in a large penetrating wound that is hemorrhaging, that the patient is at risk of bleeding out from, and you can use that to put it in the wound and stop the bleeding, at least enough to stabilize them until they can get to a surgeon. You have got advanced airway kits, like the ones that I used in the field to establish an airway that would otherwise kill someone. You've got things like decompression needles to release a pneumothorax, which is air trapped around a lung that would often and has historically killed men in battle.

So a number of these things that have historically been battle wounds that someone would die from, now you can save that person's life and to expand on that a little bit, another huge part of that is the proximity of the surgical capabilities. So from where I was, which was Echelon I of medical care, right there in the field, Echelon II is just minutes away, by ground or helicopter, and there you have full field surgical capabilities that can perform highly advanced surgeries right there in the field to save that person's life, and then again, they can medevac them from there to even an even higher surgical field capability. So those advancements and bringing that equipment so close to the battle have made a huge difference.

One of the emotional parts was there's these men who you have trained with and learned to... Or become close with, some of them even your close friends over the months leading up to deployment, and then you go into combat and some of them are brought to me at the cloverleaf, I treat them, and then they're gone. If their wounds were severe enough, they're gone and out of my sight for the rest of their deployment, and then we eventually make it back home and I would, and did, run into some of the Marines that I treated, a couple of them with pretty severe wounds, and it was just amazing to run into them, again see them, hug them, shake their hands, and have a pretty emotional reunion as I'm thinking about it right now, it's actually making me choke up.

Not all of them were great reunions. One was a particular Marine who had just ... He was a poster boy Marine, he had a massive shoulder wound from an RPG that propelled through his shoulder, canoed through his shoulder, did not explode, otherwise it would have killed him, and then landed or hit a wall behind him, exploding behind him. But his shoulder was just fileted open, I treated him, stabilized him, got him out of there, and then I saw him back at home and his arm was just atrophied and essentially useless, he was struggling a lot with mental health and depression because of the severity of his wounds, and it was just really hard to see his quality of life go down the tubes. And that's the last I've seen of him, but he made it back and he's alive and to be honest, I've been actually thinking about tracking him down to see how he's doing today and if there's anything more than I could do for him, including working with foundations like the Gary Sinise Foundation, who gave me an endorsement for my book, and I think is a wonderful organization.

That's also just an evolution and again as I look back at my military history and deployments and then the aftermath, I've definitely remained very involved in the mental health component of our vets and just being an advocate for PTSD victims and things like that. The greatest thing is that the stigma of PTSD and combat stress has been... It continues to be removed as stigma and military members are talking about it and getting treatment for it a lot more than they used to.

I was in charge of giving some of the briefs, some of the information to the men about PTSD as we transitioned back home. I'll never forget being in an auditorium with all 900 Marines looking at me and I got to give this required combat stress brief to the men before we get home, and as I'm giving it, I'm not even considering that I could be a part of that or that I need to listen to that advice myself as much as I'm giving it to the men, because I just figured I'm a healthcare provider, I'm a doctor, and I didn't pull a trigger. I wasn't out in the line of fire. But shortly after that, after I got home, I realized that that toll of combat, of mortars, of living in that environment, it took its toll on me too, and I started to have some of my own symptoms of hyper-vigilance and just irritability and anger and even some emotional issues as the months went on after deployment. So providers are clearly not immune from it, and just being subject to mortars and rockets and treating combat victims over the months of my deployments which were two of them, it took its toll on me and I was able to finally recognize it and get some help and just talk about it and fortunately I did very well and did not have severe symptoms. But if I didn't recognize it and talk about it, I would have suffered more than I needed to. So that was my journey with the emotional and PTSD part of it.

When we loaded up the battalion from our forward base right outside Fallujah in the middle of the night and headed out and left Fallujah, I'm sitting in the back of a seven ton truck, to the open air, it's 1:00 in the morning, I'm sitting with one of my buddies and we're driving past Fallujah in the dark, headlights off, snaking our way out of that dangerous part of the world and I just looked ... I was looking at the city and thinking to myself, "Here we are and there you go Fallujah, and you didn't beat us," and I made it and I knew we weren't completely out of harm's way, but I just knew that we were going to be okay. And that was about a seven hour truck drive to a different base from there, but that was a real just kind of poignant event and I was able to kind of relax my nerves a little bit and then from there, from that next base, when we got on that plane and as soon as we got up to altitude, it was just the fact that we were out of the range of, let's say anything that could harm us, and we were on that plane. That's when my senses told me that it was going to be okay, and that I was going to make it home again and definitely had a pretty emotional just response as I was sitting there on that plane, to myself. Shed a few tears and was elated at just knowing that I was going to go back to my future wife waiting for me at home and that we were going to make it.

For me, I just felt like, "Okay," I would tell myself during the deployment, ‘To earn the right to go home, I'm going to get through the next day and the next day and the next until I've earned that right, and we're going to do it together. The whole battalion. That's the culture. That's the mission.’ And every one of us had that same feeling to some extent and you're right, when we were sitting there on that plane and for us the ultimate ride home was in an American Airlines and we all climb up with our weapons still in tow and all still pretty dirty in our combat cammies and I just kind of was musing to myself about this scene on this beautiful airliner that was decked out with fanfare and things like that, and all these dirty, ugly Marines with their weapons, but what a great sight that was because all of the men were ... The faces, the look, the tension on their faces just instantly changed, like you said.

The main challenge was unexpected. That second deployment my commanding officer had literally the week prior said, "Hey Doc, I think things look good. You'll probably stay at this new duty station," which was Port Hueneme in Oxnard, for the rest of my commitment, and then a week later, he called me in and said, "Doc, sorry. I lied. I just got orders. I need a seasoned physician to go back to Iraq." So that conversation was tough with my wife because we knew what we were in for and it was even a longer deployment.

But you know, once we got over that and through that, we just knew this was what we signed up for and I went back to another month of trauma training at USC County Hospital which was wild, but I lived there for a month, working with the trauma team because the Navy has a little installation there for training, and I got some great training and went back to Iraq, out to Al-Qa'im on the Syria-Iraq border and it was kind of like a little field ER, but it was a much safer environment and that is where staring at the outskirts of Iraq again, looking at the landscape and hearing the sights and sounds, that's where I decided to write the bones of Code Red Fallujah, and that's how I passed some of the deployment writing that book, and that helped me get through that second deployment, being able to write about my first deployment in Fallujah. And then I came home and put that down and picked it up a few months later and decided, "Hey, I'm going to make a book out of this." So that's how the book was born.

I can look back on it and still be proud of everything we did and I'll give you a generalized answer or at least statement, that I do feel that the United States and the peacekeepers of the world I'll call them, have an obligation to squash evil and terrorism where it exists. Now does that mean that I want us to be in a 10 to 20-year occupation of a country? I'd say no. But I do feel that the peacekeepers of the world need to have the wherewithal to rise up and combat evil and terrorism where it exists, and I think we should learn from what has been done in the past, these wars specifically, and how we might be able to better as a unified front do that in the future. Call it a version of the United Nations or something different or better, because this isn't the last time we're going to see this. As we all know, it's not going to go away, and I think we can do it better without necessarily having to commit to such a long occupation and price tag, both financially and lives. And I think a lot of smart military leaders would agree with that and actually have voiced that.

Would I jump back into it right away again if I was given the opportunity? Maybe. I'd have to have a serious conversation with my wife, but I'll tell you, when my private practice was suffering during the pandemic, which it did, and there was a few months where I almost had to close down the doors, I said, "Well hey babe," to my wife, "I can always go join the Navy again." And although it was said with some jest, I am not completely kidding because I always know I could go do that again and go back to an environment and a home that I loved. There were lots of ... Many parts of it that were challenging and that I would not want to do again, but I don't regret a minute of it, I wouldn't change it, and I value every part of it because it did make me a better physician, husband, father, and human for sure. All those parts of it.

So in the end, I would describe it as, I know that although parts of it were hard for me to accept, it's where God wanted me and needed me and it's where I was supposed to be. It's where I was supposed to be.

Ken Harbaugh:

That was Lt. Cmdr. Donnelly Wilkes.

To learn more about Dr. Wilkes’s deployments, read his book, Code Red Fallujah.

Thanks for listening to Warriors In Their Own Words. If you have any feedback, please email the team at [email protected]. We’re always looking to improve the show.

For updates and more, follow us on twitter at Team_Harbaugh.

And if you enjoyed this episode, don’t forget to rate and review.

Warriors In Their Own Words is a production of Evergreen Podcasts, in partnership with The Honor Project.

Our producer is Declan Rohrs. Brigid Coyne is our production director, and Sean Rule-Hoffman is our Audio Engineer.

Special thanks to Evergreen executive producers, Joan Andrews, Michael DeAloia, and David Moss.