This week has been a busy one. It started Sunday, when I was on call. We had a relatively quiet morning, with a couple of operative cases to do, and then everyone except me and my backup, vascular surgeon T, filtered out to go to the gym, church, or some "rack time" in their bunk.

Just as our last operative case was finishing up, the call came overhead: "Trauma call times nine to the ER, trauma call times nine to the ER." Well...sounded like some business coming our way. I walked the twenty yards to the ER to find the breathless chief of the medical staff telling us the report: an IED explosion in a Balad market (per CNN, a VBIED, or vehicle-borne IED), with probably as many as 30 casualties coming to us. This is known in ER parlance as a "mass casualty," with many more patients than immediate resources, triggering a sequence of events to meet the surge in demand. Everyone gets called in, and as the hospital personnel start to arrive, so do the first wave of casualties.

By the time all the dust cleared, we had taken in 23 Iraqi casualties. Many more died at the scene, and a few were taken to a local hospital. It becomes difficult keeping everyone's blood, Xrays, and vital signs straight, with no names, SSNs, or wristbands, only a numeric identifier written in Sharpie on their forehead. The scene is hard to describe, and some surreal moments stick in my head: the third-country national housekeeping staff "mopping" the floor between waves of casualties using chux pads in a "wax on, wax off" motion; the young child who arrived without signs of life and never regained them; the linear trail of blood on the bottom of the CT donut where each patient passed over it; the operating rooms with two cases, side by side, being done concurrently. It is a remarkable place that can do these things, and it speaks to the incredible professionalism and competence of the staff I get to work with here. They are all, in the words of General F, "rock stars."

But who does this? Who willfully blows up children, shopkeepers, wives, mothers, babies? I can hope that a just God will visit his wrath one day on those who would do this, and at the same time I see the dark corners of hatred and bitterness in my heart. I guess I'm just shocked to see it writ large in this country.

So now, 96 hours later, it has begun to settle. Open abdomens are closed, wounds washed out a few times, some patients have escaped the ventilator, and the few minimally injured have discharged. And we wait for the next one.