The artist Steve Mumford originally went to Baghdad in 2003 to work as a war artist, embedded with the U.S. military, both writing a journal and making drawings and watercolors of what he saw there. In early 2007 he returned to Iraq for approximately a month, where he worked at an army hospital. This is the second of three reports on that trip. The first, "With Good Company into Iraq," was posted on Mar. 8, 2007. The archive for Mumford’s original "Baghdad Journal" can be found here

The staff of the 28th Combat Support Hospital (the "cash" in military lingo) takes the news of their extension relatively gracefully. When I arrive in March an announcement has just gone out that every military unit in Iraq due to leave in the summer will stay an extra three months. The morale here seems pretty high. Based in the Green Zone’s Ibn Sina Hospital, the docs, nurses, medics and other staff remain safer than military personnel in the red zone. But more importantly, they’re saving lives, both U.S. and Iraqi.

I’m met at the front gate by Lt. Justin Kocher, the public affairs officer who is also a dietician for the hospital. Kocher shows me the various departments, including the emergency and operating rooms, the intensive care ward and the landing pad for helicopters delivering wounded soldiers.

Kocher seems startlingly young. He’s cheerful and smart, and straightforwardly lets me know that he’ll follow me around at first to make sure I respect the guidelines for media. Although I have more leeway than photographers, who aren’t allowed to show patients’ faces, I won’t be allowed to draw suspected insurgents being treated, or bodies in the morgue. However, much more important than specific rules, I soon discover, is the rapport established from just hanging around and having the hospital staff see what I’m doing.

That afternoon, some U.S. soldiers pull up in a humvee at the hospital emergency room, and unload a black body bag onto a motorized cart. One of their unit’s Iraqi translators had just been killed by an IED.

Later, Lt. Kocher and I stroll over to the morgue, a low stucco building supplemented with a couple of climate-controlled trailers. A Titan Corp. employee, a middle-aged American woman, is there with an Iraqi assistant to remove the torn and bloody uniform from the translator’s body. It’s the first corpse I’ve seen this trip and my heart is pounding. I have an impulse to draw but it feels inappropriate or prurient to do so. It takes me a few days to completely shed this shyness.

Later they’ll transport the interpreter’s body to his family. He looks distorted, his face broken. I wonder if his family has any idea that he’s dead, or if they even knew that he was working as a translator, perhaps the most dangerous job in Iraq. Many young men keep these jobs completely secret so as not to further endanger themselves or panic their relatives.

That night, after dinner at the hospital cafeteria, Kocher and I find a pickup truck pulled up to the ER, blood spilling from the bed. Inside the ER people are milling around. An air of urgency pervades, like an active beehive.

Besides Lt. Col. Bill Costello, who directs the ER, I see Col. John Lammie, the hospital’s deputy commander checking in, as well as Col. Ruth Lee, the deputy commander of nursing.

Two people are on the ER tables. Pools of blood and medical supplies are strewn about the floor. There’s a flurry of activity around each table, as medics and doctors try to pump some life into the bodies while other personnel mill around. A rocket had landed near a mail facility in the Green Zone where a soldier and a civilian contractor were outside, perhaps smoking cigarettes. Several have landed here in the last few days, although none to this effect. As I watch, the two patients are pronounced dead. The soldier, a heavy-set man, burned and bloody, seems drained of blood, his battered face clearly lifeless. There’s a gaping hole is in his side, where the doctors attempted to massage his heart back to life. The two bodies are sent to the morgue.

A few minutes later the man is rushed back in, and after a frenzied attempt to revive him he’s pronounced dead a second time. It seems that while being transferred to the morgue, someone detected a faint pulse, only to find that it was a delayed but meaningless effect of drugs administered to his heart.

Such grim scenes, while routine here, don’t tell the whole truth of the hospital, which saves many more lives than it loses. The staff is generally congenial and cheerful, perhaps due to the proactive nature of their jobs. There are moments of strange humor, too, as when one night a hugely muscled black soldier is wheeled in to the ER, shirtless, his arm in a sling. He explains to the surprised nurses that he’s broken his arm in an arm-wrestling contest. Sure enough, the x-ray shows a perfectly clean break in the middle of the bone.

"Did you win?" Kocher asks.

"Oh yeah."

"Was it worth it?"

"Definitely," he says softly, in a tone that seems to belie the mix of emotions playing over his face.

During my stay, most of the hospital’s patients are Iraqis, many from the army and police, brought in with shrapnel and bullet wounds. Lots of patients are Iraqi civilians who’ve been caught in crossfire or bomb blasts and picked up by U.S. soldiers, such as a little girl brought to the ER one night with a bullet in her bottom. She’s wailing at the top of her lungs, as much from fear as pain, while the docs examine her. Her dad is there, holding her hand. He seems relieved to be at this hospital rather than an Iraqi facility. I sometimes sense a complicated set of reactions on the Iraqis’ part: gratefulness at the friendliness and competence of the American staff, conflicting with a deeper general mistrust of American intentions.

The CSH is not a long-term facility and beds are limited, so patients have to leave once they’re stabilized enough to be moved. U.S. soldiers who aren’t returned to duty get sent to Germany, where they can get treatment in a much cleaner environment, away from the pervasive and sometimes deadly Iraqi bacteria. Iraqis are sent to an Iraqi hospital complex in Baghdad known as Medical City, where they face an uncertain fate. I’m told the ratio of patients to nurses there is something like 35 to 1, and sectarian killings have been carried out in the wards. Iraqis never look happy at having to leave the American hospital.

Some half-dozen chlorine gas bombs are set off by al Qaeda insurgents in Ramadi while I’m at the Baghdad hospital. Many of the resulting Iraqi casualties are brought here. Chlorine, which is widely used as a cleaner in Iraq, burns the lungs on contact when it’s exploded in a bomb. What isn’t destroyed will scab up, so the lungs have to be constantly drained. Breathing apparatuses administer pure oxygen to the patients, while the staff waits to see if they survive. Four children with lung damage are in the ICU when I arrive; two live, including an 18-month-old boy dubbed Henry by the nurses. He revives after a few days, but all he can do is whimper plaintively. He’s adorable, and many of the docs drop by to pick him up and gently rock him on their shoulders. No one knows where his parents are, although an uncle shows up occasionally to watch him.

In another chlorine bomb attack, a young woman survives, but when she begins to revive a few days later it becomes apparent that she’s brain dead. Her head lolls about listlessly, while her eyes focus on nothing. The nurses tell me her brain was oxygen-starved for too long. She’s transferred to Medical City. No one I talk to knows if there are any records about who she is or if anyone from her family knows where she is.

The most harrowing events for me, aside from attempting to draw a surgeon picking shrapnel from a man’s testicles, are being in the ER during a "mass-casualty event," when it’s filled with men hollering in pain.

On March 31, 2007, the ER is filled with casualties from an IED attack on a 10th Mountain patrol. One soldier is pronounced dead on arrival, and taken directly to the morgue. Amid the bellowing, the men sometimes lapse into sobs. The pain seems to come in waves. A soldier manages to ask a medic about his dead comrade, "Sir, the guy who was next to me -- how’s he doing?"

The medic lies, "I’m not sure. . . they took him to CATscanning. . . we’ll know in a little while. . . ."

One man, blood seeping from his wounds, is wheeled out to the CATscan room, and blurts out, "I yelled at my wife. . .," his voice filled with remorse.

The doctors are working frantically on a soldier who has lost consciousness. His handsome face is grimy from the bomb blast, contrasting with the vulnerable whiteness of his lithe body, stripped of his tattered, bloody uniform. I follow him up to the operating room where three surgeons waste no time getting to work. As the night deepens, bowl after bowl of blood-soaked gauze spreads across the floor while the doctors crowd in to work on the soldier’s traumatized liver. Behind a small tent of operating sheets, the anesthesiologist monitors the oxygen pumps, and other vital signs. The young man’s face looks so peaceful, so oblivious to the urgent concentration over his open body.

A little before 1 a.m. I find that I can’t draw any more and quietly slip out. The next day I hear that he didn’t make it.

Master Sergeant Billy Fonshee says, "We try to keep the medics from getting too involved, too attached. We don’t need to know who these guys are, where they’re from. Our job is to patch them up, get them out. I’ve seen nurses get tattoos with the names of guys who died on them, try to remember too much. You can’t dwell on stuff on this job."

The ER staff see themselves a bit the way front line grunts do, in contrast to the docs, nurses and medics of the operating rooms and the ICU. If the latter try to maintain a positive, can-do attitude, the ER medics claim to take a tougher, more pessimistic outlook, though often infused with humor.

Staff Sergeant Chris Hensley tells me about a Colombian contractor who was brought in after a mortar strike. "Dude was in a lot of pain -- we jacked him up pretty good on ketamine. That’s strong stuff. So a little later he opens his eyes and says, ‘Where am I?’ We’re like, ‘You’re in Colombia!’

"He looks around all wide-eyed and shouts, ‘Why are the gringos in Colombia?!’ That became sort of a greeting for us for awhile."

The walls of the hospital’s hallways are festooned with patriotic tributes from school kids, sometimes stitched together into huge banners and flags, with countless variations of messages like, "We ♥ you," "Thank you for all you’ve done," or "Thank you for keeping us safe."

One morning while I’m hanging out near the ER a nurse taps me on the shoulder. "Hey, you’ve got to check this one out, I guess no one noticed it," she says with a giggle, pointing to a gigantic mural from a middle school in Massachusetts, where tucked amid all the enthusiastic thank-you’s, young Nick Perrotta opines, "George Bush is an idiot -- thanks for your efforts, though."

U.S. and Iraqi soldiers with head wounds are often sent by helicopter to Balad airbase, which specializes in neurosurgery. The patients are accompanied by someone from the CSH. One evening Major Bill White goes along with a soldier who’s been shot in the head. I see him a few hours later and ask about his flight.

"We took some fire on the way back," he says, "going over Sadr City, wouldn’t you know it. Of course we were flying black (without lights), but someone on the ground painted our helo with a laser. So the pilots put out the flares in case of an incoming laser-guided missile. That really lit up the bird for their guys, and you could hear the AK rounds popping on the helo. They’re getting smarter, the bad guys.

"No big deal, though."

On March 27th, I’m drawing a big Iraqi soldier on the operating table, wounded from an IED. Lt. Col Paul Benfanti and Major John Sloboda cut open his body and recoil at the stench of decaying tissue. His infections have been barely reduced enough to operate and now Benfanti and Sloboda are slicing away dead muscle tissue from his right side and arm. Eventually they have to split his chest to accommodate the tissue swelling from his massive infections.

A couple of days later I find the Iraqi soldier in the intensive care ward. With all his bandages and missing parts, his massively swollen body, split chest, external fixators and breathing apparatus, he looks like Frankenstein’s monster.

1st Lt. Ken Bailey, a medic in the ICU doesn’t look hopeful.

"All the drug-resistant bacteria in the soil here, it’s a huge problem. His infections are out of control, they’re just not responding to antibiotics. And his liver is deteriorating from the infusions of antibiotics. I really doubt he’ll make it."

The Iraqi’s father arrives and stands impassively by his son’s side, holding his unresponsive hand. He speaks little English, and Bailey tries to explain his son’s condition through a translator. It’s hard to tell how much he’s understanding and Bailey’s hesitant to spell out his worst fears. I ask permission to draw the dad next to his son, which he consents to. When I’m done he asks for the drawing. I photograph it and give to him.

The next day I’m surprised to see the Iraqi’s eyes fluttering and briefly opening. His dad is elated, and says to Bailey hopefully, "Good, mister? Sir, my son -- very good?"

Bailey looks alarmed, caught in the headlights: "Well, maybe. . . I don’t know." The infections are worse than ever, he tells me.

A couple of days later the soldier’s gone. Bailey says, "He needed dialysis, which we can’t do here, so we sent him to Medical City. His kidneys were worn out from the antibiotics. I honestly don’t think he has a chance."

His voice tinged with regret, he adds, "I guess no one told the dad. He showed up here today and was shocked to see his son gone. I tried to explain it to him, but I was working on someone else. . . ."

Soldiers who are wounded in nearby parts of Baghdad are usually brought in by their buddies in their humvees, which come roaring down the road to the ER entrance. These are emotional, fraught encounters, difficult for the ER staff trying to help.

A nurse tells me about an incident in the ER that happened while I was drawing elsewhere. After a soldier had been brought in and pronounced dead from a roadside bomb, a distraught buddy slugged his sergeant, shouting, "I told you not go down that fucking road!"

One evening the driveway is littered with discarded sweat-soaked flak jackets as soldiers and medics frantically try to extricate a guy from a humvee. Something has jammed against the door-post and the wounded soldier gets stuck.

"Fuck!" In a fury a hulking soldier hurls his helmet to the ground, then lashes out, roughly shoving one of the medics. The hospital’s deputy commander of administration, Col. David Dunning, happens to be walking by, and jumps in to help extricate the wounded man. They finally get the soldier free and rush him on a stretcher to the ER. He’s limp, the color of wax.

The medics take turns applying CPR, while PFC Gerald Montero secures the patient’s airways, but nothing works. Eventually he’s declared dead and the chaplain arrives to administer last rites. Then a gurney is pulled up with a body bag and he’s gently zipped into it and wheeled to the morgue. I notice that everyone has tears in their eyes.

Staff Sgt. Hensley tells me later, "We always try to bring them back until a doc pronounces them dead. You never know -- the human body’s a weird thing. We’ll crack open the chest and massage the heart directly. That’s worked a few times. But if you can’t get any blood pressure, if the veins and arteries are destroyed, there’s not much you can do, they’re going to bleed out. You try to make them comfortable and you let them go."

These scenes and others from the 28 CSH were some of the most moving I’d experienced and tried to draw from all my trips to Iraq. The deaths leave a deep impression, yet it’s the soldiers who survive, and the staff who keep these lives from slipping away that define the day-to-day experience here. But I felt that beneath the cheer in their sharp, young faces was a lingering sadness, an understanding that the scars of the survivors can never be erased. The scars of the hospital staff aren’t visible but occasionally the hurt contributes, in their daily actions, to something like a state of grace.

STEVE MUMFORD is a New York artist.