BALAD AIRBASE, Iraq -- Inside the cramped and hot confines of the Blackhawk helicopter, flight medics from Oregon care for two soldiers severely wounded by shrapnel from a roadside bomb.

The flight will take them to Balad Airbase, 40 miles north of Baghdad, on route to Germany for long-term care.

Seeing a young man or woman swathed in sterile blue blankets instead of a uniform, carried on a litter by six or seven hospital staff, causes a sensation that defies description.

“I’m sure we’ve all seen the war movies and the action movies in Hollywood,” says First Sergeant Travis Powell, a flight medic from Mollala, Ore. “No one can parallel or even give you anything close to what it's like when you see your own.”

The sensation can't last for long: medics focus on giving wounded soldiers and civilians, whether they are Americans or Iraqis, the best care possible when things go wrong.

Hear Powell talk about the toughest patients:

That's the case at Balad, where Powell and over a dozen medics from Charlie Company, 7th Battalion, 158th Aviation, a medevac unit from Salem, Ore., wait for missions to come in on radios strapped on their hip belts.

There are three categories of missions: urgent, priority and routine.

Urgent missions pick up patients under threat of life, limb or eyesight or in need of urgent surgery. Soldiers on “first up” or on urgent mission duty must be ready in less than 15 minutes from the time they get the call on their radio -- “medevac, medevac, medevac” -- to when the aircraft takes off.

Priority missions pick up patients that have up to fours hours before threat of life, limb or eyesight becomes immediate.

Routine or Contingency Aeromedical Staging Facility (CASF) missions are always scheduled in advance and pick up injuries like broken fingers or dislocated shoulders or arrange for the transfer of blood or tissue. Some patients need treatment and appointments at the Balad Theater Hospital in Joint Base Balad. Other patients with more serious injuries wait for a transfer to Landstuhl Hospital in Germany.

The Oregon medevac unit arrived in early May and put their Blackhawks into action within the first week in country.

CASF missions are completed on a daily basis. The only thing stopping Charlie Company from work is the sudden fog of a desert dust storm, which can ground the Blackhawks and other aircraft for up to 20 hours.

On May 18, 2009, Powell received his patient lists. Following procedure, he maps the flight route depending on each patient’s condition, ensuring a circle formation from each pickup site.

Hear Powell talk about the mission's patients:

The route is discussed with the pilots. The whole crew -- including two pilots, a crew chief and medic -- is briefed on destinations, number of patients, weather and other important information for the day’s mission.

In less than a half hour, the aircraft carrying Powell passes over lush patches of palm trees and a crowded city of sand-colored buildings.

The Blackhawk lands inside the high concrete walls barricading the landing zone next to Ibn Sina Hospital in Baghdad. Powell and another medic enter the double doors where their patients are awaiting care. Inside, Powell calls out the names of patients and grabs a bit of “face-to-face” time with staff and soldiers, asking for any new information that may not be on a paper.

“I was basically finding out what’s under all those bandages,” says Powell, who works with a sort of "less is more" mentality because messing with patients that have already received treatment is unnecessary.

On this mission, the hospital is filled with over 30 soldiers and hospital staff members. Powell finds his patient, a young man with his arm in a beige sling. The two men lean against the sterile white wall and talk in low tones despite the chatter in the room. In this brief conversation, the soldier unloads his story.

“He was the least injured in his squad," Powell said later. "The other one [soldier] had already been sent forward. He had a lot worse wounds in his lower extremities."

Powell lowers his voice.

“They worried," he said, "if they’d be able to save it or not.”
      
Powell, focused on emotional care as well as physical care, wants calm patients before transporting them over a landscape that carries menacing memories of things like Improvised Explosive Devices hidden in dusty roads.

“Now I’ve got to be concerned with from here to there," he said. "What’s gonna happen? Is the enemy going to fire at us? We’ve heard all these reports of different engagements.”

Powell engages soldiers in conversations about their lives, hoping it will take their mind off the harsh realities of the present.
      
Heavy words between the two soldiers are not uncommon; every soldier can understand the language of grief. All too often, fallen comrades haunt the men and women in the service.

The medics aren't immune.

On his last deployment in Afghanistan, Powell thought his most difficult task would be caring for the enemy.

“How am I going to deal with this person that just hours before tried to take the life of the people I serve with?” Powell said.

He quickly found out the greater difficulty of facing a litter carrying a wounded American soldier.

For Powell, a firm believer that everyone has their own style, finds comfort in a personal attachment with patients, who may be on their fourth or fifth transition.

Wounded soldiers may receive initial treatment from a battle buddy in the field, who may be relieved by a medic at an evacuation point. Then at the hospital any number of nurses or doctors may handle a patient.

“In all that time juggling around," Powell said, "maybe each time they were handed off they were just handed off.” Powell likes to be more than just a pair of hands.
      
Powell, updated by the medical staff, decides to load his patients. Hospital staff roll a patient on a litter towards the aircraft, its engine roaring and rotor blades thundering. The patient with his arm in a sling is loaded into the back seat. Then Powell directs the staff, making sure his patient with a lower extremity wound is loaded correctly.

Within minutes the aircraft is back in the air flying smoothly over the city and the palm trees and the desert.
      
In the aircraft, medics expect small changes in pulse or breathing just from patients being in a new place and in the hands of a new person.

Powell stays vigilant even though this patient appears stable.

“At any time a patient could crash on you,” he said, setting up a monitor in the cabin cramped by three large seats leaving only several feet of width of maneuvering room for Powell.

Hear Powell discuss caring for a patient aboard a Blackhawk:

Sweat runs in several tracks down his reddening cheeks.

“It's not that all of a sudden we get stressed out and wigged out, but you start doing any kind of extraneous stuff in this weather…” Powell said. “You feel bad, you’re doing the best you can. But you have your perspiration taking off.”

Hear Powell talk about conditions inside the Blackhawk:

Powell tried to not drip sweat over his patients or look alarmed to anyone with his moist appearance, but he said his patients are usually just as overheated.

“I’m calm, things are good, unfortunately I’m just sweating like a pig,” Powell said about the message he wants to relay to patients. “Its not because things are terrible, it's just it's stinking hot in that aircraft.”
      
Another obstacle for medics is the carousal, a large metal rotating wall in the Blackhawk’s cabin used to accommodate a large number of patents all at once.

“The tight cramp, it isn’t fun,” said Powell, who struggles with the setup because the days of mass casualties are infrequent. But anything could happen here, and aircraft must be ready for a full patient load.

Powell squeezed his body, loaded with an extra 40 pounds due to his Kevlar vest and gear, from the monitor over the patient’s head to his seat at the window by the patient’s feet. The wounded soldier lay still, sunglasses over his eyes, without raising his head in an attempt to see out the window. His hands lay without fidgeting over a donated quilted blanket with patches of footballs and American flags.

Hear Powell talk about donated blankets:

In less than 30 minutes, the Blackhawk lands on the landing pad in Balad. Under a billowing tent, hospital volunteers wait for the clear to roll the gurney to the litter patient and roll him into the hospital. Powell followed, ensuring his patients will be properly checked into the Balad Theater Hospital.
      
As darkness fell, Powell’s litter patient was wheeled deep inside the hospital. Powell walked outside.

His part in the wounded soldier’s life was over. Powell stood on the edge of the airfield looking up into the sky, his blue eyes looking to the distance. Despite the sometimes quiet days inside the high concrete walls Powell lives behind, he feels the weight of the wounded.

Shrapnel, the enemy, explosions and firefights exist.

Back home, tragedies only exists when hundred fall or when the front page reports casualties.

In Iraq, when sitting face to face with a wounded human, one is all you need to feel that heavy lump deep in your heart.

Cali Bagby is embedded with the Oregon Army National Guard from Charlie Company, 7th Battalion, 158th Aviation, a Medevac Unit based out of Salem, Ore., for KVAL.com. Her work has been published in the Washington Post and the Eugene Weekly.  | More stories | Visit her Web site