CHICAGO — The patient had been shot on the streets of Chicago, but when Dr. Jared Bernard stood over his open body in the operating room, he could see that the single bullet had unleashed the same kind of massive infection inflicted by roadside bombs in Afghanistan.
Although the wounded man lay in a modern American hospital, saving his life would be no different than caring for a soldier wounded by a bomb exploding under a Humvee. That's why the Navy is sending its doctors, nurses and medics to Stroger Hospital, a Cook County facility that, in its own way, stands in the middle of a war zone.
Because the Navy doesn't have any trauma training facilities in the U.S., military medical teams can't get experience dealing with penetrating wounds, inserting IVs in emergencies and other techniques common to combat areas, said Bernard, a 37-year-old lieutenant commander who has been deployed to Afghanistan. He's a trauma surgeon at the Lovell Federal Heath Care Center in North Chicago, where the Navy teams work when they aren't at Stroger.
Launched this past spring, the program is one of two of its kind in the country. The other is at the Los Angeles County-University of South California Medical Center.
Navy doctors, nurses and medical corpsmen rotate through Stroger because its trauma unit is one of the busiest in the U.S., a result of the nearly constant gun violence in some troubled neighborhoods on Chicago's South and West sides.
Last year, Stroger treated nearly 600 gunshot victims, more than 260 people with stab wounds and almost 900 people injured in traffic collisions — all categories represented over the July 4 weekend when Navy Petty Officer 2nd Class Dwight Koontz helped treat a man whose body was riddled with bullet holes.
After helping cut the man's clothes off, Koontz's chores included putting little EKG discs on all the bullet holes to help doctors quickly understand what they were up against — an exceedingly tough job given how tiny bullet wounds can be and how much blood can pour out of them.
"He had 15 holes in him," Koontz said of the man, one of dozens of gunshot victims rushed to Stroger during a particularly bloody weekend. "It took about two hours for us to get him stable enough to get him to surgery." The man survived, he said.
Working at Stroger gives medics a chance to help treat patients who have been shot in the chest, abdomen and pelvis — wounds that have become rare in combat zones because of body armor. Learning to treat those kinds of injuries is invaluable because bullets and shrapnel do occasionally find gaps in soldiers' Kevlar vests.
At the same time, the hospital staff gets to watch the work of military medics who have performed their jobs under enemy fire, to see the kind of decisiveness required when there is no doctor around and a single corpsman is the difference between life and death for a wounded Marine, soldier or sailor.
Stroger's reputation for treating gunshots is so strong that police officers have been known to insist on being taken there after being wounded. So there may be no better place to learn what happens after a piece of metal pierces a body and tumbles through the tissue, shredding everything in its path.
There are no IEDs exploding in Chicago, and Navy medical professionals seldom see wounds from small-caliber handguns. But there can be striking parallels between the two worlds.
"Land mines and IEDs ... and high-speed car crashes can cause similar types of injuries," said Dr. Faran Bokhari, the head of Stroger's trauma department who helped establish the partnership with the Navy. "So we need to do hemorrhage control here or there."
Back in the operating room, the infection inside the Chicago man rages. His organs are so swollen that it is impossible to close his body each time the doctors go in and cut away more dead tissue.
Three weeks have passed since he was shot. In that time, the infection has spread like a slow-motion version of an IED blast that hurls shrapnel, dirt and other nearby material into a soldier. The stool inside the bowels spills throughout the body, triggering a widespread infection and eroding blood vessels.
"From that standpoint, this is almost the exact same thing as the IED," Bernard said.
As with the bomb blasts, it is the infection from the gunshot, not the bullet itself, that often forces doctors to amputate limbs or large parts of them as the infection advances. The concern with this man is that he too might lose at least one of his legs.
"Because the infection goes down into the pelvis ... the only way to control it is to take his leg and part of his pelvis," Bernard said. "We need to clear all the dead tissue out."
For Bokhari, the man's treatment helps explain why he wanted the Navy to come to his hospital.
"What we do here with him," he said, "will be translatable to what they do on the front lines."