Every day, they arrive by the busload -- broken, bandaged and bloodied from war.

They are American, Canadian and from many other nations -- "wounded warriors" delivered from Iraq and Afghanistan with blown-off limbs, severe burns and battle fatigue.

Some arrive fresh from conflict with blood still on their boots. Some come with less visible injuries, such as post-traumatic stress disorder, chronic back pain or severe headaches. Others need medical treatment or tests they can't get in the field.

When Canadian soldiers are injured in combat, they are evacuated here to Landstuhl Regional Medical Center, a sprawling, fast-paced American military hospital that is the biggest medical facility outside the U.S. For Canadian troops, it is the gateway between Kandahar and Canada, and a crossroads between the brink of death and life.

Shell-shocked troops confront the grim reality of a future as an amputee, or grapple with the guilt of survival as their comrades return to Canada in flag-draped caskets.

Since the war on terror spawned two major conflict zones, Landstuhl's story has become one of the brutality of war, of survival, and of resilience.

"Here, they get a fighting chance to live -- a fighting chance to get back home," says Capt. Colin Muise, a Canadian Forces nurse working as a liaison officer at the hospital. "To be able to get them back to live reasonably productive lives at home in Canada is pretty amazing."

At 1:39 p.m., a cluster of hospital staff begins to assemble. An alert has gone out of the "wheels down" of a medical evacuation plane at the nearby Ramstein air force base. In roughly 34 minutes, the seamless transfer of 21 patients will unfold: From the C-17 in theatre, to ambulatory bus, to hospital. A "muscle" team -- which always includes a chaplain -- dons blue plastic gloves and prepares to unload a parade of gurneys at Landstuhl.

"I welcome him by first name and offer words of comfort," says CF Capt. Patrick Lublink, a chaplain who is the first to greet a Canadian soldier arriving by stretcher from the combat zone. "I tell him: 'Your job is done for the moment. You are safe here. Be calm.' Even if they are sedated I still speak to them -- we never know what they'll hear. The tone of voice, the French language. That might touch them, I don't know."

When the patient is not in a deep coma or heavily medicated, they are often reeling in pain or shock. But Lublink believes the familiar signs of his Canadian green combat gear and a Maple Leaf flag on his arm provide at least some comfort in these darkest minutes and hours.

The average patient will stay at Landstuhl eight days. Sapper Mike McTeague teetered between life and death here for 10.

At age 20, he was rushed here in September 2006 with shattered bones on both legs and a bowel ripped open by shrapnel after a bomber detonated himself just metres away on his village foot patrol.

Spells of unconsciousness and heavy doses of morphine have blurred most recollection of McTeague's time in Germany. Yet he still sees Landstuhl as the portal where remarkable surgery and top-notch staff pulled him back from the edge of death.

"They reconstructed part of me. They definitely saved my life," he says. "I either wouldn't be alive or I wouldn't have recovered as well."

McTeague now works a desk job for the military in Toronto.

When Lublink speaks with survivors, he must sometimes pass on the grave news of comrades who didn't make it.

"They cry, and it's normal," he said. "I find it's amazing that they can be so injured, yet the first words out of their mouth are to ask not about themselves, but about their buddies."

Seared in his memory is one young Canadian, heavily bandaged and unable to speak, who scratched out a message after learning of a fallen comrade .

"It said, 'I'm single. The sergeant was married with two kids,'" Lublink recalls. "I understood exactly what he was saying. It was this sense of guilt that he had stayed behind when the man with family was gone."

Lublink is haunted by the agony of woman whose soldier husband battled but succumbed to burns that ravaged 90% of his body.

"You're helpless. You can be with her and hold her hand. I can pray with her, reassure her and spend all day with her. But she is facing a death and asking, 'What am I going to do? That is the most difficult," he says.

Whether they are Christian, Jewish or Muslim, Lublink encourages the wounded and their loved ones to cling to their faith. For those who don't pray to a God, he suggests they put their trust in the excellent doctors and nurses at Landstuhl.

Surrounded by the daily impact of war, weapons, killing and suffering, Lublink is forced to continually ponder the worst of mankind. But it also allows him to see its best -- the doctors, nurses and volunteers tirelessly working to help the sick and injured troops they view as "heroes."

Part of Lublink's job is also to administer donations to wounded soldiers, who usually arrive with nothing but the clothes on their back. Displaying boxes and racks of toiletries and clothing in the Chaplain's Closet, he becomes emotional sifting through a box marked "Single Shoes."

Each piece of unmatched footwear represents a soldier who has lost a leg. They keep the odd shoes for the next who will lose the opposite leg.

About 200 Canadians have passed through Landstuhl since the mission began, usually for stabilization before they are returned to Canada or to the base in Kandahar.

Unlike conflicts of the past, not many arrive with bullets to the chest or head; more come now with shrapnel wounds and raw, ragged limb amputations from hidden mines and "improvised explosive devices."

"As the Taliban or insurgents change their tactics we get different types of injury," says Dr. Marc Dauphin, a Quebec physician now working in Landstuhl.

After receiving medical training through the Canadian military, he remained as a reservist as he worked in the civilian hospital system. Now 55, he has returned to serve with his "brothers in arms."

He supervises the care of all Canadian patients, including requirements for specialists, the transition of care back home, and air evacuation. For wounded soldiers, safe travel home to Canada depends on intricate measures of physiology, vibrations and oxygen.

Better protective equipment, more comprehensive training and medi-technological advancements mean far more soldiers survive today than would have in past wars. The so-called "golden hour" -- the critical wedge between life and potential death -- has been substantially prolonged.

"Most soldiers today are treated by their buddies in the field in the first minutes -- and they save lives," Dauphin says.

That bond stretches from the battlefield to this hospital, where everyone helps to lend a hand. He has watched high-ranking colonels take a handle to lift a stretcher from a bus.

He holds his deepest honour for those injured in battle.

"Many of them are maimed for life, yet they have this extraordinary resilience," he says. "I'm a cynical old fellow, but I was surprised by the spirit of the soldiers. They're positive, and they know what they're doing is right. These guys are the heroes, so if I can help, I'm very happy."

Capt. Rhonda Crew's job is also to help the sick and injured, but recently she has become the patient.

Deployed to Kandahar as an emergency nurse, she is part of a coalition critical injury team that swoops in by chopper to the "site of injury" on the combat field.

The team administers emergency aid to resuscitate and stabilize the soldier until they reach a tent hospital. If the wound is at risk of infection or requires more intensive treatment or surgery, the soldier will then be evacuated to Landstuhl.

Each case is flagged as urgent, priority or routine.

Crew concedes it was odd to be at the receiving end of medical care when she contracted an unknown respiratory illness in Kandahar. She believes the virus was transmitted from a local Afghan who brought up blood and spit in her mouth and eyes as he came out of anesthetic.

"It's a dirty, dusty climate. Lots of bugs there don't get killed by the cold," Crew wheezes, before erupting in a violent coughing fit.

With trouble breathing, she was evacuated to Landstuhl along with other coalition troops.

She gave up 10 vials of blood for tests that aim to return Crew to health -- and to Kandahar.

Capt. Colin Muise's father was an amputee who coached baseball and taught him to swim. He draws on that experience when wounded troops begin to despair.

At Landstuhl, the CF nurse interprets medical jargon, helps families and co-ordinates the patient's journey back to Kandahar or Canada.

He sees Landstuhl like a second front line, where the soldier patient hovers at death's door while surgeons, doctors and nurses battle for his life.

In awe of the soldier's spirit, Muise has witnessed more stories of survival than death here. Even when a Canadian succumbs to injuries, he can sometimes manage to live on. Muise says he will never forget the remarkable story of a Canadian killed in a vehicle rollover in Afghanistan.

"His family were strong believers in organ donation, so somewhere in Europe, he is still saving many lives," he says.

MEDICAL CARE
LRMC in Germany is a full-scale U.S. hospital that provides medical care to military personnel and their families. It also treats Canadians and soldiers from 40 other nationalities serving in conflict zones.

SINCE THE 'WAR ON TERROR'- 8,731 battle injuries from Iraq
- 857 battle injuries from Afghanistan
- 45,272 patients
- 7,642 returned to theatre

STAFF
- 2,928 total
- 1,096 civilians

SPECIAL VISITS
- Cher, Jennifer Lopez and Chuck Norris are just a few of the celebrity guests who have visited LRMC.

by Kathleen Harris, National Bureau
© Copyright 2008, The London Free Press Unauthorized reproduction or Web posting prohibited.
- used with permission