Paradise General: Riding the Surge at a Combat Hospital in Iraq

by Dave Hnida

IN 2004, AT THE AGE OF FORTY-EIGHT, DR. DAVE HNIDA, a family physician from Littleton, Colorado, volunteered to be deployed to Iraq and spent a tour of duty as a battalion surgeon with a combat unit. In 2007, he went back—this time as a trauma chief at one of the busiest Combat Support Hospitals (CSH) during the Surge. In an environment that was nothing less than a modern-day M*A*S*H, the doctors’ main objective was simple: Get ’em in, get ’em out. The only CSH staffed by reservists— who tended to be older, more-experienced doctors disdainful of authority—the 399th soon became a medevac destination of choice because of its high survival rate, an astounding 98 percent.

This was fast-food medicine at its best: working in a series of tents connected to the occasional run-down building, Dr. Hnida and his fellow doctors raced to keep the wounded alive until they could be airlifted out of Iraq for more extensive repairs. Here the Hippocratic Oath superseded that of the pledge to Uncle Sam; if you got the red-carpet helicopter ride, his team took care of you, no questions asked. On one stretcher there might be a critically injured American soldier while three feet away lay the insurgent, shot in the head, who planted the IED that inflicted those wounds.

But there was levity amid the chaos. On call round-the-clock with an unrelenting caseload, the doctors’ prescription for sanity included jokes, pranks, and misbehavior. Dr. Hnida’s deployment was filled with colorful characters and gifted surgeons, a diverse group who became trusted friends as together they dealt with the psychological toll of seeing the casualties of war firsthand. 

In a conflict with no easy answers and even less good news, Paradise General gives us something that we can all believe in—the story of an ordinary citizen turned volunteer soldier trying to make a difference. With honesty and candor, and an off-the-wall, self-deprecating humor that sustained him and his battle buddies through their darkest hours, Dr. Hnida delivers a devastating and inspiring account of his CSH tour and an unparalleled look at medical care during an unscripted war.

Genres: Nonfiction, Military Fiction, Medical, Memoir, Medicine, War, History

314 pages, Kindle Edition

First published April 27, 2010

Reviews

[Kristina · Rating 4 out of 5]

This excellent memoir of a doctor’s wartime experience in Iraq was enlightening and very engaging. Dr. Hnida was able to integrate his emotions and humanity into the narrative without overdoing it. His humor and perseverance as well as his humility in acknowledging the importance of his team was inspiring and impactful. Overall, his experience helped me to better appreciate what so many people (military and civilians) endure during times of war and I’m very grateful to Dr. Hnida for his willingness to serve and his willingness to share his experience.

[Buggy · Rating 5 out of 5]

Opening Line: “The last time I talked to my dad was on a sweltering April evening in 2004.It was a lopsided conversation. He had died of a heart attack almost thirty years earlier.”

Paradise General is the gripping personal account of Dr. Dave Hnida, an ordinary civilian doctor from Colorado who spent four months as a trauma chief at one of the busiest combat hospitals in Iraq.

Staffed by reservist medics this modern day M.A.S.H unit consisted of a series of rundown buildings connected by tents, cement blocks and sandbags in the middle of the desert. For this forty-eight year old volunteer soldier the working conditions may have been sparse, but he and his fellow doctors managed to maintain a 98% survival rate. Using a form of fast-food surgery, they put the mangled bodies back together in a “get em’ in get em’ out” method that then saw them being airlifted out of Iraq for more extensive repairs. Their wounded often including the very insurgents that placed the American soldiers within their OR and the Hippocratic Oath was common place. If you made it into Paradise General his team would take care of you.

Avoiding any political judgements "Dr. Dave" instead focuses on the care of his patients, his dislike of most things military and the diverse group of surgeons who become his new family. Told with a whole lot of self-deprecating humour we witness his frozen fear during his first shift and follow him through round-the-clock on call chaos, and inspiring dark hours. Throughout he manages to provide a level of humour and comedic relief to overcome the stress of putting IED maimed bodies back together, 130 degree heat, “foo-foo” coffee, threat of attack, and military madness that surrounds him. Hnida doesn’t shy away from the blood and gore here and in doing so the reality of war and death is brought home.

This book has been heavily compared to the TV series M.A.S.H and for good reason, as Hnida and his fellow surgeons use pranks and childlike misbehaviour as a prescription for sanity. His disdain for military acronyms and authority is another obvious comparison. Although (as another reviewer pointed out) it’s more like the final seasons of M.A.S.H, when the comedy held a dark edge and Hawkeye’s despairing introspection showed the true absurdities of war.

Often told on a case by case basis a couple of chapters really stood out for me; “Anatomy Of A Trauma” which takes the reader through a hurry up and wait timeline…
“09:12:00 the radio crackles. A firefight has taken place after an IED attack. Estimate two urgent casualties -arrival by helicopter in 25 minutes. Condition unknown –so we prepare for four patients and arrival in 10 minutes. Information is often muddled from a thundering helicopter.“

And “Blursday” which parallels Dr.Hnida’s day in trauma with that of the missing “fifth guy” from a routine patrol, presumed dead after an IED blast took out their Humvee. Hnida finds him outside the OR smoking a cigarette in the moonlight without a scratch on him.

I also appreciated the personal look we get into why Dave volunteered and the relationship he had with his veteran father, who only in death (and combat) was he beginning to understand.

I honestly had a lot of trouble putting this book down; told with candor and boyish humour Dr. Dave manages to deposit you right into the heart of the 399th CSH and the hell that war creates and leaves behind. It will be a long time before I can forget what I’ve read here.
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[Lynn · Rating 5 out of 5]

For Those Who Serve

I read that the main players all flew out of Ft. Benning and went to places I have sent care packages to, so I read this book in honor of friends who either operated in combat support hospitals or and other sundry duties after signing on the dotted line for Uncle Sam.

Dave Hnida is a family practice doctor from Colorado, who like many of us came from a family already primed with a military background. Four days before he died, Dave’s father told him about his experiences with war and dumped his lifelong regret for the loss of life that happened on his watch that the elder Hnida could never put down. Dave’s father died four days later.

The death of his father with practically a death bed confession combined with other traumatic events, left Dave feeling as if there was a deficit in some column that he had yet to complete and it had to do with saving other people’s children. That made him sign up for the reserves, and would do two tours in a combat support hospital.

This is a very heavy book and not for the casual reader. Understand before you pick it up that it covers many of the ugliest aspects of military duty and war. It also covers the very best, such as the fact that people in traumatic situations bond more closely than in any other time in life, and Dave was fortunate in the people he worked with. Please note that I call him Dave rather than Dr. Hnida, mostly because he didn’t want to be called Major or Dr. by any of the people he worked with, because he was a nice guy. He hated the military protocol and in that way was probably a lot like Hawkeye from MASH. This is a book filled with many victories, because these guys are good! Yet, there are reminders and tearjerkers throughout the story that remind you that war is a deadly serious business, no matter how well they prop each other up.

This was well written in the first person by Dr. Hnida, speaking in his most casual Dave voice, but with the authority of someone with the thousand yard stare. Easy five stars for the humble doctor from the Rockies and the crew from the Paradise General.

[Kat (A Journey In Reading) · Rating 4 out of 5]

This is the story of an American physician who volunteers for two tours in Iraq. The story touches on his first tour and then goes deeper into his second tour where he is an ER physician working "just another day in Paradise".

Some would think that because this is a book about a war and a memoir that it will be dull and boring, it is anything but. Dr. Hnida shares his thoughts about his dad, his practice in Littleton, CO, his daughter and the sights he saw while on tour.

I love how he brought humor into an otherwise dark situation. He details the accounts of injuries to soldiers, who were the age of his children, from car and road side bombs, gunshot wounds and assaults and at the same time having to treat the very people who did the bombing, shooting and the assaulting. All physicians take an oath "to first do no harm", some who are not in the medical field may not realize how hard that oath is to keep at times. Dr. Hnida shows that he is truly a man who cares about humans and takes that oath seriously.

The story also shows how complete strangers, the physicians and other medical staff, formed a great bond, were able to lean on each other during the dark times, and laugh during the good times even while in the midst of some unfortunate circumstances. I highly recommend this.

[Daniel · Rating 4 out of 5]

I keep telling myself that I am done reading books about the war in Iraq, but Paradise General offers a fresh look at the war that transcends politics. If you can get past the gore and black humor, it is a poignant book about mankind's humanity and lack thereof.

[Petra X · Rating 4 out of 5]

The author is as interesting as his exploits, which makes this a very good read indeed. Especially if you like either military or medical memoirs.

[Jon · Rating 4 out of 5]

I won this book from the Goodreads giveway and I personally would like to thank Dr. Hnida for selecting me as well as his signing and personal note attached to book.

This is a really good memoir and a fast-paced read. I am astonished at Dr. Hnida self-sacrifice to serve our country - to be deployed not once but twice to the theater of war. He could have easily stayed at home and continued his successful private practice, but as he highlights he felt penance. Dr. Hnida is a Littleton, CO Pediatrician who lost some of his patients in the 1999 Columbine High School shooting. He is also the father of Katie Hnida, the first female to every kick in a Division 1 football game. The culmination of the Columbine shooting, his daughter's rape and his Father's tortured soul from his experiences in WW2 are what led Dr. Hnida to join the military and help our troops.
In his book, he did a phenomenal job of illustrating the hellish conditions our troops are serving under and the ghastly injuries they are suffering. He provided a very humorous and humanistic touch to his writing to keep himself and others sane, while also providing comfort, shelter and world-class care to the vulnerable who often hung onto life by a thread. Many lives were saved as a result.

One of the most troubling aspects of this book however was aid and comfort to the enemy. A Doctor's creed is to do no harm, but when that life is an insurgent who just finished planting a bomb, which is the primary cause of American casualties in Iraq, how difficult for the layman to comprehend that our Doctors do everything they can to save their lives. Dr. Hnida handled this dilemma extraordinarily well and I certainly understand that at the end of the day we're human first and it goes against any Doctors' principle not to treat a patient if brought to their operating room. It is clearly a dichotomy. My sincere hope from this is that it leads to a realization within that individual that your enemy just saved your life. Further that our media would focus more of their resources on bringing these kinds of stories to light.

[Pamela Pickering · Rating 5 out of 5]

As a disclaimer, I am in the healthcare field (nursing) so I may find myself geared towards medical reads more than the average reader. I am also a resident of northern Colorado and have seen the author on Denver TV stations so I was intrigued.

Loved this book! Hnida kept me riveted with this humble, tender, and at times both funny and angry memoir. I found myself both laughing out loud and figthing back tears. As someone who has worked with surgeons on a regular basis it was refreshing to see the vulnerable side of these skilled professionals compared to the facade they often present at stateside hospitals (not all of them do, of course). New nurses often feel overwhelmed and freaked out when they start a new profession and I appreciated Hnida's candor in showing the fear of a family practitioner who is faced with the horrors of war. Touted as the modern day M*A*S*H, this memoir depicts a different type of comrade of arms than we are used to seeing.

Don't expect the normal "Oo-rah" military memoir if you choose this one. Hnida doesn't project a big love of the army but a pure devotion to the soldier--wounded or not. Thank you, Hnida, for giving us a peek into the the world of the hard working people who take care of our troops.

[K. · Rating 5 out of 5]

I was given an ARC to review. Paradise General is an unforgettable look inside a combat hospital. Dave's humor is unexpected in a setting so blood-filled. Early on I doubted the humor could last, but he manages to weave in funny details and anecdotes through almost every chapter. Dave's internal journey is something that most adults can relate to. The mid-life odyssey is a traumatic search for answers and inner peace. We all dream of doing something that tests us, that gives to mankind, and that leads to a discovery. Hnida does this while the reader watches. His tellings have the feel of a diary and the frankness of a friend telling a story.

Sometimes it was easy to forget about the man telling the story because the circumstances were so compelling, but as I read, I couldn't help but wonder what memories Hnida replays during a single day. Yes, it seems like a modern day M.A.S.H., but even war has evolved, and the men and women of the 4077th never saw the destruction and havoc wreaked upon the human body by an IED. To be continued.

[Sookie · Rating 3 out of 5]

I wanted to read about war from the perspective of a doctor and chose Dr. Hnida's memoir to understand the scars of war. I am still looking for memoirs written by doctors from Doctors Without Borders since their plight is far more complicated than a combat doctor. Not that a combat surgeon has it easy.
Combat doctor carries all the things that they would need in their med kit but also carry gun and other bits and bops that a soldier would carry. This memoir begins with Dr. Dave Hnida signing up for army and his first Iraq tour and then his placement in a combat hospital in Iraq, right in the middle of war zone. Dr. Hnida's narration is very matter of fact and he doesn't delve deep into metaphors and philosophy and gives an account of his experience. His voice is refreshing and his critique of army is noteworthy.

[Rachel · Rating 4 out of 5]

I thought this book was very good. I was mildly surprised that I enjoyed it so well. I thought it was going to be fairly dark, since it takes place in the middle of the war in Iraq. But it wasn't. I mean, it was dark but the darkness had quite a bit of humour spread throughout it (if that makes sense). It was a book that was very well written, I saw maybe one or two spelling mistakes, but that's expected in almost every book. There will always be a mistake they miss. It was nice to see the doctor's point of view of the war. It's very different from what you hear from the soldiers and others. So, in all, I have to say that I really like the book. I think anyone should read this book, even if you don't usually like war stories (like me).

[Adrienne · Rating 3 out of 5]

I read this book because:
1. A guy in my couples book club chose it for this month.
2. The author lives in my neighborhood.
3. I sort of know him in that 2 of my kids dated 2 of his kids in high school and his kids were charming. I have a particularly high regard for his daughter, Katie.
4. He's a local celebrity in that he is the medical reporter for a local news station.

All that being said, I didn't really expect to like the book. Non-fiction war books are not generally my cup of tea. I was pleasantly surprised. It was a fast read and very effective in making me grateful that there is no chance anyone will ever ask me to be a combat surgeon in Iraq.

Its sort of like MASH, only not as funny (though it has its funny moments) and it hits closer to home.

[Jenny T · Rating 5 out of 5]

The true account of a 48-year-old American physician who volunteers for a second tour of duty in Iraq, to work at a combat-support hospital, the equivalent of a MASH unit. Dr. Hnida writes of saving the lives of a group of American soldiers severely injured in a bomb blast, then struggling to save the life of the 15-year-old insurgent who planted the bombs... Because they're all someone's kids. Heartbreaking, but told with an incredible amount of humor and humanity. An incredible read, this book really made it all seem real for me and put a voice to what's really going on with our soldiers overseas.

[David Allison · Rating 5 out of 5]

This book accurately depicted everything I've felt since my last tour took my through the hospital at Balad the author so envied. Although my accomodations were nothing like his, the horror intially felt when the blades of a med-evaq cut through the desert was the same. I applaud the author, this was a fantastic book.

[Lance · Rating 4 out of 5]

Very interesting, I read it in one sitting. I am grateful there are people who volunteer for this type of duty.

[Chris · Rating 4 out of 5]

Good book about a physician's second deployment to Iraq as an ER doctor in a Combat Support Hospital for four months. The author conveys what every emergency medical practitioner feels: the sheer terror when you're put to the test with your first cases, the questioning of yourself and actions on certain patients, the routine it all eventually becomes, but then getting rocked to your core when you discover you can't save them all no matter how much you know and how much you do for them. The adrenaline, the sleepless nights, the guilt; it's all laid bare. Would definitely recommend this book to others, especially coworkers in the medical field.

As an interesting aside, I hadn't realized this book is authored by Katie Hnida's father. She was the first female to score in a Division 1 college football game, and while I was in high school, I read her book regarding her experiences. He mentions her a few times in this book.

[Paula · Rating 5 out of 5]

This was an excellent, very human account of one army doctor's experiences in Iraq. What I liked most was that the reader never loses his or her sense of Dave Hnida as a doctor and a father. I wept over the death of a fifteen-year-old insurgent, an "enemy soldier." I cried harder at the deaths of Americans, because Dr. Hnida never lets us forget that someone at home will have to be told the news, grieve the loss. And yet, through it all is his kind of corny sense of humor--one my own father would have found infinitely appealing if he were still with us. This book is not about politics. It's about people. And war.

[Leah Wicks · Rating 4 out of 5]

A well written book from a perspective we don't hear much about. Dr. Hnida is a good writer with an honest and at times humorous view of the tragedies of war. The casualties sustained by our young men and women are life long. It bothered me that our doctors were required to provide medical care to insurgents whose goal was to kill Americans. These military doctors stayed true to their oaths, but I can only imagine how hard it must have been. It's also a story about friendship, family, and serving a community.

[Joanne · Rating 4 out of 5]

I thought this was a very well-written, highly entertaining book about subject matter that is sad, worrying and disturbing. The author is a family practice doctor (whose was GP to some of the Columbine victims) who signs up to serve as an emergency doctor in Iraq. This is about his experiences there. So it's kind of like MASH with a more subtle, serious sense of humor. One of the best Iraq memoirs that I have read.

[Craig Brantley · Rating 4 out of 5]

No matter your political persuasion it should be remembered that young men and women are serving our country in harms way. Hnida's modern MASH makes the "old news" Iraqi conflict relevant and vivid to the reader. I hate the reasoning’s behind this war ever being fought, but moved by the heroics documented in this book.

[George Huner · Rating 5 out of 5]

A very moving, funny account of his time in Iraq, that reminds us of the very real cost of war. The quote of witnessing the "rude unhinging of the machinery of life" is chilling to think about. It is good to know that we have people like Dr. Dave caring for our troops.

[Lindsey Trujillo · Rating 5 out of 5]

"My dad was a good man, although up until a few days before his death I didn't always think so. A hard toiling factory worker, he drank 1/5 of cheap whiskey every day was a mean drunk and always left me searching for the answer to why any man felt the need to retreat to the safety of the bottle. I had my hints and theories, but never walked in his shoes, or in this case, his army boots. It took three hours in a ditch to get a first-hand revelation about why the liquor cabinet was permanently open while I was growing up.”

Wow. Wow. Wow.

I am in complete awe of this book. Hnida has truly created a masterpiece.

The author's style of writing was like having a conversation with a close friend. This book made me run through a gamete of emotions: from laughing at the many pranks and funny interactions between Hnida and his fellow soldiers and patients to the deeply emotional cases where he lost his patients in violent attacks, and described how their deaths affected him and those around him. His many bedside conversations with both US soldiers, Iraqi civilians and enemy soldiers that came into the hospital were deeply moving and at times funny, as he always looked to the positive side of a situation, even if there was none- he would find a way to make one.

The ways that the author tied in his father's time in the service and how this affected his father's, and in turn his own, life was eloquently described and all together heartbreaking and poignant. As described in the above quote, it wasn't until he was quote on quote was "in the shit", that he realized and could appreciate why his father was the way that he was after the war. I know for a fact that the sacrifice and pain of father like Hnida's is a driving force for how sons and daughters live their lives, and it is up to that child to determine the right or wrong way to go – Hnida, of course, chose the right way.

Paradise General quickly made its way into my top 10 favorite books I've ever read and I already am looking forward to re-reading it in the future.


Several, of many, of my favorite quotes:

“…The death of the young soldier hurt with a pain none of us could put into words. We are not gods; sometimes we made mistakes and even when we don't, we suffered because we are not able to undo the damage one human can inflict on another. Each of us would see this young man's face the rest of our lives, but his family would be the ones that missed his face the most.”

“My decision (to join the Army), you know a lot had to do with your grandfather, I wish you could have met him. A funny guy but he carried a lot of demons. Sometimes I think it was my job here to lay some of those demons to rest, but you know they don't make shovels strong enough or holes deep enough to bury the past. Even though we can learn from the past we just can't undo it, we can only look forward, and even then, be ready for what life throws at us. We adjust or we spend our lives in misery complaining. As the old saying goes, “Get busy living or get busy dying”.”

“…You couldn't beat death by simply practicing good medicine. There are forces at work beyond our control; forces that are very humbling. Learn that, accept that and you will cheat death 99% of the time. But the 1% will haunt you the rest of your life.”

“…More than 30 years after his death, I told my dad that I finally understood even though he went through life burdened by guilt, he had in his own way taught me the lessons and given me the tools to conquer our perceived failures, real or imagined. Our debts are now erased.”

[Madi · Rating 5 out of 5]

For those of you who are like me, non-fiction is not the first section that we visit when we enter the library, but when reading paradise general by Dave Hnida, I was just as excited to read as I am any other genre. This exciting page turner was about the adventures of a trauma doctor for the war in Iraq. This book covers the mental and physical aspects of the torture that war inflicts on people. Taking care if both the soldiers that protect our freedom and the insurgents that are hurting our soldiers, Hnida allows you to follow him through the struggles of his humanity over his wanting to let those who hurt our soldiers die as he decides how to help everyone that crosses the threshold of his hospital no matter what side they are on.
The whole excursion starts as his dad is driving him to his first year of college. His father had never talked about the war too explicitly but on this ride, the haunting stories that his father encountered during his time as a soldier leaked out. It forced Hnida to be more curious about how the war effected his father. Hnida joins the army because of the stories that his father tells him haunt him into knowing why his father was never out playing catch but instead was fighting to stay sane in the comfort of a bottle. He ends up as a trauma doctor for a hospital that all of the medics and nurses call paradise general. The first couple of days were hard as he had to command those who had been there for much longer than him. The worry of losing the life of someone that fought for his everyday hung over him. After many hard experiences and many saved lives, he creates bonds with the ones that are working with him that are inseparable. Hnida lures you in with his personal account of finding strength through the path that his father took. This book will have you begging to read more and will pull you in further with every word. You will find yourself stopping to ask yourself what you would do in the situations that he is placed in. I truly couldn’t put this book down, it touched me personally.

[Garrett · Rating 3 out of 5]

The stories were educational and entertaining, the author was not. He assumed the role of the typical military physician, who didn’t know the customs of the organization he was in, flaunted chain of command, and found his own corny jokes to be of great comfort to his patients. I have no doubt Dr. Hnida truly cared for his patients and was affected by their trauma and suffering, whether physical or emotional. But the way he frames his narrative with his interactions with his fellow doctors is about as painful as a root canal. I finished the book because I am interested in military medicine, and I do think it is educational in that aspect, but I recommend that anyone who reads this take it with a grain of salt. Dr. Hnida’s deprivation of military medicine is not universal, and points to some of the narcissism that doctors have when dealing with other Soldiers, Marines, Sailors, and Airmen.

[Reba · Rating 4 out of 5]

Well, this is a rather depressing read..

OK, I wrote the above statement when I was about halfway through this book. However, now that I have finished, I am very glad that I read it. This is a pretty powerful reminder about the atrocities and horrors of war, without getting too political. This is a sobering, eye-opening read, and I would recommend it freely to all readers.

The coolest part? In the acknowledgements, Hnida thanks an X-Ray chief, and it's a friend of mine! I couldn't believe it. It truly is a small world.

[Cheryl · Rating 5 out of 5]

The last time Dr. Dave Hnida saw his dad, they talked about Mr. Hnida's experience in World War II. In an attempt to understand his father better, Dave signed up for two tours of duty in Iraq. In this moving and sometimes humorous book, Dr. Hnida brings to life his experiences while serving his second tour at "Paradise General", a combat support hospital in Tikrit. His intimate account of life, duty, and sacrifice there is humbling. This is an honest, well written, great read!

[Nate Andrews]

Great book so far, lot's of dark humor.

[Glennis · Rating 5 out of 5]

Fantastic read. A wonderful story teller! I enjoyed each and every page of this book.

[JakubWojt · Rating 5 out of 5]

This was one of the books that spent the longest in my collection; I bought it almost four years ago, and it’s sat on the shelves of 6 different flats of mine. It’s a remnant from the time I was convinced I was going to be a emergency medicine doctor.

I finally gave it a chance and read it and I’m so glad I did.

Dr Hnida talks about his experiences in such an eloquent way, that this book would have me go from laughing to tearing up over mere pages. His descriptions of his time in Iraq were as human and real as possible. He didn’t glorify war or upsell his involvement or paint a propaganda-like view of what being an army doc was like. He spoke candidly and you got the feeling that he was a man who had his beliefs and stood by them, and confronted the evils of war and military service where he could.

This book was incredibly honest in its depiction of medical practise in an extreme area, where the goal wasn’t to fix the patient but make them survive the plane ride out of Iraq, and even writing this review, my heart quakes a bit at the stories this book told and how it told it.

Go read it.

[Danny Smith · Rating 5 out of 5]

Thank you for your service!

I truly enjoyed this story of modern-day and real life MASH. I have tremendous respect for the author to have left the comforts of civilian life and volunteered to take his skills to a war zone. God bless you, Major, and thank you!