Emergency Room

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Under Cornum, the hospital has been thoroughly modernized. Today's combat doctors are likely wired to e-mail and cell phones. Holcomb, who now heads the Army's Institute of Surgical Research in Fort Sam Houston, Texas, says he routinely gets an e-mail "from some doctor in a tent outside Fallujah," saying a soldier has been burned in an explosion minutes before, and is being flown by helicopter to the combat hospital in Balad. An hour later, a physician in Balad calls Holcomb, saying he's putting the patient on a plane to Germany. At that point, Holcomb can dispatch a burn team to Landstuhl to bring the soldier back to the Army's specialized facility in Texas. "He's here 24 hours after being wounded," he says with amazement. Landstuhl is now a crucial stop-off point, where the details of each injury are compiled in a dossier that's carried to military facilities in the U.S.

But sometimes the system can be chaotic, say Landstuhl's doctors. "Half the time the records at Landstuhl don't make it back to guys in the U.S. who are taking care of them," says Dorlac. Landstuhl's surgeons are often left to decide a soldier's fate themselves: whether to return him back to the war after being stitched up, or send him back to his base, or home.

Partly with Cornum's coaxing, U.S. military commanders in Europe have begun requiring every soldier returning from Iraq to consult a psychologist for post-traumatic stress syndrome. Cornum, who previously led the 28th Combat Support Hospital in Bosnia, has also hired several trauma surgeons and critical-care nurses and added operating rooms to the icu. "It's a completely different place now," Putnam says. He ranks Landstuhl as "a world-class trauma center," with top-of-the-line equipment. Landstuhl's eight operating rooms are busy most days, with doctors performing 25 to 30 procedures, including neurosurgery. Physicians set bones and clean out wounds, and carry out a lot of amputations.

From within the trauma wards, Landstuhl's doctors and nurses have had a close-up view of the war's mayhem, almost as intense as in Iraq itself. After being wheeled through Landstuhl's doors one snowy morning in late January, Brent Jurgersen, 42, a first sergeant from Low Moor, Iowa, was rushed into an operating room, where surgeons amputated his left leg at the knee. The day before, as Jurgersen led his Humvee through a village near Samarra,

Only 16% of American injuries in Iraq have been from bullets, but the amputation rate of injured Americans is 6% — almost double that in previous wars

three men stepped out of an alley and fired rocket-propelled grenades, splitting apart the vehicle. In the brief moment he was conscious, he saw the blinding flash of the explosion and the dead body of his gunner sprawled across the back seat.

Days later, doctors in Iraq e-mailed surgeons at Walter Reed to say that Jurgersen had flatlined twice in the field hospital in Balad, before being flown to Landstuhl. Like many other soldiers who've landed here during past two years, it was not Jurgersen's first evacuation. Last June, he survived a bullet that pierced his tongue and lodged in the back of throat. He spent more than three weeks recovering at Landstuhl. Jurgersen, tall and powerfully built, insisted on returning to Iraq to complete the 1st Infantry Division's yearlong mission, which ended last month. "My husband's never not finished anything in his life," his wife, Karin, wrote in an e-mail a few days after his leg was amputated, adding that when he heard Time had seen him arrive at Landstuhl, "he asked that you don't make him a hero."

Attached to the e-mail were photos of Jurgersen, leaning on a walker in the passage of the Walter Reed Army Medical Center in Washington as he began learning how to manage with one leg. Last month, he insisted on flying back to Germany to welcome home his soldiers from their year in Iraq. Last Thursday, he was back at Walter Reed, being fitted with his first prosthesis. But Jurgersen — already an aging soldier — is focused on a single goal: returning to his command. If doctors declare him fit for duty within a year, he could head back to Iraq. A precedent has already been set by Captain David Rozelle, a 33-year-old amputee who lost his right foot after his Humvee rolled over a land mine in Iraq in June 2003. He headed back to Iraq earlier this month to command a 3rd Armored Cavalry Regiment troop.

Aside from those daily slow-drip shrapnel and bullet wounds, there are the times that Landstuhl's doctors call simply "surge modes" — stretches of up to 24 hours when they perform nonstop operations. Like military historians, they can rattle off without pause the war's bloodiest events for American soldiers, when casualties spilled into the passages: the bombing of the U.N.'s Baghdad headquarters in August 2003, two major offensives against Fallujah last spring and fall, and the devastating suicide bomb in a dining hall in Mosul last December.

Month after month of seeing planes arrive loaded with fresh casualties has also sharpened the cynicism of many staff. Some say they are wary of the upbeat assessments given by politicians. Major Kendra Whyatt, Landstuhl's head orthopedic nurse, says she was from the start skeptical about the reassuring tone in Washington. She watched President Bush on television nearly 23 months ago as he declared major combat in Iraq over under a mission accomplished banner onboard the U.S.S. Abraham Lincoln off the coast of California. She quickly dismissed the rhetoric. "The life we live and the life Americans believe are two different things," says Whyatt, 37, who's been an Army nurse for 14 years and moved to Landstuhl with her three small children in 2002. "There are still casualties coming from Iraq, whether or not the incident is newsworthy."

Scores more casualties have arrived at Landstuhl since Chilles, Jurgersen and Salter were admitted to the hospital back in January. Back home, Chilles' breakneck evacuation from Iraq seems unreal to him now. "I spent nine days in the hospital and traveled about 8,000 miles, just so I could sit with my dog and watch some TV," he e-mailed from Modesto, California, from where he shuttles to local military facilities to have his shrapnel wounds cleaned and dressed. "It isn't the way I thought I would be spending my 28th year of life. But I guess it's better than no life at all."