Houston, TX - University of Texas cardiologist and colonel in the US Army Reserve Dr Samuel Ward Casscells has returned safely from a three-month tour of duty in Iraq, bringing home with him some hearing loss and stories to last a lifetime.

Dr Samuel Ward Casscells

As previously reported by heartwire, Casscells finished his two-week reserve-officer basic course at Fort Sam Houston less than a year ago and volunteered to go to Iraq, where he felt he'd be "most needed." Sooner than he expected, Casscells was called up to serve on a policy mission, working as a liaison to the US ambassador to Iraq and the Iraqi health minister to create a protocol for health policy and medical administration in the region.

Safely home, Casscells spoke with heartwire about his time there.

"It was pretty atypical for a cardiologist and darn exciting," he said. "It was an amazing experience—frustrating, sad, but not traumatizing or embittering. I wouldn't say life-changing; it was inspiring, educational, and a little bit humbling."

Casscells said he almost expected to return home "somehow seething, or resentful about something, or having bad dreams." But he isn't, and he hasn't. More than anything, he's acquired a profound respect for the people he served alongside.

In cardiology, we believe in randomized trials, but there won't be an Eric Topol/Rob Califf randomized trial of Iraq. I wish there could be, because our level of certainty in cardiology is so high.

"Here I think, I'll go for three or four months, every other year or so, but there are people who never return to a safe, high-paying job like I have; there are people who have been doing this for decades. They volunteer for it, they're good people, they love their families and their country; they're not right-wing lunatics. They are just normal people who talk about baseball and their kids' soccer teams, but they don't whine or mope about it. . . . I'll tell you frankly, if someone said you're going to spend the rest of your life with the guys you play golf with, or in the faculty club at the university, and I had to pick one group of people, I would go back with these guys. They really live to a higher standard. They don't take shortcuts, they don't run each other down; if they compete, it's open and honest, they don't hold grudges."

He continued, "It's hard to convey to a colleague from Harvard Medical School because their certainty is that these are people who have no other choice in life, that they join the military because they needed a job, they couldn't work elsewhere, they wanted out of a bad marriage, or because they like to kill people. I never, ever heard anyone gloat or express a desire for war or killing. More than anyone, these people want to be home with their families, they want peace, but they have a long view that they truly believe that their families are safer if they're over there."

It's hard to convey to a colleague from Harvard Medical School because their certainty is that these are people who have no other choice in life, that they join the military because they needed a job, they couldn't work elsewhere, they wanted out of a bad marriage, or because they like to kill people. I never, ever heard anyone gloat or express a desire for war or killing.

Casscells spent most of his time in and around Baghdad but also went to Irbil in northern Iraq and Taji. "I went to a lot of Iraqi cities and a lot of parts of Baghdad that I didn't really want to visit but had to, because my mission was a policy mission to figure out how we are going to help Iraqis take care of their own. Not their soldiers, but their civilian population. There are very difficult problems."

During his hospital visits, Casscells described the consequences of horrific crimes believed to be committed by insurgency fighters. "The torture is something unspeakable. We would go to the morgue and there would be heads there without bodies; people with all the skin scalded off; arms, legs, and fingers broken; eyeballs gouged out; holes drilled in the brain; cigarette burns on the lips; genital mutilation; lye stuffed in the mouth; drill holes in the ear—can you imagine?"

Casscells lived in the fabled "Green Zone" (also known as the International Zone), in a camp not far from the Republican Palace. "It had a swimming pool, and if the shells weren't falling you could take a swim," Casscells said. "We didn't do too much of that, because too often there were mortar and rocket attacks and it was better to be indoors."

Casscells says the only injury he sustained during his service was an infection in his elbow that developed after it was hurt when the Humvee he was traveling in swerved to avoid a suspected improvised explosive device (IED).

"I was in the emergency room (ED) getting my elbow drained, and a tough old army nurse came in and said, 'Listen up: we've got two choppers coming in with critically wounded Iraqis from a big IED explosion in North Baghdad, I need every table. What's that colonel doing there? Can't you treat him somewhere else? Get him out of here, I've got real injuries coming in,'" Casscells recalls. "Here I was, a full colonel and US citizen with a bona fide infected elbow, and I was thrown out of the ED and put out in the hall. I thought, God bless the US Army that they have nurses like this."

Now home, Casscells says he was better, physically, in Iraq than he often is at home. "I got enough sleep, I exercised every day, I lost a bit of weight, got in shape. I did lose some hearing—there's a lot of bombs and explosions and the helicopters make a ferocious noise."

Casscells and Dr Brian Allgood

One of his colleagues was not so fortunate. Dr Brian Allgood, whom Casscells describes as his "best friend" in Iraq, was killed shortly after Casscells returned home. Allgood was one of 12 soldiers killed when the UH-60 Black Hawk helicopter they were in crashed on January 20, 2007, after being hit by a rocket in Taji.

"He was a great guy," Casscells said. Allgood's memorial service is on Friday in Colorado Springs.

Casscells himself "took fire" in Iraq but was never hit, although many around him were, including his translator and guide. He only once drew his gun from its holster during battle—he was told to "lock and load" when a Humvee he was traveling in was shot at—but he didn't fire it.

Asked what he thinks about the enduring debate over the ongoing US troop presence in Iraq and role of the US military there, Casscells sighed.

"I go back and forth," he said. "I'm just a doctor and those are big questions. . . . I just don't have good answers. Those are the right questions to ask, I'm just glad it's not my responsibility to answer them. All I have to do now is check blood pressure and if it's too high, all I have to do is choose between a diuretic, a beta blocker, or an ACE inhibitor."

The US soldiers in Iraq, he said, are convinced that by fighting there they are staving off attacks on US soil; they also believe the Iraqis, on the whole, appreciate what they are doing.

"I'm not sure either proposition is true, frankly. In cardiology, we believe in randomized trials, but there won't be an Eric Topol/Rob Califf randomized trial of Iraq. I wish there could be, because our level of certainty in cardiology is so high. When we say we know something, we know it. But in the foreign-policy arena, as far as I can see, you almost never have real certainty about things."

Casscells does, however, think that in time the American and multinational forces will have a positive impact, even if it's slow in coming.

"When American platoons go into an Iraqi village, and they have men and women, black and white, Asian and Indian, with names like Rajah, O'Brien, Cohen, Smith, and Al-Alwan, Iraqis look at the name tags that are obviously Arabic, Hindu, Buddhist, Jewish, and they look at the faces, and they are stunned. And then they see these people acting as a team, adhering to a code of regulations, acting courteously, and never asking for anything. And this has a stupefying effect on the village. They don't know what to make of it. . . . This visible example of American soldiers with their true diversity, their true teamwork, and true sense of honor is a shining example to the Iraqis, and it has to have a lasting effect."

Iraqis also have plenty of criticisms about the US, many of them justified, Casscells adds. "They also know that America is a culture where the elderly are not taken care of, where there's divorce, where women are preyed upon, where there are drugs, where people get drunk and kill each other on the highways. They have plenty of criticisms for our country, some of which are quite valid."

And yet, he says, most of Iraq outside of Baghdad is experiencing an economic upturn, and they're "dealing with the example that we've set there."

"I actually think it's going to turn out okay there over the next decade," he said.