Two men are on operating tables, badly injured and undergoing surgery when the first rocket lands nearby.

Peter D. Ray, far right, performs surgery during his time in Salerno, Afghanistan. Ray, a pediatric plastic surgeon, served for 11 months in Afghanistan as the U.S. Army base’s lone general surgeon.

A pretty solid explosion hits, but Peter D. Ray, M.D., and his team of nurses didn’t appear to be in immediate danger. A second rocket hits a few minutes later, whistling as it comes in, shaking the ground under Ray’s feet when it lands. The Taliban has a forward observer near the U.S. Army Forward Operating Base Salerno in the province of Khost, Afghanistan. He’s radioing the position of the forces to his comrades.

A third rocket hits so hard and so close that supplies fly off the walls. 

Ray, the only surgeon on the base, gets the call from ground command: Leave the enemy soldiers on the operating tables and get in the bunker.

“If it had been our guys, American soldiers on the operating table, it would have been my job to assign someone from my support staff to stay with them. So now, I’m responsible for the lives of my support staff, too,” Ray says. “And you have to tell them ‘you have to stay here and make sure this guy stays on the ventilator until this thing is over.’ That’s complicated. And that’s what it’s like – every day, for 300 days.”

Ray is home in Birmingham now. He is an associate professor of plastic surgery at UAB, seeing patients at Children’s and UAB hospitals. Afghanistan prepared Ray for his work here in ways he never imagined. For one thing, conducting operations while under enemy fire builds mental discipline quickly, he says. 

But treating the children who were shot, lost limbs after stepping on land mines or suffered burns was where Ray began to find his true comfort zone. It may seem like a long way from there to treating the children of Alabama and the Southeast – most of whom have been run over by a lawnmower, injured in a car wreck or suffered burns. But Afghanistan has given him better perspective on the severity of injuries and the likelihood of recovery, giving him confidence with children and their parents – and giving UAB a valuable asset.

“I think I’m able to look at the parent and say ‘I’ve seen this before. I can tell what it’s going to be like.’ And I can do it without pretending what is going to be doable and what isn’t,” he says. “It’s very much within my comfort zone to take care of some bad injuries in kids.”

Ray, a 38-year-old native of Buffalo, N.Y., native, is a humble man. “If you get too high on your horse, that’s when things start looking for you,” he says. Ray didn’t go to war seeking fame and fortune as a doctor. He just wanted to help people.

The U.S. Army Specialized Training Assistance Program (STRAP) gave him the opportunity. He says he’s a better doctor because of it. 

“This taught me how to work with nursing staff, pharmacy staff, blast staff and other people in the hospital because I didn’t have a choice,” Ray says. “It was a big education in interpersonal communication and in how to be a good hospital citizen, respecting what others do and getting them to understand how I think. I never would have gotten that otherwise.”

STRAP exists to obtain medical staff in critical Areas of Concentration (AOC). Ray completed his general surgery residency prior to entering plastic surgery residency, and it is his Army AOC. He signed up for the same reason many enlist in the military – he needed money. 

“My student loans were such I really didn’t have anything to eat except Ramen noodles,” he says. “I signed up basically because I was broke.”

Ray enjoyed his stipend – not to mention solid food – for two years until he completed his surgical residency. Then he received a letter congratulating him and directing him to San Antonio for an observation course. It was 2002, and he says it was clear something big was coming.

He was assigned to the Fifth Medical Group on Green Springs Avenue and soon was sent to Bosnia for five months.

On to Afghanistan
Ray was back six months from Bosnia before he was told he was going to Iraq. Instead he was diverted to Afghanistan with the 325th Combat Support Hospital out of Kansas City.

Ray was in Salerno for 11 months operating on U.S. and enemy soldiers, Afghans working with the Army and other citizens. Ray treated 250 major traumas – around 130 more than he could have expected to see in his first year of practice.

And it was in Afghanistan that he began to take care of children, many of whom were harmed falling into open fires used for cooking in their home.

Ray kept in touch through e-mail with his boss, John Grant, M.D., director of the UAB Cleft and Craniofacial Center. He often told Grant of the struggles faced daily. Grant was talking with one of his patients who had lost his legs as a young child and grew up with a series of prosthetics. Grant told the child how Ray was treating children who lost limbs after stepping on land mines. The child decided to box up his old prosthetics and ship them to Ray.

“I was actually able to put a few of them on the kids I was treating,” Ray says.
He was permitted to build a clinic just outside the base in Salerno, and his first sergeant drew up the plans. “We were able to get it approved and actually had it built with concrete blocks,” he says.

“We’re not there to do humanitarian work, but at the same time we have the ability and it helps the hearts and minds of the local nationals. And what else are we going to do? It’s just a complex world to work in.”

Ray and his staff clearly did their job well. About 50 percent of the injuries treated were blast injuries. The general in charge of the war theater came to visit the base once and praised Ray and his staff for their work.

“He told us, ‘From my perspective, you guys are just a dot on a map,’” Ray says. “But he adds, ‘The one thing I do notice is that any American soldier who gets injured and comes here gets to Germany. Something you’re doing down here is right. I don’t know anything about medicine, but I do notice that pattern.’”

Ray was awarded the Bronze Star by the Army for his 11-month service. He didn’t take his two-week break until the end of his service time. The Bronze Star for service is an award Ray appreciates, but it’s the memories of overheard conversations on the work of the medical staff he treasures.

“We had this area where soldiers could go to call home using satellite phones, and it was not uncommon at all for us to hear a helicopter pilot or someone talking to their families saying ‘Honey, don’t worry. It’s great because we’ve got the best hospital in the country here.’”

Help back home
With his two tours of duty, Ray was away from home for more than a year and a half, putting a significant strain on his co-workers at UAB and Children’s hospitals.

His voice is still tinged with regret that his colleagues had to pick up his work during his absence.

“It put a huge burden on the remaining residents here to do my work while I was gone, and this is a very, very busy place,” Ray says. “I owe so much gratitude to those guys who took care of things while I was gone. For anybody in the military to do their active duty, there is a tremendous amount that falls on the shoulders of the people who are doing the work when they’re not there. That’s an unmeasured cost.”

Ray wondered if he would get to keep his job back home since he was gone for so long. For Ray’s boss, there was never any doubt Ray would be accepted back.

“Dr. Ray is a high-quality person and we didn’t want to lose him,” Grant says. “The long-term future gain is worth the short-term investment. He was pulled to serve and did his duty and we shouldn’t have him pay the extra sacrifice of losing his job here. I think there’s a moral obligation for that. Plus, he’s a fantastic doctor. I’ve known him a long time and taken part in his training. I’ve worked hard to build this center, and I wouldn’t trust it to just anyone.”

Ray says he is glad to be back in Birmingham working with children. “Kids don’t seem to know how bad things can be,” he says. “All they have is hope, and all they want to do is go play.”

Army future
There is a very good chance Ray’s service in the military isn’t over.

His STRAP contract runs through 2012. He likes to mention the last line in that contract – “or as dictated by the needs of the United States Army” – both to inform and to remind himself that the next letter requesting his service can arrive at any time.

Ray will travel with the 946th Forward Surgical Team out of Mobile the next time he is called. Ray, a major, is the unit commander.  “My terminal date of service at the current time is listed as indefinite,” he says.