I watched our medics and nurses work on a small child, one of several who arrived at our makeshift forward surgical unit in northeast Syria. We had been running traumas for eight months, and the team knew what they were doing. I could see that the child had a clear airway, his color looked good, and at this point, there wasn’t much I could do.

I thought about how strange it was to be there. Our “surgical unit” near the Euphrates River was once a classroom. Faded Arabic script and kid stickers clung to the giant green chalkboard, which was now our trauma board.

Across the hall, another classroom was converted into an operating room; the gym just a few doors down was now our mass casualty area. This child, maybe 5 years old, would probably have attended this very school if his country was not in the middle of multiple wars.

“Sir, I can’t get an IV,” said one of our medics.

As the senior nurse anesthetist, I often stood at the head of the bed and, by default, everyone looked to me when a problem arose. (It could work the other way, too: If something failed, their gazes also came my way.)

I hated these moments when the stakes could mean the difference between life and death. Most likely, I would be successful, but nothing is certain. At any given time, someone was going to die, and I hoped today was not the day. But I couldn’t confess that.

“I’ve done this a thousand times,” I reminded myself.

“You have also failed before, too,” the same inner voice retorted as I grabbed an ultrasound and prepared to start the line.

With everyone looking over my shoulder, I placed the needle in the only place on his small arm that was free of IV attempts. In a flash, blood returned to the needle. I threaded the catheter, connected the tubing, and taped down the whole setup.

I looked over the boy again. We had been hearing stories of ISIS using civilians, especially children, when fighting. His right arm was partially amputated. His abdomen had a festering wound. A laceration from a knife? A graze from a bullet?

It was hard to say; the wound had been there for a while. Either way, from what we could discern, his injury patterns looked like someone had used him as a human shield.

“Let me get him some pain meds.” I stood up and walked away.

At the beginning of our deployment in 2018, most of our patients had been military-aged men, almost all of them from our partner forces. Occasionally a bad guy, and even more rarely, one of our own. Honestly, it was exciting at first.

Then it became routine, then annoying and burdensome. Eventually, it just turned into static. Eat, sleep, trauma, repeat. Sometimes minus the sleep and eat.

But as the war dragged on, our patients changed. First, it was a civilian truck driver, later an elderly man and a pregnant mother. Then the children started showing up.

We were winning! Yet somehow that was translating into more civilian casualties as ISIS pushed into a smaller and smaller area. The dichotomy between what was happening strategically and what we were seeing on the ground was dizzying.

War is easy to process when the wounded are combatants. When the injured become people who should never have been part of the fight, it cracks any wall you build.

If you let tragedy, especially death, reach you emotionally, it will eat you alive. I had to create boundaries to survive: patients were often not people, but tasks to focus on, problems to fix.

Still, I wondered about our mission. A child. A mother. An elderly man. Were we really winning?

I returned with morphine and ketamine.

“What do you want to do?” I asked one of our surgeons.

“He needs his arm amputated and abdomen washed out,” he replied.

“Great, what do you want to do?” I asked again.

“Surgery.”

“Not here! He is stable. We should just send him to Hasakah. I can do the anesthesia, but it’s probably not the best idea here.”

I took a photo before the boy left for a local hospital. Looking back, I don’t know why. While we often took videos and photos to document and improve our care, this picture wasn’t medically useful.

In it, he lies on a stretcher wrapped in an Army wool blanket. Eyes closed, his face snuggled into the bandage on his right arm. A comforting hand on an innocent child trapped in a war zone.

The image stayed with me longer than I expected.

It’s been seven years since that day. I now live in a small New England city and have a child of my own, around the same age as the boy in the picture. I prefer the adrenaline of finding powder on my skis over that of a trauma room. Other than the license plate on my car, it might be hard to tell I was once a soldier.

My life has gone on. Yet, that image, that boy, that evening, remains with me. In moments that should entirely belong to my child, my mind drifts back to that night.

When I treat children back home, I have a good idea how their story turns out. Whether they will recover or what their future might look like. Sometimes even tragedy leads to something good, like a change in a law or procedure that protects others.

It’s different with this boy and my time in Syria. Our purpose was to push back ISIS. We talked about “winning hearts and minds,” but in reality, we were fighting a war. I like to think I did the best I could in the role I was given, but as one small part of a larger system, I am still not sure how productive my effort was.

When I replay my time in the Middle East, the patients who chose to fight fade more easily. It is those without a choice who remain with me.

That small child has never left my mind. Did he even survive? Does he have a negative memory of that time, even though we all tried to help him? Is he happy and living his dream? Or did we push him toward the very thing we were fighting?

I find myself wondering if our efforts made a difference.

What happened to him?

This War Horse Reflection was edited by Kim Vo, fact-checked by Jess Rohan, and copy-edited by Mollie Turnbull. Kim Vo wrote the headline.