Sunday, December 19, 1982
THE OLDER MAN walked toward the young captain. He was elegantly attired
in a dark blue pinstripe suit and a crisp white shirt despite the
Panamanian heat. His tie was a red foulard; a matching pocket square
puffed from his breast pocket. The Army captain—on his first
assignment since graduating from medical school—hoped Dr. Gonzalez’s
medical acumen was equal to his appearance. They needed a miracle.
As they walked down the hall to the examining room where their patient
was being treated, the captain briefed Dr. Gonzalez. “The parents
brought their daughter in early this morning. She was lethargic. We
examined her thoroughly and connected her to an IV, thinking she had
acute bacterial diarrhea—like ninety percent of the kids we see.”
They entered a small, windowless room away from the chaos of the
emergency room examining bays. Dr. Gonzalez immediately removed his suit
jacket and tie and draped them over a chair. The little girl was lying
on an examining table, barely conscious. A nurse was stroking her
matted, sweaty hair.
“Her breathing has been irregular all day,” the captain explained.
“She continued to be lethargic, so we intubated her.” The young
captain looked at Dr. Gonzalez, seeking approval but got nothing. The
elder doctor just continued to stare at the little girl. “I’ve never
had to cut such a small trachea,” he continued.
Still no response. “She’s been on the ventilator most of the day.”
“That’s good,” said Dr. Gonzalez, finally nodding. “The oxygen
will protect her brain if the blood supply has been compromised.” He
washed his hands and shoved them into the surgical gloves offered by the
senior nurse. They snapped against his wrists. With great formality he
turned and walked to the table, where he gave—first the nurse and then
the patient—a practiced smile. “You don’t look too good, Sweetie.
I hope we can make you feel better soon.” The little girl’s glassy
eyes stared up at him, her face expressionless.
“We’ve also kept her on an IV,” said the captain. “When she
presented, she couldn’t keep any fluids down, and we were worried
she’d dehydrate.” The head nurse held a file folder in front of the
captain and pointed to something. “Oh, yes, and she had a seizure that
caused her to lose consciousness.”
Dr. Gonzalez stopped his examination and stared straight ahead. “What
time did this seizure occur?” he asked, squinting his eyes.
The captain turned to the nurse. “Thirteen thirty hours, sir.”
“That’s 1:30 p.m., Dr. Gonzalez,” said the captain.
“You should have called me sooner,” he sighed, shaking his head.
“We tried, several times…” Dr. Gonzalez abruptly stopped his
examination, stood erect, shoulders back, and then turned to face the
captain but said nothing. The young officer said nothing and avoided eye
contact. After a few moments of silence, it was clear who was in charge,
and Dr. Gonzalez turned back to his patient. He closely examined her
neck and moved her head slightly from side to side. Taking a small
penlight from his shirt pocket, he shined it into each eye. “Her
pupils are dilated and respond sluggishly to light. Nurse, please make a
note in her records.” Turning to the captain, he added, “That is a
What is her blood pressure?”
“It’s low, 78 over 40.”
“What tests have you run?” asked Dr. Gonzalez—raising his
eyebrows, as he looked over the top of his glasses, which had slid to
the end of his nose.
“Just the usual tests we run when we suspect the patient has bacterial
diarrhea. Cultures. Blood work.”
“No CT scan?”
“No. There’s only one scanner, so we have to request authorization
“We need a CT scan immediately,” said Dr. Gonzalez. “Nurse, please
call Colonel Meacher. Tell him Dr. Gonzalez needs a CT scan on an infant
female. Tell him it is urgent.” He watched her scurry off and then
turned back to the captain. “We need to have a CT scan to see if her
brain is swelling. If it is, we need to know how much and where.” He
paused and shook his head. “I fear it might be too late.”
“What else should I have done, Doctor?” asked the young
captain—his voice now trembling slightly.
“Nothing, Capitain,” he replied with a comforting half smile.
“These things are very difficult to diagnose.” He perused her
medical records, which included only the treatment she had received that
day. After ten minutes that seemed like an hour, the nurse returned with
word that Colonel Meacher had approved the CT scan.
The nurses moved their patient onto a gurney and wheeled her, the IV
bag, and the ventilator to the room where the CT scanner was located.
The big, white doughnut-shaped machine was intimidating to most people.
But this little girl was too sick to register any protest as the big
machine clunked and whirred around her.
On his way back to the examining room, the captain stopped
by a break room and poured coffee into two Styrofoam cups. He took a
sip. It was harsh and bitter. Probably been sitting there since this
morning, but at least it’s hot. He picked up a handful of sugar
packets and the jar of powdered creamer and returned to the examining
“I wasn’t sure how you take your coffee, Doctor, so I brought
“No time for that, Capitain. The scan confirmed that this child’s
brain is swelling. We must operate immediately to relieve the pressure.
I need for you to obtain consent for surgery from her parents.”
When the senior nurse offered the captain a consent form, he fumbled
with the cups, causing him to spill hot coffee onto his bare arm. He
flinched and set the cups on a counter.
“Quickly, Capitain. Tell them we are going to do a craniotomy. ”
“I’m not sure that…”
“We have no choice, Capitain. This little girl will die if we do not
operate. Get an operating room ready immediately.”
The young captain froze. After a few moments, he turned to the head
nurse, standing next to him like a coiled spring. “You heard him. Get
OR One ready ASAP. Dr. Gonzalez, is there anything in particular you
“We will need to make burr holes, and we will pro’ly need to do a
“Ensure that Dr. Gonzalez has a complete set of instruments. Get
going.” He turned back to Dr. Gonzalez, “I’ll go talk to her
“Hurry, Capitain. You will be assisting me.”
After a few minutes, the captain rejoined Dr. Gonzalez. “I’m not
sure the parents understand what’s going on…”
“I will talk to them after the surgery,” said Dr. Gonzalez.
“Quickly, Capitain, change into scrubs and get washed up.”
The two men walked into the operating room. Their little patient—still
connected to the IV and ventilator—now had all manner of monitors and
machines and tubes connected to her as well. Two nurses hovered over
her, assisting the anesthesiologist, who was finishing his work. Within
a few moments she was under.
“Shave her head,” said Dr. Gonzalez. “Quickly, please.” The head
nurse—now in scrubs—stepped forward and with just a few strokes
shaved the little girl’s hair. Her movements were smooth, precise,
efficient. She caught the hair in a towel, which she tossed into a
receptacle and then washed the girl’s head with an antiseptic soap
that resembled strong tea.
The captain stared at the motionless child. Her eyes were closed, and
tubes and monitoring lines were everywhere. The ventilator clicked and
whirred as it methodically pumped air into her tiny lungs. It sounded so
mechanical. And now, without hair, she looked even more fragile—a
little shell of a person hanging on to life.
“First, we will make a burr hole,” said Dr. Gonzalez, sounding like
an instructor in medical school. He took a scalpel from the tray and
made an incision in her scalp. Then he took a retractor and positioned
it to hold back her scalp. “Cauterize those bleeders, Capitain.” The
captain’s hands shook as he worked to stop the bleeding.
Dr. Gonzalez picked up a sharply pointed drill. He pulsed it a few times
in the air to ensure it was working properly. The sound of the motor
announced to everyone what was about to happen. He touched the slick,
freshly shaved head and then pressed the bit against her cranium in the
center of the incision he’d just made. As the bit dug into her skull,
pieces of bone and tissue and blood splattered onto Dr. Gonzalez and the
captain. Unfazed, he continued, “You must start with the sharp drill,
and once the hole is large enough…” He stopped and picked up an
instrument that resembled a carpenter’s brace. “You switch to a
blunt-ended burr hole bit to complete the drilling through the skull.
This brace and bit minimizes the chance that you will penetrate the dura
prematurely. You must be very careful at this stage. There… I’ve
penetrated the dura.” He looked intently at her skull. “Mierda! Just
as I feared. Her brain is swelling.”
The captain looked down and saw brain tissue oozing through the hole in
her skull like toothpaste from a tube. For a moment, he forgot he was
looking at the skull of a little girl.
Dr. Gonzalez continued his directions. “We must remove a portion of
her skull immediately.” The captain stood transfixed, staring down at
the skull. “Capitain, listen to me! Assist me. Open her scalp to
approximately six centimeters.” The captain flinched and then
tentatively picked up a scalpel and started to increase the incision.
“I need more room, Capitain. I need to remove a portion of her skull.
We must relieve the pressure immediately. If her brain herniates and
swells downward, she will die. Do you understand? The areas of the brain
that control her breathing and other functions will be compressed, and
she will die. Do you understand me?”
The captain stared at the experienced surgeon’s hand, as he used what
looked like a small electric saw to make precise cuts into the girl’s
skull in the shape of a triangle. As he cut, her skull pressed upward,
and more brain tissue seeped out.
“Nurse, I need some gauze on my brow,” said Dr. Gonzalez.
“This is terrible. Have you given her any steroids, Capitain?”
“Nurse, give her ten milligrams of dexamethasone,” said Dr.
Gonzalez. “Immediately. Let’s see if we can slow down this edema.”
The nurse left and quickly returned with a vial. She stared at the two
doctors, awaiting instructions.
“Give her ten milligrams. Quickly.”
“Should we remove more of her skull?” asked the captain.
“No. This is as much as we can remove without risking serious
infection,” said Dr. Gonzalez with more emotion in his voice than at
any time since he arrived.
“What do we do now?” asked the captain.
“We wait. We wait to see if what we’ve done helps her.” “What if
it’s not enough?” asked the captain.
285 days earlier
Tuesday, March 9, 1982
ROBERT E. CLARK stepped out of the plane at Howard Air Force Base and
was blinded by intense sunlight. It felt as if God had turned an
interrogation lamp on him—the only thing missing was His booming voice
and a burning bush. He reached for his sunglasses but stopped when his
three-year-old began to squirm in the crook of his right arm. He grabbed
the stair rail with his left hand, fearing he might stumble down the
steps with her. At the bottom, he felt extreme heat rising from the
tarmac and saw blurry waves as light refracted near its surface.
Disoriented, he forgot to put on his cap and gave no thought to whether
his wife had made it down the steps. He just wanted to get inside the
terminal… fast. As he approached the open door, a rush of
air-conditioned coolness helped him regain his composure.
“Welcome to Panama,” came a Southern drawl from some-
where in the darkness. As Clark’s eyes adjusted to the light inside, a
wide, toothy grin appeared. It belonged to a tall, slim officer whose
rather long, sun-bleached hair caused him to resemble a lifeguard
dressed up in an Army officer’s khaki uniform. “Hot as hell, isn’t
it?” he continued, without losing his grin. Then, extending his hand,
“I’m Trip… Trip Stephens, your sponsor.”
“Hell, yes, it’s hot… Robert E. Clark,” he said, shaking
Trip’s hand, “But my friends call me ‘Clark.’ How do people live
in this shit?”
“You’ll get used to it,” Trip laughed, “You’re a Southern boy,
aren’t you? Let’s go get your stuff.”
“I’ve gotta go to the bathroom,” blurted a voice nearby, causing
Clark to realize for the first time since leaving the plane that his
normally talkative wife was behind him, also stunned by their new
“I’m sorry, Sugar. I should’ve helped you down the steps.” He
turned to see his wife, cheeks flushed and drenched in sweat.
“I’m all right,” she huffed, “but I do have to go to the
“Trip, this is my wife, Janelle Clark. And this sweet little thing is
Eloise, but we call her ‘Ellie’.” Ellie smiled at Trip with bright
blue eyes and then tucked her face into her daddy’s shoulder.
“Delighted to meet y’all.”
Clark turned back to his wife. “Why don’t you take Ellie and go find
the ‘facilities,’ while Trip and I get the luggage?”
Although the Clark family had flown down from the States on what looked
like a civilian passenger jet, the baggage-claim area bore no
resemblance to a civilian airport. Instead of a circling carousel of
suitcases, there was a pile of duffle bags, suitcases, and boxes thrown
in the corner of the terminal. Although Clark had marked their bags with
distinctive yellow tags, it took some time to locate all six, which he
and Trip lugged to the curb outside the terminal.
Trip left to get his car and returned in a few minutes in a midnight
blue, late model BMW 530 with tan leather interior. He jumped out to
help Clark with the luggage but, upon opening the trunk, discovered
he’d forgotten to unload his golf clubs. That meant three bags had to
ride in the back seat, piled next to Clark and Ellie. Janelle sat in
front with Trip.
As Trip drove down the palm-lined streets of Howard Air Force Base,
Clark had no idea where he was headed. He knew Trip was taking them
across the Panama Canal to Fort Clayton, where he would begin his career
as an Army lawyer. He knew that, but he had no inkling of what was in
store for him there. Everything he thought he knew about himself, his
values, and the world around him was about to be challenged.
But at that moment those challenges were months away. He rode along in
blissful ignorance of what was to come, excited about his future and
captivated by the natural beauty around him. Red, pink, and yellow
flowers formed splashes of vibrant colors against lush green foliage.
Palm fronds on the trees lining the street swayed in the breeze against
a brilliant blue sky. Crossing the Bridge of Americas, high above the
water, they had a spectacular view of the Panama Canal and the Gulf of
Panama. Two large, white cruise ships glistened in the sunlight,
alongside two drab, box-like freighters, all waiting to enter the
Miraflores Locks on their way to the Caribbean. Janelle turned around
from the front seat and said, with wide eyes, “You know, Bobby, it’s
kinda like what Dorothy said: we’re not in Georgia anymore.”
A condescending smile crossed Trip’s face, but it quickly disappeared
when the traffic stalled and the grimy face of a small boy appeared
outside the driver’s side window. He held up a plastic bottle of gray
water and a dirty rag, offering to clean the windshield. “Go away!”
Trip shouted through the glass, waving his hand. The boy disappeared,
and Trip proceeded through the thick traffic. “Sorry, Janelle.
Sometimes you have to be rude to these people. Now, where were we? Oh
yeah. Tell me about yourselves.
Y’all are both from Georgia, right?”
“That’s right,” Janelle began, “Pemberton, Georgia, right
outside Savannah. But, of course, most recently we’ve been at Fort
Hood and Athens and the JAG School. You know, Trip, Bobby
and I have known each other our whole lives.” “Really?” The thin
Janelle then proceeded to tell their entire life story to this person
whom they’d just met. It wasn’t the first time—she loved to talk
about anything and everything to anybody. On their flight to Panama,
she’d given the woman in the seat next to her a detailed account of
their daughter’s birth.
Her monologue continued. “We dated in high school. During Bobby’s
first year at West Point, I wrote him every day. Until he went off to
school, the only time we were apart was when we went to church. My daddy
and me are Baptists, and Bobby’s family is all Methodist.”
“You know how that goes in a small Southern town, Trip,” Clark
offered from the back seat, “most folks are Baptists or Methodists,
although there isn’t much difference—they’re all pretty
conservative. Folks used to say, ‘Our churches are so conservative
even the Episcopalians handle snakes.’”
Trip smiled again. “I’d say that’s pretty conservative. There
wasn’t much talk of snakes in my church back home.” “Where are you
from, Trip?” Janelle asked.
“Well, I guess you’d say I’m an Episcopalian from Jackson,
After a few moments of silence, Clark coughed and said,
“Trip, I, uh, I meant no offense by that joke.”
“Oh, none taken, Bobby. Or is it ‘Clark’?”
“It’s ‘Clark.’ Only Janelle and my family call me ‘Bobby’
“Yeah, no offense taken, Clark. It’s actually pretty funny because
it’s true—Episcopalians are a pretty formal bunch.” Trip paused,
seeming to collect his thoughts. “My family’s been in Mississippi
forever…” His voice trailed off as if he’d lost his train of
thought—or decided not to continue. After a few moments, he began
again, “Y’all will soon find out that Panama is a lot different from
the States. I suppose it’s the hot weather that makes people a little
crazy. It’s a fascinating place, though. By the way, do either of
y’all play golf?”
Before Clark could say anything, Janelle answered, “No, Trip, Bobby
doesn’t play any sports. All he does is work. He’s been that way his
whole life. In high school all he did was work and study, work and
study. He dudn’t know how to have fun.”
Clark squirmed in the back seat, causing one of the suitcases to slide
in Ellie’s direction. After shoving it back into place, he said,
through clenched teeth, “Well, I knew I needed to be prepared for West
“You worked like a mad man there, too,” she said, turning to the
back seat. “Didn’t you say you only slept five hours a night?” She
paused when she saw the look on his face and softened her tone.
“Bobby, you know everybody in Pemberton was proud of you.” Smiling,
she turned back to Trip. “When we thought about West Point, Trip, we
thought about the men carved on Stone Mountain—Robert E. Lee,
Stonewall Jackson, Jeff Davis. For one of our boys to be going to their
school was a big deal.”
“The truth is, Trip, none of them thought I’d make it.”
“Well, you never made the football team. You didn’t play any
“I don’t think Trip is interested in my lack of athletic ability,
Janelle,” Clark said with a forced smile.
“Well, you remember when Stanley Griffin came back home from the Air
Force Academy when we were seniors. And he’d been the captain of the
football team and class president his senior year. People thought if he
couldn’t make it…”
“But you obviously did make it through West Point,” Trip
interjected. “That must’ve been tough. And you must’ve done pretty
well—you were a FLEP, weren’t you? If I remember correctly, aren’t
there only twenty-five officers out of hundreds of applicants who get
selected for the Funded Legal Education Program?”
“Yeah. That’s right. Then I went to law school at the University of
Georgia. Where’d you go, Trip?”
“Ole Miss,” he sighed. “It’s a family tradition: my father and
grandfather both went there. If I ever have a son, I’m sure they’ll
expect him to go there, too. ‘Hotty Toddy, Gosh almighty,’ and all
that…” Trip smiled, but not like a loyal Ole Miss Rebel. After a few
moments, he continued, “So, after law school you went to the JAG
School in Charlottesville?”
“We had a number of FLEPs in my basic class,” Trip offered. “Most
of them were West Point graduates. We used to watch them in classes like
‘Introduction to Map Reading.’ They were bored out of their minds.
But they said the training we had on the Uniform Code of Military
Justice was much better than what they’d had at West Point or the
basic courses in their original branches.”
“I’d agree with that,” Clark replied. “In fact, I decided to
become a JAG, in part, because nobody in my unit, including my company
commander, seemed to know how to use the UCMJ to deal with all the
“What do you mean?”
Janelle interrupted. “Are there any malls down here, Trip?”
“Huh? Uh, yeah, but you’ll find they aren’t like the ones back
home. Mostly cheap junk. The good shopping is in downtown Panama City.
I’ve found some fine linens and jewelry that were very reasonably
“I was trying to answer Trip’s question, Janelle. Trip, you asked
what I meant about all the BS. I was referring to what I found when I
got to my platoon. Vietnam had been over less than a year, and the Army
was exhausted. We had more dirt bags than good soldiers, more
high-school dropouts than high-school graduates. And nobody seemed to
know how to use the Uniform Code of Military Justice to get rid of the
bad apples. One of my troops even pulled a knife on me. When I told my
company commander about it, he just asked me if the guy lunged at me.
Can you believe that? What difference should that make?”
“It sounds like you want to be a prosecutor.”
“Well, we’ll have to see what Colonel Allen has to say about
that,” Trip replied, in a way that suggested there was something
important he wasn’t saying.
For a moment Clark considered asking him to explain but decided to play
it safe. “So, Allen is a full colonel?”
“No. Lieutenant colonel. That’s what’s authorized for this SJA
“What’s an SJA?” Janelle asked, indicating that she was paying
“It’s the staff judge advocate,” Clark explained from the back
seat. “He’s the head lawyer in Panama.”
Trip turned off the road and pulled up in front of a dreary pink stucco
building with a terra cotta tile roof. The mold on the outside walls
gave a hint of what they’d discover inside. “This is it,” he
announced. “The visiting officers’ quarters. Unfortunately, y’all
will have to stay here for a while. We couldn’t put you in for
quarters, because you have to do that yourself when you inprocess. It
isn’t too bad, though. At least it’s air conditioned, and the food
is pretty good.”
The oppressive Panamanian heat greeted them again when they got out of
the car. Janelle took Ellie inside to get cool, while Clark and Trip
hauled in the luggage. They had barely exchanged “goodbyes” when
Janelle started whispering her list of complaints.
“Trip was right about the air conditioning, but it’s really too
cool. Do you smell that? It smells like cigarettes and mold at the same
time. Ellie should not be breathing that stuff.”
“We don’t have any choice, Janelle. There’s no other place to
stay.” She gave him a sullen look, as he turned to approach the
Without looking up, the plump woman seated behind the counter mumbled,
“How lon’ you gonna stay here?”
“We just arrived from Charleston. Here’s a copy of my orders,”
Clark said, pushing the document across the counter.
“I don’ nee’ to see no orders. Capitain Stephens tol’ me you
gonna be here until you ge’ into quarters. Did he tell you how
“Well, you gonna be in Room 215. I’s a nice room.”
“Is there anyone to help us with our bags?”
The clerk looked up for the first time. “No, you gotta tha’
yourself, and you can’ leave dem here. You nee’ to hurry i’ you
wanna eat, ‘cause the restauran’ gonna close’ in t’irty minutes,
an’ we go’ no room service.”
Great. Welcome to Panama. Turning toward Janelle, Clark was going to
suggest that she take Ellie to their room, but she was already on the
way. It took him three trips to get all six bags to the room. They held
everything the Clark family would have until their furniture, dishes,
and other household goods arrived. Because the VOQ was old—and because
modern comforts like elevators were low on the Army’s priority
list—Clark had to lug the suitcases up narrow stairs two at a time. He
felt like a rookie, going through some sort of initiation or rite of
The next morning Clark got up early to start “in-processing,” an
Army term for running all over the installation, clutching reams of
paper, and waiting for a clerk to take a copy of your orders and stamp
your in-processing checklist with a rubber stamp. Army bureaucracy at
its finest. Fortunately, Trip drove Clark around post, so the process
went more quickly than it had on his previous assignments.
As Clark walked into the orderly room of Headquarters Company—the last
stop on his inprocessing checklist—he had a flash of déjà vu. The
smell of musty files, the gray steel desks and chairs, the bulletin
board with its neatly arranged documents that no one ever read—all of
it brought back memories of his time as a line officer. This company was
different, though, because it was not a line unit. It was, instead, the
repository for everyone who was assigned to the headquarters staff, and
it reminded Clark that he had become what soldiers derisively call a
REMF—a rear echelon motherfucker. Still, this was the headquarters
company of an infantry brigade, so it was more spit-and-polish than
He was completing the last of several forms when the clerk yelled to the
company commander. “Sir, the new JAG officer is signing in. I think
you’re gonna want to meet him.”
The company commander emerged from his office, and Clark immediately
thought of one of his grandmother’s sayings: “he had a grin on his
face like a mule eatin’ briars.” Some might have even called it a
“shit-eatin’” grin, although this soldier looked like an
infantryman from the top of his crew-cut head to the toes of his
spit-shined boots. He was fit and trim and appeared to be about the same
age as Clark.
His grin grew to a broad smile, and his eyes widened. “You’ve got a
Ranger Tab,” he said, referring to the patch Clark proudly wore on the
upper left sleeve of his uniform, signifying that he’d graduated from
the Army’s toughest school. “You’re a JAG, and you’ve got a
muther-fuckin’ Ranger Tab.” Then, looking down at Clark’s orders,
his eyes got even bigger. “And your middle name is Elmer! Pleased to
meet you,” he said, extending his hand. “I’m Elmer T. Jackson.”
At that moment, Captain Elmer T. Jackson and Captain Robert Elmer Clark
bonded for good.
“Yeah, it was my grandfather’s name,” Clark replied, “But I
usually just use Robert E. Clark. Uh, no offense, Elmer, but I’ve
always been teased about my middle name.”
“Are… you… kidding?” Elmer said the words slowly and
deliberately, emphasizing his mock disbelief. Then, the grin reappeared.
“It’s a great name. What other name allows you to walk up to a
gorgeous woman in a bar and say, ‘Hi, my name is Elmer. I’m all
outta glue, but I can still stick to you.’” He paused and stared at
Clark with an expectant look.
“That really works for you, huh?”
“Like a charm. Every time.”
As Clark later learned, Elmer wasn’t kidding. His boyish grin and
aw-shucks charm made “Elmer” the most well-known name on post,
especially among the attractive Panamanian secretaries who worked in the
Clark was pleased with himself as he settled into Trip’s BMW to head
to the JAG Office. It had been a good morning. He had arrived.
Excerpted from "Death in Panama" by William H Venema. Copyright © 2017 by William H Venema. Excerpted by permission. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher. Excerpts are provided solely for the personal use of visitors to this web site.