Since I last wrote, the hospital has seen a steady stream of customers.

Trauma volume increased in the past 30 days. Major cases included an Iraqi national with burns over 50 percent of her body, an insurgent with multiple injuries including both hands blown off while placing an improvised explosive device (IED), a coalition service member who sustained a gunshot wound, an Iraqi police officer and soldier with gunshot wounds, and four Iraqi army soldiers involved in a Humvee rollover.

Caring for the insurgent IED victim brought with it a rush of emotions and conflicts but not during the actual providing of emergency care. At that point, training and instinct are in control and care is provided the same as it would be to anyone at a hospital emergency department.

But after it is all over, and you start to collect your thoughts and discuss the case with colleagues, it is apparent that as medical professionals we all wrestle with similar ethical dilemmas.

Are you glad that it was this guy who suffered the devastation of his own device and not the coalition service member who would potentially come across it? Do you wish he was killed so that limited resources aren't expended to save him?

A few days later, we found out that the man was a foreign fighter -- there are many insurgents in Iraq who come from other countries to fight -- and that he provided valuable information that led to the capture of other bomb makers and explosive materials.

Is that the silver lining?

It was interesting being in Iraq on March 19, the fifth anniversary of the start of the war. It didn't appear to mean much to the troops on the ground, just another day.

I'm not even sure whether many of them knew the significance of the day. But while watching the news channels in the dining facility, some mentioned how disheartening it was to watch or read the media coverage of the day. There was little, if any, mention of the successes that our military has achieved during the past five years.

The story lines, instead, seemed to concentrate on the negatives such as the financial cost of the war, and the number of casualties among U.S. forces and Iraqi civilians.

Easter Sunday was a time for reflection. I missed being with my family and participating in all the family traditions of the day and thought about my son's upcoming birthday.

In perspective, however, those things are so small compared to the sacrifices that many of the service members at Al Asad have made.

I have met troops who are here for 12 to 15 months, some for the second or third time. They have missed a year's worth, or more, of birthdays, anniversaries and holidays with their families.

Some have new spouses or newborns at home, whom they barely got to know prior to shipping out, or they had a new baby delivered while they were here who they have yet to hold.

I met one female soldier who had a baby and then, three months later, found herself in Iraq.

They are the true heroes, answering their nation's call, regardless of when or where.

Occasionally, we take care of someone who exceeds our capabilities and needs to be evacuated either to Germany or the United States.

One would think that they would welcome the opportunity to get home, but in fact the most common question I get asked in those cases is, "Hey doc, how fast do you think I can get back to my unit?"

These are incredible men and women.

March 25 was a sobering day as reports came in that the United States had sustained its 4,000th casualty.

We routinely train in the ER, running mock resuscitations, so that our skills are honed and everyone knows their role when a casualty arrives.

Our job is to keep that number from rising and everyone here takes that mission seriously. I continue to be amazed by the professionalism and skills of the young medics of this unit, many of whom have civilian jobs that are unrelated to medicine.

Today is April 2: Day 60 or two-thirds of the way home. Although everyone looks forward to returning home, there is no evidence of "short-timers" syndrome here. They remain focused and dedicated to the mission to conserve the fighting strength.