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Nick Vogt graduated from West Point in 2010 with an acceptance to medical school and plans to become one of the Army's top trauma surgeons.
But first, the Ohio-born 22-year-old wanted to understand the physical and mental demands on an infantryman in combat. So he went to Ranger School and Airborne and landed with 1st Stryker Brigade, 25th Infantry Division, first in Fort Wainwright, Alaska, and later, Afghanistan.
"It felt necessary for me to go out there, to experience what the soldiers experience, so when I'm a doctor, I'll know," said Vogt, now 24.
In Panjwai, near Kandahar, Vogt's affable demeanor and willingness to learn quickly earned his men's allegiance.
"I really liked the guy. He was really motivated to get out there and work with us," recalled team leader Sgt. Adam Lundy.
But within two months, the popular lieutenant would be clinically dead, having taken a wrong step onto an improvised explosive device.
And what happened afterward is now a chapter in the annals of military medicine.
On Nov. 12, Vogt, now a first lieutenant, will celebrate his first "Alive Day," the anniversary of the day both his legs were shorn off by a makeshift bomb. He survived, receiving 500 units of blood, more than any other casualty survivor in U.S. history.
His story epitomizes the advancements in casualty care in the past decade and illustrates just how far the U.S. military will go to save one of its own.
One bad step
"I still remember every detail of his story. The fact that he didn't die on us just kept us going," said Air Force Maj. Raynae Leslie, a blood bank specialist who worked at Kandahar Role 3 hospital in November 2011.
The day began eventfully for "Rage" Platoon, Bravo Company, 1/5. In the morning, during house-to-house searches, the unit discovered a weapons cache and came under small-arms fire.
During a break to rest their bomb-sniffing dogs, Vogt consulted with Lundy to set up a security zone. As the last man assumed his place on the perimeter, radio-telephone operator Spc. Calvin Pereda, standing not far from Vogt, took one small step, triggering an IED.
Nearly simultaneously, a second detonated under Vogt's feet.
Lundy, two feet to Vogt's left, was hurled into a wall. After recovering from the impact, he crawled through dust and dirt toward Vogt's screams.
When he got to the lieutenant, his training overcame instinctual horror, he said. Vogt's left leg had been pulverized, with nothing left but a mass of indiscernible blood and froth. The right, still wearing a combat boot, had been stripped of skin and muscle midthigh down.
"I took care of the left leg first. Normally, with that kind of wound, you put a tourniquet on it. But he didn't have anything there to wrap," Lundy said.
So the sergeant "grabbed what was left and squeezed it together to slow the bleeding" and called for medic Spc. Tom Underhill.
Underhill was working on Pereda. The radio operator also had lost his legs but was conscious.
"It seemed like I could get him stabilized," Underhill recalled.
Hearing Lundy, Underhill moved over to Vogt and began treating the right leg. Lundy fashioned an abdominal tourniquet around Vogt's torso and attempted to revive the lieutenant, who by then had lost consciousness.
When Vogt's breathing stalled, Underhill performed a cricothyroidotomy, puncturing a hole in the officer's neck to allow in more air.
And he administered the synthetic starch Hextend, which boosts fluid levels, through a line he placed in Vogt's sternum — one of many moves that helped save Vogt's life.
The line would stay in Vogt for the next 24 hours, a portal that allowed doctors and nurses to continue giving him lifesaving medications.
Catastrophic wounds
Combat survivability in Iraq and Afghanistan is higher than in any American war: Only 10 percent of all injuries in operations Iraqi and Enduring Freedom have resulted in death, compared with 16.1 percent in Vietnam and 19.1 in World War II.
The biggest killer of troops has been roadside bombs, which are responsible for about 75 percent of the U.S. casualties in Iraq and Afghanistan.
On the dust-off, Vogt nearly became another casualty: His heart stopped for the first of five times.
"They had to get out those little paddles," said Lundy, also on the helicopter because he had suffered head, neck and shoulder injuries in the blast. "I was pretty sure the lieutenant was not going to make it."
Ten minutes after arrival, Pereda, a 21-year-old from Fayetteville, N.C., succumbed to massive internal injuries.
And Vogt's heart stopped again, forcing the physicians to crack his chest open to perform manual heart massage. The gaping chest wound now contributed to Vogt's blood loss.
"It was coming out faster than we could pump it in. Right from the start, we knew he needed blood, but I didn't know he was going to go through our entire supply," Leslie said.
Vogt ran through the hospital's stock of platelets, whole blood and plasma. And as he was prepped for surgery, Leslie knew he'd need more.
"The doctors wanted reserves so they could stay ahead of him," Leslie said.
By this time, Lundy had been cleaned up and allowed to leave. Sitting with Sgt. Stephen Dodson, his battalion's wounded soldier liaison, the two discussed how they could help.
Leslie, pressing doctors for more information on Vogt's blood requirements, began organizing a team. Lundy, Dodson and Spc. David Beaudoin stepped up to volunteer. Their plan: to rally blood donors from across the Kandahar post.
"We hopped in a truck and drove anywhere there would be people," Lundy said. "I'm pretty sure a message went out on the Big Voice telling people to get to the hospital."
On their way back to the hospital, Lundy and Dodson got pulled over for speeding — "Yeah, they do that over there," Lundy said, but they talked their way out of a citation. Arriving at the hospital they found a line of coalition and U.S. forces — Army, Navy, Air Force and Marines — winding out the door and along the sidewalk.
More than 300 troops gave a pint that evening.
"I like to say I'm now truly multinational and multiservice," Vogt quipped a year later.
The fight continues
Vogt had been at Kandahar for slightly more than 12 hours. Dozens of doctors, nurses and technicians had worked on him.
"He never regained consciousness at Role 3, but his quiet strength kept us wanting to help no matter what," Leslie said.
At Kandahar alone, Vogt received 404 units of blood components, according to Leslie.
And in the days and 30-plus operations that followed, he'd use at least 100 more.
"He has truly amazed us," Leslie said.
Vogt was moved to Bagram Airfield a few days later. After he was stabilized, he went to Landstuhl Regional Medical Center and then to Walter Reed National Military Medical Center Bethesda, Md.
But his struggles were not over. At Walter Reed, Vogt endured infections, kidney failure and an aneurysm requiring brain surgery.
It was during that procedure that his heart stopped again — twice.
"We were really relieved when he got to Bethesda, but he wasn't out of the woods yet," said Vogt's father, Steve Vogt.
And there were three weeks when Steve and Vogt's mother, Sheila, had to explain daily to Nick how he lost his legs.
"It was like 'Groundhog Day.' Every day, he'd ask 'What happened. Did I screw up? Did anyone die?' And then he'd cry," Steve said.
But there also were breakthroughs: the day Vogt wrote a note saying how happy he was to be alive, the morning he was removed from a ventilator, the first time he ate a Popsicle.
And the second, six months after the blast, that he remembered his Facebook password.
"It was amazing! It popped into my head and the whole world just opened up," he said.
He even uploaded a video on YouTube, showing himself doing pushups with balance and grace.
"Things like missing legs can have some advantages. For example, I've lost 70 pounds. Ha, ha," he wrote in the comment section.
Reunion
In May, Vogt traveled to Fort Wainwright for an emotional reunion with Lundy, Underhill and his unit.
"The last time I'd seen him, he looked like he was not going to make it, and here he was," Lundy said. "It was overwhelming."
"Seeing him, it's hard to describe what I was feeling. I am really happy he is alive, but it brought up the memory of Pereda. It was pretty upsetting," remembered Underhill.
"I laughed and cried. I owe them so much," Vogt said.
A year after the blast, Underhill has applied to become an Army flight medic. Lundy plans to leave the Army, heading home to Nebraska. Leslie has put in her retirement papers. And many of the reserve doctors who worked on Vogt at Kandahar and elsewhere have returned to their civilian lives.
Vogt carries on, spending his days at doctor appointments and therapy, stretching his body and mind to prepare for the future.
From his barracks, he can see the medical school where he was accepted two years ago.
"I think God has something in store for me," he said. "People will tell me, 'Oh, you did such a good job!' But I'm like, 'I was just the meat.' I owe a lot to everyone — they are the ones who are inspiring. I have every reason to become a doctor, so I can give back."
