Taking Care of A Dictator

By Tom Lacock and Rob Monger
Wyoming Medical Society

Military deployments were nothing new for Joseph Horam, MD -- he had been deployed six times before. However, this deployment to Iraq, scheduled for May 2006, started much differently than previous tours. Horam, a colonel in the Wyoming Army National Guard and former State Surgeon received a call from Col. David Wilmont, State Surgeon of Indiana in March 2006.

The request was simple: Could he come a month early? We have a special mission.

“Usually you come into the theatre and you meet with the local unit commander who says, ‘Here is your villa and your gear, let’s get to work,’” Horam says. “Instead, I am told to meet with Maj. Gen. John D. Gardner and he presents me with the mission to provide the medical care to Saddam Hussein. With the admonition that you will keep him alive so justice will prevail. “That was a sobering way for the meeting to start. And then Gen. Gardner says, ‘Let’s go meet your patient.’”

Caring for a Dictator
He had many nicknames among the military physician community -- HVD1 (High Value Detainee No. 1); VIC (Very Important Criminal) and the Ace of Spades -- but most of the world knew him simply as Saddam. Hussein was one of eight patients Horam was responsible for while in Iraq, with the other seven high-ranking members of Hussein’s cabinet who were also co- defendants in Hussein’s crimes against humanity.

Horam says a typical day involved morning rounds, a directed physical on Hussein followed by medical reporting, lab test- ing, medication review and arranging consultations as needed. Just as important as the medicine being practiced was the need to establish trust with his new patient. (During the courthouse activity he similarly made rounds on all the defendants at least twice daily.) When not involved with the detainees Horam was assigned to the Golby Troop Medical Clinic providing primary care to U.S. and coalition soldiers.

“Social visits were important as it related to the trust,” says Horam. “It wasn’t every night, but a lot of evenings we would have dinner together, not just me but some of the higher-ups. We would have dinner and we would chat about everything. He actually had a lot of candor. It seemed like a lot of times we got together and had very interesting discussions. Saddam would get really engaged in our American culture.”

Through much of his career in the National Guard, Horam worked with friend, neighbor and fellow Cheyenne physician, Col. David Lind, MD, who says it was Horam’s ability to see the big picture while respecting the local values of a culture that made him the perfect person to take care of the dictator.

“He actually got to know Saddam really pretty well as an individual,” says Lind. “He spent a lot of time with him and I think struck up almost a friendship with him. I know Saddam would invite Joe and the others he valued back in the evening for cigars. I think that made Joe one of the assets for that situation and that time.”

“He had his cigars and these were Cubans,” Horam says. “That was the social thing. I had never smoked anything before and here we were smoking a Romeo and Juliet. I learned quickly not to inhale because those things are tough on you.”

Engrained in Horam’s mission to take care of the Iraqi dictator was a 10-year gag order, which forbade him to speak of Hussein until this summer. It was an agreement Horam took seriously enough not to mention his patient to his wife, Carol. Horam laughs when he says Carol has been very supportive through his military career -- but in 2006 there were questions why, despite being in the same deployment and facility as Lind, he didn’t call his wife as often as Lind called his. Horam says Carol found out about his mission during an event at West Point six years after he returned from the Middle East when some of the wives of the physicians who took care of Hussein mentioned it to her.

“We signed a 10-year non-disclosure agreement,” Horam says. “The whole thing was about security. All of the various activities where we traveled about were very covert, and the judicial actions were a very high-secure operation.”

The Health of a Dictator
Taking care of Hussein offered its challenges, mostly due to his age (around age 67) and a life lived hard. Hussein’s military medical record folder was nearly a foot tall by the time Horam received it and included a difficult case of hypertension with adrenal adenoma. Horam says on a daily basis he logged the status and plan for 15-20 various ailments, and asked for consultations with cardiology, dental, psychiatry, and urology for Hussein.

“We had him on every anti-hypertensive,” Horam says. “He had a lot of stuff  for his age, but one time he kept complaining about his leg. I checked him out and said, ‘It looks okay, but let’s give it a basic x-ray.’ He had shrapnel all over his leg. I showed it to him and he was like, ‘Oh yeah, that was from a shoot-out many years ago.’”

Horam says Hussein was generally a good patient, reasonable and compliant. However the relationship was not without its firey moments.

“He tried to fire me at least three times, generally related to the perception that I was not doing enough to mediate a pardon agreement with higher authorities, and allow him to have some renewal of leadership management of his Iraqi people,” Horam says.

Much of Horam’s time with Hussein was spent during the initial legal proceedings against Hussein. The trials meant moving the high-value detainee to a jail in the basement of the courthouse where the prisoners were housed during hours out of court for up to two weeks at a time. As the physician for the trial, Horam had his own cell in the basement along with the “Elite Eight” defendants.

Hussein was indicted in a total of 12 consecutive trials, with the first being the trial of Dujail, a small agricultural community in Iraq. During a visit to the community in the 1990s, there was an attempt on Hussein’s life. His alleged response was to have the Iraqi military kill 148 residents of the community.

Making medical care during trial more difficult was a 19-day hunger strike during which Hussein lost 11 pounds, and Horam says he felt the dictator’s mental faculties were slipping as the strike continued. Horam reports some of the other detainees were cheaters and actually gained weight. Horam performed some psychiatry in hopes of gauging his patient’s faculties after Hussein refused a military specialist. Horam would ask questions suggested to him by psychiatrists, who then analyzed the answers. After day 19, Horam was called to meet with the chief justice, who asked if Hussein was ready for the trial’s closing arguments. Horam says he told the judge Hussein was not.

“I told the generals this is potentially a disaster,” Horam says. “At this point ... the trust came in. I said, ‘What we have to do is take care of his health, and we were going to take care of Saddam in the hospital.’ Saddam didn’t mind. He was sav- ing face because we didn’t force him to eat as he agreed to a feeding tube.”

After five days of bringing him back up slowly Hussein began to get back to his old self again. (Which meant a defiant dictator attitude during the “world stage” of court testimony. Eventually, the Tribunal convicted the entire group of eight defendants. Hussein was executed Dec. 30, 2006. His cabinet and co-defendants were executed in 2007.

“Saddam and I often spoke of his impending execution, which he discounted as a lost opportunity to return him to the leadership of Iraq,” Horam says. “His narcissism served him to the end.”

Horam said on the way out of Iraq he had a chance to say goodbye to his famous patient and the meeting was not without some emotion. Horam said Hussein also thanked him for taking care of him and for looking at him as more of a patient than a prisoner of war.

“I was not a sympathizer and kept it professional, but the last day, yeah, it was personal,” Horam says. “I had no admiration for the individual. He has a charisma that you step into a room and there was something about a person like that. His ability to be a cruel, brutal dictator was always there.”

Tidbits about Hussein
Horam says from his time with Hussein, it was clear that the dictator believed his legacy as president was someone who cared for his people and excelled in the areas of infrastructure, education, medical, and military development. He also prided himself in selecting a cabinet of Sunni, Shiite, Kurds and Christians.

While many of the other defendants in Hussein’s cabinet wore traditional Arab clothing, Hussein spent much of the time during his trial in Western-style suits. Horam says he thought Hussein felt more sophisticated than the other defendants and wanted to set himself apart as the leader. He said Hussein did wear the Arab clothing, but during social events with others from the middle east.

Horam said there was only one evening when Hussein requested any real sort of entertainment. After a conversation about the movie “The Passion of The Christ,” Hussein expressed an interest in watching the movie. Horam said, though Hussein was a Muslim, he had a general curiosity about the Christian faith. Horam, Hussein and other high-ranking officials watched “The Passion of The Christ,” together and afterwards, Hussein said only, “Jesus suffered."

“We would talk a lot about religion,” Horam says. “He could show he had a religious side to him, but I thought it was more for show - supercial. He had a curiosity about different religions. He would acknowledge Christianity and the faith concept.”

Outside of the movie, Horam says he feels Hussein spent his off-hours trying to remain focused on the trial, as well as writing some poetry, which Horam compared to Psalms in the bible. Hussein also read Hemmingway and would talk about “The Old Man and The Sea.”

“If you wanted to get him angry, talk U.S. policy,” says Horam. “He would say, ‘Get me and Bush in a room and we will work it out.’ There was a time when Bush was a quarter-mile away and they never met. He was okay with American people but very much hated President Bush. He would go on tirades about President Bush. That was his focus.

“I think he regretted underestimating the will of the United States. We talked about that and asked why he went into Kuwait. He said it was (Iraq’s) sovereign right; ‘The land belongs to us and we wanted it back.’ They went through the Iran-Iraq war for seven years and there were funding issues and a sense of getting back the people’s trust in his military might. That was an easy opportunity to jump in there, take all that land and oil-developing areas. Who is going to complain?

Horam was a veteran of Operation Desert Storm, during which he was stationed in Riyadh, Saudi Arabia, with the 50th General Hospital. He says in 1991 his sta  was briefed to expect chemical casualties in the hundreds. That meant physicians would live at the hospital to treat the wounded. After three days and nights it never happened.

“I personally asked Saddam (about that),” Horam said. “I said, in the time of Desert Storm I remember that we were to expect large scud mis- sile attacks and we were prepared to take care of chemical injuries. He looked at me and said, ‘Yes, but too much consequences.’”

Reactions
Ten years after his mission, Horam has had time to re ect on his time in the Middle East and the detainee he worked so hard to keep healthy until his execution. He admits that concept, in and of itself, was an interesting philosophical issue to consider as a physician.

“Having had some background taking care of detainees in the war environment, you do have to address the personal respect to other individuals regardless of their criminal of war status,” Horam says. “You have your professional perspective. You have to provide a standard of medical care you personally feel comfortable with.”
Horam says he was disappointed with the way the Iraqi authorities chose to execute Hussein.

“I felt terrible about the way his execution was set up. He was brought in and there was this shouting between him and those who were in the gallows area, and they were basically ridiculing him. They showed the execution on TV, and then he was buried in a private area so they couldn’t create a martyred remembrance of that for the country. I didn’t feel like it was handled very well.”

A Retirement from the Military
Horam, whose father was active duty Army for 27 years, earned his medical degree through the Army, including University of Colorado School of Medicine and a pediatric residency at Tripler Army Medical Center in Hawaii. Horam was then stationed at Fort Knox, Kentucky, for four years. After his active duty military career, he joined the Wyoming Army National Guard, worked as a  flight surgeon, and rose to the level of state surgeon during his 20 years with the Guard. Horam regards providing the unit leadership that maintained combat readiness for over 1800 Wyoming Guardsman as his most im- portant military accomplishment.

His deployment to take care of Hussein was his third tour in the Middle East. He says he also worked with a group of Iranian exiles, many with terrorist backgrounds that weren’t known about until the U.S. occupied Iraq. The Iranian community of more than 4,000 people featured 10 doctors whom he worked with to provide medical logistics, such as pharmacy and durable medical equipment. He later assisted with a NATO Peacekeeping mission in Kosovo in 2009 where he and six other physicians were in charge of the health of around 5,000 U.S. soldiers and consultants to more than 20 other countries. (Humanitarian missions were provided on a frequent basis with Albanians and Serbs from various communities throughout Kosovo.)

“The military medical environment can expand your horizons and from the civilian standard of care may seem screwy, but it works as you develop skills and apply them as a team in the combat environment,” Horam said. “I enjoyed the vast exposure to providing primary care, emergency medicine,  first-assist surgery,  ight medicine and detainee care.”

Horam retired in 2013 with 27 years of military service in- cluding more than two years on deployment, the same month as his friend, Lind.

“My confidant, David Lind, provided an important reality base of support,” Horam says. “I thought of Dave as sort of my go-to guy and I think he felt likewise.” For his part, Lind agreed.

“He understands what he has to do and what I have to do, and we always worked really well together,” adds Lind. “If there were ways to support each other we would. He is just a phenomenal guy to be with, a good battle buddy and a good partner.”

Dr. Joseph Horam has been a resident of Cheyenne, Wyoming since 1994, a pediatrician at Cheyenne Regional Medical Center and the Medical Director for Blue Cross Blue Shield of Wyoming.