This is not an anti-war column, but a reality check. Violence and mayhem are the currency of war, and no one trying to come to a decision about his or her support of a war in Iraq should fail to understand what that means. If you want to know what the impending war in Iraq will be like, ask a doctor, a nurse or a soldier who has been in combat. Even though many like me have never been to war we have an idea of its reality because we have seen many of its brutal parts during the course of our training and our work right here in the United States.

The difference in what we have seen in America’s ERs and hospitals and what real war will bring to Iraq is a huge difference of degrees one can only imagine. These are degrees of violence, depredation, intensity and misery, but still only differences of degrees.

Worst of all will be the high velocity, explosive violence and what it can do to the human body. The results are unimaginable to those who have never seen it; the most graphic movies or photographs are pristine by comparison. Even in my relatively peaceful medical career I have seen limbs severed and almost severed, faces torn by bullets, and flesh charred to the bone. I know the smell of burned flesh from among the million of scents around us, and if it came to me on the breeze of a distant war I would know instantly what it was. Television brings us the sights and sounds of war, but we should all be so lucky as to never know the smell.

Some of what war will bring will be less violent but more haunting for those who are there, and most doctors have seen that, too. These are the faces of the dead. We remember the sadness of empty eyes waiting to be closed, and the sadness of closing them. I remember most the faces of those who died early and surprised. Doctors know the finality of a body bag being zipped, and the reluctance to zip it. We know of death’s egalitarianism; the greatest and weakest among us look equally small and alone in death.

Even more haunting than the faces of the dead can be the faces of those left behind, those who grieve and beseech. They have filled the lands of war throughout the ages, and ER’s throughout ages of bad nights. Doctors and nurses remember the families of the injured and the stricken, of the dead and the possibly dying, because those faces looked to them for hope and answers and were often disappointed.

We think of their faces when we see other such faces from the lands of war on TV. The look of uncertainty and prayerful hope for a loved one in jeopardy is universal, as is the look of tragic loss; they are not different on the face of a Christian or a Muslim, a Palestinian or an Israeli, an Iraqi or an American. Causes may be just or not, right may be on one side or the other, but the misery of personal loss is equally unfair to all who suffer its pain. If there is a difference between the faces of loss on a televised war and those in the ER it is only that faces on television can be dismissed at the click of a remote by those who do not wish to see them.

The mayhem of war falls most heavily on those innocents caught up in the blast and ricochet of war, as does the mayhem of poverty, domestic abuse, and alcoholism in America. Those innocents are the old, the ill, the young, and the non-combatant women. Doctors will know without being told that war will rupture the threads of the social fabric in Iraq which even in the best of times barely protects the most vulnerable; they deal with patients here whose lives hang by such threads. Some children in Iraq will go without food, some of the sick will go without medicine, and some women will go without security. The mentally ill may come unraveled, and their ranks will only grow. Doctors know that there will be cries of hungry children, suffering of raped women, and the debilitating effect on noncombatants of constant fear and vulnerability.

The drums of war often drown out the impending sounds of the human misery that war brings. If you want to know the reality of the war to come, don’t look to the television. Talk to those doctors, nurses, medics, and soldiers around you who have lived with America’s human misery and violence, who can tell of it first hand, and hear their tales. That most of them will not tell of it without being asked first says a lot. Only then, when you truly understand the price of war, should you decide whether it must be paid again, as it has sometimes had to be paid in the past.

Erik Steele, D.O. is a physician in Bangor, an administrator at Eastern Maine Medical Center, and is on the staff of several hospital emergency rooms in the region.