Vincent Worrell lay shivering on a trauma bay. He felt something in his mouth. He sat up and spat fragments of his front teeth into a bedpan. They were mixed with blood and tissue torn from inside his mouth.

He heard someone say: "Significant laceration to the cheek and lip." And then: "Frag under the eye … frag in the face … frag in the shoulder … possible thumb fracture."

A bomb fashioned from two mortar rounds had detonated a few feet behind Worrell, an Army staff sergeant, as he walked on patrol near Tall Afar on the morning of Nov. 6. Now he was inside the Air Force Theater Hospital, a tight web of interlocking tents set up on packed sand 50 miles north of Baghdad.

Worrell was groggy; he had been given morphine.

He asked a doctor: "Will I need reconstructive facial surgery?"

"Nope, just some new teeth."

Worrell glanced down and was surprised to see a Purple Heart resting between his legs. Somehow the medal made him think of his wife, Jayme.

"My wife's going to be pissed," he told the doctor. "She specifically gave me instructions not to get perforated over here."

At that moment, Jayme Worrell was driving to the couple's ranch-style home in Fayetteville, N.C. She did not yet know that Vinny, the gangly boy she had dated in high school, the restaurant cook who had joined the Army to give meaning to his life, was about to be cut open inside a tent in the Iraqi desert.

The grit and shrapnel in Worrell's face was just a small part of the bloodshed from the first week of November. In a typical week in Iraq, about 110 American troops are injured in action. Doctors, medics, nurses and litter bearers in Iraq fight daily to keep the wounded from joining the ever-lengthening rolls of the dead.

After three years of war, the military has honed a highly efficient lifesaving process that moves the wounded swiftly from the battlefield to emergency surgery in the combat zone, and on to military hospitals in Germany and the U.S. The approximately 17,400 troops wounded since March 2003 have been swept up in a medical effort unmatched in any previous war.

In November, 402 troops were wounded in Iraq. Among them were Worrell and four other men who were delivered the same week, bleeding and in excruciating pain, to the hospital here.

On Nov. 5, an explosion tore into Marine Lance Cpl. Francisco Ponceherbozo, 20, a Peruvian-born Californian, as his squad pursued insurgents in western Iraq. The blast knocked him down and left a hole the size of a silver dollar in his left foot.

On Nov. 6, an improvised explosive device upended an armored Humvee driven by Army Spc. Joshua Griffin, 18, who had joined the Army in Texas a year earlier with his mother's permission. He was on a mission to hand out soccer balls and teddy bears to children near Taji. Griffin's smooth face was blackened by second-degree burns, his jaw was broken in two places and his right femur was shattered.

On Nov. 7, a land mine detonated beneath a Humvee carrying Marine 2nd Lt. Mike Geiger, 24, a military brat from North Carolina, as his platoon in Haditha distributed leaflets advising civilians how to avoid being shot at U.S. checkpoints. Geiger's face was bathed in blood, and his right foot was broken in several places.

On Nov. 8, a grenade tossed by an insurgent exploded at the feet of Marine Lance Cpl. Ryan Buchter, 20, a baby-faced former high school football star from Pennsylvania, as his unit cleared farmhouses of enemy fighters in western Iraq. Shrapnel shredded his left leg, crushed his right hand and ripped into his nostrils.

Those five men, each one an eager volunteer in Iraq, would spend a long winter recovering from the most searing experiences of their lives. The medical care that saved them was extraordinary, but it was only the beginning. They endured dozens of surgeries in five military hospitals on three continents. They returned to their families much different from the fit young men who had set off to war.

For some of them, what happened on the battlefield wasn't the worst of it.

Vincent Worrell's lips were a deep blue. Trauma and blood loss had lowered his body temperature. Despite the blankets covering him, he could not stop shivering. He had never felt so cold.