Greetings to my eChapter Colleagues,

I am going to attempt to keep somewhat of a journal for my days in Iraq and a bit of information for you on the process of getting here.

November 27, 2005 was my report date to CRC, (Continental United States Replacement Center). This area is for small groups or individuals to become prepared to join a unit that has already deployed. The reason for this can vary from say someone being injured to someone getting out of the military. I am replacing someone that was injured while the unit was preparing for deployment.

CRC is only for one week and it a week packed full of activity. The days are filled with medical and immunizations, issue of equipment and uniforms, weapons issue and briefings. The outdoor activities include firing the weapons and qualifying, learning to low-crawl and maneuver while wearing the IBAC and Kevlar helmet. Doesn’t sound like a big deal until you realize that everything has now added about another 30 pounds to my already somewhat stout frame. I am in great hope that maybe the 30 pounds may not be so bad if I can reduce my frame weight by that much while deployed. Guess it will be a wait and see what the future holds for me. The briefings include what to expect when we arrive “in country”, cultural differences, and the trip itself.

We started the process of preparing for departure at 2300 which is in and of itself a rather lengthy story but one that they would just as soon we not share. Suffice it to say it was a long process over 2 days. I will say once we finally were on the plane and in the air the rest of the trip was very nice. The flight attendants did an outstanding job with all of the weary soldiers and we were fortunate to have plenty of room for sleeping on the plane.

The arrival in Kuwait International Airport was my very first time travel across the Atlantic ocean, I am not a world traveler and really had no idea what to expect. I doubt that a world traveler would have known what to expect. Because we travel in such a large group they had several large buses waiting for us on our arrival so it is a process of getting off of the plane and onto the busses. Our bags area still being handled for us at this point, each of us had 3-4 duffle bags and one carry on bag. We also had our Keflar and IBAC, gas mask, and weapon. What a site we were. I had the good fortune of meeting another major that was my room mate at CRC and we ended up traveling together. It is better if you have another to share in your misery and “no idea of what we are doing next” than doing it by yourself.

The bus trip was interesting as we waited for a couple of hours for the escorts to arrive, Kuwait police and our MP’s. The guards on the buses had their weapons loaded and locked for the convoy trip to our first camp. Since I am not exactly sure what I can and cannot say I will leave out the names of the camps. It is now somewhere after midnight Sunday night and we have been moving since Friday night. We were divided into the countries that we were assigned and given instructions on where to go to make sleeping arrangements.

The tents had beds for about 10-14 females per tent. Audra and I added our 7 bags beside our bags and went scouting the area. The camp had trailers that had regular flushing toilets, (no paper in the toilets) but a treat not to have to use the port-a-pots. They had shower trailers as well so that was good. The camp had a very nice “mess hall” that opens at various hours of the day and night. We saw a McDonalds, Pizza Hut, Subway, and internet café, even had a Mr. Bean coffee shop.

Our travel started the next morning to another camp for more briefings and weapon qualifying. We were there for about 4 days and once finished there we returned to our first camp for travel to Iraq. Every trip that we made once we arrived in Kuwait meant toting the 7 duffle bags back and forth. Audra and I became very adept at working together lugging the bags. You know how you see the soldiers with the duffle bags on their backs and look so strong and fit? Well we carried the bags one at a time working together, no way we were going to get a back injury trying to carry the bags.

We met at 0600 with all of our bags for loading on the bus, loaded all the bags onto the buses and made the trip over to the Air Force staging area only to find out that the flight had been cancelled so back we went to the camp. We got to unload all the bags and take them back to the tent. We decided to take a nap after the disappointing trip and had just fallen into a nice sleep pattern when we heard my name being called. We loaded the bags back to the buses and loaded them back onto the bus and off we went to the staging area again. Anyone that has ever been in the military knows that just because we are told something is going to occur at a certain time more than likely that time will come and go and you still wait. We made it to the staging area, unloaded the bags from the bus and found out we had to take the bags to another area. So working together as a team we moved our 7 bags and then helped the Navy guys move all of their equipment to the Air Force area. Once we got over to the Air Force area everything was loaded onto skids and we were finally done with loading and unloading the duffle bags, at least for that stage of the trip.

The wait then began for the trip to Iraq. We had MRE’s for lunch and had time to watch a movie on our computer before boarding an Air Force cargo plane. New experiences continued to abound. With earplugs in and all of our battle rattle on we took off into the “wild blue yonder” headed for Baghdad. I am not sure what I expected but it most certainly was not what happened when I arrived. It is a good thing I am able to go with the flow of things. Because Audra was Air Force she was met at BIAP (Baghdad International Airport) by a liaison and escorted away to a lounge. I on the other hand wandered into a desk area and asked how I was to get in touch with someone from the Combat Support Hospital (CSH). I was given a phone number and again left to my own devices. No answer when I tried calling so I realized I was going to be on my own for finding transportation to the hospital. There are only 2 ways to travel from BIAP, helicopter and rhino’s. Rhino’s are some type of ground transportation buses.

Journal #2

Greetings to my eChapter Colleagues,

My trip to Iraq on the Air Force transport plane was quite an experience. The planes do not have all the fancy inside interior as the commercial flights so they are extremely noisy and cold. By the time we arrived it was dark and a bit overwhelming to say the least. I did not realize till later in comparing a planned commercial trip to this unplanned trip to Iraq the differences that I would encounter. Let me just name a few: the standby time and being unsure of a flight or not, exactly where I was flying and what time I would arrive and the biggie, would anyone be there to meet me.

We arrived at Baghdad International Airport (BIAP), it was dark, loud and we had to walk from the plane across the tarmac to the terminal. This would be only a minor inconvenience if we did not have Keflar helmets, lead vests, weapons, and a personal carry-on to add to our already tired frames.

The Air Force nurse that I was traveling with was met by a liaison and taken to a lounge to wait on a flight to her next scheduled stop. My experience was about to broaden. There was no one to meet me and assist me so I had the opportunity to exert my communication skills with the personnel at the reception desk. It was not exactly a warm and fuzzy experience. Everyone seems to always be in a big hurry and no one seems to have any idea where phone numbers would be located. Once the phone numbers were located they had no idea why no one would answer the phones. I did finally find a Sergeant that gave a bit of direction, go 2 buildings down and wait for an announcement, when you hear the announcement come back to the rear gate and wait for instructions. Simple enough!

I only had to wait 3 hours for the announcement and instructions then I was lucky enough to wait in line for a helicopter ride to a landing zone closer to the unit I would be working with and so my next segment of the trip began. I was fortunate to meet with a couple of soldiers returning from R & R waiting in line with me so that when the helicopter landed and we were running to get loaded they helped me drag my four duffle bags inside for the ride. This was my first helicopter ride and the experience was both breathtaking and frightening at the same time. Wind blowing in your face, the lights from Baghdad all around you and a gunner on each side of the door openings, what a way to come into your new place to work.

Landing at what I thought would be my pick up point proved again how flexible you must be traveling alone and in the military. No one met me at my final destination point so the 2 soldiers that had assisted me getting my gear on the chopper now helped me figure out where I would spend the night. Between the three of us we managed to carry all of our bags to the Embassy only stopping about 6 times for me to take a break. Once there, they were extremely helpful in making sure I had a room for the night and again got my bags to my room. I will be eternally grateful for their assistance otherwise I am sure I would have spent the night sitting on my bags at the drop zone.

Morning and sunlight did brighten things including my outlook on my 1st day “in country” and having someone available to actually answer phones. Seems odd to me that the phone line was out of order for me that evening and yet everyone that I have spoken with had the same greeting when they arrived. I truly think there is a rather consistent glitch in the system.

My Air Force friend did tell me she had a nice meal, was assisted to the chopper and had a great ride to her FOB (Forward Operating Base) only the place they dropped her off was not actually her FOB, so the next day she was taken to the correct FOB. She spent the night sleeping on the floor. So much for me thinking she was going to have it so much better than me!!

I have come to realize the worst part of the trip was getting from Kuwait to my actual quarters. Now that I am settled in and had some sleep it is so much better. The unit I am with has a concrete building to sleep in, electricity, running water, plumbing, showers and toilets. We have heat and air conditioning. We also get to share rooms, have to climb the stairs to the 4th and 5th levels and wear the battle rattle when leaving our immediate FOB. That includes crossing the street to go to the gym. Please do not take that as a complaint. Some areas have to sleep in tents, walk half a mile to get something to eat, are using trailer showers and toilets. I am blessed to be where I am currently and have no burning desire to leave till it is time to come home.

One of the overwhelming issues when first arriving is the moving around from room to room until you finally get a place that should be your final stop. Another issue to consider is how to go and finding out where it is you can safely travel/walk and where you are no longer safe. There are several FOB’s within walking distance but it is not recommended to walk to all of them. The Tigres River is just a couple of blocks from here and they regularly send fire over here. The other side of the river is not considered a safe zone. The international zone or IZ is considered the safe zone. The US Embassy is located within the zone and is one of the places that we are allowed to walk to and spend some time. There are Iraqi shops with in the safe zone and the merchants are anxious to sell their wares.

It can either be comforting or unsettling to walk along the street and see a convoy of Humvee’s with gunners rolling along beside you. I guess it depends on how you view it, half full or half empty. I prefer to think of them as guardian angels making sure it is safe for me to have the freedom to walk to the Embassy, even if full battle rattle is required. Better safe than sorry.

The first couple of weeks were like being in another world to me, the trauma that we were seeing on a daily basis was brutal and I wondered how these soldiers ever made it to us. They are operated on here to begin stabilization and resuscitation and then transferred out to Germany and the States as soon as possible. We care for the coalition, Iraqi Army and National guard, Host nation (Iraqi Civilians), US and Foreign contractors, State Department, all US military, and detainees (insurgents). That includes pediatrics and on occasion OB/GYN.

We are limited supplies here with items used in the States. The biggest problem we have faced is resupply and figuring out how to order within Theater to get the right supplies. The numbers do not always match the items much to our chagrin. My nurses were not trauma experienced when they arrived but they most certainly have the experience now.

I have been told that we are one of the busiest multi trauma facilities in the world. I would have to agree. Our patients get the absolute best possible care available. The practice is much different here than we have in the states and it does take some adjustment. There is much I want to share with you but before I can share too much I must get approval so I will work on that part of things.

I will tell you that the nightmares that you have read about in books, magazines and newspapers are real. It does not matter if you are actually the one pulling the trigger or caring for the injured. We have no idea when a patient rolls through our OR doors if they are the one that just built the IED (Improvised Explosive Devise) or if they are the one that happened to be in the wrong place at the wrong time. The insurgents are getting very clever at building IED’s that have the ability to do so very much damage with little skill at building and hiding them. The only way we know it is an American Soldier is because of their social security number instead of the hospital assigned number which sometimes is not the case because if it is a mascal the last 4 numbers are used.

Journal #3

Greetings to my eChapter Colleagues,

I have spent several months trying to decide what I really want to say regarding the types of cases we do and how we do the cases. The OR here is somewhat typical of an Operating Room in the states except we do not have air exchanges in the room, we have air conditioning that blows when and as often as it pleases and bed pads that have been soaked with blood too numerous to begin counting. We have cleaned and soaked them and left in the sun to dry, partly to dry them quickly and get some of the odor out of them. We have windows in the OR’s that help with lighting and give us an opportunity to see the sky change as a sand storm is blowing in to Baghdad.

Our housekeepers are Iraqi men who just want a chance to work and feed their families. Working for the Americans puts their lives in danger everyday. Our night housekeeper tells us only his wife knows where he is working. It is too dangerous for any other family members to know where he works. One of our housekeepers lives in a hotel here and goes to see his wife and kids every couple of months, a 3 hour drive from here. He is happy to be able to support them and that they are safe from Baghdad.

I remember when I first arrived I was surprised at the number of cases that we do in a week in a 2 room OR. We have the ability to expand to 7 beds if absolutely necessary but then staffing would become a real obstacle. We operate the way we would in a field environment in that we can open 2 beds in each room having a circulator for each bed and a surgical technician for each bed. We have a big C/arm that we use for Ortho and we have a mini C/arm. I would say that we are almost as well supplied here as most hospitals in the states. If you know what a Neptune system is we are just receiving one from Stryker so that we can and will have dependable suction capabilities. What a gift that is to us in the OR. We share suction between beds and the lights.

Supplies become a big issue if we run out of something, it is not like we can call the hospital down the street and borrow! Some of our supplies come in thru the airport and some of supplies come in thru convoy’s. We had 1500 laps on order and we still ran out of them. We had to have them flown in by helicopter from other hospitals in theater. The convoy’s were not running on schedule, had been hit with IED’s, the roads were closed or they were sitting waiting on transport into the International Zone to our hospital. Imagine trying to run a trauma with no lap sponges. The supply system in the States now is a very user friendly computer system but over here it is a nightmare. Just because we order it does not mean we have something coming to us. If vendor’s have changed then the number has changed which then means we are not getting the order and the system does not notify you when something has changed. We have learned here that we order or at least try to order a couple of months ahead of time for supplies so that we do not run out. It may take 6-8 weeks for common supplies but can take up to 6 months for some supplies.

The trauma’s here are more than you can imagine in any nightmare. The training that the surgeons receive here dealing with the traumatic amputations, belly, chest, bladder, and buttocks cases are something they will forever remember. These are surgeons that have great hands and it is something to watch as they talk amongst themselves trying to figure out a way to make the patient’s life survivable and livable. Research continues to be a priority here so that our equipment and technology to care for our wounded is high quality and high technology. I lost my first soldier on Christmas Day. It was so quiet here and we just did not expect to have any cases as everybody was supposed to be hungered down so that we would be without any casualties over this time period.

The injury was just so devastating that we were not able to save him.

The patient’s do not usually come in with just one wound but multiple injuries and it takes several of us to do the preps before they can get started. We had one patient that had a pelvic wound that was so severe we were unable to get the sheet off of him for several days. Remember we do many patients besides soldiers. He recently was sent to Jordan for reconstruction surgery, we did a hemipelvectomy on this brave Iraqi bodyguard. The fact that he survived is a miracle! He spent at least 3 months here before he was finally stable enough to evac.

Burns are another big factor here. The number of children burned and treated here is a surprise. The burns happen because of the type of heating and cooking fuels used in the homes. A beautiful 5 year old little girl that is now at home with her parents, but will spend years recuperating from the burns and not knowing what her medical care will be like is difficult for us. We are very fortunate to have surgeons here from the burn center in San Antonio. I realize it takes a very special group of nurses and surgeons to work in a burn unit for any amount of extended time. I have been told the center in San Antonio is truly a work of art and state of art center. The hospitals here is Iraq can not and do not have the capabilities to take care of burns. We now are seeing some of the Iraqi surgeons come thru here to see our facility and see how we are caring for the patients. We have not had any nurses to come through here. The medical system here is taxed just like every other system here is Iraq is taxed. It is hard to educate nurses and doctors if you do not have a government to establish an education system.

We do not have any personal experience with the hospitals here in Iraq or Baghdad as they are outside of the International Zone and are not considered safe for us to travel. We stay within the IZ. Speculation is difficult but when we see the number of Iraqi patient’s that we do and know that they do not want to be treated in a hospital by their own countrymen makes you think.

We are fortunate that a program has been put together so we are able to get feedback on how the patients/soldiers are doing once they leave here. We are able to know how they were when they arrived in Germany and how they are doing in the states. Our lives are touched and it is important to us to know we made a difference.

Journal #4

Greetings to my eChapter Colleagues,

The time in Iraq is finally drawing to an end. It has been a bit since I last sent anything; I have been trying to decide what I would really like to say about this experience. The good and the bad or some such thing, I would say the good would be the team work that develops among the staff. When you work together, sleep together and eat together it does change relationships. The bad is seeing the grief on the soldiers’ face when they find out a fellow soldier has been pronounced or that an extremity is gone.

Most of our patients are already intubated by the time they arrive in the OR which in some ways make it easier for us, we do not have to answer the questions or hear the fear in their voices. There are occasions when they do come up to us and are awake. They are terrified, so the idea is to try and get their minds off what is actually happening around them and talk to them while Anesthesia is trying to get lines started or just get set up. Recently I had a soldier come into the OR with the possibility that he would lose an arm and he was so afraid of going to sleep and waking up without his arm, so we talked and I asked him about his family, kids and where he was from as he was drifting off to sleep. We did the surgery, he did not lose the arm and later when I went to see him in ICU he told me he was looking forward to going home and hugging his kids with the use of both of his arms. He will have a bit of rehab but should regain full use of his arm. The extent of trauma that we see regularly has made us see things differently, it will be an adjustment to go home and do “routine surgical cases”. There is a trauma high and each of us has felt some form of it over the last year.

I am really proud of the care that we give to our patients here. I know that I have said before that we treat all patients with the same care. It is true that our hearts are truly touched when we treat our own and when we care for the children. We have been fortunate that our housekeepers are becoming more fluent in English so they have become excellent translators for us. The ability to tell someone to take a deep breath, open your eyes or open your mouth or that we are going to give them something for pain has become second nature to most of us, anything beyond that requires having a translator in the room.

There are things that I would like to see changed although since I am in the Army I realize that they will not happen in my lifetime. I just choose not to go into those areas right now. I will be moving into Perioperative Education when I return home so I can say that I will have the knowledge to assist in preparing new periop nurses on what to expect when deployed and they will be deployed!! No question about it. The Army Nurse Corps has made a commitment not to send brand new out of school 2nd LT’s to Iraq, give them a chance to actually do some nursing for a year and then yes they will be deployed. Periop nurses have had an opportunity in nursing so unfortunately they do not get the opportunity to work in an OR for at least a year after finishing the course. We had only one nurse right out of the program here, she has done an outstanding job and can say that trauma nursing is under her belt. Once she goes home it will be a learning process again for her. Many of the things we do here are not what we can or would do at home but we do the absolute best that we can do here realizing that there are better ways that can be done in the States. These last few weeks as we are waiting to go home and praying that extensions do not force us to remain here are a constant in the back of our minds each and every day. I spoke to a couple of the soldiers (non medical) that are here now after being extended another 4-6 months. I was actually ashamed of myself for wanting to go home so badly when I know what they endure each day. They come into our area/zone for safety and then go out and patrol to keep us safe. It is hot, scorching hot for them, every hour of the day. The vehicles are as safe as they were designed to be but the IED makers are steps ahead of the weak spots and are extremely capable of placing the IED’s where they can do the most damage. My heart cries out to these fine young soldiers, all younger than my own children and not much older than my oldest grandson. Please remember them in your prayers, they are not only protecting us here, they are protecting everyone in the States each and everyday.

The mortar blasts seem to have increased which would make sense from what the news reports to us on TV; we get the same news as you. We just hear and see the blasts in a different way than you do from home. It is sad knowing that we are leaving people behind that would really like to get out of this country. They are afraid each day and we are not even to offer them hope that they will get a visa and be allowed to leave the country. It is not so much that they cannot get to another country but that they cannot leave this country.

I think I have rattled on long enough for this article. My next and last should be about the trip home. I look forward to another two years on the Echapter Board of Directors. My wish is that our chapter becomes more active online, getting to no one another. It has been a delight to hear back from you when I post something, thank you