There is light at the end of the tunnel :) I will be leaving Iraq in less than a month. I hope these next few weeks go quickly. Tonight I packed my military stuff away and put some of my comfort items in a big box that should ship home next week. THANK GOD!
When I get home, I want to clean out my closet while blasting music and singing at the top of my lungs in my underwear. Can't wait.
Ambient temperatures have reached 127 degrees (that I know of). 91 feels cold. Dirt still smells dirty. The wind feels like a hairdryer, but not just a normal hairdryer, it burns like when you hold it on the same place on your scalp too long- just over your WHOLE BODY! I flash burn on my legs and nose if I walk outside. I have no doubt that summer outside in Iraq is very much like Hell.
Patient care has held steady with something there all the time, but nothing really interesting. We had one guy with heart attack like symptoms and he got to Germany and went ASAP to Homburg for a CABG because of extensive vessel occlusions. He was a mean old man when we were telling him he had to stop smoking while in our care, but Joe says he got really nice to the LRMC nurses after they told him he was lucky to be alive. Oh, denial. Other than that, we're packing the hospital for downsizing and moving to a new location (so glad I'll be GONE).
My saving grace here has been Glee. I love it. Now, I love Joe, but Mr. Shue singing Dream On made me melt. Safety Dance with Artie was the neatest thing they've done so far next to the Madonna episode overall and the video with Sue. Did you realize that Finn (Cory Monteith) was born in 1982?? That makes him older than me. Therefore, do you think I stand a chance to be on Glee? Haha, I wish.
Not much else is going on around here and that's giving me a professional crisis. Obviously, since in my head I can be a doctor and be on Glee at the same time! At least I've learned one thing: I can't stand being bored and I can't stand not being intellectually challenged. I definitely need to find something that I like doing, because this hasn't been it. If I'd known at 18 years old just how young I would still feel at 25, I would have gone to med school- no doubt. But, now that I'm about to get married, kids will soon follow. That would make med school / residency very challenging. I feel like I'm called to do more than nursing though. CRNA would be good, I've been doing a lot of reading here and I feel that I would be good at it. I've been very supported by the anesthesia staff here who have told me that they think I'm a great candidate and I'm ready to apply now. That's one option. I love love love OB-GYN. I was in elementary school when I first wanted to be an Obstetricain (and I knew how to spell it too). So maybe advanced nursing in that specialty would be good. But, my google research has indicated that I cannot practice both obstetrics(well, midwifery, no surgery involved-and I want surgery) and general women's health at the same time as a nurse practitioner, I'd have to pick one or the other. I can be educated in both, but I can't practice both. So, then I go back to med school in my head so I can do both and do surgery. But, if I do med school that would make being in community theater hard too and then I'd never be on Glee ;)... oh, such a dilemma. It's a good dilemma, but it's a lot to consider and it's so much harder when it's not just about me anymore. I need guidance, but first I need to get OUT OF IRAQ!
16 days & a wake up!
17 June 2010
16 Days & A Wake-up!
16 May 2010
Wedding Planning
Currently, our time line is:
Rehearsal is at 1600
Babysitting and it's Hot outside
So, as much as I had some cool stuff in April. May has made us a certified psych ward. I am not a pysch nurse, I don't like pysch nursing, why do I have to do it? Why can't people who are going home in 10 days keep their suicidal and homical thoughts out of their heads? Now, that's not totally fair. I'm not really that insensitive. We've had two soldiers recently we felt good for taking care of. K and I have never sat so long and listened to these individuals who really needed the intervention of hosptial admission. Most of the patient's we've had in the last few weeks truly have a disease and have really needed help. But, the fact that we are in a country that is less of warzone and more of a boring get-paid-more-for-doing-nothing in the desert doesn't help. I have experienced the lack of professional satisfaction that comes from seeing fewer battle injury patients than I would be at LRMC. I often feel that I could be doing better things had they kept me in Germany. These combat troops feel the same way if they'd been sent to a hotter spot. Now, I don't really want to have to feel professionally statisfied by shooting a gun outside the wire, but for many people who train for that job, that's what it means to them. When they're unsatisfied professionally it leaches into their personal life and people get in trouble and trouble brews back at home. It's perpetually frustrating. What has become of our society that people can't manage to occupy themselves with healthy outlets? Why must people smoke "spice", commit adultery, and threaten to bash their commands face in?
Seriously, I went to knitting club this week for the first time and there were 3 men there learning to knit. One of our docs is knitting a bright peach afghan. BRIGHT PEACH! There are productive outlets out there. But, this enviornment is a black hole. You can't help but feel hopeless at times. It's such a black hole that a soldier, who was on 1:1 watch already, snuck out at night when the guard fell asleep and shot himself in the head in a port-a-potty; and our Ambulance crew had to go pick it up.
We all came here wanting to help people, but at some point, you just wish you didn't have to. Psych admissions tend to provide more of the question, "What failed you? Where is the failure in the system? How did it come to this?" We have hours and hours and hours of suicide prevention training. The Army has spent so much money trying to answer the same question. I sometimes feel I am closer to K than to Joe because of the Army's battlebuddy policy, no one is ever supposed to be alone. These buzz makes the threshold is so low for admitting BH patients, it's "the soldier who cried 'suicide' ". This black hole and incidents like the successful sucide are why we are full of "Bravo Hotels" constantly. No one wants to be the doc that saw the soldier who said "the world would be better off without me", didn't take him seriously, and gets the call that that soldier is the next guy who shoots himself in the bathroom. I just wish the Army had a better way of realizing who NOT to deploy before they get here and decompensate. So many of our patients have a previous psych history, a previous family history, you can only think, "how did you get here in the first place?" At this rate, I can't wait until we all get out.
It's also become HOT. It's now hot all the time. The buildings still radiate heat from the day at 2 am. It's over 100 degrees in the day and doesn't get much lower than 90 at night. Heat is no fun. I will never take AC for granted again. The generator broke on Friday and by 1100 my room was as hot as it was outside. The only difference between outside and my room was outsdie there was a "breeze" of hot air and inside there wasn't any sun. I woke up at 1100 drenched in sweat. I got a cold can from my slowly melting fridge and laid with a can on my skin... it didn't last long. K and I checked oursleves in to the "hotel MCU" until the generator was fixed. I can't IMAGINE having to be here earlier when there were tents and NO AC.
This wasn't meant to be a ranting blog, but it kind of turned into one. One cool thing we did see in spite of all the behavioral health patients was a a patient with Malignant Hyperthermia. I gave him to K to take care of for the night. He went to the OR for a routine appy, was intubated using Sux and incuded and maintained with anesthetic gases. When they tried to wake him up after surgery he wouldn't breathe, narcan didn't help, his pH was 7.1, and his CO2 was in the 80's! They caught it quick, his temp only went to 99.9. We treated him in the MCU later one with Dantrolene Sodium, and rested him all night on the ventilator. We woke him up and extubated him in the morning. He did great. MH has a 50% mortality rate, but since we are so bored, everyone was in the OR and it was caught and treated QUICK
Like Joe says, it's not always what we're doing here, it's what we're ready to and might have to do at a moment's notice.
Hearts Reuniting
I had been taking care of a patient who'd had some chest pain. We ruled him our for heart attack but an echo revealed that his ventricle wasn't moving right and it wasn't pumping out as much blood with each beat as it should. So, we filled out the evac paperwork and he was scheduled to fly the next night to Germany for some further testing.
That night I was working with N, and at midnight rounds PAD came over and said, "the Air Force wants him to fly with a cardiac monitor and medical attendant". My heart JUMPED. Last time this happened, they sent another nurse, but I knew that not only was I qualified to take this patient, I knew him already and I was off the next two nights. There were a million and one reasons why I should be the one to fly with him. I told PAD we'd page the doc and let them know first thing in the morning. The rest of the night I was jittering from nerves and excitiation at the same time.
Dr. S came first thing in the morning and I told him what the Air Force was asking. He saw how excited I was at the thought of going and he said if he saw MAJ H, he'd endorse my selection. Before I left that morning, I had been told to get ready, give PAD my info, turn in my weapon, and pack my bags. I was so thrilled, but until I got on that plane, I didn't trust that something wasn't going to go wrong. And, it almost did. I ran in to MAJ H after I turned in my weapon, nearly 3 hours after change of shift, and she told me to follow her. I thought, "oh no, here it comes." Apparently, higher powers believed that I should not be allowed to go because I was from Germany and they knew my fiance was there. The firmly believed that I would drag my feet and "get stuck and be gone for weeks". My head nurse pulled out the list of qualifications and won the debate. She said she even had more in her arsenal if resistance came up again. After all, I got a 300 on my PT test earlier that week. Most places give their soldiers a 4 day pass when they get 300's. So, I'd been warned, "don't drag your feet". I have to say, I was very hurt that the higher powers believe I would do that. I don't think that I have ever demonstrated myself to be less than a professional or not committed to my duty and the mission. But my head nurse rocks and stuck her neck out for me. That meant a lot!! I was determined to not let that ruin my excitment. I was ready to go. Now, I just had to get some sleep!!!
4 hours later, I woke up to get ready! I had NOT told Joe that I was flying, but it was also my night off, as well as his, and we were supposed to have our nightly skype date. So, how was I going to keep him from suspecting?? It worked out perfectly, I skyped him and was talking to him about nothing special when my pager went off to tell me the flight had been moved earlier and I had 15 minutes before I needed to be there. So what did I tell Joe? "Crap, I just got paged, I have to go in. I'll try to talk to you online later!" Toooo easy.
The patient and I got on a flight around 6pm to Balad where we stopped in at the CASF (Contingency Aeromedical Staging Facility). It's essentially a hold over for stable patients. We stayed their waiting to find out if we were going to make the maniest for the 2am flight going to Landstuhl. We had dinner, I read, he was seen by the doctor, he called home, I got online hoping to catch Joe and continue my charade. Well, Joe went to a friends house for dinner so I ended up missing him. But, I told him in an e-mail that I was working, there was a cardic patient who needed a nurse, and that I'd be on again later. All true.
The CASF has a list of names on the board with a red star next to the names to be manifested. My patient was a priority patient, but every time I walked by more and more names had stars next to them.... except his. I was getting really nervous thinking we'd have to stay there overnight and I'd miss Joe's day off. But, at the last minute, with my pestering I'm sure, we got confirmation that he was on the flight and a red star showed up next to his name. So much weight was held in the little red star. Thank God, we're going to Germany!!
We got on the C-17 that was set up for patient transport and spent a freezing cold 5.5 hours in the air. My patient slept, his heart kept beating, and his 02 sat stayed good. I was reading Pride & Prejudice on my new kindle from the wonderful fiance I was going to surprise. It was hard to stay awake after only 4 hours of sleep, I dozed a few times, but finally we were landing and I perked up with excitement. My patient knew that I was from Germany and he was in on the game that I was going to get to surprise my fiance.
The blue bird buses were waiting for us when the tail opened. Germany was GREEN and chilly. It looked as wonderful as ever. We got on the bus and drove to LRMC. Funny thing about LRMC is that all cardiac patients first admit to the ICU. So, my walking, talking, stable patient on the ambulatory bus was called off of it and sent up to the ICU. I recognized many people who were working. As the patient got settled in the room, CDR P walked in to ask him a question. I said, "Hi, Ma'am" and she stopped, looked, and stated, "Oh!! Does Joe know you're here?". "No". "Oh!! I'm calling him in! I'm telling him we've got 23 patients, he's got to come in a work!" She came back and told me that she'd called Joe and told him he needed to come in, be here in 15 minutes, and don't even change into scrubs. It took him nearly an hour. I was trying to hide in the room, but the longer it took the more I started doing stuff with the patient.
Joe says that he got to work and everyone was playing the game. The shift leader told him he'd be taking a cardiac patient with an orienting nurse and he'd probably go to cath lab and maybe he'd be able to go home later, sorry man. Joe said it was ok and walked towards Room 6. I was telling the patient how to call his wife from the phones in the room when Joe walked by. He says he saw the hair, saw the downrange ACU's, and then heard my voice and thought "It can't be". He popped his head in the door just as I turned around. I heard him exclaim, "Oh my god..!" and he put down his bag and came in the room to pick me up in a huge hug.
Joe said one of his first thoughts was, "That sucks, she's here and I have to work!" No, silly, it was part of the game. He didn't have to work, even though there really were 23 patients, he got me. I was released from the patient by the attending physician and had my orders from DWMMC around noon. I called our TOC at my first chance at a phone. I had until 0600 the next morning when I would report to the PAX terminal to find out when the next flight going to Balad was.
Joe took me home. The house was clean and so familiar, yet foreign at the same time. I showered without flip flops, I brushed my teeth naked, I put on JEANS, and I put in earrings. We went to Barbarossa for 'breakfast for two' and he made me my favorite white roll with butter, jelly, and brie cheese. It was a strange feeling. I felt like I'd been gone forever and not at all at the same time. I knew that it was 1/2 way and I'd be back before I knew it. 6 months wouldn't feel so long in the end as it had before I left.
We spent the day together, went to the PX, ran into friends, made Mac & Cheese for dinner ;-). I was exhausted, but it felt so nice to just lay in Joe's arms I didn't care if I was awake or alseep as long as I was there.
The next day Joe worked, I went to the terminal and there were 2 flights to Balad that evening. They told me to come back at 1500 for roll call. I went and had lunch with Joe, and even though we both wanted more time, I knew I was getting on one of those flights. We kissed in the stairwell of the tower 3rd floor and then I left and Joe went back to work. I got space on the 2nd one and flew to Balad that night. I spent the night in the Balad terminal and flew to Speicher in the early morning. I was back in less than 3 days. I slept that day and worked that night. It was the greatest trip ever, even though my time was so fleeting it felt like I hadn't gone anywhere at all.
Now, I only have about 9 weeks left. I am counting the time on my fingers. I can't wait to get back and continue the rest of my life with the man who makes my heart beat harder. I know seeing me does the same to his.
15 May 2010
Outside the Wire 22-23April
I posted on facebook awile ago that I would write about my experience outside the wire. I have been motivated, but not inspired to write. My muse is still slightly elusive, but I'm going to try for the sake of productivity on my night off.
Our Ambulance mission got a call that said a gunshot wound patient was at the gate. N got geared up and rolled out. It appears that an Iraq SF soldier was shot in the head, he'd been taken to the Iraqi hosptial, and when his buddies were told they could not do anything for him, they took him out of the hosptial and drove him to us to seek further help. Our Trauma Team was in the EMT when the patient arrived. K and I were in the unit preparing our ICU bed. N came in covered in blood and full of adrenaline. He told us that the patient was breathing on his own, bleeding all over, and had solid signs of life. Our surgeouns were prepared to take this patient to the OR for a craniotomy. When the Neurosurgeon in Balad saw the CT scan, he said "no". What makes this man a man is gone, the bullet had destroyed his higher brain function, his brain was swelling, and all we could do was make him comfortable.
He came to me and K sedated, intubated, and ventilated. His head was wrapped in a pressure dressing. He had a femoral triple lumen, a cordis, and an arterial line. He had a foley that was POURING urine. He'd been given 8 units of blood and FFP's through a rapid infuser in the EMT. His heart rate was in the 80's and his BP was in the 130's/90's. Now were were mearly going to watch him die....comfortably?
A translator was with him, he asked if we could turn the patient's bed around so that he could face Mecca. We unplugged everything, turned the bed around, and extended all the cords to set up him. The translator then sat at the head of the bed with the Holy Qur'an and read him his last rights in Arabic.
The patients initial assessment revealed rhonchorus lungs, fixed and dilated pupils bilaterally. Warm extremities, and Normal sinus rhythm. He was unresponsive to pain. He had no gag no cough reflex.
As the night went on, his face swelled from a shattered orbital rim. His right eye no longer opened. The skin became increasingly bruised and shiny. His ventialated breaths never gave way to any spontaneous breaths. His body was putting out liters of fluid an hour. by the end of the night, he'd put out 13 liters of urine. His brain swelling was putting pressure on the gland of the brain that controls telling your body to hold to water, so instead, his body was flushing all fluids out his system. The blood and FFP's created a lot of volume to go through and make urine out of, but the rapid accumulation of the vast quantities of urine is the result of the brain swelling affecting circulating hormones.
If he lived throughout the night, we were going to take him back to TTH at 0830 so that when he did die, they could prepare for his burrial in the proper way. We were told that he had 24 hours to be properly bathed, wrapped, given to his family, and placed in the ground. Any amount of time in our care past his death took away their time to say good-bye. We hoped he'd last the night.
As sad as the futility of it was, it was amazing to watch the body die. Hour by hour was watched his vitals signs fight to compensate his body's failure. His bowel sounds disappeared, his urine by then end was decreasing as his kidneys shut down, his heart rate increased nearly 10 beats every hour as his systolic BP dropped nearly 10 mmHg every hour. What had started as normal vitals became those of a body burning out. When shift change came, his BP was 70's/50's and his heart rate was in the 160's. But he was still alive.
K and I stayed past shift change to transfer him to the care of the Iraqi's. We changed into our ACU's, pulled on our 35 lb vests and helmets, and transfered him on a portable ventilator to the Field Litter Ambulance waiting outside. We both didn't need to go, but neither one of us wasn't going to miss the chance. We had a medic as well as a respiratory tech. The doors of the FLA closed and we began to roll out to Area 51. It was a long, hot, bumpy ride.
We couldn't see anything from the inside of the FLA. It's a big dark military box on wheels that holds 4 litters. But, we could still tell when we got to the gate. Things somehow change. When we turned off the road into the dusty lot that was to be our meeting point our hearts pounded a little harder. Area 51 isn't outside the wire like it would be for combat soldiers, but none of us had been this far from the CSH, except for our Ambulance medics. The doors opened flooding the inside with light before our eyes adjusted to see 30 Iraqi men standing in a huddle waiting for their soldier to be returned to them. There was a mixture of traditional Iraqi dress, suits, and sandals. The ambulance crew were the only ones in jeans and jackets. We removed all the monitors from the patient and breathed for him while we unloaded him from our vehicle and onto theirs. Our doctor felt that he probably would not make it to TTH alive. I don't how how far away TTH is from our meeting point. There is an odd feeling in squeezing an ambu bag for the last time and watching a patient leave your hands. For all we know, that was his last breath.
In the moment between being patient-less and getting back in the vehicle, I felt very vulnerable. The area around was a trash dump, for lack of a better word. The buildings were square, crumbling, and graffitied. Trash was scattered everywhere. There were battered vehicles surrounding us and men standing up in the beds of trucks. I had my weapon slung over the front of my vest, and my hand never left it. Once the patient was gone, I was ready to get back to the CSH as fast as I could.
18 April 2010
This is Not a Drill.
17 April, 2010 @ 2343: *BEEP* *BEEP* *BEEP* *BEEP* My pager goes off. The messages reads, "MASCAL MASCAL MASCAL. This is not a drill. Black Hawk Down aprox 2-4 patients. ETA 10 minutes." And it started.
I pretty much hung up on Joe then I dressed as fast as I could, threw on my shoes, grabbed my M16 and ran out the door as other lights around me were turning on and other doors were flying open. K and I broke through the walls of the LSA and joined the group of people that were also running to the CSH. In my mind I was thinking, "I had a feeling this was coming." As I leapt over a rock in the road, both my feet landed *SPLASH* in a puddle of water up to my ankles. Just perfect. MASCAL in soaking shoes.
We got the MCU and N had also leapt into the same puddle as did H. We were all so focused on rushing, we all got wet. The ward was bustling, getting supplies out for casualities we didn't know the degree of injury on. Each bed was set up and we were all standing ready. Our accountability was 100% within minutes. As I was pulling on my scrub top I heard the choppers flying in. I left the MCU and stood out in the rain and watched it approach with a spolight on the helopad as it lowered down. Then the radios started talking.
The first thing we heard was "1 KIA". Then we heard that 2 stable patients were coming in. Hip and shoulder pain and then an arm injury. It was awhile before they came from the EMT. I was standing at the board talking on the radio getting the info on the patients as treatmets were done. Army guy went to the operating room, roger, got it. From Xray, Hip guy came to us. Then it came across the radio, "2 KIA". Damn. That makes 4.
Hip guy had beautiful clear pale pale blue green eyes. They were full of tears. He'd heard two of his buddies were gone. He was in pain, but two guys that he knew... that he flew with... that he spent the moments of the crash with, were gone. No one knew who they were, but he said he had a feeling he knew. The surgeon called his mom from our phone and he said "I'm Maj X, I'm the surgeon that was with your son. You're going to talk to him in a minute, but he was injured in a helicopter crash..." Somewhere, a family member is receiving notification that a crash occured, but they won't know their son/husband/brother was killed until a vehicle pulls up and two uniformed officers come knock on their door.
There were 10 guys in the helicopter. We never heard why it went down. We only heard of 2 KIA. Others went to Balad who were more seriously hurt and some came walking in to visit. These guys were young 20's guys. They were real hooah looking soldiers. They wore uniforms I've never seen and had an intimacy that you'll never even see in a marriage. Their names were changed, their birthdays were made up, and the socials were 123-45-6789. I won't ever know what really happened.
My patient was Arm guy. He came from the Midwest and has spent his time here in Iraq almost exclusivly since 2008. He was younger than me. He goes home for 1 month no more than every 6 months and then comes back. He was supposed to go home in a few weeks. He was awake after his washout and our main focus was to treat his pain. I struggled with him to get to a 5/10 so he would get some sleep tonight. I gave him my favorite drug, Morphine, and slowly we reached our goal. He still looked like he hadn't processed what happened. He looked far away and shell shocked still. (yeah, I know I gave him Morphine too). When I told him I was giving report to a different nurse for the rest of night he looked bummed. I told him, "I'll see you tomorrow night." and that seemed to help.
Tonight, I finally did something that mattered.
09 April 2010
What if you were told today was the last day of your life?
Being in a warzone, we often think of life and death in terms of battle injury. Gunshots, mortars, vehicle rollovers, or IED's exploding. But, what if it was you who was, in essence, a ticking time bomb? Today we saw a patient, C, who presented with migrating pain from the throat, to the epigastrum, to the back, and then it went away. Lucky for a doctor's spidey-sense, he obtained a CT Scan of C's abdomen. C had an aortic dissection from the level of the aortic valve (the top) alllllllllllllllllll the way to his legs!! And he's sitting in our EMT saying, "I just don't feel well, but I can't quite tell you what it is." His life went from going to sleep feeling fine, to waking up with localized pain, to being told his chances of surving the next 24 hours are 50/50. So, what if today was the last day of your life?
What is an aortic dissection?
"Aortic dissection is a tear in the wall of the aorta that causes blood to flow between the layers of the wall of the aorta and force the layers apart. Aortic dissection is a medical emergency and can quickly lead to death, even with optimal treatment. If the dissection tears the aorta completely open (through all three layers), massive and rapid blood loss occurs. Aortic dissections resulting in rupture have an 80% mortality rate, and 50% of patients die before they even reach the hospital. If the dissection reaches 6 cm, the patient must be taken for emergency surgery."
Basically his aorta is ripping apart in layers, and since the blood is not flowing through the true lumen of the vessel and the dissection expands into the vessel space, the organs are not perfusing. Since the dissection affects the aorta from heart to hips (or more), all of his organs are at risk. This includes the brain, one of the kidneys is already compromised, the bowels, the lungs, and of course the heart...pretty much everything. If this rips through from any location, he will die. He will bleed out. If the dissection gets worse and prevents blood flow to orgrans, he will go into organ failure and he will die. He could develop clots that go to his lungs, heart, or brain.... and he could die. The outlook is grim...but C left here alive.
The risk of rupture is higher with uncontrolled blood pressure. High blood pressure+smaller lumen vessel= high velocity blood flow and turblence. Think of using your finger on a hose to make it spray. So, Dr. S ordered blood pressure and heart rate controlloing medications. The risk of low blood pressure is lower cerebral perfusion pressure. Is his brain getting enough oxygen? It's a risk to weigh when the other option is rupture.
C knows how serious his condition is. I can't imagine what is going through his mind. No one wakes up thinking the next step they take could be their last. We are all aware that life is a gift and is taken away all too easily by accidents, long term illness, and war, but you don't generally believe that it's your own body that is fused to detonate if you trip the wire.
C is currently on a plane to LRMC where he will go straight to Homburg for surgery. This is an emergency situation and because he was in Iraq, it took 10 hours for a team to get here and it will take 7-9 hours for them to get to LRMC. Pray that he lives that long.
I wanted to write more, but sleep is calling to me....
23 March 2010
MARIO
Today is day 62 in Iraq. March is almost over. It's been a long month, but a good month. I've been working on day shift and that has it's pluses and minuses. We've been through the Iraqi elections which, for those who've read the news, know it went surprisingly well. We've also had a lot of admin time during our regular work day. In layman terms it means we've had very few patients. Taboo words in the CSH are "slow", "quiet", and "lull". We never say those words or patients get admitted.
March has been fun for a few reasons: 1. It's Mustache March. All the boys have been growing their mustaches resulting in a progressive state of amusement on the part of everyone around. 2. March 2010 in military date looks like "MARIO". I have actually started writing "MARIO" on all my acuity paperwork because it is much more fun then "MAR 10". It's the little things....
During these "Admin days" I've been working on my Rock Band skills. I can play bass on the hard level for quite a few songs. The orange and purple notes often give me grief and cause me to fail, but I'm practicing. I would like the Beatle's Rock Band or POP band!! I think the makers of Rock Band would get a very large female following if they made Pop Band. I'm not sure that the guitar part would be as fun, but I know I'd be singing my heart out!
Despite the moments of relaxation that we've had, we've had a few heart stopping moments. Last week we heard EOD exploding things outside the wire that still shook the CSH and today we heard a mortar come into our base that shook my CHU. Thankfully, the first explosions were controlled and the one today did not yield any news of injuries that I know of, at least as of our 100% accountability check (where I recieved the April schedule and my own personal pulse oximeter. SWEET!) One thing I have learned is it appears you can distinguish a bang from a boom by the reverberation in your chest. People bang around the CHU's all the time. If you drop your boots in one room, it shake the floor in the room 2 down and gives you a start. With the few explosions we've heard, it hits you in the chest and feels deeper. As cushy as it is here, it's impossible to forget where I am.
As I reflect on the war outside the wire, we are waging our on own little war inside the wire-with the laundry people. Our laundry is done for us (so sad, I know). We turn our laundry in and get it back two days later. It comes back folded and stiff. It doesn't smell bad anymore, but it doesn't smell GOOD either. They wash everything together on cold water. Before the 47th CSH left, they recommended 3-in-1's to us. A detergent, softener, and dryer sheet all in one and you get back good smelling laundry, Viola! It sounded simple enough. We would throw a sheet in the laundry bag, turn it in, get it back.... no different, they were tossing the sheets out. No biggie. So, we adapted and put it in a pocket. Well, the laundry guys check pockets and they take them out. So, we got more inventive and started putting them in the toes of socks-which was bulky but it was working on occasion. So it was modified-If you scrunch up your socks with the sheet in them they get softer and less obvious, but it's still not 100% success. As we've gotten more inventive in the effort for cleaner feeling and smelling laundry, the laundry staff have gotten more thorough in their laundry checks to thwart us. As I was walking back from breakfast this morning, I came to a new conclusion. Let's cut each sheet into strips and divide it between the socks! That way if they find one they might not find them all and a little is better than nothing!! When I said that to K, I realized it was the same thought process that was resulting in the improvment of improvised explosive devices and our military's designs to interrupt them.
Tomorrow is the 1 year anniversary of my first date with my wonderful fiance Joe. We went to the Hohenecken castle by my house. It was cold and windy and damp. He held my hand down some stairs where our pinkies lingered interlocked for a split second. Then, the wind hurt my ears and he hugged me in his coat. I had butterflies in my stomach wondering "does he want to kiss me?" Oh, if I'd only looked up at him when he had his arms around me... And then we got lost for an hour and a half on our way back down the "trail" from the castle and ended up in Kaiserslautern. I knew while we were looking for my car that he was either a really nice guy who liked to talk or he had to be interested in me because we were LOST and we kept talking and getting to know each other while we corrected ourselves back towards Hohenecken. I was obvious that I had found someone special when he out-talked me. It's what I'd always been waiting for, just ask my mom!
I've been making our wedding invitations during my off days. As I started making them I got more and more creative and had to order more supplies. It's been fun. I'm glad I decided to do it so that I've got somthing goal oriented and tangible to do for the wedding while I'm deployed. It's kept me focused and is helping the time go quicker!
One other advantage to days is I was able to go to the dental clinic here on a walk in. I asked the dentist about whitening options when I got back and she said "we can do it here." I was excited! I had impressions taken and this week I picked up the molds and the whitening gel. She also said that when I'm happy with the color, they'll replace my compsite to match the enamel since they're not the same color right now. I'm not supposed to tell too many people though because it's supposed to be for VIP's. I'm so excited that I will have pretty white teeth for my wedding. Who knew, costmetic dentistry in Iraq?!
We also have a wedding website: www.theknot.com/ourwedding/MichaelaMcculloch&JoeWagner
13 March 2010
Code of Honor
Today was one of those days. It was a day where anything could have gone wrong and it somehow ended up being incredibly efficient. K and I were the only nurses on the floor today and we turned over the ward twice. We had our first "same day surgery" patient. Not only did we conduct efficient and amazingly thorough patient care involving a lot of patient handouts and teaching, we worked on standardizing our paper charts and I'm currently writing a policy on it. We also completed chart audits, ordered clothes from our clothing ordering system, and cleaned up the ward. However, none of this is what this blog is about....
Today while our same-day patient was in surgery, K called the EMT because we heard a helicopter flyover, land, and stay there. We had heard a patient was being flown in with an Myocardial Infarction (heart attack). He had been found slumped at his desk, was coded and resuscitated twice at his station of origin for ventricular fibrillation, and had been flown to us in stable condition. Dr. S, our cardiologist, said he felt one coming just yesterday, that he sensed one. A few months ago, I wrote that I knew I would see my first code and my first death on this deployment. None of us knew that today was that day. K got off the phone with EMT and said "they're coding him right now, let's go". We were lucky the MCU was empty at the time, so we both ran to EMT and came in the back door not knowing what we were going to see or do to help.
People always tell you it's a zoo during a code. Everyone is standing around and there are a million people surrounding the bedside. Like I was taught in ACLS, it was easy to identify the code team. Dr. S was the leader, MAJ M was the medicine nurse, there was an IV starter, Anesthesia had him intubated and was bagging him at the head of the bed, multiple people were rotating out chest compressions, someone was at the crash cart, and there was a recorder at the foot of the bed. Lab and Pharmacy were running back and forth with additional runners being sent when needed. K and I stood to the side ready, if necessary, to take over chest compressions for someone if they were tired. Sometimes you just have to know when not to try to help and wait for instruction.
He was in a rhythm called pulseless electrical activity. The monitor was showing that he was in ventricular fibrillation but in reality, he had no pulse. Medications like epinephrine, amidoarone, atropine, and magnesium sulfate were being administered rapidly through a femoral line and there was no response. They began pushing anything they could think of in the cardiac arrest indexes to try to get any response. He was shocked multiple times and finally he went into complete asystole. Chest compressions where always resumed immediately to give any treatment time to take effect while maintaining the pumping motion in effort to deliver blood to the brain and the rest of the body. After 40 minutes of cardiac arrest, 10 of which were in the air, all intervention was stopped. They looked for rhythm from different leads measuring electrical activity on different planes of the heart and felt for pulses. Anesthesia was listening for sounds with a stethoscope. After 40 minutes of cardiac resuscitation effort, they called it. The soldier was dead. An Echo or ultrasound (i think) was performed at the bedside by Dr. S that confirmed there was no electrical activity in the heart. The curtain around the bedside was pulled and the mortuary affairs team began to tend to the soldier. There was a chaplain who flew with the patient here and was standing at the bedside the whole code. He said to me, "he's one of my guys." with tears in his eyes. You realize that even though a soldier might be away from their spouse, children, parents, and siblings, they have a family here in the combat zone that has been standing by their side, eating with them, showering with them, even peeing with them, and suddenly their gone. The grief affects that family and it can't be devalued as anything less than love.
K and I had a patient come out of the OR immediately, they knew we were in the code and were actually waiting on us for a few minutes, so there was no time to processes it. We jumped right back into our busy day. Our head nurse had heard that we went to the EMT to help from the head nurse of the EMT, so she came in to let us know that there was to be a ceremony right around shift change. Some of the other MCU staff memebers had come in to grab some stuff not knowing what had happened today and agreed to cover the floor while we attended the ceremony.
There were may people who came to send this soldier home. The sidewalk from the EMT to the helipad was lined with soldiers from our CSH and from this soldiers unit stationed on our base. For a brief moment I was standing At Ease across from another McCullough. How strange. We spread out and at the command came to the position of attention. The soldiers transport team walked up the aisle to greet the litter team and together they went from the EMT to the helipad. This soldier will be personally escorted all the way home. As the team came by with the soldier in a black bag on a rickshaw, everyone presented arms (salute) and held it until the soldier was on the chopper and the litter team had returned. Faintly, you could hear a trumpet playing from a room across the street. Whether it was intentional or not, it was only noticeable if you were listening...
20 February 2010
Dust Storm
Oh, so long ago....
Ugh, this is a tanget, but someone's got to understand. Smokers are gross. In Iraq I have very limited air to begin with. Smokers take that away. There are only a few places where I am safe from them. You would THINK that the bathroom would be one of them. NO. I walked into a port-a-potty FILLED with cigarette smoke. I still smell like that cigarette smoke filled port-a-potty that I was in for an extremely short period of time. It wasn't even raining out, it's perfectly nice today. Smokers can already smoke outside my room so stay out of my toilet. Gross..... ugh! I would like to come home from this deployement with out asthma or cancer, thank you.
16 February 2010
Routine
Well, today is day 26. Thank you to everyone who as sent me packages, post cards, and letters since I've gotten here. It's so much fun to get mail!
We've changed to a 2 on, 2 off shedule which I am thankful for. 6 in a row, even when you're patient census is low, leads to stupid errors. We're finally getting settled, I love being on nights, and I've got a great routine down. I work 7pm to 7am and when I get home, I generally get to be by 0730 or 0800. I sleep ALLL DAY to wake up at 1530. I work out from 1600-1700, then I shower from 1700-1800. At 1800 the night shift team meets for dinner. Report is at 1900 for my 12 hour shift. Rinse and repeat. My off days aren't much different, I spend that 12 hour chunk of time in my CHU doing various recreational activities which I will now go into more detail about:
1. Working Out:
I have been known to be a pain in the ass about going to they gym. I don't like it, I don't want to do it, you can't make me. But, when you're in Iraq, there's nothing else to do and it's TOO easy to get chubby here with all the fried and greasy food they serve. Currently, I'm on a 6 day a week workout program divided into two categories: 1. the couch to 5k and 2. muscular workout and/or weight trainning. It all started when we decided to work out as a team. EH had done the couch to 5k before and liked it. I figured it would be worth trying. So, 3 times a week EH, KH, and I go for a run. We either run the 1/4 mile track or we run the roads. Today we ran week 4 day 2 along the roads. It consisted of a brief stretch, a 3 minute run, a 90 second walk, a 5 minute run, a 2 minute walk done twice. The weather was slightly overcast and it had rained which left a hint of moisture in the air. Great running weather. My ultimate goal from this program is to be able to acheive 100 points on the run. AKA 15:34 2 mile.
My strength training involves A LOT of core exercises. We pretty much do core every day. My favorite is the stability ball. I like being able to use the full range of motion while engaging balance. We also do free weights, the machines, and streching. Usually we do arms and abs one day, then legs and abs the other day. I can already tell an improvement in my overall strength. I can't wait until my body starts to look leaner and fitter. All the boys have to do (My battle and I work with all boys) is say, "A girl who wats to fit into her weding dress works out" or, "A girl who wants to fit into her wedding dress doesn't eat 3 cookies". It makes me laugh and keeps me responsible.
2. The Cookies:
There are WONDERFUL white chocolate and macademia nut cookies here. I became so addicted I had to quit. Now I'm only allowed cookies once a week on the 3rd run day. We (as a run group) made a pact that that was the day we were allowed our comfort food. Otherwise, I eat a lot of chicken and rice. I have also taken to eating broccoli with every meal. If you know me, you know how unlike me that is. For other people, there are ALWAYS hamburgers, hot dogs, onion rings, french fries, a soda fountain, cheese sticks, battered chicken wings...plus the short order line, plus the main line, plus the grill... it just keeps going. We are the best fed deployed people ever. The dining facilily does rate their foods as "performance food". They rate them green for high performance food, yellow for moderate performance food, and red for low peformance food. Obviously, the more green you eat, the better off you are. I pretty much stick to the green stuff. Occasionally, like pasta night, I'll have some yellows. And then of course there's the one day a week I can savor the delicious cookies.
3. CHU time.
I spend at least once a week cleaning my CHU. I clean off the floor, I swiffer, and I vaccum. I change my sheets, make my bed, and I put stuff away. Then I turn in my laundry and I take out the trash. It's easy to throw stuff on the opposite bed and leave it there, but I am more motivated to clean my small space here than my overwhelmingly full space at home.
I have my computer here with my slow internet so I don't spend as much time on it as I thought I would. Skype is still the best program in the world and I get to talk to Joe almost every day on it. Seeing him makes this time apart easier.
I also have a TV with DVD player. The DVD store here sells movies cheap so I've seen some movies recently that are still in theaters. I enjoyed Couples Retreat and I still have It's Complicated and Sherlock Holmes to watch. I haven't watched as many movies as I thought I would either, mostly due to my recent addiction...
...I have been addicted to reading. I read all 4 Twilight books in just under a week. I read the 2nd and 3rd ones in one night each. I even started reading the digital draft of Midnight Sun on Stephenie Meyer's homepage. I took a break from the Sword of Truth series to read them and they took over my life. I enjoyed them, but I think my favorite book was the first one. It was meant to be a stand alone book and I like thinking of it that way. I would also like to read Forever Dawn (the adult version of Breaking Dawn) because I think I might like it better, but I doubt the public will ever get to see it. Now that I'm done, I think I'll get back to my sword of truth books and finish the last 5 books of that series. Then, I might do something completely different. I think I might read some Danielle Steele or something. the PLX tent has a huge shelf of books and there are a TON of DS on it. I've never been interested in reading any, but since this is a place where nothings is normal, I'm going to go with the flow and do something I wouldn't normally do. I'm up for it.
I have also been cross stitching. What a midwest thing to do. Funny thing is, my battle brought hers too and she's from Illinois! You can take the girl out of the midwest, but you can't take the midwest out of the girl. I brought two with the hopes of finishing one. I'm pretty sure I will as long as I divide my time wisely. Read, watch a movie, or cross stich, oh my?! It's nice when my only concern is, "what do I want to do tonight?"
4. The Wedding
I'm sure many people are starting to wonder what Joe and I are thinking of doing for our wedding. Well, first, it's a lot harder than I thought to plan this from Iraq. I am struggling with being so far away and not being able to do this for myself. My mom, my best friend Kristen, and Joe have taken a lot upon themselves to help me out. My mom ordered my dress last week and I'm so excited. I found it in a magazine and fell in love with it. The picture is taped to my wall right by my head (with a picture of Joe, of course) so I can look at it every night and dream of wearing it. I was sad that I didn't get to try it on, but I knew when I saw it that I wouldn't have needed to. When I described to my best friend Emily what I wanted, even before I started looking, I pretty much described this dress. The picture my mom took on her blackberry was even more beautiful than it looked like online. I really want to post a picture of it, but I don't want to spoil the surprise for EVERYONE.
Since we want to get married before I leave Germany, it's going to be simple and small. The date is still August 28, 2010, in Seattle. It's hard to decide what small means so the list keeps growing. I don't mean like 100 people growing, but it went from 12 to now more like 20 with maybe a few more. We are still sold on doing the reception in the summer of 2011 in New York which we hope everyone will be at. The wedding is mostly for family while the reception is going to be the big hoopla. It also gives me a chance to wear my dress twice!!! I'm thrilled with that idea.
I haven't been able to do much, so Joe is going to send me my printer and I'm going to make our invitations from here. Besides, the postage is free! It will give me something to look forward to and something creative to do to pass the time. Something I want to learn is calligraphy and I thought that might coincide well with doing inviations (that's a birthday hint).
The concept of time is very weird here. I really don't care what day or date it is. It's much easier to think, 'it's day 26', '14% over', or 'already february 16th' than think, 'I still have March, April, May, June, AND July!! AHHHH!!!' The quote, "one day at a time" has never been more true. Time flies much faster when I don't look so far ahead.
Well, as much as I enjoy 2 on, 2 off, I'm on my 2nd night off and I haven't done ANY of my above preffered recreational activities. I'm going to go spend some time with myself!
27 January 2010
tikrit
Last week TF21 left Kuwait in 5 chalks. We had too many people going to 3 different locations for the Air Force to give us big planes. Some people got to fly directly there, and others were stuck for days in layover locations before finally arriving. I was on the 4th chalk but I got to fly direct. We left Camp Buehring in the afternoon after loading all of our gear and cleaning the tent. The first 2 chalks left the night previous and didn’t help us clean the tent at all. It was completely gross how much hair and dirt was left where people had not swept the whole 10 days we were there. So, it was left to us. Gee, thanks guys. Either way, we were all glad to finally be leaving.
That day it decided to rain, thunder, and lightning. I never would have thought that my flight would be compromised by weather in Kuwait. Chicago in the winter, yes. Kuwait, no. When we arrived at the Air Base we were departing from, the other chalks that we supposed to have left earlier in the day were still there. They had cancelled their flights. We got set up in a long tent that had chairs and couches and we were prepared to stay the night. It wasn’t looking good but since our flight was supposed to be late, we had hope. We were there for a few hours while they double checked the manifest and prepared the plane. In order to get our gear on the plane with us, we had to palletize it. All of us went out to the truck, got in a double line, alternating with the person across from us, and passed the gear down to be stacked and secured. Some of our gear was ridiculously heavy and even though we had to wear our battle rattle on the plane, it didn’t help relieve a lot of weight. With everyone helping, it made the gear off load quickly and we got to get out of the rain. It seemed like our chance for departure was slim, but then we were told “gear up”. We were heading out to the flight line! We wore our vests, our helmets, eye protection, ear protection, and gloves. We also had our weapons with a 30 round magazine-not loaded. It was a tight squeeze on a C-130, but we fit 50 people and our gear. We all grabbed motion sickness bags because we were warned that flights into theater aren’t like normal flights. I had flown on a C-130 in the states with a patient once and I hated it then, this was going to be worse.
The flight into Tikrit was about an hour and a half. I kept my eyes closed the whole time. The fumes made me nauseous to start, but the roller coaster flying kept me nauseous the whole time. I actually managed to fall asleep too, but whenever I woke up I felt sick. Roller coaster is the best way to describe a flight into theatre. There are a lot of quick ups, downs, lefts, and rights, and it’s not a gentle landing. Once we were on the ground and the hatch opened we were all looking for a breath of fresh air, but we got a face full of exhaust instead. First they had to unload all our gear before we could get out so we were stuck. Once we managed to untangle from each other and get off the plane we all felt much better. We squeezed onto tiny little buses and were immediately driven to our LSA (Life Support Area). There we were assigned our CHU’s (Containerized Housing Units) and we moved in. I have never been more thankful for a crappy mattress on a frame then I was that night (or morning by that time). We managed to get about 6 hours of sleep before having a formation in the morning. Luckily, we were given the day to adjust before starting work. Penny met me and I unloaded her TV, fridge, microwave, and DVD player into my CHU. Then we traded wall lockers with Kristina’s room next door because I had two big and she had two little. We walked around post a little and found the Post Exchange, the DFAC, the CSH, and the laundry. The people who arrived the day before oriented to the MCU (Multidisciplinary Care Unit), a combination ICU/Ward/PACU, where we will be working for the next 6-12 months.
Since then, the days have all melted together. I have no idea what day of the week or date of the month it is. We conducted a few days of skills lab training and then all too quickly, I started night shift. Currently we are working 6 days on and 1 day off. My first day off isn’t until the 28th. We were given 24 hours to adjust. We trained one day and worked the following night. I ended up just sleeping all night and all day for the first night. Normally, it’s not so hard to adjust to nights if you’re going to work nights for a few moths and you’re able to go home and go to sleep. That’s normally. The first morning after the first night we had to be back on the MCU at 0900 for a Mass Casualty exercise (MASCAL). That lasted 3 hours. Then we had to go back to sleep to go back to work at 1830. The second morning after the second night we had to be back at the CSH at 0930 for helicopter loading training. Then, we had to go back to sleep to be back at work at 1900 for our first night working solo without the 47th CSH there to help us. Then, the third morning after the third night we went to sleep to be woken up at 0900 for a MASCAL exercise. There is no sound worse right now than a fist pounding BANG BANG BANG BANG BANG BANG on your door when you’re deeply asleep. So, up I got, to the CSH I ran, and 3 hours later they finally called “end exercise”. It was total chaos. Granted, it was our first exercise ran by us. The first one we watched the 47th do it. This was our show. Communication is the hardest thing when there are 12 patients, not enough staff, 10 minute theoretical operations, ridiculous traffic up and down the floor, and a helicopter waiting for 6 patients to get packed and loaded when there’s only room for 4. It was crazy. I was crabby. We are staffing this combat support hospital with 1/3 the staffing that the 47th has. It’s going to be rough when we get a real MASCAL. Thankfully, when it was all over, my head nurse said, “night shift is coming in a 2200.” I first thought she said “2000”-like 8pm. No, it was 2200!! SWEET! So we got lunch and went back to bed knowing that we could get some decent sleep, finally!!! I’m sure day shift wasn’t happy to work 15 hours, but they were all good sports.
The dust here is unbelievable and it’s only winter. Not only is there a constant haze to the air, you can taste it too. There’s no escape-even in our CHU’s. We essentially live in a fortified trailer park. The people who built the trailer park didn’t build them to code. There are leaks everywhere. The doors don’t seal and the roofs don’t meet the walls squarely. We have air fresheners everywhere, dryer sheets in our AC units, and surgical towels as secondary filters-anything to try to improve the air. I am very thankful for a working heater because it’s COLD. It’s so nice to walk into a warm room and get cozy in my bed.
The internet is slower than anything. It doesn’t work very well. But, it’s all relative. I’m lucky to have my own room, a bed, internet in my room, AFN (which I don’t even have in Germany). The walls are so thin you can hear everything. So, it’s a false sense of privacy, but it’s wonderful nonetheless. After being here for about a week the biggest thing that I need is swiffer pads. I bought a swiffer duster because I had to buy something and I know that I have 3 swiffers at home but it costs more to mail one than buy a new one. They only sell the wet pads here and I need the dry ones too. Other than that, we have Subway, Taco Bell, Pizza Hut, Burger King, and a mini mall with shops run by local vendors. It’s not a bad place to be.
Currently, we’re learning where things are on the unit. One thing we learned in the MASCAL today was that knowing the general area of equipment wasn’t enough to find what you needed when you needed it NOW. SPC Palmer even sent us on a scavenger hunt to find the 4 locations where we keep IV supplies. I thought that was a really good idea. Later, we’re going to practice packaging a patient for flight, or “burrito-ing” the patient. Luckily, LRMC has a very similar process, so it’s familiar to me. It’s only 0200 and we’re here until 0700. Time is going slow tonight. I cannot wait for my first night off. I will relish it.
16 January 2010
Itching....
.... smallpox is starting to itch!!!! It's driving me crazy! The blister is just bigger than an eraser now and it's starting to weep. I was supposed to go to the Troop Medical Clinic (TMC) to have it "read" today because if it didn't take, they would have to re-administer it. Well, since I know it took and I'm going to have this evil thing for about 4 weeks, I feel that I am in no hurry to get it looked at. I might just do it in Tikrit. What a rebel.... hah.
We are also all just itching to get out of here. Today is Saturday. This is day 7 and we have nothing to do for the day. We woke up at 5, went to the gym and ran, went and got breakfast, showered, went to formation where we were released until tomorrow's formation, had a nursing meeting, then changed into our PT's and came to Starbucks- where we have been since. We're tired of the Dining Facility (DFAC) food and are debating Taco Bell for lunch.
I know everyone is waiting for pictures, but since I'm not settled and not on a secure network, I'm going to wait until I get to Iraq.
We had a meeting with our Clinical Nurse Officer in Charge (CNOIC) aka Head Nurse. Apparently we can't call her Head Nurse anymore. I will be starting on night shift working 12 hours shifts. We work 6 days on, 1 day off...at least for now. In theory, there could be one ICU nurse and one med-surg nurse per shift if we were to change over to a team schedule with 4 teams. We actually only have 3 ICU nurses and 4 Med-Surg nurses total. We do have LPN's, and Medics, but I'm not sure how many there are. We will also be covering the recovery room for the OR which apparently does 2 surgeries..........a month.
So, it sounds like I'm just going to pick up my bags and move my vacation to Tikrit. In what other world could you possibly get paid MORE than your normal salary for doing what I've been doing the last few days... virtually nothing. Granted, like MSG Palk told us, fire fighters are for the fires that might start, we're there for the trauma that might happen. Iraq is a waning battlefield, which is good, but as a nurse deploying to take care of troops, It's difficult to feel good about it and I know I'm not the only one here who feels this way. There's a sense of validity in going downrange to be the hooah nurse. Think Baghdad ER. Combat trauma, life saving operations, critical thinking to create something from nothing....not so much anymore, which i know is good; our soldiers aren't getting hurt in Iraq as much. But, it's hard to know that Afghanistan is the hotspot, all of those casualties go through Landstuhl, and I just left Landstuhl for my "vacation" in Iraq. You don't have to be a good nurse to go to Afghanistan, it's just luck of the draw. So, many of us here are struggling with the knowledge that while we are going to Iraq, our collegues, other nurses, even newer nurses, are going to Afghanistan to do the nursing care that we signed on the dotted line to do. However, the battlefield is ever changing, it is a battlefield, we are not going to be complacent. The locations we are being sent to are still seeing Trauma, there are elections happening in March, and as we are pulling out of Iraq, as things are being packed up and our numbers decreasing, attacks could start rising again. We just don't know. Well, that wasn't a tangent I meant to get on.
On a completely different note, I think I found my wedding dress. There are 3 stores it might be at. One in Lakewood, WA. One in Gilbert, AZ, and one in South Carolina that I can order online. I haven't called the boutique locations for a price estimate, but I think the SC location might be the winner from the reviews of her store and from her efficient and courteous long-distance communication. I just hope I can order the right size on the first try!
Joe is in Prague this weekend. Since our communication has been quite limited and the communication we have had has been a lot about Orsino, we're quite anxious to get back to talking about our wedding and making more plans. Right now I'm not sure if I'll get back in early August or late August. It might be cutting it close to hope to get married August 28th, but until they tell me otherwise, there is no reason I should be there too much longer than 180 days from the day we arrive in Iraq. My replacement will not be requested until 90 days out, so we'll see. In theory our replacements have already been identified, but they won't be activated until the CSH places the request. So, the key to this ceremony is going to be simplicity!
Well, I'm going to surf the internet some more.
14 January 2010
Sitting in Starbucks....
Well, I finally got a wireless card and I'm sitting in Starbucks with a Raspberry Black Currant frapuccino. We've been in Kuwait 5 days now and we're hear for another week. It's almost like vacation... in a twisted world. We have been waking up at 0500 every day, either because we have to or because the rude people at the end of the tent think turning on the lights and being loud is their god-given right. It's hard living in a 40 person tent for more than a few days. We're all part of Task Force 21, but we've been divided into 3 locations. Therefore, we all have different training schedules and different first formation times. Mine this morning was 0845, so when the noise started and the lights turned on, my battle, Kristina, and I got up and went to the gym.
We go to the gym a lot here... at least once a day, if not twice. I'm going to be in the best shape of my life when I come back from this deployment. I have been doing a lot of cardio and some light weights and lots of stretching. I want to look good for my wedding!! I can't wait for a care package with 2010 bridal magazines to look at.
One brief sad note, my 3.5 year old cat, Orsino, died last week when I was flying here. Joe was there, he saw it happen instantly from what was most likely a heart attack, and he was able to take care of him in my absense. I found out only a few days ago and I have been devastated. I cried myself to sleep the first night. I am slowly getting over my grief because I know he's in kitty heaven and he was loved. Many of you already knew, but many probably didn't. It's been hard to tell people without getting sad.
Anyway, we really haven't done a lot of training. We have done a lot of briefs and a lot of walking around. The most common locations you will find us when we are not in the gym are: the BX, the USO on phones, computers, XBOX 360, or PS3, the tent, or the movie theater. Yes, we have a movie theater-it even has popcorn. So far, I have seen Whiteout and Avatar. I actually really enjoyed Avatar, although I'm sure it would have been more fun in 3D!!
Today, we had the MRAP rollover. Mine Resistant Ambush Protected vehicle. They are bigger Humvee's and much more fun to rollover in. There are apparently 5 different kinds of MRAP. We trained on 1 of 2 of them. The one that I was in seated 11 people. We sat forwards and backwards on either side of the vehicle in 2 pods of 4 with a driver, a truck commander, and a gunner. The MRAP seatbelts are 4 point seatbelts that connect into a circle on your belly, 1 on either side of your waist and 1 over each shoulder. We did two rollovers, 1 180 degree rollover, and a 90 degree rollover. The 180 degree you end up doing a sumersault to get out of and the 90 degree depends on if you're on the top or the bottom. I was on the top and you're handing sideways and then you unsnap your seadbelt and you thud to the ground and hope your rotated to get your feet under you.
We are scheduled to leave here next week. This weekend I guess is more training and then Monday we will go to the range and fire our weapons.
If you have any questions, just ask. Sometimes it's hard to know what to say about where I am and what I'm doing because it all seems like the same-old, same-old to me. One the flip side, I like hearing about whatever you guys think is your same-old, same-old. It's hard to be so far away knowing that your lives keep going without me there, because whenever I come back it feels like I never left, but things are different.
Well, i really really really have to pee and so does my battle, it's also cold once the sun goes down and we're in shorts and t-shirts. I will be so thankful for the privacy of a bathroom when I come back!!! It's a pain in the butt going everywhere with someone, even someone you like, and waking up every 2 hours to escort each other to the port-a-potty 100 meters from the tent.
10 January 2010
Turn and burn
well, I am in kuwait now. the keyboard i am on does not have a shift key so i am not going to be using capital letters.
we left fort hood on january 8th at 2234. to back up a little bit, we all gathered in a gym on base where families came to spend time with us before we left. we were on 'lock down'. we were no longer allowed to go anywhere. we had to check in on the manifest, check our carry on size, and hang out for about 3 hours. at the end of that time, col holcomb made a speech and gave us 1 minute to say our good-byes before forming up to leave. once we were in a formation, we were called to attention and began to file out the door of the gym to waiting buses. it was a very emotional time for those with families saying goodbye. the hardest part is watching little kids cry as their parent lined up to leave.
once on the buses, they drove us to the airfield where we sat in the terminal for a few hours. there is a pattern in the military, you have to leave right now so that you can sit somewhere for umpteen number of hours... hurry up and wait as we always say. our flight time changed forward and backward multiple times as we sat there. as we were waiting, i had to get my smallpox vaccine. i'm not looking forward to the next 4 weeks of taking care of it, but it's not an unpleasant experience. it's just supposed to look gross in about a week when it starts to blister and weep.
when it came time to load, we left through the terminal doors and walked straight along the airstrip to the plane. it was a big plane. it reminded me of ants approaching a watermelon at a picnic. we flew on an md-11 and i sat with two friends across the middle 4 seats. they told us we were doing what was known as a 'turn and burn'. we land only long enough to refuel and do maintenance. we actually took off from fort hood at 2234. we flew to bangor, maine and then leipzig, germany before finally landing in kuwait city, kuwait. total time from takeoff in texas to landing in kuwait was 18 hours 3 minutes. then we got on charter buses and drove for 2 hours from the airport to camp beuhring where we are now located for the next 7 to 10 days. the weather is gorgeous 50-60's during peak day, but it's flat and sandy. there is nothing to be seen for forever, except an occasional pallate of water. they're everywhere.
today is an adjustment day. we got our gear, we got our tents, we picked our cots, and we got oriented to the area. we started our day here at 0630, just in time to salute the flag. so what are we supposed to do after 24 hours of travel at 0630 in the morning? well, we started with breakfast, then a briefing, then we were released by 0830 for the rest of the day. my battle, kristina, and i went exploring. we went to the uso for the first time [this is my 3rd time already tody and it's only 1620] and then we went to the bx where i bought an hp netbook for 350 dollars. my other laptop crashed the night before we left... perfect timing... then, we showered. we are allowed 15 gallons per person per day. we're supposed to take green showers here where you turn the water on only when you need to rinse. as i was changing my clothes for the first time in almost two days, i looked at my legs, and i didn't even recognize them. they were so swollen i had lines from my boots and lines from my socks. i did take a short nap from around 1200 to 1400 and it was wonderful. i always sleep wonderfully in the field. i can't wait to eat dinner at 1700 and crash for the rest of the night until 0600 tomorrow morning.
well, i'm on a time limit. i must give the computer up for someone else.
oh, there is a starbucks here. that's pretty amusing. it's actually a real starbucks. comfy chairs, wi fi, and everything.
08 January 2010
T minus 1 and counting....
Well, it's finally happening. I'm back at Fort Hood enjoying my last day in the United States. Well, sort of. I'm currently sitting in a food court paying for the use of the internet, but who cares! It's 20's and windy outside and our room has a significant draft which resulted in me using a blanket over the door to help seal the cracks and decrease the amount of air coming in... it doesn't do much good. So, we escaped.
I departed Germany on January 4th. When I got back to Fort Hood and heard our flight date had been changed for the later, I thought, "What the heck are we going to do until then!?!?" Well, I don't have a clue what we did, but the time is gone! I'm packed, I can't lift any of my gear, and if I open my duffel bag it's going to go POP. My rucksack is almost bigger than me! Yes, it still goes on my back. We are all very anxious leave because once we do, our pay starts and our countdown can start. I really want to get going so that I can get home so that I can get married on August 28th! We get to fly on a commercial plane, just with our M16's in our laps. It sounds like it's going to be free for all seating and I'm praying for inflight entertainment ;-).
This morning, we got up and wheeled our 50 gallon tough boxes full of our comfort items to a loading dock with the hope that there is room on the flight leaving today. We had previously been told that we would have to ship them on our own dollar. Then they changed their minds and are trying to put them under the plane. If not, it's going with the rear detachment and we won't see them for a month or so. I really hope they make it under the plane. ... oh ouch, my platoon sergeant just told me all tough boxes are being mailed... well, bye-bye box and if I think of anything I need, I'll let people know.
02 January 2010
Once Upon an Engagement...
...Joe and Michaela met in the ICU at Landstuhl. Michaela was applying for advanced nursing education through the Army and needed ICU experience to qualify for the program. On Michaela's off days, she would volunteer in the ICU working with the team that Joe was on. Michaela worked with various nurses as preceptors to provide oversight on critical patient care. One day, Joe noticed Michaela working on the unit and casually asked who she was, how long she'd been here, and what brought her to the ICU. He was very social, very attentive, and had honest eyes and a genuine smile. Many new nurses rotate through the ICU for shadowing experiences and it was generally assumed that Michaela was a brand new nurse to the hosptial. Joe recognized that Michaela was not brand new and was intruged by the motivation and determination that brought her in on her off days to work the ICU. Casual meetings turned into "friending" on facebook where they would talk occasionally but generally only saw each other in brief passing. Little did Michaela know, one day Joe saw Michaela approach him down a hallway and he thought, "Wow, a pretty girl." When he realized it was her, he said "hi", she said "hi", and as she passed, he waited for a few seconds and turned around to watch her disappear.
Soon after, Michaela was in the ICU again and was assigned to a patient with Joe as her preceptor. Michaela blushed with nerves about working with Joe for the first time. The patient was an incoming cardiac patient via CCATT (Critial Care Air Transport Team). They had a few hours before the plane landed to prepare-so they talked. Michaela embarassed Joe by calling him "sir". Once the patient came, they admitted him, started IV's, and told him what to expect while in the hospital. The patient was stable and tired so they closed the door and let him nap-and they talked some more. They talked and talked and talked for a 12 hour shift while sitting next to each other at the single computer. Her knee touched his knee...and lingered- It was chemistry.
Not long after that day in the ICU, Michaela took a day off on her day off and sent Joe an instant message on facebook. Joe was very excited that Michaela initited contact. Minutes later, Joe got a phone call that said "take a holiday and dont' come into work tomorrow." Michaela's response was, "Do you want to come over and play?" YES! Michaela and Joe went on their first date the very next day, March 24th, 2009.
Joe and Michaela have been inseperable since their first date except for a few times where one of them traveled to the states for the military. They knew very early on that they had something special and often talked about a future. Joe knew that if he was ever going to ask a woman to marry him, he was going to go to New York City, his favorite city in the world, and pick out the perfect ring. Michaela and Joe had visited Tiffany's in July so that Michaela could have breakfast at Tiffany's. After that, Joe knew that if Michaela were the one, it would have to be Tiffany's in New York.
From the beginning, Joe and Michaela knew that Michaela was to be deployed for 6 months and they had agreed it would be best overall if they waited until she was back before getting engaged. Michaela left Germany for a 17 day training exercise at Fort Hood and while she was gone Joe thought, "What am I waiting for?!" So, without a pass or leave or letting anyone else know what he was thinking, Joe looked for a ticket to fly to New York City on his two days off to go to Tiffany's. But, when he saw that the tickets were $2,900, had 1 or more layovers, and was on Air India, in combination with all the rules he was willing to break, he was disappointed and thought, "It's just not going to happen until she comes back." When Michaela got back to Germany for the holiays, Joe had planned a special overnight trip for the two of them. Michaela did not know where they were going or what they were going to do there.
The day of the trip arrived and Joe and Michaela walked down to the train station and hopped on an express train. Michaela guessed they were going to Paris but, having been to Paris a few times already that year, didn't know what new thing they were going to do. Joe indicated they were on a timeline and he had an address they needed to get to. Upon surfacing from the metro, they were on a busy shopping street. The storefronts were full of people gazing at the holiday windows still ablaze. Joe noticed they were by the Paris Opera house and suggested that they go to the front and eat the ham and cheese sandwhich they'd gotten on their way out of the train station. After finishing their sandwich, Joe took Michaela up the stairs of Opera House and said, "The real reason reason I took you to Paris is because I couldn't take you to Tiffany's in New York. I love you very much. I want to be your husband and I want you to be me wife. Will you marry me?" YES!! "There's a Tiffany's here in Paris, just down one of these streets, and all we have to do is find it."
Michaela and Joe walked from the Opera House down the Rue de la Paix to the doors of Tiffany & Co. and together picked the ring that promised their futures to each other. Together, they picked a classic solitaire with a round diamond. The Jeweler put it in the classic turquoise Tiffany box and tied it with a red holiday ribbon. Michaela & Joe celebrated with Champagne and a wonderful dinner at the Cafe de la Paix. Then they walked around the city at night hand in hand...