thedrifter
05-07-06, 07:10 AM
Nurses face wear, tear of war
Working in a combat support hospital, Navy nurses come face to face with the reality of the war in Iraq.
BY JIM HODGES
l 247-4633
May 7 2006
PORTSMOUTH -- In another life, Ken Dubrowski was a warrior, an Army Special Forces weapons sergeant who earned a Purple Heart for being blown up by an antipersonnel mine in Panama, then a Silver Star for pulling three people out of the same minefield.
Only nine months ago, he was a Navy nurse, an officer watching a man die in a hospital in Iraq.
"That combat warrior, that warrior spirit, was crushed right there because there was nothing I could do for him," Dubrowski says softly.
Lt. Cmdr. Eileen Knoble understands.
Seven months earlier, Knoble, a nurse with a pediatrics background, watched a man die in that same tent in Al Taqaddum, near Fallujah.
"I went to my rack, curled up in a ball, pulled a pillow over my head and cried," she says. "What else can you do?"
At least 236 nurses have deployed to the Middle East or Afghanistan from Portsmouth Naval Medical Center since the war in Iraq began. Knoble went to a unit where the Kevlar vests they wear when the shooting starts were so bulky that it was hard to work in a group around a stretcher. So sometimes the vests just had to come off.
You go in with a feeling of power. You can save everybody.
"If they came in with a heartbeat, they went out with a heartbeat, by God," Knoble says of her hospital, where more than 400 combat wounded were treated in her seven months there in 2005.
Then, you learn that sometimes you are powerless. You can't save them all. "You don't want to let anybody else see you (cry) because it runs the morale down," Knoble says.
"I can't let my corpsmen see that because I'm supposed to be strong for them," she said.
From the start of the war, the United States has worked to get care as close to wounded soldiers as possible.
Lessons from previous wars showed that treatment in the first 60 minutes after a wound is suffered often means the difference between life and death.
"Our technology has improved so much that we're able to now get somebody off the field and to a hospital in 12 to 15 minutes," says Lt. Cdr. Dan Swisshelm, who has served two tours with hospitals in Kuwait since 2002. "That's the time in Iraq to get to a Level 2."
A Level 2 facility is where doctors, nurses and corpsmen work to patch up wounded to be sent to better equipped hospitals in Bilad or Baghdad, then often to Germany, then to the United States.
With Level 2, think M.A.S.H., only now it's called CASH, or combat support hospitals.
Marines are in the thick of the fighting, and Navy corpsmen are in the field with them.
Not far away are Navy doctors and nurses.
Hours after arriving at Al Taqaddum in February 2005, Knoble learned how far she was from pediatrics.
"We had four men come in," she says. "One had 80 percent of his body surface burned. He died in June (in San Antonio). Another was 60 percent burned. I think he died shortly after leaving us. Two more ended up in the (operating room), and only one of them survived that I know of."
She had spent a Naval career working with ambulatory children.
"That was the first trauma I had ever seen," she says. "Yeah, I got quite sick after that. And that was the 'oh ...' realization."
She was at war, working in a tent only minutes by helicopter from places where insurgents were trying to give her more business. This wasn't pediatrics anymore.
Reality came to Dubrowski hours after he landed at the same hospital in late summer.
Years earlier, he had cross-trained as a medic in the Special Forces and had treated wounded soldiers on a battlefield.
He had even spent time in Kuwait with Swisshelm, working in a hospital and patching up guys to send back to their units in Iraq.
"I'd seen it from a different viewpoint," Dubrowski says. "When I got (to Iraq), I thought, 'God, I hope none of these guys have to come in here and we have to take care of them. I'd rather sit here for seven months and not do a thing.' "
Less than 48 hours later, he was up to his hips in blood.
"There were 12 casualties in a matter of an hour, all of them combat trauma," he says. "There was a multiple IED (improvised explosive device). ... We didn't even get a practice 'mass casualties.' That was our practice.
"Our biggest casualty count was 35 in an hour."
Says Knoble: "Our worst was 19 casualties in 20 minutes."
In a "mass casualty" situation anybody from the group of about 50 medical people can become a triage doctor, marking patients black - expected to die, red - treat immediately), yellow - treat within 24 hours or green - walking wounded.
They work with the knowledge that an attack can come at any time, in a cloth-and-sand atmosphere in which cleanliness is next to impossible. A shower is wonderful, but then the towel is sandy.
Knoble talks of a run interrupted by a siren that signaled a rocket was on the way. "I sprinted back two miles to my flak (jacket) and Kevlar," she says. Danger is never completely out of their minds, so they try to discipline themselves to concentrate on the task at hand.
"The first couple of times, you've got generators going on around you, you've got suction canisters and you've got the chapel being taken out by a rocket," says Dubrowski. "After a couple of times, that stuff is tuned out, and we're focusing on the patients."
They worked on Marines, on Army personnel, on military contractors, on civilians caught in the wrong place at the wrong time. On wounded insurgents, brought in bound and blindfolded.
"I tried to block that out of my mind because they were another person who needed medical care," Knoble says.
The unit scorecard showed that 96 percent of the people who came in alive went out that way. But the other 4 percent are haunting. "I remember their names," Knoble says. "I remember their faces."
You never get used to it, and it never quite goes away.
"I had one man come into the (operating room), and he was an Army (Special Forces soldier)," Dubrowski says. "His left arm was missing, and he had a tourniquet on and he said, 'Hey guys, where's Chaps?' Chaps (the chaplain) came over, and the guy said, 'Say a prayer for me, and I'll see you on the other side.' And then he closed his eyes. He knew he was gone. He had lost most of his blood before he got to us."
You wonder if anyone is ever safe.
In Kuwait, Swisshelm remembers his work when a busload of soldiers overturned. "Seventeen were hurt; one was killed," he says. "They were on their way home. It was heartbreaking."
The lessons linger. It's hard not to let them affect you after what you've seen. Knoble's husband, Bill, is a retired Navy SEAL.
"He knew exactly what I was doing," she says, "and he was terrified for me."
So was Sierra Rose, their 9-year-old daughter. Mom is different since she got back from Iraq and began working with family practice at Portsmouth.
"I'm tougher now," Knoble says. "Before, I was tolerant. Now I'm not so tolerant anymore - on the job or at home."
The night he got back to Camp Lejeune from Iraq, Dubrowski was in a hotel with his wife, Brenda, standing over her and asking, "Didn't you hear an explosion?"
"She said it was just a backfire or something," says Dubrowski, now an operating room nurse in Portsmouth. "She said, 'Where are you going?' And I said, 'I'm going to the shelter.' She's like, 'You're not taking me?' And I said, 'You're an adult, you're on your own.' "
They know they could go again. And that they'll never be closer to anyone than to those with whom they have shared danger.
"This time, we're here, next time we could be there," says Swisshelm. "Once you do it, once you get it in your blood, you kind of want it more. It's something that holds you, that binds you together."
Ellie
Working in a combat support hospital, Navy nurses come face to face with the reality of the war in Iraq.
BY JIM HODGES
l 247-4633
May 7 2006
PORTSMOUTH -- In another life, Ken Dubrowski was a warrior, an Army Special Forces weapons sergeant who earned a Purple Heart for being blown up by an antipersonnel mine in Panama, then a Silver Star for pulling three people out of the same minefield.
Only nine months ago, he was a Navy nurse, an officer watching a man die in a hospital in Iraq.
"That combat warrior, that warrior spirit, was crushed right there because there was nothing I could do for him," Dubrowski says softly.
Lt. Cmdr. Eileen Knoble understands.
Seven months earlier, Knoble, a nurse with a pediatrics background, watched a man die in that same tent in Al Taqaddum, near Fallujah.
"I went to my rack, curled up in a ball, pulled a pillow over my head and cried," she says. "What else can you do?"
At least 236 nurses have deployed to the Middle East or Afghanistan from Portsmouth Naval Medical Center since the war in Iraq began. Knoble went to a unit where the Kevlar vests they wear when the shooting starts were so bulky that it was hard to work in a group around a stretcher. So sometimes the vests just had to come off.
You go in with a feeling of power. You can save everybody.
"If they came in with a heartbeat, they went out with a heartbeat, by God," Knoble says of her hospital, where more than 400 combat wounded were treated in her seven months there in 2005.
Then, you learn that sometimes you are powerless. You can't save them all. "You don't want to let anybody else see you (cry) because it runs the morale down," Knoble says.
"I can't let my corpsmen see that because I'm supposed to be strong for them," she said.
From the start of the war, the United States has worked to get care as close to wounded soldiers as possible.
Lessons from previous wars showed that treatment in the first 60 minutes after a wound is suffered often means the difference between life and death.
"Our technology has improved so much that we're able to now get somebody off the field and to a hospital in 12 to 15 minutes," says Lt. Cdr. Dan Swisshelm, who has served two tours with hospitals in Kuwait since 2002. "That's the time in Iraq to get to a Level 2."
A Level 2 facility is where doctors, nurses and corpsmen work to patch up wounded to be sent to better equipped hospitals in Bilad or Baghdad, then often to Germany, then to the United States.
With Level 2, think M.A.S.H., only now it's called CASH, or combat support hospitals.
Marines are in the thick of the fighting, and Navy corpsmen are in the field with them.
Not far away are Navy doctors and nurses.
Hours after arriving at Al Taqaddum in February 2005, Knoble learned how far she was from pediatrics.
"We had four men come in," she says. "One had 80 percent of his body surface burned. He died in June (in San Antonio). Another was 60 percent burned. I think he died shortly after leaving us. Two more ended up in the (operating room), and only one of them survived that I know of."
She had spent a Naval career working with ambulatory children.
"That was the first trauma I had ever seen," she says. "Yeah, I got quite sick after that. And that was the 'oh ...' realization."
She was at war, working in a tent only minutes by helicopter from places where insurgents were trying to give her more business. This wasn't pediatrics anymore.
Reality came to Dubrowski hours after he landed at the same hospital in late summer.
Years earlier, he had cross-trained as a medic in the Special Forces and had treated wounded soldiers on a battlefield.
He had even spent time in Kuwait with Swisshelm, working in a hospital and patching up guys to send back to their units in Iraq.
"I'd seen it from a different viewpoint," Dubrowski says. "When I got (to Iraq), I thought, 'God, I hope none of these guys have to come in here and we have to take care of them. I'd rather sit here for seven months and not do a thing.' "
Less than 48 hours later, he was up to his hips in blood.
"There were 12 casualties in a matter of an hour, all of them combat trauma," he says. "There was a multiple IED (improvised explosive device). ... We didn't even get a practice 'mass casualties.' That was our practice.
"Our biggest casualty count was 35 in an hour."
Says Knoble: "Our worst was 19 casualties in 20 minutes."
In a "mass casualty" situation anybody from the group of about 50 medical people can become a triage doctor, marking patients black - expected to die, red - treat immediately), yellow - treat within 24 hours or green - walking wounded.
They work with the knowledge that an attack can come at any time, in a cloth-and-sand atmosphere in which cleanliness is next to impossible. A shower is wonderful, but then the towel is sandy.
Knoble talks of a run interrupted by a siren that signaled a rocket was on the way. "I sprinted back two miles to my flak (jacket) and Kevlar," she says. Danger is never completely out of their minds, so they try to discipline themselves to concentrate on the task at hand.
"The first couple of times, you've got generators going on around you, you've got suction canisters and you've got the chapel being taken out by a rocket," says Dubrowski. "After a couple of times, that stuff is tuned out, and we're focusing on the patients."
They worked on Marines, on Army personnel, on military contractors, on civilians caught in the wrong place at the wrong time. On wounded insurgents, brought in bound and blindfolded.
"I tried to block that out of my mind because they were another person who needed medical care," Knoble says.
The unit scorecard showed that 96 percent of the people who came in alive went out that way. But the other 4 percent are haunting. "I remember their names," Knoble says. "I remember their faces."
You never get used to it, and it never quite goes away.
"I had one man come into the (operating room), and he was an Army (Special Forces soldier)," Dubrowski says. "His left arm was missing, and he had a tourniquet on and he said, 'Hey guys, where's Chaps?' Chaps (the chaplain) came over, and the guy said, 'Say a prayer for me, and I'll see you on the other side.' And then he closed his eyes. He knew he was gone. He had lost most of his blood before he got to us."
You wonder if anyone is ever safe.
In Kuwait, Swisshelm remembers his work when a busload of soldiers overturned. "Seventeen were hurt; one was killed," he says. "They were on their way home. It was heartbreaking."
The lessons linger. It's hard not to let them affect you after what you've seen. Knoble's husband, Bill, is a retired Navy SEAL.
"He knew exactly what I was doing," she says, "and he was terrified for me."
So was Sierra Rose, their 9-year-old daughter. Mom is different since she got back from Iraq and began working with family practice at Portsmouth.
"I'm tougher now," Knoble says. "Before, I was tolerant. Now I'm not so tolerant anymore - on the job or at home."
The night he got back to Camp Lejeune from Iraq, Dubrowski was in a hotel with his wife, Brenda, standing over her and asking, "Didn't you hear an explosion?"
"She said it was just a backfire or something," says Dubrowski, now an operating room nurse in Portsmouth. "She said, 'Where are you going?' And I said, 'I'm going to the shelter.' She's like, 'You're not taking me?' And I said, 'You're an adult, you're on your own.' "
They know they could go again. And that they'll never be closer to anyone than to those with whom they have shared danger.
"This time, we're here, next time we could be there," says Swisshelm. "Once you do it, once you get it in your blood, you kind of want it more. It's something that holds you, that binds you together."
Ellie