by K. Sue Roper
On 21 January 1991, my thirty-third birthday, I was informed that I would be deployed on board the hospital ship USNS Mercy (T-AH 19) for temporary additional duty. The Mercy had deployed in August 1990 in support of Operation Desert Storm. By early 1991, fighting between the coalition forces and Saddam Hussein’s Republican Guard loomed close on the horizon.
Arriving on board the ship and being one of the later arrivals, I was assigned to an open-bay berthing area. Where I was berthed mattered little to me, for I was simply excited and eager to have the opportunity to be in the action, supporting our military forces in the best way I knew how. My primary work assignment would be a subunit of the triage area dedicated to major- trauma victims who might be brought on board via helicopters. Ens. Mike DiBonaventura was assigned to this area with me as my staff nurse, and neither he nor I could have ever imagined that the next time we would see one another would be twelve years later in the sands of Kuwait.
When my services were not needed in the triage area, I worked in the ICU. Fortunately, the Mercy did not receive numerous casualties of war during Operation Desert Storm. Also known as the Gulf War, that operation was quick and precise, and it resulted in very few personnel wounded in battle. With the exception of a few American and coalition fighting troops injured in accidents, the majority of those for whom we provided care were our own prisoners of war who were brought back on board the Mercy when we sailed into Bahrain.
Although my shipboard tour was brief, about three weeks in duration, I loved everything about the Mercy. We were not overloaded with patients, yet the training we received was invaluable. Commander Deprima, with whom I had been stationed twice previously, guided us in our efforts and work. Her trusting leadership style was a perfect match to my conscientious, thorough, and independent work approach.
Returning to the Naval Hospital, Camp Pendleton, I resumed my position as charge nurse of the ICU. Life returned to normal; I worked hard, continued running marathons, socialized with friends, and pursued a variety of other outdoor interests. Soon, as is the case with all military installations, personnel staff changes occurred at the Naval Hospital, and I found myself working for a supervisor who was a micromanager. This supervisor, unlike Commander Robinson, did not trust my judgment or decision-making process. Despite this disparity, I continued making sound, independent decisions specific to the management of the ICU that were not always in concert with the desires of my supervisor. As a result, I received a less-than-favorable annual fitness report (FITREP). I was miserable and believed this FITREP would squash any chances of future promotion. I even thought it might prove to be the demise of my career as a navy nurse. I adamantly disagreed with my evaluation and steadfastly refused to sign it.
Fortunately, my career would soon be saved by the arrival of the new director of nursing service, then-Captain Deprima. She thoroughly researched the circumstances surrounding the various decisions I had made specific to the ICU, and the FITREP was revised. The subtle negative verbiage contained in the report was removed, and I happily signed it just prior to leaving to execute my next set of orders to the NSHS, San Diego.
In November 1991, I reported to the NSHS, where I would be assigned as an instructor at the Hospital Corps School. I had always wanted to teach there and saw it as a way to pay back all that had been given to me as a young enlisted sailor. This was my opportunity to give to the young folks, the navy’s future, just as so many had given to me when I had first started my naval career. Watching my students grow, learn, and discover their skills and talents was tremendously fulfilling. Still, the position was also strenuous; I found myself assisting these young people in solving an array of personal issues, ranging from severe financial difficulties to delicate marital, family, and relationship problems.
As my tour at the NSHS drew to a close, I found that I had achieved all of my initial career goals and more. I was as clinically experienced in the field of ICU as I could be, I had fulfilled my dream of teaching at the Hospital Corps School; I had been given the opportunity to travel throughout the world; and I had met and become very close friends with many wonderful people. I had even been selected and promoted to the rank of lieutenant commander, the rank I needed to achieve in order to retire and receive the maximum retirement benefits for my service. Still, I believed there was more to do, and I began thinking about what I wanted to do next.
Reflecting on my days in nursing school at Fort Hays University, I remembered a time when various advanced practiced nurses came to the school and spoke to us about their particular specialties. I distinctly remembered a nurse anesthetist being one of the speakers. She told us how her role incorporated pharmacology with the patient’s physiological state, plus patient care. I knew even then that the role of a nurse anesthetist was a perfect match for what I desired most, and I began researching the prospect of attending the navy’s education program for nurse anesthetists.
Completing my student candidate’s packet for nurse anesthesia school was extremely time consuming, requiring several months to develop. It was comparable to developing and writing a master’s thesis, or at least it seemed so at the time. I developed the most comprehensive, straightforward, and precise packet I was capable of creating. Guiding me in my efforts were Capt. Sherry Henderson, a family practice physician assigned to the NSHS, Cdr. Barb Ramsey, a fellow navy nurse, and Cdr. Anne Hanzel, who spent hours reviewing and editing several versions of my school packet. My diligent work, the support of my friends, and the letters of recommendation from Lt. Cdr. Judi Jo Johnson, Lt. Cdr. Karin Lundgren, and Lt. Cdr. Julie Donahue Pearson, all of whom were certified registered nurse anesthetists (CRNAs), paid off. On 21 January 1994, my thirty-sixth birthday, I was informed that I had been selected for the nurse anesthesia program. I was due to report to the NSHS, Bethesda, Maryland, six months later.
About that time, the navy’s nurse anesthesia education program became affiliated with Georgetown University’s CRNA program, and it would prove to be the most grueling and relentless experience I had ever encountered. My days and nights were totally consumed with attending lectures, studying, writing papers, and performing dissections in the anatomy laboratory. The year of didactic instruction at Georgetown University was brutal, but with the help of my fellow students and study partners—Lt. Cdr. Tamara Martin and Cdr. Debra Yarema—I completed it successfully and advanced to phase two of the program. This phase consisted of eighteen months of additional training and supervised clinical practice at the Naval Medical Center (NMC), Portsmouth, Virginia, and at various civilian hospitals in the southern Virginia Tidewater area. Being exposed to other nurse anesthesia providers in civilian facilities demonstrated to me the vast difference between anesthesia practice in the navy and the practice within the civilian community. The emphasis for the navy’s nurse anesthetist was to function independently as the only anesthesia provider, making sound, quick judgments and taking immediate action no matter what the situation or environment might encompass.
Two weeks prior to graduating in February 1997, my mother experienced a global ischemic attack, and she, along with others in my family, was unable to attend the graduation ceremony. Concerned about my mother but happy about reaching my goal, I graduated with a Master of Science degree in nursing anesthesia and reported for assignment to the National Naval Medical Center (NNMC), Bethesda.
Being in Maryland brought me the closest to my family’s home that I had ever been in my navy career, and I was pleased. My youngest cousin, Kathy, was in her third year of fighting breast cancer and had recently come out of remission. Her cancer had metastasized, and I wanted to be close to home, ready to help her as much as possible. Now that I was in Maryland, I would be able to go home quickly.
In April 1997, while visiting my family in rural Pennsylvania, I received a call from Capt. Jan Chandler, a navy surgeon, and Capt. Carol Cooper, a navy lawyer. These neighbors of mine in Maryland had been collecting my mail and watching over my residence while I was away. I had been waiting eagerly
to hear word about my nurse anesthesia certification results. When Jan informed me that I had indeed passed the certification board’s testing requirement and was a true CRNA, I was extremely happy. It was even more meaningful to me because I had the opportunity to celebrate this accomplishment at my childhood home surrounded by my family.
I would continue to remain assigned to the NNMC from 1997 until 2000, all the while making frequent trips home to Pennsylvania on weekends and extended holidays. This three-year tour of duty was enjoyable. I steered clear of the ever-changing political climate of the day and concentrated on learning, practicing, and refining my skill as a CRNA.
While at NNMC, I was also assigned collaterally as the chief nurse anesthetist for the hospital ship USNS Comfort (T-AH 20). In this position, my sole responsibility was to ensure that the ship’s anesthesia department was ready for any contingency, whether it was in response to war or a national disaster or for humanitarian purposes. This collateral assignment to the Comfort would be the first of many more shipboard nursing experiences I would encounter as my career in the navy continued.
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ANCHORS AWEIGH
In June 1997 the USNS Comfort pulled out of Baltimore Harbor on a humanitarian mission called the Baltic Challenge. We would be deployed for more than a month to several Baltic countries and would see many sites none of us had ever witnessed before. The experiences we would have—clinically, socially, and culturally—would be incredible and would reside in our memories forever.
At one of the first ports in Lithuania where we dropped anchor, a woman ran up to the ship and cried, “Please! Please, help me! Help my child!” Her fifteen-year-old son had a large tumor growing from the back of his head. The extensive, delicate neurological surgery to correct the deformity would take close to nine hours to perform. I felt privileged to be involved in this procedure. The Comfort had been outfitted with the best medical equipment and advanced telecommunications capabilities, allowing us to transmit computed axial tomography (CAT) and magnetic resonance imaging (MRI) scans to the Radiology Department at NNMC for expert review and analysis. This ability to send and receive images and medical testing between ship and shore was a first; we were making history. The standard of care enhanced by the telecommunications capabilities initiated on board the Comfort during the Baltic Challenge set the standard for future shipboard medical practice.
Returning to NNMC, I continued to work as a staff CRNA in the operating room. My cousin Kathy was receiving extensive treatment in her battle against breast cancer, including stem cell transplant. She was hospitalized in Philadelphia; I would work in Bethesda during the week and travel to Pennsylvania to assist her on the weekends. Being the only medical professional in my family, I was looked to for explanations why certain treatments and procedures were being performed, what to expect as a result of those treatments and procedures, and what treatment choices might be best.
In August 1999 I was notified that I would be assigned to Fleet Surgical Team Eight based at Little Creek Naval Amphibious Base, Norfolk. In preparation for this assignment, I was provided an opportunity to deploy on the aircraft carrier USS Roosevelt (CVN 71) for a month of training and hands-on practice at sea. I thoroughly enjoyed being on the carrier, and I loved practicing the art of anesthesia in a true navy operational setting. I would soon discover, though, that aircraft carriers are 100 percent different from amphibious ships, on which I would also be deployed.
In April 2000 I reported to Little Creek. As the only anesthesia provider to be deployed on various amphibious ships for durations of up to six months, I knew I needed to be as knowledgeable, responsible, and highly skilled as possible. My number one priority was the care of the sailors and marines attached to the ship.
The differences between the amphibious ship and the Roosevelt were readily apparent. Whereas the aircraft carriers received generous supplies and equipment immediately upon request, I discovered that obtaining supplies and equipment for the amphibious ships took diligence, perseverance, and even some scrounging. Compensation for that which we were unable to acquire in supplies or equipment would require creativity, imagination, and the ability to efficiently use or modify whatever supplies we had on hand to get the job done. This lesson would serve me well a mere three years later when I would find myself providing patient care with even fewer supplies and even more archaic anesthesia equipment than what was available on board the amphibious ships.
Berthing on board the various ships would also vary. The carriers were equipped with individual staterooms, but the berthing on board the amphibious ships, especially the USS Saipan (LHA 2), proved to be a different story. As one of the older multipurpose amphibious ships, she had not been fully retrofitted to accommodate female sailors. The small group of us assigned to the ship was berthed in one hallway, and we all shared one small head that was designated “for females only.” Officer staterooms were shared; my roommate was a lieutenant female helicopter pilot.
During my six-month Mediterranean cruise aboard the Saipan, I worked with a dynamic group of medical and nursing professionals, including Lt. Alex Matthews, surgeon; Lt. Mike Picio, family practice physician; and Lt. Gene Trusdale, operating room nurse. The corpsmen were also well trained, hardworking, and eager to provide the best patient care possible. Our deployment in the year 2000 brought many challenges, some surgical and some environmental. We encountered some storms so fierce that our commanding officer likened them to The Perfect Storm. He often remarked that the conditions we encountered during that cruise were worse than any he had experienced in nine previous deployments.
While we were meeting the challenges of working and living on board the USS Saipan as she was tossed violently about by the storms, we were notified of the 12 October 2000 bombing of the USS Cole (DDG 67) while she was docked in Yemen to take on fuel. Killing seventeen young sailors and injuring thirty-nine others, this terrorist attack brought changes to our ship’s itinerary, heightened security to ports of call, and created a need to relocate scheduled training missions. Unrest between Palestine and Israel was also occurring during this time, and instead of docking at an Israeli port, a plan that had been in place for more than a year and a location where the marines had routinely performed military exercises and maneuvers, the Saipan went to Croatia. Despite this abrupt change of the ship’s course, the Marine Expeditionary Force (MEF) was able to conduct an outstanding training experience, and Croatia would soon replace Israel as the location for future overseas MEF exercises.
During that Mediterranean cruise, I became acutely aware of the heightened unrest and threat of terrorism in the Middle East. Another nine months would elapse before I would know just how unsettled the world was and how terrorism would impact every citizen of the United States of America.
In June 2001, Fleet Surgical Team Eight, to which I was still assigned, was attached to the USS Wasp (LHD 1). We were docked at one of the many piers at the U.S. Naval Base, Norfolk, Virginia, and as crew members we were in the process of preparing her workups and sea trials for an upcoming six-month routine and scheduled Mediterranean cruise. For close to three months our days were typical, and the start of 11 September 2001 seemed to be no different, other than calling my mother to wish her a happy seventy-seventh birthday.
On learning of the 11 September 2001 terrorist attacks on the World Trade Center and on the Pentagon, all shipboard military personnel were mandated to report immediately to their assigned ships. Thousands of sailors and marines residing in the Tidewater and Hampton Roads area surrounding Norfolk scrambled to get their affairs in order, pack their seabags, say goodbye to their loved ones, and make their way expeditiously to their assigned ships. Snarled in what seemed like a never-ending line of traffic, compounded by an additional delay as we were carefully scrutinized by the base’s heavily armed guards before being allowed on base, I spent four long hours trying to reach the ship, which was a mere twenty miles from my home.
Once aboard the Wasp, we were told to “hold tight.�
� No one knew whether we would deploy or hold fast or what our role might be as the devastation of the attacks began to unfold hour by hour and the reality of the events began to sink in. As night approached, we were told to go home, “stand by,” and be ready to return to the ship at a moment’s notice. From September until December 2001, I continued to maintain a personal state of readiness, equipped and prepared to report for duty, no matter what that duty might entail.
In November, while still attached to the Wasp, I received orders to report to Naval Medical Center, Portsmouth, Virginia, in January 2002. My replacement, Lt. Bob Hawkins, had reported to the Wasp, and after a thorough turnover was completed, I had an opportunity to deploy in a temporary-additional-duty status to the USS George Washington (CVN 73) prior to executing my permanent-change-of-station orders to Naval Hospital, Portsmouth. I thoroughly enjoyed being deployed for three weeks on the carrier, and it provided me with additional experience in operational medicine, something I loved and knew I would never have an opportunity to experience as a civilian CRNA.
Unfortunately, during this same period of time, my cousin Kathy’s medical condition took a turn for the worse. During the Thanksgiving holidays of 2001, I had visited with her and expressed my love and gratitude to her for our unconditional “best friend” forty-year-long relationship. As I sat on board the George Washington somewhere in the wide-open, expansive Atlantic Ocean, I grew frustrated when I received her e-mail telling me she would be entering the hospital for what she expected to be her final days. For four very long days prior to returning to home port, I knew very little of Kathy’s condition, and my sense of urgency to get back to Pennsylvania to be with her grew stronger with each passing hour.