Deployed Army Nursing: 101 Things I Learned While Deployed
As many of you know, I recently spent nine months in Afghanistan. For those of you who don't know, I'm an Army nurse in the ER specialty category. I deployed with a Forward Surgical Team (FST) as the ER nurse, in charge of the Advanced Trauma Life Support (ATLS) section (essentially the ER of the FST). It was a great learning experience, and I had the privilege of serving with a fabulous team. While our living conditions were not great (okay, they were pretty bad), they could have been much worse! So here is a collection of things I knew, things I learned, and things I "woulda/coulda/shoulda" and "did" for deployment. Not sure if I'll really get to 101, but we'll see.
1. Afghanistan gets very, very cold in the winter. People think "desert," "heat," and "sand" when you say Afghanistan, but let me tell you that it's more like "dirt and dust," not sand. And we had plenty of ice and snow in the winter months. I was located at an elevation of 6500 feet, so think Colorado.
2. Don't let CIF tell you that they are out of your size in cold weather gear (see number 1). Take the next closest size so that you have silks, waffle tops, and a fleece jacket at the very least. When I was told they were out of small, I asked what I was supposed to do. The response was "Don't worry ma'am, it's not cold there yet." Uh...
3. Prime is amazing ... if you actually get mail. Our mail would sit at another location for about 6 weeks before we'd get it, so don't always count on the mail. I ordered a cheap coyote brown fleece jacket (see #1 and #2) from Amazon, and thank goodness I did it early enough to get it in time for cold weather.
4. Things that smell nice really matter. There aren't a lot of opportunities for good smells in Afghanistan, so having nice-smelling moisturizer, for example, was a boost. This one is more likely for the girls, but guys will also appreciate things that smell nice at some point into the deployment. lol
5. The water will not be kind to your skin or hair. Moisturize!
6. Do not drink the water. With that being said, some folks did opt to brush their teeth with it, and I'm sure I got water in my mouth while showering, but do not consume it with a purpose. Our water came straight from a well in the ground without any treatment or chlorine, so who knows what was in that water?
7. Your laundry will never really be clean (see #6 about the water source). We had one washer and dryer for about 20 people, and it was like the plumbing Olympics to keep that thing going. The pumps would burn out, the hoses would freeze, it was like Christmas when we actually got a load of laundry done. Some larger locations have local national employees who wash your clothes for you, but I've not heard great things about that service, so I'm grateful that we had to do our own.
8. Be prepared for the dirt. Afghanistan can be a dirty, dirty place. I can't even convey to you the actions of the laws-of-physics-defying dirt in Afghanistan. I kept swearing the dirt was sentient, it would constantly creep in while we weren't looking. We cleaned and cleaned, recognizing that it was a never-ending battle. In the summer and during dryer months, we had what we called "moon dust" on our compound: fluffy dirt that was as deep as our ankles, no kidding.
9. Do not become overly attached to your running shoes in Afghanistan, it's not likely they'll survive the deployment. Between the dirt and the gravel surface of FOBs and compounds, those shoes will be toast.
10. Go to the gym! Seriously, this was the best thing I did for myself. I developed a daily routine, which is a huge part of staying sane during deployment when every day is like Groundhog's Day (as in the movie with Bill Murray). When I am home in my ER I will NEVER have time to go to the gym during a shift, so I did this while deployed if we didn't have any patients. Sometimes I'd get pulled out of the gym for incoming patients, but that was to be expected.
11. Sign up for a class while you're deployed. I did a seven-week Legal Nurse Consulting course (which really taught me one thing: I don't want to be a Legal Nurse Consultant, haha). I was hesitant to take my last MSN class (last class before capstone, that is) because our internet connectivity was a little sketchy at times, but I finally signed up during the last 8 weeks we were in country, and I'm almost done with the class now. Most larger FOBs have pretty reliable internet, and even on our tiny compound the computers in our MWR really only went out during a blizzard, at which point one of our OR Techs and I cleaned off the satellite dish using a flyswatter, it worked and our connectivity was restored. We both had school work to do, we were serious!
12. The flies are insane. We decided that "Kamikaze Afghan Houseflies" would make an excellent punk rock band name. They are insidious, they will try to fly into any available opening on your vented patients who cannot wave them away. I spent a fair amount of time shooing flies from eyeballs, mouths, noses, ears, whatever.
13. Do not pet the animals unless you want rabies treatment. Enough said! Military working dogs are an obvious exception, we had one on the compound who was awesome and loving who loved to be petted, but check with their handler first. Even working dogs get cranky and have bad days.
14. Be prepared for some wildlife: notably snakes, spiders, and mice. I was quite grateful for the noisy mongoose under the FST, I told myself that it only SOUNDED like it was in my room, and it would eat snakes and mice (and probably spiders). The mice will get in just about anywhere they can, so limit the food in your room unless you have a mouse-proof door (which I finally did, after another OR Tech was kind enough to nail some boards down across the area where the door met the floor). Shake out boots/shoes before you put them on. I never had a spider in my boots, but I told myself I would if I didn't check.
15. Drink water. Hydration is important! Bottled water is generally plentiful, I had cases in my room (we had to bring the cases inside when it got cold to keep them from freezing, too). It annoys me now to pay for bottled water, but that's the price of being home, so I gladly pay it!
16. Solar showers are handy things to have for the times when the showers might not be working. I only had to use mine a few times, but I was glad to have it.
17. Water kettles are handy too. You can use them to heat water for the solar shower (if there's no sun/time to heat it), or to heat water for tea, instant coffee, oatmeal, etc. I ordered one from Amazon, it was like $20. I gave it to one of the green beret guys when I left. We used water kettles to defrost our shower lines, climbing up on top of the shower trailer and pouring hot water on the pipes and hoses.
18. Another handy item: a Keurig. A friend of mine sent me one, and my significant other sent me a K-cup adapter and plenty of delicious coffee from Fresh Market. There is something to be said for not having to leave your room to make coffee!
19. Don't become attached to any personal items you might receive, like Keurigs or water kettles. By the time you're leaving, you'll want to carry as few items as possible. I left as much as I could.
20. If you're PROFIS (Army professional filler system) to another deploying unit and you deploy through the CONUS Replacement Center (CRC) at Ft. Bliss, you will be traveling with about three duffels of stuff that you will likely never use. I had it all, from canteens to kneepads/elbow pads to an e-tool. I got the whole rifleman's kit, and I didn't even have a rifle! (I had an M9, a Beretta 9mm pistol.) The only way to avoid being given a truckload of stuff is to take a memo from an O-6 or higher that allows you to draw only what you want to draw. Needless to say, I was not aware of this tidbit, so I had duffels aplenty. One cool thing is that I also got the multicam Army Combat Pants issued to me at CIF, and they were comfortable and made me look all hardcore n'stuff. The rest of the FST was jealous. I have no idea why I got them, I am not an uber-tactical human and never left the compound the entire time (an area roughly the size of a Walmart parking lot, without the convenience of an actual Walmart).
21. Be safe with your weapon. If you are not proficient, admit it! If you are not comfortable with your weapon, admit it! Ask for help. The knowledgeable people don't expect all medical types to be weapons experts. This is one thing you don't want to screw up: a negligent discharge (accidentally firing your weapon) is a HUGE deal, and it's worse if you shoot someone else (or yourself) during that negligent discharge. I'm talking dishonorable discharge, loss of benefits, jail time, plus having to live with hurting someone else. Now doesn't that make asking for help with your weapon a little easier? Trust me on this one.
22. Do NOT leave your weapon anywhere and walk away from it. Leaving your pistol in the latrine, for example, is a no-go and a very big deal. Be mindful of your weapon!
23. Clean your weapon, even if you haven't fired it for a while. See #8 regarding dirt ... it gets in your weapons as well.
24. Don't use the incoming alarm as the alarm tone on your iPhone. It's rude. That sound will make people run and will cause tachycardia, then generalized anger in your direction.
25. Re-rack your weights in the gym, or risk the ire of all your co-deployed comrades.
26. Be kind to the DFAC (dining facility) staff, they are doing their best with what they have (likely to be cheap ingredients and not a lot of fresh stuff).
27. Celebrate holidays with your people. These things matter, and boost morale.
28. Call home when you can. Your people at home love to hear your voice.
29. Wifi is usually available, but may not be free or even cheap or even reliable. I paid $99/month for wifi and used it mostly on my smartphone. Skype worked well enough to make phone calls much of the time.
30. We had regular 110 outlets where I went in Afghanistan, but this might not be the case everywhere. If you travel to or through Kuwait, you will probably need an adapter to plug things in. However, as long as your computer/phone/whatever chargers say "100-240v," it's generally safe to plug them in using the adapter (but don't sue me if you fry your stuff, see what others are doing first).
31. You might not have all the equipment you want as a nurse, but you will have everything you really need. It's amazing how we can adapt to varying levels of austerity.
32. Whole blood is not the devil. Repeat after me: whole blood is not the devil! I know the idea of whole blood transfusions is appalling to some, but let me tell you: it is lifesaving. I've seen it.
33. Be prepared to wear many, many hats beyond nursing, from patient movement coordinator to combat refueler to shower pipe defroster to sandbag filler to builder of shelves to latrine housekeeping. Your rank doesn't mean a lot when all hands are needed to accomplish something for the good of many, don't count on the "Joes" to do all the hard labor. Get your hands dirty, they probably already are anyway: this is Afghanistan!
34. Don't assume that the Afghans don't speak English. Many do, or can at least understand what you're staying.
35. "Afghanis" refers to money, "Afghans" are people.
36. If you have an opportunity to urinate, take it. Sometimes you don't know when you'll get another chance to do so, like after drinking four bottles of water while being on baggage detail in Kuwait in 120-degree weather and having to get on a bus for an hour ... the bladder Olympics can be painful.
37. When you're notified of incoming patients via MEDEVAC, you'll have a few minutes. Hit the latrine and grab a snack.
38. Clean up after yourself. Your mother likely didn't deploy with you, and CIF does not issue maids (at least to lowly LTs, haha).
39. Share your care package items with coworkers. It's amazing what can perk people up, and they'll likely share right back.
40. If you have opportunities to do cool things like weapon ranges or firing mortars or blowing things up with EOD, take advantage of these opportunities. Where else can a nurse do these things?
41. Keep an eye on your buddies. If someone looks sad or upset or seems depressed, ask them how they're doing. Deployment is more difficult for some than others, and problems at home don't go away just because you're in a war zone.
42. Check your LES every month. If you're in Afghanistan, you'll want to see some extra pay: Hazardous Duty Pay (HDP), Imminent Danger Pay (IDP), and Family Separation (FSH) if you have dependents back home. Also make sure that taxes are not being taken out. Make sure you are accruing leave at an appropriate rate.
43. Get an Eagle Cash Card before you deploy. This card is linked with a designated bank account (your own, haha), and you can load money onto the Eagle Cash Card at kiosks in various locations. Most vendors accept Eagle Cash Cards. Do NOT use your debit or credit cards in Afghanistan anywhere outside the PX/BX unless you want your accounts plundered.
44. Take your laptop, but be prepared to have it broken. I know a few people whose laptops got broken during travel, when IDF rattled their rooms and knocked things over, when the Afghanistan dirt crawled inside of the laptop, etc.
45. Take an external hard drive. People usually have a lot of movies and TV shows on external hard drives, and they are handy to have. Some people brought media players, which can be attached to TVs via HDMI cables; the hard drives can be plugged into the media players. We watched a lot of movies in our downtime.
46. Nap when you can.
47. Females, there is something called a "Freshette" that allows you to urinate standing up. I didn't use one personally, but some of my female counterparts did. That allowed them to pee into empty bottles in their rooms, which the guys did all the time (without using a Freshette of course, haha). I know, you're grossed out by this, but think about what you'd do when you wake up in the middle of the night, it's 10 degrees outside and snowing, you have to go SO BAD, and the latrine is a five-minute walk. Don't judge!
48. Don't take your best stethoscope, it might get lost and/or damaged.
49. Take underwear that you really don't care about. Bras too. And socks. I threw a lot of things away as I moved from Afghanistan to Kuwait on my way home because I knew I had the nice stuff waiting for me at home.
50. Remember that life is simple in Afghanistan: our choices are limited. Our people back home have the same level of daily information-inundation on top of missing you, so make sure you thank them for holding down the fort.Last edit by Pixie.RN on Apr 5, '16
About Pixie.RN, MSN, RN, EMT-P Senior Moderator
Pixie.RN: a short green-eyed redhead, very tattooed, Emergency/Trauma Nurse, former CPT/66T (Army). Avid reader, addicted to good shoes, allnurses, and her Android smartphone.
Pixie.RN has 'Paramedic: 14, RN: 9' year(s) of experience and specializes in 'ED/Trauma'. From 'everywhere and nowhere - global nomad'; Joined Aug '05; Posts: 16,218; Likes: 12,830.Apr 7, '14I admire your positive outlook and respect your credentials. I've read a few of your blogs. Good work. And great work over there. Thank you.Apr 8, '14Thank you for your service, Pixie! I am pleased you made it back to American soil safe, sound and in one piece!As many of you know, I recently spent nine months in Afghanistan.Apr 8, '14Thank you for your service, Pixie. This is a great list. My micro professor did two tours in Iraq and had many stories about the dirt and spiders alone!Apr 9, '14God bless you for your service, so thankful for all of our servicemen and women! You are awesome!Apr 9, '14Welcome home. Where were you in Afghanistan? I'm Air Force but was deployed with the Polish Army to FOB Ghazni in the eastern part of Afghanistan. I was the senior critical care nurse and trauma nurse. We had about 5 bays for trauma.was our lifesaver..orders usually took about 2-3 weeks to arrive to our base. Haaji shops were charging like $10 for a big bag of potato chips. We were ordering lots of snacks and bath items for cheap. Weather was extremely hot during the day and freezing cold at night. I was there Sept 2012 to March 2013. The fighting season actually was extended where we were due to the unusually mild winter we experienced. Feels great to be back home and to be in the reserves now compared to active duty.Apr 9, '14Thank you for your service and your story. I have great friends who worked in Kabul for two years with an international organziation, and they loved it there. The stories and relationships formed were amazing. I also now am the proud owner of several rugs they bought at the local marketplace.
He actually wrote a book on his work- Window on Afghanistan: Rebuilding Health, Hope and the Human Spirit. Great read!Apr 9, '14I'm so glad to have you back! Thank you for taking care of our sons and daughters, brothers and sisters, husbands and wives. I loved your article, too.Apr 10, '14Thanks, everyone. I have found that I am VERY cheerful back in my home ER. I was discharging another nurse's patient around 6pm while working a 7a-7p shift. The patient asked if I had just arrived, because I seemed so cheerful. I told her I was just so happy to NOT be in Afghanistan! Hahaha.
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