For the latter half of this year I've had the wonderful opportunity of being deployed as the only ER RN with a Forward Surgical Team (FST). One of the interesting things about being with these folks is the "forward" part. That means we're a little further forward (i.e., in austere locations) than your typical Role 3 facility, which is a Combat Support Hospital (CSH). CSHs tend to be located on larger Forward Operating Bases (FOBs) like Bagram and Kandahar, where they even have cafes and sit-down restaurants and crazy things like paved roads. Heck, even our transient base in Kuwait had a McDonald's and a Subway, among other things. But even the larger FOBs have their drawbacks, despite a few extra amenities. It's still a war zone.
Out here on our compound we don't have much. It makes life very simple because our choices are so limited. We have an awesome gym, a plywood hospital that the Navy SeaBees built for us from scratch (love those guys and gals!!), a dining facility (DFAC), an MWR room (that's Morale, Welfare, and Recreation) with computers, and ... yeah, that's about it. We have toilets that flush and showers with warm water (bonus!). There's no Post Exchange (PX) where we can shop, so that cuts down on spending money. We don't get mail that often - maybe once or twice a month, surely to decrease in winter - so mail day is like a holiday. We walk on the most awkward and unforgiving gravel you'll ever encounter; most of us have left a fair amount of knee skin on the ground here. There is never silence, for it is always broken by the hum of generators.
With the grace of Amazon.com and friends and family, I've made a comfortable room for myself. I have a small Keurig for coffee, a water kettle for tea, a string of lights of warm LED lights around my room (much nicer than the harsh fluorescents), a washable/cleanable rug made of woven recycled plastic, a super-comfy Sherpa/fleece blanket, and other small amenities that add up to a lot of creature comforts. When we have a day off (once a week we are excused from showing our faces in the building), it's a nice place to relax and watch movies on my laptop.
Speaking of laptops, we do have wifi in the building, but it's not free. It costs $99/month for unlimited access, but in terms to being able to chat during the day with our significant others via Skype or Google Hangouts or whatever, it's worth every penny. (Though I do groan each month when I have to pony up the next $99.) For a while in July, when we were moving from our tents and the FST at the former FOB next door (closed and bulldozed), we weren't sure if we'd even have internet at the new place. Yikes! But luckily the internet company sent a guy to move the equipment and hotspots over, and we cheerfully paid up. It's been pretty reliable and the customer service is great.
I've discovered that nursing is pretty much an international language. Our patients who don't speak English still respond the same way to our care, be it a friendly touch or a tetorifice booster. When they enter our ER, they seem to know that they're in capable hands, and they trust us. I have finally beat the urge to speak Spanish to the Afghan patients, too. Haha. Respira profundo!
In an FST, the ER is also known as the Advanced Trauma Life Support Section, or ATLS. I have a fantastic ATLS crew: two medics who are eager and willing to learn just about anything, and an LPN/NCOIC (noncommissioned officer in charge) who is also a seasoned medic. It has been exciting to see us grow as a team and also to see them grow in their skills sets. We have two trauma bays and all the usual ER equipment that we check daily (oh yes, I even made a checklist!): monitors, suction, vents, Belmont rapid infusers, a Zoll defibrillator, and a host of other items. We work very closely with our general surgeons, orthopedists, CRNAs, OR staff, and ICU staff. As someone who has only ever worked in the ER, getting to go into the OR is so interesting to me! We get a lot of opportunities for hands-on procedures that we'd rarely get to do elsewhere.
Of course, it's still a war zone. We have good days and bad days, triumphs and tragedies, buckets of blood and mangled body parts. We also sometimes have to deal with incoming mortars, which is why I developed the "tactical nudity" concept. Imagine this: you're in your room getting dressed or changing clothes or whatever, and you hear a boom and feel the earth shake. It's time to sprint to the bunker! But hold on, wait a minute! You're NAKED! Tactical nudity means that you're able to get dressed or change clothes in such a manner that you're never completely naked or fully undressed. I don't know how the Army has not yet promoted this concept, but we are going to patent the idea. ? Of course, in the shower, all bets are off (though we do wear shower shoes, so again, never completely naked.)
Random things I am looking forward to doing when I get home: brushing my teeth with regular tap water vs. bottled water, showering in bare feet, ordering pizza, eating fresh vegetables, walking like a normal human on pavement vs. the evil gravel, and hearing silence with no generators humming in the background.
It's a strange kind of nursing we do out here. Some days we have MASCALs, some days we have onesies and twosies that trickle in, some days we have ortho clinic during which our former patients come back for external fixation removal or revision. Sometimes we take care of our own people as well, if somebody is dehydrated or hurting. We can remove an appendix or reevaluate a bum shoulder. We've had locals bring in their children who are suffering from lasting effects of this war, and it's enough to break your heart. It's often for a second opinion that's unfortunately no different from the first.
We're almost at midtour; the days are getting colder and the hours of sunlight are dwindling. We will apparently see snow! I'm half excited and half dreading it. Either way, I know that the members of the team will carry each other through the rest of the time we'll be spending together. I am so lucky to be deployed with this crew!
