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Members of the 28th Combat Support Hospital Survive Extended Tour in Iraq

Monday December 3, 2007
<B>One of Col. Ruth Lee's, RN, chief concerns as deputy commander of nursing was buoying her staff's morale.</B>
One of Col. Ruth Lee's, RN, chief concerns as deputy commander of nursing was buoying her staff's morale.
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Baghdad, Iraq — This past spring the nurses and medics of the 28th Combat Support Hospital (CSH) were counting down the final weeks of their year-long deployment at Ibn Sina Hospital when they learned their tour of duty was extended by three months — three more months in the bloodiest streets of Iraq, during the bloodiest year for U.S. troops since the war started almost five years ago.

The news crushed the staff's morale the way countless improvised explosive devices had damaged the bodies of so many soldiers carried into the hospital's ED.

"They had to start counting the days all over again," says Col. Ruth Lee, RN, the deputy commander of nursing for the 28th CSH. "People get tired and frustrated with what they see here. It's very stressful. The biggest challenge I have is keeping our morale up."

The 28th CSH is an active-duty unit from Fort Bragg, N.C., located in the Ibn Sina Hospital built by Saddam Hussein for his family and members of the Baath Party. The entrance of the ED is encased in white and gray marble tiled floors and walls and looks as modern as any hospital in the U.S.

An Iraqi baby is cared for in the 28th Combat Support Hospital's ED in September.
Although the hospital itself is located in the small, protected area of Baghdad known as the International or Green Zone, Ibn Sina Hospital is the hub of military medicine in Iraq. It cares for more trauma than any other military medical unit in the country.

"We see more fresh trauma off the streets than anyone else," says Lee.

Trauma climbed when 30,000 more soldiers started arriving in Baghdad this past winter as part of President Bush's military "surge" to quell violence in and around Baghdad. Soldiers also left the safety of U.S. military bases to patrol Baghdad's neighborhoods. More soldiers in harm's way meant more Americans were killed and wounded this year than in any previous year since the war started. In November, the toll for 2007 was 853 dead, already higher than the 850 soldiers killed in 2004, according to the Associated Press.

The parade of dead and wounded soldiers and the unexpected extension of their tour of duty wasn't all the 28th's staff had to endure this year. One of their own, Army nurse Capt. Maria Ortiz, was killed in July by indirect fire from a mortar attack in the International Zone as she was walking back to the hospital from one of the area's gyms with fellow Army nurse Maj. Stephen Williams. She was the first military nurse to die in combat in Iraq or Afghanistan. Williams was seriously injured and returned to the U.S. to recover.

Blackhawk helicopters brought a stream of wounded soldiers to the 28th Combat Support Hospital in 2007, the bloodiest year of the war for American troops in Iraq.
The staff, especially the intermediate care wards where Ortiz was head nurse, struggled with her death.

"It was rough for the first few weeks," says Lee, who was visiting the 28th CSH's sister hospital in Mosul when Ortiz was killed. "[Ortiz's] ward has become a tight little group."

Lee forces back tears when she says Williams is doing well and he will be at Fort Bragg to greet the 28th CSH nurses when they return to the U.S.

Unlike her staff, Lee does not count down the days until she returns home, even though this is her second tour of duty at Ibn Sina Hospital. From 2004 to 2005, she was the hospital's trauma nurse coordinator. Lee, who is the grandmother of two, also spent a year with the 47th CSH in Kuwait.

"I feel this is why I went into the Army," Lee says. "I don't hesitate when the Army tells me to go." Lee has been in the Army 28 years.

However, this seasoned combat nurse is not immune to the war's tragedies. She recalls the first female servicemember to die in the hospital during this deployment, a pretty, 22-year-old woman in the Air Force.

"Her death was hard for everyone," Lee says.

She’ll also never forget four soldiers, burned beyond recognition, who were brought to the morgue. “I’ll always remember the sight and smells of those bodies,” she says.

Lee copes with death by “going to my room, thinking about it, and then putting it away because I know there are more coming. I’ve learned how to deal with my feelings about being around death. It helps you to grow and bring things into perspective.”

As chief guardian of her staff’s morale, Lee says she spends time walking around the hospital talking with people and watching for changes in them. A staff member who is having trouble coping may become quieter or act out of character.

“You get to know people’s behaviors,” she says.

Sometimes Lee will rotate nurses who are having trouble coping with the stress to the sister hospital in Mosul for six to eight weeks where the pace is slower. Other times she may ask the chaplain to talk to the person and find out what is going on.

“We’ve been good at spotting people who are having a tough time,” says Lee.

September, October, and November brought some relief to the 28th CSH as the surge began to work and the number of dead and wounded noticeably declined. The slower pace has helped lift the staff’s morale.

“People are getting more rest,” Lee said in a follow-up telephone interview with Nursing Spectrum in November, shortly before the 28th was scheduled to return to the U.S. “They’re having more time to read books and watch movies. Now the big push is to make sure everything is ready for the new unit. It won’t be long before they get here.”

Lee and the nurses and medics of the 28th CSH returned to Fort Bragg last month.

Janet Boivin, RN, is editorial director for the Greater Chicago and New England editions.To comment, e-mail editorSW@nurseweek.com.