Deep Impact
Nurses who care for the soldiers injured in Iraq carry lasting memories of their patients and the disturbing images of war
By Janet Kilgore
December 13, 2004
Paulette Smith-Kimble, RN, has a war journal, one that spares few details of the awful scenes she saw from the war in Iraq. The Army Reserve captain, who was deployed for a year at a military hospital in Germany, wrote about soldiers who had severe shrapnel wounds on their arms and legs — when they hadn’t already been lost to bombs or mortar fire. She wrote about the helicopter arriving with five or six critical care cases at once. She also experienced the daily toll of helping soldiers cope with the emotional trauma from witnessing horrifying scenes of death.
Writing down these scenes, and telling them to others, helps Smith-Kimble handle her own ordeal and suffering, through the toll that war brings to health care workers treating and saving the lives of the wounded.
“I was fortunate enough to care for one of the POWs, and she was very sick,” Smith-Kimble says. “But it wasn’t until 12 or 14 hours later that I was able to think about it, to process all her injuries, and think about how she could have sustained them.
“I just prayed that she wouldn’t remember it,” Smith-Kimble says.
From Gettysburg to Iwo Jima, from Vietnam to Iraq, American health care professionals have answered the call to serve during wartime. Weaponry and tactics change, but the toll taken on the wounded, and on those who care for them, remains the same.
Smith-Kimble, who was deployed from her position as ICU nurse manager in Olin E. Teague Veterans’ Center in Temple, Texas, spent a year at the Army hospital in Landstuhl, Germany, one of the interim destinations for wounded coalition forces flown out of Iraq and Afghanistan.
Keeping the journal helped her immensely, especially upon her recent return, as she is better able to share the experiences with others. The journal, along with a presentation, provides her cathartic therapy to the devastating scenes she witnessed as soldiers arrived from field hospitals in Iraq.
“I was reading some of it to my husband, and it still brings a tear, brings back all you were feeling when you were caring for a specific soldier, it brings back all the senses, the smells,” she says. She tells listeners at her presentations at the Teague Center that “we may be working hard here, but it’s a lot worse over there. When the chopper lands and you get five or six critical care patients at once, you have to work until they’re all taken care of.”
“I’m trying to bring to them the realities of what it’s like over there,” Smith-Kimble says.
Over there
Clara Moses, RN, knows the reality. An Army Reserve major and a surgical charge nurse with the JPS Health Network in Fort Worth, Texas, she says her yearlong deployment was a life-changing experience, despite having medical experience in a combat setting.
“When I was deployed for the 1991 war, I worked postop and didn’t see the kinds of injuries I saw this time,” Moses says. “The burns and loss of limbs, sometimes multiple limbs, were terrible.”
She personally cared for about 400 soldiers at Landstuhl, and found them to be selfless and endearing. “They never asked for anything, but I tried to get little things for them, socks or a magazine. One young man asked for a Popular Mechanics, and he was so happy when I brought it,” Moses says.
“They were all like my sons, and I would tell them I was going to be their mom while they were there.”
In her presentation, Smith-Kimble methodically describes how soldiers receive their treatment after suffering combat wounds. They are air lifted to a field hospital close to the front for emergency aid, before a helicopter flies them to a hospital outside the combat area for additional treatment and surgery, including amputations and suturing. The soldiers are kept until they are stable enough for the four- to five-hour flight to a combat support hospital in Germany or Spain. If necessary, they receive more surgery, and remain until they are strong enough for the flight back to the United States.
Most are sent to Walter Reed Army Medical Center in Washington, D.C., or the National Naval Medical Center in Bethesda, Md., but burn cases are flown directly to Brooke Army Medical Center in San Antonio.
Because the troops wear body armor, “the majority of the injuries we saw were to the extremities due to shrapnel,” Smith-Kimble says.
“We saw a lot of amputations due to the blasts. We also saw quite a few emotionally distraught individuals. A lot of the soldiers were in close proximity of either seeing their comrades receive major injuries or actually killed.”
“I’ve been in the military for a long time, and the Army trains you well, but I don’t think anything can prepare you for seeing someone killed right beside you,” Smith-Kimble says.
Back home
The deployment of nurses like Smith-Kimble and other health care professionals also had its impact back home.
With 29 staff members from Olin Teague deployed at the same time, including housekeepers, social workers, chaplains, nurses, and doctors, the workload at the center had to be spread around whenever possible. In some cases, such as when two of their three orthopedic surgeons went over, a backlog of surgeries resulted.
Teague Center orthopedic surgeon Col. Gerald Dreher with the Army Reserve spent five months in an Air Force hospital in Kuwait. “The real unsung heroes are my colleagues left behind with the extra workload. The hardest part of the deployment for me was the disruption it caused at the VA,” Dreher says. He feels more health care workers are needed in the military and the reserves to help out on both ends. “These are our kids, our neighbors’ kids, and they need to be taken care of,” Dreher says.
And those kids, Smith-Kimble says, provided marvelous examples of courage and selflessness. “I have to tell you, with all the soldiers I’ve taken care of, despite the circumstances surrounding their injuries, the majority want to get back out there and do their mission. They’re not focusing on their injuries,” Smith-Kimble says. “They’re focusing on their unit, and they feel that with one soldier down, that’s less they have to fight with. They want to get back out there.”
Moses agrees. “Even with horrendous injuries, I never heard one soldier complain or question why they were there.”
Most of the soldiers also came to appreciate the nurses’ presence more than anyone could have imagined, Smith-Kimble says. “Part of our job was to provide solace. When they hear you speaking English, they know they’re a little closer to home. And although they may have lost an arm and a leg, they’re thanking you for being there for them.”
Times like that still made it difficult not to break down, Smith-Kimble admits. Despite their optimism, the reality is that the soldiers have suffered tragedies and are forever changed by the experience of war. “You have to hold it in, because that’s their way of coping with the traumatic injuries they’ve gone through.”
It’s made even more difficult by the relative lack of resources to help nurses and other health care workers deal with their trauma. Debriefing and counseling in the military is concentrated on soldiers, Smith-Kimble says. “There’s not that much out there for noncombatants, but I hope they’ll have more available in the future.”
Wayne Gregory, who heads the post-traumatic stress disorder program at the Waco VA Medical Center, says the impact of the war also is affecting his clients who have fought in past wars. “The similarities between the wars in Iraq and Vietnam are incredible, never knowing who the enemy is or when he’ll attack,” he says. “The possibility of civilian casualties is a terrible thing that has to be dealt with.”
Moses, like Smith-Kimble, hopes for more programs to counsel returning medical personnel. In the meantime, she tries to set aside time to volunteer at the VA hospital in Dallas. “It’s a passion I have to continue to help them. These memories are here to stay.”