Images of war are easy for many people to call up, thanks to the media. Between Hollywood's versions of war movies and actual film footage from the news, the pictures never quite fade away: Young men who were holding baseballs and milkshakes a short time ago suddenly are now handling rifles and grenades, or they become lonely men writing home to loyal wives or unfaithful girlfriends. The fear, the courage and the devastation linger in memories far beyond the war itself.

Emotions often are mixed when people think about the Vietnam War, but one group that is remembered with gentle smiles and infinite gratitude is the military and civilian nurses who served during that war. Their tenderness, compassion and skill made the difference between life and death for many of the wounded.

Although most of these nurses were sent to Southeast Asia on the pretext of teaching the Vietnamese nurses, the majority spent their tour of duty taking care of patients and dealing with the inevitable death, grief and loss that are a part of any war.

Their pain and pride as they look back on those days is a testament to the nursing profession.

Keeping memories alive

More than two decades ago, Elizabeth Norman, Ph.D., RN, FAAN, was studying for a doctorate at New York University and was inspired to write a paper on nurses who served in Vietnam. But as she searched for information, she found little to go on. "I turned to the military for statistics and names, and they had nothing. I changed my paper to a dissertation and began researching," she said. "I wanted to save a piece of nursing legacy."

By 1990, that dissertation had turned into the book Women at War: The Story of Fifty Military Nurses Who Served in Vietnam (1990; University of Pennsylvania Press).

Norman, now professor and director of the doctoral program in the Division of Nursing at New York University, found the women through the "snowball" method. "I would call one nurse and she'd give me the names of others," she explained. All of the women she talked with shared some common bonds. "They loved the men they were with and were so proud of what they did, but they were also scared, lonely, far from home and embittered over their home country's attitude," she said.

In addition, Norman said, the nurses were united by shock over the extent of the wounded and dying they had to deal with day in and day out. It was something that most of them had never seen before-or had ever even imagined.

A simple gift

Like many others, when Marion Mullin, RN, signed up for an 18-month stint as a nurse in Vietnam, she had no idea what she was in for. The U.S. government was trying to help the South Vietnamese by sending medical personnel to teach their medical staff. "They needed us to go over and act as advisers to the Vietnamese nurses," Mullin said.

Originally from Oregon, Mullin found herself at a language school in Hawaii for four months. "We had to learn Vietnamese," she said, "and it was very intense. The language is based on tones and since I am fairly musical, I could hear them and it was easier for me. I could carry on a decent conversation."

Mullin landed in Vietnam in November 1967, on her 30th birthday, and was assigned to the second-largest hospital in Da Nang. On her first day, she encountered a huge black spider in her shower-and she was deathly afraid of spiders. "I leapt out all covered in soap, sat down on my bed and cried," she said. "All I could think was, 'What had I done?' "

With 725 beds available, the hospital usually contained more than 1,000 patients. "Patients were two to three to a bed," Mullin said. "There were stretchers on the floor and tents outside."

Unlike other hospitals, which primarily took care of soldiers, this hospital's patients were mainly babies, children, women and the elderly. In the Vietnamese culture, if one family member became sick or injured, relatives would stay with him or her round-the-clock, and this meant family sleeping under beds and on the ground. It was unbearably crowded, miserably hot and, thanks to no plumbing or screens, it was a haven for flies.

"We commonly had insects in the operating room," Mullin said. "We had to leave the windows open for light and air."

One day, Mullin said she had a particularly horrific moment. "I was making rounds and I saw an elderly gentleman lying on the floor of the veranda. It was over 100 degrees that day," she said, "and he was covered in this big, wool blanket. I reached over to take it off and when I did, I could see it wasn't a blanket at all, but a mask of flies.

"What I found there was unbelievable," Mullin said. "I saw the bubonic plague, tuberculosis, typhoid, diphtheria, smallpox-you name it. These were diseases I had only read about in textbooks. People were infested with parasites and worms and there was no sanitation."

After the Tet Offensive in 1968, things went from bad to worse. "In the first nine days," Mullin said, "we had almost 900 patients come through with horrible wounds. What did we do? We dealt with it and then just went on."

It was understandably difficult to keep morale up in this environment. Going home from the hospital didn't bring much respite to these nurses either. The government-provided housing-built when France had colonized Vietnam-had no air conditioning, smelled like mildew and had contaminated water.

Despite these horrors, Mullin remembers tender moments, too. "I took care of a little boy [of] about 7 and his 5-year-old sister. Their village had been bombed and their parents had been killed," she said. "The sister's legs had been blown off and the little boy, as head of the family now, stayed with her constantly to guard and protect her. It just broke your heart," Mullin said.

The girl improved and before the siblings left the hospital, they came by to say thank you. "The boy put a piece of old, crumby, crumpled gum in my hand," she said, "and that was his gift. It was the only thing of value that he had."

Mullin returned to the United States in May 1969. She continues to keep in contact with some of the other nurses, and said of her 18 months, "It was the experience of a lifetime and I have never regretted it. We helped people and we saved lives."

Brave enough

"When I was a child, I read the story of Anne Frank," said Patricia Walsh, RN, "and I always wondered if I would have been brave enough to have helped Anne. When I was in Vietnam, a young Vietnamese girl cried out to me for help. I was part of triage and windows were being blown out, blood, needles and IVs were running low and casualties were filling up every space. I turned to look at this girl and I saw the face of Anne Frank. That's when I knew that, yes, I was brave enough."

Walsh went to Vietnam as a civilian nurse in 1967 at age 24. "Vietnam profoundly affected my life," she said. A Marine she was in love with was killed while she was there and when the air base she was in was attacked with rockets, she was permanently injured while scrambling to get into the bunkers. She was overcome by the futility of war.

"Our guys would shoot them and we would patch them up," she said. "The perfect example was this old man with cataract-covered eyes. He was clutching a dirty rag to his abdomen while he smoked his pipe. He spoke of the attack on his village and the helicopters he saw. He had never been in a building with four walls before this one. He refused to get on a stretcher and it wasn't until the end of the day that he finally allowed me to touch him. When he moved the rag, his bowels fell out on the floor. While I helped rush him to surgery, he asked me why would white men make this hole and then a white woman try to patch it up? It was such wisdom."

When Walsh returned to the United States the following year, she spent time wearing iron braces and a 40-pound body cast. She began writing about her experiences in Vietnam and, in 1982, published Forever Sad the Heart. Four years later, the story caught the attention of Paramount Pictures, which optioned it for a film with Cher playing Walsh's part.

"It was never made because they couldn't get a decent screenplay," Walsh said, "and so I taught myself how to write one, and now it's back in Hollywood."

In 1993, Walsh reunited with some of her Vietnam nurse friends at the dedication of the Vietnam Women's Memorial. While there, she hired a free-lance film crew to record the event. She put that together with footage and photographs from the war.

"I dug through film archives for four months," she said, and in 1995 "The Other Angels" was aired on PBS nationwide. In 1997, the one-hour documentary was named Grand Award Winner by American Women in Radio & Television and won the coveted Gracie Allen Award.

Walsh has been interviewed on "Oprah" and has appeared nationwide. During her acceptance speech, Walsh said, "Women have been serving in wars as long as men have been starting them."

'I didn't want to go'

Susan Leigh's reason for joining the Army was simple-she needed the money. "I was in my junior year of college," she explained, "and my boyfriend's father had a flyer about the Army Nurse Corps. I sent in an application and in one week, a recruiter was on my front step. They told me that they had already gone through their entire volunteer corps and they were desperate for nurses."

Leigh quickly found out that by joining up for two years, she would have the rest of her schooling paid for, as well as free medical and dental care. "I had led a sheltered life and thought this would be a good chance to travel," she said with a chuckle. certainly didn't sign up to go to Vietnam."

After basic training in Texas, Leigh was sent to San Francisco for nine months. While there, she received orders to report to Vietnam. "I took a month to say goodbye to my family and friends," she said, "and by July of 1970, I was in the Mekong Delta." She was stationed in a hospital that had two options: Stabilize the patients enough to send them on to Saigon, or send them back out into the field.

For the first six months, Leigh worked in the surgical ward of the hospital, but then transferred to the medical ward. "Everyone wanted to work with the war heroes in surgery, the ones who had bullet wounds. The guys in medical that had fever, diarrhea or malaria weren't considered heroes. No bigwigs ever visited them."

Because Leigh arrived later in the course of the war, she saw some differences. "Physical trauma was down," she said, "but psychological trauma was up." Her fondest memory was when the medical personnel put on the play "Bell, Book and Candle" for the wounded. "We had enlisted officers as actors, directors and prop people," she remembers with a grin. "I played Aunt Queenie and we played to three perfectly packed houses. The soldiers were so grateful; they said that we helped them forget where they were for a few hours."

In 1972, Leigh was diagnosed with Hodgkin's disease. Today, she is an oncology nurse and cancer survivorship consultant. When she reflects on Vietnam, she's ambivalent. "I'd never say I was sorry that I went, but I wasn't particularly glad either. I didn't want to go to Vietnam, but neither did most of the men there. I felt obliged to take care of them and was just so sorry that we had to have the war in the first place."

'Am I doing enough?'

Another struggling college student, Anne Payne, Ed.D., MS, RN, saw joining the Army as the solution to her problems. She signed up for three years and, in April 1969, found herself on her way to Vietnam. "I wasn't really scared until the plane was flying over the country-it was too much of a TV war, but now that I could see it, I was frightened," she recalls.

Assigned to the 24th Evacuation Hospital about 20 miles from Long Binh, Anne Payne was put in the neurosurgery center. "The heat and the constant mortar shelling were tough, but the most difficult part of it all was seeing so many patients that we couldn't do anything for. If a soldier had a brainstem injury, there was nothing to be done and we just had to let him die."

Assigned to the 24th Evacuation Hospital about 20 miles from Long Binh, Payne was put in the neurosurgery center. "The heat and the constant mortar shelling were tough," she said, "but the most difficult part of it all was seeing so many patients that we couldn't do anything for. If a soldier had a brainstem injury, there was nothing to be done and we just had to let him die."

When Payne remembers her days in Vietnam, her voice fills with emotion. "Four years ago, I would not have been able to even talk about it," she said. "I was such an inexperienced nurse and I kept asking, 'Am I doing enough?' This one young GI's lungs kept filling up and I kept suctioning them until the doctor stopped me. I just kept thinking, if I do better, I can save him!"

After her first year, Payne was promoted to captain. While she has kept in touch with some of the others she knew in Vietnam, she made a conscious decision not to remember the names of any individual patients. "It's the only way I knew to cope," Payne said.

When Payne's tour was over, she returned to a hostile America. "Our country didn't welcome us back," she said. "We had to be quiet about our time here. It was a pretty lousy thing the U.S. did to our generation. They shoved us under the rug; we were an embarrassment and so we were ignored."

Payne spent more years in the military. She was promoted to lieutenant colonel and served in Desert Storm. Later, she was diagnosed with post-traumatic stress disorder and spent several months in counseling to deal with the anger, guilt and rage she had buried for so long. In 2000, she was diagnosed with breast cancer, but today is cured. She is an associate professor of nursing at the Boise (Idaho) State University Department of Nursing, and credits going to Vietnam with changing her life's goals to earn a master's degree in pediatric nursing.

When asked if she would go back to Vietnam and do it all again, knowing what she knows now, she surprised herself by answering, "Yes. I wasn't there because I supported the war," she said. "I was there to take care of soldiers and I would do that again. I did a good job and it was the right thing to do."

Contact Tamra B. Orr at writinggoddess2@attbi.com.