From the June 1, 2008 Issue

Chris Keith, BSN/RN, CNOR, and a current student in NIFA’s RNFA program, is currently stationed at Naval Hospital Lemoore in Lemoore, Calif.

My name is Chris Keith. I am a Lieutenant in the U.S. Navy. I was commissioned in May 1999 and reported to Pensacola, Fla., as my first assignment as a nurse. I worked on the Medical/Surgical unit for two years, then moved to the PACU (Post Anesthesia Care Unit).

It was there in the PACU that I learned and became interested in the PeriOperative community; specifically the operating suite. I submitted a request to attend the Navy’s PeriOperative training and was accepted. In January 2003 I moved to Jacksonville, Fla., and successfully completed the training. In May of that same year I was sent to Naval Medical Center Portsmouth (NMCP), Portsmouth, Va., for my first tour as a PeriOperative nurse.

NMCP is a spectacular place. For Navy Medicine it is one of the “big three.” NMCP has 17 operating rooms in the main operating suite building and another four in the Labor & Delivery area and six more in the Ambulatory Procedure Unit (APU) of building 215. NMCP does it all!

While stationed there I was involved in all aspects of the PeriOperative arena. I worked general surgery and became the lead nurse for bariatrics. From there, I was moved to charge nurse of Pediatric General surgery. When those services had no cases I circulated OB/GYN and Plastics.

As I grew into my new surroundings, the leadership decided that I needed more opportunities. I was hand-selected to work the new open-heart team. [Now some of you are saying “big deal.” Well, for the US Navy it was a big deal. NMCP started their program from scratch! It takes a lot of recruitment to lure a heart surgeon away from a profitable practice!] On days that there were no heart cases, I worked Thoracic/Vascular and Neuro/Spine. I just figured it was all in a day’s work. By the way, NMCP averages three to five patients per room per day. That comes out to between 12,500 to 21,000 cases per year. So, for the Navy it is a big command.

From Portsmouth I was transferred to Naval Hospital Lemoore, Lemoore, Calif. If you don’t have any idea where Lemoore, Calif., is you are not alone. Naval Air Station Lemoore is about 47 miles south of Fresno in the San Joaquin Valley. We are surrounded by agriculture and dairy farms. It apparently is a great place to fly an F-18 Super Hornet.

It was here at Lemoore that I had my opportunity to deploy in support of Operation Iraqi Freedom. I left my family in August of 2006 for a seven month tour. [When you think of tour- please do not think of sight seeing!] I was stationed at Al Taqaddum, TQ Surgical; a shock trauma “facility.” Al Taqaddum is located in the outskirts of the Al Anbar province just outside of Habbaniyah, Iraq, which is between Fallujah and Ramadi.

TQ Surgical moved from tents to wood as we were arriving. The Sea Bee’s had just finished framing out an airplane hanger as a medical treatment receiving facility. We were what the military calls an echelon two facility. (There are five echelons of care in a “war time” environment. Echelon one is buddy aid/battalion aid station and echelon five is brick and mortar facilities with rehabilitative services.) As an echelon two facility we were there for life and limb-saving surgeries. TQ surgical was a casualty receiving bay, four ORs and a small “ward.” So, you can see that we were small. We had to be because as a shock trauma platoon the mindset is quickly mobile. We move to where the situation calls for. Luckily we never did and the transition was to be just that way.

While at TQ Surgical, I was one of one. I was the only OR nurse for the seven months I was there. I carried a radio 24/7. I ate with it, exercised with it, showered with it and slept with it. I was never without it. I never want to carry a radio like that again.

With all of that said, my deployment was the most professionally rewarding job I have ever done. While there we did 468 total surgeries. Of those, 367 were primary trauma. We did these cases on stretchers. (The stretchers were placed on field expedient stands.) There were times when I circulated two and three rooms at a time. Two of the traumas, I had to safely position PRONE.

I became very creative and had to learn to utilize supplies very wisely. Safety of the patient was paramount to me. As far as I know, we never had any untoward events of the patients that we were able to send on to higher levels of care (no retained instruments, sponges [unless used for packing & packaging for hemostasis to the next level] and no reports of pressure sores from the stretchers).

The other 101 patients were wash-outs and surgeries that would limit a Soldier or Marine’s time away from their unit or to limit opportunities for the “bad guys” to shoot at aircraft. The occasional hernia or open appendectomy was a welcomed relief from the stress of incoming carnage.

We took care of all patients coming to our facility. We took care of Americans and allied forces, Iraqi Army & Police, civilians and the ever-present “persons of interest” (bad guys). We took care of lots! While there we had over fifteen mass casualty situations. The most memorable was the mosque attack in February 2007 in which we received, triaged and cared for over 108 patients. Those are just the ones that survived the explosion. Apparently a dump truck loaded with explosives and trash can do a lot of damage to people and places.

I don’t want to turn my memoirs into a political piece. I will say this, though. Medically we are changing hearts and minds of the Iraqi people. The populus around us knew that we would treat and help them. We had stories of people traveling over 100 miles through dangerous sections of outlying places just to come to TQ Surgical and receive care. They felt the risk of death was worth the opportunity to be taken care of by the Americans. I was glad to do it.

It was in this deployment that I decided that I wanted to do more in the OR. I saw opportunities that I could learn and help in a larger capacity. I wanted to learn to assist the surgeons. It was there that I saw that one surgeon with an assistant could free up another surgeon to save some other patient needing hemorrhage control or limb-sparing surgery. Upon return I immediately went on a search for first assistant training and came upon NIFA. I enrolled at once and since then I have not looked back. I have a better appreciation for the roles of circulator, scrub and assistant. I feel that I can anticipate better and help our scrub technicians grow professionally. I look forward to continued professional growth and opportunities to excel.