February 24, 2008

A healer's mission
Angie Palmer helped soldiers and civilians as a nurse in Afghanistan

By CORY ELDRIDGE
of The Dalles Chronicle

Going to Hawaii was a mistake.

The time spent in airports, the time spent in airplanes, and the stress of travel took away from the few days Angie Palmer had with her family. After three months of training in Indiana and eight months commanding the operating room at Forward Operations Base Salerno near the Khyber Pass in Afghanistan, Angie wanted time with her husband and three children, not sandy beaches.

The family had two weeks together, and they needed to stretch every second it held.

“It was like two days,” said David, Angie’s husband. Angie said, “It was gone in a blur.”

Eight months earlier, amid a group of Afghan base workers waiting outside Salerno’s gate, a suicide bomber detonated his explosives. Angie heard the blast at the hospital tent. Within minutes, 15 wounded people overfilled the small hospital’s eight beds and two operating tables. Angie says maybe 15 others died in the explosion. She’s not sure. There were a lot of small pieces.

“It was a baptism by fire the first week we were there,” Angie said. “It was definitely, ‘OK, here we are.’”

Angie chose this mission. When she joined the military in January 2005, she wanted to do a job like this, a job that challenged her, that wouldn’t let her get bored. She had only graduated from Columbia Gorge Community College’s nursing program in spring 2003, but she felt she had already seen everything an operating nurse could at jobs in The Dalles and Portland.

David found a postcard from the Army reserves in the mail and suggested that Angie, in her mid-30s, join. She signed up at the Vancouver Barracks a few weeks later.

They turned her down. In the early 1990s Angie had heart surgery to fix a birth defect, and the Army said it disqualified her. She tried again, was denied. Tried again — denied. It took a year of physicals and pleading before Angie persuaded the Army to take her.

Already possessing the medical knowledge for the job, her military training included a few weeks of learning how to salute and understand military jargon. Angie spent the next 18 months doing the one weekend a month, two weeks a year reservist gig — not what she joined for. A year-long deployment in Afghanistan opened and Angie volunteered.

During the mission, Angie’s hospital performed 1,100 surgeries, mostly traumas. Blast wounds became a common sight for Angie — not daily, but nearly, she said. She would care for American and NATO soldiers caught by roadside bombs, sometimes people she had seen and talked with at the 1,500-strong base. Angie would wait in the hospital tent and then a call would come that a soldier or a group of soldiers were coming in.

A helicopter brought the wounded, and Angie and another operating nurse assisted the two general surgeons and the busier orthopedic surgeon to patch and stitch the Americans so they could fly to a bigger hospital and then home.

“It’s really, really hard to work on hurt American soldiers, but that’s why we’re there,” she said. “It’s very emotional. Sometimes it was people we knew and they’re not just little owies, they’re really, really bad injuries. You do your job, you do what you have to do, but it’s so much more personal when it’s someone you know.”

Most of the wounded were Afghans from the national army and police. A Humvee’s door and Kevlar armor provided an American soldier little protection from a bomb, but it helped. The Afghans patrolled in small, East Asian pickups, with men sitting on the sides of the truck’s bed.

When a bomb enveloped these exposed soldiers, Angie, the surgeons and the hospital technicians were their last stop. Except for brutal peace enforced by the Taliban, the region around the Khyber Pass, a main link to Pakistan, has seen fighting since the Soviets invaded in 1979. Most infrastructure and professionals
this rural area had disappeared. The best hospital in the region was the tent at Salerno.

And this meant that when a bed opened, an Afghan civilian filled it. Angie and the hospital staff performed surgeries, treated burns, gave blood transfusions to children with thalassemia, a common genetic disease in the region. Some of the patients, especially young burn victims, would arrive days after the accident — after the fear of losing their child outweighed their fear of a reprisal from Taliban fighters.

“We were glad to do it,” Angie said. “We were the best hope that most of these people had. It’s really short life expectancy over there. The local hospitals don’t have the equipment or the supplies or even the knowledge to deal with these things. So kids tend to die rather than be treated.”

Even in the winter months when the fighting slowed, work didn’t. The camaraderie of the hospital staff and the gratitude of the civilians and soldiers, including a female Apache helicopter pilot who regularly emptied the hospital’s garbage, helped Angie through. But she and David said the salve, the thing that made it bearable, was an internet connection.

“Twice a day we would talk,” David said. “She’d sit in the operating room and type to me, before or after work. If it hadn’t been for that, I can’t imagine what it would be like. It would’ve been horrible.”

“It was a lifeline. It really was,” Angie said. “I missed two Christmases, two Thanksgivings, two birthdays for my daughter. You really depend on the home connection, just to find out what normal people are doing because what we were doing wasn’t normal.”

Even with the assurances of her safety, David couldn’t handle the thought of his wife leaving the base. She went outside the relative safety of Salerno three times, traveling with a convoy to provide the locals a day-long clinic. They did checkups, physicals, gave passes to come to the base for surgery.

“We saw 400 people in one day,” Angie said. “We can’t do a lot, because we don’t have all the equipment where we would go to, we’d be out in the middle of nowhere. I think we did some good. You can’t do a lot while you’re there ... These people, their nutrition is so bad, even just handing out vitamins is a good thing.”

The worst that happened on these trips was a forced detour when the convoy discovered a roadside bomb ahead. This didn’t make it easier on David.
“You just about had to sedate me. Oh, it was bad,” David said. “It was one thing for her to work on the people who were getting IEDed, it’s a whole other to be where the IEDs are.”

Angie’s tour ended Jan. 18, and she’s inching toward readjusting to civilian life. When she leaves the hospital in Portland, she and David only need to worry about her drive through the gorge.

She doesn’t need to worry about assisting surgeries in her body armor as mortars detonate nearby; mice don’t scurry about the operating room; the injuries she sees rarely happened because people tried to kill each other. But the staff lacks camaraderie, politics charge everything, and the pace and her responsibilities are a fraction of what she faced in Afghanistan.

Another, shorter, tour is available this summer. Angie and David have talked about it, it might be too soon for this tour, but she will go back. For now, they just want to stretch the time they have for every second.