Back in the heartland

So after a week of this:

And this:

And lots of this:

We had to do this:

The week was a blast and lots of memories were made to last us the next long nine months. I hated to leave, but Nate and the kids are doing great, are healthy and happy, so there's not much more I can ask for. They are off on a summer of adventure with an opportunity to see family and friends, which never would have been possible if I wasn't leaving for so long. After meeting up with the rest of my team here in Indiana, I am off soon for Afghanistan. It is an odd feeling: a small amount of fear of the unknown mixed with a lot of excitement and a readiness to get this mission started, so the clock can start for our return home. I promise more to come as we get settled and I learn more about our mission, roles and responsibilities.

Shameless plugs

Believe it or not, I have managed to find some free time while at home this last week, and I am finally getting to some blog work I had wanted to do from the beginning. Since starting this journey, I have been meaning to explain the blogs I follow (see right side of page).

My good friend, Meg, started my whole interest in blogs with her site, "Soup is Not a Finger Food." She is an amazing writer and has a hysterical outlook on raising three boys in the DC suburbs. Her posts are usually humorous and, if they aren't, they leave you thinking. Thank you, Megster, for all the blog support and your friendship!

Next in the line-up is "Drifter Sends," a newly created blog by one of the soldiers I will be deploying with. This career Army officer has spent two tours in Iraq and will be our operations officer in Afghanistan. He lends a ton of experience to our group but admits this deployment is different, because of our unique mission, and he will be leaving his young son for the first time.

The "Accidental Soldier" is a member of the team that is currently in Afghanistan, which we will be replacing next month. Felipe's posts are a great way to see what that team has accomplished, and they provide a window into what we will be doing for the next nine months.

The final blog in my list is "Waariya"—actually a Web page and blog started by the public affairs officer in our group. Darrick is an accomplished writer and former Marine who will be very busy helping to get the message out to the public about our mission. He does great daily posts and will provide another perspective on our mission in Afghanistan.

Finally, I can't say enough about the Honor Society of Nursing, Sigma Theta Tau International, http://www.nursingsociety.org/default.aspx. This is the organization that started this whole blog ball rolling (Thanks, Rach!). They provide an editor for my posts (Thanks, Jim!) and even helped with the banner artwork. I never would have embarked on this journey without all the support Sigma provides.

There, enough of the shameless plugs. I am off to be the mommy for a few more days, relishing this world before returning to my life as a soldier.

Home sweet home!!

Finally, the nearly three months of training in Indiana are over, and I am home for a much needed break from reality. The kids are stuck like glue—that's them above—and I am loving it! We have so far spent time at the pool, enjoyed catching up with each other and with friends, and eaten a wonderful curry dinner. Nate planned a spa day for me on my first day home: hot rock massage, nails, hair; quite the pampering for an amateur soldier! It gets better! Tomorrow, we head for San Antonio for a few days of seeing more friends, SeaWorld and the chance to make more memories to carry us through the next nine months. Forgive me if the posts are few and far between this next week. I plan to spend it stuck to my family and dread the pain when they peel me off for the flight back to Indiana next week.

Reconciliation

Have you ever had to reconcile two parts of your life? I am currently working to reconcile the need to become proficient in firing at least two different weapons with my calling as an NP. Not only will I be trained to use these weapons, they will become my constant companions for the next year, and I am expected to use them, if necessary.

I did not grow up in a hunting family, nor does my husband own a firearm. We never felt the need to protect ourselves that way. With our lack of experience with firearms and two inquisitive children in the house, we figured the risk far outweighed the benefits. I am not an anti-gun activist—and I do agree that people kill, not guns. I don't care if you own your own arsenal (although I question the need) but I just do not aspire to gun ownership.

As an NP, my job is to help and heal people, not inflict mortal wounds. We have already had the ethics lecture with the vignette depicting the need for triage between a minimally injured American soldier and a significantly injured insurgent. My answer, based on my responsibility to heal and the triage concept, was met with heated discussion from the commanders (all non-medical) about how they would argue to have their troop cared for first. Now, imagine getting back to base after a skirmish only to be presented with an injured enemy troop and discovering you were the one who had fired the offending bullet.

My analytical mind enjoys the challenge of target shooting and the puzzle of disassembling and reassembling a weapon. My desire to keep my fellow PRT members (and myself) safe from the “bad man” will motivate me to become as proficient as possible on all our weapon systems. But, the healer in me will continue to struggle and pray that I never have to pull the trigger on another human being.

Constantly under the microscope

As a medical provider, I have spent many hours in a clinical training environment, with any variety of preceptors looking over my shoulder. It becomes routine to adjust to another's opinions of "the right way," sometimes incorporating their suggestions, sometimes just smiling and moving on.

Well, we "soldiers"—my generic term for all of us here in training, really made up of Air Force, Army and Navy team members—at Camp Atterbury are currently undergoing a mission readiness exercise, otherwise known as "living under the giant microscope." We are conducting missions, throughout the acreage of the base, meant to replicate those we will likely experience once deployed to Afghanistan. We plan as we will in-country, conduct mission rehearsals and travel by convoy as a means of ironing out processes prior to leaving the training environment. So far, it has been the best training yet—a true time to put it all together and synchronize the information we have gained in the last two months. The drawback? Everywhere we turn, we are being observed, critiqued and assessed on our ability to do all of the above tasks.

We really appreciate all the work these dedicated trainers are doing, but some days it seems like we can't win. When that happens, we just smile, take the advice as intended and move on. We know we will soon be on our own in Afghanistan and the decisions will be ours. If, out of 20 suggestions, we utilize one, we have gained another tool to help us in our missions. And the additional time spent working together can only strengthen our bonds and improve our effectiveness once our boots "hit the ground."

When will that be? For security reasons, I can't say for certain and, to be honest, it changes every day. What I can tell you is, I anticipate celebrating my 39th birthday far from the safe shores of the United States!

Hey Doc, could you look at this...

As previously discussed, my role here is, first and foremost, senior medical provider. The senior part is just to make it sound important. In reality, I am the ONLY medical provider to members of PRT Parwan. I am lucky to have two very experienced and motivated medical technicians, but the buck stops here—with me.

The military is its own animal when it comes to using “mid-level practitioners” (a term I really dislike but it does clarify where we fit into the medical provider picture). In addition to nurse practitioners (NPs), there are also lots of physician assistants (PAs) to be found. And don't get me started on general medical officers (GMOs), medical school graduates with a single year of internship who, for whatever reason, do not enter a residency. They are sent to various assignments in physician billets but are not really qualified for that level.

We NPs continue to be licensed in our state of choice and we carry the required certification, depending on specialty but, within the walls of our military treatment facility, we practice fairly independently. We have full prescribing authority, are empaneled, have our own patients and conduct our own peer review. Some days, I equate it to hanging out a shingle and starting your own practice. I'm lucky. At home, I work with two great physicians who are ready and willing to answer my questions, or help me find answers when none of us have them.

On deployment, the independent practice concept can be taken a step even further. We NPs and PAs are often deployed forward of a hardened medical facility, where the physicians and surgeons stay, awaiting arrival of the really sick and injured. They are a phone call or Internet connection away, but there are no hallway consults. And, with luggage weight at a premium, our reference materials dwindle to what we can load into a PDA or find on a somewhat unreliable Internet connection. You quickly realize that explaining to every last troop what an NP does and what our unique role is is just more than they want to know. They want to know someone is there to take care of them when they are sick or injured, and “Doc” quickly becomes your accepted call sign.

Here at training, I am already getting the request to “take a look at this.” Thankfully, it is usually a sprained ankle, bug bite or, for many, the cold virus that has quickly spread among units (can't be helped when living in such close proximity). My goal now is to build confidence for when we are downrange and the concerns get different. Stress can reveal itself in many forms, including physical and mental fatigue, illness and even thoughts of suicide. As an NP, my strength for that “gut feeling,” when it comes to my fellow PRT members, will be critical, as mission preparedness can often equate to mission success. So, NPs of the world, never fear. I will continue to laud our strengths even while answering to “Doc” for the next year.

Why Afghanistan?

This is a question I ask myself most days. What is it all about? Why are we going? I have learned a TON in the last several weeks about the region, in general, and the long, tumultuous struggle the people have endured. They have been at war for the last 30 years—first the Soviets, then the Taliban and ensuing civil war, and now “occupation” by international forces. I use “occupation” in quotes as we are not there to fight the people of Afghanistan; we are there to liberate them from the Taliban. But some, here and abroad, see it as something else.

Who remembers that many of those involved in the attacks of 9/11 were from Afghanistan? Did you know Afghanistan has the highest infant mortality rates in the world? That nearly 80 percent of the population is illiterate? That just a few years ago, more than than 80 percent of the population lacked access to any medical care? That is why we are there. The long-term goal is to leave the people better off than the day we arrived (opposite the goal of those who came before us, when you consider the destruction caused by the Soviets and the Taliban).

So, why is a family nurse practitioner going? And what will I be doing to make the above happen? We—the members of my team and 11 other teams training here with us—are part of something called a Provincial Reconstruction Team (PRT). There are 25 PRT teams spread across Afghanistan, 12 manned by U.S. forces, 13 by other international teams. Our goal is to connect the Afghan people with their government and promote growth throughout each individual province.

In general, it is believed that the insurgents have an easier time manipulating people who are isolated from their govenment and countrymen, so our main responsibility is building roads. We don't actually do the manual labor; we have engineers on our team who help the Afghan locals bid and hire the necessary labor required to complete the job. Throughout the project, we return frequently to ensure adequate quality standards are enforced. We also partner with local leaders, physicians and educators to help meet the basic needs of the villages.

Prior teams have built schools, clinics and government offices. As a whole, the work done by American military and coalition members has enabled more than 50 percent of the population to have access to health care. Now, many more children—boys AND girls—have access to basic education.

I didn't really answer what I am doing, did I? I will wear several hats on this LONG trip. When you include training, it will be at least a year away from home! I am the senior medical advisor to the commander. As a senior ranking member, I also have some responsibility to ensure that everything, in general, runs smoothly. I will provide daily opportunities for our team to receive medical care, organize the necessary medical support for any missions off the relative safety of our home base and develop various medical outreaches to the local communities. In addition, I am constantly preparing for the worst-case scenario by training the entire team on how to respond to battle injuries and save their buddy, if injured. We want to leave in a year knowing we helped the Afghan people of Kapisa province, but our primary goal is to come home with everyone we leave here with.

As the coming year develops, I am sure there will be many more “hats” I will wear. Some days, I am the motivator, the one keeping the group moving forward on a five-mile march. Some days, I'll be the listener as lives back home compete for our attention. Some days, it will be my turn to struggle with the daily stress. Our team has a great sense of humor and lots of variety in skill sets, which will definitely come in handy.

So, readers, what else do you want to know about our upcoming job? About my role? Think I am crazy?

Where's the Mommy?

I knew the hardest thing about deploying would be being away from my family and, so far, it has proven true. Prior to leaving, I was asked several times how I could be leaving my family for so long. How do you answer that? If you say, "It's just part of the job," you seem pretty cold and uncaring. If you break down in tears, people question your commitment to your chosen career.

I joined the Air Force nearly 16 years ago knowing a deployment was a constant possibility but, after all these years without being tasked, it became something that happend to other people. Now, here I sit in southern Indiana, learning all kinds of skills that one doesn't usually associate with a nurse practitioner. I have learned to shoot two weapons (M4 and 9MM), I have called firing comands to a HMMWV gunner, and have a basic understanding of greetings in Dari.

The best thing about the training? It keeps us busy and helps the time pass so I don't miss my family so much. My husband is doing a great job "holding down the fort," but somethings just cry out for the Mommy. My daughter turned eight a few weeks ago and Nate baked the cupcakes for her class. He also planned a great evening out at her favorite restaurant and fun was had by all, but I just hate not being there to celebrate with them. My boy "graduated" from kindergarten last week. (I know, a silly idea but tradition where we live. It is considered second only to the actual event 12 years later.) His teacher was so kind and forwarded some photos she took of him but, again, it isn't nearly as good as being there.

It is an odd feeling, knowing life is going on without you. Your children will continue to grow, events will happen in your loved ones' lives that you will never be a part of. That is a hard thing to accept and, some days, the "mommy guilt" is overwhelming. But even on the worst days, I soldier on, knowing each day brings me one day closer to home and believing that what we are going to do will make a difference in other's lives. While my family will have memories of this year that won't include me, I will be helping to change lives in Afghanistan and will forever be part of someone's memories there.