4/28

I had my first detainee patient today. 

The "fighting season" has officially begun and the intensive care unit has been slammed with roadside bomb and gunshot wound patients from both sides of the fight. The injuries are crazy; anything from extremity amputations to enucleated pupils to one guy's chest literally being opened up and attached to a wound vac. 

My patient suffered from a gunshot wound to the neck with an exit wound resulting in the loss of his left eye, and severe soft tissue damage from is left thigh down to his calf. He is young, probably in his twenties, although sometimes it is near impossible to tell. When the interpreter asked him his age, he didn't know it. The interpreter said that it was pretty common for people in this part of the world to not know their age. 

When a detainee comes through the hospital, a guard is assigned to watch over the nurse. We use mobile curtain partitions. I kept my partitions completely surrounding my patient's bed and monitors, so that he could not see the exit or other patients who are on the ward. I left a small opening in the partitions to walk in and out of my makeshift room, and positioned it so that the guard could have eyes on me at all times. At one point, some Afghan soldiers came in to visit their fallen comrades, and I completely shut off the partitions so that my patient could not see anyone.

I had heard horror stories of other detainee patients shouting, spitting at their nurses, and being downright hateful to everyone trying to help them. I also knew the rumors that everyone is addicted to heroin (this is the poppy capital of the world, after all, and heroin is probably the number one export for Afghanistan) so many patients who come to the hospital start going through withdrawals.  I heard of one guy yanking his urinary catheter out and then banging out all of his teeth on the metal bed frame.

My detainee patient, however, was neither rude nor going through opiate withdrawals. He mostly slept, waking up occasionally to ask for "ooba" (water) or saying "dard" (pain). After giving him something for his pain, his respirations and oxygen saturation began to dip down a little, a common side effect for this medication. I simply demonstrated taking deep breaths and then pointed at him, and he willingly complied. 

This was not the experience that I had prepared myself for this morning when my shift leader told me that I would have him. My patient is no different than anyone else I have cared for. In fact, I'm having a pretty decent day and can't complain about anything. I spoke to my senior leader, a Lieutenant Colonel who’s been an ICU nurse for years, about it.  This isn't his first rodeo. He basically broke it down for me like this; not every "bad guy" is on that side because they want to be. Some fall into the Taliban when they are children. Some become part of it because they have families to support. It's no secret that members of the Taliban have an easier life than others. These people are already uneducated far beyond my imagination. I mean, who doesn't know when their birthday is?

I'm not saying that the Taliban is ok by any means, but maybe I shouldn't be so quick to judge someone when I don't know their circumstances. What would I do if my situation was different? What would you do? 

But I did not have a patient who was spitting at me. My views might be a little bit different tonight if I did. 

I also got promoted to captain today. We did it right there in the ICU. Everyone broke away from their patients' beds so they could watch the promotion ceremony, which lasted about five minutes. The Lieutenant Colonel pinned my rank on. 

Later this afternoon, one of the British nurses called me over to her bed space. Her young Afghan patient, who had just lost both of his legs, was trying to tell me something in Pashtu. He pointed to my chest where my new rank was and then clasped his hands, gave me a thumbs up and smiled. He had seen the promotion ceremony, and although he didn't speak English, he understood what was going on and wanted to congratulate me. I'm not a super emotional person, but that resonated deep in my heart.

This deployment has already been worth it for me. I don't know how I'll feel after six months, but I'm thankful for the experiences I've had thus far. It's helped to break down some of my barriers and perceptions. It's been incredibly humbling, and this is still just the beginning.

Part 5 of a 13 part miniseries following the personal memoirs of a deployed soldier

Texas Army National Guardsmen honor the memory of Sgt. Tomas Garces, at a ceremony held in Weslaco, Texas, Sept. 6, 2014.  Garces  was killed in action,Sept. 6, 2004 and was the first Texas Army National Guard Soldier to die in combat since World War II. (Photo courtesy of Texas Military Forces)

Commentary by: Capt. Martha Nigrelle

Soldiers and family members of the 436th Chemical Company, Texas Army National Guard, released 1,000 balloons in honor of five of their fallen soldiers during a ceremony held at the National Guard armory in Laredo, Texas, Sept. 9, 2014. (U.S. Army National Guard photo by Staff Sgt. Amanda Torres/ Released)

4/25

It's funny how our perceptions of a situation or a group of people can be changed in a matter of hours.

Yesterday I was assigned to take care of an Afghan patient who I could barely stand to touch when assisting with a turn a few days ago. I looked at him, with his thick scraggly beard and dark skin, and only felt disgust. I knew he wasn't a part of the Taliban but I still had strong reservations. I had a difficult time seeing them as people. Of course, the fact that he was intubated, sedated, and missing both legs with several inches of femur on one side sticking out of his new stump didn't help. It can be hard to see past that and look at the patient as a person sometimes.

I was taking report from the outgoing shift when I learned that he wasn't just a local. He was part of the Afghan National Police, and had set off an IED while on patrol searching for Taliban. So maybe he's not so bad after all. Maybe he's just trying to make this country a better place for his family, just like our ancestors did years ago in this country for us. And unlike us, he hasn't had the same access to a life of privilege, education, and opportunity. 

Today when I came to work he had been extubated and off of his sedation, so it was even easier to interact with him. He didn't speak any English, and I certainly don't speak Pashtu, but we were able to communicate nonetheless. The look of gratitude in his dark eyes was unmistakable in any language. I fed him a banana and some French toast, and when he got transferred to the med-surg floor, I told him it was an honor and a pleasure to care for him. I don't know if he understood the words, but I'd like to think that he understood the meaning.

Working in this hospital is going to be a challenge. It's advanced yet primitive at the same time. For example, flies should never be buzzing around in the ICU, yet we have a staff of some of the most qualified surgeons in the nation here. The British may speak English, yet they have many different words for things and it can get confusing. Today one of the nurses needed to hang some fluids and asked me for a Gemini. I came back with the Gemini infusion pump. All she needed was the tubing. Oh well, at least we weren't in a code. A lot of the medications we use are the same but have slightly different names as well and not all of their equipment functions like ours. 

I know the day will come when I have to take care of a detainee. I'm not sure how I will feel about that, I guess just take it as it comes. I'm thankful, however, that my first experience with an Afghan patient was with this one. It helped break down some of the unfair and ignorant biases that I had and see them as people. 

Part 4 of a 13 part miniseries following the personal memoirs of a deployed soldier

Commentary by Laura Lopez

CAMP MABRY, Texas (August 26, 2014) – Maj. Gen. John F. Nichols, The Adjutant General of Texas  is pleased to announce Brig. Gen. Gerald “Jake” Betty will take command of the Texas State Guard on Sept. 1, 2014, upon the retirement of Maj. Gen. Manuel “Tony” Rodriguez, who has commanded since August 2012.

Governor Rick Perry made the appointment last week. As commander, Betty will be responsible for the organization, training and administration of the Texas State Guard, reporting directly to the Texas Adjutant General.

Betty joined the TXSG in January 2006, serving first as the Director of Personnel and Administration for the organization headquarters. While commander of the 8th Regiment, Betty, served on several State Active Duty missions for Hurricanes Dean, Gustav, Dolly, Edouard, and Ike. He is currently the TXSG Deputy Commanding General of the Army Component Command.

Betty was commissioned in 1973 upon graduation from Texas A&M University and holds a bachelor’s and master’s degree in education administration. He retired from the U.S. Army Reserve in 2003 and currently resides with his wife in College Station.

Betty is honored to take command from Rodriguez and is ready for the next chapter of his military career.

“I am honored and humbled to be selected for this role by our commander in chief,” said Betty. “I look forward to serving our citizens of Texas.

An official change of command ceremony will take place in October with the details forthcoming.

Commentary by Michelle McBride

Photo by Staff Sgt. Tamara Dabney

CAMP MABRY, Texas (Sept. 9, 2014) – The Adjutant General of Texas, Maj. Gen. John F. Nichols, is pleased to announce the promotion of Col. David McMinn, Texas Air National Guard Chief of Staff, to the rank of Brigadier General.

In a ceremony at Camp Mabry, in Austin, Texas, September 6, 2014, Brig. Gen. McMinn thanked the command group, his friends and family for their continued support over the years and their trust to allow him to serve his state and nation.

“It is an honor to serve with the people in this room,” he said. “Thank you very much for allowing me to continue to serve.”

Brig Gen. McMinn received his commission upon graduation from Clemson University in 1985, completed Undergraduate Pilot Training and was assigned to Pope AFB, North Carolina as a C-130E pilot in 1986. While there, he specialized in Low Altitude Parachute Extraction System Tactical Air Delivery and Adverse Weather Aerial Delivery System formation flying. 

After serving during Operation Desert Shield/Desert Storm, Brig. Gen. McMinn transferred to the Texas Air National Guard and joined the 136th Airlift Wing as an instructor pilot and later served as the 321st Expeditionary Operation Group Commander during operations Enduring and Iraqi Freedom.  

As a traditional Guardsman, Brig. Gen. McMinn has gained over 5,000 flying hours both in his role as a command pilot in the T-37, T-38, C-130E, and C-130H2 aircraft and as a First Officer for a major commercial airline.

4/22

Today has been extremely long and cumbersome.

We have been in country for a little less than a week. It's a bit of a commute to the hospital -A little over a mile to be exact. I tell myself its like walking to work back home.

The past three weeks were spent training with our British and Danish counterparts in a hospital exercise meant to simulate the military hospital we are assigned to in Afghanistan. The days were long, and the nights were spent carousing at the local pubs. It was one of the best times of my life. I mean, when you combine pints of beer, massive amounts of fried potatoes, and cute British soldiers to flirt with, what's not to like?

While we were there, the Boston marathon bombing took place. All of a sudden, our situation, and the reason as to why we are here as soldiers, became real again. No matter how much fun we are having while training or how much everyone around us claims that things are winding down and we should have a quiet summer, the fact is we are still at conflict.

The trip to Afghanistan took almost three days. Even in the dark, I could tell that our base was a small bustling city that never sleeps; a far cry from the primitive settlements that I had experienced in Iraq ten years prior. 

We took a few days to get settled into our barracks and adjust to the time difference. Tensions have started to arise and attitudes have begun to come out. No one is on their best behavior anymore, and small things like invasion of personal space and consumption of personal time are making people cranky. Generally, I try to be laid back and keep a positive attitude, and I can usually fool people even on my worst day. 

Today, however, was our first full shift at the hospital. The ICU wasn't particularly busy, just a couple of Afghans who had been hit by IED blasts. It would normally have been an easy day but we butted heads with the UK from the moment we began our shift. We barely knew where any supplies were, which sucks when your patient extubates himself ten minutes into the first shift.  Also, it has become painfully clear that the US and UK have some very different nursing methods. It's very hard to set aside our evidence based methods of patient care and adopt someone else's protocols. Ah well, it's only the first day. Hopefully within the month tensions will subside and we will all be able to care for our patients harmoniously.

Then there's the issue of our patient population. As a nurse, or any healthcare provider for that matter, we are sworn to provide care no matter the circumstances. I never thought that would bother me until now. Our patients today were just Afghan locals, and although I gave the best care that I could, it was difficult to not have a completely biased opinion about them. What am I going to do when I have a detainee? I used to pride myself on being able to separate myself from issues such as these. A few months ago, I had a patient back in the states that had a history of incarceration for homicide and I never thought twice about it. Maybe it's the years I spent caring for the soldiers in the wounded warrior ward that makes me a little sick to my stomach now. I have seen firsthand what the Taliban is capable of.  Now I'm supposed to save them?

Part 3 of a 13 part miniseries following the personal memoirs of a soldier

Detective Mike Jennings, Driving While Intoxicated Program Coordinator, Austin Police Department gives Capt. Martha Nigrelle, Joint Force Headquarters, Texas Military Forces, a field sobriety test during a presentation at Camp Mabry in Austin, TX, August 2, 2014. Jennings briefed soldiers from the Joint Force Headquarters on what his department is doing to prevent DWI-related casualties in the city and how to help prevent DWI accidents. (U.S. Army National Guard photo by Sgt. 1st Class Malcolm McClendon).

Commentary by: Capt. Martha Nigrelle

Detective Mike Jennings, Driving While Intoxicated Program Coordinator, Austin Police Department, spoke to Soldiers from Joint Force Headquarters, Texas Army National Guard, about preventing DWI accidents and how Austin Police Department is working to prevent DWI-related casualties during a brief at Camp Mabry in Austin, Texas, August 2, 2014.

“This is an important topic,” said Maj. David Tyler, Joint Force Headquarters Company Commander, Texas Army National Guard. “DWIs are unacceptable.”

Perry, a citizen soldier, also serves as a full time police officer for the Austin Police Department. He enlisted the help of a fellow officer to educate his Soldiers on the effects of drinking and driving because it is one his top priorities as a commander, but also a direct parallel to the Adjutant General’s top priority, taking care of Soldiers. 

Austin’s DWI program was developed in 1998 and has taken a proactive stance in preventing DWI-related accidents in Austin, as well as working with other police departments across the state to improve investigations. The program’s mission is to reduce fatalities, injuries and loss of property due to DWI crashes in the city.

“If we detect alcohol, we have to do some sort of an investigation,” said Jennings. “We can’t let you drive until we know you are OK.”
The program uses three primary field sobriety tests to determine if a person is driving under the influence: the horizontal gaze nystagmus, the walk and turn and the one leg stand. Each of these tests has a 79 percent or higher accuracy rating.

The horizontal gaze nystagmus is 88 percent accurate and the most popular test. 

“HGN tests for eye muscles and peripherals,” said Jennings. “Alcohol slows your reaction time down in your eyes and you lose your peripherals quite a bit.”
After a person is unable to complete one of the three field sobriety tests, the detaining officer will ask for a sample, either through a breathalyzer or a blood sample. If the person suspected of a DWI refuses, the officer can apply for a blood search warrant. If a judge decides the evidence is sufficient, a warrant can be granted for a blood draw. These samples will be tested for drug and alcohol levels and the results can be used in court.

“It’s very hard for the defense attorney to fight a blood test,” said Jennings. 

It isn’t just alcohol and recreational drugs causing DWIs. It’s important to remember that some prescription medications cause drowsiness and impair senses said Jennings. If the label on the medication says, “do not operate heavy machinery,” that also applies to driving a vehicle.
Jennings showed Soldiers a public service announcement that presented a graphic representation of some of the second and third order effects of driving under the influence. 

“Drinking and driving is a crime,” said Jennings. “From 2008 to 2011, there were 118 alcohol related fatality crashes in Austin.”
The video said it best-

“For everybody’s sake…drive safe.”

3/29

I never meant to join the Army. 

I was nineteen and stuck in a volatile marriage to my high school sweetheart who had just finished the Special Forces Qualification Course the year before. By our one year anniversary our fights were getting worse every day and I knew something had to change. So I enlisted and two weeks later I shipped off to basic training, followed by language school at the Defense Language Institute. I didn't tell my husband what I had done until the contract was signed.

I graduated from the Basic Korean course in July of 2002. By January of 2003 I was arriving to my duty station at Fort Campbell. During the two years of language school my husband and I fought constantly, but decided to give our marriage one more chance.  Then war was declared on Iraq. So my husband left for Kuwait a mere three weeks after I arrived at Ft Campbell. Six weeks later, I would follow him.

Preparing for the Iraq deployment was difficult. I was essentially a brand new soldier who had been issued mounds of equipment that I had no idea what to do with. I was also extremely broke, and had developed some questionable means to make it to the next payday. I was the queen of floating checks and lived on peanut butter and jelly. I didn't get to buy any of the "cool guy" Army gear but made do with what I was issued. The day before we left, I patched up a busted out window in our rented house with newspaper and duct tape.

A few months into my deployment I received a message that my husband was sick and was sent back to the states on emergency leave. His prognosis was extremely poor. His family took over his care, and persuaded me to sign over legal guardianship since I was so young, only twenty two. I never returned to Iraq, which was always an internal struggle for me; I hated leaving my team who had become my family in a short time but my husband had only been given six months to live.

His parents kept him alive in a persistent vegetative state for five years, with the help of feeding tubes, supplemental oxygen, and other great advances in modern medicine. During this time I decided that the enlisted life wasn't for me. I got selected for a Green to Gold scholarship and went to college, where I got a BSN. I had become pretty good at providing care, so why not get a degree in that? 

My husband passed away during my senior year of college. Shortly after, I graduated and commissioned as a 2nd Lt.  in the Army Nurse Corps. I changed my name back to my maiden name and moved. I thought that if I changed everything about myself, I could erase the past from my memory. It doesn't really work that way, especially since I became a nurse.

I've been a nurse at a military medical center since the fall of 2009. I initially worked caring for the wounded warriors. It was incredibly rewarding and emotionally taxing at the same time, and after a couple of years, I was ready for a change. 

Preparing for this deployment has been a complete 180 from the Iraq deployment ten years ago. I was able to afford cooler gear such as new Oakleys, as well as a spa day the week before I left. The girl who wrote hot checks to pay the light bill is a distant figure in the past.

The week before I left, I was invited to a function at the White House as a guest of a good friend, for Women's History Month. It was a cold, wet Monday afternoon in March. All of my nice clothing had been packed away in storage with the rest of my apartment, to include my umbrella. I was wearing the best outfit I could scrounge up and looked like a drowned rat next to all of the other women in their beautiful dresses and elegant coats. I almost turned around to leave, not wanting to embarrass anyone when it finally dawned on me. I am a female soldier going to Afghanistan to serve my country. I may not look my best, but that's OK.

Part 2 of a 13 part miniseries following the personal memoirs of a TXMF soldier

27 March

There's nothing like deployment preparation to make you go crazy. For example, prior to coming here we were told that we were getting issued cold weather gear and that we could only bring one duffle bag, so none of us packed any cold weather gear. However, after arriving, we were told that no, we are not getting cold weather gear issued anymore. And of course, when we were told to only bring one duffle, makeup and cute civilian outfits took precedence over my fleece. 

Yesterday, we got issued our multi cam uniforms, complete with a new pair of boots. A least, everyone else got a new pair of boots. I unfortunately wear a size 2.5 extra wide, and those never seem to be in supply (or anywhere else for that matter). So it's no surprise.  A friend of mine who deployed with me was slightly upset. It sucks but I really try not to let it bring me down too much. There are worse things to be upset over, like standing outside in sub freezing temperatures with no cold weather gear. 

The other girls here seem ok; I am slowly starting to warm up to them. I never get too close to anyone right away. I like to step back and observe everyone's personalities before I say much to anyone. Hopefully there won't be too much drama.  This is one of the reasons why I've made it in the military for so long. It's important to keep an equal mix in gender around to keep everyone in check. I'm glad my friend is here with me though; she gets me, understands my need for quiet time and shares an appreciation for makeup, which we have decided we won't be giving up for this deployment.

Part 1 of a 13 part miniseries following the personal memoirs of a TXMF soldier.

Commentary by: Capt. Martha Nigrelle

AUSTIN, Texas – A serious injury or illness often means an extended stay in a hospital with numerous follow up appointments during the recovery period. For many service members this means a lengthy visit in or near a military hospital to receive care from military providers. During this time, loved ones might spend a large sum of money to be there for their service member, or in the worst case scenario, because the cost of hotels and plane fare is too expensive, that service member won’t have a loved one by his or her side.

The Fisher House Foundation was created to help military families during these times. 

Theresa Johnson, Fort Hood Fisher House volunteer, spoke with soldiers assigned to the Joint Force Headquarters, Texas National Guard about the services Fisher Houses around the world offer, in a presentation July 12, 2014 at Camp Mabry in Austin. 

“This training is very important,” said Maj. David Tyler, commander, Joint Force Headquarters, Texas Military Forces. “This is a benefit that a lot of Texas National Guard soldiers don’t know about.”

Johnson told soldiers how she started volunteering at the Fisher House at Fort Campbell in Kentucky, and has since volunteered with a Fisher House in Hawaii and Fort Hood in Texas. 

“It’s like a hotel with no maids,” said Johnson, explaining that the Fisher House is a home available to the loved ones of any military patient being seen at nearby military medical facilities. 

The only requirement for staying at a Fisher House is that the service member being seen must have a military identification card. For the loved ones, Fisher House will never ask to see military orders or a military identification card, making it possible for parents, aunts, uncles, cousins, significant others and friends to stay at the Fisher House.

“I’m glad we had this training,” said Sgt. 1st Class Pablo Martinez, Joint Force Headquarters, Texas Military Forces. “I knew injured people went to Fisher Houses. I didn’t know families could go, too. I think this should be mandatory training for everyone in the military.”

The Fisher House also helps family members purchase plane tickets and pay for hotel rooms, if a Fisher House is unavailable, Johnson said. 
Anyone can donate frequent flyer miles and hotel points to the Fisher House Foundation, and the Foundation then uses those miles and hotel points to pay for family members who need help getting to their loved one. 

“My son got into a car accident that almost took his life,” said Johnson. Following this, the Fisher House Foundation paid for her plane ticket and put her up in a Fisher Home while her son was recovering. "If you have ever donated your frequent flyer miles to Fisher House, I want to thank you. That paid for my plane ticket to see my son when he needed me,” she said.

This year, the Fort Hood Fisher House is organizing a “Fallen Hero Remembrance Run, Walk or Roll 8K” to honor service members who made the ultimate sacrifice. Johnson said her goal is to collect 7,000 combat boots, one for every service member who lost their life since 9/11. Each boot will have a picture attached to it for the service member it represents. These boots will be displayed in a field on Fort Hood during the event Nov. 1, 2014, there. 
“There is no cost. They’ve already paid the price,” said Johnson.

Anyone can participate in the event. The unit that has the most service members participate will receive a bronzed set of combat boots. Johnson is still looking to collect old combat boots. With only about 1,000 collected so far, she has a long way to go.

For members of the Texas Military Forces wishing to donate, Sgt. Brandon Ancar, with Joint Force Headquarters, will be collecting boots for Johnson in the Joint Force Headquarters orderly room in Building 8 on Camp Mabry.

There are 45 Fisher Houses in the United States, seven located right inside of Texas in Dallas, El Paso, Fort Hood, San Antonio and Houston, there are even two Fisher Houses located overseas in Germany and the United Kingdom. According to foundation records, upon completion of each home, the Fisher House Foundation donates the home to the U.S. government as a gift and each home is run as a non-profit organization primarily on donations.

Fisher House is for all service members, National Guard, Reserve or Active, Army, Air Force, Navy, Marine or Coast Guard.

“Fisher House is about being a family,” said Johnson. “I want you to know we are just down the street. We’re there for you.”

For more information on the Fisher House Foundation visit the website at www.fisherhouse.org. For more information on the Fort Hood Fisher House visit the website www.crdamc.amedd.army.mil/fisher/ or Facebook fort hood fisher house