Nurses in VietnamSource:
pp. 12 - 17.
JACQUELINE NAVARRA RHOADS
Jacqueline Navarra Rhoads
One was a young guy who had had his face blown away, with hundreds of maggots eating away where his face used to be. Another one, he had his eyes wide open. He was staring up at me. I remember he had a large hole in his chest and I knew it was a gunshot wound or a grenade injury. It had blown his heart, his lungs, everything to shreds. He had nothing left but a rib cage. Evidently, they had lain out on the ground awhile before someone could get to them. The corpsmen were told to take care of the wounded first, instead of spending time getting the dead in the bags. There were GIs exposed to flame throwers or gas explosions. We used to call them "crispy critters" to keep from getting depressed. They'd come in and there would be nothing more than this shell of a person. That was a little easier to take, they didn't have a face. It could have been an animal's carcass for all you knew. But to have to go looking for the dog tags, to find the dog tags on a person, that bothered me. I remember the first time I looked in a body bag I shook so badly. One of the doctors was kind enough to help me through it, saying, "Come on, it's your duty and you're going to have to do this. It's just something that I'm going to help you through. It's just a dead person." It was such a close-knit group. We were considered the most beautiful women in the world. The guys treated us special. You could have been the ugliest woman in the world, but still you were treated special. The mass - cal, that's mass casualty situation, traditionally was anything more than 10 or 15 wounded. It was mass chaos, bordering on panic. There'd be a corpsman walking around saying, "Dust off just called and they're bringing in 25 wounded. Everybody get going." So we'd pull out all our supplies. The nurses would put extra tourniquets around their necks to get ready to clamp off blood vessels. The stretchers were all prepared, and we'd go down each row hanging IVs all plugged and ready to go. It was mass production. You'd start the IVs on those people where the doctor was able to say, "This one is saved, this one is saved." We put them in triage categories. The expectant ones were the ones who required too much care. We'd make them comfortable and allow them to die. I guess it was making us comfortable too.
I remember this guy named Cliff, a triple amputee we once had. He came in with mast-trousers on. Mast-trousers is an apparatus you inflate that puts pressure on the lower half of your body to allow adequate blood flow to your heart and brain. When Cliff came in, he was conscious, which was amazing. He looked like a stage dummy who'd been thrown haphazardly in a pile. One of his legs was up underneath his chin so that he was able to look down at the under- side of his foot. His left arm was twisted behind his head in a horrible way. We couldn't even locate his second leg. He had stepped on a land mine. With his legs that bad, we knew there probably wasn't much backbone left. He was alive because of these trousers. The corpsman must have been right there when he got wounded. He had put him in this bag and inflated it. Cliff should have been dead.
It was really funny because he looked at two of us nurses there and said, "God, I think I've died and gone to heaven . . . a roundeye, an American, you look so beautiful." He was so concerned about the way he looked because of us standing there, "Gee, I must look a mess." But he was alert, he knew where he was. '"Doc, take good care of me. I know my leg is pretty bad because I can see it, but take good care of me, doc." The docs couldn't put him in the expectant category and give him morphine to make him comfortable, because he was too alert. The docs had trouble letting go. So one of them finally said, "Well, let's get him into the operating room, deflate the bag, and let's get in there and see if we can't do something."
Well, we knew just by looking at him in that condition that he wasn't going to last, that as soon as we deflated the bag he'd bleed to death in a matter of seconds. Somehow, he knew it too. I remember I was getting blood prepared for him. He called me from across the room, "Jacque, come here quick." I went over to him and said, "What's the matter Cliff, what's wrong?" He said, "Just hold my hand and don't leave me." I said, "Why, Cliff? Are you in pain?" We always worried about pain, alleviating pain. We'd do anything to alleviate pain. He said, "I think I'm going to die and I don't want to be alone." So I stood there crying, with him holding my hand. And when we deflated the trousers, we lost him in seconds. We found no backbone, no lower part of his body. Really, he had been cut in half.
The leg that was folded underneath his neck was completely severed from his body. It was just there. The corpsmen had evidently bundled him together into the bag hoping maybe something would be there that was salvageable. And he just died. I remember he had blond hair, blue eyes--cute as a button. I had to take his body myself to graves registration. I just couldn't let him go alone. I just couldn't do that. I had to pry my hand away from his hand, because he had held on to my hand so tightly. I had to follow him to graves registration and put him in the bag myself. I couldn't let go of him. It was something I had to do.
Usually the expectants had massive head injuries. They were practically gone, they couldn't communicate with you. You were supposed to clean them up, call the chaplain. You did all that stuff, I guess, to make you feel as though you were helping them. To preserve their lives, you would've had to put them on a respirator and evac them to a neuro facility, which in our case would have been all the way to Da Nang, which was hours, miles away. I was an operating room nurse, but when there was a mass-cal, since there were only 12 of us, we'd be called into triage to work there. After that, I'd follow them into the operating room and help do the surgery. A lot of the shrapnel extractions we'd do ourselves, and a lot of the closures too. The docs would say, "Why don't you close? I got this next case in the next room." You didn't have to worry about it too much, if you got into trouble he'd be right there next door. We wanted to save everyone. We had a lot of ARVNs (Army of the Republic of Vietnam), we called them "Marvin the ARVN." We tried to take care of the Americans first, but we also had to take care of whoever needed care--period, whether he was a Vietnamese, a POW, or whatever. In fact, when we tried to save Cliff, they brought in the Vietnamese who had laid the mine. He had an amputation. He was bleeding badly and had to be treated right away. And we saved him. I guess in my heart I felt angry about what happened.
We were short on anesthesia and supplies. And we were giving anesthesia to this POW, which made me angry because I thought, "What if--what happens if someone comes in like Cliff and we don't have any anesthesia left because we gave it all to this POW?" Again, because I was very strongly Catholic, as soon as I heard myself thinking this, I thought, "God, how can you think that? The tables could be turned, and what if it was Cliff in the POW's place, and how would I feel if he received no anesthesia simply because he was an enemy?" First of all, it shocked me and embarrassed me. It made me think, "Gosh, I'm losing my values, what's happened to me?" I had been taught in nursing school to save everybody regardless of race, creed, color, ethnic background, whatever. Life is life. But suddenly I wasn't thinking that anymore. I was thinking, "I'm American, and they're the enemy. Kill the enemy and save the American."
Before I went to Vietnam, I was kind of bubbly, excited about life. I haven't changed that much really, I'm still that way. But back then, suddenly, I began questioning things, wondering about what we were doing there. I remember talking with the chaplain, saying, "What are we doing? For what purpose are we here?" We were training Vietnamese helicopter pilots to go out and pick up their wounded and take them to their hospitals. And we treated plenty of them at our hospitals, too. Yet when we'd call up and say, "We got a wounded soldier in Timbuktu," they'd say, "It's five o'clock and we don't fly at night." We had soldiers in the hospital shot by l0-year-old boys and girls. We had women who'd invite GIs to dinner--nice women--and they'd have someone come out from behind a curtain and shoot them all down dead. I mean, what kind of war was this?
The chaplain told me, "Hey Jacque, you can't condemn the American government. We can't say the American government is wrong to put us in this position here. We can't say, because there is so much we don't know." It was good advice at the time, it really helped me. I was thinking, "Here I am judging, and I'm saying what the heck are we doing here, look at all these lives lost, all these young boys and for what? And who am I to judge that? There has to be a reason." I guess I'm still trying to hold on to that belief, even though people laugh at me when I say it. They think I'm living in a dream world because I'm hoping there was a good reason.
I didn't really have much time to worry about right and wrong back then, because during these mass-cals we'd be up for 36 hours at a stretch. Nobody wanted to quit until the last surgery case was stabilized. By that time, we were emotionally and physically numb. You couldn't see clearly, you couldn't react. Sounds were distant. We kind of policed each other. When we saw each other reacting strangely or slowly, we'd say, "Hey, Jacque, get some sleep, someone will cover, go get some sleep." That's how close we were. That's how we coped with stress.
You didn't have time to think about how unhappy you were. It was afterwards, when you couldn't go to sleep . . . here you were without sleep for 36 hours, lying in your bed expecting sleep to overwhelm you, but you couldn't fall asleep because you were so tensed and stressed from what you saw. I knew I had a problem the day I was with a nurse I was training who was going to replace someone else. I remember I had completed this amputation and I had the soldier's leg under my arm. I was holding the leg because I had to dress it up and give it to graves registration. They'd handle all the severed limbs in a respectful manner. They wouldn't just throw them in the garbage pile and burn them. They were specially labeled and handled the good old government way.
I remember this nurse came in and she was scheduled to take the place of another nurse. When she saw me, I went to greet her and I had this leg under my arm. She collapsed on the ground in a dead faint. I thought, "What could possibly be wrong with her?" There I was trying to figure out what's wrong with her, not realizing that here I had this leg with a combat boot still on and half this man's combat fatigue still on, blood dripping over the exposed end. And I had no idea this might bother her. . . .
pp. 94 - 98
I worked mainly in the emergency room and triage area. That's where you do life-saving procedures before sending them into the operating room. I literally picked them up off the helicopter or the ambulances, and brought them into the emergency room, and stabilized them as best I could before the operating room. The expectant category, that was the hardest. We are taught, trained, and socially groomed as nurses that every life is important. Your job as a nurse is to try to save human life to whatever extent possible. So when casualties were coming in fast and furious, and someone came in with such extensive injuries . . . what you'd be doing is sacrificing this one life who's expected to die anyway, and doing something for three or four others who could be saved. That was hard. Usually the nurses would have to sort out the wounded with a physician at hand. Some physicians were doing procedures to the patients, while still others were preparing for casualties in the operating room. But we always managed to keep them comfortable as far as medications were concerned.
We assigned a corpsman to each expectant so they wouldn't be by themselves. That was a hang-up on my part. I didn't like the idea of their being by themselves at that time. And whether they knew anyone was there or not, I always made sure someone was. At least there would be another human being. If they were in the expectant category, most often they could not communicate with anybody. Usually the only ones you put in expectant were the ones who had massive, open chest wounds with so much blood and body fluid lost that they were unconscious anyway. Or they had massive head injuries. Anything else, they went to the operating room and the surgeons there tried, to the best of their ability, to help them pull through. Although the expectants generally were comatose, one would occasionally grab your hand. You could never know with those folks whether they could hear you or not. The worst of the other non-expectant ones were the traumatic amputations of legs or other limbs. These had suffered tremendous blood loss, but there was always a wait for donor-specific transfusions. It took 45 minutes or so before they could have the blood typed and crossed and have it ready by the time they were taken into the OR. So most were transfused with O-negative before the crossmatch was complete. There was a tremendous blood loss, tremendous fluid loss, and there was some concern as to whether they'd make it or not.
When I think back to individual cases I saw coming through there, I'm very much aware of this one young man. Ours was like the dropping off point, we had the major air field at Qui Nhon. Men were coming up to go to the 1st Division or the 173rd Infantry. So they were arriving and their units came down to pick them up. There was one young man, he was very small and blonde. And it was obvious he hadn't shaved yet, because he was probably of Scandinavian origin; but he was very short and very blonde and I kept thinking how awfully young he looked. He'd stopped me to ask directions to the Red Cross, because he wanted to call his mother back in the states and tell her that he had just arrived. So his unit came and picked him up and three days later he came back into the emergency room with both his legs blown off. He had stepped on a land mine. He was awake and he remembered me. I called him by name, his name was Mark. I still remember that. He just looked up at me and put his arms around my neck and pulled me down saying, "Please don't let me die." And that was very hard. It was particularly difficult because he happened to be one of a large number coming into the emergency room. There were about 60-70 coming in at the same time. I told him, "We'll certainly do our level best," and I stayed with him. Although I was head nurse of the emergency room, I did my best to stay with him until he went to the operating room. His right leg was six inches from the hip, the left was four inches above the knee. There was no part left. Both legs had been totally obliterated. The medic in the field had medicated him, so he was conscious and reasonably comfortable until you moved him. Then the pain became exaggerated. He was semi - conscious and his vital signs were weak. The medic had put IVs in both arms which kept him from bleeding to death.
Fortunately, he did survive the surgery and made it back to the states. And I understand, from the best I was able to keep up, that he did fairly well. Now how he managed as far as adjusting to life was concerned, I don't know. But he survived. He spent about two hours there in the emergency room talking to me while waiting for the jeep to come down and pick him up. He was drafted right out of high school. He had been an exceptional student in school, and had intended to go to medical school after he finished his commitment. He was going to go to the University of Michigan--he was from Grand Rapids--and go to medical school afterward. This was his goal in life. Who knows, maybe he would have been the individual who found the cure for some disease that is giving us so much of a problem.
Some died in the field, and we never saw those. They brought them back in body bags to Qui Nhon. We'd have them brought to us with the tags on them. It was an eerie thing to see a name you recognized in a big, black body bag. We had dozens more who came in with all sorts of injuries. One had wounds to the chest, we put chest tubes in him. He also survived. One came in, he had a massive face injury. He did not make it into the operating room. We had a very excellent oral surgeon who attempted to tie up the major vessels to get him through, but he had almost the full side of his face blown off. His buddy in front of him stepped on a mine. When you stepped on a mine, all you did was arm it. It's when you stepped off of it that you had the problem. His buddy who stepped on it didn't hear it click. When he stepped off of it, it exploded and the guy behind him got it in the face. He died in the emergency room.
We all had questions as to what we were doing in Vietnam, why we were there. We didn't seem to be getting anywhere. Day after day, things seemed to be pretty much the same . . . they'd take a hill, lose a hill, take a hill, lose a hill. Being in the age group where motherhood and children were a big factor, I think you do think: "What are we doing to the future generations of this country? What sort of genius would this blond young man have been had he been allowed to go about his life and do his own thing?" Most of the time you were so busy, just literally, physically busy that--although these thoughts stayed with you for awhile--you soon forgot about them, because it always seemed like there was someone else coming in to take the previous patient's place. Only when you got attached and knew someone before they got injured did it really bother you, as was the case with Mark.
It wasn't so depressing all the time, I must admit. We went on medcaps, medical missions to remote villages, places where there was no regular medical care. We did reconstructive surgery on children, gave them false limbs, and taught them how to get around. These kinds of things helped relieve some of the frustrations I was feeling. Some things that bothered the other people bothered me less. Seeing children with napalm burns, for instance. The reason it didn't bother me was that I saw children in Phoenix who had been shot by their fathers for no other reason than that the fathers were angry with the mothers. I had resolved that a long time ago. The children happened to be innocent bystanders. I'm not saying it's right. It's tragic, but it happens. It's unfortunate. Another thing was that Phoenix was the major source of napalm used in the bombs. There was a big chemical plant nearby. So we'd get burn patients when there'd be an accident at the napalm factory. I was used to treating napalm wounds, probably one of the few nurses in Vietnam with prior experience of this kind. You worked hard to restore them to their maximum health so they could carry on with their lives. It made very little sense, but at least I had already taken care of that in my personal life back in the emergency ward; so that when I got to Vietnam I could concentrate on restoring that child back to health as much as possible. . . .