ARTicles vol. 7 i.1: Voices from Landstuhl

It was September 2005 and I had landed at Ramstein Air Base, a NATO center in southwest Germany, after an intense three weeks in Africa. The U.S. Army’s Landstuhl Regional Medical Center, a military hospital just 3 miles from the base, was the final stop on a research expedition to gather material for Let Me Down Easy, my play on the resilience and vulnerability of the human body and spirit.

At Landstuhl, I heard from the doctors and nurses who treat wounded soldiers arriving from Iraq and Afghanistan, often within 24 hours of an injury. We wrongly thought Germany would be some sort of relief.

I don’t know many civilian hospitals in the United States that look like the one at Landstuhl. It was immaculate. Stunning. Like a movie set of a hospital from a different era. I don’t need to tell you, the reader, that to a potential patient (and that’s one thing we have in common: we all are) hospitals these days in the United States seem to be full of paper gowns piled high in wastebaskets, lethargic workers at all levels, no privacy, conversations about your life or death held in a hallway for any passer-by to hear.

I haven’t met many hospital workers like the ones at Landstuhl. Is it that a mission energizes a place? I think, for example, of M.D. Anderson Cancer Center in Houston where I saw the same kind of focused energy. Everyone at M.D. Anderson wore an ID attached by a string that had “Make Cancer History” written on it. At Landstuhl, I suppose that slogan could have been “Finish the Job” (more on that later). No one at Landstuhl seemed to have had too many carbs or too much sugar. No one who I dealt with seemed to have “an attitude.” No one looked as though they would rather be sleeping, or watching television, or conversely: about to explode at you if you were to ask a question.

At about 3 o’clock one afternoon, I waited with Diana Walker, a photographer, and the hospital staff for a bus full of injured, amputated, near-dead soldiers to arrive. Its arrival had been anticipated since 10 a.m. We noted that spirits were high. Diana pointed out one very attractive, blond, female soldier. “What’s she doing here?” she asked. She looked like a debutante, but in Army fatigues. (It turns out that schedules allot time for working out at least three times a week, so almost every worker we saw was in top physical condition.)

Having been in a television series about a hospital, I could not help but compare reactions to emergencies here with the way we had behaved in our make-believe hospital on a studio lot. You know the scene: A stretcher, a patient in critical condition, an actor/doctor running alongside the stretcher speaking in medical jargon as fast as his or her tongue can move. No one at Landstuhl was running. No one was talking at high speed. Urgency was manifest as focus, not chaos.

Diana was not allowed to take pictures of faces. In fact, the person from the communications office kept her at a respectful distance as the buses pulled around the corner with their 19 injured. The various workers calmly walked toward the buses. I walked up as close as I could, trying not to get in the way. I saw no faces. I saw machinery covering faces. The bus was unloaded in what seemed to be seconds. It was over as soon as it started. The whole thing felt as if the group were singing some sort of song. But they weren’t. It was moving to see that the chaplain was the first to make contact with each of the 19 wounded bodies as they were carried off and handed down the line. The spirit was one of welcoming more than the kind of panic that I had expected to see.

Diana was still standing on top of a bench in an area where she was designated to remain. I approached her. “I’ve never seen anything like this in my life,” she said quietly. Actually, she had said the exact same thing when we stood atop a hill overlooking a vast cemetery in Durban, South Africa, looking out at fresh grave after fresh grave: those graves being occupied for the most part by victims of the HIV pandemic. Both statements addressed scenes that were peaceful, orderly and tragic all at once.

There was a mantra that we heard both at Ramstein and at Landstuhl. It had to do with the dedication of the soldiers, their sense of mission, their sense of purpose. Usually when people talked to me about it, they’d start out by looking me right in the eye and calling me by name: “… and you know Anna… .” And they’d go on to emphasize that no matter what kind of shape a wounded soldier was in, all he wanted to do was “get back down range.”

Right after the buses left, we met with Commander Bryan Gamble, who ran Landstuhl. He put it this way:

Commander Bryan Gamble: “I’ve gone around to talk to wounded soldiers and so on. ‘I got to get back to my unit. What we’re doing is good, what we’re doing is the right thing. I need to get back to my unit.’ And it just, you know, somebody with an amputation or something, or multiple different type of injuries, it’s almost without a doubt, it’s almost like a choir, they would want to get back to their unit, get back to work so….”

While at Landstuhl I met with the chief psychologist, Lt. Col. Gary Southwell. I was particularly interested in how one could be blown to pieces, half sewn up, and still have the desire to “get back with your unit.” Like everything else at Landstuhl, Southwell appeared to be laid back. Yet, he was very focused. While I was setting up my recording equipment, he and Diana talked about cameras. His facial expressions as captured by Diana were very lighthearted. He sat to the side of the table, with his hand on his cheek as though we were having a casual seminar on any number of authors. But then again, why would I expect anything else? His job was to survey and analyze and report information. My theory about wanting to get back down range was that the soldiers were in denial about what had happened to them. That’s not where Southwell goes with it:

Lt. Col. Gary Southwell: “…it’s human nature to continue to process and think about things until you’ve completed it. And many of them, most of them, I think, feel that this is important and that they have a job to do and they have buddies that they are responsible for and responsible to and accountable and they have that kind of sense of camaraderie and there’s a strong need to finish the job. But I think that, you know, it’s odd because there’s such harsh conditions to want to be back there. Doesn’t seem—it seems counter to anything that we would suspect and I think most of them become kind of ambivalent in some ways ’cause they’re kind of glad to be, you know, in a cool environment and they’re happy to be here, but—so—and I think it’s really part of human nature to want closure and to want to finish the job…”

But as Southwell spoke, he went on to discuss the other patients at Landstuhl. Not just the soldier patients, but also the staff, those very motivated young people I had seen waiting for the buses, who so efficiently greeted and moved the bodies in. He talked about their form of suffering: something called “compassion fatigue.”

Lt. Col. Gary Southwell: “So for instance the nursing staff and the doctors in the ICU, in the OR, who are chronically exposed to high levels of stress, they’re chronically exposed to these really gruesome traumatic injuries, you know, these traumatic amputations where arms and legs are blown off or the burn injuries that are really horrendous. And, you know, the nurses that, you know, with a burn injury they have to, the patient actually develops edema so they begin to kind of swell and they actually have to cut the skin to allow the fluids to escape and these nurses are up there basically filleting these young soldiers and it’s just traumatic for the nurses to begin to do this over and over every day. And they begin to develop an emotional reaction that we’re calling compassion fatigue.

“Like many of the symptoms of kind of emotional distress, it goes on kind of a continuum from, you know, increased irritability, poor concentration, absenteeism, increased alcohol use, and then basically just feeling, just developing anxiety and depression. And so our goal is we’re working with this on kind of multiple levels. Prevention, education, teaching people how to develop support systems, how to talk about it, working with the leadership on developing reasonable schedules so they’re not always in this kind of high, what they call high-stimulus environment. It’s very high stimulus. We’re realizing this is not something that’s going away.”

Compassion fatigue, it seems, is a real battle scar that comes from working up close. This war is at a distance for most of us. I wonder if we have something to learn from those who have the duty and the privilege to learn daily about compassion—its wonders and its limitations. Do we have something to learn about the true nature of compassion by looking at the military’s study of compassion fatigue? We as a nation like to think of ourselves as a compassionate people, yet meanness seems to be quite strong in popular culture and media.

We live in a society that tends to lack mission in many areas of the workforce. Might we learn something from the military of the relationship between physical fitness and performance? Might we learn something about how to enhance physical fitness in a population that daily becomes more obese, more lethargic, more medicated for mood disorders?

At the end of the first day of my visit at Ramstein Air Base, I watched the Honor Guard practice. Sgt. Mary Lane explained to me that things were done in a manner that called for much more than technical proficiency—they called for “heart.”

Sgt. Mary Lane: “One of the things that we strive for is to carry that casket level. As level as possible. And it, and it can be hard. Walking through that terrain and stuff or upstairs or downstairs or whatever. It takes strength but it also takes, takes heart. You know, to keep hold of that and keep it as straight as possible so it… . To me to do the honor guard with heart takes everything.”

Reprinted by permission from Stanford Medicine magazine.

Articles Issue 7_1