Fall 2007
Vol. 14/ No. 2

Lieutenant James Goss, BSN ‘92, and LCDR Dick Turner, BSN ‘92, spent the early months and years of the Persian Gulf War on the U.S. Navy ship Kearsarge. Although Goss and Turner are both retired from the military today, this article chronicles some of their personal thoughts about being a nurse in the U.S. Navy during that time period.

Date: 2003, March 31

LT James Goss

We will do our best in providing the world-class nursing care our troops deserve. Dick and I manage to run into one another several times a day onboard Kearsarge. In fact, Dick and I are sitting in the same room this very minute in sick-bay. 

He just scared the heck out of me by asking me to confirm the correct spelling of Dorthea Orem's last name. Believe it or not, I've actually applied aspects of the Self-Care Deficit theory in my own practice from time to time.

We are both safe and healthy. Plan to remain that way too! I need to because I am approved for retirement from the Navy on January 1, 2003.  Hard to believe I have nearly 24 years in the service already. I think Dick is going to stick around a few more years. 

Date: 2003, April 1

LCDR D. W. Turner

I look with great fondness on my days at Mizzou.  For me, Orem 's Self-Care Deficit theory has been an invaluable tool. With the push for shorter hospital stays and laproscopic surgical procedures, the time we spend with patients gets shorter and shorter and the need to identify their self-care deficits is critical to good outcomes. 

I also use the self-care deficit theory when I have to deal which leadership issues involving individuals and teams. Individuals and teams do not function at their best if they have unfulfilled needs and if they can not find the means to fill those needs (self-care deficit).

Date: 2003, April 2

LT James Goss

Dick and I will send pictures and notes your way as the odyssey continues.

We have a few pictures that may prove enlightening regarding the medical capabilities of our ship. The bottom line, no matter how modern or up-to-date the technology and equipment, we always find ourselves falling back upon strength of our knowledge base and the ability to improvise and overcome obstacles we are presented. 

There is a true team spirit aboard this ship and among the embarked medical team. You would be impressed by the camaraderie and collegial respect among the staff, from the most senior surgeons and nurses to the most junior corpsmen, knowledge and experience is not withheld or discriminated. It has been and continues to be an honor to be an Nurse Corps officer in the U.S. Navy.

Date: 2003, April 3

LT James Goss

We received this e-mail message from our colleagues closer to the front.  Navy Medical is performing its mission at all levels and we ask that you support our friends closer to the action than Dick and I. 

Navy Surgeons Fight For ‘Golden Hour'

SOUTH-CENTRAL IRAQ , March 31, 2003

(AP) The howitzers flash, recoil and roar, lobbing shells over the heads of sweating U.S. Navy surgeons.

Inside sweltering khaki tents, the eight-man operating team tends to the wounded: Moaning Iraqi fighters, claiming to have been shot by their own when they tried to surrender. Two Marines. Two British allies, one dying.

If the chop-chop-chop of helicopters signaled the closeness of hospital units to the front in Korea and Vietnam , the howitzers do the same in Iraq - firing American outgoing artillery over the heads of surgical teams operating between American and Iraqi lines. Front-line units like these make it possible to get critically wounded people onto the operating table within an hour of the time they fall in battle.

"The 'golden hour' of trauma. You have one hour to get them to surgery before bad things start to happen," says Cmdr. Robert Izenberg, a surgeon in T-shirt, operating scrubs and pushed-down white mask.

"We ARE the front line," adds Capt. Tony Serfustini, a surgeon, standing outside one of the tents, a discarded and bloody wooden splint by his feet. "Can't get any farther forward than that."

The teams, called forward resuscitative surgical systems, are operating for the first time ever in combat. The six eight-member teams, scattered over Iraq, mark the closest Navy teams have ever operated to the battlefield.

The front-line lifesaving units grew out of the 1991 Gulf War, Somalia and other Marine engagements of the past decade or so.

Past wars, including Vietnam and Korea, were more static. In Vietnam, 14 hospitals that never moved tended to patients scooped out by helicopter or plane.

In the Gulf War and onward, Marine units rushed too far forward, on too many fronts, for the old-style "scoop-and-run" medical teams to get critically wounded to care in time.

"It's a different conflict," said Serfustini, a Vietnam veteran and now a surgeon and Navy reservist. "This is a conflict in motion. Vietnam was a conflict in stagnation."

The forward surgical units took seven years to design. Navy physicians and others worked to come up with mobile units that were truly mobile - replacing ones that at times needed a C-130 transport plane, and a landing field, to move.

The result: a surgery team that can move in four trucks, set up in an hour, and tear down in an hour. There are two surgeons, an anesthesiologist, a nurse, operating technicians, and corpsmen, together capable of tending to a maximum of 18 patients in 24 hours.

Their intended patients: the 15 percent to 20 percent of battlefield wounded who die if they do not receive critical care in an hour. The front-line surgeons are meant to stop bleeding, stop contamination and get the wounded on down the line. Nothing time-consuming: shunts instead of intricate grafts on torn blood vessels, clean up instead of repair of perforated intestines.

"It's lifesaving surgery and limb-saving surgery," said Serfustini, wearing sunglasses, a flak vest over bare skin and a bandanna wrapped around his head. "Damage-control surgery. I still provide the same high level of care. It just doesn't have all the bells and whistles," said anesthesiologist Cmdr.

Bruce Baker, who works with a portable oxygen generator, blood-gas monitor and devices to warm fluids going into patients.

The Iraqi sun keeps the medical tents a stifling 80-plus degrees F (32-plus degress C) during the day, instead of the 68 degrees F (20 degrees C) surgeons prefer to keep sweat off the tools and out of the patients.

Despite tightly sealed seams, dust from southern Iraq's sand storms snaked up black hoses leading to monitors.

In south-central Iraq, the team one day treated only one Iraqi civilian, brought in - praying, his guts showing - with what appeared to be shrapnel wounds, cause unknown. The Geneva Conventions and the doctors' Hippocratic oath requires them to treat all critically wounded persons, Iraqi soldiers and U.S. Marines alike.

At Zubayh, the heaviest test yet, the team dealt with two U.S. Marines, two Britons and eight Iraqis. Some of the Iraqis "said they'd tried to leave and surrender, and been shot" by their leaders, Serfustini said.

For the Iraqis in particular - who lack the Kevlar helmets and flak jackets of American forces - immediate surgery meant stemming blood loss, and survival.

"We're making a difference," Serfustini said. "The real proof will be the assault against Baghdad . Check back with us in a couple weeks."