Nightlife on USNS COMFORT / July 4 with the Surgeon General

What does the crew do at night aboard the USNS COMFORT you may wonder? Well last night may illustrate a few of the options. There are only so many places to go and things to do onboard a ship. After dinner, I ventured towards the operating room. Inside I saw a group of folks watching the movie “Don’t Mess with the Zohan” (relatively funny Adam Sandler movie). Two of my friends, LCDR Vic Diaz (my Nurse Anesthetist roommate) and Lieutenant Junior Grade Marcela Zelaya were part of the group. Those two could be brother and sister.

Zelaya, whose family is from El Salvador, is extremely smart, speaking six languages, getting her PhD in astrophysics, and a former Olympic Trials qualifier in swimming. If they made a female version of the Zohan who was from Central America it would be Marcela. She’s Wonder Woman. After a while I grew tired of the movie and moved along to see what else I could find going on aboard the ship.

I ventured back to the galley to get some more water because I was already dehydrated (hot ship). People are stil getting soft serve ice cream, but I decide against having another. In line is LT Matt Gill, public affairs officer extraordinaire for the mission. I’ve been corresponding with Matt for months now, working on several strategic communication initiatives to get the word out about Continuing Promise 2009. He is a levelheaded Naval Officer with Explosive Ordnance Disposal and Navy Diving background.

Gill is steady, does not overreact, stays on point and gets the message across- just what you need in a Public Affairs Officer. You wouldn’t know he has such a dry sense of humor until you got to know him better. He has a great family back home in Norfolk and soon they will be headed to their new port station in Naples, Italy. I snap a photo of him and move along.

I hear my name (or something close to it) called from across the room. It is Warrant Officer Tuparan- a gregarious Navy Officer of Filipino decent who works in Patient Administration. “How you doing Alec?Need anything?” He’s the guy who knows how to get something if you need it. Kind of like “Red” in the Shawshank Redemption.

So when the paperwork needed to be straightened out, Warrant was the guy who knew someone who knew someone. “Nah, I’m good Warrant. Thanks, though!” I filled up another glass of Gatorade and picked up some more saltine crackers (that’s all they have to eat on the mess decks after dinner is over). I like the crackers. Warrant Tuperon always has jokes, and smile on his face. I hope his kids will go into Navy Medicine as well.

There is someone singing/rapping “In Da Club” by 50 Cent from across the room (fairly well I must say). The ship is having their COMFORT IDOL finals tonight – Karaoke style. I just watch for a bit, and see that the guys and gals are having fun. The “Fun Boss,” Jeremy (recent Penn State grad, not in the military) has things under control and is doing his job. The Fun Boss’s sole job that he is highered for on the deployment is to come up with events each night and at liberty ports for entertainment.

He hosts Bingo nights, Video game competitions, Athletic bouts, Karaoke, Movie Screenings, etc., etc. I went up to him and asked if he had a business card. I just want to see if his card reads “Fun Boss”. One of my good friends worked for the Sheraton in Hawaii and his job was the “Director of Fun” for the hotel and that’s what his business card said. No kidding

I ventured downstairs to the Officers Lounge and found CDR Bill Graf. Dr. Graf is an interventional radiologist and a fellow Navy Deep Sea Diver. He is a steadfast athlete, and we always seem to find ourselves PTing (physical training) next to each other.

I just found out a few days ago that Graf and I both grew up in Lancaster. A cool thing about the Navy is that you can be halfway around the world, and meet someone that grew up down the street from you. Two days ago while running with Graf on the treadmills I noticed the yellow LIVESTRONG bracelet on his wrist. “You lose someone to cancer, Sir?” I asked him. He told me the story of how his wife had lost someone and was very active with fundraising for cancer research and supporting the LIVESTRONG movement created by cancer survivor Lance Armstrong. I told Graf the story of my uncle who had rapidly and painfully lost his life to pancreatic cancer and the work I do with PANCAN.org. Tonight Graf handed me a cap and a yellow LIVESTONG band. I put is on and we got a photo. “PA Pride” (Pennyslvania Pride) we both said and pounded fists to our chests.

Time to head back to the other end of the ship and see if anything is happening back there. I stop quickly to check the computer and see if the outside communication is working. As usual the answer is no. Only email we are receiving is from intranet (within the ship). The one message I did receive internally from the supply office informs me that I have a letter and package waiting at the post office. Wow! Things were looking up. I go up there and ask the postal clerk (it’s after hours but they are still up watching movies) what he’s got. He hands me a bag and a letter.

In the bag is a white T-shirt with El Salvador proudly painted on the front with adjectives and things that make the country special. It was a gift from one of the El Salvadorian patients I had seen and the note expressed her thanks to all on this mission. Even though the T-shirt was three sizes too small, and had colorful writing that would not last long in these washers, it was the best token of graciousness that I could have received and it made my night. Thumbs up to you!

In a jovial mood, and feeling even more joyful because it was the eve before Independence Day, I decided to return to my favorite chair in my room and put in the HBO TV series John Adams. Very fitting to watch the signing of the Declaration of Independence that occurred 233 years ago on a DVD video player on my Mac on my lap in the underbelly of a floating converted Oil Tanker off the coast of Nicaragua. If you have not seen this Series based off of David McCullough’s book chronicling the life of our 2^nd President John Adams, I highly recommend it. Paul Giametti does a fantastic job playing Adams and clearly shows the courage and fortitude our founding fathers displayed time and time again so that we could live with life, liberty and the pursuit of happiness. I have not felt very homesick up until this point, but everyone wants to be on American soil for July 4^th. So any of you reading this, please give a salute, a howdy! and a thank you to any military personnel you know serving around the world today. With these thoughts in mind, I dozed off to sleep in the chair, woke up at 1am, and my first thought was Happy 4^th of July! Next thought was “Hey Baldwin, get in your rack for Pete’s sake! You fell asleep in this chair for the past three hours!”

Happy Independence Day! I am still shipboard since I’ll be working the back half of our Nicaragua stay ashore (my friend Karen Jacobson and others have been out there the past few days). Today is another good opportunity to work out a lot and read medical textbooks. This morning was the ritual Dave Bacon spin class, followed by a reading session on Bioterrorism agents. When I was falling asleep from the material, I decided it was time to work out once again. Sick of running and falling off the treadmill, I asked a recent Newbie, LCDR Lynn Sterni if she wanted to run the ramps of the ship with me. She nodded yes in a manner that said “yes, get me out of here!”

The ramps are switchbacks used for loading and unloading large cargo, and also the entry point for mass casualty receiving. The walls of the ramps are lined with stretchers and the floor painted red to conceal the blood. Pray we do not have to use them. From bottom to top at a gentle incline is .16 miles. So going up and down three times completes a mile. Sterni is a pediatric anesthesiologist in the Navy. She has red hair, practices in St. Louis, is super nice, and I always see her working out. I come to find out while running the ramps that she is an outstanding runner and triathlete. I was winded trying to keep up with her. Turns out that she was at the TAPS Good Grief Camp in D.C. that my foundation Got Your Back Network (www.gotyourbacknetwork.org) helped out with in May for families of the fallen. Very nice thing for her to do. She is quality people. After 9 times up and down on those ramps (3 miles) in the stifling heat with calisthenics in between, we were drenched with sweat and spent. Two solid workouts on the 4^th and we were ready for the Ice Cream Social that evening.

July 4 was extra special this year on USNS COMFORT. The Acting U.S. Surgeon General, Admiral Galson, came aboard with his staff (my friends Julie and Tomas) to visit the ship and to celebrate the anniversary of the U.S. Public Health Service.

We have just shy of 100 Public Health Service Officers onboard from all throughout the country. They serve in numerous roles from Environmental Health Officers, to Epidemiologists, Physicians, and Veterinarians. Over the past few months while in Washington, D.C. it is been an honor to help Admiral Galson with his “Healthy Youth for a Healthy Future” initiative combating childhood overweight and obesity throughout the United States. For more info see: www.surgeongeneral.gov and pledge your support today.

For the Surgeon General’s visit we had a very nice dinner in the Wardroom with distinguished staff. They brought out the best china and silverware for the occasion and everyone in attendance had a personalized nametag at their table setting, as well as a colorful Independence Day menu.

Given the choice of ribs or chicken, I went for the poultry. I sat next to a very nice Veterinarian LCDR who I found out attended Cornell University for Veterinary School (the same undergrad school that my parents and sister attended), and it was fun to talk about the beauty of Ithaca, NY and Cayuga Lake. I have been there many times. Across the table from me was CAPT Beadle who has led the Medical Operations and planning for this mission from the start. She is the brains and the powerhouse behind the medical planning and execution. I told her good job- “Bravo Zulu ma’am!” Bravo Zulu (BZ for short) means good job in Navy lingo. “We’re not quite there yet! Almost,” she said. With all the moving parts that this mission has, the amount of time she has put in is remarkable. I hope CAPT Beadle feels proud and people give her a pat on the back for the great job she has done. Dinner was excellent (best food I’ve had on board yet) and I thanked the Petty Officers who served us and asked them where they were from and what their goals were. Solid kids. The Surgeon General made some remarks in addition to the Commodore (Captain Negus), Captain Ware (Medical Commanding Officer), and Captain Finger (Ship’s Master). They call this trio of Captains the “Three Amigos.”

After dinner we had the usual 7pm Confirmation Brief, and the packed mess decks as always felt like a sauna. The Three Amigos name a “Person of the Day” every evening and tonight it was a truly special person- the lead vocalist for the Air Force Band. As if on cue she took the microphone and started singing right in front of the American Flag- “God Bless America.” The entire crew came together singing in unison to finish out the hymn and you could feel the pride. The only thing missing was fireworks. But we did have Ice cream! Tonight it was the real stuff- fresh with several flavors from the scoop- no soft serve. As they turned on the movie Flags of our Fathers, enjoying the dessert, smiles abounded and we (at least for a little while) forgot we were off the coast of Nicaragua. In our minds and in our hearts we were home, proud to be Americans, celebrating the day that 233 years ago fifty six patriots pledged their lives so that we could live in freedom. God Bless America.

Catholic Mass aboard a Ship

The days run together out here and after a while you forget which day of the week it is. Weekends and weekdays are all treated the same way. There is a certain time of the week though that does stay sacred and that is Sunday and we are all given a chance to give thanks and worship.

Tonight we had a very special guest aboard to lead Catholic Mass- the Bishop of South America’s Northwest Region. About 50 of us gathered in the Wardroom in our Coveralls and Working Uniforms facing a makeshift altar of a card table draped with white tablecloth, Jesus on the Cross, two candles, and a statue of the Virgin Mary. We joined in song as we waited for the Bishop to arrive. As he walked in and we stood, he related to us that he had taken the RHIB boat (fast boat) over to the Ship at night from shore, and was a bit soaked J. We helped him get dried off and luckily the ceremonial garb had been kept dry in a dry bag. I was raised and confirmed Catholic, and even served as an altar boy back in Lancaster, PA, but this was the first Catholic I had been to onboard a ship, and from a distinguished high ranking member of the Church. It felt good to take a break, convene together, and have some time to think about things. Sunday was always a day that my family got together when I was growing up, and here too aboard the USNS COMFORT we were family.

Two weeks into this mission and it feels like I have been out here for a few months. So many experiences happen each day, peaking the senses at all times, making the perceived time seem longer than the actual time. That is my theory anyway. It is the same type of feeling that I had when I was going through the intense experience on TV.

It’s go, go, go, and rarely have a chance to step back and reflect. Tonight was good for that.

The reflection must have been calming because I awoke the following day feeling as bright eyed and bushy tailed as ever. Even without coffee I was raring to go at 5am ready to hit the shore and see patients all day long. We were assigned to the RHIB boat again today, but today the water was glassy and we were able to pick up speed and not get wet.

Amongst our crew was CAPT De La Pena, a 70-year-old Family Practice doctor, who is a bulldog and funny as all get out. For him to be hard charging as a Navy doc at this age is commendable (I think he joined with he was 52 J). Also in the mix was Petty Officer Waters, a fairly new Navy recruit (age 20 I think) who I had noticed working all sorts of thankless jobs such as dishwashing, cleaning the johns, scrubbing the decks, and now she was headed out to the site to help out. I was happy for her. She’s the type of young service minded youth that is good to see. And she wasn’t afraid to speak her mind either, which made for a good laugh most of the time.

Things were a bit disjointed at the site today. We arrived early, and I saw the largest group yet waiting to be seen outside the fence of the school.

In particular I noticed a lot of children (ninos). Supposedly there were several busloads of families from the “campo” (country) that had been bused in overnight to be seen. This was going to be fun I thought. The most interesting patients (and often the most appreciative) are from the rural areas. We waited for about an hour and they still had not let the patients through the gates. There had been some confusion and fighting outside about who would get to see the doctors first, as the government had pushed the “campesinos” (country people) to the front of the line. This was not taken well by some. Eventually they barged through the gates and my translator and “nurse” Maria and I set to work. Much was the same patient in and patient out, and to keep myself sane I would try to have each patient leave with a smile, even if it meant just talking with them about their lifestyle, what they liked to do for exercise, what they liked to eat, and give them some advice on living healthy. I asked them about their families, their love life, their goals, and dreams, and to tell a story about the country or the city or their youth in Colombia. As opposed to many of the patients that I have seen in urgent care settings in the United States who just want to get in, get their medication and get out as soon as possible, their was a different type of appreciation and respect for doctors here in Colombia. These people literally hung on every word a “U.S. Doctor” (me) said to them. The most productive part of these visits was health education, teaching the patients about the importance of exercise, what foods to eat, to not smoke, not drink alcohol, limit sweets, and lose weight. They may have been fooling me, but these patients clearly took what I said to heart and started making lifestyle changes even right there in front of me as they turned over their flasks, cigarettes, chocolates and hard candies. It was this lifestyle education (clearly missing for some) that I found most rewarding, as it is this knowledge that will sustain and make a difference into their futures.

This afternoon my favorite patient of the day came in. A 75 year old gentleman, looking a bit hunched over, with his shirt draped over his shoulders, came in with his daughter. She explained that he had traveled over four days from the country (much of it by boat) to get here to Tumaco. Four days ago he was working on the farm and to avoid colliding with a branch had put his arm out and proceeded to dislocate his shoulder. As I removed his shirt I saw his left shoulder clearly out of socket anteriorly. Wow! Four days ago?? When one dislocates a joint the muscles contract around and unless you pop it back in immediately, it becomes increasingly difficult to get that joint back in articulation the more time that goes by. This 70 year old farmer was extremely strong and this was going to be challenging without any anesthesia to relax the joint. I asked his permission to yank on his arm to try and see if I could force it back in, and he replied, “Yes, whatever it takes. I have traveled long and far in a lot of pain. What is a little bit more?” I used all my strength to try and force the head of the humerus bone back into the normal shoulder socket. It would not budge. Damn! I took off my uniform top, as I was sweating up a storm. “Let’s go over to the physical therapy room where I can put you on a table to get some leverage.” There was a stretcher set up on a stand that had been functioning as a PT table and I put the man up on that in a prone position. I then instructed an assistant to take a sheet and wrap it around his body to provide leverage the opposite direction to which I would be pulling traction on the man’s left arm. I had my friend and Dermatologist Dr. Carrie Hall who was nearby push on the Humeral head as I pulled the man’s arm downward with all of my might. It still was out. The man winced in pain, but said Sigua! Sigua! (Continue! Continue!). We realigned and took our positions and then on the count of three, I pulled again as hard as I could.

As I released the humeral head slid back into normal position! The old man rolled over with the biggest smile on his face that I have ever seen. He shook out his arms and shoulders, looking like a Colombian Michael Phelps shaking out his muscles on the blocks before a race. As we rigged up a shoulder sling for the man, his daughter and he could not stop saying thank you, and I smiled and said you’re welcome. This was a team effort. Yes indeed it was.

Day 6 ashore. 70 patients seen today. 457 patients and smiles this week. Total Colombia patients seen by USNS COMFORT Team- 9,968

Abandon Ship!

Last night I tossed and turned and could not fall asleep. It may have been my fascination with the words- A MAN, A PLAN, A CANAL, PANAMA which spells the same thing forwards and backwards. Or it could be because the seas are becoming rougher and I find myself shifting back and forth in my bed with the rolling of the waves. I have found over the years that this rockin either puts me to sleep, or keeps me up for hours. Argh…. It must have been 3am by the time checked out, and luckily today we were ALLOWED to sleep in. I woke up at 9am and the sea state was even rougher. We must have been taking on a ton of water, because the ship was leaking everywhere, and as I made my way up topside, I saw outside that we were in monsoon conditions. Wow it was raining hard. The deckhands had things under control, and so I figured I’d go partake in an acrobatic spin class taught my roomy LCDR Dave Bacon. Bacon is a microbiologist and a salty guy, the last person I would have suspected to be teaching a spin class on a hospital ship, but he was darn good. Hard charging music and a great sweat to start off the day. Dipping side to side with the waves on a bike on a ship gave it an added degree of difficulty.

After a quick shower and brunch (no bloody marys here) the medical crew assembled in the medical spaces for training. My other roommate Dr. Mike Berretti mentioned the link to pancreatic cancer incidence. Given the fact that Mike is currently smoking a pack a day, and he is applying to a pulmonary fellowship I find very disconcerting and I have made it one of my mission goals to get him to quit.

At 1300 we hear an alarm go off aboard the ship announcing a fire in the forward engine spaces. The medical response team jumps into action with the stretcher, medical kits, and radio. The next sound over the intercom is Abandon Ship, I repeat, Abandon Ship! Followed by six short blasts by the ship’s whistle and a long continuous blast from the horn. It was a mad rush to the door as we scrambled for lifejackets and made our way up to the flight deck and our life raft positions. It was a sea of orange on the flight deck with close to 800 people from all walks of life ready to abandon the COMFORT. Good thing this was only a drill and there was not a real fire. But if there had been, no doubt we would have made it off the ship safely. The orange life jackets had a nice way of making you look pregnant as my friend Dr. Karen Jacobson found out. She held her bun in the oven with pride.

Even aboard the USNS COMFORT, just north of Colombia, in the open seas of the Pacific Ocean- my Navy Medicine recruiting efforts continue. CDR Hartzell and I assembled a group of about 30 pre-professional students, members of Project Hope, and other NGOs for a presentation on the Navy Health Profession Scholarship Program. Again I was struck by the intelligence of these young UCSD students and their unending amount of questions. It was fascinating on two levels to talk with students who study right by where my condo is in La Jolla, and also to describe Navy Medicine to them and have them actually onboard and experiencing a Navy humanitarian mission. The Navy Health Professions Scholarship is an incredible deal which pays for ones medical or dental school in return for the commitment to serve in the Navy as a health care provider for the equivalent number of years. It is the best decision I have ever made, allowing me to achieve a professional medical education, travel and adventure, the opportunity to work with outstanding selfless people, and most importantly to wear the Navy uniform and serve my country proudly. I find that when giving this talk, and especially when taking questions, there are two types of people- those that are service minded believing in sacrifice and teamwork for the common good, and those that are selfish and see the world through a “ME” lens constantly asking the question how will this affect ME?

The answer. We don’t want the latter. Enough said. Go NAVY!