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Nurse provides comfort at 'top of the bed' in Iraq

Lt. Col. Paulette Schank prepares 4 year-old Iraqi child for surgery at the Air Force Theater Hospital at Balad AB, Iraq. The child was burned over 40 percent of his body andhad to undergo over 20 sugical procedures.

Lt. Col. Paulette Schank prepares 4-year-old Iraqi child for surgery at the Air Force theater hospital at Balad Air Base, Iraq. The child was burned over half his body and had to undergo 20 sugical procedures.

Lt. Col. Paulette Schank in operating room with body armor and helmet during a heighten state of readiness. Balad AB, Iraq is a target for insurgent mortar attacks.

In the operating room, Lt. Col. Paulette Schank wears body armor and a helmet during a heighten state of readiness. Balad Air Base, Iraq, is a target for insurgent mortar attacks.

WILLOW GROVE AIR RESERVE STATION, Pa. -- Serving in the Air Force theater hospital at Balad Air Base, Iraq, was a "dream come true" for Lt. Col. Paulette Schank.

If asked, the chief nurse in Air Force Reserve Command's 913th Medical Squadron here will tell you she always wanted to do combat anesthesia. So, when the opportunity came, the nurse anesthetist at St. Mary Medical Center in Langhorne, Pa., jumped at the chance to deploy to Iraq.

"It is a privilege to serve [at Balad]," the Air Force reservist said.

Her eyes sparkle when she talks about her experience 6,000 miles from home.

"I worked at the top of the bed," she said. "I was the person a patient saw at a time they are scared the most ... I was the person who talked to them as they went under ... held their hand ... relieved their pain ... and made sure they slept while the surgeons did their work."

As a nurse anesthetist, Colonel Schank was responsible for keeping the patient stable through a procedure. She anesthetized the person, watched the vital signs, administered medications, controlled blood transfusions and called the shots if a patient started to "crash."

"It was my job to keep them [patients] alive so the surgeon could repair the holes," she said.

Colonel Schank left for Iraq Jan. 15 and arrived at Balad about a week later. After getting to her room at about 4:30 a.m., she reported to the hospital about three hours later. Within the first hour, casualties started rolling in and she found herself in an operating rooming working on a young soldier.

"My first day on station, I worked 11 hours on one patient," said Colonel Schank, who soon discovered this was a short workday.

While deployed, her medical team worked more than 16 hours a day in the hospital.

A week after arriving, she became the fight commander for the operating room and anesthesia department. The flight was a joint operation made up of 54 Army and Air Force medics, technicians, nurses and doctors.

Colonel Schank said the unit was "an orchestra playing a symphony ... everybody playing their instrument to the beat, rhythm and intensity of the work."

To describe the intensity of the work at Balad, she cited the scrub technician position as an example. A scrub technician is the person who hands the surgeon instruments. A normal day for a scrub tech would be come to work; meet with the doctor; be briefed on the planned surgery, such as taking out an appendix; prepare the instrument tray; and assist the surgeon with the procedure.

In a Stateside trauma center, a scrub tech may need to support two doctors, such as a general surgeon and an orthopedic surgeon dealing with a bad car crash.

"At Balad, a scrub tech could have as many as five surgeons working on one patient at one time," Colonel Schank said. "It was common to have a general surgeon working on injuries in the abdomen, a neurosurgeon doing a craniectomy (removal of part of the skull), and one orthopedic surgeon amputating one limb while a second is working on another limb."

In this case, the scrub tech would handle all the instruments for all the doctors.

When asked about her toughest case, Colonel Schank wells up and starts talking about a young Army sergeant.

"We worked 14 hours on him ... trying to keep him alive," she said whispering.

Over the 14-hour period, she pumped enough blood products into him to have replaced his blood over five times.

"Towards the end I thought, 'Come on sarge ... we worked too hard to let you die now... come on,'" she said. "We worked so hard [to keep him alive]."

Unfortunately, the patient did not survive his wounds.

Her most heartwarming patient was a 4-year-old Iraqi boy who was severely burned over half of his body. His worst burns were to the side of his face where he lost an ear and his right hand that was at risk of losing his thumb.

"The doctor opened his abdomen to stitch his burnt thumb inside," she said. "The doctor needed to get a blood supply to the thumb. A week later when we remove the thumb from his abdomen, it had worked.

"I spent over 20 operations with this boy and, by the time I left, he was ready to go home with his dad," she said.

Many of her experiences as a commander were positive and rewarding. One of the issues she dealt with was a policy on supplying blood.

At her civilian hospital, Colonel Schank has access to blood in the emergency room. At Balad, the ER personnel did not. If patients needed a blood transfusion, they would need to wait until they were taken into an operating room.

Colonel Schank went to the Balad lab and voiced her concern.

"By giving me blood in the ER, you are giving minutes ... critical minutes ... to start stabilizing a patient," she said.

However, the lab people were concerned the blood would spoil before it was used in the emergency room. With a little brain-storming, they came up with a plan to store a small quantity of blood.

"This gave me the ability to start stabilizing a patient 10 precious minutes sooner," she said.

After four months, it was time for Colonel Schank to return home.

"It was nice to be home but tough to leave," she said, adding that "it would be a privilege to return to Balad" if asked to deploy again. (AFRC News Service)