Christine Elmer Collins

As soon as I arrived in “the sandbox,” otherwise known as Afghanistan, I started journaling. In fact, it was within the first 24 hours. It may sound weird, but I was very aware of my surroundings. I was very tuned in. And not simply “tuned in” as an American service member serving in a war zone who needs to stay “tuned in” to survive. It was a “tuning in” to everything that being there was soon to unleash and unload on me.

Reflecting on it all, I knew that I was going to Afghanistan for a purpose. I wasn’t sure what exactly that purpose was, but I knew that it would be a life-changing event for me. It all seemed to start with how I got there—the many delays in our flight, the hang-ups, all these things that played a factor in my eventual arrival and then my first patient. It was like I was meant to be there on that day, to take that first patient at that very moment. There was something profound in that event. It was more than just the patient. It was, in a way, symbolic of what the rest of my tour was going to be. It was a deep connection in a way that I could only share by capturing it with words. Much in the way that the Ernest Hemingway quote says. I didn’t know how to write. I wasn’t even sure what to write. I just knew that I had to get it out, let it out, and spill it out. I suppose the quote is true, and almost in a literal way…I had to bleed.

So, in my very first journal entry, it's like I recognize that. It all made sense why certain things happened before for me to get to where I was on that day, to get that patient to do then the work that I did for that person. And it was from there, that patient, that moment, that I just started journaling. When I decided to start writing, my intentions were twofold. On one hand, it was more of a catharsis—a therapy for me. Deep down inside me, there was a seed of hope that I could transfer this chaotic, traumatic, minute-by-minute experience that I knew I'd be having daily. The goal was to put it on paper to capture its essence. On the other hand, the second part of my writing was to send home to my husband, Clinton. I wanted him to understand what that place was like and what the experience was like for me. I wanted him to know that I was going to return a changed person and that I had written the reasons why in my journals. I wanted him to understand, later on, why. The woman, mother, wife, nurse, and American who deployed to a war zone in 2009 was not going to come home whole. I knew I was going to be different even before I left, but I didn't know how or who I would be when I returned. My hope was that these journal entries would help Clinton better understand what I went through so that he would be somehow prepared for the woman who was (hopefully) going to come home one day. The real truth? The part I never shared with anyone until now in this book? I wanted to be able to read about the woman I was, so I could read her words and find my way back if I ever got lost.

A lot of jacked-up shit happened. And I want you to know, yes you, that this is going to be a fucked-up mess. My greatest hope? The reason why I write this book? Because if you’re reading this, you too have likely been through, or are in the midst of, some kind of fucked up mess. Maybe this will be a beacon of light, of hope for you. Perhaps by reading my story, you’ll see yourself. And in the end, you’ll realize what I am still realizing today. That the only way to truly thrive is to share it, talk about it, let it out, and live. Fucking live! Come on now. Buckle up. Lock and load. We’re going to Afghanistan.

My First 72 Hours - Afghanistan, January 8, 2009 - Amazing, absolutely amazing...the way I felt today. Over the last 72 hours, I have flown from Germany to Manas, Kirghizstan, to Afghanistan. Not only have I traveled across the world in these 72 hours, but I have done something so amazing I get emotional just thinking about it...you ask, WHAT??? What can be so amazing??? Well, I will tell you, over the past 72 hours, I have been nonstop traveling, missed flights, getting held up due to bad weather, aircraft failure, the hustle and bustle of in-processing, a change in preceptors for orientation to the unit and even a change in shift, which all lead me to one of the most important 72 hours of my life.

For the first time in my life, as a nurse, I have never felt more purposeful in what l am doing as a nurse. I took care of a young 26-year-old Romanian Coalition forces member who was fighting side-by-side with our American troops, and his mission was to be completed in just 3 days. This young guy just had his 26-year-old birthday on the 1st of January, and then on January 3rd, he ended up with blunt force trauma to the head due to an Improvised Explosive Device (IED) blast, causing a basal skull fracture. We had to evacuate an epidural bleed on the brain in order to help save his life. In addition, he also sustained an open fracture of the left hand, both eardrums were blown out, and he is on a ventilator. I was this patient's nurse...I was the lucky one to be here to help take care of him and make a difference! He was on 8 different intravenous (IV) drips, he was being artificially ventilated, and he could not speak English, so his interpreter had to be at his side 24/7. The patient had just been admitted a few hours before my shift began (remember the start of the 72 hours...how timing is everything...or maybe it was fate?). I carefully received report from the off-going nurse, and ever so meticulously, I started my head-to-toe assessment, looking at every line, every IV drip, the ventilation settings, looking at his battered and broken skull, which was held together with staples, assessing his neurological stats...as I was doing this, I noticed the patient's interpreter just watching me; he looked so sad. As I completed my assessment, I took a moment and reached out to him with a warm smile. I introduced myself and then began to ask him if he needed anything. I also began to explain what was going on with the patient and what the overall plan was. In addition, we went over all the IV lines, the arterial line that was placed in the patient's right wrist to help monitor his internal blood pressure; we also looked over the ventilator and cardiac monitor. I answered all the questions that he had been holding onto for the last few hours. I could tell that Lt. Fulga was very appreciative and put at ease. He was also able to provide more accurate updates to his Commander. I then began to focus on my patient. For the next 13 hours, I gave my all to this patient—this 26-year-old male whom I will never meet, and he will never know who Lt. Collins was. In a way, I feel as if I gave a small piece of me to him.

The last hours of my first 72. My shift started at 0630, and there, my patient lay, ventilated, and medically sedated. Per the night shift nurse, there was no change in his status. I had gotten word from our Patient Movement Section that my patient would be air evacuated by CCATT, meaning he would be transported by a large aircraft with the Critical Care Air Transport Team. Immediately after I got to work, there was so much to do in such a short amount of time. The team would arrive in just a few short hours. As I began to get the patient ready to be transported, l made sure that I sat down with Lt Fulga. We discussed the transport, and I went over the condition of the patient (believe it or not, the patient is expected to make a full recovery). As Lt. Fulga and I talked, I began to ask about the patient's family. My first question was, does he have a family?? And the answer to that was “YES.” I then asked if the family had been notified. And that answer was also “YES.” Lt. Fulga began to tell me that the Romanian soldier has a mother and sister that he keeps in contact with. He calls the patient's family every day, and I found out that the patient's sister is also a nurse. In no time at all, the CCATT team was here to take the soldier to Germany...talk about controlled chaos. As we packaged the patient on the transport gurney and reconnected him to the CCATT equipment, Lt. Fulga came to me and with the sincerest eyes I have ever seen in my life, he took my hand, squeezed it, and said, "Thank you, thank you so much for all you did." I simply replied, "Thank you...I was just doing my job". Lt. Fulga asked me if he could take a photo of me so that when the Romanian Soldier awoke and was recovering, he could show the soldier who took care of him and helped save his life. As they left through the trauma intensive care unit (TICU) doors, Lt. Fulga waved and smiled with a tremendous amount of gratitude radiating from his face. It is life at its finest: living moment to moment with an uncertainty of what patient will be coming through our doors. What new challenges we may face, or what new ethical dilemma we will encounter.

During that same first 72 hours, I also had the opportunity to recover a patient from the operating room. As the patient came to our unit, something was different. This patient had a pair of blacked-out eye goggles securely over his eyes, to ensure he could not see anything, and hearing protection on so that he could not hear anything around him. This patient was different. This patient was an enemy combatant. He was part of the Taliban.

This particular member of the Taliban had been trying to shoot one of our helicopters down, and as a result, he ended up with a gunshot wound to the leg. The man was very fragile looking, almost malnourished; he had two Radical Islamic books with him that he had been reading prior to his hospitalization. It was strange to look into the face of a man who, if he had the chance and a weapon, would not hesitate to kill me right on the spot. As I removed the blacked-out goggles, I looked into the eyes of this man and could feel a sense of rage, horror, and hatred. I was looking deep into the soul of an American killer. As I helped care for this man, I could not help but think about my 26-year-old patient who was struggling to live because of something that this enemy combatant may have had a part in. As we quickly recovered this patient, we transferred him to our TICU, where he was under 24-hour watch by two fully armed guards (12G shotguns and 9mm Beretta). I still struggle thinking about caring for these people whose sole mission is to destroy and kill Americans and any others who dare try to help us. I think it will be a constant theme during my time here in Afghanistan.

A Day Just Like Any Other Day - Afghanistan, January 9, 2009 - As I sit here and think about what that phrase means to me now that I am here: “A Day Just Like Any Other Day?” You ask, what does it mean?? Well, here in Afghanistan, today, just like any other day, has a meaning of everyday trauma, gunshot wounds, burns, suicide bombers, IED explosions, and our American troops coming to us broken and battered. I thought I had seen it all, but today..." a day just like any other day," was less than what I described above. We had a new patient; this new patient was not an American; it was not a local Afghan man; this patient was a young 14-year-old girl who had been raped by a man who her father had befriended months ago. This man not only raped her and left dishonor to her family, but six months later, her family has now realized that she is pregnant. This young girl's mother and brother wanted to hide the pregnancy to prevent public humiliation, so her mother took this young girl to a cowshed located behind their house, held her down while the girl's brother proceeded to cut the unborn baby from her body, using only a razor blade and string to stitch her gaping wound closed.

This poor child lay lifeless and cold in the middle of a cowshed while her brother took the newly born baby and buried it. The girl was in and out of consciousness through this horrific ordeal due to the unreal pain she felt. Remember, this is one of the poorest countries in the world; there was no pain medication, no anesthesia, there was nothing for this child.

Here with us, this sweet girl clings to life. We are doing our best to save her; she has been on life support for the past 2 days. We continue to care for her, rid her of the lice infestation that covers her head, and diligently change her abdominal wound dressings to help with the healing process and prevent infection. She is expected to make a full physical recovery, but the emotional wounds and scars are what I am worried about. How will those heal??? In so many other ways, I hope she doesn't make it because of what may happen at home when she returns. I am so afraid that one of their family members will kill her or sell her off as a slave. Once she is stable to move out of this hospital, I will forever wonder what has become of her. Who will take care of her when she leaves??? I sit and think about what this young girl's future holds; I still continue to pray for her and pray that she remains strong. As her father sits by her side, we will provide medical care for her and be a strong support system for her and her father.

As I began to wonder what her future holds, I heard a voice on the overhead paging system. “Level 1 Trauma,” ...” Level 1 Trauma,” and I immediately went to the ER to report. There were six teams waiting for wounded American soldiers. I was lucky enough to be a part of one of the six teams. We all were waiting for 6 American soldiers who were involved in a suicide bomber attack. As each trauma came through the door, I thought to myself, "This is it...this is the real war...this is the ugly face of war". In a split second, I began to wonder...if they have family, if they have children, do their mothers know they’ve been blown up???

This was it; my patient was here, and I began to yell out what the doctor requested, "I need 1gram of Ancef", and "Pharmacy, I need 100 MCG of Fentanyl." as the ER doctor started his primary assessment I continued to yell out questions to the physician, "Is the trachea midline," "Do you hear bilateral breath sounds," "Equal chest expansion,"...as the dusty greyish-white floor around the gurney began to change into various shades of red, the floor transformed into a palette filled with the soldier’s blood due to massive injuries, he sustained to left arm, left thigh, and right chest wall; I had to pause for a split second and take a deep breath. I had to tell myself, we will get through this; this guy is going to live, he is going to live! As he became more stable and ready to move, we took him to the TICU, where I continued to care for him as his nurse. As this 30-year-old Army soldier lay in our hospital bed, he began to tell me about the incident. I immediately stopped what I was doing and sat down next to him. He began to tell me that he saw the suicide bomber, he saw the vest, he should have known sooner. As he spoke, his eyes rapidly moved from right to left. His sight started to become blurry due to the collection of tears in his eyes. I just held his hand and listened. He then told me that the suicide bomber was waiting for their Lieutenant to get closer. The bomber was trying to take out their Platoon leader. The patient saw the guy push the button, and then the next thing he remembers was seeing two of his buddies dead lying close by. I had tears in my eyes as I looked at his burnt, bloody, and dirty face. I can't help but wonder, after all the external injuries heal, what will come of this soldier? What will happen to his emotional scars? As I sat there next to his bedside and held his hand, I was present. I was emotionally available to him; there wasn't any more exchange of words; the moment was stripped down to a nurse’s ability to show compassion, understanding, and being present during one of the darkest times of this patient’s life.