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New arrivals often did a double take when the mustachioed African American sashayed in for the first time. But they quickly learned the benefits of staying on Mr. Nick's good side. He'd boycott the room of anyone who gave him lip. For those who didn't, such as a badly injured 19-year-old, there was nothing he wouldn't do. The soldier was so depressed he could barely speak, until Mr. Nick persuaded him to confess that he was homesick for his parents, who couldn't afford the trip to Washington. Mr. Nick immediately left the room, returning a few minutes later with a form for government assistance. He helped the patient fill it out and walked it back to the right office. "Let Uncle Sam deal with it," Mr. Nick advised. The parents arrived a few days later.
A 16-year veteran of the ward, Mr. Nick was its sage and institutional memory. Nurses came to rely on his judgment. Above all, he advised that they keep their emotions in check around patients. These days that was a particularly tall order. For all but the past nine months, the staff had worked primarily with retirees recovering from orthopedic problems; they rarely stayed more than a few days, and the pace had been relaxed. Only 14 amputees had been treated at Walter Reed during the brief Gulf War of 1991, and they had been scattered around the hospital. Although nurses had been warned to expect a large influx of amputees from Iraq this time, no one was prepared psychologically for the relentless, wrenching sight. Bombs left the body looking very different than a surgical amputation. Blast wounds were dirty and gory, usually accompanied by the ravage of shrapnel — BBs, nails, and metal shards. Just six weeks into the war, the patriotism and professionalism that drove the ward's workers began to crumble. It wasn't just the carnage — the patients were difficult to comfort. The endless cycle of surgery led to endless pain, usually accompanied by anger, amplified by relatives who squatted like gypsies, and directed at those who were held responsible for easing it. Media and VIP visits made for a tense, fishbowl atmosphere.
Even head nurse Tammy LaFranois , a 14-year veteran of army hospitals, wasn't immune to the strain. She went home many nights in tears, and was particularly struck by the plight of a 26-year-old sergeant who had arrived in early August with both hands missing. Months later, his wounds had healed; his pain was managed. But he continued to live on 57 because he couldn't take care of himself. One autumn day he approached LaFranois at the front desk. He seemed so normal to her until he asked her to tie his shoes. LaFranois waited until that night before she broke down. "You can't believe the things we see," she told her husband.
When many of LaFranois's 20 nurses complained of burnout and threatened to quit, she took the problem to hospital commanders, who called in the hospital psychiatry department. Already overburdened with patients, therapists let the nurses vent and recommended ways of coping. First lesson: Remember the patient has suffered a life-altering loss. Second: Don't personalize the emotional aftermath.
It took novel strategies to persevere. Mr. Nick swallowed the sadness until he left work, then unwound by listening to classical music at home or window-shopping at malls. My day nurse, Tami Barr, had her own game plan. One of the civilians hired to replace army nurses deployed to Iraq, Tami was overwhelmed her first day on the job: the responsibility of caring for young men who had fought for her principles was daunting. Pulling herself together, she decided that she would take it day by day, shift by shift, sizing up each patient's individual needs, then striving to meet each one of them. Armed with her checklist, she was careful not to remove the bedsheet of a soldier who was unusually self-conscious of his deformity or fail to administer anesthesia when changing the dressing of a patient in extreme pain.