The Bosnian War was an international armed conflict that took place in Bosnia and Herzegovina between 1 April 1992 and 14 December 1995. After popular pressure, NATO was asked by the United Nations to intervene in the Bosnian War after allegations of war crimes against civilians were made. In response to the refugee and humanitarian crisis in Bosnia, the United Nations Security Council passed Resolution 743 on 21 February 1992, creating the United Nations Protection Force (UNPROFOR). The UNPROFOR mandate was to keep the population alive and deliver humanitarian aid to refugees in Bosnia until the war ended.
Operation Deliberate Force was the name given to operations in the Balkans. As a part of the UNPROFOR forces, LT Jeannie Comlish, NC, USN provided critical medical support under the UN mandate as part of Operation Provide Promise. One of the most experienced operational nurses in the Navy, now CAPT Comlish retires from active duty in December of this year, following tours as Chief Nurse aboard USS Carl Vinson (CVN 70), Executive Officer at Oak Harbor Naval Hospital, Commanding Officer of Naval Hospital Guam, and a tour in the Pentagon under the Assistant Secretary of Defense for Health Affairs and Liaison to the Defense Health Agency. These are some of her experiences during Operations since the Cold War.
I am proud to have served as a Navy Nurse Corps officer from September 28, 1990 to the day I retire on December 1, 2018. I have been blessed with amazing opportunities to serve my country, to train alongside the most dedicated men and women of the United States military, and to care for warfighters, their families, and retirees who have served before us. On this 100th Anniversary of Armistice Day, I have reflected on those memories specifically of operational experiences I have had as a nurse.
Following the February 6, 1994 marketplace massacre in Sarajevo, United Nations Secretary, General Boutros Boutros-Ghali requested NATO support. Responding to the UN request, Admiral Jeremy Boorda ordered air strikes against targets determined to be responsible for attacks against civilian targets. At this time, I was a Lieutenant stationed as an intensive care and emergency department nurse at Naval Hospital Camp Pendleton. I was a member of the Fleet Hospital Six team of nurses, doctors, allied health, and hospital Corpsmen who had trained together for such a mission only months prior. On March 13, 1994, I found myself on a C-130, sitting in orange mesh jump seats bound for the very long trip to Zagreb, Croatia to support the United Nations Protection Force (UNPROFOR). Immediately upon arrival, we marched in to a large tent for a lecture on mine safety. Essentially we were told that the Former Republic of Yugoslavia was a territory covered with land mines long forgotten by those who placed them, as borders were pushed back and forth between warring sides. We were told to stay on paved roads only, to avoid any woods or grassy fields, and what types of injuries land mines caused, something I had never seen as a Master’s prepared Trauma/Critical Care Clinical Nurse Specialist in US hospitals.
I was assigned to the Intensive Care Unit, Casualty Receiving, and as a medevac nurse. At that time, there had been no formal Navy training provided for helicopter flight nursing, or en route care, and only the Emergency Nurses Association’s course entitled Trauma Nursing Core Course, which few nurses had taken and was not yet a requirement for deployments. Our team of roughly 23 nurses, 24 physicians, and a much larger group of Corpsmen, allied health and administrative professionals were selected from several Naval hospitals along the West Coast, including Naval Medical Center San Diego, and Naval Hospitals at Camp Pendleton, Naval Station Bremerton, Marine Corps Station 29 Palms, and Naval Air Station Lemoore.
While my experiences were incredible and varied, and each patient was unique and cherished, my most memorable experiences were in the care of UNPROFOR soldiers from Russia, the Ukraine, Poland, and Canada. Nurses are trained to provide holistic care for patients, which means we must always take into account a patient’s physical, psychosocial, emotional, and spiritual well-being, as well as their educational level and best form of communication to ensure they are informed of their healthcare options. The memories I share below provide such examples.
The Russian soldier was a 19 year old who had stepped on a land mine, losing one leg and severely damaging the other. He became almost a mascot to our team as his case was one of the first serious casualties, and one who remained with our team beyond his acute injury into rehabilitative phases of care. While Dimitri survived his physical trauma, he was separated from his “family” of fellow Russian troops and was still developmentally a teenager. It was unusual for a Fleet Hospital, essentially what civilians may understand as a MASH unit, to care for patients beyond acute injury. Normally once a patient was stabilized, they would be transferred back to their home country for further routine care and rehabilitation. But concerns were voiced that Dimitri may not have the kind of resources for which amputees in our country have access. So, our team from the physical therapy department worked with him extensively, and were able to acquire a prosthetic leg. Imagine our surprise and joy when Dimitri walked out, assisted only by a cane, to observe our 4th of July parade and ceremony when we received the United Nations Medal presented by Force Commander, General Bertrand de Lapresle and MGEN Raymond Crabbe. During Dimitri’s stay with us in a holding area once he was no longer in need of acute care, it was difficult at times to keep him from sneaking out with friends who would take him to a bar and drop him off drunk in the wee hours of the morning. At one point, we resorted to hiding his prosthetic leg. All in all, I believe that keeping Dimitri with us allowed him to transition well from a very traumatic event to a more normalized life with his prosthetic leg, and met a holistic approach to care that one might not expect in a deployed unit.
The Ukrainian soldier was not as happy a story. This 27 year old was a lookout near Sarajevo and was unfortunately the victim of a sniper. He was medevac’d to us in grave condition. Our team did all we could and we maintained him on life support in the ICU until we could acquire a second opinion from a Croatian surgeon on brain death. But this case taught us all a lesson on cultural differences in medicine. In the US, brain death signifies death in almost every case. However, in this soldier’s country, cardiac death was considered definitive. With advanced technology being what it is, and in young adults, the heart and lungs and other vital organs may be kept functioning for quite a long time. After several weeks, we were finally able to obtain a 3rd opinion from a Ukrainian physician and further life support efforts were deemed futile. But the story doesn’t end here. Our Commanding Officer, CAPT J.A. Johnson, MC, USN, was a man with a strong faith. He found out that our patient was of Eastern Orthodox religion and endeavored to find an Eastern Orthodox priest who could provide last rights prior to removal from life support. This was no small feat, as there were reportedly only two in the region. On the day the priest arrived, looking absolutely like Rasputin- tall with a long grey beard, long black clerical vestment, and black hat with long material extending from it, the ICU staff and our CO gathered around the patient’s bed. Incense was dispersed via a thurible by the priest as we all prayed. It was one of the most reverent ceremonies I had ever taken part in on a deployment, and I believed supported the final spiritual needs of the patient. Following the patient’s death, representatives from numerous countries supporting UNPROFOR troops assembled on the tarmac, as the casket was draped in the Ukrainian flag, and we rendered our final salutes as this soldier was returned via plane to his country. I remember feeling like all of us, represented from many different countries around the globe, were united in respect for the sacrifice of this soldier and our desire for peace. It was a profound lesson.
The Polish patient was an older man who was admitted for severe abdominal pains. Through our diagnostic capabilities, it was determined he would need a cholecystectomy- removal of his gall bladder. However, the challenge was- how do we communicate so that the patient has informed consent for surgery when he spoke only Polish? We had no one on our staff who spoke Polish and no access to a Polish translator. However, I have found that with every operational mission I have ever taken part, one becomes a “MacGyver” in that one can practically make a ventilator out of some duct tape and paperclips or whatever is on hand- innovation is critical. We found a patient who spoke English and Russian. We found another who spoke Russian and Polish. We were able to communicate in a “telephone game” type fashion by speaking English to the English/Russian patient, who then spoke Russian to the Russian/Polish patient, who then communicated directly to the patient. Since that time, we now have the luxury of iPhone Google Translator and other such devices and apps, but at the time, we did what we could to ensure our patient had at least some semblance of informed consent.
My final memory of that deployment is one I will indeed cherish always. Two Canadian soldiers were traveling in a vehicle when they drove over a land mine. The explosion resulted in one soldier losing both legs, and his Lieutenant sustaining shrapnel wounds to his face and eyes as well as an injury to his leg. I was the medevac nurse on call that day. We had never had any night airevac missions as they were deemed too dangerous, and the permissions required included notifying the opposing forces and obtaining agreement not to shoot us down. The patients originally were too unstable for flight during daylight hours, and as the evening approached, we were growing concerned that the mission would be delayed until the next day. However, we finally got permission to launch. We had to fly to a hillside where the Canadian Battalion had a MASH hospital similar to ours. We landed and received report from our counterparts, but as it had grown dark, the mission was at risk. An orthopedic surgeon, a nurse anesthetist, a Corpsmen, and I were attending to the Lieutenant in near darkness in the UH-1 helicopter when our microphones used to communicate with each other went dead. Always improvising, the Corpsmen shone a light on our faces while we mouthed directions and made up hand signals to communicate vital signs and doses of medications to push intravenously en route.
When we landed, we further stabilized the Lieutenant and then loaded him into an ambulance to take him to a local Croatian hospital with an ophthalmologist surgeon. I remember talking to him and telling him to stay strong, he was going to make it and we would stay with him as long as we could. To my amazement, his UN ID card showed we shared the same birthday, the day his injury had occurred. After several days in the Croatian hospital, the patient returned to us with his jaw wired and patches on his eyes. On the day his eye patches were removed, I got a wheelchair, improvised again by placing wood on the seat to extend out for the patient’s leg, and wheeled him outside to the edge of the compound to watch the sunset over the Medvednica Mountains. I remember the fields were in full bloom and looked golden as the sun set. I was also with the patient the day he and his driver, now a double amputee, were picked up by a private jet belonging to the Canadian Prime Minister to return home these two soldiers of Princess Patricia’s Royal Canadian Light Infantry. A year later, when I was back in the US and remembering that medevac mission, I found the Lieutenant’s address and decided to write to him. I wrote of the unprecedented mission flying at night, that I had found the reason our microphones failed during the flight was because the pilots had cut us off while frantically trying to convince the opposing force that we were “friendlies” and on a medevac mission, in the midst of a MIG jet being launched to shoot us down otherwise. I told him how worried our team was to leave him in the care of others for whom we did not know, in a hospital in which no one spoke English. To my great surprise, I received back a three page legal-size letter bringing me up to date on what he was doing and relaying that, while he was unaware of any of the details I provided him, he said, “…my main memory was that you were the nurse who wheeled me out to see my first sunset, when I thought I would never see again. Thank you.”
As a trauma nurse, we see patients at the very worst of their lives, when they are unconscious or fighting for their lives. Our portion of their resuscitation and care is often forgotten during their recovery period. We never expect to receive thanks because our reward is our efforts have contributed to their survival, but when we occasionally do, it’s enough to keep us going for years!
My deployment in support of Operation Provide Promise to Zagreb, Croatia was at the
beginning of my Navy career when I was a Lieutenant. As a Lieutenant Commander, I had the opportunity to be stationed on the USS Carl Vinson (CVN 70) aircraft carrier as the only nurse during 9/11. I distinctly remember the day, as the ship was in the Northern Arabian Sea, and the Commanding Officer announced, “The United States has just been attacked, we are going to war, we are ready, that is all.”
I would use this statement years later as Commanding Officer of US Naval Hospital Guam when I discussed the importance of readiness with new members of my team. I would tell them, “when I was a Lieutenant, or even as a Commander, if anyone had told me that I would one day be a Captain or a Commanding Officer of an overseas hospital, I would not have believed them. But as it is, here I am, and if the United States, specifically Guam, under a North Korean threat was ever attacked, I would like to be able to say with confidence: We are ready.” I explained to my team what I felt was the foundational principle for all that we do, and that is TRUST- Teamwork, Readiness, Unparalleled quality patient care, Stewardship of our resources, and Training and mentorship. We would be ready personally, professionally, mentally, and have the spirit to fight. The lessons I learned during my naval career carried me each step of the way.
In November of 2014 I was assigned as the Chief Nurse of the USNS MERCY (TAH-19)
hospital ship. I had been told by everyone that it would be an easy assignment as the ship hadn’t deployed since 1990 Desert Storm, and in fact, was being discussed for
decommissioning. However, within 45 days of being assigned, the ship’s crew was called upon to respond to the massive destruction of the Southeast Asia tsunami. We were able to get the ship underway within 96 hours, and headed west across the Pacific Ocean with our mission merely stated as “Go West and Do Great Things.” Our core crew of approximately 60 civilian mariners and 60 medical personnel were initially augmented by approximately 278 personnel sourced from several Naval Hospitals across the United States, but as we made our way to Hawaii, we further augmented our team with volunteers from the US Public Health Service and the Non-Governmental Organization (NGO) Project Hope. Our stop in Guam added a security team.
I remember being on one of the first helicopters from the ship to land in Banda Aceh, Indonesia. While I have never been to Hiroshima, Japan, I have seen photos of the massive destruction caused by the bombs that leveled the city. As I flew over a beautiful ocean and got closer to what had been the shoreline, I saw nothing but devastation that mirrored those
photos. Over the next several weeks, as Chief Nurse, I worked to integrate a “team of teams” from a variety of military and civilian backgrounds, to train our staff on equipment that was different from land-based hospitals, and to re-orient staff to hard-copy charting as we did not have electronic health records. Among my numerous memories are those that challenged my organizational and leadership skills. Our Project Hope staff was tremendous, but were volunteers, largely from Massachusetts General Hospital initially, and as such, could only volunteer for a three-week period. At one point we had three wards open, filled with patients and their family members, in addition to the operating and recovery rooms, casualty receiving, and intensive care units.
When it came time for the Project Hope volunteers to rotate out, there was a 48-72 hour
period of time between the next Project Hope group of volunteers arriving, being trained, and ready to care for patients and not enough military nurses to care for all the patients. Through impressive networking and collaboration with other country providers ashore, we quickly were able to bring onboard enough Australian nurses to work alongside our team so that appropriate care and assistance could be provided to patients and their families while awaiting the next Project Hope team to get acclimated and trained. I know of no civilian hospital in which they can average 54 admissions a day, 30-50 discharges that required coordination including transportation off the ship via helicopter or boat, with over a 60% staff turnover rate, while maintaining superior safe patient care, yet our team had such unity of focus that we were able to accomplish just that.