FROM ONE CHILLING VOICEMAIL, I knew from 30-plus years of critical care nursing experience that Elizabeth would not be returning to my clinical group any time soon.
“Hi. My name is Elizabeth* and I'm in your clinical group,” the message began. “I just want you to know that I have to miss our first clinical day in the ICU because I just found out that my husband was wounded in Afghanistan and is being flown to the Army's burn center in Texas. I'm on my way to meet his flight but I'll be back for clinical in a week or so. Thanks for your understanding.”
She did not yet realize that being evacuated to the nation's premier burn center was not a good sign. Just surviving the flight, from Afghanistan to Germany to Texas, would be an amazing feat. I immediately called Elizabeth. After a little small talk, I asked her if she remembered if they told her what percentage of burns Dylan had.
“I think they said 90 percent. I know that's bad,” she said. “I'm leaving soon, once I get someone to watch our dogs and stay in our house. I'm taking our young son with me so he can see his dad as well.”
“Please don't worry about school work or clinical right now,” I said. “Your top priority is getting down to Texas as fast as you can, and we'll figure out the rest later. Safe travels and circle back to me as soon as you have some news. I'll be praying for you and yours.” She thanked me and said she would talk to me soon.
Elizabeth flew to San Antonio and reunited with her husband at the U.S. Army Institute of Surgical Research Burn Center, located at the Brooke Army Medical Center (BAMC) in Fort Sam Houston, Texas. Dylan was alive but was in fact burned over more than 90% of his body. He had also suffered a traumatic brain injury that made him uncommunicative, which is not uncommon with blast injuries. A roadside bomb had incinerated the vehicle transporting Dylan. The fact that he survived the blast was a miracle.
After being at Dylan's bedside for a week or so, Elizabeth called me and said, “It's bad. They had to amputate Dylan's legs and one of his arms because of infection. He goes to the operating room every day for something, whether it's an amputation or a debridement of his burns. He remains in a coma, so I don't even know if he realizes I'm here, but I do talk to him. I don't want my son to see his daddy like this so I'm waiting for the right moment to bring him to Dylan's bedside. I don't think I'll be back this semester. I just don't know what to do, but I have to stay here. I can't leave Texas right now.”
I told Elizabeth that I would figure out her schoolwork from my end and when she was ready to continue, we would have a plan in place. A week later Elizabeth reported that Dylan remained uncommunicative but was alive and breathing on his own, and that his condition was relatively stable. She asked what her options were for completing her BSN degree. Elizabeth was in her last year of our nursing program, so we just had to figure out how to help her complete two semesters of schoolwork. We researched having her complete her BSN as a transfer student in several Texas universities, but the plans of study differed from ours. Even if they had been similar, Elizabeth would not have met the university residency requirements from either our end or theirs.
Ultimately we figured out a way to deliver Elizabeth's didactic content online. Because I was a U.S. Navy Nurse Reservist who sat on a tri-service nursing advisory board, I asked my Army colleagues if Elizabeth could complete her clinical hours via a preceptorship. She could—as long as the clinical was not performed in her husband's ICU at BAMC.
I'll never forget the day I got the email from a nurse educator at BAMC stating, “We will make this happen. We have already identified preceptors for Elizabeth. I see in the syllabus you sent us that she is required to complete some simulation exercises. If you send us those scenarios, we'll run them for you.”
Talk about teamwork! Both Elizabeth and I cried when I shared the news. Within the next week, Elizabeth started her clinical rotations and caught up with her coursework via our online learning management system. Sometimes her ICU clinical shifts had to be rescheduled, especially if they were on Dylan's surgery days, but Elizabeth excelled and completed all of the requirements that her on-campus peers had to complete.
Fortuitously, I had to fly to San Antonio toward the end of Elizabeth's last semester of the program. Before flying to Texas, I contacted the manufacturer of our school pin, explained the circumstances, and said I would be paying for Elizabeth's pin. The receptionist replied, “We've talked this over with management and you're not paying for the pin. We want to donate it on behalf of the sacrifice Elizabeth's husband has made for our country.”
Wow! Out of this tragedy, something good has transpired, I thought. I was then able to visit Elizabeth, meet her son, thank the staff who helped with Elizabeth's clinical rotations, and perform a ceremony in which I presented her with a graduation congratulation letter from her husband's commanding general.
Elizabeth completed all of her coursework several weeks later and the BAMC nurse educators held a graduation ceremony for her. She wore her graduation gown (which I had hand-carried to her) and received her school pin.
I lost touch with Elizabeth about a year after her graduation, mainly because she moved with her husband to different centers in various states for care. Sadly, I recently learned that Dylan had passed away, succumbing to his war injuries almost 7 years after he had been flown to Texas.
As Memorial Day approaches, keep in mind that it is a day of remembrance for those who have died in service to the United States of America. On this and every future Memorial Day, I will be thinking of Dylan and always wondering how his wife and son are doing.
* Names in this article have been changed to protect anonymity.