By the end of 2003, I knew I was getting out of the Air Force (AF). I had been stationed at Elmendorf AFB, Alaska since November 2001 working as an Operating Room (OR) nurse in a busy, understaffed OR. While we toiled away banging out cases, I saw our immediate leadership as mostly lazy white-gloved “clipboard” nurses–and no, that’s not a compliment. We had a mixed bag of staff. Many were excellent; hardworking and dedicated. Others purposely dragged their feet just enough to ensure their room’s scheduled cases didn’t end first–because finishing your scheduled cases meant you got the urgent and emergent add-on cases.
Time is everything in an OR: What time did I interview the patient? What time did anesthesia personnel interview the patient? When did we start opening sterile supplies in preparation for surgery? What time did we enter the OR? What time was the patient intubated? When did the surgeon do the “time out”–a final check that the consent form matched the surgery to be performed? What time did I insert the foley catheter? When did the surgeon make the incision? What time did the surgeon apply intraoperative medications? What time did we count the small items (and instruments depending on incision size) ensuring nothing was left inside a patient? What time did the surgeon close the wound and place the dressing? When did I remove the foley catheter? What time was the patient extubated? What time did we leave the OR with the patient? When did we arrive at PACU (Post Anesthesia Care Unit)? What time was the OR cleaned and ready for the next case? And on to the next patient. Rinse and repeat. Again and again… as fast as you can, day in, day out, holidays, weekends, and in the middle of the night.
Efficiency is everything in an OR. Yet it was well-known who among us took unnecessary extra minutes here and there to open the room or interview a patient. Over the course of a day, and several procedures, those minutes add up. There would inevitably be add-on cases, unscheduled urgent or emergent surgeries and even if you weren’t on call, you might get stuck in a room past your normal shift. Why? Because the nurse on call was often stuck in their room that was running late with scheduled cases. Or there might be another urgent or emergent case that ties them up. And the nurse on call had no incentive to work efficiently to relieve you. The more you did, the less the on-call nurse had to do. Also, there was a good chance the on-call nurse, who was already working late, was coming back sometime in the middle of the night for a C-section, appendectomy, cholecystectomy, or a trauma.
Working hard wasn’t rewarded. The more you did, the more you got. The only incentive was internal. Integrity and not wanting to leave someone stuck in a room were personal choices. And we knew who’d leave you hanging. And in my experience, with rare exceptions, our leadership would leave you hanging too. Most of the time they remained safely in uniform shoved behind a desk tapping away at a keyboard. I say “safely in uniform” because they weren’t in scrubs. There’s literally a red line to the entrance of every OR and only staff dressed in proper scrub attire can cross it. More often than not, the nurse running the board (tracking surgeries and staff for each OR) did their 8 hours and left. The bean counters looked out for themselves, not their worn-out staff. There are many surgical specialties and OR nursing skills are perishable. The way I saw it, leadership wasn’t only lazy, they couldn’t hack working in the rooms.
That lack of support carried over into my personal life. With a father who’d been a part of JSOC since age 10 and who remained active in it until almost literally the day he died, military service dominated my family life growing up. It dominated my Air Force life as well. In my mind, family and military service were inextricable. When my son was born in September 2002, it had been a struggle to take leave to be with my wife (Jen), 3-year-old daughter, and newborn son. Why was this a struggle? We were short-staffed and the mission came first. But also, no one from my family was able to come visit us. It stung. This had become a trend as, three years earlier, no one from my family was on hand to celebrate when my oldest daughter was born in Louisiana. This was hard–we needed support, in the OR and outside of it.
Thankfully, my wife’s parents came when my son was born, just as they had in Louisiana. I had volunteered to deploy in February 2003–I thought it was to Iraq. Growing up, deploying to the world’s worst hot spots was what you did in my family and I wanted to be a good son as much as a good father. But I’d been sent to Guam instead of Iraq… yeah Guam. The deployment was a metaphor: I wasn’t doing enough. I hadn’t yet earned a place in my family, in my extended tribe. And I wanted so much to be a close-knit family.
Soon after returning from Guam, Jen became pregnant with our third child and we weren’t having any more. I mentioned this to my mom and asked her to be there for the birth. I’m sure my father was deployed or TDY with JSOC. Mom seemed hesitant but agreed, timing her visit with Jen’s due date of February 21, 2004. But when the due date came and went, she explained if Jen didn’t deliver by the 27th, she would have to return to North Carolina. So when Jen didn’t deliver on the 27th, I drove my mother to the Anchorage airport at o-dark-thirty on February 28th. It stung, like a sliver of ice, worming into my heart. It was a familiar, but now amplified, pain that had been with me since age 10. I didn’t recognize it then, but it was the same feeling I experienced as a child realizing that my father prioritized his work over his family. I didn’t want to accept it.
After dropping mom off at the airport, I returned home to find Jen in labor and immediately took her to the hospital. We checked her in the hospital at 6:30 am and our daughter, Jenna, was born shortly after noon. Mom had a change of heart during a layover and though she had missed Jenna’s birth, returned and stayed one more day. And again, I had to fight with my superiors to take leave to be with Jen, our 4-year-old daughter, 17-month-old son, and now newborn daughter. Why? It was always the same: we were short-staffed. My boss said, “Don’t you have family that can help?” It broke my heart to tell him no. Thankfully, Jen’s mother came up and stayed for three weeks. I don’t know what we’d have done if she hadn’t. I was thankful for them but also wanted my parents to be there too. No, what I really wanted was for them to want to be there.
I refused to accept where my family and I fell among the priorities of my family in North Carolina and there wasn’t enough camaraderie in the AF to fill that space. When my DEROS (date eligible to return from overseas) was up I planned to separate from the AF and move back to NC to be closer to them. Mom was actively involved in my sister’s kids’ lives. I told myself that I just needed proximity to have the close-knit family I’d always wanted.
I reasoned that we had lived in Louisiana, then Alaska when my children were born–we’d been too far away. I was asking too much of my family to be there. But my DEROS wasn’t until November 2004. I’d have to do my time in an overworked OR with lackluster leadership support (with one notable exception). I didn’t realize it at the time, but the disconnected and dysfunctional leadership reflected the experience with my own family. I took it personally. I worked hard, respected those that did, and seethed at those who didn’t. I would do my time and get out–and find a place in my tribe back in NC.
When I heard about an upcoming deployment to Iraq in September 2004 I jumped at the chance. I had to go. Although the specific location was undisclosed, this time it was no secret that it was Iraq. Finally, my military service, at least some small part of it, would mean something. I could do something to be proud of; something my family back in NC would be proud of. Except.. someone else was tapped to go. So I could go to Iraq only if I switched with him. He’d PCS’d to Elmendorf AFB that summer, had recently deployed to Turkey, and was only too happy to swap places with me. And I was only too happy to go.
I remember a fellow nurse eyeing me suspiciously when he found out I volunteered. “What’s your angle?” he sneered.
“Patriotism,” I answered not hiding my disgust at his question.
We locked eyes for a few seconds.
“No… No… you’re getting something out of it,” he shook his head, “I just can’t figure out what it is yet.”
I’d like to think I told the guy to go F*** himself, but I probably just shook my head and moved on. People like that were nothing to me. It just didn’t click with him–or much of the AF as far as I could tell. Not part of my tribe after all, I guess.
In the Air Force corporatism, not patriotism, seemed to prevail. Air Force culture–suffused with the ever-present 20-year countdown until retirement. Arrogance permeated the enlisted ranks almost as much as the officers. Though there were definitely some great people in it, it seemed most of the brass weren’t interested in their subordinates. Most had their eye on the next rung of the AF corporate ladder or else biding their time until they could get out. The Air Force Core Values are Integrity First, Service Before Self, and Excellence In All We Do. But in my experience, it wasn’t much more than a commercial. I saw precious few who actually conducted themselves that way. I was a true believer in the military, but I didn’t belong in the Air Force. While there were some good folks, the AF as a culture wasn’t my tribe.
The truth is I didn’t want to belong in the AF because, in hindsight, that corporate goon of a nurse had a point. I was practically born a patriot–I believed in the mission. I wanted to serve my country. But I also wanted to belong to my family back in NC. I wanted a place among them, not just for me, but for my wife and three young children. But first I had to go to Iraq. I embraced the siren’s call to deploy that I’d heard singing since age 10. It promised that we might matter more to them if I did.
That was my angle.
Mike Warnock is the editor-in-chief of The Havok Journal, an Air Force (USAF) veteran, and a retired Army Nurse Corps officer. After working 10 years as both a civilian Operating Room (OR) nurse and USAF OR nurse, he served in the Army from 2007-2019. The majority of his 23 years of professional civilian and military service were spent in clinical nursing, which included working in several ORs, in various clinical leadership and staff Officer positions with two deployments to Iraq.
As the Voice of the Veteran Community, The Havok Journal seeks to publish a variety of perspectives on a number of sensitive subjects. Unless specifically noted otherwise, nothing we publish is an official point of view of The Havok Journal or any part of the U.S. government.