1. Irwin, Maria BS, RN

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I'm a commissioned first lieutenant in the 344th Medical Task Force, stationed at Abu Ghraib Prison Hospital in Iraq, on the western outskirts of Baghdad. I joined the Army Reserve after September 11, 2001, and made an eight-year commitment. I have five years to go, but who's counting?


For seven years before being deployed to Iraq, I was a clinical nurse III on a hematology-telemetry floor at Memorial Sloan-Kettering Cancer Center (MSKCC) in New York City. I went into nursing after being the primary caregiver for my mother, who was diagnosed with esophageal cancer when I was 24. I've since remembered what it's like to take care of someone you love who is suffering.


I've never been married, and I have no children. I have one orange striped cat named George that I rescued from the pound. I have one older brother, Russell, and a four-year-old godson, Henry. The staff at MSKCC is my surrogate family. I would give up everything for a nice guy and a golden retriever.


I had a hard time leaving my cat, and I don't understand my peers who have left young children at home. At least I don't have that heartbreak to contend with.



On the way to Iraq we stopped in Kuwait, at Camp Buehring, about 30 miles from the Iraqi border. When we arrived at the Kuwaiti International Airport, we were loaded onto buses. We had to save the first two seats in the front for the shooters. Every time we went over a pothole I expected to be blown sky high by an IED (improvised explosive device).


Kuwait is pretty much what you would expect: white, hot, and sandy. To simulate the Kuwaiti experience, turn a hair dryer on high and stick it on your eyeball. And throw sand on yourself.



Long hours, no cappuccinos, no massages, and too many long days in a row. Here I mostly do pin care for external fixations, insert nasogastric tubes, and treat gunshot wounds. We get very few burns. Nurses have almost total autonomy here, so I try to maintain a high standard of clinical practice-tricky when I've only worked as a leukemia nurse and don't know much about wound care.


The patients I'm caring for here aren't called patients; they're "detainees." The stories of abuse and torture that made headlines in April 2004 are impossible for me to reconcile with the people in the army reserve whom I've known for three years and whose values are loyalty, duty, honor, respect, courage, selflessness, and integrity.


Respect for human rights is intrinsic to nursing. Being a licensed RN means that one is bound by a code of ethics, and I've actually glued the ANA's code of ethics into an army manual I brought with me to Iraq. Of all my worries, none preoccupies me more than the issue of detainee abuse: how do I adhere to the code when I'm taking care of detainees, some of whom are subject to interrogation? Am I colluding with interrogators if I provide resuscitative care to a patient who is then handed right back over for more questioning?


Clear signs of what the army calls "suspicious" injuries-burns, bruises on the soles of the feet, soft tissue injuries to the back-are easy to detect and document. This is familiar territory to most nurses because we handle such cases in the same way we handle the abuse of children and elderly people: we document our clinical findings on the assessment form and inform our superiors; we also write in the patient's comments in the subjective portion of our notes. In addition, we must report any suspicious findings to the Criminal Investigation Command, which will investigate the allegations. But what about the more subtle symptoms, like dehydration, exhaustion, or muscle pain caused by stressful positions? This is murkier ground. And what about the patient who has been shot 15 times, has lost a leg, and is covered with scars from the bullet wounds. Has he been abused? I haven't seen any clinical evidence of torture. After all, this is a combat zone and people get blown up every day-civilians, detainees, and American GIs alike. But how do I know for sure?


The army maintains that the Geneva Conventions must be observed, and that the dignity and safety of detainees must be protected at all times. The army also forbids the interrogation of detainees while they are receiving medical care, meaning that nurses must safeguard their patients while they remain on the floor.

FIGURE. Maria Irwin,... - Click to enlarge in new windowFIGURE. Maria Irwin, left, and a fellow soldier in Iraq.
FIGURE. Irwin with h... - Click to enlarge in new windowFIGURE. Irwin with her father in New York City, before deployment.

During a 10-day, predeployment training session at a simulated combat support hospital in Fort McCoy, Wisconsin, I learned how to communicate with detainees using translators and Arabic fact cards to explain their rights and responsibilities as they undergo medical care. One thing was made very clear: the army is serious about prisoners receiving the best medical care we can give them.


As an officer I believe in the army's values, and conversely, I hold the army up to its own standard. As a nurse, I feel I must offer my patients-no matter who they are-the best care possible.