TACOMA – The hug seemed to go on forever. Neither wanted to let go.
Rory Dunn and Tina Sundem hadn’t seen each other since their lives briefly crossed in an Army hospital’s intensive-care unit in Baghdad’s Green Zone nearly two years ago. Dunn is a former soldier from Renton who suffered a traumatic brain injury and other wounds near Fallujah, Iraq, in May 2004 when a roadside bomb exploded next to his humvee.
He has no memory of the earlier encounter. He was in a coma and given little chance of survival.
But Capt. Sundem, an Army nurse who treated him and now lives in Pierce County, vividly remembers former Spc. Dunn.
“He was so severely wounded I never imagined he would live,” she said.
On a recent dreary evening at a Red Lobster restaurant in Tacoma, the two met for the first time since Iraq.
For Dunn, 23, the reunion was a chance to say thank you. But for Sundem, 34, it was another step in her own recovery. Sundem’s experience in Iraq left her so traumatized that she attempted suicide 10 days before her tour was to end. She was diagnosed with post-traumatic stress disorder. She spent time in a psychiatric ward at Walter Reed Army Medical Center in Washington, D.C. She’s found it therapeutic to write about her flashbacks from her home in Roy.
Sundem read about Dunn in The News Tribune last summer. She knew seeing him would help her confront the darkest memories of her days in Iraq and give some comfort that her nursing skills, at least in Dunn’s case, paid off.
“Since I came back from Iraq, I haven’t been able to touch a patient,” she said. “It’s so sad. That’s who I was. I was good at it. Others with PTSD can go on to become bankers or lawyers. But the thing I am, I can’t be anymore.”
Sundem is not alone. Nearly one-third of U.S. soldiers who were in Iraq during the war’s first year have sought mental health treatment, according to a recent study published in the Journal of the American Medical Association.
About 12 percent of the 220,000 Army soldiers and Marines surveyed suffered serious mental problems, including depression and post-traumatic stress disorder. An earlier study of Iraqi war veterans had found that between 15 percent and 17 percent displayed PTSD symptoms.
The disorder is triggered by exposure to life-threatening or horrifying experiences. Symptoms can include flashbacks, anxiety, nightmares, anger and insomnia. The disorder can be treated with medication and counseling.
Maj. Gen. George Weightman, who oversees Army medical training, said the Army tries to prepare its medical personnel for what they will face at military hospitals in Iraq.
“We call them trauma factories,” Weightman said. “It can be a shock when 12 or 15 wounded arrive all at once. In the states, you see people injured in car accidents or wounded by guns or knives. You don’t see high-velocity or explosion wounds. It can get pretty intense.”
Health care professionals in any setting can suffer from “compassion fatigue,” a form of burnout. PTSD, however, can be far more serious.
“We are trained to be objective and not grossed out by the blood and gore,” Weightman said. “But at some point – who knows what will trigger it – the emotional floodgates open. As a civilian, you can get away from it. In a combat zone, you can’t.”
Before becoming a neurosurgeon, Dr. Jeffrey Poffenbarger was an infantry soldier and an Army Ranger. He served 14 months in Baghdad, mostly with the 31st Combat Support Hospital, the same unit as Tina Sundem.
The pace was relentless, the casualties often horrific, said Poffenbarger, 43, now in private practice in Virginia.
“I would see people who have been shot only 10 or 15 minutes earlier dirty, grimy, with shrapnel sticking out of their skin,” Poffenbarger said. “In any other war, these soldiers would have been dead.”
Though the months he spent in Baghdad are a blur, Poffenbarger said he remembers Dunn. Medical teams thought they had lost him a couple of times.
Poffenbarger seemed uncomfortable when asked about Sundem, though he did say he understood the stress she and other nurses were under. In many ways, Poffenbarger said, the nurses in the Baghdad ICU had it tougher than the doctors, because they provided care 12 or 16 hours a day for six or seven days at a stretch.
Others who served with the 31st Combat Support Hospital in Baghdad say that since returning, they are a little edgier, a little angrier and a little less tolerant.
“Everyone who goes there comes back changed,” said Maj. Nancy Parson, an ICU nurse who was in Baghdad for a year. “You would do everything you could, and they would still die. Sometimes it felt like no matter what you did it wasn’t enough.”
Sundem started as a nurse’s aide when she was 16. Her father was career military, and it seemed only natural for her to eventually join the Army as a nurse.
She said she got three days notice before leaving for Iraq. She was working in a clinic at Fort Leavenworth, Kan., where her husband, Chad, an Army Ranger, was going to school. The 31st Combat Support Hospital needed an intensive-care nurse, and Sundem received her orders.
Sundem chose her words carefully as she talked about her time in Iraq. Her kids, Hannah, 4, and Bridger, 3, kept popping out of the family room, where they were supposed to be watching a video. She shooed them away as she talked about the carnage she dealt with in Baghdad.
“I can’t describe the horror,” she said. “I swiped a wounded soldier’s eyeball into a trash can. At times I would think, ‘This kid isn’t going to make it, this kid will be a vegetable.’ It was never-ending. There was no escape.”
Sundem said she worked 14- or 16-hour days, six days a week, and the ICU was always full.
If it wasn’t U.S. soldiers, it was coalition soldiers, wounded civilians – including children – or enemy combatants. Trash cans overflowed with empty transfusion bags and the wrappers from burn pads. Intercranial pressure monitors and intravenous pumps beeped continually. She recalls soldiers without legs or arms or faces.
One night as she tried to sleep, the blast from a mortar shell shattered the window, spraying her bed with glass shards.
But Sundem said it was not the danger of living and working in a war zone that got to her. More than anything, it was the wounded.
“I would lean over and whisper in their ears, ‘You aren’t going to die on my watch,’ ” she said.
She kept a journal. Over the days and months, she turned to it in an effort to unburden her anxieties. As a nurse and a career Army officer, she knew she shouldn’t become too attached to her patients or too emotional in treating them. But there was no escape. She said she began feeling hostile toward her co-workers and, especially, the enemy combatants she treated. At one point, she didn’t sleep for four days.
Sundem sought help. She was on medication and had been in contact with a psychiatrist. But near the end of her year in Baghdad, she snapped when she heard a doctor had bad-mouthed her care.
She tried to commit suicide but survived, and the Army sent her to a hospital in Landstuhl, Germany.
“I was a zombie when I got to Germany,” she said. “One doctor said I was the worst case of PTSD he had ever seen.”
While in Germany, Sundem said she couldn’t call home, at first.
“I was afraid to come home,” she said. “I had changed. When I went over there I was a successful, happy person. Every premise of my value system was challenged and destroyed.
“I had lost my faith in God. I had lost my faith in humanity. I felt soiled and impure. I felt like a monster. I didn’t want to poison my children, and I was ashamed of what my family would see in me.”
After a time at a psychiatric ward at Walter Reed and a stint at Fort Leavenworth, Kan., Sundem and her family settled in Roy. Chad Sundem is assigned to a Stryker brigade at Fort Lewis and could be headed back to Iraq.
Sundem is gradually putting her life back together.
“I have good days and bad days,” she said, adding that she remains on the Army’s temporary disability retirement list and could be recalled to active duty in the next five years.
The flashbacks come mostly when her mind is idle.
“I can feel them coming,” she said. “It’s like I am there, the smells, the sounds.”
As the flashbacks sweep over her, she retreats to her favorite living room easy chair, pulls out her laptop and writes. She has written a book she titled “Lest They Be Forgotten: An Army Nurse’s Memoirs.” No publisher has shown interest. But Sundem said she will continue seeking one.
Sundem said she no longer has nightmares about Rory Dunn. After she learned that he had survived, it took her almost six months to make contact.
“He had really haunted me,” she said. “It helps to know he survived.”
Though others she treated in Baghdad still haunt her, Sundem said Dunn no longer does. Their February reunion at the Red Lobster helped ease her pain.
“Rory, we didn’t think you would make it,” Sundem said as she and Dunn finally stepped back from a long hug. “You look beautiful.”
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