Vol. 25
No. 8
www.cnic.navy.mil/bethesda/
March 8, 2013
Wounded Vet Undergoes Successful Double-Arm Transplant
Photo courtesy of Johns Hopkins Medicine
Several plastic, orthopedic and hand surgeons, rehabilitation specialists and nurses work together to perform a successful double-arm transplant on Iraqi war veteran Brendan Marrocco in December at Johns Hopkins Hospital. Only six other patients have successfully undergone the surgery in the United States. In addition to Walter Reed Bethesda, the surgery team also consisted of doctors from UCLA, Curtis National Hand Center in Baltimore, and the University of Pittsburgh. By Sarah Marshall WRNMMC Journal staff writer After losing both arms and legs in 2009 while serving in Iraq, Brendan Marrocco is now regaining his independence, thanks to a doublearm transplant at Johns Hopkins Hospital, performed by surgeons from across the country, including one of our own at Walter Reed Bethesda. Marrocco was driving an armored vehicle in Iraq when he was struck by a roadside bomb. He is the first Soldier to survive after losing all four limbs in the Iraqi conflict, according to Dr. W.P. Andrew Lee, who
led the team that performed the transplant. “[The procedure] was particularly meaningful because the recipient was a wounded warrior, someone who lost limbs during combat in Iraq, and our research has been sponsored by the DOD,” Lee said. The procedure took place over two days, Dec. 17-18, and lasted a little more than 12 hours, said Lt. Cmdr. Patrick Basile, who assisted the transplant team and is also assistant chief of Plastic Surgery and director of Microsurgery at Walter Reed Bethesda. Several plastic, orthopedic and hand surgeons, nurses, rehabilitation specialists and nurs-
es worked together to perform the transplant, which only six other patients have successfully undergone in the U.S., Basile said. In addition to Walter Reed Bethesda, the team also consisted of surgeons from University of California, Los Angeles (UCLA), Curtis National Hand Center in Baltimore, and the University of Pittsburgh. “The team is so much stronger from the collaboration of people not only from different institutions, but different disciplines,” Lee said. Basile explained the extensive procedure begins with doctors determining whether the patient is a good candidate for the transplant.
The patient’s medical history is evaluated by looking at whether the individual is missing any key structures, such as bulk muscle or significant nerve loss, that could prevent a positive outcome, he said. They also evaluate the patient’s disposition, ensuring the individual will be accepting of his or her new limbs and whether they would be capable of several hours of rehabilitation per day for years to come. “That’s one of the keys to success,” Basile said. Once the patient has been accepted into the transplant program, he
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The Journal
Bethesda Notebook
Sequestration and Furlough, The Financial Impact Recently, Department of the Defense (DOD) civilian personnel were informed that, as a result of sequestration, there may be a possible furlough on the horizon. Sequestration, as a result of budget shortfalls, entails the permanent cancellation of budgetary resources by a uniform percentage across the federal government. This would require all military services and defense agencies to furlough most DOD civilian employees for an average of one day per week for up to 22 weeks beginning April 25. This action equates to a 20 percent cut in pay for DOD employees. Some more seasoned DOD employees may have experienced furlough in the past and are familiar with the terms and what it will mean to them financially. However, for some, a furlough may result in undue stress and financial hardship. The best way for individuals to face a potential furlough is to be prepared and have a financial plan in place. Some simple tips for everyone to consider in helping to close that 20 percent gap in pay include: • Start now! Organize all your financial documents. Complete a thorough assessment of your personal finances. Review your monthly spending plan and prepare to make any “realistic” adjustments you can. The more organized you are, the less of a headache and stress for yourself later. Remember, needs trump wants during the financial crunch and food, clothing, shelter and medical costs are priority. This may be a great time to give up smoking if you are a smoker. • Assess your overall monthly credit payments. Continue to try and make every payment each month throughout the furlough. If necessary, reduce your monthly payments to just the minimum payment required. If you have a positive consumer relationship with your creditor, you may be able to obtain a penalty free payment deferral for a month or two. It doesn’t hurt to ask. If you do receive a deferral on payments, be sure to ask your creditor if the deferral will impact your credit report.
Published by offset every Thursday by Comprint Military Publications, 9030 Comprint Court, Gaithersburg, Md. 20877, a private firm in no way connected with the U.S. Navy, under exclusive written contract with the Walter Reed National Military Medical Center, Bethesda, Md. This commercial enterprise newspaper is an authorized publication for members of the military services. Contents of The Journal are not necessarily the official views of, nor endorsed by, the U.S. Government, the Department of Defense, or the Department of Navy. The appearance of advertising in this publication, including inserts or supplements, does not constitute endorsement by the Department of Defense or Comprint, Inc., of the products or services advertised. Everything advertised in this publication shall be made available for purchase, use or patronage without re-
Stages of Healing
Walter Reed Bethesda’s Stages of Healing (SoH) hosts guitarist and singer Alexis Babini on Monday at noon in the America Building adult hematology/oncology treatment room, followed by a performance in the pediatrics outpatient clinic waiting area. On Wednesday at noon, Michael Rohd, who will conduct a workshop on effective listening and collaborating in the America Building’s rheumatology conference room (#3313). For more information, call Dr. Micah Sickel at 301-295-2492.
• Postpone any major purchases. You may be in the market for a new car or new television or some other large ticket item. You may want to consider holding off making such purchases until you know you can reasonably afford it. • Review your Leave and Earning Statement and consider changing your tax exemptions to reflect your family’s size. This will result in a lower tax return at the end of the year but will help alleviate the financial stress you feel during the furlough. • Consider your TSP and other investments. If necessary and ONLY if necessary, reduce your TSP (thrift savings plan) to the government matching limit minimum. Use reduction of any investments such as TSP, IRA’s, Mutual Fund, etc. as a last resort only. • Reduce unnecessary spending. Limit your visit to the local coffee shop to only a couple times a week instead of daily. Dine out less frequently, commute with a friend or co-worker and cut back on some of the other out of pocket expenses that are often not considered in your spending plan. • If you are expecting a significant tax return, consider setting that money aside to offset any financial shortfalls you may be anticipating. These are just a few of the things you can consider in preparation for sequestration and furlough. If you would like to meet with a financial coach to conduct a review of your spending plan, to review your credit report or for any financial questions or concerns you may have as we get closer to the furlough period, please contact the NSA Bethesda Fleet and Family Support Center at 301-400-2414 and ask to speak with one of our three financial coaches. In preparation for the furlough, planning is crucial and we are standing by to assist.
Ask Your Leadership
Ask Your Leadership is a new staff communication tool for you to view and post questions and comments for official responses from the Walter Reed Bethesda command leadership. The tool is on the WRB Intranet page, click on the Town Hall/Leadership Forum icon, and then click on Ask Your Leadership.
Irish American Celebration
The Bethesda Multicultural Committee is sponsoring an Irish American celebration on March 14 from 10:30 to 11:30 a.m. in the America Building atrium in observance of Irish American Heritage Month. The Hurley School of Irish Dance is scheduled to perform. For more information, call Sgt. 1st Class Jason Zielske at 301400-3542.
Brian Pampuro, AFC Personal Financial Manager Fleet and Family Support Center Bethesda
gard to race, color, religion, sex, national origin, age, marital status, physical handicap, political affiliation, or any other non-merit factor of the purchaser, user, or patron. Editorial content is edited, prepared and provided by the Public Affairs Office, Naval Support Activity Bethesda, Md. News copy should be submitted to the Public Affairs Office, Building 11, lower level, Room 41, by noon one week preceding the desired publication date. News items are welcomed from all installation sources. Inquiries about news copy will be answered by calling 301- 295-1803. Commercial advertising should be placed with the publisher by telephoning 301-921-2800. Publisher’s advertising offices are located at 9030 Comprint Court, Gaithersburg, Md. 20877. Classified ads can be placed by calling 301-670-1700.
Remember to set your clocks ahead one hour, before going to sleep Saturday night in preparation for Daylight Saving Time.
Naval Support Activity (NSA) Bethesda Commanding Officer: Capt. Frederick (Fritz) Kass Public Affairs Officer NSAB: Joseph Macri Public Affairs Office NSAB: (301) 295-1803
Journal Staff Staff Writers
Managing Editor NSAB Editor WRNMMC Editor
MASN April Beazer Sarah Marshall Sharon Renee Taylor Cat DeBinder David A. Dickinson Jeremy Johnson MC2 Nathan Parde MC2 John Hamilton Bernard Little
Walter Reed National Military Medical Center Office of Media Relations 301-295-5727 Fleet And Family Support Center 301-319-4087
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Walter Reed Bethesda Leadership Prepares for Sequestration By Bernard S. Little WRNMMC Journal staff writer On Feb. 27, two days before sequestration was enacted, Walter Reed National Military Medical Center (WRNMMC) leaders provided employees with an update on Walter Reed Bethesda’s operating budget, and addressed previously submitted questions as well as additional queries from staff members who were present, about plans at the Nation’s Medical Center. The four town halls, held throughout the day to ensure all staff had an opportunity to attend, began with Rear Adm. (Dr.) Alton L. Stocks, WRNMMC commander, emphasizing quality and safe patient health care would continue. “Any adjustments that we have to make, based on any decisions that are being made above us, we’re going to keep [quality, safe patient care] as our mission,” he said. The commander added one team of health-care providers exist at WRNMMC, be they military, civilians, contractors and volunteers. “If anything does happen affecting our civilian workforce, I can expect the active duty to step up, and [they] might be expected to work more hours, but we’re not going to sacrifice patient quality or safety, or our staff ’s safety.” Army Col. Ramona Fiorey, WRNMMC chief of staff, echoed Stocks, adding, “[The possibility of civilian furloughs] is a very sensitive and emotional issue. It will affect us individually and as an organization.” “We can’t prevent furloughs,” Fiorey added. “We don’t have that authority. But we have to plan, in case they happen.” Navy Capt. Dave Breier, assistant chief of staff for resources and comptroller for WRNMMC, explained that deputy commanders are developing plans to identify reductions in spending at Walter Reed Bethesda, and actions have already been taken to reduce staff travel, staff overtime, compensatory time and contracts. Breier said if furloughs happen, they will likely start with the pay period beginning April 21. “At that point, there are 11 pay periods left in the fiscal year, [so] that would be two days a pay period, and that’s where the 22 [furlough] days come from.” “There’s no one set area we’re going to see savings, no one quick fix that we can get all these savings from,” Breier continued. “We have to nibble around the edges pretty much with everything we do, but not to impact services, keeping the
same standard and level of quality care.” The captain encouraged staff to do “any little thing to help save money, just like at your house,” such as turning out the lights, going paperless, and third party collections. “All these savings we do, just by doing those little things, add up to a lot of money when it gets to the end of the year.” Sandy Lehman, deputy director of the Civilian Human Resources Center at Walter Reed Bethesda, said employees must receive a 30day written advance notice before being furloughed. “Employees should begin planning immediately for reduced paychecks beginning in April. Your pay rate does not change; pay reduction comes from reduced hours at work,” she said. “Furlough is like leave without pay, [and] you’re still a federal employee.” “At this time there is no provision for furloughed employees to receive retroactive compensation for work lost as previously done in the past,” Lehman added. “An employee is still entitled to holiday pay if in a pay status the day before or day after a holiday.” She added Federal Employee Health Benefits and Federal Employee Group Life Insurance coverage will continue. If furloughed, there will be a reduction in the employee and employer contribution to the Thrift Savings Plan unless the employee sets a dollar amount versus a percentage of pay contributed to the TSP. Federal employee dental and vision insurance coverage continues; however, employees may be billed directly if payroll deduction cannot be taken. Full employee contributions must be received to avoid dental and visual coverage cancellation. Federal Employees Retirement System (FERS) and Civil Service Retirement System (CSRS) coverage continues during an administrative furlough of less than 30 days. Fiorey added alternate work schedules will be rescinded during the furlough. Furlough days also cannot occur on the same days as holidays or scheduled leave, and are at the discretion of deputy commanders, department and service chiefs. For more information about furloughs and sequestration, visit www.opm.gov/furlough. Questions can be sent to jtfcapmed.chrc@ health.mil. Information regarding town halls and leadership forum is available on the WRNMMC intranet.
Photo by Bernard S. Little
Army Col. Ramona Fiorey (left), Walter Reed National Military Medical Center (WRNMMC) chief of staff, and Rear Adm. Alton L. Stocks, WRNMMC commander, brief staff on plans of the medical center to continue to provide quality patient care while facing possible civilian furloughs.
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The Journal
7/365 Highlights Patient Safety Always By WRNMMC Patient Safety Office In an effort to raise awareness and encourage the engagement of patients, families, health care providers, and the public, this week Walter Reed National Military Medical Center (WRNMMC) is participating in the 2013 Patient Safety Awareness Week campaign, Patient Safety 7/365. Patient Safety Awareness Week is an annual education and awareness campaign for health care safety led by the National Patient Safety Foundation (NPSF). Each year, health care organizations around the world take part in the event by displaying the campaign logo and promotional materials within their organizations, creating awareness in the community, and utilizing NPSF educational resources with hospital staff. Tuesday during Patient Safety Awareness Day, WRNMMC Patient Safety Office hosted a cake-cutting
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with games and giveaways in the America Building lobby to draw attention to this year’s observance. Patient Safety Awareness Week was created by NPSF in 2002. This year’s theme, Patient Safety 7/365, highlights the need for everyone to understand the importance of focusing on patient safety all year round according to Kathleen Oberst, patient safety manager at WRNMMC. The seven day campaign, which began Sunday, also serve as time to recognize the range of work being done to improve health care safety worldwide. “Walter Reed Bethesda will engage staff, patients, and the community through educational and awarenessbuilding activities specific to patient safety,” Oberst stated. “The Patient Safety program’s mission is to improve the safety of health care delivered to all beneficiaries. The patient safety program is a comprehensive program which provides products, services, education and training to ensure the safe delivery
of health care to all those entrusted in our care,” she added. “Patient Safety 7/365 reminds us that providing safe patient care requires a constant and valiant effort, 365 days a year. This week encourages a sustainable and conscientious collaboration between health care organizations, providers, and consumers, regardless of their current state of health. The week is also intended to imprint an indelible statement that efforts toward patient safety must be collaborative and that we must never be satisfied with the status quo,” said Patricia A. McGaffigan, interim president, NPSF. NPSF encourages creative collaboration among provider groups, patient advocates, and other community organizations to help patients and consumers understand how they can participate to be part of the solution. For more information about patient safety or Patient Safety Awareness Week, visit www.npsf.org.
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Photo by David A. Dickinson
Hospital Corpsman 1st Class Donald Calero demonstrates the functions of SimMan 3G, an Advanced Patient Simulator, used for education and training at Walter Reed National Military Medical Center (WRNMMC), during WRNMMC’s Patient Safety Awareness Day event on Tuesday. SimMan simulates many human functions for practice purposes. He speaks, has dilating pupils with blinking eyelids, a pulse, can take transfusions and oxygen, and a defibrillator can be applied to him.
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Pioneer of Army Kidney Transplant Surgery Made History at Walter Reed By Sharon Renee Taylor WRNMMC Journal staff writer March is National Kidney Month. Kidneys remove wastes from the body and help regulate blood pressure. When kidneys fail to work properly, some patients must undergo dialysis as they wait for kidney transplants. More than 95,000 people await kidney transplants in the U.S., according to the Department of Health and Human Services. In honor of National Kidney Month, Walter Reed Bethesda honors Dr. Joseph Alexander, who led a team of five other transplant surgeons 42 years ago at the former Walter Reed Army Medical Center (WRAMC) in Washington, D.C., to perform the Army’s first kidney transplant on Aug. 10, 1970. The landmark surgery for Army medicine was one in a series of “firsts” in Alexander’s trailblazing life. Born in Oneonta, Ala., on Oct. 29, 1929, Alexander graduated magna cum laude from Fisk University. In 1951, he became the first African American admitted to the University of Louisville Medical School in Louisville, Ky., and the first to graduate in 1955. He joined the Army and completed his surgical residency at Brooke General Hospital at Fort Sam Houston, Texas. Alexander served as chief of general surgery at the U.S. Army Hospital in Fort Hood, Texas, and later, as the commanding officer of the 5th Surgical Hospital in Heidelberg, Germany. Two years after serving as chief of the general surgery service at Kimbrough Army Hospital, Fort Meade, Md., Alexander completed research fellowships at the Walter Reed Army Institute of Research, Harvard Medical School and Peter Bent Brigham Hospital in Boston, where he studied under Nobel Prize-winning surgeon Dr. Joseph E. Murray, who performed the first successful human organ transplant. Alexander became chief of the Organ Transplantation Service at WRAMC in 1969. There, he served until 1971, and wrote the Army regulation for transplants, according to Sanders Marble, senior historian at the U.S. Army Office of Medical History in San Antonio. The colonel left the Army to become the first chief of surgery at the Martin Luther King, Jr. General Community Hospital in Los Angeles, Calif., and served as a professor at the Charles R. Drew Post Graduate Medical School. In 1988, he became the first African American member of the California Club, L.A.’s oldest private social club, which at one time barred women, Jews and blacks from joining. Alexander was the first black member to sign the club’s registry in their 101-year history. Former colleagues and friends
Courtesy Photo
A photo which accompanied a newspaper article published nearly 43 years ago at the former Walter Reed Army Medical Center, touts the trailblazing surgery led by Dr. Joseph Alexander (second from right), which witnessed the Army’s first kidney transplant. of Alexander called the transplant surgeon a courageous pioneer who broke barriers, and a military leader who knew how to get things done. “He is one of the reasons why I went into transplant,” said Dr. Jimmy A. Light, a retired Army colonel and 42-year veteran of organ transplant surgery, who called Alexander a mentor and friend. The kidney and pancreatic surgeon explained how the two met. “It turns out I was on call the night he came in from Europe with his diagnosis,” said Light, a thirdyear resident at WRAMC when he first met Alexander in 1967. The two shared conversation and common interests in medical research during the early morning hours as the young resident helped Alexander get admitted and processed as a patient. The surgeon transferred to the medical center from Germany for treatment of his colon cancer, according to Light, who explained Alexander’s diagnosis eventually led him to immunology research and ultimately organ transplant surgery. “How courageous he was as a man in his 30s, that had metastatic colon cancer, to survive surgery, the treatment, chemo, and then go on to dedicate his life to transplant work, immunology work and then have that same courage to chair the department of surgery at a brand new hospital in Watts, the Martin Luther King Hospital. That’s the part I thought was most amazing about him,” Light said. “He identified together with the Surgeon General’s Office of the Army, skilled people coming in the service who had transplant training or aspirations, identified them and got them to be a part of the program.”
Light eventually became chief of the Organ Transplantation Service at WRAMC before going on to lead a team of transplant surgeons at Washington Hospital Center in
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Washington, D.C. “The transplant program [at WRAMC] would’ve never come to fruition if it hadn’t been for Dr. Alexander,” Light said. Dr. Joshua Miller established groundbreaking transplant protocols at Northwestern University and served as the president of the American College of Transplant Surgeons in 1998. The research professor was one of six who helped establish the Army transplant program with Alexander. He came to WRAMC in 1969 as an Army major after completing training in general thoracic surgery at Yale. Miller helped establish the tissue typing lab at Walter Reed Army Institute of Research, housed at that time on the WRAMC medical campus. He joined Alexander in rounds on transplant patients and scrubbed in for surgeries; the two worked together in both the laboratory and the clinic. Cited as a transplant pioneer himself, Miller recalled the tumultuous time in the nation’s history when Alexander established the Army’s kidney transplant program: amidst the Vietnam conflict as well as preconceived notions about organ transplantation. “It was definitely [Alexander who] broke the ground,” Miller said of his
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The Journal
Navy Medical Officers Celebrate 142nd Medical Corps Birthday By Jeremy Johnson NSAB Public Affairs staff writer Navy medical officers from the District of Columbia and across the country celebrated the 142nd birthday of the Navy Medical Corps during a formal ball held Saturday evening at Bethesda, Md. The Crystal Ballroom, located at the Hyatt, was filled with officers in all stages of their career, including Annapolis midshipmen and retirees from the Medical Corps. The event began with a reception where attendees and guests could have portraits taken and participate in a silent auction while getting to know each other. The formal portion followed and included several traditions, including a moment of silence for MIA/ POWs, a formal toast, and a cutting of the cake by the youngest and most senior
uniformed Medical Corps celebrants at the event. Speakers included Chief of the Navy Medical Corps Rear Adm. Colin Chinn,; Vice Adm. Matthew Nathan, Navy surgeon general; and Assistant Secretary of the Navy for Manpower and Reserve Affairs Juan Garcia. In his remarks, Garcia highlighted examples of the good being done by Navy doctors and young Sailors offering assistance to those in need worldwide, reminding the audience that the service is seen as a “global force for good.” He also thanked the members of the Medical Corps for their dedication to providing the best service possible for military members and their families. According to Cdr. Jeffrey Blair, the master of ceremonies for the event, the Navy Medical Corps began with the establishment of the Photos by Jeremy K. Johnson Continental Navy in 1775, but wasn’t formally estab- Assistant Secretary of the Navy for Manpower and Reserve Affairs Juan Garcia chats with guests at the reception held just before the formal event. lished until 1871.
Surgeon General of the Navy Vice Adm. Matthew Nathan praised members of the Medical Corps community for their devotion to duty before introducing the keynote speaker, Juan Garcia. Attendees and guests of the Navy Medical Corps 142nd Birthday Ball began the evening at a reception where they could have portraits taken and participate in a silent auction while getting to know each other. Ens. Angela Zah (left) and Capt. Stewart Brazin honor tradition and cut a cake as the youngest and oldest uniformed Medical Corps celebrants at the event.
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Pain Management Classes Begin at WRNMMC By Cat DeBinder WRNMMC Journal staff writer Life was never meant to be a pain. That is why the Wounded Warrior Pain Care Initiative at Walter Reed National Military Medical Center (WRNMMC) is offering an Interactive Pain Management Series (IPMS). According to the American Academy of Pain Medicine, millions [of Americans] suffer from acute or chronic pain every year, and the effects of pain exact a tremendous cost on the country in health care costs, rehabilitation and lost worker productivity. The classes, offered at Walter Reed Bethesda, will be held every Wednesday from 2 to 3 p.m. in the America Building (19), second floor Desert Conference Room (2301) and, is open to not only wounded warriors, but all patients, family and staff members. Registration and referral are not required to attend the series. Walter Reed Bethesda’s official goal of the pain management series is to provide treatment and education to all those who suffer from pain, or who are a caregiver or family member of someone suffering from pain. Some of the topics to be
covered during the series include Mind/Body Medicine, Pain Procedures, Acupuncture, Opioid Management, Transitional Care, Sexual Health, Sleep and Nutrition. “Pain is the most frequent reason patients seek physician care in the United States, and more than 50 million Americans suffer from chronic pain,” according to the American Academy of Pain Medicine. “The physical, emotional, social, occupational and financial aspects of life are impacted negatively by chronic pain,” added Amy Osik, deputy program manager for the initiative. “The lives of family members are also greatly affected by their loved ones’ pain.” “We want to empower patients and family members with skills, education and resources to manage pain,” said Dr. Christopher Spevak, an anesthesiologist in the Wounded Warrior Pain Initiative. Spevak said the series will not consist of just lectures, and organizers are looking at flexibility to meet the needs of beneficiaries. “We will constantly be changing the dynamic in the modality to meet the needs of those attending,” he explained. Jasmine Anthony, a certified physician assistant,
Courtesy graphic
director of the program and responsible for its management and weekly modules, said the series will include lectures by behavioral health specialists, physical therapists and social workers. Dr. Aubrey Verdun, a WRNMMC anesthesiologist who gave a presentation at the first class of the series, said the war on pain seems like it is always changing. “Any pain that continues for four to six months, is con-
sidered chronic pain,” said Verdun. He said some pain can be blocked at multiple levels, including at the spinal cord level. “Patients get the effect [of pain medication], but not the side effect.” Lois Clinton, the pain psychotherapist for the Wounded Warrior Pain Care Initiative, gave a demonstration on visualization techniques during the class. She asked attendees to imagine something they enjoy - saying it could be a sunny beach, a
pet, any other personallypleasant scenario and asked what bodily effects participants felt. She also described a technique known as “tracking,” which entails tracking sensations in the body in an attempt to regulate them. Clinton said it is possible to “talk the body” into letting down its defensive response and regulate sensations pleasant versus painful sensations. “The goal is to teach patients self-treatment skills,” said Clinton. The first class was attended by a number of providers, but they hope to get patients and family members involved as well. “We really want to get to wounded warriors, families, staff and active duty about how pain issues are causing a host of other issues, along with other topics that are impacting them greatly,” she said Army Lt. Col Shannon Lynch, chief of the Physical Therapy Service, who attended the class stated, “It is a great initiative. We need this educational program for the population we treat.” For more information about the Wounded Warrior Pain Care Initiative class, call Jasmine Anthony at (301) 400-1016, or Amy Osik at (301) 295-4455 (ext.171).
Greek Plays Parallel Wounded Warrior’s Combat Injuries By Mass Communication Specialist 2nd Class Nathan Parde NSAB Public Affairs staff writer Naval Support Activity Bethesda hosted a dramatic reading of scenes from two ancient Greek plays, presented by “Outside the Wire” at the Warrior Café March 1. “Outside the Wire is a company that uses theater and community discussion as a catalyst for addressing public health and social issues,” said Artistic Director Bryan Doerries. With a college background in classic literature, specifically Greek and Latin, Doerries began the undertaking of translating his own
versions of Sophocles’ plays from the Greek, but he didn’t really unlock their meaning until he presented them before a military audience, he said. “Originally, I thought that I was pretty clever and that I understood them. Then, I got them in front of a military audience for the first time in 2008, and I realized I had no idea what the plays were saying. They were written in a code that, as a civilian, I had no access to. I needed the military audience to translate the plays for me.” The term, ‘outside the wire’ is a military term, but Doerries believes it also applies to anyone who comes in contact with suffering or death.
“That’s the audience we’re going for, because the core belief is that those audiences can reveal something about these stories, and the stories can help them unlock something in themselves that might be hidden,” he said. “We’ve now reached nearly 50,000 service members, veterans and their families with Theater of War.” “Theater of War” is the first project from “Outside the Wire”, which presents readings of Sophocle’s “Ajax” and “Philoctetes” to military communities across the United States. According to Doerries, many Greek performers appeared to be veterans or cadets themselves, and ancient Greek drama may have been a means to
help combat veterans return to civilian life after deployments. He believes this has direct parallels to the modern day and many patients’ experiences at Walter Reed Bethesda. “I can think of no more appropriate place to present these plays that talk about the visible and invisible wounds of war, and give voice to them and normalize them and say – across time, you are not alone,” he said. “This has been warriors’ experience across thousands of years. And to bring the entire community together, wherever we are, and collectively (or at least symbolically) shoulder that burden is our mission.” Sgt. Jack Eubanks, a pa-
tient at Walter Reed Bethesda, first attended a “Theater of War” performance when the company visited the Uniformed Services University a few years ago. “It impacted me a lot, because I had come back from Iraq, and there was a lot of things that I saw,” said Eubanks. “I was going through PTSD (post-traumatic stress disorder) and otherwise. I came to realize a few things, and a few things started clicking. I was able to take a step back and reevaluate where I was and help fix myself and move forward. After the performance, we kept in touch, and I was asked if I would like to be on the dis-
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The Journal
‘Heart of the Hospital’ Celebrates Recent Renovation Ribbon-cutting Opens New Sterile Processing Department at Walter Reed Bethesda By Sharon Renee Taylor WRNMMC Journal staff writer Walter Reed National Military Medical Center Commander Rear Adm. Alton L. Stocks joined Walter Reed Bethesda surgeons, operating room (OR) staff, as well as surgical and instrument techs for a ribbon cutting of the new Sterile Processing Department (SPD), Jan. 17. Renovations for the SPD began in July 2011, according to Army Lt. Col. Laura Desnoo, chief of the SPD. The physical space of the department that sterilizes instruments, tools and equipment for surgeries, doubled in size to accommodate the addition of seven new operating rooms at the medical center, plus three remote sites. The upgrade brought in state-ofthe-art equipment to accommodate new services, specialties and robotic Photo by Sharon Renee Taylor technology with the integration of Lt. Col. Laura Desnoo, Chief of the Sterile Processing Department the former National Naval Medical (SPD), Rear Adm. Alton Stocks, WRNMMC commander, HN Zach- Center and the former Walter Reed ery English, Priscilla Hailstorks-Smith, and Maj. Guy St. Louis, as- Army Medical Center, according to sistant chief of SPD, cut a ribbon celebrating the renovation of the Navy Cmdr. Norman Charboneau, medical center’s Sterile Processing Department, Jan. 17. department chief for peri-operative
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that oversees the SPD and three other departments. Enhancements include the addition of a classroom for staff training, water, electrical and communication upgrades, as well as a new, dedicated “clean” elevator that goes straight from the SPD, located in the Basement of Building 9, to readily provide equipment to the OR upstairs as operating surgeons requests them. A new walk-in sterilizer, two turbo washers and a multi-chamber index washer have increased the capacity of instrument sets, or “cases,” the department can process, requiring less time. What makes the SPD at Walter Reed Bethesda unique from those at other hospitals is the larger decontamination section, necessary to accommodate the level of care required to treat wounded warriors, the variety of specialties at the medical center, polytrauma services, as well as the change of surgeons and technology, according to Desnoo. She explained the medical
See STERILE page 10
The Journal
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COMBAT Continued from 7 cussion panel this time.” According to the “Theater of War” program, “plays like Sophocle’s Ajax and Philoctetes read like textbook descriptions of wounded warriors, struggling under the weight of psychological and physical injuries to maintain their dignity, identity and honor.” Eubanks said he identified with many of the themes and messages in the plays, especially with the character of Pholoctetes, who is marooned on a deserted island by his army after contracting a serious and debilitating illness. “You can very easily feel like Philoctetes, where you feel alone, even when you are at home,” said Eubanks, adding that the military community is essential in the process of healing and recovery. “One of things I’ve noticed while at three hospitals, and with all of my buddies who were injured – if they are going to talk to someone, they want to talk to their battle buddies, at least at first. And
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Actress Joanne Tucker performs in a dramatic reading of Sophocles’ play “Ajax” in the Warrior Café March 1. The main character, Ajax, falls into a depression near the end of The Trojan War, and his wife, Athena, attempts to intervene before it’s too late. they usually won’t start to open up until they do. And I think this was the way for the Greeks to do it, to share with the audiences and generals who were there leading the way.” Eubanks said if he was
to take one message from the plays and recent performance, it would be that the visible and invisible wounds of war are not a new subject or something that you have to face alone. “These issues that we
have now, coming back from a war, were the same issues that they had 2,500 years ago,” he said. “And a lot of it is that you need your battle buddies to stick by you, inside the service and out.” Doerries could not agree
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more. With more than 200 performances of “Theater of War” under his belt, he said his hope is that performances like the recent reading at the Warrior Café will continue to impact audiences and assist with the recovery of wounded warriors and veterans who have experienced the wounds of war. “I know that people are going to be affected and reengaged at each performance,” said Doerries. “It’s always powerful, and I never get sick of hearing the audience respond, especially at a place like this. I hope that we can come back soon and have more warriors and their families involved with this.” The “Theater of War” dramatic reading at the Warrior Café featured four professional actors, including David Strathairn, known for his roles in the movies “The Bourne Ultimatum” and “Lincoln”, and the recent T.V. series, “Alphas”; and Adam Driver, who also was featured in “Lincoln.” More information about “Outside the Wire” and “Theater of War” can be found at the web site, www.outsidethewirellc.com.
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TRANSPLANT Continued from 1 added the team determines what the recipient needs - be it an entire arm or just the forearm. “Every component that’s needed for a functional arm, you would need that,” he said. Then, doctors search a database for a match, and that can be a challenge, as doctors must match tissue, skin tone, size of the limbs, as well as
The Journal gender, Basile added. Individuals are listed in an active registry, through which they may elect to donate only particular organs once they are deceased, or any organs needed by a recipient, Basile explained. Once the logistics are in place, the large team of doctors, specialists and nurses work together to connect “everything that’s part of an arm,” Basile said. “It’s the skin, the nerves, the muscles, then tendons and bone.” After the transplant, doctors must first ensure the transplanted limbs are getting sufficient blood flow, he
said. Then, after about a week, the patient receives a bone marrow transplant from their donor. This helps the body to build tolerance for its new limbs, he explained. Otherwise, the recipient’s body may recognize the transplanted organs as “foreign,” and “reject” the transplant. The patient is also put on immunosuppressant medications, after the transplant, to further help prevent the body from rejecting the transplanted limbs. As the body recognizes its new organs, the patient is weaned off the anti-rejection medications, Basile said. He also explained that the newly attached nerves will grow about an inch per month, and so it will take some time before they reach the full length of the patient’s arm, and allow him to have feeling in his fingers. Since the surgery, Marrocco has still been able to put his new limbs to use. “He’s already using his arms to text [and] to type,” Basile said. Most importantly, he said Marrocco is regaining his independence and can dream big. He will one day be able to drive again, and won’t have to constantly rely on others, Basile added. “Now, I can move my elbow. I can rotate it a little bit,” Marrocco said, during a Jan. 29 press conference. Though he is unable to move his right arm much yet, he said, “We’re hopeful for the future to get some pretty good function out of it.” “It feels amazing. It’s something I was waiting for, for a long time. Now, it finally happened. I really don’t know what to say, because it’s such a big thing for my life,” Marroco said. “It’s just fantastic.” Basile noted Marrocco’s remark-
able outlook on life, and said he was grateful for the opportunity to be involved in his transplant. “It’s just a tremendous honor to be a part of this and to help. It’s just incredible,” Basile said. He believes this will continue to benefit wounded vets, allowing doctors to better understand what to preserve during amputation. It also gives surgeons a better understanding of rejection and tolerance to transplants, as well as the rehabilitation process. “With every case, we learn more and more about what works better and what doesn’t,” Basile added. Lee echoed similar sentiments. “I’m hoping with continued advancements in research, this becomes a common procedure,” Lee said. “Research is an important component in this,” he added. Lee, who also conducted the nation’s first double-hand transplant in 2009, explained that research has helped the team develop protocol for the double arm transplant. He went on to note that Johns Hopkins and Walter Reed Bethesda, as well as Uniformed Services University of the Health Sciences (USU), have worked together on research projects. They also rotate residents, and have surgeons from Walter Reed Bethesda and USU serving as adjunct professors at Johns Hopkins, Lee said. Lee hopes to continue enhancing the partnership between the facilities, benefiting more recipients, both military and civilian, and being able to transplant other parts of the body. Those who believe they may be a potential candidate for the arm transplant should contact Dr. Basile at patrick.l.basile.mil@health.mil.
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boneau called the department, “the heart of the hospital.” He said the unit supports surgeries and procedures that require sterilized equipment in the medical center’s 23 operating rooms, 17 clinics as well as additional specialties and sites. “This is a big job—really important for the hospital,” said Stocks, who explained he was amazed by all the unplanned changes that occurred during the 17 month-long renovation of the department. “You adapted to those changes to make a better outcome so I want to personally thank all of you for all you do for all the patients that are going to benefit,” Stocks added. Capt. Lisa Mulligan, deputy commander for surgery at Walter Reed Bethesda explained the SPD, does the “heavy lifting” of the OR for the surgeries performed upstairs. She said the SPD staff “has done an absolutely exceptional job” and maintained their level of service during a hard renovation completed in two big projects, one comprised of five phases. “They kept the OR [supplied],” Mulligan said. “We joke that they feed the OR, and they kept the beast fed the entire time throughout the whole renovation.”
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center is both a training facility and a center of medical advancements. “It’s been a rough 17 months,” Desnoo explained. “Every time you turn around something was happening and we had to adapt, but everybody was really good about working together,” the SPD chief said. The challenge helped to bring staff from the two military treatment facilities together very quickly, she said. A staff of 55 instrument and surgical techs in the SPD process instruments for surgeries and procedures at the medical center, along with tenant commands such as the Uniformed Services University of the Health Sciences (USUHS) and outlying clinics including the DiLorenzo TRICARE Health Clinic at the Pentagon. Charboneau estimated the SPD processed more than 17,000 cases of equipment during the course of the renovation that lasted more than a year. “We have not slowed down a bit, [since 2011],” he explained. Char-
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