Mission Jamaica: Complete

April 21^st, 2011

Jamaica MEDCAPS (Medical Civil Action Program) complete!

April 22^nd, 2011

Ok, didn’t have much time to write yesterday.  That’s because we had our last day of clinic at the National Sports Arena, and we were able to borrow some free WiFi from the office building next door.  WiFi = Skype!  So I got to see the kids and Scott for about 20 minutes – the connection wasn’t great but it was better than nothing!  I’m told we will probably get WiFi again in Haiti, but until then, I’m planning on the archaic internet connection on the ship.

There’s an email going around the crew here called “My Donut of Freedom.”  It’s a pie chart (donut, get it?) that someone created in Excel, charting the percentage of deployment completed to date (it also has a second-by-second countdown).  As of today, we are 12% done!!!  It sounds awful, but actually 12% seems pretty good to me.

Getting back home is definitely a prime topic of conversation around the ship.  Another hot topic: liberty.  I can definitely see why the sailors on liberty port may go a little crazy.  You would think we had all been away from civilization for months, the way we are planning our 4 days of freedom (which, by the way, is still over a month away).  For many of us, one of the most anticipated parts will be the ability to wear civilian clothes – for me, the prospect of just wearing anything other than combat boots is making me happy.

Today is our last day in Jamaica.  For those who have asked, we are anchored in Kingston, the capitol of Jamaica.  There is a very good reason why cruise ships and tourist airlines don’t fly into Kingston.  It is poverty-ridden and dirty.  There are no Caribbean blue beaches nearby, just brown-black water with lots of floating trash.  To get ashore, we take a small “hospitality boat” that holds 35 people.  It’s about a 2-3 minute ride to the BLZ – the boat landing zone.  The BLZ is in downtown Kingston, with office buildings, banks, and street vendors close by.  You can see the Blue Ridge Mountains from the ship.  I’d love to come back and see the rest of the island, as a tourist.  Who’s with me?

April 24^th, 2011

Happy Easter!  We are back at sea, en route to Peru.  We left Jamaica on Friday morning and have had a quiet “holiday” weekend, with a relaxed schedule (got to sleep in until 6:45 yesterday morning, woo hoo!).  Today, I attended the Easter Sunrise service on the flight deck, somewhere in the Caribbean, southwest of Jamaica and northwest of Peru.  Pretty cool.

When we first got underway in Portsmouth, I wasn’t sure how I would handle the rocking of the ship.  It was definitely an adjustment, made much harder by the fact that I had a nasty cold and was very, very congested.  I spent several days with a feeling of “disequilibrium” – even after we anchored in Jamaica I had the disconcerting feeling of falling backwards, and found myself leaning forward in my chair, and even in bed.  My abs got a workout those few days.  Once I stepped foot on land, my disequilibrium went away (coincidentally, so did my cold).  So I was nervous to restart the journey – especially when the ship’s master (the civilian mariner in charge of operating the ship) sent an email telling us about the Pacific swells that were to come.  I will say, now that we have been back underway for 2 full days, that I LOVE the rocking of the ship.  It is so soothing and comforting somehow.  It’s funny to walk through the halls and see people leaning to one side or the other without thinking.  We all look like we’re failing a mass sobriety test.  And like I’ve mentioned before, there is nothing like being on a treadmill while at sea – it’s really a cool feeling though.

The bad part about moving again, is what my Navy colleagues refer to as “hull chatter.”  Hull chatter describes the seemingly endless variety of random noises that the ship produces as it cuts through the water, at all hours of the day and night.  I have gotten out of my bed on more than one occasion to find out who in the hell is banging on our lockers with a hammer in the middle of the night.  Well, obviously, no one is banging on our lockers with a hammer in the middle of the night – somehow this noise represents normal ship functioning.  My roommate Carrie (another Air Force internist) is convinced there is an elf who scratches on the wall above her head continuously.  And there are apparently crewmembers upstairs from us who repeatedly throw their bowling balls on the floor.  Of course, some of the noises ARE explainable – when the ship rocks side to side, it opens and closes doors and lockers, so there’s a “creak-SLAM-creak-SLAM” rhythm to enjoy too.  Hull chatter. 

Tomorrow we’re back to our regular at-sea routine.  This means a 6:00am wake-up call (“Reveille, reveille!  <<crackle crackle something>> all hands on deck <<something something>> - I’ll let you know if I ever figure out what they’re saying).  Of course, for those of you who know me well, you know that the wake-up call is simply alarm #1, and that there are plenty of snoozes to come.  I will finally crawl out of bed around 6:30, get dressed in ABUs, and head to the mess deck for breakfast.  Breakfast is the best meal of the day, and would get 5 stars if they only had decent coffee.  After breakfast, we muster in our duty stations at 7:15 – my duty station is the Sick Bay, although I don’t usually work there.  We take roll call, hear the POD (Plan of the Day), and get specific instructions from our specialty leaders.  I think I’ve mentioned there are 6 internists here, and we have a really good group.  We each take MOOD (Medical Officer of the Day) call one day out of six, and there’s otherwise a lot of downtime when we’re in transit (when we get in port, we are usually doing shorework when we’re not the MOOD).  As an aside, there’s also a POOD (Pediatric Officer of the Day) and a DOOD (Dental Officer of the Day) – I think we got off lucky with the MOOD title.  Tomorrow we are having an M&m conference – for the non-medical folks, this stands for morbidity and mortality, and is an opportunity to share possible adverse outcomes and lessons learned.  We will be doing this once at the end of each mission site.  Thankfully, there are no “big M’s” (mortalities) to present, and it will primarily focus on frustrations and possible areas of improvement for future missions.

After the M&m conference, my day is free.  The funny thing is, most of my at-sea days start off completely free, and usually by 8:00 or so, are 100% booked.  People are pretty good about taking initiative to schedule various informal teaching sessions, formal training classes, group workouts, Bible studies, movie matinees, and administrative meetings.  Throw in time for email and phone calls, as well as lunch, dinner, and a nightly Ops Brief, and the day fills up fast.  Every night there is an evening prayer over the “1MC” (ship’s audio system), and then at 10pm, it’s “Lights Out.”  It’s only a little bit like being in prison, I promise.

We also have a great MWR (Morale, Recreation, and Welfare) department on the ship – the “fun boss,” as she’s called, is one of my other roommates.  They hosted an ice cream social a few nights ago (with lots of toppings – very well received) and have arranged for a Bingo night tonight.  On Tuesday, we’ll cross through the Panama Canal, and will have our first “steel beach picnic” – a picnic on the flight deck, so we can enjoy the view passing through the Canal.  Sometime this week, we will also cross the equator.  Some of you may have heard of the Crossing the Line ceremony – we are apparently doing this on the way back up (since there’s already quite a bit going on this week).  I am a little nervous about that but I think it will be fun – and then I will no longer be a pollywog, but a mighty shellback!  I’ll let you know how it goes…

More Jamaica...

April 17, 2011

We are halfway done with the first mission stop in Jamaica.  We got here on Wednesday morning and I spent the last 2 days at the Northside Arena clinic in Kingston.  What an experience.

When we arrived into port, I was so excited to get off the ship (after 5 long days at sea with nothing to do).  This excitement was tempered somewhat when I discovered I’d have to be ready to board a “hospitality boat” at 5:20 am.  This meant a 4-something o'clock alarm in order to get dressed, eat breakfast, pick up my MRE (meal “ready-to-eat” – as unappetizing as it sounds), and muster up.  There’s a lot of mustering in the Navy.  I forced down some coffee (suffice it to say, I really miss my Keurig), knowing it would be a long day, and was ready to go by the appointed time.  Turns out the Navy is just like the Air Force in its HUAW mentality – that’s hurry-up-and-wait.  We finally left on our hospitality boat at 6:15 or so.  As I mentioned previously, the Comfort is not docked in Kingston, but actually anchored several hundred yards offshore, so it was a quick ride.  Once we arrived on land, we boarded buses which took us to one of 2 clinic sites.  Like many places in the Caribbean, driving in Jamaica is terrifying – narrow roads, fast cars, opposite-side-of-the-street driving.  On top of that, we had a police escort with sirens and lights, and didn’t stop at a single stop sign or traffic light.  Not sure if this was for safety or celebrity status – I’m choosing to think the latter. 

After being driven through countless poverty-ridden neighborhoods, we arrived at the clinic site a little after 7am, with maybe a hundred patients already waiting in line.  My clinic site was actually not a clinic at all, but the city’s sports arena – a large indoor building with lights, some air-conditioning, and fixed plumbing – all luxuries that we were told not to expect.  Of course, the tradeoff was that there were no actual medical facilities, so everything we needed we had to bring ourselves.  There were several privacy screens, that we set up between long tables, kind of like this:

Hmm.  It took me a really long time to make that little drawing, and it doesn't appear to have copied into blogger.  Damn.  Actually, looking at it now, I’m pretty sure you would have had no idea what it was supposed to be anyway.  I’ll post pictures if I can.  Basically, there were 5 rectangles next to each other at the top of the drawing, and 5 rectangles next to each other at the bottom, with little lines in between.  There were 3 other rectangles on the far right of the drawing.  Each rectangle on the left 2/3 of the picture represents a table.  The top row was for adults, and the bottom row was pediatrics.  The three rectangles to the left were our Physical Therapy/ Back pain station, our mobile lab, and our pharmacy staff.  I put an X on my table, which you can't see.  That clarified things, right?  There were 2 providers at each table, and we each saw patients on our side of the table.  There was one private exam area set up outside this picture, under a staircase, with a privacy screen surrounding, but detailed physical exams were the exception, not the norm.

The only equipment we had at our table was a blood pressure cuff, an ear/eye scope, a stethoscope, and prescription forms.  We also had Purell at our table and a hand washing station close by.  It didn’t take long to familiarize ourselves with the “clinic,” and we started seeing patients shortly after we arrived.  The next 8-9 hours are kind of a blur.  Prior to seeing the medical provider (physician, nurse practitioner, or physician’s assistant), the patients were screened outside to determine their chief complaint.  They were given a wrist band with one of 4 categories – medical, dental, optometry, or pediatrics.  The hard-and-fast rule was ONE CATEGORY PER PATIENT PER DAY.  This was very difficult to explain and enforce.  I saw, obviously, patients who requested adult medical care.  We had a limited number of medications we could dispense.  We could also check a very small number of labs – Hemoglobin (only), iStat, fingerstick glucose, urine dipstick, and pregnancy tests, along with tests for malaria and HIV.  Labs in general were discouraged.  The first day I was there, we had no radiology capabilities, but the second day, we had plain films and ultrasound.  Radiology studies were generally discouraged too.  At first I didn’t really understand why, but after seeing a few patients, it quickly became clear.  There was really no way to follow these patients up.  I’ll get to that more later.

Patients came in for a variety of reasons – acute illness, chronic medical problems, second opinions, free medications, “to meet an American doctor,” routine check-up, and a variety of other complaints.  As it turns out, Jamaica actually has a decent health care system – the best of all the countries we’ll be visiting, apparently.  Health care is free to the public, but because of this, the wait list for most specialists or radiology studies is 1-2 years.  Patients who don’t want to (or can’t) wait that long have the option of going to a private clinic, and paying out-of-pocket.  One patient I saw came to me with the diagnosis of “cervical polyps,” and was scheduled for polypectomy in a few days at the local private hospital.  She was wondering if it could be done on the Comfort instead.  When she showed me her paperwork, I understood why: the operation, a relatively minor procedure performed in a same-day surgery clinic, was going to cost her nearly $20,000 Jamaican.  I contacted the ship to see if one of our gynecologists could perform the procedure, but the surgery schedule was already completely full.  Very frustrating to have to tell her that.

Many of the patients I saw came in with relatively minor complaints that were easily fixed with a couple of medications (that we were giving out for free): allergies (Claritin), constipation (Dulcolax), headache (Tylenol), or UTI (Bactrim).  Unfortunately, a lot of patients came in with more complicated problems – abdominal pain, chest pain, cough, shortness of breath, or back pain.  In the US, some of these problems wouldn’t really be considered “complicated,” but would definitely warrant further investigation – either with labs, EKGs, or X-rays or CT scans.  None of that was really available – and even if it was, scheduling follow-up for the results was next to impossible.  We were instructed before we went ashore to try to abandon the practice of “evidence-based medicine” (a concept taught to us since medical school), and instead to practice “empiricism medicine.”  Fever and a cough should be treated as pneumonia – no need to get a chest X-ray.  This was a hard concept to adopt – until we realized there was really no choice.  For a few patients, where I simply couldn’t treat anything without further evaluation, we had local discharge coordinators, who would assist with placing referrals for necessary tests.  However, for these patients, the same wait list or out-of-pocket expense applied, leaving me doubtful that the problem would be managed in a reasonable amount of time, if at all.  I was frustrated that we couldn’t do some of this evaluation on the ship – but then I realized that even if a CT or lab test revealed the diagnosis, the patient would not be able to get necessary follow-up care.  Even for the patients that we could treat, for example, Claritin for allergies, the prescriptions we gave will only last a month at the longest – so our help is only temporary.

We were also told before we went ashore that the “street value” for some of our free medications was fairly high – and that some of the patients would probably not take the medications they were given, but would sell them instead.  For this reason, we were advised to try to limit the prescriptions we gave to 2 per person.  I don’t know about street value, but I definitely had a lot of patients requesting certain medications by name, although they had never taken them before.  The other problem I ran into was that patients would see their friends receiving other prescriptions and would come back requesting those too – they weren’t supposed to be able to come back in, but somehow many of them did.  At first, I tried to help out and give them what they asked for, but eventually I felt like I was being taken advantage of – and for every patient who came back and asked for something else, that was one new patient that had to wait longer or possibly not be seen.  So by the end of the second day, I got good at telling patients, in an apologetic-but-firm way, that they had already received treatment and that they would have to wait in line again if they had other problems they needed addressed.

That was my other problem.  At home, in my oncology clinic, my standard practice is to ask, at the end of every visit, “Anything else?” and to keep asking that until the patient says, “Nope, that’s it.”  Many of my physician friends groan when they hear this, as it is a sure-fire way to extend the visit and run late in clinic, but I’ve found, as the sole oncologist, that it actually serves me well.  If I don’t do this, patients will remember something they forgot to tell me the next day, and will call the clinic to leave me a message.  Or, they’ll come in for chemo (in the middle of another busy clinic day for me), and stop me in the hall (“I forgot to ask you the other day…”).  So I like to try to take care of everything in the scheduled clinic visit.  In Jamaica, asking, “Anything else?” is a HUGE MISTAKE!  There is ALWAYS something else!!  And while we are trying to provide good, personalized care to every patient, there are literally hundreds more patients waiting to be seen.  We are trying to see 40+ patients per day, per provider – that translates to 10-12 minutes per patient.  I quickly realized that “Anything else?” should not be part of my repertoire, but old habits die hard.  I made that mistake several times, to the amusement of my partner provider across the table.

I could write about my patient encounters all day, but this has already been a pretty long post.  Thankfully, I have the next 2 days off, so I’ll continue to regale/ bore you with stories, I promise.

Here's my first attempt at uploading a picture - but I only have 20 minutes before church, so not sure if it will work.  No, I'm not kidding or exaggerating.  Ok, it didn't work.  It was going to be a kind of boring picture anyway, so I'll just show you when I get home. =)

Jamaica Mission

April 14^th, 2011

We’re in Jamaica, mon!  We pulled into anchorage (not into dock) yesterday morning and the first crew went ashore yesterday for site setup and patient screening for surgery.  Some of the medical folks went out today, but the clinic doesn’t really open until tomorrow.  I’ll be heading ashore bright and early, by “hospitality boat” and then by bus to the clinic site.  I’m anxious to get started – hoping the time will go by faster once we’re out and about. 

The last few days have been really eye-opening, though, full of preparations and planning activities for not only the Jamaica mission, but the next mission in Peru.  It’s amazing to me the amount of logistical coordination that goes into these missions.  In addition to medical care (which in itself is a huge undertaking – detailing pharmacy formulary, de-worming protocols, and patient flow), the ship has an entire “det” (detachment = section) dedicated to civil and environmental engineering, who will be performing non-medical humanitarian work, from building shelters to fixing plumbing systems to repairing schools.  There is also a group tasked with educating the host nation medical and lay personnel on hand and water hygiene, preventive medicine procedures (vaccines, mosquito nets, etc.), and a variety of “SMEEs” – subject matter expert exchanges.  I’ve been asked to provide several heme/ onc related talks and will hopefully get to meet with some of the local oncologists to see how cancer care is delivered in these less developed countries.  Like I said, eye-opening!

On a different note, I’ve discovered over the last few days some of the frustrations of ship living.  The biggest one by far: laundry.  There are some very strict laundry rules on board ships, apparently.  The ship’s laundry service (which, incidentally, are the same people who staff the mess hall) will wash and dry certain items – uniforms, towels, socks, and underwear.  However, the restrictions placed on how these items are accepted are laughable.  Socks and T-shirts have to go together, separate from towels and underwear.  Whites must be separated from darks (not sure where the “lights” are supposed to go).  Uniforms are to be rolled up and kept separate from the above items.  No civilian clothes will be laundered.  Bags must be secured with a laundry pin (which must be correctly ‘weaved’ through the top of the bag), and must be accompanied by a work slip detailing the contents of each bag.  Name and room number must be written on all uniform items.  Following these rules requires at least 20 minutes to prepare laundry properly, and several different laundry bags, each about ¼ full.  And today, my entire floor’s laundry was “rejected” because all of the laundry bags had drawstrings – which are evidently prohibited.  Truthfully, I wasn’t too concerned, as there are “self service” laundry machines available for use and I had the day wide open to accomplish a mere 2 loads of laundry.  As it turns out, the days on which these machines can be used depends on rank, and there are 10 washers and 8 dryers (for a crew of 900).  Given the restrictions above, there were some people with a LOT of laundry – one person had filled 5 washers at once.  Again, with not a lot to do, I wasn’t particularly bothered, and after a short wait, I got my clothes clean and dry (actually cleaner and drier than when they were done by the ship’s laundry service).  But wow, were some people ticked off!  Note for future deployments: clean clothes are a big morale booster.

Now, I’m told on a real “grey hull” ship, things work a lot differently.  The crew is smaller, and the percentage of officers on board is much smaller as well.  All laundry is taken care of by the ship’s service, and Navy personnel who have been on other ships have told me they’ve never even heard of rejecting a laundry bag.  They’ve also told stories about the officer’s “ward room,” which on the Comfort is a smaller, less crowded, less well-stocked version of the main cafeteria (mess deck), open to ranks O-4 and above.  Apparently on the “grey hulls,” the ward room is open to all officers and is somewhat like a restaurant, where a member of the mess crew takes orders and delivers food and drinks.  Sounds much more luxurious than what we’ve got here, but, oh well.  It could be a lot worse.  Apparently, in the Navy, serving a tour on the Comfort or its sister ship, the Mercy, is a big career-booster.  I have been asked countless times, by my Navy colleagues, “How did you get to come on CP11?”  They are astonished when I tell them this was just another deployment that was assigned to Eglin, and that I was in the band to deploy, and so here I am.  In the Navy, this humanitarian mission, although 5 months long, doesn’t count as an official deployment – so they don’t get any R&R (rest and reconstitution) time when they get back, and they can still get tasked for a “grey hull” deployment at any time.  I knew there was a reason I joined the Air Force!

At sea...

April 10^th, 2011

Today marks one week aboard the ship, and 2 full days at sea.  So far, no seasickness, but lots of homesickness. L

This first week has been inexplicably exhausting.  There has been no real “work” to be done, but somehow I’ve been falling into bed every night by 9pm completely wiped out.   Today was a down day, and after an 8:15am muster (1 hour later in honor of it being Sunday), I spent my time in church, outside on the “fantail” (the back of the ship) getting some fresh air, and in a man-overboard drill (where they intentionally hide several crew members to make sure we can appropriately account for ourselves). 

Yesterday and Friday, I spent all day in the Military Medical Humanitarian Assistance Course (MMHAC), which was a fantastic overview of, you guessed it, Humanitarian Assistance in the military.  The rocking back and forth of the ship and the lack of palatable coffee made staying awake a challenge – but it was a great course.

We’ll be arriving in Jamaica in a few days, and then the fun (read – work) will start.  I’m still not entirely sure of my role on this mission.  There are 6 internists on board the ship – myself, a cardiologist, nephrologist, ID doc, endocrinologist, and general internist.  Between all of us we’re pretty well covered.  We are rotating call as the “MOOD” – the medical officer of the day.  The MOOD is responsible for any on-ship calamities (man-down, code blue) that may occur.  Once the mission starts, the MOOD will also cover pre- and post-operative internal medicine consults and cardiac clearances.  It has potential to be busy, but we only cover that position one day of every six.  So far, the preliminary schedule has it so that the following day (post-call), we have down time, to rest, and then the following 4 days will be spent doing MEDCAPS (Medical Civilian Assistance Programs – ie, shore care).  This is VERY tentative however, as the motto of the medical crew seems to be “Semper Gumby” – be flexible.  Apparently shore time is extremely physically and emotionally challenging, and some have suggested we should only do 2-3 days at a time.  So we’ll just have to see.

On shore, I imagine I’ll be seeing standard internal medicine patients – just not sure how much I’ll be able to do for them.  A big part of this mission is surgical, and we have on board several general surgeons, orthopods, urologists, ENTs, dentists, and optometrists/ ophthalmologists.  As time passes I imagine I’ll have a better feel for my role.

As for ship life, I have gotten a great appreciation for how the sailors live.  The ship is pretty big, 896 feet long and >100 feet wide, and there are officially 887 people on board.  It is pretty damn crowded.  As a field-grade officer, I am very, very lucky.  I am in an 8-bed stateroom, but there are only 3 other women assigned to it so far.  We may be picking up some NGOs (non-governmental organization volunteers) once we get into country – although several are on board already.  Most of the other staterooms are near capacity.  Company-grade officers and all enlisted are in 80+ person rooms.  I never appreciated privacy so much – and again, I only share with 3 others.  The cafeteria (“mess deck”) is separated into 3 areas – one for enlisted, one for CGOs, and one for field-grade officers and above.  I think the enlisted get better food selection.  With that said, the food is pretty good.  There is definitely no lack of it!  The saying going around is, “Eat until you’re tired, and sleep until you’re hungry.”  Pretty much sums it up.

I have made it to the gym a few times so far – to compensate for all that eating and sleeping.  Last night was my first night there since we left port.  The seas weren’t particularly rough, but running on the treadmill made me laugh out loud – half the time, I was running downhill, the other half, uphill – due to the boat rocking back and forth!  Something I never even considered.  The boat rocking is pretty noticeable, but after 2 days at sea, I already have my sea legs, apparently (evidenced by the constant leaning back and forth while standing).  The rocking is also the world’s best sleep aid.

There are about 45 Air Force members on the ship, total, with about half of us being medical and the other half linguists or logistics crew.  We are definitely outnumbered by the Navy!  Over the last few days, I have frequently found myself grateful to USUHS (my med school) for the tri-service connections.  There are 2 physicians here from my med school class, and several other “friends of friends” and other USUHS alumni – it really is a small military community and it’s nice to have ties and common experiences to share.  Everyone is very friendly, but it’s nice to see an even friendlier face from the past when you’re otherwise surrounded by complete strangers.

On a lighter note, we had our first bathroom back-up this week.  Apparently someone had stuck a toilet-freshener (you know, the one that makes the water blue) into the bowl, and it clogged the pipes.  This resulted in a sewage backup into the enlisted berthing area, about 3 inches deep.  I didn’t see it (or smell it, thankfully), but no one was able to use the toilets for several hours while it was fixed.  I am now a believer in the 3 P’s and a T.

It’s 4:45 and time for dinner – totally at the mercy of the ship’s dining hours, but like Pavlov’s dog, I am ready to eat when they announce “supper for the crew!”  I’ll continue to write when I can.  To those who have emailed – thank you!!!  It is SO NICE to know people are thinking of me and to be reminded of home.  Miss you all!

April 4th, 2011

I just finished my first “Navy shower” – and it wasn’t as bad as I expected.  The ship produces its own water supply, and can produce up to 300,000 gallons daily, but given the number of people on board, water conservation is highly encouraged.  Hence, showers are to be turned on only to get wet and then during the rinsing step.  I thought this would be really cold and miserable, but it turns out they keep the “head” (Navy term for bathroom) really warm.  Which is especially nice considering that our “berths” (rooms) are freezing.  Not sure why this is, but I’m definitely glad I brought my own blanket.

I’ve been on board the Comfort for just under 24 hours now.  It feels like much, much longer.  I’m hoping this has less to do with the possibility that time is crawling, and more to do with the fact that it has been a completely packed 24 hours.  After in-processing late last night, I found my berth – no small feat, given the quaint and distinctive Navy terminology for right, left, front, back, stairs, walls, and the completely un-intuitive room numbering system.  I was very happy to find that I was assigned to an 8-person stateroom – many of the junior officers and all of the enlisted personnel are in “overflow” – 126-person bays.  So far, there are only 4 women assigned to my room – but more staff will continue to inprocess over the next several days, so I’m expecting that to change.  The room is plain and utilitarian.  I’ve dressed my portion up with a nice red blanket and some pictures of Scott and the kids.  I’m hoping to get to the NEX (Navy exchange – like a big Wal-Mart, but tax-free!) over the next 2-3 days to get a few more decorations.

My day today started at 5:45am – similar to being at home, but without the cute kids jumping in bed with me. L  Breakfast was cafeteria-style, and fine.  Then we “mustered” (gathered) in our duty station – my duty station is sick call.  That means while we’re underway, I’ll be helping to care for ship personnel who get sick or injured.  Not particularly glamorous.  We met several Navy and Air Force people in charge (haven’t figured out all the actual titles yet), and then it was death by PowerPoint, where I learned how to deal with actual ship emergencies like Man Overboard, Abandon Ship, Fire on Deck, and Poop Back-Up.  Seriously, there must have been 30 slides on how old the ship’s pipes are and how nothing – NOTHING – goes down the drain except the 4 P’s (pee, poop, puke, and SHIP’S TOILET PAPER – get it?).  Ick.

An uneventful day, overall.  Completely overwhelming and underwhelming at the same time.  I have used the word “surreal” to describe my thoughts many times over the last 24 hours.  To think that yesterday I woke up in my own cozy bed, and played with my precious angel kids, and kissed my amazing husband and parents goodbye, and now I’m on a huge Navy ship surrounded by 500 people who will quickly become my lifeline, but who I don’t know at all right now, is completely and utterly, well, surreal.  Exciting, but hard to grasp right now in my very sleep-deprived state.

Once we’re underway (at sea), it looks like internet access will be even more limited than I originally thought.  If I cannot access gmail or yahoo, I’ll be sure to pass on my official Navy email address.  Once I have it.  I didn’t make it that far today.

Ship email

Ok, not sure if I'll be able to access gmail or yahoo once we're underway, so for those who feel compelled/ guilted into contacting me, I have ship email! It's Melissa.King.mil@ah20.navy.mil. Feels a little weird to have navy address...

And for those who have been dying to send me care packages, here's my mailing address:

Major Melissa King
H-1/ Dept. Of Medical Services
USNS Comfort T-AH 20
FPO AE 09566-4008

No need to send anything yet, though, as we're still in port for a few more days...

Once I figure out Internet access I'll post a longer blog update.