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The soldier nurse

Image: David Blumenkrantz

Nursing can be one of those fascinating careers that always brings with it new experiences. There can be plenty of drama, surprises and emotional highs and lows. Talking with Bernardino Ramos, the head nurse at a Veterans Affairs clinic and a veteran himself, it’s apparent that for those working in the military, the extremes can be even greater.

After earning his RN at the University of Florida, the Puerto Rican–born Bernardino started his nursing career in the civilian sector, working at Olive View Hospital in Sylmar, Calif., from 1990 to 1995. Then in 1997, at the relatively advanced age of 35, he enrolled in the Army.

“For some reason I liked the military life” is his typically taciturn explanation. After receiving basic training in San Antonio, Texas, Bernardino was deployed to South Korea as a first lieutenant, and was later promoted to captain. He worked at a facility called 121 Casualty, where they dealt with “all kinds of emergency situations.” Much of the nursing done in South Korea was not battlefield-related, and Bernardino recalls one tragic emergency occurring when a pediatrician, who was there covering for another doctor on leave, was stabbed in the street.

Two years later, Bernardino found himself stationed back in the U.S. at Fort Huachuca in Arizona, training medical personnel to deal with all manner of field casualties. Fort Huachuca is home to the U.S. Army Intelligence Center and School, and when the 911 terrorist attacks happened, as Bernardino casually recounts, “We were mobilized to move into bunkers, where we spent three days.”

In 2003, he switched from the Army to the Air Force. Stationed at Travis Air Force Base in northern California, Bernardino worked with what he described as a “flying ICU unit,” going into the battle zones of Iraq and Afghanistan to evacuate the wounded. His eyes take on a faraway look as he recalls the worst of it. “It’s traumatic—they are flying out for better care, missing body parts—no legs, no arms, no faces, abdominal wounds. So many people we don’t see. We only hear about those who are killed. These are things you don’t see in civilian life.”

Four years ago, Bernardino retired from the service. He was, in his own words, “feeling crazy. Seeing patients missing arms, eyes, legs—that is stressful, not only to them, but also to those who care for them. It took me almost a year to recover from the stress,” he admits. “It was hard to incorporate myself into civilian life.” He spent six months in therapy in San Diego while searching for an elusive job in the civilian world.

The Sepulveda Ambulatory Care Center (SACC), where Bernardino eventually found work, is one of the largest facilities in the Department of Veteran Affairs Greater Los Angeles Healthcare System. Bernardino is in charge of a specialty unit known as the Blue Team, one of 10 clinics at SACC. He directs six nurses, coordinates patient care and supervises the involvement of social workers and case managers. The Blue Team sees referrals from the primary clinic—veterans suffering from physical pain, disabilities and trauma. Bernardino explains that while the majority of their patients have historically been Vietnam vets, “now we are seeing more from Iraq.”

There are also many neurological cases, as well as those that require psychology and psychiatry. While not downplaying the physical traumas that afflict war veterans, Bernardino seems particularly interested in and knowledgeable about the emotional toll of war. “I’ve been there—as a soldier. I know what’s going on with the veterans, both physically and mentally. When you are mobilized to Iraq or Afghanistan, there is stress right there. No matter if you go for three months, six months or more, you are under fire all the time. Many soldiers who come back don’t have physical wounds, but emotional ones. We see a lot of post-traumatic stress.”

The government’s undying commitment to providing healthcare for patriots who make the ultimate sacrifice for their country comes with some drawbacks. The patient population at SACC is so big that sometimes patients are told to come back for follow-up appointments after three months. Bernardino cites medical refill lapses as an ongoing concern of his. “I work with doctors, reminding them to review prescriptions to ensure that their medications last until their next visit.”

Yet Bernardino is quick to downplay public perceptions of the VA as an inefficient bureaucracy. He also works weekends at a USC extension hospital in Orange County, and is well suited to compare civilian healthcare with government healthcare. His old soldier’s loyalty comes across as genuine as he defends the VA, insisting that while there will always be complaints, “patients here are treated like family. I think the care the patients are receiving in the VA is better than in civilian life, because there they only treat ailments. Here they treat the whole person.”

He says that some patients come in for one thing and “we find other problems, like financial or transportation issues.” The social workers deal with outside issues, which include homelessness and patients treated by caregivers at home. Bernardino says the VA arranges transportation for patients coming from as far away as Bakersfield, while volunteers help disabled veterans get around on the hospital grounds. Furthermore, Bernardino asserts that when it comes to using cutting-edge technology, the VA is up to date, making it “a leader in the field of healthcare.”

On a personal level, Bernardino cites exercise as the single most important factor in relieving stress and keeping him fit for duty. An athletic 52, he starts every day with a military regimen of sit-ups and push-ups, and runs “a minimum of two miles” before showering at home and heading to work. He boasts that he still runs miles of eight minutes or less, and can still pass the Army physical with a score of 100 percent.

“That’s part of my heritage from the service,” he says, flashing a rare smile. “Exercise.” He does his best to share his enthusiasm for working out with the veterans he meets every day at SACC. “That’s what I tell the patients: ‘You learned all these skills in the military. Use your body.’ Some listen, some don’t.”

Married for 30 years, Bernardino has two children, both adults now. He’s proud to announce that his son is entering the National Guard. Since Bernardino began his career in nursing, he has added both an MSN and an FNP to his resume. He expresses optimism that the latter, which he just completed last year, will give him “the opportunity to work with veterans in a more direct way.”

See the powerful photo essay featuring Bernadino and his patients.

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David Blumenkrantz

David Blumenkrantz’s professional experience includes an eight-year stint doing documentary work and freelancing in Africa, where he traveled extensively covering a wide variety of relief and development-related social issues. He ran a photography training course for Eritrean freedom fighters in Asmara, and spent more than two years running an information department for the Undugu Society of Kenya, an organization dedicated to improving the quality of life for street children and the urban poor. Upon his return to the United States in 1994, Blumenkrantz worked for the Los Angeles Times and various other publications as a freelance photojournalist. In 2004 he joined the journalism department faculty at California State University, Northridge, where he teaches documentary journalism and photojournalism.
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