Robert E. Springer, CRNA, APN

  • May 1, 2017

Rank during Vietnam tour: First Lieutenant, U.S. Army
Served in Vietnam: July 1967 to July 1968

My name is Robert E. Springer, CRNA, Bob to my friends, Robert to the IRS. I am a member of the AANA and the NRA. I was born on August 14, 1945, “VJ Day,” (“Victory Over Japan Day,” which signified the end of WWII) in Catawba, Ohio, the son of a Methodist minister and grandson of a WWI veteran. I will tell you a few things about my father first, because they help explain how I got to where I am at almost 72 years old.

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1LT Robert E. Springer "at home"

In 1950, my father changed course from being a minister, and became the purchasing agent (nowadays called a materials manager) at White Cross Hospital in Columbus, Ohio (this is now part of Riverside Hospital). In 1957, we moved to Chicago where he was purchasing agent for Presbyterian Hospital while it merged with St. Luke’s Hospital, all part of Rush University Medical Center now. He went to night school at Northwestern University and earned a Master’s degree in hospital administration.

We then moved to Edgerton, Wis., when I was in the seventh grade. I got a job delivering newspapers by bicycle, and one of my customers was the sole CRNA where my father was the administrator. When I found out what this man did for a living, it fascinated me. I also was impressed that when I delivered his paper, he always seemed to be at home sitting on his front porch reading a book. It looked like good work to me.

While attending Limestone High School in Bartonsville, Ill., I was only a fair student. As my junior year was finishing, I started to get a bit nervous about the future, because in those days you either went on to college after graduation or you went into the Army like Elvis. I needed a plan and I recalled that CRNA in Edgerton who had that cool job. To this day I clearly recall approaching my parents to see what they thought of my plan to go to nurse’s training (that was back when nurses were “trained,” and not so “educated”) and then on to anesthesia school. I think I was surprised by what a good idea they thought it was.

So, in the fall of 1963, I headed to Springfield Memorial Hospital in Springfield, Ill., which at the time was one of the few nursing programs in the area that accepted male students. There was one male student in the class ahead of us, Jack Pierce, CRNA; and three in my class, Robert “Bob” Otkin, CRNA, Jacksonville, Ill.; Larry Iungerich, RN; and myself. During our time in school the Vietnam War was expanding, and by our senior year the prospects for a new graduate male nurse were not very good for avoiding the draft. The U.S. Army offered a student program to senior students to join up as a private first class (PFC) and to go on active duty after passing state boards as a second lieutenant (2LT). I also knew if the Army worked out, I could go to an anesthesia program in the Army one day. This program offered big bucks, base pay and a housing allotment which totaled about $215 a month! Being smart with my money, I bought a ‘65 Mustang and an engagement ring.

After graduation I worked in the operating room (OR) until late November 1966, when I entered active duty and was sworn in as a 2LT in the Army Nurse Corps (ANC). Basic training was at Fort Sam Houston, Texas. ANC basic training was a breeze compared to enlisted basic. We learned to march, Army Medical Systems and Structure, spent a week in the woods for eating out of mess kits, day and night compass and infiltration courses. In basic training I met a lifelong friend, Tom Watters, CRNA; and First Lieutenant (1LT) Kenneth Shoemaker, CRNA.

My focus was never on “floor nursing,” and to avoid getting that duty, I applied to the Army’s six month Basic Operating Room Nursing course and was accepted. Anesthesia was my goal and the OR was always my second love. So after basic, I headed to school for my first assignment at Fort Benning, Ga. A tour in The Republic of Vietnam (RVN) was an almost guaranteed graduation present from OR school, and I was married to a student nurse who would be entering her senior year. So I requested to be assigned to Vietnam, knowing she would graduate about the time I would get back stateside. Sounded like a good plan, but as a young man, I didn’t know everything I should have. Twenty-four years and three wonderful children later, the marriage ended.

The 24th
Early in July of 1967, I boarded an airliner for my trip half way around the world to Vietnam. After landing, I got a ride in the back of a deuce and a half (a two and one-half ton truck) to the 91st Replacement Company (just like almost everyone did) to spend a night and receive my orders to the 24th Evacuation Hospital, Long Binh.

The 24th Evac was the highest class of hospital “in country.” In order of medical sophistication, the Army classified its hospitals from general, field, evacuation, surgical, and aid station. This doesn’t mean that the more critical patients always went to the more “sophisticated” hospitals, but it did reflect the surgical specialties that might be assigned to that unit. The 24th had neuro, vascular, general, ophthalmology, orthopedic, maxillofacial and yep, even the only gynecological doctor in all of Vietnam.

The hospital buildings were comprised of several Quonset huts organized in a rectangle. Like the OR buildings, some of the huts were interconnected with passage ways. The OR “suite” consisted of four interconnected huts.

One hut was for preoperative, postoperative and “expectant” patients; the second and third huts each had three operating room “areas” (they were not rooms, but had portable wooden screen dividers in an otherwise open area); and the fourth hut was for central materials, sterile processing and storage. Each of the Quonset huts was marked on the outside with large red crosses and was sandbagged about four feet high on the sides. The other huts were for ER, lab, x-ray, medical and post-surgery patients, administration, and of course the Post Exchange (PX), and mail room. The helipad was large and could handle as many as eight or more choppers at a time.

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Typical operating room. Notice the two surgical lights, the one on the right is in the next "room." Oxygen and nitrous oxide tanks were chained to the wall and the suction was a portable machine.

My room assignment was in a GPM (General Purpose Medium) tent with a concrete slab floor that was shared with about a dozen and a half others, at least that is what I recall. Our beds were the old folding Army cots. We each had a wooden locker for our uniforms and our stuff. There were locals who would come in and took care of laundry and boot shining for a small fee.

 

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The view of the GP medium tents from the top of a water tower.
The sandbags cover the bunkers.

 

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Corner view of the tent

Latrines were 4-6 “hollers” with a 55-gallon barrel which had been cut in half and placed under the sets to catch the “droppings.” A detail would come around almost daily and remove the barrel and replace it with an empty (not clean, just empty) one. The full ones would be taken away to someplace I didn’t ever want to visit, gasoline was placed in it and the content was burned. Latrines were not the safest places. On one occasion I recall a sergeant who, while using the “facilities” and smoking at the same time, dropped his cigarette butt into the barrel below him. It seems there must have been residual gasoline in the barrel and he received a flash burn on his back side in the form of a perfect “church seat.”
 

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The officers' latrine

On another occasion in an engineering company, it appears that a sergeant had irritated some of his men and while he was relieving himself, a large bulldozer “happened” to bump into the latrine, tipping it over. He presented to the 24th with a fractured arm and in need of a bath.
 
Now don’t get the idea that we didn’t have running water, we did. Around the compound there were several large tanks about 10 feet in the air supported by wooden frames, which supplied water to the OR, central supply, and other areas for scrubbing and instrument washing. There were also tanks of water to provide water for the shower rooms. These tanks would be refilled almost daily from large tanker trucks that would make their rounds through the compound. If you wanted a “warm” shower, you needed to take it after the sun had warmed the water and before it was refilled.
 
During the summer the monsoon rains would come every afternoon. To handle all of the rain water, the compound had a series of ditches about every 100 feet or so, which one would have to jump over as you traveled from place to place throughout the compound.
 
I recall also that dysentery was not an uncommon problem. We had a major who was chief of professional services, and he had this condition during a heavy monsoon rain late one afternoon. He stood in the doorway of our hut and waited and waited for a break in the downpour. Finally, he could wait no more and he took off running for the latrine as several of us watched. He was doing just fine in the pouring rain until he had to jump the first ditch. When he landed on the other side, he slipped and fell. He picked himself up and changed direction toward the showers. When he finally returned to the hut he said that he had just learned something, “When in doubt, don’t blouse your britches.”
 

News Travels Fast
In November 1967, right after Thanksgiving, we got word that 1LT Kenneth Shoemaker, CRNA, and 1LT Hedwig Diane Orlowski, an OR nurse who was in my OR class at Fort Benning, and others died in a plane crash when returning to the 68th Evac after helping out at the 71st Evac. It took a few days for word of the crash to get on the grapevine and find its way about 100 or so miles south to our location. There was no formal notification, but in a small unit news travels fast.

I didn’t know Kenneth well, I remembered him from basic training company and remember one night several of us went out to eat supper at the Bean Pot restaurant in San Antonio. I recall from this outing that he always seemed engaging, on the ball, and a good guy. I had lost track of him after basic training.

Diane I had known as a fellow student for six months in our class of six students in OR school. She was the quiet one who seemed a bit shy, but was an excellent student and a great nurse. I am sure that both Kenneth and Diane where among the best the 68th Evac had to offer to have been assigned the mission of helping out at the 71st.

This news impacted all of us. Some of us knew one or both of these soldiers, which of course was a personal loss. But their deaths also pointed out to each of us that, had the cards been stacked differently, that could have been us.

Daily operations
I worked as an OR nurse for the first five months. We worked 12 hour shifts, six or seven days a week. I have never worked with a better team of professionals since then. I often marveled at how young enlisted men with no prior background could attend a short course and quickly become excellent scrub techs.

As we treated all types of war injuries, I always had my eyes on the CRNAs. These were some special people and I wanted to be one of them.

The Tet Offensive of 1968 came and we were very busy. The Long Binh ammunition dump about a mile from us was hit, caught fire and ordnance exploded for a few days. We spent some time in the bunkers that were located by our huts. When things cooled down caring for our wounded, we cared for enemy wounded.

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The ammo dump burning, as viewed from the helipad.

We had a POW hospital right next to the 24th and there was a call for anesthesia to go to it and give anesthesia for three leg amputations. A CRNA whose name I will not reveal asked me if, since I wanted to be a CRNA, I would like to go with him and give the anesthetics with his guidance? He didn’t have to ask twice and off we went.

The POW OR was in a GPM tent. The anesthesia apparatus was a Field Anesthesia machine designed so that it folded out of an Army green O.D. (olive drab) metal case, which looked like a trunk that was about 18 inches by 30 inches. At the 24th, the machines were fitted with halothane vaporizers, Fluotecs, but the machine I used had just oxygen and nitrous oxide flowmeters. In those days we took blood pressure measurements manually; we used a precordial stethoscope, eye signs and had our hands on the patient’s pulse. That was all we had. There was no pulse ox, expired CO2, EKG, oxygen monitor, nerve stimulator or ventilators. The cases I did were done with the “Liverpool Technique.” Sodium Pentothal and drip succinylcholine IV and oxygen 30%, nitrous oxide 70%, were administered using a bag, mask and oral airway, because the machine was not equipped with a Fluotec or a side arm Vernitrol vaporizer. The cases went well and recovery was a few minutes on the OR table, and then they went back to their hospital rooms in those GPM tents. As an OR nurse, I got my first three anesthesia cases in and knew I was going to like it!

During the Tet Offensive, our helipad was used as a staging zone to resupply pinned down troops in the field. Carts similar to those used to move baggage at an airport came in on Chinook choppers, loaded with cases of C-rations. It was soon obvious that there were many more cases of rations than would be needed in the field. I will not say a lot about this, but we did some moonlight shopping on those carts and had all the snacks we needed for months.

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The helipad. Offloading a patient on a stretcher.

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Quonset hut #1, surgery. Notice the sandbags and the water tower on the right.

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A CRNA preparing the anesthesia equipment. Notice the tape recorder, we had to have our music. Just beyond the tape recorder is an electrosurgical machine (Bovie).

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CRNA giving anesthesia. Notice the air conditioner placed in a hole
cut in the side of the hut. Better view of the Bovie unit at lower right.

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A view down the length of the operating rooms in Quonset hut #1.

Life and Death
Of all my memories, this story stands out the most. We had a Vietnamese lady present to the 24th, pregnant at term. No fetal heart sounds were detected and she was not NPO (she had eaten in the past eight hours). My memory differs from someone else who wrote a book about this case as to why she came to us, but it really doesn’t matter. Because the baby was not viable, we waited eight hours for the mother to be NPO and then went to C-section. It turned out that she was pregnant with twins. Due to extraordinary OR corpsmen, these “dead” twins were resuscitated.

 

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The two corpsmen who resuscitated the babies.

Now we find that we need a neonatal intensive care unit in a war zone. Incubators were fashioned from cardboard boxes. Gooseneck lights became infant warmers. Dixie cups became oxygen masks. Diapers were made from ABD (Army Battle Dressing) pads. Mothering instincts poured from both male and female staff. One of the twins did not survive past the third day. The mother abandoned the babies as soon as she could leave the hospital. The other baby did very well and was like a little mascot to our unit until one fine man, SGT Leon Rodriguez and his wife adopted her. SGT Rodriguez was the non-commissioned officer in charge (NCOIC) of the 24th Evac OR. He fell in love with our girl and went through the overwhelming task of getting the adoption arranged. The full story is written in his book Bring Our Baby Home.

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The newborn twins.

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The surviving twin with a nurse. Taken in the inner courtyard
of the rectangle of the hospital Quonset huts.

Injuries
The injuries we treated varied greatly. As you can imagine we saw a lot of multiple fragment wounds, gunshot wounds, traumatic amputations, head and facial wounds. Many times it was combinations of all of these. We had a poor soul come in with a live RPG (rocket propelled grenade) round in his face. While these were part of war, I was really more affected by some of the senseless injuries we treated. I recall a gunshot wound to the abdomen that occurred in an Australian enlisted men’s club. Another time two of our soldiers had a “Gunsmoke” shoot out duel in the streets of Bien Hoa with their .45 caliber hand guns. Both were shot.

A third incident happened when a patrol of men in the jungle stopped to take a break. Two of the men were entertaining themselves by tossing a white phosphorus grenade back and forth to each other as they sat “Indian style” (cross-legged) on the jungle floor. Of course it exploded and both men received phosphorus burns to their groins and anterior bodies. Phosphorus burns and keeps on burning until it is neutralized. We debrided burned tissue and irrigated with copper sulfate solution to neutralize the chemical until we had cut out all of the burned tissues.

One more, a nurse who ended up with an amputated leg when she was in a Jeep accident while returning from a noncombat mission to a nearby post’s Officer’s Club.

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We had a local man ("the rat man") who went through the compound daily, going from trap to trap. He would transfer the caught rats into a wire cage. At the end of the day he would have 10 or so in the cage.

Respiratory Therapists Needed
There is a saying in the Army that all soldiers know, and it may go back centuries, “There are three ways to do things: the right way, the wrong way, and the Army way.” At this time in the 1960s, respiratory therapy (RT) was still an emerging specialty and the Army had not yet created an MOS (Military Occupational Specialty) for this discipline. There was definitely a need for RTs at the 24th. In the good old ways of the Army, they found a way to get things done. Three therapists were located serving in an infantry battalion and the negotiations began. It seems that a respiratory therapist at that time had the same value as a case of beef steak. Three cases of steaks were transferred to the infantry, and we got our three RTs. The 24th got the best of that deal.

All in a Day’s Work
About five months into my tour I was assigned to be the head nurse of the central supply unit. I don’t know if that was because I was not a good OR nurse, or if I was the only one who would take that job. Again, I was amazed by the character and quick learning of the corpsmen. These young men were able to put up complicated instrument sets, learn the funny names of neuro, ophthalmic and ENT gadgets, as well as operate field autoclaves and make our own irrigation saline.

I recall the day I learned not to make assumptions for the anesthesia team. My supply officer came to me and said he just could not get his hands on three-way stopcocks with extension tubing. I looked at the IV sets and said, “Well, they can just use these side ports and all should be fine.” Major Norma Horsley was the chief CRNA and she let me know that one, it wouldn’t be okay, and two, don’t ever make a decision for her again. I learned fast.

About this same time we got a new home, if we built it. It was an ADAMS Hut. I can’t remember what that stands for, but it was aluminum modular building about 24 x 40 feet and if we wanted to live in one, we had to put it together ourselves. The engineers poured a concrete pad and the rest was up to us in our spare time. When completed, it was divided into 10 rooms with Masonite walls, bamboo mats for a ceiling and oriental beads in the doorway. We saved a little area to use as a lounge. This was a big step up from that damp miserable GPM tent.

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Working on the ADAMS hut

Something I enjoyed doing on a day off was to join a “Med-Cap.” To this day I don’t know what that stands for. We would put together a small medical team of a doctor and nurses and travel out to a village near our post. We would hold a “sick call.” We saw a lot of children and older people. One of the things we did a lot of was handing out soap. We were armed and guarded the entire time by military police who would circle the village in a Jeep with a .50 caliber machine gun mounted on it. On one occasion I was able to go to Saigon with an ophthalmologist and helped him do cataract surgeries in a hotel lobby.

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1LT Springer. Photo taken during a MEDCAP

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1LT Springer on MEDCAP in a nearby village.

Home
In July of 1968, it was my turn to go home. The military got me to San Francisco and then I was on my own ticket back to Illinois. When I sat in my seat I noted that there was this “hippy” in the next seat. I had never seen one before. Armed Forces Radio had not told me much about them. I thought he smelled sort of funny…I know what that odor is now. We took off on time and got leveled out when a buzz started moving from row to row though the plane. Someone has a bomb on board! Of course I am thinking, “I made it a year in RVN and it’s going to end like this.” We made an emergency nighttime landing in Salt Lake City with what looked like every piece of fire equipment they owned chasing our plane down the runway with their emergency lights flashing. The plane stopped as far from the terminal as possible, and we all deplaned in weather too cold for my lightweight khakis. They had only two station wagons to transport the passengers of a loaded plane to the terminal. At first I thought women and children first, but when my teeth started to chatter, I jumped in the next ride. Thankfully this was a hoax and within a few hours we were back in the air.

I arrived back in Illinois in time for the Fourth of July celebrations. There was a family picnic and all I remember is that every time someone set off a fire cracker I reflectively ducked and looked for cover.

Now I am back stateside. Robert Kennedy and Martin Luther King have been killed. There have been riots in the streets. There are those hippies I don’t understand. The first movie I saw was “The Graduate,” let’s just say Mrs. Robinson shocked me.

Anesthesia school
My next assignment was back to Fort Benning, Ga. Within no time I was accepted to start anesthesia school in May of 1969 at Letterman Army Hospital, Presidio of San Francisco. This was at the height of the hippy and Haight-Ashbury days. I recall going to the roof of the hospital one summer day to watch a group of protesting hippies trying to storm the outer gate of the base. Sometimes it was a bit uncomfortable being in that community and being the only one with a green uniform and short hair.

The Lt Col who was our first instructor; let’s just say she was old school. She would stand behind you during an anesthetic and worry you to death. I learned a lot from her, but often it wasn’t very pleasant learning. Alex Ferry and Bill Story, both majors, finished us off and were outstanding instructors.

The first few months of our course were all didactic. At about month three we finally got into the operating room. Letterman had eight ORs, and was a very new and up-to-date hospital. It was a full service hospital with open heart and neurosurgery. The open heart room was the only room with cardiac monitoring. In those days you would debate if a patient had enough heart trouble to need EKG monitoring. If they did, we had one monitor that was affectionately called a “bullet.” It was a two-foot-long tube with a three-inch screen on one end that gave a bouncing ball EKG tracing. The leads were attached to the patient by inserting subcutaneously, five all metal 20-gauge needles that were attached to the end of the cables. Since five needles would hurt we would wait until we had the patient anesthetized before hooking up the EKG. I think one reason EKGs were not used more often at the time was that few people in anesthesia knew much about interrupting one.

The Army always had very up-to-date anesthesia machines, but because Letterman was a teaching facility, we had several current but older machines. We used only Ohio (now Ohmeda) machines. Many of the machines had Copper Kettles or Vernitrol side-arms vaporizers which could be used for halothane or ether. The American Association of Nurse Anesthetists (AANA) required that we administer 50 ether cases to take boards in those days. These vaporizers we equipped with thermometers, so that as the agent cooled during use from the latent heat of vaporization, one could adjust the flow rates to keep the delivered agent concentration stable. This was a lot of math, but we did have slide rules that could be used once you had proven to your instructors that you knew how to calculate it. The machines were the Ohio 2000 series.

We were introduced to the Ohio DM5000 machines. These were state-of-the-art machines: ether, pentrane and halothane capable. The problem of agent cooling during a case was handled by heating the vaporizers. Only one problem, the ether somehow would migrate into the ether flowmeters. Today that would have resulted in a national recall, but in 1969 they just told us not to use the ether.

Anesthesia ventilators were now available and we had them on most of our machines. These were pressure limited; volume-limiting ventilators were still years away. We were several months into our course before we were permitted to use ventilators because we needed to learn the feel of the bag. In those days endotracheal tubes were washed and reused, and the cuffs had to be replaced about every 20 uses or so with a new latex one, which was placed by wetting a long nasal speculum in isopropyl alcohol, stretching the inner side of the new cuff over the end of the endo tube. A once-used IV three-way stopcock was attached to the pilot tube to hold the air in and to keep cleaning solutions out of the cuff.

One thing stands out in my mind was I was administering the anesthetic for a young man with a cerebral aneurysm and he died on the table. I was about half way though the 18-month program at the time. After he was pronounced dead, the neurosurgeon came up to me and put his arm on my shoulder and made a point of telling me it wasn’t my fault. I have often thought of the insight and kindness he demonstrated. A few times I have heard a doctor say, “You killed that patient” to someone. We all need to try to know what others are thinking and feeling.

I finished out my eight years and a few months in the Army as a Captain at Fort Jackson, Columbia, S.C. I truly enjoyed my time in the Army, but promotions were slowing down with the Vietnam War ending. I located a solo CRNA position in South Hill, Va., in 1974. The skills and experience of the military and very good backing from the internal medicine doctors made this a very rewarding practice setting. In 1977, Roger Jacquelin, CRNA, joined me. In 1985, my long time Army friend Tom Watters, CRNA, joined us.

Vietnam and Veterans
I have been to Washington, D.C., and had the opportunity to visit the Vietnam Wall. At that time I could not bring myself to do it. Later, I did visit the Traveling Wall and I found myself overcome with emotion. If you have not read Ken Bopp’s story of his trip to the Wall, I recommend it. I believe he has been able to put into words what most Vietnam vets experience at some point and have difficulty expressing and understanding. I recall when my wife and I were dating in the early ‘90s, the Statler Brothers’ song “He’s More Than a Name on the Wall,” came on the radio while we were driving around. I broke into tears and had to stop the car. This would-be tough guy has a hole in his heart for those KIAs, MIAs and wounded. It is always there, but it doesn’t always show. In our everyday work stateside or in a war zone, we are taught to contain and control our emotions for the sake of the mission. We do what is asked of us and we try to do our best, but the pain of what we have witnessed stays with us and at times comes to the surface of our lives.

I think most veterans, regardless of which war(s) they did their part in, file some of their experiences, the good and the horrible, into that “box” in the back of their minds, trying to make it part of their past. When it stays in the “box,” I think I am doing just fine, but as in Ken Bopp’s story of visiting the Vietnam Memorial Wall and my experience with hearing the Statler Brothers’ song, that “Jack-in-the Box” can pop open. I don’t always know what might trigger it, but when it does, it is not haunting me; it is helping me to maybe heal and to put it in a proper perspective. Healing can leave scars that our “mind’s eye” takes a look at when we least expect it. Don’t get me wrong, it is not something that comes up often. When it does it is usually just for a few minutes and I get it back in the “box.” Friends and family want to help, but they usually don’t know what part of themselves to give you and you don’t know what to do with what they are giving you.

"You gotta walk that lonesome valley,
  You gotta walk it by yourself,
  Nobody here can walk it for you,
  You gotta walk it by yourself....
  Nobody else can walk it for you,
  They can only point the way.”
  —Woody Guthrie.

In my office hangs the picture of the man reaching into the Vietnam Memorial Wall and shadowy military men in the Wall reaching out to him. On a table below it is my grandfather’s picture, the flag that draped his casket, and every Veteran’s Day card I ever received. I wish to refer you to a website created by a special young man who collects military uniforms and researches the man or woman who wore them. He is Robert Mackowiak and his web page is: “Exhausting and Dirty Work.

Now almost 50 years have passed. I retired in 2016 with 50 years in nursing and 46 years as a CRNA. We live on a small farm in Virginia and raise a few beef cattle, breed Labrador retrievers and enjoy our grandchildren. God bless the broken road that led me to my wife.

Do I have any advice? 1. If you are looking for someone to marry, find someone who is a hell of a lot nicer than you are. 2. Always remember that you can be right or you can be happy; always pick happy. 3. Remember when you define yourself to do so by defining who you are as a human being, not by what you do for a living.

Bob Springer, CRNA
bkspringer1160@gmail.com