Maj. Richard Krasuski, USAF, a renowned researcher and top-notch cardiologist at Wilford Hall Medical Center, Lackland AFB, Texas, has a copper-wire sculpture of a bonsai tree on his desk. The tree was created and given to him by one of his favorite patients, an 80-year-old retired chief master sergeant.

Krasuski, director of both cardiovascular research and noninvasive cardiology, began treating the chief master sergeant more than two years ago. When the two first met at the center’s Heart Failure Clinic, which Krasuski runs, the chief master sergeant had severe heart failure and got winded sitting still. Because of edema his legs had swollen to more than 30 inches in diameter and were weeping fluid, and he required inpatient care every two weeks.

To improve the chief master sergeant’s health, Krasuski began treating him three times a week. He made sure his patient received a specialized pacemaker and defibrillator, adjusted his diuretics and other medications, and started him on kidney dialysis. Today, the chief master sergeant has normal-sized legs, walks every day, and only needs
a checkup every six months.

“I don’t think you could go anywhere else and find a 78-year-old gentleman, now an 80-year-old gentleman, who has received that level of care,” says Krasuski.

Doing more with less

Providing first-rate health care to military retirees, active duty servicemembers, and their dependents is important to the 4,500 people who work at Wilford Hall, the Air Force’s largest medical facility. Achieving that goal is tougher these days: Approximately 32 percent of the center’s 3,250 staff members eligible to deploy have done so since the start of Operation Iraqi Freedom. At the same time, the hospital’s patient load has increased as wounded servicemembers return home.

“Teaching hospitals like Wilford Hall provide better care for patients who have complex medical problems, such as war wounds, because they provide multiple levels of care,” says Krasuski. “You’re not just seen by a single physician. You’re seen by a whole cadre of students, doctors, staff, and technicians, and each level of care provides important assets to the treatment and improvement of the patient.”

Although Krasuski enjoys treating patients, he’s equally dedicated to his research. His findings on cardiovascular disease frequently appear in peer-reviewed publications, and his views on preventive medicine and patient care often are quoted in newspapers, in magazines, and on popular medical Web sites.
 
Staffing levels, however, have made it difficult for Krasuski to pursue his research. Since the Sept. 11 terrorist attack, the cardiology department’s staff has decreased from 10 members to eight, and seven members of the department have deployed at various times.

“Even though you see a lot of my publications and my presentations at meetings, and I do a lot of medical speaking, etcetera, 90 percent or more of that is done on my own time,” says Krasuski, who received Wilford Hall’s Researcher of the Year Award in 2004. “During the day, I see patients and do procedures. Then I go home, see my kids, put them to bed, and maybe watch a little television. After my wife goes to bed with the baby, I sit down and begin working on my academic pursuits. You have to have a lot of dedication to keep that up. Fortunately, I am quite capable of living on four hours of sleep on a routine basis, but it’s not an easy lifestyle.”

Krasuski’s skills as a cardiologist also are in demand. Since coming to Wilford Hall four years ago, he’s performed a number of highly specialized surgery-sparing procedures on military members and their dependents who hail from every service branch and live throughout the world. In 2002, he became the first cardiologist in San Antonio—and one of only a handful in the world—to perform percutaneous atrial septal defect (ASD) closures. ASD, the most common form of congenital heart disease in adults, can cause heart failure, lung problems, stroke, and rhythm disturbances.

The less invasive procedure has a quicker recovery time than traditional open-heart surgery; Krasuski has performed it on patients ranging from 20-something military spouses to active duty soldiers. Most returned to their lives with renewed vigor.

“There’s nothing more satisfying on a daily basis than to see [patients] in whom you’ve made a difference in their quality of life,” says Krasuski.

Treating the war fighters

At Camp Pendleton, Calif., Lt. Cmdr. Debbie Ruyle, USN, is hard at work at the 52 Area Branch Medical Clinic. Ruyle heads the ambulatory care clinic, which provides medical services for an ever-growing number of Marines who are going through the School of Infantry before heading to Iraq. The clinic also cares for the school’s instructors and dependents residing on the north side of the massive base, which covers approximately 200 square miles.

A certified ER nurse, Ruyle has deployed twice since the war on terrorism began. In November 2001 she went to Afghanistan and was assigned to a shock trauma platoon (STP) that provided emergency surgical care to wounded Marines in Operation Enduring Freedom.

In January 2003 Ruyle deployed to Iraq with another STP that provided medical care to Camp Pendleton Marines from the 1st Marine Expeditionary Force (MEF), which spearheaded the charge toward Baghdad in the early days of the war. The highly mobile platoon, which was far-forward deployed, drew fire on many occasions and even was ambushed once.

Members of her platoon later received Combat Action Ribbons for defending themselves during the ambush, and Ruyle received a Navy-Marine Corps Commendation Medal for the outstanding care she gave injured Marines during her deployment. Each platoon member also received the Presidential Unit Citation for providing medical support to members of the 1st MEF, which has the distinction of being the first Marine unit to receive the award since the Vietnam War.

Ruyle thinks the military’s use of STPs and other far-forward deployed medical assets is saving lives by closing the gap between care on the battlefield and care at hospitals in the rear. However, she’s happy her current job doesn’t put her in close contact with war-wounded Marines on a daily basis, because it has given her a chance to detach from many of the things she experienced during her two deployments.

“The military depends on very young Marines to be out there fighting for us,” she says. “These are 18- and 19-year-olds that are in the middle of the fighting, and those are the ones we’re treating, so it’s very hard to see that.”

Naval Hospital Camp Pendleton, with a 123-bed inpatient capacity, has cared for more than 1,415 wounded Marines since the start of Operation Iraqi Freedom, and 22 percent of the hospital’s total staff has deployed at some point. Currently, 149 staff members are deployed, and reservists are backfilling only 53 of those positions. Staffing shortages have increased pharmacy wait times, decreased inpatient capacity, and diminished the support the hospital provides its eight off-base medical clinics. Dependents and retirees also are having a tougher time accessing specialty care.

In addition, the demand for mental health services has increased as more Marines return home, and a post-deployment surge in the birth rate has kept the Maternal Infant Services Ward filled. Military medical professionals at the hospital are working harder than ever. Ruyle, for example, is pulling double duty. In addition to heading up the clinic, she also is part of a medical evacuation watch team that mobilizes whenever war-wounded Marines are air-evacuated to nearby Marine Corps Air Station Miramar. Although most of the Marines are ambulatory, some need more care, and Ruyle or another ER nurse will monitor them during the trip to Naval Hospital Camp Pendleton.

Handling waves of incoming casualties has staff members at the hospital working overtime. Following the assault on Fallujah in November 2004, for example, the hospital processed 57 casualties in one week. Many had orthopedic injuries caused by gunshot wounds or shrapnel and were treated on an outpatient basis. However, casualties had to be examined as soon as they arrived and set up with a future course of treatment.

“It’s funny to watch the people who are working at the hospital,” says Ruyle. “You know they’re tired of the long hours and stuff, but they do it because these guys coming back are the ones who are injured and need care. They’re doing it for them.”

Hospital administrators at Camp Pendleton currently are working to resolve staffing issues by adding more reserve personnel. The hospital also is looking to fill some slots with contract personnel, something that will become more common as the Navy civilianizes 5,500 medical positions during the next five years.

Caring for families

At nearby Naval Medical Center San Diego (NMCSD), the Navy’s most technologically advanced health care facility and a major teaching and research center, medical personnel are working harder than ever. Approximately 8,000 military and civilian personnel work at NMCSD. Since Operation Iraqi Freedom began, 47 percent of the 2,076 staff members who are eligible to deploy have done so, and 379 military medical workers currently are deployed.

In addition to treating many wounded servicemembers, the hospital provides care to more than half a million eligible beneficiaries in San Diego County. Many are the dependents of active duty or retired military members.

Providing first-class care to dependents is important these days. Like other military treatment facilities, NMCSD is in the midst of a post-deployment baby boom, averaging 300 births each month. Although expectant military moms can elect to receive maternity care in the civilian sector, many insist on having their babies at NMCSD because they like the hospital’s recently renovated labor and delivery suites. NMCSD personnel also notify husbands who are deployed or out in the fleet that they have a new son or daughter—a service not provided by civilian hospitals.

The booming birth rate also is keeping the Neonatal Intensive Care Unit (NICU) busy. The hospital’s neonatalogists not only care for sick infants and premature babies, they also look out for the patients’ families. Deployed fathers receive updates on their baby’s condition, and area commanders are notified if one of their sailors or Marines has a baby in the NICU.

“What we’re seeing right now in our pediatric inpatient clinics are moms, and typically it is the mom— although that’s not always the case—who doesn’t have anywhere else to turn,” says Cmdr. James J. Chun, USN, chairperson of pediatric and adolescent medicine at the hospital. “They have a child that is sick, and they know when they come here they’re going to be surrounded by people that understand their husband is deployed to Iraq, and he’s going to be gone for seven months in harm’s way. We appreciate that because we’ve been there, too.”

In February 2003, Chun experienced firsthand the level of caring and support provided by personnel at the hospital. Hours before he deployed to support Operation Iraqi Freedom, his wife entered the hospital with severe abdominal pain and had surgery to remove her appendix.

“Although very stressful for all of us, the network of support that wrapped itself around my wife and daughter from that point on was extremely reassuring and helped me make it through the next few months [of my deployment], knowing that there were good folks looking out for them,” says Chun.

While deployed with Alpha Surgical Company, Chun provided emergency surgery and trauma care to members of the 1st MEF from Camp Pendleton. Many of the casualties Chun treated were not much older than the teenagers he treats at Balboa. His pediatric experience also helped save the life of a severely injured 12-year-old Iraqi boy who was caught in a firefight near his home in Baghdad.

Following his deployment, Chun and the members of Alpha Surgical Company received the Presidential Unit Citation for the medical support they provided members of the 1st MEF. Chun also supervises interns who are training at the hospital, and he has been named twice as the Pediatric Teacher of the Year by the Uniformed Services University of Health Sciences in Bethesda, Md. Before coming to Balboa, he received a Navy-Marine Corps Commendation Medal for providing outstanding care to his patients at Naval Medical Center Portsmouth, Va.

“Our civilian counterparts are absolutely overwhelmed at how friendly the people are when they come here,” says Chun of NMCSD. “I think they are somewhat surprised because they think of a military organization as being rigid, joyless, and cold. Then they come here and say, ‘You are great teachers, great doctors, and you’re friendly and engaging. This wasn’t what I was expecting.’ ”