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Picture marching from the most eastern point of Rhode Island to the most western point and back, in three days. Now imagine carrying a 22-pound rucksack while doing this. Now conjure up immediately going back to work following the trek.
The hypothetical scenario became a reality when U.S. Army Service Members from Landstuhl Regional Medical Center participated in the annual De 4Daagse (International Four Day Marches Nijmegen), the largest multi-day marching event in the world, this summer.
Since 1947, U.S. Armed Forces personnel have participated in the event, commonly referred to as Nijmegen after the host city in the Netherlands, which challenges civilian and military participants to trek 30, 40 or 50 kilometers a day for four days. Military participants are further challenged to carry a 10-kilogram load throughout the march.
LRMC Airmen and Soldiers participate each year, however this year’s event challenged the troops both on and off the march as record-breaking heat waves scorched Europe, ensuing a cancelled first day of marching.
Close call
“It was a crazy experience,” said U.S. Air Force Maj. Tiffany Winston, a physician at LRMC’s Emergency Department. “It’s kind of like giving birth, you forget the pain and then you’re like I won’t do it again but then say you’d do it again.”
Winston, a mother of three and seven months pregnant at the time of the march, spent months training for the march. However, it was her medical training which made an impact following the first day of marching.
“Other event participants knew we were medical staff and they asked if we could see one of their team members,” recalls Winston, a Dallas native. “We had just finished the ruck within the last hour and had just returned to our tent, so I was (recovering) as well. The individual came over to me complaining of leg pain and was concerned of shin splints.”
Following an impromptu assessment, Winston determined the possible shin splints were far more serious, requiring immediate attention.
“I felt the leg and discussed their medical history. The lateral part of her leg was really tight, a sign of compartment syndrome,” explained Winston.
Compartment syndrome, a painful swelling or bleeding of muscle tissue usually in the legs, can lead to permanent damage, even amputation if not treated in time.
“There was like a long line to the official medical station, that’s why they stopped by our tent first,” said Winston. “(The individual) wanted to kind of push through it and march the next day. I recommended for them to be evaluated at the official aid station, where they were later evacuated to the local university hospital for surgery.”
The individual, a U.S. Service Member, underwent a fasciotomy with follow up surgery at LRMC soon after.
Despite marching for two, Winston finished the march with her 32 fellow LRMC marchers from Army, Air Force, U.S. Army Reserve and Veterans. Her keen observation and obligation to patient care, despite marching 25 miles on that first day, possibly preserving another Service Member’s wellbeing.
In sixth grade, Winston became interested in medicine to help people. Growing up, she was involved in healthcare programs at school and in her community, visiting the local medical school on Saturday mornings to experience the health care environment.
“I was attracted to the emergency department because there’s a lot of variety, it’s been great,” said Winston, who is part of the Ground Surgical Team with the 86th Medical Group out of Ramstein Air Base.
Although marching in her third trimester challenged Winston, she states she couldn’t let the opportunity to participate in Nijmegen, which had been cancelled the last two years due to COVID-19, pass her by.
Fatigued formation
“I’ve always had an interest in rucking. I did the Bataan Death March last year where I knocked out the full marathon length,” said 1st Lt. Kelsey Lisitsyn, an Emergency Department nurse at LRMC. “(Nijmegen) was a pretty surreal experience.”
On the second day of marching, approximately totaling 50 miles at that point, the cohort had retreated to their quarters where they recovered and were passing time playing a game of cards when a sudden thump and call for help disrupted the game.
“All of that excess heat was still going on, it was raining but still like 90 degrees Fahrenheit,” explained Lisitsyn, a native of National Park, New Jersey. “All of a sudden we hear something slam on the ground and I hear somebody scream ‘medic.’ We got up and saw someone had collapsed right outside our tent. My first thought was, the individual looks pretty pale and diaphoretic, so I lifted their legs. As soon as I did that blood went straight to his head and he came right back around.”
Following the initial response, the individual’s colleague mentioned they hadn’t ate much following the ruck march, indicating a possible case of low blood sugar.
“One of the nurses with me grabbed some gummies and started heaving them down their throat,” recalls Lisitsyn. “It completely woke them, and we just kept trying to get sugar levels back up. We had brought a bunch of medical supplies to treat blisters and stuff like that and had plenty of (intravenous) saline bags, so I offered them one but just before administering it, the even medics came into the tent with a defibrillator.”
Following the arrival of the event medics, the individual was escorted to the event aid station where they were later allowed to return.
“I ended up seeing them on the final day as we were getting ready to finish and I like looked over at them and they remembered me too,” said Lisitsyn. “As we’re walking with another unit, (the individual) praised (LRMC staff) and told the other unit you guys are in good hands.”
Lisitsyn’s intricate journey into medicine exemplifies her yearning to help others. Before finding her calling as an emergency department nurse, Lisitsyn was first seeking a degree in physical therapy, followed by the possibility of becoming a physician, before joining the Army as a mortuary affairs specialist and later commissioning as an Army nurse.
“My mom always told me not to become a nurse,” said Lisitsyn, whose mother is a Licensed Practical Nurse. “I did the exact opposite what she told me, and I’ve loved it ever since. You just never know what’s going to pop up (in patient cases) and that’s kind of the beauty of it.”
Lisitsyn’s love for medicine was evident in her actions which facilitated a fellow Service Member’s completion of Nijmegen.
“No matter where you’re at, in a deployment setting or even out having fun, something might happen at any time. It’s nice to be ready and on your toes.”
Critical conditions
“It was rough, I didn’t think I could take another step but somehow I finished it,” said U.S. Air Force Staff Sgt. China Rosales of her first Nijmegen experience. “It was maybe one of the hardest things I’ve had to do but the whole experience was pretty rewarding at the end.”
Following the three-day trek covering 75 miles, Rosales, a medical surgical technician at LRMC’s Medical-Surgical Ward and native of Hutchinson, Kansas, was eager to return to Camp Heumensoord, where military personnel were boarded during the march, but the ride back would present one more challenge as dozens of other finishers were packed into transportation back.
“It was the last day, everyone had just rucked like over 80 miles and we were all literally jam-packed, as many could fit on onto buses,” explains Rosales. “I got into one of the buses and I was sitting near the front, about 10 minutes into our drive I heard people shouting in the back.”
The cries of distress indicated a problem, which sprung Rosales to her feet, leading her to the commotion where she found two unconscious foreign military members.
“I did not think my feet were capable of even getting up to help but the second I heard that someone was in need I was able to forget about my pain and more worried about helping the person,” said Rosales. “After assessing the individuals, I realized it was heat exhaustion. It was like the scariest feeling for me was knowing there were two people on the bus with a medical emergency and I was the only medic there.”
Fortunately for Rosales, U.S. Army Staff Sgt. Ivett Mallaupoma, an operating room technician at LRMC, was also on the same bus and able to assist with directions from Rosales.
“(Mallaupoma) had enough background to assist while I was jumping back between the two. We were able to stop the bus so that way we could go under cover and take of some heavy clothing to help cool off,” said Rosales. “We were able to elevate his feet, give him some electrolytes and basically cool him off until we could get a higher level of care for him.”
Fearing the patient would turn for the worst, Rosales improvised and used the patient’s own smartwatch to monitor heart rate. After stabilizing the first patient, Rosales moved to the second patient whose colleagues didn’t speak fluent English. Having to translate through the patient’s friend, Rosales determined the patient was also dehydrated.
“We were able to get them both stable enough to take to the hospital once the ambulance came,” said Rosales. “Interestingly, on the bright side was my pain (from marching) was gone. I didn’t feel any of it afterwards because of the adrenaline.”
By the time Rosales arrived at the camp, the endorphins had faded, and she could barely walk to her cot.
“This crazy thing had just happened but required me to walk to go tell people, so I just laid in bed and elevated my feet,” recalls Rosales.
Her humble response is typical for Rosales, whose interest in medicine started in her youth with a desire to help chronic illness in family members.
“I hated the fact that I didn’t know what was really happening with their medical care or I couldn’t help out in any way,” said Rosales, who is currently completing an undergraduate degree. “I’m actually planning on a career in medical administration so I can still impact patients, their health and how they receive it.”
