journal_030713

Vol. 25 No. 8 www.cnic.navy.mil/bethesda/ March 8, 2013

By Sarah MarshallWRNMMC Journal staff writer

After losing both arms and legsin 2009 while serving in Iraq, Bren-dan Marrocco is now regaining hisindependence, thanks to a double-arm transplant at Johns HopkinsHospital, performed by surgeonsfrom across the country, includ-ing one of our own at Walter ReedBethesda.

Marrocco was driving an armoredvehicle in Iraq when he was struckby a roadside bomb. He is the firstSoldier to survive after losing allfour limbs in the Iraqi conflict, ac-cording to Dr. W.P. Andrew Lee, who

led the team that performed thetransplant.

“[The procedure] was particular-ly meaningful because the recipi-ent was a wounded warrior, some-one who lost limbs during combatin Iraq, and our research has beensponsored by the DOD,” Lee said.

The procedure took place overtwo days, Dec. 17-18, and lasted alittle more than 12 hours, said Lt.Cmdr. Patrick Basile, who assistedthe transplant team and is also as-sistant chief of Plastic Surgery anddirector of Microsurgery at WalterReed Bethesda. Several plastic, or-thopedic and hand surgeons, nurses,rehabilitation specialists and nurs-

es worked together to perform thetransplant, which only six other pa-tients have successfully undergonein the U.S., Basile said.

In addition to Walter ReedBethesda, the team also consistedof surgeons from University of Cali-fornia, Los Angeles (UCLA), CurtisNational Hand Center in Baltimore,and the University of Pittsburgh.

“The team is so much strongerfrom the collaboration of people notonly from different institutions, butdifferent disciplines,” Lee said.

Basile explained the extensiveprocedure begins with doctors de-termining whether the patient is agood candidate for the transplant.

The patient’s medical history isevaluated by looking at whether theindividual is missing any key struc-tures, such as bulk muscle or signifi-cant nerve loss, that could prevent apositive outcome, he said. They alsoevaluate the patient’s disposition,ensuring the individual will be ac-cepting of his or her new limbs andwhether they would be capable ofseveral hours of rehabilitation perday for years to come.

“That’s one of the keys to success,”Basile said.

Once the patient has been accept-ed into the transplant program, he

Wounded Vet Undergoes Successful Double-Arm Transplant

Photo courtesy of Johns Hopkins Medicine

Several plastic, orthopedic and hand surgeons, rehabilitation specialists and nurses work together to perform a successful double-armtransplant on Iraqi war veteran Brendan Marrocco in December at Johns Hopkins Hospital. Only six other patients have successfully un-dergone the surgery in the United States. In addition to Walter Reed Bethesda, the surgery team also consisted of doctors from UCLA,Curtis National Hand Center in Baltimore, and the University of Pittsburgh.

See TRANSPLANT page 10

2 Thursday, March 7, 2013 The Journal

Published by offset every Thurs-day by Comprint Military Publi-cations, 9030 Comprint Court,Gaithersburg, Md. 20877, a pri-vate firm in no way connectedwith the U.S. Navy, under ex-clusive written contract with theWalter Reed National MilitaryMedical Center, Bethesda, Md.This commercial enterprise news-paper is an authorized publication formembers of the military services. Contentsof The Journal are not necessarily the of-ficial views of, nor endorsed by, the U.S.Government, the Department of Defense,or the Department of Navy. The appearanceof advertising in this publication, includinginserts or supplements, does not constituteendorsement by the Department of De-fense or Comprint, Inc., of the products orservices advertised. Everything advertisedin this publication shall be made availablefor purchase, use or patronage without re-

gard to race, color, religion, sex,national origin, age, maritalstatus, physical handicap,political affiliation, or anyother non-merit factor of thepurchaser, user, or patron.Editorial content is edited,prepared and provided bythe Public Affairs Office, Naval

Support Activity Bethesda, Md.News copy should be submitted to

the Public Affairs Office, Building 11, lowerlevel, Room 41, by noon one week pre-ceding the desired publication date. Newsitems are welcomed from all installationsources. Inquiries about news copy will beanswered by calling 301- 295-1803. Com-mercial advertising should be placed withthe publisher by telephoning 301-921-2800.Publisher’s advertising offices are locatedat 9030 Comprint Court, Gaithersburg, Md.20877. Classified ads can be placed by call-ing 301-670-1700.

Naval Support Activity (NSA) BethesdaCommanding Officer: Capt. Frederick (Fritz) Kass

Public Affairs Officer NSAB: Joseph MacriPublic Affairs Office NSAB: (301) 295-1803

Journal StaffStaff Writers MASNApril Beazer

Sarah MarshallSharon Renee TaylorCat DeBinderDavid A. DickinsonJeremy Johnson

Managing Editor MC2 Nathan PardeNSAB Editor MC2 John HamiltonWRNMMC Editor Bernard Little

Walter Reed National Military Medical CenterOffice of Media Relations 301-295-5727Fleet And Family Support Center 301-319-4087

WRNMMC OmbudsmanJulie Bondar 443-854-5167

NSAB OmbudsmanJojo Lim Hector 703-901-6730

Visit us on Facebook:Naval Support Activity Bethesda page:https://www.facebook.com/NSABethesda

Walter Reed National Medical Center page:http://www.facebook.com/pages/Walter-Reed-National-Military-Medical-Center/295857217111107

Uniformed Services University of the Health Sci-ences page:http://www.facebook.com/pages/Uni-formed-Services-University-of-the-Health-Sciences/96338890888?fref=ts

Stages of HealingWalter Reed Bethesda’s Stages of

Healing (SoH) hosts guitarist and sing-er Alexis Babini on Monday at noonin the America Building adult hema-tology/oncology treatment room, fol-lowed by a performance in the pediat-rics outpatient clinic waiting area. OnWednesday at noon, Michael Rohd, whowill conduct a workshop on effective lis-tening and collaborating in the AmericaBuilding’s rheumatology conferenceroom (#3313). For more information,call Dr. Micah Sickel at 301-295-2492.

Ask Your LeadershipAsk Your Leadership is a new staff

communication tool for you to view andpost questions and comments for offi-cial responses from the Walter ReedBethesda command leadership. The toolis on the WRB Intranet page, click onthe Town Hall/Leadership Forum icon,and then click on Ask Your Leadership.

Irish American CelebrationThe Bethesda Multicultural

Committee is sponsoring an IrishAmerican celebration on March 14from 10:30 to 11:30 a.m. in the AmericaBuilding atrium in observance of IrishAmerican Heritage Month. The HurleySchool of Irish Dance is scheduled toperform. For more information, callSgt. 1st Class Jason Zielske at 301-400-3542.

Remember to set your clocksahead one hour, before going to sleepSaturday night in preparation forDaylight Saving Time.

Bethesda Notebook

Recently, Department of the Defense(DOD) civilian personnel were informedthat, as a result of sequestration, theremay be a possible furlough on the horizon.Sequestration, as a result of budget short-falls, entails the permanent cancellationof budgetary resources by a uniform per-centage across the federal government.This would require all military servicesand defense agencies to furlough mostDOD civilian employees for an average ofone day per week for up to 22 weeks be-ginning April 25. This action equates to a20 percent cut in pay for DOD employees.Some more seasoned DOD employees

may have experienced furlough in the pastand are familiar with the terms and whatit will mean to them financially. However,for some, a furlough may result in unduestress and financial hardship. The bestway for individuals to face a potential fur-lough is to be prepared and have a finan-cial plan in place. Some simple tips foreveryone to consider in helping to closethat 20 percent gap in pay include:• Start now! Organize all your financial

documents. Complete a thorough assess-ment of your personal finances. Reviewyour monthly spending plan and prepareto make any “realistic” adjustments youcan. The more organized you are, the lessof a headache and stress for yourself later.Remember, needs trump wants during thefinancial crunch and food, clothing, shel-ter and medical costs are priority. Thismay be a great time to give up smoking ifyou are a smoker.• Assess your overall monthly credit

payments. Continue to try and makeevery payment each month throughoutthe furlough. If necessary, reduce yourmonthly payments to just the minimumpayment required. If you have a positiveconsumer relationship with your creditor,you may be able to obtain a penalty freepayment deferral for a month or two. Itdoesn’t hurt to ask. If you do receive a de-ferral on payments, be sure to ask yourcreditor if the deferral will impact yourcredit report.

• Postpone any major purchases. Youmay be in the market for a new car ornew television or some other large ticketitem. You may want to consider holdingoff making such purchases until you knowyou can reasonably afford it.• Review your Leave and Earning

Statement and consider changing yourtax exemptions to reflect your family’ssize. This will result in a lower tax returnat the end of the year but will help alle-viate the financial stress you feel duringthe furlough.• Consider your TSP and other invest-

ments. If necessary and ONLY if neces-sary, reduce your TSP (thrift savingsplan) to the government matching limitminimum. Use reduction of any invest-ments such as TSP, IRA’s, Mutual Fund,etc. as a last resort only.• Reduce unnecessary spending. Limit

your visit to the local coffee shop to only acouple times a week instead of daily. Dineout less frequently, commute with a friendor co-worker and cut back on some of theother out of pocket expenses that are of-ten not considered in your spending plan.• If you are expecting a significant tax

return, consider setting that money asideto offset any financial shortfalls you maybe anticipating.These are just a few of the things you

can consider in preparation for seques-tration and furlough. If you would like tomeet with a financial coach to conduct areview of your spending plan, to reviewyour credit report or for any financialquestions or concerns you may have as weget closer to the furlough period, pleasecontact the NSA Bethesda Fleet andFamily Support Center at 301-400-2414and ask to speak with one of our threefinancial coaches. In preparation for thefurlough, planning is crucial and we arestanding by to assist.

Brian Pampuro, AFCPersonal Financial ManagerFleet and Family SupportCenter Bethesda

Sequestration and Furlough, The Financial Impact

The Journal Thursday, March 7, 2013 3

By Bernard S. LittleWRNMMC Journal staff writer

On Feb. 27, two days before se-questration was enacted, WalterReed National Military MedicalCenter (WRNMMC) leaders pro-vided employees with an update onWalter Reed Bethesda’s operatingbudget, and addressed previouslysubmitted questions as well as ad-ditional queries from staff mem-bers who were present, about plansat the Nation’s Medical Center.

The four town halls, heldthroughout the day to ensure allstaff had an opportunity to attend,began with Rear Adm. (Dr.) AltonL. Stocks, WRNMMC commander,emphasizing quality and safe pa-tient health care would continue.“Any adjustments that we have tomake, based on any decisions thatare being made above us, we’re go-ing to keep [quality, safe patientcare] as our mission,” he said.

The commander added one teamof health-care providers exist atWRNMMC, be they military, civil-ians, contractors and volunteers. “Ifanything does happen affecting ourcivilian workforce, I can expect theactive duty to step up, and [they]might be expected to work morehours, but we’re not going to sacri-fice patient quality or safety, or ourstaff ’s safety.”

Army Col. Ramona Fiorey,WRNMMC chief of staff, echoedStocks, adding, “[The possibility ofcivilian furloughs] is a very sensi-tive and emotional issue. It will af-fect us individually and as an orga-nization.”

“We can’t prevent furloughs,”Fiorey added. “We don’t have thatauthority. But we have to plan, incase they happen.”

Navy Capt. Dave Breier, assis-tant chief of staff for resourcesand comptroller for WRNMMC,explained that deputy command-ers are developing plans to identifyreductions in spending at WalterReed Bethesda, and actions havealready been taken to reduce stafftravel, staff overtime, compensa-tory time and contracts.

Breier said if furloughs happen,they will likely start with the payperiod beginning April 21. “At thatpoint, there are 11 pay periods leftin the fiscal year, [so] that would betwo days a pay period, and that’swhere the 22 [furlough] days comefrom.”

“There’s no one set area we’re go-ing to see savings, no one quick fixthat we can get all these savingsfrom,” Breier continued. “We haveto nibble around the edges prettymuch with everything we do, butnot to impact services, keeping the

same standard and level of qualitycare.”

The captain encouraged staff todo “any little thing to help savemoney, just like at your house,”such as turning out the lights, go-ing paperless, and third party col-lections. “All these savings we do,just by doing those little things,add up to a lot of money when itgets to the end of the year.”

Sandy Lehman, deputy directorof the Civilian Human ResourcesCenter at Walter Reed Bethesda,said employees must receive a 30-day written advance notice beforebeing furloughed.

“Employees should begin plan-ning immediately for reduced pay-checks beginning in April. Your payrate does not change; pay reduc-tion comes from reduced hours atwork,” she said. “Furlough is likeleave without pay, [and] you’re stilla federal employee.”

“At this time there is no provi-sion for furloughed employees toreceive retroactive compensationfor work lost as previously done inthe past,” Lehman added. “An em-ployee is still entitled to holidaypay if in a pay status the day beforeor day after a holiday.”

She added Federal EmployeeHealth Benefits and Federal Em-ployee Group Life Insurance cov-erage will continue. If furloughed,there will be a reduction in the em-ployee and employer contributionto the Thrift Savings Plan unlessthe employee sets a dollar amountversus a percentage of pay contrib-uted to the TSP. Federal employeedental and vision insurance cover-age continues; however, employeesmay be billed directly if payrolldeduction cannot be taken. Fullemployee contributions must bereceived to avoid dental and visualcoverage cancellation. Federal Em-ployees Retirement System (FERS)and Civil Service Retirement Sys-tem (CSRS) coverage continuesduring an administrative furloughof less than 30 days.

Fiorey added alternate workschedules will be rescinded duringthe furlough. Furlough days alsocannot occur on the same days asholidays or scheduled leave, andare at the discretion of deputy com-manders, department and servicechiefs.

For more information about fur-loughs and sequestration, visitwww.opm.gov/furlough. Questionscan be sent to [email protected]. Information regardingtown halls and leadership forumis available on the WRNMMC in-tranet.

Walter Reed Bethesda Leadership Prepares for Sequestration

Photo by Bernard S. Little

Army Col. Ramona Fiorey (left), Walter Reed National MilitaryMedical Center (WRNMMC) chief of staff, and Rear Adm. Alton L.Stocks, WRNMMC commander, brief staff on plans of the medicalcenter to continue to provide quality patient care while facing pos-sible civilian furloughs.

1037972


By WRNMMC PatientSafety Office

In an effort to raise aware-ness and encourage theengagement of patients,families, health care pro-viders, and the public, thisweek Walter Reed NationalMilitary Medical Center(WRNMMC) is participatingin the 2013 Patient SafetyAwareness Week campaign,Patient Safety 7/365.

Patient Safety AwarenessWeek is an annual educationand awareness campaignfor health care safety led bythe National Patient SafetyFoundation (NPSF). Eachyear, health care organiza-tions around the world takepart in the event by display-ing the campaign logo andpromotional materials withintheir organizations, creatingawareness in the community,and utilizing NPSF educa-tional resources with hospitalstaff.

Tuesday during PatientSafety Awareness Day,WRNMMC Patient SafetyOffice hosted a cake-cutting

with games and giveawaysin the America Building lob-by to draw attention to thisyear’s observance.

Patient Safety AwarenessWeek was created by NPSF in2002. This year’s theme, Pa-tient Safety 7/365, highlightsthe need for everyone to un-derstand the importance offocusing on patient safety allyear round according to Kath-leen Oberst, patient safetymanager at WRNMMC. Theseven day campaign, whichbegan Sunday, also serve astime to recognize the range ofwork being done to improvehealth care safety worldwide.

“Walter Reed Bethesdawill engage staff, patients,and the community througheducational and awareness-building activities specific topatient safety,” Oberst stat-ed. “The Patient Safety pro-gram’s mission is to improvethe safety of health care de-livered to all beneficiaries.The patient safety programis a comprehensive programwhich provides products, ser-vices, education and trainingto ensure the safe delivery

of health care to all thoseentrusted in our care,” sheadded.

“Patient Safety 7/365 re-minds us that providing safepatient care requires a con-stant and valiant effort, 365days a year. This week en-courages a sustainable andconscientious collaborationbetween health care organi-zations, providers, and con-sumers, regardless of theircurrent state of health. Theweek is also intended to im-print an indelible statementthat efforts toward patientsafety must be collaborativeand that we must never besatisfied with the status quo,”said Patricia A. McGaffigan,interim president, NPSF.

NPSF encourages creativecollaboration among providergroups, patient advocates,and other community organi-zations to help patients andconsumers understand howthey can participate to bepart of the solution.

For more informationabout patient safety or Pa-tient Safety Awareness Week,visit www.npsf.org.

7/365 Highlights Patient Safety Always

Photo by David A. Dickinson

Hospital Corpsman 1st Class Donald Calero dem-onstrates the functions of SimMan 3G, an AdvancedPatient Simulator, used for education and trainingat Walter Reed National Military Medical Center(WRNMMC), during WRNMMC’s Patient SafetyAwareness Day event on Tuesday. SimMan simu-lates many human functions for practice purposes.He speaks, has dilating pupils with blinking eyelids, apulse, can take transfusions and oxygen, and a defi-brillator can be applied to him.

1037783 1038045


By Sharon Renee TaylorWRNMMC Journal staff writer

March is National Kidney Month.Kidneys remove wastes from thebody and help regulate blood pres-sure. When kidneys fail to workproperly, some patients must under-go dialysis as they wait for kidneytransplants. More than 95,000 peo-ple await kidney transplants in theU.S., according to the Department ofHealth and Human Services.

In honor of National KidneyMonth, Walter Reed Bethesda hon-ors Dr. Joseph Alexander, who leda team of five other transplant sur-geons 42 years ago at the formerWalter Reed Army Medical Center(WRAMC) in Washington, D.C., toperform the Army’s first kidneytransplant on Aug. 10, 1970. Thelandmark surgery for Army medi-cine was one in a series of “firsts” inAlexander’s trailblazing life.

Born in Oneonta, Ala., on Oct. 29,1929, Alexander graduated magnacum laude from Fisk University. In1951, he became the first AfricanAmerican admitted to the Univer-sity of Louisville Medical School inLouisville, Ky., and the first to grad-uate in 1955.

He joined the Army and complet-ed his surgical residency at BrookeGeneral Hospital at Fort Sam Hous-ton, Texas. Alexander served as chiefof general surgery at the U.S. ArmyHospital in Fort Hood, Texas, andlater, as the commanding officer ofthe 5th Surgical Hospital in Heidel-berg, Germany. Two years after serv-ing as chief of the general surgeryservice at Kimbrough Army Hos-pital, Fort Meade, Md., Alexandercompleted research fellowships atthe Walter Reed Army Institute ofResearch, Harvard Medical Schooland Peter Bent Brigham Hospitalin Boston, where he studied underNobel Prize-winning surgeon Dr. Jo-seph E. Murray, who performed thefirst successful human organ trans-plant.

Alexander became chief of theOrgan Transplantation Service atWRAMC in 1969. There, he serveduntil 1971, and wrote the Army reg-ulation for transplants, according toSanders Marble, senior historian atthe U.S. Army Office of Medical His-tory in San Antonio.

The colonel left the Army to be-come the first chief of surgery atthe Martin Luther King, Jr. GeneralCommunity Hospital in Los Angeles,Calif., and served as a professor atthe Charles R. Drew Post GraduateMedical School. In 1988, he becamethe first African American memberof the California Club, L.A.’s old-est private social club, which at onetime barred women, Jews and blacksfrom joining. Alexander was the firstblack member to sign the club’s reg-istry in their 101-year history.

Former colleagues and friends

of Alexander called the transplantsurgeon a courageous pioneer whobroke barriers, and a military leaderwho knew how to get things done.

“He is one of the reasons why Iwent into transplant,” said Dr. Jim-my A. Light, a retired Army coloneland 42-year veteran of organ trans-plant surgery, who called Alexandera mentor and friend.

The kidney and pancreatic sur-geon explained how the two met.

“It turns out I was on call thenight he came in from Europe withhis diagnosis,” said Light, a third-year resident at WRAMC when hefirst met Alexander in 1967.

The two shared conversationand common interests in medicalresearch during the early morninghours as the young resident helpedAlexander get admitted and pro-cessed as a patient. The surgeontransferred to the medical centerfrom Germany for treatment of hiscolon cancer, according to Light,who explained Alexander’s diagno-sis eventually led him to immunol-ogy research and ultimately organtransplant surgery.

“How courageous he was as a manin his 30s, that had metastatic co-lon cancer, to survive surgery, thetreatment, chemo, and then go on todedicate his life to transplant work,immunology work and then havethat same courage to chair the de-partment of surgery at a brand newhospital in Watts, the Martin Lu-ther King Hospital. That’s the partI thought was most amazing abouthim,” Light said. “He identified to-gether with the Surgeon General’sOffice of the Army, skilled peoplecoming in the service who had trans-plant training or aspirations, identi-fied them and got them to be a partof the program.”

Light eventually became chiefof the Organ Transplantation Ser-vice at WRAMC before going on tolead a team of transplant surgeonsat Washington Hospital Center in

Washington, D.C. “The transplantprogram [at WRAMC] would’ve nev-er come to fruition if it hadn’t beenfor Dr. Alexander,” Light said.

Dr. Joshua Miller establishedgroundbreaking transplant proto-cols at Northwestern University andserved as the president of the Amer-ican College of Transplant Surgeonsin 1998. The research professor wasone of six who helped establish theArmy transplant program with Al-exander. He came to WRAMC in1969 as an Army major after com-pleting training in general thoracicsurgery at Yale.

Miller helped establish the tissuetyping lab at Walter Reed Army In-stitute of Research, housed at thattime on the WRAMC medical cam-pus. He joined Alexander in roundson transplant patients and scrubbedin for surgeries; the two worked to-gether in both the laboratory andthe clinic.

Cited as a transplant pioneerhimself, Miller recalled the tumul-tuous time in the nation’s historywhen Alexander established theArmy’s kidney transplant program:amidst the Vietnam conflict as wellas preconceived notions about organtransplantation.

“It was definitely [Alexander who]broke the ground,” Miller said of his

Pioneer of Army Kidney Transplant Surgery Made History at Walter Reed

Courtesy Photo

A photo which accompanied a newspaper article published nearly43 years ago at the former Walter Reed Army Medical Center,touts the trailblazing surgery led by Dr. Joseph Alexander (secondfrom right), which witnessed the Army’s first kidney transplant.

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By Jeremy JohnsonNSAB Public Affairs

staff writer

Navy medical officersfrom the District of Colum-bia and across the countrycelebrated the 142nd birth-day of the Navy MedicalCorps during a formal ballheld Saturday evening atBethesda, Md.The Crystal Ballroom,

located at the Hyatt, wasfilled with officers in allstages of their career, in-cluding Annapolis midship-men and retirees from theMedical Corps.The event began with a

reception where attend-ees and guests could haveportraits taken and par-ticipate in a silent auctionwhile getting to know eachother. The formal portionfollowed and included sev-eral traditions, including amoment of silence for MIA/POWs, a formal toast, anda cutting of the cake by theyoungest and most senior

uniformed Medical Corpscelebrants at the event.Speakers included Chief

of the Navy Medical CorpsRear Adm. Colin Chinn,;Vice Adm. Matthew Nathan,Navy surgeon general; andAssistant Secretary of theNavy for Manpower and Re-serve Affairs Juan Garcia.In his remarks, Garcia

highlighted examples of thegood being done by Navydoctors and young Sailors of-fering assistance to those inneed worldwide, remindingthe audience that the ser-vice is seen as a “global forcefor good.” He also thankedthe members of the MedicalCorps for their dedication toproviding the best servicepossible for military mem-bers and their families.According to Cdr. Jeffrey

Blair, the master of ceremo-nies for the event, the NavyMedical Corps began withthe establishment of theContinental Navy in 1775,but wasn’t formally estab-lished until 1871.

Navy Medical Officers Celebrate 142nd Medical Corps Birthday

Surgeon General of the Navy Vice Adm. Matthew Nathan praised members ofthe Medical Corps community for their devotion to duty before introducing thekeynote speaker, Juan Garcia.

Photos by Jeremy K. Johnson

Assistant Secretary of the Navy for Manpower and Reserve Affairs Juan Garciachats with guests at the reception held just before the formal event.

Attendees andguests of theNavy MedicalCorps 142ndBirthday Ballbegan the eve-ning at a re-ception wherethey could haveportraits takenand participatein a silent auc-tion while get-ting to knoweach other.

Ens. Angela Zah (left) and Capt. Stewart Brazin hon-or tradition and cut a cake as the youngest and oldestuniformed Medical Corps celebrants at the event.


By Cat DeBinderWRNMMC Journal

staff writer

Life was never meant tobe a pain. That is why theWounded Warrior Pain CareInitiative at Walter ReedNational Military MedicalCenter (WRNMMC) is of-fering an Interactive PainManagement Series (IPMS).According to the Ameri-

can Academy of Pain Medi-cine, millions [of Americans]suffer from acute or chronicpain every year, and the ef-fects of pain exact a tremen-dous cost on the country inhealth care costs, rehabilita-tion and lost worker produc-tivity.The classes, offered at

Walter Reed Bethesda,will be held every Wednes-day from 2 to 3 p.m. in theAmerica Building (19), sec-ond floor Desert ConferenceRoom (2301) and, is open tonot only wounded warriors,but all patients, family andstaff members. Registrationand referral are not requiredto attend the series.Walter Reed Bethesda’s

official goal of the pain man-agement series is to providetreatment and education toall those who suffer frompain, or who are a caregiveror family member of some-one suffering from pain.Some of the topics to be

covered during the series in-clude Mind/Body Medicine,Pain Procedures, Acupunc-ture, Opioid Management,Transitional Care, SexualHealth, Sleep and Nutrition.“Pain is the most frequent

reason patients seek phy-sician care in the UnitedStates, and more than 50million Americans sufferfrom chronic pain,” accord-ing to the American Acad-emy of Pain Medicine.“The physical, emotional,

social, occupational and fi-nancial aspects of life areimpacted negatively bychronic pain,” added AmyOsik, deputy program man-ager for the initiative. “Thelives of family members arealso greatly affected by theirloved ones’ pain.”“We want to empower pa-

tients and family memberswith skills, education andresources to manage pain,”said Dr. Christopher Spe-vak, an anesthesiologist inthe Wounded Warrior PainInitiative.Spevak said the series

will not consist of just lec-tures, and organizers arelooking at flexibility to meetthe needs of beneficiaries.“We will constantly be

changing the dynamic in themodality to meet the needsof those attending,” he ex-plained.Jasmine Anthony, a cer-

tified physician assistant,

director of the program andresponsible for its manage-ment and weekly modules,said the series will includelectures by behavioralhealth specialists, physicaltherapists and social work-ers.Dr. Aubrey Verdun, a

WRNMMC anesthesiologistwho gave a presentation atthe first class of the series,said the war on pain seemslike it is always changing.“Any pain that continues

for four to six months, is con-

sidered chronic pain,” saidVerdun. He said some paincan be blocked at multiplelevels, including at the spi-nal cord level. “Patients getthe effect [of pain medica-tion], but not the side effect.”Lois Clinton, the pain psy-

chotherapist for the Wound-ed Warrior Pain Care Initia-tive, gave a demonstrationon visualization techniquesduring the class. She askedattendees to imagine some-thing they enjoy - saying itcould be a sunny beach, a

pet, any other personally-pleasant scenario and askedwhat bodily effects partici-pants felt.She also described a tech-

nique known as “tracking,”which entails tracking sen-sations in the body in an at-tempt to regulate them.Clinton said it is possible

to “talk the body” into lettingdown its defensive responseand regulate sensations -pleasant versus painful sen-sations.“The goal is to teach pa-

tients self-treatment skills,”said Clinton.The first class was attend-

ed by a number of providers,but they hope to get pa-tients and family membersinvolved as well.“We really want to get to

wounded warriors, families,staff and active duty abouthow pain issues are causinga host of other issues, alongwith other topics that areimpacting them greatly,” shesaid Army Lt. Col ShannonLynch, chief of the PhysicalTherapy Service, who at-tended the class stated, “Itis a great initiative.We needthis educational program forthe population we treat.”For more information

about the Wounded WarriorPain Care Initiative class,call Jasmine Anthony at(301) 400-1016, or Amy Osikat (301) 295-4455 (ext.171).

Pain Management Classes Begin at WRNMMC

Courtesy graphic

By Mass CommunicationSpecialist 2nd Class

Nathan PardeNSAB Public Affairs

staff writer

Naval Support ActivityBethesda hosted a dramaticreading of scenes from twoancient Greek plays, pre-sented by “Outside the Wire”at the Warrior Café March 1.“Outside the Wire is a

company that uses theaterand community discussionas a catalyst for addressingpublic health and social is-sues,” said Artistic DirectorBryan Doerries.With a college background

in classic literature, specifi-cally Greek and Latin, Do-erries began the undertak-ing of translating his own

versions of Sophocles’ playsfrom the Greek, but he didn’treally unlock their meaninguntil he presented them be-fore a military audience, hesaid.“Originally, I thought that

I was pretty clever and thatI understood them. Then, Igot them in front of a mili-tary audience for the firsttime in 2008, and I realizedI had no idea what the playswere saying. They werewritten in a code that, as acivilian, I had no access to.I needed the military audi-ence to translate the playsfor me.”The term, ‘outside the wire’

is a military term, but Doer-ries believes it also applies toanyone who comes in contactwith suffering or death.

“That’s the audience we’regoing for, because the corebelief is that those audiencescan reveal something aboutthese stories, and the storiescan help them unlock some-thing in themselves thatmight be hidden,” he said.“We’ve now reached nearly50,000 service members,veterans and their familieswith Theater of War.”“Theater of War” is the

first project from “Outsidethe Wire”, which presentsreadings of Sophocle’s “Ajax”and “Philoctetes” to mili-tary communities across theUnited States. According toDoerries, many Greek per-formers appeared to be vet-erans or cadets themselves,and ancient Greek dramamay have been a means to

help combat veterans returnto civilian life after deploy-ments. He believes this hasdirect parallels to the mod-ern day and many patients’experiences at Walter ReedBethesda.“I can think of no more

appropriate place to pres-ent these plays that talkabout the visible and invis-ible wounds of war, and givevoice to them and normalizethem and say – across time,you are not alone,” he said.“This has been warriors’ ex-perience across thousandsof years. And to bring theentire community together,wherever we are, and collec-tively (or at least symboli-cally) shoulder that burdenis our mission.”Sgt. Jack Eubanks, a pa-

tient at Walter Reed Bethes-da, first attended a “Theaterof War” performance whenthe company visited theUniformed Services Univer-sity a few years ago.“It impacted me a lot, be-

cause I had come back fromIraq, and there was a lot ofthings that I saw,” said Eu-banks. “I was going throughPTSD (post-traumatic stressdisorder) and otherwise. Icame to realize a few things,and a few things startedclicking. I was able to takea step back and reevaluatewhere I was and help fix my-self and move forward. Afterthe performance, we kept intouch, and I was asked if Iwould like to be on the dis-

Greek Plays Parallel Wounded Warrior’s Combat Injuries

See COMBAT page 9


By Sharon Renee TaylorWRNMMC Journal staff writer

Walter Reed National MilitaryMedical Center Commander RearAdm. Alton L. Stocks joined WalterReed Bethesda surgeons, operatingroom (OR) staff, as well as surgicaland instrument techs for a ribboncutting of the new Sterile Process-ing Department (SPD), Jan. 17.Renovations for the SPD began

in July 2011, according to Army Lt.Col. Laura Desnoo, chief of the SPD.The physical space of the depart-ment that sterilizes instruments,tools and equipment for surgeries,doubled in size to accommodate theaddition of seven new operatingrooms at the medical center, plusthree remote sites.The upgrade brought in state-of-

the-art equipment to accommodatenew services, specialties and robotictechnology with the integration ofthe former National Naval MedicalCenter and the former Walter ReedArmy Medical Center, according toNavy Cmdr. Norman Charboneau,department chief for peri-operative

that oversees the SPD and threeother departments. Enhancementsinclude the addition of a classroomfor staff training, water, electri-cal and communication upgrades,as well as a new, dedicated “clean”elevator that goes straight fromthe SPD, located in the Basementof Building 9, to readily provideequipment to the OR upstairs asoperating surgeons requests them.A new walk-in sterilizer, two tur-

bo washers and a multi-chamberindex washer have increased thecapacity of instrument sets, or “cas-es,” the department can process, re-quiring less time.What makes the SPD at Walter

Reed Bethesda unique from thoseat other hospitals is the larger de-contamination section, necessary toaccommodate the level of care re-quired to treat wounded warriors,the variety of specialties at themedical center, polytrauma ser-vices, as well as the change of sur-geons and technology, according toDesnoo. She explained the medical

‘Heart of the Hospital’ Celebrates Recent RenovationRibbon-cutting Opens New Sterile Processing Department at Walter Reed Bethesda

Photo by Sharon Renee Taylor

Lt. Col. Laura Desnoo, Chief of the Sterile Processing Department(SPD), Rear Adm. Alton Stocks, WRNMMC commander, HN Zach-ery English, Priscilla Hailstorks-Smith, and Maj. Guy St. Louis, as-sistant chief of SPD, cut a ribbon celebrating the renovation of themedical center’s Sterile Processing Department, Jan. 17. See STERILE page 10

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cussion panel this time.”According to the “The-

ater of War” program, “playslike Sophocle’s Ajax andPhiloctetes read like text-book descriptions of wound-ed warriors, struggling un-der the weight of psychologi-cal and physical injuries tomaintain their dignity, iden-tity and honor.” Eubankssaid he identified with manyof the themes and messagesin the plays, especially withthe character of Pholoctetes,who is marooned on a de-serted island by his army af-ter contracting a serious anddebilitating illness.

“You can very easily feellike Philoctetes, where youfeel alone, even when you areat home,” said Eubanks, add-ing that the military commu-nity is essential in the pro-cess of healing and recovery.“One of things I’ve noticedwhile at three hospitals, andwith all of my buddies whowere injured – if they are go-ing to talk to someone, theywant to talk to their battlebuddies, at least at first. And

they usually won’t start toopen up until they do. AndI think this was the way forthe Greeks to do it, to sharewith the audiences and gen-erals who were there leadingthe way.”

Eubanks said if he was

to take one message fromthe plays and recent perfor-mance, it would be that thevisible and invisible woundsof war are not a new subjector something that you haveto face alone.

“These issues that we

have now, coming back froma war, were the same issuesthat they had 2,500 yearsago,” he said. “And a lot of itis that you need your battlebuddies to stick by you, in-side the service and out.”

Doerries could not agree

more. With more than 200performances of “Theater ofWar” under his belt, he saidhis hope is that performanc-es like the recent reading atthe Warrior Café will contin-ue to impact audiences andassist with the recovery ofwounded warriors and vet-erans who have experiencedthe wounds of war.

“I know that people are go-ing to be affected and reen-gaged at each performance,”said Doerries. “It’s alwayspowerful, and I never getsick of hearing the audi-ence respond, especially ata place like this. I hope thatwe can come back soon andhave more warriors and theirfamilies involved with this.”

The “Theater of War” dra-matic reading at the War-rior Café featured four pro-fessional actors, includingDavid Strathairn, known forhis roles in the movies “TheBourne Ultimatum” and“Lincoln”, and the recentT.V. series, “Alphas”; andAdam Driver, who also wasfeatured in “Lincoln.”

More information about“Outside the Wire” and “The-ater of War” can be found atthe web site, www.outside-thewirellc.com.

Actress Joanne Tucker performs in a dramatic reading of Sophocles’ play “Ajax”in the Warrior Café March 1. The main character, Ajax, falls into a depressionnear the end of The Trojan War, and his wife, Athena, attempts to intervenebefore it’s too late.

COMBATContinued from 7

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added the team determines what therecipient needs - be it an entire armor just the forearm.“Every component that’s needed

for a functional arm, you would needthat,” he said.Then, doctors search a database

for a match, and that can be a chal-lenge, as doctors must match tissue,skin tone, size of the limbs, as well as

gender, Basile added. Individuals arelisted in an active registry, throughwhich they may elect to donate onlyparticular organs once they are de-ceased, or any organs needed by a re-cipient, Basile explained.Once the logistics are in place,

the large team of doctors, specialistsand nurses work together to connect“everything that’s part of an arm,”Basile said. “It’s the skin, the nerves,the muscles, then tendons and bone.”After the transplant, doctors must

first ensure the transplanted limbsare getting sufficient blood flow, he

said. Then, after about a week, thepatient receives a bone marrowtransplant from their donor. Thishelps the body to build tolerance forits new limbs, he explained. Other-wise, the recipient’s body may recog-nize the transplanted organs as “for-eign,” and “reject” the transplant.The patient is also put on im-

munosuppressant medications, af-ter the transplant, to further helpprevent the body from rejecting thetransplanted limbs. As the body rec-ognizes its new organs, the patientis weaned off the anti-rejection med-ications, Basile said.He also explained that the newly

attached nerves will grow about aninch per month, and so it will takesome time before they reach the fulllength of the patient’s arm, and al-low him to have feeling in his fin-gers. Since the surgery, Marroccohas still been able to put his newlimbs to use.“He’s already using his arms to

text [and] to type,” Basile said.Most importantly, he said Marroc-

co is regaining his independence andcan dream big. He will one day beable to drive again, and won’t haveto constantly rely on others, Basileadded.“Now, I can move my elbow. I can

rotate it a little bit,” Marrocco said,during a Jan. 29 press conference.Though he is unable to move hisright arm much yet, he said, “We’rehopeful for the future to get somepretty good function out of it.”“It feels amazing. It’s something I

was waiting for, for a long time. Now,it finally happened. I really don’tknow what to say, because it’s such abig thing for my life,” Marroco said.“It’s just fantastic.”Basile noted Marrocco’s remark-

able outlook on life, and said he wasgrateful for the opportunity to be in-volved in his transplant.“It’s just a tremendous honor to be

a part of this and to help. It’s justincredible,” Basile said.He believes this will continue to

benefit wounded vets, allowing doc-tors to better understand what topreserve during amputation. It alsogives surgeons a better understand-ing of rejection and tolerance totransplants, as well as the rehabili-tation process.“With every case, we learn more

and more about what works betterand what doesn’t,” Basile added.Lee echoed similar sentiments.“I’m hoping with continued ad-

vancements in research, this be-comes a common procedure,” Leesaid. “Research is an important com-ponent in this,” he added.Lee, who also conducted the na-

tion’s first double-hand transplantin 2009, explained that research hashelped the team develop protocolfor the double arm transplant. Hewent on to note that Johns Hopkinsand Walter Reed Bethesda, as wellas Uniformed Services Universityof the Health Sciences (USU), haveworked together on research proj-ects. They also rotate residents, andhave surgeons from Walter ReedBethesda and USU serving as ad-junct professors at Johns Hopkins,Lee said.Lee hopes to continue enhancing

the partnership between the facili-ties, benefiting more recipients, bothmilitary and civilian, and being ableto transplant other parts of the body.Those who believe they may be

a potential candidate for the armtransplant should contact Dr. Basileat [email protected].

TRANSPLANTContinued from 1

center is both a training facility anda center of medical advancements.“It’s been a rough 17 months,”

Desnoo explained. “Every time youturn around something was happen-ing and we had to adapt, but every-body was really good about workingtogether,” the SPD chief said. Thechallenge helped to bring staff fromthe two military treatment facilitiestogether very quickly, she said.A staff of 55 instrument and sur-

gical techs in the SPD process in-struments for surgeries and proce-dures at the medical center, alongwith tenant commands such asthe Uniformed Services Universityof the Health Sciences (USUHS)and outlying clinics including theDiLorenzo TRICARE Health Clinicat the Pentagon. Charboneau esti-mated the SPD processed more than17,000 cases of equipment duringthe course of the renovation thatlasted more than a year.“We have not slowed down a bit,

[since 2011],” he explained. Char-

boneau called the department, “theheart of the hospital.” He said theunit supports surgeries and proce-dures that require sterilized equip-ment in the medical center’s 23 op-erating rooms, 17 clinics as well asadditional specialties and sites.“This is a big job—really impor-

tant for the hospital,” said Stocks,who explained he was amazed byall the unplanned changes that oc-curred during the 17 month-longrenovation of the department. “Youadapted to those changes to make abetter outcome so I want to person-ally thank all of you for all you dofor all the patients that are going tobenefit,” Stocks added.Capt. Lisa Mulligan, deputy com-

mander for surgery at Walter ReedBethesda explained the SPD, does the“heavy lifting” of the OR for the sur-geries performed upstairs. She saidthe SPD staff “has done an absolutelyexceptional job” and maintained theirlevel of service during a hard renova-tion completed in two big projects,one comprised of five phases.“They kept the OR [supplied],”

Mulligan said. “We joke that theyfeed the OR, and they kept the beastfed the entire time throughout thewhole renovation.”

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