Remember Nurses Who Have Served

On this Memorial Day, I began thinking about nurses who have served our country and the sacrifices they’ve made. Nurses have been administering to troops throughout the history of the United States, but the story of the nurses in the Philippines during World War II grabbed my attention.

Ninety-nine were stationed on this Pacific outpost, and most became prisoners of war after U.S. and Filipino forces surrendered the islands to the Japanese in 1942.

There are many stories about their imprisonment from 1942 to 1945, but two things are for sure: None of the nurses who were caught in the crossfire of the world’s largest conflict ever expected their lives to take such a turn, and they all acted heroically.

Most of the nurses who signed on for duty in the Pacific theater were just “in search of a little adventure,” as one journalist put it. They expected to pass their time with the Army and Navy doling out aspirin and caring for the few who contracted tropical diseases. All that changed on Dec. 7, 1941, when the Japanese attack on Pearl Harbor set in motion a series of events that would forever change the lives of these nurses.

The invasion of the Philippines began 10 hours after the attack on Pearl Harbor and dozens of nurses were captured and eventually sent to Los Banos POW camp in Manila where they tended to the sick and injured under extremely primitive conditions.

One nurse, Ruth Straub, wrote in her journal that the first hospital on Bataan was a "jungle land and everyone lives under trees. Rows of beds snuggled under the trees with narrow winding paths between them and the night sky overhead.”

Nurse Elizabeth M. Norman, who eventually became an associate professor in nursing at New York University, was stationed on Corregidor, an island in Manila Bay that was important to the Philippines’ defense. General Douglas MacArthur used Corregidor as Allied headquarters until March 1942. Two months later, U.S. and Filipino forces surrendered to the Japanese.

"The nurses stood mute and edgy,” Norman said of the surrender scene in her book, "We Band of Angels: The Untold Story of American Nurses Trapped on Bataan."

“Up and down the line walked the Japanese, looking them over. It was difficult, at first, to read the enemy's face, to separate reputation from reality, reality from fear... The sight of women in uniform was so alien to the Japanese that they seemed puzzled, indeed almost confused, by the nurses' presence."

The nurses spent nearly three years in the POW camps and conditions deteriorated over time, especially during their last year of captivity.

"Some people started eating weeds, flowers and roots,” Norman wrote. “A few of the nurses grew a little talinum (a succulent) and okra, then fried their meager harvest in cold cream that came in Red Cross kits."

According to another nurse’s account, the POWs were "reduced to eating anything they could find -- dogs, frogs, even rats."

Many of the nurses fell ill themselves, but they continued to work, caring for the soldiers and hundreds of others who also were held prisoner.

"When your world is crumbling around you,” Norman wrote, “you need this kind of structure.”

Another nurse who told her story was Rita Palmer of the Boston area, who died in 2002. According to her obituary, she was “among the few World War II female veterans to receive the Purple Heart.”

Palmer joined the U.S. Army Nurses Corps in 1941 and served in a field hospital in Bataan and Corregidor until the surrender, in which she was wounded and taken prisoner. After the war, she told her story to the local newspaper.

The first two years “went fairly pleasant,” she related, but things changed in 1944. The nurses had only rice to eat and that was rationed. Some contracted beriberi (a nervous system disease caused by lack of thiamine). They turned to eating cats, and a flock of pigeons that had nested in the eaves “gradually disappeared.”

Palmer was “in the hospital with dysentery when the Americans arrived in tanks. She went to the window to watch American soldiers pour into the camp. One gave her the first chocolate bar she had eaten in two years.”

Amazingly, all the nurses who were imprisoned in Manila lived to be liberated by American forces in early February 1945. They were decorated for bravery at the White House that summer.

HIPPA, Airplanes and Afternoon Naps

We all work hard to maintain the HIPPA rules on privacy of medical information, and I, for one, am grateful. I don’t want everyone or anyone to know about my medical problems. They are my business, but apparently, not all people share this opinion.

What is it about getting on an airplane that prompts some people to let down their defenses and feel compelled to tell perfect strangers the most intimate details about their state of health?

I recently was trying to survive a trans-Atlantic flight from Germany in a very small coach seat when I realized I was surrounded by passengers telling other passengers about their medical trials and tribulations.

The man across the aisle was talking to the man in front of him who had turned around and was draped over the back of his chair. They did not speak in hushed tones. The first man was going into great detail about his experimental spinal surgery that would’ve cost $100,000 had he undergone the procedure in this country. Instead, he paid $23,000 to have it done in Thailand and seemed happy with the results. He went on at length about his symptoms before the surgery, his physician, his vitamin regimen, his post-op course and his family. He’d recently given his teenage son a new car for his 16th birthday (he’ll regret that decision) and had been bankrolling a daughter who wanted to be a movie star.

And, oh yes, he had three ex-wives.

The man draped over the back of his seat didn’t let the opportunity to pontificate about health care delivery and his problems pass. After all, he’d been a good listener, so when there was a break in the conversation, he jumped right in.

Without even trying hard to listen, I learned he had been career military for 32 years and was currently seeing doctors at a military hospital. He was taking drugs for hypertension and hyperlipidemia, and was trying to lose weight, but “it’s tough,” he said. He was pretty satisfied with military medicine, but his wife, sitting next to him, was not. She had developed many problems following a hysterectomy, performed the day after Christmas two years ago. (In case you’re wondering, I got so intrigued I began taking notes.)

Behind me sat a woman I’d guess to be in her 30s and another woman, perhaps in her 70s. The younger woman was a first-time mother and concerned about the quality of her 4-year-old daughter’s poops. The older woman went on about “raising children in my day,” her son’s prostate cancer (he was in the “watchful waiting” mode), and her own medical problems which included osteoarthritis, a hip replacement and dizzy spells. I zoned out when she began describing her litany of medications.

Fortunately, my fellow passengers eventually tired of all the medical talk and settled in with their books and movies – except another man just across the aisle who had a major snoring problem. He enjoyed his nap, but I’m not sure the rest of us did.

What Have We Learned From the Nurses’ Health Study? Lots!

If you haven’t read the column just before this one, go back and do so.

If you have read it, you know about the Nurses’ Health Study I, II and III, but you might be wondering what researchers have learned, thanks to the 238,000 nurses who have faithfully continued to fill out questionnaires and send in tissue samples for more than three decades. Here’s an amazing associated fact: Because of the vast quantity of information gathered from the studies, more than 100 papers were published in 2005 alone. This research helped create national guidelines on weight, diet and exercise.

For instance, our national food policy has been transformed because Nurses’ Study researchers learned that the association between weight gain and fat consumption was much stronger with trans fat than with other types of fat. Some people may complain about this, but when you look at the research, there is every reason to ban trans fats, especially when there are substitutes that work just as well in the taste and consistency categories.

Evidence from the Nurses’ Study also has helped scientists and nutritionists understand the role of vitamin D in cancer. Although more research is necessary, experts are leaning heavily toward concluding that many people get inadequate amounts of vitamin D, and that prolonged low levels of vitamin D predispose to developing cancer. Researchers say that getting an adequate amount of this vitamin from food is difficult, and that supplements are recommended.

Now here’s a scary finding: Nurses who worked rotating night shifts for many years had a 35 percent greater risk of developing colorectal cancer and a 47 percent greater risk of developing endometrial cancer.

Another finding: Women who used estrogen plus testosterone were about twice as likely to develop breast cancer as those who had never used postmenopausal hormones.

A couple more findings: A high consumption of certain omega-3 fatty acids is associated with a lower risk of cataracts; and high insulin levels – the result of insulin resistance – is associated with greater memory problems, even in women who don’t have type 2 diabetes.

I could go on and on, but you get the picture; the Nurses’ Health Study has provided invaluable information about the health of women, who until the study began, were woefully absent in most research.

Calling All Nurses Ages 22 to 42: Harvard Needs You!

If you’re younger than 60 – and there are a whole lot of you – you will not have participated in the big Nurses’ Health Study out of Harvard, but chances are you’ve heard of it.

I call it the “big” study because the number of participants dwarfs all other studies. More than 238,000 nurses make up the two groups of women. With money from the National Institutes of Health, researchers at Harvard began more than three decades ago to investigate the potential long-term consequences of the use of oral contraceptives, which hundreds of millions of
women were taking. Registered nurses were chosen as volunteers because investigators felt that, with our medical backgrounds, it was good bet that we’d be accurate in our responses and that we wouldn’t drop out.

So in 1976, about 122,000 nurses out of the 170,000 who were contacted by mail responded – an incredible number by research standards. Every two years these nurses receive questionnaires about diseases and smoking, hormone use and menopausal status.

In 1992, at the request of some nurses, quality-of-life questions were added. In 1989, Nurses’ Health Study II was formed. It began studying the effects of oral contraceptives, diet and lifestyle risk factors in a group of younger nurses whose number eventually totaled more than 116,500.

Now you younger nurses will have your chance at joining the mother of all lifestyle studies. Harvard is launching the Nurses’ Health Study III to examine how new hormone preparations, dietary patterns and occupational exposures impact women’s health. Researchers are looking for female RNs and LPNs/LVNs ages 22 to 42 from across the country. Researchers will save money on postage this time around because the study will be entirely Web-based. They’ll be looking at fertility and pregnancy, and there will be greater focus on adolescent diet and breast cancer risk. Another goal is to include women from more diverse ethnic backgrounds than are in the two earlier groups.

The initial mailing went out about 6 months ago to one million nurses. If you received an invitation and haven’t yet acted, re-consider. Follow your cohorts that went before you because by taking just a few minutes every few years, you’ll contribute to a body of knowledge that will be of immense help to your daughters and sisters and grandchildren.

To read more about the study, visit http://www.channing.harvard.edu/nhs/.

The Nurses’ Health Studies are among the largest and longest running investigations of factors that influence women’s health. Started in 1976 and expanded in 1989, the information provided by the 238,000 dedicated nurse-participants has led to many new insights on health and disease. While the prevention of cancer is still a primary focus, the study has also produced
landmark data on cardiovascular disease, diabetes and many other conditions. Most importantly, these studies have shown that diet, physical activity and other lifestyle factors can powerfully promote better health.