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It was February 9th, 2003 about 10:00 at night when Billie Hoyle, a Certified Registered Nurse Anesthetist (CRNA) and a major in the US Air Force, first laid eyes on the tiny air base in the northern desert of Kuwait. She could see her breath in the cold, dry air, but knew those pleasant temperatures would only last for two more months before the crushing heat of the desert took hold.

It was a place not many people could locate on a map and after 32 sleepless hours of air travel in what was euphemistically called "high density seating," the stark surroundings didn’t quite register that first night. Morning was another story. The vast, empty, lunar-like landscape contrasted starkly with her North Carolina mountain home, and on a low promontory that overlooked the rest of the base, she and her fellow medics set up shop on "The Rock."

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Their Expeditionary Medical Deployment System (EMEDS) was a tent hospital that shared this sandy patch with the Readiness, Radar, and Security Force guys, among others, as well as camel spiders, lizards, scorpions, a few feral cats, and lots of rats. "SOF (Special Ops)-land," Marineland," "The Snake Pit," and a few other aptly-named barrios made up the rest of the base where males far outnumbered females. This bare bones frontier post along the US security perimeter was meant for a small population of approximately 1,000. But it became a jumping off point, or "lily pad" as the war planners called it, for thousands more troops waiting to forward deploy into Iraq in support of Operation IRAQI FREEDOM. 

Troops arriving in-country were supposed to bring a 6-month supply of toiletries—soap, shampoo, toothpaste, etc. The ones who had deployed before even brought their own toilet paper because you just never knew what you’d find in theater. Of course women had to bring feminine articles as well. Unfortunately, baggage often arrived days later or not at all and the small Base Exchange (BX) offered little for the men and even less for the women. Still, at any one time up to 75 people would stand patiently in the long line, which snaked around two sets of barricades, for a 2 to 4 hour wait in the sun. But it became apparent to the women that the exchange was geared entirely for the male population. The rare articles of female clothing for sale consisted of a ridiculous assortment of impractical and undersized junk. The unlucky few with missing baggage were reduced to purchasing men’s underwear. More importantly, there was nothing in the way of monthly feminine needs. But the situation in the remote outlying camps was even worse. There was truly nothing.

The forward-deployed folks were on the worst camping trip imaginable. It was six months of sleeping in a tent with no privacy, three squares a day of the infamous Meals-Ready-to-Eat with the indefinite shelf life, privies that were essentially a hole you dug in the ground, and a re-supply system that could be iffy. Major Hoyle recognized the urgent need of the women in these locations and contacted her father’s church back home for help. The women’s group of the New Hope Friends church wasted no time. They roused the members of their congregation to immediate action collecting and shipping feminine items of every kind. Major Hoyle then coordinated with the local chaplain services and saw to it that these items were distributed to the women dispatched to these distant outposts. Even after downsizing began at the end of official hostilities Major Hoyle vigilantly ensured an uninterrupted supply of feminine necessities. She also rallied church members, relatives, and friends to send boxes of homemade cookies, candy, and snacks that she passed out to the soldiers back at the main base while they stood in endless telephone lines waiting to call home. Yet as important as these morale-boosting efforts were, Major Hoyle had another even more crucial role to play in the theater of operations.

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Major Hoyle and her partner, a fellow CRNA, were members of a small cadre that provided the only surgical support, 39 miles south of the Iraqi border, for coalition troops from the base and surrounding camps. During their stint, she and her partner provided no less than 50 flawless anesthetics for surgeries that included everything from "routine" appendectomies and minor orthopedic procedures to not-so-routine bowel resections and bomb-blast injuries. All this was within a section of a 32 foot x 20 foot tent that they set up to handle two simultaneous surgeries. With faith in the Patriot interceptor batteries they continued 24/7 operations, even while Scud missiles were being lobbed at their camp, and sweated through ballistic missile attacks in full chemical gear ensemble.

Lack of sleep was commonplace because the missiles invariably came at night. The warning sirens jolted sleeping troops out of bed with a heart-pounding start. This happened innumerable times. After awhile, the unmistakable sound of the electronic "click" that immediately preceded the actual "Giant Voice" loudspeaker alarm was all the warning that anyone needed to leap into chem gear. The chronic threat of chemical attack took its toll on the troops. As Major Hoyle observed, "You were taking your life in your hands to get out of your chem gear just to take a shower or go to the latrine." So, as one of only a handful of hypnotherapy-certified CRNAs in the military, she combined the alternative holistic techniques of healing touch and hypnosis to help troops manage the overwhelming stress and fear. Impressed with her effectiveness, the chaplain learned these techniques from her and enthusiastically used them to great success. She even tutored the psychologist and helped him refine his hypnotherapy approach. Together they helped troops overcome the very real and incapacitating "gas mask phobia." In addition, Major Hoyle taught classes in the medical management of mass casualties as well as preparing for and defending against chemical and biological attacks. Through all these experiences Major Hoyle’s commitment to her patients and comrades never wavered. She was the living, breathing embodiment of the Air Force’s Core Value of "Service Before Self." Therefore, when downsizing began and she could have gone home, without a moment’s hesitation she instead volunteered to stay behind and allow her colleague, a father of five, to return to his family. Two months later, she returned home to her own family.

Like Florence Nightingale before her, Major Hoyle brought a strategic vision to her mission in Kuwait. This vision incorporated the four aims of nursing which are to promote health, prevent illness, restore health, and facilitate coping. Major Hoyle achieved all these goals. She established a home-based pipeline that solved critical supply issues for female troops, initiated morale-boosting activities, and provided stress management therapy and world class anesthesia for all members of the coalition forces in her region. With compassion she provided superb nursing care in the most challenging circumstances. The actions of this one person contributed immeasurably to the overall effectiveness of the troops fortunate enough to be with her. Especially for her patients about to be "put under" for surgery in a tent, she was the most important person on Earth.

Today, in more civilized surroundings at the 35th Medical Group of Misawa Air Base, Japan, she continues to provide flawless anesthesia with her uniquely holistic and selfless approach to patient care. For Major Hoyle and all of our Air Force Nurse Anesthetists, it’s all about being there…wherever your patients are.

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