138 - Tiffanie Rampley Pt 1: No Regrets

Join Washington State University’s Foundational Practice and Community-Based Care Department Chair and Spokane, Washington native Honored Guest Tiffanie Rampley as she waxes eloquent about her career including receiving multiple degrees from many universities, why she chose nursing, joining the Air Force, falling in love with critical care, becoming a Critical Care Air Transport nurse, her incredible experience being deployed to Afghanistan, and more!

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Transcript

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Hello and welcome to this episode of the Feeding Our Young® Podcast. Today is a very special episode. We are calling it Congested Monday because we're recording this in the middle of the start really of summer of 2025 and there is a cold going around and I've got a little bit of it. My Honored Guest has got a little bit of it and we're gonna not share it with you. With that, without further ado, I'd like to introduce an Honored Guest who practically needs no introduction. I have been looking forward to speaking with her for quite some time. The one, the only, Dr. Tiffanie Rampley. Tiffanie, good morning, how are you? Good morning, Eric. It's so great to be here and I'm a little bit congested as well. And so we shall be, well, misery loves company, right? We'll just be congested together and we will get through this conversation in some way, or form. um With that, Tiffanie, I'm not gonna waste any time here, because I know you've got an incredible story to share. But why don't you, if you don't mind, introduce yourself to the lovely audience. Who are you and what position do you hold? Okay, so my name is Tiffanie Rampley and currently I'm at Washington State University College of Nursing and I'm the director of the pre-licensure BSN program. have oversight of our Spokane campus, our Yakima campus and our Tri-Cities campus. So it's a very large program. If you don't know, we are the largest undergrad nursing program in the state. So we graduate more nurses than any other school in the state. And then July 1st, I will be taking a new position where I will be the department chair. um So my boss, Dr. Vicki Denson, is retiring in one week. I will, I'm being promoted up to department chair. So I will have the pre-licensure BSN program in my department, our RN to BSN program. And then we have a new exciting program starting. It's a pre-licensure master's in nursing program that will start in next June, May. I think we'll admit the first students in May. And that's for students who already have a bachelor's degree in something because, but they want to be a nurse. And so why would you want two bachelor's degrees um when you can get a master's in nursing? So I'll have those three programs underneath me. starting in July and we just hired a new, pre-licensure masters program director who will also start July 1st. Yeah, so. goodness. Well, okay, so in rapid fire then, congratulations. my goodness, had no idea. And God be with you, because oh my goodness, that sounds like you're going to be an even busier lady than you've been in the time that I've known you. Oh my goodness, you're hearing it here first, ladies and gentlemen. We've got Tiffanie in studio before... I can't even, no, I'm not even gonna let my mind wrap around the things that you're going to be in charge of. But that is an incredible honor and I'm so, thank you so much for taking time to speak to our nursing students because I know in the interactions that I've had with you how passionate you are for the uh nursing students of tomorrow, or the nursing students of today, the nurses of tomorrow, as the case may be. Wonderful, well, obviously, ah in these roles you hold numerous degrees, I imagine. If you don't mind just, Share and ever so briefly, what degrees have you obtained and when did you obtain them? Yes, and I, when we talk later, I'll go a little bit more into my extensive career, but my first degree is a BSN, Bachelor of Science in Nursing, and I graduated from Auburn University in Alabama. But I did most of my prereqs at University of Alaska in Anchorage. Then my first master's degree is a master's in leadership and management through Webster University, and that was on Fairchild Air Force Base, the Extension campus. And then my second master's degree is in military science and I got that at it's called Air Command and Staff College, Air War College through the military. And then, um, then I did a post-grad in global health and development. So I have a post-graduate certificate, global health and development from the University of Arizona. And then I finished my PhD from University of Arizona in 2018. So a lot of schooling in there, yeah. A lot of schooling and a lot of schooling from all over. I cannot wait to hear your story. let me, it's obvious you love to learn and we'll talk about that here shortly. Before we do, let's just get out those normal intro questions. um What three words, Dr. Tiffanie Rampley, have you chosen to describe nursing school? I chose rigorous, enlightening, and powerful. love it. And do you have three favorite songs in life right now? I do. So the first one and all anyone that knows me well knows this, this one. It's Don't Stop Believing by Journey. I love Journey. I love everything about Journey. I know every Journey song. I've seen Journey in concert about nine times now. Just went and saw them in Nashville, Tennessee in March. I go every year, sometimes twice a year. I follow Journey. So love Journey and love that song. The second is Try from Pink. I saw Pink in Las Vegas last year. She's pretty powerful as well. And what I love about that song, the words that always, like if I'm having a hard day, um one of the lyrics is, just because it burns doesn't mean you're gonna die. You gotta get up and try. So sometimes when we feel like, we're having such a bad day and it hurts so bad, like, it might hurt right now, but you're probably not gonna die. You just got to get up and try. So I love that song. And then the my other favorite song right now is No Regrets from Édith Piaf. So if you don't know who Édith Piaf is, she's she was a French singer from the 40s. And I love old like um songs from the 40s and 50s. And so she has this song called No Regrets. And em it's all about living life to its fullest, living unapologetically, and living without regrets. So most of the songs are all in French, but that's what the meaning is, and it's just a really cool song. Oh my goodness, well I cannot wait. have a Feeding Our Young® Honored Guest Spotify playlist, which I'll happily send your way, but those three songs are definitely going to be added to that. Perfect. Another thing that's funny is we've been buying albums lately. And so I went to one of the stores, I think it's called Finley's or Finn's. um And I went in to buy the record and the guy said, I don't know what is going on. He said, but this is my last Édith Piaf record. He said, she's making this comeback. He said, everyone's been trying to buy her record. He had one left in. So. That's incredible. And I think that speaks to the timelessness of, know, I think what every artist strives for. And I guess in a way what we hope to strive for here on the podcast as well are these recordings that just hopefully stand the test of time and that speak to people well beyond, I mean, you're talking, you said the 40s and 50s, right? So this is 80 years ago that this woman is impacting people today. Oh, that's amazing. ah Well, then I... I almost, for the sake of time, I almost don't want to do it, but I'm gonna do it anyway. Let's, uh, Dr. Tiffanie Rampley, you are willing to undergo the patent not pending, unofficial Feeding Our Young® personality test. Is that correct? Yes. Okay, once we hear all of the answers to your questions, these five questions will know exactly what type of person you are. I'm so excited. You can give them rapid fire or you can give rationale if you feel compelled. Starting with the first question. Isle seat or window seat? window. Would you rather never be able to go out during the day or never be able to go out at night? day. day. Would you rather never have to wait in line or always have a parking spot? always have a parking spot. That didn't even take thought at all. Would you rather lose the ability to lie or believe everything you're told? I believe everything I'm told. Wonderful and the very last one would you rather have one wish granted today or? Ten wishes granted ten years from now today. won today. Well, the results are in. Tiffanie, are outstanding. Congratulations. Yay. Just confirming what you hopefully already knew. All right. Enough of the games. Fun and games just to open up and to kind of loosen us both up and hopefully loosen up this congestion. My apologies to everybody. The other thing that we have going on here, I have no bones about sharing the issues that go on in the podcast. I cannot mute myself today because when I do, we go all garbly with the recording and it happened earlier. So I get to sniffle and I don't get to mute it. So my apologies to you, Dr. Ramley, but also, this is gonna be a fun ride. Without further ado, let's go all the way back to the beginning, which is usually a great place to start. Why nursing, Tiffanie? Hey, this. Yeah, I have a very interesting career that has taken so many different turns and paths, so hopefully the listeners will find some inspiration into just go with the flow and when life, you know, send you opportunities, definitely grasp onto those. So in high school my. Mom had a friend that worked at a nursing home and she needed some people to help out um in the activities department and then also in the kitchen. So I got a job working in the activities department and then also as a dietary aide and I just loved it. I loved the residents. I loved the people. I just knew right then that I wanted to become a nurse. So. The summer between my junior and senior year, I went and got my CNA license at the Spokane Skills Center. I grew up here in Spokane. I went to high school here in Spokane and then worked at the nursing home as a nursing assistant and thought, all right, I'm going to go to nursing school. But when I graduated from high school, I felt just a little lost. Like I don't know where. go, what to do. I felt like I just needed to do something adventurous. So I had a friend who had joined the Air Force and she came home on leave and she was working as a medic in the Air Force and it sounded so exciting and so fun. And I had another friend that took me out to Fairchild Air Force Base and I saw the planes taking off and I said, I'm joining the Air Force. I need an adventure and I'm joining right now. And so I went down to the MEP station and signed up. didn't tell my parents. I signed up and I came home and said, I joined the air force today and my parents were not happy. They like my better term. Yeah, so my dad said, no, my little girl is not going in the military. And my mom said that I didn't like authority and I don't know where that came from. But she said, so I don't know why you would, you know, want to go into the military. But I told them that I really just needed an adventure. said, I just want to go for a couple of years and, you know, see where it goes. And then I'll come back and go to college or I'll get money for college. Whatever. I, so in August of 1990s, now you know how old I am, I joined, I went off to basic training in San Antonio, Texas. So did basic training for six weeks there and I joined as a medic. So then I went to medic school also in San Antonio, Texas. Stayed in San Antonio for about a year working as a medic and then got stationed in Elmendorf, Alaska. So it's in Anchorage, Alaska. And there I worked in, it was called an aeromedical technician. And so basically we were medics that were assigned to, I was assigned to a fighter squadron. So the, um of F-15s and so F-15 fighter squadron. so my job was to make sure that the pilots and the air crew were medically clear to fly and take care of the aircraft. And so that was a really cool job. And while I was doing that, I started taking classes at University of Alaska Anchorage for pre-nursing, all my pre-nursing requisites. And then the Air Force sent me, I did four years there and they sent me to um Montgomery, Alabama. So there I was just finishing my prerequisites and applied to nursing school at Auburn University in Alabama, got accepted there, so went to nursing school on the Air Force. So that was nice as well. Did two years there. And then while I was in nursing school, which in Auburn was an excellent nursing school, I really felt to have gone to such a great nursing school. I didn't know anything about Alabama or the South. It was my first time ever in the South. It was a little bit of a culture shock coming from Washington state, but really loved it there. And then in nursing school, my first day in ICU when I did my ICU rotation, I fell in love with critical care. And I said, this is where I'm going to work. And when I graduated, I needed to do a year before getting commissioned into the Air Force. And so I convinced the nurse manager of the cardiac ICU at, it's called Baptist Health Hospital in Montgomery, Alabama to hire me as a new grad. I said I have military experience, I was a medic, I already know how to start IVs and do quite a bit of stuff. And so she took a chance on me and I did my first year in cardiac ICU. And then after that, and what a... I don't know if I recommend that. That was what I was going to ask you. just a pause in the journey at the moment because my goodness, already you're doing prerequisites while in the military. If you want to speak a little more towards how challenging that might be. And now the challenge of jumping into the cardiac ICU despite your medic training right out of nursing school. Yeah, so challenging. I love school. I love um education. so doing the pre-reqs all while I was working full time in the military was, me, it was just exciting because I, and I was young and, you know, I think I had a lot more energy then as well than I do now. But I just couldn't wait to go to classes. And I just, to me, it was a dream to go to nursing school. And so doing the prereqs was, you know, I put everything I had into it. So I had to go in the evenings and weekends. Now I had really great bosses in the military and because some of my classes, like especially when I got to anatomy and physiology, they were only at certain times. And so I had to come to the clinic early and I opened up the clinic every day at 6 a.m. I left for two hours in the middle of the day to go to school. And then I had to close the clinic in the evening. I was always the last one there and those were my extra hours that I had to do so that I could go to school during the times that they were offered. Like chemistry was only offered at a certain time. But I had these great bosses that knew that my dream was to finish these prereqs and go to nursing school. So it was great. So yeah, they were super supportive. And then in nursing school, I only had to do one weekend a month with the Air Force Reserves to keep my time and that was pretty minimal and the rest I could go to school full-time. So I felt pretty lucky there. Yeah, and then, yeah, when I graduated, didn't realize what a large learning curve ICU was going to be even with my medic training. I mean, it was... much different of course, but I loved it and but it was and and when I graduated from nursing school there was no nurse residency or um mean I had six weeks of orientation and that was it yeah. It was total sink or swim learning you know ventilators and I mean I went to cardiac ICU and so we had at the time swan gans catheters and ice inject aid and like things that we don't really do anymore in the ICU, but it was a big learning curve. And then after that one year, I had the cardiac enough of ICU experience that I commissioned into the Air Force as a second lieutenant, as an ICU nurse. And yeah, so that was great. So what I wanted. my first duty station was uh Biloxi, Mississippi was called Keesler Air Force Base and it was a combination cardiac ICU, medical ICU, and surgical ICU. I think we had 32 beds. It was pretty busy ICU, but it was great. Once I got into the military, then there was a lot more training. They sent us to all kinds of training classes. And while I was there, They were starting a new program called Critical Care Air Transport. We call it CCAT now, and now it's like, you know, world renowned. I mean, there's all kinds of like articles about, you know, how great the Air Force Critical Care Transport team is, but it was brand new. It was a new course. And so the Air Force sent me to San Antonio, Texas to learn to a critical care air transport nurse. So I went through the altitude chamber, did all kinds of flight training. And so what we did is flew critical patients. At the time we weren't in the middle of a war. So at the time we were flying patients just within the United States. So if we had a patient who needed to be transferred to one of our other military medical centers, like we flew patients quite a bit to San Antonio, which is where the large Air Force Medical Center was at the time, or to California. once in we'd fly patients over to California. And so we would fly, it would be a nurse, a critical care nurse, a critical care physician, and a respiratory therapist. That was the team. So those three, and we could have up to two patients at that time. I know now, sometimes during wartime, they'll have a few more than that. But at the time we could have up to two patients and we would fly usually with the regular medevac team or every once in while would fly. Some of the Air Force has some smaller private jets that we would sometimes fly patients if they needed to get out urgently and we didn't have a crew to take us. But it was an excellent experience and really cool to do, cool to say I did that. Yeah, very cool. Well, by then I'd been, I guess, critical care nurse for about four and a half years and the Air Force said, okay, you need to do something different next. The Air Force loves diversity and loves nurses to have like a real depth of knowledge and I said, well, you what are my choices? And they said, we're desperate for labor and delivery nurses. I mean, just desperate. And you can go anywhere you want if you'll become a labor and delivery nurse. And I said, Eh, I don't know. So, yeah, I don't know. So I went one night, I went over to, I called one of my friends at Work to Labor and Delivery at the hospital and I said, can I come over and just shadow you for a night and see what it's like? And I went from the loud, chaotic, beeping and noises of the ICU to this kind of quiet environment and very regulated and the patients had one IV. and could talk to them. And I thought, you know, and I really wanted to go to California. I wanted to go back to the West Coast and my, we had. that are assigned to us to tell us like where our next assignments were going our assignment officer. That's what was. My assignment officer said, if you do labor and delivery, I will send you to California within the next month. And I said, okay, I'll do it. So I went to Travis Air Force Base in Fairfield, California, just outside of Napa for, six, I think I had six months of training in labor and delivery. And yeah, so it was excellent experience. And my critical care really helped in some of those instances too. mean, labor and delivery is definitely a critical area. I mean, you have to be on toes all the time. Things can change so quickly. Well, while I was in California, our chief nurse said, sent an email out and said, would anyone like to go to England? We're desperate for labor and delivery nurses in England. And so I emailed her back and said, I want to go to England. And she said, can you leave in six weeks? I need someone who can leave right now. And I said, sure, easy to pack up. Sounds like a plan. So I went to, it's called Lakenheath, England. So it's a base just north of Cambridge, maybe about two and a half hours north of London. So I spent two years there as a labor and delivery nurse. And while I was there, it was a small hospital. Sometimes there weren't even physicians in house, except for one ER physician. I delivered nine babies on my own. I delivered one in the hallway. I delivered one in base housing. I delivered one in their car in the parking lot. Yeah, so it was a crazy experience, but an excellent experience. I learned very independent. and we were very short staffed. Sometimes there was only one nurse in labor and delivery and one nurse in postpartum, and sometimes in postpartum you would have eight couplets by yourself. Yeah, so it was very, so we um as a collective, um our small nursing group, and we had Air Force technicians who are very highly trained that helped us too, and they did quite a bit, but we wrote to The Force Chief Nursing said, this is very unsafe. We need more staff here. Luckily, nothing um critical ever happened, but we said this is very unsafe. And we were working every day, and this is... on a time bomb. mean anything, you it just takes one thing. Goodness gracious. And we were like, we worked so hard to make sure that nothing happened, but we were like, this is unsafe. And then there were really a couple worked where I was the only trained critical care nurse in the hospital. Like we had a patient that had a C-section and I'm not, can't remember all that happened, but had to be intubated and then was on. some pressers and so they were calling up to this one bed ICU and none of the nurses up there had ever given these pressers before. So I said, well, I guess I'm taking this patient too. And so I cared for her in our one bed ICU. But after we had voiced our concern, they increased all the staffing at that hospital. And now I heard that they have four nurses on. every shift and they're following all the A1 regulations of staffing. So that made me feel much better that um you can very professionally voice your concern and write a letter and have very, you know, we had very good examples of where we needed staff and why. So, it was labor delivery was just never, I learned a lot. it wasn't my first love. I really, really missed critical care. So after I left England, joined a reserve unit where I could do critical care air transport and critical care in California. And I did that for a year. And then there was an opportunity that came up back here in Spokane to be the flight commander out of Fairchild. And so California, I came back to Spokane and worked out at Fairchild Air Force Base, which was great, and bought a house on the South Hill. And that's when I started working supplemental at Sacred Heart on Two South. So I worked on Two South critical care from 2006 to 2008 and worked quite a bit. there. And also while I was at Fairchild, they said, well, you're, and I kept my critical care. In the military, it's kind of like when you get certified, you know, here you get certified, you know, like as a CCRN, there you get you have a job code and on that job code, you have an indicator of what your specialty is. And so then the Air Force starts looking around like a G means you're a labor and delivery nurse and E means your critical care and is med surge. There's an F for flight nurse. There's one for ER. So you have these specialty codes. so, yeah, so I carried the ICU and the labor and delivery code, both. And they said, see that you're a critical care nurse and so, you're being deployed to Afghanistan as a critical care nurse. And I said, okay, because I'd never, because I was labor and delivery and we were so short staffed in England, had just, my name had never come up as getting deployed. And so they said, yep, you're going to Bagram, Afghanistan as a critical care nurse. And so in 2008, I went to Afghanistan. and spent six months at Bagram, Afghanistan, working in the ICU. And usually when people ask me about it, I was like, was a great experience and a awful experience at the same time. I learned so much and the team that we worked with was so close. I mean, I'm still friends with them to this day. We were still. super close for just those six months that we were together, but we took care of Afghan National Army patients. We took care of all coalition patients, so that was the US. Now, the US patients we'd get were out very quickly. We had a medevac that came in all the time. They went to Germany. So those patients would come in with different types of blast injuries. but we would get them out as quick as we could. We also took care of, know, like the Canadian forces, German, Polish, anyone who was there that, you know, was part of the coalition, we would take care of them. And then the other piece that we took care of that I wasn't prepared for, because they sent me to Baltimore shock trauma in Baltimore for three weeks before going to Afghanistan. because Baltimore Shock Trauma, if you don't know, is the only dedicated trauma hospital in the US. So we have, like the whole hospital is just trauma. Everything that comes in the ER is trauma. Everything that's in the ICU there is trauma. So I spent a week and a in their ER and a week and a in the ICU just taking care of trauma patients. A lot of gunshot wounds, gang members, lots of different... motor vehicle accidents, the military, had an agreement with Baltimore Shock Trauma that anyone that was going to go to critical care or get deployed would go through Baltimore Shock Trauma before deploying because that was the best place to try to get you as ready as you can because it's just pure trauma. I felt pretty prepared for the traumas it would take care of that were ours and our coalition, but we took care of a lot of Afghan children. I was not prepared. One, I'm not a pediatric nurse and I just was not prepared at all for taking care of the kids. Then they said, well, you worked labor and delivery and you worked newborn nursery. You have more pediatric training than other nurses here. You're going to be in our PICU. And I thought, I don't have any pediatric training. Like these were newborn, these were healthy newborns I took care of. So, but I ended up loving it. And the pediatrician we worked with was great. And we really came up with, we had to call to Germany and send pediatric, like we didn't have pediatric ET tubes. We didn't have pediatric, I mean, we didn't have any pediatric supplies, but Afghan people would sometimes just come and drop their kids off at the front gate. And so there was another hospital there run by the Koreans. It was a Korean pediatric hospital. So once we could get the children stabilized, we would send them to that hospital. But some of the kids would come in that were like playing, like we had the little boy who was playing soccer and stepped on a landmine, lost the bottom of his leg. But his dad would say to us, yeah, but he has the other one. Because there are so many kids that were like this. He was like, well, was only one. We would think, my goodness. But the Navy had a really, really phenomenal hospital that they would fit the kids for prosthetics. And they would fit them through. life. And so a lot of the kids were kind of used to it, which was, I mean, it was hard for us to understand, I mean, how resilient these kids were. But we took care of tons of children. And the other thing that was really interesting to us is, except for one little girl that we took care of, her mother came, other than that, the women weren't allowed. So women can't travel, women couldn't come to our hospital. It would be a dad or an uncle or a brother that would sit with the kids. Never did we ever see the mom. And we had really good interpreters and we'd say, I'd ask the interpreter, like, where's the mom? And they were like, moms aren't allowed to travel and they're not allowed to leave the village. And so I just thought, that's gotta be so tough for this mom to wonder her like where their kid is, right? Yeah, and how they're doing and you know what I mean? Did they survive? And my goodness. Yeah. So that part, yeah, was like, wow. But we felt, you know, that if we could, like the, you know, the one piece of the war that we thought maybe we could at least try to influence is if they see us as these compassionate, caring people and we're providing this care to these kids. And they did a lot of um cleft lip and cleft palate. surgeries there too, to try, you know, to give back. I mean, that was our humanitarian piece is that if we can show, you know, the people that, you know, we're compassionate people, you know, maybe, you know, we could, we could help out in that way. And so we got to know, you know, the whole, we had two kids that were there the whole six months I was there. There was one little girl that was there for a year and she had swallowed a watch battery. And so she had a trach and the US after two years finally got enough money. sent her Cincinnati Children's to get it all repaired and then sent back to Afghanistan. But yeah, so those six months were definitely like one of those times in my career. was like, okay, I'm in the military. I've been training for this. But until you go there and see it, It was like wow. So let me, two questions pop in my brain based on what you're saying. And if it's okay with you, what I'm gonna do, I'd like to ask you those two questions, have you respond to those two questions, and then we'll just kinda pivot real quick and turn you into a double episode if that's okay. It's not extra time on your part for the most part, it just means that if I know we've got a little bit more than an hour, because I know there's a lot more you wanna share, I'd love to encapsulate that into two episodes if that's okay with you. Wonderful. But just in, I wanna pause at this moment here because my goodness, first of all, this is a perspective, like I'm a homebody, I've admitted that. is, know, Spokane is uh basically Washington state is where I've lived, grown up and all the things. Never been into the military myself. I have nothing but the greatest respect for you and everyone that has served. um But I just knew very early on, I was the opposite. I knew it was not for me. So just, I'm just sitting here along with the, everybody listening going. I just want to hear more. So with that, you talk about A, taking care of so many patients within this coalition, for example, and you kind of touched on it briefly, but I'm just thinking how much of a pain in the rear in the hospitals it is to sometimes use Marty the translator, the electronic translator. A, how did you guys address translator services? And B, I'm going to give you both questions at the same time so you can decide how you want to order that. But B, Like you said, you knew you were going in the military. You knew you were prepared for this as well as you could be, but yet this is, we talk about trauma bonding in nursing school and that's a thing, but it's not, this is trauma bonding. You talk about these wonderful people you served with and you're like, we still communicate to this day for obvious reasons. How do you deal with that day in and day out of the trauma that you see there with these missing limbs and on kids and adults and all of it, all together? think what was different in 2008 than what it is now, then we didn't really talk about it. Now I think we're a lot more open like, wow, today's really bothering me. I need to go home and rest. The other thing is we were so busy. You work six 12 hour shifts and you get one day off and even on that one day off, you're doing like laundry and like cleaning and I shared a... dorm, I called it a dorm room, I what it was, but with three other people. So I had like a little pod in my room and then we had ah two bathrooms in our whole dorm. And so you're like cleaning, doing laundry, you know, trying, maybe going to, there was a couple stores, you know, on the base so you could do a little bit of shopping. And there was a beauty salon. I used to laugh like, I was like, oh, I'm getting my hair cut with a nine millimeters, like, you know, in my holster while I'm getting my hair cut. And tanks are like going by on the road as I'm getting my hair done. This is very strange. But I... Now you just think, oh, this is really odd. But I think some of it... you do like, you know, I've worked in the ICU for a while and so it's kind of like, okay, each in your brain you think that's just another ICU, getting the patient from the ER. Most of the coalition forces spoke English, the or they brought an interpreter with them. The we had assigned interpreters that were em Afghan nationals that would interpret all four. any Afghan patient that we got. So, and those interpreters stayed with us for a long time. And I'm still friends with two of my interpreters on Facebook. Like one just sent me a message the other day because we spent every day together. And then after five years as an interpreter, they get sponsored to come to the US. Now I read that some of our, I'm not going to get into politics, but some of our politicians might want to send some of them back. But they did a really great service for us and I would really hate to see that. So we all wrote letters at the end of the five, they would write to us and say, you know, we did our five year service. Now we'd like to come to the US and be sponsored. sort of answer your question of how you deal with it. One, it's kind of the same with people who work in ICU now that You see this every day and so you try not to take it home, you try to decompress. Went to the gym, the gym was our space, everyone went to the gym every single day. That was our outlet. I you went, I went every day while was there. Everybody comes back very fit and trim because you're, that's like one of your one way. And then two, the, worked... mainly day shift in the evenings we would play games, you know, like we had, you know, different board games and, cause there's nothing else to do or nowhere else to go. So it's not like, hey, I'm going out today to see my family. I'll see you guys later. It's like, no, we're all there together. The other part that was really difficult was taking care of a prisoner when they came in. So you would hear, you we would hear through the radio or through our teams that, you know, a convoy had just been blown up or something and that it would be this, they had found the person that did it and they would bring that person to the ICU for us to take care of. And we were like, or we would have taken care of the soldiers that were in that convoy that morning. And now You've got the perpetrator. yeah, we have somebody from, you know, the Taliban or something that we're now taking care of. And it's like, it was really hard because I would think, okay, how do I now show any sort of compassion or want to give any type of pain medicine to this person that just did this? But same thing, we just said, okay, this is a human being. They're heavily influenced by this other regime. We can't help that. But maybe if we can show them a little bit of compassion or something. that was, I think, taking care of the kids and taking care of what we call the enemy was really hard. Yeah, those were the two things where we were like, yeah, it was tough. But you're right. Our team, we all worked together the whole, like we deployed. same time all six months together and we really bonded as a team and we trusted each other and the other thing that was sort of nice in a weird way so they don't have any joint commission there's no regulation no one's monitoring our charting or I charted much more minimally on some of the patients like the afghan like nationals we gave them excellent care but like no one's gonna read that chart later I mean that's not gonna Yeah, yeah. they get discharged, they go back to their village and, you know, we charted very well, obviously, on our US soldiers before they went to Germany so they knew what was going on. But we could, I felt like we could give just regular, good bedside care because we were not charting an epic. We're not charting a bunch of extra stuff. mean, maybe closer, like, than what you're describing to me, I feel like maybe you feel closer to the days of Florence Nightingale, right? Like, you are, you're there offering the care, literally in the trenches, you know, taking care of other human beings, and not necessarily having to worry about all this extra stuff we have to worry about in modern day, yes? Yeah. Yeah. So in that way it felt very autonomous. uh We had an excellent relationship with the physicians. We could make some decisions on our own of what we wanted to do. it was really, in that aspect, I felt like it was like real nursing. could, yeah, like you said, you could just sit by the bedside and yeah. give nursing you weren't worried about kind of all the extra stuff today that administrative stuff wasn't there all this epic charting and yeah so it was kind of nice to that piece. I love that and I thank you. We're gonna end your first episode on this note, because I feel like it's kind of a positive note. Anyone listening to this who is a nurse is going, my goodness, you know what I mean? Like the circumstance is not ideal. ah But the benefits from that are totally different. You get closer to that heart of nursing and man, I'm just like, I'm encouraged just hearing that. So if it's okay with you, Tiffany, we're gonna make the jump to. uh the side B of the Tiffany Rampley experience talking about records. Alright, well then you guys, you don't want to miss it because this just, correct me if I'm wrong, we've just reached up to about 2008, correct? Yeah, so we've only got another 17 years to go, it's fine. We'll encapsulate it in one more hour. you guys, you don't want to miss it. She's got an incredible heart and I'm excited to find out where the journey takes her. So we'll catch you on the flip side.