THOMAS LARSON

(University of San Diego Magazine Summer 2006)

Elaine Allen, a 66-year-old retired Navy captain, is being wheeled into the emergency room at the Naval Medical Center San Diego. Her body and head are strapped to a backboard and her neck is collared; she blinks at the fluorescent ceiling lights whizzing by above her. It’s not clear yet how serious her injuries are—15 minutes ago, she was hit from behind by a driver doing 80 mph. Allen asked to be brought here because she’s Navy and she knows the hospital’s reputation. She’s rushed into a curtained bay where a nurse leans over her and makes eye contact. He tells Allen that he’s here to take care of her. She’s frightened, disoriented. He says he knows how uncomfortable she must be with her head pinned. The nurse, an open-faced man with a satiny shaved head, says he and his team are going to move her: she may feel a jolt.

”Are you ready?”

She responds with a question. “You military or civilian?”

“Military.”

“What’s your rank?”

“I’m Lt. Cmdr. Starks, U.S. Navy, head of nursing.”

“That’s good,” says Allen. “A lot of my Navy friends are nurses.” She reaches her hand up to Starks’ rubber-gloved hand, and he takes it. They squeeze, and he counts, “One, two, three.” She’s lifted from the paramedic’s gurney onto an ER bed.

Soon Starks stands aside for Dr. John W. Love, one of two physicians on the floor today. Love begins the medical exam, telling Allen that he’s concerned about internal bleeding, broken ribs, the pain in her back she’s already noted. Allen is now relaxed and joking with the attendants; X-rays will later show her injuries are minor.

Providing this critical initial connection to patients is something Lavencion Starks would like to do more of. But his days bulge with duty; he’s in charge of the emergency room’s 35 nurses and 40 enlisted staff. He’s also fresh out of the University of San Diego’s graduate nursing program, with a master’s in executive nurse leadership. Prior to that he served at the White House under President Clinton. As an executive, he chairs meetings, whiteboards the schedule and chooses who will be deployed to Iraq, his toughest call. All of that can be taxing. Which is why several times a month the 39-year-old loves to don turquoise scrubs and work a 12-hour shift. It’s not only that he likes being reminded what “my people are going through.” It’s that administrating can drive him loco. “You might say getting out here to care for patients keeps me sane.”

To be a nurse and a male is not as incongruent to Starks as it may seem to some of us. The trade runs in his family. His mother, a single parent for several years, was a nurse in Chicago, where Starks was born and raised.

“We didn’t have a baby sitter, so when the pager went off, we’d get in the car and take off. I would travel with her to Cook County Hospital. I’d sleep on the gurneys in the hallways while she worked in surgery. Then, in the morning, if she was still busy, one of the nurses would take me to the cafeteria for breakfast, and if she was still busy, somebody would take me to school.” He says the bond between nurses and their families is special. “It’s the best part of the nursing culture.”

At 15, Starks took advantage of one hospital’s summer program and worked as an intern beside his mother. “I was an orderly, helping transport patients, empty bedpans, take bodies to the morgue.” When he was trying to decide on a career when starting college, his mother put the nursing bee in his bonnet: “‘You’ll always have a job,’” he recalls her saying. “‘You’ll always be able to take care of yourself. It’ll offer you diversity if you decide you want to go into anesthesia or the operating room; it offers you dynamics and range.’”

Central to his decision was the glowing example of his mother. “Doctors historically get all the credit,” he says. “But I saw things from the nurse’s perspective. My mother was my idol. I saw her in a position of authority, (having) a great deal of control. Wow! She was saving lives. I wanted to emulate that.”

When he enrolled in the nursing program at Delaware State University, Starks was the only man in a class of 40 women. “I feel like I’m a pioneer in the field. The percentage of males has grown; that’s a very good thing for the profession. But yes, then, I was a minority of minorities.”

Rather than face gender discrimination as a nurse, Starks says that “many of the guys on campus were envious of me, being around women.”

The question Starks usually gets when people find out he’s a nurse is, ‘Didn’t you want to be a doctor?’ As if men would only see nursing as a rung on the ladder to physician. His answer is straightforward: “I’ve had no desire to be a physician. I like what I do. Nursing, because of my mother, is a very comfortable and natural position.”

In 1989, during his senior year of college, the Navy recruited him. “They offered me the opportunity to come to California. I grew up in Chicago; I went to college on the East Coast. I was young. I wanted some adventure.” He signed a three-year contract and was sent to officer training school. From there, he got his first command at Naval Medical Center San Diego, a facility that today employs 6,000 military and civilian personnel.

He first shipped out on the USS New Orleans, a small helicopter carrier ship. Duty also took him for eight months to Saudi Arabia and Kuwait during the Persian Gulf War. There, with a mobile medical group, he provided care to Marines. Starks is still struck by the daunting challenge of fighting a war on the other side of the globe. “America basically takes a big shovel, scoops up our armed services and transports them halfway around the world. They must sustain themselves with food, tents, vehicles, weapons, everything. My unit was attached to a major re-supply detachment that carried the beans, the bullets, the water, the fuel for the soldiers. As the fighting forces went forward, we were 20 miles behind them.”

Starks’ unit stabilized the wounded and sent them back to larger facilities. “Those injuries were nothing like the high-intensity combat injuries we’re seeing now in Iraq,” he says. “We did see limb injuries, and unfortunately, almost as many friendly fire incidents.” He particularly remembers the fear of massive casualties at the war’s inception — and the widespread relief when doomsday scenarios failed to materialize. “For the first three days, people were saying, ‘3,000 casualties, man, it’s going to be horrible.’ But the Iraqis didn’t want to fight. They were surrendering to everybody, even to medical people. We spent a lot of time feeding them, seeing to their malnutrition, dehydration and infections.”

In 1996, three years into his stint in the intensive care unit at the Naval Medical Center, Starks got word about an opening for a nurse at the White House. He fit the criteria, was selected as a finalist along with six others (3,000 applied), flew to Washington for interviews and landed the position. Starks worked for three years as part of a 20-person team in the Old Executive Office Building next door to the White House. He cared for President Clinton and Vice President Gore, as well as their families. When Clinton traveled abroad on Air Force One, Starks was sent ahead to survey hospitals and clinics where—in case of an emergency—his boss might have to go.

In his office, three candid photos of Clinton and a beaming Starks line the wall. In one, Starks is cutting a cake on Air Force One and celebrating the end of his White House tenure. Clinton, Diet Coke in hand, is making Starks laugh. “He was commenting on not missing some of the exams we used to give him.” Because of patient privacy, Starks can’t share certain specifics, but he does recall President Clinton with affection.

“What I learned in the political arena is that generally there’s a certain person you see when the camera and the lights are on, and there’s a different person when the camera and the lights are off. Clinton was always the same person. He was the kind who would walk through the aircraft and find the guy handling the trash and talk sports with him.

I was a low-ranking military officer, and he still took time out to say, ‘Thank you very much for everything you do. I appreciate it.’” On his right shirt pocket, whether it’s his khaki or bright white uniform, Starks wears a Presidential Support Badge, the seal of the president—an eagle whose talons grasp an olive branch and a cluster of arrows.

After his time at the White House, Starks was assigned for three years to a small U.S. base in Atsugi, Japan. He lived in the city and met his future wife; they now have a 2-year-old daughter. But then, in 2003, he decided that “for my professional growth, I needed a master’s degree.” Starks applied to the University of San Diego as part of a Navy program that would pay for his two-year grad-school education and continue his salary as long as he stayed in the Navy for four years following graduation. Fifty percent of the nurses in the program were men: “Times have changed.”

Starks put on his civvies and spent his first year in class and writing papers. His second year was devoted to clinical work at hospitals in Escondido. On campus, he says, “I was a little lost. There’s a different thought process for those of us who’ve been out on the grindstone.” Then, he met two women who were major influences. Clinical professor Linda Urden was one of them. “She was the first one who helped me develop direction, tunnel my focus. She’s an incredibly smart lady, a visionary.”

Urden remembers Starks as having a “big-picture approach” to health-care systems. “He’s inquisitive and questioning; he’s very articulate, very well-read. He quickly synthesized information and came to conclusions.”

From professor Jane Georges, Starks learned grant-writing, information-gathering and the fundamentals of research. “I enjoyed her coursework the most.

She showed me how to find the science behind any particular problem in health care for which you need money to solve.”

Starks beams, recalling the school’s esprit de corps. “I loved it,” he says. “It was an incredible, remarkable, wonderful experience. I was always happy on that campus. It’s beautiful. If anyone wants to provide

Lt. Cmdr. Starks a scholarship so he can get his Ph.D.,” he jokes, “he’d be more than happy to take them up on it.”

Doctorate or no, he’s delighted to be working at the Naval Medical Center again. Nursing will always demand long hours and emotional strain. He’s got to be ready, he says—reviving a shipboard metaphor—for “whatever falls on the deck plates.” But to continue to be stationed in San Diego? “I’ll sign any contract.”

In January, Starks chose four nurses from his staff for deployment to Iraq. He’s sent others before, but this group is new to war. He says it’s always a tough decision. “I won’t send a brand-new nurse. But I will make sure they have the skill sets and the experience to do the job.” How did they take the news? “They know they may have to go to war when they sign up,” Starks says. “They will be forward deployed, which means wherever the Marines are—even on the front lines—that’s where they’ll go.”

About the conflict, Starks says, “I look at CNN just as you do. You could be driving down the street in a Humvee and be hit by a roadside bomb, or they could lob missiles into the chow halls. Everyone is at risk.”

Back in the ER, Starks is assessing a procedural change he has just implemented. One day last October, every ER in San Diego was overwhelmed. Full moon or freakish fate, all day long the waiting room at the Naval Medical Center was clogged. Ambulances arrived hourly. “It was a hospital traffic jam,” Starks recalls. “In America, people want high-quality health care, and they want it right away. We had to make changes.” Starks focused on triage time. “There’s no reason we shouldn’t be getting to patients in the first five minutes.”

It’s later in the day now, when the critical-care volume picks up. A boy with a bruised face goes by in a wheelchair. At the bedside of a sleeping woman, a soldier in camouflage and tall black boots stares at a monitor, its electro-luminescent waveforms tracking to the right. The manic pulse of television’s “ER” is rare, though it does happen. Most people who come through the door need non-urgent care. But that doesn’t keep Starks from innovating: “You never know when we’re going to be bursting at the seams again. I want my people to make quicker decisions.”

In the waiting room, a big sigh comes from a frazzled, bed-headed man in a T-shirt, shorts and sandals, his legs ghostly white. It’s a sigh of relief: a corpsman is cradling his arm and pumping up the blood pressure cuff.

Soon, the man is on his feet and shuffling into the ER, holding out an elbow for Starks, who, taking it, greets him. “Good afternoon, sir.”

His touch is gentle, affirming.

“You a doctor?”

“No sir. I am a nurse.”