MANAMA, Bahrain -- It may be one of the world's largest trauma centers, a ship with a mission both rewarding and grim. It might be the most distinctive Maryland presence in the Persian Gulf, thanks to its home berth in Baltimore and a crew that mostly hails from between the Potomac and the Mason-Dixon Line.
But the USNS Comfort, a hospital ship taking on injured from Iraq, is also something else. It is a small city where people live and sleep, make new friends and long for others, eat junk food and watch their weight, read fiction and philosophy, work hard and sit around, do taxes and plan their divorces -- some prompted by Dear John letters that have already arrived.
It is a tangle of streets that can dead-end or go on forever, where getting lost is common and not asking directions is simply stupid. It is a place of top bosses, middle managers and service workers, of the mainstream and offbeat.
Reminders of life outside medicine are visible everywhere. In the emergency room, where the frenzy of a helicopter landing can give way to hours of downtime, people have stashed DVD players, supermarket tabloids, sketchbooks and novels. Elsewhere, photos of wives and children are displayed on desktops and on the steel walls beside triple-deck bunk beds. One such gallery includes a photo of a smiling woman in a wet T-shirt that might as well be mesh.
The activity level aboard is directly proportional to the amount of blood spilled in battle. The 1,000-bed ship is staffed to treat mass casualties, but so far it is less than 10 percent occupied. Capt. Charles L. Blankenship, the ship's commanding officer, says without apology: "We'd rather be bored."
The Comfort's 10 decks contain everything from sleeping quarters to high-tech operating rooms. Through one window, visitors can see blood banks or a laboratory with microscopes dotting countertops. Scattered through the ship are 40-bed wards and an intensive-care unit. Through double doors, staffers enter a 50-bed emergency room far larger than that of the Maryland Shock Trauma Center.
In the emergency room, nurses and doctors -- many of whom trained at Johns Hopkins or Shock Trauma and work in peacetime at Bethesda Naval Hospital -- have everything they would have at an urban hospital. "We have extremely comparable technology here," said Lt. Karen Ritchie, a nurse who trains other nurses and corpsmen.
The operating rooms contain the standard: banks of monitors, doughnut-shaped lamps, ordered tangles of tubing. Though compact, they are as spacious as any but the newest operating rooms back home. Surgeons say there is really no difference operating here from anywhere else, except one: No land-based hospital rocks back and forth. For a ship's surgeon, pinning bones together and reconnecting lengths of bowel require skills one would need no place else.
The first rule, said Cmdr. Ralph C. Jones, is never look up. If one stands squarely on two feet and looks only at the patient, surgeon and patient will move together and the world will seem still.
In particularly rough seas -- and there have been some lately -- a surgeon can elect to sit in a steel chair that is bolted to the operating table. This takes buckling legs out of the picture, though Jones says the stopgap is seldom necessary.
"I've stood up in storms and done OK," said Jones, the chief of surgery. He did concede that sometimes he likes to use a magnetic pad that is fastened to the operating table and secures the metal instruments like nothing else.
The medical facilities fill only part of the ship. There are exercise rooms with treadmills and weights, an officers lounge with a large-screen television and a ship's store that may as well be a 7-Eleven. It sells potato chips, sodas, microwave popcorn and pickles wrapped in plastic. Such items are cheap, but for $575, crew members can buy a portable DVD player, a luxury item that sells faster than one might think.
There are also countless nooks and crannies where life goes on, such as a place outside one stairwell landing where four men worked out harmonies to a doo-wop tune.
A popular hangout is the smoking deck, a terrace bounded by high railings where people go to relax during breaks. Though open to the breezes, it is hard to get away from tobacco smoke, and on foggy days conversation is interrupted by a deafening foghorn that blasts every two minutes.
"There is no outside world, so this becomes our outside," said a rare nonsmoker. "We talk shop, talk about family, about what we're going to do when we get home." As a sailor nearby railed about a small annoyance in the supply room, the officer conceded that complaining is routine.
"There's an old saying," she said. "A bitching sailor is a happy sailor."
A common gripe has to do with the frequent e-mail blackouts. Though the Comfort is equipped with Internet-accessible computers, the command frequently orders a halt to all outgoing e-mail. During a recent blackout that lasted four days, many people received messages from family members who wondered if they were being ignored.
This has led some people to write letters, which are picked up by departing helicopters but take as long as 12 days to reach their destination. It is an activity encouraged by the ship's mental health counselors, who say committing words to paper can reduce the pain of separation.
"By writing personal letters, they get in touch with the feelings they have for their families," said Capt. Ralph Bally, a clinical psychologist from Gaithersburg. "At home, we live with our families every day, but we take them for granted. It isn't until we are separated from family that we realize how much we love them."
The crew has also benefited from packages of food sent from home, though one sailor who has been aboard since January when the ship left Baltimore said she is still waiting for a package that was sent two months ago. It was delivered to Spain and the island of Diego Garcia in the Indian Ocean, arriving both times after the ship had left port.
The Comfort also has a legal staff, which handles everything from disciplinary problems to questions of how to handle wounded Iraqi soldiers according to the Geneva Conventions, as well as the arcane matter of what to do with Iraqis in civilian clothes who may or may not have been combatants.
But Lt. Byron Adams of the Judge Advocate General Corps said he also helps sailors with personal problems. About 75 have needed help drafting wills, and close to 100 have asked his staff to help prepare their taxes. Already, he has helped 10 to 15 crew members draw up legal separation papers; some received Dear John letters -- or e-mails -- from spouses back home. There is nothing surprising about this, he said. It always happens during times of war.
Enlisted sailors, who make up the majority of the crew, sleep in crowded berthing areas that remain dark for the benefit of those who work night shifts and sleep by day. In the three-tiered bunk beds, they have no choice but to get used to sleeping with just a foot and a half of space overhead.
Most sleep behind a drawn curtain, which turns the bed into a tight cocoon. Reaching the top bunk is an acquired skill that requires gripping one's toes to the edges of the lower bed frames and climbing without waking anyone who might be using those beds. It is no mystery why the bunks are called racks.
Beatriz Paz, 24, a Bolivian immigrant who lives in Washington, runs the galley, a vast kitchen where meals are prepared around the clock. On a recent day, galley workers prepared 500 pounds of chicken, 200 dozen eggs, 60 pounds of bacon, 300 pounds of chicken nuggets and 200 pineapple upside down cakes.
On Tuesday, faces brightened on the dinner line when sailors saw they could have lobster tails (they had been frozen), T-bone steaks or both.
"They really kicked our butt that night," Paz said of the crew. "They even came through the line twice."
The ship has a subculture of civilian mariners, 60 in all, who steer the ship, run the mechanical systems and fix whatever is cracked, clogged or broken. Some have long hair, bandanas and grizzled faces, and they tend to be pretty relaxed.
On Saturday, when a persistent haze and rough seas gave way to sunshine and calm, mariner John Morgan of Virginia Beach lay shirtless on the smoking deck, zoning out to Fleetwood Mac playing loud on a boombox. He wore shorts and an American flag bandana.
"I entertain the crew," Morgan said. "I play guitar out here at night and practice for the weekend shows. It's mainly to give the Navy a break from the monotony."
Morgan was planning a mock Gong Show that night under the stars. Another mariner, a smooth talker who hosts a radio show in Hawaii when he isn't at sea, would be master of ceremonies. Morgan was to play celebrity guest Ted Nugent, the fading rock star.
Bill Thomas, the third assistant engineer, had planned to retire to his home in Mississippi after serving in the Navy. Two years ago, not long after leaving the service, he decided to join the merchant marine because the money was better than anything else he could find. Besides, working on ships was what he knew.
With all his time at sea, he acknowledges that he has little time to see his two children, ages 2 and 10. A few months ago, he returned home and saw for the first time that his young son, Scottie, had learned to walk.
"He recognized me, came running right up to me," Thomas said. "He's probably talking now."