ABOARD THE USNS COMFORT - -Baltimore Sun reporter Robert Little and photographer Kim Hairston are aboard the USNS Comfort, chronicling its rescue mission to Haiti.
They clogged the chow lines, then overwhelmed the dishwashers, and then the crew of the U.S. Navy's Haiti-bound hospital ship assembled shoulder-to-shoulder on the mess deck as the executive officer told them to expect another 350 crew members when they arrive in Port-au-Prince.
"You think it's crowded in here now, wait a few days," Capt. John Larnerd said.
Word came from the Pentagon just hours after the Comfort's mission began: Prepare to push the floating emergency center to the outer boundary of its capabilities. The ship left Baltimore with enough crew and supplies to run the equivalent of a 250-bed hospital and four operating rooms - about a quarter of its theoretical limits. With the additional crew, which will board in Haiti, the 894-foot ship will reach its full operational capacity for the first time since it was delivered to the Navy in 1987.
Military leaders also are moving to assemble a 150-bed surgical hospital at the naval base in Guantanamo Bay, Cuba, which will coordinate patient loads with the ship's operating rooms.
So even before Comfort's arrival in Haiti later this week, its already frenzied deployment has turned into a mission that will strain the ship's limits and test the Navy's capacity for expeditionary medicine.
And for the vessel itself - whose missions to wars, disasters and impoverished countries the past two decades has left a wake of critics who say the Baltimore-based ship is too slow and cumbersome - Haiti could provide the first chance to show what it can really do.
"This is the right way to use this ship," said Cmdr. Tim Donahue, a urological surgeon from Bethesda and director of surgery for the mission to Haiti. "It doesn't make sense for us to go down there with only four operating rooms when we have 12 that we can use.
"If we're down there, we need to maximize the capability of the ship. And we are."
Designed with the treatment of gunshots and other combat injuries in mind, but more accustomed to gall bladder removal, hernia repair or other less urgent care, the Comfort was swarming Sunday as more than 600 Navy and civilian crew members prepared for some hybrid of the two.
It should arrive in Port-au-Prince by the middle of the week to a scene that has likely changed since the crew last had access to news broadcasts and cell phones.
Capt. Jim Ware, commander of the ship's medical facilities, said the vessel's role in Haiti is still being defined. But he expects its job - and the need for it - to be immense.
"You can't help but believe that it will be very extreme," Ware said.
Medical officers expect to treat complex fractures, crush injuries, burns and a host of illnesses such as dehydration and infection. The complement of 20 surgeons is stacked with orthopedic specialists and trauma veterans. But there also is an obstetrician onboard - a rarity on any military ship.
The ship has 1,000 patient beds, though half are designed only for providing "minimal care." With 12 operating rooms and side-by-side tables, the ship can, in theory, perform 24 surgeries simultaneously.
Realistically, the Comfort expects to bring about 500 available beds and 10 fully staffed operating rooms to Port-au-Prince Harbor - larger than a typical ground-based hospital.
In addition to its medical facilities, the vessel can make 300,000 gallons of fresh water and 7,000 meals a day, and is stocked with prepackaged food and water to distribute to disaster victims.
Many of the voyage's challenges so far - establishing communications and Internet access, counting and stowing pallets of supplies - are common to any hurried departure. The Comfort left the pier in Canton with just three days' notice, which its officers call a record.
Other work was being done Sunday with the uncertain hazards of Haiti in mind. As sailors inside the ship took inventory of the mammoth supply of mosquito repellent and anti-malarial medicine brought on for the mission, for instance, others on deck were installing machine gun mounts on railings and stanchions.
The ship has only a handful of native Haitians onboard, but will need as many as 100 translators if a full load of patients arrives. As the ship's leaders arranged for more, translators onboard were working with doctors to build a list of common questions - "Where does it hurt?" - that could be practiced in Creole.
"I know what Haiti is like on a good day, and the level of poverty is essentially unimaginable," said Cmdr. Laura Roberts, head of anesthesiology and a veteran of two of the Comfort's humanitarian missions to the country. "When I heard there was an earthquake, I knew there would be thousands dead without even hearing it on the news. And I knew there was no way our country would just stand by and let that happen."
Converted in 1987 from an oil tanker into a mobile hospital, and designed primarily to care for troops in combat, the Comfort has sailed the globe ever since in search of a purpose.
It deployed to Operation Desert Storm in 1991 but waited six months in the Persian Gulf and the Gulf of Oman for a flood of casualties that never came. It steamed to New York after the 2001 terrorist attacks and to New Orleans after Hurricane Katrina, but in both places found missions more suited to a medical clinic or a hotel than a full-service emergency room and surgical center.
Since 2007, the Comfort has twice sailed on months-long humanitarian missions around Central and South America, making scheduled stops to set up health clinics and bring patients aboard for elective surgery.
But those missions - which carried more public affairs specialists than surgeons - were more about foreign relations than disaster medicine. Each tour took more than a year to plan and coordinate, and the ship stuck to a rigid schedule even when hurricanes or floods presented unexpected emergencies within its range.
While hailed as peacetime successes, the humanitarian missions raised questions within the Navy about their military value. And they exposed the complexities of using a giant ship - which often can't sail within a mile of land because of inadequate water depth and port facilities in developing countries - to help patients on the ground.
Donahue remembers treating a Navy admiral as part of his normal practice in Bethesda when the man noticed his USNS Comfort belt buckle, acquired on an earlier mission. "He said 'That's going to be a collector's item soon,' " Donahue recalled. "I said 'Why?' and he said 'We're getting rid of that thing.' "
With the Comfort soon to be at full capacity, and with orders to stay in Haiti indefinitely, Donahue said the ship's crew is ready to prove its value with saved lives.
Previous humanitarian missions - both included stops in Haiti - offer the closest thing the crew has to a rehearsal for what is to come. The Comfort plans to use the same stretch of Port-au-Prince waterfront as a staging area that it used in April. The ship's commanders are already coordinating with many of the same Haitian and American officials and relief agencies who worked on the humanitarian tour.
But the rhythm of the ship, and the intensity of the crew, is different than it was on preplanned missions. Crew members left their dress uniforms at home this time. There will be no liberty port. There's no room onboard for the Navy band.
"Now the script is different - we don't have one - but we will improvise," Donahue said.
Despite the Comfort's history in Haiti, more than 80 percent of the crew members have never served on the ship and a handful have never been to sea. Ware said one of his greatest concerns is preparing the crew for a scene that could be vastly different - more dangerous, more disturbing - than anything they've seen.
It was a theme echoed by the Navy's surgeon general, Vice Adm. Adam M. Robinson Jr., when he visited the Comfort the night before departure.
"This is not a training mission or a weekend away," said Robinson, commander of all Navy medical facilities and vessels.
"You're going to have the best medical facility in the Caribbean. And you're going to get involved with, and see things - devastating injuries, death, destruction - that you've never seen. It's not going to be easy, and it's not going to be fun.
"But you're going to get the chance to serve a country that needs you, and people who need you."
Haiti update
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