This story is part of a WHYY series examining how the United States, four decades later, is still processing the Vietnam War. To learn more about the topic, watch Ken Burns and Lynn Novicks' 10-part documentary "The Vietnam War" running Sunday, Sept. 17 at 8 p.m. through Thursday, Sept. 28 on WHYY-TV.

It’s been more than 40 years since the Vietnam War ended.

But for the combat nurses who served there, the details remain as sharp in their minds as the needles they used to help patients heal.

Like the tropical heat that greeted Marsha Four when she arrived in July 1969 at the 18th Surgical Hospital at Camp Evans north of Huế. 

“It was so hot, I felt like I had water pouring out of every pore in my body, including my fingernails,” she said.

Or the warning of lurking danger that Grace Moore got after she arrived in May 1968 at the 12th Evacuation Hospital in Cu Chi.

“They put us in Army-green school buses that had chicken wire in the windows,” she said. “It was hot, and I reached up to put the windows down, and the driver hollered: ‘Don’t put those windows down! If we have incoming, the chicken wire will protect you from shrapnel!’ We were like, ‘OK, didn’t think about that!’ ”

Or the rare moments of humor. “They had these bugs; they called them nurse-eaters. They were like crickets — huge, huge and they would fly at you,” said Joanie Moscatelli, who served in Cu Chi from August 1968 to August 1969. “Well, I was carrying this urine specimen, and this damn nurse-eater flew up at me. That didn’t go well.”

joanie moscatelliJoanie Moscatelli served in Vietnam from August 1968 to August 1969. (Photo provided)

Once they start talking about Vietnam, it’s hard to stop — maybe because, for years, there was no talking at all. Those who served Vietnam came home to bitter hostility from thousands of Americans protesting one of the nation’s most unpopular wars.

Military women, who didn’t sport the short haircuts that gave away their male counterparts’ war involvement, more easily dodged the scornful insults of “babykiller!” that combat soldiers endured upon returning. Still, they found that most of their friends and acquaintances at home didn’t want to hear about their war experiences.

So, it became a hidden part of their histories.

“You would get to a point where you could almost see a screen go down, like they really don’t want to hear about it. And so you just quit talking about it,” said Moore, 72, an Iowa native who now lives in Doylestown. “I didn’t tell anyone I was a veteran, let alone a Vietnam veteran. I just packed all that up, stuffed it in a box and put it virtually away.”

grace mooreGrace Moore arrived at the 12th Evacuation Hospital in Cu Chi, Vietnam in May 1968. (Photo provided)

Time helped change perspectives. For some veterans, catharsis came with sharing their stories and recognizing how their war experience shaped who they became.

“When the first Gulf War happened, I sat on a sofa watching it on TV. I couldn’t turn it off. I watched that TV, I’ll bet, 24 hours a day. I was waiting for someone to knock on my door and say: ‘C’mon back! We could use you again!’ I would have gone the minute they knocked,” said Four, 70, an Ohio native who now lives in Springfield, Delaware County.

“As difficult and devastating as it was from time to time, it was the most extraordinary event of my life,” Four added. “And at the end of the day, I know I was part of something greater than myself.”

No place like home

Nearly 10,000 women in uniform served in Vietnam during the 20-year war, according to the Vietnam Women’s Memorial.

Most were nurses. Many were just barely out of nursing school when they were sent overseas.

“I came straight from nurses’ training to the military,” Four recalled. "I had no idea what I was getting into. I had no experience in emergency room nursing, no trauma nursing, very limited/almost nonexistent intensive care training. I had next to no training starting IVs. I was a totally, totally green nurse.

"To say ‘challenging’ doesn’t come close to the feelings that I had about being incompetent. Their lives were in my hands. I was responsible for them. And I’m not talking about somebody who’s got a broken arm.”

Marsha - VietnamMarsha Four works at her desk at the 18th Surgical Hospital in Vietnam. (Photo provided)

Combat hospitals were so busy that nurses worked 12 hours a day, six days a week.

“I became a charge nurse of a 70-bed unit within four weeks” of arriving in Cu Chi, said Moore, who was just 22 at the time. “There wasn’t a lot of choice as far as how quickly you had to learn.”

And combat hospitals were like none they’d worked in at home.

Four’s first station was a MUST unit, or Medical Unit Self-Contained Transportable, which essentially was a mobile shelter with inflatable ward sections.

At Cu Chi, Moore and Moscatelli worked in steel Quonset huts that had screens in the windows, no air conditioning and just floor fans to lend the slightest relief from the sweltering, dusty air.

“Our beds were iron, and there were no cranks or electric buttons. So if you wanted to lift the head of the bed, you had to lift it up” manually, Moore said. They used sandbags for traction and a hose to clean the floors. There was no running water.

Vietnam was the first major conflict to use helicopters to get injured soldiers out of combat zones quickly and deliver them to military hospitals. So troops could be injured during fighting one hour and in surgery the next. The goal of the first nurses and doctors who saw them was to fix and stabilize them within a few days before sending them to more remote hospitals for recovery — or back into battle.

“The wounds were …,” Moore said, struggling to find words. “There’s nothing that could prepare you for it. I don’t care what you saw in basic training, what you learned in basic training. If you see somebody with their arm or leg blown off, you don’t see that in a civilian hospital, as a rule.”

Infection, in the tropical climate, was a constant threat.

And many nurses found themselves in unexpected roles.

“We didn’t just take care of their physical wounds. Any nurse who has served in any war zone would tell you that,” Moore said. “We were their emotional support system. We were their mother, their wife, their girlfriend, their sister. You listened a lot, did a lot of hand-holding, comforting.”

cu chi hospitalThe steel Quonset huts at Cu Chi had screens in the windows and no air conditioning. (Photo provided)

The nurses also treated prisoners of war and Vietnamese citizens.

“I had one pediatric patient — he was about 7 — who got thrown by a water buffalo,” Moore said.

Still, it was the injured American soldiers whose fates still haunt many nurses.

“I remember two patients vividly,” Moore said. “One was a farm boy who had lost his arm, and he was afraid that his fiancee wouldn’t have him when he went back. The other was a captain who had lost all of his men and his leg. And he just blamed himself, like: ‘Why am I left?’

"I would love to know what happened to those two guys. Were they OK? Did his fiancee take him back? Did the captain recover and go on to a happy, productive life?”

Moscatelli still tears up remembering one patient excited about Miss America’s visit.

“The nurses, we all wore fatigues, we wore combat boots, dog tags and ball caps. The Miss Americas, though, they had the hair, the makeup, the jewelry. So the guys were so excited, especially this one poor guy who was severely injured,” said Moscatelli, 71, who splits her time between homes in northwestern Pennsylvania and Mount Laurel, New Jersey.

“So the next morning, I went over to his bed to see how his visit with Miss America went. And there was an autographed picture of Miss America on his pillow. That poor soldier had died that night," she said.

"I still see that cold white pillowcase, with her picture, autographed, on it. And the bed was empty. And that just is the trauma of war. That will always be in my heart.”

A tough transition

When their tours ended, many nurses went home, got married and started families.

Many stayed in nursing. The adjustment was far from easy.

“When I first got back, I was on such overload that I didn’t want to have to make another decision the rest of my life. I was tapped out,” said Four, who served from July 1969 to August 1970. “I had been living in such a deprived setting for so long, it was very difficult to deal with the everyday life of home.”

Everything from listening to the dinner chatter of her large family to riding in cars felt foreign to her.

“Doorknobs! We didn’t have doorknobs in Vietnam,” Four said. “Just everything was so much that I found myself staying in my room for a very long time.”

marsha four then nowMarsha Four is shown during her tour in Vietnam and recently, at home in Springfield, Delaware County. (Photo provided/Emma Lee/WHYY)

Her beau Tony, a veteran she’d met in Vietnam, helped her heal.

“When he came home, he bought a Volkswagen van, gutted it out, made it in an RV, and asked me if I wanted to go on a trip with him,” Four said. “I said sure, which did not please my parents, to be traveling around the country in a van like a hobo with a man I wasn’t married to.”

The pair traveled for four months. They wed the next year and have been together since.

Before her wedding, Four got a nursing job at Memorial Sloan Kettering hospital in New York.

But she quickly discovered that state law hadn’t caught up to combat medicine.

“I did, in my mind, next to nothing,” Four said. “They could have picked somebody out on the streets and had them come up and do the job I was doing. I was not allowed, because of state law, to hang a unit of blood on an existing IV because it was against state law. Only a doctor could hang blood on a patient in New York state. (In Vietnam) hanging blood was nothing. It was nothing! I felt totally useless and so I did not stay.”

Instead, she went to work at a grocery store, helping the butcher package meat. She eventually returned to nursing in Colorado, working in a nursing home.

Moore had a similar experience.

“In 1969, nurses still weren’t allowed to do a lot of the things they do now — like start IVs, put down stomach tubes, do wound care, stuff like that,” Moore said. “You just weren’t allowed to do it in civilian nursing. For me, that was like being hobbled, because I had the skills. I had done it before. And yet I wasn’t allowed.”

There were some positives. Gone were the long, adrenaline-packed days of treating patients in a war zone.

“It was like vacation — we worked eight-hour days, five days a week, that’s all,” marveled Moore, who went on to nursing jobs at Episcopal Hospital in Philadelphia, Warminster General Hospital and Chestnut Hill Rehabilitation Hospital.

Moscatelli went into industrial nursing, tending to employees at a glass factory in Illinois.

It took years before any of them began talking again about Vietnam.

The war never ends

For Moore, a stranger’s phone call in 1985 changed everything.

The caller was a veteran who had been injured in Vietnam and treated at the 12th Evacuation Hospital in Cu Chi.

He wanted to thank combat nurses for their service. And he told her about a new chapter of Vietnam Veterans of America forming in her area. She’s been involved in veterans’ causes ever since.

grace moore nowGrace Moore at her home in Doylestown, Bucks County where she is active in the local chapter of Vietnam Veterans of America. (Kimberly Paynter/WHYY)

“That’s when I was able to say I am really proud of what I did. Really proud of what I did. And I still am,” Moore said.

That realization hasn’t come for everyone.

“Vietnam veterans have been in the woodwork so long, it’s going to be hard to get them out,” said Moscatelli, who has gotten involved with the Vietnam Traveling Memorial War in several towns.

“I called probably 50, 60, guys, trying to get them to come to the wall. I remember one guy telling me: ‘I’ll be sitting up on the hill. That’s as close as I’ll get.’ Another guy said: ‘I know 43 names on that wall. I can’t come any closer. I won’t.’ ”

Decades haven’t dulled the pain many veterans still feel, not only from their war experience, but also from the rancor they encountered when came home.

Seemingly innocuous sounds like the chop of a helicopter's blades or shouts of a protesting crowd can hurtle a veteran back in time.

“Helicopters remind me of incoming wounded,” Moscatelli said.

And some veterans still live with war’s after-effects, including exposure to toxins like Agent Orange, and depression, post-traumatic stress disorder and other mental health issues that lead to high rates of veteran suicides, Four and Moscatelli said.

“I don’t think the war ever ends” for combat veterans, Moscatelli said.

Joanie Moscatelli then nowJoanie Moscatelli is shown during her tour in Vietnam and recently at her home in western Pennsylvania. (Photos provided)

Four plowed her feelings about her combat service into helping troubled veterans.

In 1994, she started a program called Philadelphia Stand Down, a three-day annual event in which volunteers help homeless and needy veterans with everything from medical care to drug treatment to job assistance. She served as executive director of the nonprofit Philadelphia Veterans Multi-Service and Education Center and helped establish its Mary E. Walker House in Coatesville for homeless women veterans.

She also now serves as vice president of Vietnam Veterans of America.

“If you’ve been to war, it is a part of your life forever,” Four said. “In my mind, it makes you who you are. There are things about you that are different than people that have not to been to war. And there is much, much likeness between anyone who’s been to war in one era and another era. It doesn’t matter where you were, it doesn’t matter what culture it was, it doesn’t matter what weapons you had. It doesn’t matter whether you feel it’s just or not.

"Blood smells the same, death is the same, fear is the same, survival is the same, and you carry that with you, and you never forget.”

To learn more, watch Ken Burns and Lynn Novicks' 10-part documentary "The Vietnam War" running Sunday, Sept. 17 at 8 p.m. through Thursday, Sept. 28 on WHYY-TV. WHYY Members will have extended on-demand access to the series via WHYY Passport through the end of 2017.