At Walter Reed Army Medical Center, the automotive repair garage now has a dual purpose. It's also a decontamination unit, should terrorists strike Washington with chemical weapons.
At Andrews Air Force Base, the gymnasium and the indoor tennis courts are not filled with playing equipment but with 250 quickly assembled hospital beds. Soon, the new ward could be packed with wounded from the Persian Gulf awaiting transfer to other places.
While the dimensions of the Gulf war are yet unfolding, it is already clear that the medical preparations have a decidedly East Coast focus, in contrast to the Vietnam War, when the medical burden fell more heavily on West Coast military bases and treatment facilities.
Walter Reed, set to expand immediately from 845 beds to 1,300, is a primary receiving center for the injured, according to Defense Department officials. Andrews, along with Charleston Air Force Base in South Carolina and McGuire Air Force Base in New Jersey, is one of three designated locations where the returning wounded are expected to land.
The result is that the Washington area, with its large number of military hospitals, could soon be a major setting for one of the most painful aspects of war: the long struggle by the wounded to recover.
"If we never have to do anything, I'll be the happiest person there is," said Brig. Gen. Robert W. Poel, commander of Malcolm Grow Medical Center at Andrews.
So far, the impact of the war on the local medical community has mostly consisted of preparation. Ten area civilian hospitals, including D.C. General, Georgetown and Sibley, have been instructed to stand by. They could be used if military hospitals and the Veterans Administration facilities are filled with patients.
Eighty-seven beds for burn patients have been reserved at two hospitals in the District and Baltimore. An empty building at Crownsville Hospital Center near Annapolis, one of Maryland's oldest state mental hospitals, is being returned to service to treat soldiers suffering from psychiatric problems because of the war, state officials said.
While some area residents are mourning the loss of a favorite doctor suddenly called up to active duty, most civilian hospitals report that they have not been significantly hurt by the deployment of reserves. But nearly every facility has lost a few veteran surgeons, emergency room nurses and trauma experts.
Last week, Martin Eichelberger, the director of emergency trauma services at Children's Hospital for 10 years, departed for a tour as a commander in the Navy reserves. Eichelberger, the presiding surgeon for five Washington children wounded in a drive-by shooting in December, sees his new duties as another instance of treating young, shattered patients. He calls it a transfer from "one war zone to another."
Civilian doctors are also helping out by sponsoring seminars at Bethesda Naval Medical Center to prepare military psychiatrists and other doctors for the "psychiatric casualties of war," said Wayne Blackmon, a board member of the D.C. Medical Society. "The civilian sector is filled with doctors who have military experience" and are aware of the problem dealing with casualties, he said.
For officials at area military hospitals, this has been a critical time of expanding and preparing for a possible onslaught of wounded while watching their own ranks shrink because of troop deployments. Perhaps nowhere is the impact more striking than at Malcolm Grow, which has lost 40 percent of its medical military personnel, or about 500 people, in the last two weeks. The doctors, nurses and other personnel have been deployed to Britain to open and operate a 500-bed hospital for soldiers removed from the Persian Gulf.
The result is that most elective surgery at Andrews for military personnel and their families has been canceled. The cardiopulmonary, gastroenterology and internal medicine clinics, among others, are "limited to urgent referrals," a spokesman said. The outpatient pharmacy will fill new prescriptions only, and then only on weekdays.
"In some clinics, we're able to do business as usual. But some have lost 80 percent of their staff -- surgical specialties primarily," said Poel, who also oversees a hospital licensed for 305 beds but has the staff to treat only 230 patients.
"Until I get others from the National Guard and the Reserves to come in, we're doing limited work," he said, adding that he expected to get in "as many people as we lost."
At Walter Reed, reservists and retirees have already largely replaced the 200 people who have departed for active duty, a group that included 35 doctors, a spokesman said. The Bethesda Naval Medical Center was in a dire situation a few months ago, with more than 1,000 members of its permanent staff deployed to the Middle East. But the inpatient load is now back to 80 percent, and the outpatient clinics are able to handle about 45,000 patient visits a month, said Lt. Cmdr. William Clyde.
If there are significant numbers of wounded, they will be routed from the war theater to military hospitals in Germany and Britain, then to hospitals in the United States, with the Walter Reed facility in a position to receive large numbers of patients, according to a Defense Department spokeswoman.
In this war, Andrews may end up becoming the Travis Air Force Base of the East, replacing in prominence the California base that received so many wounded during the Vietnam War.
Back then, Walter Reed, the Army's largest medical facility, played a relatively minor role, providing certain specialized care and treatment of wounded who had relatives living in the area. It has been so long since Andrews was fully used in wartime that some of the blankets retrieved from old packets of "war readiness materiel" to cover the beds in the gym were dated 1944, Poel said.
At Walter Reed last week, packages containing new pajamas were placed atop the beds that have been readied for the wounded -- a very real reminder that the wards may soon be in use.
On a recent day, the smell of fresh paint was heavy in the air. As part of a $1.5-million war-readiness project, workers have knocked out walls on the fourth floor and installed heart monitors, oxygen supply systems and other equipment. The 34-bed intensive-care unit is quickly being expanded to hold 100 beds. Underused operating rooms are being converted to wards. Eventually, the hospital, which had 643 patients on a recent day, could expand to hold a total of 2,600, officials said.
"It's not physical beds -- you've got to have the equipment and the people," said Col. Russ Zajtchuk, deputy commander at Walter Reed.
The facility also has a decontamination team to handle local terrorist attacks as well as the decontamination unit housed in the former garage. And the staff has been participating in emergency-preparedness drills. "It's a very remote chance," said Zajtchuk, "but you always prepare for the worst. And even if you don't use it, fine."
Last week, the staff at Walter Reed was augmented with the arrival of reservists from the 2290 Reserve Hospital in Rockville. Among those new workers is Lt. Col. Don Bonin, 46, a registered nurse who still has vivid memories of helping with the air evacuation of the injured during the Vietnam War. Bonin has left behind his Silver Spring business, which contracts nurses and medical technicians, to oversee the operating room schedule at Walter Reed. He sees this as an anxious time; he does not look forward to what he might face when a new generation of wounded begins to arrive.
"There's a sense of tension for me in leaving my business in somebody else's hands. There's also a tension here in what we are going to receive," Bonin said. "It's not in doing the job but from what you're going to see -- the injuries and the emotions of the patients. Because we're going to see a lot of that: pain and anger and just the happiness of being alive."