Wendie Skala is a longtime registered nurse and a veteran of America's past decade of war. As a major in the Air Force Reserve and a flight nurse in the 349th Aeromedical Evacuation Squadron, she leaves this month for her fourth "down-range" deployment since 2001.
This time, she'll be assigned to the initial aid stations at forward operating bases in Afghanistan.
"I'll be on the front line," said Skala, 56, trauma prevention coordinator at Kaiser Permanente Medical Center, south Sacramento. "My job will be to prepare for transporting patients."
Skala, with four grandchildren, is part of a force that's older, more experienced and more proportionately female than other service branches: The Reserve is populated by professionals at midlife and mid-career, many of them grandparents like her.
The average age of Air Force Reserve officers is 42, while almost half of active duty members throughout the armed services are 25 or younger, according to Department of Defense statistics.
And the Reserve accounts for 60 percent of aeromedical evacuation efforts, quickly transporting critically wounded service people to higher levels of treatment via on-board intensive care units that take them from the line of fire to the military hospital in Landstuhl, Germany.
While efficient air evacuation has resulted in markedly higher survival rates for casualties, it requires older, more experienced nurses and technicians to handle that level of pace and medical care, said a Reserve spokesman, Lt. Col. Robert Couse-Baker.
They're also more emotionally mature.
Skala simply calls herself a late bloomer: Unlike many reservists, who were once active duty service people, she didn't join the military until she was in her early 40s.
Raised in San Jose, the oldest of six children, she knew from childhood that she wanted to be a nurse. She worked in a convalescent home during high school and then dropped out to marry and have a daughter, Shelby Penman, now 35.
By 20, Skala was back in school, earning her high school diploma and attending junior college before receiving a nursing degree from San Jose State.
She worked in intensive care and open heart surgery, then spent a decade with Stanford Hospital's Life Flight program. There, she learned to thrive on competence and to develop a core of kindness and strength.
"In trauma, you realize your life can be altered in a moment," she said. "You were only driving down the road, and now you're in the hospital with a broken pelvis and spine, and forever your life is changed."
And so her life changed, too. She divorced in 1989 and in the 1990s lived for five years with a partner whose future depended on receiving a liver transplant.
His time ran out in 1999.
"I was at the height of my nursing career," said Skala. "When he died, I stood back and decided I needed to find another direction. I was left with this big void in my life."
The Reserve filled it. She joined as a captain, attending officer training school, an experience she describes as more physically and emotionally draining than childbirth.
Physical requirements vary by age and gender, but she's still so intent on meeting standards that she's at the gym working out by 4:30 every morning.
"I was very proud of her when she joined the Reserve," said Penman, who lives with her family on the same Citrus Heights property as Skala, "and I was very grateful she could start another adventure."
On 9/11, Skala was driving to work, listening to radio reports, and she knew immediately that her Reserve unit would be called up. By early 2002, she was in Afghanistan for four months.
"The first time, I didn't know if I'd ever recover from the things I saw," she said. "The kid who flicked a cigarette butt into what he thought was water but turned out to be gasoline. The kids whose arms and legs were blown off.
"You learn as a seasoned nurse to put your emotions away. But to re-engage, you have to go back and readdress the sadness, so you don't become frozen inside."
Other deployments took her to Germany, to handle air evacuation across the globe, and to Kyrgyzstan.
With air evacuation, planes fly in to the war zone carrying cargo, are retrofitted as flying hospitals and depart carrying casualties. To Skala, the challenge of deployment is less the work than the waiting.
"Air evacuation is a waiting game," she said. "People are on alert status up to 72 hours, and you're waiting all the time. Some people, when stress overwhelms them, they hide out in their rooms. It isn't healthy. As senior nurse, you have to find jobs to keep people busy and engaged."
At home, her daughter waits, too, trying not to dwell on the dangers her mother faces.
"It would eat me up if I did," said Penman. "It's like having a police officer in the family. You can't think about it. One time with Life Flight, she had to scale down a mountain to grab a teenager whose car had gone over the edge.
"I'd make myself sick if I thought about it all the time."
But the truth is, Skala's upcoming deployment on the front lines worries her, too.
"She's been extremely stressed out over it," said Christy Frecceri, Kaiser's south Sacramento trauma program manager. "She's the best person for the job. She has the most training. She didn't expect to be on the front line, and we're looking forward to getting her back safely."
As part of the aging Reserve population, Skala plans to spend another seven years in the service.
"When I get my young troops ready to go, I tell them they need to have support people in place at home," she said. "We have jobs and families and lives we need to transition back into. You need to take the time."