181127-N-QM691-1121 PACIFIC OCEAN (Nov. 27, 2018) Lt. Cmdr. Shannan Rotruck, left, a certified registered nurse anesthetist, discusses the progress of an emergency appendectomy with Lt. Mark Abadilla, a critical care nurse, aboard the San Antonio-class amphibious transport dock ship USS Somerset (LPD 25), Nov. 27, 2018, while underway in the Pacific Ocean. Somerset is part of Littoral Combat Group One, which is deployed in support of the Enduring Promise Initiative to reaffirm U.S. Southern Command's longstanding commitment to the nations of the Western Hemisphere. (U.S. Navy Photo by Mass Communication Specialist 1st Class Andrew Brame)