Hippocrates In San Diego

Veteran’s Day Blues

I spent the better part of an hour watching “Combat Hospital” on CNN. I could barely choke my pizza down past the lump in my throat. This was hard for me: although I had seen similarly gruesome visual images in medical school, the context of the images on the screen made them intensely powerful. Every one of the patients brought into the Combat Support Hospital (CASH) was under the age of 25, with the exception of a sergeant who collapsed from emotion after transporting two of his wounded troops to the hospital. American soldiers and Marines as well as Iraqi civilians of all ages were treated by the doctors and nurses. It seemed like an incredible waste of youth. To be 18 or 19 years old, given a powerful weapon (and often becoming a powerful weapon), to be taught unending discipline, all for the end result of a mangled limb or shattered psyche — this was the opposite of everything that I had been taught or trained to do in medicine. We are taught not to think of disease as the enemy, because that dehumanizes our patient, turns them into a battlefield rather than a person. “The War on Cancer” or “Assault on Diabetes” sounds antithetical to what I’m trying to do — improve the quality, and frequently the quantity, of life. Where in these soldiers’ field training manual is the quality of their life mentioned? Is it only addressed after a lucky, but incomplete, survivor leaves the CASH?

I’ve never been a patriotic person — I’ve been taught a healthy dose of cynicism about politicians and authority figures by my parents, who learned from their own experiences growing up in Iran under the Shah’s harsh regime. Parallel to my cynicism however has been a respect for people who feel strongly about a cause, including those who feel strongly enough about their country that they join the military with the understanding that their life may be in danger at some point during their service. I can’t say that I could ever make the same choice.

After reflecting on the program, I thought of three of my medical school classmates, members of the military who joined to serve their country, and to help pay their tuition. They all started their residencies in 2003, like I did, the same year that our military invaded Iraq. All three probably were or are now serving in some capacity outside of the United States, in a CASH or other destination hospital where stabilized CASH patients are transported, in Germany or Saudi Arabia. How do you reconcile one set of training instructions with the other? At some level military doctors are doctors — one trauma doctor in the CNN documentary stated as much. “We take care of patients,” he said, regardless of national affiliation, or status as a civilian, insurgent, or “terrorist.” They approach each patient with their medical skills at the fore, thinking about blood pressure, hemorrhage, and intravenous access rather than political designation. But they also are soldiers — taught to assume the worst, as if their life depended on it. Some might say this leads to partiality, bias, and prejudgement. “[A]s much as we hate to admit it, if it’s an American soldier in there, as opposed to anybody else, our stress level goes up.”

Image courtesy ViewImages.com.