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AAMC Reporter: September 2007Viewpoint:
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This month, Army Gen. David Petraeus's report to Congress on the impact of President Bush's troop buildup is expected, along with other reports, to affect the future course of our nation's involvement in the Iraq conflict. As the national discourse on Iraq continues, I decided to share my thoughts as someone who recently returned from serving in the Iraq theater as a medical doctor. The thoughts and opinions expressed in this viewpoint are not meant to espouse a particular course of action for the United States' involvement. It is simply my hope that readers may learn from this account of my experiences, just as I did.
Exposure to novel situations and the ability to explore various niches within my field are two of the benefits I find in my career in academic medicine. My work with the University of Texas Health Science Center at Houston allowed me enough flexibility that I could recently take a few months off and explore those benefits as I volunteered for active duty with the United States Air National Guard. Despite 11 years' experience in the guard, this deployment for Operation Iraqi Freedom was my first time in a combat zone. Although the separation from my family was a burden, the deployment was tremendously satisfying on both professional and personal levels.
While in Iraq, I served as the physician member of a Critical Care Air Transport Team (CCATT). Our primary responsibility was to care for critically injured and ill patients during the five-hour flight from Iraq to Landstuhl Regional Medical Center in Germany.
During these flights, I was able to talk with several of our service members. One man I met had been part of a team that entered a house to take custody of some suspected enemy personnel. Things did not go as planned, and a firefight ensued. One shot severed his rifle sling. Another penetrated his left arm, causing him to drop his rifle. He retreated into the depths of the house and under fire, lost contact with the rest of his team. Even though he received several additional gunshot wounds, he was able to draw his handgun and successfully defend himself against several enemy personnel armed with automatic weapons.
Although awake, his injuries were serious. When I met him, he was just hours out of his first surgical operation, and fitted with an external fixator on his left upper extremity. He had several surgical drains that accompanied his new colostomy. Dark purple bruises marred the skin over his liver and heart—undeniable evidence that his body armor saved his life. Despite his condition, he was in good spirits, joking about his injuries, looking around the aircraft, and offering words of encouragement to other injured patients. He asked me how long it would be until we could "fix him up," so he could get back to his unit. He explained that the enemy had killed one of his team members and he wanted to be back in action as quickly as possible to continue his mission and help prevent future American casualties.
I found great satisfaction not only in the excellent men and women like this for whom we cared, but also in the high caliber of the other physicians serving in Iraq. One morning at 3 a.m., while preparing a patient for flight, I had a question about the management of a patient with an open thoracic spinal cord injury. I asked one of the nurses to get the trauma surgeon for me. I expected to discuss the case with him on the phone, but was delighted to see that despite the early hour, he came to the ICU to meet with me personally. In his competent yet unpretentious style, he told me that he had the same question and had consulted the base neurosurgeon just a few hours earlier. Likewise, I always found the staff radiologists happy to discuss their findings at any hour of the day or night.
The professionalism of the guardsmen serving in Iraq was a source of great pride for me. While all of the other CCATT teams in the country were composed of active-duty military personnel, all three of the members of my team were from the Air National Guard. Guardsmen have not always interacted so seamlessly with their active-duty counterparts during wartime. During Operation Desert Shield, after mobilization, rather than filling the combat assignments that they had trained for, highly qualified members of my unit backfilled military hospitals in California and Great Britain. Given the drawdown in the size of the active-duty military over the past decade, the United States cannot afford to operate like that any longer. Members of the reserve component in the combat zone are now indistinguishable from active-duty service members. This is particularly true in the medical fields. Not only are today's guardsmen and reservists just as well qualified as their active-duty counterparts, they tend to be a bit older. On this deployment,my team had decades more experience than the younger active duty crews. My status as a guardsman did not hinder me at all when I found that due to my rank, I was the senior CCATT physician in Iraq.
Our service in Iraq gave us unmatched professional benefits. Throughout my career, I have been interested in disaster medicine. Military airlift is an important resource for civilian disasters. It was critical after Hurricane Katrina, yet few physicians understand its capabilities and limitations. My new firsthand knowledge of the aeromedical evacuation system, from both professional and administrative perspectives, will allow me to contribute more to planning for the medical response to catastrophic disasters in my own community.
I also had tremendous personal benefit from the knowledge that I had truly made a difference. Our military heroes deserve the best care possible. I feel honored and humbled that I had the opportunity to play a small role in the care of our nation's finest who had sacrificed so much to serve and protect our country.
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