The wounded Americans were treated preferentially; the Vietnamese casualties were overflown to their (ARVN) hospital in Hue, where survival was circumspect. There was no Vietnamese blood-banking system. As a priority, the American precious lifesaving liquid was given to our boys. A limited supply was available for the ARVN wounded. The outdated blood was sent from our blood bank to the ARVN hospital in Hue.
These disclosures may horrify some. They should, but visualize your son’s desperation as he screamed in unrelenting pain with his life’s blood oozing from his wounds onto the ED concrete floor only to be directed to a drain by the spray of water from a nearby hose.
Dehumanizing the Vietnamese people was part of the war-zone moral code and condoned putting American boys first in line for treatment. Would I be capable of defaulting to the stateside code upon returning home? Many who served are still in limbo wanting to engage their original stateside-default moral code so to be capable of navigating normal society but are unable to completely shed their guilt or even create a boundary around the perceived sin of succumbing to the war-zone moral code.
To those now denouncing me, I must stress that when we did operate on the Vietnamese, we did so with the same intense level of professional commitment rendered to our boys.
We were not without compassion. One evening, a captured North Vietnamese (NVA) enemy soldier was brought to the ED with abdominal pain. I was on call, decided he had appendicitis, and brought him to the OR. Phu Bai Fred was a big man and stood ready to induce general anesthesia. The prisoner was consumed with terror not understanding what was transpiring. Was this white room a torture chamber and Fred in his scrubs the instrument of torture? I comforted the neutralized enemy by cradling his head and held his hand as anesthesia was induced. He did have a hot appendix.
As touched upon previously, the moral compass of a safe society does not translate to a war zone. All who serve in combat are changed forever. One observes and participates in horribly unspeakable occurrences.
In accepting the new definitions of a war-zone moral code, it is intensely imperative that the combatant’s violence be confined within parameters of warfare that avoid atrocities. This ability to restrain emotionally driven responses at times is a very gray area when adrenalin driven during a fire fight and just grasping for survival.
Being unable to save a battered wholesome eighteen-year-old patient despite all your skills in the OR traumatizes one’s soul. Killing a fellow human being tears the soul apart and if not healed, results in a weakened and fragile psyche. The clinical dysfunction was referred to in the sixteenth and seventeenth centuries as Nostalgia, the Civil War as the Soldier’s Heart, Shell Shock in World War I and Battle Fatigue in World War II. Now, all the world recognizes the term post-traumatic stress disorder (PTSD).
I would recommend reading War and the Soul by Ed Tick, PhD. He references the native American Indians’ isolation, away from the tribe, of the returning warriors to allow them to complete the “warrior path before reintegrating into their peaceful tribal society.
There are volumes written about the etiology and treatment of PTSD. I believe if the military were as dedicated in reconditioning a combat survivor with techniques of dealing with healing his soul after witnessing carnage or actually killing as the instructors were dedicated in basic training in conditioning the warrior to kill, instituting a preventive measure of temporary separation prior to discharge for reconditioning would be instrumental in a plummeting incidence of PTSD.
This reverse-warfare conditioning must be accomplished while the soldier is still on active duty and before his unit is dispersed, isolating returning combatants before discharge within their unit structure and defusing traumatic experiences by allowing and encouraging open and honest discussions that are free of a superior’s distain and of possible punishments for perceived moral or military rule infractions. The military must allow them to switch back to the default stateside moral code and be reassured that abiding by the combat moral code in a war zone was a justified and a humanly natural and mentally stabilizing adjustment, which they undoubtedly will experience again on redeployment.
It is ludicrous to expect all returnees to reintegrate into a civil society by the current sink-or-swim mentality of our military. This method is our country’s present approach. There are a few pitiful attempts at counseling prior to discharge, but they are totally ineffectual.
A proactive preventive approach to PTSD will be so much more effective than chasing its symptoms once this life-destroying malady has engulfed our young members of the military.
FINALLY, THE OR
The day after I arrived at the 85th Evac, I was processed and directed to obtain my helmet and flack jacket. As I approached another shanty, this time a pale sickly green, an army sergeant E-6 in a cubby hole opening condescendingly and disapprovingly asked my name, rank, and serial number, i.e., my social security number. There I was in brand-new unwashed OD green fatigues, everything was green, with a face too young to be of major’s rank but being such as a result of the caduceus on my collar point. He asked me my date of rank, and I responded, “August 3, 1970.” He then asked me the date I entered the army, and I repeated, “August 3, 1970.”“No, no, that can’t be,” he repeated over and over as he slammed the opening shut and parted with “come back tomorrow, I can’t take this shit.” So I returned the next day when a more understanding sergeant humorously greeted me with a knowing smile.
The next day, it was down to business. Multiple casualties arrived from the jungle, and the entire hospital base went to work. Any and all personnel who were free of responsibility descended on the ED area to help. My desperately injured patient was a grunt who while patrolling through a small, recently used enemy clearing, spotted a piece of Styrofoam on the jungle floor.
What does a typical eighteen-year-old do but bend over and pick it up? The enemy knew well the psychology of our young soldiers, and predictably, the Styrofoam had been booby-trapped.
His was a major injury in the lower extremities, their arteries, the perineum, genitalia, urinary bladder, and abdominal organs and vessels. I was asked if I could handle it, and Roger told the inquiring surgeon not to worry. My extensive trauma experience at MCV kicked into gear. Since it was my first case, a surgeon who had been in Vietnam a year assisted me, a responsible move. However when, in the OR, it came to prioritizing my patient’s injuries for a timeline of action and the most efficient action to salvage the patient, allowing for perhaps less perfect cosmetic result, my judgments prevailed. Thank you, Dr. David Hume!
This young man’s prolonged surgery required 106 units of blood. He survived the surgery and regained consciousness, but due to the massive tissue damage, prolonged surgery (even with time-saving surgically acceptable shortcuts) and massive transfusion volume, he developed renal, i.e., kidney failure. I accompanied him on a flight to Saigon’s Third Field Hospital for dialysis and was abruptly dismissed by their staff.
“Tree (Dave,) Gus and Roger
I had poured my heart and soul into this boy. I was totally invested in and committed to his survival. I was consumed by him. Then suddenly, I had to turn off the physician and compassion switch and return to the 85th Evac. But that’s medicine. To mentally survive, one has to be efficient in drawing boundaries and move on to the next patient with an unfettered mind. He was my true first patient after residency training. There, one’s actions were monitored, dissected, and altered by a physician more senior in the academic hierarchy. I was now on my own.
A week later, I was notified that he had died.
ACCEPTANCE
After a few more trauma surgeries, the nurses in the Recovery Room/ICU presented me with a love-bead necklace they had made for me to inform the 85th Evac that I was accepted as a competent surgeon. The necklace now resides in