FINAL THOUGHTS

While working on several projects about America’s war on terrorism and our wars in Iraq and Afghanistan, I decided I wanted to pay tribute to the medical personnel who care for our nation’s wounded warriors. From the Navy corpsmen and combat medics accompanying our front-line troops and convoys, to everyone at aid stations and the field hospitals, on the dust-off flights and the Nightingale transports from the war zones, and the stateside military hospitals, burn wards, rehab centers, and VA hospitals, I sought to tell their story. Actually I wanted them to tell their own story . . . if I could just get them to sit still long enough to do it!

I quickly learned that many of these Type A personalities don’t know how to slow down long enough to write about patients they can’t forget. Even those who were willing to write something weren’t sure if they could select just one patient from the hundreds, possibly thousands, they have cared for over many years.

For some who wrote stories for The One, they welcomed the task of recalling their patient and the events that unfolded while caring for them.

Robert G. Holcomb, who wrote “Mission to Kosovo and Back,” wrote: “At the completion of the transport flight, we all felt like any marathon runner who experiences the post-race ‘high,’ a compilation of jubilation, relief, and a sense of tremendous pride. For me, reliving that flight today brings back that feeling, like a glorious reward for a job well done. In reality, it defines a passion all who do medical transport flights have, and validates we are truly following God’s chosen path for us.”

Col. Stanley Chartoff, who wrote “Richard”—and generously provided me with invaluable guidance in completing The One —explained the special bond those who work in military trauma medicine share and have a hard time leaving: “My testimonial to the importance of military medicine relates to a talk I heard at a military medical conference. I listened to a young female captain physician who concluded her talk with the story of an Air Force former pararescuer (PJ) missing a leg, who walked into her office, asking her to medically clear him to return to duty in pararescue—one of the Air Force’s most difficult occupations recovering downed aircrew in hostile areas and providing emergency medical treatment.

“She could have told him it was hopeless, but instead she wrote his waiver and pushed it through. That airman was returned to the PJs and is now saving the lives of others. Knowing that young professionals like this Air Force captain are there to continue the tradition of military medicine makes me proud.

I reached out to hundreds in military trauma medicine, in collecting stories for The One. They all expressed interest in the project, though many said they either didn’t feel comfortable with their writing skills, or couldn’t find the time. Here’s an example of just one message I received from a trauma surgeon who has served in both Iraq and Afghanistan: “I have a hundred stories, but I will send you the one that not only sticks in my mind and heart, but the one I can barely speak of without crying. I pray I am able to honor my hero appropriately with mere words.” (Unfortunately, despite several promises to send in her story, this surgeon still didn’t feel comfortable writing about the soldier who ended up being flown to Landstuhl Hospital in Germany, then stateside for follow-up surgeries and rehabilitation.)

Several doctors and nurses wanted to write about their tours in Iraq and Afghanistan, but that would divert from the theme of the book, which is remembering “The One” patient they can’t forget: “I must confess it has taken a whole bunch of patient experiences to add up . . . not just one earth-shattering experience. As a group, the wounded warriors I took care of in Afghanistan remain the greatest inspiration.”

With so many critically injured patients, an endless unbroken chain of carnage, was it easier to deal with if these care providers shut off their emotions?

Connie Bengston (“Learning to Run” and “The Silly String Ambush”) wrote: “I entered each new assignment knowing it would cost, and it would take a toll, but still I did so every time with eagerness, wanting to be of service to those willing to sacrifice everything for our country. These are things we do not talk about as nurses. Our duty is to be care providers, and we are responsible to plan that care, to ensure each patient receives proper care, but it is never appropriate for us to truly ‘care.’ We all know that doing so is going to hurt emotionally. I knew that caring too much was going to break my heart, it was going to leave scars that may never be seen by others, but that was a price I was willing to pay for those who freely went in harm’s way for me and for our country. I plan to continue to write and maybe at some point have something worthy to offer in the form of my own book. It might be painful sometimes, but whatever the outcome, it will be a journey that is necessary to complete.”

One longtime trauma surgeon dispelled the impression that military doctors and nurses are just performing meatball surgery, and don’t have any compassion for their patients, that they simply don’t have time to care. “To me all of these brave troops have stood out in my mind as being something very special, especially those we could not successfully treat. It’s very sad to see the youngest ones, who had a hopefully long life ahead, who had not really experienced living and never got the chance.

“Every night you just weep bitter tears, and pray for those they leave behind . . . parents, siblings, wives, girlfriends, children who will never know their dad or mom.” (It was too emotionally draining for him to write a story for this book and I certainly understand.)

Every combatant who makes it to the aid station or field hospital is someone’s son or daughter. They may be married, and they might have kids. Tragically many of them are mortally wounded, and so then it becomes a priority to keep them on life support and get them home as quickly as possible, so their families can see them one last time:

“Writing about my one patient stirred up a lot of memories,” wrote Trish Hayden, author of “A Knife in the Head” and “The Best Job in the World.” “I thought about the heroes we brought home to receive a higher echelon of care, and also of the ones we kept alive just long enough for the flight, so the families could say goodbye. After every deployment I come home thinking ‘don’t sweat the little things’ because transporting wounded warriors is a reality check. After a while, things get back to normal and I start to let the little things bother me again. Writing this was a nice reality check . . . it reminded me that life is too short and we never know when it will be over.” And a nurse who served in Iraq, wrote: “While deployed, I saw too many soldiers come through our ER. One evening I helped inventory the personal effects of a soldier. He had just returned to the war zone after a short trip home for some well-deserved leave. This particular situation triggered something and I went back to my room after my shift and wrote a letter to him apologizing for not being able to save him. I never wrote down his name due to patient confidentiality, but I think my apology was really for all the soldiers I could not save.”

I found it interesting that this nurse took it personally that she couldn’t save this and many other soldiers, even though an entire team of medical personnel are involved with the treatment of every patient. Still, she carries a heavy heart because she couldn’t do more. As such, when one becomes one too many, compassion fatigue or burnout can take its toll.

Debra Berthold (“A Quiet Conversation”) had a similar experience, and wrote about the young soldier who was killed in the Berlin disco bombing many years ago. Her job was to prep his body for transport to the States and list his possessions: “I don’t think I truly understood what it meant to be a soldier until I had to deal with such a useless act of terrorism which took the life of a vibrant young man . . . who was the age my youngest son is now.

“Being able to write about the disco bombing and this soldier made me appreciate the fact that I have my sons, and there’s a mother who hasn’t had the joy of seeing hers become a husband and a father. I wish I could hug her. Even today, many years later, it still hurts to think about it. God bless our soldiers!”

All of the doctors, nurses, medics, and corpsmen who care for our wounded warriors have spouses and children of their own, so it’s hard not to think about the family members back home, those whose lives are shattered by the loss of their military hero.

“Nobody wants to go to war, least of all the American serviceman,” Dr. Holcomb wrote. “Sure, when commanded to or in the name of preserving our beloved country, we go in a heartbeat. Still, war is not a video game, war does not just involve soldiers, and death is the only certainty with war. For me, I get to see just how war affects the non-combatants, as they are referred to. I’m talking about the innocent children and their families. These are my patients during war. Taking care of kids affected by war carries a much deeper emotional scar. When my team is called in, it’s as if we see our own children in each and every patient we transfer. The boy we moved out of Albania wasn’t but a few years older than my son at the time. He began his day, a week earlier, heading out of the house to play. Unfortunately, the war-torn country of Albania was his playland.

“The memory of ‘The One’ for me will last a lifetime. I just wish I could engrain it into every world leader before they give the order, the declaration of war. War may be necessary, but make sure you know the total cost of war before giving any marching orders. Thank you for bringing our message to the rest of the world, and I look forward to continuing work with you in the future.”

Remembering, at least for military medical personnel, isn’t always a pleasant experience. Many have haunting memories, especially of the ones they couldn’t save.

Lt. Col. Gail Fancher (“Three Special Guys, from the Many at Landstuhl”) wrote: “The staff at Landstuhl sees the wounded at their worst. Many who arrive suffer from multiple injuries—“poly-trauma” so extensive that several teams of surgeons with different specialties— neurological, thoracic, ear and eye, facial reconstruction, and orthopedic, among others—may work on an individual patient, often simultaneously. Bodies are blown apart or crushed by IEDs, grenades, and suicide bombs, but so skillful are the medical teams there, so advanced the techniques and technology, Landstuhl’s survival rate runs as high as 99.5 percent. (The survival rate among American wounded in World War II was 70 percent.) But all that success takes a toll. One of the little discussed but potent side effects of war is what’s called combat and occupational stress reaction or secondary traumatic stress disorder. Compassion fatigue.

“After all the years of fighting in Iraq and Afghanistan, many of the doctors, nurses, and other staff at Landstuhl are exhausted or worse. Given what they’ve seen—the horrific wounds and amputations, the infections, agony, and grief—some walk around ‘like zombies,’ ” one therapist said. Feelings of empathy and kindness yield to loneliness, despair, and burnout. Many of the compassion fatigue symptoms are similar to posttraumatic stress disorder (PTSD)—physical effects like headaches, gastrointestinal problems, reproductive troubles as well as mental—nightmares, flash-backs, anxiety, emotional distance, isolation, and more.

“Working with physically damaged men and women who are so deeply traumatized rubs off. The emotional rawness is contagious. A hospital handout on PTSD understatedly reads, ‘When life-changing events occur, perceptions about the world may change. For example, before soldiers experience combat trauma, they may think the world is safe. Following combat, a soldier’s perceptions may change—a majority of the world may now seem unsafe.’

“That’s why returning vets may reflexively search alongside a US interstate highway for roadside bombs, only shop at Walmart at three in the morning, or worry to excess that their children’s school will be attacked by terrorists. And it’s why after hearing the stories of their patients, reliving the horrors of war, watching them endure pain and sometimes countless operations, medical practitioners can suffer from the same fears— whether it’s the surgeon who heals the wounds, the psychiatrist who probes the mind for the source of anguish, or even the clean-up staff decontaminating and removing the blood from surgical tools. Combine that with homesickness, the high operational tempo of Landstuhl, the low tolerance for mistakes, the downtime when the mind takes over and remembers every awful experience. It’s a dangerous, often unhealthy mix.”

For many of the doctors and nurses I reached out to, even years later, they still haven’t forgotten those who came to them broken and battered, some mortally wounded. Even though they did everything they could, they still feel they should have done more.

“Hardly a week goes by without my mind turning to one or another of the service members that I flew on medevac transport planes,” wrote Susan Fondy (“ ‘Two Someones?’ ”). “Names, faces, situations; they come back unbidden, sometimes during quiet times, other times during conversation; sometimes with sadness, other times with wondering, anger, frustration, or joy. This book is a tiny glimpse into the daily reality of the military medical professional and our service to our heroes, the front-line grunts.”

The author Paul Gallico wrote in 1946, “It is only when you open your veins and bleed onto the page a little that you establish contact with your reader.” For many who wrote stories for The One, the writing process proved to be just as painful, as if they were doing open-heart surgery with a rusty scalpel, as they recalled and related to their unforgettable patient.

“I do certainly have many stories (somewhat buried in the subconscious at this point) that are powerful landmarks of my medical practice,” wrote Anthony Pansoy (“A Proud Father”). I spent a year in a very high intensity combat environment with much time ‘outside the wire.’

“I felt as though my patient’s story had to be told regardless of how angry and sad it would make me feel. I felt as though this might also help readers get a better understanding of compassion fatigue and how health care workers can become overwhelmed seeing traumatic combat injuries on a daily basis.”

Dr. Yang Wang (“ ‘Have You Ever Seen It This High’ ” and “ ‘Cat Alpha—GSW to the Head’ ”) wrote: “I felt it was impossible to sum up everything about my deployment in a single conversation when family or friends asked me, ‘What was it like?’ I needed a way to process through everything in some sort of methodical way, and putting discrete missions into written words was a way to try to sort all the random images and smells and sounds floating in my head into some semblance of a linear narrative. It was a start, but it was helpful, and so I’m writing more. I still get goose bumps when I think back on the things we saw and did, and I sometimes even tear-up with nostalgia for that punch-drunk mixture of exhaustion and excitement we carried stumbling off the plane at 0700, watching the sun rise over the Afghan mountains, after flying back-to-back missions since 1500 the day before and having crossed the entire country three times over. At this point in my life, I can’t imagine anything in the civilian world that’s going to measure up to all the ups and downs, frustrations and triumphs, losses and rewards that were all packed into those five months when I played my little part in the war in Afghanistan.”

“Writing these stories reminded me of how privileged I feel to have been chosen to be a poly-trauma nurse,” recalled Connie Bengston. “It has been a true honor to serve these men and women who sacrificed so much and worked so hard to fight back from debilitating injuries and make the best of what they have left. The easy part of writing these stories was recounting what I observed, what I was witness to, about the men and women to whom I was a nurse.

“The difficult part was going back in my emotions and thoughts to what it felt like for me to experience being a poly-trauma nurse. When I first sat with my laptop to recount that first story about the young Marine critically injured by an IED, I started to type just one word and immediately the tears flowed. I shut the computer off and returned to it later, but the subsequent tries weren’t any easier. It was raw, it was visceral. I’d never before been asked to write something like this and it was foreign, and sometimes hard to comprehend! I had to figure out why it was so difficult. The conclusion I have reached so far is that I have given all I have emotionally and physically, and I’m fully invested in the outcome of those wounded warriors I would be assigned to care for.”

Like many of the soldiers who volunteer for combat deployments, one doctor served multiple tours in several war zones, with barely enough time to get reacquainted with his family before it was time to head “downrange” again. In his emails he has hinted at so many stories, and maybe someday he’ll retire and write his own book, but for now, he can’t slow down, not even long enough to write just one of those unforgettable stories.

But for those who did take the time to write something for this book, an amazing thing happened, something that didn’t necessarily come out in their stories, but which they revealed to me in correspondence afterward. Nearly all of them admitted that writing about the one patient they could never forget was emotionally painful, and yet it was also therapeutic, almost like a cleansing of their conscience, a clearing out of the cobwebs that had been tormenting them for all these years.

“While I often recount my war experiences, using them to train others to do the job I did, writing for The One opened many personal memories I had pushed to the side. Much of what I wrote came from my journal and it gave me the chance to read observations I haven’t seen in years. Even better, I stumbled across an envelope containing all the letters and drawings my children sent that were hung on the wall of my tent. I was reminded how important my family is to me and the bond we have.”

Dr. Stanley Chartoff During several email exchanges, Anthony Pansoy explained compassion fatigue to me. Others I’ve been communicating with mentioned burnout among health care providers, especially those who deal with trauma patients. While the intent of The One was merely to showcase the dedication of military medical personnel, this book also shines a spotlight on compassion fatigue.

For one doctor, he never admitted it to me, but I heard from his wife. Finally, she understood why he had built invisible walls so many years ago, and shut everyone out all this time, including her and their children. After writing his story, he decided maybe it was time to tear down those walls and reconnect with his family.

Again, my intention for The One was to pay tribute to those who care for our nation’s wounded warriors. I should have been able to predict that many of the caregivers were emotionally wounded from dealing with so much trauma, and just maybe they too needed their own TLC: some more than others.

In one of my early deployments as an Army photojournalist, my immediate public affairs supervisor near the Korean DMZ was SFC Sheppard Kelly. Some days I dreaded briefing him on what I was working on or showing him what I’d written, because he never let me cut corners, never accepted anything but my very best. Looking back, more than anyone else, Kelly inspired me to love writing and respect everyone. He drilled into me that everyone is unique. Everyone has a story to tell. Getting them to tell their story is the real challenge.

Each story in this book is unique, and each author not only recalls a patient they could never forget, but they also reveal why. Some revealed more about themselves than they ever realized. Each of them and the thousands more who serve as military care providers work under extremely difficult situations for prolonged periods of time. On a daily basis, they rise “above and beyond” and face unimaginable challenges, both physical and emotional.

Bloomfield, on the Korean DMZ PHOTO BY GALEN GEER

I can’t help but think of a quote by Stephen Grellet (1773–1855), which may explain why these very exceptional individuals—those in military medicine—do what they do: “I expect to pass through this world but once. Any good, therefore, that I can do or any kindness I can show to any fellow creature, let me do it now. Let me not defer or neglect it for I shall not pass this way again.”

One dictum I had learned on the battlefields of France in a far distant war: You cannot save the world, but you might save the man in front of you, if you work fast enough.

—DIANA GABALDON

The views expressed herein are those of the author(s) and do not reflect the official policy of the Department of Defense, or the US Government.