Has anyone had good experiences they'd like to share?
As a former LtCol senior anesthesiologist in the USAF who, as you may know, resigned his commission in protest and lost 15 years toward retirement, I did, in fact, have some good experiences while on active duty:
1) I trained in an excellent program at Wilford Hall USAF Medical Center (sic), which has since been shuttered and merged with BAMC. Wilford Hall, the former flagship of USAF medicine for years, is now barely a superclinic.
2) I had the honor of caring for some of the best patients in the world: Tuskegee Airmen; WWI, WWII, Korean War, Vietnam War, Iraq I, and Iraq II vets; and, let us not forget, the hard-working dependent spouses and their kids, who make the entire prospect of serving our country under fire bearable for their deployed loved ones. This made dealing with substandard care committed on these most deserving folks unbearable. When you care, everything bad hurts; when you don't care, it's all good.
3) I saved the life of a 9 year old child against the wishes of our administration. I got a Letter of Reprimand for this.
4) I ensured the safety of the mother of a hospital VIP pre-carotid-endarterectomy. I got a Letter of Reprimand for this.
5) I deployed in support of Operating Enduring Freedom as the only anesthesiologist in Turkey. I worked with extremely competent CRNAs to make the world safe for colonoscopies, EGDs, and knee scopes. I got to enjoy the hospitality and graciousness of the Turkish people while essentially restricted to Adana, as my security clearance never came through, so I couldn't go downrange on any cool missions. I did, however, perfect my Starcraft, Diablo II, and Kohan skills while playing computer games in my luxurious VIP suite in the Hodja Inn.
6) I got almost every single Federal Holiday off, when I wasn't on in-house call for 24 hours doing the jobs of the incompetent (and lazy) interns, residents, RNs, phlebotomists, and techs by drawing blood and starting IVs on patients at all hours of the night. We wrote several policies stating Rules of Engagement for IVs (i.e., some doc had to have tried before calling anesthesia). They were all ignored. I got good at IVs...well, after 10 years as an anesthesiologist, better.
7) I learned medicine at USUHS, the best medical school in the country, in my humble opinion. There is no med school on earth, I am convinced, which combines such solid grounding in the Art and Science of Medicine with the esprit de corps and mission-oriented focus of the military. This made graduation from residency, with its attending (sic) shock at the perverted values of "the Real Air Force" (CYA, optimize personal OPR, screw subordinates & patients), that much more intolerable to anyone who got an "A" in ELSA ("Ethical, Legal, and Social Aspects" of Medicine at USU). P.S. I got an "A".
8) I made the august rank of Lieutenant Colonel (O-5), which entitled me to being blown off by Army E-1s while walking around Walter Reed's campus; to be called "the anesthesia dude" to my face by an Air Force E-3; and to be yelled at by a nurse midwife O-4 when I refused to honor her request for an epidural for "her" patient before consulting with the M.D. resident in charge of the Labor Deck.
9) I personally stood up against CRNA independent practice at Travis AFB in 1999-2000 (the Great MD-CRNA Civil War). I prevented same while there. As a result, I was rewarded with unaccompanied PCS orders to Elmendorf without my two autistic kids and my AD USAF FP wife, who was on the labor deck at 29 weeks in premature labor with my third son. In the end, independent practice was instituted at Travis anyway, to the permanent detriment of a young, active duty troop:
http://www.medicalcorpse.com/MII Travis AFB FINAL 7 Nov 03.ppt
10) I personally saved the lives of several patients who were almost killed by the incompetence of various people (M.D.s, CRNAs, techs, RNs) who were placed into positions way beyond their capabilities by an Air Force system which does not vet for clinical acumen, but rather for shoulder decoration:
- "Oh, the pulse ox is working now (that the patient has an airway), thanks"
- "You mean you want me to call in the pediatrician? The heart can't have any problem, because it isn't enlarged on CXR"
- "The patient has to be in jackknife prone, not sitting up, when doing a hypobaric spinal? Oh."
- "Dr. Jones, analgesia is different from sedation. But...epidural duramorph can cause worsening hypotension when the patient is sitting at 70 systolic? Oh."
- "Come quick, the patient just had a one beat run of V-Tach! Oh, um, it was a PVC. Oh, yeah, I forgot they had a different name for that. Never mind."
- "I didn't know that sufentanil and vecuronium cause bradycardia (leading to bradyasystole in this patient)...But you did...Oh..."
- "Oh, you mean mg/kg/hr is different from mcg/kg/minute? So 6 mcg/kg/minute isn't enough to sedate an active duty O-6 M.D. who is intubated and paralyzed...Oh..."
- "Just because the textbooks say we need cardiopulmonary bypass backup for a symptomatic anterior mediastinal mass doesn't mean we can't TRY to do her surgery here..."
- "Don't worry, Dr. Jones, he lives there" (with 3 mm, downsloping ST depression going on for an hour without my being called, vs. 0.6 mm ST depression at baseline). "No, X, nobody lives there...he's going to DIE there if we don't do something" (didn't succeed in this one...sadly)
- etc. Many more examples in my book: http://www.medicalcorpse.com/fithexcerpt.html
Those were my 10 best memories. Please do not ask me for my worst memories.
Your "Eternal Sunshine of the Spotless Mind" antidote,
--
R
P.S.
11) Teaching MS-Is at USU...a supreme honor
12) Teaching MS-IIIs at Andrews...always rewarding
13) Getting the USU Department of Anesthesiology Outstanding Medical Student Educator award for July 03-June 04 (a period
of extreme stress and depression for me)...inadvertently given to me on my birthday by my Absentee Landlady...extremely rewarding.
14) Signing the paperwork to leave the Air Force after 24 years in uniform (including ROTC and USU)...priceless.
