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244913
I was recently discharged from active duty, after four years as an operational flight surgeon and two combat deployments. I have fond memories of reading the posts of some of the elders on this forum as they exited the military for good and moved on. I recall being envious of them, and dreaming of the day when I too could post a missive on SDN making that simple proclamation, that declaration of freedom signifying the end of one life and the beginning of another. So here goes.
I don't want to dwell too much on the negatives. Military life is full of vicissitudes. You learn after a while to take the good with the bad, roll with the punches, and do the best you can for the men depending on you. Because the guys on the line really do depend on you. My greatest joys as a flight surgeon came from serving them.
I think the military relies too much on GMO's, but I understand the need for operational physicians given the burden of the Wars these past ten years. It is not an ideal system, either for the military or the GMO physician, but I think the problem is unsolvable at this current juncture. I think military GME suffers from a lack of experienced clinicians. A lot of the good Docs get out at 8, 10, or 14 years. What you have left is young hard chargers just out of residency and basically non-practicing administrative types, many of whom got out of the doctoring business long ago. I don't believe this system is conducive to good resident training. Also, because the .Mil is a small, closed community, the likelihood is high that at some point you will end up with one of these non-practicing physicians as your boss. They can make life difficult, to be sure.
Many residents who complete their training, and are at the top of their game clinically (with energy to burn) find themselves posted to backwater community hospitals with few resources where most of the pathology has been farmed out to the civilian sector. So skill atrophy is a big issue, especially for surgeons and specialists. I think TRICARE has been an unmitigated disaster for military GME. It has caused an exodus from military healthcare of the old and sick patients that residents and staff physicians need to keep evolving as clinicians.
The red tape and bureaucracy is tedious, but there is bureaucracy in medicine wherever you go nowadays. The military has a tremendous proportion of annoying administrative types, mostly nurses, who use their rank inappropriately and waste time on inane initiatives that have little to do with providing good and efficient patient care.
In any case, these complaints are commonly known and have been stated much more eloquently by others on this forum.
What did I get out of military service? Well, it helped me to get an excellent civilian residency for which I otherwise might not have been fully qualified. Program directors were almost universally receptive and viewed GMO service as a big plus.
I learned how to be flexible, how to navigate in a bureaucracy and jump through hoops to take care of my men. I learned to put the needs of my squadron above my own. I learned which battles were worth fighting, and what was better left alone.
What I really learned was the value of comradeship. It is not a term I use lightly, and like many of the very best things in life, it came with a tremendous price and required extraordinary sacrifice.
I fought in Afghanistan during the worst of the surge, in Kandahar and Helmand provinces. I flew hundreds of combat missions, mostly air assaults and point of injury MEDEVAC flights in an often futile effort to stave off the destruction wrought by the sophisticated weapons systems employed by our enemies. On my second deployment I was at a small FOB on the Pakistan border.
Some things stick with me:
- the look of determination in the eyes of the aircrew and pilots as we donned our gear to fly a night air assault into a fortified area.
- treating a young soldier with a tension pneumothorax as we evacuated him out of a hot and dusty LZ, flying single ship with no escort coverage. I remember how happy I was to hear that he'd survived after making it to the CSH, and was on his way to Landstuhl and back home.
- how helpless and empty I felt when we'd make it to the CSH, too late, and salute as the fallen were taken off the aircraft and spirited away.
- how one of my flight medics, after a mission in Helmand province, broke down in tears on the LZ at the FST. I can recall looking at him, not knowing what to say, or really what could be said.
- having dinner the night before mid tour leave with an old friend, talking with him about his plans for the future, his girlfriend and his motorcycles. And then coming back three weeks later to find out that he'd been killed on a mission up north. He never did get the chance to propose to his girlfriend.
- nights spent half dozing in the back of a Chinook, waiting for the call to exfiltrate the rangers and special forces guys we'd dropped off several hours before.
There is no better feeling in the world than sharing a cigarette with a crewchief on a moonlit night off the back ramp of a CH 47, enveloped in the warm rotor wash.
I remember how much I enjoyed the flurry of choreographed activity in the back of the helo as we prepared for a mission. Every one one of us in perfect harmony, united with a common goal, and the occasional lewd and bawdy insults passed over the ICS, which at the time seemed the height of wit.
I grew extremely close to my aircrew, by necessity, because we depended on each other. We shared common dangers, and fears, we experienced the same exultation, boredom and despondency familiar to any deployed soldier.
These were men whom I probably never would have met in civil life. They came from much a different background than I did, indeed we had almost nothing in common besides our commitment to each other, a miracle of silent fraternity.
They saved my life on several occasions and I felt very badly leaving them. They were comrades in the truest sense of the word. The rest of my life will always be dedicated to them in an abstract sense.
I'm looking at a long road ahead. Most of my contemporaries have finished their residencies, gotten married, are making big money and driving expensive cars. I am just beginning that part of the journey after my four year detour. Yet I wouldn't trade places with them for anything.
I was lucky enough to experience true comradeship, a feeling so strong that I can hardly credit it's existence, sitting in my comfortable apartment now, with a beer in hand, typing out this screed.
I fear that the rest of my relationships in both residency and beyond will always be found wanting when viewed through the prism of the crucible we experienced together. But I am thankful, grateful to have lived the life I did.
In concluding, I wish everyone here the best. I hope that my words give some encouragement to future GMO's as they prepare to go out to the line. The life you will live there is not always easy, but if you do things right you will be given gifts that you never realized existed, gifts that you can carry with you for the rest of your life as both a physician and a person. Just be open to the possibilities, because before you know it, your tours will be over and you'll be heading back to more comfortable, familiar pastures.
This was supposed to be a celebratory post and I fear that it has turned into a requiem. So I'll sign off.
- ex 61N
I don't want to dwell too much on the negatives. Military life is full of vicissitudes. You learn after a while to take the good with the bad, roll with the punches, and do the best you can for the men depending on you. Because the guys on the line really do depend on you. My greatest joys as a flight surgeon came from serving them.
I think the military relies too much on GMO's, but I understand the need for operational physicians given the burden of the Wars these past ten years. It is not an ideal system, either for the military or the GMO physician, but I think the problem is unsolvable at this current juncture. I think military GME suffers from a lack of experienced clinicians. A lot of the good Docs get out at 8, 10, or 14 years. What you have left is young hard chargers just out of residency and basically non-practicing administrative types, many of whom got out of the doctoring business long ago. I don't believe this system is conducive to good resident training. Also, because the .Mil is a small, closed community, the likelihood is high that at some point you will end up with one of these non-practicing physicians as your boss. They can make life difficult, to be sure.
Many residents who complete their training, and are at the top of their game clinically (with energy to burn) find themselves posted to backwater community hospitals with few resources where most of the pathology has been farmed out to the civilian sector. So skill atrophy is a big issue, especially for surgeons and specialists. I think TRICARE has been an unmitigated disaster for military GME. It has caused an exodus from military healthcare of the old and sick patients that residents and staff physicians need to keep evolving as clinicians.
The red tape and bureaucracy is tedious, but there is bureaucracy in medicine wherever you go nowadays. The military has a tremendous proportion of annoying administrative types, mostly nurses, who use their rank inappropriately and waste time on inane initiatives that have little to do with providing good and efficient patient care.
In any case, these complaints are commonly known and have been stated much more eloquently by others on this forum.
What did I get out of military service? Well, it helped me to get an excellent civilian residency for which I otherwise might not have been fully qualified. Program directors were almost universally receptive and viewed GMO service as a big plus.
I learned how to be flexible, how to navigate in a bureaucracy and jump through hoops to take care of my men. I learned to put the needs of my squadron above my own. I learned which battles were worth fighting, and what was better left alone.
What I really learned was the value of comradeship. It is not a term I use lightly, and like many of the very best things in life, it came with a tremendous price and required extraordinary sacrifice.
I fought in Afghanistan during the worst of the surge, in Kandahar and Helmand provinces. I flew hundreds of combat missions, mostly air assaults and point of injury MEDEVAC flights in an often futile effort to stave off the destruction wrought by the sophisticated weapons systems employed by our enemies. On my second deployment I was at a small FOB on the Pakistan border.
Some things stick with me:
- the look of determination in the eyes of the aircrew and pilots as we donned our gear to fly a night air assault into a fortified area.
- treating a young soldier with a tension pneumothorax as we evacuated him out of a hot and dusty LZ, flying single ship with no escort coverage. I remember how happy I was to hear that he'd survived after making it to the CSH, and was on his way to Landstuhl and back home.
- how helpless and empty I felt when we'd make it to the CSH, too late, and salute as the fallen were taken off the aircraft and spirited away.
- how one of my flight medics, after a mission in Helmand province, broke down in tears on the LZ at the FST. I can recall looking at him, not knowing what to say, or really what could be said.
- having dinner the night before mid tour leave with an old friend, talking with him about his plans for the future, his girlfriend and his motorcycles. And then coming back three weeks later to find out that he'd been killed on a mission up north. He never did get the chance to propose to his girlfriend.
- nights spent half dozing in the back of a Chinook, waiting for the call to exfiltrate the rangers and special forces guys we'd dropped off several hours before.
There is no better feeling in the world than sharing a cigarette with a crewchief on a moonlit night off the back ramp of a CH 47, enveloped in the warm rotor wash.
I remember how much I enjoyed the flurry of choreographed activity in the back of the helo as we prepared for a mission. Every one one of us in perfect harmony, united with a common goal, and the occasional lewd and bawdy insults passed over the ICS, which at the time seemed the height of wit.
I grew extremely close to my aircrew, by necessity, because we depended on each other. We shared common dangers, and fears, we experienced the same exultation, boredom and despondency familiar to any deployed soldier.
These were men whom I probably never would have met in civil life. They came from much a different background than I did, indeed we had almost nothing in common besides our commitment to each other, a miracle of silent fraternity.
They saved my life on several occasions and I felt very badly leaving them. They were comrades in the truest sense of the word. The rest of my life will always be dedicated to them in an abstract sense.
I'm looking at a long road ahead. Most of my contemporaries have finished their residencies, gotten married, are making big money and driving expensive cars. I am just beginning that part of the journey after my four year detour. Yet I wouldn't trade places with them for anything.
I was lucky enough to experience true comradeship, a feeling so strong that I can hardly credit it's existence, sitting in my comfortable apartment now, with a beer in hand, typing out this screed.
I fear that the rest of my relationships in both residency and beyond will always be found wanting when viewed through the prism of the crucible we experienced together. But I am thankful, grateful to have lived the life I did.
In concluding, I wish everyone here the best. I hope that my words give some encouragement to future GMO's as they prepare to go out to the line. The life you will live there is not always easy, but if you do things right you will be given gifts that you never realized existed, gifts that you can carry with you for the rest of your life as both a physician and a person. Just be open to the possibilities, because before you know it, your tours will be over and you'll be heading back to more comfortable, familiar pastures.
This was supposed to be a celebratory post and I fear that it has turned into a requiem. So I'll sign off.
- ex 61N
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