PHYSICIANS ON THE FRONT LINE
(continued from page 15)
in Harstad, a town 200 miles north of the Arctic Circle, on a foggy,
cold, drizzling night in September 1988. Around the table were
medical officers of the Royal Navy, the US Navy, the Norwegian
Brigade Nord and the West German Army. During the consumption
of varying amounts of Mack, a strong northern Norwegian beer,
an attempt was made to translate a word for the West German of-
ficer. “Clusterf**k” was a term we frequently used to describe the
training of the US military. After a rousing discussion, the closest
German translation was “group sex” (not an exact description of
our preparedness drills).
In the early 1990’s, I was assigned as Director of Surgical Services
at a Headquarters Training Command located at Naval Air Station in
Millington, Tenn. This was the command structure for an 800 bed,
full-service tent hospital which, in the event of a conflict, could be
set up outside the combat zone, in a neighboring country. The Naval
Reserve personnel to run the hospital were in detachments scattered
around the southeastern US. This was a supervisory, training and
administrative position. The goal was to provide an adequate number
of trained reservists to meet the surgical needs of this hospital in the
event of deployment. Annual active duty training involved bringing
the roughly 1000 reservists attached to this command to the desert
on the Marine Base Camp Pendelton, Calif. In a barren section of
desert, the tent hospital was literally taken out of containers and set
up in anticipation of a casualty role play scenario provided by the
Marines. Had the 100-hour Operation Desert Storm lasted longer,
our group would have been deployed next.
In the mid years of the 1990’s, I was attached to the National
Naval Medical Center, Bethesda, Md. and then to the Naval Medical
Center in San Diego, Calif. until retirement in August 1998. These
were the two main general surgical resident training programs for the
Navy that allowed maximum flexibility and basically functioned as
intermittent visiting professorships. With talks ranging from breast
cancer to thyroid/parathyroid surgery, to skin cancer, I would spend
one to two-week intervals teaching residents, staffing clinics and
OR cases for the Navy and interacting with students and residents
from the Uniformed Services University of the Health Sciences
while at Bethesda.
In addition, I had the opportunity to take a number of annual
active duty tours at the US Naval Hospital in Naples, Italy. This fa-
cility was located in a Naples suburb up the street from the 6 th Fleet
Command Headquarters and a short distance from a NATO base.
It provided medical support to all naval personnel and dependents
attached to the 6th Fleet, operating primarily in the Mediterranean.
Weapons training was a requirement of all active duty and reserve
medical personnel. This involved familiarity with semi-automatic
hand guns, .45 and 9mm., and the M16. In my younger years, with
clear, sharp eyes, I managed to obtain marksmanship ribbons with
all three weapons. When I acquired bifocals, I could still aim and
hit targets that were yards away. However, to hit a downrange target,
I had to line up the sights using the lower part of my glasses, while
seeing the downrange target with the upper, distant vision half.
16
LOUISVILLE MEDICINE
These adjustments seriously reduced my accuracy and helped me
understand why there are no snipers wearing bifocals.
In the late 1980’s, I brought a medical unit to Fort Knox for
weapons qualification. The Army had an outdoor range with pop-
up targets, instead of static ones, which made this training more
interesting. The senior Staff Sergeant had me sign papers relieving
the Army of any responsibility if any of the naval reservists managed
to shoot themselves or each other. He also wondered out loud if
the nurses and doctors would be required to defend the ship and
pointed out that it’s harder to find a target if you are simultaneously
being shot at.
Evaluating the influence of military experience on a long pro-
fessional career is a challenge of introspective analysis. For me, this
came down to leadership, accountability and adversity. As division
officer during active duty, I had to manage the enlisted personnel
in the unit and deal with issues with morale, conflict, work perfor-
mance and behavior. As a recent medical student, I had no developed
skills for this, and it was a steep learning curve. I found that the
optimal basis for these interactions was mutual respect, even in the
hierarchy of the military.
In my final year at the University of Maryland Hospital in Bal-
timore, I was asked to serve as the chief administrative resident in
surgery. This meant making the schedule with resident rotations
and vacations. An incoming resident insisted that his schedule be
changed to accommodate his dog. I refused; the resident did not
enter the program and I had to inform the chairman. Luckily, he
agreed that this was not a promising initial contact, more likely a
harbinger of future management issues with this person.
In the early years of practice in Louisville, while serving on a
downtown hospital surgical oversight committee, we were made
aware of worrisome practices by a senior surgeon. After spirited
discussion, three of us were assigned to investigate, culminating in
loss of privileges and retirement of the surgeon. A few years later,
as chief of surgery, I had to confront a prominent surgeon who
threw a blood-soaked lap sponge on one of the OR personnel. The
surgeon was promptly suspended and afterwards had much better
behavior. I credited my Naval service in part for a willingness to
confront adversity of this inappropriate activity, and to address the
need for accountability. These principles served me well during
many decades with the Louisville Surgical Society and multiple
leadership positions at Norton Hospital, the University of Louisville
Department of Surgery, the Brown Cancer Center and the Society
of Head and Neck Surgery.
Finally, military service, with its ritual, rules and hierarchy is
not for everyone. I was comfortable in that structured environment.
The ability to comfortably function in the structured environments
of hospital, university and medical society committees, engage in
dialogue, not be intimidated by bombast and the sense of privilege,
in my opinion, was the consequence of my experience as a Naval
Officer on active duty.
Dr. Flynn is a retired Captain, MC, USN. He practiced Surgical Oncology.