November 21, 2024

By Richard Watson, M.D.

This year I have retired from clinical practice, ending a career that began at Georgetown Medical School sixty years ago. A good friend and colleague recently wondered whether this milestone might serve as an occasion to recommend me for an upcoming Humanitarian Medical Award. My experience in the field of Combat Casualty Care would not typically be counted as a humanitarian enterprise. However, nowhere is there a more impressive instance of humanitarian care than the life-saving support that military doctors, medics and other health care professionals provide to our severely wounded soldiers, sailors, marines and airmen. They serve heroically, often risking their own lives, to provide life-saving care for our critically injured troops, who have given their utmost to protect us and to preserve our freedom.

My introduction to Combat Casualty Care began in 1968 with my internship at Walter Reed Army Medical Center during the massive Tet offensive in the Vietnam war. The combat was gruesome. Loss on the American side included 1,580 U.S. casualties (526 killed, 1,364 wounded.) Although Walter Reed was halfway around the world, we could safely receive wounded soldiers because of our air dominance. Injured soldiers were air-evac’d within less than a week of their injury. Many were seriously wounded and not all of them survived. Walter Reed was the destination for many because the injured were air-transported to the medical center nearest their state-side family and home. We were one of only three such centers east of the Mississippi.

Sometimes a more delayed transfer would arrive with foul-smelling green pus exuding from his leg cast. A bad sign – It was “melioidosis,” a serious infection of Burkholderia pseudomallei (rare, but endemic to Southeast Asia). Other times, small, wiggling white worms – maggots – would be found crawling inside of the cast. A good sign – maggots only ate dead or infected tissue, leaving the wound efficiently debrided!

A life-changing experience for me occurred, late one night, when a planeload of newly-arrived wounded soldiers had been lined up in stretchers along the hallway. As an intern, it was my duty to expedite admission and disposition. One patient, while stable, had a significant cervical spine injury. The option for admission was between the orthopedics and neurosurgery services. Residents from both services arrived and engaged in an exchange, arguing over whose turn it was to admit this patient. In typical, albeit regrettable, resident banter, one resident was telling the other that it was his turn to take “this dump.” The patient was not awake. I alone overheard the comment. Nevertheless, I hope that the soldier’s family (who were on their way from their home in Northern Virginia in order to be at the side of their badly wounded son) would never hear their son referred to as a “dump.”  I thought to myself then, without ever realizing how much it would later affect my life, that I hoped that there might come a day when residents would argue for the privilege of providing best care for this wounded young man, who went on to pay for the rest of his life the grim price of defending our liberty.

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Years later, as a staff urologist at Letterman Army Medical Center in San Francisco, I would periodically volunteer my service as an instructor at the tri-service Combat Casualty Care Course (“C-4”) Task Force in San Antonio. Physicians, dentists and other military health care professionals from all three services and from across the country, were flown there. They would be required to spend a week in the foothills of South Texas, living in small tents (“under canvas”), in squads of 12 students each, in order to simulate the hands-on care that would be expected of them if they were ever called upon to provide front-line medical support in time of combat. My role as a volunteer instructor was to spend the weekend, along with other instructors, providing these C4 students training in the Advanced Trauma Life Support (ATLS) course. They received this instruction at Fort Sam Houston, San Antonio, prior to heading out to the rough terrain of Camp Bullis, several miles to the North.

During one of these sessions, I spent a while chatting with the commander of the operation, who happened to be a fellow urologist, Navy Captain Sam Steele. He said it was time for him to turn over the reins to a new commander. They were right then deciding upon a candidate. I asked him who he thought would do the best job. He surprised me by saying he thought it should be me!  He strongly encouraged me to volunteer.

The idea certainly caught me by surprise, but my thoughts turned back to that wounded soldier on a gurney in Walter Reed. Arriving back home, my wonderful wife Leonie, herself a veteran of the Army Medical Corps, advised me that if I really felt called, she would not want me to spend the rest of my life wondering what I had missed. With her amazing support, we packed up, along with all of our six young kids, and headed for the Lone Star State. She took years away from her practice as a skilled, board-certified family medicine practitioner – one of the first in our nation – in order to provide incredible care, as a model mother for our children and as an amazing wife while I was away, treading the hill country of south Texas in combat boots.

For two years, I was the commander of the C4 Task Force. Every 2 weeks, a new contingent of 120 students arrived. These students were not particularly enthusiastic about being pulled abruptly from their first-class medical centers in the midst of their training. My challenge was to convince them, “You need to be here!”

Addressing the physicians, in particular, I reminded them that, at the core of their profession, is their lifetime commitment to trustworthiness. In combat, there could be no more cogent example of total trust being placed in a physician’s care than that which he or she receives from a soldier, when the physician is treating his wounded foxhole buddy. The bond between fighting men under fire is so great that they would risk their own life to bring back the dead body of their comrade.

I told the physicians, “Understanding this, imagine if you one day find yourself serving at a combat support hospital, when a field ambulance pulls up carrying a wounded soldier and his foxhole buddy. The companion soldier turns to you and says, ‘Please, Doc, I know he doesn’t look like much right now, but he’s my buddy and I promised him I would see that he gets good care. I’ve got to go back to the front now.’ And then that soldier entrusts the care of his companion to you. The trust he places in you is a prize more greatly to be valued than any other. In this light, you are here now at C4 to learn more capably the combat medical skills you will need in that moment. More importantly, not only in combat, but throughout your entire career in medicine, you need to forever practice earning that sacred trust, which is placed in you every day by every patient you treat. You have made a lifetime profession to be, in the tradition of Hippocrates, a wise, compassionate, trustworthy physician.”

After that, I spent the remainder of the week with them at Camp Bullis, in extreme field conditions with the temperature often ranging from boiling heat to frigid cold, convincing them by my presence and by my words, “Yes, you do need to be here!”

At the end of the course, despite all the privations, the students would give us a standing ovation. They were especially impressed by the active-duty Marines who served as a leader for each of the individual squads. While the students found field conditions challenging, the young Marines talked about how easy this duty was for them considering they had real cots to lie on and canvas overhead!

Serving my tour as Commander of the C4 Task Force was a major milestone in my life. Looking back, I am so grateful for that chance moment of inspiration that had so captured my attention, standing by the stretcher of a wounded troop in Walter Reed.

I would strongly encourage all physicians and other health care professionals to please give their serious consideration to volunteering in one of our Armed Forces – whether on active duty or reserve. Beyond that, whether in a civilian or military capacity, always be open to opportunities to serve others selflessly. Yes, please do be open should a chance moment in life ever arise, to take a risk. “To do,” as Mother Teresa would say, “something beautiful for God.”

Dr. Richard Watson is a retired U.S. Army colonel and has received multiple awards and commendation medals for his medical military service. He is a long-time CMA member along with his wife Leonie until her passing last year. He also authored the Linacre Quarterly article entitled Pope Saint John XXIII: Army Medic and Military Hospital Chaplain.

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