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Medicine and the military

Yale Medicine Magazine, 2011 - Spring


Life in the armed forces offers some physicians a chance to serve both country and patients.

Scott Hines, M.D. ’99, made quite an impression when he showed up for his admissions interview at the School of Medicine. Proud of his position as a flight test officer in the U.S. Navy, he wore his dress whites, which he considered an expression of his identity. As a veteran of combat missions in Operation Desert Storm, Hines was used to pressure, but the interview put him on the spot in a different way. How, he was asked, could he justify going from a career in which his job was to kill people to a new calling—healing people? Hines didn’t see a conflict. As a military officer, his goal was to provide a strong defense that would deter war. He saw military service as a way to save lives, albeit in a different way from the work of a physician.

The reasons physicians serve in the military or soldiers go into medicine are as varied as the individuals who take these paths. For some, the armed forces offer a way to finance their medical education; for others the choice reflects a desire to serve their country. Still others were obligated in the past to serve as a result of the doctors’ draft, which, from 1950 to 1973, required male physicians and other health care providers to serve in the military. While deployment overseas and separation from their families deter some from entering the military, travel, the experience of leadership, and the thrill of adventure entice others. One common ideal, however, unites those who choose both the military and medicine. As Sarah Goss of the Class of 2013, a West Point graduate and commissioned Army officer who plans to serve in the military after medical school, expressed it: “They both involve service and lifelong learning.”

From TOPGUN to trauma platoon

In 1985 Hines had just graduated from Boston College with a scholarship to attend Ohio State University College of Medicine. Instead he signed up to become a Navy pilot. “The day I walked into Aviation Officer Candidate School I knew that I was going to make a career of the Navy,” he said. “It felt right from day one for me.”

Hines studied at the Navy Fighter Weapons School in Miramar, Calif., popularly known as TOPGUN. He served for three years during the Gulf War, in which he completed almost 40 combat missions. After the birth of his first child Hines realized that his Navy career path would mean multiple deployments and a lot of time away from his growing family. It was time for another change.

Hines applied to the School of Medicine and received a scholarship from the Navy. After medical school he did a transitional internship at the Naval Medical Center Portsmouth in Virginia and then became a flight surgeon—a general medical officer. In 2004 he completed his residency in emergency medicine at Portsmouth in a program that is rigorous yet largely unrecognized. “A lot of folks think the only people who stay in military medicine are the ones who can’t cut it on the outside,” he said. “That is simply not the case.”

Hines believes that his years as a flight surgeon made him a better and more confident resident. He stayed on at Portsmouth as a staff physician in the emergency department. In 2008 he was deployed to a remote airstrip in northern Iraq for eight months and he came home to the realization that his deployment had taken a significant toll on his family; one of his three sons had difficulty adjusting to his return. Hines retired from the military in December 2009. Even after 22 years of active service, he still wonders whether he did enough.

An expert in bullet wounds

Martin Fackler, M.D. ’59, became interested in medicine because his grandfather and uncle were physicians. The doctors’ draft was in effect when he went to medical school; after his internship at the University of Oregon at Portland, he served in the Navy on a transport service that carried troops, their dependents, and government employees all over the Pacific. Fackler was one of two naval doctors aboard the ship.

After a general surgery residency at Chelsea Naval Hospital in Boston and training in plastic surgery at Bethesda Naval Hospital, Fackler was sent to the Naval Support Activity Hospital in Da Nang, Vietnam, in December 1967; one month later, the Tet Offensive began. “You just can’t get that kind of training in trauma surgery anywhere else except in the military in time of war,” he said.

In Da Nang, Fackler stabilized incoming casualties. Most cases were flown out within a day or two, but extensive ones remained at Da Nang until healed. Thus, in Da Nang, Fackler had limited experience treating postoperative complications. His next post, however, was in Yokosuka, Japan, where patients were sent to recover from surgery. He expanded his overseas experience by transferring to the Army and becoming chief of surgery at Landstuhl Regional Medical Center in Germany—the largest military hospital outside the continental United States.

After 20 years in the military, Fackler was thinking of retiring but was invited to set up and direct a lab for the study of gunshot wounds at the Presidio Army base in San Francisco. A competitive shooter since the age of 14—he had been captain of the rifle team at Gettysburg College—Fackler jumped at the job, which also made use of his experience in Da Nang. For 10 years, Fackler devoted all his time to wound ballistics research, thanks to funding provided by the Army’s Medical Research and Development Command.

Fackler is now regarded as one of the world’s foremost ballistics experts, having developed wound profiles for 26 different types of bullets. He retired from the Army in 1991 after 31 years of active duty. Since then he has testified in over 200 trials as a ballistics expert. He now lives in Gainesville, Fla., where he is on the staff of the pathology department of the University of Florida. He still receives calls to testify but rarely travels.

William Heydorn, M.D. ’59, a classmate of Fackler’s, has also done his share of traveling with the Army, with two postings in Germany and one in Korea. Heydorn served under the doctors’ draft after completing his internship at Bassett Hospital in Cooperstown, N.Y. He completed a tour of duty in Germany, then a residency in general surgery, and began a 13-month tour in Korea in 1966, where he was the hospital commander and only fully trained general surgeon at the 44th Surgical Hospital. His first patient was a Korean farmer who had stepped on a land mine. Heydorn returned to Germany as a general surgeon and then trained in cardiothoracic surgery at San Francisco’s Letterman Army Hospital. Heydorn crossed paths with Fackler during his third tour at Letterman, and ended up spending the last 14 years of his career at Letterman as chief of surgery and commanding officer before retiring in 1989 after 30 years of service. Heydorn now surveys hospitals for the Joint Commission International, an organization that accredits hospitals around the world; he has worked in 17 countries during the last four years.

Adrenaline and a sense of accomplishment

It would have been easy for Heydorn to leave military service after 10 or 20 years, but he stayed because he enjoyed both the work and the places he visited. Lionel Nelson, M.D. ’69, on the other hand, initially thought a career in the military wasn’t for him. When he received his draft notice in 1971, during his first year of surgical residency at Stanford, he joined his local Air Force Reserve unit. He expected to be mobilized, but the Vietnam War was winding down. He didn’t much care for his military stint and spent the next few years building his otolaryngology practice and doing head and neck trauma surgery in San Jose, Calif. In 1984, the year he turned 40, he found himself looking for excitement. He found it one night at the bedside of a swat police officer he’d treated for a gunshot wound. The officer suggested that Nelson join the local Army Reserve Special Operations Civil Affairs Unit. From that time on, he was hooked. He trained to become a flight surgeon and over the next 18 years he left his practice several times a year for short missions as the physician and flight surgeon on small teams involved in civil-military operations, mostly in Southeast Asia. Nelson was expected to take care of the medical needs of the pilots and crew, which included inner ear, sinus, or vision problems that could adversely affect a mission, as well as any other medical issues that cropped up. He also addressed medical needs of the local population.

Nelson retired from the Army Reserve in 2002, but in 2008, in response to a growing need for flight surgeons, he volunteered for a tour of duty in Iraq. Three months before his 65th birthday, he became the brigade flight surgeon with Task Force 449 at Camp Striker in Baghdad. Embedded with the troops and far from the comforts of a support network, he found that his work differed from what he was used to in his otolaryngology practice; here he served as GP, flight surgeon, surgeon, podiatrist, and sometimes dentist. “There was no telling what challenge was about to come through your tent flap next,” he said of his three-month tour. “Life could change in a moment from mundane to high drama. It forced you to pull up medical knowledge from those deep brain recesses that you don’t remember learning, but must have at some time as a medical student or house staff.” He described the experience as “an unforgettable adrenaline high accompanied by a great sense of accomplishment.”

As the senior medical officer Nelson had a lot of experience, but he also took flak for his age; some of the younger soldiers, he heard, were making bets on how soon he would fall and break his hip. Little did they know that at home Nelson rises at 4:30 a.m. for a 70-minute workout before surgery. As it turned out, the soldiers who once laughed at him came to confide in him, viewing him as a father—or perhaps grandfather—figure. “Some of my most interesting experiences in Iraq were just sitting and talking,” he said. “The soldiers were young; for most of them it was the first time they had been away from home, they were in a hostile environment, and they were on edge from mortar attacks. You can call it psychiatry, but it was basically friendship.”

“Nothing like it in civilian life”

The idea of being a physician in the military often conjures visions of what Nelson experienced in Iraq: an austere environment, lots of noise, and tedium punctuated by mayhem. In reality, however, the military offers a variety of experiences. William M. Narva, M.D. ’56, spent most of his 35-year Navy career in the Washington, D.C., area. During medical school in 1952, the draft was still in effect but student deferments were not. Narva wrote to the Army, Navy, and Air Force, seeking a commission in the reserves. Within a week the Navy responded, and he enlisted as an ensign in the medical corps. “It’s 60 years later and I still haven’t heard from the Army and the Air Force,” he quipped.

Narva accepted the dermatology training offered by the Navy, completing an internship at Bethesda and his residency at a naval hospital in San Diego. After a five-year tour at a naval hospital in Oakland he was named chief of dermatology at the National Naval Medical Center in Bethesda, Md. Within a week, Narva found himself in the bedroom of President Lyndon B. Johnson. Narva treated every president up to George H.W. Bush.

Narva continued his ascent with posts that included staff medical officer for the chief of naval operations, director of the Naval Reserve Division at the Bureau of Medicine and Surgery, and vice president of the Uniformed Services University of the Health Sciences (USU). Five years after being promoted to rear admiral in 1982, he was appointed attending physician to the U.S. Congress, which included members of the Supreme Court. He never expected to spend his entire career in the Navy but every time he thought of retiring, a new opportunity would arise. “In our practice, we were getting referrals from all over the world,” he said. “Bethesda was a diagnostic center and there wasn’t a day that went by that I didn’t see something I had never seen before.”

Except for a year in Vietnam in the mid-1960s, Robert Joy, M.D. ’54, M.A., spent most of his 26-year Army career doing research stateside. Joy began his military career in the ROTC during medical school. He took an Army internship at Walter Reed Army Medical Center in Washington, D.C., not only because it offered excellent training, but also because he had a wife and baby—a standard internship paid $50 a month, while the Army paid about $250. Joy was founding commander of the Army Research Institute of Environmental Medicine in Natick, Mass., and held senior staff positions in medical research in the Office of the Army Surgeon General and the Office of the Secretary of Defense. In 1976, he became the first Commandant of USU in Bethesda, where he founded the Department of Medical History in 1981. He has been professor emeritus at USU since 1996.

At 81, Joy still goes into the office one day a week. Looking back over his long career, what he enjoyed the most was tutoring, advising, and encouraging young men and women. Beyond that, Joy relished being in command. “There’s nothing like it in civilian life,” he said. In some aspects, however, the Army is not unlike other careers: “It’s a system that’s workable if you know how to work it,” he said. “If you are respected for your work, are liked as a person, and are willing to be flexible, you can pretty much get what you want.”

Not for everyone

For some alumni, military service was a way to finance their education and serve their country, but from the beginning they viewed it as a short-term commitment along the way to other career plans. John Lundell, M.D. ’94, received an Air Force scholarship to attend the School of Medicine and owed five years of active duty after his residency ended in 1999. Two years later, the world changed abruptly; and both he and his wife, Andrea L. Lundell, M.D. ’94, who was also in the Air Force, faced the possibility of simultaneous deployments. They had to arrange for relatives to care for their two young children in the event that happened. Andrea remained stateside, but John went to Iraq in 2003 as part of a mobile field surgical team. The next year he finished his commitment. Although he enjoyed his military service, he wanted an academic position and took a faculty spot at the University of California, San Diego, later moving to Baylor University in Dallas, where he has a private practice. “I got a lot of great experience at a young age and it gave me a lot of confidence,” Lundell said.

Monika Dalrymple, M.D. ’96, financed her Yale undergraduate and medical education by joining the Air Force ROTC. She owed eight years after graduating, but it turned into 12 when the Air Force required her to do a military (rather than civilian) residency in diagnostic radiology at Wilford Hall Medical Center at Lackland Air Force Base in San Antonio.

Neither Monika nor her husband, Neal Dalrymple, M.D., who also served in the Air Force, was ever called overseas. Neal finished his commitment just before 9/11, and Monika has a medical condition that exempts her from serving in a desert environment. But she worried that the Air Force would change the rules. She also found it difficult to manage child care for her young daughter because she had to be available 24/7 but never knew when she would get a call. “The military never really fit me personally,” she said.

At West Point, an interest in medicine

Goss, currently a medical student, had no interest in the military until her family toured the Naval Academy in Annapolis, Md., during a vacation. After a pre-college summer program there, she entered West Point. During military training in the summer between her freshman and sophomore years, she got a blister that developed a MRSA infection. While she was in the hospital, the idea of being a military officer and a physician took hold. The summer between her junior and senior years she spent a month at Brooke Army Medical Center in San Antonio, where she worked with wounded vets returning from Iraq and Afghanistan, including many amputees. “That experience sealed the deal for me,” she said. “Even the ability to pick up a fork or open a door had such an incredible effect on their spirit.” Back at West Point, she devoted her senior project to designing and building a “bionic” foot with a group of fellow cadets. The group incorporated a motor within the foot that engages when the patient steps down, creating propulsion to mimic a human gait. In May 2009, Sgt. 1st Class Patrick King, who lost his foot in Iraq, was the first to try the device, which will eventually be tested on other military amputees.

After medical school, Goss plans on doing her residency at a military hospital, after which she’ll owe 10 years of active service and six years of reserve service. She is leaning toward emergency medicine or orthopaedics, and is open to spending her entire career in the military. Like all physicians who enlist in the armed services in today’s post-9/11 world, Goss has no choice but to reconcile herself to being deployed overseas, which she knew was a definite possibility when she enrolled at West Point.

Goss may find it difficult to imagine what awaits her. But Lionel Nelson is very clear regarding what he liked about serving in the military: “Besides the chance to see wondrous places far off the tourist trail and the chance to give back to the country,” he said, “it was almost always a great adventure, a significant sense of accomplishment, and rarely routine or dull.” YM

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