Pre-Deployment Training

Since Sunday evening I've been at Army Medical Headquarters at Fort Sam Houston in San Antonio, Texas attending a five day course called Tactical Combat Medical Care. There are about thirty of us and and we're all headed for Afghanistan or Iraq. About half of us are physicians and the rest are mostly Physician Assistants.

The course is taught by senior army medics who have each had several deployments and have personally handled everything they're teaching. Most of them have gone back to school and are now Physicians Assistants. I've also met former enlisted soldiers with combat experience who have gone back to school and are now physicians.
 
There is still a GI Bill and there are generous educational benefits offered to soldiers, even while they're in the military. Of course the soldier must commit to school and get acceptable grades which unfortunately is often a huge obstacle. We see our soldiers go through extreme training and then they must endure the enormous hardships and danger of going out on patrol in extreme weather conditions. They carry huge packs and they face suicide bombers and a very vicious enemy and then sign up for another deployment. This they are able to do but so many soldiers who are so bright say they are terrified at the thought of going to school even when offered generous scholarships. I can't help comparing them to other young adults who would never go anywhere near the military which they would find terrifying but are so comfortable and happy in a university atmosphere.

Anyway, all medical providers "going down range" are taught to be combat lifesavers. This means how to handle the seriously wounded soldier, during a battle, who is going to die from their wounds unless they get emergency medical care using only the supplies that can be carried on a backpack. Once they've been stabilized they are still not out of danger. They still have to be moved forward to a higher level treatment faility or moved by helicopter to a facility that can perform surgery.

This doesn't mean that we are going to be sent onto the battlefield to gather up the wounded because that's not my job. However, as an educational foundation they want to train us as first responders because that is what the medics in the army do and being a first responder is the ethos of army medicine. So, I have to learn what to do when you come upon a soldier seconds or minutes after loosing limbs from an explosion or unable to breath because of a gun shot wound. If you give them the correct treatment and manage to get them transported rapidly to a facility that can do surgery you can save their life. Otherwise they will die from shock and blood loss where they have fallen.

The days have been very interesting and intense. . After each class I have to eat rapidly and go to my room and study every night, tomorrow is the final and graduation.

We'll see what next week brings.

Major Martin

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Separation From My Family & Absence From My Practice

I have never been away from my family for more than a week. My wife and I do not take separate vacations and we are not having marital problems. In addition to the very long hours I work, Joan also works more than full-time and we are a very busy household. I don't manage as many domestic things as Joan does and although I'm not indispensable there are several things that I'm responsible for that Joan is going to have a hard time keeping up with when I leave.

I feel that I'm close to my three children, two of whom are young adults and I try to always be there for my youngest child, Julia who is 16 years old and I love her dearly. I do work very long hours and when I do take time off, being with my children, especially Julia, is always my number one priority.
 
Yes I do like to travel and I'm not an especially anxious person but deploying to Iraq is completely out of the ball park compared to anything else I've ever done. It is also totally out of character for me as a husband and a father. I also have a mother who is 92 and several of my relatives and my in-laws are elderly.

I'm a Family Practitioner in solo practice and I had to create a coverage system for the next 120 days. Army pay doesn't even come close to what I presently earn andf the overhead expenses for my office continue whether I'm in the office or in Iraq and I could go on and on with reasons not to do this.

I will miss my family enormously and my absence from them has already started and it is profound. Even without a National Guard commitment my typical day is anything but routine and generally every day seems to have more than one major crisis. My practice is busier than ever and I can't thank my office staff enough for the amount of work this is putting them through. I will also never forget the Physicians & Nurse Practitioner that have stepped forward and will be coming to my office to see my patients as well as the Administrators from other practices that have helped me recruit my coverage. I'm also thankful to the many physicians who have offered to help in the future if I need more coverage. I'm actually now forming a Medical Coverage Reserve Force and I'll try to orient these providers now. They'll be kept on a reserve status for now but I think the chances are high that they will be called up to serve in my office before this is over.

The patients seem confident and many of them are actually quite proud to be inconvenienced by their doctor being sent to Iraq. After all their country is involved in two wars and they want to do their part.

There is no simple answer that explains my motivations and my reasons for enlisting and thereby subjecting my family, my patients and myself to so many hardships. The amount of planning that I've had to put into this has been quite enormous.

On the other hand there is a very simple explanation for my decision which should be obvious to anyone who has read this entry or any of my previous entries.

Why have you wished me well and told Joan that you hope to keep in touch with her and help her out? You and I have many different interests that we don't even bother to share but essentially everybody I know seems to want to know more about my deployment. The extent of your interest has taken me by surprise and I now see that people are asking for more and more information and the answer is not simply because you like me or because this deployment is so special.

I have come to realize that whether or not we discuss it, all of us (except perhaps the hardcore apathetic and self-centered) are deeply concerned about our countries struggles. Who among us has not been traumatized by the casualties of our brave soldiers, all volunteers, who we all love dearly. Somewhere in our hearts all of us have to recognize, that regardless of ones politics, the burden of the War on Terrorism should not fall so heavily on one group of citizens who get deployed again and again, while the rest of us are completely untouched. Your constant requests for more information, that Joan is asked to relay to me, is not just about me. It's also about your own connection to our soldiers and your hope that they get the best services, including medical services, when they sadly become casualties.

I think that if your looking for an answer to your question of why I decided to leave my family and everything else behind and go to a place like Iraq, start to think of how deeply you have been impacted by the the thousands of casualties we have suffered since 09/11. If you can recognize your own connection to these events and it's impact on you I'm sure that you will have a good understanding of my decision.

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TODAY IS 09/11/2010

There has never been a date that has meant so much to every one of us as September 11, 2001 but for obvious reasons (which I won't go into) in recent years it seemed as though public participation in commemorative events was floundering.

This year the controversy about the Ground Zero Mosque has rekindled the meaning of this date. It is still not clear how 09/11 will be observed in the future and at the present time it is neither a national holiday nor a day of mourning and rage. Schools and businesses are open and the commemoration is confined mostly to the families Predictably , for the time being, elected politicians make appearances at these ceremonies but if observance lags they will also drop out. 

When I ponder how we now celebrate the yearly anniversaries of September 11, 2010 I'm reminded of an expression I would occasionally hear from my own Jewish upbringing. Sometimes individual Jews who were not that observant themselves but who considered themselves experts of Jewish rituals would offer to define the level of observance for different Jewish holidays. Let me explain. While many Jews celebrate the well known Jewish holidays (Rosh Hashanah, Passover Yom Kippur) there are several other Jewish holidays that are only celebrated by the more religiously observant ones. For those who celebrate all the holidays the “Yontifs” are those in which you are not allowed to work, drive a car, use a telephone etc. Then there are other holidays, such as Hanukah & Purim in which you are permitted to drive, go to work etc. So the vernacular for some Jews, when speaking about Hanukah & Purim might be to say “it’s not a real yontif”. This is basically a down and dirty way of stating that although there are many holidays in which the observant Jew won't be at work and won't answer their telephone on these holidays they will be at work and will answer their telephones.

So the bottom line is that at this time 09/11 is just not a real Yontif, that is it's not an official holiday. That could also mean that we don't want to diminish its meaning by making it another national holiday because it could inevitably end up being another day off for from work and school like most of our national holidays.

Other than some participation in the official ceremonies I was not aware of any formal observance of 09/11 by the National Guard or the military. This year it fell on a Saturday but I’ve never closed my office on 09/11 and I have no plans to do so next year.

The reason I’m deploying to Iraq is both directly and indirectly because of 09/11. Our feelings about 09/11 were so strong that eighteen months after the event the majority of us supported the decision to invade Iraq. Now we’re all so tired of the war that we've basically chosen to simply not think about it. People have gotten so discouraged and bored with these wars that even the politicians have noticed. During the 2008 presidential race the public often seemed far more interested in local issues than the ongoing wars in the Middle East & Central Asia. In less than a decade, other that the more observant among us, the events of n09/11 along with the War in Iraq & the War in Afghanistan is so unpleasant that possibly the majority of Americans simply avoid even thinking about it.


Although it does indeed seem like people are avoiding dealing with the extreme unpleasantness of Iraq, Afghanistan and 09/11, I also know that if they are engaged appropriately they are not apathetic and they have intense passions . I suppose I've gotten to see the reactions of hundreds or perhaps even thousand of people (this includes countless patients) after they learned that I was deploying. A disproportionate number of the people I know personally tend to vote Democratic but I also know many who are quite conservative and I also have alot of patients who are in the military who clealry are more conservative.

Well I'm very happy to be able to say that there is essentially no difference in how either group responds when they hear that their friend, relative, neighbor, casual acquaintance or doctor is deploying to Iraq. After they get over their surprise it is clear that they all offer me the same interest and support and without a doubt they show the same love for their country. They start out surprised and confused as to how someone like me at my age could be going to Iraq but when they realize that this is to bring medical care to our soldiers they all get it because we are all American.

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Deployment minus 6 weeks

Next week is the 9th "anniversary" of the 09/11/2001 attack and in about five weeks I will report to Fort Benning, Georgia for 120 days of active duty in the United States Army on behalf of "Operation Iraqi Freedom". During my own "run-up" to this deployment people have made a big fuss over my decision to volunteer but it's not at all that simple.

In December/2008, at the age of 57 and after an application process that lasted almost an entire year I took my Oath of Office and entered the Massachusetts National Guard as a medical officer with the rank of Major.

I want to thank everyone who have wished me well and expressed their respect for my decision. Please don't look at me in awe because before I made this decision consider what I been doing for the six years since 09/11 had occured? Well, the answer is that I stood on the sidelines for the first six years after "The War on Terrorism" began and I was probably destined to stay there until I ran into a National Guard Health Professional Recruiter.
Almost three years ago I had attended my 20th anniversary medical school graduation event which was being held at the same time as a related medical meeting. Outside of the meeting there were the usual pharmaceutical vendors who I was trying to avoid so I went over to the booth set up by the National Guard. After all, that seemed more interesting and I've always been a type of military wannabe. I had recently discovered the military channel and it quickly became my passion and it was about the only thing I ever watched on television.



Joe Guerriero, who was a retired Lieutenant Colonel (LTC) , was the recruiter at the National Guard booth and he didn't appear to have any other takers so he was more than happy to talk to me. From what I thought was going to be a little military chit chat I heard some very serious and profound remarks from the retired LTC. He told me that throughout the years of The War Against Terrorism our military has continuously been faced with a shortage of physicians that was so serious that they were actually accepting physicians in their sixties!!



There actually are a small number of physicians & dentists who volunteer for the military out of a sense of service but without a draft the military must resort to offering scholarship money in return for military service. Even with offers of loan forgiveness and multiple cash incentives there is still a shortage so the military is spending a small fortune on hiring a force of recruiters to try to flush out physicians (like me) who might be willing to enlist.

I found the entire spectacle of a retired high level officer essentially soliciting uninterested physicians during a time of war to be painful and embarrassing. 

So if you've expressed your admiration for my decision to enlist please also consider that if this was World War II and if I took six years to decide to step forward the war would have already been over for about two years and I would have been called a draft dodger.

So more than six years had passed since 09/11 in which I didn't volunteer for anything and never had the most remote thought of getting involved. 
I supported our soldiers but who didn't? The bottom line is that for me the years after 09/11/2001 were essentially the same as the years before 09/11/2001. This was the Pearl Harbor of our time and it wasn't touching me as a citizen. Far from making sacrifices for the war effort President Bush was lowering taxes and promising less spending and I wasn't asked to do anything. So year after year after 09/11/2001 I was sitting on the sidelines during a war in which in which all Americans, with the exception of our military, was being asked to sit on the sidelines.



Immediately after 09/11 I felt that there was going to be radical changes in our way of life. I fully expected further domestic terrorism and higher taxes and rationing to support our war on terrorism. My predictions were wrong and I had to accept the fact that in 2008 my personal income had essentially been going up every year since 09/11. The burden of year after year of war had fallen completely on the shoulders of the members of our volunteer military and their families.

Universally, everybody was saying that we supported our troops, but the troops were making all the sacrifices.

Among my social acquaintances and extended family I hardly knew a soul in the military. When I first submitted my enlistment application I was asked if I had prior service or other connections to the military. I responded that my only connection to the military was that I was a "baby boomer" and that I protested the War in Viet Nam.

In a way I could say that I'm descended from a great military tradition of sorts. My father and all my uncles and likewise my wife's father and all her uncles served in World War II. But that was a world war and there was a draft. Once that war was over we were all more than willing to let that blip on the radar fade away and that was the end of my families military traditions.

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