Sal's Reflections

Michael had been at the Hospital for Special Surgery for almost five years, and his practice was thriving. Financially he had gone from being totally broke to now being able to afford a Townhouse in one of New York’s most desirable neighborhoods. The townhouse was a beautiful 19th century edifice close to Central Park.It was over 3500 square feet wth three full bathrooms,and a half bathroom on the first floor.The building had double parlors,a wood burning marble fireplace in every room, and a cherry wood ceiling in the formal dining room. They loved that despite contemporary upgrades the Queen Anne architectural splendor had been maintained.Both he and Arlene were very conscious of their good fortune, and in no way put on airs, or acted as though they were above anyone. Michael remembered the words of his grandmother in her inimitable Irish brogue when one of their neighbors was putting on airs”You know Michael you can’t shine shite.”Their roots were in Jersey City and they never once felt the urge to be pretentious
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The only difficulty that Michael could not resolve was his relationship with his fourteen year old son Michael Jr. Initially Michael thought it was just the normal process of adolescence, but he soon realized that it was deeper than just a phase. Junior was disdainful of everything that Michael valued including the Catholic Church. He procrastinated every Sunday morning and it was a constant irritant for his father. While at church he paid no attention to the liturgy, and never received communion. He had refused to attend confirmation classes ,and whenever Michael tried to engage him in conversation it usually ended up by Michael losing his cool.

There appeared to be no avenue to reach his son ,and though he was a gifted athlete he did not try out for the grammar school basketball or baseball teams. Michael knew from their summers at Long Beach Island that his son was an excellent swimmer, and it was on those days at the beach that he seemed happy and less sullen. Michael encouraged Michael to try out for the city’s swimming team but as usual he failed to show up for the trials. Another point of confusion for Michael was his son’s total lack of interest in dating. He thought at this age he should be captivated by the opposite sex.The current bone of contention focused on where Junior would attend high school. Michael insisted that he take the exam for Regis high, and though absolutely dismissive of this choice Michael junior agreed to take the test.

Michael received a letter from Regis stating that his son had failed the entrance exam ,and would not be admitted to the freshman class. He was angry at this result ,and believed that Junior had failed the test on purpose. Rarely did Michael resort to influencing decisions like this, but he had an ace in the hole. His friend Father Aumack was teaching at Fordham ,and perhaps he could intercede and get his son accepted at Regis. The request worked, and he was notified that after new consideration Juniorwould be welcomed as a member of the freshman class .Overjoyed at this news Michael did not realize that this temporary victory was doomed to failure.
Michel junior failed every subject in the first month, and at the teacher conference his parents were informed that if his performance did not improve he would be asked to leave. This news fostered a major confrontation and Arlene tried to mediate a resolution. After the shouting ,she counseled Michael to back off and give junior some space. She believed that sooner or later he would find his stride ,and recommended that they include junior in the decision as to where he wanted to attend school. Initially this went down like a lead balloon with Michael but eventually he agreed ,but in a very real sense began to further distance himself from his son.

Packing the last few items into his duffle bag Michael closed his locker and readied himself to catch a helicopter to Da Nang where he would board a flight to Hawaii.He was too excited to eat, but had already imbibed three cups of coffee, and was on a caffeine high. This base had consumed his every waking moment for months, and it was a two edged sword in leaving. He yearned to see his family, but felt a twinge of guilt leaving a place where he had been so involved in the lives of wounded Marines. He had been personally involved with those he had medically treated and never was any patient merely defined by his wounds. He cared about them individually, and always found time to listen to their hopes fears and dreams. As he walked to the chopper landing area he turned and gazed wistfully at the medical unit. He wondered about so many that had gone back to the states. It was difficult not to consider what their lives were like, especially those that had multiple injuries. He knew that to some degree he would carry them in his memory and thoughts forever.

Michael had picked up a word that seemed to be a constant with all of the combat marines. He often heard them in the mess hall refer to DEROS.This was a word that stood for” Date Eligible for return from overseas”Even the most hard nosed vets in the group who lived daily with possibility of being maimed or killed had this as their daily mantra. Michael at least at the subliminal level had subscribed to watching the calendar, .and he was only months away from returning to the states.

Two factors had an impact on Michael in the ensuing months. The first was the ongoing conversations with Father Ray Aumack about the purpose and value of the conflict. His deep belief in the righteousness of the war had not waned, but he could not readily dismiss the impact of Father Aumack’s beliefs.His respect and admiration for Father Aumack was so deep that it forced him to examine his own reasons for defending the US involvement. At the end of the day, the daily treatment of the wounded and dying continued to be the foundation for the commitment to his belief in the value of fighting for freedom against the forces of evil..

The second circumstance that somewhat concerned Michael was the visible impact that the daily Triage had on members of the staff.Frank Ziegler a cardiologist from New Jersey appeared to be wearing down emotionally, and there were a series of incidents that gave Michael a feeling that Frank was on the verge of coming unglued. In the past he and Frank had a series of conversations about family and religious beliefs which had been sources of bonding. Frank was a practicing member of the Lutheran Community, and served on the board of Directors at the Somerville Lutheran hospital. He was a man of deep and abiding Christian faith, and neither smoked nor drank alcohol. He was a gracious gentleman, and known to have a sharp wit . He had a degree of fame due to his one liners which often alleviated the tension in the Triage process.

Lately Frank seemed more aloof ,and there had been a series of shouts from him during the night which obviously were caused by dreams or nightmares. Michael noticed in surgery that Franks hands would tremble ,and though the OR was very humid Frank was often drenched from perspiration even before surgical procedures. Michael had tried to probe his concerns, but Frank waved them off with the statement that ‘he was just physically tired.”

Michael received the news one morning at breakfast that Frank had been reassigned overnight to a hospital in Japan.This seemed rather strange and abrupt to Michael so he visited Colonel Bultz’s office and inquired about Frank. Colonel Bultz never ducked a direct question from a staff member, and shared with Michael that Frank had experienced a difficult period ,and in his opinion was a classic case of “battle fatigue.” “ He was on the verge of a mental breakdown, and I would appreciate your keeping that information under your hat.”Michael assured Colonel Bultz that he would honor his forthcoming statements but added” I knew that he was having some difficulty, but not to the degree that he would have to leave.” Colonel Bultz poured himself a cup of coffee and said” Michael if any of us stays here too long we may wind up in the same boat.I am at the stage where I hope that in the next few months I will be reassigned to the states Colonel Bulttz hesitated and then asked”.Are you Ok and handling the job without any of Frank’s symptoms?” Michael paused and reflecting on the question answered.” The downsides are obvious but what we do has such value that at least for now I think that I can continue to handle it. Though truth be told I realize that I only have four more months here and then back to the states.”

“Alright Michael but if it ever gets out of hand don’t hesitate to let me know.”.Michel rose and for some reason both men extended both their hands in a double handshake.

Michael had never seen Mass as an obligation, but rather as a source of strength and spiritual fulfillment.The opportunity despite his chaotic surgical schedule to attend mass daily on the base was his anchor in this sea of madness. Father Ray a Jesuit chaplain celebrated mass when it was possible each morning, and would make the rounds in the infirmary distributing communion and blessing all of the individuals under his care. Father Ray or “: Father Nails” as he was affectionately called because he was an extraordinary man who was deeply admired by everyone on the base .While on patrols with other Marines he never ran when the firefights began .He tended to the wounded and dying with a calmness that defied logic. One morning after making surgical rounds and receiving communion Michael was invited by Father Ray to have a beer and a smoke outside the infirmary .The two sat on the steps of the hootch and clinking two bottles of beer sipped the ice cold brew.

Father Ray took a pack of cigarettes from his pocket ,and offered Michael a cigarette. Michael never had a cigarette in his life and waved his finger at Father Ray in a dismissive fashion. He told Father Ray smoking was a habit that would have dire health consequences . Father Ray smiled and said “living in this hellhole you believe that smoking is even near the top of the things that can do personal harm to me?Every day I deal with snakes,rashes,dysentery sniper fire , and you think I should be alarmed because of my smoking?” Michael laughed and said “I guess on the list of the things that would impact your health smoking is probably very low” Father Ray took a cigarette out of his pack lit it ,, took a deep drag and said” How are you holding up Michael? “”I guess as well as could be expected Father. Some days are overwhelming when you deal with so many lives that are changed forever Father Ray took a deep drag and said” I can imagine because there are things that you and I see that will be embedded in our minds forever.” Michael nodded in assent. and said” However I have to tell you in some way I feel privileged to be here. I am humbled by the approach of these young kids with regard to their buddies. Frequently while attending a wounded Marine the first thing he will say is I’m okay Doc take care of my buddy he’s a hell of a lot more severely wounded than I am.” These kids are so brave that I feel privileged to operate on them. Also I have developed a strong love for the Marine Corps, and the sacrifices these kids are willing to make”

. Father Ray was silent for a few seconds but finally responded.” Michael this may come as a shock to you but the reason I asked for this assignment has little to do with the Marine Corps or with the US involvement in the war,” Michael was confused by the statement.”Not sure what you mean by that Father.”Reaching for another cigarette Father Ray responded “I don’t believe in war Michael, and I am here only to minister and help. I take no pleasure in the killing, and though I keep it to myself there is no joy for me me in viewing the bodies on the rice patties there are referred to as “Gooks”. Those are just like our kids,they are persons.”Michael is not used to anyone on the base feeling this way and has difficulty digesting Father Ray’s words. ” Don’t you believe in the just war theory?”” Michael I think the just war theory is bullishit. Every day you and I deal with the horrors of the so-called just war.There has to be a better way for people to behave in this world “Michael immediately responded” but there is evil in the world that must be addressed.”” Michael people in high places start these damn wars and young people pay the price. Those kids on the other side believe as deeply as our kids that they are fighting for some noble cause.. Or they are fighting to protect the life of the kid next to them. Once war starts morality flies out the window.”

Michael is to some degree shocked by Father Ray’s beliefs ” I gather that you are of the school of Father Berrigan and all the protesters in the states “” I know Dan Berrigan and do not always agree with his tactics, but I totally agree with his position on war.” Michael did not wish to be involved in confrontation, but needed more deeply to understand Father Ray. ” Would you disagree that the United States should have fought against the evils of Germany and Japan during the world war?”No I would not; my point is that war is always the result of human failure, political failure, social injustice ,poverty, greed and a host of other moral failures “I respect your views Father but I guess I’m still very patriotic, and believe in the righteousness of what we’re trying to do”” I’m also patriotic Michael but not blind to the false premises of all politics Every time I cradle a mangled kid and anoint him I am filled with anger for any and all who cannot see the insanity of the situation.”

Michael had been in Vietnam for several months, and though it would be impossible to completely adjust to the circumstances, he found himself more and more settled with his duties as a combat surgeon He marveled at the number of severely wounded Marines that his unit was able to save on a daily basis. in his opinion this was attributable to certain factors. The first being the heroism of the helicopter pilots who faced constant enemy fire to transport wounded Marines immediately to the triage area. Time is of the essence in stabilizing those who would have bled to death without the extraordinary heroism of the chopper pilots. in many cases, within two hours severely wounded Marines would be experiencing multiple surgical procedures which would prevent them from bleeding out.

Other areas of a breakthrough were the ability to almost immediately hydrate the wounded, and the use of synthetic sprays which would automatically freeze a great deal of bleeding. As in all wars the triage team did not depend on approved medical devices and practices ,but rather what worked and what could save lives .In addition to some of the technical and medical breakthroughs there was also the process of triage, and the ability for nurses and physicians to make immediate decisions which ultimately saved many lives .However some of the injuries were so grave that it created painful medical decisions. It was possible to save a shattered body, but it would be followed i by enormous consequences regarding the future of a particular Marine.

Two days ago Michael made a decision that despite the extensive wounds of an individual Marine he would operate and try to stabilize his condition. Despite losing both legs, part of his right arm and having his cheekbone exposed the young Marine was still conscious. As Michael leaned over him he said”son”we will be able to deal with all of your injuries”. The Marine aware of the loss of his extremities ,and the degree of his injuries pleaded with Michael”.let me die Doc there’s no way I want go to the rest of my life as half a man. Take care of some of my buddies, please let me die. There is no way I want to go back home in the condition I am in now.”This was the kind of area which made being a physician in Vietnam intensely painful.. Here was a young Marine pleading for something which he felt he had a right to, and Michael was caught between the reality that his job was to try to save his life knowing that no matter what happened ,even under the best of circumstances life would be extraordinarily difficult in the future.

Three days after the surgery on the marine who pleaded for his death Michael visited him in the infirmary.Heavily medicated the young man when seeing Michael said”what are you doing here you bastard?I hope you feel good about keeping me alive but I hate you.” .With that the marine turned his torso and buried his face in a pillow.Michael understood the anger, and left the infirmary with the realization that the immediate decisions made have consequences for years to come.

The heat and humidity in Vietnam surpassed even the record-setting days that Michael had experienced at Bellevue during July and August. He had because of the humidity in the barracks slept fitfully, and was drenched with perspiration when he woke up at five o’clock. Dressed in fatigues and a t-shirt he made his way to breakfast and felt that he was actually living in the sauna..After making morning rounds in the infirmary, he thought perhaps taking a shower would at least temporarily lower his body temperature . .The coolness of the water flowing over his head was so refreshing.Suddenly he heard a sound which was to be part of every day in Vietnam. The whirling blades of the choppers spawned immediate activity within his barracks. All the stuff members raced to the triage area. Quickly drying off his body he rapidly dressed and joined his colleagues.

As the wounded Marines were transported from the choppers to the triage area nurses and physicians immediately decided who could be treated , and who was so severely wounded that there were beyond help .One Marine had most of his brain exposed, and a nurse held his hand, and did her best to comfort him in his last few minutes of life. The nurses and physicians appeared to have a sixth sense about how and who was to be treated immediately. Michael was stunned by the injuries, and their severity. He emulated the rest of the staff members and began to involve himself in the treatment and decision-making.

The next helicopter unloaded a headless Marine, two with severe vascular injuries and two others missing limbs. Michael realized that the traditional medical approach to trauma was woefully inept, and as Colonel. Bultz had said” even in a major city like New York you would never see this number and degree of injuries”.Performing a tracheotomy on one the wounded he was amazed at the response of the young nurses in the triage area. Many of them were in their early 20’s and barely out of nursing school. They were the backbone of the triage process, and often the last person to speak with a Marine in the final minutes of his life Michael had learned long ago that excellent medical care dependent on a collegial approach, and nurses were vital to excellent health outcomes.That belief was never more true than in this war zone..

That first triage experience was to be repeated day in and day out , and Michael’was counseled by his fellow physicians to avoid against personalizing each patient. This advice was offered with all good intentions ,,and he was advised to see them not us kids from Iowa ,Indiana, New York or any other state but as cases of multiple surgeries to be treated. One physician told him” if you personalize their lives you will be overwhelmed by the horror of this war.” Michael did not easily dismiss this counsel but it went against the very fiber of his personality and spiritual beliefs. He tried to implement a detached approach, but quickly reverted to what had been at the core of his personal and medical history.

True to his word Fergy appeared at daybreak and setting down the chopper he immediately helped Michael on board and headed for the base.After landing Michael had his papers and Id scrutinized by the MP’s and he was escorted to a large wooden building where he would be issued all the necessary items for his stay at the base.Once he had gathered his equipment a marine corporal led him to the living quarters which he would share with five other physicians.After placing his gear in his storage locker he was taken to the office of the chief medical officer Colonel Barry Bultz.

Due to gale force winds and torrential rain Michael’s commercial flight to Hawaii was cancelled.. Stranded with three Air force officers it appeared that he would be spending the night in an airport chair One oi the Air Force officers suggested that instead of waiting until the next morning they take a cab to Travis Air Force base and try to hitch a ride with one of the regular flights to Hawaii..
Michael who was having reactions to the preventive injections that he had received at the Naval base yesterday was willing to take that chance.

A cargo flight was headed for Hawaii, and then on to Vietnam, and the pilots were more than happy to provide rides to the stranded group. The flights were anything but smooth ,and on two separate occasions Michael made his way to the rear of the planes and regurgitated. Eventually after hours of turbulence and motion sickness Michael arrived at the Da Nang airport. After exiting the plane he was immersed in a sea of civilians and military personnel, and it took him twenty minutes to find his way to an information area. He was informed that that one of the chopper pilots would give him a lift to the marine base,, and was escorted after a review of his orders to a spot behind the main runway. Michael waited for almost two hours before a chopper landed in his area. It was at the close of the day ,and dusk was settling on the area. Suddenly a chopper appeared and landed almost thirty yards from Michael’s area. After the blade stopped spinning a tall lanky pilot opened the cockpit door and dropped down to the ground.:”Where are you headed sir”? Michael eagerly responded to the Marine base at Da Phu.”” .Hop on I am Frank Jorgensen but everybody calls me Jorgie I see by your papers that you are a physician. Is this your first time in Nam’”? Michael nodded”Yes it is””I don’t envy you Doc.I have carted more dead and mangled bodies than anyone should see in a lifetime.”Before Michael could respond Jorgie had started the engine and the whirling sound of the propeller made conv”ersation impossible.

Once airborne the light had faded almost completely, and the flight was engulfed in darkness”I had hoped to get you to the base before complete darkness Doc but it is too late so I am going to Have to drop you.?” “Drop me? Where the hell are you going to drop me?” About five minutes from the base. We have no patrols out now and would be sitting ducks for a VC missile. I will land in an a open area ,and pick you up at daybreak once our patrols are out.”Michael was terrified at the thought of being alone on the ground in this strange war zone..Fergie asked.” Do you have a weapon Doc?” Michael in an almost feeble voice replied” No I don’t.Z”
“Look behind the back seat. There should be an automatic rifle. Take it and during the night none of our patrols are out ,so if anything comes out of the tall weeds it is going to be VC. Open fire before they have a chance to shoot at you. “ Michel thought to himself that Bellevue was a picnic compared to this insanity.

Jorgie dropped Michael off in a clearing between two areas of large weeds. “See you in the morning Doc.”
As the chopper flew away Michael sat on the ground, and over the next three hours glanced at his watch every twenty seconds. It was a still clear night ,and suddenly he was aware that the weeds about thirty yards from him were appearing g to move. He could barely breathe ,and there was absolutely no saliva in his mouth. Closer and closer the weeds were moving, and with trembling hands he pointed his weapon and was ready to fire. At the very last moment the weeds unfolded and a Bengal Tiger sauntered out and either did not notice Michael or was disinterested and entered the second weed area.