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The Purposeful Doctor

Mary El Pearce

Rules of Leadership

I met my husband when we were both working for a military health facility that provides care to soldiers suffering from the effects of traumatic brain injury. I’d been supporting various military missions by the way of public affairs for nearly a decade, but none struck me as more important than this one-treating service members suffering from the invisible wounds of war. Though we worked in different areas, we were mutually drawn to each other. He would describe our meeting as destiny. I tell him now that it was his charm and flashy smile, but the truth is I was both inspired and enchanted by the passion in him to find innovative ways to care for his fellow service members. He brought that passion to every meeting and patient encounter, and his peers lauded him for it on his last day of work after he finished his tour of duty. This passion stretches beyond his personal goals and reaches into the heart of everyone he treats or examines. It’s bigger than himself— it’s compassion at its finest, the kind that can only exist from having contended with loss, pain, hardship and heartache firsthand, allowing it to penetrate his core but not decimate his soul.

As I got to know this man whom I first revered and then grew to adore, I learned about some of the experiences that shaped him into the purposeful doctor that his patients and colleagues admire, and the caring, confident man I would later marry. During his 24-year Army career, my husband served on three deployments—two to Iraq and one to Afghanistan. Beyond doubt, his tour in Iraq from January 2004 through January 2005 was the most rewarding yet the most gut-wrenching, as the impact it would have on his family would dramatically change his views of the world and himself.

M. El Pearce, B.A. (*)

Writer, 8405 Greensboro Dr #120, McLean, VA 22102, USA e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it © Springer International Publishing Switzerland 2017 E.C. Ritchie et al. (eds.), Psychiatrists in Combat, DOI 10.1007/978-3-319-44118-4_7

When combat operations started in Iraq and Afghanistan, most psychiatrists had never deployed due to the period of relative peace since Vietnam, so little institutional experience was available when he received the notification that he would be deploying. The experience was life altering and rewarding, but at the time he had some misgivings as he was asked to substitute for another psychiatrist who was initially assigned to that position. Because my husband was the most junior staff at Walter Reed Army Medical Center, he went in place of the other psychiatrist. Thankfully, he had ample combat care training and knowledge to guide him through this time of uncertainty.

My husband was commissioned as an officer in the U.S. Army in 1992 when he began medical school at the Uniformed Services University of the Health Sciences, or USU, in Bethesda, Maryland, the nation’s only military medical school. Besides USU being the best choice among other schools he explored, joining the Army was part of his family’s tradition of military service—his father was an Army medic stationed in Korea during Vietnam; his uncle was shot and killed in an ambush serving as an infantryman in Vietnam; and his grandfather was rescued from the shark- infested Pacific Ocean after his ship sank while serving in the Navy during World War II. In addition to standard coursework, he took military-specific courses, like military medical history, tropical medicine, and operational and emergency medicine. During summers he participated in operational rotations including spending time with line units or going on training field exercises. Although he didn’t expect to deploy any time soon, on these field exercises he began to learn how to operate in a deployed environment.

Between his first and second year, his classmates and he spent a week in the field learning the basics of military operations. Each of them took turns in leadership roles so they had all served in various capacities inherent to the company element by the end of the week. One night he was acting as squad leader for a nighttime casualty extraction exercise. They rode in troop transport vehicles and used land navigation to find coordinates of the known casualty. He set up a defensive perimeter as a team searched for their casualty in the woods, eventually pulling out the mannequin which represented the patient. They were behind on their timeline, so they mounted up hastily and headed back to camp. Upon their return, they basked in the satisfaction of their completed mission, but back slaps and high fives were soon interrupted by an irritated classmate covered in mud. My husband had sent him out as one of the perimeter security elements, but the classmate was too far away to hear the order to mount up and watched the taillights of their vehicles fade into the night. With no other option, he traversed the road for several miles back to the campsite in the darkness, stumbling through puddles and uneven terrain. He was rightfully angry, and my husband felt tremendous regret for having left a soldier behind. He would never forget the importance of attention to detail and accountability after this incident. Thankfully, it was just a training exercise, and these are exactly the types of lessons young officers are supposed to learn.

The following summer my husband spent six weeks with a line unit performing duties as a Second Lieutenant (his rank). He trained with a medical unit from Fort Bragg bringing heavy equipment, such as tanks, onto a shore without port facilities.

He witnessed field medicine in action and had a very tolerant company commander who gave him plenty of opportunities to excel and make novice mistakes. That summer he learned four key rules he felt were integral to being a good leader: (1) Command presence is critical; (2) Not standing out in incompetence is far more important than standing out in excellence; (3) Knowing your limits and listening to your NCOs promotes success; and (4) Command strategy may not always be readily apparent to boots-on-the-ground troops, and from the ground troop perspective, accepting that rather than becoming disgruntled will save you a lot of energy.

The final exercise of medical school during their senior year, an intensive field exercise that required them to apply all that they’d learned over the past 4 years, was the first time he felt competent as a physician. They had helicopters and mou- lage patients (real people with mock injuries), and for 96 hours they provided casualty care in a simulated combat environment. He graduated shortly afterwards, completed a five-year residency, and became board certified in internal medicine and psychiatry. He later did a fellowship in geriatric psychiatry, and because of his specialized training he was stationed at Walter Reed Army Medical Center in Washington, D.C., instead of going to a remote post like many of his peers. When the Pentagon was attacked in 2001, he had the opportunity to go with his mentor and boss, Harold Wain, to Arlington Hospital to see patients who had been brought straight from the building. Although he’d treated combat-wounded from the Bosnian War, the U.S. Embassy bombing in Kenya and the bombing of the USS Cole, their experience in taking care of the 9/11 terror attack victims (many who eventually transferred to Walter Reed for definitive care) set his foundation for handling patients with combat stress.

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