GUEST EDITORS' NOTES
The following essay was written by a current Naval Medical Center San Diego co-chief residen! to reflect on his impending graduation during a time of war. Lieutenant Commander Epperly is a medical school graduate of the University of Virginia, Charlottesville. He completed his internship at the National Capital Consortium Program in Bethesda, Maryland. He then spent 2 years as a general medical officer stationed with 1st Marine Division at Camp Pendleton, California. He is completing his pediatric residency as a co-chief resident while raising 2 children with his active duty physician spouse.
Pediatrics - really the entire medical profession - is full of individuals with prior military service. Our reasons for joining the military are as varied as our choices of specialty. Many join because of family tradition, a desire to serve our country, or simply for the financial benefit of having funded medical school. I joined primarily for the scholarship, but I was also drawn by a sense of service and the opportunity for a unique experience.
To say that the world into which we are graduating is different from that when we were interns is a tremendous understatement. Every generation of pediatric graduates has had its own challenges to face. The events of the past 18 months have created a state of affairs that none of us expected when we started medical school or even residency training. Phrases that have entered common conversations - the war on terror, homeland security, weapons of mass destruction, disaster preparedness - all have medical ramifications. Those of us in military medicine are more familiar with the medical aspects of some of these concepts. Mass casualty situations, chemical and biological defense, and the recognition, triage, stabilization, and treatment of those exposed to chemical or biologic agents are all included in our training.
A common career path in Navy medicine as one trains for a medical specialty - be it pediatrics, radiology, or general surgery - isa year of internship followed by a 1 - to 3-year general medical officer (GMO) tour ?? duty. This can occur on a ship, with a helicopter squadron, or with a Marine unit. Many are stationed or deployed overseas during their tours. Following this experience, they return to a training hospital to complete residency. A GMO works as a general practitioner, providing primary preventive and acute care for a largely adolescent active duty population (the average sailor on a ship is 19 years old). The part of the job I found most interesting was offering medical expertise and a physician's perspective to unit commanders while planning for training exercises or real-world operations.
The GMO experience often involves more extensive training in nuclear, biologic, and chemical (NBC) defense, both from the operational perspective and the medical point of view. Two memories stand out from my NBC training with the Marines.
The first was in the gas mask confidence chamber. Several of us, sporting gas masks, filed into a small tent lull of tear gas. After about 30 seconds in the tent, my freshly-shaved neck began to sting - a feeling that worsened as time went on, and for a few minutes after we left the tent. I later mentioned this to my colleagues.
"Oh yeah, Doc, didn't anyone tell you not to shave today? 'Cuz if you do, it really hurts!" was the reply.
The second occurred as our battalion was preparing for deployment later that year. We went through a 2day exercise that focused on functioning in a simulated NBC environment. Most of this time was spent wearing full chemical protective suits. This particular exercise included mock casualties - the "patients" had both chemical and more conventional injuries. Trying to place an intravenous line wearing the thick rubber gloves of our protective gear really drove home how difficult working in that environment would be.
In addition to the chemical threat, there is the suddenly more real possibility that any of us could be involved in a mass casualty situation where the number and acuity of injured or infected patients exceeds the resources of the health care system. Military medicine, particularly combat medicine, expects such situations. All military physicians take Advanced Trauma Life Support followed by several days of field-based mass casualty training with simulated wartime, practical application scenarios.
Also looming is the specter of long-lost infectious diseases to add once again to differential diagnoses. Smallpox, anthrax, and a handful of other diseases make not only effective weapons but also bioterror agents. Many of these diseases have been relegated to the back chapters of pediatric textbooks in recent decades. if they are mentioned at all. Very few practicing pediatricians have even seen a case of smallpox. Pulmonary anthrax, for all practical purposes, is only seen after exposure to the weaponized form of the disease.
The world today is full of potential new threats that affect us both as everyday citizens and as physicians. Many of these are similar to situations for which we train for in the military. Although we did not have this in mind when we joined, I for one find it a welcome benefit at this point. My time with the operational forces has given me a perspective that I can share with many of my patients and families. Having deployed to the Persian Gulf for 6 months when my son was 4 months old, I know how such separation feels. My memories have become pearls of advice for parents, especially ways to keep their children connected with a deployed parent. I have seen how our fighting forces conduct their daily business, and I am proud to have the opportunity to care for the children of the men and women who secure and protect our freedom. In January of this year, my wife left on the same Persian Gulf development that I did 3 years ago. I am now a "geographic single dad" for our two children, and I find this has given me an appreciation for the demands on many of the mothers I see in clinic.
As I approach graduation in the coming months. I am not only preparing to move to take on my first assignment as a staff pediatrician at a US-based Navy hospital. I also find myself wishing colleagues and attendings well as they are shipped to foreign lands to care for our fighting forces. I pray that none of us has to use our knowledge of chemical or biologic defense and treatment, but I am certainly thankful to have it to rely on.