Military medicine needs compassion, collaboration

Adm. William McRaven, the former commander of the U.S. Special Operations Command, got personal during a conference of federal medical professionals. For most at the conference, it was an opportunity to share advances in science and medicine and the latest tools in treating the prevalent or the confounding wounds of war.

McRaven offered up a story. He took his audience to a day in 2010 when he was at Bagram Airfield in Afghanistan and got word that two of his SEALs had been shot in a close fight. McRaven ran across the road to the combat hospital and watched as the doctor struggled in vain to save each of his men. Unable to do so, the young doctor slid to the blood-soaked floor and simply wept.

A year later, McRaven met the widow of one of the SEALs and shared the details of that day. It gave her closure, she told him, to know that people who cared were present when her husband died. The story was emotional, one told in order to drive home to his audience of medical professionals the power of compassion in medicine – even when it can’t save a patient’s life.

But in its telling, McRaven was forced to stop in his tracks and take a long pause before he could complete his story. For 10 seconds, the audience sat in silence as he struggled through his own emotions to find his voice. It drove home yet another lesson: No one – not the top warrior nor the highest star admiral - is immune to war’s toll. “Ever since I’ve come back it’s been like that,” McRaven said later, during a brief interview. “I’ve told one story a dozen times and I still can’t get through it.”

McRaven now serves as the chancellor of the University of Texas, where he runs an academic system that has 14 medical institutions – eight universities and medical schools and six health science centers.

He sees himself as the CEO – running a large institution by building relationships with the people who work there and providing them with the resources they need. It’s a reasonable next step for a top military commander.

But he also brings with him a lifetime of experience with military medicine – from an active boyhood filled with regular visits to the military facility at Lackland Air Force Base in Texas where his father was an Air Force pilot, to his 37-year military career during which he suffered severe injury and raised his children on military health care.

As a child, the medical care seemed more like “a processing station,” he said. But his mother valued compassion in medicine and believed she saw those qualities in their many trips to the doctors.

Later, when there were complications during the birth of his children, McRaven saw the limitations of military medicine. He lived in Virginia Beach in the early 1980s, when Portsmouth naval hospital was in such bad shape, he said, that there were not blankets for the children’s’ ward and military families had to raise money for hospital supplies.

After a scandal, the military began pouring money into the hospital, and the change was “immediate apparent,” McRaven said.

It told the service men and women that the military cared, he said. And it made him realize how investment can lead to a dramatic improvement in quality and equally, how rapidly that can decline “if we fail to pay attention.” Without a doubt, McRaven said, the training that special operations medics and corpsmen go through is the most demanding in the world – years of advanced trauma and emergency care training before the medic or corpsman can join a special operations unit.

He wondered if it was worth it, he said, until on July 18, 2001, McRaven was in a serious parachuting accident. It “ripped my pelvis apart” and tore all the muscles out of his stomach. He was in serious shock when the medics arrived. But he is convinced that the corpsman who treated him likely saved his life and at the very minimum, saved his way of life.

The latest wars have brought even more dramatic improvements to military medicine and tremendous investment in its infrastructure across the world from combat hospitals to medical air evacuations to trauma centers such as Landstuhl Regional Medical Center in Germany and Walter Reed National Military Medical Center in Bethesda. All of it, he said, is predicated on doctors who maintained their compassion.

But still missing is full medical collaboration between military agencies and the civilian world. “All my presidents within the University of Texas system understand my emphasis on collaboration,” he said. “Collaboration should become the new normal.”v After 9/11, McRaven said, the wars flattened the hierarchy that had existed. Because of the nature of urban warfare, young troops were in charge of towns. It was risky, he said, but they did magnificently “and they learned to collaborate.” “For us old folks out there, collaboration is tough, but it’s simple for the young kids who come up.”

Another example of collaboration were the civilian doctors – whether volunteers or reserve and National Guard – who brought their skills to the wars. They served alongside military doctors, taking care of service men and women, and at the same time, got experience in types of trauma care they would not have been exposed to at home.

McRaven once again turned the conversation personal. Five years ago, he was in Afghanistan when he was diagnosed with chronic lymphocytic leukemia, a typically slow-growing cancer that attacks normal blood cells, making it difficult for the body to fight infection. The doctor told McRaven he needed to be sent out of Afghanistan immediately, have his spleen removed and start on chemotherapy. He told the admiral his career was over.

But by the time McRaven got home, his wife had done some research and arranged for her husband to see a top civilian oncologist who looked at his numbers and said McRaven’s cancer was indolent and while he needed to be monitored, he was fine.

The doctor said when it came to oncology, the military was still practicing medieval medicine. The doctor offered to get together with military oncologists and teach them. McRaven eagerly accepted but when he tried to organize it, he hit up against a wall. “Everybody put roadblocks in front of me,” he said. “I tried for a year and a half to pull great oncologists from the civilian sector to be able to have a forum with military doctors but we couldn’t pull it off. Why is that the case? That should never be the case.”

Fourteen years of war has been a boon for military medicine, McRaven said, and will likely save thousands of lives in the future. But collaboration between military and civilian health care is crucial moving forward, he said.

Article from Stars and Stripes