As an anesthesiologist, on a purely pragmatic level, it is hard not to bear some animosity toward those who smoke.

When this issue of US Medicine reaches our readers, we will be well into the holiday season and drawing 2011 to a close. Like many, I often find myself using this time of year to reflect on the previous 12 months, new directions, challenges, successes and failures.

If I were unfortunate enough to sustain a severe trauma, I would prefer to be taken to a U.S. Military Combat Support Hospital (CSH) over nearly all other medical institutions in the world.

I had the misfortune recently of stumbling across a movie documentary, “Expelled: No Intelligence Allowed” narrated by Ben Stein, as I was channel-surfing with my eldest daughter following the evening news.

“The prayer that has been mine for 20 or more years, that I might be permitted in some way or sometime to do something to alleviate human suffering, has been answered!” – Walter Reed (1851-1902)

This quote was from a letter Walter Reed wrote from Columbia Barracks, Quenados, Cuba, to his wife and daughter during the last few minutes of the 19^th century, 11:50 p.m., December 31, 1900.¹

One of the most stimulating aspects of being a federal medicine provider is the truly global nature of our medical community and patients. Whether at a combat support hospital at Camp Bastian, Afghanistan, a health clinic in Diego Garcia, British Indian Ocean Territories, or the 8th Medical Group, Kunsan Air Base, South Korea, few places on this planet have not been touched at some point by federal medicine.

“God is in the details.”
- Ludwig Mies van der Rohe (1886-1969)

I recently took a two-week cruising vacation with my family on our sailboat “Family Knot” (Gemini 105Mc). Our goal was to circumnavigate the Delmarva Peninsula, the large East Coast peninsula that contains portions of the states Delaware, Maryland and Virginia. The majority of this trip was confined to the relatively protected waters of the Chesapeake Bay and Delaware Bay, but a portion of the trip required venturing out into the coastal Atlantic Ocean.

“I always tried to turn every disaster into an opportunity.” – John D. Rockefeller (1839-1937)
As scenes of devastation from the magnitude 9.0 earthquake and subsequent tsunami that struck Japan on March 11 continue to play on the world’s media outlets, the precarious reality of man’s existence on this planet, in the face of natural forces, is all too obvious.

I recently returned from another medical training mission (our fifth annual visit) in Vietnam. These missions are tremendously valuable for training my fellowship and resident physicians on how to educate and function in challenging medical environments. Over the years I have had a number of military physicians comment that their medical mission experience was the single most important training they received in preparation for working in a battlefield environment. Our Vietnamese hosts benefit from the exposure to modern American medical technologies and procedures. While this mutually beneficial relationship has been a medical education success for both parties, I often think our team comes away with far more benefit then we necessarily bring.

“Somewhere, something incredible is waiting to be known.” – Carl Sagan (1934-1996)

I began my fascination with the scientific method and the process of research early in college. Decades later (more than I like to admit) as I look back, I am awed at the accelerating pace of medical discovery and dismayed at the concurrent explosion in the bureaucracy of research conduct known as the Institutional Review Board (IRB). Most of my medical research colleagues consider ‘IRB’ a four-letter word, and we all have personal horror stories of navigating procedural insanity imposed by IRBs, sometimes euphemistically referred to as the ‘office of preventative research,” in the name of human subject protection.