A good plan, violently executed now, is better than a perfect plan next week.

Editor-In-Chief, Chester "Trip" Buckenmaier III, MD COL, MC, USA

Chester “Trip” Buckenmaier III, MD, COL, MC, USA

“A good plan, violently executed now, is better than a perfect plan next week.” Gen. George S. Patton (1885-1945)

I recently turned 50 years old and celebrated my birthday while on an annual field exercise, called Operation Bushmaster, with the Uniformed Services University (USU) fourth-year medical students. Bushmaster is the capstone event of the Operational Medicine Curriculum in which military medical students participate during all four years at USU. This year I was serving as a student faculty evaluator for the program.

During this experience, I could not help but reflect on several milestones that have passed and are coming to pass for me in 2014. More than 20 years ago, I was a USU fourth-year student being evaluated in the Bushmaster program. Now I am one of the evaluators. I will be retiring with 26 years of service in November, and I have a half-century of life experience under my belt (literally, where did that 18-year-old abdomen go). In short, I had a wonderful time reliving old operational and deployment experiences, sharing 26 years of, “Army training, sir!” with the medical students, and having an entire platoon of students sing “Happy Birthday” to me. I did not necessarily plan to be in the field for my 50th, but I could not have planned a better birthday celebration. I was doing what I always wanted to do.

Some of my earliest memories involve my desire to be a physician, pronounced “physic-can” to my mother’s horror. I also knew that I would likely be in the military, like my father and every generation since my great-grandfather who arrived from Germany in time for the Spanish-American War. Certainly like many physicians from my era, the television series “M*A*S*H” was influential, and I developed a strong desire to take care of soldiers, perhaps someday in a time of war. For these reasons, USU was a natural and first choice for a medical education. While I was accepted to other fine medical institutions, I wanted something that USU specialized in. I wanted to be a military physician.

USU usually holds the Bushmaster program in October, but sequestration and congressional budgetary brinksmanship prevented the routine execution of this vital military medical experience. The USU 2014 graduating class was at risk of being the first class to graduate without the benefit of this realistic training exercise that simulates the stresses new military physicians will face as unit surgeons providing combat health support at the battalion aid station role of care. Graduates of the nation’s only military medical school are expected to be able to perform in this capacity the day after graduation.

The USU leadership could not imagine graduating a class of students without this experience and, through a Herculean effort of USU faculty and staff, managed to pull off the weeklong exercise at Fort Indiantown Gap, PA, this past May, only two weeks prior to these students’ walking across the stage for graduation. I will admit that the initial motivation of the students involved was nothing to write home about. Who could blame them? These kids (same age as my own kid) were two weeks from one of the most significant events in their lives, and we had them managing a simulated combat mass casualty event — fake blood, screaming and all the moulage trimmings — in the field!

By the end of the field problem, though, they all seemed to understand that, if the past 13 years were any guide, what they were experiencing at Indiantown Gap could only be too real in just a few months. I was impressed and pleased to see how these students quickly adjusted, applied themselves and were soon performing as military medical officers and successfully managing difficult combat medical scenarios. This class, like all those before, would be ready for the challenges of medicine during armed conflict.

As a USU ’92 graduate, I am admittedly biased in favor of the university and the education it provides. I do believe that USU provides the nation with a truly unique medical resource that has proven its value in the nation’s wars and natural disasters. The university’s motto is, “Good medicine in bad places.” I think this distills the essence of what distinguishes a USU graduate. Like our civilian colleagues, we learn what it means to be a physician in arguably the most sophisticated health system on the planet. Unlike civilian training, USU graduates learn to provide medical care when all the technology and resources that modern medicine depends on is suddenly rendered moot by war or natural disaster. Certainly physicians from other institutions can and do learn these skills in the military, but USU students graduate with leadership skills and abilities to function in these most difficult of medical environments from the start. USU physicians know how to absorb the blows and confusion that a bad situation such as a combat mass casualty might bring, formulate a plan and execute.

I found myself channeling Gen. Patton multiple times during this training exercise as a young physician, in the role of the battalion surgeon, looked on in dismay as their battalion aid station was quickly overwhelmed with casualties. Mistakes were made, some decisions were comical, but they all learned to act and overcome the bad situation presented. The blessing of Bushmaster is the opportunity to experience this stress in a simulated environment, rather than dealing with these issues for the first time during the actual disaster. Personally, I have fallen back on my USU training countless times during my 26 years as a military medical officer. I imagine this latest class of military physicians will likely do the same.

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  1. Justin Woodson says:

    Thanks to you sir and ALL of our dedicated volunteer faculty members at Bushmaster. Couldn’t do it without you! and as you pointed out so well…hard to articulate the value of allowing these students the opportunity to make those “free” mistakes when the stakes are low. I echo much of your sentiment about my own Bushmaster experience as a student. Thanks again!

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