I wonder if a soldier ever does mend a bullet hole in his coat?

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 “A ball had passed between my body and the right arm which supported him, cutting through the sleeve and passing through his chest from shoulder to shoulder. There was no more to be done for him and I left him to his rest. I have never mended that hole in my sleeve. I wonder if a soldier ever does mend a bullet hole in his coat?” Clara Barton (1821-1912)

Clara Barton (1821-1912)

Known as the “angel of the battlefield,” Clara Barton organized medical supplies and food for the wounded during the Civil War. As a nurse, and perhaps one of the first “combat medics,” she would encourage her supply-wagon drivers to follow the cannon to the front, often well ahead of medical units traveling in the rear of the column. In the midst of fierce fighting, she and her associates would dash among the wounded to bring comfort and aid. The quotation introducing this column speaks to the horror, danger and selflessness of her efforts.

I was introduced to the history of Clara Barton as a high school student living in Fairfax Station, VA. An old church near my neighborhood (St. Mary of Sorrows) served as a field hospital during the Second Battle of Manassas where Clara tended to the wounded. I have been more recently reminded of her exploits with the centennial marking her death in 1912.

Beyond her efforts as a self-trained battlefield nurse, she also established a notification system for families concerning wounded or killed soldiers. Although her place in history was assured by her service during the Civil War, she did not rest on those laurels but went on to found the American Red Cross, having been inspired by the Red Cross organization in Geneva, Switzerland. Her vital notification system continues today through the Red Cross. Clara Baron had an intense desire for service to her fellow man, particularly in times of war or disaster and is perhaps one of the best examples of what it means to be a nurse in times of war.

Modern medicine depends on the nursing profession. For many decades the profession has been dominated by women, but that is quickly changing in developed nations. Efforts to enhance the medical systems in both Iraq and Afghanistan have been hindered by a general lack of skilled nurses in these countries. Cultural mores of these societies traditionally have frowned on professional women, providing little social incentive or compensation for the work.

Even when men, in these male-dominant societies, are inculcated into the occupation, decades of war in both countries have severely damaged educational systems to the point where many nursing candidates cannot even read. From my perspective, it does not surprise me how the absence of a modern nursing tradition can derail efforts at bringing either country’s healthcare system into the 21st century.

Time and again in my own career, the first essential step to building a new medical system or achieving meaningful positive change in federal hospitals centers on hiring quality nursing staff. Nurses are the “doers” of medicine. As an acute pain medicine physician at Walter Reed, I often like to say that I am pretty good at developing a pain care plan for inpatients, but it is the nursing staff that actually makes those plans work.

In my research organization, the Defense and Veterans Center for Integrative Pain Management, most major clinical research projects begin with a discussion about hiring a research nurse manager.

There is no denying it: My success as a physician has depended on the field of nursing. I am continually impressed at the flexibility of the nursing profession to mold its constituents into new roles and responsibilities, regardless of the direction that modern medicine takes. I am married to an intensive care nurse who, after sidelining her career to raise our three daughters as the Army moved us around, has reinvented herself by training as a licensed massage therapist, complementing her nursing training as she works to bring the benefits of massage to the burgeoning geriatric population.

My wife often comments that the most special flowers I bring home are the ones presented without an occasion. I purposely timed this editorial — more a note of recognition and thanks to the profession of nursing — when this acknowledgment was not scheduled. From my first days as an intern on the wards to the combat support hospitals in Iraq and Afghanistan to my efforts now as an acute pain medicine attending physician, my success as a physician has depended on nurses. I have witnessed the selfless service and compassion of federal nurses working with the wounded at home and on the battlefield. I am encouraged for the future of federal medicine because I know the standards of Clara Barton persist in her posterity. So to all the nurses I have met and those that I have not, I will finish with a heartfelt and hopefully unexpected, “Thank you.”

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