Snatching defeat from the jaws of victory

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“Snatching defeat from the jaws of victory”unknown

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 do not believe I am exaggerating when I suggest the American CSH and evacuation system is the most efficient and advanced source of trauma care and transport on the planet. The federal system of combat-casualty care is perhaps the fullest expression of modern allopathic medicine. I have been witness for years to the miraculous work this system performs on a daily basis in preserving life in patients with horrific wounds in the most difficult environments. American service personnel have a greater than 90% survival rate following wounding, a statistic never before achieved in the history of warfare. All of federal medicine can be justifiably proud of the roles we all have played in this historic achievement, this victory over the wounds of modern battle.

It is no secret to my readers that I am proud of federal medicine, its accomplishments and the population in its care. Then I am reminded that hubris is considered the most serious of the seven deadly sins. I will explain …

I recently had the pleasure of speaking at the 21st National Conference of the American Society for Pain Management Nursing, in Tucson, AZ. I was part of a general session dinner symposium on military pain management. As part of this presentation, we had the rare opportunity to humanize our comments by relating them to the life story of a wounded warrior, Army SPC Alex Knapp. His story is an uplifting account of the success of American battlefield trauma care and rehabilitative care, coupled with the epic determination of an Army soldier, to produce a real success story and model of how wounded warriors and their families can not only survive, but also thrive following devastating injury. Alex was injured in Iraq when his vehicle was struck by an improvised explosive device. He sustained shocking injuries to both lower extremities that would result in both legs being amputated above the knee. The consummate soldier and leader, Alex, despite his overwhelming injuries, was able to drive his vehicle to a safer location and initially attempted to refuse medical care until he was assured that other members of his squad were treated. Despite his devastating trauma, Alex had much in his favor for recovery. Survival from the initial injury was made possible by his own dogged determination and the most technically advanced trauma and evacuation system ever seen in war.  Perhaps more important for his eventual recovery, he had the loving care and support of a devoted family. I was personally touched and honored to meet Alex’s younger brother, Michael Shane Knapp, and his mother, Jeannette Knapp, at the symposium ceremony to celebrate Alex’s accomplishments.

Prior to his injury, Alex was an avid hockey player, and he continued his love of the sport as part of his rehabilitation, joining a sled hockey team, the Michigan Sled Dogs out of Macomb, MI. Alex continued to give back to the community by working as a motivational speaker, advocating for Homes for Our Troops and helping to raise community consciousness on the challenges faced by wounded veterans. By all accounts, Alex was back and better than ever. 

Tragically, on Oct. 2, 2010, Alex suffered a massive heart attack while playing an exhibition hockey game at Ferris State University and died at only 24 years of age. I had the pleasure of speaking at length with Jeannette Knapp following the symposium about these events and the Knapp family. She described her dismay at feeling the family had “recovered” from Alex’s war trauma, only to be struck by this second heartbreak. Jeannette expressed nothing but praise for federal medicine and the care Alex had received during his long recovery. As our conversation progressed, she did note that, despite the incredible rehabilitation work accomplished with his amputation injuries, providers did not confront Alex about his smoking habit. She even mentioned how the family had observed his raw stumps blanch when Alex smoked. 

I was struck by this comment and could not help wondering if all of the incredible recovery effort by this wounded warrior, his family and the federal medicine system and been thwarted by the lack of a simple preventive medicine conversation about the risks of smoking and heart disease. Had we become so focused on recovery from the physical injury that we had neglected the simplest advice to the patient to follow a healthy lifestyle? Had we neglected the person attached to the amputation that we were managing so effectively? Had our devotion to the allopathic tradition of reductionist medicine caused us to snatch a defeat from the clear recovery victory that was Alex’s case? Clearly I have no evidence or additional insight to answer these rhetorical questions, but I believe there is value for every federal medicine provider to ponder Alex’s story, if for no other reason than to honor the sacrifice that this brave soldier and family have given our country.

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