Extraordinary times

“Extraordinary times call for extraordinary measures.” — Benet Wilson

Last month’s U.S. Medicine August 2020 editorial, “It feels like writing ‘Bad things are about to happen’ on a napkin and then setting the napkin on fire.” — Colin Carlson, was angry. This month’s editorial is an admission of regret for that anger, a recognition that anger serves no useful purpose in the face of national tragedy. It perhaps defines a better way to act going forward. Admittedly, the editorial was cathartic for me. Still, I am not sure it was much of a public service to my readers. The depth and breadth of the COVID-19 pandemic in this country has been overwhelming to society. It has exposed divisions in our union that have been simmering under our national veneer of unity.

Bad things are about to happen

“It feels like writing ‘Bad things are about to happen’ on a napkin and then setting the napkin on fire.” ~Colin Carlson

This month’s quote comes from Dr. Colin Carlson, a research professor specializing in infectious disease from Georgetown University who commented to reporter Ed Yong in The Atlantic magazine article entitled “The pandemic experts are not OK—many American public-health specialists are at risk of burning out as the coronavirus surges back” July 7, 2020. This comment struck me, because it sums up the last several months of watching SARS-CoV-2, dubbed COVID-19) spread out-of-control around most of this country. It has been heart-wrenching to watch exhausted healthcare workers, battling on the front lines of this pandemic, pleading with Americans to take this viral epidemic seriously.

The Real Enemy is Arrogance

“The real enemy is arrogance.” —fictional Gen. Mark Naird, Netflix “Space Force,” Episode 10.

Like many Americans, I thought we had reached rock bottom in terms of things going wrong for our society, but it appears we have begun to dig. The COVID-19 pandemic seems to have scoured the pleasant American veneer of union and equal rights under law and exposed this fiction as the true reality of our society. The reality being exposed is the unpleasant and deeply painful truth of institutionalized racism and wealth inequality that has plagued our culture since its inception with the signing of the Constitution. This is not to say we have not made progress. There is no denying that our struggle to form a more perfect union in this regard has advanced since the American Civil War; the first major surgery to begin the process of addressing racism through the abolishment of slavery.

You Gotta Fight for Your Right to Party

“You gotta fight for your right to party.” ~Beastie Boys (lyric released 1986)

“If I get corona, I get corona. At the end of the day, I’m not going to let it stop me from partying.” This statement was made by a young Miami Beach spring-breaker on camera to a Reuters reporter on March 18, 2020.1 This sound bite played on the national news and summed up the feelings of thousands of young people who had been planning to attend this beach party for months, and they were not going to let a silly virus get in the way. Recognizing that March 18 feels like a decade ago and the impact of COVID-19 on our country was only beginning, I can empathize with this young man’s priorities. That is not to say I was not shocked and appalled when I saw this video on the nightly news.

Action Speaks Louder than Words

“Action speaks louder than words but not nearly as often.” ~Mark Twain (1835-1910)

COVID-19, often referred to as coronavirus, has dominated the news as this new viral threat spreads across the globe as the latest major pandemic. Pandemics are nothing new in world history: HIV/AIDS pandemic (at its peak, 2005-2012) 36 million dead, flu pandemic (1968) one million dead, Asian Flu pandemic (1956-1958) two million dead, flu pandemic (1918) 20 to 50 million dead, sixth cholera pandemic (1910-1911) 800,000 dead, flu pandemic (1889-1890) one million dead–and the sordid list continues into recorded history. Any student of medical history is not surprised by this latest plague beyond the fact that it did not happen sooner.

Yes, improvements in the general hygiene (in the developed world) of humans on this planet and the incredible contribution of vaccinations (thank you, Edward Jenner–smallpox vaccine, 1798) has improved general health and accounts for many human plagues being eliminated or at least uncommon.

If you Think Adventure is Dangerous

“If you think adventure is dangerous, try routine; it is lethal” ―Paulo Coelho

My wife, Pam, and I recently returned from a fantastic sailing adventure in the Bahamas aboard the Liberty Clipper, part of the Boston Harbor Liberty Fleet of Tall Ships. The 125-foot gaff-rigged schooner is a modern replica of the small merchant vessels that plied the American coast in the 18th and 19th centuries. While the steel-hulled ship caters to tourism in Boston during the summer, taking guests on short sails around Boston Harbor, it overwinters in the Bahamas out of Nassau, providing weeklong cruises throughout the islands for those looking for something different in cruising.

This cruise is more of an adventure tour. The food was outstanding—my glass was never empty—and the scenery was incredible (we sailed the isolated Bahama Exuma islands), although the cabins were consistent with a working sailboat. While we did have a private bathroom, we slept in bunks, and Pam and I could not pass each other in the cabin without one leaving the room.

If you want to clean up the world, first clean up your room

“My mother used to say to me if you want to clean up the world, first clean up your room.”—S.E. Cupp, CNN interview aired Jan. 4, 2020, 1800 ET.

CNN reporter Sarah Elizabeth Cupp was interviewing Rabbi Joseph Potasnik concerning recent anti-Semitic attacks on members of the Jewish faith. My spouse, Pam, viewed the CNN interview and made me aware of Cupp’s quote used above from the broadcast. My wife and I have been discussing the ongoing challenges to the world’s environment due to the consequences of climate change, the horrifying ongoing bush fire disaster in Australia being the most current and poignant example. Unpleasant changes in our global environment from extremes in weather, animal species extinction or rising sea level seem to be routine on the nightly news.

The Two most Frightening Words in Washington: “Bipartisan Consensus”

“The two most frightening words in Washington are ‘bipartisan consensus.’ Bipartisan consensus is when my doctor and my lawyer agree with my wife that I need help.” —P.J. O’Rourke

I have been struggling with the idea of consensus-building for some time in my machinations within the Defense Health Agency to mold effective pain management policy for military beneficiaries. P.J. O’Rourke, one of my favorite modern authors and satirists, cuts to the heart of the issue with brevity and humor. I can easily identify with the feeling that O’Rourke’s comment on consensus evokes in my efforts to move forward on any front within pain medicine by forging agreement among military medical leaders.

As I have noted many times in this column, decisions for medical change are far easier to achieve during a hot war, when the necessity for action is made clear through the clarifying lens of servicemembers’ blood, injury and suffering.

“Not Part of the Ordinary Medical School Curricula”

“Treating mass casualties or performing emergency procedures in the middle of a firefight or while under chemical attack are not part of the ordinary medical school curricula.”

Rep. Constance A. Morella (R-MD) Constance “Connie” Morella was a Republican representative for Maryland’s 8th Congressional District from 1987-2003 during the Bill Clinton presidency and made the above comment in 1994.

At that time, Vice President Al Gore and a team of congressional leaders were working to reduce the nation’s deficit. They were planning the demise of the Uniformed Services University, suggesting that military physicians and nurses could be procured from civilian medical institutions through health professions scholarship programs at significantly less cost than graduates from America’s only military medical school. Clinton’s spending plan for the 1994 fiscal year called for the first significant steps to close the institution.

Embrace the Suck

As I write this editorial, I am fully engaged in the Uniformed Services University’s Operation Bushmaster1 as a platoon team leader instructor. I have mentioned this activity numerous times on this editorial forum. The Bushmaster experience is perhaps the best example of why USU is clearly a unique medical university producing medical leaders for our military and our country. For the USU School of Medicine, Bushmaster is the culminating final exam where students exercise four years of military-specific training in leadership and battlefield trauma management provided through the USU Department of Military and Emergency Medicine, where I currently serve as a professor of anesthesiology.

I told you so

I told you so

“The four most beautiful words in our common language: I told you so.”—Gore Vidal (1925-2012)
I wrote an editorial in U.S. Medicine on June 10, 2018, entitled “If you tell a big enough lie and tell it frequently enough, it will be believed.”

In an Age of Incompetence

In an Age of Incompetence

“I am, as I’ve said, merely competent. But in an age of incompetence, that makes me extraordinary.” ~Billy Joel

Like many others who pursue a career in medicine, I invested my early years as a 20-something in a seemingly endless effort to obtain the necessary education and training requirements to place an MD at the end of my name. Yes, I would find part-time work in the summer for extra beer money but did not need to work while in school. I was fortunate to have parents willing to financially support my educational efforts and “Uncle Sugar” (the U.S. Government) was willing to pay for my collegiate and medical school expenses in exchange for Army services in defense of the Constitution.

Do as much nothing as possible

Do as much nothing as possible

“13. The delivery of good medical care is to do as much nothing as possible.” “Laws of the House of God,” ~Samuel Shem

I have been a part of U.S. Medicine and this column for several years now. I am occasionally asked where my ideas come from for the editorials I produce. Many ideas, of course, are pulled right out of the headlines or the nightly news. Others are derived from my experiences, both medical and otherwise, that have a link (no matter how tenuous) to our collective experience as federal medicine providers.

“God help us, if, the first time something fails—and something will fail—we crush whoever it was … whoever’s responsible,” —Gen. John “Mike” Murray

Gen. Mike Murray made this comment as he became the first commander of the Army Futures Command. The command’s website describes the mission of the organization with the following statement: “Army Futures Command leads a continuous transformation of Army modernization...