“Embrace the suck.” – Military expression.

Editor-In-Chief, Chester “Trip” Buckenmaier III, MD, COL (ret.), MC, USA

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.

The quality of this exercise has received international attention with the best foreign military medical students from numerous countries (United Kingdom, New Zealand and Israel last week) attending annually. Completing Bushmaster defines the USU student as ready to serve the nation as a Role 1 physician or advanced practice nurse in support of our warfighters. Ask any physician to recall their cellular biology professor or biochemistry experience from medical school, and they will likely struggle. Ask any USU student about Bushmaster, and you will get details. No student completes this experience without being profoundly and positively changed.

The military is known for the intensity and difficulty of its training programs, especially for Special Forces units (Air Force Pararescue, Army Ranger, Navy SEAL as examples). I am not equating Bushmaster to these other distinct and life-defining experiences, since comparisons are necessarily artificial as each training program is unique to the mission of that service. What sets Bushmaster apart is the focus on building a medical system to deal with war trauma in a resource-constrained field environment. Students are confronted with complex and incredibly realistic (“Walking Dead” graphic moulage) trauma cases, behavioral health issues and preventive medicine problems, while trying to lead a medical platoon in support of a notional military action in the fictional country Atropia. Students rotate through various leadership positions within the medical platoon (platoon leader, surgeon, ambulance team leader, medic, behavioral health officer and preventive medicine officer as some examples) that is in support of coalition forces in a hot war. They are in the field at Fort Indiantown Gap at the mercy of the weather and a typical 24-hour day represents four of five full Atropian days, so the pace of activity is purposefully breakneck fast and exhausting. In short, the Bushmaster exercise creates a level of stress and discomfort that most medical students in this country would consider in modern vernacular to “suck.”The Bushmaster exercise does suck like any military training of significance. Military training is designed to suck, because war sucks more. Many of the elite training programs I mentioned as examples simulate the stress of war through extreme physical stress. Bushmaster is focused on the profound mental stress associated with managing the trauma of war in a field military setting. We are hard on our students in a way that few civilian medical students would comprehend or accept. USU students understand they have a sobering responsibility to care for those in our military who place themselves in harm’s way in defense of our country. They also understand from history that this care is often rendered in some of the most challenging and unpleasant situations. They are a proud and vital part of the 0.5% of our population that accepts this dubious deal because of an underlying desire to serve the nation.

Bushmaster is the defining medical school experience for those medical professionals who are willing to serve as leaders in military medicine and “embrace the suck.” As a pain specialist, I am often heard saying, “Pain is often unavoidable, but suffering is always a choice.” Most activities of any value in our society require people to do things outside of their comfort zone. Just becoming a medical professional requires effort outside of the usual comfort zone of most people. Becoming a doctor requires a level of dedication and personal devotion that, at times, just sucks. I think this is one of the reasons society continues to venerate the profession. It is deep within the fabric of our society that we respect and appreciate those who set aside personal comfort and desire in altruistic efforts that benefit the greater community. Police, firefighters, servicemembers, and, yes, Bushmaster graduates are all examples of this laudable slice of our society. Folks in this club face the “suck” every day, and they chose to embrace it and overcome it for the benefit of others. From my perspective, there are few more honorable activities to which humans can aspire or choose to spend their days..

In a few hours, I will be back in the field with my platoon ruining my students’ day with my fickle finger of medical fate. Nothing ever seems to go well for my platoon in Atropia. I will be responsible for extreme suck in their Atropian activities today. I am not concerned about this, and I would argue, USU students are not bothered either, for they understand the importance of dealing with this artificial suck so they can function in the real suck of war when lives are on the line. As the patch on my left shoulder states (no worries, it is a nonmilitary uniform), they have learned to “embrace the suck” for the honor that comes with caring for those who defend us.