Freedom is not the right to do as we please, but rather the opportunity to please to do what is right

Like many Americans, I have enjoyed the gradual return of regular activities as the COVID-19 pandemic appears to be waning as significant numbers of our population receive one of three available COVID vaccines. I have relished freedoms I took for granted 16 months ago, like eating in a restaurant, going to a movie, or entering a supermarket without a mask.

“He who wishes to be a surgeon should go to war.”

I was teaching this month at Fort Indian Town Gap, PA, for Bushmaster 2020. Running a Bushmaster exercise in the spring is uncharacteristic since the event usually occurs in October. Unfortunately, the COVID-19 pandemic struck in March of last year with a vengeance. Like many folks, the calendar at my desk in our office building is still on March 2020 as I sit at home writing this.

There is nothing like it for morale, to be reminded that the years are passing—ever more quickly

I found this comment from Prince Philip, Duke of Edinburgh, compelling as the English royal family faced Philip’s death on April 9, 2021, at age 99. His passing might have hardly been noticed by me beyond my respect for his service to the UK and what he represents for America’s closest ally. Sadly, though, the event was poignant for me personally as I recently lost my own father, Chet Buckenmaier, unexpectedly just a few weeks ago.

“Wear a mask.” – Anthony Fauci, MD.

Dr. Anthony Fauci made the now-famous statement, “Wear a mask,” during a 60-Minutes interview at the start of the COVID-19 pandemic in March 2020. The verbal missive has been requoted countless times by government officials and healthcare leaders during the past year. The Yale Law School library has listed this statement as one of the top 10 quotations that define the year 2020.

“Meditation is allowing what is.”

“Meditation is allowing what is.” —Victor Davich
Indulge me for a moment. Move to a space where you are alone and can be comfortable. Close the door to the room you are in and turn off any nearby electronic devices that might command your attention. Do not worry; this will only occupy a few minutes of your time. Pick an object in the room and focus on it while taking two or three deep breaths in through your nose and out through your mouth. Then, gently close your eyes and focus your mind on the sensation of breathing.

Anything that you can conceive of as a supply chain, blockchain can vastly improve its efficiency

“Anything that can conceive of as a supply chain, blockchain can vastly improve its efficiency—it doesn’t matter if its people, numbers, data, money.” —Ginni Rometty, CEO IBM

Well, we enjoyed five decent days in 2021 before the Jan. 6 insurrection; I guess we should hope for better in 2022. I am paraphrasing a statement I heard on social media (I am sorry that I do not have the original source). I feel like 2020 is analogous to a drunken college roommate who has been out all night involved in some unspeakable debauchery and comes home to vomit on your floor in the morning

Among other common lies, we have the silent lie

“Among other common lies, we have the silent lie — The deception which one conveys by simply keeping still and concealing the truth. Many obstinate truth-mongers indulge in this dissipation, imagining that if they speak no lie, they lie not at all.” —Mark Twain (1835-1910)

In “The Art of War,” Sun Tzu reminds us that “all warfare is based on deception.” As an ROTC cadet at Catawba College in North Carolina, my military instructors often provided examples of how commanders utilized deception to gain an advantage over the enemy. In fact, “here’s to the confusion of our enemies” is a toast often heard at military celebrations.

We the people are the rightful masters of both Congress and the Courts

“We the people are the rightful masters of both Congress and the Courts, not to overthrow the Constitution but to overthrow the men who would pervert the Constitution.” —Abraham Lincoln (1809-1865)

Last month, my editorial was written following the debacle of the first presidential debate. By any standard, the debate was a sad commentary on the state of our union, as well as an affront to civil decorum owed to the American public by our leadership. I admitted in that editorial that my faith in the resilience of our longest-established democracy had been shaken.

That was a hot mess inside a dumpster fire inside a train wreck.

“That was a hot mess inside a dumpster fire inside a train wreck.” – Jake Tapper, CNN

On Sept. 29, 2020, the first presidential debate was hosted in Cleveland by Case Western Reserve University and the Cleveland Clinic. Like millions of other Americans who believe the upcoming election is one of the most consequential in our 244-year history, I settled in with a beer to watch. I have been consuming the historical fiction series, “Vikings,” on Hulu that involves considerable hacking and slashing battle scenes. During the course of the debate, I was tempted to turn back to “Vikings” for something a little less traumatic and disturbing.

Only One Rule in Medical Ethics Need Concern You

“Only one rule in medical ethics need concern you – that action on your part which best conserves the interests of your patient.” — Martin H. Fischer (1897-1962)

My mother, who I give complete credit for my abilities to manipulate the English language to craft these editorials, recently sent me an article by Julie Steenhuysen (Reuters, Aug. 14, 2020) entitled, “U.S. to make coronavirus strain for possible human challenge trials.” Mom, who is not one to mince words, included the email comment, “OMG! Crazy … ” I believe my mother’s remark was able to convey the meaning behind this month’s quote by Dr. Martin H. Fischer, but she managed to do so with just 12 characters. Although my mother is not a healthcare professional, she understands a foundational medical ethics concept of which I, Dr. Fischer, and all healthcare providers are familiar with—primum non nocere.

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...