Return to Duty

During this deployment, I have witnessed countless Purple Heart ceremonies. Usually a general and his entourage come to the hospital to honor the wounded warrior. They will march into the hospital ward and spend a few minutes with each soldier or airman. It's a nice touch. A few nights ago we had 5 Purple Hearts awarded. I had admitted all 5 of these patients in the wee hours of the previous night. The group had been out and about in Afghanistan when their vehicle was hit with a rocket propelled grenade. I do not know much more than that. We try to respect the privacy of our patients here allowing them time to process what has happened. Sometimes they will talk openly about a firefight or an explosion. Most of the time they just want to sleep. This is rather obvious when the entire medical staff does hospital rounds together at 0630 every morning. The patients will often just pull the sheets over their heads and try to ignore us all. There is no need to bother them at this point. The thing they need the most is time away from the insanity of war.

But let's get back to my 5 patients from the other evening. The general entered the ward with a slew of support staff. He offered some words to each soldier before the following was read aloud, "This is to certify that the President of the United States awards the Purple Heart to Staff Sergeant ______ for wounds received in combat on 12 April 2010." The declaration goes on to say that the Purple Heart was first given out by General George Washington. These ceremonies are important moments for our troops. I have yet to get tired of seeing one of our wounded warriors be recognized. If I am present when a patient of mine receives the Purple Heart, the emotions are strong.


It is not uncommon for patients to come to our hospital after an IED attack (and they are definitely attacks when you consider the intent of the terrorist is to kill), get a full battery of tests, and then be deemed "Return to Duty". Essentially, the patient does not have any major injuries that require surgery. However, this is not to say that the effects of the attack are not profound. There is a term from years ago, shell shocked, which goes a long way in describing these patients. In the year 2010, we call it combat stress. Whatever you want to call it, the bottom line is that the mental strain of war has made its mark. After all, just being in a combat zone is beyond the normal human experience.

4 out of my 5 patients from earlier this week did not need surgery or long term therapy. They did not need to be hospitalized from a purely medical standpoint. But, we kept them there for a day anyway. The old adage of "three hots and a cot" still rings true. It is generally accepted in military medicine that getting these soldiers back to the fight is actually the best thing for them. I agree with this to a certain extent. I do not rush these patients back out to their forward operating bases. To me, being in a life threatening situation then being flown to a hospital for a full medical work up warrants some time off for pete's sake! This is where my training in Family Medicine comes in handy. We are trained to be advocates for our patients. So, my patients get a letter stating that they should be on convalesence for 72 hours and we make arrangements for them to stay near the hospital for that time. This seems like a reasonable compromise to me whether they are a special forces guy who is gung ho or an infantryman who is scared out of his mind.