Book Review: "The Surrendered"

The Surrendered by Chang-rae Lee












My rating: 4 of 5 stars

I chose to read this book because of its roots in the Korean war, written by a Korean. Current events compel me to be very interested in Korea these days. Also, I'm writing a novel and a screenplayrefer hinged to the ongoing strife between North and South Korea as backstory.

In "The Surrendered" we first meet the protagonist, June, as an eleven-year-old refugee fleeing Seoul for Pusan and struggling to protect her two younger siblings against horrific physical and human challenges. Following June's life in a non-chronological way, we eventually come to know the other main characters, Hector and Sylvie, through their own stories.  All are rooted in one way or another to the Korean conflict of the early fifties, but carry forward to the modern era as well. The author skillfully and meticulously weaves the characters' lives together through the second half of the book, creating at the end a cohesive tapestry of both yearning and fulfillment.
It's a well crafted, provocative story with some magnificent prose, albeit overly descriptive at times. Not as dialogue/action rich as other contemporary novels, it is worthwhile read nonetheless. I especially appreciated the well described insights about the physical and psychological effects of war on common people and young conscripted soldiers.

Some of the images are not pretty, but then neither is war or its aftermath. And sometimes life is just like that.

Metal Chopsticks, Driving on the Right, and....

....kim chee, of course.


I'm back in Korea for a few days. Seoul, to be exact, a very different place from Busan, the southern port city where we usually stop with the Flagship. Seoul is to Busan as New York is to Norfolk. Seoul is sophisticated, cosmopolitan, with a panoply of architectural delights and any delectable ethnic cuisine that you want. Driven in from the airport this evening, I saw a Mexican restaurant next to an Australian fish house. Did I mention cosmopolitan?


Seoul is one of those cities that you know you'd love if you could just spend more time getting to know it. We usually stay in Busan two weeks at a time twice a year. I get to Seoul once a year for two days of meetings. Make no mistake, Busan is just fine to visit. Even neighboring Chinhae has its own special charm. But Seoul is an international destination, like many of the world's capital cities. Koreans go to Busan for a beach vacation. Americans go to Seoul to see Korea.


Oh yeah, I know about that crazy man up north and his erratic shenanigans. So what? As it should be with any terrorist, he doesn't deter the ROKs from enjoying life, even within range of whatever destructive toys he claims to have pointed in their direction today. Maybe living under that repetitive threat enables the GSMA* denizens to enjoy life all the more. "Better the devil you know," right? Would victims of 9/11/2001 have lived their lives differently knowing they were under imminent attack? Perhaps for the better. Life is fragile, wherever you live and whoever has you in his/her gunsights. So, carpe diem. The ROKs seem to have a heckuva good time doing just that.


Koreans typically use metal chopsticks...washable, reusable. You can take them with you if you have to move in a hurry. Japanese use wood, some of which are washable, many disposable. Plenty more from where those came. They don't plan to move any time soon.


Although they certainly have their own history and culture, ROKs seem more westernized. They drive on the right side of the road. ROK music and movie stars are pop icons, even in Japan. In general, our ROK friends seem less encumbered by history, tradition, and austere culture than their Japanese counterparts. Neither is bad. This job enables me to learn about both these and the many other Asian cultures in the region.

Naturally, each culture enjoys its own cuisine. I relish both. I can wrap my lips around Korean BBQ any day, or bulgogi, or bibimbap, and -- yes -- kim chee. I also enjoy my sushi, sashimi, ramen, and tempura. It's a blessing to have access to both. (As well as the scrumptious Chinese food to be had in Singapore, but that's for another post on another day.)

Tomorrow we will parlay with our ROK medical counterparts over some fairly serious business. We do live in a hazardous world that makes for daunting challenges in force health protection and operational medical support. Our main purpose, however, is learn about each other's capabilities, so we can work together as a team. After these serious discussions, then, we will do what men and women of good will and mutual respect often do when teambuilding. We will man up our metal chopsticks and dine together. We'll probably drink a bit together too. That's diplomacy, folks.

*GSMA ("gizma") = Greater Seoul Metropolitan Area

A Big Gentle Man

The sight was unusual because you seldom see a man wearing yukata on the Shinkansen, the Japanese bullet train. You would more likely come upon a woman in kimono, but even that would be extremely rare. Sojourning nihonjin typically wear casual travel attire or the ubiquitous dark suits that mark traveling business men.

Nearing the end of a pleasant weekend in Osaka and Nara, we stood by on the Osaka platform as the train scheduled ten minutes before ours disembarked its passengers. The yukata-wearing gentleman caught my eye as he completely filled the train's doorway. Perhaps his huge body mass, atypical of slighter Japanese frames, first drew my gaze. My mind quickly associated the yukata, the roughly 300 pound build, and traditional hair bun to identify this man as a sumo wrestler. Encountering one of these professional athletes on a train platform in Japan would be as noteworthy as spying a professional ballplayer at the departure gate of an American airline.

I wondered if a sumo tournament had come to Osaka, all the more puzzled why a man of such stature would arrive by Shinkansen. Sumo wrestlers enjoy the elite status in Japan similar to professional athletes in the U.S.  Perhaps, I thought, this man is juryo, like a U.S. minor league baseball player, as opposed to a makuuchi, which is the higher division of most accomplished banzuke. In the U.S., one might see a minor league ballplayer traveling commercial air, although probably sporting a muscle shirt instead of yukata.

The man who must be sumo moved very slowly through the doorway, pushing a wheelchair ahead of him. "Perhaps he is injured," I mused. But once he was on the platform, he raised his hand to the official whose job is to keep the trains moving on time. The gesture clearly said chotto matte, "Wait a minute." Then he turned to assist someone disembarking behind him. His traveling companion was a thin, frail man who moved painfully slowly with the shuffling gait so typical of one stricken with Parkinson's Disease. (I know it well.) Then the huge man very gently assisted the impaired man off the train and helped him into the wheelchair. Only when his companion was fully secured did he signal the railway official to release the train on its way.

As the bullet train left the station, the sumo man pushed his fragile companion in the wheelchair towards the elevator. Here was a full slice of the human condition. This athletic behemoth, who devotes his entire adult life to heaving other big men onto the dirt, was now very gently and humanely engaged in the care of his frail and failing father.

As the enfeebled father and burly son slowly left the platform, I recalled another time and place. A small tear came to my eye.

Meanwhile, Back on the River

(Warning: This post contains graphic, unpleasant descriptions and explicit anatomical references, all of which do lead to an important conclusion.)

Men can also sail Denial River, sometimes with dramatically tragic outcomes.

I remember this 45-50 year-old businessman from way back to my student days at the Medical College of Wisconsin. On call at the VA Hospital during my 3rd year general surgery rotation, I picked the patient up after his initial triage in the ED. The chief complaint line on the ED chart simply stated "Smells Bad."

His employer had forced him to seek medical attention. "Man, you stink, and you have been stinking for too long. I can't have you around our customers when you stink. So either go to the hospital and find out what's wrong, or you're fired."

In spite of having showered that day, he absolutely reeked, like an obnoxious combination of feces and rotting flesh. We wondered how he could even stand to be around himself, let alone foist his malodorous presence onto others. He'd been that way for weeks if not months, yet had somehow managed to deny to himself and his family that anything was wrong...until threatened with financial ruin.

The symptoms of his underlying disease began about six months previously, with a change in his bowel habits and persistent abdominal bloating. He had sometimes noticed blood in his stools, but figured he must just have hemorrhoids. Finally he had only liquid stools, nothing solid, and a chronic sensation of incomplete evacuation. And, yes he had lost weight, but couldn't say how much. Plus he admitted to progressive fatigue. And he didn't sit much, because it hurt his buttocks to do so.

When examined, he was running a fever and looked ill. His abdomen was mildly distended, diffusely tender and tight, with rare high pitched, rushing bowel sounds. The cause of his vile odor resided in his perineum and peri-rectal area, where a raging infection had invaded the soft tissue spaces around his rectum and genitalia, enlarging his scrotum to the size of a softball. 

The cause? Some time previously, a fungating invasive cancer had  perforated his rectal wall and allowed the bacteria-laden fecal stream to gain access to the highly vulnerable soft tissues on the other side of that wall. For months these voracious microbes, who do not require oxygen to live, had feasted at will on his flesh, creating new pus-laden cavities where only virtual spaces normally exist. Had he not been forced to seek medical attention, these insensate microscopic space invaders would eventually consume the life of their most accomodating host.

The treatment turned out to be more gross than the disease. The surgical team labored for hours, with oil of wintergreen stuffed up their noses to fight off the stifling stench, methodically filleting wide open all the involved tissue to get rid of the bacteria, then packing the exposed flesh (testes included) with gauze to encourage healthy remaining tissue to overgrow that which had been destroyed by the microbial invaders. The cancerous tumor, meanwhile, had to be left alone for the nonce. It would continue to grow in place because we had to control the infection first before the surgeons dared to resect the tumor.

I rotated from that surgical service while this unfortunate man was still in the hospital, but I believe he survived this tragic event. His open wounds were gradually healing, and the surgeons talked of taking him back to the OR to get rid of the cancerous mass. That would take extensive resection and an even longer recovery, and would leave him with a permanent colostomy. But he would live.

A prominent colo-rectal surgeon once stated that the most efficient, effective, and cheapest diagnostic tool for early detection of rectal cancer is a digital rectal examination...an admittedly uncomfortable and sometimes embarrassing procedure for the patient. In truth, most rectal cancers can be felt by the examining finger way before they can take down a grown man like this one. 

Considering alternatives like the one above, overcoming denial and accepting that simple procedure seems well worth the brief moment of embarrassment and discomfort.

NaNoWriMo - The End Is the Beginning

Indeed, it happened.

In twenty-six days I spewed 50,940 words onto 191 pages and called it a novel. Really a very rough draft of a novel, the product does contain the prototypical elements: Plot, characters, conflict, beginning, middle, end, and so on. This "novel" is no more publishable than a roughly hewed hunk of marble is a pieta. Many revisions must occur before it ever leaves the hard drive on which it now reposes. Yet even Michelangelo was once a rookie sculptor. I do not compare myself to the masters of art or literature, nor even to today's genuine authors, but I do relish the completion of something I'd never done and wasn't sure I could do.

This post is not to call attention to me. I really hope to share some observations for anyone who might consider a similar effort:

Like running, writing is a therapeutic passion. The investment of time and energy yields a  positive return in self-fulfillment and self-knowledge. "Wow, I really had that stuff skulking around inside my brain? Yikes! Talk about catharsis!" Quite fortuitously that catharsis comes without the cost of a shrink to set it loose. And, it beats the heck out of PowerPoint briefs, be it reading or making them.

Regardless of the actual written result, the creative process compels a deeper and broader understanding of life and self. A scene begins headed in one direction, but then it comes out all different...usually but not always better than originally conceived. Where did that come from? What subconscious power drove fingers over keyboard in exactly that sequence to produce exactly those words? Curiously, the ripest sentient idea sometimes never bridges the gap from brain to fingers. Instead a more profound expression takes form, one not fully conjured until it splays itself fully across the page, seemingly on its own power. It becomes the tangible summation of multiple cerebral synapses firing faster than the speed of light, or even of dark.

The NaNoWriMo challenge promotes that creative, insightful process. With only 30 days to put those 50,000 words into some sort of story, the erstwhile writer cannot afford the time to self-censor. And with that overbearing superego set aside, novel things do happen. That's the beauty of it.

In the end, it does not require perfection or publishability. It simply is. Just as the real value of a marathon is in the training, the benefit of this challenge is in the writing. At the end of the day you realize you can do it, and you want to do it again...and better.

Sometimes You Need That Egyptian River

"This is Rescue 7,"said the paramedic's tremulous voice over the radio as his vehicle's siren wailed in the background.

"We are en route Code 3 to your facility with a 15 year-old female, gunshot wound lower abdomen. Pulse 120, BP 90 over 60, respirations 26. We have started two large bore IVs of Normal Saline and have 100% oxygen running by mask. ETA your location is five minutes."

Now this be badness.

It happened early in my civilian practice, before the hospital where I worked established itself as a Level I Trauma Center. An abdominal GSW mandates surgery. As the nurses set up the trauma room, I phoned the on-call general surgeon and gave him the news that he needed to leave his office full of patients and come immediately to take this young lady to the OR. He would arrive in 30 minutes. In the meantime I was on my own.

I gave the nurses a litany of STAT orders to be done as soon as our patient hit the door: "Complete blood count, chemistries, urinalysis, type and crossmatch for six - make that eight - units of blood. Foley catheter..."

The doors burst open as the paramedic team rolled through with our patient. She was a pretty caucasian female with long blond tresses. I quickly surmised that her usual complexion was probably less pallid than her currently white skin color. She'd clearly lost a significant amount of blood, which I could not see because it was inside her abdomen. So no telling how much. Undressing her quickly, we found a single entrance wound about two inches below her navel. We rolled her on her side to examine her back. No exit wound. And no telling where the missile had traveled once it entered her body. Rolling her back to supine, I noticed powder burns around the bullet hole.

I turned to the medics. "How did she get shot?"

"Appears to have been self-inflicted," they responded. A neighbor heard the shot and called 911. We found her in her bedroom. She had her father's handgun."

As I turned back to the patient, the nurses completed inserting a urinary catheter into her bladder. The drainage was red with blood. "Keep those IVs going wide open," I ordered. "And get me a central line setup. Any word on our surgeon yet?"

"On his way," replied a nurse.

I quickly started a central IV line in order to give her more fluids. Her vital signs had begun to stabilize, so at least we were matching her blood loss and keeping her intravascular volume steady. She would make it to the OR where our surgeon could definitively stop the bleeding and repair whatever organs were injured.

Another look at the girl's entry wound had me feeling her lower abdomen. Sure enough, a mass the size of a softball was palpable. (There was no such thing as ED ultrasound in those days.)

"The OR is ready and the surgeon is prepping," said the nurse.

"Good," I replied. "Tell them to call an obstetrician as well."

This pregnant teenager survived her internal injuries. The fetus whom she shot herself to kill did not fare as well.

Not Only the Egyptian River - Part Two

Some time after the 18-year old single female delivered the baby she didn't know she carried in her womb, I saw a 39-year-old married woman who presented to the emergency department with - yep - acute onset crampy lower abdominal pain of several hours duration.

Other than her age, marital status, and somewhat less obesity, this lady's case evolved very similarly to the one I described in my last post. History was unremarkable except for irregular menses. Physical exam at first revealed nothing, then the unmistakable contractile mass in the abdomen, with palpable fetal head in the pelvis. No clinical badness here. This lady was in active labor with a full term baby, yet vigorously denied that she could be pregnant.

"My husband had a vasectomy," she told me with absolute sincerity. "We can't afford another child. I'm not pregnant."

My mind quickly sorted through the various reasons why the mere fact of her mate's vasectomy did not rule out what the physical exam unequivocally indicated. I reassured her that she was indeed 1) pregnant, and 2) in active labor. Then we did the math. She recalled the date of her husband's vasectomy with fair certainty. Assuming that she was now truly at term and in her 40th week of gestation, she had conceived roughly two weeks BEFORE her husband underwent the baby prevention procedure. At the very least, that should mitigate any paternity doubts that might afflict her mate.

I found her husband in the waiting room and invited him to join his wife briefly before we whisked her up to labor and delivery. "Yes," I confirmed, "she's in labor." The gentleman appeared briefly stunned but took the news in relative stride. He opened his mouth as if to ask a question, then paused, and then remained silent.

As he entered the room, his wife looked at him plaintively. "Sorry," she said. He held her hand. "What are we going to do?" she moaned.

"We're going to have this baby," he replied warmly, "together." Then he tightly but gently squeezed her hand.

I smiled as they were whisked out of the emergency department to L & D.

They say that good pitching beats good hitting on any given day in baseball. In life, truth holds that same edge over denial.

NOT ONLY THE EGYPTIAN RIVER - Part One

"Eighteen year-old female c/o abdominal pain," read the Chief Complaint section on the emergency department treatment record that I picked up in the midst of a busy evening shift. The venue was John C. Lincoln Hospital in Phoenix, early in my civilian days of emergency medicine practice. I was not residency trained. None of us were, because EM residencies barely existed in those days. We gleaned our knowledge base mostly from the trusting patients who sought our care. I worked about 192 hours a month, single coverage. I saw a many women with abdominal pain, but never anyone like this lady, from whom I learned several valuable lessons.

Approaching the bedside I observed a young, very obese woman in obvious distress, holding both hands over her lower abdomen. In between her paroxysms of pain, I asked the usual questions intended to quickly identify any potentially life-threatening source of her abdominal pain. When first evaluating a patient, regardless of presentation, the emergency physician must immediately look for badness, especially treatable badness, and intervene appropriately if warranted.

Abdominal pain infrequently harbingers "badness" in the true emergency sense. Patients usually define "badness" differently, as in "I really hurt" or "I'm really scared." Because they came to the ED they expect us to do something about it NOW. They want relief. We want a diagnosis. This difference in perspective sometimes generates early conflict in the ED physician-patient relationship. Said conflict often leads to a different sort of "badness," and often makes the subsequent evaluation more difficult for both the physician and the patient.

In many cases of abdominal pain, we can initially rule out true badness by the history alone. My interview of this lady tweaked my badness sense, but did not raise the titer to alarming levels just yet:

Pain is crampy in nature, started four hours ago rather suddenly, gradually increased in intensity, no fever or chills, no nausea, vomiting, or diarrhea, no urinary symptoms, last menstrual period started this morning, and she's always been irregular.

Needing more information I went directly to a focused physical exam. I felt her massive doughy abdomen and did not elicit any areas of rigidity or point tenderness, so maybe no badness there after all. But then the exam findings suddenly changed. A large contractile mass rose up to meet my examining hands. Quickly palpating the mass, I noted it extended most of the way up her abdomen. As the contractile mass relaxed, I thought I felt a small arm or leg move under my fingers. I quickly reasoned the need for a more accurate history.

"Are these cramps regular," I asked. "Yes," she replied, "they come about every five minutes."

"And tell me again, when was you last period, and how heavy was it?" I asked.

"Just this morning, not heavy."

Finally the right question: "When was the prior period?"

"I don't remember," she said. "A few months ago maybe."

She denied she could be pregnant, but I pretty well knew better by that point. A quick speculum and manual vaginal exam confirmed that this woman was indeed in mid-labor well on her way to delivering a full term infant. A couple of hours later, with the help of our reluctant on-call obstetrician, she delivered a healthy baby. Proverbially, mom and baby both did well, at least by our ER definition of lacking badness.

Over the years I've sometimes thought about this lady, although not so much about the emergency department drama. This case taught me most of all about the role of denial in the human psyche. Somewhere deep in her mind this young unmarried woman must have known or at least suspected she was pregnant. But so terrible to her were the psychological consequences, that her mind simply yet elaborately blocked that fact from conscious thought – even once the inevitable process of childbirth began.

This learning case was ultimately not about emergency medicine, or obstetrics. The most valuable lesson learned here came from the realm of mental health: Denial is a powerful yet subtle human defense mechanism that can ultimately wreak great havoc in one's life, greater even than whatever the psyche fears from the inciting event.

This was the first such case in my early emergency practice. I would not be the last...

Old Dog Meets Best and Brightest

At least a third of the people in the room with me today were not even born when I attended my first ever Scientific Assembly of the American College of Emergency Physicians (ACEP) in 1975. That meeting was held in Las Vegas, which makes it all the more remarkable that I remember any of it.  (Can you say "Palomino"?)


At that time I had recently completed a surgical internship, and even more recently eschewed a promising neurosurgery residency to become one of those new "ER Docs" who limited their practice to the hospital "Emergency Room." I was one of about 5,000 early members of the College, all of whom were "second-career" emergency physicians like me. The specialty of emergency medicine was not yet recognized in the house of medicine (AMA), and the American Board of Emergency Medicine was merely a dream in the heads of the hardy pioneers who founded ACEP. They established the College to support the continuing medical education of us second career docs. In the absence of any formal body of knowledge or curriculum that was a daunting task.


Although details might vary from one ER Doc to the next in those days, my breadth of medical knowledge contained Swiss cheese-like holes that required rapid filling before I could safely treat emergency department patients while practicing (literally) this "newest specialty in medicine." I felt very comfortable diagnosing surgical or neurologic disease and managing victims of traumatic injury. But hand me an electrocardiogram, and I had difficulty knowing which end of the paper was up, let alone recognizing subtle indications of what nowadays is termed "acute coronary syndrome."


Over the ensuing years the College succeeded in winning support for the formal recognition of the specialty of emergency medicine by defining a body of knowledge and core content. The American Board of Emergency Medicine became a reality, and I eventually became not only a diplomate but an oral examiner. Training of emergency physicians progressed from the pick up games of those early ACEP meetings to a formal curriculum adroitly taught by ACGME-accredited residencies in emergency medicine. The specialty rapidly became so popular that positions in EM residencies were among the most sought after in the entire house of medicine. In those days we boasted that emergency medicine attracted the "best and brightest" graduates of the US medical education system.


My naval career gradually drew me away from the emergency department as I became more involved in executive and operational medicine. But recently I decided that my previously home-grown emergency medicine skills were long overdue for refreshment...a decision driven in no small part by approaching retirement from the Navy. So I signed up for and endured trans-Pacific travel in the very back of a JAL 777 to attend a course entitled, "Essentials of Emergency Medicine 2010" in San Francisco.


Wow! Talk about the best and brightest! The quality of evidence-based knowledge and education here blows me away. We're talking major leagues here, folks. Looking back on my early days as a leader in the specialty, I feel as if I'm awakening from a long sleep to find a dream come true. In those very early ACEP Scientific Assemblies we had to rely on educators from other specialties to teach us the various aspects of our "specialty in breadth." Those presenters were often irrelevant to ED practice, simply reflecting their own specialty perspective (or bias).


Today a cadre of emergency medicine superstars, most of them from one program as USC LA County, presented topic after topic, fully researched and developed to a depth of understanding and practical relevance to the emergency physician, and more importantly the ED patient, that we barely fathomed in those early days. These are indeed, in every sense of the term, the best and the brightest stars in the house of medicine. I must add that the audience, hailing from throughout the U.S., Canada, and abroad, contains many similar luminaries.


This experience moves me to extreme optimism about the quality of emergency care available to U.S. citizens and beyond, now forty plus years after those early visionaries of ACEP devoted their time and energies, sometimes against formidable opposition, to achieve that very end. Names like Wiegenstein, Mills, Rupke, Krome, Mangold, Rosen, Hannas, Haeck, Riggs, Podgorny and many others resonate deeply in my mind this evening. The best and brightest of today truly do stand on the shoulders of those bold-thinking, dedicated giants from the early days of our specialty.


For my own part, a highlight of my attendance at "Essentials" yesterday was the EKG session. Looking at the first of a series of practice EKGs, I recognized -- within mere seconds -- that I was holding it upside down. Now what was that cardiac rhythm...?

"Turiku Turito"

Sunday evening's invasion of the Yokosuka Navy Base did not make international or even national news. Nevertheless, thousands of disguised, bag-totting nihon no kodomo and their parents traipsed all the way from the main gate to our Gridley Lane address in order to threaten us with "turiku" if we did not cross their palms with "turito":

They came in large groups:

And smaller groups:

Some earned single billing:

Some came as traditional American invaders:

While others emulated Japanese pop culture icons:

They relished American food:

And then, with a hearty "Hoppee Haroweeno," they were gone.

Leaving us to ponder the wonderful cultural interchange we'd just experienced, and what to do with all that leftover American candy...

NaNoWriMo

So, what is this "NaNoWriMo"? (Other than a reason why I may create fewer blog posts this month?)

The acronym stands for "National Novel Writing Month," a product of the Office of Letters and Light, which also sponsors "Script Frenzy" each April. NaNoWriMo promotes creative writing by challenging participants to complete a 50,000 word (or more) original novel in one month, between 1 - 30 November. Thousands of writers from all over the globe participate, many taking advantage of the resources available on the sponsoring web site, as well as support from writing groups set up in key locations throughout the world.

One "wins" NaNoWriMo by simply accomplishing the goal of writing that much original fiction in one month. The goal is to produce the words, so the products are rough drafts, not polished or publishable tomes. Serious writers may opt to rewrite their work into finished novels after the competition. Indeed, some past participants have gone on to publish their novels. But such is not the real intent. NaNoWriMo primarily encourages would-be novelists to venture beyond the dreaming and dive into the actual crafting. In the process many learn that they can, indeed, just do it.

Last April I participated in Script Frenzy, which had a similar goal of writing a 100 page script for either stage, screen, or comic book, within the 30 days of 1 - 30 April. I'd never written drama before, but figured nothing to lose by trying, especially with the ship underway and time on my hands. Much to my surprised delight, I completed a three act play a few days short of the deadline. (Not, however, ready for prime time even to this day after several rewrites.) More importantly, I really enjoyed the process. When it was all over, I continued to develop my interest in dramatic writing and recently completed a draft teleplay for for a one-hour television drama pilot. (Also not ready for prime time, pending a couple more rewrites.)

So now I've elected to try creative fiction writing in the novel format. So far it's an interesting and fun transition from present tense, dialogue heavy, action-based writing to past tense, descriptive narrative emanating from the minds as well as the voices of the various characters. Also a bit daunting, I might add, which makes me appreciate those true professional authors who turn out best sellers year after year. Much as with Olympians or accomplished musicians, we admirers usually see only the polished perfection that is the result of hours, days, weeks, and years of steadfast practice and hard work.

But, if creating beauty or entertainment were really easy, where would be the pleasure of watching a virtuoso performance, enjoying a fine movie, or curling up with a really great book?

Kudos to those committed, creative professionals whose ardent labors enlighten our lives through art, music, and literature!

Tank

The President of the United States didn't really bestow the nickname, "Tank," on the young Marine, although that made a good story. POTUS did meet Tank at the National Naval Medical Center, and he took an immediate liking to the charming young man. But he didn't coin the nickname. In typical Marine camaraderie, Tank's fellow wounded combatants bestowed the moniker.

Tank arrived at NNMC Bethesda in that first wave of injured Marines. He was a victim not of enemy fire, but an equally dangerous threat called "DNBI," for "Disease/Non-Battle Injury." Simply defined, DNBI is death or disability that we inflict on ourselves. Looking at any conflict in our history you will find that DNBI usually exacts a larger toll on battle effectiveness than does any enemy action.*

A U.S. Abrams tank caused the non-battle injury to its namesake Marine. In the heat of sustained combat operations, Marines rest when and where they can. Tank dozed with his back warmed by the Iraqi sand. By design, his desert camoflague uniform blended right into the terrain, and the driver of the maneuvering vehicle never saw him. One track of the Abrams ran over Tank's body at pelvic level. If laying on asphalt or concrete, he would have been killed almost instantly. But the soft sand absorbed enough crushing pressure that he sustained reparable injuries, a fractured pelvis and ruptured bowel.

He came to Bethesda with a repaired bowel, temporary colostomy, and still bedridden from the fractured pelvis...physically and emotionally still in combat. His indomitable spirit rapidly overcame the restriction to bed. No wallowing in the rack for this Marine! Before we knew it, he was up on crutches. Every day he made his own rounds on the ward where about 30 wounded Marines recovered from a variety of injuries. He exhorted them, cajoled them, encouraged them. "Oo-rah, Marine," he would say. "Look at me. If I can do this, so can you!"

Most of those wounded Marines did survive and got on with their post-traumatic lives, in or out of the Marine Corps. But in truth, our advanced trauma care and sophisticated technology were merely adjuncts to the primary healing force on that ward: Tank and other Marines like him who simply refused to quit, refused to consider themselves disabled, and rallied each other to health.

I recall another recovering young Marine's immediate response when asked where he wanted to go for convalescent leave upon discharge from acute care in the late spring of 2003.

"Bagdad," he said.

Semper Fi, Marines!


*In my early flight surgery days I did a little study demonstrating how injuries sustained in hangar bay basketball games and other recreational sports negatively impacted the medical readiness of an aircraft carrier's crew. The conclusion asked for improved safety measures, not cessation of these important recreational outlets for deployed sailors.

...Fi!

The two Latino-Americans grew up in the Texas Hill Country, not far from each other.  Roughly the same age, they both entered military service soon after high school. Staff Sargeant Alameda, USMC, and Hospitalman Alvarez, USN (not their real names) met and became good friends when both were assigned to a Marine Corps Logistics unit shortly before Operation Iraqi Freedom (OIF). Staff Sargeant Alameda was a regular Marine. Hospitalman (HN) Alvarez was a Navy hospital corpsman assigned as medical support to that Marine unit.

Navy Medicine provides health care to the Marine Corps, which owns no intrinsic medical assets. Many Navy doctors, dentists, nurses, medical service corps officers, and hospital corpsmen are assigned to the Marines over the course of a career. They wear Marine Corps uniforms, drill and exercise with their Marines, adhere to the same physical standards, and otherwise become an integral part of the units they support. Above all, the relationship of a hospital corpsman to his Marines is the most important and revered. Every Marine depends on his "Doc" for his life, and he knows that the Doc is prepared to make heroic efforts to save the life or limb of a Marine.

So there they were, in the early days of OIF traversing southern Iraq, miles behind the initial assault. The unit had stopped for rest and chow. Diving into his MRE, Staff Sargeant Alameda strolled around near his vehicle. A sudden, deafening explosion disrupted the tranquility of the place, quickly followed by a primal scream. The young Marine had stepped on a concealed Iraqi land mine. He lay in agony on the sand, bleeding profusely from the remant stump of a leg blown off.

"CORPSMAN UP!" came the immediate call. Hospitalman Alvarez, as any corpsman would do, rushed to the aid of his fallen friend and comrade, mindless of his own personal safety. As he knelt beside the victim, another explosion unexpectedly scrambled the scene. The ensuing primal scream came from HN Alvarez himself. He had knelt onto another concealed mine, whereupon he suddenly became not the rescuer, but the second casualty. And he too had lost a leg in the detonation.

Thanks to the most sophisticated and capable field trauma care in history, both amigos were rapidly medevaced to a nearby emergency resuscitative surgery site, where they underwent immediate life-saving operations to control bleeding from their traumatic amputations. They were then air lifted out of Iraq to the Landstuhl Regional Medical Center in Germany where they received their secondary definitive surgery. Within three days of the initial explosions, the two comrades in arms arrived at the National Naval Medical Center (NNMC) in Bethesda, MD. They were two of the first four OIF casualties received there.

Even though they were now safely ensconced in a hospital room thousands of miles from the war, emotionally and physiologically they were both still in combat. The support they gave to each other in those first few days, and that given and received from fellow Marines, made a huge difference. Both survived their initial wounds and ultimately wore state of the art prostheses. If you passed either of them on the street six months after their injuries, you would not recognize either one as an amputee.

Once he recovered from his injuries, newly promoted HM3 Alvarez elected to stay in the Navy and requested orders to NNMC Bethesda. He wanted to continue caring for wounded Marines.

The year after his knee hit that land mine he and his spouse were honorees at the annual Hospital Corpsmen Ball. They seemed ill at ease sitting at a head table with a Navy Medical Corps Captain and his equally uncomfortable spouse.

The HM3 didn't feel particularly worthy of all the honor and attention. He never considered himself a hero. He was just the Doc taking care of a wounded Marine.

Similar scenes have occurred thousands of times since OIF began in early 2003, and will recur as long as this or any conflict involves Marines going into harm's way. It's what Hospital Corpsmen do. It's what all of us in Navy Medicine do when called the serve the Marines.

We remain supremely honored to do so.



Semper Fi, Marines!

Semper...

The first three grabbed my attention as I approached the US Airways ticket counter in San Diego. I had just arrived TAD via San Francisco from Tokyo for a Navy medical meeting. I was now checking in for my leave flight to Arizona for a reunion with many extended family members.

Even in my jet lagged state the three U.S. Marines enthralled me. Only one was in uniform, the semi-dress version with the blue trousers and khaki shirt. I could tell from their high and tight haircuts and ultrafit habitus that his companions were also Marines. None of them appeared a day older than my own son who is now a college freshman.

With boarding pass in hand I proceeded to the assigned gate, along the way encountering similar knots of very young Marines either in groups or with family. They were young recruits, clear not only from their tender ages and youthful vigor, but also from the single National Defense Ribbon that each sported over the left pocket of his khakis. Most also proudly wore brightly polished new silver marksmanship medals.

These Marines became a sizeable portion of the passengers who boarding my flight to Phoenix. From snippets of overheard conversation I gleaned that these were all brand new graduates of the San Diego Marine Corps Academy, aka boot camp. Our nation's newest U.S. Marines now headed home or elsewhere  for a couple of weeks of liberty before moving on their next assignment. Most would go to specialty training in the various warfighting skills for which Marines are famous. Beyond that? Some would surely see action in Afghanistan.

Youthful exuberance and justifiable pride pervaded the ranks on this particular day. In the dusk of my military career, I could not help but envy them a bit as they relished the dawn of their own.

On the plane I sat next to the mom of one Marine. She sat next to her ten year old son, and proudly told me that her Marine son was up in first class because a generous passenger, honoring the uniform, had traded boarding passes with him. Engaging in conversation with two other newly minted Marines sitting ahead of us, she gushed on about how wonderful was the graduation ceremony, and how proud (and relieved) she had been to spot her son among the ranks, the first time she had seen him or heard from him in five weeks.

Across the aisle another young Marine entertained a youth of about 10 - 11 years old, with descriptions of what it means to be a Marine, what training he had, and his aspirations for his future career. They young listener, who wore a camoflague jacket of his own, hung on every word, himself probably a future Marine.

Just before landing, the flight attendant announced that on board were some very special people, a group of United States Marines who had just graduated their basic training. The plane erupted in genuine applause and cheers. 

A sexagenarian veteran Navy doctor somewhere in the middle let out a loud OOO-RAH, even as a tear formed in the corner of one eye.

Marines occupy a special place in my heart as my personal heroes, along with EMTs and Hospital Corpsmen. Sharing the pride and patriotism of these young warriors and their beaming parents and siblings was a peak moment for me. Tonight I pray that wherever they go next, each and every one eventually returns home to those same parents and siblings, safe and healthy.

Semper Fi, Marines!

It Ain't Like Coolidge Street

I recall one time as a kid helping my Dad paint the outside of our house on Coolidge Street in Phoenix. (That was before they installed the vinyl siding.) The original brick exterior was white. We painted it gray. For access we had an extension ladder and a simple stepladder. That involved a lot of climbing up and down the ladder, carrying paint cans and roller pans, not to mention brushes and rollers, and rags, and edgers, and all the accoutrements of DIY housepainting. I don't remember how long the project took, but I imagine quite a few days...a bonding experience for Dad and son.

Recently a Japanese contractor repainted the exterior of our house here on the Yokosuka Navy Base. The process would have fascinated Stuart.

First, a very nice Japanese lady who speaks excellent English stopped by to inform us that this project would take place over about a two week period. She also provided us with a detailed written game plan, telling us exactly what to expect on any given day. Follow-on daily notes stuck to our front door documented progress to plan, which included some unavoidable weather delays. Sometimes the nice Japanese lady would stop by, with the non-English speaking foreman, to provide verbal updates and a preview of the day ahead.

Several days were devoted to erecting elaborate scaffolding encircling the entire house. I am reminded of the erector set with which I whiled away countless childhood hours on Coolidge Street. 

Then the entire house was powerwashed. Following this step, an outer veil of material was attached to the scaffolding, presumably to keep paint spray and debris from escaping into the environment. It could also shade the painters as they worked in unseasonably high temperatures and afternoon sun.

Following the actual painting, a series of inspections resulted in another day of touch-up work. Then another inspection before the contractor was allowed to tear down the scaffolding. This step took two days. A final inspection authorized the contractor to actually remove the disassembled scaffolding to the next house down the street.

Careful advance planning. Attention to detail. Daily documentation of progress to plan. Frequent communications with the customer. Rigorous quality assurance. All resulted in a very nice-looking product. A good model for business, or for government.

I wonder how that house on Coolidge Street is looking these days.

Faces and Feet on Mikoshi Day

A mikoshi is a portable Shinto shrine. Shinto followers believe that it serves as the vehicle of a divine spirit in Japan at the time of a parade of deities. These elaborately decorated mikoshi  are very heavy. This requires a few dozen people to heft and carry it on their shoulders by means of two to four large poles.

During a matsuri, or Japanese festival, people carry the portable shrine around the neighborhood. At certain festivals, the people who bear the mikoshi wave it wildly from side to side.

Each fall the City of Yokosuka and Fleet Activities Yokosuka (our Navy base) sponsor a mikoshi parade. This festive event begins in the city, processes down the main street, and then enters the Navy base. Interspersed among the various mikoshi, carts or vehicles carry taiko drummers whose rhythmic percussion provide a fitting accompaniment to the festivities. Most impressive, however, is the enthusiasm of the people, from the very young to the very old, in a typically Japanese show of community spirit and enjoyment. The faces and feet tell the story far better than words can.

We are truly privileged to live among such joyous and wonderful people and to experience their culture and traditions.