It still fascinates me (much like watching a particularly gruesome train wreck fascinates me) that Bush supporters, even veterans, are more than willing to overlook the shortcomings of their own candidate’s service record in order to smear the record of the opposition. They would certainly never tolerate any similar questioning of their own records, and even a simple look at the comparative records of Kerry and Bush casts a glaring light upon the weakness of the alleged “military service” of the incumbent. They would be much less likely to question the propriety of the medals awarded veterans of Panama, or Grenada (where more personnel were issued commendations than actually were participating in the invasion itself), then the commendations awarded Senator Kerry.
Additionally, it seems to me that most of us are able to remember schoolmates, roommates, and even friends from many years ago, let alone fellow squad or squadron members, yet not one person can recall serving with George W., son of a U.S. Congressman, despite his protestations to the contrary. And while the fact that he or anyone else served with the ANG is nothing to be ashamed of, how he obtained his cushy, very desirable, and ultimately avoidant, job piloting obsolete jet fighters over the Caribbean through wealth, power, and connections despite his obviously substandard qualifications and how he conducted himself in that position serves as an object lesson on the type of man he is. And yet how disappointing it is that he and his similarly “service-minded” cronies (Cheyney, Rumsfeld, Wolfowitz, etc) are so willing and eager to put young lives at risk today.
Perhaps it is because some cannot forgive Kerry’s subsequent opposition to the Vietnam War, a grossly unjust conflict that even the most hardened veterans would admit was mismanaged by the political masters of the time. Or perhaps they simply cannot see beyond the rhetoric and posturing of the self righteous and self proclaimed anti-terrorist and anti-WMD ideologue to truthfully consider the qualifications of a man who stated outright that he did not wish to serve his country overseas, who may or may not have even been present for his much reduced Air National Guard duties, who regularly and glibly serves up the half truths about his service record as easily as he does about the existence of WMD’s and the effectiveness of his tax cut programs to stimulate jobs and economic growth, and who has deliberately co-opted and abused his position of power to manipulate intelligence information and put American service personnel at risk.
So, which man do you want to lead this country for the next 4 years? Is this what we really want it to boil down to… medal counting and service records? Or is this just more smoke and mirrors about what is really at risk… the needs and wants of the People vs. the needs and wants of the privileged and powerful?
Brothers in Arms?
George W. Bush and John Kerry both spent their mid twenties in uniform. The similarities end there.
John Kerry
February 18, 1966:
A senior at Yale, Kerry commits to enlist in the Navy.
December, 1967:
Kerry is assigned as an Ensign to the guided-missile frigate USS Gridley. After five-months aboard, he returns to San Diego to undergo training to command a Swift boat, used by the Navy for patrols in Vietnam.
June, 1968:
Kerry is promoted to Lieutenant.
November 17, 1968:
Kerry arrives in Vietnam, where he is given command of Swift boat No. 44, operating in the Mekong Delta.
December 2, 1968:
Kerry gets his first taste of intense combat, and is wounded in the arm. He is awarded a Purple Heart.
January, 1969:
Kerry takes command of a new Swift boat, completing 18 missions over 48 days, almost all in the Mekong Delta area.
February 20, 1969:
Kerry is wounded again, taking shrapnel in the left thigh, after a gunboat battle. He is awarded a second Purple Heart.
February 28, 1969:
Kerry and his boat crew, coming under attack while patroling in the Mekong Delta, decide to counterattack. In the middle of the ensuing firefight, Kerry leaves his boat, pursues a Viet Cong fighter into a small hut, kills him, and retreives a rocket launcher. He is awarded a Silver Star.
March 13, 1969:
A mine detonates near Kerry's boat, wounding him in the right arm. He is awarded a third Purple Heart. He is also awarded a Bronze Star for pulling a crew member, who had fallen overboard, back on the boat amidst a firefight.
April, 1969:
According to Navy rules, sailors that have been wounded three times in combat are eligible to be transfered to the U.S. for noncombat duty. Kerry is transferred to desk duty in Brooklyn, NY.
January 3, 1970:
Kerry requests that he be discharged early from the Navy so that he can run for Congress in Massachusetts' Third District. The request is granted, and Kerry begins his first political campaign.
February 1970:
Kerry drops his bid for the Democratic nomination and supports Robert F. Drinan. Drinan, a staunch opponent of the war, wins the race and goes on to serve in Congress for ten years.
June 1970:
Kerry joins Vietnam Veterans Against the War, and becomes one of the group's unofficial spokespeople.
April 23, 1971:
Kerry helps to organize a huge anti-war protest outside Congress, earning a place on president Richard Nixon's "enemies' list." He joins a group of Vietnam veterans who throw medals and campaign ribbons over a fence in front of the Capitol.
April 23, 1971:
Kerry testifies before the Senate Foreign Relations Committee. He tells lawmakers: "How do you ask a man to be the last man to die for a mistake?"
November 10, 1971:
Kerry quits Vietnam Veterans Against the War.
April 1972:
Kerry moves to Massachusetts' 5th District to run for Congress again. He wins the Democratic nomination but loses to Republican Paul Cronin, in part because of his anti-war views.
November 1972:
After losing the election, Kerry is hired as a regional coordinator for Cooperative for American Relief to Everywhere(CARE).
September, 1973:
Kerry enrolls at Boston College Law School.
-----------------------
George W. Bush
February, 1968:
A senior at Yale, Bush takes an Air Force officers test. He scores in 25th percentile in the pilot aptitude portion, and declares that he does not wish to serve overseas.
May 27, 1968:
Bush enlists in Texas Air National Guard. Aided by Texas House Speaker Ben Barnes, he jumps over waiting list. He pledges two years of active duty and four years of reserve duty.
June 9, 1968:
Bush's student deferment expires.
September 1968:
After basic training, Bush pulls inactive duty to act as gopher on Florida Senator Edward J. Gurney's campaign.
November 1968:
After Gurney wins, Bush is reactivated and transferred to Georgia.
November 1969:
Bush is flown to the White House by President Nixon for a date with daughter Tricia.
December 1969:
Bush transfers to Houston and moves into Chateaux Dijon complex. Laura lives there too, but they don't meet till later.
March 1970:
Bush gets his wings.
June 1970:
Bush joins the Guard's "Champagne Unit," where he flies with sons of Texas' elite.
November 3, 1970:
George Bush Sr. loses Senate election to Lloyd Bentsen, whose son is also in the "Champagne Unit."
November 7, 1970:
Bush is promoted to first lieutenant. Rejected by University of Texas School of Law.
January 1971:
The Texas Air National Guard begins testing for drugs during physicals.
Spring 1971:
Bush is hired by a Texas agricultural importer. He uses a National Guard F-102 to shuttle tropical plants from Florida.
May 26, 1972:
Bush transfers to Alabama Guard unit so he can work on Senator William Blount's reelection campaign. According to his commanding officer, Bush never shows up for duty while in Alabama.
August 1972:
Bush is grounded for missing a mandatory physical.
November 1972:
Bush returns to Houston, but never reports for Guard duty.
December 1972:
In D.C. for the holidays, Bush takes 16-year-old brother Marvin drinking and driving. Confronted by father, Bush suggests they settle it "mano a mano."
October 1, 1973:
The Air National Guard relieves Bush from commitment eight months early, allowing him to attend Harvard Business School
Tuesday, December 11, 2007
Date: 2003-12-19 17:58 Subject: Interesting article I found on while attempting to study...
Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomized controlled trials
Gordon C S Smith, professor1, Jill P Pell, consultant2
1 Department of Obstetrics and Gynecology, Cambridge University, Cambridge CB2 2QQ, 2 Department of Public Health, Greater Glasgow NHS Board, Glasgow G3 8YU
Correspondence to: G C S Smith gcss2@cam.ac.uk
Abstract
Objectives To determine whether parachutes are effective in preventing major trauma related to gravitational challenge.
Design Systematic review of randomized controlled trials.
Data sources: Medline, Web of Science, Embase, and the Cochrane Library databases; appropriate internet sites and citation lists.
Study selection: Studies showing the effects of using a parachute during free fall.
Main outcome measure Death or major trauma, defined as an injury severity score > 15.
Results We were unable to identify any randomized controlled trials of parachute intervention.
Conclusions As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomized controlled trials. Advocates of evidence based medicine have criticized the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organized and participated in a double blind, randomized, placebo controlled, crossover trial of the parachute.
http://bmj.bmjjournals.com/cgi/content/abstract/327/7429/1459?etoc
Gordon C S Smith, professor1, Jill P Pell, consultant2
1 Department of Obstetrics and Gynecology, Cambridge University, Cambridge CB2 2QQ, 2 Department of Public Health, Greater Glasgow NHS Board, Glasgow G3 8YU
Correspondence to: G C S Smith gcss2@cam.ac.uk
Abstract
Objectives To determine whether parachutes are effective in preventing major trauma related to gravitational challenge.
Design Systematic review of randomized controlled trials.
Data sources: Medline, Web of Science, Embase, and the Cochrane Library databases; appropriate internet sites and citation lists.
Study selection: Studies showing the effects of using a parachute during free fall.
Main outcome measure Death or major trauma, defined as an injury severity score > 15.
Results We were unable to identify any randomized controlled trials of parachute intervention.
Conclusions As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomized controlled trials. Advocates of evidence based medicine have criticized the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organized and participated in a double blind, randomized, placebo controlled, crossover trial of the parachute.
http://bmj.bmjjournals.com/cgi/cont
Date: 2003-11-06 21:35 Subject: A somewhat different topic today...
I got this posting from an Emergency Medicine Listserv that I subscribe to, and I just had to respond... I'll probably get flamed to death for it, but I just felt like I had to ramble a bit... (I've covered the name of the original posting for anonymity, but the response is what I posted to the list)
I was listening to the local NPR station this AM. They were doing a feature about the public defender system. The concept that indigent criminal defendants are entitled to a court appointed attorney has been operative for ~40 years. Up until recently, in most jurisdictions, the attorney was appointed at no charge to the defendant. However, the attorney still gets paid, by the state or local government. The point of the piece was a discussion of the recent trend toward charging the defendant a nominal amount for the attorney's services. The state being profiled was, I believe, Wisconsin, which recently passed legislation requiring a $50 (total, not per
day) payment by the defendant. The payment is due within 30 days of the attorney being assigned. Of course, the attorney is paid regardless of whether the defendant pays or not. None the less, some of the attorney's were quoted were aghast at the idea that their clients might have to cough up $50 in return for thousands of dollars of legal fees. I guess the high ground is easier for them to achieve than it is for me.
Interesting. Politicians decide that criminal defendants have a right to an attorney even if they cannot afford one, and set up a system to provide it.
Sounds a bit like EMTALA, doesn't it. The politicians decided that people have a right to access the ED 24h/day without regard to ability to pay. So they set up a "system" to provide the care. One difference though. The attorneys get paid for representing their criminal defendants. But the system the politicians set up for "free" emergency care doesn't provide payment. WE (EP's) pay for with longer hours, smaller paychecks, etc. Gee, I wonder if that has anything to do with the power of the legal lobby and that many politicians are lawyers?
We are sheep. Why did we ever agree to work for free? Do our colleagues do it? Only on true "emergencies" once we've separated the wheat from the chaff. Do lawyers do it? Sometimes they do, it's called "pro bono". But it is done at their convenience and pleasure, and they think it makes them morally superior creatures to be providing that occasional free service. For many of us EP's, if consider both no pay and Medicaid (which is the next thing to "no pay", at least here in the People's Republic of New York), 50% or more of what we do is "pro bono".
Think how much nicer your career would be if your work was almost always paid for. You could work 1/2 as many hours or make 2x as much money. For indigent patients, in a real emergency, the government would pick up the tab. Otherwise, no pay, no service. Except when you were feeling generous, just like the lawyers. Then you could go home self satisfied, with a puffed chest, and boast to your family how you took a couple of "pro bono" patients today.
R** *. K***, MD
******* Dept. of Emergency Medicine
PS: before the bleeding hearts jump on me, the above was mostly tongue in cheek.
RK
---------------------------
and the response:
Some interesting points to consider:
1) Pro-bono work, which is not the same as the public defender system, averages about 40-42 hours/year for the roughly 45% of attorneys that participate, for example, in the State of New York (1997 statistic).
a) this is time/work product (counted only in "billable hours") donated to a person/client/cause that the attorney knows up front has no possibility of payment; at least philosophically, if not practically, somewhat different that the EP's situation, where we are supposed to be (at least theoretically) blinded to the capabilities of our patients to pay. It is only in the statistical post-treatment analysis that we consider how much we have "donated."
b) there is also somewhat of a skewing of the perspective in that deliberately inadequate or incomplete or reimbursement by HMO's and insurance companies are counted as "payment" for service rendered.
c) lawyers still do put up with all the other problems of running a business, with clients that refuse to pay, or are slow to pay, just like physicians and hospitals.
d) I think you would be hard pressed to find an attorney that would seriously say that because he does pro-bono work, that he is morally superior in any way, shape or form. For anyone of us, physician, attorney, or janitor to claim such a position over our fellow man would be, in my humble opinion, truly arrogant and clear evidence of the exactly the opposite.
2) As for the payment of public defenders by various jurisdictions, this is to compensate them for work contracted by various attorneys and firms in lieu of running a full time public defenders office, rather than time "donated" or "volunteered" by firms. It should not be equated with pro bono work in any form. It merely provides a way for jurisdictions to conveniently provide the Constitutionally guaranteed right (6th Amendment) of representation without having the administer an full-blown (and often, more expensive) office of the public defender.
My small perspective is that pro bono work is volunteerism, pure and simple.
It is no different than physicians donating time in a homeless clinic or for a missionary clinic. It makes neither lawyers nor physicians any more entitled to claim the moral high ground for themselves, no matter how much or how little good you may think you are doing.
As to the question of whether or not EP's are sheep, that I cannot answer; having recently hung up my spurs after just short of 13 years of full time and 5 years of part time practice, and traded them in for a place as a full time law student, I have always felt that what I did as an EP was honorable and reasonable. However, it has always been my contention that we as physicians (and perhaps more so among EP's) have been bred to be loners, the captain of the ship, the Lone Ranger, as it were. We are deeply and intensely mistrustful of the decisions of other and have never learned to work for the collective, and therefore have been easy to divide and conquer, by legislature, by insurance companies, by attorneys. Crying over the perceived inequities of reimbursement and payment between physicians and attorneys or whomever we wish to compare ourselves to (insurance CEO's and Bill Gates top my list...) only to serve undermine any possibility of unity in the battle for fairness.
That being said, however, I should point out that we should not let our rhetoric and quest for what we perceive to be fair pay rise to such a level that we risk sounding like a bunch of whining spoiled brats, as many attorneys have, as evidenced by such web sites as www.greedyassociates.com .
We make more than the vast majority of the American working class, with much less discomfort and risk than many of our fellow workers. I, for one, would not wish to trade my position for that of an infantryman, or an inner city schoolteacher, or a city police officer, or an iron worker, or any number of very necessary and very honorable professions. One of the risks that anyone who works in a difficult and harsh environment runs is the development of a pervasive cynicism and loss of humanity that blunts our perspective to the needs of those around us. Yes, fight for what is fair, fight for what is right, but keep in mind that the final winners should not necessarily be the physician and his paycheck, or the profession and its status and power, but the patient and the public at large.
I was listening to the local NPR station this AM. They were doing a feature about the public defender system. The concept that indigent criminal defendants are entitled to a court appointed attorney has been operative for ~40 years. Up until recently, in most jurisdictions, the attorney was appointed at no charge to the defendant. However, the attorney still gets paid, by the state or local government. The point of the piece was a discussion of the recent trend toward charging the defendant a nominal amount for the attorney's services. The state being profiled was, I believe, Wisconsin, which recently passed legislation requiring a $50 (total, not per
day) payment by the defendant. The payment is due within 30 days of the attorney being assigned. Of course, the attorney is paid regardless of whether the defendant pays or not. None the less, some of the attorney's were quoted were aghast at the idea that their clients might have to cough up $50 in return for thousands of dollars of legal fees. I guess the high ground is easier for them to achieve than it is for me.
Interesting. Politicians decide that criminal defendants have a right to an attorney even if they cannot afford one, and set up a system to provide it.
Sounds a bit like EMTALA, doesn't it. The politicians decided that people have a right to access the ED 24h/day without regard to ability to pay. So they set up a "system" to provide the care. One difference though. The attorneys get paid for representing their criminal defendants. But the system the politicians set up for "free" emergency care doesn't provide payment. WE (EP's) pay for with longer hours, smaller paychecks, etc. Gee, I wonder if that has anything to do with the power of the legal lobby and that many politicians are lawyers?
We are sheep. Why did we ever agree to work for free? Do our colleagues do it? Only on true "emergencies" once we've separated the wheat from the chaff. Do lawyers do it? Sometimes they do, it's called "pro bono". But it is done at their convenience and pleasure, and they think it makes them morally superior creatures to be providing that occasional free service. For many of us EP's, if consider both no pay and Medicaid (which is the next thing to "no pay", at least here in the People's Republic of New York), 50% or more of what we do is "pro bono".
Think how much nicer your career would be if your work was almost always paid for. You could work 1/2 as many hours or make 2x as much money. For indigent patients, in a real emergency, the government would pick up the tab. Otherwise, no pay, no service. Except when you were feeling generous, just like the lawyers. Then you could go home self satisfied, with a puffed chest, and boast to your family how you took a couple of "pro bono" patients today.
R** *. K***, MD
******* Dept. of Emergency Medicine
PS: before the bleeding hearts jump on me, the above was mostly tongue in cheek.
RK
---------------------------
and the response:
Some interesting points to consider:
1) Pro-bono work, which is not the same as the public defender system, averages about 40-42 hours/year for the roughly 45% of attorneys that participate, for example, in the State of New York (1997 statistic).
a) this is time/work product (counted only in "billable hours") donated to a person/client/cause that the attorney knows up front has no possibility of payment; at least philosophically, if not practically, somewhat different that the EP's situation, where we are supposed to be (at least theoretically) blinded to the capabilities of our patients to pay. It is only in the statistical post-treatment analysis that we consider how much we have "donated."
b) there is also somewhat of a skewing of the perspective in that deliberately inadequate or incomplete or reimbursement by HMO's and insurance companies are counted as "payment" for service rendered.
c) lawyers still do put up with all the other problems of running a business, with clients that refuse to pay, or are slow to pay, just like physicians and hospitals.
d) I think you would be hard pressed to find an attorney that would seriously say that because he does pro-bono work, that he is morally superior in any way, shape or form. For anyone of us, physician, attorney, or janitor to claim such a position over our fellow man would be, in my humble opinion, truly arrogant and clear evidence of the exactly the opposite.
2) As for the payment of public defenders by various jurisdictions, this is to compensate them for work contracted by various attorneys and firms in lieu of running a full time public defenders office, rather than time "donated" or "volunteered" by firms. It should not be equated with pro bono work in any form. It merely provides a way for jurisdictions to conveniently provide the Constitutionally guaranteed right (6th Amendment) of representation without having the administer an full-blown (and often, more expensive) office of the public defender.
My small perspective is that pro bono work is volunteerism, pure and simple.
It is no different than physicians donating time in a homeless clinic or for a missionary clinic. It makes neither lawyers nor physicians any more entitled to claim the moral high ground for themselves, no matter how much or how little good you may think you are doing.
As to the question of whether or not EP's are sheep, that I cannot answer; having recently hung up my spurs after just short of 13 years of full time and 5 years of part time practice, and traded them in for a place as a full time law student, I have always felt that what I did as an EP was honorable and reasonable. However, it has always been my contention that we as physicians (and perhaps more so among EP's) have been bred to be loners, the captain of the ship, the Lone Ranger, as it were. We are deeply and intensely mistrustful of the decisions of other and have never learned to work for the collective, and therefore have been easy to divide and conquer, by legislature, by insurance companies, by attorneys. Crying over the perceived inequities of reimbursement and payment between physicians and attorneys or whomever we wish to compare ourselves to (insurance CEO's and Bill Gates top my list...) only to serve undermine any possibility of unity in the battle for fairness.
That being said, however, I should point out that we should not let our rhetoric and quest for what we perceive to be fair pay rise to such a level that we risk sounding like a bunch of whining spoiled brats, as many attorneys have, as evidenced by such web sites as www.greedyassociates.com .
We make more than the vast majority of the American working class, with much less discomfort and risk than many of our fellow workers. I, for one, would not wish to trade my position for that of an infantryman, or an inner city schoolteacher, or a city police officer, or an iron worker, or any number of very necessary and very honorable professions. One of the risks that anyone who works in a difficult and harsh environment runs is the development of a pervasive cynicism and loss of humanity that blunts our perspective to the needs of those around us. Yes, fight for what is fair, fight for what is right, but keep in mind that the final winners should not necessarily be the physician and his paycheck, or the profession and its status and power, but the patient and the public at large.
Date: 2003-10-29 20:47 Subject: Another semi-focused rant...
One of the physicians on the emergency medicice list I subscribe to forwarded this article to everyone, and it made me consider my experiences so far in my life, and brought me to a feeling of distinct ambivalence about the twilight of my medical career. On one hand, though I wish for the courage to go to such a desperate place as Iraq, the realities of serving at the whim of the politicians that see fit to push the honorable men and women of our armed forces into the line of fire for some twisted and shortsighted agenda of their own creation offends me deeply. And yet there is significant guilt for abandoning the profession and the patients I would have treated, be they overprivileged suburbanites, undeserving and unappreciative dirtbags, or the truly and urgently ill and injured. And what of the path I have now embarked upon? Are these merely longing looks backward seeking the comfort of the known, despite all the troubles that seemed so overwhelming previously while the future beckons with adventures unknown? If I could only sort all this out... If I could only understand civil procedure... and property...and....
The Wall Street Journal
October 29, 2003
IRAQ IN TRANSITION
In a Tent Hospital, A Close-Up View Of Attacks in Iraq
Doctors Face Rising Toll Of Badly Injured Troops
By YAROSLAV TROFIMOV
Staff Reporter of THE WALL STREET JOURNAL
BALAD, Iraq -- Shortly after 11 a.m. last Thursday, the crackle of the
radio brought the first of the day's bad news to the U.S. Army's 21st
Combat Support Hospital.
"Two U.S. soldiers injured," a helicopter pilot said on the radio.
"Six minutes to landing." An armored ambulance Humvee rushed to the
nearby landing pad.
As the chopper's blades churned up sand and dust near the field
hospital, the ambulance driver and the pilots unloaded a stretcher
carrying the more severely injured soldier and ran back to the Humvee.
Sgt. Chuck Bartels, a reservist, was still clear-headed despite his
injuries. His face was bloody and swollen, one of his arms was a mess
of torn flesh.
"We drove on that road a hundred times -- and nothing happened
before," he said in the ambulance. "I don't know how they got us."
With Sgt. Bartels during the bumpy ride was Maj. Beverly Beavers, the
hospital's operations officer, who tried to comfort him. "Chuck, I'm
glad you're still talking," she said.
The emergency room was an air-conditioned tent decorated with
Halloween skeletons and drawings mailed by children from the U.S.
Doctors and nurses quickly converged on Sgt. Bartels, 25 years old,
and his injured buddy, Sgt. Jared Myers, 23.
In this part of Iraq, deep in the so-called Sunni Triangle north and
west of Baghdad, the attacks on American soldiers have become so
frequent that emergency medical procedures are now almost routine.
Medical personnel here -- one of four such U.S. facilities in Iraq --
have to deal with the biggest influx of military casualties since the
Vietnam War. The Iraqi campaign has been producing far more fatalities
and nonlethal casualties than the Persian Gulf War in 1991, the
Balkans action in 1999 and the war in Afghanistan since 2001.
In a White House press conference Tuesday, President Bush conceded the
rising violence, but vowed that the U.S. and its allies would
persevere. "Iraq is dangerous, and it's dangerous because terrorists
want us to leave, and we're not leaving," he said. (See related
article^1.)
While attention focuses on the number of American soldiers killed in
Iraq -- 115 by enemy fire since Mr. Bush announced the end of major
combat on May 1 -- the military doesn't generally publicize the
more-frequent incidents in which soldiers are wounded. According to a
tally kept by the U.S. Central Command, as of 7 p.m. on Oct. 27, the
U.S. military had sustained a total of 1,737 nonlethal casualties from
hostile action in Iraq, including 1,186 since May 1.
[medic]
The toll includes American casualties in the rocket attack on
Baghdad's Al Rasheed hotel on Sunday, and U.S. military police killed
and wounded in suicide bombings that devastated four Iraqi police
stations across Baghdad the following day. October has been the
bloodiest month for U.S. troops in Iraq since the occupation began.
Advances in medical care and bulletproof vests allow more soldiers to
survive the kind of injuries that would have killed them in past
conflicts. But the recent switch by Iraqi insurgents to powerful
roadside bombs as their main offensive weapon has raised the number
and severity of wounds even for those with high-tech protection. These
bombs are usually rigged artillery shells that, hidden in vegetable
crates, bicycle baskets or simple debris, can be detonated close to
their target and shower it with shrapnel.
"Since May, the number and the rate of casualties has increased," says
Col. Doug Liening, commander of the 21st Combat Support Hospital,
which also operates a facility in the northern city of Mosul. "People
in the United States do not appreciate what's going on here." In
peacetime, the 21st Combat Support Hospital is based at Fort Hood,
Texas, as are many of its personnel currently in Balad.
For many doctors and nurses, the daily gore makes it hard to sleep at
night. "It's like a horror movie," says Capt. Nancy Emma, 49, a nurse
for 16 years who worked on Sgt. Bartels in the emergency room. "I
served in a trauma unit, I saw death in the face -- but nothing like
here. And those who live, you've got to wonder how they are going to
make it back in the States."
After the emergency room, Sgt. Bartels was wheeled into the operating
room. His buddy Sgt. Myers, who received shrapnel wounds in his right
arm and face, called his family back in Kansas as he waited to be
treated. The two sergeants, reservists attached to the Fourth Infantry
Division, were driving from a meeting at the town of Baqouba's
agriculture ministry office. They accompanied a civil-affairs officer,
Capt. John Teal, who was filling in for their usual captain, on leave
in the U.S.
Sgt. Myers asked nurses what happened to Capt. Teal. No one could
muster the courage to tell the sergeant the captain was dead,
instantly killed by the roadside bomb that went through their
unarmored Humvee.
After Sgt. Bartels' surgery was over, he was wheeled into an
intensive-care tent and put on a cot next to an 8-year-old Iraqi girl
being treated for massive burns. A large, muscular man, the sergeant
was called up just as he was finishing his work for a master's degree
in Russian studies at the University of Kansas. The operation had left
his right arm just a short bandaged stump. Pieces of flesh were
missing from his face.
The orthopedic surgeon, Lt. Col. Kim Keslung, sat down after the
surgery and sipped Kool-Aid. Her desert-tan uniform was stained with
blood. "His nerves and blood vessels were just shredded. There wasn't
anything to fix in his arm," she said. "He'll have to adjust to his
new life."
Like most doctors and nurses here, Col. Keslung preferred not to
venture outside the confines of the Sustainer Air Field, the sprawling
base where the hospital is located. "I don't volunteer to leave
because I've seen what happens outside," she said.
Many doctors and nurses, deployed to Kuwait and then Iraq, have been
overseas for more than 400 days in the past two years, which is
considered the upper limit on such deployments. Few expected to deal
with such a steady stream of casualties more than six months after the
fall of Baghdad.
It was a mistake to discount the Iraqi resistance, Col. Keslung said,
adding, "If someone invaded Texas, we'd do the same thing."
As she spoke, new patients arrived at the hospital. Another
remote-controlled roadside bomb had exploded near a Humvee that was
leading a convoy 10 miles outside the Sustainer base. The blast made
the windshield cave in, but it went off too early to inflict serious
injuries on the three military policemen from Rhode Island inside the
car. They had ringing in their ears, which a doctor said would go away
in a week or two.
Specialist Kindre Marines, the gunner who stood on the Humvee, says he
saw the blast's flash and instinctively ducked inside before he was
hit by the wave of shrapnel. This may have saved his life. After being
examined, the soldiers went back on the road.
In the intensive-care tent, Sgt. Bartels woke up. He had known right
after the bomb attack that the captain was dead, and he praised Sgt.
Myers for driving on to the safety of the nearest U.S. base with a
piece of shrapnel the size of a pocket watch lodged in his arm.
Sgt. Bartels spoke in a clear voice, without betraying emotions. "We
never even had a close call before," he said. "You just drive around
-- and next thing there's a boom, and your life changes." Just before
going to war, Sgt. Bartels had a job interview with the State
Department, and was expecting a posting with diplomatic security in
Moscow. That's not a job he could do without an arm, he said
matter-of-factly.
Sgt. Myers, a phlebotomist in civilian life, learned that Capt. Teal,
31, was dead. A few tears fell from his eyes. Sgt. Myers was the
driver, while the captain sat in the passenger seat. The agriculture
official whom they were supposed to see in Baqouba wasn't there when
they arrived; a rich businessman, he was traveling to Canada. On the
way back to the base, just before the blast, Capt. Teal complained
about the trip.
"Then there was a big puff of dust, smoke and a sharp pain in my arm,"
Sgt. Myers said. The radio was fried by shrapnel, he said. The
captain, who sat between the bomb and Sgt. Myers, took the brunt of
the explosion. "If Capt. Teal wasn't there, I would probably have
died," the sergeant said.
The civil-affairs team has been lobbying for months to get armored
vehicles -- equipment they lack because, in conventional war,
civil-affairs teams are supposed to be operating far behind the front
lines.
It was dark outside as Lt. Col. Trip Buckenmaier, an anesthesiologist
from the Walter Reed Army Medical Center in Washington, walked into
Sgt. Bartels's tent and offered him a new procedure that would take
away the pain. Col. Buckenmaier pierced the skin atop Sgt. Bartels's
shoulder and then tried to locate with an electric stimulator the
nerves responsible for the hand and the arm.
As the sergeant's body convulsed, the surgeon kept talking: "Chuck, I
know you don't have a hand, but can you feel your fingers moving? Now?
And now?"
After finding the nerve, Col. Buckenmaier inserted a catheter linked
to a pain-killer dispenser that Sgt. Bartels could control with the
other hand. This procedure -- tried on battlefields for the first time
during the Iraqi campaign -- allows patients to stay conscious and in
control while disabling only the nerves that produce pain from
injuries.
"We're kind of pushing the science right now," Col. Buckenmaier said.
"War tends to do that." He hadn't finished the procedure when an
assistant walked in to say that choppers were bringing in a new load
of casualties.
Around the stretcher bearers in the emergency room, doctors and nurses
huddled again, both those on duty and those, in gray army T-shirts and
black shorts, who were supposed to be resting for the next shift. A
Fourth Infantry Division base had just been shelled with mortars in
Baqouba. This shelling, like the mortars that rain almost every night
in the Sustainer Air Field, is usually inaccurate. But when the
attackers manage to hit the base camps, they can cause serious damage
because soldiers inside the perimeter don't usually wear helmets or
body armor.
Almost 20 soldiers were injured in the Baqouba attack Tuesday night,
but only three seriously enough to be brought to Balad by helicopter.
A piece of shrapnel had carved out part of one soldier's face and
lodged behind the eye; he had also received severe shrapnel wounds in
the back. A nurse picked up his blood-soaked ID card to fill in a
report. Two other soldiers, a male and a female, had sustained
less-serious wounds.
In the morning, Sgt. Bartels and Sgt. Myers prepared for their flight
to the Landstuhl Army Medical Center in Germany, the first stop for
wounded American troops evacuated from Iraq. Air Force flights to
Landstuhl leave Iraq almost every day. Sgt. Myers's parents were
already on the way there. Sgt. Bartels, given his injuries, was likely
to be transferred quickly to Walter Reed. Col. Buckenmaier told the
sergeant he could call the colonel's wife in Washington if he needed
any help while at Walter Reed.
That morning, two soldiers were killed and several wounded in a mortar
attack on a base in Samarra, less than 20 miles north of here. "This
has been a typical workload," said Col. Carol McNeill, the Balad
hospital's chief nurse. "We're getting smarter, but the bad guys are
getting smarter too."
Write to Yaroslav Trofimov at yaroslav.trofimov@wsj.com4
URL for this article:
http://online.wsj.com/article/0,,SB106737808452447200,00.html
Hyperlinks in this Article:
(1) http://online.wsj.com/article/0,,SB106735657938775000,00.html
Updated October 29, 2003
[b.gif] Copyright 2003 Dow Jones & Company, Inc. All Rights Reserved
The Wall Street Journal
October 29, 2003
IRAQ IN TRANSITION
In a Tent Hospital, A Close-Up View Of Attacks in Iraq
Doctors Face Rising Toll Of Badly Injured Troops
By YAROSLAV TROFIMOV
Staff Reporter of THE WALL STREET JOURNAL
BALAD, Iraq -- Shortly after 11 a.m. last Thursday, the crackle of the
radio brought the first of the day's bad news to the U.S. Army's 21st
Combat Support Hospital.
"Two U.S. soldiers injured," a helicopter pilot said on the radio.
"Six minutes to landing." An armored ambulance Humvee rushed to the
nearby landing pad.
As the chopper's blades churned up sand and dust near the field
hospital, the ambulance driver and the pilots unloaded a stretcher
carrying the more severely injured soldier and ran back to the Humvee.
Sgt. Chuck Bartels, a reservist, was still clear-headed despite his
injuries. His face was bloody and swollen, one of his arms was a mess
of torn flesh.
"We drove on that road a hundred times -- and nothing happened
before," he said in the ambulance. "I don't know how they got us."
With Sgt. Bartels during the bumpy ride was Maj. Beverly Beavers, the
hospital's operations officer, who tried to comfort him. "Chuck, I'm
glad you're still talking," she said.
The emergency room was an air-conditioned tent decorated with
Halloween skeletons and drawings mailed by children from the U.S.
Doctors and nurses quickly converged on Sgt. Bartels, 25 years old,
and his injured buddy, Sgt. Jared Myers, 23.
In this part of Iraq, deep in the so-called Sunni Triangle north and
west of Baghdad, the attacks on American soldiers have become so
frequent that emergency medical procedures are now almost routine.
Medical personnel here -- one of four such U.S. facilities in Iraq --
have to deal with the biggest influx of military casualties since the
Vietnam War. The Iraqi campaign has been producing far more fatalities
and nonlethal casualties than the Persian Gulf War in 1991, the
Balkans action in 1999 and the war in Afghanistan since 2001.
In a White House press conference Tuesday, President Bush conceded the
rising violence, but vowed that the U.S. and its allies would
persevere. "Iraq is dangerous, and it's dangerous because terrorists
want us to leave, and we're not leaving," he said. (See related
article^1.)
While attention focuses on the number of American soldiers killed in
Iraq -- 115 by enemy fire since Mr. Bush announced the end of major
combat on May 1 -- the military doesn't generally publicize the
more-frequent incidents in which soldiers are wounded. According to a
tally kept by the U.S. Central Command, as of 7 p.m. on Oct. 27, the
U.S. military had sustained a total of 1,737 nonlethal casualties from
hostile action in Iraq, including 1,186 since May 1.
[medic]
The toll includes American casualties in the rocket attack on
Baghdad's Al Rasheed hotel on Sunday, and U.S. military police killed
and wounded in suicide bombings that devastated four Iraqi police
stations across Baghdad the following day. October has been the
bloodiest month for U.S. troops in Iraq since the occupation began.
Advances in medical care and bulletproof vests allow more soldiers to
survive the kind of injuries that would have killed them in past
conflicts. But the recent switch by Iraqi insurgents to powerful
roadside bombs as their main offensive weapon has raised the number
and severity of wounds even for those with high-tech protection. These
bombs are usually rigged artillery shells that, hidden in vegetable
crates, bicycle baskets or simple debris, can be detonated close to
their target and shower it with shrapnel.
"Since May, the number and the rate of casualties has increased," says
Col. Doug Liening, commander of the 21st Combat Support Hospital,
which also operates a facility in the northern city of Mosul. "People
in the United States do not appreciate what's going on here." In
peacetime, the 21st Combat Support Hospital is based at Fort Hood,
Texas, as are many of its personnel currently in Balad.
For many doctors and nurses, the daily gore makes it hard to sleep at
night. "It's like a horror movie," says Capt. Nancy Emma, 49, a nurse
for 16 years who worked on Sgt. Bartels in the emergency room. "I
served in a trauma unit, I saw death in the face -- but nothing like
here. And those who live, you've got to wonder how they are going to
make it back in the States."
After the emergency room, Sgt. Bartels was wheeled into the operating
room. His buddy Sgt. Myers, who received shrapnel wounds in his right
arm and face, called his family back in Kansas as he waited to be
treated. The two sergeants, reservists attached to the Fourth Infantry
Division, were driving from a meeting at the town of Baqouba's
agriculture ministry office. They accompanied a civil-affairs officer,
Capt. John Teal, who was filling in for their usual captain, on leave
in the U.S.
Sgt. Myers asked nurses what happened to Capt. Teal. No one could
muster the courage to tell the sergeant the captain was dead,
instantly killed by the roadside bomb that went through their
unarmored Humvee.
After Sgt. Bartels' surgery was over, he was wheeled into an
intensive-care tent and put on a cot next to an 8-year-old Iraqi girl
being treated for massive burns. A large, muscular man, the sergeant
was called up just as he was finishing his work for a master's degree
in Russian studies at the University of Kansas. The operation had left
his right arm just a short bandaged stump. Pieces of flesh were
missing from his face.
The orthopedic surgeon, Lt. Col. Kim Keslung, sat down after the
surgery and sipped Kool-Aid. Her desert-tan uniform was stained with
blood. "His nerves and blood vessels were just shredded. There wasn't
anything to fix in his arm," she said. "He'll have to adjust to his
new life."
Like most doctors and nurses here, Col. Keslung preferred not to
venture outside the confines of the Sustainer Air Field, the sprawling
base where the hospital is located. "I don't volunteer to leave
because I've seen what happens outside," she said.
Many doctors and nurses, deployed to Kuwait and then Iraq, have been
overseas for more than 400 days in the past two years, which is
considered the upper limit on such deployments. Few expected to deal
with such a steady stream of casualties more than six months after the
fall of Baghdad.
It was a mistake to discount the Iraqi resistance, Col. Keslung said,
adding, "If someone invaded Texas, we'd do the same thing."
As she spoke, new patients arrived at the hospital. Another
remote-controlled roadside bomb had exploded near a Humvee that was
leading a convoy 10 miles outside the Sustainer base. The blast made
the windshield cave in, but it went off too early to inflict serious
injuries on the three military policemen from Rhode Island inside the
car. They had ringing in their ears, which a doctor said would go away
in a week or two.
Specialist Kindre Marines, the gunner who stood on the Humvee, says he
saw the blast's flash and instinctively ducked inside before he was
hit by the wave of shrapnel. This may have saved his life. After being
examined, the soldiers went back on the road.
In the intensive-care tent, Sgt. Bartels woke up. He had known right
after the bomb attack that the captain was dead, and he praised Sgt.
Myers for driving on to the safety of the nearest U.S. base with a
piece of shrapnel the size of a pocket watch lodged in his arm.
Sgt. Bartels spoke in a clear voice, without betraying emotions. "We
never even had a close call before," he said. "You just drive around
-- and next thing there's a boom, and your life changes." Just before
going to war, Sgt. Bartels had a job interview with the State
Department, and was expecting a posting with diplomatic security in
Moscow. That's not a job he could do without an arm, he said
matter-of-factly.
Sgt. Myers, a phlebotomist in civilian life, learned that Capt. Teal,
31, was dead. A few tears fell from his eyes. Sgt. Myers was the
driver, while the captain sat in the passenger seat. The agriculture
official whom they were supposed to see in Baqouba wasn't there when
they arrived; a rich businessman, he was traveling to Canada. On the
way back to the base, just before the blast, Capt. Teal complained
about the trip.
"Then there was a big puff of dust, smoke and a sharp pain in my arm,"
Sgt. Myers said. The radio was fried by shrapnel, he said. The
captain, who sat between the bomb and Sgt. Myers, took the brunt of
the explosion. "If Capt. Teal wasn't there, I would probably have
died," the sergeant said.
The civil-affairs team has been lobbying for months to get armored
vehicles -- equipment they lack because, in conventional war,
civil-affairs teams are supposed to be operating far behind the front
lines.
It was dark outside as Lt. Col. Trip Buckenmaier, an anesthesiologist
from the Walter Reed Army Medical Center in Washington, walked into
Sgt. Bartels's tent and offered him a new procedure that would take
away the pain. Col. Buckenmaier pierced the skin atop Sgt. Bartels's
shoulder and then tried to locate with an electric stimulator the
nerves responsible for the hand and the arm.
As the sergeant's body convulsed, the surgeon kept talking: "Chuck, I
know you don't have a hand, but can you feel your fingers moving? Now?
And now?"
After finding the nerve, Col. Buckenmaier inserted a catheter linked
to a pain-killer dispenser that Sgt. Bartels could control with the
other hand. This procedure -- tried on battlefields for the first time
during the Iraqi campaign -- allows patients to stay conscious and in
control while disabling only the nerves that produce pain from
injuries.
"We're kind of pushing the science right now," Col. Buckenmaier said.
"War tends to do that." He hadn't finished the procedure when an
assistant walked in to say that choppers were bringing in a new load
of casualties.
Around the stretcher bearers in the emergency room, doctors and nurses
huddled again, both those on duty and those, in gray army T-shirts and
black shorts, who were supposed to be resting for the next shift. A
Fourth Infantry Division base had just been shelled with mortars in
Baqouba. This shelling, like the mortars that rain almost every night
in the Sustainer Air Field, is usually inaccurate. But when the
attackers manage to hit the base camps, they can cause serious damage
because soldiers inside the perimeter don't usually wear helmets or
body armor.
Almost 20 soldiers were injured in the Baqouba attack Tuesday night,
but only three seriously enough to be brought to Balad by helicopter.
A piece of shrapnel had carved out part of one soldier's face and
lodged behind the eye; he had also received severe shrapnel wounds in
the back. A nurse picked up his blood-soaked ID card to fill in a
report. Two other soldiers, a male and a female, had sustained
less-serious wounds.
In the morning, Sgt. Bartels and Sgt. Myers prepared for their flight
to the Landstuhl Army Medical Center in Germany, the first stop for
wounded American troops evacuated from Iraq. Air Force flights to
Landstuhl leave Iraq almost every day. Sgt. Myers's parents were
already on the way there. Sgt. Bartels, given his injuries, was likely
to be transferred quickly to Walter Reed. Col. Buckenmaier told the
sergeant he could call the colonel's wife in Washington if he needed
any help while at Walter Reed.
That morning, two soldiers were killed and several wounded in a mortar
attack on a base in Samarra, less than 20 miles north of here. "This
has been a typical workload," said Col. Carol McNeill, the Balad
hospital's chief nurse. "We're getting smarter, but the bad guys are
getting smarter too."
Write to Yaroslav Trofimov at yaroslav.trofimov@wsj.com4
URL for this article:
http://online.wsj.com/article/0,,SB1067
Hyperlinks in this Article:
(1) http://online.wsj.com/article/0,,SB1067
Updated October 29, 2003
[b.gif] Copyright 2003 Dow Jones & Company, Inc. All Rights Reserved
Date: 2003-09-20 00:07 Subject: minor rant
I heard something yesterday that set me to thinking... a son of a friend recently started as a freshman at a high school in a town not too far away. He worked very hard all summer on his golf game and was one of only a few freshmen that was invited to join the golf team at school. However, that was all for naught, as he was caught at school for having a small toy gun, purple and yellow, with no real resemblance to a real gun, in his backpack. It was reportedly there from a weekend trip to a friend's house and merely a forgotten toy, yet spotted by someone at the bus stop, it became a weapon, and without any real due process or, perhaps more importantly, without any real thought or consideration, he became just another victim of a school's zero-tolerance policy. Suspended, detentions to serve, and most devastatingly, off of the golf team.
Now I will be among the first to say that what he did was stupid, that kids should not have guns or gun-like toys in school. and I would even be willing to say that the punishment meted out was not unreasonable, but not the way in which it was done. I mean, what is "zero-tolerance policy" but a way to kowtow to the most unreasonable and illogical of our fears, and substituting a knee-jerk, brainless rule, promulgated by fearful, small-minded administrators and politicians to give us artificial solace. And why do we believe we are better off with a zero-tolerance policy, or mandatory sentencing, or "three strikes, your out" rules? Are we really safer for it? Is the thoughtless application of a rule more beneficial to our society that the more difficult, sometimes uneven application of justice that occurs with the intervention and consideration of a human brain? I guess I shouldn't be that surprised; any society that values McDonald's as a reasonable source of nutrition, that prides itself on the quality of grocery store sushi, that allows itself to be manipulated into allowing an unelected buffoon take the highest office of the land, and then lead us into a pointless quagmire of a war, will get exactly what it deserves.
May God have mercy on our [stupid and thoughtless] souls.
Now I will be among the first to say that what he did was stupid, that kids should not have guns or gun-like toys in school. and I would even be willing to say that the punishment meted out was not unreasonable, but not the way in which it was done. I mean, what is "zero-tolerance policy" but a way to kowtow to the most unreasonable and illogical of our fears, and substituting a knee-jerk, brainless rule, promulgated by fearful, small-minded administrators and politicians to give us artificial solace. And why do we believe we are better off with a zero-tolerance policy, or mandatory sentencing, or "three strikes, your out" rules? Are we really safer for it? Is the thoughtless application of a rule more beneficial to our society that the more difficult, sometimes uneven application of justice that occurs with the intervention and consideration of a human brain? I guess I shouldn't be that surprised; any society that values McDonald's as a reasonable source of nutrition, that prides itself on the quality of grocery store sushi, that allows itself to be manipulated into allowing an unelected buffoon take the highest office of the land, and then lead us into a pointless quagmire of a war, will get exactly what it deserves.
May God have mercy on our [stupid and thoughtless] souls.
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