Work is hell. War is work.

There are many ways in which war surrounds, infuses, and informs what we do in the emergency room as ED (emergency department) docs.

Surgeon Dominique Jean Larrey modeled a concept of emergency medical care on the carriages of the French flying artillery from the wars of the French revolution. In so doing, he gets to be the father of EM (emergency medicine) in the loosest and most French of senses.

Where do you think victims of bombings in Iraq or Israel go for their shrapnel injuries? — the local ED, of course.

Modern American emergency medicine (as we are exporting to the rest of the world) originated with experiences of medical evacuation (medevac) from Vietnam.

The weapons that cause the wounds that we see in the ED were all originated for war (automatics, mass produced guns, standardized ammo), and the types of traumatic wounds that occur in civilian life, from crime or accident, happen in war: Gun shot, blunt force, deceleration, and penetrating trauma of all sorts.

Rotating at Shock Trauma at Maryland reinforced to me how many of the techs, nurses, anesthesiologists and surgeons were ex- or reserve military. I think almost all of the trooper helicopter jocks were ex-military.

Many of my colleagues over the years have had military experience. Currently, I work with a guy who was a dust-off medic for helicopter evacuation of wounded soldiers in Vietnam who after the war went to nursing then medical school and became a EP (emergency physician) in L.A. I gave him sign-out tonight. Another guy (I worked with all day) was a Navy coreman attached to the USMC at the battle for Dong Ha in 1968. He is quoted extensively in the book The Magnificent Bastards: The joint army-marine defense of Dong Ha, 1968. [Keith Nolan, Dell Books, 1994]. One afternoon I was sweating, whining and fretting terribly and had stretchers lined up in the hall, procedures to do, a host of stalling consultants to deal with and my interruptions being interrupted. I asked him why he never seemed rattled and he said, “Greg (sic), if don’t have to feel in the dark for bleeding and no-one is shooting at me, I don’t get anxious.”

We half-heartedly prepare and talk about preparing to respond to another act of war at home: biological or nuclear attack. We will be where the public turns to be disappointed in the case of major terrorist attack?

Cook County Hospital (where I rotated as a medical student) claims to be the first trauma center (opened in 1966). Dr. Boyd from Cook County was drafted into the United States Army. Then he was the first shock-trauma fellow at the Shock Trauma Center in Maryland (where I rotated as a resident). Then he went and opened Cook’s department.

Helicopters are all about emergency medicine. This is paramilitary. The medics are mostly ex-military. The emblem of Hopkins Emergency Medicine includes a helicopter. At a great program for emergency medicine in Chicago – the residency director says in his speech to the applicants that “If you don’t want to fly in a helicopter, don’t rank us.” I didn’t and didn’t. It meant a separation from a mentor, but, like Stevie Ray Vaughn wishes he had, I just said no to rotary wing travel. Although that has little to do with my point currently.

Do doctors facilitate or deter war? Do they have anything to do with it at all?

Doctor warriors I can think of: Che Guevara, Doctors Spock and McCoy, Doctor Who (was he a PhD?), Josef Mengele, Radovan Karadži?, Shiro Ishii, Joseph-Ignace, Guillotin, François Duvalier, Ayman al-Zawahiri. I would only like to be like three of them – tops. Did med school and residency help them become who they were, or were they that despite their training?

The American Academy of Emergency Medicine’s logo is a minuteman.

Seven months without a blog entry: shameful. After my ignominious defeat at the hands of the board, I have been skulking in the corner, liking (sic) my wounds. And, of course, parenting a toddler and still working full time as an EP has taken a bit of time. Oh, yeah, and studying to retake the boards. It is still unclear to me how long I have until time runs out on my efforts to pass the boards. The human I spoke with on the phone says if they are unable to reschedule me (the next exam is in October) then they give me as much of an extension as I need. So you of the public will be reassured to hear that a doctor does not have to be board certified to practice in a specialty. If you have a license (which you generally get from states just for passing USMLE 3), and someone is willing to hire you, and someone is willing to insure you, you can practice. Thank goodness. Baby needs new shoes.

War is hell. The ED this last Friday after the Poison concert was no picnic.

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