Perspective
Serving the Next Greatest Generation
By James R. Rundell, M.D.
Reflections of a retired military physician on treating today’s veterans.
Before coming to work at Mayo Clinic in August of 2005, I spent 23 years as a military physician. The first half of my career in military medicine was during the Cold War, and the emphasis was on taking care of Vietnam and other war veterans, and preparing to fight the Soviets in Europe. The precipitous “Fall of the Wall” in 1989 changed all that.
Despite the hope that peace would reign supreme, and despite the significant downsizing of the U.S. armed forces, the military operations tempo around the world has steadily increased as troops were deployed to such far-flung places as South Korea, Bosnia, Somalia, and Haiti to keep peace, provide humanitarian relief, and manage disasters, among other duties. Nearly one year after the Berlin Wall came down, Iraqi forces invaded Kuwait, setting the stage for the first Gulf War in 1991. This war produced different types of casualties and medical issues than previous ones. Unexplained symptoms such as chronic fatigue, cognitive dysfunction, bronchitis, asthma, and joint pain that veterans suffered over time have proved a challenge for those of us in military medicine and in the Department of Veterans Affairs (VA) because of the difficulty of characterizing their etiologies.
One important change that’s happened since the Gulf War is the development of body armor, metal plating that protects truncal areas from blast injuries. This technology has resulted in the survival of patients who would have died from abdominal or chest injuries in previous wars. But although these soldiers survive, they have proportionately higher rates of head, face, eye, and limb injuries and loss. They also suffer the emotional scars that go along with the loss of a significant body part or disfigurement.
The War Comes Home
During my military career, I worked as a clinical psychiatrist and held various leadership and teaching positions within the Air Force. Before retiring, I had the opportunity to talk with many of the returning service members from Operation Iraqi Freedom and Operation Enduring Freedom in Afghanistan. Sometimes these conversations took place during ward visits when I was serving as medical director and deputy commander for clinical services at a military hospital in Germany. Sometimes they were part of psychiatric evaluations or treatment. And sometimes the conversations were informal—taking place on a bus, on a train, or in the dining room.
Two themes consistently emerged, no matter what the setting. First, these individuals talked about their need to find meaning in their service. Despite the controversy about the war in Iraq, each soldier, sailor, airman, or Marine strives to—and almost always does—find the positive in their contributions and sacrifices. They might see themselves as having improved the Iraqis’ lives, helped the United States fulfill a mission following the Sept. 11 terrorist attacks, assisted a fellow service member, and represented their country, state, or town overseas in a fledgling democracy. Second, there is a universal devotion to one’s fellow troops.
I’ll never forget one soldier I took care of after he had been evacuated from Iraq to the military hospital in Germany where I was working. He was on his way back to the United States for rehabilitation following amputation of most of his right leg. The young soldier was tearful and not very forthcoming. When I asked him why he was so sad, I expected him to talk about his loss of limb and overall sacrifice. Instead, he said—I’ll never forget his words to me, “Doctor, I feel terrible that I can’t go back and rejoin my buddies.” This is an example of the devotion of America’s next Greatest Generation for their country and their mission.
Because of military downsizing, we have seen an increased reliance on National Guard and Reserve service members for duty overseas in Iraq and Afghanistan. These Guard and Reserve members go back home after their active-duty service and are more likely to have their medical needs met by physicians in the civilian sector than by those in military and VA hospitals. For that reason, all physicians and health care providers must understand the needs of these veterans. They need to be able to help returning soldiers get care for medical conditions they experience as a result of their deployment. They need to connect them with mental health providers who can help them adjust to the normalcy of life at home after spending months under the duress of combat. And they need to be able to assist these veterans with getting the medical benefits to which they may be entitled because of their service. After all these heroes have given their country, don’t they deserve the best medical care America can give them? MM
James Rundell retired from the Air Force in July 2005 and is now a professor of psychiatry at Mayo Medical School and a senior associate consultant in the department of psychiatry and psychology at Mayo Clinic.