The seeming randomness of who was going to ’Nam and who was going somewhere else was the first sense we all had that war was at best a crapshoot. Turn right instead of left and you could be hit; linger a bit out on patrol or move too fast and you’d be the one blown up.
What I would soon learn about war and what was to prove so terrifying was not the “fog of war” that the military philosophers and historians talk about, or that no battle plan lasted longer than the firing of the first bullet or the dropping of the first bomb. It was the simple fact that it really didn’t matter how clever you were or how talented or even how well-trained or committed you were.
Whether you were killed or wounded remained what it has always been—an exercise of simple luck. Bend over to pick up a dropped cigarette lighter and the bullet that would surely have killed or crippled you cracks harmlessly out over your back. Forget for a moment to look down because you’re distracted by a noise or a glint of sunlight off a wet leaf, and no matter how diligent you’ve been, you’ll miss the wire stretched across the track or the detonator plate half buried in the dirt. If you are in the wrong place at the wrong time, you are doomed and there is little you can do about it. It was said that during the Second World War, the marines on their way to Iwo Jima already viewed themselves as dead.
Sheer chance on the battlefield is not only the final arbiter of winning or losing, but also, of living or dying. When Napoleon was asked what quality he admired most in his generals, he answered without hesitation: “luck.”
Fort Sam was both an astonishing transition and a personal conversion. You get on the bus as a civilian and you get off the bus as part of the Army. That much was made clear to all of us from the moment we were greeted by sergeants who seemed to understand, even if we didn’t, that not only were we all in the Army now, but that it was an army at war.
I remembered during those first few weeks of basic training that in Tolstoy’s War and Peace, General Kutuzov, having decided that there was no choice but to burn Moscow to save Russia, was smart enough to understand that the decision to burn the capital wasn’t made at the moment he realized there was no alternative, but at some other moment when he’d made that wrong decision or the mistake that had led to this desperate act.
Tolstoy was either clever or smart enough to know that it is never the last circumstance that forces your hand, but the previous half-dozen poorly thought-out actions or opportunities missed or ignored. It’s these that precede the need to have to act foolishly or desperately.
That was exactly the way I felt as basic training took me and everyone else deeper and deeper into the war. How did I get here? How did we all get here? What had we been thinking and where had we been looking? How had we all so completely missed what should have been so obvious? I was baffled.
I had attended one of the best undergraduate schools in the country and one of the most prestigious medical schools. I had just finished a much-sought-after internship and residency at a world-famous hospital, and had my whole personal and professional life ahead of me.
How did I end up in Texas? How was I suddenly learning about weapons, bullets, fragmentation wounds, crew-served weapons, potable water, and the best way to navigate at night using a flashlight, a compass, and a back azimuth?
It was clear from the long silences during the different lectures and presentations that those going to ’Nam felt that same kind of bewilderment and confusion even more deeply than I did and, quite honestly, all the rest of us. This was not what they, or any of us, had bargained for.
Still, I drew some kind of comfort, if not understanding, from Trotsky’s admonition to the youth of Russia and all of Europe at the beginning of World War I: “You might not be interested in war, but war is interested in you.” Maybe we all should have paid more attention.
But the truth was that suddenly the war was now everywhere for all of us. It was increasingly in the daily class work and formations, where Vietnam, while not quite the main point of discussion, was certainly the main focus. It was in the lectures and conversations and in the knowing looks of the NCOs and the officers. Med-evac choppers and gunships were constantly flying over our heads, and on occasion, we would see tanks and armored personnel carriers on the roads, as well as artillery batteries set out in the middle of the fields surrounding the base. It was in the crew-served weapons demonstration out on the weapons range, when the instructors set up machine guns and completely obliterated human-shaped targets at 1500 yards, that the reality of what we were now part of suddenly hit all of us. One of the instructors explained that automatic fire was sometimes erratic which might “give you a chance to survive, but that was not a likely outcome, not if the enemy knew what they were doing.”
We were shown films of what bullets could do to blocks of gelatin and pigs and sheep. They could have shown us films of the effects of artillery barrages or roadside bombs or even of 120-mm tank rounds, but to those of us who were uninitiated—and that meant all of us—the Army was showing us what would be the classic wounds of fighting in a jungle where those who are shooting at you are looking right at you, or waiting in ambush, or alongside the edge of a trail or path. What we were watching being done to the animals and the blocks of gelatin was what would be happening to those we would be trying to save. To take a round through the chest or abdomen and certainly the head was to be a mortal wound. If you were not killed outright, you would bleed to death, and that happened all the time.
The Army knew enough about Vietnam to know that the VC and NVA would not be using artillery or fighter-bombers, tanks, or helicopter gunships; they would be using light machine guns and AK-47s. The wounds would be from bullets, so the animals being shot and the blocks of gelatin being exploded by the impact of a high-velocity round was the reality of what would be happening to our troops. Small arm and automatic weapon rounds were to be the signature wounds of ’Nam and that meant that you would either be killed right there where you were hit, or you would be dead before the med-evac chopper could get in to take you to the nearest surgical or evac hospital.
Brain injuries of any kind in Vietnam were universally fatal, either because they would be the result of taking a round through the head, or because they were associated with multiple chest or abdominal injuries. It would take forty years and another two wars for traumatic brain injuries to become the signature wound that resulted from sending more of our soldiers and marines out to another “Edge of Empires.”
In forty years it would be IEDs, roadside bombs, and suicide bombers. There would be nothing very high-tech anymore and nothing that you couldn’t put together in your own kitchen or bathtub or steal from an ammunition dump. All you would really need would be a couple of 155-mm shells along with some home-made high explosives, some wires, maybe a cell phone and a detonator cap. The enemy wouldn’t even have to show themselves, and they definitely wouldn’t have to be close enough to actually be shooting at you.
What those of us going to ’Nam in the late 1960s and early ’70s to care for the wounded—whether as battalion surgeons out in the boonies or at the surgical hospitals or as specialists in the different Evac hospitals along the medical evacuation routes back to the states—would soon find out, was that our soldiers and marines would be shot or wounded by small anti-personnel booby-traps, mortar rounds, or satchel charges thrown or laid by sappers, along with the more than occasional rocket-propelled grenade. The wounded that we saw in the different hospitals would be the ones who did not bleed to death within minutes of being hit. The types of wounds were the reason that throughout the whole of the Vietnam War over 52,000 U.S. soldiers and marines would be killed, while the final tally of overall casualties would be less than 2.4 wounded survivors to every death. The majority of those severely wounded in ’Nam did not survive. They died where and when they were hit. You wouldn’t need the new poly-trauma units or the numbers of occupational and physical therapists or the large numbers of orthopedic or neurosurgeons for Vietnam that you would need later need in Iraq
and Afghanistan. The graveyard was to be the real legacy of ’Nam.
Entering the Army in the 1960s was like having entered some kind of parallel universe that none of us had noticed, but that had always been there. But the true reality of what we were now so much a part of, as well as what we had clearly become, occurred out on the infiltration course. Live rounds from 30-caliber machine guns were cracking through the air less than six feet over our heads. It had been made crystal clear to all of us that, as medical officers, we were not to even try to deal with a combat situation. If under attack, we were to take orders from any trained military personnel, even if that soldier was no more than a private. In combat, we were to listen and obey whatever the private asked and whatever he ordered.
“You have to know how to do this, or you and those around you will be killed,” was how simply it was put. What “this” was became clear out on the infiltration course, with those rounds firing over our heads and explosive charges going off in the bunkers surrounding us as we crawled forward through the dirt and dust of Central Texas. It was noisy and it was scary. We were reminded before we started that these were live rounds being fired over our heads and that whatever happened, we were not to stand up.
It wasn’t Anzio or Normandy, but it was just as real. It was not naïve or romantic to say that for most of us, to have death no more than a few feet away was not only unnerving—it was transforming. All you had to do was just stand up and you would be gone. That kind of thing can change not only what you think about, but how you think. You get through the barbed wire part of the infiltration course by rolling on your back and wiggling your way forward under the strands of barbed wire, being careful where you put your hands, to stay clear of the sharpened barbs.
Most of us had finished the course, when an overweight obstetrician, forgetting to turn completely onto his back, got caught on the wire and couldn’t move forward or backwards. Above the sounds of the machine gun firing and the detonations of explosive charges in the bunkers, we all heard a plaintive, terrified voice, “I’m caught … help me … I’m caught on the wire … I can’t move … help me.”
For a moment we all froze, not sure that the panic in the voice wouldn’t lead to his doing something really stupid. At that moment, I clearly understood that the Army was not in the business of killing obstetricians, any more than it was in the business of killing anyone else other than the enemy. Standing there at the end of the course, sweating and covered with dirt, I was confused and troubled by the realization that they could have stopped the firing a couple of minutes earlier to be able to go safely out on the course to cut him free. But then I realized that the NCOs in charge of the course wanted to make a point with us young smart-alecky docs. And they did.
As it turned out, we were all caught on the wire. During the fourth week of basic, during morning formation, those of us who had arrived at Fort Sam with orders for a two-year tour of duty at hospitals and medical facilities outside of the continental United States were told to remain at attention. Those who had come to Fort Sam with orders for ’Nam or for military facilities within the continental United States were dismissed and allowed to go on to breakfast.
Virtually all of us who remained had graduated from medical school in the mid-1960s and accepted Berry Plan deferments to finish our specialty training before being drafted. We had been convinced that the two or three additional years of deferment that we were signing up for would buy us enough time so that when our deferments ran out, we would have everything we wanted—we would be board-eligible in our chosen specialty and the war in Southeast Asia would surely be over. It seemed a good deal all the way around. As it turned out, we were only half-right.
At the time most of us had applied for the Berry Plan, General Westmoreland, the U.S. Commander in Vietnam, had asked for 100,000 troops to win the war. The next year, it was another 150,000. By the time we reached Fort Sam, he had asked for, and President Johnson had given him, an additional 300,000, taking the total number of military personnel fighting in Vietnam to more than half a million.
There were clearly stresses working their way through a system that had sent 500,000 troops to Southeast Asia. That morning, we were to learn about one of them—specifically, that the Army was running out of physicians to take care of the increasing numbers of casualties, as well as being able to fulfill all their other worldwide obligations.
The major in charge of the Medical Student Battalion stepped to the front of our formation and announced without the slightest hesitation, confusion, or embarrassment that those officers with orders for permanent duty stations other than Vietnam, but outside of the continental United States, would have their orders changed to the 90th Personal Replacement Vietnam. Once in country, those officers would be assigned as needed, unless they agreed voluntarily to extend their tour of active military duty from two to three years. Those of us with such orders were to come to his office by 1600 the next day to personally give him their decision.
That was it—an extra year in the Army or Vietnam.
It was a shocker to those of us who had thought we’d been spared. I had my orders to Japan, while others had orders for medical facilities and hospitals in Germany, England, Korea, Okinawa, the Middle East, and the Philippines. For all of us, it meant another year wherever we were going, but a year that would keep us safely out of the war zone.
A bit elitist and definitely pampered throughout college as pre-med students, and admired throughout medical school as future physicians, we all pretty much expected to do what we wanted, or at least be listened to when it came to things we thought were important. None of us expected to be told what to do by someone who wasn’t a physician, much less someone who probably had never finished college.
Not to be asked what we wanted and without so much as a minimal negotiation, simply because someone else wanted it done their way, left all of us stunned. Again, we’d missed that one, too. Clearly, an organization dedicated to killing people and breaking things was not fundamentally subtle or willing to give any view other than their own much consideration.
The twenty-four hours following that ultimatum remain confusing and mysterious to this day, both to me and to everyone else having been given that Hobson’s choice. Surprisingly though, there was no glee or sense of smugness on the part of those in the class who had come to basic training already going to ’Nam. Almost the whole class was now in the same boat. Apparently, at least in some cases, envy is not mean-spirited. That, too, was a surprise.
The truth was that the new orders made those who were already headed to ’Nam even grimmer. The real message to them was that this shifting about of personnel meant that, with more doctors needed in ’Nam, things were clearly going even worse than the Army was willing to admit.
It definitely was not a good sign for anyone already going to ’Nam, whether soldier, special forces, marine, or physician. That, coupled to the military’s strange view of modern medicine, made the ultimatum seem even more bizarre and more dangerous. It didn’t really matter to the Army what kind of doctor you were or how well-trained you’d been in your specialty. In the end, to the Army, a doctor was a doctor and all of us should be able, regardless of training or sub-specialty, to keep a wounded soldier alive.
It was at best an old-fashioned view of medicine and one that seemed to all of us not only archaic, but suicidal. But forget about democracy or reason and maybe even the truth in the military. This was the Army’s game, and they were in charge. They could do what they wanted. That, too, was a surprise for the naïve among us.
By that evening, the shock at the ultimatum had turned to a kind of silent outrage. Everyone who had a family member who knew anyone in government, from congressmen and senators to state representatives, made calls. If it wasn’t panic, it was close.
“Unfair” … “Stupid” … “Astonishingly short-sighted” … “What good am I going to be in a Battalion Aid Station when I have my boards in Gastroenterology?”
But in private
, thoughts were, “What about my family? Who is going to take care of them if I get killed?” “They’re treating me like I’m some eighteen-year-old school kid.” “I’m not going to be much good to anyone not practicing what I’ve been trained to do.”
And then came the real anger and sense of abuse. “This wasn’t the deal we were given.” “Hell, if I knew this would happen I’d have gone into the Army right after medical school and gotten the two years of military service over with once and for all.”
No one said what was really on his mind, the “What about me?” And that was pretty much what I thought too: “What about me?” But I already knew how this would all turn out from that Pentagon letter to the chief of my hospital. There was a war going on.
The Army was in charge. In the end, everyone who went in to see the major extended, but me. I was one of the few single physicians in our class. No family, no kids, no responsibilities. Before I left for the Army, I had sold my Volvo and put what little I owned into a few boxes and left them in the basement of the home of one of the staff physicians at the county hospital to be stored until I came back to the States.
I had left for Fort Sam without owning anything and without having a single key in my pocket. There were no excuses I could use, except the excuse of being afraid. Caving into that seemed a bad precedent for the future. Besides, giving the Army three years of my life seemed a very long time, as well as a very bad deal. I did want to get on with things. Extending would clearly have been worth it if I were to be killed or wounded. But in the end, time won out. I guess I still didn’t know enough, back then, to do the right and prudent thing.
The next afternoon, I walked into the major’s office and told him that I would not extend. Instead, I’d go to Vietnam. As soon as I said it, I knew it had all been a scam. It actually took the major a few seconds to look up from my personnel file. There was more of a look of confusion on his face than surprise.
Broken Bodies, Shattered Minds: A Medical Odyssey From Vietnam to Afghanistan Page 2