Crossings

by Jon Kerstetter

  I signed my application for the Iowa Army National Guard—age forty-two. After congratulating me, Major Regur set up a preliminary appointment for a screening interview with Lieutenant Colonel Kent Frieze, commander of the 1/113th Cavalry. The 1/113th drove tanks and flew older Cobras and Hueys. Some of the helicopters and their pilots had seen action in the jungles of Vietnam. The Cav needed a flight surgeon. The only thing I knew about the cavalry was that they fought against Indians and enlisted one tribe to scout against another tribe, and of course that Custer and the 7th Cavalry had been slaughtered at the Battle of the Little Big Horn.

  Lieutenant Colonel Frieze had a large corner office in the Cavalry headquarters building of Camp Dodge in Des Moines. On the wall behind his desk hung a black Stetson with a gold-braided Cav hatband with his rank insignia pinned on the front. He was medium build and stocky, square-jawed—what I had expected of a cavalry officer.

  “You’re older than most applicants,” he said. “Why do you want to join the National Guard now?”

  Collin had asked that same question several times and I had responded confidently, yet now, when I faced it from a senior officer, I hesitated. Why did I really want to join the Guard? What did I have to do with soldiering? Was the military just another venue for trying to fill an unsatisfied need? Would I ever be satisfied in my career as a doctor?

  “Well, I got a late start in medical school,” I said. I gave him the short version of how I prepared for medical school and then redirected my answer toward aviation. “I had planned to join the Marines and become an aviator. My plans changed, but I’ve always thought about joining the military one day.”

  That part about always thinking about joining the military wasn’t true. It just popped out like an inane and passing note of small talk that I failed to correct. I had only reconsidered joining because emergency medicine pulled me between the extremes of total satisfaction and total frustration. I didn’t say that to Lieutenant Colonel Frieze. Rather, I muddled through an explanation of how being older didn’t hold me back from becoming a doctor and that I had probably accomplished more than most applicants regardless of age. I let him know I wanted to take the Army combat trauma course and become a flight surgeon.

  “We’re always short of flight surgeons,” he said. “You have to apply to the flight surgeon academy after a year of service. In the interim, you’ll need to take your officer training courses. Your initial assignment will be as a field surgeon.”

  I was surprised. “I didn’t realize I couldn’t go directly to the flight surgeon course,” I replied.

  “You’ll be first on the list after you finish your officer training and your initial assignment. Look at it like medical training,” he said. “Training follows a hierarchy. Basics first, then advanced.”

  After twenty minutes of chitchat, Lieutenant Colonel Frieze gave me a direct look. “The job of the Army is to break things and kill people,” he said abruptly. “You’re a doctor. You okay with that?”

  I had always thought my role as a military physician would focus on the care of the wounded, and never on the need to kill, yet without hesitation I said I was okay with it. Internally, I felt a nudge and a pause. The commander had put it so bluntly—the stated purpose of the military. I dismissed it. I left it hanging like a quirk of science.

  —

  Major Regur called about a week later. My application had been approved. In late September 1992, Lieutenant Colonel Frieze administered the oath of a military officer and gave me a set of captain’s bars. First assignment: the 1st Squadron of the 113th Cavalry Regiment.

  I drilled in Des Moines or Waterloo one weekend per month. In the summer the entire regiment convoyed to Camp Ripley in Minnesota or Fort McCoy in Wisconsin. Training included range firing—mortars, pistols (the old Colt 45 and the newer 9mm), and the M16 assault rifle. I learned to throw grenades and drop mortar rounds—heard them thump, then hit downrange. Lofting mortar shells and firing at human silhouettes was odd in the sense that, for the first time, I saw the glaring irony of my life. A doctor training to become a soldier, a Native American in the modern cavalry whose roots extended all the way back to the Indian Wars. The branch insignia sewn on my uniform, its bold caduceus distinctive from any other branch of the military, told everybody, including me, that I was a medical corps officer. The designation set me apart as a soldier whose hands were trained to heal, yet in the cavalry those same hands were being trained in the art of war and the craft of killing. I contemplated how the two roles pulled against each other and how I needed to balance doctoring and soldiering and make them both work together.

  That balancing act gave me pause, but it didn’t prevent me from acquiring soldiering skills. I made my own ghillie suit by stuffing twigs and leaves and dried grass into the slits of my helmet cover and my camouflage jacket. My face and hands became a forest of camo paint: black, brown, and green. I ran the land navigation course with the best of the young Cav officers. I absorbed it all: the dirt, the smell, the tactics, and the unit camaraderie. I wanted to fit in. I did fit in. I saw the experience as another boundary that I had pushed against and crossed. It was another source of validation—another way of fulfilling that unrelenting need to become something more than I had been.

  Following my first summer training camp, I requested airborne training thinking it might make me more of a soldier and a leader. Lieutenant Colonel Frieze denied the request and kept me focused on medicine and aviation. When a class position opened to attend the Combat Casualty Care Course (C4) at Camp Bullis, Texas, he approved my application immediately.

  During the C4 course, I performed well enough to earn one of three recommendations for further training as a trauma instructor in the military. As a result, earlier than promised, during my initial field assignment, the Iowa Guard sent me to the flight surgeon course at Fort Rucker, Alabama. The course included lectures on the physiology of flight and the mechanisms of aviation-related injuries. The physician instructors taught from the vantage point of experience in Desert Storm or Vietnam, and whenever I could I peppered them with questions about combat trauma. The flight surgeon academy reminded me of medical school. Each new lecture fostered new interests in, maybe even a love for, all things medical and military. I viewed my new specialty as evidence that I had finally arrived at becoming the kind of doctor I had always dreamed of becoming.

  As part of aviation operational training, I flew several hours in helicopter simulators to gain cockpit familiarization. The simulations rehearsed basic in-flight emergencies and included a scenario for landing. I crashed in two out of three trials and wanted to spend more time than was allotted. The instructors said the purpose was familiarization, not mastery. I talked them into one more hour of simulator training.

  Even the fitness workouts were engaging. Before breakfast each day, I ran three miles, sometimes five. I spent an hour or more in the gym each day, pumping iron and punching the speed bag. I felt invigorated and renewed, fit and capable. When the flight surgeon class ran as a platoon, we sang a cadence: “I don’t know but I’ve been told…flight surgeons are mighty bold.” Most of the officers in our class were young, brash, and full of vigor. I was older but still full of vigor.

  I captured every bit of the excitement packed in the academic and field training, reveling in the delusion among students and instructors that flight surgeons were a select group of Army doctors who deserved just a few more kudos from the ranks because we volunteered to practice medicine in the higher-risk environment of aviation operations. Our perception rested purely on pride in our specialty. It had no basis in fact or in the greater scheme of military medicine. The reality was that one kind of Army doctor held no greater or lesser significance than any other, and the doctor whose significance was greatest was the doctor whose skills matched the needs of a given patient at a given time.

  The curriculum included high-altitude training, complete with an altitude chamber that simulated hypoxia. As part of the experience, trainees had to rem
ove their oxygen masks in a rapid ascent to over 18,000 feet (simulated). I learned to experience the physiological changes and the early warning signs of oxygen deprivation and equipment failure. I tried to defy the hypoxic changes by taking shallow breaths. It didn’t work. I felt the gradual onset of lip tingling and facial numbing, the fading of acute hearing, and the gradual confusion and dyscalculia. I wrote simple math problems in a notebook. 2+2= ___; 5-1=___. I couldn’t solve them. I used my supplemental oxygen and recovered. Lesson learned. Recognize cognitive symptoms early. Correct problems quickly.

  In all of the simulations and flight operations training, there was a pace and level of performance that distinguished military medicine from that of civilian practice. The medical principles held true and invariable in either case. Bleeding was bleeding, wounds were wounds; the treatments were the same. But military medicine added the dimension of performing under the pressure of combat where medical care was complicated by the military paradigm of battlefield triage and the need to return soldiers to duty as soon as practical. Triage allowed military doctors to withhold life-saving treatment based upon a soldier’s likelihood of survival. In civilian emergency medicine, that decision was rarely, if ever, allowed.

  Our class participated in a newly introduced training module, hyperbaric medicine. Many aspects of the training paralleled the science and medicine of naval deep-sea diving. As with all my encounters with new disciplines of medicine, I felt the need to explore the subject as if I were studying anatomy or physiology during the first weeks of medical school. The exploration not only satisfied a longing for more knowledge, it satisfied a deeper need to belong to something extraordinary. I was never satisfied with the ordinary. I had to become something and somebody beyond ordinary, a bold person who defied complexity and shaped it into my unique and ordered universe.

  On March 22, 1993, an Army flight surgeon who had served in the Vietnam War delivered the graduation address to our flight surgeon class. The Vietcong had captured him when his helicopter went down on a rescue mission. He spent several years as a prisoner of war at the Hanoi Hilton. His daily prison routines included constant near starvation and the persistent brutality of the guards with their physical and mental torture. During his imprisonment, his captors hung him from his wrists and flogged him nearly to death because he ate a prison guard’s cat to stay alive. As he described the details of his torture, I imagined myself as a captured soldier, and I knew I could never endure imprisonment. He told us how his fellow POWs developed a secret tap code and how they tapped out words on the prison walls to encourage each other or to say good night. They recited scriptures and prayed for each other and said “God bless.” There were times when prisoners got a distant, unresponsive look in their eyes, and when they got that look, other prisoners tried to encourage them or sneak them food. The encouragement usually failed. The doctor described his eventual release from prison and how, over the years, he began to heal by turning from bitterness and hate. He said that his turning released him to live and love once more.

  “I have a full life now,” he said. “I’ve learned to forgive and to heal. The scars are still there, but they’re less important.” His peaceful manner gave strength to his message. Still, it was difficult for me to understand how a soldier could recover from years of torture and imprisonment, how a prisoner of war could come to the point of forgiveness. He reminded the graduating class that becoming a flight surgeon demanded more than acquiring a special set of skills; it demanded even more than a willingness to respond to an edict of war. He challenged us to think of our specialty as a commitment to provide healing and strength to fellow soldiers, whenever and wherever they needed a doctor the most—whether in a field hospital, in a medevac helicopter, or in a POW camp. He signed off by saying “God bless” in tap code: tap-tap, tap-tap—tap-tap, tap. As he finished his talk, the room was silent. Then it erupted in standing applause and tears.

  Despite all I had heard about the inhumanity of war, I celebrated my new role. Yes, it meant struggling to balance the roles of a soldier and doctor, and if the need arose, pulling a trigger to kill. Yet within that struggle was something more powerful than war’s inhumanity; it was the humanity of a military doctor bringing hope and healing to soldiers gripped by the certainties of war. And becoming a flight surgeon gave me the sense that I could do just that.

  The commander of the academy called the graduates forward by name: “Captain Jon Kerstetter, Iowa National Guard.” He pinned the silver wings of an Army flight surgeon on my uniform. My new orders read: “Captain Jon R. Kerstetter is awarded the U.S. Army Flight Surgeon Badge and hereby qualified as Military Occupational Specialty, 61N—Flight Surgeon.”

  —

  Over the course of several years, I was assigned an administrative headquarters position in the office of the state flight surgeon that involved mostly flight physicals and monitoring the medical regulatory compliance of aviation units. I preferred the field. After a year in the headquarters assignment, I received a promotion to major and was reassigned to the 1/113th Cav. Lieutenant Colonel Dan Fix, a former Marine who had fought in Vietnam, was the new unit commander. In civilian life he ran a tire and oil company in Waterloo, Iowa. His executive officer was Captain Orr, a high-speed, low-drag Army Ranger who loved training.

  Commander Fix lived the doctrine “Train like you fight—fight like you train” and he stressed that every officer should know every other officer’s role and be able to assume command if required. To teach that lesson, he simulated broken communications, destruction of the tactical operations tent, and downed helicopters. He faked his own death and took various officers and NCOs out of action, then observed how other officers struggled with tactics and leadership. Captain Orr shifted to the commander position and I became his medical advisor or executive officer. To push the medics, the commander had me killed in a simulated firefight. It was eerie watching from the sidelines as the medics faced overwhelming numbers of wounded. The commander honed us beyond our own specialized training and taught us to adapt to a continuously changing battle. His training matrix keyed officers for war, not just for summer training exercises.

  “Think contingencies. Plan for everything you don’t expect,” Commander Fix insisted. “Train like you fight. Fight like you train. Adapt and overcome.”

  “Yes, sir,” we responded in after-action reviews. We did as commanded. I didn’t know then that I would soon use that training in response to a war without direct U.S. involvement, and that the skills I learned, as critical as they were for field survival, would seemingly serve no useful end in the face of overwhelming carnage.

  In April 1994, the Rwandan president and Hutu leader Juvénal Habyarimana was assassinated when a surface-to-air missile shot down his private jet near Kigali, Rwanda. During one hundred days following his death, armed Hutu militia retaliated and massacred an estimated eight hundred thousand Tutsis and moderate Hutus. In retaliation for the retaliation, the Tutsi-led Rwanda Patriotic Front overran the capital city of Kigali and vowed to cleanse Rwanda of all ethnic Hutus. Some news reports claimed up to two million refugees fled into Tanzania, Burundi, and Zaire (now the Democratic Republic of the Congo).

  I read about the carnage in the newspapers and in the May 1994 edition of Time magazine. A correspondent quoted a missionary about the warring state of affairs in Rwanda. “There are no devils left in hell. They are all in Rwanda.” Those eyewitness words alerted the world to the genocidal atrocities. Other news reports described the horrors with words like “innocent” and “child” and “corpse” in juxtaposition with “murder” and “rape” and “machete.” In the reportage, brutality and death became synonymous with ethnic cleansing.

  USA Today ran a front-page special report on the genocide. I was on duty at the Finley Hospital in Dubuque, Iowa, when I read it at lunch. It hit me that millions of innocent people had fled their homes in fear for their lives, many suffering from injuries and an epidemic of cholera. The carnage and inhumanity were unspe
akable. In a sidebar column of the article was a list of international aid organizations that were preparing for a humanitarian response to the crises. There was a call for professionals to volunteer for medical work in the refugee camps. I read the article twice, the sidebar probably five times. I was intrigued by the intense nature of the crises and the possibility of participating in a dangerous yet humanitarian effort. Earlier that same day I had performed a trauma resuscitation on a five-year-old girl involved in a car accident. The intervention was successful and she survived her injuries. One of the staff surgeons asked me how it felt to be involved in giving a child a second chance at life. When I read the article about the Rwandan refugees, I wondered who was trying to give them a second chance and if my presence there could make a difference.

  By the end of my shift in the evening, I had phoned several of the organizations on the list and asked if they needed doctors. One of them wanted me to join their team within the following week. I phoned Collin and told her about my day, about the USA Today article, and about my phone call. I told her I should go help. When I got home, we discussed it.

  “I think I have the right skills to help those people,” I said with confidence. “They need emergency doctors. This is something I could do.”

  “But it’s so dangerous. Doesn’t the UN or the military have doctors who can go?” Collin had a serious frown that I usually interpreted as “no.”

  “The UN is there, but they are using humanitarian groups to provide medical services. I don’t understand how it all works, but I would be on a rapid response team and work in the refugee camps.”

  “We can manage a month or so on our own, but I’m still worried about safety,” she said cautiously.

  “The fighting has stopped,” I pointed out. “They’re supposed to be in a recovery phase.”