On Patrol

Army Lieutenant Colonel John Burson, M.D., served two tours in Iraq, where surgeries sometimes lasted most of the night. Photo Courtesy of Lieutenant Colonel John Burson, M.D.On July 30, 2011, Major General Timothy McHale presented me a birthday cake as I celebrated my 77th birthday on active duty at New Kabul Compound in Afghanistan.

Any reasonable person might wonder why the Army is allowing old men like me back on active duty. Have we gotten this desperate for manpower? To compound the question, this was my fourth combat deployment—two to Iraq and two to Afghanistan.

This all began in 2005 when I received an email from the surgeon general informing retired physicians that active duty was available for those who qualified. I retired in 1985 with 30 years of service and had never given a thought to returning to active status. Thus began the laborious process of filling out dozens of forms, getting an updated physical and, finally, reporting to Fort Bliss, Texas, for “re-greening.” And indeed, it was literally a re-greening since I had no uniforms that were still in service.

Two weeks later, I was all togged out in new BDU uniforms and ready—along with my four duffel bags of equipment—to head out for Iraq. Most of my previous service was in command and staff jobs in the “real” Army. I only joined the Medical Corps after I graduated from medical school in 1975, at which time I had just made O-6, or colonel.

When I asked to transfer to the Medical Corps, I was told that one must resign their commission and be re-commissioned in the Medical Corps where your rank was determined by your medical experience. Thus, I went from an O-6, or colonel, to an O-3, or captain, which was commensurate with my medical experience at the time. This would be my first active duty job as an M.D. so I was just a bit apprehensive.

My first deployment was with a National Guard medical company from Indiana and my first job was running a clinic at Camp Victory, Iraq. This was mostly routine sick call—care of minor injuries and only an occasional trauma patient. After a few weeks of this, I had an interesting change of pace.

Saddam Hussein was kept under heavy guard at one of his previous hunting lodges within Camp Victory and we had a physician who stayed with him full time. The replacement for this position was delayed and I filled in for a few days.

I found this despotic dictator—under these circumstances—to be very pleasant and charismatic, as one might expect a typical politician to be. It was quite interesting to see a side of him that was rarely displayed to the public.

Army Lieutenant Colonel John Burson, M.D. retired in 1985 with 30 years of service, but his return to the Army was set in motion by an email he received in 2005. Photo Courtesy of Lieutenant Colonel John Burson, M.D.After this brief assignment, I was transferred to the U. S. Embassy in Baghdad, where we ran a clinic that cared for Embassy and associated military and civilian personnel. After a few days there, I received a consult request from a combat support hospital (CSH) just a few blocks from the Embassy.

This CSH was a very busy trauma hospital that, as the first surge was just beginning, was getting lots of casualties from Fallujah and other surrounding combat sites. At that time, there was only one other physician in the CSH with a head and neck trauma background so I was asked to assist in the surgical care of the large number of casualties arriving every day.

It was a great experience for me to care for these wounded GIs and see the extremely high level of care that was provided. There was no typical day at the CSH. We operated around the clock many days caring not only for GIs but also for many wounded civilians and even insurgents.

I trained in a very busy charity hospital and had seen my share of trauma, but never anything that would compare with the degree of trauma we routinely saw. Our primary job was to stabilize injuries so patients could be transferred to the next-level hospital at Balad and later back to Landstuhl, Germany, or to Walter Reed as indicated by their condition.

To give you an idea of how efficient this care was, it was not unusual for severely wounded troops to be at Walter Reed within 24 to 36 hours after being wounded.

Two years later, I had a second Iraq deployment to Camp Cropper with a North Carolina military police unit that processed and provided medical care to all of the detainees captured at the height of the surge. Camp Cropper was the prison established after the closing of Abu Ghraib.

This deployment gave me an opportunity to have better insight into the mindset of the insurgents. We came across many so-called “high value” insurgents, as well as innocent civilians who were sometimes swept up in a raid.

This was not a particularly challenging tour after the CSH experience, but provided a good look into another aspect of military medicine.

Since much of my military experience prior to becoming a physician had been in combat and combat support units, I wanted a tour with an infantry battalion in Afghanistan to experience conditions closer to the actual fighting. I was fortunate to get a tour with an infantry battalion at Mehtar Lam which was close to the notorious Kunar Valley near the Pakistan border. We also had a combat outpost farther out in the hills at Najil.

I had experienced an occasional mortar attack in previous deployments but here it was an atypical day if we didn’t receive indirect mortar or RPG fire and almost routine small-arms fire, particularly at our COP at Najil.

In this job, I got a very different look at medical care here, mostly with the first providers. I had seen, indirectly at the combat support hospital, the terrific job the combat medics do to resuscitate and stabilize battlefield injuries. It is this care during the “Golden Hour” that enables the physicians at support hospitals to provide the great care they do.

Unfortunately, the downside to this assignment was the much more personal side of war with the loss of troops whom you had come to know well. In this setting, you often experience the close camaraderie from being around these soldiers in the gym and mess hall and sometimes, unfortunately, being a part of their memorial services.

I suppose a natural question is why do I keep doing this when I could stay home and enjoy my very comfortable life? I certainly don’t consider my actions as heroic and I don’t really have a very good answer other than to say that I keep getting an urge that needs to be acted on. I am reminded that, in many ways, I have truly lived the American dream and this is just a means by which to repay, in a small way, the sacrifices of those many who have gone before me.

Another frequently asked question is about the morale of our troops. A part of my medical duties is an exit interview for each troop redeploying. These interviews remain strongly positive, with the great majority very proud of their service. However, even though morale remains high, there has been a significant dropoff in these later tours with a lot of combat fatigue.Now, many of these troops have been on eight to 10, or even more, deployments. The most depressing finding is the very high suicide rates that are now prevalent. I fear that in the near future, the military and VA systems are likely to have a huge influx of veterans with minimal brain injury and post traumatic stress.

When all is considered, it has been the experience of a lifetime and one I shall never forget.