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Thursday, March 28, 2024
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Naval Neurosurgeon, what more can happen?

When I walked in the door of the Portsmouth Naval Regional Hospital in 1976, I became—as my family said—a real doctor for the first time. The uniform of the day was dress blues because there was some celebration or other going on. I saluted the flag outside the hospital and felt altogether like a naval medical officer. That afternoon—after a brief meeting for introductions of the staff members—I started in the clinic. I had three clinic days and two operating days as my schedule. The clinics were packed. Since the medical care in the navy was free, we saw a great many of the walking, “barely wounded”; people with headaches from a cold; people with low back pain who wanted a chit to get off duty; people with the “pink-slipper syndrome”—more or less neurotic or those with somatization of psychological problems; lonely women whose husbands were deployed abroad and needed a nice man to talk to; and enough actual neurosurgical issues to warrant surgery. The latter group constituted maybe ten percent. Clinic was an exercise in boredom. I swore that when I got out of the navy and really became a “real doctor” things would be different. As it turns out, they weren’t.

                One of the other neurosurgeons and I determined that we were going to make our naval neurosurgery service one where we attracted serious cases: intracranial aneurysms, brain tumors, arterio-venous malformations, cranio-facial malformations, and pain syndromes. Neither of us had any good idea of what a crying need there was. Within a month of letting our intentions be known around the area serviced by the medical center, we were busy enough to enlist one more of the staff to work with us, and shortly, we had a service that required all three of us to operate three days a week, and sometimes to do elective cases on Saturday.

                It was interesting. We served Camp Lejeune, Marine base in North Carolina and found real enthusiasm for our services from the doctors and the brass on the base. Two events stand out: we had to take a helicopter to the marine base. Once, I was riding along trying not to gripe about the cacophonous noise or the bone shaking rattle of the rotors, when the pilot made an announcement that “we are going down, buckle up.” I didn’t exactly see my life flash before my eyes, but I was highly discomfited by my vision of the near future. We landed smoothly upside down. The pilot had just returned from a tour in Viet Nam, and crashes for him were not that big a deal. Aside from a few bruises, and a lifelong aversion to flying in helicopters, none of us was hurt; and we conducted our clinic as usual.

The other thing that happened may be of more interest to you history buffs. On that occasion, my helicopter was diverted to Fort Bragg. I walked into the dispensary and was met by an excited coterie of doctors, nurses, and military police. I was directed to examine and to pronounce dead—if appropriate—a mother and her two daughters. Collette MacDonald was pregnant; so, in fact, there were four dead people. That was abundantly obvious: The scene was carnage. Every victim had been repeatedly clubbed and stabbed in what could only be characterized as “overkill”. I made a blanket pronouncement of death, then I was taken to see the distraught husband, Capt. Jeffrey MacDonald. He did not want to talk, and I pitied him more than I had ever sympathized with any other man. My role was negligible, and my observations were not even formal. Army CID, FBI, and DOJ, personnel attended to the formalities; so, no mention was made of my presence or pronouncements. My last serious interest in the case came during my last year in the navy when I learned on the news that Capt. (Doctor) MacDonald was tried, convicted, and sent to a federal penitentiary for life—first in California and then in the Federal Correctional Institution in Sheridan, Oregon.

I served as chief of neurosurgery and one odious task I had was to testify against one of my colleagues who was accused of rape. I had witnessed the act. After prolonged legal wrangling, he was allowed to leave the navy and to move to Missouri while he awaited trial. He fled the country—probably back to his native Colombia, where someone told me that he set up a lucrative practice. For the most part, my naval experience was positive. When I announced that I was leaving the navy at the end of my tour, the brass tried everything they could to get me to stay because they were—by then—desperately short of neurosurgeons. I refused, and I have wondered ever since if I should have finished a navy career.

                Question: Military medicine, like Medicare, is essentially socialized medicine. It is imperfect, but it works and works well. No one can rationally deny that we Americans need real health-care delivery reform. Why not change over to a one-party (federal) payor system like the rest of the civilized world?

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