A Houston physician’s experience in the Texas Air National Guard

BY Richard N.
Bradley, M.D., UT
Health Science Center,
Houston Department of
Emergency Medicine

Not a day goes by when I do not feel thankful for the wonderful job I have. I cannot imagine a better career than that of a physician. Men and women who have devoted their lives to caring for their patients surround me. I am fortunate to be working with a group of colleagues that represent the very best that our specialty has to offer. They are some of the best clinicians, physician administrators and teachers that I have ever met. Not too long ago, they gave me the opportunity to practice medicine in an entirely different environment. They allowed me the flexibility to take a few months off and volunteer for active duty with the United States Air National Guard.

I have been in the Air National Guard for eleven years. During this time, I have participated in several realistic exercises and had the opportunity to deploy for humanitarian missions to provide medical care in Honduras and El Salvador. Nevertheless, this deployment to Iraq was my first time in a combat zone. Although the separation from my family was a burden, the deployment was tremendously satisfying on both a professional and personal level.

While in Iraq, I served as the physician member of a Critical Care Air Transport Team (CCATT). Our team, comprised of an intensivist, a critical care nurse, and a respiratory therapist, had the responsibility to care for critically injured and ill patients during the five-hour flights from Iraq to Landstuhl Regional Medical Center in Germany.

During these flights, I was able to talk with several of our service members. One man I met had been part of a team that entered a house to take custody of some suspected enemy personnel. Things did not go as planned and a firefight ensued. One shot severed his rifle sling. Another penetrated his left arm, causing him to drop his rifle. He retreated into the depths of the house and under fire, lost contact with the rest of his team. Even though he received several additional gunshot wounds, he was able to draw his handgun and successfully defend himself against several enemy personnel armed with automatic weapons.

Although awake, his injuries were serious. When I met him, he was just hours out of his first surgical operation, and fitted with an external fixator on his left upper extremity. He had several surgical drains that accompanied his new colostomy. Dark purple bruises marred the skin over his liver and heart – undeniable evidence that his body armor had saved his life. Despite his condition, he was in good spirits, joking about his injuries, looking around the aircraft, and offering words of encouragement to other injured patients. He asked me how long it would be until we could “fix him up,” so he could get back to his unit. He explained that the enemy had killed one of his team members and he wanted to be back in action as quickly as possible to continue his mission and help prevent future American casualties.

I found great satisfaction not only in the excellent men and women like this whom we cared for, but also in the high caliber of the other physicians serving in Iraq. One morning at 3 a.m., while preparing a patient for flight, I had a question about the management of a patient with an open thoracic spinal cord injury. I asked one of the nurses to get the trauma surgeon for me. I expected to discuss the case with him on the phone, but was delighted to see that despite the early hour, he came to the ICU to meet with me personally. In his competent yet unpretentious style, he told me that he had the same question and had consulted the base neurosurgeon just a few hours earlier. Likewise, I always found the staff radiologists happy to discuss their findings at any hour of the day or night.

The professionalism of the Guardsmen serving in Iraq was a source of great pride for me. While all of the other CCATT teams in the country were comprised of active-duty military personnel, all three of the members of my team were from the Air National Guard. Guardsmen have not always interacted so seamlessly with their active-duty counterparts during wartime. During Operation DESERT STORM, after mobilization, rather than filling the combat assignments that they had trained for, highly qualified members of my unit backfilled military hospitals in California and Great Brittan. Given the drawdown in the size of the active-duty military over the past decade, the United States cannot afford to operate like that any longer. Members of the Reserve Component in the combat zone are now indistinguishable from active-duty service members. This is particularly true in the medical fields. Not only are today’s guardsmen and reservists just as well qualified as their active-duty counterparts, they tend to be a bit older. On this deployment, my team had decades more experience than the younger, active duty crews did. My status as a guardsman did not hinder me at all when I found that due to my rank, I was the senior CCATT physician in Iraq.

Our service in Iraq gave us unmatched professional benefits. Throughout my career, I have been interested in disaster medicine. Military airlift is an important resource for civilian disasters. It was critical during the response to Hurricanes Katrina and Ike, yet few physicians understand its capabilities and limitations. My new first-hand knowledge of the aeromedical evacuation system, from both a professional and an administrative perspective, will allow me to contribute more to planning for the medical response to catastrophic disasters in my own community.

I also had tremendous personal benefit from the knowledge that I had truly made a difference. Our military heroes deserved the best care possible – I feel honored and humbled that I had the opportunity to play a small role in the care of our nation’s finest who had sacrificed so much to serve and protect our country. I am thankful to my colleagues who covered my clinical obligations and allowed me to have this chance to serve.