Maybe the Marines have it right

One of the advantages of writing a column is the ability to hijack it when the need arises. Recently I retired and moved to the Camp Pendleton Marine base in San Diego. But lessons in patient care weren’t far behind.

Never doing half-way

When I retired, I was going to get into shape. One of the advantages of living on a military base is the multiple free gyms. So shortly after moving, I went in to one with my head held high and feeling confident. In retrospect, seeing the Marine with the T-shirt stating, “Pain is weakness leaving the body” along with his buddy’s T-shirt, “The more we train in peacetime, the less we bleed in war,” should have been a clue as to what I might expect. I stepped onto a treadmill that must have been set for a 4-minute mile and flew off, twisting my ankle. I attempted to limp past the front desk when the attendant stopped me and made me fill out an injury report. It was mostly my pride that was injured.

I returned later in the week and decided that the weight machines looked safer. I also found that the minimum weight was 2X, as much as my suburban “Mom” gym in my previous home in Washington, D.C. As I attempted to remove the pin, pulling and twisting to get it out of the slot, it finally let go. I flew into the machine next to me and split my head open. As I sat there dazed, I was surrounded by 50 Marines in various stages of undress: a medic, a scrub nurse, a doctor and of course, the front desk person with the incident form again. I called my husband for a ride to the urgent care for nine stitches and was asked by the urgent care staff why I bothered contacting my husband when I had 50 Marines available to me. I did not have a good answer for that.

Two weeks later, after my sister, the pediatrician, removed my stitches, I returned to the gym. I decided pick-up women’s volleyball sounded safer. After all, it was “pick-up” and it was “women’s.” How bad could it be?

I was wrong. During the 2^nd volley I had the ball spiked into my face, splitting my nose open, popping out one of the lens from my glasses, twisting the trifocal frame into an impossible design. I went back to the front desk trailing blood the whole way and facing the formable incident form once again. The front desk had pre-populated my name and address already.

As the desk staff attempted to twist my remaining lens into a useable position and found they could not, another staff member packed my nose to stanch the bleeding. I limped back to the volleyball court to pick up my teenager. As I did so, the first question was “Are you coming back in? We saved your position.”

When you fall, get back up…again

Stories aside, the point is that not being able to see, dripping blood, and a cracked head are not reasons to quit. These Marines keep going. I look back on my practice as a PA. How many times had I just stopped encouraging patients to lose weight? How many times had I not bothered with my “no smoking” lecture? How many times had I said: “Well, at least your A1C is not in double digits?” I accepted less than the best from my patients. Maybe the Marines have it right.

Thinking outside the box

I met with my nephew, a chef, to set up a dinner at a site that did not have a kitchen. He told me it was impossible to have a dinner without a full kitchen. I explained that the contract for the site was already signed; payments had been made and he needed to figure out a way to make this work. As we talked, my mind wandered to Army surgical scrubs techs.

Our hospital was near Fort Belvoir in Virginia and prior to moving to nephrology, I spent 15 years in orthopedic surgery. We had a large contingent of retired Army surgical scrub technicians. Things can go wrong: the bone we are attempting to put together is cracking and falling apart; the patient is bleeding out, and anesthesia is yelling at us, “I want an Army scrub tech in here with me.”

The scrubs (males and females) are the most imaginative and “never say die” group I have ever met. When we lost a titanium screw in a cavity during surgery, they suggested using a magnet. When it turned out titanium is not magnetic and the C-arm X-ray was useless to locate it, the tech suggested a tiny ENT scope to thread down to catch a glimpse of metal reflecting in the light of the scope.

Another time, we had stripped a screw head and could not remove it without making a bigger hole in the bone than we started. The tech suggested a hacksaw (yes, engineering let us sterilize theirs) to cut off the head and bury the screw body. When blood was spurting out and we seemed to have too few hands, the surgical tech automatically jumped in without ever being asked to help.

I snapped back to reality as I listened to my nephew continue to explain to me all the reasons why a kitchen-less dinner party would not work. I mentally wished for a retired Army chef who could manage to put together a meal in the middle of a desert without a full kitchen.

Stand your ground

When I left San Diego in the 1970s, the Vietnam War was just ending and the schism between the military and civilians was still raw. I had seen my father, a Navy trained nuclear engineer, spit upon when he was in uniform. I was embarrassed to be associated with him and gravitated to boyfriends with long hair and no interest in the military.

After living 35 years in Washington, I have returned now to San Diego. To say it is a night and day difference is to undersell the change. The San Diego I returned to is incredibly supportive of their military. Walking off the Camp Pendleton Marine base meant I was surrounded by a community that went overboard to support their military comrades. There is a summer thank you bar-b-que in Oceanside, a film festival in San Diego, free Xmas trees for troops, discounts and priority everywhere you go, etc. The military in San Diego has not changed; the San Diego civilians have. Instead of denigrating their military comrades, they hold them on a pedestal. While this is almost as difficult to comprehend as the hatred of the 60s and 70s, it is also proof that if you keep doing what you think is right and good, someday it will be appreciated. Good kids (and I do mean kids) tried to do the right thing for 40 years and now they are appreciated. What goes around, comes around. Perhaps there is hope for my clothes…they may come into style again.

As we celebrate Veteran’s Day this month, we celebrate what the military has to teach us. And maybe, just maybe, those Marines with the No Guts, No Glory T-shirts do have it right. Never give up.

For us in health care, that means keep working with our patients. Expect nothing less than their best. We went into medicine to make a difference. Burning out is not acceptable in the military and it is not acceptable in medicine. Take a deep breath and go in there and silently repeat the Marine’s motto, “Semper Fidelis” — always faithful.