Casualties of War -- Military Care for the Wounded from Iraq and Afghanistan
From The New England Journal of Medicine, whose publishers have kindly served up this article to guests, so you don't have to register or log in to read it. (Don't everybody try to browse it at once! Their server is painfully slow to upload.)
Rush Limbaugh complained an hour ago on his radio program that "some scholar at The New England Journal of Medicine is now suggesting that soldiers are living worthless lives because they are surviving their wounds." I can understand how a cursory glance at the article might lead one to that conclusion. But Rush, you're mistaken. In fact, Dr. Atul Gawande, the article's author, is actually paying tribute to the advances in modern medicine, and the superb job done by the military medical corps, that has made it easier than in any war we have fought previously to get shot in combat and live to tell the tale.
You have to understand Dr. Gawande's target audience: he is writing to his fellow doctors, saying, "This is how they're doing things, and it's not like your community-based surgical practice." Anyone ought to expect that. And some of Dr. Gawande's remarks do sound like blowing things out of proportion. For example, he says that 10,726 soldiers, sailors, airmen, and so on have been wounded in the War Against Terror, and of those, 1361 have died (including 1004 who qualify as KIA rather than dying afterward) and 5,174 were wounded too badly to return to duty. Dr. Gawande calls this "the largest burden of casualties our military medical personnel have had to cope with since the Vietnam War." What Dr. Gawande does not mention in the same context is that our casualties in Vietnam were much, much higher--at least 50,000 dead. (Don't just take my word for it: go to the Great Wall of the Dead in Washington, DC and count the names for yourself.) So, yes, Dr. Gawande is distorting historical perspective in this instance.
But the rest of his article has some very heartening statistics. Combat deaths in the War Against Terror have amounted to only ten percent of all those who have gotten shot, partially or totally blown up, or whatever--compared to thirty percent in WWII and 24 percent in Vietnam. (Dr. Gawande does not have comparable statistics for the War Between the States, but I have oral sources that put the lethality rate at about fifty percent. Interestingly, Dr. Gawande says that at least as many soldiers have been injured in the present conflict as in the War for Independence or the War of 1812 or in the first five years of Vietnam. He does not mention the War Between the States or the Spanish American War or either World War.)
The rest of his article is a detailed description of the various levels of military medical care and how they are delivered. Dr. Gawande pulls no punches, and some of the content of this article is not for the squeamish. Again, he is writing as one doctor to another--and, being a doctor myself, I can fully appreciate the challenges that the Forward Surgical Teams and Combat Support Hospital units (formerly called Mobile Army Surgical Hospital or MASH units, immortalized on celluloid by Donald Sutherland, Elliot Gould, Alan Alda, Wayne Rogers, Mike Farrell, McLean Stevenson, Harry Morgan, and many others) face, and how they've had to adapt to the changing conditions of the war.
But in the end, Dr. Gawande does not make any statement about the quality of soldiers' lives, nor does he make any anti-war statements. Instead, his article is a tribute to military doctors everywhere--probably the best such tribute that could have passed editorial muster at the NEJM, considering the still-remaining legacy of its ultra-liberal former editor-in-chief, Dr. Arnold S. Relman (about whom the less said, the better).
Read this article if you want to know about another set of unsung heroes (and even a few leaders) in this or any war.
Rush Limbaugh complained an hour ago on his radio program that "some scholar at The New England Journal of Medicine is now suggesting that soldiers are living worthless lives because they are surviving their wounds." I can understand how a cursory glance at the article might lead one to that conclusion. But Rush, you're mistaken. In fact, Dr. Atul Gawande, the article's author, is actually paying tribute to the advances in modern medicine, and the superb job done by the military medical corps, that has made it easier than in any war we have fought previously to get shot in combat and live to tell the tale.
You have to understand Dr. Gawande's target audience: he is writing to his fellow doctors, saying, "This is how they're doing things, and it's not like your community-based surgical practice." Anyone ought to expect that. And some of Dr. Gawande's remarks do sound like blowing things out of proportion. For example, he says that 10,726 soldiers, sailors, airmen, and so on have been wounded in the War Against Terror, and of those, 1361 have died (including 1004 who qualify as KIA rather than dying afterward) and 5,174 were wounded too badly to return to duty. Dr. Gawande calls this "the largest burden of casualties our military medical personnel have had to cope with since the Vietnam War." What Dr. Gawande does not mention in the same context is that our casualties in Vietnam were much, much higher--at least 50,000 dead. (Don't just take my word for it: go to the Great Wall of the Dead in Washington, DC and count the names for yourself.) So, yes, Dr. Gawande is distorting historical perspective in this instance.
But the rest of his article has some very heartening statistics. Combat deaths in the War Against Terror have amounted to only ten percent of all those who have gotten shot, partially or totally blown up, or whatever--compared to thirty percent in WWII and 24 percent in Vietnam. (Dr. Gawande does not have comparable statistics for the War Between the States, but I have oral sources that put the lethality rate at about fifty percent. Interestingly, Dr. Gawande says that at least as many soldiers have been injured in the present conflict as in the War for Independence or the War of 1812 or in the first five years of Vietnam. He does not mention the War Between the States or the Spanish American War or either World War.)
The rest of his article is a detailed description of the various levels of military medical care and how they are delivered. Dr. Gawande pulls no punches, and some of the content of this article is not for the squeamish. Again, he is writing as one doctor to another--and, being a doctor myself, I can fully appreciate the challenges that the Forward Surgical Teams and Combat Support Hospital units (formerly called Mobile Army Surgical Hospital or MASH units, immortalized on celluloid by Donald Sutherland, Elliot Gould, Alan Alda, Wayne Rogers, Mike Farrell, McLean Stevenson, Harry Morgan, and many others) face, and how they've had to adapt to the changing conditions of the war.
But in the end, Dr. Gawande does not make any statement about the quality of soldiers' lives, nor does he make any anti-war statements. Instead, his article is a tribute to military doctors everywhere--probably the best such tribute that could have passed editorial muster at the NEJM, considering the still-remaining legacy of its ultra-liberal former editor-in-chief, Dr. Arnold S. Relman (about whom the less said, the better).
Read this article if you want to know about another set of unsung heroes (and even a few leaders) in this or any war.
posted by Temlakos at 3:18 PM
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