Authorpreneur Dashboard – Gus Kappler MD FACS
Welcome Home From Vietnam, Finally
Biographies & Memoirs
I served as an Army trauma surgeon at the 85th Evacuation Hospital, Phu Bai, Vietnam, '70-'71. Into our emergency room were intermittently deposited the wounded, some grievous others not, by the daredevil Dust Off medieval pilots who risked imminent death with each mission. We routinely witnessed the devastation of war on the body, mind, and soul. The corpsmen, technicians, nurses, anesthesiologists, and surgeons explored every known and out-of-the-box technique to salvage life and limb. If the wounded arrived alive at the 85th, he had a 95% chance of survival. It was and still is that 5% whose injuries were so severe or whose blood loss could not be stemmed that haunt us today. That's PTS. By storytelling for fifty years since returning to the US in late August 1971, I have avoided the (D) and mollified my demons. The intense emotions during my traumatic experience have softened greatly but, I am back in Vietnam on a daily basis. In 2015 I compiled my stories into Welcome Home From Vietnam, Finally, A Vietnam Trauma Surgeon's Memoir. It is gripping, honest, real-life, and disturbing. Then we realize that the 58,000+ lives lost did not change a thing. No dominos fell and Vietnam is now our close trading partner. They have been gracious victors.
Book Bubbles from Welcome Home From Vietnam, Finally
#9) Saved By My Subconscious
A helicopter flew over. I was back in Vietnam as a trauma surgeon. It’s been over half a century. I awakened to a mechanism I unconsciously employed in Vietnam, keeping my PTS in check. We were compassionate during my surgical training at the Medical College of Virginia. Alternatively, in clinical discussions, each patient was referred to by their surgical disease, i.e., “The gallbladder...” During my time in Vietnam, I was unaware that I hid behind that same detached approach to avoid mourning the gruesome deaths I could not prevent and obsessing over the repercussions of the wounded’s injuries. My subconscious suppressed remembering names. I did not consider how a deformed extremity or rerouted internal organs would affect the patient’s life. Most wounded would be medivaced to Japan within twenty-four hours. Out of sight, out of mind. We cared for the wounded with excellent skills, profound compassion, and unreserved respect. They were loved and, when inevitable, were guaranteed death with dignity. I would serve in the Vietnam War for a year. I had to cope almost daily with the devastation of young men’s (actually boys’) bodies and souls. I was fortunate to have retained sufficient positive subliminal traits of religion, education, science, and morality to allow my subconscious to utilize that mechanism to keep me functional. My PTS was under control.
#8) Finally, the OR
From the #18 insight under ONE DEGREE: "Physicians, especially surgeons, must become expert compartmentalizers. Whatever the result in the first case, one must engage their full mental and physical attention to tackle the next issue. However, it is impossible to scrub the bad outcomes and complications from our minds. To seek closure, we must analyze every aspect of our patient care." These repeated mental gymnastics wear down a physician's steady state. Outside, they at first appear unaffected. Inside, one's resistance to crumbling is wearing down. As with the military, our society, in general, stigmatizes mental illness. Would you visit a doctor who sought a psychiatrist's help? Most would not! The suffering physician then attempts more enormous compartmentalizations that begin to leak. A short-term resort is self-medication - alcohol or drugs. The helplessness and isolation become overwhelming; families fall apart, and divorce increase. Brain tissue, neurons, die, and areas of cavitation are visible on MRI. Prefrontal cortical executive function falters to the point wherein suicide becomes the most reasonable choice to exorcise one's demons. The suicide rate for physicians exceeds that of the general public. This same scenario is endemic in active duty military and veterans. Please watch https://youtu.be/T9EMz23LBZk
#7) The ED
The wounded died from the inhibition of oxygen delivered to the body’s tissues. We administered packed red cells and salt solution to reverse blood loss shock. Wounds or trauma to the chest may cause a leakage of air into the chest cavity that, in excess, may collapse that lung and inhibit the return of blood to the heart. It’s called a tension pneumothorax and may be fatal. Our rule was to place a drainage tube empirically into the chest cavity before surgery if there were the slightest chance a collapse would occur under anesthesia. We encouraged the corpsmen to perform procedures above their pay-grade. These corpsmen, nurses, and docs worked as one to accomplish all the tasks required for life-saving. They took vital signs, placed large tubing into veins for blood and salt solution administration, set up the chest tube drainage, drew blood samples, bagged the intubated patient. They replaced IV solution bags, squeezed the blood bags to infuse more rapidly, and stabilized fractures.They gave pre-op meds and antibiotics, placed a urinary catheter to measure output, checked blood oxygen levels, did multiple x-rays to localize metal fragments and definite bone fractures. And they also checked peripheral pulses to rule out arterial damage and read the chest x-ray to rule out injury or fluid overload.
#6) Medivac
Yes, I’m in the minority. But I prefer Medivac to Medevac. The young men that flew and manned the Dust-Off (Medivac) Huey UH1 helicopters of the 326th Medical Battalion were dedicated to rescue and deliver the wounded to our medical facility, the 85th Evacuation Hospital. Fourteen of their number were KIA during the year I served. My dear friend, Bob Nevins, piloted Dust Off missions for the 326th to the 85th that same year. They were heroic kids challenging the odds of survival as if crashing vehicles in a State Fair demolition derby. The choppers were sitting ducks for penetrating small arms fire and rocket-propelled grenades. Not deterred, they flew in borderline weather of mist, rain, and wind to navigate jungle growth in attempting to extract the wounded. Bob, a modest man, related one of his crashes wherein he extracted his crew from the wreckage, evaded the enemy, and awaited rescue. He vividly describes the white-hot rocket going through his aircraft. Few have heard his story and the stories of most veterans. I dealt with my PTS by story-telling, talking. Most veterans do not allow themselves to do the same. That and other factors contribute to PTSD and suicide. Bob Nevins has created the wildly successful equine-assisted Alliance 180 to address the veterans’ and first responder demons.
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#5) Nurses
We fully trained thirty-something doctors were Majors and supposedly the masters of our universe. However, the young nurses in the ICU/Recovery Room and on the Medical Wards ran the show. The great majority were in their early twenties, recently graduated from nursing school, and had volunteered for Vietnam. They received six months of Army medical training before deployment. They were the same age as the wounded. These women witnessed the gruesome physical wounds, emotional shock of realizing that arms or legs were forever missing, and the acceptance by some that death was imminent. They quickly surmised the expertise of the physicians. When deemed competent, a nurse anointed the candidate with a chain of "love beads." Nurses were the expert conduit of information regarding a patient's medical and surgical welfare. When we were criticized or informed, we listened and responded. Rank and titles did not apply. Physicians, nurses, and corpsmen were on a first-name basis. There was mutual respect. We recognized the contributions of all involved were of equal importance. A few nurses were married to chopper pilots and lived with them on the 85th compound. The men would leave in the morning to go to work (killing the enemy) and return in the evening for dinner and a night at the Officer's Club. That was crazy!
#4) Finally, The OR
I soon encountered the nexus of my Vietnam adventure, the responsibility of attempting to surgically correct or modify the devastating wounds inflicted by the high-velocity weapons of war. I committed to medicine as a high school sophomore. Soon after, my interest morphed into a determination to become a surgeon. I did not wish to discuss a patient’s care endlessly but to get inside and efficiently fix things. I did not appreciate the sacrifice entailed to accomplish my goal. I endured thirteen years of schooling/training after high school. I lost the decade of enjoying my twenties. Robin and I married at twenty-three after my second year at Cornell University Medical College in NYC. At age thirty, Robin and I loved Kim, five, and Chris, six months, when I left for Vietnam after completing my surgical residency. I believed I was ready to leave the residency “nest,” wherein one always could call for help. In Vietnam, my first post-residency patient suffered extensive high-velocity wounds. Making the right decisions when operating on this poor soul reinforced my feeling that Dr. Hume’s intensive Medical College of Virginia surgical training prepared me to be on my own. As any surgeon, we were happiest in the OR away from outside distractions. This place allowed us to be artists. The work began postoperatively.
#3) Our Mission
Each subject referenced in this chapter is expanded upon by a wealth of articles and texts. Most importantly, how did the United States enter into the quagmire of a guerrilla war in Vietnam? Read Dereliction Of Duty, H.R. McMaster, and Vietnam, An Epic Tragedy, 1945-1975, Max Hastings. The destructive influence of war on an individual’s psyche irreparably changes everyone. Ed Tick, P.hD. in War and the Soul proposes that fracturing the warrior’s soul is the root cause of subsequent active duty and veteran challenges. The soldier obeys the moral code of war; killing the enemy is expected. Forever, he lived by the moral code of peace; life is sacred. He finds it impossible to function, honoring one code without being influenced by the other. Therefore the soul’s moral code is fractured, and he serves in a moral limbo. Reconciling this dual existence during basic training and when deployed to a combat zone is the key to rehabilitating the soldier. Stigmatization of the military culture guarantees order but inhibits the warrior from pursuing the path to healing. PTSD, substance abuse, and suicide, therefore, become rampant. The healing must begin without the threat of stigmatization, in a safe place, and without record keeping. The US Air Force Deployment Transition Center does precisely that. So will my approach: https://youtu.be/Q-FDupMy8J8
#2) Transformation
The chapters Robin And Eddie, Our New Life, Moving On, Uncharted Waters, Life-Altering Plans, and Basic Training expand on the book’s initial posting. Then, somewhat depressed, I was On My Way. Honestly, part of me wanted to go for, in the prevailing surgical culture, Vietnam was the ultimate adventure and learning experience. In Phu Bai’s All Right, it felt as if I had landed “at the end of the earth.” Utilizing the lessons I had learned from Donald Sutherland (Hawkeye) in the 1970 movie Mash, I acclimated to the inevitable Transformation experienced by a young trauma surgeon stationed in a combat zone. One became numb to the mutilated kids, deforming surgery to salvage life, anguished screams of the wounded, and accepting that a few young victims would not respond to your best efforts and die. I learned from my dad to treat everyone in the same respectful and transparent way. Thanking all hospital staff members who contributed to the patient’s welfare became routine. I eliminated “rank’s” trappings. Addressing each other by one’s first name became the norm. This approach was well-received back home during my surgical practice years. That transformation is a dominant factor in how I deal with life. We who served have left part of ourselves in Vietnam, and our thoughts return daily.
#1) Leaving On a Jet Plane
It was September 1970. High school dating in 1957, Theta Xi fraternity parties at Cornell, our June 1963 wedding, receiving my MD degree from Cornell University Medical College in 1965, the birth of two children, and in 1970 completing an arduous five-year surgical residency at the Medical College of Virginia in Richmond were history. I was drafted as an intern in 1965 and received a deferment to complete my surgical training. We were sure by 1970; the Vietnam War would also be history. No way! So in July 1970, Robin and I went back to Wading River, Long Island, NY, to prepare for a drive across the country to San Antonio, Texas, to complete basic training at Fort Sam Houston. The clock was ticking. Two weeks ahead of me at Fort Sam, Ed Kayser, my first roommate in medical school, who had trained as an orthopedic surgeon, said good to his family and left for Vietnam. Robin and I did our best to make the most of our remaining time as a family. My orders eventually arrived. I was to board my plane in Dallas, Texas, in early September 1970. The count down to separation was getting closer. We drove to Dallas and stayed with friends. Ben took me to the airport. Helen consoled Robin. My most devastating day! Ever!
ONE DEGREE
Mystery, Thriller & Suspense
ONE DEGREE is an historical medical mystery thriller involving a fatal infectious illness that begins in the 1971 Vietnam wartime jungle. Five Vietnam Veterans who observed the illness first hand and others touched by it are followed in their stateside journey to define and irradicate this fatal gruesome disease. The veterans feel helpless to treat this disease first encountered in soldiers during the early 1970s, peaking globally in the mid-1970s, and essentially disappearing by 1975. A talented plastic surgeon, Claire Ferrier, tragically succumbs to this dormant illness after returning to the US from Cameroon in 1986. With great effort, dedication and original thinking the brotherhood of Vietnam Veterans spearheads the discovery of the disease's causation and eliminates this vile occurrence. Corrupt activities of Big Pharma in collusion with an influential US Senator are at the root of the causation of the disease.
Book Bubbles from ONE DEGREE
#19) Declan and Matt Commit
Physicians, especially surgeons, must become expert compartmentalizers. Whatever the result in the first case, one must engage their full mental and physical attention to tackle the next issue. However, it is impossible to scrub the bad outcomes and complications from our minds. To seek closure, we must analyze every aspect of our patient care. Declan Burke is no exception. Two of his wounded patients have succumbed to this infectious grime reaper. He now intensives his involvement in pursue of an explanation. Matt now reflects on the common denominator in three gruesome deaths - the abnormal macrophage white blood cell. Both he and Specialist Ryan were ignored in their concern over that deformed white cell by their superiors. "Pangs of guilt" resurfaced. That same guilt victimized Matt when first discharged from the Army, initiating the deep depression of PTSD. His rehabilitation and reintegration into a peaceful society were progressing. But, being victimized again was a constant threat. Matt now understood that he did not control the stigmatization ethos utilized to generate control by the military machine. He abided by the military culture. They were guilty. I just read in the Cornell Chronicle, March 29, 2021, - "The results showed that white blood cells called macrophages are much more abundant in the lungs of severe COVI -19 patients…." It sounds like ONE DEGREE!
#18) "Heroin"
The enemy's bloody Tet Offensive in 1968 finally convinced our leaders in Washington that the Vietnam War was not winnable. An inauspicious exit would be the new goal. Before Tet, the fabric of the Army was strong and meaningful. After Tet, it fell apart. The US had given up. Who wanted to be the last to die in Vietnam. Anxiety was high. Discipline fell apart. First Lieutenants who persisted in pursuing risky patrols invited an M16 round in the back or a fragmentation grenade under their hooch. Post traumatic stress symptoms began to appear. There was increased adrenalin and cortisol circulating in the grunt's bloodstream. Self-medication with alcohol, marijuana, and heroin was commonplace. When I was there, ’70-'71, heroin usage was epidemic. Those providing these sedating agents were thriving. South Vietnamese governmental officials were a prominent source. Daily, the mamma sons smuggled pure heroin onto the 85th Evac. compound. Recognition of a heroin crisis threatened military reputations. One of our physicians reported the heroin travesty to the commanding general in Da Nang. He was threatened with a court-martial and Leavenworth if he did not desist. Eventually, the same physician converted a hooch into a colorful Halfway House to detox the troops. Passing a clean urine sample allowed the soldier to return home. Prescribed quality marijuana softened the agonizing process.
#17) Tsumani of Deception
After WWII, Truman supported French colonialism in Indochina. Eisenhower equipped the French fighting the Ho Chi Minh inspired Vietnam insurgents. With the French defeat in 1954, this President supported a division of Vietnam into two countries and chose to nation-build in South Vietnam. More and more US “advisors” arrived in South Vietnam. By 1961 twenty-five boys were KIA. The elected group of egotistical US decision-makers believed the inflated fanciful reports of the South Vietnamese generals. Equally deceptive US Saigon officials passed them on. One was the US Ambassador. Commanding General Westmoreland participated in the tsunami of wishful thinking, resulting in nearly 560,000 troops deployed by 1968. US and South Vietnamese forces repelled the enemy’s extensive January 1968 Tet Offensive, but the fact it occurred destroyed the delusional thinking of being victorious in Vietnam. By the end of 1968, almost 37,000 Americans were dead. There was the Kent State massacre. The anti-war movement grew. President Johnson replaced General Westmoreland with General Abrams. Not winning, but a graceful exit was now the goal. The soldiers knew the change. Who wanted to be the last to die. The fabric of the Army unraveled with disastrous results. Read Vietnam, An Epic Tragedy, Max Hastings and Dereliction of Duty, H. R. McMaster to learn of the deception that lead the US into the Vietnam War.
#16) "Kill the Messenger"
The disease is a figment of my imagination. But, the abusive treatment of returning Vietnam veterans is so real. The January 31, 1968, VC and NVA planned and successfully executed Tet Offensive, imploded, and disseminated the US myth that the “good guys” were winning. Our proficient guerrilla opponents had fiercely attacked throughout the entire length and breadth of South Vietnam. Intense, bloody fighting erupted, resulting in vast numbers of casualties on both sides. The “good guys” prevailed, but we did not win. We are so powerful! How could this happen? Why are our leaders pursuing this mutilating, immoral, and deadly action? By then, there 40,000 American KIA. The antiwar sentiment became a movement. Walter Cronkite’s pessimistic broadcast fueled the flames. The killing of innocent civilians increased; Collateral damage. No way would we win their “hearts and minds.” The public’s twisted conclusion placed the blame on those fighting in the Vietnam War quagmire. They were an easy target, especially entering airports when returning home, awarded with all the acts I described, including physical violence. The word spread that a quick trip to the bathroom to change into civilian clothes was the best protection. These young adults, averaging twenty-two, were already devastated and confused by their wartime actions. Now, they endured a total rejection by their country.
Would you help me?
I've found that writing a book is the easy and fun part. Marketing is 1000 times more difficult and work. Reviews do drive sales on Amazon. Would you please write a review for ONE DEGREE? To write go to the bottom, at the left, of the book's page on Amazon. Thank you for your time and support.
#15) Now It's Four
In author insight #14, we learned of the nidus for the fatal infection research group — Matt, Mike, and Michelle. Now the relationship between Matt and Ryan Larkin is presented. They shared documenting the abnormal macrophage white blood cell only to have this finding dismissed by their superiors. Ryan learned that the patient whose blood smear concerned him died from a necrotizing infection after being evacuated from Vietnam. The 1970 Christmas Eve mass casualty at the 85th Evacuation Hospital was a real event. This tragedy still haunts every one at the 85th who was involved. To us, this shocking event occurred yesterday. Visit my memoir's Facebook page (https://www.facebook.com/welcome.home.from.vietnam.finally/) and scan past postings to grasp how the 101st Airborne members remain crushed. The rawest emotions arise when contemplating how this "friendly fire" erupted in the "fog of war." I spent hours in the operating room that evening and could not save my very young charge. The description in the OR is my recollection. Part of me never left Vietnam. These are Vietnam Veteran notes to me. "After 40 years, have you not learned you do not come back from Vietnam." Gary Hundley "I'm there more than here." James Cook "Is it ever going to be over?" David Harbour "We never left." George Dale
#14) Common Ground
In Book Bubble #13, Matt describes an abnormal macrophage white blood cell. He believes it implicated in Private Richard Burrows’ fatal infection at Walter Reed Army Hospital. A decade later, he has come to terms with his PTS, obtained a Master’s in Journalism from Columbia University, begun a family, and successfully fulfilled his increasing responsibilities at an influential Long Island newspaper, Newsweek. Matt and Mike Clark shared a childhood near Milwaukee, and in 1969 both volunteered for Vietnam. Their paths diverged until 1983 when Matt accepted a journalistic position near Mike in Wisconsin. Matt disclosed his guilt to his old friend concerning Private Richard Burrows’ demise. The revelation distressed Mike. He had been the OR scrub tech assisting Dr. Declan Burke during the Private’s successful complicated surgery. Mike committed to supporting Matt in his search for the actual cause of their patient’s death. He had engaged with Michelle, Burrows’ fiancé, and knew she would join them in their quest. Three people were now invigorated to unravel this medical mystery. Mike Clark served as an OR tech at the 85th Evacuation Hospital. ’70-’71. He often scrubbed for my cases. His presence in the OR was reassuring. All these years later, he suffers from a stubborn illness due to Dioxin in Agent Orange.
#13) Matt's Conundrum
Our blood has red and white cells. The red cells contain hemoglobin. This entity binds with oxygen that passes from microscopic air sacs (alveoli) into capillaries that cluster around the alveoli. Oxygen, delivered by the red cells, is necessary for the body's systems to function. The hemoglobin then scrubs the carbon dioxide exhaust from the body's metabolism and delivers it to the lungs for elimination. White cells exist to protect us from bacterial and viral infections. The structure and function of the macrophage are well defined. It identifies the invasive agent and approaches, entraps, and neutralizes the intruder. Matt Rogowicz, a lab tech at Walter Reed Army Hospital, identifies distorted, vesicle packed, engorged macrophages in Private Richard Burrows' blood. He reports his finding to Major Grossman, who, following his consultations, considers Matt's discovery not to have significance. Specialist Rogowicz believes the abnormal macrophage contributed to private Burrows' demise. He begins to deplore his choice of not being more aggressive in advocating his conviction. But he is trapped in a military culture that dictates one's subjugation to a superior officer. When Matt learns of subsequent deaths related to the same abnormal macrophage, he is overwhelmed with guilt for not speaking out. Matt Rogowicz produced Wounds We Feel at Home, an Albany, NY area PBS Vietnam documentary in which I participated. https://www.wmht.org/woundswefeelathome/
#12) Richard's Demise
Chapter 4 reveals the tragedy of Private Richard Burrows’ unexpected demise. One Degree’s medical mystery begins at Walter Reed Army Hospital. My ward description is what I remember as a resident surgeon at the McGuire VA in Richmond, VA. Very informative were the recollections of my friend Gary Stoller who spent six months at Walter Reed recovering from boobytrap injuries to both legs. The uniqueness of Richard’s rapidly progressing septic fate is apparent. He senses that the changes he is experiencing are the gateway to death. The total frustration of treating physicians is on display. They seem to surrender to what seems inevitable. During my years as a surgeon, I have been in their shoes! His fiancé, Michelle, is shaken by Richard’s desperation. He has a premonition of his wake in Amsterdam, NY. “The comfort of prayer had deserted him. His last thoughts, as his exhausted debilitated body began to shut down and yield to eternal sleep, were of Michelle and his parents.” As the mystery unfolds, keen retrospective observations generate an understanding of why Private Richard Burrows died.
#11) High-Velocity Wounding
"Phu Bai "Fred administered twenty-eight units of blood during Richard's procedure. An initial thought could be that Declan was a sloppy surgeon, losing an excessive amount of Private Burrows' blood. Military missiles, bullets and fragments from exploding ordinance, travel at 2,600 feet per second or more. As they speed along, air molecules cannot get out of the way, becoming compressed into a ballistic shock wave. Just like a jet, "going through the sound barrier." This energized wave scrambles molecular structure as it passes through tissue. Immediately following, the kinetic energy associated with the speeding missile striking the body imparts an extraordinary amount of power, creating a hydrostatic shock wave that destroys tissue and, passing nearby, fractures bones. It is called hydrostatic for the body's density is essentially that of water, its major component. Skin and fatty tissue are somewhat resistant to damage. The surgeon must debride all dead (devitalized) muscle, for it becomes gangrenous and infected, threatening the patient's life. Often referred to as "meatball surgery," meticulous dissection is required to define and enter the viable muscle, thus releasing excessive blood loss that requires replacement. Coagulation issues occur due to decreased platelets, fibrinogen, and clotting factors (molecules that create the clot). The surgeon must order these components restored. Fresh warm "walking donor" unprocessed blood solves that problem.
#10) Meet a Few People
During the Vietnam War, the great majority of military physicians, following graduation from medical school, were drafted the moment they began their internship. The military's Berry Plan deferred a lucky few to complete their training. The others, as General Medical officers, GMOs, often lived and patrolled the jungle with the grunts. I proudly served with Duane Wall, Bob Hooper, MD, Mike Clark, Patti Hendrix, RN, Fred Brockschmidt, RN, and Roger King, MD. I see them, except for Hooper, at our therapeutic 85th Evacuation Hospital '70-'71 biannual reunions. After fifty years, we still harbor our Vietnam demons. Duane (a grape grower Napa Valley) and Mike (a cardiac OR tech) were exceptionally talented ED and OR corpsmen. Patti (retired Army Lt. Colonel) efficiently supervised the young OR staff. Fred (retired Army Colonel) saved my butt, actually the patient's, more than once with his skill. Roger King (practiced in Morgantown, WV) and I trained together at the Medical College of Virginia in Richmond, and we shared time at the 85th Evac. We often operated together like a well-oiled machine. Mike's severely diabetic wife, Connie, died following a heart transplant as I was writing ONE DEGREE. We wished to preserve Connie's memory. These individuals and others you will meet are part of my being and are indeed considered a brotherhood.
#9) I Served Honorably. Now, I'm Punished!
Our military sprayed fifty-four thousand three hundred gallons of Agent Orange (AO) over Phu Bai, Vietnam. It was the home of the 85th Evacuation Hospital. I served there as a trauma surgeon in '70-'71. Dioxin is a predictable by-product in Agent Orange production. It is a potent carcinogenic and mutagenetic compound. This poison was in the dust we breathed and water we drank. It's now fifty years later, and I'm eighty years old but feel like I'm fifty. Six months ago, I was diagnosed with Chronic B-Cell Lymphocytic Leukemia (CLL). I just learned that the Veterans Administration recognizes Dioxin as the cause of my blood disease. Now I'm a statistic! It's not just the other guy anymore. I served my country honorably, and now I'm being punished for dedicated service to my wounded patients. It's remarkably ironic that my historical medical mystery, One Degree tells a similar story. Go to www.guskappler.com and visit essays to read my thorough analysis of the Agent Orange tragedy.
#8) Bob Nevins
Bob Nevins is a real-life character in my medical mystery thriller, ONE DEGREE. This 326th Medical Battalion medivac pilot flew the wounded to me, a trauma surgeon at the 85th Evacuation Hospital, Phu Bai, Vietnam, '70-'71. He was shot down and crashed several times. He rescued the surviving crew members and waited for extraction. This transmission is genuine: "We can't land. Do you think he'll make it to first light?" asked the pilot. A long destining pause came over the radio as the sound of rain pelted the helicopter. "He's not going to make it 30 minutes," the voice on the ground radio replied hopelessly. The crew onboard looked at each other intensely as the monsoon swirled around them, making it difficult for the copter to stay in the air. "Ok," the pilot replied. Hang in there, "We're turning around to get you." Bob and I have collaborated in researching which neural pathways align to allow a veteran with PTSD to switch off his demons and begin to reintegrate into a peaceful society when introduced to equine intervention. Now, in Saratoga Springs, NY, he rescues those with PTSD with the program he created - Alliance 180. Visit: https://www.alliance180.org/your-fight-is-our-fight
#7) Agent Orange
54,300 gallons of Agent Orange were sprayed from fixed-wing aircraft over a small area in northern South Vietnam identified as Phu Bai. That was where the 85th Evacuation Hospital was located when I served as a trauma surgeon. Dioxin, one of the most carcinogenic and mutagenic compounds known to science and a predictable contaminant in Agent Orange production, was in the dust we breathed and water we drank. Nine men I served with have either died from or have been treated for cancers caused by the Agent Orange (AO) contaminant. Its presence and consequences were totally understood by the government officials who ordered the continued spraying. Our service in Vietnam is still, after half a century, killing Vietnam Veterans. My experiences with and study of Agent Orange profoundly influenced the plot of "One Degree.” My AO challenge: https://www.youtube.com/watch?v=g8BUnLPQDkw
#6) Golden Hour
When wounded in the Civil War, the soldier's first thought was to determine if he were "gut shot." If so, he would die a prolonged, agonizing death. In Vietnam, the booby trap fragments angled upward, threatening one's manhood. These shards of metal, screws, glass, and feces impacted with massive energy, destroying excessive amounts of muscle, tendons, blood vessels, and bone. My friend, Sergeant Ken Israel, directed the enlisted men in the 85th ED, '70-'71. Untreated blood loss of 3 pints or more results in less cardiac output, and hemorrhagic shock develops due to insufficient oxygen delivery. The body becomes acid, and death follows. The term Golden Hour is a metaphor; begin shock therapy in less than sixty minutes, for the shock state is still REVERSIBLE, and the patient has a better chance of survival. The placement of multiple IV sites is required—excellent IV access results from using IV tubing in arm and leg veins placed through small incisions. Replacing blood alone DOES NOT achieve resuscitation. In shock, the body's saltwater becomes depleted. For replacement, we at the 85th Evac used Ringers Lactate (a unique table salt solution). If, as early in the war, excess RL is administered, life-threatening "shock lung" developed. Go to https://youtu.be/yZ7AXi_pkOg for an in-depth shock review. Watch 0 to 1:40 and 6:13 to 6:50 minutes.
#5) Booby Trap
Gary Stoller will be seventy-three during September. He lives in Meco, NY, not far from Mayfield, NY where he graduated high school and soon found himself, as an eighteen-year-old, with the First Calvary in the Quang Tri region of Vietnam's I Corps. In April 1968, now nineteen and a Buck Sergeant, he was severely injured by a VC booby trap. We have been close friends for almost forty years. During that time I've remembered snippets of his guarded Vietnam War disclosures. I used them to describe Private Richard Burrows' traumatic experience. The booby trap explosions delivered between 4 to 6000 horsepower of energy to create devastating wounds; decimated flesh and multiple bone fractures. The Soviet-designed AK 47 imparted similar energies when wounding. Long bones, as the femur, were fractured by only the shock wave associated with this weapon's high-velocity missile. Bubba Smith, also a hunter, lives in Meco, NY. Bill Papas is an outdoor buddy from Breakabeen, NY. Donn Gates was a corpsman at the 85th Evac in its ED. Sgt. Ken Israel was in charge of the 85th's ED corpsmen. The distinctive sound of the Medivac chopper's swirling blades was uplifting to the wounded for they knew that definitive care and therefor survival was not far away.
#4) The Dehumanizing Vietnam Jungle
Only one out of every eight ground troops actually saw combat. The other seven were in support rolls. The "grunts" served in combat. The majority of them were 18 to 20 years of age. A patrol could last from a day to a month or more. The monsoon season permanently drenched them. The heat of the remainder of the year was intense and dehyrdrating. Negotiating the dense jungle vegetation was exhausting. They were on constant alert, for their dedicated, experienced, and adaptable enemy could ambush and attack at will from massive tunnel systems and spider holes. The Viet Cong and North Vietnamese Army accepted excessive casualties. The US military leadership inappropriately considered "body counts" in our favor as a sign of American success. At the Paris Peace Talks, a proud US diplomat chided a North Vietnamese negotiator that "the US never lost a battle." "Yes," was the response, "but we won the war." This YouTube video will show you more about patrols. https://youtu.be/Bk58cRKI5xQ
#3) I Propose Prevention
Matt's mental state improved by sharing his demons with a group of men who suffered similar wartime experiences. Modern medicine controls the occurrence of a myriad of potentially lethal diseases through applying PREVENTIVE measures; vaccinations (Smallpox), pills (Malaria), medications (High blood pressure). The warrior must be rescued from the onslaught of adrenalin and cortisol; the Limbic System must be calmed PRIOR to discharge or reassignment. I propose a THERAPEUTIC TIME OUT where in the soldier's UNIT (a brotherhood) is isolated in a safe place without record keeping and threat of stigmatization to defuse their experiences by "opening up" and realizing they are Not crazy. ALL are reacting predictably to military stresses. The US Air Force is successfully applying this approach! Watch https://youtu.be/Q-FDupMy8J8 for details.
#2) Why did Matt develop PTSD?
The average age of the Vietnam warrior was twenty-two. The majority of Vietnam KIAs were twenty-two or younger. The portion of their brain that makes sense of their challenging environment is physiologically less potent than that portion that is explosively reacting to their stresses. Adrenaline and cortisol flood their bodies and result in hyper-vigilance, increased heart rate and respiration, tunnel vision, increased hearing acuity, sweating and a readiness to fight. They were conditioned to react in that fashion. When Matt's discovery of the abnormal white blood cell was dismissed by those he would not dare question and similar deaths became global, he was consumed with guilt and depression. His peers, just before discharge, were helpful but once back in the US there initially was no support system and he self medicated with alcohol to still his demons. His new peer group understood and supported him. He became functional. Next week I'll discuss the preventive approach to PTSD and not accepting its occurrence as the "cost of doing business."
Gus went to Vietnam. A changed Gus came home.
This is my first bubble attempt. In the fifty years since I arrived in Vietnam as a trauma surgeon I have researched and dealt with PTS(D). I never reached the (D) designation for I chose Vietnam War storytelling to defuse my demons. It was like the little teapot. In 2015 I published a compilation of the stories in Welcome Home From Vietnam, Finally, A Vietnam Trauma Surgeon's Memoir. It is loving, brutal, funny, vile and truthfully real-life. For more information, go to www.guskappler.com. I have studied PTS(D) on the psychological, chemical, cellular and molecular levels. I consider myself an expert. Early in One Degree I introduce the reader to one PTS effector. Next week I will expand on today's excerpt. Each week I'll relate the book's text to real-life.
