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Gus Kappler MD FACS
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Welcome Home From Vietnam, Finally
Biographies & Memoirs
Author Insight
#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.
Book Excerpt
Welcome Home From Vietnam, Finally
The next day, it was down to business. Multiple casualties arrived from the jungle, and the entire hospital base went to work. Any and all personnel who were free of responsibility descended on the ED area to help. My desperately injured patient was a grunt who while patrolling through a small, recently used enemy clearing, spotted a piece of Styrofoam on the jungle floor.
What does a typical eighteen-year-old do but bend over and pick it up? The enemy knew well the psychology of our young soldiers, and predictably, the Styrofoam had been booby-trapped.
His was a major injury in the lower extremities, their arteries, the perineum, genitalia, urinary bladder, and abdominal organs and vessels. I was asked if I could handle it, and Roger told the inquiring surgeon not to worry. My extensive trauma experience at MCV kicked into gear. Since it was my first case, a surgeon who had been in Vietnam a year assisted me, a responsible move. However when, in the OR, it came to prioritizing my patient’s injuries for a timeline of action and the most efficient action to salvage the patient, allowing for perhaps less perfect cosmetic result, my judgments prevailed. Thank you, Dr. David Hume!
This young man’s prolonged surgery required 106 units of blood. He survived the surgery and regained consciousness, but due to the massive tissue damage, prolonged surgery (even with time-saving surgically acceptable shortcuts) and massive transfusion volume, he developed renal, i.e., kidney failure. I accompanied him on a flight to Saigon’s Third Field Hospital for dialysis and was abruptly dismissed by their staff.
“Tree (Dave,) Gus and Roger
I had poured my heart and soul into this boy. I was totally invested in and committed to his survival. I was consumed by him. Then suddenly, I had to turn off the physician and compassion switch and return to the 85th Evac. But that’s medicine. To mentally survive, one has to be efficient in drawing boundaries and move on to the next patient with an unfettered mind. He was my true first patient after residency training. There, one’s actions were monitored, dissected, and altered by a physician more senior in the academic hierarchy. I was now on my own.
A week later, I was notified that he had died.
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