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Gus Kappler MD FACS
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Welcome Home From Vietnam, Finally
Biographies & Memoirs
Author Insight
#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.
Book Excerpt
Welcome Home From Vietnam, Finally
Dehumanizing the Vietnamese people was part of the war-zone moral code and condoned putting American boys first in line for treatment. Would I be capable of defaulting to the stateside code upon returning home? Many who served are still in limbo wanting to engage their original stateside-default moral code so to be capable of navigating normal society but are unable to completely shed their guilt or even create a boundary around the perceived sin of succumbing to the war-zone moral code.
To those now denouncing me, I must stress that when we did operate on the Vietnamese, we did so with the same intense level of professional commitment rendered to our boys.
We were not without compassion. One evening, a captured North Vietnamese (NVA) enemy soldier was brought to the ED with abdominal pain. I was on call, decided he had appendicitis, and brought him to the OR. Phu Bai Fred was a big man and stood ready to induce general anesthesia. The prisoner was consumed with terror not understanding what was transpiring. Was this white room a torture chamber and Fred in his scrubs the instrument of torture? I comforted the neutralized enemy by cradling his head and held his hand as anesthesia was induced. He did have a hot appendix.
As touched upon previously, the moral compass of a safe society does not translate to a war zone. All who serve in combat are changed forever. One observes and participates in horribly unspeakable occurrences.
In accepting the new definitions of a war-zone moral code, it is intensely imperative that the combatant’s violence be confined within parameters of warfare that avoid atrocities. This ability to restrain emotionally driven responses at times is a very gray area when adrenalin driven during a fire fight and just grasping for survival.
Being unable to save a battered wholesome eighteen-year-old patient despite all your skills in the OR traumatizes one’s soul. Killing a fellow human being tears the soul apart and if not healed, results in a weakened and fragile psyche. The clinical dysfunction was referred to in the sixteenth and seventeenth centuries as Nostalgia, the Civil War as the Soldier’s Heart, Shell Shock in World War I and Battle Fatigue in World War II. Now, all the world recognizes the term post-traumatic stress disorder (PTSD).
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