opinion

Humbled by those who crossed Bridge of No Return

A message to all physicians from AMA President Cecil B. Wilson, MD.

By Cecil B. Wilson, MD is an internist in private practice in Winter Park, Fla. He served as chair of the AMA Board of Trustees during 2006-07 and was AMA president during 2010-11. Posted Nov. 8, 2010.

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Lately I've been thinking about bridges. One bridge in particular has been in my mind since preparing for the 2010 Interim Meeting in San Diego: the so-called Bridge of No Return between North and South Korea.

Here's the story. More than 40 years ago, as a young naval medical officer, I was part of the team that examined crew members of the USS Pueblo after they were released from captivity in North Korea.

The Pueblo, a U.S. communications monitoring ship, had been in international waters -- legally -- when it was surrounded and fired upon by a North Korean warship.

One crewman was killed and 10 others were wounded before Cmdr. Lloyd "Pete" Bucher surrendered the ship. Had he not surrendered, the superior firepower of the North Korean ships would have prevailed and many more of his men would have been killed.

Bucher and his crew -- 82 in all -- were held in captivity in North Korea for 11 long months, during which time they were beaten, tortured, starved and humiliated on a daily basis. When they were finally released, they walked to freedom across that Bridge of No Return.

Overall, the Pueblo's commander and crew were in pretty bad shape physically -- all had lost weight, and there were skin diseases, jaundice, pneumonia, infections, contusions, abrasions and broken bones.

Despite their ill health and being tortured, the Pueblo crew walked across that bridge united, loyal and upbeat.

None had been co-opted by the North Koreans. They had not turned on one another.

In their forced confession they had managed to send a message of their own to the American authorities.

Their spirit could have been destroyed, but it was not. Today, the behavior of the Pueblo crew during that captivity is held up as model of prisoner-of-war resistance.

I have always felt privileged -- and saddened -- that I was on hand to meet these men and their commander after they came across that bridge and were brought to the Balboa Naval Hospital in San Diego.

It is a time I shall never forget. And a time that remains with me in lessons learned.

Above all else, I am reminded of -- and humbled by -- the enormous sacrifices that our young people make every day in the armed forces of our country. We recognize those sacrifices as a nation each year on Veterans Day, Nov. 11.

For more than two centuries, our military has been a major contributor to the growth and strength of our nation. But the country also has benefited in other ways.

As a former naval medical officer, I am keenly aware of how much my civilian medical practice owes to military medicine.

Emergency and disaster medicine, in particular, are the offspring of battlefield medical experience. So is public health.

Here are a few examples:

  • During the Seminole Wars in the early 1800s, Army physicians discovered that quinine was effective in treating people with malaria.
  • Following the Spanish-American War in 1898, military physician Walter Reed headed a commission that proved the link between yellow fever and mosquitoes.
  • The North African battlefields of World War II were also a battleground that proved the miracle of antibiotics.
  • During World War II, the work of Navy Capt. Robert Phillips broke new ground in the treatment of cholera.

Trauma and disaster medicine also have military roots:

  • Medical triage first took place on Napoleon's battlefields, offering a way to deal with casualties and save lives in an orderly way.
  • In the late 1940s, military physicians did pioneering work in the treatment of burn victims.
  • As a result of casualties in the Middle Eastern conflicts we have seen new treatments for amputees and advances in prosthetic technologies.
  • Out of Vietnam came an understanding of the importance of the "golden hour" and the need for early, even pre-hospital treatment. Our civilian EMT and medevac systems are a direct result.
  • The Vietnam War and more recent military conflicts in the Middle East taught the value of a systems approach to handling mass casualties -- a lesson civilian medical teams applied after the 9/11 attacks, the 2004 tsunami, Hurricane Katrina and the earthquake that hit Haiti early this year.

Today the military is a leader in telemedicine -- sending patient information from the battlefield and receiving expert advice back from around the world to physicians who are on the front lines.

This is technology that ultimately may be as important to a physician and patient in remote rural America as it is to those on the battlefield.

All of this is a reminder of the importance of learning from one another, of being united, of facing obstacles together. That is my message for physicians today.

Our experience during the enactment of the health system reform legislation certainly cannot be compared in any way to the terrible suffering of the Pueblo crew. Or the incredible stress of battlefield medical teams.

Yet I hope that our response to the new Affordable Care Act will be similar -- that we continue to work together despite internal differences, that we remain united in the face of obstacles and that we never give up until we have made something workable and valuable that benefits patients and the dedicated physicians who care for them.

Cecil B. Wilson, MD is an internist in private practice in Winter Park, Fla. He served as chair of the AMA Board of Trustees during 2006-07 and was AMA president during 2010-11.

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