Friday, December 25, 2020

I Almost Always Trust My Wife's Advice

Jeffrey L Brown

 When I finally conceded that my wife is the better day-to-day decision-maker, we rarely had any disagreements. She wanted us to adopt a dog. I thought it would complicate our lives, but I became a convert. Now she complains, “You don’t look at me the same way you look at the dog.” Next, I traded my sports car for an SUV because my wife said, “It's silly to own a car with a stick-shift.” She never drives my car, but she was right. The automatic transmission is easier to drive and there is more room for the dog. Then, I stopped wearing my favorite golf shirt because, “The green color reflects off your skin and makes you look sickly.” Right again! No more green shirts, and my doctor says I look healthier than ever.

So, it was no surprise that she came to my rescue when Vinnie, my barber, shuttered his doors and retired to a warmer climate. “No problem,” I thought. I only want a generic medium-length no-frills haircut and minimal conversation. Unfortunately, all the local barbershops had morphed into unisex salons. I ignored them because they reminded me of “beauty parlors” where women of my mother’s generation had their hair cut, colored, and curled before giant drying-hoods swallowed their heads like aliens in a sci-fi movie. The name-change did not fool me. Beauty parlor was marketing hyperbole. Looking-better-parlor would have been more truthful and less stressful for the operators – but maybe not so good for business. Salon implied sophistication. Unisex meant that men could wander in too.

When my wife learned I was searching for a barber who would give me a boring haircut, she referred me to a nearby salon. She told me with a straight face they have a barber named Amanda who cuts lots of guys’ hair just the way they like it. I had a premonition this would not end well. My barbers had always been named Tony, Richie, Nick, or Vinnie – a.k.a. Anthony, Ricardo, Nicholas and Vincenzo when they worked in salons. None were ever named Amanda! And, there was no striped barber's pole at the shop’s entrance.

The salon’s waiting area was populated by two wet-haired women and one sheepish-looking man with a towel on his head. Instead of the traditional narrow storefront with dim lighting and hard barber-chairs, it was spacious, well-lit, and featured pastel colors and contoured lounges. High-quality speakers played comfort music – a definite upgrade from Vinnie’s counter-top radio that played Yankees baseball, operatic arias, and Golden Oldies. And, Amanda’s cute pants outfit was a clear winner over Vinnie’s side-buttoned dentist shirt that barely covered his expanding midriff.  The strong scent of perfume brought tears to my eyes and itching to my nose. But my biggest complaint was the slippery pink-nylon smock – management’s version of prison-orange that discouraged me from making a quick dash to the street.

Mandy (her preferred name) offered me a cup of coffee. A nice touch except for the little hair clippings that swam on the surface like tiny protozoa.  I broke the conversational ice with, “Please clean up my hair a little and don’t cut it too short.”

I liked my barber Vinnie because he seemed like a really nice guy, but I knew nothing about him. I would say, “How’re things goin’?” and he would say, “Good.” End of conversation. Mandy immediately chronicled complex details of her active love-life, summarized local gossip she said was confidential, and described medical symptoms that could make a doctor blush.

My head was spinning from all this information when she tilted my chair backward and gently massaged my temples with warm soapy water. I closed my eyes. This seemed unexpectedly intimate. “Why are you doing this?” I whispered.  “I can give you a better cut when your hair is wet,” she said softly. “Okay,” I whispered. At least I knew that her hands were clean. When I was catapulted to an upright position, I stayed very still and very alert because Mandy waved her arms while talking and her sharp scissor tips were pointed at my right eye. My hair was sprayed with enough lacquer to withstand a tropical storm and she asked what I thought. It was hard to see through the mist, but I thought she cut it too short. I dutifully replied, “It looks very nice.” Then I paid a bill that was twice what Vinnie charged, over-tipped her, and went on my way.

Not admitting defeat, my wife had already scheduled the next haircut at a different salon – this one with an Asian motif. She had warned the manager about my haircutting proclivities in advance. The Caucasian operator never spoke. A brightly colored pseudo-kimono offset her stone-faced expression. She bowed while motioning me toward the well-padded chair. I nodded. Once I was seated, she bowed again, and I nodded again. “I just want my hair cleaned up a bit,” I said. “And please don’t make it too short.” This time, she bowed and I nodded in unison – a good sign. I tried to relax. The earth-tone décor was pleasant, and I already knew the salon-routine from my first experience. But then a young Asian lady presented me with a wooden bowl of steaming-hot lemon-scented towels that had no obvious purpose. Not wishing to offend her, I removed each steaming towel by its edges and tossed it from one hand to the other hoping to avoid a trip to the hospital's burn unit. Their green tea was garnished with the traditional hair clippings and the music sounded like ocean waves crashing on a beach. An excellent choice because my shirt was soaked from a minor mishap during the hair-washing ritual. After 20 minutes of snipping-combing-snipping-combing, the kimono-lady massaged my shoulders with her knuckles. When she held up a mirror, I was too distracted by the welts on my neck to notice that my hair was the same length as when I entered. “It looks very nice,” I said. Then I paid the expensive bill, over-tipped the stone-faced lady, and returned to my car.

It was time to take the initiative and confront any negative comments from my wife later. I spoke into my mobile phone using a military command voice. “Okay Google,” I said. “Directions to nearest barbershop.” I was in luck. Google said Tony’s Barbershop is only 4.6 miles away with light traffic. I recognized it immediately by its familiar barber’s pole and an old-fashioned sign that read, “Tony’s Barber Shoppe.” I peeked through the window to confirm that the shop was narrow, dimly lit, and had traditional-looking barber-chairs. There was even a table-top radio and I could hear it playing Yankees baseball. I sighed and took a deep nostalgic breath before entering. When I opened the rickety door, a little bell tinkled to summon the barber from a back room. “Hi,” the 20s-year-old said. “My name is Britney. How can I help you?”


An Army Doctor's First Loss of the Vietnam War NYTimes Magazine



 An Army Doctor’s First Loss of the Vietnam War: The Woman He Loved        Jeffrey L. Brown   February 13, 2020        

New York Times Link: 



                                         Jeffrey Brown, Cu Chi 1966


I was 26 when I was sent to Vietnam, along with 2.7 million men and women of my generation. As an infantry battalion surgeon, I cared for soldiers’ wounds and helped treat their pain — but for me, going to war was also tied to the distress of leaving my first love. I was a doctor and she was a licensed practical nurse at a hospital in Hartford, Conn. Our work had brought us together. Going to war would break us apart.


Jeffrey Brown is a retired physician who teaches as a medical school professor. He has written several published books and many articles. While serving in Vietnam as a combat Army doctor, he was awarded a Combat Medical Badge and the Bronze Star Medal for Valor.

Thursday, December 24, 2020

A Moral Matrix Adapted from Columbia's J of Narr Med and the NYTimes At War


Adapted from: The Moral Matrix of Wartime Medicine, The Intima

Columbia University Journal of Narrative Medicine – Fall 2015


A Moral Matrix     

Jeffrey L Brown, MD [1]


My Arrival

A trim flight attendant wearing a powder blue skirt and a friendly smile pushed her food cart down the center aisle. At first glance, this looked like a routine flight. It wasn’t. The passengers were combat ready troops who were young, somber, and silent. Some chose sleep to escape from troubled thoughts; others anesthetized them with the droning noise of twin jet engines. A consequence of our rapid buildup in Vietnam was that soldiers were transported on commercial airlines. Doctors like me had only six weeks to transition from civilian to military life before we shipped out with them. We wore summer weight khaki uniforms but felt like civilians until the moment that overhead speakers crackled news of our arrival. 

It was late August 1966 and monsoon rains would continue for another two months.  The strong wind that delayed our landing had just blown by and we walked quickly through hot thick mist that smelled like wet wool. The sky was gray. All else was olive drab splattered with brown mud: boots, gear, vehicles – everything. Like other military items stenciled with descriptors, I was labeled too: captain’s bars, a caduceus, and a black plastic name tag announced what and who I was to anyone who was interested.

The Camp Alpha processing center was located near Saigon – now called Ho Chi Minh City. It looked more like a tropical prison than a welcoming area for incoming troops. Heavily armed guards patrolled perimeter fences topped with coiled concertina wire. Muddy rainwater separated neat rows of screened and sandbagged barracks.  Malaria-infested mosquitoes fed on hot sweating skin. And if not for a poorly tested vaccine, fleas from indigenous rats could infect us with the same bubonic plague that created medical mayhem during the Middle Ages. 

I was housed with junior ranking officers. War noise and jet lag assured a miserable night’s sleep.  At first light, a sergeant appeared. His ethnicity was nondescript, but his bearing was not.  He was professional and unambiguously intimidating: straight back, athletic build, piercing gaze. Somehow, his fatigues were pressed and boots shined despite pouring rain and no rain gear. This was quite remarkable. Either he was secreted away with us overnight or he possessed special powers that repelled mud and water.

“Attention to orders,” he barked.  We paid attention.  

"The following orders have been changed...."  

I was assigned to the 2nd Battalion, 14th Infantry Regiment.  

Other names and orders followed.  

There were groans.  

One came from me.  

I stood tall, stepped forward, and did my impression of an Army officer.  "Sergeant," I said. “I am scheduled to join the 85th Evacuation Hospital in Qui Nohn. I am classified 3-C because of a medical problem that disallows my assignment to a combat unit. What is the explanation for this change of orders?”


Without effort, he morphed into a hotel manager denying a confirmed reservation.  "Sir,” he said with a hint of condescension. “I am so sorry I can’t help you. Your medical file is in transit. I suggest you discuss this issue with the doctor when you get to the two-fourteen in Cu Chi.”  

“But you said I am going to be the doctor at the two-fourteen.”  

“That is correct, Captain. Effective 0600 today, you are the battalion surgeon for the two-fourteen.”  


This man had not earned his stripes for nothing. A few months later I would have responded to this ridiculous Catch-22 dialogue, but at the time, I was speechless. With luck, maybe a higher level of stress hormones would lessen my frequent bouts of asthma. 


That afternoon, I was convoyed west to join elements of the “Tropic Lightning” 25th Infantry Division in central Vietnam. I felt like an imposter wearing a steel helmet, a bulky pre-Kevlar flak jacket, and jungle boots reinforced against punji stakes. My accessorized vehicle foreshadowed what came next: Sandbags to keep land mines from exploding through the floor, a slotted vertical bar to cut throat-high wire strung across the road, and a locking cap to keep local kids from dropping hand grenades into the gas tank. We drove through large areas of denuded landscape that were sprayed with Agent Orange herbicide. We were told it harmed only vegetation; human toxicity is now measured in parts per billion. 


At Cu Chi, my 30 medics were armed and did not wear Red Cross insignia. Before being embedded with 900 infantry troops as their only doctor, I was issued an M-16 rifle and a .45 caliber pistol. Notwithstanding the Geneva Convention and my lack of weapons training, the Viet Cong were known to target medical personnel. 


I was 26 years old, one year out of medical school, and just a few weeks earlier worked as a medical intern in a teaching hospital. I had not chosen a career path and joined the military to avoid being drafted, but this assignment did not resemble the training program I was promised. Clearly, the person who got me into this mess deserved a stern reprimand.  Unfortunately, the culprit was me. 


The Mercy Killing


My first week in the field was uneventful; the few patients I saw had minor complaints. On the morning of the eighth day – during my transition from mostly asleep to almost awake – I heard a shout. "Where’s the doctor?” the voice said.  I grabbed my gear and came running.  


Framed in the center of an empty dirt road, the backlit silhouette of a young soldier walked toward me, awkwardly, as though he was afraid of dropping something fragile. His deuce and a half (2½ ton truck) was parked to the side with its engine still running. He wore a helmet but no body armor, and his shirt shined with sweat and dark red blood. An M-16 rifle was slung over his left shoulder because he was cradling a scraggly, malnourished, mixed-breed dog. Its brown fur was matted from the fine misty rain and it was whimpering in the most pitiful way.   

The cause of the dog’s pain was obvious. A two-inch shard of whitish bone protruded through the torn flesh of its right hind leg. The soldier tried valiantly to protect the injured leg from moving but the dog’s cries evidenced his limited success. Despite holding the dog, he stood mostly at attention and addressed me in the staccato voice used for military report. "It was an accident, sir. I never saw him. It was dark, my headlights were dimmed, there was a thud, I exited the vehicle, and this is how I found him." The dog was not wearing tags or a collar. "Does he belong to anyone?" I asked. "I don't think so, sir. He just shows up. We play with him and feed him, but I’ve never seen anyone actually looking after him."  

Involuntary tears left tracks on both cheeks. He studied the dog's pained face with affection usually reserved for close friends and relatives. I am quite certain that today I would protect my dog’s life with my own, but at the time, I was not a dog-loving person, and I had little empathy for the depth of this man’s emotion. His combat platoon received sniper fire a day before. Two members of his squad were killed, others seriously wounded, and these tears were shed for a stray dog.  

Successful treatment of this pathetic patient required the skill of a surgeon, a proper medical environment, and prolonged convalescence. These did not pertain to me, the situation, or the dog. Like all doctors assigned to military units, my title "surgeon" was vestigial from battlefields of earlier wars, not based on surgical training. The equipment in my aid station was meager, and to make matters worse, we were packing up supplies before moving out the next day.  


One of my medics approached from the rear. "I’m sorry,” I said in a calm voice. “There isn’t much we can do except relieve its pain.” The dog was placed on a poncho at a spot shielded from the rain. I kneeled in the mud and carefully propped the injured leg to what I thought was a comfortable position. The dog yelped. I flinched. Without conversation, the medic handed me some ampoules of morphine. An average soldier weighs about six times more than this dog, so I reasoned that half an adult's lethal dose should end its life in a compassionate way. Army medics love giving morphine, and for good reason. No matter how severe their patient’s injury, it relieves pain and anxiety quickly. On the dark side, a large dose inhibits breathing and can cause death.   

I located the vein that runs down the dog’s foreleg, inserted the needle, and administered the first dose. Injecting it directly into the bloodstream increases potency and protects against erratic absorption. Almost immediately, the dog closed its eyes and seemed at peace. I was relieved; sometimes pain causes more distress for the doctor than the patient. Thankfully, I thought, this will be over soon. It wasn’t. I injected a second larger dose, and then a third …. Nothing much happened. The dog’s breathing slowed a bit but was not shallow. I doubled the next two doses. The dog was still breathing normally, and his pulse was strong as ever.  

This was not going well. If death was the goal, it seemed nowhere in sight. And now I was outside my comfort zone. I had never used medical knowledge to end a life and didn’t like the way it made me feel. I wondered if I miscalculated the dose or my pragmatic morality was being tested. Was it remotely possible some spiritual force was telling me it is not this dog’s time to die? 


I held my ground and injected more morphine …. The dog was still breathing …. more morphine …. still breathing …. And then, without warning, the dog was dead. I stopped breathing too, devoid of thought, air, and sound. When I recovered, I refused to tell myself that I put the dog to sleep or out of his misery. It seemed necessary to acknowledge what I had done.   

Once again, the soldier slung the rifle over his shoulder. Taking great care to protect the dog’s injured leg, he hugged its warm limp body to his chest. His tear-filled eyes stared directly into mine. This innocent dog’s death symbolized the misery that surrounded us. Plain words expressed sadness, betrayal, anger, and resignation. "I feel really miserable, sir," he said. 


I did not possess the medical magic that might have saved this dog’s life, nor the wisdom needed to comfort this grieving man. I felt pain admitting to my incompetence. I failed this soldier, and surely hoped that one day I would have the skill to do better. I nodded, looked away, and said nothing. 



The Mine Field  


Most troops greeted me with “Hey Doc, let me show you something.” It is impossible to maintain decent hygiene living in the jungle or wading through rice paddy water, so the "something" was usually skin that was lacerated, abraded, ulcerated, blistered, weeping, or infected with bacteria and fungi. There are no private body parts in this setting, so I got to know these guys pretty well in short order.  


Our battalion was conducting search and destroy operations in Tay Ninh province near the Cambodian border. We were the bait used to draw enemy soldiers out of hiding. My new home was a small sandbagged tent that doubled as the forward medical aid station. It was located less than 100 yards from the perimeter machine guns, which meant we could be under fire while treating casualties. The triage and treatment area consisted of two canvas stretchers called litters that rested on metal racks; we increased capacity by laying ponchos over the mud. There was no suction, oxygen, or blood products – none of the medical stuff I had taken for granted. Changes in tactics and helicopter evacuation had relegated combat doctors to the role of highly trained medics, and battalion surgeons were gradually being transferred from field duty to medical facilities; the added risks were not justified.  


Shortly after arriving, I embarrassed my novice self by leading my medics on a frantic search for burn dressings. I heard there was a firefight and imagined soldiers with flame throwers. I didn’t know that a “firefight” is an exchange of small arms fire. About five weeks later, that same inexperience compelled me to join two medics who were treating a critically wounded soldier. He had wandered into a well-marked minefield and they were having trouble keeping him alive. The area was seeded with “Bouncing Betty” landmines that contained a small first charge that lifted the second waist high before exploding. They inflicted gruesome damage and an unfortunate misstep mangled this man so badly there was no place to apply tourniquets. Not helping my medics did not seem like an option. And, like a mother running into traffic to save her child, I ran toward them, as if the danger did not pertain to me.    

The man was writhing and screaming.  His bleeding slowed as his blood pressure dropped and he went into shock. I injected him with morphine, applied pressure dressings to gaping wounds, and managed to start IV fluids. Then, we lifted his battered body onto a litter, exchanged glances, shrugged to acknowledge the frailty of our existence, and without speaking – we simply walked out. It was a humbling experience.  Detonating a single mine could kill us all. Our survival relied on a random series of near misses. If a boot struck the ground here, we were okay. If it struck there – we were not.  


An evacuation helicopter was in transit and we were covered with blood. This young soldier’s wounds were lethal, but the end came when he threw-up blood, gasped, and breathed vomit deep into his lungs.  One of his buddies pleaded, "Do something! Do something!"  But with no suction available, our attempts at clearing his airway and resuscitation were futile. It was hopeless. All we could do was watch him struggle to breathe, suffocate, and die.


It was over so quickly, I didn’t notice which of my brave medics assisted me or the name of the dead soldier. His friend’s pleadings are still in my memory. We did not speak about this incident again. The next day would be another day.




The Wall

I was attending a conference in Washington, DC when I visited the Vietnam Veterans Memorial for the first time. The sun was shining, the air was crispy cold, and there was a trace of snow on the ground. I had been happy practicing pediatrics in a New York City suburb for 15 years, but something reminded me of Vietnam every day – sometimes, the phantom smell of blood mixed with mud; other times, the unexpected image a wounded soldier. It made me feel like a military doctor dressed in civilian clothes. I felt much older than my age. I had little patience for daily concerns that bothered my friends and workmates; they often seemed trivial, petty, or naïve.

The Vietnam Veterans Memorial is located in the National Mall.  Its serenity belies the chaos and violence that killed 58,000 soldiers who are remembered there. The clean peaceful lines were designed by Maya Lin, a Chinese American architect, who wanted to bring focus back to the soldiers and away from the divisive war. It is called “The Wall” because its most distinguishing feature is a series of graceful and beautifully landscaped black granite panels that record soldiers’ names by dates of death. Each name follows the next in a run-on style that creates an unsettling impression that the list might never end.

There were tears in my eyes as I read the name of each person who died while I was in-country. There were many and it took longer than expected. I rushed back to my meeting, had a late dinner with friends, and returned to my hotel. I was agitated and could not sleep. At 3 a.m., I called a taxi that took me back to the memorial. I was not dressed for the drop in night-time temperature and stood shivering, at attention, in front of this polished wall that was lit to the intensity of daylight. I read each name again, more slowly than before, and was overwhelmed by emotion. Not because I recognized the names – but because I didn’t recognize them. I had comforted some of these men and watched them die but did not know who they were. Killed soldiers weren’t just replaceable during that war, the public’s antagonism had made them disposable. I found comfort knowing that most had not died alone. I and others like me could bear witness to their final moments.

Medical personnel cherish their work when they are doing something to keep patients alive. We don’t always appreciate the pastoral importance of being present when someone dies. Our presence at death creates an existential bond that is never broken – even when we don’t recognize names of the dead that are written on a long black wall.



A Moral Matrix

Post-traumatic stress symptoms are manageable – until they disorder a patient’s life. Anxiety, hypervigilance, self-doubt, and depression are expected, but time disorientation is not. Past events blend into the patient’s present-day self, making them contemporary.  Aging veterans are physically and emotionally vulnerable and have more time for reflection. Older folks are always surprised when they become symptomatic years after the precipitant trauma occurred. When I told a psychologist I did not think my late-in-life symptoms were caused by my time in Vietnam, he smiled. “You treated critically wounded patients in a minefield and under fire, you watched them die, and you disarmed a disturbed soldier while he was threatening to shoot you. If you think this did not affect you – you are an idiot!”   Maybe his diagnosis was correct. “Is there an official diagnostic code for this?” I asked. 


Military medical personnel discover that professional terror can be far worse than fear of personal injury. It was only possible to fulfill our medical responsibilities if we made do with what we had – not what we wished for. The best we could do was redefine acceptable outcomes and performance. Conflicts between military mission and obligations to individual patients were the most difficult to navigate: providing medical care that keeps troops combat-ready might send them to their deaths.


A soldier with a severe headache relies on our intuition to decide whether he should go on patrol; a wrong decision places him and his squad at risk. A critically ill patient at a hostile landing zone might die without immediate transport; not waiting until it is secure adds danger for the medevac team. I naively thought that keeping every patient alive was an uncomplicated goal until I treated patients with severe brain injury and multiple amputations. Should we keep them alive because we can, or spare them and their families years of pain? Even worse, we did not know what they and their families would choose. These decisions made us weary, and we had to live with the consequences.


Morality was determined in the moment. Trying to stay alive while an enemy was trying to kill us, especially one with no sense of basic decency, resulted in choices that were certain to harm innocents – and our moral selves. Enemy soldiers tortured and hid behind civilians; women and children became unexpected assassins; everything was booby-trapped and might explode at any moment.  Rules that were once painted in the primary colors of rights and wrongs became kaleidoscopic. There would be no do-overs for our choices. Only the do-laters we could use to improve the future.   ####







Youth is not wasted on the young.

If we were wiser

When we were younger,  

We’d not make mistakes   

And feel the pain 

We need to learn

What life will bring.


But –

If we regained the youth that’s passed

Exuberance would overwhelm the past. 

And we’d no longer be

Those smarter folks

Like you and me

Who’ve learned to see the world

Through older wiser eyes.           JLB



About the Author

Dr. Jeffrey L Brown is a recently retired pediatrician who teaches as a Clinical Professor at New York Medical College and Weill Cornell Medical School.  He served in Vietnam during 1966 and 1967 as an infantry battalion surgeon, a brigade surgeon, and then as a clearing company commanding officer.  He received a Combat Medical Badge for his service and was awarded the Bronze Star medal for valor.



Vietnam Photo Album Link (Click here)