T Nation

Wars Of The World


"How do you do this without emotion affecting you?" I hoped my words came out the way I had planned. She said, "It does affect me sometimes. I was depressed for three weeks during the case I presented." That was the world of this particular maxillofacial prosthetic surgeon and that case she presented made me realize that while war and politics may go hand in hand, war is larger than who you voted for and who gets elected. It's effects last long after the voters have forgotten it and long after it gets written into history books.

This particular case...correction, that soldier...that father, that particular husband won't ever be the same. I suppose that is putting the cart before the horse, however.

Once upon a time there was a mechanic in the Army. This particular mechanic was tired of his job. Deep down, he felt as if he wasn't giving enough to something he believed in. Because of that, he cross trained and became a gunner. For those who don't know of such things, that means he could now operate the machine gun often mounted on top of an army vehicle. Time passed until one day...one especially warm day...his last day as a gunner, a car with a bomb in it rammed into the army vehicle and exploded. Hitting the passenger side, it killed two soldiers immediately, tossed the driver many feet away with relatively minor injuries, and blasted shrapnel with incredible force into and out of the face of the ex-prom king operating the machine gun on top of the vehicle.

With modern technology, an injured soldier can be back in the states within days as opposed to the months it took during Viet-nam. Because of that, more lives are being saved. However, also because of that, there are more lives changed from that point forward.

The ex-prom king, ex-mechanic, ex-gunner found his way to Wilford Hall Medical Center, a world away from where he was injured. Though he was stabilized, the case presented as follows;

Patient Name: Private
Age: 23
Medical History: NSF
Observational Findings: Removal of mandible after traumatic injury in order to sustain the airway. Loss of nasal cartilage and bone including anterior portion of the maxilla.

The job of the maxillofacial prosthetic surgeon? To create a new jaw, a new upper jaw, and create a prosthetic appliance that will allow the patient to see his kids without them crying. However, that would be several surgeries away.

One year later, severely depressed at the situation, this particular soldier stopped treatment and refused to return for any more surgeries.

I could easily have told you about another case where the soldier is doing very well, is very optimistic and has learned to use his new arm with near surgical precision. However, the ex-prom king is the one that stayed in mind. I wonder how long it will be before he is forgotten.


Very sad. My fear if I were a soldier wouldn't be death but being crippled or disfigured for life. Personally I think that'd be worse than death.


The moral of that story is 'stick to what your good at'...........I'm going to hell.


I did my clinicals at BAMC. While I was there, I crossed paths with a soldier who survived a blast. This guy was barely looked like anything human. His facial features had been melted off. He suffered extensive damage to his limbs and neurological damage as well. He was in rough shape, and while he would live, his definition of what life is surely changed.

I am a medic. I consider myself capable at my job and deal with it in a professional matter. I have not come close to seeing it all, but in my time, I have seen more than I care to. I would like to think that I can callous myself to things the average person cannot handle.

I mention the fact about myself because I could hardly look at this guy. What stood out most about this guy was his wife was there, smiling, helping eat and showing her support. The strength and devotion she showed amazed me. As horrible as it may sound, in that situation, I would think it better to lose my life than put my wife through that.

As the Prof said, those soldiers who survive the initial inury are very likely to survive through it. In Iraq, if an evac time is an hour, it is a long time. It is not uncommon for an injured soldier to be in the hospitals in Germany within 48 hours, and stateside in a few weeks. Surely, this changes the way the military thinks about medicine, but it also means more vets are coming home disfigured. I don't know the statistics (and I try not to follow them, likely some day I will be involved with one of those numbers in some form or another), but I think the Iraq death toll is around three thousand. I think it would be a safe estimate those coming home permanetely injured is ten times that.


You've got that right, E-man. I am a strong person, but it would be extremely difficult, to say the least, to exist as a scrap of what I once was. I would likely adapt and go on, but maybe not. I certainly won't be forgetting that soldier who lost his face. I'm one of those people who likes to look past the polished veneer that people like to put on things to make them seem better.


That is terrible, i just cant imagine what it would be like to spend the rest of my life like that.

welcome back prof.


The honour we accord another comes in how we remember them.

Tough job you do. May you and others of the same path reap all the rewards deserved.


The sad thing is how many stories like this there are that hardly anyone knows about.

War is a terrible thing, no matter how right either side is.


There is never any winner.
War is fought by people who the elite
consider expendable cannon fodder.
I feel for that soldier.

I wonder what he thinks about war now.

This is a very difficult subject.

Food for thought.


I heard a saying once that said:

"War does not determine who is right, war determines who is left."


Fred Reed had an article up on just this subject recently. The link is: http://www.fredoneverything.net/FOE_Frame_Column.htm

Then from the left column, choose article 318- Thoughts on War.

On Recent Wars

Things Not Figured Out

May 17, 2006

People ask how we got into our splendid mess in Iraq and why we can?t get out. The question is a subset of a larger question: Why, since WWII, have so many first-world armies gotten into drawn-out guerrilla wars in bush-world countries, and lost? Examples abound: France in Vietnam, America in Vietnam, France in Algeria, Russia in Afghanistan, Israel in Lebanon, etc. Why don?t they learn?

The answer I think is that militaries are influenced by a kind of man?call him the Warrior?who by nature is unsuited for modern wars. He doesn?t understand them, can?t adapt to them.

The Warrior is emotionally suited to pitched, Pattonesque battles of moral clarity and simple intent. I don?t mean that he is stupid. Among fighter pilots and in the Special Forces for example it is not uncommon to find men with IQs of 145. Yet emotionally the Warrior has the uncomplicated instincts of a pit bull. Intensely loyal to friends and intensely hostile to the enemy, he doesn?t want any confusion as to which is which. His tolerance for ambiguity is very low. He wants to close with the enemy and destroy him.

This works in wars like WWII. (Note that the American military is an advanced version of the military that beat Germany and Japan.) It does not work when winning requires the support of the population. The Warrior, unable to see things through the eyes of the enemy, or of the local population, whom he quickly comes to hate, wants to blow hell out of things. He detests all that therapeutic crap, that touchy-feely leftist stuff about respect the population, especially the women. Having the empathy of an engine block, he regards mention of mutilated children as intensely annoying at best, and communist propaganda at worst.

On the net these men sometimes speak approvingly to each other of the massacre at My Lai. Hey, they were all Cong. If they weren?t, they knew who the Cong were and didn?t tell us. Calley did the right thing, taught them a lesson. There is an admiration of Calley for having avoided bureaucratic rules of engagement probably dreamed up by civilians. War is war. You kill people. Deal with it.

If you point out that collateral damage (dead children, for example) makes the survivors into murderously angry Viet Cong, the Warrior thinks that you are a lefty tree-hugger.

Today, the battlefield as understood by the enemy, but seldom by the Warrior, extends far beyond the physical battlefield, and the chief targets are political. In this kind of war, if America can get the local population to support it, the insurgents are out of business; if the insurgents can get the American public to stop supporting the war, the American military is out of business. This is what counts. It is what works. The Warrior, all oooh-rah and jump wings, doesn?t get it. Vo Nguyen Giap got it. Ho Chi Minh got it.

Thus the furious, embittered insistence of Warriors that "We won Tet of ?68. We slaughtered them! We won, dammit! Militarily, we absolutely won!" Swell, but politically they lost. It was a catastrophe on the order of Kursk or Dien Bien Phu. But they can?t figure it out.

The warrior doesn?t understand what "victory" means because he thinks in terms of firefights, courage, weaponry, and valor. His approach is emotional, not rational. Though not stupid, he is regularly out-thought. Why?

It?s not mysterious. An intelligent enemy knows that America cannot be beaten at industrial war. So he thinks, "What then are America?s weaknesses?" The first and crucial one is that the American government enters into distant wars in which the public has no stake. Do you want your son to die for?get this?democracy in Iraq? You diapered him, got him through school-yard fist fights, his first prom, graduation from boot camp, and he comes home in a box?for democracy in Iraq?

The thing to do, then (continues thinking the intelligent enemy) is to make the Americans grow sick of the war. How? Not by winning battles, which is difficult against the Americans. You win otherwise. First, don?t give them point targets, since these are easily destroyed by big guns and advanced technology. Second, keep the level of combat high enough to maintain the war in the forefront of American consciousness, and to keep the monetary expense high. (Inflation and gasoline prices are weapons as much as rifles, another idea that the Warrior just doesn?t get. Bin Laden does.) Third, keep the body bags flowing. Sooner or later the Americans will weary of losing their sons for something that doesn?t really interest them.

However, the Warrior does not grant the public the right to grow weary. For him, America exists to support the military, not the other way around. Are two hundred dead a week coming back from Asia? The Warrior believes that small-town America (which is where the coffins usually go) should grit its teeth, bear down, and make the sacrifice for the country. Sacrifice for what? It doesn?t matter. We?re at war, dammit. Rally ?round. What are you, a commy?

To the Warrior, to doubt the war is treason, aiding and supporting, liberalism, cowardice, back-stabbing, and so on. He uses these phrases unrelentingly. We must fight, and fight, and fight, and never yield, and sacrifice and spend. We must never ask why, or whether, or what for, or do we want to.

The public of course doesn?t see it that way. In 1964 I graduated from a rural high school in Virginia with a senior class of, I think, sixty. Doug took a 12.7 through the head, Sonny spent time at Walter Reed with neck wounds, Studley I hear is a paraplegic, another kid got mostly blinded for life, and several, whom I won?t name, tough country kids as I knew them, came back as apparently irredeemable drunks. (These were kids I knew, not all in my class.) It was a lot of dead and crippled for a small place. For what?

Cowardice? I was on campus in 1966 on a small, very Republican, very patriotic, very conservative, very Southern campus. The students, and their girlfriends, were all violently against the war. So, I gather, were their parents. Why? Were they the traitors of the Warrior?s imagination? No. They didn?t want to die for something that they didn?t care about.

This eludes the Warrior. Always, he blames The Press for the waning of martial enthusiasm, for his misunderstanding of the kind of war we are fighting. Did the press make Studley a paraplegic? Or kill the guy with all the tubes who died in the stretcher above me on the Medevac 141 back from Danang? Did Walter Cronkite make my buddy Cagle blind when the rifle grenade exploded on the end of his fourteen? Do the Warriors think that people don?t notice when their kids come back forever in wheelchairs?

They don?t get it.


There are far too many stories like this all through the history of warfare. The difference now is that, in past wars, the injured could take some pride in saying "I did it for my country." But with this war in Iraq, it's hard to justify living the way injured soldiers are living. Why are this young men and women dying?

Why are ex-prom kings disfigured? Is any of it worth it? War is never worth it, but this particular one defies logic. If I had it my way there would be no more casualities, not one more life would be wasted in this war of freedom. In the end, I pray those at fault will be held responsible for this war.


Very poignantly written, Prof. Very glad to have you back.

Your piece reminded me a bit of an editorial I read today about Memorial Day.

I hope everyone has a great holiday, but also takes a little time to reflect on its meaning.



I think we all hope we never have to be in a situation like that but that's a magnitude of humility we should all wish to cultivate. Truly amazing.


Most of these guys wouldn't make it at all without their wives or parents. The suicide rate is unacceptable. For a guy who has lost both arms beneath the elbow, getting dressed in the morning would be a feat without any help at all. These are stories not shown on the nightly news. I suppose it just isn't newsworthy enough.


And sadly the suicide rate is probably going to remain just that for people who've had these accidents: unacceptable. I don't see how any amount of counseling can comfort someone who has lost limb(s) over bullshit, which is basically what this all boils down to.

Does anyone know how much (if any) these guys are compensated? If you get yourself blown to bits over the stars-and-stripes the least the government can do, and ourselves as tax payers, is make sure these guys are well taken care of.


I was quoted one stat recently that claimed the widows of dead soldiers receive $12,000. There is a HUGE problem here that seems to be ignored in Washington and in the homes of those claiming they want war so badly.


I think they have a set price depending on what the limb is. I heard that it even gets broken down as far as the pinkie finger being less than the index.

I don't know what the actual prices are, but I'm sure anyone who lost a limb would rather have the limb than the money.


well, at least it was not in vain...

Bush and co. have more money in their pockets, corporations got their monopolies, and a bloody civil war is ripping Iraq apart.



Not tho' the soldier knew
Someone had blunder'd:
Their's not to make reply,
Their's not to reason why,
Their's but to do and die:
Into the valley of Death