Taking Orders

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I should know better by now than to answer a call at 9:30 at night. It can’t be good news. But I’m always afraid that I’ve made some bonehead scheduling mistake and have failed to show up for my shift. So I left the family watching March Madness basketball and took the call in another room.

I should know better by now than to answer a call at 9:30 at night. It can’t be good news. But I’m always afraid that I’ve made some bonehead scheduling mistake and have failed to show up for my shift. So I left the family watching March Madness basketball and took the call in another room. When I returned, my wife could tell from my face that I had just gotten some important news. There was a long silence.
“Is something wrong?” she finally asked.
“That was the med battalion CO (commanding officer for all you non-military types). He says I’m headed back to Iraq for another deployment.” She muted the TV and stared at me. I just stood there silently as a million thoughts flew through my head. All I could do was screw up my face like I had eaten something nasty.
“You told me about the email from some guy the other day asking you to go back. But I thought you told him no?”
“Yeah, I told the CO all the reasons I had given to the CPS (Chief of Professional Services) the other day as to why I had declined to go back.”
“So, what’s the problem?” she shrugged. She was beginning to squint at me as she moved into interrogation mode. “I thought you told me you were free and clear.”
“First of all, the CO is a really nice guy,” I said, suddenly feeling the need to provide my CO with a little cover. I could just imagine her calling him up and giving him a piece of her mind. “He told me everyone else who could go back has done it, and now I’m at the top of the list. Well, actually, I am the only one left on the list. And, he told me that the CPS wasn’t really…asking.” I slowly articulated the last three words.
“So you ‘volunteered’ to go back?” she asked, shaking her head.
“I guess you could say that.”
“How long?”
“Six to eight months.”
“How soon?”
“Pretty soon. Work-ups begin next month.” We both sat silently looking at one another.
The old timers joke that NAVY stands for Never Again Volunteer Yourself. But no one was laughing tonight. My first deployment had been hard, but there were some definite benefits, I began telling myself. Exercising daily in 100+ degree heat with 18-year-olds had knocked 25 pounds off of my frame and put me into the best physical condition of my adult life. Working with some Iraqi civilian doctors had broken down my bigoted stereotypes of Arabs and left me with a desire to see them achieve the same freedoms that we had. I had come home the first time with a sense of accomplishment.
But there was one benefit to deployment, if you can call it that, which was particularly difficult to appreciate without the proper perspective. And that was experiencing first hand the frustration of what it feels like to not be in control of my life. Loss of personal control, even for a few months, gave me a fresh look at how the majority of the world has to live their lives.
Our patients experience that all the time. One minute they are doing whatever they want to do, and the next they are strapped to a board waiting to be assaulted by a team of strangers. Seldom are they asked for their permission to be touched, exposed, or stuck with needles. No bodily orifice is off limits as patients often get violated without explanation or even notice. The patient’s clothes are cut off, leaving them cold, embarrassed, or both. In the name of medical efficiency our patients become totally at the mercy of those around them.
Even in non-urgent situations our patients have to surrender control. They lie in beds for hours watching us go back and forth, eating, laughing and talking on the phone, and they wonder what is going on. We order tests on them that can cause them considerable discomfort and run up bills that may take years to pay off, all without their permission. We take it for granted that they understand we are acting in their best interest. But should we make that assumption?
It’s no wonder our patients can be bewildered, frustrated, and sometimes even downright angry. Maybe it shouldn’t be aimed at us, but we are the messengers who tell them that they are not ultimately in control of their lives.
In my case, the military is pretty good at letting you know that you are not in charge of your life. Despite my CO’s gentle manner and his attempt at letting me think I was volunteering for this assignment, the truth of the matter was that I was not. The last time I had control of my situation was when I raised my hand at swearing in. No, what I was going to receive in the mail was not a request to return to duty. They were orders. And soon all the goings and comings of my life would be at the mercy of someone I didn’t know. I could only hope that they cared about me just a little.
As emergency physicians we are accustomed to making decisions about other peoples’ lives. We write orders and expect them to be followed to the letter. And we hold people accountable when they are not. We are also accustomed to governing our own lives. If we don’t like the way things are being done, we can change the situation or leave. As Americans, as physicians, we feel that we are largely the masters of our own fate.
“It’s good to experience that loss of control from time to time that my patients know so well,” I told myself. “This will be good for me. I can do this.” The rest of the evening was quiet as we both let the news sink in and began the process of adjusting to a different life. “This will be good. I can do this,” I kept repeating.
The next morning, though, my thoughts were less sanguine as I sat in front of my computer answering emails and compiling a list of all the things I needed to do before leaving. I looked around at the comforts of my office while I sipped my morning coffee. “Who am I fooling?” I finally asked myself. “This is going to be tough. I’m 56 years old. At this point in my life, I do anything I want to do,” I said to myself in a momentary lapse of braggadocio. “I eat what I want to eat. I drink what I want to drink. I wear what my wife lays out for me to wear.” Suddenly I heard my wife call out from the guest room. “Honey, can you take out the trash in the kitchen. It’s really beginning to smell.”
“I’m really busy,” I shouted back.
Before I had even completed the sentence her face appeared at the door of my study, flush with perspiration from carrying a heavily loaded laundry basket.
“I wasn’t really asking,” she said firmly.
“Aye, aye, ma’am,” I mumbled, rendering a mock salute. “Who am I fooling, here?” I muttered under my breath as I made my way past her to the kitchen. “I’m not in control of my life now. This deployment is going to be a piece of cake.”
“I heard that, sailor,” she taunted as I continued to grump down the stairs. A minute later I heard her shout from the laundry room.
“Do you need any help packing your sea bag?”

Mark Plaster, MD, practices emergency medicine in Baltimore, Maryland


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