The Boxer

I don’t often get calls from thoracic surgeons asking for my help. But this was a unique circumstance. His son, a first year student at the U.S. Naval Academy (a plebe as we call them) was going through his first baptism by fire. He was concerned that his son was hitting a breaking point, so he reached out for my help.

I don’t often get calls from thoracic surgeons asking for my help. But this was a unique circumstance. His son, a first year student at the U.S. Naval Academy (a plebe as we call them) was going through his first baptism by fire. He was concerned that his son was hitting a breaking point, so he reached out for my help.

“It’s not right what they are doing to him,” my friend said bitterly. “I’m about to tell him to get on the next plane home.”

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“I’ll look into it,” I promised. It seemed to give him some reassurance. But the truth was that there was little either of us could do but stand by and watch.

As a senior Naval Officer and part time staff member at the U.S. Naval Academy, I have the privilege of mentoring some of the midshipmen – students at the academy. One of the most important experiences that they will encounter at Annapolis, and one of life’s most important teaching moments, is their first big failure. When these students arrive in Annapolis on the first day of July each year, bright eyed and vowing to give their lives for their country if necessary, many have never failed at anything. They are among the “best and brightest” that this country has to offer. Loved and admired by family and friends, more than a few have received rousing send offs from their home towns or schools. Most are in top physical condition and believe themselves to be just as tough mentally. But most are unprepared for the magnitude of what they will encounter in the months ahead.

Like so many, my friend’s son was a top student in high school, and a handsome, superior athlete. As the ring side physician for the Plebe Summer Boxing “Smoker”, I had seen his son absolutely demolish another plebe, then behave magnanimously toward his bloodied opponent. So no one could question his toughness or character. But now he was facing a situation that he had never encountered before. One of the upperclassmen assigned to train him had decided it was time that he failed. Some would see it as simply cruel hazing. But this upperclassman had decided to test his plebes with an endless series of mind-numbing tasks that seemed to have no real value. And further, no one, especially my friend’s son, could ever seem to perform satisfactorily. Each ‘failure’ resulted in public berating bordering on humiliation. Adding to this, the long days of physical and academic training resulted in severe sleep deprivation, bringing the plebes to a breaking point. No matter how smart, strong, courageous, or persistent they were, they each had their limit. And it was the job of this upperclassman – a task which, by the way, he enjoyed with devilish delight – to take the plebes to that breaking point and push them over the edge. That’s when the trainers found out whether the plebe would quit, blame someone else for their ‘failure’, cut corners, or get up and try again. No one, not even a parent, knows what their son or daughter will do when they are pushed to that point.

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I explained to my friend that I had been through similar agony years before, when my own son had attended the Naval Academy. I, too, wanted to put out a contract on the student who was ‘torturing’ my child. I was ready to encourage my son to quit even though it was never on his radar. After a long conversation with my friend, we came to agree that though it was painful to watch, it was both necessary, and reminiscent of some of our own experiences in the past.

I recalled my first week as an intern when I had a patient die suddenly, during morning rounds, of a previously unknown dissecting abdominal aortic aneurysm. Yes, in retrospect, the blame for the catastrophe lay at the feet of everyone from the attending down. But on that morning, it all landed in my lap. All I could see was a man dying right in front of me due to my incompetence. What further burned the event into my psyche was that when I called the pathologist about doing an autopsy, his only opening was at that moment. A little over a month before I had been feted by my family and friends for my graduation from medical school. But on that morning I stood at the autopsy table within hours of my patients death, viewing my bloody failure. I have to admit that I wondered at that moment whether I had what it took to be an emergency physician.

Years later, when I had been elevated to the position of director of the emergency department, our group endured a long, hostile, and losing battle with a segment of the medical staff who resented our group of young board certified emergency physicians. Our group had insisted on raising the bar of what emergency physicians could and should do. We insisted on seeing all the patients – what a novel idea – instead of having them wait in the waiting room for their private physician to come in. The president of the medical staff, one of the main reasons we were willing to come to the town, had promised our group that as long as he lived we would be welcome in that hospital. He died two years later. And our entire emergency medicine group was fired on the following April Fools Day. It was front page news in that small town. People wrote the paper telling of how our group had saved their lives. But it didn’t matter. Many of my colleagues who have been around since the beginning of emergency medicine can tell similar tales. I wondered again whether I, as an emergency physician, or we as a specialty, had what it would take to survive.

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But survive we did. And we did it by not cutting corners; emergency medicine training is some of the most grueling. We could have backed down from the jibes of other specialists who “own” their little area of expertise.

We did not. And though we could have complained at the breadth of knowledge that was required to practice our speciality, we put our collective shoulders to the wheel and pushed for higher and higher standards. And we became the better for it.

I talked to my friend again not long ago to see how his son was doing. He told me a story that said it all. Despite suffering setback after setback, humiliation upon humiliation, his son had simply continued to do his best. After boxing well against plebes, his son had gone out for the brigade boxing team. In order to test his mettle, the coach had put him in the ring with a much older, more experienced boxer. Time and again he was knocked to the mat. But each time he got up to face his opponent.

I later asked one of the coaches, a decorated Navy SEAL, about my friend’s son’s performance in the ring. “He’s got a lot to learn,” he said. But then turned to a time worn axiom. “It’s not the size of the dog in the fight that counts,” he said. “It’s the size of the fight in the dog.”

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Plebe, intern, resident, or attending, we’ve all spent our time in the ring. And we’ve all looked up from the mat a time or two. It’s what you do next that counts.

Dr. Mark Plaster is the founder and executive editor of Emergency Physicians Monthly