(Former stainless staples now in gull-wing configuration and removed from my flesh. Photo Socotra.)

I saw the face of medical care coming at us. It wasn’t a Death Panel, per se, but I was pretty interested in what I heard. It is not so much about health as it is about resources. If you want to call it something fancier than what people are calling the mechanism to protect medicine from patients, you could call it what the professionals do: ‘triage,” or you could just call it what it is.

Resource decisions.

Anyway, the insight popped up as Papa Doc was working the four beds in the Cast Clinic on the second floor of the new America Building at Walter Reed. Baby Doc was at his side, along with Judy, the volunteer assistant. I was present with ENS Socotra for a little weight loss program yesterday morning. It was all steel: here are the 23 staples that were removed by the second class Corpsman with whom we were goofing around.

I was in the second bay in the Cast Clinic. We got in early that morning, and hoped to escape the same way. I was upbeat, since in a pinch (and it is a pinch) I could escape the clutches of military medicine as soon as the first of July, when the new Company Medical benefits are expected to kick in.

But I like the team at Walter Reed, and the frequency of the visits should diminish over the course of the next nine weeks of enforced convalescence. Baby Doc was proud of the line of gleaming stainless steel that marched from below the kneecap to well up the thigh. I asked how she did it, and she said she had a cool staple gun.

“Whack, whack whack!” she said with a smile, blowing past the end of the bed. I noticed she wore earth shoes, which is apparently an optional uniform item. Baby Doc is an Annapolis grad, and later of the Uniformed Services University of the Health Sciences (USU), the only federally-funded medical college in the country.

“Doc, what is the obligated service requirement for all that education?” I remembered the pay-back requirement for getting a masters degree through the Navy, and the OBLIGSERVE incurred was two years commitment to active duty for each year of education. Baby Doc smiled.

“I specialized in orthopedic surgery,” she said briskly. “That gives me an obligated service requirement of 18 years.”

I gave a low whistle. “That is some commitment. Do you like it?”

“Yes,” she said. “Thank God. It would be a looong time otherwise.”

She went off to do something else, and HM2 began to take his little surgical pliers and break each of the 23 staples on their backs, first working his way up, and then working his way down. It tickled, but not in a way that made me want to burst out laughing.

I don’t want to violate patient confidentiality, so just imagine that there is a consult happening in the bay next to the one where ENS Socotra and I sat drinking coffee he had procured on the concourse one deck down from the Cast Clinic. Note to readers: it helps to have a commissioned officer with you as an informal adjutant in these military settings. Most of the care at Walter Reed is provided by enlisted personnel, protecting the Medical Corps officers, and it seems to add some juice. Or maybe it is just my imagination.

Anyway, just for argument’s sake, imagine a discussion between a physician- one of the few and much in demand- and a young ROTC student with a sports injury. There was some discussion about next steps. MRI was inclusive, apparently, and the medical consensus appeared to that a scope with camera was going to be necessary to determine exactly what was wrong.

Imagine you heard something like this: “We would like to get to that, but probably not until August or September. We have nine cases of combat injuries coming in today alone, and we have to concentrate on stabilizing them.”

Imagine, further, you heard a concerned father, and a very concerned young person trying to broker a deal. Imagine that the Physician was concerned, and regretful, but unable to put the kid ahead of a solider who had just stopped the angry shredding blast of an IED with his-or-her lower body.

Speaking hypothetically, I might have looked over at ENS Socotra and mouthed the words: “Was I lucky, or what?”

Imagine that a deal was brokered, only the services necessary would be provided by a Doctor who had not yet reported at a facility located thirty-five miles up the road at Fort Meade, where many activities have been concentrated by the forces of the Base Re-Allocation and Closure. Not optimal, of course, and commitments made in this ward were not binding on a physician in another, but that was the best they could work out- hypothetically speaking, of course.

It is just a question of resources. There are not enough to go around at the time that you might want them. In the case of my imaginary ward-mate, he was a kid who wasn’t actually even on active duty. But it is his future- college starts in August, and if he misses it, he may miss a career and fundamentally change his life.

I finished my coffee as HM2 plinked the last of the stainless piercings out of my skin. I thanked him for his professionalism.

“Nah, ain’t nothin,” he said. “We have to put the things in our own legs to practice taking them out with the least amount of discomfort.”

“You are very good, HM2,” I said. “And thanks.”

Baby Doc was very stern with me, as she outlined the recuperative goals for the next two weeks. Flex to 30-degrees, no more, and while prone only. Rigid vertical lock must be engaged when ambulatory on the crutches. No getting the brace wet. Invest in a shower seat and keep the leg dry. NO swimming until further notice- probably 68 days away, depending.

I dutifully repeated the instructions back to her, not certain that if I fell again before things healed sufficiently I would not be on my way to Fort Meade or somewhere really inconvenient to talk to a Doctor who had not yet been assigned.

ENS Socotra wheeled me out of the ward when he had bandaged the angry-looking incision and re-strapped the Bledsoe G3 Post Op Brace on my pathetic excuse for a left leg. We stopped to get the follow-on appointment that Baby Doc had directed, and then managed to get the chair into the elevator and head for an escape.

“Man,” I said. “Was I lucky.”

“Luckier than the guys coming back from Afghanistan today,” said the Ensign. “They are going to be mighty busy here for a while.”

Copyright 2012 Vic Socotra

www.vicsocotra.com