More than once during his yearlong duty, thirty-two-year-old Dr. James J. Paul wondered what had possessed him to leave the security of a neurosurgery practice in the Midwest to experience the blood, guts, and gore of brain surgery at a forward marine hospital during the Vietnam War. In Blood on China Beach, Paul, a neurosurgeon from the Mayo Clinic, shares the story of how he learned his craft in a rudimentary hospital in Vietnam, twelve thousand miles from home.
This memoir picks up where most Vietnam battlefield memoirs leave off-when the choppers deliver the dead and gravely wounded to the field hospitals and the dedicated doctors and medical staff struggle under primitive and unsterile conditions to preserve life. In this environment, Paul was charged with carrying out emergency neurosurgery on those soldiers sustaining head injuries. He details both the emotional and professional factors that played a role in his service and provides a unique perspective to the Vietnam War.
Insightful and historically significant, Blood on China Beach shows Paul's reverence for life and his admiration for the bravery of the marines he operated on, even as he questioned his own ability to make a difference. This memoir shows Paul's evolution from child to man and from neophyte to surgeon.
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BLOOD ON CHINA BEACHMy Story as a Brain Surgeon in Vietnam
By James J. Paul
iUniverse, Inc.Copyright © 2012 James J. Paul
All right reserved.
Chapter OneThe Wall
The Wall. That's what it's called, even though the official name for it is the Vietnam Veterans Memorial. The polished black granite glistened even in the subdued gray light filtering down from an overcast sky as I stood looking at the names etched into the stone. So many names. So many dead brave Americans. In all, there were 58,195 etchings artfully and simply carved on the expanse of mirror-like darkness, though over the years more names have been added, bringing the total to 58,272. Glancing to my right, I took in the spear of the Washington Monument to the east. The Lincoln Memorial rose to the west, and I reflected on the apparently diminutive nature of the Memorial Wall in comparison to the grand monuments around the National Mall.
The Vietnam Veterans Memorial was not without controversy. It was not supposed to be a war memorial, but rather a site dedicated to the memory of all who served in Vietnam, not just those who died there. Some said Maya Ying Lin's concept of making the memorial a park within a park was not sufficiently honoring the bravery of our soldiers, while others thought it was just the right thing to do. The Wall had just been dedicated a week or so before my visit, opening to the public in a somber ceremony on November 13, 1982. So it was all new to me and everyone else at the time. I was one of the first of millions of visitors to come see it. For me, the Wall was special, haunting, and not a little disturbing because of the memories it summoned.
I'd come to Washington, DC, not expressly to see the Wall, though there was some odd connection between the two I didn't quite comprehend at the time. I was in town for a meeting about a proposal by the Bureau of Medicine and Surgery within the navy to withdraw neurosurgeons from the battlefield position to a much better equipped facility well back from the front lines. Since I had experience working as a brain surgeon under terrible conditions in the jungles of Vietnam, my input was sought.
A bunch of other neurosurgeons with similar experience had come together in committee fashion to weigh the advantages and disadvantages of this proposal, and either concur with the idea or make a counter proposal to the navy. Over the previous two days I had been confined in a meeting room of a local hotel for eight hours each day, during which time all of the ramifications and implications of such a proposal were discussed in detail and either supported or challenged by those in attendance.
The forward position, known as an Echelon II facility, manages emergency surgery. It has limited capabilities and is crude. Care, however, is rapidly delivered. The Echelon III surgical facility is well equipped, well staffed, and provides very good care. It, however, is often hours from the battlefield. Brain injuries cannot tolerate delayed surgery, making it unwise to move the neurosurgeons away from the battlefield. I was in favor of keeping neurosurgeons in Echelon II facilities, and I repeatedly said so.
When the meetings finally ended, I had some time to kill, and I found myself drawn inexorably to view the Vietnam Veterans Memorial. I couldn't go home without seeing it. As I stood in front of the Wall, I realized that the place held great meaning for me, and I was emotionally unprepared. It was a private and pristine recess and in no way ostentatious.
At the top of the shallow column of stairs stood a pedestal crowned with a broad thick book that looked like a medieval Bible. This large text was enclosed in a weather-shielding glass case affording protection from the elements on the sides and the top. One could access the book, however, by opening the hinged glass cover and perusing the pages. The book contained literally thousands of names arranged alphabetically.
I shivered and drew my coat closer. The temperature was about thirty-five degrees, and the wind coming off of the nearby Potomac River was kicking up. Dead leaves brushed by my face as I studied the book, transfixed as my memory drifted back through the years to a place fifteen thousand miles from this spot. The scene reunited me with many of the names I recognized and recalled as I turned the pages of this large parchment-like bound tome. The cold wind and gray winter day were erased from my mind as my eyes drifted slowly from name to name. I remembered the seeming futility of trying to operate on kids out in a jungle forward aid station, and how I felt when I'd first arrived in-country. I'd performed my surgeries to the best of my ability, only to lose yet another good man.
I continued to follow my freezing and admittedly trembling finger as it traced the names over many pages, and I occasionally recognized one more. Then another. I'd picture the gaping head wounds, the burns, the stumps where legs and arms had once been. Then, whether it was the inclement weather, the increasing chill, the whistling wind in the bare trees, or a still scarred and unhealed emotion, a new horrific picture was painted in my mind. I began to shudder. The horror and the madness loomed clear in my memory once again.
Turning from the huge reference book and looking directly at the Wall, I saw that a few tourists had wandered down the steps to gaze upon the black shining inscribed surface. Approaching the Wall within inches, they were scanning for names. Several minutes later a woman in her thirties came by with a young girl about ten or eleven years old. They walked down the steps to the Wall, searched a short while for a particular name, and then turned slowly away. Holding her daughter's hand, the woman came back up the stairs. As they walked by me, the young girl asked, "Won't Daddy get cold down there?"
I had had enough. Washington, with its marvelous monuments and reams of history—the heart of American government and society—was for a short period entirely negated in my mind. It was diminished because of this disturbing encounter and a vivid reminder of an imperishable mental record that I knew I would have for the remainder of my days.
I walked off the path, exiting the monument, which was lined with winter-bare trees, the cold, biting wind whistling through their branches. Again, fallen leaves swirled up by the gusty wind frequently bounced off my face, thus preventing me from becoming so distracted that I would wander aimlessly.
I proceeded to the edge of the Mall, found a taxicab, and went directly back to my hotel. It was late afternoon, and with little else to do, I lay down on the bed in my room. Hearing nothing save the sounds of the gentle hum of the heating system, I grew drowsy. I rolled over on my side, looked out the window, and saw again nothing but gray overcast and dark-colored buildings in the distance.
Ironically, my window was positioned such that in the distance one could look across the city and see the brightly lit dome of the US Capitol. I was struck by the fact that the monument that moved me so much was not even visible. In fact, it was well below the treetops of the rows of trees on the Mall. All that's important was sinking away. I lay back, stared directly at the ceiling, and felt my eyes growing heavy, although I had no intention of sleeping for several hours yet. The emotional experience of the riveting afternoon consumed my energy, though. I tried to resist falling asleep, but I was emotionally drained from my experience at the Vietnam Veterans Memorial. I fell into a deep sleep.
And the dream came again. It was one of many dreams I had that brought me back to when I was only thirty-two and a fledgling neurosurgeon in the midst of war. The horror of young vibrant marines turned into raw meat jolted me awake in a cold sweat.
Chapter TwoA Time of Discontentment
AT TIMES, EVERY PERSON MUST FACE the proverbial fork in the road, or a time of indecision that is bad for the soul. I was in such a time early in 1965. I was within days of finishing my residency training as a neurosurgeon at the Mayo Clinic. Every day I wondered where I would go and what I would do with this newly acquired capability of something called neurologic surgery.
Although I had spent over five years at the Mayo Clinic learning the various nuances of neuroanatomy, neurophysiology, and neuropathology, I lacked the all-important hands-on experience that imparts the hand-eye coordination, the earmark of an adept surgeon.
Although during my years at the Mayo Clinic I was exposed to and learned quite accurately the didactics of this relatively obscure division of surgery, this hands-on experience was a major shortfall at that institution. The reason is quite simple. Patients come from great distances and spend a great deal of money to go to the institution for what they perceive as the ultimate in medical and surgical care. Such patients rightfully thought they deserved only the best surgeons, which made on-the-job training of a new surgeon like me somewhat problematic.
Although I felt competent in those aspects of the field of neurosurgery that did not include actual operations on patients—namely, the evaluation and diagnosis of neurosurgical diseases, the examination of the patient, and the various radiologic and electrodiagnostic tests that were required—the day I completed training and left to seek a private practice of my own, I could not "operate"! I was very well aware of my lack of confidence in myself as a surgeon at the time, and I believe to this day that I was right to feel as I did.
At the time I completed my training, I had achieved everything I set out to do in my life, and yet I felt a sense of insecurity and loneliness, much like a metaphorical ship without a rudder. I had interviews with a few interested neurosurgeons seeking an associate. Unlike the four other young men with whom I trained, I failed to make a commitment and, thus, at the completion of my program had made no arrangements for a professional position. I was thirty-two and emotionally drifting. I simply tossed my few belongings in the trunk of my car, filled the tank with gasoline, and with less than two hundred dollars to my name, left the city of Rochester on a bitter cold January morning in 1965. I started driving through southern Minnesota and then crossed over the Mississippi River into the state of Wisconsin, heading toward Chicago.
The countryside was winter bleak. The sun had not shone for weeks, and woods were covered with snow. The temperature hovered in the twenties.
After driving several hours, I found myself on the outskirts of Milwaukee, Wisconsin, and elected to stay there for the night. After checking into a motel and having something to eat, I went to my room and wondered whether a position was available in this city. I then opened a local Yellow Pages, went to "physicians," and then looked for the subheading of "neurological surgeons." I called one and inquired about a job.
As chance would have it, this individual was just one year older than me, had been in practice about one year, and indeed was looking for a partner.
We met the next day, talked, and discussed the merits of the practice (trauma versus elective cases), financial considerations, etc. Then we agreed upon a professional relationship and proceeded to complete the necessary paperwork.
I rented a furnished efficiency apartment and moved in my belongings, which were easily absorbed in about half of one closet. Shortly thereafter, I went out and bought a new car—a convertible. I assumed this notion was designed to fit the image of a flowering, if only embryonic, career-insecure as I was!
The next several days included meeting my new partner's office staff, applying to the staff of the three local hospitals where he maintained his practice, and meeting multiple physicians at the various facilities. Together we began seeing patients, responding to consultations from the hospital and emergency rooms, and embarking upon the traditional private practice of neurosurgery.
A low rumbling, however, was mounting deep in my mind. I felt unhappy, unfulfilled, and insecure. Ironically, the news on the radio and in the newspapers was beginning to echo a brewing and slowly expanding military conflict in far-off South Vietnam.
For reasons that were not immediately obvious to me, I found myself seeking more information about this growing conflict. Meanwhile, I continued methodically and in a Pavlovian fashion, discharging the daily responsibility of a neurosurgeon in a community environment, with its attendant responsibilities of not only evaluating and carrying out surgery albeit with a sense of anxiety over insecurity, but additionally meeting more and more potential referring physician sources, attending the traditional cocktail parties, and increasing my potential exposure so as to attract more and more referrals. I was gradually becoming mired in a class system, which included a strata I found progressively repulsive.
For five years I had trained, often day and night, to ultimately arrive at this point in my life, a spot in this world where most men would be delighted (personal, financial, and professional success guaranteed). I was not content. More and more, the news from Southeast Asia dominated the networks and the newspapers, curiously mesmerizing my thinking. This news acted as my potential escape from the social quagmire into which I was beginning to become entangled.
Certain events from my younger years were clearly intertwined and operative in the development of my growing anxiety. Not the least of these was the fact that I had grown up in a family where, as a young boy, I saw three older brothers enter the military and go to the South Pacific in the course of the Second World War. Additionally, my father had served in the First World War in France and often reminisced. Indeed, a younger brother entered the military during my college years and returned as a veteran before I had even graduated from medical school.
One evening late in my medical education, while sitting in the living room of our home, my father looked at the wall covered with portraits of each of his sons in their uniforms. Then he turned to me and said, "Jim, do you think you will ever be good enough to be on the wall?"
Driven partly by this parental rejection and an additional poorly understood array of motivating factors, I found myself yearning for an escape from this confined, labyrinthine environment that many young men would give their all to have.
Maybe something about the confining discipline of training had left me ill equipped to enter into civilian practice. Maybe not. In any case, a mounting sense of nationalism, excitement, and adventure, with its inherent risks, plus a sense of insecurity and a desire to run tempted me to contact the medical department of the navy in Washington, DC.
Why the navy? I haven't the slightest idea.
For the next few weeks I convinced myself that this was both foolish and dangerous. The notion was abandoned. Whatever this underlying emotional process was, however, it could not be extinguished. For many days I would think about the call—and then stop short. The back-and-forth cycle began to drive me crazy, but I buried my inner turmoil, or at least I tried to. In the meantime, the practice continued: office consultations, elective surgery, and more structured entertainment to meet additional doctors. I met and worked with several physicians for whom I had the highest professional and personal respect. Although I wanted to, I never shared my mental conflict with my partner or anyone else.
Yet, I could not escape from my feelings. I was emotionally torn by the conflict between what I should be doing and what I was contemplating. The gnawing, unquenchable need to give up everything I had worked so hard to achieve and strike out into the unknown persisted. In retrospect, I think the risk and danger, and the possibility that I might die in the war, motivated me more than I admitted to myself at the time.
The day of my decision remains vivid to me even now, so many years later. It was about two o'clock in the afternoon while I was sitting at my desk in our medical office building. I assured myself that the door to the secretary's office was closed. Then after obtaining the phone number through the long distance information operator, I was able to contact Captain Black, the medical program director for the navy. He answered the phone in a polite yet direct fashion, identifying himself and his position.
I stated my name and indicated that I had recently completed a residency in neurosurgery and was in private practice but was interested in joining the navy, specifically for the purpose of being assigned to a position with maximum need and excitement and with no particular regard to location.
There was a hesitation on the part of Captain Black for at least thirty seconds. In fact, I thought for a moment he hung up the phone. However, he had not, and when he did respond, he asked, "Are you for real?"
I continued that I was and that I was sincere in my intent.
He then said rather abruptly, "Give me your social security number, and wait at that phone for thirty minutes."
Excerpted from BLOOD ON CHINA BEACH by James J. Paul Copyright © 2012 by James J. Paul. Excerpted by permission of iUniverse, Inc.. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Table of Contents
Contents1. The Wall....................1
2. A Time of Discontentment....................6
4. Journey to Nam....................18
5. Alien World....................31
6. Charlie Med....................42
7. Toil and Trouble....................51
8. Settling In....................66
9. China Beach....................83
10. Supply and Demand....................103
11. Bloody Spring....................117
12. The Commander....................128
13. Between Darkness and Light....................141
14. Noble Attempts....................156
16. Summer Heat....................188
17. Mission of Mercy....................204
18. Winding Down....................219
19. Separation Anxiety....................229
Most Helpful Customer Reviews
Dr. Pitlyk tells his story in an engaging manner. He narrates his experience of working at a forward marine hospital in the jungle near Da Nang. The book is a war story but more than that it is a statement of dedication, courage, endurance and self-sacrifice. I highly recommend this book. to all who wish to walk with this young doctor as he shares the physical and emotional challenges that faced him and the medical staff at the field hospital during the Vietnam War.
This was great read!!! I learned more about the times & the experiences of our men, what they endured & the conditions . I am recommending it to all my friends !!!
another good novel by a surgeon in the Vietnam war.
UNLEASH TEH WRATH OF MILLY TEH MOOOUSE!