combat writing badge C O M B A T
the Literary Expression of Battlefield Touchstones
ISSN 1542-1546 Volume 04 Number 03 Summer ©Jul 2006

The Qualitative Dilemma

"The only questions worth asking today are whether humans are going to have any emotions tomorrow, and what the quality of life will be if the answer is no."
by Lester Bangs

Each day is different ... and yet the same as all those throughout time ... like all the days gone by and all the days to come. Each day recreates the universe. Each is uniquely poised on the brink of promises, and every tomorrow is destined to fulfill the potential of all our yesterdays. Each day is what it has always been, will always be, becoming by mysterious means what we can only know as circumstance or chaos ... frightening and fascinating by turns.

Dawn broke, the way it always did at this time of year, with a kiss of the sun on the glistening leaves and mist in the draws as birds raucously proclaimed their domains. Colors transformed my landscape of mottled graytones to vibrant hues of shifting intensities as the wildlife took its turn at the chuckling rill running past my windows, an aperture onto nature's stage. An eddy brought a whiff of evergreens into my room. The scent of coffee and toast drifted in from the kitchen, so I knew my mother had already begun her day. Another day of paralysis stretched before me like a carpet runner disappearing into the distance, woven with a repetitive pattern in tones to make the inevitable wear less noticeable.

I thought about an interview that had recently been broadcast, featuring a uniformed physician in Iraq, who complained to the sympathetic journalist about the state of medical technology ... not that it was substandard, but that it was too good! He argued to an audience that had sons and daughters in the combat zone that medical practice was so advanced that there was literally almost no one who could not be saved from their injuries ... that no matter how badly they'd been wounded, medical technology could keep them alive ... and that this was, for him, a licensed medical doctor, a problem of medical ethics, because some of these people would not enjoy a life of quality. He would not, or perhaps could not, deign an exposition on what constituted a meaningful life that's worthy of his talents, and would warrant the resources necessary to preserve the life of a countryman wounded by our nation's enemy ... or perhaps, as they have done with so many other reports, the media simply censored that portion of his opinion.

I was not surprised to see this broadcast, since the media has been lending aid and comfort to our nation's opponents for decades, but this expression of inhumanity from a physician in uniform did surprise me. Perhaps it should not, given the accommodations made in schools and churches, the military and other public institutions to enable the anti-American agenda of the counterculture; but then I remembered my last medical exam at the veteran's hospital. It is difficult at best to transport me, from home to van to facility, for a scheduled appointment. I wait in a crowded room that cannot conveniently accept my appliances, and so am shunted like a too large lump of lesser-grade beef into an examination that takes less time than the trip from the van through the parking lot into the hospital. The luck of the draw last time paired me with a foreign doctor who barely spoke English, and used my appointment period to call his bank and his broker to check on his investments. The visit before was not dissimilar except that the doctor was female and called to check on her children and a time-share vacation. It would probably detract from their performance rating if they acted professionally by using some personal time between patients to conduct their private affairs, but I am reliably informed that the well rounded care-giver is now preferable to the dedicated workaholic. They don't think they're abusing the system, since they believe that they are the kingpins of the system, and the patients have no choice!

Given the fact that this is the way it is at the dawn of the new millennium, where our military can be winning a foreign war while politicians and their confederates proclaim it to be a loss, where the counterculture has infected every traditional institution so it can erode from inertia, and where objection or disagreement is categorized as hate speech, we must still consider how a practicing physician, who's repaying his educational assistance with military service, could possibly graduate with such an inhumane attitude. First is the practical matter of obligation, such that if someone accepts the privileges of an association that one is required to perform the bidding of that contract, and not bite the hand that feeds him. I suspect the character of anyone who makes a commitment but reneges after enjoying its benefits. But such defaulting has become normative for irresponsible libertines.

Most Americans are given a free pass to self-indulgence, with everything from minimum wage and unemployment compensation to voting rights and presumption of innocence; and most people are either ungrateful or demanding of preferential treatment. With the exception of soldiers and sailors, police and firefighters, who constitute a distinct minority of the citizenry, Americans are not required to pledge allegiance or swear an oath of loyalty. Whether we, like other nationals, should be so required is debatable, and probably unenforceable, given the tenor of modern society. A cursory survey of medical schools and their programs on ethics reveals that a physician's oath is not required, and that where one is used, the graduates may select from a score of recognized oaths, from Asclepius and Sun Ssu-miao to Hippocrates and Maimonides, or they can write their own. This hyperextension of individualism has been expressed in marriage vows for decades, but, as usual, these super-autonomous entities are missing the point of creeds, which is to unite the commonality of fellow believers. There has never been a majority of honorable men! ... nor a plentitude of brave men! ... which is why, even in this sophisticated era, we continue to esteem these traits. That a young physician, privileged in every way, and availed of the opportunity to associate with the heroes in our midst, elects otherwise by spurning the trust of his office is shameful.

Perhaps I'm unreasonably sensitive about these decisions because I'm one of the people they're talking about ... one of the ones who's supposedly without a qualitative life. The poorest American today lives better than royalty did a century ago, and that probably distorts our perspective on the impoverished conditions extant in some foreign lands, some not too distant. There is no ascription of credit or blame for this situation, for we have all inherited our own plight and contributed to it in our own ways. But it is unrealistic to presume perfection in all things, everywhere at once, as a humanistic usurpation of God, simply as a presumption of rearranged priorities. As has been proven around the world with socialism, redistribution increases suffering and bankrupts the system. The allocation of limited medical resources is not a new concept ... during war and other calamities, triage is a necessary procedure, and the lore is replete with accounts of survival after abandonment ... even enroute to burial. But the presenting problem for the battlefield surgeon is not the race or creed or color or lifestyle of the patient, but his condition at the time of in-processing ... when someone like me would be set aside during mass casualties, but was given immediate care on a slow day in the war. The evident dilemma, which is defined as a choice between equally undesirable results, should never be the physical result or the social value of the patient's life ... for no matter how arrogant physicians may become in their desire to engineer a politically-correct result, to pander to consumerism, to fiscally aggrandize their profession, they are not gods! ... as close as they come is being empowered to save lives. Any fool can kill with much less training!

When I was transported to a sanitarium, it happened to be one that also specialized in blind rehabilitation ... and if you don't think that's funny then you don't understand the military mind ... only Uncle Sugar would send a bunch of guys who can't see to bump into a bunch of guys who can't move! They say that misery loves company and it was probably the best thing they could've done with us, because we were compelled to recognize that we were not alone, that some of us were better or worse off than others, and that self-pity had no role in the equation. We shared the swimming pool with the blinks and would gather outside the messhall, which was one of the first indoor travel assignments for the blinks, and hold discussions in the vestibular atrium ... which they called the quad quadrangle in retaliation. Some of our guys who could still sing formed an informal glee club that also met in the quad quad because of its excellent acoustics, and some of the blinks joined us, two of them playing instruments. It was a good place to get your head screwed on while your body healed after undergoing a life changing episode.

We weren't disheartened by our plight. We were young and enthusiastic and positive, recognizing that whatever the rest of our lives held for us, it would have to be done differently than everybody else. The most frequent phrase heard by everyone was: there but for the grace of God ... and we witnessed it everyday in every way. On our side of the quad, a guy who couldn't lift his head and so viewed everything through a mirror. On their side, a triple amputee who was learning cane travel from his wheelchair. We had a guy with a severed spine who had to keep going back for more surgery. And they had a guy who'd been burned with white phosphorous who was having eyelids and ears grafted. Ironically, some of them felt sorry for us, and some of us felt sorry for them; and amazingly whenever the discussion got around to what if, we all felt that we could handle our own condition, but weren't sure if we could endure being deaf or brain damaged or whatever malignancy tormented any one of us. There was always some further or greater nightmare lurking around the corner, hiding in the shadows, or hanging in the rafters. Eventually we recovered enough to venture forth.

I haven't kept in touch with most of those guys, so I don't have statistical data to refute the contention concerning quality of life, but I know myself. I could give a few anecdotal accounts of veterans who have succeeded despite their handicaps, ones who have even managed to recover from divorce or professional failure to make another start at fulfilled personhood, but multiplied truth doesn't make it more valid ... or as a friend has said, if you reject one miracle then you must reject them all, and if you accept one miracle then you must accept them all. I am grateful for the love and care of the Army doctors who saved my life. I'm glad that they did not euthanize me out of some misguided estimate of my ultimate worth, of my socioeconomic potential, of my presumed quality of life. Each day is a blessing ... new and different and full of the universe.

"Do not take any reward [which may be offered in order to induce you] to destroy and to ruin, Do not harden your heart [and turn it away] from pitying the poor and healing the needy, Do not say of [what is] good; it is bad, nor of [what is] bad: it is good ... And to cleave to the name of the Lord God of spirits for all flesh, And the soul of every living being is in His hand to kill and to make live, And there is none that can deliver out of His hand."
by Asaph ben Berakhyahu and Yohanan ben Zabda [6-8 and 25-27 of the pact in The Book of Medicines, cited in "The Oath of Asaph the Physician and Yohanan Ben Zabda, Its Relation to the Hippocratic Oath and the Doctrina Duarum Viarum of the Didache" by Shlomo Pines, pp223-64 Proceedings of the Israel Academy of Sciences and Humanities (9/1975)]

by Bill Cummings
... who is a disabled veteran and freelance writer, whose work has appeared previously in this magazine.

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C O M B A T, the Literary Expression of Battlefield Touchstones