Imagine being in the middle of a full surgery schedule and a healthy complement of back-to-back office hours. Now imagine receiving a call that orders your sudden and abrupt departure from your livelihood.

This has been the reality for the several ASPS Active Military members and U.S. armed forces reservists counted among the societys nearly 6,000 members. These plastic surgeons have been involved in the Iraq relief effort by traveling to the Middle East or backfilling another physicians spot in the military.

Some, like ASPS Active Member and Naval Reserve Cmdr. James F. Thornton, MD, have filled positions in other parts the United States at a moments notice.

Dr. Thornton has a busy practice at the University of Texas Southwest Medical Center, Dallas, one that he's temporarily relinquished, he says with a laugh.

Dr. Thornton was called to active duty to replace a flight surgeon sent to a U.S. fleet surgical support group. He is one of the Navys six reservist plastic surgeons, which also has five Active Military plastic surgeons.

"I've been a reservist for nearly 10 years, and this call-up was about as out of the blue as you can get," Dr. Thornton notes.

"I'll never forget how I was called: It was on a Tuesday, I was sitting in a clinic full of patients and all of my surgeries had been booked out for a month or so. My reserve unit commanding officer told me I needed to be in Jacksonville, Fla., by Friday. At the time it was very disruptive," says the Dallas-based plastic surgeon. "My wife and I have four children, and now I'm in the hole for babysitting for the next nine months," he says from his temporary office in Corpus Christi, Texas.

"But my partners in the practice were great; they came together for me and filled in my schedule completely. And the Navy, bless its heart, once I arrived at Corpus Christi, let me go back home on a few Fridays to straighten things out and take care of some of my patients."

Dr. Thornton is serving as a flight surgeon for the Naval Air Training Wing. His father is former NASA Astronaut William Thornton, who flew on space shuttle flights in 1983 and 1985. The senior Dr. Thornton conducted experiments in space, designed and developed the shuttles treadmill for in-flight exercise and maintained crew conditions in flight.

Asked if he would follow his father into earth orbit, Dr. Thornton replies with a chuckle:"No, Im too old and have too many kids for that."

The Navy has Dr. Thornton working as a flight surgeon, "one of these good-deal jobs. I take care of the pilots in the morning, perform a few physicals and oversee the four junior flight surgeons. Since Ive been down here, the pilots have taken me flying nearly every day. It has been a bonanza of flying, and it has been wonderful."

Dr. Thornton told PSNthat he hoped to return by July 1. "The university has a residency training program, and July 1 starts the new residency year. Id like to be back by then." Fortunately, he and the military were on the same page: Dr. Thornton returned to Dallas and his busy practice - on July 1.

Navy 'float' on the Persian Gulf
U.S. Navy Commander Teresa Buescher, MD, traveled a long way to assist the militarys effort in Iraq. An ASPS Active Military member based at the National Naval Medical Center (NNMC) in Bethesda, Md., Dr. Buescher on March 6 shipped out to the hospital ship USNS Comfort, en route to the waters outside Bahrain, east of Saudi Arabia.

She, too, faced a quick turnaround on the order of Uncle Sam.

"On March 4, my superior officer said, Pack your bags, youre going now. But we knew it was coming; there had been heavy hints dropped at the end of February," she says.

Normally a plastic surgeon would not receive a "billet", or assignment, on the Comfort, but the possibility of great numbers of thermal injuries convinced the military brass to bring Dr. Buescher aboard. "The military doesnt consider plastic surgery to be a combat specialty, so plastics is usually not forward (near the battle front)," Dr. Buescher explains. "Its usually back in the continental U.S., where all the reconstructive surgery takes place. But this time there was more concern about the potential for large numbers of thermal injuries."

Aboard ship, she was a trauma team leader and responsible for thermal injuries. Over the course of two months in the Persian Gulf, Dr. Buescher, chief of the plastic surgery division at Bethesda, treated wounded U.S. military personnel - and Iraqi prisoners of war.

"Most of the enemy prisoners of war (EPW), when they figured out we werent going to do any harm to them, accepted treatment, and some were very grateful for it," notes Dr. Buescher. "But some were convinced we were going to do them harm, and they maintained that belief."

The lack of Arabic translators made verbal communication with the EPWs difficult, adding complications to an already complicated situation, she adds. "It was difficult to always have a translator around when you needed to talk to a patient, and everything took longer because you had to wait for a translator. But we made sure one was present before the EPWs went into surgery and for other major events. Its so much easier to work with someone when communication is easy."

She performed 74 operations burn excisions, wound debridements and wash-outs, skin grafting, stump revisions and muscle flaps. "These were dirty wounds, combat wounds; sometimes we would wash them out three, four times. Some of the orthopedic surgeons went five and six times to try to get the bone clean," Dr. Buescher recalls.

"There were a lot of extremity injuries, which follows the pattern of previous wars," she adds. "Most of the torso wounds were not devastating wounds; had they been, they wouldve been mortal wounds and would not have reached us."

Another difficulty was the uncertainty of where the wounded EPWs would go after treatment. Without such knowledge, surgeons had to provide the most-comprehensive treatment reasonably possible, she says. "We had to try to supply more definitive coverage and closure, as opposed to getting them stable and moving them along the evacuation chain. They had no evacuation chain. They had no place to go."

The civilian burn victims, however, eventually went to burn units in Kuwait or Bahrain, she notes.

The Iraqi civilians made the deepest impression on Dr. Buescher. "There were thermal injuries that resulted from house fires," she recalls. "Six civilians had burns over significant portions of their bodies. Although they needed to go to a burn unit, none was available to them when they first arrived. We kept them for about a month; that was difficult for everyone who took care of them. We were able to provide good general hospital care, but a general hospital is not the same as a burn center. Everyone wanted to do more, but we were limited in what we could offer."

'Fiercest battles since Vietnam'
Injured Navy and Marine personnel were often transported to the NNMC at Bethesda, where Dr. Buescher is assigned and which, upon her deployment on the USNS Comfort, needed another plastic surgeon to "backfill" that opening.

ASPS member and U.S. Naval Reserve Cmdr. Martin Morse, Great Falls, Va., was one of two plastic surgeons mobilized for duty at Bethesda. He was joined by ASPS member and active duty Air Force Lt. Col. Robert Rossio, Silver.Spring, MD.

At Bethesda, Dr. Morse treated injuries resulting from fierce battles in southern Iraq including in Nasiriya, where Jeff Colyer, MD, had travelled with the International Medical Corps (see PSN August 2003, page 22). "The Marines told me that the southern Iraq battles were the fiercest they've been engaged in since Vietnam," Dr. Morse recalls.

The injuries were mostly to the extremities, he adds, due to the new Kevlar vests and combat helmets issued to the U.S. soldiers, but he also treated buttock and catastrophic abdominal wounds. "These included 18 combat casualties from all over Iraq, primarily involving rocket-propelled grenades (RPG) and land mines, but also mortars and small arms fire," Dr. Morse notes.

The path of the injured naturally followed the path of the war. "At first, the injured came from southern Iraq as ground troops advanced toward Baghdad," says Dr. Morse. "That is, until late March, when we saw the Marine casualties coming from Nasiriya. In early April, they came mainly from Baghdad, followed by those injured near or in Tikrit, to the north. Finally, in mid- to late April, we began seeing casualties occurring after the war from both munitions and ambushes in Baghdad."

Dr. Morse also treated more than 150 clinic patients over his 75-day deployment, mostly active duty personnel, their dependents and Washington, D.C.-area veterans.

Duty at Bethesda, "The Presidents Hospital," had a bright side. Its fame brought celebrities such as Arnold Schwarzenegger, Jennifer Love Hewitt, Drew Carey, "Hulk" Hogan, Sheryl Crow and cheerleaders from nearly all of Washington, D.C.s professional sports teams, as well as President George W. Bush, Vice-President Dick Cheney and Defense Secretary Donald Rumsfeld, who visited injured military personnel, mostly from the Navy and Marines. (The Armys injured were transported to Walter Reed Army Medical Center.)

Dr. Morse says he likely had it easier than most in preparing to reporting to active duty. "I was very fortunate," he maintains. "Bethesda is where I normally drill throughout the year, and its only 30 minutes from my home. Ive been able to continue to keep my practice solvent, as Ive seen patients on the evenings and on weekends, despite working 60 hours per week at Bethesda. But I am well aware that most reservists physicians or otherwise have been uprooted from their homes and families, to travel thousands of miles in some cases, to their deployment location. I am fortunate."

The atmosphere among the reservists at Bethesda during and after the war "was phenomenal", he says. "About 800 of the approximately 1,200 NNMC staff had been deployed, and the reservists easily stepped in and had the hospital up to its usual working capacity within a few short weeks - all along caring for the battle casualties," Dr. Morse notes.

"Although extremely tiring, as I kept my practice viable and worked extraordinary hours at Bethesda, this was a remarkable experience," he adds. "I am extremely proud and honored to have served and continue to serve my country."

Been there
ASPS Active Military Member W. Bryan Gamble, MD, Fort Wainwright, Alaska, didn't leave his office to assist the conflict just ended, but he can give counsel to those returning from the Persian Gulf.

Dr. Gamble was a plastic surgery Fellow at Walter Reed Army Medical Center with the rank of U.S. Army major when he was shipped to Dhahran, Saudi Arabia, to serve with the 85th Evacuation Hospital. It was October 1990, approximately one month after Iraq invaded Kuwait and three months before President George Bush Sr., launched Operation Desert Storm.

In anticipation of the conflict, the U.S. military made a great effort to provide the most reasonable level of supplies and technology to its field surgeons, Dr. Gamble says, and he sees no reason why Operation Iraqi Freedom would be any different. "You might not have a $30,000 maxillofacial plating set at your disposal, but then again God gave you wire, and you can use that to get the wounded to the next level - which is, a more secure location. The Army does provide great levels of available technology to the soldiers and medics in the field," he says.

Dr. Gamble says his return home was noteworthy for two reasons: family and cleanliness.

"The best experience for me was realizing that the family was still there, and the kids - their main thing from the minute I walked through the door was, 'C'mon, let's sit on the floor and play with Legos,'" he recalls. Dr. Gamble says the advice he would give to someone returning from an extended period there would be: Just make sure you spend time with your family when you get back.

Second to that, he notes, was getting out of the dust and dirt and getting clean. In spite of rudimentary shower facilities, there is still quite a bit of dust and dirt in that environment and it gets into everything. "Even when you're clean, you're dirty," says Dr. Gamble.

Like most servicemen in general, care packages from home became essential. "They all played a vital role in keeping up my spirit, energy level and focus. Spending that time there made me value my time with my family and my relationships more."

Dr. Gamble was in Dhahran, Saudi Arabia, on Feb. 25, 1991, when an Iraqi Scud missile that penetrated the protective net provided by ground-based Patriot missile batteries struck a U.S. Army barracks. The relative calm of the night had been replaced in an instant by nonstop, feverish action, he says.

As soon as news of the strike reached him, "I went down to the hospital, prepared to receive casualties, triaged them and then went to the operating room to perform surgery to save lives," Dr. Gamble recalls.

In all, there were 28 killed and 98 wounded.

The experience didn't cause jitters among medical personnel, he says. "It wasn't uncommon that some of the Patriot batteries would fire off and intercept Scuds on almost a daily basis, because Scud launches were pretty common, particularly toward our general location. They were generally intercepted, so they didn't bother us. Not much changed after the Feb. 25 incident," he claims.

Dr. Gamble describes a typical scenario in which they would learn they were under attack. "We would be having dinner, and all of a sudden we would hear the Scud alarm, followed by the Patriot launch sometimes the Patriots would precede the Scud alarm and wed run for our chemical protective outfits."

"The Patriots gave off a very distinctive whoosh sound, and the report from the interception varied in intensity, depending upon where the Scud was intercepted. At a distance, it would sound like fireworks; once it happened overhead, and it was very loud, as you can imagine,"he recalls.

Today, Dr. Gamble is commander of U.S. Army Alaska Medical Activity at Fort Wainwright, a role akin to a civilian hospital CEO, he notes. "I run the health care system for my military community, and Im the only plastic surgeon in this hospital, located just outside Fairbanks."

"Most of the 14 or so plastic surgeons in the Army are at Walter Reed Medical Center in Washington, D.C., The Brook Army Medical Center at Fort Sam Houston near San Antonio, Texas, Tripler Army Medical Center in Hawaii or the Madigan Army Medical Center in Tacoma, Wash. Im an abberation in our plastic surgery community; I command a hospital," Dr. Gamble says.

-Plastic Surgery News
September 2003