One of my most vivid memories of Afghanistan was all the fences. I remember standing in a line looking out at an Afghan village wondering what life was like on the other side of all the barbed wire and security barriers. My attention was drawn back to reality with the sounds of gunshots. I had just realized that I left my earplugs in my bag at the stress control center. I just arrived in Afghanistan and I had to verify that my M9 handgun was in good operating condition, should I ever need to use it. Thankfully I only had to shoot three rounds and I can still hear out of both ears.

Getting to this point in my story was not exactly a straight shot. I grew up in a rural community in north western Rhode Island. I attended a boarding school in Connecticut for high school and then went on to Brown University for college. As I consider it now, I have been fenced in all my life. My high school is truly a beautiful place with buildings, walls, and arches made of stone. Brown has incredible rod iron fences which separate the people of Providence from students inside. Walking through the gates of Brown, I knew that I wanted to be a physician, but I had no idea that in 13 years I would be providing care with a weapon attached to my waist.

I started my career at Brown, like other freshmen, with lofty goals and ambitions. I decided to triple major in psychology, history, and music. The boarding school that I came from was very structured, requiring all students to engage in sports and arts. Brown was slightly less structured with no core curriculum with a more liberal, open environment. In an effort to recapture that structure and to challenge myself, I enrolled in ROTC.

Brown did not have an ROTC program (they kicked ROTC off campus in the 1970s) so every morning at 5 AM I would drive to Providence College to do physical training and to attend military education classes once a week in the afternoons. ROTC was my first exposure to military training and I enjoyed it, apart from the early morning awakenings. This was also about the time that I started pursing research in the field of sleep.

Shortly after being accepted to Brown Medical School, I was offered a 4-year scholarship with the Health Professional Scholarship Program . This scholarship requires 1 year of active duty service after residency for every year of medical school funding. I took the scholarship because I had enjoyed the comradery of being in ROTC and the values based culture of the Army.

My journey in becoming a military physician started in medical school caring for veterans on the inpatient psychiatric ward of the Providence VA. I cared for patients who were still dealing with physical and psychiatric injuries from wounds afflicted years or decades prior. In caring for our veterans, I developed an appreciation for the enduring consequences of trauma and the socially debilitating aspects of chronic psychiatric illness.

After graduating from Brown Medical School in 2007 , I decided to complete a combined residency in Internal Medicine and Psychiatry. My residency at Walter Reed was one of the most challenging and rewarding experiences of my life. The fences in my life were changing in style, the ones at Walter Reed now included some chained links, armed guards, and the occasional vehicle checks.

I was seeing service members returning from the ongoing and intensifying conflicts in Iraq and Afghanistan. Predicting the long-term impact of the psychological and physical wounds of war is impossible. On the consultation and liaison service, we would see every service member who had been evacuated from the battlefield. The severity of the apparent illness or injury was in no way indicative of how an individual was coping with their new identity as a casualty of war. All of the service members that I cared for on the wards of Walter Reed were coming to grips with a new identity that included challenges , and at times bereavement, and regret.