© Springer International Publishing Switzerland 2017
Elspeth Cameron Ritchie, Christopher H. Warner and Robert N. McLay (eds.)Psychiatrists in Combat10.1007/978-3-319-44118-4_44. Psychiatrists in Combat: From the Deckplates to Division
(1)
Medical Corps, United States Navy, Washington, DC, USA
Keywords
Combat psychiatryNavy psychiatristPsychiatrist in military deploymentIraq, BaghdadOperation Iraqi FreedomPsychiatrist in combatCaptain Kevin D. Moore
is a retired US Navy psychiatrist. This chapter reflects on events surrounding the invasion of Iraq in 2003 by coalition forces, when he served as Division Surgeon for First Marine Division and Psychiatry Specialty Leader for the Navy Surgeon General.
As the First Marine Division (1st MARDIV) approached Baghdad , Iraq, I was assigned to the Reportable Incident Assessment Team (RIAT) . This team, prototyped by 1st MARDIV Commanding General (CG) , General Mattis, could be task organized to investigate any alleged or potential incidents that may be perceived as a war crime. We had been asked to investigate a reported Red Crescent ambulance that had been shot by US forces. Membership for this assignment included Division Staff representatives from Civil Affairs , Staff Judge Advocate (SJA) , and Surgeon.
We entered the city far ahead of the main command headquarters. The scene was complete chaos. Dead, injured, damaged buildings, along with looting and lines of people trying to evacuate were everywhere. There was no means of communication between the two unarmored Humvees transporting us. Armed with several M9 pistols, a few M16s, and a couple of shotguns that had been acquired en route, we used maps to find grid locations. Navigation was not easy, because GPS devices were in limited supply.
Unable to find the location during the day and becoming too dangerous to remain outside unprotected, we pulled into the United Nations compound as night fell. When I sat down to an MRE, I suddenly noticed lights above me. I quickly realized these were actually tracer rounds from incoming gunfire and immediately took cover. A group of Marines came to inform me that someone was down. They needed “the Doc.”
I arrived on scene with two Corpsmen beside me. A Marine had been shot. The Corpsmen had done the initial assessment and stopped the bleeding, but the patient needed medical evacuation (MEDEVAC ) . When the firefight stopped, the patient was sent in a Humvee for pick up by helicopter, but his MEDEVAC flight never arrived. The Marine looked at me when he got back to the compound and said, “Doc, please don’t send me out there again. They will kill me this time.” We kept him until daybreak for MEDEVAC, and the team left the compound to continue our search of the ambulance. Our actions later qualified for the Combat Action Ribbon (CAR) .
The Reportable Incident Assessment Team was eventually able to locate the Iraqi vehicle that had been shot. It was not an ambulance after all. While being guarded by armed security, I entered the disabled vehicle to examine the three dead men that had been shot. A review of video footage revealed that they had run up behind an armed convoy and refused to back off. The shooting appeared justified, but it was still a sad, tragic reminder of the victims of war.
4.1 Why Did I Join The Military?
People tend to join the military either because they had a father who was “too good” (or overbearing), and they want to keep one into adulthood, or because they had a father that was “too bad” (or absent), and they hope to find a better one. My dad was both.
I was raised a “military brat ,” adopted by a US Navy Chief Petty Officer . He retired from active duty when I was in the seventh grade. A decorated combat veteran, who joined the Navy when he was only 17 years old, he had served in World War II and Vietnam . He had lost half of his crew when his carrier, the USS BUNKER HILL , was struck in its main flight deck by two kamikazes in WWII.
Throughout my childhood, my father would deploy for many months at a time. I never understood why he would choose to be away from his family so much for so long. He said that he loved “being underway and part of a team.” I think he simply loved being in the Navy. He was proud to serve his country and to wear the uniform. Welcoming back his returning ships and attending award ceremonies as a child, I remember being very proud of him.
Retiring to his home state of Kentucky, my father often seemed frustrated and unhappy after leaving the Navy. He was still a Navy Chief even after he hung up his military uniform. I had missed him while growing up, and I had wanted him to not leave home again, but I had trouble connecting with him.
His salty advice seemed crude. “Opinions are like assholes, everyone has one.” “You all are like a bunch of sea gulls. All you do is eat, shit, and squawk.” Where did he learn all this? I could not help but wonder, did he ever miss me when he was gone?
One day, at the ripe age of 16, while watching a documentary on television about Vietnam , I proudly announced to my father that I didn’t understand why it was such a big deal to be a conscientious objector. I told him that if I didn’t believe in a war, I would probably think of doing the same as they had. Why would I go to a war I didn’t support? He flatly replied, “Get the hell out of my house!” Even with the hubris of youth, I knew that was not the time to debate.
I became the first in my family to attend college, attending Western Kentucky University (WKU) on a War Orphan’s Scholarship . Since my father had received 100 % service connected disability through the Veterans Administration, I qualified. Not knowing much about majors or degrees, I took courses that interested me. When I ended up at the top of my classes, I was encouraged to consider “premed.” I completed my undergrad with two degrees in 4 years, a Bachelor of Arts in Psychology and Biophysics along with Bachelor of Science in Biology and Chemistry.
Although I was accepted early decision to University of Kentucky, I was not sure how I would pay for medical school. I applied and was selected for the Navy Health Professions Scholarship Program (HPSP ) . If accepted, it would obligate me to 4 years of active duty service after completion of training. Student loans were my other option.
My father had not appeared very supportive of me becoming a doctor. He once asked, “Why would you want to be in school all your life to have a job where your mistakes were dead people?” When I asked my father if I should take the HPSP scholarship, he told me, “The Navy was good to me, son. Now that you are a man, you will have to make that decision for yourself.”
I decided to join the Navy. My dad had a hard time concealing his pride when he saw me repeat the oath of a commissioned officer at the Louisville recruiting station.
Never did I plan a career in the Navy. I would do my payback and return to the civilian world. Never did I think of combat deployment. After all, we were not at war in 1982. Nor did I consider deployment with ground forces. I was joining the Navy.
My father told me the best thing about the Navy was, “You have a warm, clean place to sleep every night. If you lose it, you lose everything, not like the poor bastards in the Army or Marines.” He spoke from experience at the Deckplates.
4.2 Preparation for Greenside
Dad never mentioned that Navy doctors take care of the Marines. I learned during Officer Indoctrination School (OIS) that the US Marine Corps does not have its own medical officers. They have their own lawyers, but Chaplains and “Docs” are Navy.
During my internship and residency at National Naval Medical Center (NNMC) , Bethesda, Maryland, I treated Marines and Sailors, performed disability and limited duty assessments, rotated to The Basic School (TBS) , Quantico, Virginia, to gain “Greenside” exposure, and taught at the Uniformed Services University of Health Sciences (USUHS) , as a field instructor for the combat stress prevention course.
As chief resident during Desert Storm/Desert Shield (DS/DS) when exposed to all the resulting chaos and emotions exhibited by those chosen and not chosen to deploy, I had started a paper entitled “To Not Be Chosen,” exploring parallels with those emotions of not being picked for the first string team on the playground. Those of us left behind could only support those in preparing and returning as well as the others not chosen. The paper was never published.
I saw some staff crying in the hallway when they were notified of impending deployment, upset that they “didn’t sign on to go to war.” It was now an all-volunteer force, and many recruiters focused on the low possibility of another conventional war. After all, the Cold War had reinforced the concept of the military being used as a deterrent to a shooting war. If we fired the first shot, we had failed our primary mission. Even though DS/DS would not last long, it marked the return of large-scale deployments and the need to prepare for such.
Most troops had redeployed by the end of my residency. I felt I had missed something. I was looking forward to my first assignment after Graduate Medical Education (GME) . I hoped for a clinic in Hawaii, but I was called into the office of my Specialty Leader shortly before the list announcing orders was released. He told me that I was needed as the Division Psychiatrist in Okinawa, Japan . There was not an option to decline.
The Navy and Marine Corps are in the same Department of the Navy. Both are expeditionary, but their cultures, like their uniforms, are profoundly different. Navy personnel have the option of adopting Marine uniform regulations when they are assigned to a Marine unit , but they will never be a Marine, even if the Navy Doc learns to look and talk like one. Translating between Blue and Green can be very difficult.
While the “Division Psych ,” I provided the clinical services for the Marines and Sailors assigned to the Third Marine Division (3d MARDIV) . Since I was the only “operational” psychiatrist for Third Marine Expeditionary Force (III MEF ) , I became the first choice for the other Marine units in the area. Marines like to take care of their own, but if I could not manage them as outpatients, US Naval Hospital, Okinawa, was available for referral. Pride and pressure resulted in them rarely being used.
After my first year, I complained to my Division Surgeon that I was getting too little operational exposure “baby sitting” the Division in garrison. He was more than happy to accommodate me. Over the next 2 years, I then deployed throughout Asia for battle staff and field exercises. I served as a medical planner on field exercises and performed humanitarian aid on Medical Civic Action/Dental Civic Action (MEDCAP/DENCAP) missions .
I returned for the Military Forensic Psychiatry Fellowship sponsored by Walter Reed Army Medical Center . The first Navy graduate of the program, I was subsequently assigned as the first billeted forensic psychiatrist at NNMC , until I went to the Naval Hospital, Charleston, South Carolina.
When it was time for my next assignment, one of my mentors, who knew I had done well as the Division Psychiatrist , urged me to “put my name in the hat” for the Division Surgeon at 1st MARDIV . I thought it would be a chance to return to the operational arena in a more senior assignment. Besides, I had missed the Marines and their leadership style.
Many criticized my possible return to Division. “Why would you want to go back to the Marines? You are going to be bored. All you’re going to do is get ready for exercises. We’re not going to do anything. Do you think we are going back to the Middle East? That isn’t going to happen. We just got out of there.” I applied anyway.
After a series of interviews and waiting several months, I received the congratulatory call from the office of the Medical Officer of the Marine Corps notifying me of my selection. I asked, “How long do I have to decide if I want to accept?” The voice on the other end went silent. Then I heard, “No one tells the General ‘No’ after he has made a decision.”
I was to detach from Charleston on 11 September 2001. The furniture was gone. Our home of 3 years had been sold. I awoke on an air mattress. Most of the suitcases had been packed into the van for our trip to California. The air mattresses, coffee machine and portable TV were all that remained to be loaded.
Getting up to make one last pot of coffee, I turned on the news to see the planes crashing into the Twin Towers and Pentagon . I knew that the nature of my assignment had instantly changed.
As a result of the attacks on 9/11, all military personnel were frozen in place. Security was increased on all bases. A few days later, as the shock wore off, movement was again authorized. My family and I started our cross-country drive.
I attended Advanced Officer Leadership Training at San Diego, California, prior to reporting to 1st MARDIV in Camp Pendleton, California. Most in the class were headed to new duty stations. All wondered what was next.
4.3 Reporting as Division Surgeon
Division Surgeon is a misnomer. Many assume that this is a surgeon from the operating room, resulting in a quizzical look when a psychiatrist is introduced. Division Surgeon is the senior medical officer for the Ground Combat Element (GCE) , the infantry, within a Marine Air Ground Task Force (MAGTF) . The Division Surgeon is a special staff officer under the cognizance of the G4, the general staff officer in charge of logistics.
I expected a few comments about being the General’s Psychiatrist, but being the Division Surgeon during the preparation for the first invasion of another country in decades would not be an easy role to fill regardless of medical specialty.
The staff of the Division Surgeon was small, in accordance with the expeditionary mission of the Marines. Deploy quickly, stabilize and then go home. Surgeon, Psychiatrist, Medical Administrator, Environmental Health Officer and a few Corpsman were at headquarters, the rest were assigned to battalions and regiments. An Assistant Division Surgeon had been appointed from one of the second year GMOs (General Medical Officers) . Like his contemporaries, he had completed his internship and had accepted a tour with the Marines planning to return to his residency program.
Related posts:
Zero to Sixty: From Residency to the War Zone
Someone Always Has It Worse: The Convoy to Balad
The Road to Iraq
Chronicles from the Cradle of Civilization
Farm Boy Turned Military Psychologist: A Summary of War Deployment Experiences, Struggles, and Coping
Out of Residency and into the Field: Reflections of a Junior Psychoanalytic Psychiatrist on a Iraq Deployment
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
