Health care workers provide care, to everyone

“Proximal control of bleeding, volume replacement, prevent hypothermia, economy of motion.”

I had a habit of mumbling these principles to myself as I did the hardest part of an incoming casualty… waiting. I was standing in the receiving area of the Forward Surgical Team structure at Camp Dahlke, Afghanistan. This wasn’t remotely my first rodeo, and the reminders to myself were out of routine rather than fear of forgetting.  About midway through my third, and final, overseas deployment as a Trauma Surgeon in the United States Army attached to the 3^rd Group Special Forces, there wasn’t much left that could surprise me.

The preparations for an announced incoming casualty were like a ballet accentuated with checklists and pronouncements of supply levels of needed components. It is impressive to watch, and I had been in dance countless times before by 2015 and, while I would never describe an incoming casualty as routine, there was comfort that had been born out of repetitiveness.

This time, however, would be different.

A coordinated attack on one of our gates (referred to as an ECP) had been repelled with, fortunately, no injuries to American soldiers. The sudden and organized attack had come with the objective of breaching the ECP, allowing insurgents to get inside the perimeter of our Forward Operating Base. Their efforts, impressive as they were from a tactical standpoint, had been swiftly and decisively defeated.

The sounds of explosions and small arms fire had abated when we received a call for an incoming casualty.  Multiple gunshot wounds and unstable. Serious certainly, but not unusual for our unit. The difference this time was the casualty was a Taliban insurgent who had been severely wounded in the firefight. The enemy was inside the gate, and needed medical attention.

It’s not everyday that you see a patient with their wrists and ankles zip-tied to a gurney, but this was combat medicine and you learn to expect the unusual. We were informed that our patient had tried to attack one of our soldiers in the vehicle on the way to our facility. As we started to cut away his clothing, assess his vital signs, and gain IV access, one of the SF soldiers leaned into my ear and said, “Doc, if he breaks out of those zip-ties he will try to kill you without hesitation.”

I put it aside and went to work. I began my head-to-toe evaluation calling out the visible injuries to a scribe and making mental notes of the ones that were most threatening and, therefore, the ones that needed attention first. Vitals looked pretty good and, after evaluating, I decided a right-side chest tube would be the first intervention, and I started relaying my surgical plans to my anesthetist and bunkmate Randy.

As we prepared to place him under anesthesia, the entire operating base began to reverberate with the repetitive staccato electronic clangs announcing incoming indirect fire (that’s mortars and rockets for you civilian folks). Non-essential team members donned their body armor and headed for the bunker while those of us in direct patient care did what we had been drilled to do: I draped myself over my patient to protect him from the potential explosions and shrapnel that could come from a close impact.

At this point I need to say that, while I pride myself on being a professional, there was a bit of irritation that invaded my consciousness while we waited for the sounds of impact that would follow the sirens. Here I was creating a shield with my own body to absorb potentially deadly shrapnel to protect… a dude that would kill me if he had the slightest opportunity. But I dealt with those intrusive thoughts as my Detachment Sergeant always advised: I stowed that sh*t away. Yes, the man under the bomb shield (that was also known as me) was the enemy, but he was currently a patient under my care.

I was a soldier and a doctor. Whoever came in front of me injured and need of my skills would benefit from my duty-bound directive to care for them all. War changes many things, but that isn’t one of them.

Why, 11 years later, did that memory jump on the stage of my awareness today?

Enter Erik Martindale: A nurse anesthetist from Miami who proclaimed, “I will not perform anesthesia for any surgeries or procedures for MAGA. It is my right, it is my ethical oath, and I stand behind my education. I own all of my businesses and I can refuse anyone!”

It appears that Erik’s plan to refuse medical care to those who believe differently than him is not only right but required based on his “ethical oath.”

Here’s to you keyboard crusader. You likely accomplished your immediate goal: praise and affirmation from your like-minded peers, which, in the days of social media, seem to stand supreme over righteousness in the form of actual effort. But the problem with a desire for going viral… is sometimes your wish is granted.

Erik’s electronic virtue signaling, like the firecracker that falls in dry grass, took on a life of its own and went worldwide. His performance had reached an audience beyond those that would offer their air snaps, rivaling the best open-mic poetry night in his philosophical echo chamber. That audience now included fellow health care professionals and those that might one day need medical care, and they weren’t particularly wild about passing a thought-screening to be deemed worthy of help. And that audience, which included me, didn’t like it one bit.

This is not the first time I’ve seen colleagues do this. A few short years ago, I watched fellow professionals brag about withholding care from COVID patients who were unvaccinated. The recent past has witnessed doctors encouraging colleagues to withhold care or even actively harm patients based on their political views, their faith, or their religion. A couple weeks ago, a maternity nurse posted her wishes for the current White House press secretary to suffer debilitating injuries during childbirth for the sin of thinking differently than her.  The disgust at seeing these was eclipsed by the horror of the number of health care professionals voicing their agreement.

I’m sorry, Erik, but medicine is different. In our vocation beneficence is not encouraged; it is required. You don’t get to pick and choose. The screening test for whether you should treat the sick or injured is… are they sick or injured. If your need for praise or your confidence in the supremacy of your beliefs makes you feel different, you are in the wrong profession.

Dr. Samuel Mudd was imprisoned (avoiding execution by one vote) for setting the broken leg of John Wilkes Booth, who had come about his predicament after leaping from a balcony onto a stage. Oh, and this was done right after assassinating Abraham Lincoln. Booth was a treasonous criminal who will get no sympathy from me for the fatal bullet he received 12 days after his unforgivable act. But, if you’re a doctor in 1865 with that man in front of you with a broken leg… you set the leg. We do not get to cosplay as a judge or executioner by withholding care. It is the oath we take, and Twitter acclamation does not override that duty.

So, Erik… if you want to claim the right of a business owner to refuse service to whomever you want, open a hot dog stand. But if you want to stay in this profession and enjoy the reverence and status that it can bring, do your job and put your personal judgement aside. There is a difference between fame and infamy, and neither should be a factor in your decision to aid the infirm.

“Health care workers provide care, to everyone” was originally published on www.carolinajournal.com.