By David E. Hogan, DO, MPH, FACEP, Vice President, Educational Development and Chair, TeamHealth Emerging Infectious Disease Taskforce
Healthcare and Military Experience
I served in the U.S. Army just shy of 15 years, which were some of the best 15 years of my entire life. My military background began as I entered medical school on a Health Professions Scholarship Program (HPSP). I went through basic training during my first and only summer off during medical school. As I began to actively serve in the Army, I was initially posted at Fort Leonard Wood in Missouri as a general medical officer.
Following this posting, I went to an emergency medicine residency program at Fort Hood Darnell Army Community Hospital. After graduation from residency, I stayed there as a member of the teaching faculty and a clinical provider through my active duty commitment. When I left active duty, I was the rank of major, promotable to lieutenant colonel. I remained in the Army Individual Ready Reserve for an additional 10 years.
The exposures, experiences and opportunities that occurred during my Army tenure at Fort Hood and elsewhere in the Army were nothing short of amazing. The amount of training that I received and the connections I made while in the Army have stayed with me and will continue to stay with me throughout the rest of my career.
Experiences that Shaped My Life
The training program as well as my involvement in emergency medicine were highly impactful during my time in the Army. We experienced high volumes of critical patients at Fort Hood. Although we were not a designated as a trauma center, these were the early days of trauma systems organization, we were the de facto Level II Trauma Center in that part of Texas. While I was serving as chief of emergency department operations, we responded to a mass shooting – the Luby’s mass shooting – both as a receiving facility and on scene. The first casualties that I evaluated were deceased, and two of these individuals were people that I knew from my son’s elementary school. This had a significant personal impact on me. I had always had an interest in the field of disaster medicine, but this event spurred me to develop and enhance my knowledge and skills in that area. I became intensely involved in the section of disaster medicine through the American College of Emergency Physicians. This led to further efforts to shape national disaster medicine policies as well as educational and research programs.
It was a struggle to reconcile the horrific impacts of that mass shooting event, as well as later events – such as the Oklahoma Bombing – in my personal and professional life. I attribute my desire to try to make a positive difference out of such hideous events to the training and counsel I received from the military staff and chaplain service in the Army. I eventually learned how to deal with the lasting effects of these events, unfortunately, some who were involved did not. I lost a beloved colleague to suicide directly associated with the Luby’s mass shooting 10 years later.
My Veteran Experience
I have many takeaways in my experience as a veteran. When I began training back in the late 80s, the attitude in training programs and in the military medical corps was suck it up and go on. The general idea was this was your job to deal with all the stress, horror and mayhem. It was not a particularly healthy approach.
However, during my tenure at Fort Hood, this approach changed a bit. We began to try addressing some of the stressors and the human side of the equation – for both patients and providers. Our hospital chaplain had been in charge during a major air disaster in Germany, and he had worked with survivors of that event. Having that experience, he had much to offer us. Due to his efforts, recognition of some of those stressors and the impact they have on the very human providers, became more prevalent in the military. In fact, the Department of Defense became a leader in this approach nationally attempting to heal the healers – so to speak. A concept that was a long time coming.
We began to move on from the “just go on about your duty” attitude to understanding that one must address the mental health of the health care providers. That attitude translated directly as I transitioned into civilian life.
After leaving active duty, I entered civilian practice as faculty at the University of Oklahoma, Emergency Medicine Residency Program, along with several other Army veterans. And, I started a division of disaster medicine. The idea was that we were going to study disasters and try to put it on a scientific footing. At the time there were very few actual scientific studies of mass casualty or disaster events. But from the very start, we incorporated the concepts of critical incident debriefing and addressing the mental health impacts of such experiences on the providers.
I was working in the emergency department at the university hospital when the Oklahoma City bombing happened. Shortly after the event, professional associations and friends that I had made during my time in the Army appeared to assist me in managing and researching the medical impacts of that event. These were people like editors of major medical journals, division directors at the Centers for Disease Control and injury prevention and trauma services nationally. We were able to come together and do what are some of the first formal epidemiologic studies to provide real information about terrorist bombings with building collapse. Those publications are still referenced to this day. That would not have happened if not for the experience and professional associations I had made in the Army.
Advice for Veterans and Clinicians Who May Be Struggling
Having lived through a number of significant events personally and professionally and having had colleagues succumb to the stresses of the job and take their own lives, it is important for me to try and get an important message across. My advice for veterans or any clinician who may be quietly suffering and at a loss as to where to get help is to begin by acknowledging and admitting to yourself that you’re human – and that’s a good thing!
Though admitting we are human emotionally can be difficult. It means admitting that we are susceptible to the ups and downs associated with being human. Another important thing to keep in mind is that you don’t have to experience mass casualties, major disasters or spend time in combat to feel overwhelmed, helpless or at your wits end. Just experiencing daily cumulative events that stack stress upon stress can be too much for the best of us. Look back at your military experience and remember you are not just fighting for the flag or fighting for a cause, or some abstract idea, you are fighting for each other. And as such, you are taking care of each other as well as the patients.
It is OK to talk and share experiences with others. By talking about these things with colleagues, you’ll probably find that most of them have similar experiences. After the Luby’s mass shooting, our chaplain put all of us who had been involved in patient care together. We were in that room for an hour, and we all cried, we talked, and we shared with one another. Sometimes it’s just a matter of being able to get together with a colleague and go someplace to just talk for a little bit.
As a leader, it is important to be sensitive to individuals who are struggling, and it is imperative that you speak to them. Whether it is just talking or helping them get professional counseling, or other available resources, it is critically important. I finally learned to integrate my feelings and experiences into who I am as a person, and eventually, you learn that you can go on. Good things and bad things stay with us in life, and they eventually become a part of who we are. We have to learn to make these experiences into a positive force that helps us make a positive difference for others.
Veteran Support at TeamHealth
It is important to find a supportive environment, and we offer that through our Veteran Resource Group. This group not only offers easy access to information for veterans but also honors clinicians and administrative associates who currently serve or previously served in the military, as well as military spouses and family members.
If you or someone you know is struggling or in crisis, please reach out for help. Reach the 24/7 Suicide & Crisis Lifeline by dialing 988.
Veterans, thank you for your service! Today and every day we are grateful for your sacrifice for our country.