the holes are filled with memories of grief for years and veteran's we all know and admire. there are a few people in the audience who pulled a few fast one on me tonight. my family has shown up from all points of the globe. my grandson, owen, one of my champions is here. [applause] my son's martin and mark drove in from god knows where and joanne. this is a total surprise to me. i had no idea they were going to be here. in any event, i want to talk to you about our experiences in vietnam, but my approach is just a little bit different. i'm not a warrior. i certainly don't qualify as a historian, has jan herman does, and i know very little about the geopolitical circumstances that lead to wars. i am a physician, surgeon, and for a brief period of time, with

ed feldman, joe wolf and others, and one of the most remarkable situations a surgeon could ever be in and that is the siege of qassam. ..

>> i tried to break focus to the fact that war is a constant part of history you know, more about that than i do. but there is very little of the 12,000 books and articles written about the unknown, one at about the actual medical surgical component of those conflicts and that is what i want to try to talk to you about tonight. let me see if i can get this to work. the first thing i want to show you is a little geography see you can get some idea what we are talking about. this whole area is a vietnam this is north vietnam's and

saigon is down here but up here is the dmz. in case on it is a right here. so whole time we were in the northernmost portion of south vietnam's which was called by quarter by the marine corps. i mention that because of all the stories you'll hear so much is related to where you were. just a brief aside when i came back from vietnam i returned to the department of surgery at pennsylvania at a friend of mine had been in the united states army just outside of saigon. he was way down here and the two of us were invited to the women's club of university of pennsylvania to describe our experiences in vietnam. of course, i took dazzle the

care in i-corps and he was with a medical army unit with not much combat experience but sick call but where the lady said can you tell me about drug use amongst the troops? i said the only thing i can tell you with the entire year i was up in that i-corps area there was one occasion when a marine came in. i will digress. when they came in everyone was stripped naked because you want to miss a minor shrapnel wound near the rectum or armpit or base of the school that could easily be missed and then we put their positions in one bank. when time in 12 months i heard a big commotion and they found a funny looking cigarette in one of the

pockets. one cigarette in 12 months. i said to the ladies, i don't know what you are talking about. i was with the marines for 12 months and i saw no evidence whatsoever of drug use. the other guy gets up and says everybody i know was doan for 12 months. [laughter] my point* is the lot of the stories have to be taken on a geographic basis because it is like the three blind men feeling the elephant and describing it as a totally different animal perk up bear that in mind. the other point* i want to make an differentiating vietnam from other wars and i am no authority on the other wars. if you look at the history of world war ii and correa the scene is the concept of a front line rather europe

or up and down the korean peninsula usually the stores of the battles are identified with a front line. no one ever existed in india number of this shows where the battles broke out. somebody help me. [laughter] the point* is simultaneously early 1968 dozens and dozens of battles broke out at the same time all over the country and this was another key point* to differentiate our experience from hours and the other words. we were never at a point* where we could say we are here and they are there we were often surrounded by them or another enclave surrounded them.

that made a great difference of the medical and surgical care of the casualties. all of these little burst indicate the battles that broke out simultaneously january and february 1968. i make the point* regardless of what surgical unit you were a the attached to there was no frontline. i want to talk the differences between the wars and the casualties. this shows the number of casualties from the different wars in vietnam comes in third with 58,000 dead and in terms of the rankings it is in fourth place so quite a number of casualties. this just gives you a brief idea of the injuries that we saab based on body

distribution. this is a standard slide represents pretty much what we did see. this also emphasizes the need for the naked casualty. i cannot emphasize that enough i cannot tell you how often we have injured marines coming am looking with no visible injury then on careful inspection find the wound in the back for the growing that was not seen unless you have a total naked person inspected 360 degrees. i will just move on. just before we get to the lead discussion of specifics of case on i will tell you of some of these statistics of people that served in vietnam. some of this comes from

general of the outgrow ratio assn samberg sysco. are thought his numbers were so meaning there were 2.7 million people who served our country in vietnam. almost 10 percent were casualties. despite what you read in the media and the impression they would like to convey a 97% of those military individuals were honorably discharged the vast majority return to a will adjusted civilian life and employment rate was higher than the average population and drug usage a lower price by have always been exquisitely see sensitive to the media's attempt to portray the derelict vietnam veteran. the statistics show that the population men and women who returned from vietnam did very, very well.

another never i want to give you especially with our audience, a 267,000 women served in vietnam. i find that an amazing number. somebody asked me that before i got the data would not have guessed anywhere near that. 267,000 women served in vietnam during the entirety of the conflict. this is an aerial view of the base that caison. it was half a mile wide and one mile-long surrounded by four or five troops and on the edge of that strip sat charlie. initially we wicket casualties coming in by ambulance if they were on the base themselves and

fixed-wing aircraft very quickly and this is another major differentiating points of its vietnam's that it turns into a helicopter base. interesting way you should know there were over 12,000 helicopters in vietnam in the eighth to over 500,000 medevac missions during that conflict. there are a few examples of the helicopters. i do this only because this is so important to realize our surgical experience is changing and dictated by the existence of those helicopters. this is an unfortunate distraction of one of the fixed-wing aircraft right after this all fixed-wing aircraft were banned from caison the ribisi targets for the gunners and they were attempting to lay and/or taking off so slowly

they were easy targets. right after this fixed-wing aircraft were -- stopped. real implications for a surge in are different than if you're just thinking of war. certainly they have their place in assisting the troops to take them in and out and adding firepower but for the first time, we had our marines engaged in serious firefights and ambushes for serious casualties occurred helicopters were called for that in my opinion every helicopter crew in my area it should happen highly decorated they flew into firestone's, extracted casualties but from the surgical point* of view what

happened is that we suddenly had guys seven, 10, 12 minutes out of battle. with horrendous total body injuries. go back to world war ii. troops wounded there had two either be carried on their buddies, stretcher or wait for a cheap for the ambulance than a long ride back to where the station was. part of the mortality of the injuries in world war ii in korea was the delay before they got treatment. even if they got their the delay would still have a bleeding and infection to occur but we were suddenly in a situation where because of the helicopter crews dropping into firefights extracting casualties and chopping them in a matter of minutes. what does that mean surgically?

we were suddenly seeing young marines so horribly injured nobody had ever seen before a live so we instituted a whole new set of principles for treating based on old fashioned rapidly so the situation in trees rise would be first to get them off the helicopter when friend of ours the standard approach as the pilot came in with the casualties would be to say i have 20 walking wounded five killed in action and 10 wounded so we knew what to expect some really get the number if you are in the triage surgeon you stand in the doorway and that is french for sorting out you

look at the castle-- to say station one, station do with your quick assessment of how badly they are injured. that may sound crude but it was incredibly accurate. you could stand in that doorway and almost at a glance say station one, station eight and it worked reasonably well. once they were on the i universes' teams converged on each letter to strip the guy naked and intervened penis lyons were put in a growing blood could be pumped in extremely rapidly done was always available if it was low there is say all those that were taipei lineup over there and we never had any trouble getting blood. [laughter] and very frequently it was necessary to do within a breathing tube and the integrate the patient and open the chest and massage a heart and i want to talk

about that. >> i usually wore more closing but at any rate i show this was some trepidation knows explaining earlier that i am reluctant to show slides like this but i want to make a major point* again from the perspective of the surgeon and a casualty and not so much from the war. imagine this. of the marine is out in a foxhole and a firefight. he is injured it does not matter how come he is bleeding badly and a helicopter extract sam and brings him to us in a matter of minutes and literally on the verge of death having bled out. he has no blood volume in his arteries and veins but a healthy 19 year-old and they are really hard to kill.

[laughter] you get them on our litter and we go through the routine i just mentioned. hugh diapies, a breathing tube, but if you try the classic television version of closed chest massage we found out early because the system was empty of blood instead of the car being this big it is this big so you can push like this until you're blue and not get much of a result so we started early on with a little kids just a little silver retractor -- retractor that is a rips better and actually grab a hold of the heart and start pumping while the blood is pumped in through the lines. if you can get the of blood volume back up to the decent level then you have blood in the heart and the send a chance that resuscitation. when i arrive there during closed chest massage.

you are used to seeing that. in the early fifties dr. judah invited -- invented closed chest massage was only invented in the fifties and became the thing to do. said i don't think this is going to work. he was not interested in my opinion. [laughter] i wrote to dr. judah at the miami heart institute and i said this is my experience and he said you are absolutely right you cannot do that with a patient to has no blood volume so we converted to this system. i show you this picture and i apologize it is gory but this was a common common event. when we've reached a point* we had a marine that was salvageable with no pulse or blood pressure reinstituted this intensive resuscitate of effort and produced

results. know this side story. some of you may be aware of the story of jonathan spicer. he was a conscientious objector that made his way through boot camp in the marine corps through vietnam and ended up on the hills outside caison and kept saying to the senior officers will do anything you want but i will not shoot anybody and the marines were not happy with that response. [laughter] mehsud of court-martialing some said send him down to pfennig and so we made him the letter bear. you saw the helicopters when we first got to caison and their doctors before made their was a series of tense and sandbags up at about four and a half the and i always wondered i will ask the general someday if you

are 6-foot 1 inches in the sand bags are four ft. one in response to do with the upper reflect of my body? [laughter] but the casualty comes 10 from the top tier and there's about a 20-foot read somebody had to get them under heavy fire. spicer was one of those guys. everybody did it but he was one of the leaders carrying guys and after we stabilize them we have to fly a them out and jonathan would run out if he was constantly out there moving those casualties back and forth. everyone more flak vest but as the temperature went up and they came open and one of the things we really about in the summertime you

could see pictures submarines by the dozens of the flak vest unbuttoned and the incidence of injuries with heart and lungs went up because they would not but it one day we heard spicer is down long story short it if they rushed him into the bunker. he was dead. and i think don suggested he had blood in the heart sac we did and did opened his just exactly like this one stitch in his heart and everything came back. later for his efforts he got the navy cross. one middle conscientious objector who made a difference. but at any rate, i will move on. i will say this not because of our i operate but in the background this is on the

base it is a cut officials are within supplies on the back shelf in his libel sinned of plank of plywood basic simple stuff but the point* i want to make that in these situations we had everything we needed. i am asked all the time did anybody not make it because you did not have what you needed? no. we always had what we wanted. , i remember one time we have these little balloons we were cleaning out blood vessels little balloons on the end i said we will run out but i said we need some of these. i just went back and forth to okinawa faster than you can count. we always got what we needed. contrast less with a bunker at case on.

labels cramped quarters but if you look around the sides , these are big 12 by 122 make the walls, but the by the, supplies, accrued and elementary but we had what we needed. but if we said bled the chopper crew would come flying in with day container of blood even in that circumstance we have what we needed and if we needed something it came in urgently. here is the bunker again. cramped quarters but everything there that we needed to do what we did. the parachute story we will tell another time. this is the cover of the book. the left-hand corner it is my new best friend joe. [laughter]

he was our anesthesiologist and had extensive training before vietnam's. a three months. [laughter] came up to caison but blended tactical situation was bad and somebody who needed surgery and we could not get them out by chopper either due to rain or fire, when our backs word to the ball he would put them to sleep and we would operate on them with basic equipment we could do that. could die on the far end i want to mention because he stayed with us. he died a few years back of malignant melanoma but he was one of the top heart transplant surges in america he founded a program and did 100 consecutive heart transplant surgery is without a death threat of the other guy was a hollywood movie star dr. ed

feldman and we will talk about him later. moving to gain more serious topic i cannot really do this myself so i will take a second for you to read the poem that i wrote to and value look at it i will tell you that a story than a follow-up with something else that is the mark difficult parts of this discussion. in the triage area of casualties' would come in so we knew what to expect. one occasion in-state told us we would have put a dozen wounded and i was the triage surgeon the guy at the door saying station one, station to. the worst guy that i think i have never seen and i said station one. his name was lopez and i say that because there was

nobody that would be able to identify him. no pulse or blood pressure. the loans are all over his body and we went through this same effort with a breathing tube, a big intravenous tubes pumping blood open the chest and everything. we worked on him for maybe 20 or 30 minutes but no pulse or blood pressure. i said he is dead taken to the grave registration they picked him up and took him across the pad to their graves registration were the k i a dose of free to carry the casualty is 15 minutes later they came crashing back to the door and said this sob is alive and is moving. you don't argue with m-16 marines slung over their shoulders of 53 went through the entire resuscitate of effort again.

read and debated and massaging his heart for another 20 minutes and absolutely nothing. i said i am sorry. he is dead and taken to graves you can guess they came rushing back and this smb is moving and we are not taking him back. [laughter] so oyster to go through it again getting virtually no where i call one of my and other surgeons again that practiced in winston-salem and 40 years after the war i said take this guy back to the operating room. he said he is dead. i said taken back to the operating room and operating. i am the triage surgeon. do it. i don't care frankly. and i am not sending him back to graves registration. he had two just tombs and a

breathing tube and the whole 9 yards her by six for the abdomen and see what you can do. he looks at me like i have lost my mind. i finish the casualties and go back and anesthesiologist is giving me daggers' i am doing this for a dead guy. peat looks amelia go get a drink for all of a sudden they anesthesiologist says i have a blood pressure of 60. yes. i think i feel a faint polls. 80/50. 20 minutes later when hundred 20/80 they finished the surgery and repair the intestine the next morning he is awake in the icu he is bandages head to toe but awake and alert and ready

for medevac. that is a chapter in the book and the story i tell because i am still amazed when i hear myself say it is an absolute experience that we had and the end result is something that i have talked about before when you do enough of this when you triage and treat as many casualties as we have, you come to realize there is a certain force beyond what you can do. i don't care of your religion or philosophy or if you believe in god or the force or buddha but when you have experience is like that you have to come away saying there is something else going on because there is no question that very, very confident physicians have announced this guy did three times in the next morning he was fit as a fiddle. unfortunately like so many he