>> james finnegan recalls his time as a combat surgeon in vietnam in 1967 and '68 where he headed up a team of doctors. dr. finnegan, who was wounded during the war was awarded a purple heart and the bronze star. the army and navy club here in washington is the host of this event. it's about 50 minutes. >> this is a singular honor for me tonight. i want to first say how humbled i am by this whole event. we've stayed here before. i'm well aware of the tradition that this club represents. the halls are filled with memories of great warriors and veterans that we all know and admire. there are a few people in the audience who pulled a few fast ones on me tonight. my family has shown up from all points of the globe.

my grandson, owen and one of my champions here and my son drove in from god knows here and my wife. this is a total surprise. i had no idea they were going to be here. in any event, i want to talk 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 as jan herman does. and know very little about the geopolitical circumstances that lead to wars or end wars. i'm a physician. a surgeon. and for a brief period of time with ed feldman, joe wolf and others, in one of the most remarkable situations the surgeon could be in the siege of khe sanh. as colonel mccarthy mentioned for a three-month period in

early 1968, while we were surrounded whether it was 25 or 40,000 nva troops, we'll never know for sure, and under constant bombardment and that team and those 26 corpsman provided casualty care for 2500 wounded marines. it is a remarkable moment in time for me, i'm sure some of you. and it has always been a watershed moment in my life. so the book is not about war per se or military tactics or any geopolitical considerations. it's an attempt to convey to you that the real story of war from my point of view are the 58,000 names on that wall in washington and the 300,000 casualties that took place during that conflict. i try to bring focus to the fact that war is a constant part of history. you all know more about that than i do.

but there's very little -- of the 12,000 books and articles that have been written about vietnam, there's very little about the actual medical surgical component of those conflicts and that's what i want to try to talk to you about tonight. let me see if i can just get this little clicker to work here. the first thing i wanted to show you a little bit of the geography of vietnam so you can get some idea of what we're talking about. if you look at the map here, this whole area is vietnam. this, of course, is north vietnam. saigon is way down here. but way up in here, the red line here is the dmz and khe sanh, of course, is right here. so we were the whole time in the very northernmost portion of

south vietnam, which was called eye corps by the marine. of all the stories that you'll hear about vietnam, and there are many, many different versions of it, 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 the university of pennsylvania. a fellow there, a friend of mine had been in vietnam. the two of us were invited to the women's club of the university of pennsylvania to describe our experiences in vietnam. and, of course, i told stories of casualty care in eye corps and ira was a medical officer with an army unit in the south that had not much combat experience but a lot of sick call and so forth. but the key point was one of the ladies in the audience said, could you tell me about drug use amongst the troops.

the only thing i can tell you there was one occasion when a marine -- let me digress tell you when the casualty load came in everybody with you stripped naked is the reason you didn't want to miss a miner shrapnel wound in the armpit and up near the rectum that could be miss. we had a canvas, a diddy bag we put all their possessions in. one time in 12 months i heard one of the commotion in one of the litters they found a funny little cigarette in the pocket in one of the marines. one little cigarette. in 12 months. so i said to the ladies, i don't know what you're talking about. i said i was with the marines for 12 months and i saw no evidence, whatsoever, of drug use. ira gets up and said, everybody i know was stoned for 12 months.

[laughter] >> so my point is an awful lot of the stories in vietnam have to be taken on a geographic basis. because everybody -- it's like the three blind men feeling the elephant and describing it as three totally different animals. so bear that in mind as we look at that. let me see if i can make this work. all right. the other point i want to make in differentiating the different wars, if you look at the history of world war ii and even korea, the one thing that runs through them is the concept of a front line. whether it was fighting through europe or fighting up and down the korean peninsula, usually the stories of the battles were identified with some sort of a front line. no such line ever existed in vietnam. this slide shows where the

battles broke out -- oh, i'm sorry. let me go back. i did something wrong. somebody help me. at any rate, if you can fix that, the point is simultaneously in early 1968, dozens and dozens of battles broke out at the same time all over the country. and this was another key point in differentiating our experience from that recorded in the other wars. we were never anywhere where we could say they're here and we're there. we were very frequently in one enclave surrounded by them or another enclave, another unit surrounded. and that made a great tactical difference in terms of the medical and surgical care of the casualties. are we back online? so these bursts show the battles

that broke out. i make that point regardless of what surgical unit you were attached to, there's no front line, okay? now, i want to talk about the differences between the wars again in terms of casualties. this brief summary shows the number of casualties from the different wars. as you can see, vietnam comes in third. with 58,000 dead and 300,000 wounded. and in terms of the ranking of the wars, it's in fourth place in all the major wars that we fought in the last century. so quite a number of casualties. this just gives you a brief idea of the injuries that we saw just based on body distribution. this is kind of a standard slide. but this pretty much represents exactly what we did see. this also emphasises the need for the naked casualty. i can't emphasize that enough.

i can't tell you how many we had injured vietnam looking as if there's no visible injury but on careful inspection find the wound in the back, the wound in the groin that is not seen unless you have a totally naked person inspected in 360 degrees. let me just move on here. before we get to some discussion of the specifics of khe sanh, let me just tell you a little bit about some of the statistics concerning the people who served in vietnam. some of this comes from general mike miat who's out in the general marine association in san francisco. and i plagiarized some of his

numbers. almost 10% of those were casualties. in spite of what you read in the media and the impression they would like to convey, 97% of those military individuals were honorably discharged. the vast majority of them returned to a well adjusted civilian life. their employment rate was higher than the average population and their drug usage was lower. and i mention this specifically because i've always been exquisitely sensitive to the media's attempt to portray the derelict vietnam veteran. every war has one or two of those. but these statistics show the population of men and women who returned from vietnam did very, very well. one other number i want to give you especially since we have the audience that we have, and i was amazed to find this out myself. 267,000 women served in vietnam. i find that rather an amazing number.

if someone had asked me along the way before i got the actual data, i would not have guessed anywhere near that. 267,000 women served in vietnam during the entirety of that conflict. this is an aerial view of the base of khe sanh. it was 1 mile long and a half a mile wide. surrounded by four or five divisions of nva troops. and right on the edge of that strip sat -- right in here sat charlie med. initially, we would get casualties coming in by ambulance if they were on the base themselves. and we would get medevacked by c126 or c130, fixed wing aircraft. very quickly and this is one of the major differentiating points of vietnam from the other wars -- it turned into a helicopter base.

interestingly as an aside, you should know there were over 12,000 helicopters in vietnam. and they flew over 500,000 medevac missions during the time of that conflict. these are just a few samples of the -- examples of the helicopters. and i do this only because it's so important to realize that our surgical experience was completely changed and dictated by the existence of those helicopters. this is an unfortunate destruction of one of the fixed wing aircraft. and it was right after this that all fixed wing aircraft were ban from khe sanh. they were so slow and lumbering and they were easy target for nva gunners. and taking on so slowly they were easy targets. so right after this fixed wing aircraft were stopped and we switched everything by helicopter. now, the implications of that for a surgeon are different than what you would think of if

you're -- just thinking of helicopters in war. certainly they had their place assisting the troops, taking them in, taking them out and adding firepower. but for the first time, we were having our marines engaged in serious fire fights, ambushes, et cetera, where serious casualties occurred, helicopters were called for. and i must also point out that in my opinion, every helicopter crew that flew in our area deserved to be individually and highly decorated. i have never seen braver men in my entire life. they flew into fire zones, extracted fire crews and we suddenly had guys on our litter, 7, 8, 10, 12 minutes out of battle with horrendous total body injuries. again, go back to world war ii.

the troops who were wounded there had either to be carried by their buddies, carried on a stretcher or maybe wait for a jeep or an ambulance. and then a long ride to back wherever the aid station might be. part of the mortality of the injuries in world war ii and korea for that matter was that delay before they got somewhere for treatment. okay? even if they got there, the delay would still let bleeding curbs infection occur and so forth. but we suddenly were in a situation where because of the helicopter crews, they were dropping into fire fights, extracting badly wounded casualties dropping them at delta med, challie med in a matter of minutes. what does that mean surgically? we were suddenly seeing young marines so horribly injured that no one had ever seen them before alive. and so we instituted a whole new set of principles of treating these people based on

old-fashioned surgical principles applied extremely rapidly. so the situation in triage would be -- first we would get a call from the helicopter. a friend of ours eddie knows very well wrote a book called "2010 and 5" the standard approach as the pilot was coming in with the chopper -- with the casualty would be to say, i have 20 walking wounded, 10 literally wounded and 5 killed in action. so we knew what to expect. we would get that number. the litters were iron horses they would bring the litters right on them. if you're the triage surgeon, you're standing in the doorway, and literally triage, of course, is french for sorting out. you're literally standing in the doorway looking at the assessment. i will tell you it was incredibly accurate. you could stand in that doorway and almost at a glance say, station one, station eight and

so forth. and it worked reasonably well. once that litter was on those iron horses, teams converged on each litter. stripped the guy naked. huge intravenous lines were placed in the veins in each groin. blood could be pumped in extremely rapidly. blood was always available because if there was even a hint it was low, the gunny sergeant would just say all usobs would line up over here. we never had any trouble getting blood, all right? we would pump in blood and very frequently it was necessary intubate the patient and place in the tube and massage the heart and i want to talk about that later as we move on here in a minute. this is not meant to ties operating in a t-shirt. i usually wore more clothing than that. but at any rate, i show you this with some trepidation.

i was explaining earlier to the gentleman that i'm always reluctant to show slides like this but i want to make a major point again from the perspective of the surgeon and the casualty and not so much from the war. imagine this if you will. a marine is out in a foxhole in a fire-fight. he's injured horribly. whether it's rifle, shrapnel shots, it doesn't matter. he's bleeding badly. the helicopter extracts him and brings him in literally minutes. he's literally on the villager of death having bled out. he has no blood volume in his veins and he's a healthy 19-year-old and they're really hard to kill. we get them on our litter and we go through that routine i just mentioned to you. huge ivs in the groins, breathing tube. but if you try the classic television version of closed

chest massage, because the system is empty of blood instead of the heart this big it's this big. so you can push like this until you're blue and you're not going to get much of a result. so we started very early on with a little kit. it was that little silver retractor which you see which is just a rib spreader and little incisions spread the ribs and actually grab ahold of the heart and start pumping while the blood is being pumped in through the other lines. if you can get the blood volume back up to a decent level, then you have blood in the heart. and you can get a response to your resuscitation. just as an aside, when i first arrived at the third marine division they were doing closed chest massage. now, you're all used to seeing that on tv. you may not remember that in early '50s, dr. jude, from the miami heart institute and a doctor from the netherlands invented closed chest massage and it only came about in the '50s and it became the thing to do.

when i first got there, i said to one of the senior surgeons, i don't think this is going to work. and he was not interested in my opinion. [laughter] >> so i wrote to dr. jude at the miami heart institute. and i said, you know, dr. jude, this is my experience -- and he wrote back you're absolutely right. you cannot do that in a patient who has no blood volume in their system. and so we converted to this system. and the reason i show you this picture -- i apologize. it's a little bit gory because this was a common, common event. when we reached the point where we had a salvageable marine at least we thought he was salvageable but had no pulse and no bloop. -- blood pressure. we instituted this intensive resuscitated effort and produced results. now, the side-story from this -- i'll just leave that there for a minute. some of you may remember the story of the jonathan spicer and i'll just do this very briefly. jonathan was a objector who made his way through boot camp in the

marine corps and to vietnam. and ended up on one of the hills outside of khe sanh. he kept saying to his senior officers, i'll do anything you want but i'm not going to shoot anybody. and, of course, the marines were not really happy with that response. [laughter] >> at any rate, instead of court martialing somebody said why don't you send him down to finnegan. so he came to charlie med and we made him a litter bearer. now, again you saw the helicopter. -- helicopters. when we first got up to khe sanh and joe and dr. feldman were actually there before me, it was a -- charlie med was a series of tents. sandbags up to about 4, 4 1/2 feet. i always wondered -- i'm going to ask a general some day if you're 6'1" and the sandbags are 4 1/2 feet high, what am i supposed to do with the upper foot of my body -- i never -- no one ever gave me a good answer to that question. at any rate part of the problem was the casualties would come in by chopper. and there was about a 20-yard

run from the chopper to charlie med into the treatment bunker. and somebody had to take them off the chopper and get them into the bunker under heavy fire because the helicopters as you know were known as mortar magnets. spicer was one of those guys. everybody did it. but he was one of the leaders. carrying guys back. and then after we stabilized them we had to fly them out to a rear area. call the chopper in again. and the same fire would come in. jonathan would run out. he was constantly out there moving those casualties back and forth. another side light, everyone wore flak vests you can see from the pictures but as the temperature went up the flak vests came open. and one of the things that we railed about is -- in the summertime you could see pictures of marines by the dozens with the front of the flak vest unbuttoned and the incident of injury to the heart and lungs went up. we heard spicer's down. long story short they rushed him

in to our bunker. don, joe, ed -- we went around him. he was dead. and i think it was don who suggested that maybe he had what's blood in the heart sac and we his heart just like put one stitch in his heart and everything came back and he was medevacked. later on for his efforts he got the navy cross. so one little conscience objector who really made a difference. at any rate, let me move on here. not too many stories. this i show you only not because of i want to show you how i operate. but in the background, this is the combat base. the room is of a hut. the shelves are wooden. still supplies on the back shelf. the lights are light bulbs in a bank of plywood. the anesthesia machines were basic simple stuff but i point i

want to make is in these situations, we had everything we needed. one of the questions i'm asked all the time is, did anybody not make it because you didn't have what you wanted needed to do and my answer is flat out no. we always had what we wanted. we had these little balloons for cleaning out veins and we ran out and i said to the officer we need some more. a jet went back and forth okinowa and got them. this is a bunker at khe sanh, light bulbs, cramp quarters but then if you look around the sides of it, these are just 12x12 to make the walls of the bunker. but ivs, supplies, very crude, very elementary, but we had what

we needed. and anytime we said blood, one of those chopper crews would come flying in with a container of blood. so again even in that adverse tactical circumstance, we had what we needed. and if we said we wanted something it came in urgently. this is the bunker again. casualty on the litter. cramped quarters but everything there that we needed to do what we did. the parachute story we'll tell some other time. this is actually the cover of the book. and i would -- and i would just like you to know some of these guys. in the left-hand corner there is my new best friend joe wolf. [laughter] >> joe was our anesthesiologist. he had extensive training before the vietnam war. three months. [laughter] >> came up to khe sanh. but when the tactical situation was bad and we had someone who needed surgery and we could not get them out by chopper because

of whatever either fire or rain or whatever it might be, when our backs were to the wall, joe would put the guy to sleep and we would operate on him and again with basic equipment we were able to do it. the guy on the far end, don i want to mention because he was one of the stalwarts who stood with us the whole time. don died a few years back of malignant melanoma and he became one of the top heart transplant surgeon and he did 100 consecutive heart transplants without a death. very, very tough good guy. the other guy looks sort of like the hollywood movie star, that's dr. ed feldman. i'm going to talk about him a little bit later. i'm going to move to a more serious topic now. i can't really do this myself so i'm going to take a second and just ask if you would all read this poem that i wrote.

and while you're looking at it, i'm going to tell you that i want to tell you a story and then follow it up with something else the more difficult part of this discussion. in the triage area, as i mentioned, the casualties would come in 20, 10 and 5 so we knew what to expect. on one occasion they told us we were going to have a dozen or so litter-wounded. and i was the triage surgeon, which means i was the guy at the door saying station one, station two. and the worst guy that i think i've ever seen came in. scombaind station one. -- and i said station one. and i say lopez, there were so many lopez and nobody would identify him. no pulse. no blood pressure. wounds pretty much all over his body. and we went through that same effort. breathing tube, big tube, open his chest.

worked on him for maybe 20, 30 minutes, no pulse, no blood pressure. so i said to the marine guys, litter bearers, i said, you know, he's dead take him to graves register administration so they picked him up and took him across the helo pad and took him to the grave registration where the kias go. started taking care of the other casualties and 15 minutes later they came crashing back in the door with lopez on the litter and said this sob is alive and he's moving. you don't argue with four marines with m16s slung over their soldiers. you put him on the first litter. so we went through the entire resuscitative effort again. reintabated him. started resuscitating him. the whole nine yards. maybe ten minutes or so. absolutely nothing. i said, i'm sorry, he's dead. take him to graves. and they did. you could almost guess the rest of the story.

they come rushing back in about 15 minutes later. this sob is moving and we're not taking him back. [laughter] >> so i started going through it again. getting virtually nowhere. and i called one of my other surgeons over, pete parker, a great guy. practiced in winston-salem, north carolina, for 40 years arthwar. -- after the war. i said pete, take this guy back over and operate on him and he said jim, he's dead. i said take him back on the operating room and operate on him. i'm the triage surgeon. do it. he said what do you want me to operate on him. i'm not sending him back to graves registration. this guy had a breathing tube, two chest tubes, groin lines, the whole nine yards. i said pete, take him back and explore his abdomen and see what you can do. take him back in the operating room and he's looking at me like i've lost my mind. in the meantime, i finished the rest of the casualties.