Surgeon-Journalist Plies Both Trades in Iraqi War Zone

Photo by Graham Ramsay Erica Seiguer

Most physicians trained at Harvard will practice medicine in familiar settings: an academic health center inpatient or outpatient environment, a local or community hospital, or a private practice. Few of us will experience battlefield medicine—practicing near a forward line in wartime.

Sanjay Gupta, a senior medical correspondent for CNN and a practicing neurosurgeon at Emory, not only reported on the current war in Iraq, but became part of the story when his surgical skills were critically needed. His experience highlights the success of military medicine and the physical and emotional demands placed on soldiers and physicians in such settings. I spoke with Gupta recently about his time in Iraq, where he was embedded with the “Devil Docs”—the U.S. Navy’s medical unit.

Quicker Care for the Wounded
Military medicine, especially in forward areas, has seen tremendous improvements, particularly over the past few decades. In a recent New England Journal of Medicine article, Atul Gawande, HMS assistant professor of surgery at Brigham and Women’s Hospital, showed that the lethality of war wounds has declined from a peak of 42 percent in the Revolutionary War to 10 percent in Afghanistan and Iraq. Part of this decline has been attributed to Forward Surgical Teams (FSTs), which follow close behind the advancing front line and are able to set up an operating theater in less than an hour. Gupta believes many of these improvements have come since the Gulf War a decade and a half ago. In that conflict, he said, the technology was available to save lives, but it was not available within that “golden hour” during which the injured will die if they do not have advanced medical and surgical care. “The major change between 1991 and today,” he said, “was to move the medical units forward so we can get people treated in time.”

Courtesy Sanjay Gupta Neurosurgeon and journalist Sanjay Gupta reports for CNN from a medical unit on the front lines in Iraq.

But moving health care professionals into the forward zone raised questions. “The conflict was this: do you take health professionals and expose them to the risk? The answer has been yes,” Gupta said.

He recounted the moment when he first saw a physician carrying a stethoscope in one hand and a gun in the other—a sight that became familiar on the front lines. “It was striking to me as a physician and a civilian,” he recounted. “But that is the awkward dance that surgeon-soldiers have to deal with. It has made them more a part of the battle experience. They have come under attack and have had to defend themselves.”

I asked about whether he noticed ambivalence among these physician-soldiers, who literally with one hand were saving lives and with the other were prepared to take them in their own defense. Gupta said they did not. “The fact that they did not was the most interesting to me. They talked about how they did both.”

Saving the Enemy
If there was any ambivalence, it was when they had to take care of individuals who had previously killed or attacked U.S. soldiers. Gupta related a dramatic event he watched unfold. During his time there, he had gotten to know two marines very well. They were young, perhaps not even 20 years old. One day, as they were clearing a site of mines, one of the soldiers was shot in the neck and killed by a sniper. The second soldier shot the sniper. Then the soldier grabbed the sniper and instead of ending his life, saved it. “He brought the sniper into the medical camp, where he was operated on,” Gupta said. “This was striking to me on so many levels. A 19-year-old kid had to make a decision. This is the nature of the beast—doctors take care of the patient no matter who he is.”

While the advent of FSTs has brought important capabilities to the front lines, improvisation and making-do in a tent in the desert in the middle of a battlefield is still a fact of life. Gupta observed this as a journalist and lived it as a neurosurgeon. “At home, we are so used to incredible access to technology. But look at what we can accomplish with very little. In an era of increasing health care costs, there might be a time when we can learn to be more efficient. On the battlefield, you have to be efficient, and the whole process by which military medicine is practiced relies on this.”

“These are truly selfless people... They are heroes on so many levels: they save others, and they put themselves in harm’s way.”

Gupta operated on five separate occasions in which the wounded would not have survived transport to a facility equipped to handle their injuries. Yet the military was not set up to do neurosurgery in the field. So Gupta and his colleagues had to be creative. To perform craniotomies, he sterilized and used a drill meant to set up the tents. And he was able to fashion the interior of a sterile saline bag into an outer layer to cover the brain after surgery, protecting the patient from dangerous infections.

Yet Gupta’s dual role as a journalist and physician drew some criticism from fellow journalists and observers of the profession. He was surprised that there were concerns: “I went to Iraq as a journalist, though the doctors there knew I had a background in neurosurgery. They asked for my help when someone was injured, and who had no chance of survival without immediate surgery. Of course I said yes—this is what doctors do. It’s ludicrous that people would think otherwise.”

Gupta describes his experience with the Devil Docs as “life-altering.”

“These are truly selfless people,” he said. “A lot of them don’t have to do what they do—they have great practices back home, but they wanted to do this for their country. They are heroes on so many levels: they save others, and they put themselves in harm’s way.”

—Erica Seiguer is an MD–PhD
student studying economics in
Harvard’s Doctoral Program
in Health Policy.

The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.

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