On the Frontlines of Medicine
“Hello, Ma’am! This is Matt Lammers ... from Kansas.”
Alisa Gean met Matt Lammers in Landstuhl, just hours after an explosion ripped through his Humvee on a hot June day in southern Baghdad. The explosion took off both his legs and his left arm. “He remembered everything and was able to tell me what he saw and how it felt after the blast, including when he tried to move his left arm and it just came off,” says Gean. She and Lammers had long talks at Landstuhl, and stayed in touch when she returned to the United States. Late last year, when Gean was giving a speech in Kansas, she and Lammers reconnected. As Lammers fights to recover, battling depression and the breakup of his marriage, struggling to learn to walk with prosthetics, and staying connected to his two small daughters, he describes Gean as his “inspiration.” Recently he wrote her:
“Without you I wouldn’t be here and you will always have my deepest appreciation and gratitude. ... For a while there, I felt as if I were a mistake being alive still, but after listening to everything you told me and seeing the pictures [of his daughters] I have never felt more proud and thankful to still be here. ... Hopefully next time we see each other I will be able to walk up to you.... Thank you for everything, my friend.”
Stanford medical alumni are no strangers to war. In every conflict, in every theater—in World Wars I and II, Korea, Vietnam, the Gulf War, and now Iraq and Afghanistan—physicians, nurses, physical therapists, and other caregivers have been heroes on the frontlines and back at home, helping generations of veterans make the long journey from injury to recovery. Recently, Bench & Bedside talked to just a few of the too-often unsung heroes—a traumatic brain injury (TBI) specialist, a plastic surgeon, an orthopaedist, and a neurobiologist-turned-chaplain. In a related In My Opinion (pp. 18) Ken Kizer, ’72, MD, MPH, and former undersecretary of health for Veterans Affairs, offers his keen observations on traumatic brain injuries.
Alisa D. Gean, MD ’83: Taking on the Four B’s
A professor of radiology, neurology, and neurosurgery at the University of California, San Francisco, and a neuroradiologist at San Francisco General Hospital, Alisa Gean lives in a world of central nervous system trauma. In late 2007, she volunteered to serve for a month at the Landstuhl Regional Medical Center, the U.S. military hospital in southwest Germany, to study combat TBI in wounded soldiers returning from Iraq and Afghanistan.
“I wanted a better understanding of the 4B’s of combat injury—burns, blast, bullets, and blunt,” she says. “It’s civilian trauma on steroids. It’s dirtier and uglier.” Seeking insight into how these multiple impacts affect the healing brain, Gean served as the radiology attending physician in the intensive care unit, scrubbed in on surgeries, lectured to various departments, and came away with more than she expected. “I was extremely, extremely impressed with the military physicians; it was an honor to work with them.”
While Gean delivered person-to-person clinical care, she was simultaneously fully engaged as a researcher. She studied the difference between combat and civilian trauma patients to help society deal with future terrorist attacks. She came back committed to helping the public understand that TBIs are very real injuries, suffered in epidemic proportions. “It’s the leading cause of death in people under age 45, more than breast cancer, multiple sclerosis, and HIV/AIDS combined,” Gean says. “Even so-called mild TBIs can ruin people’s lives. The patients can be compromised in many ways, and can lose their marriages, their jobs, and sense of self.”
Gean is excited about the promise of new advances in technology, particularly in imaging techniques. “They hold great promise for showing injuries that were invisible before, but they first need to be validated.” She laments the fact that, despite the $50 billion annual cost of dealing with TBIs, the issue never seems to get sufficient attention and funding. “It has taken this war to bring TBI to the forefront,” she says, “and what I want more than anything is for the funding to match the burden of the injury.”
Thomas Crabtree, MD ’87: Medicine at the Gate
To understand the intersection of military medicine and ambassadorship, listen to a tale or two from Tom Crabtree, recently retired from the U.S. Armyand his post as chief of plastic surgery at Tripler Army Medical Center in Hawaii. Crabtree’s 25 years of military service, disaster medicine, and humanitarian care have taken him from the 1989 San Francisco earthquake to six-month tours with the United Nations in Mobile Army Surgical Units in the Balkans and Central Africa to providing surgical relief in Papua New Guinea in 1998 and Indonesia in 2005 after the tsunamis occurred in those countries.
“Medical diplomacy has been around forever, but it’s really gained traction in the last few years because it does so much good for so many for so little, delivering more bang for the buck,” Crabtree says. He offers a compelling example: “I was stationed at a base south of Baghdad that straddled a key supply route. It was constantly being bombed and supply caravans were being ambushed. Then, one day a local arrived with a little boy who had a cleft lip. I did the surgery to repair it. A few days later, the boy came back for a follow-up with a whole entourage. It turned out that he was the grandson of the sheik who controlled a large part of that area. With that, the bombing and the ambushes stopped. For an operation that probably cost $100 to perform, we saved countless lives and many hundreds of thousands of dollars in supplies and equipment.”
Crabtree’s mission included establishing so-called gate clinics to provide health care in rural areas. “At outposts Alisa Gean, MD ’83, volunteered at the U.S. Army Hospital in Landstuhl, Germany, to study combat traumatic brain injuries up close. That experience took on unexpected power when she came face-to-face with Sergeant Matt Lammers — first in the ICU, then in the operating room, and later as she became a long-distance support system for his recovery. Tom Crabtree, MD ’87, has spent much of his career figuring out how “medical ambassadorship” can heal across the most treacherous of borders. Sometimes, it seems, diplomats come dressed in military-issue helmets. beyond the Green Zone, there was simply no health care available to locals. And this was in a country that had been a shining example of health care for all the Middle East up to 20 years ago. So civilians would line up at our gates to go through security, and then come in for care. Sometimes we had permission, sometimes we didn’t, but we couldn’t turn folks away.”
Crabtree says flatly that the war in Iraq, his fifth wartime experience, is like no other for two reasons. “The first is body armor. People who would have been killed in the past are now surviving, but with serious TBIs and extremity injuries. We’re seeing double and triple amputees, true polytrauma victims, in need of reconstructive surgery. The second factor is the nature of the weapons. These are super high power explosives, and the blast is so focused that the damage is unimaginable.”
Already assessing the lessons of war, Crabtree says: “We’ve seen huge advances in every aspect of treating these young people, and a quantum leap in rehabilitation practice from the design and fit of prostheses to rehabilitation services. We have also learned that the faster we can get to reconstruction and rehabilitation, the better the outcomes.”
Eugene Carragee, MD ’82: A Sense of Duty
Eugene Carragee, an orthopaedic surgery professor and director of the Orthopaedic Spine Center at Stanford Hospital & Clinics, has spent much of his career in uniform. He trained in the U.S. Army Medical Corps after medical school, residency, and fellowship. He also served as a public health officer in civil affairs, as a battalion and command surgeon in the U.S. Army Special Operations Forces, as a Forward Surgical Team commander. Ironically, he was inspired to join the military by two civilian professors at Stanford University School of Medicine— Alan Barbour, MD, who landed with the Marines at Iwo Jima in World War II, and Roy Maffley, MD. “I had terrific mentors who taught me about service, about how to be a good doctor and a good human being. They were charismatically influential, because they had such a duty to serve. They taught me that sense of duty—and it brought me to the Army.”
Timothy Meier, SJ, PhD, ’98: An Unlikely Army Chaplain
Tim Meier today finds himself far from Stanford’s labs, as he serves U.S. Army troops in the Iraq war zone. A Jesuit priest, a neurobiologist, an army chaplain, a research scientist, and a teacher, Meier is undergraduate research coordinator and director of the honors program in biology at Stanford. He blogs regularly from what the military calls “downrange” as cptdrfrtim.blog spot.com. (See “Eyes and Ears,” page 27.) The blog, titled Curmudgeon: An Unlikely Army Chaplain, demonstrates Meier’s ability to choose and navigate a surprising twist in life’s path with humor and grace.
At age 50, Meier joined the California Army National Guard. That decision came out of a 30-day silent retreat in the summer of 2005. “It became clear to me that I was being asked to join the Army, which was a big surprise.” He tackled this new situation like a researcher, took online courses, and then went to 90 days of chaplain basic training at Ft. Jackson, S.C., at age 51 (the oldest non-prior service person doing so). Ultimately, he took temporary leave from his regular job at Stanford and was deployed to Iraq.
Along the way, the man who speaks the language of molecular biology and divinity learned a new parlance and a new culture—the U.S. Army. He uses his own language as well, greeting those he encounters with a salute and always with “God bless you.” “I think of it as a prayer as well as ‘hello,’” he says. It turns out that his background in neurobiology has unexpected resonance in Iraq. “The research I did as a graduate student in Robert Sapolsky’s lab—long before I ever imagined myself wearing the uniform of the U.S. Army—looked at, among other things, the molecular neurobiology of what the Army these days is calling mild traumatic brain injury.’”
His assistant, and mentor in understanding this new world, Sgt. 1st Class Matthew McGee, says Meier’s gift as a chaplain is his ability to relate: “He is versatile at talking to people at their level and as a leader.” As Meier writes in his blog: “Whenever I find myself marveling at being in Iraq, wearing body armor, going outside the wire, and asking myself, ‘Self, how did this happen?’ I always focus on my gratitude to the women and men in my life who are veterans or still serving in the military. … I am filled with gratitude that in some small way (smaller than I’d like, that’s for sure), I might be able to be of service to them.”