Lessons Learned

Admiral Mateczun, one of my long-time mentors, once told me that the job of the military has always been to do the impossible with inadequate resources. Operation Iraqi Freedom (OIF) was no different. We never had the resources we wanted, but we accomplished the mission.

During the invasion, the days were long but the weeks were short. Movement was fast, and the injuries were less than expected. We identified the potential medical threats, took appropriate preventive measures, prepared for potential casualties, and provided the emergency medical support and MEDEVAC that was needed. Casualties during the invasion were low.

The intent of lessons learned is to learn from the experiences of others. The military implemented formal lessons where we learned to avoid being doomed to repeat past. Unfortunately, history is lost due to communication, politics, apathy, and perspective. Lessons not learned end up being little more than lessons observed.

When I reported to 1st MARDIV, I found an old copy of Lessons Learned from Operation DS/DS. The mental health issues anticipated for OIF were identical, but, years later, no action appeared to have been taken to fix any of them. The lessons were in fact “observed” and not “learned.”

Unfortunately, no formal debriefing was ever done for me as Division Surgeon. Returning combat veterans were treated like prized cows, introduced and paraded on stage until asked to talk about their experiences. If the feedback did not match the party line of higher headquarters, those with experience were quickly given the hook and exited off the stage. The opportunity to find out what really happened was often missed.

Deployment and in garrison care require overlapping, but not duplicate skills and equipment. Experience and success does not always transfer to the other venue. After DS/DS, members were assigned to the platform so they could train in the event of mobilization, but this did not incorporate a rotation plan for sustained operations. As a result rotation from theater often placed those rotating to a new command at risk for immediate redeployment, and there was no database tracking deployments or experiences of personnel.

A Marine Major summed up his observation about the internal conflict in military medicine. “Navy Medicine has not decided if they are operators or loggies. They want to tell everyone they are ready like operators, but their product requires metrics and deadlines like logistics and supply. They need to figure out which one they want to be.”

Personnel and politics were key issues. While implementing the new Command Master Chief program, tension arose as the senior Navy enlisted member forced his move to report directly to the Marine CG vice the Division Surgeon. Since military personnel systems for officers and enlisted are different, assigning the senior sailor disconnected an essential presence in the DSO (Division Surgeon’s Office).

Any deployment must deal with personnel issues: pregnancy, conflicting rotation dates, crises at home, and physical limitations or injuries. However, conscientious objectors were unique to a combat deployment. Two medical officers raised the issue. The General warned me that it would break his heart, but he would ruin their careers if they refused to go. Neither was disciplined. One deployed without a weapon. One rescinded his request for consideration.

Those that were heroes were as surprising as those that were failures. Prediction was impossible. Doing well in garrison did not predict someone would do well in the field. Some were overwhelmed. Some refused to participate. You couldn’t tell who would do what, especially with little true simulation prior to the actual event.

My Corpsmen always looked out for me. They would check to make sure I was ok. Once, one of my Sailors had acquired a Tactical (TAC) phone. I knew I didn’t want to know where or how he got it. I started to remind him that he needed to return it when he handed it to me and said, “I know you haven’t talked to your wife in a long time. I brought this so you could tell her you’re ok.” Near the end of our time in Iraq, another one of my Sailors told me that he noticed that I was always the first to wake and the last to go to bed. He knew I was looking out for them, and he thanked me for that.

An impromptu support group formed in theater. Its members knew it as “the persona non grata” (The PNGs). It consisted of the Surgeon, Chaplain, Public Affairs Officer (PAO), Staff Judge Advocate (SJA), and Communications Officer. Whenever there was a problem, one of this cast of characters was usually the fault or solution. Our high pressure, high responsibility jobs helped us bond and look out for and after each other.

“Comm sucks” is frequently heard to explain the lack of information available up and down the chain of command. Email, Skype and satellite phones sometimes made managing information flow difficult to impossible. Sharing too much and too soon can result in other communication issues. MEDEVAC needed to work during the invasion. There were problems in identifying units and locations. Communication channels were quickly overwhelmed. The idea had initially been to have higher command report down, but accountability often resulted in information being pushed up. There was not enough bandwidth to accompany both.

Everything becomes routine AFTER a period of adjustment. This is good and bad. Learning to be on guard and hypervigilant intensifies culture shock and disenchantment. Everyone changes and everyone eventually will break.

It was warm and kind when people would thank me for my service, but no chance for catharsis was offered. Some become bored, others overwhelmed by details. It is not much different than being a doctor and describing medical school. It’s just a lot scarier.

Reflections

For me, my first deployment in support of OIF was a once in a lifetime journey into a very unique world, truly a road less traveled. Like any untraveled path, there were many unexpected twists and turns. There was no map or GPS.

I wish I had been able to talk more with my father about his experiences in a combat zone. He died just before my first round of finals in medical school. I often wonder what we might now share, if only we could talk today.

Captain Kevin D. Moore is a retired US Navy psychiatrist. This chapter reflects on events surrounding the invasion of Iraq in 2003 by coalition forces, when he served as Division Surgeon for First Marine Division and Psychiatry Specialty Leader for the Navy Surgeon General.

 
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