Zero to Sixty: From Residency to the War Zone

Christopher H. Warner

My unanticipated military journey began in 1991. I was a junior in high school who was looking at numerous college opportunities with a plan to do premedical studies and become a physician. At that time, I planned to attend an accelerated medical program and then find a pediatric residency training program near my hometown. I expected that after completing my training, I would return to the area that I grew up in the Ohio River Valley near Pittsburgh, Pennsylvania and become a small town doctor. However, during that year of high school something life changing occurred when Saddam Hussein invaded Kuwait.

Over the majority of that year I watched as our nation forged a massive coalition of military power in the Middle East and pushed one of the largest armies in the world back into Iraq. During the following months, I saw those American military personnel return home as heroes and the nation embrace our modern day war heroes in GEN Schwarzkopf and GEN Powell. I became enamored with the concept of performing honorable service with honorable men and women and found myself more and more drawn to the military. I remained on my career goal of being a physician but now a military physician. I subsequently attended the US Military Academy at West Point and then Uniformed Services University of Health Sciences and found myself loving what I was doing.

While I was attending medical school, I watched as my friends and classmates from West Point participated in a number of operations other than war in locations such as Bosnia, Kosovo, Kuwait, Sinai, and Somalia. They related accounts of their experiences and I knew that I had a strong desire for operational medicine. In some respects, I felt guilty for still being in school while they were out serving our nation. I felt a desire and sense of obligation to be out caring for those amazing men and

C.H. Warner, M.D., D.F.A.P.A., F.A.A.F.P. (*)

Department of Psychiatry, Uniformed Services University, Bethesda, MD, USA

Consultant to The US Army Surgeon General for Psychiatry,

4301 Jones Bridge Rd, Bethesda, MD 20814, USA e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it

© Springer International Publishing Switzerland 2017 91

E.C. Ritchie et al. (eds.), Psychiatrists in Combat,

DOI 10.1007/978-3-319-44118-4_10

women at or near the front lines. As I began to consider what residency I would select, I found myself very confused. I knew that my childhood view of pediatrics had changed dramatically—after about the second week of my pediatrics rotation. But I remained unsure. I was drawn to the operational medicine opportunities that the primary care fields presented, but also found myself with a love and fascination for the field of psychiatry.

Fortunately, I discovered that the Army had a best of both worlds opportunity with the combined Family Medicine Psychiatry residency training program. I entered this 5-year training program in 2000, naive of how significantly the world and my life would change during that time.

Fifteen months after starting that residency, I had my second career defining experience with the attacks on the World Trade Center and Pentagon on September 11th. That day would shape the rest of my military career.

We were at Walter Reed Army Medical Center, preparing for the numerous anticipated casualties to come from the Pentagon and watching the varying news reports. I was repeatedly calling my wife who was a physician at Aberdeen Proving Grounds to reassure each other that both we and the children were okay and to share what we knew.

Throughout the morning, I looked out the window and saw the smoke from the fires in the sky. We spent the morning cross training our inpatient psychiatry faculty to be prepared for burn and trauma patients and discussing trauma event management to care for the anticipated casualties, but they never came. Most were dead; the few wounded went to other hospitals.

Over the coming days, I would serve as one of the on-the-ground physicians providing both medical and mental health care to those serving in recovery operations. I was also the physician who would pronounce those who were found as deceased before removing the bodies from the rubble. The sites, smells, and sounds from the event will forever remind me of the vulnerability that we all have. It also hardened my resolve and commitment of service to the nation, the Army, and most importantly the Soldiers that we serve.

By the time I completed my residency training in 2005, we were involved in two major wars in Iraq and Afghanistan. I had been actively involved for over 3 years in caring for the wounded. Whereas my early training was shaped with seeing critical care retiree patients and acute psychosis, my latter was heavily weighted with posttraumatic stress disorder, traumatic brain injury, and amputee management.

As I was discussing initial assignments with my consultant, COL Ritchie, I expressed a desire to deploy and get to the war zone. She reassured me that my time would come but that it would likely be about a year after graduation as I was being sent to Fort Polk to work at the hospital, as that was the only location the Army could provide where there were openings for both myself and my wife, an active duty Army Family Physician.

We were all prepared to go to Fort Polk until about 6 weeks before graduation, when a series of events rapidly changed our future. The psychiatrist deployed with the 3rd Infantry Division was unable to complete the deployment and needed to return to the United States. A replacement would be required.

Shortly thereafter, I got the phone call from COL Ritchie asking if I was still interested and noted that it would result in deploying to Iraq almost immediately after graduating from residency. Additionally, this change would result in my wife and I moving to Fort Stewart in Savannah, Georgia. After a brief discussion with my spouse, I said, “yes.”

Over the course of the next 6 weeks, we finished residency, sold our house in Maryland, purchased a home in Georgia, moved our family (including three children, two dogs, and a cat), and took our Family Medicine board exams (it would be nearly four more years before I would complete my psychiatry board exams because of constant rescheduling due to multiple deployments).

Upon arrival to Georgia, I was rapidly prepared for deployment and within less than a month of getting there I was validated on my training, issued a mound of new equipment, and put on a plane headed to Iraq. We still had half of the home unpacked by the time that I departed leaving my pregnant wife and three children behind.

During this time I rapidly looked for any material that would prepare me for what I was to encounter. Sure we had talked with some staff who had deployed and we had received some training on the principles of Combat Operational Stress Control, but all considerations and exercises were notional. As I prepared I read whatever resources I could find including the Army manual on combat and operational stress control, collections of lessons learned from prior wars, and recent accounts from other deployed psychiatrists [1-4].

Still, as I arrived in Kuwait and awaited movement into Iraq I was very green. At that point, several key things hit me: (1) I was in a war zone where there were individuals who wanted me dead, (2) I was about to practice for the first time without the safety net of a staff physician to fall back on, and (3) I was expected to not only provide combat operational stress control but lead a team of providers spread throughout the greater Baghdad region and be a key advisor to senior leaders.

Just one of those could be anxiety provoking but combined they felt daunting. As I moved into Iraq and arrived in the Baghdad area I realized how increasingly complex this mission would be and how legitimate those fears were. I was expected to split my time between two separate locations, one in Baghdad near the airport, and the other at a major base approximately 25 miles north of Baghdad with the latter being my primary location. I would lead a team of more than 25 behavioral health providers who were scattered throughout at 50 mile radius of Baghdad and be responsible for the mental health care and unit consultation for nearly 50,000 Soldiers.

Over the course of this experience, I learned four key lessons.

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