Semper Fi

The New England Journal of Medicine ^ | July 1, 2004 | Pamela Grim, M.D.

[neverdem]

A while ago, before more recent geopolitical disasters, I saw on the news that a "rapid response team" of Marines had landed in Port-au-Prince, Haiti, and I wondered whether any of "mine" were there — the recruits I see at the Parris Island Marine training facility in South Carolina. I realized my first morning here that the culture of the "Island" and the "grunts" is worlds away from my own. My first recruit-patient — an 18-year-old with pilonoidal abscess — shouted "Yes, Ma'am!" or "No, Ma'am!" whenever I asked him a question. When I was his age, I was out in the streets protesting against a war. Somehow, almost unnoticed, that war has become a long time ago. What did I know about war? About as much as these kids do, I guess.

I was quickly corrected when I called him by name: you call each patient "recruit," and he calls himself "this recruit" — no "I" allowed.

Marine basic training attempts to take a kid and turn him into a responsible, disciplined adult — in 70 training days. And it works; you can actually see the transformation from the doorway. On day 1, the recruit is lounging on the gurney as if it were a settee; on day 64, he is a taut and toned junior jarhead sitting bolt upright, a cupped hand on each knee. From the very first day, I marveled. How was this possible?

Within a few weeks, I started to get a sense of what I would see clinically. The first thing to ask a recruit is "What training day are you?" You can usually guess the final diagnosis on the basis of this information. Basic training includes 2 "intake days," 5 "forming days," and 70 "training days." The kids who come into the emergency room on an intake day are usually there with slapstick stuff: someone breaks his arm stepping off the bus, another knocks himself out by running into a wall. Not a good beginning.

During the forming days (also known as "disorientation"), the drill instructors (DIs) introduce themselves and make the first real demands on recruits. This is when the weeding-out process begins. The earliest to go are the kids who've hidden a significant medical history, anything from asthma to bad knees. These are "fraudulent enlistments." When they get into trouble, the DIs send them to us to sort out. One kid sent in for "weakness" told me he would be fine if he could just restart his medications.

"What medications?"

"Zyprexa, Prozac, Buspar, and Ambien for sleep."

"And they let you in here? Did your recruiter know about this?"

"My dad told me not to tell him."

I looked at him. "What does your father do?"

"He's career Navy."

"And he told you not to say anything?"

The kid looked sheepish. "He thought this might make a man of me."

That first week, the kids meet the Third Hat — usually the most junior of the DIs, who has been described as "a maniacal, sadistic, extremist psychopath whose name you, the recruit, will never forget." His job is to ensure that once a recruit becomes a Marine, he will not crack up, become insubordinate, or "go postal" at a critical moment. Obviously, the Third Hat doesn't accomplish this feat by being soft-spoken. And it's because of him, I presume, that I see the other common complaints of early training — chest pain, shortness of breath, dizziness, weakness. The diagnosis invariably is "panic attack," but these are ferocious panic attacks: heart rates of 180, respiratory rates of 50, carpopedal spasm, and — worst of all — tears. Seeing a 6-ft 4-in., 250-lb former high school football star hyperventilating, sobbing, and begging to be sent home is an unsettling experience. And what exactly should I do for him?

I have two roles here: doctor and member of the Marine training team. My usual remedies, benzodiazepines and reassurance, aren't really adequate for this situation. Six months from now, any one of these kids could be dying in a ditch somewhere in a country he first heard of 10 minutes before he got there. How do I help someone deal with that kind of stress?

I tell the recruit, "What you are feeling is normal fear. It's totally understandable." The recruit, say, has just come from a drill in which he's required to sit in a chamber filled with CS gas with his gas mask off for a certain period. A fair number can't handle it. They bolt out of the chamber, gasping and vomiting. We get the ones with worrisome symptoms — chest pain, severe dyspnea. Usually, it's just nerves. "It's normal to be scared," I tell the sobbing kid. "But your job now is to learn how to deal with these perfectly normal feelings. Your job as a recruit is to learn how to think even though you are frightened." Most, given time, manage to pull themselves together, but a few try to convince me that it is their constitutional right to quit basic training this very instant. (It's not.) The DI rolls his eyes. "This is the gnarliest set of recruits that has ever come through this hole," he mutters.

The DI is the catalyst that transforms recruits into Marines, and his job may have its own psychological sequelae. Recently, I saw a DI whose chief complaint was "I want to kill the recruits."

"We all want to kill the recruits," I said solicitously.

"No," he said, giving every word equally ponderous weight, "I. Want. To. Kill. The. Recruits." He buried his head in his hands. "Just send me back to Iraq. I didn't have any trouble with Iraq."

After the first few weeks, unsuitable recruits are sent home for "failure to adapt," and the long grind begins. From the endless hours of physical training, we get the traditional diseases of foot soldiers — shin splints, stress fractures, hernias, pneumonia. "Combat simulation" drills bring us shoulder dislocations, nasal fractures, and on one occasion, a mandibular fracture (LeFort type I).

The final stage of boot camp, the Crucible, is a 54-hour mental and physical gauntlet. It consists of combat exercises, forced marches, and "warrior stations." Each station is dedicated to a great Marine of the past, and as the recruits maneuver under barbed wire and over the mud flats of the Beaufort River, they are expected to relive these warriors' golden moments — Marines like Gunnery Sergeant Dan Daily, who in 1918 led the Marine charge into Belleau Woods with the cry, "Come on, you sons of bitches, do you want to live forever?"

Oddly enough, we don't get too many injuries at this stage; most of the kids are smarter about dodging blows. What we do see are kids who are end-stage sick, with double pneumonia, grapefruit-size abscesses, appendicitis. These guys will do anything now to see this thing through. By this time, a recruit has become invested — invested in making it with his fellow recruits, invested in proving the Third Hat wrong, invested in just getting the whole damn thing over with. One kid came in with fulminating Guillain–Barré and dropped out only when he became apneic.

The final stage of the Crucible, a nine-mile hike, is dedicated to the men of Easy Company who in 1944 fought their way to the top of Mount Suribachi on Iwo Jima and planted an American flag.

"Wear the Corps' emblem with pride and honor not only on your uniform but in your heart," these new Marines are told. "Remember once a Marine, always a Marine." Semper fi!

Clausewitz, the great strategist on war, says there is only one means to war: combat. And with combat come casualties. The wounded from Iraq have started to make their way back home. The first we see are those with head injuries; the scuttlebutt is that we are going to see a lot of these. Most of these injuries are from roadside bombs — "improvised explosive devices" — which differ from traditional antipersonnel devices in that they shoot shrapnel and dirt up rather than the more traditional out, making a Kevlar helmet merely a bucket that collects ordnance.

Last night, a middle-aged couple came in, the wife complaining of shortness of breath. They had gotten the news that afternoon that their only son had been killed in Iraq. The man was retired from the military, and he stood ramrod straight and expressionless. But the woman was a basket case, a bottomless pit of sorrow. Her son was supposed to have come home a month ago, she told me, but his tour had been extended because of the ongoing insecurity. I called the chaplain; I talked to her for a while; I gave her some lorazepam. What else could I do?

The Marines are in the news every morning now as I get ready for work, the anchor talking about "taking casualties" and "hearts and minds." When I go outside, I can hear the shouts floating across the water, the young recruits out there sounding off in unison as they go out for their morning run, flat-out gung-ho at 6 a.m. The shouting sounds as if it is coming not just across the marshes but across the decades, and I swear sometimes that I can hear what they are shouting — all that Marine tough-guy talk:

Lock and load!

Ready on the left!

Ready on the right!

Ready on the firing line!

Failure is not an option!

Good to go.

Source Information

From the Naval Hospital, Beaufort, Parris Island, South Carolina.

[Alamo-Girl]

Thanks for the ping!

[Vic3O3]

ping!

[mean lunch lady]

Great post. Thanks for the info. I have the utmost respect for our young people in any branch of the service.

[TheStickman]

God Bless the USMC!

[dixie sass]

The Marines are guarding the streets and gates of heaven.

Nothing finer than a Marine and no-one more loyal to their country, family and friends.

Every Marine wife knows that when she marries a Marine, she also marries the Corp - she may be widowed or divorced from the Marine, but you never divorce or loose the Corp.

SEMPER FI to all of the Marines!!!

[dixie sass]

Hello my friend! Semper Fi - I just can't get away from those marines - even when they turn swabbie...

[LonePalm]

Would that I could take the place of ANY of these young men. Not that any of these guys would let me.

I'm former Navy and the Corps doesn't want old farts. I did my pittiful little bit in the cold war. I guess it moved us along.

Semper Fi guys!

Garde la Foi, mes amis! Nous nous sommes les sauveurs de la République! Maintenant et Toujours!
(Keep the Faith, my friends! We are the saviors of the Republic! Now and Forever!)
LonePalm, le Républicain du verre cassé (The Broken Glass Republican)

[VOA]

Recommended reaadings for lurkers/posters:

1.
"Making The Corps"
by Thomas Ricks

http://www.amazon.com/exec/obidos/tg/detail/-/0684848171/qid=1088880212/sr=1-2/ref=sr_1_2/103-5847907-8671045?v=glance&s=books

2.
"Keeping Faith: A Father-Son Story About Love and the United States Marine Corps"
by John Schaeffer and Frank Schaeffer

http://www.amazon.com/exec/obidos/tg/detail/-/0786710977/qid=1088879857/sr=1-2/ref=sr_1_2/103-5847907-8671045?v=glance&s=books

[bootless]

A grateful thank you and a BUMP for all Marines!

[tet68]

Ooohrah!
We WILL avenge.

I remember the gas hut, the DIs had the biggest guy
holding the door shut on the outside, the runt of the platoon lost it and had to get out, he went through that door and bowled that big guy over like he wasn't even there!

Remember the best thing for constipation is a tablespoon
of WISK.

[LadyX]

Marines are special !!

LadyX returning to Parris Island in 2002 - 50 years after entering the U.S. Marine Corps in 1952.
Instructed Women Recruits in Classoom Subjects during the Korean Conflict, the greatest buildup in Corps history.

The replica of the Iwo Jima Monument on the Parade Deck behind me was dedicated in August of '52.
In the Dedication Ceremony were eight full companies participating, with the WM Company "A" leading it.

It was my high honor to be out front with our Company Commander as Guidon Bearer, carrying proudly the American Flag, and with the other seven Guidon Bearers going 'Front & Center' to salute the Reviewing Dignitaries.

The sweetest sound on earth is not a mother's lullaby,
but that of cadence calling
on a Marine Corps Training Base..:))

[neverdem]

Thanks for your pics and your service. God bless the Fourth of July!!!!

[neverdem]

Thanks for the links. Happy Fourth of July!!!!

[RaceBannon]

You like Marines? YAHOOOO!!

USMC 1977-1981

[Cap'n Crunch]

later read Devildog bump

[LoudRepublicangirl]

My grandfather was at Iwo Jima. How could I not have some love for the corp! Hooah!

[firewalk]

Thanks for the ping

[Dubya]

SEMPER FI

[JoeSixPack1]

..., the DIs had the biggest guy holding the door shut on the outside,...

Oh jeeez, who can forget the dam gas chamber?? With a line of snot from both nostrils to the floor as the door opens, your arms outstretched moving blindly forward waiting for the wind to clear them and remembering not to run too far or fall off the dang cliff a couple hundred feet from the gas hut!!

Good thing all that crap is just a memory now. But, what the heck, let's all do it again, just one more time, if for nothing else to see who can achieve the longest goo-bugger from a single nostil!

OOORAAHHHH

Semper FI

[tet68]

Semper Fi. MARINE.

Tet68.