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

Posted on 07/02/2004 11:35:44 PM PDT by 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.


TOPICS: Extended News; Government; News/Current Events; US: South Carolina; War on Terror
KEYWORDS: atf; parrisisland; training; usmarinecorps; usmc
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1 posted on 07/02/2004 11:35:44 PM PDT by neverdem
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To: fourdeuce82d; El Gato; JudyB1938; Ernest_at_the_Beach; Robert A. Cook, PE; lepton; farmfriend; ...

PING


2 posted on 07/02/2004 11:40:19 PM PDT by neverdem (Xin loi min oi)
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To: wardaddy; Joe Brower; Cannoneer No. 4; Criminal Number 18F; Dan from Michigan; Eaker; Squantos; ...

From time to time, I’ll post or ping on noteworthy articles about politics and foreign and military affairs. Let me know if you want off my list.


3 posted on 07/02/2004 11:42:01 PM PDT by neverdem (Xin loi min oi)
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To: river rat; tet68

PING


4 posted on 07/02/2004 11:42:45 PM PDT by neverdem (Xin loi min oi)
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To: neverdem

Add me to your list. Thanks for posting this article.

RLTW


5 posted on 07/03/2004 12:02:16 AM PDT by A Simple Soldier
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To: neverdem

Good post. Love the Marines. All women love the Marines, they are the sharpest of the sharp.


6 posted on 07/03/2004 12:12:10 AM PDT by jocon307 (Nor forgive!)
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To: neverdem; JulieRNR21; Vets_Husband_and_Wife; Cinnamon Girl; Alamo-Girl; Bigg Red; jwalsh07; ...
Semper Fi, MARINES! Carry on! ±

"The Era of Osama lasted about an hour, from the time the first plane hit the tower to the moment the General Militia of Flight 93 reported for duty."
Toward FREEDOM

7 posted on 07/03/2004 12:15:53 AM PDT by Neil E. Wright (An oath is FOREVER)
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To: Neil E. Wright

Marine Corps Bump!


8 posted on 07/03/2004 12:17:14 AM PDT by SAMWolf (Member: International Brotherhood of Tagline Thieves!)
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To: SAMWolf

Thanks, Sam. The Corps is near to my heart. Earn Marine's respect and they will follow you right into the jaws of hell.

Not easy to earn their respect, though!


9 posted on 07/03/2004 1:38:14 AM PDT by Iris7 ("Democracy" assumes every opinion is equally valid. No one believes this is true.)
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To: neverdem

"My dad told me not to tell him."

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

"He's career Navy."

great post,
SEMPER FI 74-80
GODSPEED


10 posted on 07/03/2004 4:20:19 AM PDT by alpha-8-25-02 (saved by GRACE and GRACE alone)
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To: neverdem

Great post! Thank you.


11 posted on 07/03/2004 4:34:28 AM PDT by Key West Girl
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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.

That would be February 1945, Doc.

12 posted on 07/03/2004 6:02:32 AM PDT by A.A. Cunningham
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To: jocon307

Good post. Love the Marines. All women love the Marines, they are the sharpest of the sharp.

My brother is a Captain in the Army but I have to say there is something about those Marines.


13 posted on 07/03/2004 6:05:48 AM PDT by LoudRepublicangirl (loudrepublicangirl)
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To: LoudRepublicangirl

When your son or daughter becomes a legend...

Is the day they graduate from Annapolis with a comission as a Marine Officer.


14 posted on 07/03/2004 6:53:41 AM PDT by off-roader
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To: off-roader
When I get to heaven Saint Peter's gonna say

How'd you get to heaven boy in just one day?

I replied with a with a whole lot of anger

Blood and guts and a whole lot of danger

Killing and fighting running all day

Showing Iraq that Marines are here to stay

Captain of Marines

1982-1990

Semper Fi

15 posted on 07/03/2004 7:49:03 AM PDT by Warrior Nurse (Black & white liberals practice intellectual apartheid when in comes to black conservatives!)
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To: Neil E. Wright
""Come on, you sons of bitches, do you want to live forever?""

One of those pills should cure anything.

16 posted on 07/03/2004 8:01:20 AM PDT by Eastbound
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To: Warrior Nurse

This is one grateful American who humbly says Thank you for your service!


17 posted on 07/03/2004 8:04:16 AM PDT by LoudRepublicangirl (loudrepublicangirl)
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To: neverdem

Thanks for posting that. The Marine Corps has this weird way of making former Marines respect both those who came before us, and those who come after. I couldn't be prouder of those young jarheads in Iraq.


18 posted on 07/03/2004 8:10:22 AM PDT by XJarhead
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To: jocon307

When you think your having a bad day and you cant go another mile, remember the Marines, what they do for us everyday, awesome , I have a picture of the front page of the Sun Newspaper 8th April 2003, on my wall, its a fantastic pic, says everything about the Love of a Marine.


19 posted on 07/03/2004 8:10:45 AM PDT by lillybet
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To: neverdem

Thanks for posting that. The Marine Corps has this weird way of making former Marines respect both those who came before us, and those who come after. I couldn't be prouder of those young jarheads in Iraq.


20 posted on 07/03/2004 8:11:07 AM PDT by XJarhead
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