Dartmouth Veterans: Vietnam Perspectives

Missing from Action

Missing from Action ---------------------------------------------------------c . dean razzano : u.s. navy A fter receiving an MD from the University of Kansas in Kansas City in 1968, I went to the Cleveland Clinic to embark on a career of either cardiology or heart surgery. The clinic had recently pioneered cardiac catheterization and revascularization heart surgery . After one year of internship and one year of general surgery, both prerequisites, I chose to rotate through orthopedic surgery for one month. The chief of orthopedic surgery, Dr. Mack Evarts, had just returned from three months in England, where he worked with John Charnley, who had originated the modern “cement-­ fixated total hip” procedure. Through Dr. Evarts’s efforts, the clinic was designated to be one of three institutions chosen by Uncle Sam and the Food and Drug Administration to start a trial program to begin the surgery of total joint replacements in America for an exclusive period of two years. Europe had been replacing total hips for ten years with cement fixation. Our FDA was hesitant but permitted three programs to begin this new surgery in the United States. This was late in 1970. I saw the light and my future. I applied for the Berry Plan, which enabled me to complete three additional years in orthopedic surgery without being drafted into our military and shipping off to Vietnam. The Berry Plan guaranteed Uncle Sam a needed number and quota of fully trained orthopedic surgeons yearly. Two years later, at the close of 1972, total joint replacements— ­ with cement fixation— ­ were permitted throughout the United States. It was the surgery of our future. I completed my residency training six months later, in June 1973, at the clinic. Because of my gratitude for being selected into the Berry Plan and being temporarily deferred from Vietnam, I volunteered to work once a month for the U.S. Navy for the last three years of my residency. I was 354 : dartmouth veterans stationed— ­ inactive duty— ­ for two and a half weeks in 1971 at the Philadelphia Naval Hospital, a three-­ thousand-­ bed facility at the time, on loan from my residency program in Cleveland. At this time in the Vietnam conflict, the Philadelphia Naval Hospital was designated to be the evacuation center for the Eastern Seaboard for amputees from ’Nam. Primary amputations were frequently performed — ­ guillotine fashion— ­ in the field of conflict in Vietnam or later in Germany or Japan, which were the immediate secondary evacuation medical locations for such injuries. Initial lifesaving measures were performed immediately on the field of battle or close by. Traumatic wartime amputations were, by nature, dirty and contaminated when sustained in battle, hence the need for guillotine amputation as a first stage. A guillotine amputation is not closed primarily, and the terminal portion of the limb is left “open.” Major vessels are ligated, and the open wound is packed with gauze and wrapped in compression dressings or plaster. Primary or revision closure was delayed until infection was not only controlled, but completely eradicated. Germany and Japan handled the majority of such injuries with delayed revision closure after infection was controlled. Only those amputation cases that could not be sterilized or were otherwise so horrendous because of other circumstances were sent to the Philadelphia Naval facility for final tertiary treatment. The original Philadelphia Naval Hospital was fifteen stories high, and was later expanded to house three thousand patients in fingerlike, rapidly constructed wards extending out from the primary facility to accommodate all the severely disabled amputee casualties from all the services. One, two, three, and four-­ limb amputees were all present there. Four-­ quadrant amputees were sometimes transported in nothing more than modified baskets. The coordination between naval doctors, nurses, corpsmen , professionals in prosthetics and orthotics, rehabilitation, physical therapists, psychiatrists, and many other areas of expertise was an experience that is impossible to relate or write about. I revised and performed countless more amputations in two weeks in 1971 than I was exposed to in my entire career as an orthopedic surgeon after the war. This form of surgery is very sobering and unhappy work. It is work that a surgeon never looks forward to and doesn’t enjoy thinking about in present or past tense. Amputation work is almost impossible for the average lay person to comprehend. C. Dean Razzano : 355 What is far more incomprehensible and unexplainable is the utter absurdity and inanity of war and its consequences that all...