- From Army service to physician to patient
If my experience were a script for Clint Eastwood, the title would be, "The High-5, the Good, & the Bad." I have not experienced what some other vets unfortunately have, " . . . , & the Ugly."
After graduating from college and my 2 ½ year stint in the Peace Corps in Colombia, and during the early U.S. buildup in Vietnam, I volunteered for the US Army and the Army's Special Forces ("Green Berets"), received intensive one year training as a Special Forces Independent Duty Medic to function as a physician where there was none, and was in Vietnam for two one-year tours. My four years of service did not result in any need for health care after discharge in December, 1968.
My experiences as an Independent Duty Medic in Vietnam did, however, result in a strong desire to be a real physician. After completing the premed science requirements, I was accepted by the University of Washington (UW) School of Medicine, Seattle, in September 1970, and then UW Family Medicine Residency. Part of that Residency included two months on the Internal Medicine [End Page 90] Service of the Seattle VA Hospital that was affiliated with the UW. The Director of that Service, who was also the Attending Physician with whom we residents met every day, was one of the most humane Attending Physicians I had during my three year Residency. He taught and practiced not only medical science but also compassionate medical caring for the VA's patients.
After residency in 1977, I entered the Public Health Service (PHS), specifically the Indian Health Service. PHS is a "Uniformed Service," and thus I was eligible to receive care at military and VA hospitals.
Fast forward to 1998. That year I was found to have a slightly elevated PSA test—"Prostate-Specific Antigen," indicating possible prostate cancer—during episodic medical care for other reasons at the U.S. Naval Hospital in Bethesda while on temporary duty nearby. I went to the combined university + VA hospital near my permanent duty station in the Southwest. The faculty-doctor had a reassuring patient-doctor manner. The six prostate needle biopsies were done in late July by the Urology Chief Resident there—he had just started his year as Chief Resident. The results included one biopsy lost and the others inconclusive. I asked to be seen by the Prostate Cancer Program at the Walter Reed Army Medical Center, a program with a superb reputation. The doctor I saw there instilled confidence—and did 13 prostate biopsies with great skill. The biopsies were read by the Walter Reed pathologists; they disagreed among themselves on the interpretation and thus sent the biopsies to the next-door Armed Forces Institute of Pathology, the premier pathology institute whose readings were the gold standard in pathology. Final diagnosis: early prostate cancer.
I had to decide which possible treatment to do: surgery (prostatectomy to remove the whole prostate); radiation therapy (kill the prostate and its cancer by radiation from outside the body); brachytherapy (insert several radioactive small pellets to kill the prostate and its cancer from the inside); or "watchful waiting" (follow PSA tests, to do an active treatment only if the PSA progressed higher). I, was 57 years old; my wife Carolyn and I decided against "watchful waiting."
I visited a physician in charge of each type of active treatment. The first was the head of urological surgery at the same university + VA hospital in the Southwest. He maintained no eye contact with me, staring at my medical chart as he recited his information non-stop for me (i.e., what the prostatectomy would be, its recovery time, and why it would be the best treatment option for me). I did not go back. Instead, regarding the surgical option, I met with the urological surgeon at Walter Reed who had done my 13 biopsies; I then met with the doctor in charge of Radiation Therapy at Walter Reed. Both visits had a more gratifying doctor-patient interaction.
A pioneer of brachytherapy treatment for prostate cancer and research about its results had recently moved from Memorial Sloan Kettering Cancer Center in New York City to...