MASH: An Army Surgeon in Korea

6. In the OR

(j IN r"III~ ()It The nerve center ofthe MASH, the very reason for our existence, was the operating tent. In the flux of mobility and the rapidity of case flow, the operating room became the test tube for innovation. In addition to helicopter evacuation ofthe wounded from the battlefield, several advances in emergency medicine came to fruition in the MASH in Korea: the treatment of blood-loss shock, the widespread use of antibiotics, early ambulation, and techniques in arterial repair. Other advances, in the areas of neurosurgery and initial psychiatric treatment, were pioneered in the MASH units. The neurological work was done primarily in MASH 8055, and the psychiatric work, according to my knowledge, was done in conjunction with the evacuation hospitals. Neither ofthese was done to any extent at MASH 8076. Our MASH, as noted earlier, was known as the arterial repair hospital. The conditions were ripe for medical innovation. When the peace talks came and the tactical lines stabilized and the war ground into its third year, the MASH settled into a fixed position. The military medical structure took over again, and the spontaneity that spawned innovation was squelched. But in the first year and a half, the MASH pioneered and experimented its way into the annals of emergency medicine. You had to see it to appreciate it. A number of the things that happened were merely improvisation. We had no notion that the changes we made would result in an advance in medical care. Others were ideas we thought through, discussed among ourselves, and planned before we did them. Many of the advances resulted from the peculiar nature of the mobile war and the rapid flow ofthe wounded to the aid stations and to the MASH. In World War I the front lines were stabilized and the hospitals were as much as 150 miles from the front lines. Many died during evacuation . In World War II the hospitals were more mobile, but the Medical Corps could not keep up with the tactical units. In Korea, the wounded often got to us before the blood clotted. That changed some of the ideas and the methods of treatment. IN THE 011 127 The operating tent itself was just a tent that moved along with the ebb and flow ofthe tactical situations. In the operating tent were three or four surgeons waiting for the wounded. When I arrived, Major Coleman and Captains Scow and Starr were the surgeons. The surgeon I replaced had already left. I had passed him on the road going out ofthe MASH. Three surgeons manned the operating tent. Shortly after I came, Capt. Albert Starr, a classmate from Columbia, rotated out to reduce the total number ofsurgeons to three. Albert, from Brooklyn, New York, was an excellent surgeon who later served as a professor of surgery at the University of Seattle. He was replaced by Capt. Donald "Waldo" Schwing, who arrived shortly before Albert's departure. After John Coleman left and I became the chief of surgery, Capt. Bob Meyers arrived. Waldo and Bob were excellent surgeons who fit in well in the MASH. The aggregate years of experience beyond residency of all the surgeons could be counted on one hand. Perhaps the benefit of that inexperience was idealism. They were all young, and they were all eager to become excellent surgeons and to render to their fellow soldier the best medical care possible. In the operating tent, the surgeons were assisted by the other doctors . Three doctors who were not surgeons were assigned as assistant surgeons. There were, of course, other doctors to fill out the positions assigned in the MASH. Those doctors included practically every kind of doctor found in a hospital, and they worked in their areas when the patients arrived. When the doctors were not working in their own areas, they served as assistants to the surgeons in the operating tent. Even our dentist , Dr. Rice, whom we called Rice Paddy, assisted in surgery in the operating tent. One surgeon worked at each operating table, and another doctor and several nurses assisted in the surgical procedures. The surgeons gravitated by happenstance toward certain specialties. It was not a planned or orderly assignment but more a specialty of necessity . A surgeon would perform a certain procedure until he became proficient in that procedure. Then, when a patient with that wound came in, ifthat doctor was available, the patient would informally be assigned to him. This procedure began in the pre-op tent...