Broken Bodies, Shattered Minds, A Medical Odyssey from Vietnam to Afghanistan which traces the evolution of combat medicine from Vietnam to today and offers an unflinchingly honest assessment of the true damage being suffered by the severely wounded troops, and the nation, in our present wars.During two years at an evacuation hospital in Japan as the Vietnam War raged, Dr. Ronald Glasser wrote 365 Days, an epic collection of searing combat accounts from the severely wounded that he met there. Finally finding a willing publisher in 1971, Glasser’s book was, and remains, critically acclaimed as one of the most important works of its kind. Getting similar praise 40 years later is Glasser’s
How did Dr. Glasser wind up in the Army?
It was like when Hot Lips in MASH asked about Hawkeye: “I wonder how such a degenerated person ever reached a position of authority in the Army Medical Corps?” Father Mulcahy deadpanned, “He was drafted.” I’d always wanted to be a physician and went to Johns Hopkins and then to the University of Minnesota in 1965 for pediatric residency training. When I finished there, my Berry Plan deferment was up, and even though the head of the hospital I was at wrote to his senator asking that I get another deferment to care for the indigent, I was drafted in the summer of 1968. The Army was running out of everything, including doctors and Marines. At the induction center, I saw the draftees lined up and there was a Marine sergeant walking down the line saying, “One, two, three, Marine.” It wasn’t necessarily a death sentence, but it was probably not where they wanted to be going. Marines were being killed in Vietnam then platoon by platoon.
As a pediatrician, your orders were to Japan rather than Vietnam?
My orders were for two years at Camp Zama in Japan to serve the children of military personnel, DOD and government officials. However, as we finished basic training, all of us who were not headed for Vietnam but who had orders for outside the United States were summarily given the “option” of extending our two-year tour to three years—or being sent to Vietnam. I think everyone extended but me. As one guy in my detachment said to me about the risks: “You know, they don’t have to kill you. Have you ever seen a one-armed surgeon?”
So you were prepared to go to Vietnam?
I wasn’t married. I had nothing and I could not bring myself to extend another year just because I was afraid. Well, when I declined to extend, they seemed shocked and tried to talk me out of it. But it turned out to be a big bluff by the Army to get an extra year out of all these doctors. I ended up going to Camp Zama anyway, for just two years.
What did you find when you got there?
A whole new world. We had mass casualties pouring in, and the Army was sending non-surgeons into the operating rooms. When I was ordered in—being somewhat elitist at this point—I had the nerve to tell our commander, “I’m a pediatrician and haven’t been in an OR for years.” He didn’t want to hear that. He put his hand on my shoulder and said, “That’s OK, we’ll just give you the little fucking wounds.” I realized then that when they ask you to do something in the Army, they expect you to do it.
Who ended up at Camp Zama’s hospital?
Everybody it seemed. One day on the surgery ward, as I looked around, I had this epiphany. “My God, the whole war is coming here.” I realized if I were in Vietnam, I’d be with just one unit or at one hospital, whereas at Zama everyone except Marines were coming here, from LRRPs to chopper pilots, Special Forces, infantry, everybody, from everywhere across Vietnam, having the gamut of combat experiences and suffering from every type of wound.
What led you to start writing about them?
About a quarter of the way through my tour, Life ran a photo story about the evacuation chain in Vietnam. They had decided to follow a second lieutenant, a white guy who had graduated from Princeton, who had a slight hand wound. And here I am, reading this, surrounded by guys with transected spinal cords, penetrating head wounds, guys burned over 90 percent of their body, guys with no face. It was crazy and it just pissed me off. The country just didn’t know what was really going on. This war was a lot more ferocious than anyone was willing to admit. I decided I needed to write about this, about who was really paying the price in this war.
How did you start 365 Days?
My first story was about a sergeant in the 9th ID. I asked him to tell me about what it was like in the Delta. I wrote it all up and a couple of days later took it back to him to review, because I wanted to make sure it was right, and found he had died. So I asked the ward master to let me know when the next guy from the 9th in the Delta came in. He did, and I asked the next guy to check the story. Some of my stories were edited by a number of patients. I ended up recruiting a “technical adviser,” a LRRP Ranger who was a patient. I wanted to make sure every detail was right.
How did combat medicine advance in Vietnam?
We took civilian trauma care to the battlefield. In any trauma injury, what kills is bleeding to death. The evacuation chain focused on the “golden hour.” If we could get you out to a surgical hospital in an hour, you’d probably live. If we couldn’t, and couldn’t stop the bleeding, we just watched them die. In Vietnam, generally if you died, you died right there. The Vietnam casualties were 2.4 to each death. The medevac flew you to a surgical hospital and they fixed you up and stabilized you. There were huge advances in vascular surgery. Then, when someone decided you could survive four hours on a C-130, it was off to Japan. That’s where you stayed for an average of 30-40 days before going back to the States. The survival rate at Zama was very high.
You recount in your new book about seeing Max Cleland in Zama’s ICU.
Max Cleland was sort of the poster boy for the evacuation chain, how he survived and got to Zama with both legs and left arm gone. The ICU was nightmare stuff, really. I can remember the surgeons asking themselves, “Should we just let him die?” But if you didn’t bleed to death or get killed by infection, you were likely going to survive, like Cleland.
How was the “Black Hawk Down” incident in 1993 pivotal for combat medicine?
In Vietnam, the Army prided itself on saying anyone hit was no more than 10 minutes from the nearest surgical or evacuation hospital—contingent, of course, on choppers getting in. Medics did what they did there because they understood minutes did matter, keeping soldiers alive long enough for the choppers worked in Vietnam. In Mogadishu in 1993, the choppers couldn’t get in, the Rangers died. With that, the military realized it had to change the training of medics. It was time to change from triage to intensive care, to have the ability to keep the severely wounded alive where they were hit, with little chance for immediate evacuation. This requires big-time medicine; basically the city hospital trauma unit moves onto the battlefield.
What has been the key change and what is the consequence?
The use of whole blood rather than IV fluids and plasma to treat shock has made the greatest difference. That has made it more difficult to die on the battlefield than in any of our other wars in our history.
How have the enemy’s tactics themselves altered combat medicine?
The Taliban aren’t crazy, they know they cannot stand up against gunships, fighter-bombers, missiles. So when we switched to counterinsurgency rather than counter terrorism, requiring us to win hearts and minds, we had to put troops on foot patrols. The enemy realizes that if U.S. troops are coming into the villages, they can blow them up with what we call IEDs, improvised explosion devices.
And how has our defensive counter to this tactic worked?
Body armor is saving our troops’ lives now. Largely, they are not suffering the high velocity wounds as in Vietnam. I talked to surgeons in Iraq who were in Vietnam or very familiar with the types of wounds suffered there. They were shocked when they first pulled wounded off the choppers and took off the body armor and found not a scratch from chin to groin. In Vietnam, you were shot up. In Afghanistan you are blown up. Despite the severity of the new wounds, death rates have not increased. The casualty- to-death ratio is now 16-to-1. Injuries that would have killed in Vietnam are being survived. The amputations, wounds to genitalia and traumatic brain injury are the signature wounds today.
What are the implications of the recent findings linking PTSD and traumatic brain injury (TBI)?
The connection between TBI and PTSD is critical for everybody coming out of Iraq and Afghanistan. If you want a medical diagnosis, you need a physical fact. The damage to the wiring of the brain has never been viewable until recently, made possible by the development of diffusion tensor imaging. A large percentage of Iraq/Afghanistan war vets diagnosed with PTSD could actually be suffering from TBI. It seems to me that much of the poor judgment and craziness associated with PTSD could easily be the result of a TBI.
How could that affect treatment, even of Vietnam veterans?
It changes everything. There are some in the VA system who believe all PTSD patients should be given a trial of anticonvulsive medication, which is effective for TBI. What if 80 percent of those diagnosed with PTSD are suffering from TBI? While PTSD is treatable, TBI would be a lifelong disability.
Why do you think 365 Days has been called one of the best books about Vietnam?
The most important thing about that book was that everybody who’d been in Vietnam and read it gave it to someone to read—so they didn’t have to explain it.
As 365 Days was seen as a blistering critique of the Vietnam War, in Broken Bodies, Shattered Minds you have some harsh criticism of the present wars and how we are fighting them.
When the French government wanted to send troops around the world to fight their wars, they knew the French people would not let them send their sons. So they created the French Foreign Legion, filled it with foreign nationals and did just what they wanted to do. And the French population didn’t care. In a sense, that’s what we have done with today’s volunteer Army. It has become our French Foreign Legion. Until there is conscription in the United States, the dialogue about these wars will continue to be flat and stupid.
Do you believe Vietnam vets have a special role to play in the debates about our present wars?
What happened in Vietnam and the truth about what was happening to the troops has been trumped in Iraq/Afghanistan by the insidious silence, the disinterest. No Vietnam vets I know ever thought we would be going through this nonsense again in our lifetime. Yes, we have an obligation. As far as explaining what is really going on, it’s up to us vets. That is the reason I wrote Broken Bodies, Shattered Minds.