American servicemen and women fighting in Vietnam received the best medical care in the history of warfare. For one thing, chances of surviving a battlefield wound were dramatically increased. Between January 1965 and December 1970, 133,447 wounded were admitted to medical treatment facilities in Vietnam, and another 150,375 Americans received wounds not serious enough to require hospitalization. Of the 97,659 most seriously wounded who were admitted to hospitals, the mortality rate was 2.5 percent, compared to 4.5 percent in World War II. The ratio of ‘deaths as a percent of hits’ was 29.3 percent in World War II, 26.3 percent in Korea and 19.0 percent in Vietnam.
And the same was true of disease. Even though tropical diseases such as malaria, melioidosis, elephantiasis and dengue fever were common, the average annual disease admission for Vietnam (351 per 1,000 per year) was approximately one-third of that for the Southwest Pacific theater in World War II (890 per 1,000) and more than 40 percent less than the rate for the Korean War (611 per 1,000).
These successes did not just happen. They were brought about by the hard work of the doctors, nurses and other medical personnel, from the front-line medics and dust-off crews to the staffs of the rear-area hospitals and hospital ships.
One such was Dr. Clarence T. Sasaki, who spent a year in Vietnam with the U.S. Army’s 95th Evacuation Hospital in Da Nang. His unit was responsible for the Americal Division, which consisted of 11 battalions of light infantry, one armored cavalry squadron, two armored reconnaissance troops, an air reconnaissance troop, six battalions of artillery and three battalions of assault helicopter squadrons. The Americal Division (officially the 23rd Infantry Division) almost exclusively engaged North Vietnamese Army (NVA) regulars while operating in the three southern provinces of I Corps.
Today, Dr. Sasaki is the Charles W. Oshe professor of surgery and chief physician of the Ear, Nose, Throat and Head and Neck Cancer Clinic at Yale-New Haven Hospital in New Haven, Conn. He talked with formerVietnam senior editor Al Hemingway:
Vietnam: What was your background prior to your entry into the U.S. Army?
Sasaki: I was born in Hawaii and went to Yale University Medical School. There was a deferment program called the Berry Plan at that time. There were two options available — a one-year and a three-year plan. The three-year plan meant you would be deferred from going on to active duty until you finished your residency training.
Vietnam: Sort of a medical ROTC.
Sasaki: Yes, but they didn’t pay you. I got the one-year plan. I had no choice. If I was drafted, I would enter the Army as an infantryman and not as a medical doctor. I was doing my internship at that time and agreed to my commission. I went to Fort Sam Houston, Texas, and from there to Fort Lewis, Washington. I was assigned to Madigan General Hospital and was there only three months when I got my orders. I held the rank of captain at that time, and I couldn’t understand the Army language on my new orders. So, I went to see a sergeant. He told me, ‘You’re going to Vietnam, doctor!’
Vietnam: What year was this?
Sasaki: This was 1969. My wife was pregnant with our first child. Actually, my first son was born while I was in Vietnam. I didn’t see him until he was about 9 months old.
Vietnam:What was your first impression of Vietnam?
Sasaki: I remember distinctly leaving from Travis Air Force Base. I received very little sleep. On our flight we had a bunch of returning vets going back for their second tours. On overhearing their stories, I was getting scared! What am I getting into! On Okinawa we took on Marines, which scared me even more. Just before landing in Vietnam, I looked out of the plane and saw all these craters. I thought they were bomb craters. I found out later they were burnt out latrines! We landed in Bien Hoa, and I went to a holding company where I got to know some of the infantry officers, mostly young first and second lieutenants. These guys had a high battlefield mortality rate. It was traumatic for me to talk to these people, some of whom, I knew, were going to die in combat. And I might even be treating them.
Vietnam: Where did you go from Bien Hoa?
Sasaki: I stayed there for 10 days. I hated it! The food was terrible, and the mosquitoes were brutal. I brought two bags with me — one with my clothes and the other with my medical books. Well, they issued us combat gear — flak jackets, helmets, the works. Now I had three bags. Finally, I received my orders to Da Nang. A deuce and a half truck comes at 3 o’clock in the morning to pick us up. I’m only 5 feet 5 inches tall, and I was sick with a bad cold and extremely dehydrated. I couldn’t even throw my bags on the truck! So, one of the soldiers felt sorry for me and he said, ‘You climb in the truck and I’ll throw the bags up to you.’ Well, I couldn’t even get in the truck! I finally struggled aboard. Under tight security we went to the airstrip at Bien Hoa. They unloaded the bags and threw them in a big pile! I finally got my bags and someone directed me to a gate with a big eagle on it. I thought it was the 101st Airborne. I thought: I can’t even get on a truck; how will I be able to jump out of a plane! I boarded a C-130, and I was sitting near the tail. I prayed the tail wouldn’t open because I would’ve been a goner!
Vietnam: Your first two weeks in-country were miserable ones, and you haven’t even been assigned to your unit yet.
Sasaki: The plane finally landed in Da Nang, and it was beautiful there, as I remember. I went to the 64th Medical Group. It was located between China Beach and Monkey Mountain. I stayed in a Quonset hut, by myself, for five days, waiting. Finally, they announced where I was going — the 95th Evac Hospital — right across the street! I hoped it wasn’t like this for everybody. I settled in and began my duties. As I look back on my arrival, it was rather humorous.
Vietnam: How large was the 95th?
Sasaki: We had about 200 beds. It was a good-sized hospital.
Vietnam: What about the staff?
Sasaki: We had approximately 30 doctors and between 50 and 60 nurses. It was the main U.S. Army hospital in Da Nang in direct support of the Americal Division. Of course, we would treat other solders from other units as well.
Vietnam: Did the doctors ever work shifts?
Sasaki: Usually only the nurses worked shifts. When I arrived I hadn’t had any ENT (ear, nose and throat) training yet. I assisted a fully trained ENT surgeon. He taught me triage, among other things. He was a good surgeon. There was a lot of esprit de corps. The staff worked together well as a team. There was no infighting at all. Everybody was very well trained. So much, in fact, we didn’t have any general medical doctors with us. We took turns manning the emergency room.
Vietnam: Every doctor was a specialist?
Sasaki: Yes. There were chest surgeons, ENTs, dermatologists, even a dentist.
Vietnam: When an individual was wounded and brought in on a dust-off chopper, what were the steps taken once arrived at the 95th Evac Hospital?Susaki: It was an excellent system the military had. The 67th Med Group, the administrative office for several hospitals, for example, would receive a message that five individuals were coming in. They were told what type of wound it was — head, chest, stomach, whatever. They in turn would send some of them to us. So, we would be waiting for them. If a soldier was brought in with a fragmentation wound to the face, they would telephone my hootch (living quarters) — if I wasn’t on duty — and I would get over there to operate on him.
Vietnam: That was your specialty?
Sasaki: It was my area. If there was a chest wound, they’d get a chest surgeon.
Vietnam: What if they brought in five chest wounds? Would you perform surgery on one of those individuals?
Sasaki: No, because the 67th Med Group was so organized they knew how many chest surgeons we had at any one time. They even knew when we were on R&R so as to divert patients elsewhere. Then they would send them to the naval hospital next door or to the hospital ships offshore. It was a very efficient system. However, sometimes we’d get mass casualties. Everybody pitched in then. Doctors and nurses would be everywhere — in the emergency room, stitching up wounds, giving IVs, anything at all.
Vietnam: What were the most common wounds?
Sasaki: The most common were the orthopedic injuries to the arms and legs. I remember my first mass casualty. We were on red alert, and we had to operate while wearing our helmets and flak jackets. I vividly remember one GI coming in with no arms and legs. He was awake, and I asked him what had happened. He informed me that they sent his unit from the Americal Division into a valley because the South Vietnamese Army (ARVN) refused to go. I didn’t think too much of it at the time. But later on, I heard more and more of the ARVNs refusing to do something and our guys getting wounded as a result of it. That bothered me. I learned slowly what the war was all about.
Vietnam: I hope you saved that soldier.
Sasaki: We never got any feedback as to what happened to our patients. We did our amputations and resuscitations and kept them in the hospital for about five days until they stabilized. From there, they generally went to Japan.
Vietnam: Maybe it’s good in a way that you never got any word on a person’s condition after he left the 95th.
Sasaki: That’s true. On occasion, we traveled to Japan with a patient who was seriously wounded to monitor his condition in flight. We took turns. I did it a couple of times.
Vietnam: Besides the wounded, did you ever treat any illnesses such as malaria or dysentery? Some of these tropical diseases were prevalent in Vietnam.
Sasaki: Since we were a surgical hospital, we rarely saw those types of diseases. And when we did, it was usually the civilian population who had them. One point I’d like to make is the different stages of wounds seen during my tour. When I first got there we had quite a few fragmentation wounds. Then, during the middle part of my tour, it got pretty quiet and we treated more Vietnamese. Toward the end, there were more gunshot wounds. Also, toward the end of my tour in 1970, the fighting got heavier.
Vietnam: Did you ever treat any Viet Cong or NVA soldiers during your tour?
Sasaki: Probably, but we never knew for sure. We suspected some of the injured were VC. The mama-sans who cleaned up our hootches would point and say to us, ‘VC! VC!’ But there was no way of actually knowing.
Vietnam: I co-authored an article in the October 1989 issue of Vietnam magazine about an Army nurse who experienced some disciplinary problems while serving with the 91st Evac Hospital at Tuy Hoa. Did your unit ever have any disciplinary problems?
Sasaki: There was one discipline problem — me! Toward the end of my tour, we were getting more injured Americans. And not just shrapnel and frag wounds, but more gunshot wounds, as I stated earlier. Anyway, we were told to take all the South Vietnamese that came to us. And my objection was, if we take every Vietnamese, we won’t have any beds left for our men. I had a ward that had, maybe, 12 beds on it. I said I would allocate half of it for Vietnamese. My commanding officer told me I couldn’t do that. He had orders to accept only Vietnamese. I asked, ‘What about our guys?’ We got into an argument, and he told me that he would give me an Article 15. I’m not sure if I’m correct about this, but an Article 15 is something that is given prior to a court-martial. One month to go and I’m threatened with court-martial! So, I gave in. That was the only disciplinary problem I can remember.
Vietnam: Being of Japanese descent, how were you accepted by the Vietnamese?
Sasaki: I did have some experiences that led me to believe that I was not as safe as the Caucasian Americans there. For example, when I would be in the mess hall, the Vietnamese working there knew I was Japanese and pointed at me saying, ‘You Japanese!’ And I tried to tell them I was an American. They didn’t say it in a friendly way. I knew the Japanese army during World War II had raped and pillaged through Vietnam, and they identified me as being different from the ordinary GI. Also, it worked in reverse. One Sunday I went to the Navy PX (post exchange). I was alone and I walked in and nobody was there. It was a small PX. So, I shopped around, and when I finished I began looking for a cashier so I could pay for these items. I went outside and this individual who ran the PX saw me and thought I was a Vietnamese stealing these things. He whips out his pistol and points it at me! I could’ve been shot! I didn’t feel secure. I had to be careful.
Vietnam: Was your unit ever under enemy fire?
Sasaki: Yes, but they weren’t aiming at us. They were trying to hit the Navy camp or the airstrip. The rounds would come from Marble Mountain, and some shells hit close by. Luckily, we didn’t get any direct hits. We received a ground attack from the beach once. We knew something was up because we watched the German hospital ship move out to sea. They always had inside information. And when they got word of a possible attack they moved farther offshore. Some sampans landed on the beach, and we heard some shots fired. We heard later that our unit called for Army units to assist us and they didn’t respond. The Marines came instead and drove the VC off. One of our corpsmen got shot during this attack — he was on guard duty at the gate — but his wound wasn’t serious.
Vietnam: How many patients did the 95th treat, say, in a week’s time, or a month’s time?
Sasaki: It was pretty uneven and sporadic. I personally would see 50 or 60 patients a day in our outpatient service. It was also the time President Nixon announced his troop withdrawals, so any person with a serious enough ailment would be sent out of country to further reduce the number of men in Vietnam.
Vietnam: Did you ever participate in any Medical Civilian Action Patrols (MEDCAPs)?
Sasaki: No. However, we regularly went over to the Vietnamese Provincial Hospital nearby. We found it easier if they just came to the hospital.
Vietnam: Did quite a few Vietnamese take advantage of the hospital?
Sasaki: Yes, and I’d say about half of them were children.
Vietnam: What would you consider your most unusual or most difficult case in Vietnam?
Sasaki: There were several that stick in my mind. One involved a medic on a medevac chopper. He was part of a battalion aid station, and he went out to pick up some wounded. As the chopper was lifting off, he looked out and was shot in the throat. He couldn’t talk because the bullet went through his neck. His buddy started an IV on him and just loaded him up with fluids. When he came in, they had given him so much fluid that it was backed up in his heart and didn’t have any place to go and was seeping into his lungs. So, when he was brought in, he was frothing at the mouth and couldn’t breathe. At any rate, I repaired his larynx, and he was sent off to Japan. I later heard he went to the Philippines, where I lost track of him. I would like to know what became of him.
Vietnam: And the other?
Sasaki: There was a Vietnamese child about 2 or 3 years of age who was suffering from a case of malnutrition that caused the tissues of the face to become gangrenous and fall off. He was my patient. About 3:00 in the morning, a corpsman woke me up and said the head nurse wanted to see me right away because they found a snake in bed with this child! I ran to the hospital and found, not a snake, but a large worm! It was about a foot or so in length! What made this even more bizarre was the fact it had crawled out of the child’s rectum! That I will never forget.
Vietnam:Continuing on, was there any operation that you performed or assisted another doctor with where a patient wasn’t expected to live but miraculously recovered?
Sasaki: I’m sure we did. But, again, we received little or no feedback as to the recovery rate of our patients. I can vividly recall one soldier who was wounded in an armored personnel carrier (APC) and had burns over 95 percent of his entire body. This was a fatal injury; that is, we knew he was going to die. He asked me, ‘Doctor, am I going to die?’ What could I say? I lied to him and said he was going to live and we were going to take good care of him. Luckily for him, he was so severely burned that the nerve endings were gone and he was in no pain.
Vietnam: Do you think your time in Vietnam has benefited you today from a medical point of view?
Sasaki: It certainly taught us to operate under pressure. And since I had not been fully trained yet, it was extremely helpful. My surgical skills benefited greatly from having been over there. I remember coming back and not being terribly frightened by tremendous bleeding as my co-workers were. I had seen so much of it in Vietnam. Also, my surgical techniques were better. I also found the Army to be a good experience as far as developing leadership qualities. I learned that there is a definite hierarchy in rank. But being a good leader doesn’t always mean riding his people to death. You should care for the people you are responsible for, and they’ll pay your back by doing a great job. That lesson was very clear to me. It’s helped me in my civilian practice.
Vietnam: Any regrets?
Sasaki: I have only one regret about my Vietnam experience. It seemed to me that the medical staff who were Regular Army doctors rarely got assigned to Vietnam. The people sent over there, at least to my perception because I don’t have any figures or numbers, were largely reservists. Doctors just finishing their residency, or trying to, were being sent over there. I thought it was unfair. For example, with the exception of my commanding officer, who was Regular Army, we were all reservists. The military now has a vast majority of medical staff who probably have never experienced operating under combat conditions. It would seem to me that if one selects a military career, he or she should be exposed to those wartime conditions to sharpen his or her medical skills. At that time, I was angry about it. But now, I think to myself, I’m glad I was there. And if there’s ever another war, I would be a more competent military surgeon than the guy who is Regular Army.
< This article was written by Al Hemingway and originally published in the June 1992 issue of Vietnam Magazine.
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