Decision

It's odd, but I hadn't thought about him in years: the soldier whose life I'd saved in Vietnam when my colleagues said he would have been better off dead. Then in spring 1989 I was being interviewed by a writer from American Medical News for an article on trauma care. I'm a trauma surgeon, and I told the writer about my experiences in triage—the process of treating first the wounded most likely to survive. That's when I mentioned my decision to save the life of the horribly wounded soldier.

A month later, after the article appeared in print, the writer, Peter MacPherson, called me with questions readers had raised: "Whatever became of the soldier? Do you think you made the right decision—saving him?"

"I don't know," was all I could reply.

The questions brought back the memory of that night in 1968 in vivid detail. Fresh out of surgical residency, I was stationed at the 71st Evacuation Hospital, near Pleiku. I was having supper in my cubicle when a white-faced young medic came barging in. "Doc, come quick!" Funny, I hadn't heard the helicopters bringing in the wounded...

The soldier was lying on a stretcher—so young, maybe 19, with blond hair, a handsome kid, but all torn up and covered with mud, sticks and blood. To my amazement he was conscious, moaning over and over, "Oh, God, I hurt so bad!"

A door gunner, he'd been on a helicopter that had taken a direct hit from a rocket, and he had taken the brunt of the explosion. I looked at his legs, arms, the head injuries and couldn't hold back my tears.

If the triage area had been filled with wounded awaiting medical attention, he would have been one of those shunted aside as least likely to survive. He would never have made it. But now he was the only patient, and it was up to me.

"Start IVs!" I barked. "Get X rays. We'll take him to the OR!"

During seven hours of surgery our medical team managed to save his arms, but we had to amputate both lower limbs and one finger. The neurosurgeon removed a large metal fragment from his brain. The ophthalmologist worked on his eyes, but they were beyond saving.

The next morning in the triage area, the chief of professional services put an arm around my shoulder. "Captain," the colonel said gravely, "I think you ought to know, the other surgeons feel you should have let that fellow die last night."

I stiffened. "I was trained to care for the sick and wounded," I replied. "God will decide who lives or dies."

He stared at me for a long moment, then walked off.

I went into intensive care. Ken—I learned we had the same first name—was sitting up, swathed in bandages. He seemed remarkably tolerant of his terrible injuries, almost euphoric; I put it down to the brain injury. I began to wonder if the other surgeons had been right. But still...