The Ethics of Care Under Fire

A combat medic describes his battle with the difference between the ethics of military medicine and civilian medicine

   As youngsters growing up in a small village in the early 1970s, my friends and I looked up to our local firefighters. My home was located along a river, and the bridge next to my house was a great place from which to draft water. We grew up with the fire department in our front yard, engines roaring, streams ripping through the air like swords of righteousness.

   Firefighters faced danger, and to a little boy, these larger-than-life characters carried an infectious air of invincibility about them, stomping out flames with selfless abandon, seemingly secure with faith in their no greater love.

   As our childhood years passed, from time to time we witnessed our heroes leave off their firefighting armor and provide aid to the wounded and comfort to the ailing. Parked beside the engines was the very angel of mercy herself...the ambulance. She was small by today's standards, her profile an ordinary white van, set apart by the subtle outline of gleaming lights. Every inch of her carried blankets for the cold, splints for the broken, and all manner of comfort for the sick. Her gleaming white paint reminded me of the flowing robes of angels, and even her tires hummed liked heaven's own harps as she raced through the night, brilliant beams of red light driving back the darkness of human suffering.

   In 1985, at the age of 17 and still a junior in high school, I enlisted in the military, taking my place in a long line of brave Americans who answered the call. It was the height of the Cold War, and no one imagined we would ever be in another ground war.

   After basic training, I returned home to finish my senior year of high school. The aging rescue captain in our volunteer fire department asked if I would consider becoming an EMT. The fire department was down to only six EMTs at the time, and they were getting older. I agreed, and completed the EMT course that fall.

   Soon afterward, I picked up an old base station radio and set it up at home. The village siren activated whenever there was a fire or ambulance call, and unless we were at home, we never knew what the call was until we got to the station.

   The first time the radio went off was in the middle of the night for a barn fire in the next town. I didn't have any training in firefighting yet, but I responded anyway. I spent the whole night spraying water at the barn and had a great time. The following morning I responded to my first ambulance call--a cardiac arrest.

   I was hooked, and from then on, I was both a firefighter and EMT. I used to tell my high school classmates that helping other people in a medical emergency was incredibly rewarding, but that going in with a hose and knocking down a really hot fire was like winning the Super Bowl. Each presented its own set of challenges and rewards. Seven years later, I was incredibly blessed to land a job doing what I loved as a career firefighter/EMT-I with the Burlington, VT, Fire Department.

   Twenty years later, our nation suffered the unprecedented attacks of September 11, 2001. The active military was soon stretched thin and, in 2005, our National Guard found itself in the midst of its largest wartime deployment since World War II.

   My family and I watched as the towers fell, and we felt the pain, the loss, the tragedy. In the months afterward, I reflected deeply upon the justification for war. Clearly, our nation was attacked, but by whom? Most of us had never heard of this outlaw band of radical Muslims called al Qaeda. How would we fight this invisible enemy, nestled within the safe havens of sovereign nations who ostensibly meant us no ill will? Would this be primarily a police investigation, tracking down rogue terrorists, or something larger?

   We continued on…raising our children, fighting fires, easing human suffering. In 1999, in the midst of my career as a firefighter/EMT, I became a registered nurse. After a lifetime on the engines and ambulances, I now worked full time as an assistant fire marshal/public information officer and per-diem as an ED nurse. So began the dichotomy that would later come to define my life as a combat medic fighting alongside the infantry in Ramadi.

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