The True Meaning of Semper Fidelis – Unabridged

A Surgeon’s Journey to Heal Wounded Marines

This is the story of how an orthopedic surgeon from a small California ski town came to serve at age 61 in Iraq and Afghanistan. This is a story that belongs not just to me, but to the many soldiers, sailors, and Marines who inspired, paved the way for me, and helped me along the way. This is their as much as mine.

Our older son, Nate, was a gifted musician, scholar, and athlete, a natural leader with a keen wit and wry grin. My wife, Christine, and I knew that Nate, with his God-given gifts and tireless work ethic could achieve anything in life he desired.

Like many young men and women of his generation, Nate was forever changed by the terrorist attacks of September 11, 2001.

He knew that 9/11 was a history changing event and set his course on serving his country. He sought the challenge of the Marine Corps. During the hot summer of 2004, he reported to Officer Candidate School in Quantico, Virginia and successfully completed the grueling ten-week officers’ boot camp. Christine and I later attended his graduation ceremony in August and watched in amazement as our boy-now a man- marched his company around the parade ground using a drill sergeant voice that we had never heard before. We both said, “This is the real deal.”

During the ceremony I reflected back on a backpacking trip to Southern Utah that Nate and I took to help him prepare for boot camp. At a steep, up climb, he reached down and pulled me and my heavy pack up the rock face using only one arm. Earlier that spring while we were whitewater kayaking in a Class IV stretch of the North Fork of the American River, we stopped to view a particularly difficult drop-Staircase. He looked at for a minute and then -without saying a word- calmly carried my kayak around the drop. He then boated it without a problem. Clearly on the hike and on the river- the torch had been passed. Nate was strong and confident in the wilderness, and he was now in charge of Dad.

Nate’s younger brother, Austin, was with us that day at Quantico as well. Clearly the experience rubbed off on him. He decided that day that he, too, wanted to become a Marine.

In September, 2006, Nate emailed Christine, Austin, and me as he departed Okinawa for Iraq. He wrote to us: “Almost five years to the day after September 11,2001, I have a chance to put my money where my mouth is in terms of service. I’m constantly reminded of the famous quote from Tom Hank’s character at the end of “Saving Private Ryan”-“Earn this.” Earning it will require sacrifice, determination, and doing my job to the best of my ability. I chose this and I wouldn’t have it any other way.”

Later in the deployment while Austin was at OCS in Quantico, Nate wrote him with a description of an attack that killed Sergeant Jonathon J. Simpson, a much admired member of 3rd Recon Battalion. He wrote to Austin,” Why do I tell you this? Because Sgt. Simpson and many All-Americans like him are the ones you are entrusted to lead, protect, and stand in front of. Never forget that all the trials and training that you and the other candidates go through is not about you. America’s sons and daughters will be entrusted to your care. You

owe them competence, discipline, courage, and judgment. Post Sgt. Simpson’s memorial picture perhaps up on your squad by read-board, tell your fire team and squad and platoon all about him- as a clear reminder of what this is all about. Keep it with throughout the trials ahead. Because when you hear the final roll call, the long bugle playing taps, and the bagpipes wailing- we better have everything short of the hand of God Himself to accomplish the mission and bring our Marines home. It is a sacrifice he and many like him have made fighting for each other. Earn it..”

In a satellite phone call to us in early December Nate described in detail how he and his squad saved the life of an Anbar villager. The Recon patrol had come across a band of Sunnis accompanied by an older man. Nate and his interpreter were able to quickly determine that their cover story was completely false. In actuality they were Insurgents who had killed this man’s son and were preparing to execute him as well. The Recon Marines secured the Insurgents and rescued the local man from certain death.

Later that same week in December, Nate was killed in an IED attack on his HUMVEE while on patrol near Fallujah, in Al Anbar province, Iraq

At his Memorial Service in Iraq, Lieutenant Colonel Bill Seely, Nate’s CO at 3RD Recon spoke of Nate’s “point of honor as his commitment to service. A man who’s calling was ‘Not Self, but others’ Nathan brought to this battalion professionalism, teamwork, integrity and fidelity.”…..He concluded, “ When we depart these lands and redeploy, we will not remember the words of our enemies but the long silence of friends……Nathan- your love, your brotherhood, and your memory, like the flash on the horizon at sunrise and sunset, will be endless, your silence will be deafening.”

After Nate’s death, Austin, just as he had successfully completed Officer Candidate School, was given the option of walking away from his commitment to the Marines. He never entertained the thought. One week after his brother’s death, Austin was commissioned a 2nd Lieutenant in the Marine Corps in a small ceremony in our living room in Reno, Nevada. In early January 2007, Austin returned to Quantico to begin the in-depth, six-month officers’ course at The Basic School. Christine and I returned to our orthopedic practice in the ski town of Truckee, California, near Lake Tahoe

The story could have ended there. But another Marine came into our lives: LtCol Bill Seely. The following summer in 2007, LtCol Seely came to visit our family. . As we hiked along Lake Tahoe’s Emerald Bay, I asked him a simple question: Who took care of his Marines? He told me that every Marine battalion deploys with a Navy physician, who remains with the Marines continuously. I knew, in that moment , what I wanted to do, to take of Marines in Iraq and Afghanistan.

There was only one small problem. I was 60 years old.

I called the nearest Navy medical recruiter San Francisco, LCDR Ken Hopkins. He thanked me for my interest but told me, very politely, that I would need an age waiver and he doubted I would be able to get one.

A few weeks later, we had an unexpected opportunity to meet the Commander in Chief. President George W. Bush was planning to be in Reno and wanted to meet privately with local

families who had lost loved ones in Iraq and Afghanistan. Christine and I accepted the invitation. Austin, then stationed at Camp Pendleton flew to Reno to join us.

At the end of an emotional meeting the President asked if there was anything he could for any of us. I was last to speak, “Mr President, I am an orthopedic surgeon and I want to join the Navy Medical corps, but I was told I was too old. And no disrespect sir, but I am younger than you are.” President Bush looked directly at Christine and asked, “What does Mama think about that idea?” Luckily, she supported my desire to serve in the Navy Medical Corps. The President said, “No promises, but I’ll see what I can do.”

Three days later, I got a call from LCDR Hopkins. “Well Bill”, he said chuckling, “Looks like you got your age waiver.” And so, I started the two-month vetting process to become a Navy officer.

On November 19, 2007, at our home in Reno with LCDR Hopkins officiating I was commissioned a Lieutenant Commander in the Navy. At the end of December, we closed our orthopedic surgery practice and moved to San Diego to be near my new unit- the 4th Medical Battalion- a combined Navy/Marine Reserve surgical battalion.

I felt that I had plenty of orthopedic experience from nearly thirty years in practice in Truckee. But I needed training in military medicine- especially combat casualty care -which is unique in the field of orthopedic trauma. Captain John Williams, MC, USN, CO of 4th Med Bn and Navy Captain Steve Medina, head of the Instruction and Inspection full-time Marines and sailors supporting Reservists at 4th Med, were instrumental in making sure that I checked all the training boxes to get ready for operational medicine. I spent the better part of 2008 getting trained up to prepare for deployment. I went to San Antonio to take the military’s Combat Casualty Care Course (C-4), along with Advanced Trauma Life Support (ATLS). I traveled to LA County Hospital for the Navy Trauma Training Course for three weeks. These courses were superb-often taught by military surgeons just returning from deployment and eager to share “lessons learned” with the class. To learn more about working with Marines, I headed to Camp Pendleton for the two-week Field Medical Training Officers’ Course. There I was the sole medical officer training with Navy Corpsmen who were getting field training in emergency care to deploy with the Marines.

The most unpleasant course was officers’ boot camp or the DCO Indoctrination Course (more commonly known as “knife and fork” school) in Newport, RI in the dead of winter. Marching around the parade ground during a freezing rainstorm up to my ankles in ice water certainly tested my motivation. I have heard that Newport is delightful in the summer. Sunny San Diego was starting to look very appealing.

The culmination of all the military medical training was a three-week deployment with a surgical team to Morocco in June,2008 in support of Marines doing “live fire” training with the Moroccan military. We set up our surgical suite in a tent on a remote military base in SW Morocco. While we had no major emergencies during this exercise, this was a great opportunity to learn how to function as a team in an austere environment. We flew in all our gear – including generators, ambulances, anesthesia machines, portable oxygen generators, surgical gear, portable OR tables and all our supplies. We camped next to the OR tent, ate MREs, washed our clothes in buckets, and spent our days training as a team. The Reserve’s

surgical teams were composed of older, more experienced surgeons, nurses, and Corpsmen than the typical active duty surgical teams. I found them, as a group, to be dedicated, selfless, and patriotic and more than willing to devote a weekend a month and two or three weeks in the summer to maintain their skills in the Navy Reserves. The Reserve units would be heavily utilized both in Operation Iraqi Freedom and Operation Enduring Freedom in Afghanistan.

I volunteered to deploy to Iraq in early 2009 –as an Individual Augmentee –to the 2Nd Medical Battalion from Camp Lejeune, North Carolina. There I was mobilized to Active Duty and sent to Okinawa with a small surgical team to do our pre-deployment workup at Camp Schwab, at the north end of the island. Ironically, Nate had done most of pre-deployment training with 3rd Recon Bn at Camp Schwab as well. From my quarters, I looked out at the parade ground where Nate had been promoted to 1st Lieutenant, in August of 2006. The 3rd Recon CO, LtCol Ollie Spencer quietly showed me the memorial to Nate and other fallen Marines at their nearby headquarters.

How likely was it that I would end up at Camp Schwab in Okinawa to do my pre-deployment training in 2009-essentially the same path taken by Nate in 2006? Was this just pure coincidence?

In February, 2009, we flew in a noisy, hot C-130 with mesh row seats in full combat gear including helmet, flak vests with Kevlar plates, and weapons. On approach to our base- Al Taqaddum Air Base in Al Anbar province, we went into a steep, sharply banked spiral dive into the air field in the dead of night—to avoid ground fire. I thought we had landed on the moon- there was no ambient light for security reasons, no greenery, no trees, no plants, just sand and concrete. The housing units and chow hall were surrounded by 20 feet high concrete “blast walls” for protection in case of rocket or mortar attacks. The “cans; or thin metal portable housing unit, measuring about 6 feet by 12 feet, and consisted of bunk beds, jury- rigged desk and set of drawers and the necessary AC. Communal bathrooms and showers were a short hike away from the “cans.”

The TQ surgical facility was impressive with a large trauma bay (ER) and two large operating rooms with a three-bed recovery room and small inpatient unit. This was a hardened, fixed facility that had been constructed a few years earlier when combat in Anbar was intense. The OR even included a C-arm image intensifier (portable fluoroscopic unit) to aid in fracture reduction and fixation. We had basic laboratory, blood bank, and X-ray support, as well.

Things were pretty quiet in Anbar during 2009. We saw few combat-related injuries during this deployment. We essentially did routine orthopedic care for our Marines who had sustained knee, shoulder, back, or ankle injuries during training on base or at the gym. In addition, we taught orthopedics to the battalion surgeons (general medical officers) and established a Navy corpsman’s orthopedic care course. In our spare time, we prepared for the comprehensive Fleet Marine Force Qualifying Officers test (FMFQO), available to Navy officers deploying with Marines. This deployment was a good opportunity to learn how to work in the desert with stifling heat, bad air, dust storms, and occasional indirect fire from insurgents.

Austin was deployed at the same time in Iraq (OIF, 9.2), stationed at Al Assad Air Base in Anbar province. He was not pleased when he heard that I had traveled through Fallujah in a convoy

to visit a nearby small Marine base. He asked me to meet with the CI/HUMINT team at TQ for a briefing. I had no real idea that Al Anbar province and the territory near Al Taqaddum were currently a hotbed for the Sunni insurgency. Most of the intel staff felt that the insurgency had just “gone to ground” and would reappear as soon as the Marines departed. Needless to say, I did not leave base by convoy again.

After seven months in Iraq, I redeployed to California to begin full-time work on the orthopedic staff at Naval Hospital Camp Pendleton. Just as I was getting oriented, I received a call from the Orthopedic specialty leader, Capt. Dan Unger. He asked: Was I available to deploy soon to Afghanistan?

I had to laugh. I had just gotten home and hadn’t even unpacked my bags yet. But it was a very tempting offer that I might not get again. This was a Friday. He said, “Call Monday with your answer.”

With Christine’s continuing support, I joined the 1st Med. Battalion, Bravo Surgery Co for deployment training at Camp Pendleton. The Company was led by Captain HR Bohman- an expert combat trauma surgeon with eight previous deployments and included a cardiothoracic surgeon, CDR Tad Pratt, and a fellowship trained trauma surgeon, LCDR Jon Scheff, as well as anesthesiologists and ER docs and full complement of ICU nurses, OR staff, Corpsmen, lab techs, and Marines for support and security.

In February, we flew to Afghanistan via Manas Air Base in Krygistan. The last leg was on a C-17 jet transport to Bastion Air Base – next to Camp Leatherneck, the Marine headquarters in Helmand province, in southern Afghanistan. When Colonel Bill Seely heard that I was deploying to Afghanistan, he told me to make sure that I introduced myself to Brig General Larry Nicholson, Commanding General of the Marine Expeditionary Brigade which spearheaded the Marine surge in Helmand province. In 2006, then Colonel Nicholson was Nate’s Combat Regimental CO. He sent us a long, heartfelt handwritten condolence note at the time of Nate’s death in combat. I was anxious to meet him in person. Within the small world of Marines, his aide knew about Nate and was insistent on setting up a meeting with the CG at Camp Leatherneck.

Never mind that General Nicholson was just wrapping up one of his usual twenty hour days- he sat down with me at 2200 hours and we talked for an hour about Nate and his deployment in Iraq with 3RD Recon , and then an animated General Nicholson briefed me on Marine strategy and tactics battling the Taliban in Helmand province. General Nicholson, a keen student of counter-insurgency strategies, was certain that the village mullahs and local tribal leaders were the key to separating the Taliban from the local villagers. The first element would be providing security for each hamlet or village. Small primitive Marine patrol bases were set up throughout Helmand province. Marines under General Nicholson’s leadership would not be biding their time “behind the wire” in the large, isolated bases. Marines pushed out on foot patrols on a daily basis to make their presence known to the villagers as well as to the Taliban. As I arrived in Helmand, Marines were busy stirring up a hornet’s nest in Marjah. Ultimately the MEB would be awarded a Presidential Unit Citation for their work in Afghanistan in 2009-2010.

I was initially assigned to Camp Bastion- a British surgical facility co-located with Camp Leatherneck. Navy staff worked side-by-side with British military medical personnel to care for US and British soldiers and Marines, Afghan Army and Police, as well as Afghan civilians. Bastion was the busiest surgical facility in Afghanistan. The billeting was very basic- ten surgeons on cots in a small tent- and the food was typically British-awful, the work was intense.

My first patient was an Afghan soldier with traumatic triple amputation from an IED blast – both legs amputated above the knees and partial amputation of one arm. These severely injured soldiers were treated by teams of surgeons-often two per extremity and at least two anesthesiologists to deal with airway and fluid resuscitation. Our goal was orthopedic damage control surgery- control life-threatening hemorrhage, remove foreign debris and devitalized tissue, ensure temporary blood supply to devascularized limbs with plastic shunts, release tight muscle compartments (fasciotomies), quickly stabilize any fractures or dislocations (usually with external fixators) , and get the patient out of the OR quickly to continue resuscitation in the ICU.

The critically injured British soldier might be flown out the next morning straight to the military hospital in Birmingham, England. US troops were usually routed through Bagram- the Level III Air Force hospital near Kabul for further debridement and evaluation of

wounds, before being flown to the Level IV facility at Landstuhl, Germany. Often the wounded soldiers and Marines would arrive at Walter Reed Medical Center or Bethesda Navy Hospital within a matter of a few days. Severe burn patients would be flown directly from Afghanistan to Brooke Army Hospital in San Antonio, Texas for definitive care.

After five weeks at Camp Bastion, I rejoined my surgical company to set up a Level II ER/ surgical facility in Forward Operating Base Delaram II – in remote western Helmand province. Plans were being drawn up for scaling up this base as the center of combat operations for this region and we were to provide medical/surgical support.

Within a few days we were up and running in three Alaskan tents with wooden floors. The first held our trauma bay or ER. The second was designated as our operating room. And the third encompassed lab and a portable x-ray unit. We slept in tents just across from our ER/OR and were readily available for emergencies –night and day. We were located adjacent to the helicopter pad. Unfortunately, we were also just downwind of the base’s “burn pit,” and had to deal with unpleasant (and unhealthy) fumes on occasion.

Since we were the only functioning surgical facility in the region, we saw all manner of injuries- from car wrecks to snakebites to kids with forearm fractures to severe combat injuries. We would see anyone who showed up at the main gate of the base. We cared for a pair of Afghans who claimed they had their legs blown off while riding a tractor going to their fields-but their injuries were most likely from an ill-fated attempt to plant an IED which detonated prematurely.

Unlike the moonscape of Al Anbar, Iraq, western Helmand province was bordered by rugged peaks and the Helmand River had lush greenery along its meandering banks. The air was certainly better, and summer seemed more tolerable than Iraq. Compared to Marines at

primitive small patrol bases, we had the luxury of AC, hot showers, electricity, and a chow hall at Delaram II.

On Memorial Day, I attended a solemn Marine service in the chapel on base. After the ceremony, I found a quiet,isolated spot to sit and reflect on Nate, his life, his Marine service and his loss. Just then, a lone bagpiper came by playing Amazing Grace…. Where in the world did that come from? Just seemed totally surreal. I felt as though Nate was reaching out to me.

In early July, 2010, I was reassigned back to Camp Bastion. Summer work there was non-stop. We were inundated with blast injuries from IEDs (Improvised Explosive Devices). The signature injury to our Marines was the high (Above the knee) double amputation from dismounted combat operations. Often this was combined with injuries to at least one arm as well. The chest and abdomen were less frequently injured because of body armor.

Innovations in combat casualty care were saving lives on the battlefield. Universal adoption of the CAT tourniquet helped prevent death from blood loss. All soldiers, sailors, and Marines carried at least one tourniquet and were trained in the application. In the case of traumatic amputation often two tourniquets would be used on the injured extremity. Corpsmen and Army medics were given extensive training on improving airway management which could include oral airways, specialized supraglottic tubes such as the Combi-tube and the King airway, endotracheal intubation, or when all else failed- emergency surgical cricothyroidotomy (creating a surgical hole in the windpipe or trachea). Navy Corpsmen were also instructed on needle decompression of the chest to treat tension pneumothorax (collapsed lung leading to shift and increasing pressure on the remaining lung).

Rapid evacuation- usually by helicopter to a surgical facility was standard procedure in both Iraq and Afghanistan. Secretary of Defense Robert Gates mandated that all seriously injured soldiers, sailors, and Marines be transported to surgical care with the “Golden Hour” to give them the best chance of survival. The Army “dustoff” medics and the Air Force paramedics (PJs) performed heroic work on the battlefield -often under fire- to evacuate and stabilize injured servicemen. In Afghanistan, the British evacuation help -or MERT- even included a critical care physician on bard-essentially bringing the ER to the battlefield.

Military ER physicians and surgeons changed the standard of care for fluid replacement in combat trauma. Blood loss from traumatic battle injuries was now treated with blood products instead of sterile saline solution. Fresh whole blood transfusion was the preferred product. In some remote bases, a “walking blood bank” of volunteer base Marines and soldiers provided lifesaving transfusions. If whole blood was not readily available, component blood products would be utilized including packed red cells, platelets, and fresh frozen plasma. This was a revolutionary change in trauma care that has since been adopted across the civilian trauma sector, as well.

Our orthopedic team at Bastion consisted of two British orthopedists, another Navy orthopedist, an Army orthopedic physician’s assistant, and myself. In addition, we were lucky to have on board a talented British plastic surgeon, Wing Commander Wian VanNiekirk, who was a microvascular expert as well as burn specialist. He would prove invaluable in the care of

upper extremity injuries, particularly when we needed urgent major blood vessel repair or reconstruction.

The introduction of MRAP (mine-resistant-ambush-protected) vehicles in the place of the vulnerable Humvees (HMMWV) at the insistence of then Secretary of Defense Robert Gates saved countless lives. The heavy protective V-hulls of the MRAPs proved their design when hit by IEDs and the force of the blast was directed away from the vehicle. The greatest vulnerability of the “up-armored” Humvee was from bombs planted in the roadway –since the floor of the vehicle was not armored.

I never met a Marine who complained about his injury.  A strapping young Marine Sergeant was injured in the battle of Marjah and sustained a high-velocity gunshot wound to his upper right arm with a devastating, fist-sized exit wound. He was quick to tell me that even with this injury, he had returned fire to the enemy. We took him directly to surgery to clean his wounds. And this was a big guy- his arm was easily as large as my thigh. He had lost part of his triceps muscle and would require specialized wound care back in the States. After surgery, I prepared to make the arrangements to transfer him back to Bethesda Naval Hospital in DC. But as soon as he awoke from anesthesia, he insisted that he go back to his unit in Marjah.

Initially I said no, “You’re out of here.” He said, “No way.” I finally relented and closed his wounds myself at Camp Bastion a few days later. When I last saw him to remove his sutures, his wounds were healing nicely, and he was on his way back to his unit. I later heard that he was injured again- this time with a gunshot wound to his hip. He was treated at another surgical facility and again made it back to his unit. All he wanted to do was get back in the fight- logic be damned.

One Navy Corpsman was brought into our trauma bay with grave injuries: the loss of both legs above the knee, loss of one arm at the elbow, and partial loss of his other hand. When we rushed him to the OR, we were shocked to find a large gun barrel and webbing around one of his amputation stumps. Despite his catastrophic injuries, he had directed his platoon Marines to make an improvised tourniquet out of a web belt and the barrel of a 240 Golf machine gun. A standard tourniquet would not have worked on an amputation so high on his right thigh. No doubt he saved his own life with his quick thinking.

On our busiest day at Bastion, we admitted 32 trauma patients and took 24 of those patients to surgery. They were unfortunate victims of a Taliban bomb in the busy market of the nearby town of Garesh. It was truly heart-wrenching to see traumatic limb amputations on young, innocent children. Every surgeon, nurse, surgical tech, and Corpsman at Bastion pitched in until the last patient was cared for that evening.

I was relieved at Bastion at the end of August, 2010 by Navy Captain Dana Covey, the Orthopedic Department Head from Naval Medical Center San Diego and also a very experienced orthopedic combat trauma surgeon. Our team moved back to large tents at Camp Leatherneck, awaiting redeployment to the US. The letdown was palpable. We went from 100 mph to zero in one day. Our main task now was to get to pack our gear, get to the chow hall, workout at the gym, take long walks around base and catch up on emails. Never mind that my mind was still treating Marines in the trauma bay and OR at Bastion.

My deployment in Afghanistan -especially at Bastion- was easily the most rewarding of my entire orthopedic career. The work was intense, exhausting, yet gratifying- caring for injured soldiers, sailors and Marines, Coalition troops, Afghan soldiers and policemen, and civilians.

This was truly a team effort: from the Army helo medics and Air Force PJs to the ER docs, nurses, and Corpsmen, to the OR techs, nurses, surgeons and anesthesiologists to the ICU nurses and docs and finally to the Air Force critical care flight teams. In 2010 an injured Marine who came into our facility with a heartbeat had a 98% chance of leaving Bastion alive. The trauma care was exceptional.

Ultimately deployment is harder on the family back in the States than the service member who is busy on deployment. Christine was a whirlwind when both Austin and I were deployed to Iraq in 2009. She sold our home in Reno, bought a home in San Diego that was bank- owned, arranged to move all our furniture and gear from Reno to SoCal, and rehabilitated the new home that had been neglected and unoccupied for 18 months. She wrangled dogs, horses, and chickens around on a daily basis. In June of 2010, Austin transferred to DC to an Army billet and grad school. By the beginning of Augus , Christine was definitely tired of managing our home solo and ready for me to return from Afghanistan. I will be forever grateful for her willingness to support my quest to serve in the Navy Medical Corps and deploy to Iraq and Afghanistan.

During our week of post-deployment gear check-in and administrative duties back in Southern California at Camp Pendleton we were on a reduced schedule –by design. While driving north toward the base on I-5 one morning at 30 mph, I wondered why everyone around was driving so fast! The next morning, I forget my “cover” (military fatigue cap) which was mandatory when walking outside on base. The third morning I forgot my cell phone. Clearly, I was not in normal functioning mode. I was physically back from deployment. But my mind remained in Afghanistan for at least a month after I returned. Although I did not have PTSD or nightmares of maimed soldiers or Marines or visions of permanently scarred children, I had difficulty with resuming daily military base life.

In early November, 2010, I checked back into the Orthopedic Department at Naval Hospital Camp Pendleton. Although I had been forever changed by my tour in Afghanistan, it was business as usual at the Navy hospital- plenty of Marines with knee, shoulder, and ankle injuries, disability forms to deal with, and administrative paperwork. The Marines were terrific patients- highly motivated, positive, uncomplaining, and stoic. The only problem was the Marines were often too aggressive with their post-op rehabilitation. I settled back into the routine of office hours, surgery, and emergency call and some semblance of normal life.

I felt very lucky to be selected for 0-5 and hoped to have my promotion in DC so that Austin and his fellow Marines, as well as Nate’s friends could attend. Austin suggested I contact Major General Larry Nicholson and see if he would be willing to officiate. When I reached out to him by email, he responded immediately that he would be honored to officiate and suggested the ceremony be held at the Pentagon. It was a special day with a Pentagon tour, lunch at the General Officers’ Mess, and then an emotional ceremony in Secretary Gates’s conference room hosted by General Nicholson. Christine and Austin “pinned” on my Commander’s silver oak leaves on my “summer whites”. For family, friends, and Navy and Marine colleagues it was truly an unforgettable event.

When offered a chance to deploy once more- this time to Guantanamo Bay, Cuba in the fall of 2011, I jumped at the opportunity. Guantanamo Bay Naval Base (or GITMO- is a huge, scenic Navy base set on a lovely bay in southeast Cuba. We inherited the site after the Spanish-American war of 1898 and have been there ever since. I was the only orthopedist at GITMO. The hospital was very well- equipped. My main tasking was to be available 24/7 for orthopedic emergencies. I ran weekly orthopedic clinics at the hospital with my ortho tech, scheduled elective surgeries, and saw detainee patients on Fridays at the Detainee Camp. The Detainee Camp seemed like San Quentin on steroids- just a frightening place. However, when I had a chance to consult on my first patients – I was stunned. They were polite, respectful, and spoke surprisingly good English. Not at all what I expected. Mostly I ended up treating overuse injuries from their soccer games.

Before I deployed to Iraq in 2009, a Reno journalist asked me if “ I was going there to get closure around Nate’s death? Was I planning to visit the location near Fallujah where his attack took place?” My answer at that time was that I was not seeking “closure” but rather Austin and I were deploying to Iraq to finish Nate’s unfinished work. In 2016 as I prepared to honor Nate at a Memorial Day ceremony at Mt Soledad in San Diego, the journalist called me again and asked, “Did I get closure in Iraq?” This time I was ready with my answer: I told him that the term “closure” is a meaningless term to anyone who has ever lost a son or daughter. Your family is never the same. Your loss is endless.

Mt Soledad Veterans Memorial (San Diego) chose to honor 1st Lt.Nathan Krissoff, USMC on Memorial Day, 2016. Major General Larry Nicholson readily agreed to be the keynote speaker. He had the rapt attention of all those in attendance that gloomy day when he recounted Nate’s service and sacrifice, Austin’s Marine career, my surgical work in Iraq and Afghanistan, but , most importantly, Christine’s steadfast patriotic support of her sons and husband.

General Nicholson’s question to the audience that Memorial Day was how is this country going to bridge the chasm between those young men and women who join the military and put themselves in harm’s way – that 1%- and the remaining civilians who don’t even know anyone in uniform. The wars in Iraq and Afghanistan have been fought by volunteer active duty forces with assistance from the Reserves and the National Guard units. The last US draft was during the Vietnam conflict.

Colonel Bill Seely, Nate’s former 3RD Recon CO, was with us that day too flying cross-country from DC for the ceremony. He spoke of Nate’s invaluable work on deployment as the only Counterintelligence/Human Intelligence (CI/HUMIN) specialist in 3RD Recon in Anbar. And he recounted how beloved Nate was by his fellow Recon Marines.

Since completing my tour at Naval Hospital Camp Pendleton, I have had many occasions to share our family story on Veterans Day and Memorial Day. In 2017, Lieutenant General Nicholson, then commanding general of III Marine Expeditionary Force, invited me to Okinawa for the Marine Birthday celebration. I talked of “Lessons Learned” on combat casualty care in Iraq and Afghanistan with the 3RD Medical Battalion and later with ER docs and surgeons at the Okinawa Naval Hospital. At the MCI-Pacific Marine Ball, I spoke of Nate’s service and sacrifice and related stories of injured Marines and sailors I cared for in Afghanistan. My presentation at that Marine Ball was an electric experience for me. I felt an extraordinary connection to the hundreds of MCI-Pacific Marines and their families that night.

My final morning on Okinawa I traveled once more to Camp Schwab to visit 3rd Reconnaissance Battalion in  their new headquarters. The intel shop had Nate’s picture from deployment in Iraq posted prominently on their wall. I shared Nate’s story with the new battalion of attentive young Recon Marines. Then to my surprise I received a handmade Recon Paddle dedicated in honor of 1stLt Nathan Krissoff, USMC with the inscription: “EARN THIS!”….. Austin, Christine, and I will forever be part of 3rd Recon family.

In most families Dad inspires sons. In our family, sons inspired Dad to put on the Navy uniform and serve in the military. I will be forever grateful that I had the opportunity to serve in the Navy Medical Corps and care for our servicemen and women. I joined the Navy to heal Marines. It was an honor and a privilege. In the process, I was able to learn a little about the fraternity my sons had joined. I learned there are no truer words than the Marine motto- Semper Fidelis- always faithful.

The soldiers, sailors, airmen, and Marines who do the heavy lifting- who put their lives on the line, on a daily basis, they are most deserving of our gratitude, respect, and honor. I served with men and women whose unheralded contributions to the cause of freedom continue to this day. Men like Captain Mike Dubrule, USMC. He led Nate’s military intelligence training in Virginia and spoke at Nate’s memorial service in Reno. His words apply to all those who take up the sacred duty, to serve their country.

Captain Dubrule said, “I want you all to know that Nate died doing he loved, leading men in combat, saving lives, and making a difference in the lives of so many. No greater epitaph can be written. No greater sacrifice can be made.”

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