US Air Station, Châteauroux, France
On the first day after arrival, Miles signed documents, listened to tape-recorded instructions on military procedures, received a health examination, and was welcomed to the Air Force by the first personnel officer with a cup of coffee. At the end of the day, he received a note from the hospital adjutant, Emile Macron, to meet the hospital commander, Colonel Barney Springer, at 18:00 in the officer’s club bar.
Springer arrived forty-five minutes late and offered no apology. He told Miles to sit next to him and held up an index finger to signal the bartender.
“Bring him Blanton’s Single Barrel,” Springer said. “My favorite,” he noted to Miles and back to the bartender, “Make that a double straight up for me.”
“I prefer water, no ice, please,” Miles said to the bartender.
“Ridiculous,” Springer snapped. “That’s handmade Kentucky bourbon. Best of the best.”
“I don’t drink . . .”
“On the rocks for him,” Springer insisted to the bartender.
“I prefer just water,” Miles said, ignoring Springer’s stern stare.
Springer looked from the bartender to Miles, “You don’t start your tour of duty in France with water. Not on my watch,” he said. “You a teetotaler?”
“I’ve been on and off call for years. An alcoholic drink never occurs to me, really. Eventually, I want to be a surgeon.”
“Goddamn, boy. We gotta lighten you up a bit. A Sancerre Rouge, then,” Springer said to the bartender, who stood waiting as if this happened often.
“I’ll have a Coke, please,” Miles said.
The bartender hesitated, standing ramrod straight, waiting for instructions from his superior. Springer shook his head. “That won’t do,” he said. “Just the wine for him,” he said to the bartender.
The drinks were served with salted peanuts in an unadorned, pressed-glass dish on a paper napkin.
“When do I start seeing patients?” Miles asked.
“When you complete payroll in accounting,” Springer replied. “Then get your quarters ready. You got your uniforms?”
“I’ve got one from basic training.”
“Where do I get uniforms? “
“Sarge knows. They’re issued for officers, and any tailored alterations are at your own expense. Check with Pringle about your clothing allowance.”
“Are patients being scheduled?”
“They’ll start scheduling new patients next week. Until you build a following, you get walk-ins, routine checkups, emergencies, and nonspecific referrals. Pringle will put you on the call schedule.”
“About once every two weeks.”
A waiter approached. “Dinner, sir?” he asked Springer.
“Just the drinks,” Springer replied.
As the waiter moved away, Springer confidentially leaned toward Miles. “It’s all essentially free here. A few non-free charges get deducted from a doctor’s pay before taxes,” he grinned. “Commissioned officers got advantages.”
Miles stayed quiet.
“And you’ve got triage evaluation on Wednesday,” Springer said.
“What is that?”
“Takes three hours. They got people commandeered to play victims with made-up wounds lying around in the dirt. Victims of a plane crash. A few “dead” people. You make a diagnosis, direct to preserve life on the spot, and direct transfer to the nearest appropriate facility for treatment. You’ll be graded. You don’t pass, you retake until you do.”
“Where do I learn?”
“It’s triage. You know what triage is?”
That irritated Miles. “I know what triage is.”
“Sir,” said Springer.
Springer frowned, It’s . . . I know what triage is, sir!’ You get it?”
“But what does triage expect of me?”
“Sir! Damn it.”
“Sarge will tell you. There’s a manual.”
Aggravated, Springer stood abruptly and pointed to Miles’s untouched glass of wine.
“Suck it up, Ballard. You got a lot to learn.”
“Suck it up?” Miles asked.
“Say sir! Damn it. Drink it, man!”
Miles took a sip.
Springer pursed his lips as if Miles’s reluctance debased him.
“Command is hung up on triage. They’re scared shitless we’ll all die in a nuclear attack,” Springer grimaced, glancing over the restaurant crowd.
A nuclear attack—not a comforting thought, Miles thought. “Thank you—sir.”
Springer waved a dismissal to the bartender. “Follow me,” he said to Miles, “I’ll introduce you to some cool dudes that can take care of anything you need. Then I gotta go.”
Two days later, a military school bus shuttled Miles to the acre-and-a-half field test site. The fenced enclosure was draped with opaque canvas panels. Forty-plus people with simulated injuries lay scattered over foliage and scrubby grass.
An airman struck a brass gong to start the exercise. An observer and a medical assistant accompanied Miles into the enclosure.
The victims had realistic fake wounds created with collages of plaster, plastics, molded rubber, and red fluids. Some had “exposed bones,” others had “chest wounds” that, when the victim pumped air through a tube from a bulb in the hand, suggested a punctured lung. The air hung heavy with sham moans and cries for help.
Miles evaluated mental state, the status of the airway, bleeding, and shock, and dictated lifesaving measures to a nurse. An assistant recorded vital signs and personal data. Throughout the exercise, Miles tagged each victim with a cloth rag around the right arm—red for immediate life-saving intervention required, yellow signaling treatment could be delayed up to four hours, green for the “walking” injured, white for no treatment required, and black for the deceased. Two and a half hours later, the gong sounded again, signaling an end to the exercise. All victims had been prioritized on the spot and/or scheduled for transfer.
Outside the triage area, Miles asked the observer how he did.
“Can’t say, sir.”
“You must know if I passed?”
“Colonel Springer evaluates the results for hospital staff.”
“Isn’t that a conflict of interest?”
“Springer’s staff benefits from high scores.”
“We’re observers. I make no judgments.”
“Is my evaluation based on quality of care?” Miles asked.
“No, sir,” the observer said. “I record the accuracy of your diagnosis and the time it takes you to make decisions. That’s what triage is, not care or outcome.”
Later that afternoon, Colonel Springer called Miles into his office.
“Did I pass?” Miles asked.
Springer shrugged dismissively.
“Does that mean I passed?”
Springer nodded almost imperceptibly.
“Thank you, sir.” Miles prepared to leave.
“I’ve assigned you to the General as his personal physician.”
“Really, sir. Am I qualified?”
“It’s for you to travel with the General when he asks. You take care of him personally, too, and the family when they need you. They’re all healthy. Anyone is qualified.”
“Shouldn’t the General choose his own doctor? I’ve never met him.”
“I told you, say ‘sir’!”
“Why me, sir?”
“Most docs don’t like him, and you’re available. So, you’re his personal doc.”
“I don’t understand.”
“Say, ‘sir’! He wants a doctor. He isn’t concerned with qualifications or who you are, for that matter. For chrissakes, it’s prestige for him. And it’s got nothing to do with health. Anybody alive, doctor or not, could do it. You’re the new man at the bottom of the heap. You’re his doctor! His General medical officer.”
“Wouldn’t he want a flight surgeon?”
“They’re trained to keep people in the cockpit. Exams and checkups. It’s you that does the grubby stuff.”
“What about my practice?”
“The General will only need you three or four days a month. You finally get it? And say, sir!”
“Yes, sir. Thank you—uh, sir.”
In the hallway, away from Springer’s door, Emile, the adjutant, approached Miles with a tenuous smile. “How did triage go?”
“Did Springer tell you that you tied with three others for the second-highest score recorded in the last three years?” Emile smiled widely.
“No. He didn’t seem impressed at all.”
“Well, don’t sweat it. That’s Springer. It’s his routine. He wants to debase you, make you worry a little.”
“I don’t get it.”
“He doesn’t like anyone smarter or better trained than he is.”
“Damn. And I’ve got to be a General’s physician too.”
“The General has his hand in everyone’s cookie jar, but he’s not a bad guy. Even though he is a serious hypochondriac.”
Miles shook his head. He couldn’t imagine caring for a one-star general; they didn’t seem like regular humans. “How can I get along with Springer, sir?” he asked.
“Just do the best you can. Everyone has problems.”
“Thank you, sir.”
“You can relax with me, Ballard. I’m a lieutenant. Most people call me Pepper.”
“Thanks for being straight with me,” Miles said. “I appreciate it.”