Doc Lucas Usn: A Novel of the Vietnam War
By Blair Beebe
()
About this ebook
Medical lessons from Vietnam; what did we learn?
Almost fifty years after the beginning of American involvement in the Vietnam War, we still remain embroiled in military actions that generate disease, disability, and death. Frontline physicians who were in places like Afghanistan, Iraq, Bosnia, Herzegovina, and Vietnam faced the medical consequences of war every day.
My new novel, Doc Lucas USN, based on real people and real events, brings the war down to a human scale, one person at a time. History gives us statistics and dates, but fiction helps us to better understand the meaning behind those facts.
One of my old professors defined history as lies we tell about dead people. We understand more from reading Homer, Sophocles, Shakespeare, Margaret Mitchell, and Stephen Ambrose than we ever learned from dry history textbooks. Paradoxically, the truth comes out in fiction.
During my time in Vietnam, and for many years after, I listened to stories from other physicians who served during the war and from naval aviators and marines who faced combat every day. I also heard different points of view from Vietnamese civilians who had come to America to escape the chaos after the war.
Their eyewitness accounts are the true history, but unless someone writes them down, we lose them forever. Moreover, individual stories may have little meaning to us if they lack context. Ive often heard both veterans and civilians say, I dont talk about my experiences, because anyone who wasnt there could never understand how bad it was.
Thats why we need a novel to give us a complete account in an organized way. Each character and each scene moves the action to develop a central theme about the war. We want more than anecdotes. We want to understand the how and the why of the unfolding tragedy.
Doc Lucas not only recounts the stories, he lives them. We feel his anxiety, his terror, and at times, his joy. When things go wrong, we know why, and we can feel his despair. In the good times, and there are many, we laugh along with him.
In the end, Doc Lucas learns important lessons about himself and his values centered on human rights and the relief of suffering. He emerges from the war better equipped to take his place with stronger convictions about his role in his society.
Blair Beebe
Blair Beebe, MD served as physician-in-chief of the Kaiser Permanente Medical Center in San Jose, and later as associate executive director of the Permanente Medical Group in the Northern California region. He was also a member of the clinical faculty of the Stanford University School of Medicine. Sierra Peaks is the final installment of a trilogy.
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Doc Lucas Usn - Blair Beebe
ALSO BY BLAIR BEEBE
The Hundred-Year Diet: Guidelines and Recipes for a Long and Vigorous Life
Doctor Tales: Sketches of the Transformation of American Medicine in the Twentieth Century
Doc Lucas USN
A NOVEL OF THE VIETNAM WAR
Blair Beebe
iUniverse, Inc.
New York Bloomington
Doc Lucas USN
A Novel of the Vietnam War
Copyright © 2010 Blair Beebe
All rights reserved. No part of this book may be used or reproduced by any means, graphic, electronic, or mechanical, including photocopying, recording, taping or by any information storage retrieval system without the written permission of the publisher except in the case of brief quotations embodied in critical articles and reviews.
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ISBN: 978-1-4502-3257-9 (pbk)
ISBN: 978-1-4502-3259-3 (cloth)
ISBN: 978-1-4502-3258-6 (ebook)
Printed in the United States of America
iUniverse rev. date: 6/11/10
Contents
Preface
Acknowledgments
I
FROM PHILADELPHIA TO GUAM
Chapter 1: INTENSIVE CARE
Chapter 2: HOME OF THE BLUE ANGELS
Chapter 3: WELCOME ABOARD
II
THE GULF OF TONKIN
Chapter 4: NIGHT PHOTORECONNAISSANCE
Chapter 5: HEMORRHAGING AT SEA
Chapter 6: FIRST MED
Chapter 7: IT’S NOT MUCH OF A WAR
Chapter 8: TWENTY SECONDS OVER HAIPHONG
Chapter 9: FORBIDDEN TARGETS
III
DA NANG
Chapter 10: THE MILKMAN DELIVERS
Chapter 11: THE SEA IS EMPTY
Chapter 12: THREE DEVILS FROM HELL
Chapter 13: A VISIT TO NAM HOA
Chapter 14: NAM HOA REVISITED
IV
BIEN HOA
Chapter 15: DOCTOR TRAN’S CLINIC
Chapter 16: TRAUMATIC STRESS
Chapter 17: BONSOIR, DOCTEUR
Chapter 18: ANOTHER KIND OF MASH HOSPITAL
V
THE SOUTH CHINA SEA
AND BEYOND
Chapter 19: TWENTY SECONDS OVER HANOI
Chapter 20: THE SUMMIT
Chapter 21: DOWN IN THE SOUTH CHINA SEA
Chapter 22: THE BLACKBIRD
VI
FROM BANGKOK TO GUAM
Chapter 23: BANGKOK
Chapter 24: CONFLAGRATION
Chapter 25: GOING HOME
Afterword
Glossary
The Author
For the members of VAP 61
We of the Kennedy and Johnson administrations acted according to what we thought were the principles and traditions of our country. But we were wrong. We were terribly wrong.
—Robert McNamara, 1994
missing image filemissing image filemissing image fileThe RA-3B Skywarrior near Vietnam in 1966. The A-3 was the biggest aircraft ever to land on a carrier during the Vietnam War. Fully loaded, it weighted thirty-five tons, eight tons more than a World War II B-17 Flying Fortress, and it could fly at a speed of 610 knots, three hundred miles an hour faster than a B-17. Vice Admiral (ret.) James E. Service wrote: The RA-3B was exceptionally versatile—one of many spin-offs from the initial bomber design. Air bosses were never enthusiastic about the A-3 platform due to the deck space it occupied, but the fighter and attack guys loved the tanker version, and the intelligence guys loved the photo product—couldn’t get enough of it.
The USS Enterprise in the Gulf of Tonkin in 1966. Note several A-3s on board, including the Blackbird
parked on the port side.
Preface
Many years had passed before I felt comfortable about resurrecting memories of the war in Vietnam. Even then, there were occasions when it was necessary to put this manuscript aside for a while. Certainly, I enjoyed the camaraderie in the navy carrier squadron, but the war itself cast an inescapable darkness over life. We didn’t know why we were fighting, except for the abstract notion of stopping the spread of communism. But we also knew that the elected government of South Vietnam had not set a good example promoting human rights. Most Vietnamese people were poor farmers trying to survive in a country torn by centuries of conflict, where shelter and the next meal consumed all of their attention. They were not part of a cohesive nation and understood little about political ideology.
Religion gave them an identity, but it also separated them into two mutually suspicious groups, the Buddhists and the Catholics. The Buddhists hated the Catholic governments of Premier Ngo Dinh Diem, and later Premier Nguyen Cao Ky, and accused them of corruption and persecution of Buddhists. The Saigon government cared little about anyone outside of the capital, and consequently, much of the rural population felt alienated from their national leaders. Most Vietnamese people assumed we Americans were protecting the government that they hated, and that we were just the most recent in a long string of foreign invaders interested in exploiting them. We did very little to convince them otherwise.
Doc Lucas USN follows the experiences of a navy physician who is empathetic toward American servicemen and women trying to do the right thing, and it also looks at his friendship with a Vietnamese doctor caught in the crossfire of conflicting interests. The naval aviators on whom much of the story is based were professionals, but many privately questioned why we were there. Their carrier task force represented enormous destructive potential that had doubtful relevance in a war against an enemy dispersed among farmers living in bamboo huts. Airplanes could flatten any target, but in Vietnam, President Lyndon Johnson and Secretary of Defense Robert McNamara absolutely forbade attacking the most significant ones, for fear of further escalation of the war.
American involvement began as financial aid and military advice to help the South Vietnamese government combat the Communist insurgency. But on August 2, 1964, a minor encounter involving three North Vietnamese motor-torpedo boats and two American destroyers triggered a massive American military retaliation based on misinformation.
The USS Maddox was cruising alone in international waters in the Gulf of Tonkin off the coast of North Vietnam on a surveillance mission, when, to the dismay of the skipper, Captain Herrick, the North Vietnamese boats began to shadow the destroyer, closing almost to within torpedo range. The Maddox attempted to evade the small boats, but Captain Herrick believed his destroyer was in danger and fired warning shots. What followed remains unclear, but a sonar operator on the Maddox reported hearing torpedo propellers, and Herrick ordered the destroyer to open fire on the North Vietnamese boats. Aircraft launched from the USS Ticonderoga joined the attack.
Two days later, another destroyer, the USS C. Turner Joy, joined the Maddox. During rough weather at night, both ships picked up radar, sonar, and radio signals that they interpreted as another attack by North Vietnamese motor-torpedo boats. The two American ships began firing on radar targets and zigzagging to avoid torpedoes. However, no one on either ship could confirm a visual sighting of any North Vietnamese boat, nor did anyone actually see a torpedo. Captain Herrick began to doubt whether there were actually any motor-torpedo boats in the area and requested daytime aerial reconnaissance.
He sent a coded message to Washington and the Ticonderoga: "Freak weather effects on radar and overeager sonarmen may have accounted for some reports of North Vietnamese motor boats. No actual visual sightings by Maddox during the night. The first boat to close the Maddox two days ago probably fired a torpedo that was heard but not seen. All subsequent torpedo reports are doubtful in that I suspect that our sonarman was hearing ship’s own propeller beat. Herrick."
Whether a North Vietnamese motor boat had ever fired a torpedo remained in doubt, but word had already leaked to the press from the previous messages sent by the Maddox two days earlier. Secretary of Defense McNamara told Congress there was unequivocal proof
of unprovoked attacks
on U.S. ships. The American public was enraged that North Vietnamese naval vessels had attacked American ships, and Congress quickly passed the Southeast Asia Resolution, also known as the Gulf of Tonkin Resolution, which granted the president the authority to aid any Southeast Asian country threatened by Communist aggression, including the commitment of American forces without a declaration of war.
President Johnson had been a hawk, already having sent an increasing number of military advisors to Vietnam, but he also doubted the gravity of the Gulf of Tonkin episode or whether any North Vietnamese boats had ever fired a shot. He thought Congress was overreacting and had taken a completely unwarranted step.
Those sailors out there may have been shooting at flying fish,
Johnson said.
Nevertheless, he signed the bill and gave his approval for American troops in Vietnam to engage directly in combat against North Vietnam and to begin air operations, including strikes against targets in North Vietnam. Johnson’s approval rating with the American people rose from 42 percent to 72 percent, and he won the presidential election against Senator Barry Goldwater by a wide margin three months later. Secret documents released in 1994 revealed that the CIA had been conducting raids on coastal North Vietnam before the Gulf of Tonkin incident.
Doc Lucas USN begins in 1965, at a time when lack of commitment and heavy losses had led to high rates of desertion among South Vietnamese troops. President Johnson sent in the U.S. Marine Corps to stabilize the precarious situation, but soon the marines themselves needed reinforcements. By the end of 1965, two hundred thousand American troops would be fighting throughout Vietnam, almost completely displacing the South Vietnamese Army. The number of American personnel in Vietnam would ultimately reach more than half a million, in a country with a population of only thirteen million.
I based much of the action in the novel on real people and events, but I made substantial changes to protect the privacy of my confreres and to advance the story. Sometimes I reversed the chronology. For example, Lyndon Johnson’s meeting with Premier Ky on Guam actually occurred after the Oriskany fire, not before. Most of the scenes come from the historical record, interviews of Americans and Vietnamese involved with the war, and my own experiences. The result is a collage of incidents, compressed and attributed to a handful of fictional characters whose stories propel the plot and show the war through the perspective of the physician narrator.
Blair Beebe
Portola Valley, CA
2010
Acknowledgments
Vice Admiral (ret.) James E. Service was a former commander of the U.S. Naval Air Force, Pacific Fleet, and later Executive Assistant to the Vice Chief of Naval Operations. He was the executive officer of VAP 61 during the early days of the Vietnam War. He provided encouragement and crucial technical advice.
Jim Newcomb was a lieutenant commander during the war and naval aviator with VAP 61. He contributed the story about his A-3 snapping an arresting wire on the USS Ticonderoga.
David Farrar, former lieutenant commander and photo navigator in VAP 61, supplied details about photoreconnaissance and the missions flown during the war. He was awarded the Distinguished Flying Cross for a hazardous mission over Haiphong Harbor.
Ted Kubista, MD, surgeon, was a lieutenant commander during the war and served in the U.S. Navy Support Activities Hospital at Da Nang beginning in 1969. He elaborated on the conditions at Da Nang and added technical surgical information.
Richard Geist, MD, surgeon, was a colonel in the U.S. Army Medical Corps who served at Walter Reed Hospital during the war and later as chief of surgery in a mobile frontline army hospital, MUST 403d CSH, during Operation Desert Storm. He supplied technical information regarding the details of surgery in a frontline hospital.
I
FROM PHILADELPHIA TO GUAM
Chapter 1
INTENSIVE CARE
My friends call me Luke, but my real name is William Osler Lucas. My father was a doctor, and he had always wanted a son to become one too, so he named me for the celebrated Johns Hopkins physician, William Osler. From my earliest memories, I had tried to live up to my father’s expectations, and in kindergarten, I called myself the doctor child.
I would rush immediately to attend any screaming classmate that had suffered sand in the eyes or a scraped knee and say, Stop that crying and let me take a look at this.
They would stop, too. Back then I was William, but much later, when I entered medical school, I feared my pretentious name would be ridiculed. So I became Luke.
Whenever I was sick as a boy, my mother always worried that I might die. She never actually said it, but I knew. She had good reason to be concerned, because her father and older brother had both died young of tuberculosis. I was certain I had to become a doctor in order to save her and my sister. All of that existed hidden in my subconscious, but I never seriously considered any other career option. By the time I entered high school, the only important decision remaining was selecting the kind of doctor I might become.
My father was a general practitioner, respected in the community, but he worried about a future for me in the same role.
Times are changing,
he said. You will need to specialize.
Why can’t I be a family doctor like you?
I replied.
Heart disease and cancer are increasing with the aging population. You should choose either cardiology or surgery.
Won’t we need general practitioners anymore?
Maybe not. My patients only want to see a specialist these days.
Having decided to become a specialist, I turned to worrying about the small things, like cosines and tangents, Boyle’s law, the subjunctive of the verb paraître, and the travails of David Copperfield. Every spring, my grades took a tumble. I bathed in the warm sun radiating through the window next to my desk, only vaguely aware of the strange mathematical equations and lengthy conjugations on the blackboard. Each June brought a reckoning with my irate father.
Penn State will never accept you with these grades, let alone Princeton.
Princeton had been my father’s first choice, and Penn State was only a backup. That was the plan.
My backup plan turned out to be necessary, but Penn State did admit me after all. In my yearbook, my high school classmates wrote To a future doc
and Good luck when you get to med school.
I began to fear what would happen to me if I were not accepted to medical school; I didn’t know what other people did for a living, except maybe for lawyers or teachers, and I didn’t want to become either of those. I decided I’d better study harder, at least until I had a better idea of the alternatives to becoming a doctor. No other option ever came to mind.
My four years at Penn State all seemed a long detour before the real preparation could begin. My grades were good, so my admission in 1959 to Jefferson Medical College in Philadelphia was assured. My father had attended Jefferson, and he was ecstatic.
Congratulations. Jefferson is a great school. I know you’ll do well there.
Students weren’t supposed to enjoy medical school, but to my surprise, I loved it, even the basic science courses. The clinical years were the best. I especially liked working in the operating room and became the most enthusiastic of retractor holders. The time passed quickly, and in June 1963, I received a diploma that said MD
and a promotion to intern. I was taking care of my patients,
although I no longer possessed the same self-confidence that I once had in rushing to rescue a sandbox victim. Nurses and patients called me Dr. Lucas,
although they often looked as if they were about to ask, Just how old are you, anyway?
After four years of being called hey you
in medical school, I still wasn’t used to being addressed as Doctor,
and I sometimes caught myself looking around to see who the nurse or patient was talking to.
I had just started a rotation in the hospital’s brand new experimental ICU, and I carefully read the instruction manual for each new apparatus. Few doctors had any experience with the new high-tech equipment and techniques; interns, residents, and senior staff physicians all had to learn from scratch. I had attended conferences, read journal articles, and examined the equipment and new intravenous catheters used in the ICU, but none of us, not even the faculty members, had yet provided hands-on care for very many intensive-care patients.
The Unit
contained only four beds; Philadelphia General was the one of the first hospitals in the city to even have an ICU. Most of the regular staff physicians maintained a safe distance with only faint curiosity about the noisy equipment That reminded them of Dr. Frankenstein’s laboratory. Like vines in an overgrown garden, twisted tubing sprouted from machines surrounding the beds and invaded every orifice of the cadaverous patients.
The residents and staff physicians liked to make rounds on the patients during the day, but we interns were the only ones present in the evenings and at night—and nighttime was when everything happened. At 11:00 PM on my first night on call for the ICU, the page operator called me on the loudspeaker system, Dr. Lucas to the ICU stat!
My pulse raced, and my hands were sweaty from the anxiety of being responsible for the care of an unstable patient. I had seen a few critically ill patients, but I had never before made decisions regarding their treatment.
The patient, Mr. Craig, had come to the emergency department during the evening with crushing chest pain and had suffered a cardiac arrest while an emergency physician was examining him. Up until 1963, not many patients had survived a cardiac arrest, but we had all recently been trained to use CPR, and we had also received one of the new cardiac defibrillators. Mr. Craig had been in the right place at the right time. He was ashen, but alert, when he arrived in the ICU. I sat down next to his bed.
Am I going to die, Doctor?
he asked.
I tried to sound reassuring. I know you had a scare, but you’re better now. You still have a little problem with your heart rhythm, but we’re controlling it with some medicine in your IV tubing.
That’s good.
He spoke without looking at me, continuing to stare at the ceiling.
Your nurse is watching your heartbeat on this EKG monitor,
I said.
I’m frightened.
So am I, I thought. I cleared my throat and took a breath. Are you having any more chest pain?
Just a little,
he said.
But it’s still there?
It’s not nearly as bad as it was in the beginning.
I turned to his nurse, Sally Barton. What was his last blood pressure?
She didn’t look away from the monitor. Still about eighty systolic. I can’t hear the diastolic,
she whispered.
Let’s give him two milligrams of morphine intravenously every two minutes until the pain goes away.
She frowned and looked at me. Won’t that lower his blood pressure more?
Sally had been working in the new ICU for three full weeks, making her a relative veteran. She seemed to sense my insecurity. My sweaty palms and persistent rapid pulse told me she was right. Nevertheless, I worried that if the patient remained tense, his body’s oxygen demands would increase, robbing from his injured heart muscle.
It’s a risk,
I said, but he’ll get worse if we don’t relieve the chest pain. I’m going to put in an internal jugular catheter so we can monitor the effect of his drugs and calibrate the dosage more accurately.
Sally turned fully toward me, still frowning. I’ve only seen the insertion of a catheter like that once before, and it was a vascular surgeon who did it,
she said.
Is everything okay?
Mr. Craig asked.
You’re doing fine,
I said, but we want to eliminate your pain with some medicine, because you’ll be more comfortable, and it will help you recover faster.
I motioned for Sally to move away from the patient’s bed a little so we could talk in private. I whispered, I feel like we’re flying blind without some way to measure the effect of the morphine and the other cardiac drugs that we’re using, and I don’t think I can entice a vascular surgeon to come in late at night to insert a venous catheter into a patient with such a poor prognosis.
She hesitated but then went to get a tray for the procedure and arrange the instruments. When everything was ready, she put on sterile gloves and gave me a weak smile. She prepped Mr. Craig’s neck while I put on my gloves and tried to recall how to insert the catheter, trying to envision the diagram that I had studied a few days before. The critical moment arrived: she handed me the introducer for the venous catheter.
My voice cracked slightly. Mr. Craig, I’m going to put a needle into your neck so that we can adjust the dose of your medication more precisely. It will only hurt a little.
He didn’t respond. He kept staring at the ceiling while I felt around for the landmarks in his neck. I began to question whether this was a good idea, but I was committed. What would Sally think if I said I couldn’t do it now?
Mr. Craig’s neck was slender, and I could feel the pulse of his carotid artery next to the jugular vein. I just did it: I inserted the introducer. To my astonishment, I located the internal jugular vein, and the catheter slipped in, just as in the diagram. We attached IV tubing and a monitoring device and found everything working. I felt a huge exhilaration and flashed a thumbs-up sign to Sally. She rolled her eyes, but then she gave me a real smile.
Let’s start the morphine now,
I said.
We both watched the gauge attached to the catheter and noted no worsening of Mr. Craig’s severe congestive heart failure. Within ten minutes, he was asleep. His vital signs weren’t good, but at least they weren’t deteriorating. We had to give him more medicine to interrupt a dangerous cardiac arrhythmia during the night, but he slept through it. Finally, a faint glow of dawn appeared through the lone window. Sally and I had been up all night watching Mr. Craig.
I’m going to the cafeteria to grab something to eat before morning rounds start,
I said. Can I get anything for you?
No, thank you,
she responded. We’re short of ICU nurses, so I brought a thermos and a sandwich in case I had to work extra hours.
Then she said, Luke—nice work. Most patients as sick as Mr. Craig don’t make it through the night.
I dashed to the cafeteria, glowing, and ran into my friend Roger Casey. He and I were on duty together every other night, and we shared the same on-call room at the hospital, although neither of us spent much time there. While I was on my rotation in the experimental ICU, he was assigned to the surgery service. We sometimes saw each other in the cafeteria for a quick breakfast before sprinting to morning rounds with our respective residents and staff physicians. I found him there among the other interns and nurses, all wearing hospital uniforms: crumpled white coats adorned with stethoscopes for the interns and equally wrinkled light blue uniforms and caps for the nurses.
How was your night?
I asked.
Roger was grinning broadly. I had two patients with appendicitis—two—the same night.
I hope they came in early.
One of them did,
he said.
Interns occasionally got to do appendectomies, if the right resident were on duty, but many interns never got to be the primary surgeon for an operation during their entire year’s internship.
Did you get to do the case?
I asked.
The chief surgical resident was still here. He talked me through it.
I smiled about his good fortune and hoped I would get my own case some night. Congratulations,
I said. You can put a notch on your holster.
Two notches,
he said with a little laugh.
You did the other case, too?
The second patient came in at 2:00 AM, and I called the surgical resident.
Roger stopped and took a big swig of coffee. He sounded sleepy.
Roger paused again, and I said, So?
He knew I had done the first appendectomy earlier, and he said, ‘You do it,’ and hung up.
He never came down to the OR?
Nope.
No law prohibited interns from doing an operation, but we