Day in the Life

BURDASH: When I came into the military, it was, I was looking into going to medicine, and I knew that there was an opportunity to be a medic. And so, I actually enlisted into the North Dakota National Guard as that one weekend a month, two weeks in the summer, when I was in high school thinking that man, being an Army medic is really going to prepare me for my career. So, I started there, I actually did some ROTC time in undergrad, and actually took my direct commission through the state of Minnesota, because this is where I did my medical school. And became an officer, and so when I look at my time, I started off almost kind of what can the Army give me, I’m going to be a medic, I’m going to learn the skill set, I’m going to get some experience, now that I’m older and I’m in medicine, I really see where the need is. ​

​BURDASH: Right now, we’re at our nine millimeter weapons range. So we’re getting ready, we’re getting all set up for the day. All the safety staff are getting here, and we’re starting to get all the ammo ready, and what we’ll be doing is firing at these, actually. They’ve changed the regulations, so now the way we fire, not only we’ll be standing and firing at the targets, but we also get to walk towards them and fire that way. So, that’ll be a new adventure. Like you see, you can see all the range; these will actually pop up and pop down. And then we’ll have multiple firers going at once. So I’ll be one of those firers. We’ll actually be changing magazines while we walk forward towards the firing line, from the back. So it’ll be a little bit more dynamic, a little bit more realistic.  

This is part of our annual qualifications. We have to make sure that we are proficient in whatever our assigned duty weapon is. Last time I shot, I shot expert. So, that’s my goal. And if not, at least we’ll have a good time, and try to hit as many targets as we can.

MALE:  Firers, at this time, go ahead and move out. Cease fire there, cease fire.  Clear off make sure that it’s clear. 

BURDASH: So, not quite as good as I did last year, but still not too bad. You know, sharpshooter is OK. I would have preferred expert like last year, but considering it was the first time doing walking, not too bad.  Next time I’ll practice up and try to beat these guys.  

​BURDASH:  So, let’s come on down here, and now we’ve talked about those wound cares a little bit. So, let’s give a quick demonstration. And then we’ll break into stations here and you all can give it a try.

Simple wounds like this are so, so common. They don’t have to be combat-related. This is, you know, somebody cutting themselves trying to open a package, this is, you know, falling out of a truck, you know, you stumble out and you scrape your leg. So this is something that’s very common, and something we’re guaranteed to see at some point in our careers. 

Needle at 90 degrees. And then you go through the skin, and try to come out on the other side of your wound, about the same distance that you went in on. Yeah, and that’s great, what you did right there.  

We have a nice partnership actually with a local butcher who gives us a good deal on pig’s feet. We’ve done classes where we do a cricothyrotomy, or cric, and so you have to make a cut into the airway, and place a breathing tube through that. So we’ve bought pig tracheas before, and we’ve also bought racks of ribs to practice doing chest tubes, as if we would between human ribs. And so, I think the butcher gets good business out of us on things that maybe nobody else is buying, so he can’t be wrong with that. But it gives us a really good, tangible experience because a lot of the stuff, you just can’t learn unless you feel it.  To put a chest tube in, you have to feel what it feels like to go in between the tissue of ribs. To have the confidence to do a procedure where you have to use a tool on another person, it’s helpful to have done it at some point before, so that, you know, the first time that they’re doing some sort of lifesaving procedure, and they’re realizing they’re going to have to make a cut in somebody’s throat, they aren’t having to do it for the first time just brand new, having never actually held a scalpel and cut something. And so this is what we try to do to prepare them to be safe to be able to do their jobs. ​

​BURDASH:  All right. Next topic, who’s got one?

FEMALE: Things that you would suture of staple, and why one versus the other.

BURDASH: Sure. Yeah, that’s a great one.  The idea is, is you want to do the best to help the body heal without doing any harm. That's key. You know, it’s the first rule of medicine is first do no harm. Primum no killum. I like to do stitches on almost all things, unless they are very big, or sometimes scalps are a nice place to do staples. Or if you’re in a situation where speed is of the essence. So if you’ve got a cut like that, all we want to do is bring these edges together to be able to let the body heal itself. And so, we can do that with staples, where we’ll push the skin together, so we’ll push it and hold it like that, and then we put staples in to hold the edges together. Or, we can kind of bring the skin together, and we put a needle in here through this part of the skin, out through this edge, on this side, into the skin here. And out on the other side. And we get to tie it in a knot.  

So we just finished some hip pocket or just in time training where we had a little lull while we were waiting for some additional equipment before our next class, so we basically just talk about whatever the soldiers want to talk about. Or whatever would be helpful at the time. We’ve talked about all kinds of things in the past. This time we just talked a little bit about wound cares, and respiratory infections. But we’ve just been informed that our equipment has arrived for the other class that we’re going to be doing, so we’re stopping this as needed type training, and we’re going to be moving over to our actual next class.

​BURDASH: All right. So, just head on in. Here in one of, actually one of our kind of one of the buildings where the officers stay often. Just a little bit more space than the usual barracks. And so we’re coming in, and we have to find out which room we’re in this time. Think it's in room seven. All right. Well, here we go then. Got a microwave and a TV. And here’s the sleeping quarters. Not too bad. I’ll take it. Better than a twin size. Always hard to do Army hair? There’s a little bit more space than the barracks. A little bit more to work with. And extra uniforms, just get some of these out so we’ll have them ready in case we need them. OK.   ​

BURDASH: All right, so we just got here at Camp Ripley, that’s the area where we’re going to be doing our formation, and so we’re going to walk over and meet the rest of the crew, and get ready to start the weekend. Being in the National Guard has its own sense of community, and you go through some hard times, and you go through some great times. And so you really do get to bond, and it’s almost like a little family, really. 

MALE: Stand at.

CROWD: Stand at.

MALE: Ease. Morning 204.

CROWD: Morning sir.

MALE: All together again. Thank you for your performance and exemplary representation of our unit during annual training. So, nice job. 

BURDASH: I think the formation does two big things. The first one is that it’s an accountability situation.  And so, we’re able to verify that everybody got here safely, everybody’s here when they should, so that we can execute our missions. But the other thing that it lets us do is I think it reminds us that even though we’re a medical unit, is that we’re still soldiers.

MALE: Company.

MALE:  Attention.

CROWD: Heal the warrior.  

BURDASH: Camp Ripley is a bigger facility, almost like the more formal military forts, but smaller than that. But bigger than our individual armories that we usually have for our monthly drills, where we can go and execute more what we call consolidated drills. So we’re an individual company, which is a group of soldiers that work as one together unit. And we are part of then a bigger unit above that. And so, by going to Camp Ripley, it allows our next step up, the bigger unit all to get together in what we call a consolidated drill, where we’re all at the same place. And so, there’s our medical company, a headquarters company, a financial group, a transportation group. We have all kinds of different types of groups involved within that one bigger group, and we all get to be at the same place at the same time. There’s more resources up here, and so we have weapons ranges, we have treatment facilities, it’s more so like a classic military base, but just a little bit on a smaller scale. ​

BURDASH: I’m Sarah Burdash, and I’m an emergency medicine physician at the University of Minnesota, but I’m also a captain in the Minnesota National Guard. Most of my hours in the emergency department are in the afternoons and evenings, so the earliest shift I usually work starts around 1 p.m. The later shifts start around 4:30 or 5 p.m. Tonight I’m going to have to get all packed up, and tomorrow morning I leave bright and early. We’re going to be driving up to Camp Ripley in Minnesota; it’s about two, two and a half hours away. This particular drill weekend, we’ll be doing our periodic health assessments, we’ll be doing training.  

Oh, Hi guys! Hello! Hey. 

AARON:  How are you doing?

BURDASH: Good. We should eat, I’m hungry.

AARON:  Yeah? I can get it started for us. 

BURDASH: OK. The other thing we get to do tomorrow is the aviation unit’s bringing the Blackhawk over, so we’ll be able to practice hot loads, cold loads, and get the medics in on that. So that should be good.  So we’re doing that, we have some PHAs to do. And we should be able to do some medic classes.  So.

AARON:  That’ll be fun. 

BURDASH: Yeah. 

AARON:  That’s good. Do you teach them also, or?

BURDASH: Some of them. Yeah. So some of the NCOs are teaching some of them, and I’m just adding on.  

So we’ve finished dinner, and now I’m going to start getting ready. 

I am notoriously not a morning person. It’s the advantage of those evening ER shifts, but I like to pack as much as I can the night before a drill. All right. So, we definitely want to make sure we get this in the vehicle the night before. So this little bin here, I actually keep out in the garage, it’s got my tactical stuff in it. So this way, with it being all in one spot, got my helmet, my vest, I don’t have to go looking for all the individual pieces each time that I need it. So, I’ve got this already all loaded in here. Basically at this point, all I’ve got to do now is get a good night’s sleep so we can get on the road first thing in the morning.

WINEGARNER: So thanks for coming out. We're going to do a little bit more advanced rescue training today, so this is something that you might need to use in the field if you're ever moving a patient over long distances or over difficult terrain. What this is called, it is called a three to one pulley system, to help you get a mechanical advantage to move somebody heavy, like our patient here today, up over difficult terrain.

Bit of a hike.

So we're going to run our anchor all the way around this, and then we're going to — it'll be in a straight line all the way down to our patient, so this is like the perfect spot, OK?

MALE: Pull. Pull. Pull. Pull.

WINEGARNER: So Roger, you safe there?

ROGER: Yeah.

WINEGARNER: You can probably unstrap. You guys want to come over here and see what — see what I'm seeing?

I was a little surprised we were having to work as hard as we were to get both Roger and the patient up, so we gotta make sure that the rope goes through the pulley, right? It's the first time, it's no big deal. You've never done anything like this, so next time you won't do that, right?

MALE 1: No, sir.

WINEGARNER: Good job, guys. That's your intro to high-angle rescue. 

WINEGARNER: The common wounds that we really want to train hard are the ones that are — that we've identified as being causes of death that are preventable. So there's been some landmark studies out of Iraq and Afghanistan that have looked at what people die of on the battlefield, and the big things that we've identified that guys can basically intervene on and make a difference on are the massive hemorrhage, and so putting tourniquets on and stopping the bleeding as fast as we can is the biggest thing. And then we've also developed even more to get at more of the junctional wounds, which would be kind of up here in the armpits or down here in the groin area. Those parts of the body are really hard to put a tourniquet on, and you can't necessarily stop the bleeding with that, but we’ve developed special gauzes and even some clamps that we can use in the field to stop those bleeding sites. And so, so massive hemorrhage is always something that we're always going to train when we do this TC3 training. And then the pneumothorax, which we also simulated outside, that's another thing that's been identified as potential intervention that guys can do in the field and will save a life, because with penetrating or blunt-chest trauma, there can be basically a ruptured lung and then air leaking into the chest that collapses the lung, and then can even compress on the heart and cause circulation problems. And so just by simply putting a needle in and decompressing that, we can release the tension that's inside the chest and get the blood pumping again. 

WINEGARNER: At this point, this patient is simulating the same patient that we brought — uh, that we collected and brought to the helicopter. Now he's in a higher level of care. He should have most of the same injuries that he had before; they're going to find some more injuries.

For some of these guys, it's going to be the first time they see anything like this, because they're not medical guys at all. So the medic and I will be kind of geeking out on medicine and stuff, and we'll be trying to teach some of these non-medicine folks a little bit of what we're doing.

MALE:  We need an escharotomy here. His compliance isn't good, and he's not moving a lot of air right now.

WINEGARNER: OK.

MALE: Because he feels really tense in his chest

WINEGARNER: So explain to me how you're going to do that.

MALE: Gonna clean the area with betadine, and then we're going to go with either a scalpel and cut anterior axillary line from just below the clavicle all the way down to the costal margins —

WINEGARNER: OK.

MALE: And see if that affects — do that bilaterally.

WINEGARNER:  OK.

MALE: And if his breathing gets better, we're going to... 

WINEGARNER: You probably want to cross here too.

MALE: Roll with that, but we might have to go one across the diaphragm.

WINEGARNER: OK.

MALE: We're going to go until we see the subcutaneous fat, and the skin is going to separate due to the pressure.

WINEGARNER: One thing I've had to learn as a doc in a leadership role is that it's not my training — it, I'm leading the training and these guys are the ones who are reaping all the benefits.

With you guys not being medical people, this was a whole — this was a high level of medical s— medical things going on, OK? So we were trying to walk through it with you; mainly we wanted you guys to just be exposed to it, and, you know, in the future, worst-case scenario, who knows, you might find yourself having to help out in this kind of setting. So at least now you've been through it once. I know this was a first for a lot of you guys, so thanks a lot for coming out, and Nick, I know you definitely got a lot out of this, so good job. Good work. Proud of you guys.

M:   For sure? Thanks, sir.    

WINEGARNER: All right, guys, thanks for coming out this morning. So we're here today to do some good TC3 training. Nick, you're our medic today, and so you're going to be kind of taking point, and he's going to be the boss. I'm going to be in the background; I'll be helping direct what's going on.

All right, Nick, take it from here.

NICK: And you'll be point man on the patrol. You'll be on the right side of the wedge, along with you. When we take casualties, I'll assign roles when we get there.

WINEGARNER: All right, guys, you've got superior firepower.

NICK: Left side, move to the vehicle. Right side, move to us. Get on the front side of the vehicle.

MALE: Hey, we need a hand over here.

WINEGARNER: At this stage, which we would call care under fire, is managing massive hemorrhages.

NICK: You get the bleeding stopped?

MALE: Bleeding's stopped.

MALE 1: Bleeding's stopped.

WINEGARNER: So we're moving from...

NICK: You with me? OK.

WINEGARNER: What we would have considered care under fire out there, where all they really did was stop the bleeding and get him somewhere more secure, to what we would call tactical field care here. So this is where our medic's going to take charge; he's going to start addressing every problem that he can find. Nick, what's something that you might have to worry about on this guy with a chest wound, now you've occluded his chest wound?

NICK: Might have to needle d him.

WINEGARNER: OK.

NICK: We're going to check for bilateral rise. He was good; his respirations weren't too high either. [booming noise]

MALE: We gotta get going.

WINEGARNER: All right, guys, it's not safe anymore. Let's get going. [sounds of gunfire] Move out, move out. So this is simulating — we would, you know, probably have to move him to somewhere safe for a helicopter to land, and then from here we're going to take the patient to a higher level of care. You know, now we're more in a field-hospital setting. 

WINEGARNER: You know, there's so many benefits, it's hard to even count, but really, the things that drew me into being an Army doctor was, first and foremost, they paid for school, which is awesome. I also was at the military's med school, which was great because I got married while I was there, and so not only did I have health coverage through the military for myself but my wife also received healthcare and all the perks of being active-duty military then. And then during residency, we got all the same perks. So we were commissioned as captains in residency, and we were paid as active-duty captains in the military, which is much higher pay rate than a civilian in a similar job would be paid.

I like pretty much everything about my job, really. I like the flexibility that I'm allowed to have, I like the way we run our clinic. There's a lot of autonomy in our job, and we have multiple hats that we wear, and so we'll be here in clinic and we'll wear our doctor hats and we'll do regular doctor things where we see patients and do regular doctor-type stuff. And then we'll also go over to our battalion, where we're also a member of the staff for our battalions. The role there is we advise our commander for medical issues that might come up for missions or training, that kind of thing. If you want to have that kind of -- chaotic at times, but also very fun lifestyle where you get to go and jump out airplanes or, you know, go learn how to be a combat diver, and take care of that kind of soldier, then yeah, it's a pretty good job, so. 

WINEGARNER: Hey, it's me, Dr. Winegarner.

MALE: Hello, sir.

WINEGARNER: How's it going, man?

MALE: Good.

WINEGARNER: What brings you in today?

MALE: Uh, back's been hurting me for a while now.  I've been doing a lot of PT, a lot of weight lifting, and I'm getting pretty, pretty sore in my lower back.  It's starting to shoot down my leg.

WINEGARNER: Is that new or has that been going on for a while?

MALE: Off and on for probably about a year.

WINEGARNER: Most of our Green Berets are in top physical condition. They're much more physically fit than your average soldier, just because of the physical requirements of their training.  That's a standard that they're held to.

Really what we're worried about is any type of nerve problems, so if our guys have just jumped out of an airplane and all of a sudden have back pain, they can sometimes cause some bulging in one of their desks in between the vertebrae, and that can press on a nerve and cause some pain in some of the radicular symptoms that he's kind of describing, with pain shooting down his left leg. What I'll do with these guys is I'll make sure that on their way out they'll go and check in with our physical therapist that's here in the building and get on the schedule with them, and that allows for some good continuity of care. We have some systems in place to inform our command, the commanders of the soldiers, as to what limitations they might have, medically speaking. So that's a big part of being a military doctor, is just keeping in mind that our soldiers are very active, and what kind of -- we have to always think of what kind of limitations they might have as far as their job is concerned.

From here, we'll walk down the hall to our physical therapist and go get him on the schedule for some back rehab. 

WINEGARNER: So here we are. We're at the 10th Group Special Forces Clinic that we share with Robinson Clinic. This is where we see all our patients every day. And this is also where patients would come if they were injured on the jump for Airborne Jumps. 

We've actually just recently gone to what's called the Soldier Center Medical Home Model. And so basically the Soldier Center Medical Home is a place where a soldier can come and get all the things that they need in one stop. This hallway is mostly all exam rooms; they're multipurpose exam rooms. We have these treatment rooms; it's pretty nice to have something like this here in our clinic because we can take care of some of the sicker patients without having to send them up to the ER. We have our physical therapy room, and this is where we do a lot of our musculoskeletal physical therapy rehab. At the end of this hallway we would run into our pharmacy and our lab, and that's where patients can go and get their meds after they see us, and they can go and get blood drawn or do urine studies, those kind of things. So it's a one-stop-shop for them, so to speak.

Working here in this clinic is great, because, you know, we're a pretty small little family; this is a one place where all our patients can come and just get everything that they need, and we're here basically every single day, from morning till evening, unless we're out in the field doing something with the guys. And so our guys know that they can come here and find this if they need something from us. 

TRENTINI: Alright, so part of residency is academics, so every Tuesday morning we have a conference where all the residents get together, military and civilian. The first thing on the agenda — there’s always an oral boards case.  In that situation, one resident’s called up in front to sit with one of the board examiners, and they go through an oral board case in front of the entire residency program.  So it’s a little nervewracking. After that we’ll have some simulation sessions to go through, so busy day today.

The simulation center is about as close as you can get to a real-life patient encounter. All the residents go through multiple sims throughout their career, and you can do — almost everything that you can do on a real patient, you can do in the simulation center. The experiments that we conduct in the lab downstairs are slice culture experiments. And so what we can do then is change the environment to simulate a stroke. This is the brain slice, again, that’s cut like a piece of pepperoni, lying flat on the grate, and what we’re interested in studying is this part of the brain, which is the cerebral cortex, which is the outside of the brain, which in humans is all the sulci and gyri, all the gray matter of the brain, OK? We’re interested in studying these cells and how these cells respond to an acute stroke, and if our nanoparticle treatment can prevent the damage caused by an acute stroke.

I was awarded an ROTC scholarship, which paid for college, and then in return I owed four years of active-duty service to the Air Force. So that’s when I decided to go to USUHS where — it’s a military medical school. There I did my medical degree and also did my Ph.D. degree, and it was entirely funded by the Military. And then after medical school you choose a residency, and so emergency medicine for me fit in perfectly. When I’m done, I’ll go back to an active-duty job using all the knowledge and all the experiences that I’ve built along the way to really serve my country better. 

TRENTINI: Alright, so part of residency is academics, so every Tuesday morning we have a conference where all the residents get together, military and civilian. The first thing on the agenda — there’s always an oral boards case.  In that situation, one resident’s called up in front to sit with one of the board examiners, and they go through an oral board case in front of the entire residency program.  So it’s a little nervewracking. After that we’ll have some simulation sessions to go through, so busy day today.

The simulation center is about as close as you can get to a real-life patient encounter. All the residents go through multiple sims throughout their career, and you can do — almost everything that you can do on a real patient, you can do in the simulation center. The experiments that we conduct in the lab downstairs are slice culture experiments. And so what we can do then is change the environment to simulate a stroke. This is the brain slice, again, that’s cut like a piece of pepperoni, lying flat on the grate, and what we’re interested in studying is this part of the brain, which is the cerebral cortex, which is the outside of the brain, which in humans is all the sulci and gyri, all the gray matter of the brain, OK? We’re interested in studying these cells and how these cells respond to an acute stroke, and if our nanoparticle treatment can prevent the damage caused by an acute stroke.

I was awarded an ROTC scholarship, which paid for college, and then in return I owed four years of active-duty service to the Air Force. So that’s when I decided to go to USUHS where — it’s a military medical school. There I did my medical degree and also did my Ph.D. degree, and it was entirely funded by the Military. And then after medical school you choose a residency, and so emergency medicine for me fit in perfectly. When I’m done, I’ll go back to an active-duty job using all the knowledge and all the experiences that I’ve built along the way to really serve my country better. 

TRENTINI: Sit. And sit. Present arms [dog barks] Salute. Good boy, good boy.

TRENTINI: This is Moose. This is our high-fidelity simulator. He’s a really rough and tough guy who we can intubate, we can start an IV on, we can do assessments on, put tourniquets on, pump him full of fake blood, and it makes it very realistic. And so we’re going to practice both tending to him out in the field and then extricating him out from some difficult environments and taking care of him from the back of a truck, so — should be a good day.

TRENTINI: So in here I’ve got my laptop, small textbook, my stethoscope is here, always have a 14-gauge needle, tube of toothpaste. I do happen to carry a headlamp. Here’s a bottle of Motrin. Tongue depressor, some scissors — somebody came over and they were like, “Hey, do you have a tuning fork?” And it’s (inaudible) suture. These are calipers. Airway card. Oh, and a tourniquet, of course. You never know when you’re going to need a tourniquet, so. OK, that’s it.

TRENTINI: You know, a lot of times I’ll work very strange shifts in the ER, where I’ll get home at sometimes midnight or sometimes work an overnight shift and get home at about 8:30 in the morning.

[whistles] Hey, guys. Hey, mister. Hey, Abigail. Hey, Abby girl. You hungry for breakfast?

We’ll usually just have some coffee and a little bit of breakfast, do some reading about some of the cases — interesting cases I saw the night before, and then come out here and check on the animals and get — kind of get the day-to-day things taken care of before passing out (laughter) and going to sleep and getting some rest and getting ready for the next night.

People always ask me why — you know, why farming is — like, why’d you get a farm? You know, you’re doing residency and you’re busy and all this stuff. And I’ve always wanted to have a lot of space and land and I grew up, you know, kind of around farms and cow farms and horse farms and always wondered what it’d be like to have one of my own. They’re really actually not a lot of work, to be honest. It’s just coming out, making sure they’ve got plenty of food, plenty of water. And they’ve got a good pasture out that they eat plenty of grass in, so. Well, after we get this cleaned up a little bit, we’ll put down some fresh bedding, and then I think it’s time for Carl to get a haircut.

I really connect with my patients a lot, because you’d be surprised how many alpaca farmers are in the area here, so it’s not uncommon where I’ll be talking with somebody that’s in the ER who has got a farm, a sheep, or a livestock or something, and sometimes I’ll get advice from my patients in terms of how to do stuff, so — so it’s a great connection with folks in the area here, so. And, you know, I’ve got to take care of these guys just like I take care of my patients, although I will say I’ve never given a haircut to any of my patients in the ER before.

NGUYEN: In the Military, hospitals open at sometimes six or seven o’clock, but by the time the hospital hits 1600, or 4 p.m., it’s 95 percent empty. They encourage you to have strict hours and they encourage you to leave and go home and take care of your family, because they know that if you’re not having that relaxing time and having family life, you won’t be able to contribute at work fully.

One of my favorite activities is kayaking. It combines some of the best natural elements that are available to you — one, being outside in nature, and two, being surrounded by one of the most peaceful things in the world, which is water. Water is known to be therapeutic, and to be surrounded by it and watching and hearing the waves, is very — it’s so soothing for anybody.

I think the best part was actually just hanging out with your friends on the water, where you’re just away from everybody, everything and the noise. And the awesome part is that it’s my job that took me out here. I never would have thought to even come out to the Pacific Northwest, because I grew up in DC. And that’s what’s the great part about the Military — it takes you out of your comfort zone and puts you — transplants you somewhere that you’d never even think about, and my gosh, that’s been the whole story of my career in the Military, is this continual growth, expansion and meeting new people from all walks of life.

NGUYEN: The use of ultraviolet light to treat inflammatory skin conditions like vitiligo or chronic itch — it’s a very powerful tool because there’s no ingestion of medication, and you’re using a natural form of therapy to suppress the immune system. Obviously this is something that you use for a very limited time. You don’t want to use it for a long period of time because of the risk with skin cancer and photo-aging. I’m excited because I believe that this patient will respond well to the light therapy.

NGUYEN: We’re often so busy running around either taking care of patients, doing administrative work, counseling people, that we have an hour blocked out in which you do not have patient care. And that allows you to just take a step away and get a mental break.

NGUYEN: So the neat thing about dermatology is it allows you to not only do patient care but do a lot of procedures, the surgeries, lasers, biopsies, excisions, and your patient pool is both kids, young adults and the elderly. So it allows you to see — do a wide variety of things and see a lot of different patients.

NGUYEN: I know you guys are still in the learning phases, but even, like, you would think, like, even beyond — after residency and taking your patients, like, you all — there’s always a transition phase of your career, where you’re like, “OK, I’m good seeing patients now, I want to do something else like run hospitals, or do international aid.” And that’s what’s awesome about medicine, is that the civilian side, people pretty much have to stay in that pathway, or, I mean, or then they can transition, but then to transition to the executive level, it takes a big — a big transition, while for the Military, like, you can just jump from one to another, and then just still go back and take care of patients. So it’s been — I mean, it’s just — just to encourage you that your choice to go Military was great.

FORSBERG: I drive the boat, which, you’ll be surprised to hear that that’s the least important job on the boat. My wife is running around on the bow, making sure the sails go up and down properly. And then we had Lexi trimming the sails and calling tactics, and I drive the boat wherever she tells me to drive it, so it’s not a very important job. It looks like it is, but it’s not.

FORSBERG: Alright. So everything’s ready. Temperature is — I think the temperature is just right, so we’re going to go ahead and go in.

MATT: Alright. 

FORSBERG: Whenever you want. I’ve been doing this for a while. Ten years, maybe. Technology’s changed a lot in that time. Had a chance to accumulate some of this equipment and make some of it from scratch.

MATT: I think the best one that we did was a recreation of the Founder’s Breakfast Stout, which was a dark chocolatey stout. We put it on nitro tap, which was — can’t get it anywhere like that, so.

FORSBERG: Oh, it was great. And Matt and his wife Lindsey got married, and we brewed the beer for their wedding reception. That was a lot of fun.

FORSBERG: So I have in front of me a prototype, and this prototype is designed to be attached to — attached to the skeleton. And the patient’s skin is here. And we’ve had an opportunity over the last couple of years to develop this porous material and test it in our preclinical model, to ensure that we have adequate blood supply in this area. So by ensuring that we have adequate blood supply to this area allows us to treat an infection with antibiotics, should it occur. We’re very hopeful that this technology will be useful in patients with amputations that are complicated by wound failure and heterotopic ossification.

FORSBERG: After finishing up at Walter Reed and attending morning rounds, I go to the Naval Medical Research Center to touch base with the basic science team. And they’re engaged in pre-clinical research, benchtop research, if you will. So I’ll meet with them and go over the projects and make sure everything’s on track.

I serve as department head for the Naval Medical Research Center’s regenerative medicine department. So we focus on complications like heterotopic ossification, which is the formation of bone in soft tissues. We focus on wound healing, and we also focus on improving the lives of patients with amputations.

So let’s go take a look at the lab. One of the experiments that’s ongoing right now is to determine whether a nerve injury commonly seen after a blast requires surgical treatment. If the nerve doesn’t recover, it requires surgery to be replaced. If the nerve is going to recover or has the capacity to recover, it’s better off if it were to recover on its own, without surgery.

So the purpose of this experiment is to differentiate between nerves that have the capacity to heal from nerves that don’t. The ultimate goal would be to use this technology to help guide surgical decision-making in the early phases of wound debridements.

One of the biggest benefits of being in the Military is being put into a leadership position relatively early in your career. I’ve had the opportunity to do that, both on the clinical side and on the research side. And this is not something that would happen in the civilian setting until much later in one’s career.

FORSBERG: I grew up in a little town in Montana, and my father was in the Military, my sister was an Air Force Academy graduate, and there was a strong sense of patriotism in Montana. So after high school I joined the Marine Corps, and as a Marine, applied to the Naval Academy for college. And then after that went to medical school. So I always wanted to be a doctor. Took a circuitous route through the Marine Corps, but I wouldn’t — I wouldn’t trade that for anything.