“We make a living by what we get. We make a life by what we give.”
Winston Churchill 1874-1965

Editor-in-Chief, Chester ‘Trip’ Buckenmaier III, MD, COL, MC, USA

I believe it is healthy and proper to reflect on the past year, as the new year dawns. As I ponder this editorial, the specter of the impending “fiscal cliff” looms large in the news, following, perhaps, one of the more contentious presidential elections in history. At the Center for a New American Security on Nov. 20 , Secretary of Defense Leon Panetta commented on the impending fiscal crisis and the paralysis of Congress to prevent the country from falling off the “cliff.”

He stated, “the worst thing that can happen, frankly, from my perspective is if they just kick the can down the road. All that would wind up doing is continuing to present a shadow over the Defense Department and, for that matter, the rest of government as to what would happen. And that’s the damn last thing I need.”

One need not be a rocket scientist to understand the impact these Draconian cuts to the military budget would have on federal medicine. Pundits from both extremes of the political spectrum continue to predict doom and damnation, whether from “Obamacare” or taxation of the rich. The “Arab Spring” is beginning to look more and more like a huge, Middle Eastern, smackdown by dictators disguised as reformers. Iran is still spinning uranium, Israel and Palestine still see no middle ground, North Korea is still dark at night, sea levels are rising and Afghanistan is, well, Afghanistan. Purportedly, based on the ancient Mayan Long Count calendar, the world was supposed to end Dec. 21, 2012. The fact that you are here to read this editorial is a bit of good news (more of a comment on the silliness of ignorant interpretations of the Mayan calendar than on the quality of this editorial). So count your blessings.

The ongoing insanity that is the human condition on this planet can be overwhelming at times. It can be hard to find value in individual efforts to improve things when so much seems to be wrong on such a grand scale. Certainly working in federal medicine in the United States provides a comfortable living that most others around the world would envy. In fact, I find it somewhat laughable to lament my own financial situation after the poverty that I have witnessed around the globe. That said, I still manage to grumble at my public-service salary when I look at the costs of college for my three daughters. I also recognize that I am a part of the same bureaucratic monster that, as of this writing, is playing brinksmanship with every citizen over political ideology. In fact, in my own efforts to move the ball forward in military pain medicine, I have become two things I tend to loathe: a politician and a salesman. One would wonder why people would choose to serve as public servants in the first place?

At least in federal medicine we have the refuge of our practice of medicine and our patients. It has been, and remains, a coveted escape from the bureaucratic battles of my “real” job. In fact, some of my best experiences as a medical officer have been while on deployment, where I am free of the paperwork “churn” and my only focus was on patient care. Certainly my colleagues in civilian medicine reading this will decry their own frustrations with the business of medicine, but they are handsomely paid for their troubles. Why do people make a career in federal medicine?

I believe for many, and certainly for me, there is an ingrained need to try to make some positive difference in the human condition, no matter how insignificant it may seem compared with larger world events. Compensation for this work is important, but it is not the primary driver for career decisions. Service to the government, despite its many flaws, is still service for the general greater good. Additionally, I have always appreciated the fact that the decisions I make for patients in our system are based on what I professionally think is best for their health, and those decisions are not overly influenced by the financial needs of the hospital or group. I make a comfortable living as a federal medicine physician, but I have built a life, as Churchill described, with my family in service to this country. It is this latter benefit, rarely mentioned or discussed, that is priceless for me personally.

My family has never known a life outside of federal service. Somewhere along the way, these lessons on the difference between working at a job for money vs. a career in the service of others must have rubbed off. My eldest daughter raised her own hand a few weeks ago to accept a four-year Reserve Officer Training Corps (ROTC) scholarship, beginning her own life’s journey of service. She marks the fifth consecutive generation of our family to serve in the military. Despite all the large pains in the world, good things, small things, still go right. They just do not make the nightly news as often.