Few figures in our collective American history have borne the scale and scope of war like our 34th president, Dwight Eisenhower. Yet, despite being one of the most successful military commanders in history as the supreme allied commander in Europe during WWII, Eisenhower does not speak of glory or fame, rather disdain for war: “War settles nothing.”

My wife, Pam, and I have been truly blessed. We have raised three professional young adult women who are out in the world, blazing their own paths. We are preparing later this year to retire entirely and move toward a 30-year dream of living and traveling on a cruising catamaran full-time (more on this in coming editorials, dear reader). Pam and I have always followed the adage, “pay yourself first every month.”

It has been a bumpy start for 2022, as the country begins the year with high monetary inflation, the anniversary of the Jan. 6 attack on the U.S. Capitol and a resurgence of COVID infections via the new omicron variant. I have entered the year experiencing that same feeling I often felt just before an Army physical training test, exhausted before even getting started. I found the comment concerning truth from Ted Koppel particularly poignant as we begin 2022, because the three major issues I mentioned (of course, there are numerous others) are all related to how our society processes and digests truth.

As we begin 2022 in federal medicine, I cannot help reflecting on the unprecedented transformational change our society has undergone in such a short period due to the pandemic. Assumptions regarding the workplace, school, social and religious gatherings have undergone a tectonic shift. Could you have imagined worrying about the vaccination status of a family member coming to an event like a wedding or Thanksgiving just two years ago?

I received a call today from my middle daughter, Hannah, who was in a bit of a panic. She is a second-grade teacher in the Baltimore County Public School System. While waiting for a stoplight on her way to work, a homeless (presumably) man threw a metal pipe at my daughter’s BMW rental car, denting the new car’s side door. This action was done with force and purpose.

I have had the good fortune to live in a classic Annapolis, MD, community blessed with an old-growth forest that exists throughout this Chesapeake bayside development. Many of these trees are black and chestnut oaks consisting of numerous specimen trees greater than 100 years old. My wife and I have managed to stay in this community since 2007. This is the longest I have ever lived in one place in my entire life.

My editorials for U.S. Medicine are rarely challenging to produce. I certainly appreciate the outlet and the opportunity to comment on issues of general interest to the federal medicine community. Admittedly, I have struggled more this month than any month before to produce something meaningful. I understand that you may disagree with my opinions.

Like many Americans, I have enjoyed the gradual return of regular activities as the COVID-19 pandemic appears to be waning as significant numbers of our population receive one of three available COVID vaccines. I have relished freedoms I took for granted 16 months ago, like eating in a restaurant, going to a movie, or entering a supermarket without a mask.

On May 30, 2021, my eldest daughter, Susan, married Dan Hoffman at Kent Manor Inn. For everyone involved, this was the event marking our emergence from the past 14 months of pandemic delight.

I was teaching this month at Fort Indian Town Gap, PA, for Bushmaster 2020. Running a Bushmaster exercise in the spring is uncharacteristic since the event usually occurs in October. Unfortunately, the COVID-19 pandemic struck in March of last year with a vengeance. Like many folks, the calendar at my desk in our office building is still on March 2020 as I sit at home writing this.

I found this comment from Prince Philip, Duke of Edinburgh, compelling as the English royal family faced Philip’s death on April 9, 2021, at age 99. His passing might have hardly been noticed by me beyond my respect for his service to the UK and what he represents for America’s closest ally. Sadly, though, the event was poignant for me personally as I recently lost my own father, Chet Buckenmaier, unexpectedly just a few weeks ago.

Dr. Anthony Fauci made the now-famous statement, “Wear a mask,” during a 60-Minutes interview at the start of the COVID-19 pandemic in March 2020. The verbal missive has been requoted countless times by government officials and healthcare leaders during the past year. The Yale Law School library has listed this statement as one of the top 10 quotations that define the year 2020.

“Meditation is allowing what is.” —Victor Davich
Indulge me for a moment. Move to a space where you are alone and can be comfortable. Close the door to the room you are in and turn off any nearby electronic devices that might command your attention. Do not worry; this will only occupy a few minutes of your time. Pick an object in the room and focus on it while taking two or three deep breaths in through your nose and out through your mouth. Then, gently close your eyes and focus your mind on the sensation of breathing.

“Anything that can conceive of as a supply chain, blockchain can vastly improve its efficiency—it doesn’t matter if its people, numbers, data, money.” —Ginni Rometty, CEO IBM

Well, we enjoyed five decent days in 2021 before the Jan. 6 insurrection; I guess we should hope for better in 2022. I am paraphrasing a statement I heard on social media (I am sorry that I do not have the original source). I feel like 2020 is analogous to a drunken college roommate who has been out all night involved in some unspeakable debauchery and comes home to vomit on your floor in the morning

“We the people are the rightful masters of both Congress and the Courts, not to overthrow the Constitution but to overthrow the men who would pervert the Constitution.” —Abraham Lincoln (1809-1865)

Last month, my editorial was written following the debacle of the first presidential debate. By any standard, the debate was a sad commentary on the state of our union, as well as an affront to civil decorum owed to the American public by our leadership. I admitted in that editorial that my faith in the resilience of our longest-established democracy had been shaken.

“That was a hot mess inside a dumpster fire inside a train wreck.” – Jake Tapper, CNN

On Sept. 29, 2020, the first presidential debate was hosted in Cleveland by Case Western Reserve University and the Cleveland Clinic. Like millions of other Americans who believe the upcoming election is one of the most consequential in our 244-year history, I settled in with a beer to watch. I have been consuming the historical fiction series, “Vikings,” on Hulu that involves considerable hacking and slashing battle scenes. During the course of the debate, I was tempted to turn back to “Vikings” for something a little less traumatic and disturbing.

“Only one rule in medical ethics need concern you – that action on your part which best conserves the interests of your patient.” — Martin H. Fischer (1897-1962)

My mother, who I give complete credit for my abilities to manipulate the English language to craft these editorials, recently sent me an article by Julie Steenhuysen (Reuters, Aug. 14, 2020) entitled, “U.S. to make coronavirus strain for possible human challenge trials.” Mom, who is not one to mince words, included the email comment, “OMG! Crazy … ” I believe my mother’s remark was able to convey the meaning behind this month’s quote by Dr. Martin H. Fischer, but she managed to do so with just 12 characters. Although my mother is not a healthcare professional, she understands a foundational medical ethics concept of which I, Dr. Fischer, and all healthcare providers are familiar with—primum non nocere.

“Extraordinary times call for extraordinary measures.” — Benet Wilson

Last month’s U.S. Medicine August 2020 editorial, “It feels like writing ‘Bad things are about to happen’ on a napkin and then setting the napkin on fire.” — Colin Carlson, was angry. This month’s editorial is an admission of regret for that anger, a recognition that anger serves no useful purpose in the face of national tragedy. It perhaps defines a better way to act going forward. Admittedly, the editorial was cathartic for me. Still, I am not sure it was much of a public service to my readers. The depth and breadth of the COVID-19 pandemic in this country has been overwhelming to society. It has exposed divisions in our union that have been simmering under our national veneer of unity.

“It feels like writing ‘Bad things are about to happen’ on a napkin and then setting the napkin on fire.” ~Colin Carlson

This month’s quote comes from Dr. Colin Carlson, a research professor specializing in infectious disease from Georgetown University who commented to reporter Ed Yong in The Atlantic magazine article entitled “The pandemic experts are not OK—many American public-health specialists are at risk of burning out as the coronavirus surges back” July 7, 2020. This comment struck me, because it sums up the last several months of watching SARS-CoV-2, dubbed COVID-19) spread out-of-control around most of this country. It has been heart-wrenching to watch exhausted healthcare workers, battling on the front lines of this pandemic, pleading with Americans to take this viral epidemic seriously.

“The real enemy is arrogance.” —fictional Gen. Mark Naird, Netflix “Space Force,” Episode 10.

Like many Americans, I thought we had reached rock bottom in terms of things going wrong for our society, but it appears we have begun to dig. The COVID-19 pandemic seems to have scoured the pleasant American veneer of union and equal rights under law and exposed this fiction as the true reality of our society. The reality being exposed is the unpleasant and deeply painful truth of institutionalized racism and wealth inequality that has plagued our culture since its inception with the signing of the Constitution. This is not to say we have not made progress. There is no denying that our struggle to form a more perfect union in this regard has advanced since the American Civil War; the first major surgery to begin the process of addressing racism through the abolishment of slavery.

“You gotta fight for your right to party.” ~Beastie Boys (lyric released 1986)

“If I get corona, I get corona. At the end of the day, I’m not going to let it stop me from partying.” This statement was made by a young Miami Beach spring-breaker on camera to a Reuters reporter on March 18, 2020.1 This sound bite played on the national news and summed up the feelings of thousands of young people who had been planning to attend this beach party for months, and they were not going to let a silly virus get in the way. Recognizing that March 18 feels like a decade ago and the impact of COVID-19 on our country was only beginning, I can empathize with this young man’s priorities. That is not to say I was not shocked and appalled when I saw this video on the nightly news.

“Action speaks louder than words but not nearly as often.” ~Mark Twain (1835-1910)

COVID-19, often referred to as coronavirus, has dominated the news as this new viral threat spreads across the globe as the latest major pandemic. Pandemics are nothing new in world history: HIV/AIDS pandemic (at its peak, 2005-2012) 36 million dead, flu pandemic (1968) one million dead, Asian Flu pandemic (1956-1958) two million dead, flu pandemic (1918) 20 to 50 million dead, sixth cholera pandemic (1910-1911) 800,000 dead, flu pandemic (1889-1890) one million dead–and the sordid list continues into recorded history. Any student of medical history is not surprised by this latest plague beyond the fact that it did not happen sooner.

Yes, improvements in the general hygiene (in the developed world) of humans on this planet and the incredible contribution of vaccinations (thank you, Edward Jenner–smallpox vaccine, 1798) has improved general health and accounts for many human plagues being eliminated or at least uncommon.

“If you think adventure is dangerous, try routine; it is lethal” ―Paulo Coelho

My wife, Pam, and I recently returned from a fantastic sailing adventure in the Bahamas aboard the Liberty Clipper, part of the Boston Harbor Liberty Fleet of Tall Ships. The 125-foot gaff-rigged schooner is a modern replica of the small merchant vessels that plied the American coast in the 18th and 19th centuries. While the steel-hulled ship caters to tourism in Boston during the summer, taking guests on short sails around Boston Harbor, it overwinters in the Bahamas out of Nassau, providing weeklong cruises throughout the islands for those looking for something different in cruising.

This cruise is more of an adventure tour. The food was outstanding—my glass was never empty—and the scenery was incredible (we sailed the isolated Bahama Exuma islands), although the cabins were consistent with a working sailboat. While we did have a private bathroom, we slept in bunks, and Pam and I could not pass each other in the cabin without one leaving the room.

“My mother used to say to me if you want to clean up the world, first clean up your room.”—S.E. Cupp, CNN interview aired Jan. 4, 2020, 1800 ET.

CNN reporter Sarah Elizabeth Cupp was interviewing Rabbi Joseph Potasnik concerning recent anti-Semitic attacks on members of the Jewish faith. My spouse, Pam, viewed the CNN interview and made me aware of Cupp’s quote used above from the broadcast. My wife and I have been discussing the ongoing challenges to the world’s environment due to the consequences of climate change, the horrifying ongoing bush fire disaster in Australia being the most current and poignant example. Unpleasant changes in our global environment from extremes in weather, animal species extinction or rising sea level seem to be routine on the nightly news.

“The two most frightening words in Washington are ‘bipartisan consensus.’ Bipartisan consensus is when my doctor and my lawyer agree with my wife that I need help.” —P.J. O’Rourke

I have been struggling with the idea of consensus-building for some time in my machinations within the Defense Health Agency to mold effective pain management policy for military beneficiaries. P.J. O’Rourke, one of my favorite modern authors and satirists, cuts to the heart of the issue with brevity and humor. I can easily identify with the feeling that O’Rourke’s comment on consensus evokes in my efforts to move forward on any front within pain medicine by forging agreement among military medical leaders.

As I have noted many times in this column, decisions for medical change are far easier to achieve during a hot war, when the necessity for action is made clear through the clarifying lens of servicemembers’ blood, injury and suffering.

“Treating mass casualties or performing emergency procedures in the middle of a firefight or while under chemical attack are not part of the ordinary medical school curricula.”

Rep. Constance A. Morella (R-MD) Constance “Connie” Morella was a Republican representative for Maryland’s 8th Congressional District from 1987-2003 during the Bill Clinton presidency and made the above comment in 1994.

At that time, Vice President Al Gore and a team of congressional leaders were working to reduce the nation’s deficit. They were planning the demise of the Uniformed Services University, suggesting that military physicians and nurses could be procured from civilian medical institutions through health professions scholarship programs at significantly less cost than graduates from America’s only military medical school. Clinton’s spending plan for the 1994 fiscal year called for the first significant steps to close the institution.