“Sometimes interesting paths create interesting people, and sometimes interesting people create interesting paths!” ― Mehmet Murat ildan
Editor-In-Chief, Chester “Trip” Buckenmaier III, MD, COL (ret.), MC, USA
One of the best aspects of the sailing lifestyle is discovering new anchorages and meeting the local people. Recently, after a spectacular downwind sail with consistent 10-15 knot winds off the starboard quarter (what sailors mean by fair winds and following seas), we dropped our hook at Boot Key in Marathon, Florida. Marathon is home to The Turtle Hospital, a fascinating non-profit organization dedicated to the rescue, rehabilitation, and release of sea turtles. Sea turtles are Shavasana’s (our Lagoon 42 sailing catamaran) ‘spirit’ animal, and a graphic of five sea turtles graces our bows. Pam and I felt a visit to the Turtle Hospital a must. We were not disappointed and recommend a tour of this fascinating facility if you happen to be traveling the Florida Keys.
In a conversation with one of the educators at the Hospital, the scourge of the invasive lionfish species (native to the Indo-Pacific region) on turtle reef habitats in the Keys was mentioned. The lionfish (Pterois volitant) is maroon-red or brown with white stripes and sports beautiful, although venomous, spines that jut out threateningly from its body to deter predators. Sadly, the lionfish has no natural predators in Florida and has been a blight on the local ecology. As an aside, the turtle healthcare educator noted that the lionfish was delicious and that a nearby restaurant, Castaway Waterfront Restaurant & Sushi Bar, had them on the menu. Pam and I were intrigued as well as hungry for lunch after our Turtle Hospital tour and decided to seek out the bistro.
The lionfish was tasty, and we were fascinated by all the photographs and memorabilia gracing the old establishment’s walls. Of particular interest was an ongoing film depicting divers catching lionfish with spears around wrecks and the reefs. After spearing the spiney fish, they would place the captured invaders in long plastic tubes for safe transport. We inquired about the movie to our delightful waitress, Tami, who proceeded to tell the story of the establishment’s owner, John Mirabella.
John, a Navy diver who also served on the USS Louisville (SSN-724- a large banner hangs from the restaurant ceiling honoring the submarine), arrived in the Keys 25 years ago and purchased the restaurant to be his own boss. He quickly fell in love with the area and local community. He decided the invasive lionfish was the best way to combine his passion for diving and his need for something exotic on his sushi menu. Unlike other fish that can be hooked or netted, the lionfish hides away in cracks and crevices in the reef. Diving and spearfishing are the only practical ways to obtain the dangerous, sly, and shy fish. Tami’s story about the owner enthralled me because of his success in turning a passion into an economically and ecologically sound career. The Castaway Restaurant’s success in developing lionfish as a delicacy (under Chef Bo’s direction – ask him to show you a Lionfish when you visit) now supports other economies as fishermen hunt and export lionfish for the growing demand for the sweet, firm fish. This results in more of the Caribbean’s reef system being relieved of the invader.
I appreciated John’s efforts and hoped to meet him, but he was likely out-diving, Tami related. Undeterred and always looking for content for this column, I left my contact information with Tami and puttered our dingy back to the boat. Most graciously, John contacted me that afternoon, and we had a wonderful conversation like veterans usually do (even if he was in the Navy). John inquired about the length of our stay in Marathon. We admitted that the winds were favorable, and we were leaving for Key West in the morning (sailing is freedom, weather being the notable exception since the winds dictate when you stay or go). To our delight, John asked if we would join him as his guests for dinner at his restaurant that evening. We immediately accepted. I had the lionfish prepared “wreck-diver style”. I highly recommend it.
John is a consummate storyteller, and I was consumed by his pleasant demeanor and gregarious tales between bites of lionfish and other seafood delights. What does this story have to do with federal medicine? Nothing and everything.
Throughout my federal medicine career, leaders often asked their clinicians to “think outside the box” when addressing a particularly challenging military medical problem. I am very proud that many federal medicine providers (and I include myself in that number) were able to break with tried and true (but tired) thinking to respond successfully to the novel medical challenges that the Iraq and Afghanistan wars presented. Irritatingly, the same leaders who asked for these novel ideas were often the most critical of those officers willing to buck the status quo and try something different. In my own career, I was often accused of not being a team player. In retirement, I have come to realize that the label of not being part of the team was flawed because I was not playing the same game.
One of my proudest associations was my involvement with the Military Pain Task Force Report 2010, where several leaders throughout military medicine performed a top-to-bottom look at pain and its management during the height of the wars. What we found and recommended was not always appreciated by leadership, but it was always honest, accurate, and actionable. The findings in that report are as salient in 2024 as they were in 2010. Army Surgeon General LTG Eric Schoomaker, who commissioned the Task Force, even commented that if we could fatefully execute the Report recommendations, not only would we fix pain in military medicine, but we would also be making great strides in improving medicine generally in this country.
Obviously, federal medicine was not ‘fixed’ by the 2010 report, any more than the reefs have been freed of invasive lionfish by the acts of a Navy diver. However, that does not negate the tremendous value of the effort and example. When we first started evaluating pain care in the military, our treatment at the time, particularly on the modern battlefield, had not progressed much beyond Civil War pain medicine (morphine morphine morphine). Because of the efforts of the Task Force, pain care in the military is now recognizable as a 21st-century medical effort. John Mirabella has provided a model for turning an ecological disaster and personal passion (diving) into an economic benefit that now supports many families while sustaining reef health. I applaud John’s leadership in this regard and thank him for reminding me of the benefits of taking a more “interesting path.” This career approach is definitely not the easiest. It will not necessarily improve your popularity, but it usually is the only way to find solutions to complex problems.
Next time you are in a seafood restaurant, I would ask for the lionfish for fun. Mention John Mirabella and The Castaways when they look at you strangely. What federal medicine can learn from a Navy diver is interesting and instructive.
