Military Spotlight - Chris Clinkscales

Written by Chris Clinkscales and featured in our upcoming Class Newsletter.

On July 19, 2010, I hung up my U.S. Army uniform for the last time. After 12 years of service, I achieved one of the most desired of all military acronyms – ETS, or expiration of my time of service. When I was asked to write a summarization of my Army career for our Class of 1997 Newsletter, I initially thought, No problem. Now, as I am actually putting my fingers to a keyboard, I am realizing how hard it is to condense most of my adult life into a single page, particularly when the topic evokes so many strong memories and emotions.

Upon completion of my time in the Corps of Cadets in May 1997 and graduation from Texas A&M in December 1997, I received a commission from the U.S. Army in March 1998 in exchange for my  participation in the Health Professions Scholarship Program (HPSP). I elected to attend medical school at Texas Tech University Health Sciences Center in Lubbock, TX, followed by a residency in Anesthesiology at the University of Michigan in Ann Arbor, MI. I entered active duty at Brooke Army Medical Center (BAMC) in San Antonio, TX in 2006 as a Captain and began my career as a military anesthesiologist. I
was promoted to Major in 2008, and along the way, I enjoyed my service and the experiences that service offered.

Much of my early career was spent in similar fashion to any young anesthesiologist – I was busy with patient care as well as administrative responsibilities, to include serving as the Assistant Program
Director for our Anesthesiology residency. Much of my daily work, however, was drastically different. Many of my patients were wounded service members returning home from Iraq or Afghanistan, often with significant combat-related injuries. Many of my other patients were heroes from previous  generations. More than a few, from both categories, were Aggies, and having a special kinship with these patients was particularly special. While privacy laws prohibit me from sharing names, I had the honor to care for one of my former fish in E-1 as well as one of Texas A&M’s most decorated veterans, among others. I am confident that our common bond as Aggies generated a mutual trust and respect,
similar to a spirit that can ne’er be told that is experienced by all Aggies.

One of my most unforgettable memories during my stateside assignment was caring for a young soldier who was injured in an IED blast in Iraq and suffered multiple fractures of his right arm, which was further complicated by the development of a complex pain syndrome. Upon reporting for work one morning, I was called to the ICU to help address his pain. I was not prepared mentally or emotionally for what ensued. When I entered his room, he was near delirium with pain, screaming to God to take his life instead of letting him suffer like this. His mother sat in his room, teetering between tears and rage at the situation her son was in. I quickly learned that he had been transferred to the ICU overnight with intractable pain, due in large part to one of my surgical colleagues the day before refusing to let a fellow
anesthesiologist place a pre-surgical indwelling catheter that would deliver continuous flows of numbing medicine to the nerves that were involved in the surgery, all in the name of a busy schedule. As I worked on him with one hand, pushing a multitude of different complex pain-relieving medications into his IV, I held his hand with the other and began to tear up, vowing I would never allow another of our soldiers to be put in this situation. I demanded the surgeon report to the patient’s bedside at once, believing he should witness first-hand the situation he had helped create. I was but a lowly Captain, and I did not realize initially that the surgeon was a Colonel! Nonetheless, when the surgeon presented to the bedside, he promptly realized his mistake, and we began to work together to alleviate the patient’s pain, which included my placement of the pain catheter mentioned above. From this challenging situation came some good – my surgical colleague and I worked together within our respective services to help fine-tune my department’s acute pain service, which worked tirelessly to assure that patients would not suffer needlessly again. Some weeks later, our patient reported to me how pleased he was that his situation, however unfortunate, was being used to better the care of other wounded service members.

In addition to my work at BAMC, I had the privilege to spend two tours in foreign lands, the first being a brief two-week medical mission to Tegucigalpa, Honduras as the lead anesthesiologist working with a
team of urologists. It was on this mission that I first learned how to function in a truly austere environment, performing safe and effective anesthetics without many of the advanced comforts of home. I provided anesthetic support for more than a few patients who were not medically optimized; had I
encountered them at home, they would have likely been returned to their primary care physician for additional medical optimization prior to their operation. However, in Honduras, I recognized that if I didn’t allow them to be cared for in the present, they would likely never receive the surgical care they needed. It allowed for some challenging circumstances, but each and every patient did well. My team and I were proud of the service we provided, and we were proud to be able to represent the United States, and her military, in such a meaningful way.

I spent the latter half of 2008 in Baghdad, Iraq as an anesthesiologist with the 86th Combat Support Hospital (CSH) at Ibn Sina Hospital, as well as three weeks with the 102nd Forward Surgical Team (FST) at Forward Operating Base (FOB) Normandy, just miles from the Iranian border. My FST experience was particularly unique; at the time, I was one of only two Army anesthesiologists who had deployed  forward to this extent during the Global War on Terror (GWOT). I was able to see how the “real” Army lives and breathes, which elevated my appreciation for these men and women to new heights. In  Baghdad, my clinical practice was rarely dull, almost always challenging, and typically rewarding. There were, however, experiences that tugged on me in ways I could not have anticipated. For instance, we received a MASCAL (mass casualty) one afternoon, with some of the wounded being suspected  insurgents. The young man who arrived on my OR table was promptly de-robed and found to have a fresh 0.50-caliber entrance wound in his abdomen…just to the side of a large recently-healed abdominal scar. As the trauma surgeon entered the OR, he immediately recognized the man as an insurgent who had been shot a couple of months earlier by American forces while trying to detonate an IED! My patient was back in the Ibn Sina Hospital for the second time with the same injury – a large bullet wound to the abdomen received while trying to kill Americans. I cannot express how much I initially wanted this man to die, and how little I wanted to help save him; however, after a very brief internal struggle, I decided it was not my job to play God, and the American government required me to care for this man. My job was to provide the best care I could, regardless of patient demographics, and allow the real God to  determine the outcome. I worked as hard as I could to save his life, and the patient survived; even now, I can only hope that either the stories of his injuries were wrong, or that he finally changed his path in life. Regardless, the experience reminded me that as a physician, it is my duty to provide the best care that I can to any and all; the circumstances, however, were almost certainly unlike those experienced by most in my profession.

I can still remember vividly the first American service member that died on my OR table. He was a young Marine who presented with a multitude of trunk and extremity injuries, and his very survival to reach the
OR was a testament to his physiologic stamina. Unfortunately, he slipped away from us despite the best efforts of our team to resuscitate him and to stop his internal and external hemorrhaging. As his EKG flat-lined and the room fell almost silent – the only sounds being from my monitors indicating that he was dead – most of the OR team left the room, their heads hung low. I remained behind, staring at him: my eyes welled with tears, my heart pounded, and my head wondered what we could have done differently. I became acutely aware of my own mortality as it settled on me that this man would never again kiss the lips of his wife or hold his children in his arms. I took it upon myself to speak with his Commander and First Sergeant, and seeing their reaction convinced me more than ever how much of a family these individuals were and how this Marine’s loss was akin to losing a brother. Now, as then, when I reflect on the stark differences between these two patients and their seemingly unjust  outcomes, it drives home the randomness of war and the complete helplessness that can be palpably felt but seldom explained.

Fortunately, for every life that tragically ended, there were a multitude of others that were saved by the actions of our team. I had the privilege of caring for many non-combatant Iraqi women and children, many of whom were burned severely by Iraqi men due to perceived violations of Sharia law or simply because the men thought it was deserved and they knew there would be no repercussions. Whatever the cause, it was truly rewarding to help our burn surgeons bring many of these women and children from the brink of death back to functionality, and I was time and again reminded how precious a smile is,
whether from my own wife and children or from a stranger many thousands of miles from home. I can also vividly remember one particular young soldier who had an extremity traumatically amputated in an IED blast; he arrived in the OR in critical condition, but due to the efforts of our team, we were able to save his life. I visited him in the ICU later that evening, and he was awake and pain-free, due in large part to a nerve block that I placed for him in the OR. He was preparing for evacuation to Balad, Iraq that evening, and eventually to Landstuhl, Germany that night. I held his hand and told him, “You’re going to
make it, friend. You’re going to make it.” He said he believed me, and I was right – he eventually returned to the continental U.S. for ongoing rehabilitation, and though I lost track of him, I like to think he has been fitted for a prosthetic and is continuing to lead a proud and productive life.

My return home was marked by a surprise visit at the airline gate by my wife and children, just three days before Christmas 2008. Words cannot express how much the world was lifted from my shoulders when I saw those precious smiling (and crying) faces, and nothing in the world could have prepared me for it emotionally. I believe anyone who has spent even a brief time in combat, as I did, can attest to this, and even more so for our American heroes who serve 12- and 15-month tours of duty.

As is often the case for me, I set out to write a short page, ended up with three, and could have written exponentially more. My time in the Army, while now over and seemingly brief, was incredibly rewarding. I am proud of my service, and though I am now embarking on an entirely new adventure in civilian  practice, I will always reflect favorably on the challenges and obstacles my career in the Army provided, as well as the professional and personal growth that this opportunity afforded me.