Douglas R. Bacon, M.D., Editor

Blue and Gold Stars

s my son and I were driving, a small banner caught his eye. It was red and white with a blue star in the center. Thomas, all of nine, asked what it meant. I told him that it symbolized the fact that a member of that household was serving in the armed forces. The blue star meant that the service man or woman was alive; when the star was gold, the member of the armed forces had died.

Blue Star Mothers of America is a nonprofit organization dedicated to helping and supporting the families of service men and women. The organization began in 1942 and was originally organized in Michigan, but it quickly spread all across the nation. Adopting symbolism from World War I, the star turns gold when the service person has paid the ultimate price for his or her country. Blue Star Mothers have been with our armed forces ever since, providing comfort and love as only mothers can.¹

The Blue Star Mothers continue a long tradition of women serving the military. During the long Minnesota winter nights, I have been engrossed in a wonderful book by Doris Kearns Goodwin titled Team of Rivals.² While the book portrays Abraham Lincoln and his administration in terms that I had not read before — and demonstrates Lincoln’s true political genius — a passage about Mary, Lincoln’s wife, got my attention. Mary was never a favorite in Washington, and during the war, was looked upon as having Southern sympathies, something that Ms. Goodwin takes great pains to point out was not true. Yet after the death of her young son Willie, Mary fell into a deep depression. It lifted as she quietly visited Union solders in the hospital, writing letters for those who could not, giving out fruit and comfort as only a grieving mother can. Like many good deeds, the press took little notice of her quiet acts. In many ways, Mary Lincoln’s actions foreshadowed the formation of the Blue Star Mothers.

More recently a movie about World War II opened to the usual Hollywood hype. The film revolves around one moment in the tumultuous battle by the Marines to conquer and secure Iwo Jima and the search of an adult son, James Bradley, for a part of his father that was never explained or discussed during his dad’s lifetime. The second flag raising on Mount Surabachi, immortalized in the Joe Rosenthal picture that has come to symbolize the power and determination of the United States, is the moment in time that has unrealized consequences. A sculpture of the photo in Arlington National Cemetery is the largest bronze statue in the world and stands as a permanent reminder of the sacrifice of the Marine Corps since its inception. James Bradley is the son of the last survivor of the second flag raising, John Bradley. Without the photograph, it would have been quickly forgotten by the Marines and unknown to the American public. Indeed the Marines and Navy Corpsmen thought nothing of it at the time and, according to Mr. Bradley, had trouble understanding the fame attributed to them. Flags of Our Fathers,³ both the book and movie, chronicles James Bradley’s search for the events that shaped his father’s very being.

The movie was stark. There was no glory or romanticism of war. Rather it dealt with the details of the deadly day-to-day struggles endured in combat. Several startling facts were emphasized in the film — 25 percent of all the Medals of Honor, the nation’s highest decoration for bravery, awarded to Marines during World War II were for action during this battle. Casualty rates were very high, often with only a handful of men walking off the island physically uninjured from the thousands who assaulted the beaches. Of the six men raising the flag in the famous photograph, only three survived the battle.

John Bradley, the Navy Corpsman, was badly wounded, requiring surgery before and after a bond tour that the flag raisers went on to ensure financial security for the United States to fight until the end of World War II. During initial stops on the tour, the three survivors meet with the three gold star mothers — and the raw emotion exhibited is palpable. The soldiers wish to communicate what their fallen comrades meant to them, and the mothers struggle to understand in the midst of their Mary Lincoln-esque grief.

This heroism and sacrifice seem, like the veterans of the war, to be silently slipping away. Later wars such as Vietnam, and now Iraq, had and have images of violence spread across our television and computer screens in such a way that it is impossible to ignore the horrors of battle. Yet Iwo Jima would never have been secured — and thus the Allied B-29 bombers would not have had a safe landing spot, to say nothing of less-harassing fighter planes — had the island not been taken. Was the sacrifice of the blood of so many young Americans worth it? For the Marines it was, as they witnessed the first crippled B-29 land on the secured airstrip and the airmen get out to kiss the ground — ground that they had fought for in the heat of a month-long battle. They understood that their sacrifices saved countless other servicemen — perhaps even more than had died in battle. They also knew that the bombers were attempting to destroy the ability of the enemy to make war and thus shorten the horrors for all.

For the specialty of anesthesiology, World War II was critical. ASA leaders were involved in plans to train large numbers of physicians in anesthesia long before the Pearl Harbor tragedy. Ninety-day courses were instituted in centers around the country, and large numbers of physicians were exposed to the practice of anesthesiology. They left training and went to the battlefields and hospitals both inside and outside of the combat zones. These neophyte anesthesiologists impressed their surgical colleagues with their abilities not only to provide intraoperative anesthesia but in triage and resuscitation and postoperative care as well.¹ The “90 Day Wonders” returned at war’s end, and about 40 percent stayed in the specialty. Thus our field changed and began expanding the physician component of the specialty across the nation.⁵

In the pages of this NEWSLETTER, read with pride what our colleagues are doing across the world today in armed forces hospitals, carrying on the finest traditions of anesthesiologists who care for the gravely wounded. Mortality is at an all-time low for combat because of the work of physician specialists in anesthesia and many others. We have learned how to manage pain and that infusion pumps work in the pressurized atmosphere of an airplane at 30,000 feet as well as they do at sea level. Read about the innovations within these pages that may well become standard practice in the next few years. Read also about our citizen soldiers, colleagues of yours and mine who are leaving hearth and home to go forward and serve their country. We owe these fine physicians a debt that we cannot repay.

As the father of four boys, I hope that I will never display a gold star banner in my home. My eldest has already registered with the Selective Service; my second son will do so this summer on his 18th birthday. One day a blue star banner may hang in my front window. I take comfort in knowing that should my worst nightmare come to pass, brave colleagues, like the authors and subjects of the articles in this issue, will be there to do everything for my son and yours.

Respect and honor those who wear the uniform of our country, for they have earned such respect and honor. With their blood, they pay for our freedom and the privilege to freely express our opinions without fear of retribution. Saving a place for a colleague called to the armed services may well require longer hours and less time away from clinical duties, but it is the least we can do for the sons and daughters who serve our nation. They have honored the “flags of our fathers,” will you?

— D.R.B.

References:
1. www.defenselink.mil/news/Mar2000/n03282000_20003282.html. Accessed on February 12, 2007.
2. Goodwin DK. Team of Rivals. New York: Simon and Schuster; 2005.
3. Bradley J, Powers R. Flags of Our Fathers. New York: Bantam; 2001.
4. Waisel DB. The role of World War II and the European theater of operations in the development of anesthesiology as a physician specialty in the USA. Anesthesiology. 2001; 94(5):907-914.
5. Martin DP, Burkle CM, McGlinch BP, et al. The Mayo Clinic World War II short course and its effect on anesthesiology. Anesthesiology. 2006; 105(1):209-213.

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