ost of us probably knew from an early age that we wanted to be physicians, some perhaps earlier than others. On my wall in the command suite of Naval Hospital Twentynine Palms, I proudly display (thanks to my father, the pack rat) a picture drawn in 1970 and inscribed in crayon, “My office in 20 years.” It depicts a very large, boxy blue desk with a yellow telephone, a black bag with the letters “M.D.” somewhat legibly inscribed, and three neatly aligned books between two black bookends titled “Heart, Liver, and Guts.” It has actually been 37 years since that drawing, but the fact for me remains that it is my office, and I serve as the executive officer — civilian equivalent of the chief operating officer — for a small community-sized hospital located on a Marine Corps base whose mission is to deliver health care to the men and women defending our nation in the war on terror as well as the families who support their efforts.

Shot of a sign bearing the new name for the Marine Corps Air-Ground Combat Center Twentynine Palms, California, Naval Hospital. Robert E. Bush Naval Hospital. The rededication ceremony took place May 2, 2000, honoring Robert E. Bush, Master Chief Petty Officer (RET) and Medal Of Honor Recipient.

A real benefit of being in the Navy is the organization’s flexibility in permitting its medical officers to pursue alternative career tracks in addition to their clinical track as active, practicing general anesthesiologists or subspecialty-trained anesthesiologists. The choices include 1) academia/research at one of the large medical centers: Uniformed Services University of the Health Sciences (the military’s medical school) or Naval Health Research Center; 2) operational medicine with subspecialties in aerospace medicine, diving and hyperbaric medicine; or 3) executive medicine at any of the 28 medical treatment facilities in the Navy medicine enterprise.

The Navy has offered unbelievable opportunities for this anesthesiologist, beginning with my initial training as a family medicine intern at Naval Hospital Camp Pendleton. Upon graduation, I was selected for operational training in submarines, dive/hyperbaric medicine and radiation health, qualifying me for my first real naval assignment as the medical officer for a squadron of fast attack submarines. While my medical school cohort was toiling with residency training, I was riding submarines and diving in the San Diego harbor under the guise of “ships husbandry.” My job was to provide general medical care to the squadron staff and prepare and present medical advice to the commodore, a Navy captain whose entire professional life had been dedicated to nuclear-powered submarines and the philosophies of Hyman Rickover, the heralded father of nuclear power in the Navy, where the world was colored only in black and white. The commodore was the senior officer over nine fast attack submarines, each with its own commanding officer, a Navy commander, equally as black and white as the commodore. There I was, a Navy lieutenant, full of medical “knowledge,” representing the commodore during various shipboard inspections. The commodore believed all of his officers, including his medical officer, should inspect all aspects of the ship — to include the bilges and whether or not they were clean or oily (a very “nuke” thing to pay attention to) — so when I reported out after one of my seven-day underway periods off the coast of southern California that a certain 688-class submarine had oil in it bilges, the commanding officer was furious. “What does a doc know about oil in the bilges?’ he exclaimed to the commodore during a squadron commanding officer’s meeting (somewhat akin to a board meeting). To which the commodore replied with a stern voice, “He went to medical school for God’s sake — it doesn’t take that kind of education to recognize that oil exists where it shouldn’t exist. Now clean it up.” My first experience with having support from the top.

To my good fortune, I had this 2.5-year “cooling off” period between internship and residency because I changed my interest from family medicine; subsequently, I applied to and was accepted into one of the Navy’s three anesthesiology training programs. Upon residency graduation, I was retained in the department as a junior staff member and given the collateral duty of operating room scheduling officer, which ultimately gave me real-time experience in O.R. management.

From there, I went to Sicily, Italy, to the small community-sized U. S. Naval Hospital Sigonella, where I was able to cut my teeth as department head (only three in the department), director for surgical services (which allowed me to sit on the hospital’s executive board), and physician advisor to the process improvement board and review board for foreign national physicians. This oversight board reviewed physicians applying to be a part of the network of local health care providers qualified to see and treat military beneficiaries. I was the first physician to sit on this board, and it was at that point that I realized the benefits of having grown up in a system that has utilized well delineated standards for its medical schools, residency programs and specialty boards providing validated benchmarks of excellence. A physician has chaired that board ever since.

At the conclusion of my tour at U.S. Naval Hospital Sigonella, I opted for an operational tour as the officer in charge (OIC) of a fleet surgical team. This 14-person surgical element brought trauma surgical capability to an amphibious readiness group (ARG), whose mission was to transport Marines to the amphibious objective and provide over-the-horizon support of the deployed Marines after the amphibious assault. As the OIC, I was also the senior medical officer afloat and reported to the commodore of the ARG, also a Navy captain — a ship driver, however, and non-nuke type. Their predilections lean not so much toward the world of black and white — they focus rather on ship cleanliness and, at times, creating work where none exists. To my good fortune, the commodore under whom I served was more interested in mentoring junior officers, creating leaders and engaging in every form of physical fitness during his off hours. Again, lucky for me, he took me under his wing and taught me the value of providing opportunity for personal and professional growth to all those whom you lead, making for naval officers better able to serve the organization because they want to vice being told to. We completed our six-month western Pacific deployment together on September 14, 2001, a time after which the entire world had changed.

Sailors attached to Fleet Surgical Team 2 assist Marines from the 24th Marine Expeditionary Unit during a simulated mass casualty drill aboard the amphibious assault ship USS Nassau. U.S. Navy photo by Mass Communications Specialist Seaman Mandy Hunsucker.

My executive medicine experience began in earnest with my appointment as chair for the department of anesthesiology and postoperative care at one of the Navy’s three large teaching hospitals. While in that position, I was also selected to be the interim director for surgical services for eight months, stepping in for the incumbent, a pediatric orthopedic surgeon who had volunteered to serve in Iraq. As an anesthesiologist, I was honored to lead 13 surgical departments (all told, roughly 1,000 personnel, both uniformed and civilian, with an annual budget of $24 million) and represent their interests at the executive board of directors. Despite being told by one department chair that an anesthesiologist was absolutely the wrong choice because we (anesthesiologists) don’t understand the unique doctor-patient relationship that is established between a surgeon and his/her patients, we (the surgical directorate) flourished, achieving every goal established for completion by my predecessor, potentially because an anesthesiologist was selected as the interim director. Our ability as anesthesiologists to coordinate the many needs of surgeons, O.R. staff and PACU and ward staff without creating enemies and divisions makes us uniquely qualified to lead surgical directorates and be effective and responsive to needs of the organization.

At a weakened moment (tongue in cheek), I accepted orders to the headquarters command for Navy Medicine, the Bureau of Medicine and Surgery (BUMED) in Washington D.C., where I worked on the policy and legislative aspects of future naval medical assets. Consensus-building, teamwork and the zeal to “just do it” only carries policy work so far before the realization that resource appropriation, political support and a healthy dose of patience is what is truly required to attain one’s goals and achieve a sense of satisfaction within the Beltway. As a citizen of this free nation, I was humbled and duly impressed by the inner workings of our central government.

At this juncture today, I am the executive officer at Naval Hospital Twentynine Palms, enjoying every minute of every day. Generally on Tuesdays, I carve out my schedule to accommodate working in the operating room, getting back to or perhaps hanging on to what I cannot rid myself of: the desire to provide anesthetic care to some of the most deserving patients, our nation’s war fighters and their families. I have consistently made every effort to stay engaged throughout all of my tours for two reasons: 1) I love anesthesia and 2) I never want to lose touch with those I represent and serve. Knowing and being a part of the medical staff, the operating room staff and the ward staff has allowed me to see if the decisions made in the board room get executed in the workplace. Next year, I will apply to be screened for command of a naval hospital, and it is my hope that I will continue my service as a Navy Medical Corps officer and anesthesiologist in an executive medicine role.

Capt. Bruce R. Laverty is Executive Officer, Naval Hospital, Twentynine Palms, California.