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Book Review: Citizen - Surgeon

Citizen – Surgeon. Paul Bryan Roach. Free download on iBooks, September 20, 2014, 280 pages.

Reviewed by Gerry Souter.

“Perhaps, I wondered, if guilt might represent ambition’s brake? And now that our deployment was completing and such ambitions were ramping down, perhaps that was what I was feeling. Not something bad, just painful. Like a hangover. It was a general feeling looking for any specific expression it could find. The guilt may have been slowing me down, but it was heating everything else up in the process, creating a rug-burn on my soul.”

The above sentiments, written by Paul Bryan Roach, appear near the conclusion of his memoir of time served “in country” as a U.S. military battlefield surgeon. Though his combat zone was a helicopter flight from the shooting war in Afghanistan, his fight was no less gritty; as the combat soldier depends on his squad in the heat of a firefight, Roach depended upon his surgical team. He and his colleagues fought against the collateral damage of war; they fought against death. Roach struggled with boredom and loneliness, and endured the necessity of self-sufficiency. He looked into the frightened face of our volunteer army, minus the glory and hoo-rah bravado that sustains the fighting edge, and his experiences took him beyond the high jinks and grab-ass buffering the madness behind camp blast barriers.

Citizen-Surgeon was written with the same commitment that Roach exercised when he joined the Navy and consigned himself and his medical career to the capriciousness of military service. The move was something he felt he had to do, and he found himself standing boot-deep in Afghanistan sand in front of a tent that would be his operating room in a village of tents. His call to duty came from “dust-off” helicopters bringing blasted, gut-shot, broken, burned, blinded, and concussed war fighters. And there were children, too many children: pierced, cut, and riddled with shrapnel. Enemy soldiers—no longer threats, restrained in their gurneys—stared back with hot, vengeful eyes more disturbing than their wounds.

Roach worked in a modern-day equivalent of the Korean War MASH units, employing triage, quick fixes, and life-saving and stabilizing surgery before handing patients off to more complete facilities farther from the war zone. His writing style demonstrates the same economy: straightforward, it provides just enough explanation of medical terms to keep the narrative flowing and the reader engaged. Defeats are crushing. Victories are exhausting.  Roach’s disciplined Operating Room team chafes, waiting behind the “Yellow Line” to take action as their broken human “package” is prepped.

The author punctuates stories from his battlefield of blood, scalpels, clamps, and life-or-death decisions with brief flashbacks. These background anecdotes, islands of relief, help us understand Doctor Paul Roach of present action: the man in blood-slippery boots with his hand in a child’s chest, groping for a steel splinter lodged in “Big Red,” her still-beating heart.

Citizen-Soldier is no apologia for the Afghanistan War. It is more a commendation of the men and women who committed themselves to that conflict and its attendant battles, from epidemics to anti-terrorist insertions. It is also about surviving the outcomes of that commitment once home, surrounded by loved ones and yet dealing with guilt: the “rug burn on my soul” that Roach describes so well.

We are all haunted by decisions we’ve made, and their consequences. Memoirs make good exorcists. Roach, in this hell-for-leather, unflinching, and healing self-examination, has written a serenade to the best of the men and women in our armed forces. 


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