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Peter Rhee is a Navy trauma surgeon who served 24 years in the US military. He operated in several active war zones, including Iraq and Afghanistan.
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00:00My name is Peter Rhee. I'm a trauma surgeon. I was active duty U.S. Navy for 24 years. I
00:05performed
00:06surgery on the injured and active war zones such as Afghanistan and Iraq. This is everything I'm
00:12authorized to tell you. When you go outside a wire, it's on. I remember going to a 12-vehicle
00:20convoy. We don't go in the middle of day. You're going at night, a few miles down the road. Your
00:25night vision goggles going on, lasers going all over the place, and you're checking for IEDs as
00:31you go. It's surreal because you look out, you see three, four, five blocks of just charred buildings.
00:37Not a single window has not been shot into. A military trauma surgeon is a general surgeon who
00:49has specialty training just for trauma, and you take care of people who are hurt very
00:55badly that might die. So I remember a particular day in Iraq. It was January 5th, 2006 time period.
01:02The event occurred right outside of our gates. They were doing a recruitment of civilians to join the
01:11Iraq police. They knew that there might be a guy with a bomb. They had the dogs. Of course,
01:17the dogs found the guy in the middle of this group, and then bang. We got the notification that there's
01:23a
01:23big casualty, and patients are incoming. Our facility got 70 of these people. So it was one of our
01:29major mass casualties. And where I was located is called a forward surgical unit. So there's only two
01:36surgeons. And we don't have things of a normal trauma center where they have lots and lots of
01:42resources. We're in an active war zone. So we had built two shacks that we were using as an operating
01:48room. One of them to operate on, the other one to bring people in and out of. So with just
01:54a few
01:54minutes of notice and warning, the first vehicle comes, you know, normally they go real slow, but this
02:01one comes screeching around the corner, hits the brakes. They skid 10 feet. They come and I opened the back.
02:08It was a white sedan. And in the back of the back seat was a Marine. And he was in
02:15full body armor,
02:16helmet on and not moving. I'm trying to pull something so I can touch the skin and just try
02:23to figure out if he's alive or if he's dead or not dead. The next vehicle's coming in, screaming, honking.
02:30So I stepped back because I couldn't feel a pulse. I couldn't feel him breathing. And I grabbed my medic.
02:38And I said, take him to the expectant area. Tell him how to get there and make sure he's dead.
02:46And the rule that I had as a senior trauma surgeon was I was going to do the triage.
02:51And if they need me in the operating room, then the next most experienced people would do it. So with
02:58that, I ran to the next vehicle and they got two in there. Then we start pulling them off and
03:04we put
03:04them on the ground. And then we were, you know, we're just barely getting stretchers out. So they're
03:09just going underground. They're coming in, dumping patients, taking off. Next one's screaming down there.
03:16And then before I knew it, I could have sworn it was four seconds, but there's 12 people on the
03:21ground. The next guy is got a bandage across his face and he grabs me and he's talking to me
03:29in a
03:30language I don't understand. You know, I had to take his hands off me and say expectant, what they call
03:36dead or expectant. And it's what we had to do, what we could do. You know, we didn't have ample
03:41resources.
03:42So when you see them and they're not dead and you're going to call them expectant,
03:46that's one of the hardest things that you'll do in your life. You know, I've never had to do
03:50something like that of that volume before. And then eventually I find a guy that has to go to the
03:56operating room. You know, it's hard to portray how crazy it is to operate when you're not even on a
04:03gurney, you're a stretcher. So the problem with a stretcher is you sink. I can't get to your stuff
04:08because you're like this in a stretcher. So what we built was a box and it would lift you up
04:15so you
04:15could get to the body. We figured out, you know, in order to save the boxes, we just spray painted
04:23it
04:23red because it's so bloody all the time that, you know, having it maintained was difficult to do.
04:30Myself and the other surgeon is operating by themselves with no assistance or help. So we used our
04:35text, you know, so that's how rudimentary things were. Now it's only been like about
04:41hour and a half and everything worked beautifully like a symphony in slow motion. And the people who
04:48needed to go to the operating room went and the people who could go to other places went. And then
04:5311 people that I sent to expectant were in the back. So I ran out there to check on them
05:00first to see if
05:01there's something I could do for somebody out there. So the guy who was holding me, talking to
05:05me, guy who was alive, grunting, responsive, they were bad enough that they died in that 30 minutes
05:12without the care. All of them already died. So it felt like at least I didn't miss read something and
05:19sent somebody there that was going to survive. So I felt good about those results that we've made the right
05:24call when we had to. And in the long run, I think the tally was a couple of hundred people
05:30were involved
05:31and were injured. Of the people that died in our facility, it was only about 12.
05:36So we were able to save everybody else and get them going.
05:45My career in the Navy was different than most people. And I was one of the first surgeons in
05:51Afghanistan. I wasn't assigned to anybody. And like when I went to Iraq for my thing,
05:57I didn't go to a base with a team. I was in Blue Diamond. I was in Al-Assad, Fallujah.
06:03I was there,
06:04you know, in TQ, Altacatum, and then eventually in Ramadi. Those are all the places that the Navy
06:10and the Marine Corps were at. So I don't think I'm disclosing anything that's not known. But I
06:16actually ended up going through the whole place as a guy to come in and help out here, there,
06:21and the other places. So it's not really safe for me to say, you know, I did this, this, and
06:25this,
06:25like the others are going to do. A lot of them I can't tell you. I'm not authorized to tell
06:31you.
06:31Yeah. So that was the reason why my experience was so much better than I think than everybody
06:35else's because they kept sending me to the places where there was action.
06:44When they put a surgical unit, it's in a pretty safe location, you know, outside the gate,
06:49there's stuff going on. We would have mortars coming into our compound every day, you know,
06:55every single night when we were in Al-Assad or anything, and they would just launch a random
06:59mortar or a bomb into that place. And one time actually hit the, the, the gym facility. So
07:06a bunch of people got peppered, you know, but none of them really got killed. So I never felt like
07:12I was at any threat, but you know, when these things happen, number of times that, you know,
07:17this is going on, like in the movies where, you know, you're, you're getting shelled and there's dirt
07:22falling on your patients. And that, that doesn't really happen. When you go outside a wire, it's on,
07:28you know? So, uh, I remember going to, uh, it's called South Camp. I needed to go there to talk
07:35to
07:35their medical facility, which was just a PA physician assistant and medics. And that was the,
07:42what they call the outpost. It's not really a base. It's not a fort. It's an outpost. And so I
07:48said,
07:48we've got to go. So they arranged it. And so in, in the drive, which is probably 10 clicks,
07:55five miles or so, um, it is a convoy. Usually the, the operation starts at 11 o'clock,
08:02and it'll take you three hours to get there. Night vision goggles going on. And you see the,
08:09the turrets with the lasers going all over the place and you crawl, walk slowly,
08:13and you're checking for IEDs as you go. So when you're out there doing that type of stuff,
08:19then, you know, you're in the real life fire and, uh, things can be active. It's surreal because you
08:24look out and on the main thoroughway going into the city, you see three, four, five blocks of just
08:31charred buildings. You know, not a single window has not been shot into. Once we got there and do
08:36your business and you got a red light, it's four o'clock, it's freezing, it's raining. And then it's
08:42funny because on the way back, they hightail it back. You're, you're back in like 20 minutes.
08:52When you're deployed, you have to carry, as a standard issue, your Beretta 9mm handgun. That's
08:58what all of the military officers carry. And then there'll be certain situations where you have to
09:04carry an M4, which is your automatic rifle, assault rifle, or just a 5.56 round, usual typical NATO round.
09:12It's very rare, very rare that you'll find a doctor shooting. Okay. Unless you're with special
09:19operations. The last time I've heard about doctors doing that was actually at Camp Rhino. When they
09:25first came in, we hadn't been in war for a long time. And then all of a sudden, the Marines,
09:30when
09:30they went into Afghanistan, they dug these foxholes. So it was on that base. So there was a night when
09:36there was a threat, all personnel manned the wall. So they were on the wall with their weapons. And
09:41they, they actually, the doctors and nurses, they discharged rounds out of the M9s, the 9mm Berettas.
09:47But, you know, you have to, you got to take the doctors who've never carried these things and show
09:53them how to do it. So there are courses that we try to get them through before they go out
09:58to the,
09:58to the real wars. Even as a civilian, I would come back in and teach and train at these
10:05training centers where we bring military people in because they're doctors, nurses,
10:10number one, for most. They've been wearing a uniform, but you can put a gun in their hands
10:14and they can be quite dangerous. So, you know, how to carry a weapon when you're in a helicopter,
10:20it's just all part of the continuous training, trying to teach you how to not just be a good
10:24trauma surgeon, but how to be reputable and earn some respect with your non-medical people out there.
10:32Because if you show up at the dumpy dock, you know, they'll treat you badly.
10:41Other mass casualty was actually on Pearl Harbor Day, because I remember that day, December 7th.
10:47And that was a day that when we had 11 Marines come in, all of them were Marines.
10:52The first six, we had tourniquets up at the groin and all six of those Marines on both sides.
10:59So these guys would come in and of the six, all of them had a tourniquet on, which means
11:05a potential amputation. And the one Marine already had them both clean off. You know,
11:11it wasn't like that was going to get an amputation. He came in with both legs going at the thigh.
11:18He's got tourniquets on up higher and the tourniquets worked. Okay. And that guy was alive.
11:24He had nothing here. He didn't bleed out and die. Of the 12 guys that came in, the first half
11:31dozen,
11:32all were amputations in the legs. The next six that came in afterwards, they all recovered well.
11:40The people, I would send them from my place to the major hospitals like Baghdad and and then
11:46eventually come to Walter Reed in Bethesda, where they would do their rehab. And that's
11:51one of the most amazing things I saw that when I saw, when I shipped the guys out with no
11:57legs,
11:57and then I saw them at rehab with their prosthesis, climbing walls, going to law school,
12:03getting degrees, being teachers and functioning, you know, that helped bring the entire spectrum
12:10from the initial injury to the end of the closure. You know, we had probably the best results,
12:15medical wise, survival rate wise, from the Iraq, Afghanistan experience compared to Vietnam,
12:23World War II, Civil War and all those kinds of things. Because that's the first time we actually
12:27made every one of the soldiers out there, including me, nurses and so on, wear body armor.
12:39The civil injuries are just different. In LA, when I was seeing a lot of trauma, we saw a lot
12:45of
12:45gang warfare, a lot of gunshot wounds, 9mm, .45s type of stuff. And they might come in with one or
12:53two
12:53holes, sometimes 20 holes. What I saw in Iraq, what I saw was 50 cal. 50 cal, you know, those
13:01are the big
13:01things with two handles and you've got a thumb trigger on top of tanks or, you know, Humvees.
13:07And they come in with 13, 14 holes and each hole is, you know, sucking chest wounds. Never saw one
13:14in civilian trauma. But here you would come in and you'd see the lung and, you know, there's a piece
13:20of your body wall that's missing. And so those things, you get all sorts of things like that,
13:27that you're not expecting. Major O, he treated a guy and he operated with an orthopedic surgeon,
13:34Major Kirk. And it was a RPG, a rocket propelled grenade. And that was still embedded in him.
13:40They have to treat that as a live ordinance. They have to treat it as one that could potentially go
13:45off. And so then when you do that, you have to take him out of the facility. You have to
13:50take him out
13:50because if he goes, then he's going to take everything, right? So they usually will barricade,
13:56build something, you know, or take him to an area where the ordnance guys, the guys who usually handle
14:02bombs, they go out with the, ask for volunteers, and they were able to remove this rocket propelled
14:07grenade, give it to the OED guys to dispose of. And then they were able to go back in and
14:12finish up.
14:14The sniper wounds, we were getting a lot of casualties. These are hunting rifles. The 30-odd
14:19six, they come out and they got a lot of gunpowder. So they're accurate and they can,
14:24they're devastating when you hit. But in Ramadi, we had a bunch of these. And I remember one of the
14:30first times is, one of my jobs is I have to declare someone dead if they come. And I remember
14:37opening up a
14:38body bag. It was, it was one of our special operations. And I looked around for the wound.
14:45I turned them over. There's a hole in the back of the head. I mean, grapefruit size hole. It was
14:51like
14:52someone, medical student did a dissection and removed that brain. So that's the, that's the kind of power
14:57that these sniper rifles have. I remember one night, one of our sentries, we would get him. He had no
15:03blood
15:04on the outside of him. We ended up opening the chest to what we call a resuscitative thoracotomy.
15:10And when we did this to figure out what's going on, what we finally figured out by looking at his
15:16body armor, I saw, I found a hole in the back, right under the armpit. It went into his arm,
15:21it went across to his chest, had a nice clean hole where the spine used to be. And then the
15:28bullet came
15:29out the collarbone. And so his vessels were all gone. He bled into the chest. It's, I remember
15:35every single part of that injury pattern, the bullet goes in, it's got the high energy and
15:41just dissipated by the tissue opening. So do then it rips apart while it cavitates and then comes back.
15:48So high velocity rounds are very different than a nine millimeter round, which is what like the police
15:55carried. Those are basically stabbing with a bullet. The high velocity, which is when you start to get
16:00around 2000 feet per second, hunting guns, you know, M16 rifles, AK-47s, they start to get 26, 27
16:08feet per second out of the muzzle. And that's why when we took the flak jacket off and we took
16:15everything
16:15off, got them out of that and operated on the guy, there was blood everywhere. And it had a little,
16:21like I said, even after a little hole and then it came out here and I know it came out
16:26here because
16:27I cut the bullet out and I pulled out this tiny little bullet. One thing that I didn't see in
16:34the
16:34civilian trauma centers that I saw all the time were blast injuries. When a bomb goes off and the guy
16:41comes in, he looks good. But you look at him, he's got 82 holes on him. So, you know, did
16:50they go deep?
16:50Did they not go deep? So about half of what we see is from bombs or blast injuries with what's
16:57called
16:57fragmentation or what sometimes people know as shrapnel. And they started building bigger and bigger
17:02bombs. And that's what we used to call IEDs, improvised explosive devices. And that's going to
17:07take their legs out. You've got to get those guys on the birds and then they fly to the next
17:12location
17:13and maybe half an hour away. You know, the 46s that the Marines use, the tailgate is down. It goes
17:21from
17:22boiling hot on the ground to freezing in a matter of minutes. So you've got to get your casualties in
17:28a body bag. We used a dead body bag because it was thick plastic. And we cut out a hole
17:33in the face
17:34because they're intubated. They need anesthesia continuously. They need a ventilator. They need a
17:41monitor. They have all these lines coming out. And then this nurse has to be able to keep this guy
17:47alive during transport. So it's an experience that you'll never have to do anywhere else. But it's a way
17:53to make every little thing that used to be easy as difficult as humanly possible.
18:03As a trauma surgeon, I loved going to the war. Okay. It's not because I'm a war monger and I
18:09like wars.
18:10It's fun. It's interesting. It's what I trained to do. And I took care of civilians to get my
18:18skills up to a par so that I could take care of army and military people, Marine Corps,
18:25whoever that was going to get hurt. I can help people. And that's my role during the war.
18:29We take care of everybody. So we take care of civilians. We take care of enemy combatants.
18:34We take care of the guy who shot this guy, but we don't do a political triage or anything like
18:40that.
18:40We take care of whoever needs that care first. And I remember specifically when we had this bad guy
18:46and our good guy shoot each other and they both come to me and I chose to take care of
18:51the bad guy.
18:53And my medics were pissed off because I didn't take care of the good guy. And I didn't take care
18:58of the good guy because he could wait and this guy couldn't wait. So, you know, he's got blackout
19:03goggles on, meaning that he's blinded. He can't see. You know, he's bound. He's tied up. But, you know,
19:11he started an IV, put him to sleep. And then you don't have to worry about it. Then you can
19:15take care
19:15of the body. You can take care of what's needed. I remember I called the troops in on this one
19:20and I gave him a scolding because, you know, they brought in the bad guy. He's cuffed and he's tied
19:27down and all this stuff. Some of the people were saying bad things and they were saying they want
19:32to do this to them, do that to them. And like I blocked that out and then took care of
19:37the patient.
19:38And then when we got the birds to come in and fly them out and then afterwards, you know,
19:43I assembled the troops and let them have it. You know, I just I could not believe what I was
19:48hearing
19:49that a medical profession wanted to hurt people. And it's like, hey, you are not the combatant.
19:55You want to do that? Pick up a rifle, go outside the wire. But you're here in the medical company.
19:59You take care of humans, period. Don't matter what shape and size they are. I just couldn't believe
20:04that actually even happened. And then that same day, we had a six year old girl come in,
20:09boom, went off by her house and she had this freaking piece of metal hanging out of her neck
20:15and you could see it on the x-ray was right at the spinal cord. But she was moving all
20:21four legs
20:22and we were able to put her to sleep and pull out the stuff and make sure that she doesn't
20:26bleed to
20:26death. But she was safe. So, you know, you'll take care of everybody. Now, there are operations
20:33nowadays where there are strictly forbidden to take care of civilians because they can use their
20:39supplies and our supplies are limited. But if they're in the heat of battle and they're injured,
20:44they come in, we'll do it.
20:50So the problem is that we live in a continuous state of stress. And I think it's only in my,
20:57you know, late stages that I realized that I'm not a Superman as I used to think and that this
21:04does impact you. The younger guys are still not willing to take care of the mental health issues
21:11that come along with continuously being in stress. You know, I'm so used to this that when I sleep,
21:17I have bad dreams about it. But you know what? I've been having those things through my whole
21:23medical career. But that's also what got me through medical school, right? Being stressed that you're
21:30going to spend the 22 hours reading and all the nights staying up and doing the stuff that you have
21:38to all the way through the medical school and then the residencies and the fellowships and so on.
21:44I admit now it's bad. I think what we see out there in the field, it's probably not as bad
21:52as
21:52some people think because we see bad stuff every single day. I mean, that's our job.
21:58You know, we see unhappiness when we go to work. We see horrible car accidents. We see gunshot wounds.
22:04We see bad guys, good guys. We see that all the time. You internalize everything. You're on your own.
22:10And some people, you know, they're drawn to that high level of need. Yeah. I think if you put a
22:18bunch of
22:18trauma surgeons in a room, they are different people. They're a little bit more stoic and they're
22:25not as dramatic in many ways. And I know for me particularly that one of the reasons I was drawn
22:34into this field was when there was chaos going on, it seemed that I saw things clearer. The time slowed
22:42down for me when there was someone dying and coding and we're doing CPR and we're running the code.
22:48For me, that was very easy, but you can run, run the show. You can run the command in an
22:55authoritative
22:57way without yelling or screaming, because when you have the respect and they listen to you and you have
23:01the calmness and they know they respect your opinion and your decisions, then things go well.
23:07I had just gotten out of the military. It was just a very tough period. And the job that I
23:12got recruited
23:12for was in a city, Tucson, Arizona. I had never heard of Tucson, but I went out there and my
23:18job
23:18was to come in, recruit a team, get the trauma center verified at a national level, which we did,
23:25which meant the first couple of years was pretty tough. I mean, I was on call every other night
23:30for a full year, which is physically very demanding. And, you know, that's when you're sleeping four
23:37hours every other day type of thing. And during that time period, I had one patient come in and
23:42she got shot with high velocity around to the head. And we did all this stuff. We got her to
23:48the
23:48operating room and then she died. And this wasn't the first time I've seen a child shot and killed
23:53before. But my daughter was also six years old. And it was the same thing. For someone,
23:58something got triggered and they just, yeah, I ended up just, you know, breaking down and weeping
24:04for a while. And then you catch yourself, you get out and you go out and get to your stuff
24:08again.
24:14So I got to Tucson in 2007 and we got a team together in about a year and the program
24:19was
24:20going well. We had a brand new set of surgeons and teammates and got verified. So we were practicing
24:27mass casualties as well. That's what trauma centers do. We do the fire drills all the time. So for the
24:32city, they have to be ready for all of that. One day we got our own mass casualty. This happened
24:38January of 2011. I had just gotten off my call. Our calls are usually 30 hours in a row.
24:45The new surgeon came in on Saturday. I was, I got home in the morning and I was going for
24:51my run.
24:52And I got about, you know, a mile out from my house. And then I got a phone call and
24:58my trauma
24:58surgeon who was on call that day, he said, Peter, this is Randy. Yeah, I need you to come in.
25:04And I go, what's going on? He goes, multiple gunshot wounds. And I go, yeah, I'll call your
25:10backup guy. And he goes, they say there's a congressperson here. You need to come in.
25:14So there's a kid there also. So just get your ass in here. So I turned around, ran back. I
25:19called my
25:20wife. If I go in, I got to go into the hospital. Can you put a fresh set of scrubs
25:25in my car with my
25:26keys? I run straight to my car in the garage, get in and I start hauling. And then, you know,
25:33you're driving too fast and changing and unchanging all while you're driving. And that's the reality.
25:41That's what you got to do. I know it's not, you know, but that's some of the things that has
25:46to
25:46happen. You got to put your scrubs on. So get to the hospital. And I heard there were a bunch
25:51of
25:51people that were shot and died in the field. But Gabby Giffords is one of the patients. I didn't
25:56know who Gabby Giffords was because I was so apolitical that I didn't understand. She was
26:04a congresswoman. And what she was doing was she was meeting with her constituents at a supermarket
26:09when a crazed gunman came out and opened up fire for whatever his brain was telling him. And then
26:15a lot of innocent people got hurt that day. As the trauma director there and as a senior
26:20guy, I started triaging, moving people around. What happens is that you have your core and necessary
26:27people that are called in, nurses, techs, everything in the system will come in. And then
26:34one of the earlier patients was Gabby and Gabby got shot in the head. We ran with her to the
26:40operating
26:41room, started shaving her head so that the neurosurgeons coming in would be prepped. We put lines
26:46in her, got her ready, put her to sleep. And then the neurosurgeon came and they took over and they
26:52operated on her. A couple of great neurosurgeons that were there, Marty was the guy that was on call
26:56that day. And Michael LeMond was the chief of neurosurgery and they operated on her. She came in
27:02and she had a bullet hole in the head. Not in the head, this is in the brain. So there's
27:08a distinction.
27:09You can get shot in the head, be the face, and the bullet doesn't go into the brain. But when
27:14the bullet
27:14enters the brain is another category of injury and survivability. So our trauma center had the
27:22typical survival rate of 10%. So a lot of places get shot in the brain, they let you die. They
27:28think it's unsalvageable. But I was trained in Los Angeles where my teacher, Dr. Demetriades,
27:35was very adamant about going very aggressive with these people. And what he showed is you can get up to
27:41about a 40% survival rate. And actually that's what our reports showed as well. We went from 10%
27:48and in the four years we had gotten up to 40%. And even if you're not successful and they still
27:55die,
27:55because sometimes they still die, what we found out was our organ donation went sky high because we
28:01were aggressive in saving the body, not just the brain. You know, we did like six cases that morning
28:06and then more to follow up later that afternoon. But it was nice. It was nice because you had ample
28:13resources. It wasn't like when I was in Iraq. So she was alive and she came. And Randy Freeze,
28:22who was a surgeon at that time, gave her commands and said, squeeze my hand. And she squeezed the hand,
28:29she couldn't talk. And on the side that she was squeezing the hand, she could kick. So she was
28:35moving her legs and kicking in frustration because she couldn't talk. So that's the same kind of thing
28:40that happens with stroke. And that's when you know her chances of survival are much higher than the ones
28:47when patients come in and they're doing nothing. So a live patient has a tendency to stay alive.
28:52So I think that story is pretty well documented. But Gabby did real well. I did a tracheostomy on her.
28:58And then in about a week, we were able to send her to start the rehab process. Yeah. I mean,
29:03with neurosurgical, you know, you tell pretty quickly what's going to happen. And the fact that
29:09she came in with function on one side was what gave me so much optimism. Actually, I think I was
29:14quoted as saying that she has 110% survival rate. And she did. I think that because people don't
29:20understand it, they thought that I was just being cocky. And she came in alive with the surgery
29:24and she's alive and she's going to wake up and do well. But she will not be normal
29:28in the sense of what she was like before the bullet traversed her brain. So, you know, she does have
29:35residual effects after her rehab period. She still remains somewhat paralyzed on the one side,
29:41but she's completely capable of functioning and thoughts. She just has problems expressing things
29:49because of the closeness to the Broca's aphasia and her ability to express her thoughts.
29:55So I was having these daily briefings, but back then it got a lot of press and our trauma center
30:01got a lot of notoriety as a result. You know, all the fame doesn't, doesn't make any difference.
30:07Didn't help, you know, doesn't help anybody. I would say medically, I can't say that I'm
30:13responsible for any, any of the successes that day. Okay. I would say that any qualified trauma
30:19surgeon would have gotten the same results. But what happened was, they said, you know,
30:25I got on the front pages of like New York Times and stuff like that. I actually got invited to
30:29the
30:29state dinner from Obama and they said, he's Korean. He was born in Korea. He immigrated to the United
30:35States. And so my country, South Korea started to follow me. They just kept saying, who's this Peter
30:42Reed? Who's this Peter Reed? And then the question, second question came up is, what's a trauma surgeon?
30:48Because Korea didn't have a trauma surgery. They didn't have trauma as a system. Very different
30:54world. First of all, there's zero, not one, but zero gunshot wounds in the country of 58 million
31:00people. When they started asking, what is a trauma surgeon? It got the, the people revved up enough
31:07that they went to the politicians and the politicians started to put money into the trauma system,
31:12and get a helicopter system in place and so on. So, and now they have like 11 or 12 trauma
31:19centers
31:19in Korea. So I flew back and forth a lot, trying to help the hospitals institute trauma centers. So
31:35after medical school, which is the usual hard, arduous type of work, like any other medical school,
31:42then comes internship. Internship is hard, very long, and, but it's a little bit more generalized. And in
31:51a lot to see and pay back as a general doctor for a few years. But in my situation, there
31:57were short
31:58surgeons. So they actually picked me to be a surgeon. I didn't pick myself to be a surgeon.
32:03And to do that and do it quickly, you have to go to the outside world, where you're still active
32:09duty
32:09in the military, but you go to a medical school, university setting. And I went to Irvine, California,
32:15and did my general surgery residency in Irvine. And those are lots of stories and hard hours. I mean,
32:23back then, you know, it wasn't uncommon for us to do 120 to 140 hours a week all the time.
32:29And that is
32:31inhumane. You know, that is inhumane. But we all did it. We all did it equally. Unfortunately,
32:37you know, maybe a patient was harmed because we were having sleep deprived doctors doing everything
32:43themselves. And then laws came and got civilized. And now doctors in training are not allowed to do
32:51anything more than 80 hours a week. So for us, a 40 hour week is something that we only have
32:58heard
32:58about. You become a general surgeon first, and that's usually five to seven, sometimes nine years.
33:04And then after that, to be a trauma surgeon, like a brain surgeon or a heart surgeon, it takes two
33:09more additional years. So minimum seven years, sometimes up to 11 years after medical school,
33:15to be able to be able to call yourself a trauma surgeon. And I did my trauma surgery fellowship in
33:20Seattle. So I did all that actually in the civilian world. And then I got pulled into
33:26Washington DC area, where I worked at a civilian trauma center called Washington Hospital Center.
33:33I graduated medical school in 87. It took me, you know, a long time, eight more years of training and
33:40so on. And then I started my actual payback as a full time surgeon in the year 1995. When 9
33:49-11 occurred,
33:492001, I think there were seven trauma surgeons in the Navy, maybe a dozen in the army at that time.
33:56So the military was a little slow in catching up to the civilian aspect of doing civilian trauma care,
34:03or knowing that there's a difference between a general surgeon and a trauma surgeon. We actually
34:08don't have a lot of them, because when there is no war, the military doesn't do trauma on a daily
34:14basis. So they're, they don't need them. So it's a little bit of a dilemma what to do with people
34:20who have been trained to do something, but they don't actually practice it. So in many situations,
34:25we actually put them sort of out on loan to a trauma center. They're very heavy and busy,
34:32so they can stay active. The system is way more important than a good surgeon. A good surgeon is one,
34:38so you can only treat one patient, one surgeon. You need the system to work. You need the machinery to
34:43work.
34:43You could be the best surgeon, but you got the worst nurse or anesthesiologist or whatever,
34:49whoever your teammate is, you know, your team's only good as the weakest link. It's the trauma center,
34:55it's the trauma resources, and the military is the same thing. Yeah, the trauma surgeon is only as good as
34:59his team. So some of those expectants that I called expectant, we could have made an effort on. You know,
35:10in a civilian trauma center, it's not uncommon for me to say gunshot wound and arrest. That means they're
35:19dead. They're bringing in someone that they decided is dead, so they started CPR on them,
35:24and then they're doing CPR as they've come into my room. We'll go full bore, you know. We'll strip them,
35:31we'll dive into the chest, we'll open, you know, without anesthesia, we'll open their chest,
35:36do open heart massage, try to find the bleeding, and then stop it. So you'll use sometimes a tremendous
35:43amount of expenses, you know, money, gear, equipment, time, 10 people in the room, you're paying for all
35:51of that. Whereas, you know, in the military, you can't do that. You don't have that time. If I spend
35:5620 years of blood on you, that's a lot of other people I could have tried to save.
36:01The most revolutionary thing was obviously the blood. That was the most miraculous thing that
36:07I got to witness because, I mean, I was in a place where no one had heard of fresh whole
36:12blood
36:12transfusions. If you don't give the people blood when they're bleeding, they die. That's when we went and
36:17said, no, our soldiers got a blood type on their dog tags. They've already been tested. They're good
36:23to go. So we started taking blood out of live people, volunteers, and put them into dying patients
36:29and watched them walk out with no, you know, blood transfusion problems. We don't have a lot of blood.
36:36We have some smaller units of blood. We have 10 refrigerated units of blood, but you're going to
36:42run out like within 10, 15 minutes. So what we do is we will activate the walking blood bank,
36:49and that's literally just 50 yards away from our surgical capability. It's our chow hall. So what
36:57we normally do in the United States is we take the blood, separate it into different components,
37:01refrigerate it, and then, you know, dole it out as we need to. So to take a blood from one
37:08person alive
37:09without thorough testing and so on, relying on the system to make sure that the donors are safe
37:15and to start giving to people is something that's very, very few physicians in this world,
37:21in the United States, actually have that experience. And there's some companies that try to do that,
37:27but eventually it'll just happen. You'll be able to walk up to a machine and push O negative,
37:33be positive and get that type of thing.
37:41After 24 years, you know, you get a certain age and you can't keep deploying. And the pay difference
37:51between a military trauma surgeon and a civilian trauma surgeon is huge. So you do have to finish
37:56that world, go out to your second career, work at a university, medical training centers, and so on.
38:02But after 24 years, actually, that was when my obligation for medical school was up. I was obligated
38:09since the age of 21, all the way for 24 years. So I had to stay in the military because
38:16of the indentured service, just like the West Point and other people that have to stay in the service.
38:21That's how long I had to stay in the service to pay back for the training that I got through
38:27the military.
38:28So that's when I looked at jobs available for trauma directors. I remember the first day I came back
38:35from the war and worked at a trauma center. I was still in Los Angeles. So, you know, we got
38:42the usual
38:42thing, trauma code, you come down, you go running down there. And I remember one guy came in with 22
38:49gunshot wounds. He was alive, talking and doing well. And I was not so enthused. I was just like,
38:56okay. But after all the stuff I had seen, it was like, all right, okay, we'll take care of it.
39:03And,
39:03you know, we took him to the opera and fixed all his injuries. So when you come to a place
39:08that's
39:08touted and known for freedom, the United States of America, one of the freedoms is that everybody's
39:14allowed to buy a gun. And when you have a lot of guns, then you're going to have gunshot wounds.
39:19In a city like Atlanta, it wasn't uncommon to see 12 every single day. No other country does
39:24it like us. In Australia, there are not many gunshot wounds. In Japan, there's one, no guns,
39:31no gunshot wounds. So it's just sort of that simple. So we just published on this as well. And
39:38it doesn't get a lot of fanfare because there's a lot of people who politically don't like this.
39:43But gunshot wounds are the single largest cause of what's called years of life lost,
39:49especially because it kills young people. So in medical care, people dying from heart disease is
39:57decreasing. Cancer is decreasing. Cardiovascular problems are decreasing. But what still is going
40:03up is gunshot wounds. It's just that simple. And the United States is absolutely catastrophic
40:09because we're blind to it. So we have to fix our medical system.
40:17My dad was a doctor. Yeah, he was actually a surgeon. So we came to New York, typical
40:23immigrant family, living in a hotel room until he could find a job and get visas and so on. And
40:30we
40:30lived on coupons and stuff for most of our lives until my father was able to go through the training
40:37again.
40:37So I'm the typical immigration story. And it was hard. It was hard. And eventually,
40:44I went to the military, because I had no money to pay for medical school otherwise. So the contract
40:50is simple, right? You sign on this dotted line. When you're a kid, you don't know what you're doing.
40:55If they pay for four years of medical school, your tuition and books, then you owe them four years of
40:59service. And if there's a war, I go to war. Simple. So they paid for my medical school. And I
41:06chose the
41:06Navy and my dad was in the Korean Navy. I mean, in the beginning, before you go to medical school,
41:12you have to go to officer indoctrination school where you learn how to march, wear a uniform.
41:18It's like mini boot camp for doctors. Doctors, nurses, all the dentists and all the medical
41:25personnel that serve the military will go to one of these schools. So that's ended up
41:30eventually, you know, helping out the Marines by always gravitating towards the Marine Corps side,
41:36rather than the sea side. But as I went through training, I also didn't want to be a surgeon.
41:42But I found it more and more interesting looking over the drapes and seeing what they do. So one of
41:49the other things that led me to surgery was I found that the technical things, when you have to do
41:56things, little things such as starting IVs or getting blood or sewing up wounds and stuff like
42:05that, I was actually pretty dexterous and I was able to do that. I was better procedurally. I don't
42:11know what's going on inside my body, but on the outside of my body, I think people see me as
42:15confident
42:16and capable. And I think that's the reason why you have a tendency to gravitate towards things that
42:22you're good at. And I found myself being pretty good in emergent situations. So I find that a lot
42:29more fun than just specialties where you have to be a little bit more cerebral. I don't know whether
42:35I'm truly thinking clearly or just I'm scared out of my mind. I didn't get chosen to be a presidential
42:43physician and stuff like that for the fact that I was special or anything like that. It was just,
42:49I was in the right situation. I just feel like I was in the right situation where I was fortunate
42:54to
42:54be involved with a lot of world events. And one of the things was, and I got to travel to
43:01China with
43:02Bill Clinton as his trauma surgeon, because the medical unit that supports the president, when they
43:09toured China, they said, no, if he gets injured there, we're not very comfortable with them
43:16operating on them. So they chose to bring their own surgeon. So that's when I got the behind the
43:21scenes of how the White House worked and things like that. Very educational for me. I got a
43:25presidential tour of China being one of his staffers, right? One of the staff guys in the vans in the
43:31back,
43:31that's there in case you're needed. I think that background also helped so that eventually President
43:38Obama came into Tucson to be part of the Gabrielle Giffords incident. There is a book called Trauma
43:46Read. And it's a book that I wrote when Gabrielle Giffords incident occurred because there was so
43:52much questioning about things. And so I just wanted to be able to document exactly what happened with
43:57Gabrielle Giffords. So that was all put together as a memoir, in addition to the fact that I thought
44:02some of the things I saw and experienced in the war would be interesting to others. And there's
44:08something to gain from reading about that experience.
44:15Anybody interested in the military knows how revolutionary this Ukraine war is. How a small
44:23country can fend off such large countries and what the kill ratio is there. It's all about technology.
44:30Okay. If you see the number of optical fibers on a city from the drones and the number of bombs
44:40that
44:40these drones carry, it's more than bullets. Right now, these drones are making it so that a person
44:47doesn't have to be seen by another person and they're catastrophic. What's happening on the Ukrainian
44:53side, we know very well because a lot of surgeons go to Ukraine to help them any way they can.
44:59But the way
44:59they do things in Ukraine is different too. It's like, for example, you know, we push the tourniquets,
45:04they put on a tourniquet on someone who needs a tourniquet, but then that person stays out in the
45:10field for a day and a half and doesn't get back. Okay. Now that tourniquet, it may have saved a
45:16life,
45:16but if they, if it didn't, then it's caused an amputation as well. So everything is a double-edged
45:22sword and we're learning a lot from them. But this drone warfare is the one that's so dramatically
45:28different. Well, I think gutshot wounds are somewhat easier to take care of in many ways. But when you
45:33have a blast injury that goes on, you get a combination of the actual energy from the blast,
45:39this fragmentation or the shrapnel, as some people call it, that goes into the wounds are an issue and
45:45can cause a lot of wounds. Then you've got the civilians who get injured. But the care that's going
45:51on in Ukraine is problematic because you're talking about the infrastructure is not there,
45:56their doctors now have gotten the experience, but they also don't have the resources of
46:01transporting people. Sometimes they can't get to them for a while. So all of those little small
46:05nuances are causing the difference. But the basic bottom line is the drones are the biggest change
46:14that you can imagine. The only thing I used to say is, and the only thing predictable about the future
46:19is that it is unpredictable. But however, when I was doing my research in my earlier days,
46:25one of the things that we got to do was we got to start off with the rudimentary robots,
46:31the robot surgeries that what they now have the DaVinci system. But that technology is really
46:36fascinating. The military started the funding for this robotic surgery because they were saying,
46:41oh, we're going to take a casualty in the field. We're going to take the doctors out of it.
46:46This vehicle is going to go over the casualty, open up the bay from the bottom, pick them up,
46:51and then we're going to have robots doing this. And, you know, we went along with it and go,
46:56yeah, sure, the robots are going to do this. But what I do is, you know, very physical. I'm doing
47:03very hard physical retracting, moving, getting to that thing to get to the bleeder to get that stitch on
47:09that thing. And, you know, the visualization and all that, it's just not something that a robot can
47:14do. But what I have found is that robots can do very delicate things much better than humans.
47:20Even in my late career, I went back and got robot certified and was able to bring it into the
47:25hospital
47:26and do nighttime emergent operations with a robot. And there's a lot of things I do with my hands and
47:33feel and touch and dissection. I don't know if they'll ever be able to replace that. But I tell
47:38you, that machinery lets you do things that are very, very difficult. You can do it precisely.
47:44The robots are only going to get better. When I finished surgery, we didn't even have a laptop.
47:50OK, we had a four megabit laptop. So, I mean, look at what's going on in the world nowadays. You
47:55can do
47:56technologically. AI is definitely coming in the future and it's not going to replace us. It will be with us.
48:01It will help us. We have to be prepared for what robots and AI is going to do. It's going
48:06to be a big,
48:07big part of medicine.
48:31So, in the future, we have to be prepared for that.
48:31So, let's try to get our own plan.
48:31So, let's try to get it.
48:31So, let's try to get it.
48:31And I'm sure we'll be prepared for that.
48:32So, let's try to get it.
48:33When the person gets that guy.
48:33And I'm in the world.
48:33Then I'm in the world.