You could be sent out with small mobile groups, like attached to a fighter squadron, clearing ranges with the bomb squadron or working with the intelligence corps. These would be more mobile units with very limited resources, taking basically whatever you could carry. Or you might go to a remote site. Sometimes you would be sent to smaller bases, where there are a limited number of people. At these places there may be more than one IDMT. The Navy has the same thing, which they call the Independent Duty Corpsman, on submarines and smaller ships in carrier groups.

On a permanently stationed site, like the one in Singapore, we only had a hundred or so active duty people (although there were also 400 dependents there). You set up a clinic, you run the clinic, you see people by appointments and you see emergencies. The first thing they teach you in independent duty school is that it’s okay to say, “I don’t know,” and then to find out. You refer people out to whatever services are available when you can’t take care of it yourself.

In Singapore, they have an excellent medical care system so I could refer emergencies out, like cases that would require major surgeries. But for the basic minor surgeries, like removing warts or sewing people up, I had extensive training. In the military, if you come into an emergency room, the regular hospital ER, you’re more likely to be sewn by a technician than by a doctor.

What are some of the more satisfying cases that you remember in your work as an IDMT?

Much of my time was spent in routine care, but there were those occasional cases that had a significant impact on me. Once, I did an EKG [electrocardiogram] on a seemingly healthy guy who needed medical clearance before starting an exercise program. So I ran a standard EKG and I realized right away that something was just not right. So I called my preceptor.

This is a medical physician?

Yes. I was in Singapore and he was in Japan. After that consultation, I sent the patient to a cardiologist in Singapore, who called me to say that he had done an x-ray and the patient had a retrocardiac mass. Once we knew that, my position on this case shifted from being the medical person to being the medical administrative person, because we [the Air Force] were now acting as his insurance company, as he was sent to the doctors he needed to see. We needed to decide whether to treat him in Singapore or to send him elsewhere.

So you were responsible for finding the most effective and cost-effective means of treating him.

Yes. I had to consider the emergent circumstance, the cost-effectiveness, what was available for transportation, and a variety of logistic information. The man’s mass turned out to be nothing more than a fatty tumor—no cancer, just basically a big ball of fat behind the heart that had pushed the heart off its axis. We had to decide whether to have the surgery done in Singapore or to ship him elsewhere, such as back to his home base in Texas. Because of Singapore’s excellent medical care, and the fact that his family would be there to support him through his recovery after the surgery, we decided to keep him in Singapore. In different circumstances, I would have needed to arrange to send him thousands of miles away.

How about one more interesting case?

During a field exercise, one of the arriving squadrons included an individual with infectious viral gastroenteritis. I anticipated that many more people could be exposed while they were working in the small crowded basement rooms. I made sure that we would provide each work area with fluids and gave instructions for everyone to take a break every hour. That kept the personnel hydrated and healthy. Headquarters Pacific Air Force later recognized me for preventing an outbreak.