Nearly 40 years ago I set foot on the dock of at Newport News, a civilian as green as grass, ready to take up my duties as Medical Officer of the yet to be commissioned, USS JOHN C. CALHOUN (SSBN 630). LCDR James Bush administered the oath; I became an "Officer and a Gentleman" in the United States Navy. Twenty hours later, having spent the night on the floor of LT Sorenson's apartment, I was at sea and underwater in one of the most formidable ships ever built. I would wager that no one in the history of the U.S. Navy has gone from civilian to officer at sea and underwater in such a short time! That was August 22, 1964. Unique events effected all of us in ways we only began to understand years afterward.
Being a CALHOUN plank owner of the Gold crew was one of those events. The Kennedy assassination was another; I was drafted as a result. Assignment to a submarine was lucky; had I not been in Washington at the right time to fill a slot left by another Medical Officer, I would have spent two years in Kansas doing intake physicals. The experience with environmental medicine and medical administration while on CALHOUN influenced my shift from surgery to public health. After several sea trials, a 35 day shakedown cruise, two missile shots, multiple torpedo run simulations on the plotting board, two patrols to hazardous waters, and a stint at the Naval Research Lab in DC, surgery seemed rather tame.
On the CALHOUN, I realized that a degree in Civil Engineering from MIT was an asset for myself, as well as the command. CDR Bush suggested that Lt Falcon Knight walk me through several systems so that I could assist other shipmates to become qualified on the ship. Several Gold crew members learned the vagaries of trim and drain, high pressure air, the hydraulic system, and the dynamics of the control system from the "doc". My melding engineering and medical practice started on the CALHOUN and has continued ever since.
After two patrols, I completed my two year enlistment at the Naval Research Lab. In September 1966, I entered Harvard, receiving a Masters Degree in Public Health the following June. I finished my residency in Preventive Medicine and Public Health at the University of Kentucky in 1969, and married Kathleen Sperry, who had just returned from two years in India as a Peace Corps volunteer. We trained Peace Corps volunteers for family planning work in India.
Next stop, Boston University Medical School to teach preventive medicine. Our two sons were born in Boston. In 1974, I became the first Director of Health Services for the Massachusetts Department of Correction. DOC housed 3000 prisioners in four large prisons. My job was to organize a healthcare system for this population and to provide quality care, a step up from managing a department of two on the CALHOUN (HMC Bob Simmons & myself) to nearly 200. But after two years in the Navy, three years at Harvard and Kentucky, summer courses at the University of Michigan, and several years teaching health systems theory, I felt qualified. Had I more experience in preventive medicine prior to joining the Gold crew, I would have been better prepared to handle problems on the CALHOUN; a TB outbreak, monitoring radiation, reducing smoking at sea (including clouds of pipe smoke I produced - I stopped in 1980), the effects of air pollution, and toothaches. My ignorance was the ship's and crew's loss. What I learned from these weaknesses, however, became assets in Corrections and in future public health jobs.
At DOC, we built a unified system, linking the medical programs in the prisons. We monitored disease, applied preventive strategies to reduce disease and promote health. We identified causal factors before they manifested in illness and we developed standards of care. The health system my colleagues and I put in place in the mid-1970's is pretty much what exists today in Massachusetts and in other prisons and jails around the country. We started a process to provide care to a difficult population.
The governor of North Dakota invited me to be his State Health Officer in 1976. Why go to North Dakota? Easy, it was the only state in the Union I had not visited, and they were paying my way to the interview. But I stayed because the ND State Health Department was a the cutting edge in US history. We were to find a rational pathway through the energy -- economy -- environmental thicket produced by the 1970's Arab oil embargo.
Beneath the North Dakota prairie, is coal. Coal produces power. And the nation needed power. Exploiting the low sulfur coal for power, would mean a huge economic gain for the state, and help satisfy the energy needs of the northern tier of the nation. But power plants can degrade the environment and change a rural way of life. Governor Link felt responsible to help satisfy the energy needs of the nation; he knew the sate would reap economic benefits from the "one time harvest" of coal; but he was committed to preserving the quality of the environment for North Dakotans now and in the future. He asked me to help him achieve these three goals: develop energy, improve the economy, and preserve the quality of the environment and way of life in rural North Dakota.
The North Dakota State Department of Health is the agency that enforces air and water quality and protects the health of the public. As on the CALHOUN, I was given another unique opportunity to use my engineering and medical experience on a critical issue.
The North Dakota State Department of Health ia the agency that enforces air and water quality and protects the health of the public. As on the Calhoun, I was given another unique opportunity to use my engineering and medical experience on a critical issue. As State Health Officer, I signed permits for power plants. Their construction and operation augmented the ND economy, coal was transformed into energy and transmitted to millions from Seattle to Minneapolis. But the quality of air and water in North Dakota still remains within the standards we set in the mid-1970s. We met our objectives. And Kathleen and the boys learned a different way of life from their Eastern roots.
I returned to Boston in 1980, but returned to the West in 1987 as the Director of the Wyoming State Department of Health and Social Services. Energy and the environment were no longer central concerns. HIV and AIDS, mental health and the expansion of Medicaid were the significant issues at this stop in my career. But partisan politics shortened my stay. Happily, Los Angeles County was looking for an itinerant public health official.
I become the Medical Director for the LA County Department of Health Services, a department that almost makes the Navy look small. In any year the LA DHS spends over $2 billion providing a variety of health services from vaccination of children, open heart surgery, and trauma care to 7500 injured patients a year. Six public hospitals admit 165,000 patients who consume nearly one million bed-days of care. And LA DHS sees over four million out-patient visits annually. It is a big system. It demands a clear vision to keep the system on track, to balance the budget, to assure quality care for the two million individuals who need and use the system. Another big step from the Calhoun sick bay.
But Los Angeles was not all “blood, tears, toil and sweat.” In 1993, the Calhoun called us back. My family and I flew to Fort Lauderdale to participate in the de-commissioning of the ship we had help commission in a different age. Descending the ladder into the After Missile Compartment after 30 years, meeting old shipmates, seeing the same instruments and smelling the same air was like passing through a time warp. The sea was unchanged, the ship about the same, the crew in “poopy suits” looked similar; and when we rigged for angles and dangles, or ran the “man-box” overboard drill with Captain Thurtell at the helm, the year could have been 1964. Memories and reality merged; the present and the past become one. I saw myself at the beginning of my career, and looking back on it all at the same time. The Calhoun and its crew had again rewarded me with a unique experience. Time was in a capsule, I could see the future from the beginning and the past from the end. That doesn’t happen often.
After a few days in Florida with Calhoun men and families, we returned to Los Angeles, to the reality of public service in the Hot Zone. LA in the 1990s saw floods, riots, earthquakes, fires, and the stress of trying to do more with less. Each year our budget was inadequate, and service demand inordinate. In 1995 the position of Director of the Department opened and I applied. Luckily, I was not selected. LA DHS tanked.
In 1997 Maricopa County, Arizona, asked me to lead its Department of Public Health. Not LA, but big enough; the Phoenix region has over three million people, adding 100,000 each year to the urban sprawl. Building a public health system with 1500 employees is a challenge. We have all the problems, HIV, SARS, West Nile, and the threat of bio-terrorism. Again, we are on the cutting edge of history.
In forty years, I have been privileged to lead
several public agencies. I have seen success and failure; I have been married, divorced, and married again.
And I have had the chance to work with and report to extraordinary individuals, Governors, politicians, and academic leaders.
Three of the best were in the beginning. Frank Thurtell (CO Gold) and James Bush (XO Gold) showed me that reason, common
sense, humanity and a sense of humor are necessary for leadership. I also strive to emulate Dean Axene, the commissioning
CO of the Calhoun, whose courage and integrity were major factors for improving the safety of every system in every nuclear
submarine that went to sea after 1964. Thank you Admiral.