Lessons Learned: A Surgeon at Sea

26 Sep 2018

By Pam Choi

Shortly after graduating from general surgery residency, I checked-in aboard an US Navy aircraft carrier as the only surgeon for an entire strike group of about 6500 sailors. While my former co-residents were beginning their fellowships or new attending jobs, I was entering a different world. I had to adjust from working as a surgery resident in a civilian hospital to a naval officer and sole surgical provider on a warship.

My year included the ship’s pre-deployment training cycle as a well as part of a deployment, and so I was away from my family for 7 out of those 12 months. Sometimes, I would be out at sea for 4 weeks, return home for 4 weeks (during which time I would still be working on the ship), and then go out again for another 4- 8 weeks. Additionally, living and working on a ship comes with its own challenges- I couldn’t go for a run in the park, get some Thai food, or even shower without shower shoes. When out at sea, every sailor works every day. There is no “day off”. As a medical department, we saw patients everyday, and we were always on-call. Despite the challenges and struggles, it was also a year of significant personal growth. I became a better doctor and a stronger person.






1) Keep your head on a swivel (AKA Maintain Situational Awareness)

An aircraft carrier is one of the most unforgiving working environments in the world. As such, situation awareness remains critical for not just for personal safety but also for the safety of those around you.Of course, situational awareness was also critical to us as medical providers.

As a constantly moving ship, much of our treatment plan depended on our location and our ability to medevac. Should I operate now or send him to a hospital with more resources? How far are we from the nearest hospital? Was there evena hospital within range of our helicopters or planes? What are the weather conditions like for flying a helicopter? My decisions were no longer about a single patient, but also potentially the lives of pilot and aircrew, not to mention the ship’s assets. We also had to be aware of the ship’s mission, and how our plan may impact the ship’s operations.

Additionally, our patients were not just patients but sailors. Each sailor had a role in the daily operations of the ship. There are more ratings (enlisted occupations) in the Navy than there are medical specialties, and I had to learn and understand these ratings, from an Aviation Boatswain’s Mate to Yeoman. I had to understand how their illness, treatment, or recovery would impact their ability to work and live aboard a ship as well as impact their department. The experience forced me to take a broader view of each patient I encountered as well as each procedure I performed.






2) Conflict Resolution is an essential skill.

Nothing forces conflict resolution more than necessity. Within our medical department, I worked with 10 officers and 40 enlisted Corpsmen. We saw each other every day. Seven days a week. And we didn’t just work together- we often ate together, worked out in the same gyms, hung out in the same common spaces. Frankly, there is nowhere else to go, and for better or worse, we were stuck with each other. Not to mention that for the first time since college, I was sharing a room with a roommate and had communal bathroom/showers.

You don’t realize how small an aircraft carrier can seem until you are stuck there with the same people everyday.

I was very fortunate in that our department was quite cohesive and got along very well. But that’s not to say we did not occasionally get on each other’s nerves. In such close proximity, it is easy to become annoyed or irritated with each other’s idiosyncrasies, and minor disagreements or slights can feel like major arguments or aggravations. But the reality was that we had to learn to resolve these issues, either by working it out or just letting it go.

I had to not only mind my own emotions and attitudes towards others, but I had to do the same for my enlisted sailors as well. Communication was more important than ever, either in trying to resolve my own conflicts or help others resolve theirs. But what’s more- I really did learn to let some of the small things go, which I had struggled to do in the past as a resident. Grudges can ruin group dynamics. Being in the military, it is imprinted within us that more important than the individual is the team, and even greater, the mission. In the medical department, we all had the same mission of delivering the highest care possible to each sailor in our ship or strike group. All other things are secondary.






3) Loneliness can build Self-Reliance.

Despite being surrounded by several thousand people all the time, there is nothing lonelier than knowing that you’re the only surgeon in thousands of miles surrounded of open ocean.

I had this distinct thought while doing an appendectomy during a particularly bad spot of weather. While we had checked with meteorology before starting, the weather was only going to get worse if we waited. The ship was pitching and rolling so badly that one corpsman was assigned to just hold the OR table. To make matter worse, there was an issue with the ventilation in the OR, which unfortunately had only just happened a few hours before the case started, and so it felt very hot in our space. And of course, there was a lot of inflammation and adhesions, which made it difficult to even find the appendix.

I was actively sweating it out- intellectually, emotionally, and physically. There was nobody else. There was nowhere else to go. I kept my mouth shut because I didn’t want the other corpsmen or officers in the OR to know how much I was struggling, and just worked through it. The patient ended up doing fine. And I completed the surgery while also managing not to pass out or vomit.

While at sea, I felt a loneliness that I had never experienced before during residency. I was used to a community, a locker-room, or a lounge of surgeons where we could discuss interesting or challenging cases or simply gripe. Not just to discuss our professional struggles, but personal ones as well. I struggled emotionally as well as professionally.

But like any sailor, I had to learn how to make best of the circumstances.

I tried to be critical and introspective for each case I did in order to improve myself. I tried to do whatever I could to keep busy and contribute to our department by teaching, even going so far as to make a chest tube practice set from a large cardboard box and taping together some tongue depressors and creating some tracheas out of toilet paper rolls and gauze in order to teach the corpsmen how to insert chest tubes and tracheotomies. I focused on other goals, including earning my Surface Warfare Medical Department Officer pin, a year-long process which involved learning multiple topics (including but not limited to Engineering, Damage Control, Seamanship, Reactor, Air Operations) and passing 2 oral boards.

In the end, all we have to judge our self-worth is ourselves.




4) Semper Gumby

I had just returned home after being away for six weeks and was looking forward to spending time with my family. However, after less than 30 hours of being home, I was notified that a hurricane was anticipated in the area. As a result, all of the ships on the naval base had to leave base (to avoid damage to the ships and the pier) and would spend some time out at sea for an undefined amount of time. We were to pack and board the ship by tomorrow morning.

Obviously, I was dismayed (as were my husband and young son) that I would be leaving so soon after returning, but I packed my seabag and mentally prepared myself.

However, an hour later, I was told that I would be leaving with a different ship with a different crew for staffing reasons. I wasn’t particularly thrilled about going out to sea with a ship and crew I had never met before, but I dutifully called to check in with the Senior Medical Officer on my new ship.

Half an hour later, I was called and notified that the plan had changed again, and that I was going with my original ship. An hour later, I was told that, no, I was going with a new ship. For a while it seemed like I was being called with a new plan every hour or so.

In the morning, the hurricane had bypassed us completely, and we no longer had to go out to sea. The emergency recall was canceled. By then, I was so exhausted by the multiple changes that I was simply resigned to whatever was going to happen.

Being flexible is not an option in the military, it is mandatory and a way of life. There were many things that are beyond our control. Plans changed multiple times with short notice. At certain times, we found that we just had to plan for nearly every contingency, only to find out at the last minute something completely different was going to happen.

As surgeons, we like to think that we have some control over what happens. We plan and react and plan again. I had never minded change as long as I was prepared for it. I could even deal with unpredictability when it was compartmentalized- I was fine with the unpredictability of what could happen for the 24 hours when I was on call. But this was something different- there were too many things I could not predict or control.

My experience forced me to become comfortable with last minute changes, the unknown, and the lack of control. The by-product of this was that it enhanced my resiliency to deal with such stressors.

5) Leadership is a verb.

As officers, we are naturally expected to lead our enlisted sailors. Working with the Corpsmen became the most rewarding part of my tour. I invested in them professionally and emotionally, and the dividends were far greater than anything I could have anticipated.

The most memorable times from my deployment were not anything I did as an individual, but witnessing the accomplishments of my sailors. I taught them clinical topic and skills and helped them study for their exams. I wrote letters of recommendation or award citations. Each promotion, medal, or warfare device that they earned was the greatest source of pride.

I also had helped them when they were struggling as well. When someone was not meeting expectation, I would have to sit down with them to figure out what was going on and figure out solutions. When there was conflict, I would meet with the involved individuals to help them try to resolve it. Most importantly, I took an interest in their lives. I knew what their goals were, their family lives, and who their favorite Avengers character was. I didn’t realize how much of an impact something simple like this had until right before I left, when so many Corpsmen thanked me for simply caring or making deployment easier to endure.





6) The Navy [Surgeon] Spouse is the hardest job in the fleet.

Like everyone on the ship, I missed my family terribly. Pictures of my husband and son were posted all around my stateroom and my office, and I thought about them all the time. During one phone conversation, my husband told me how our son had gotten sent home from school for hitting another child. He was three years old at the time, and it was an incident due to over-excitement and lack of self-control rather than any malice, but I still cried after I hung up.

Was it because I wasn’t there? Whether it was or not, I still blamed myself.

I felt gu

ilty all the time- not just because of the way my son was acting, but because my husband was essentially dealing with it by himself. He worked a full-time job, and at the same time he was effectively a single father. I felt guilty because we moved away from my husband’s family, friends, and work to a place where we had no friends and family, and his career trajectory had effectively stalled. I felt guilty because we were going to have to move three times in three years.

Once in a while, somebody will thank me for my service, but it’s my family who should be thanked. My poor husband didn’t just deal with all the sacrifices required of the spouse of a surgeon, but the spouse of a Navy Surgeon. To a certain degree, he sacrificed more than I did.

I’m very fortunate that he stood by me during this last year. He supported me through everything without any malice or regret or jealousy. He dropped me off at the pier at 3AM before our deployment, gave me a hug and kiss, and reassured me that they would be alright and not to worry (even though, of course, I still did). He told me to be the best Naval officer and surgeon I could be for my sailors. While I was away, he worked, and he took care of our son and managed our household. He arranged a move half-way across the country by himself. When I returned from deployment, he picked me up at the airport in a new city from the one where we last saw other. And now, after being a husband of a deployed Navy surgeon, he gets to be the husband of a pediatric surgery fellow.

Thank you, Nick, for everything.






Pam Choi (@pmchoi) graduated medical school as the University of Rochester and completed general surgery residency at Washington University in St Louis. While in St Louis, she met her awesome husband, Nick, and had their son, Calvin. After residency, they moved to Norfolk, VA where she was the ship surgeon for an aircraft carrier. She is presently the junior pediatric surgery fellow at Children’s Mercy Hospital in Kansas City and is also a Lieutenant Commander in the U.S. Navy. In her free, she enjoys eating, running, conquering Escape Rooms, and visiting National Parks with her family.

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarilythe opinion of the Association of Women Surgeons.


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