Sauces, sunflowers and letters home

An Air Force surgeon in Iraq talks of his soldiers, Iraqi families and his feelings about the war.

Christopher P. Coppola, M.D., HS ’01, didn’t get much sleep during the four months he spent as a surgeon at Balad Air Base about 40 miles north of Baghdad.

The injured would arrive without warning. For instance, soon after Coppola, an Air Force major in the 332nd Expeditionary Medical Group, arrived in January 2005, insurgents attacked a police graduation ceremony in the nearby city of Baqubah. Six surgical teams, including Coppola’s, rushed to Balad’s tent-and-shipping-crate hospital as one helicopter after another delivered gruesomely injured policemen.

On other days—and nights—the burned and wounded who kept Coppola from his rest were American troops, Iraqi National Guard soldiers, children caught in the cross-fire and men and women hurt in fights or accidents on the base that housed 25,000 American troops and 7,000 civilian employees of Halliburton subsidiary KBR. Frequent mortar attacks led soldiers to nickname the base “Mortaritaville,” Coppola said, but many of the insurgents’ decades-old shells failed to detonate. “When they did go off, they would startle me and I usually couldn’t sleep for the rest of the night,” he said.

Coppola did relax a bit when the violence abated. On those days, his only responsibilities were scheduled procedures—inserting stomach tubes, cleaning wounds. But going back to his hooch to catch up on sleep provided the unwelcome opportunity to reflect on his situation. “When you’re cut-ting off someone’s leg, you just do it, because they’re going to die if you don’t,” Coppola explained in an interview from Lackland Air Force Base near San Antonio, Texas, where he now works. “When you have nothing to do, you start thinking about it. So I couldn’t sleep.”

The 37-year-old Coppola used some of his restless nights to write long letters to family and friends. His wife, Meredith, has assembled them in a self-published book, Made a Difference for That One: A Surgeon’s Letters Home From Iraq.

Coppola described in the letters how he distracted himself from missing Meredith and their three sons and from the despair he felt about the suffering surrounding him. He ran for exercise, always wearing 35 pounds of armor and a helmet, occasionally waving to shepherds just beyond the fence; planted cilantro and sunflowers in the sandbags banked against his sleeping quarters; and earned modest fame in a moustache-growing competition. To make edible such meals as “tan stuff over rice,” Coppola assembled an arsenal of sauces. In March, for instance, faced with an entree of “meat chunks ... diluted with unmentionable adulterants,” he saluted St. Patrick’s Day by dousing it with Goodall’s of Dublin Irish Steak Sauce.

Coppola owed the Air Force six years of service in exchange for stipends while training in pediatric surgery at Children’s National Medical Center and for medical school tuition at Johns Hopkins. He did his general surgery residency at Yale, serving as chief resident in 2000-2001. Although he worked as an all-purpose trauma surgeon at Balad, word got around that he was a pediatric surgeon, and Iraqis brought their children to him for care: a girl with kidney failure, a boy with a prolapsed bowel. Coppola also treated children hurt in the war, including two sisters burned when their house was fire-bombed. One child recovered, but the other died. Soon after, Coppola discovered that he had unknowingly saved the life of the man who threw the bomb. “I instantly conceived of a variety of ways I could have meted justice on him with my own hands,” Coppola wrote. “I’ve taken care of drunks who have plowed into a family of five on the highway, in the bed next to the parents whose children were killed in the crash, but nothing prior had been as difficult as this. I was thankful I didn’t know who he was while he was here.”

Coppola recalled becoming inured to the carnage, only to be shocked yet again. “You feel like you’ve seen it all, but you haven’t. There’s always something worse around the corner.”

Coppola opposes the war. “I want out of there, yesterday. I can’t see how any father or any doctor could feel differently.” And yet the work itself was rewarding. In Texas, Coppola knows that if he does not care for a patient, someone else will. In Iraq, he said, “I had the privilege of feeling that if I wasn’t there, the person would probably die.” And although he believes the war hurts American interests more than it helps, “If there were Americans shot at, that was the place I had to be. Trying to get those guys and women home to their families is probably the most rewarding thing I’ll ever do.”

Coppola expects to be sent back to Iraq this September.

—Cathy Shufro

Made a Difference for That One is sold by online booksellers and also on www.iuniverse.com. Profits go to Fisher House Foundation, which provides housing for family members of military personnel getting treatment at military medical centers.

A long, full and active life—keeping fit and taking on lots of jobs

“The trouble with retirement is that you never get a day off,” is a saying quite familiar to Henry E. Markley, M.D. ’43. At 87, Markley went into full-time retirement when Greenwich Hospital’s Home Care/Hospice Program, where he worked as part-time medical director, closed in September 2004. Although he bristles at the closing of the program, which served up to 300 patients, he has no plans to slow down. An avid tennis and golf player, he continues to exercise up to an hour and a half each day, a testament to the notion that a healthy lifestyle leads to a long and healthy life.

Markley’s ties to the hospital’s home care program go back half a century, when an anonymous donation enabled the hospital to set up a pilot home care study for chronically ill patients who often required lengthy hospital stays. The only nursing home in Greenwich had a long waiting list, so there was a dire need for alternate long-term care. After visiting Montefiore Hospital’s home care program in New York, Markley helped set up the Greenwich service, which initially accommodated only 10 patients. “By the seat of our pants we built up the program,” he said. “We were a pioneer service.” After a year, in 1956, the medical staff voted unanimously to request that the hospital make home care a department, and Markley continued as medical director for almost 50 years. The program was recognized across the state, serving patients from Greenwich and its surrounding communities.

Markley’s medical career began with a lingering doubt. When he applied to the School of Medicine in 1939 he had little hope of being accepted. He was a top student at Penn State, but most medical schools then had an unspoken quota limiting Jews to 10 percent of any given class. One of his Jewish classmates from Penn State had already been accepted at Yale, and Markley thought it unlikely that, with a class of only 48 students, the school would accept two Jewish students from the same college. Much to his surprise, however, he entered the medical school with the Class of ’43. After being drafted, he joined the Reserve so that he could postpone his Army service until he graduated. The war ended not long after he went on active service, and following an internship at Philadelphia General Hospital, he did a residency at Greenwich Hospital. He eventually received an Army assignment to Puerto Rico, which he followed up with additional training in internal medicine at Johns Hopkins. When he was offered a position on the staff at Greenwich Hospital in 1950, he returned for good to practice internal medicine.

Markley has worn many hats over the years, in addition to founding and directing the home care program. He served as the hospital’s electrocardiographer for 24 years; formed the first professional medical corporation in Greenwich in 1963 with three of his fellow internists; served as chief of medical services from 1967 until 1974; and after selling his internal medicine practice in 1979, became medical director of Greenwich Health Examiners, a company that performed physicals for executives. In 1993, at 75, an age when most people would have been retired, he cut back his professional activities, limiting himself to running the home care program. Although it wasn’t a full-time commitment, he spent a few hours each day at the hospital reviewing charts and coordinating services.

Markley said he continued to work all these years because his father, who lived until the age of 102, retired at 75 and regretted it for the rest of his life. Even though longevity runs in his family, Markley practiced preventive medicine. He is trim, has never smoked, has only an occasional glass of wine and is very active, although age has taken a slight toll. “I’m not any good at tennis any more,” he admitted. “I know where I’m supposed to be on the court, but it takes me a while to get there.”

Markley married his wife, Nicki, 13 years ago after twice becoming a widower. “The first time I was married for 25 years, the second for 20 years. I told Nicki we’re not fooling around this time; we’re going for 30 years,” he said. Meanwhile, he has other milestones to look forward to. I went to my 60th medical school reunion,” he said. “I’m looking forward to the 65th.”

—Jill Max

A Montana doctor’s 30 years of medicine without a safety net

On January 7, 1984, Ron Losee, M.D. ’44, tramped out the front door of the hospital in Ennis, Mont., and into the snowy fields, intent on walking to his death. Losee, a general practitioner skilled in orthopaedic surgery, had just learned that he was being sued for malpractice by a woman who claimed that his operation on her ankle caused her undue pain during bowling. “If this was my reward by society for all my years of service, then I didn’t want to live anymore. I have always tried to be the best damned doctor I could possibly be,” said Losee, who since 1949 had devoted himself to his patients—even offering his own bed to patients before Ennis had a hospital. Fortunately for Losee and his loved ones, fresh bobcat tracks in the snow jolted him back to reality.

“I was fine with falling asleep in the snow and dying, but I didn’t want my b***s clawed off by a bobcat,” Losee said with characteristic frankness and good humor. He retraced his steps and made it home safely, although cold, cramped and tired.

In the dread-filled, six-month stretch that followed, the claim against Losee was deemed baseless; the woman’s discomfort was actually caused by an injury she had sustained after Losee’s surgery. However, the distaste this event left him with created the medical maverick that he is today. At the time of the lawsuit, Losee had no medical malpractice insurance. Today, at 86 vigorous years of age, Losee boasts the wherewithal and gumption to give medical consultations, perform tennis elbow operations and practice medicine without malpractice insurance, just as he has done for the past 55 years.

Losee’s decision not to carry insurance was born of practicality and the intimate nature of his practice in a rural mountain hamlet 55 miles southwest of Bozeman. He carried an insurance policy until 1975, when the cost jumped from $8,000 to $30,000—slightly more than his net income for the year. Losee simply could not abide passing the financial burden on to the cowboys, farmers, miners and waitresses who were already scraping together as much money as they could to pay for his services.

After the single 1984 lawsuit brought against him, Losee quite happily continued practicing medicine without malpractice insurance. But his insurance ire was rekindled by a letter he received in May 2005 from Blue Cross Blue Shield of Montana informing him that—because he does not carry malpractice insurance—he was no longer a recommended provider. The decision has had little effect on Losee, as patients still seek out his medical services. But after 55 years of sound medical practice, Losee finds it ludicrous that he is being “kicked out” of the medical system, especially since he believes that, depending on the circumstances, some doctors who commit malpractice deserve to be imprisoned. He penned a letter to Blue Cross Blue Shield sharing his strong views about the malpractice insurance industry and, as he said, “to teach them some manners.” In their response, Blue Cross Blue Shield said requiring malpractice insurance is an industry standard designed to protect members.

In his letter, Losee detailed what he considers serious flaws in the system. “In Montana, about one-third of malpractice claims progress to lawsuits. Of these, only a small proportion end in jury trials, with physicians prevailing in the bulk of those cases,” wrote Losee, who has served on the nonbinding Montana Medical Legal Panel, which comprises three doctors and three lawyers who evaluate malpractice claims to recommend whether they should proceed to trial. Malpractice insurance is, he believes, rarely needed, but the insurance industry has instilled a sense of fear in both doctors and patients to maintain the system. This fear, Losee asserted, is largely accomplished by a “bribeocracy” system of government: congressmen and senators receive large financial backing from trial lawyers and insurance-industry lobbyists to fund their re-election campaigns, while the elected officials, in return, fuel the malpractice insurance fire.

As an alternative, Losee advocates a no-fault medical liability compensation system. Instead of going to court, a malpractice claim would go to an expert panel that would assess whether an injury has indeed been caused by a physician or other health care provider. Compensation would be doled out from a pool of money collected from tax revenues or premiums charged to doctors.

Sitting on his porch and looking out over the Madison River to the snow-capped peaks of the Rocky Mountains, Losee often reflects on his many joyful years of practice in Ennis, which began when he, his wife and their 2-year-old daughter trekked to Montana from Connecticut in 1949 in their Army Jeep. Being dropped from Blue Cross Blue Shield’s provider network has certainly not slowed Losee’s practice. Widely acclaimed as a physician who made major headway toward understanding and surgically repairing the “trick knee” (the Losee tests bear his name), he still sees patients and operates on tennis elbows. Patients seek Losee out and return to him time and again, based on his medical expertise and sincerity rather than the amount of malpractice insurance he carries.

—Kara A. Nyberg


			Originally published in Yale Medicine, Spring 2006. Copyright © 2006 Yale University School of Medicine. All rights reserved.