Col (ret) Rocco A. Armonda, MD, FAANS; Director of Neuroendovascular Surgery for MedStar Washington Hospital Center and MedStar Georgetown University Hospital; Director of Neurosurgery at the Uniformed Services University of the Health Sciences.
A man should be judged by the “dust on his sandals and not the polish on his boots.”
During the recent visit by Pope Francis to our nation’s capital, I was reminded about the connection to serve a higher purpose. These inspiring words by the pope brought to mind all the incredible examples I have of mentors in my career that embodied service. Throughout a career of 31 years from my days as a young cadet at West Point in 1982 until my retirement from active duty service in 2013, I have been inspired, mentored and taught by many individuals who lead lives of service.
Thoralf M. Sundt, MD, West Point Class of 1952, was one of my earliest neurosurgery and military mentors. As a young infantry officer who just graduated from the academy, Dr. Sundt was awarded the Silver Star for Valor during the Korean War for his bravery at the Battle of Pork Chop Hill (where he also lost two of his closest classmates Dick Shea and Dick Inman). He later became one of the most accomplished cerebrovascular neurosurgeons and shaped the future landscape for excellence in complex neurovascular microsurgery. As a young medical student in 1989, I rotated to the Mayo Clinic and watched him operate and teach. Despite an advanced stage of multiple myeloma afflicting his spine — which required him to wear a rigid body cast while operating — he never missed his weekly Saturday morning conferences.
In 1992, shortly before he died, he was awarded the Distinguished Graduate Award by West Point. The message of his memorable lecture titled, “You Are Here For Discipline-Not Justice,” has stayed with me for over 23 years. He told the remarkable story about astronaut Frank Borman, USMA Class of 1950, defending his group of fellow cadets who had returned late from Christmas leave due to a snowstorm grounding their DC-3. “The Ace,” senior regimental tactical officer (the youngest infantry regimental commander from WWII) was nonplused. His response was, “you are here for discipline and not justice.” All were punished accordingly. Sundt’s message was clear, life is not fair and it is discipline that carriers the day. Discipline is the factor that gives one strength to complete the mission despite fatigue, obstacles and the seemingly impossible.
During residency at Walter Reed LTC (ret) Richard G. Ellenbogen, MD, FAANS, embodied service, dedication and true leadership to me. Dr. Ellenbogen’s personal example of service and dedication to each individual patient provided a model of what a military neurosurgeon was about. Deployed during Desert Storm in 1990-91, with a wife and newborn at home, he operated in the desert without a CT scanner, drills or basic neurosurgical equipment. This would become a founding lesson of “far-forward” service that would be required of an entire generation of military residents he trained. We would all find ourselves in a similar situation a decade later in both Iraq and Afghanistan. Dr. Ellenbogen did more than train us, he shaped the future of military neurosurgery to confront the challenges of tomorrow’s wars. His efforts created the small cadre of neurosurgeons who would become “far-forward” combat neurosurgeons for the next generation, and he passed the mantle of leadership to Col (ret) James M. Ecklund, MD, West Point Class of 1983, who served as the next Chair at Walter Reed and expanded the model of service. Dr. Ecklund would lead from the front, literally volunteering for both Iraq and Afghanistan while many other military personnel were working hard to avoid deployments! Dr. Ellenbogen not only prepared us for the future unknown, but connected us to the legacy of our past, including one of our then still living founders Hugo Rizzoli, MD. One of his most impressionable quotes he shared with me came from a little book of Russian poetry by Yevgeny Yevtushenko: “…Forgive no error you recognize, it will repeat itself, increase, and afterwards our pupils will not forgive in us what we forgave.”
Hugo V. Rizzoli, MD, was a living legend for me — the veritable “Godfather” of neurosurgery in Washington, DC — and thanks to Dr. Ellenbogen’s introduction I was able to enjoy his company for many years until his death in December 2014. Dr. Rizzoli’s accomplishments and contributions to the military and neurosurgery are many. He was the last resident trained by Walter E. Dandy, MD, and one of the first neurosurgeons to bring this art to Washington, DC. There he served as chair of neurosurgery at Walter Reed during the last year of WWII and remained as a civilian consultant for over a generation, shaping the leadership, training and care at Walter Reed throughout that entire era. This ensured that the best and brightest candidates were trained and that care was maintained at the highest level. He trained nearly two generations of neurosurgeons from his service in the Army and as chairman of the department of neurosurgery at George Washington University. We would meet for dinner at his favorite Italian restaurants in Bethesda, MD and he would share with me remarkable stories about neurosurgery through the past 70 years! Although technology had dramatically changed, the unending dedication to service linked this generation of military and civilian neurosurgeons to the same mission that moved Dr. Rizzoli. I was able to share his company with my family, residents and colleagues so they also will benefit from the wisdom of his life. He was an example and inspiration for all.
Voluntary Military Neurosurgeons as Heroes
During the recent conflicts, I have had the opportunity to witness amazing service and dedication from multiple volunteer neurosurgeons who have answered the call to duty. One of the most impressive has been my former partner LTC (ret) Richard T. Teff, MD, FAANS who continues to serve as a neurosurgeon for the Army as a civilian employee. Dr. Teff was the longest deployed neurosurgeon in the U.S medical corps, serving over two years as a neurosurgeon in a combat zone! This is SERVICE! It comprised four standard six-month tours, which he performed a year at a time, both served in Iraq during some of the most critical phases. In the combat theater he was tireless and courageous, frequently traveling “outside the wire” with civilian affairs teams to Iraqi hospitals. There he worked educating, training and aiding Iraqi neurosurgeons in the care of the multitudes of civilian patients. On his own, without any support from the Army, he organized an enormous book donation program between Thieme and the Iraqi neurosurgeons during the first year of the war. He personally transported multiple severely brain injured patients on some of the first Critical Care Air Transport flights from Iraq to Germany. After this, he created the first of its kind neurotrauma curriculum for the CCAT teams, trauma teams and battalion surgeons. The Army recognized his efforts with a Bronze Star for Service.
With no prior military obligation, Hans E. Bakken, MD, FAANS volunteered to serve only if he could deploy in the combat zone. This was unheard of! This occurred during some of the worst casualties of the Iraq war. As a small force of active Army neurosurgeons, we overwhelmingly welcomed his contribution without which, some of would have faced our second or third rotations. His service demonstrated the greatest dedication of our nation’s civilian-military volunteers. Not waiting to be called, but rather going forward and answering the call. What a different society we would have today if that was the rule rather than the exception.
Military neurosurgery service continues as the baton passes from one generation to the next at Walter Reed. Col (ret) Leon Moores, MD, FAANS (deployed twice) and Col (ret) Michael K. Rosner, MD, FAANS (deployed to Iraq), who were both former chairs at Walter
Reed, have recently retired. Currently returning from deployment are tomorrow’s leaders:
- LTC Sven M. Hochheimer, MD (USAF)
- LTC Michael S. Dirks, MD (USA)
- CDR Randy S. Bell, MD, FAANS (USN)
- CDR Christopher J. Neal, FAANS (USN) (present program director)
All are former Walter Reed graduates who complete the military neurosurgery lineage that stretches from Walter Dandy, MD through Hugo Rizzoli, MD, to the present. As their former teacher, I so often became the student as they questioned the conventional “status-quo” response and collaborated to chart new horizons in quality care for our patients and their families.
I honor my mentors by continuing the tradition of teaching and training. I train future Walter Reed rotating residents at Washington Hospital Center, a Level I trauma center in Washington, DC and at the Comprehensive Stroke Center. I try to advance our art by being there for our “brothers” through service in some of the most hostile of environments: To train, to inspire, and to honor those who have gone before me and the generation that now carries on.
Dr. Sundt eloquently concluded his message at West Point in 1992 with words that ring as true now as then:
As the shadows lengthen, our class ages and the ranks are thinned, returning to our beloved and hallowed alma mater becomes more of a pilgrimage than a reunion. We restore our faith, rekindle our love, gather our strength, and muster our courage for what lies ahead from just being here. Remember and be proud that there is no higher calling than service to country…Vaya con Dios.
Today, on Veterans Day, I offer praise for all these aforementioned mentors who have shaped my career as enormously deserving Military Faces of Neurosurgery.