He talks about leading a medical brigade on the battlefields of Iraq and confronting his PTSD after several of his soldiers were killed.
Rebuilding Iraq’s shattered health care system after the Allied invasion of that country in 2003 was “a very magical moment” and the highlight of Col. Donald A. Gagliano’s career.
A retinal ophthalmologist and an AAPL member since 1998, his medical and military careers began at the U.S. Military Academy in West Point, New York.
He led a 33-nation coalition that included 5,500 U.S. personnel and represents the largest medical brigade in recent history.
His experience led to subsequent vision initiatives for battlefield victims.
Not until recently, however, did he realize that he, too, was a victim of war.
Q As founding director of the Department of Defense/VA Vision Center of Excellence, your objectives include the prevention and mitigation of retinal injury in blasts and the restoration of vision — or artificial vision. What was your role as a physician leader in these objectives?
A When tasked to establish the Vision Center of Excellence, we developed a clinical registry that identified victims of vision trauma, linked them to providers in real-time, and established a research program that tracks their care from the bench to the bedside and battlefield. I’m proud to say that each of these capabilities were achieved and are ongoing. The key to this success: assembling the right personnel and partnerships.
Q How did your experience as an organizational leader of physicians before 2003 serve you as a leader on the battlefield?
A What I didn’t realize until I looked back was how much the evolution of my career, over increasingly complex leadership roles, prepared me for this responsibility. No doubt, the same leadership principles apply to leading health care organizations both on and off the battlefield: Know the requirements and capabilities, develop a clear vision, ensure appropriate organizational design and alignment, enable operational agility and sustain a clear focus on the priority of outcomes. The complexity of medicine is always challenged by limited resources, unanticipated events and integration of multiple disciplines, but keeping a mission-focus on achieving common outcomes enables the best decisions to be made at every level.
Q Helicopter crashes killed seven of your troops in Iraq. As a military medical leader, what did you learn about grief and guilt as it relates to losing soldiers vs. losing patients?
A There are no words to describe the emotions of losing soldiers under your command. As with the loss of a child, your first thought is that it should have been me, I wish it had been me. What I recently learned through Strong Star, a post-traumatic stress disorder program, is that grief never stops. However, learning to embrace the grief honors the memory of their sacrifice.
Q Nearly 14 years separated your tour in Iraq and your own PTSD diagnosis. Do you think leadership status contributed to a sense of being “bulletproof” — or were you simply in denial about your condition?
A Perhaps denial. It was never a conscious memory, but it was uncontrollable and overpowering emotions, including crying, that led me to seek help. I stopped doing speeches until a couple years ago when, after months of intensive therapy, I was asked to do a Veterans Day keynote. It was the first time I was able to publicly confront the painful emotions connected with the loss of my soldiers.
Q With therapy returning joy and normalcy to your life, what is your message to other physicians regarding self-diagnosis — or denial of someone else’s diagnosis?
A One simple message: Whether it’s PTSD or burnout, if you hear others tell you that you're different, don’t ignore it, don’t deny it. Likely you are, but you’ll never admit it for variety of reasons, all of which are wrong. Seek help.
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