Green Beret, White Coat

Whether donning a green hat or a white coat, Karl Holt has lived with a service mindset. As a Green Beret medic, he saved the lives of others during a helicopter crash in Afghanistan in 2009. He nearly lost his life that night, and spent years recovering from his injuries, both physical and psychological. Today, he is on his way to becoming a physician, and hopes that his experiences will help other veterans as they transition into civilian life.

Green Beret, White Coat click to enlarge Karl Holt has chosen a life of service -- as a Green Beret medic, or 18-Delta, serving all over the world, and today as a UNC medical student. "For me, the green beret and white coat represent service to others," he says.
Green Beret, White Coat click to enlarge Despite still recovering from his injuries, Karl ran the 2010 Marine Corps Marathon to honor the families of fallen soldiers, including his friends and brothers SFC David E. Metzger and SSG Keith R. Bishop, who were killed in the helicopter crash in 2009.

by Zach Read - zachary.read@unchealth.unc.edu

For Karl Holt, completing the 2010 Marine Corps Marathon had special meaning beyond the usual triumph of preparation, sacrifice, and endurance. Twelve months earlier, he had been in a tragic helicopter accident during Operation Enduring Freedom in Afghanistan.

The crash had claimed the lives of 10 people, including Karl’s friends and brothers from his Green Beret unit. His back, leg, and ankle were broken, both of his shoulders were dislocated, and he suffered facial fractures that would require dozens of reconstructive surgeries.

Karl spent the entire year before the marathon recovering and rehabilitating. It was a trying period – he wasn’t used to being limited physically. Prior to the crash, he could run 10 miles in less than an hour, routinely bench-press hundreds of pounds, and had run multiple marathons. But he was determined to regain his strength and return to an active lifestyle, despite his injuries. Within six months of the accident, he was doing cardio work in a pool at a rehab facility near Fort Bragg, where he was stationed. By summer 2010, he started walking without the aid of a walker. In September, with the race only a few weeks away, he was able to run 14 miles.

He credits pain medication, anti-inflammatory drugs, and sheer will for helping him successfully complete the marathon – held each October in Washington, D.C. – at a remarkable sub-four-hour pace.

“It wasn’t the smartest thing for me to do from a physical standpoint,” admits the UNC medical student, laughing. “My body wasn’t ready for it, but I felt I needed to prove that I could make it back from the injuries.”

He also attributes completing the race to another, more important reason:

“I’d lost brothers in Afghanistan. For me, the purpose of the race was to raise money for the families of fallen soldiers.”

'I can see myself doing this'

Karl moved from Anchorage, Alaska, to Baton Rouge, Louisiana, early in high school. He and his friends in Alaska had been getting into trouble, and the move helped him get on track. After graduating from high school, he became intent on helping others. In 1998, he completed a BA in Theology and began speaking with inner-city kids from Los Angeles to Chicago to New York, trying to motivate them to make good decisions with their lives.

As his interests evolved, he transitioned into the financial world. He traveled on international business throughout Central America, South America and Asia. After living in Mexico City for a time to become fluent in Spanish, he learned that his good friend, a police officer in Houston, had been shot in the stomach with an AK-47.

“They barely saved him,” he remembers. “I went to Houston right away and spent four or five nights a week with him in the hospital.”

For two years, Karl’s friend underwent surgery after surgery. The first surgeon was a military doctor who was doing a trauma fellowship at the hospital. During visits, Karl spoke with the doctor about medicine and became fascinated by the possibility of caring for others as a medical professional.

“A new world of science and service started to open up for me,” he says.

He helped the nurses change his friend’s bandages and began reading books on physiology.

“I wanted to get into medicine,” he explains. “I loved learning about the inner workings of the body, the science behind health problems, and the idea of fixing those problems. I fell in love with the whole atmosphere of trauma care and wanted that responsibility. That’s probably the first time I thought, ‘I can see myself doing this.’”

Karl Holt - Service
Karl considers his mission as a Green Beret and eventually as a physician to be related -- they are both part of a larger service, a commitment to something bigger than himself.

The perfect fit

Karl’s grandfather, Kenneth “Buck” Holt, had a huge influence on him.

“He was a hero to me,” says Karl, who remembers his grandfather’s stories of flying missions in the South Pacific during World War II.

As Karl’s interest in medicine developed and the conflicts in Iraq and Afghanistan raged on, he increasingly thought about his grandfather and felt compelled to try to serve as a Green Beret medic, known as an 18-Delta.

“Being an 18-Delta, for me, was the perfect fit,” he says. “I was ready physically. I’d been a marathon runner, and I embraced the grueling aspects of the Green Beret training and the life post-training.”

He spent one month of his year of medical training at VCU Medical Center in Richmond, Virginia, scrubbing in at 25 to 30 surgeries and “doing pretty much everything I could possibly do while there.”

The most common training experiences were thoracic injuries and gunshot wounds. By participating in the care, he developed confidence in his ability to treat trauma cases and became comfortable with the prospect of being the lone medic on a unit.

“Our job as 18-Deltas is to work in very austere places around the world,” he says. “You have to be a jack-of-all-trades, ready for anything, including amputation, veterinary medicine – you name it. You have to be prepared.”

The crash

In 2009, Karl’s unit, which previously had focused missions in Central and South America, deployed to Afghanistan. They were based at Forward Operating Base Shindand in the western part of the country, in the Herat province, only 75 miles from Iran.

In the five months he was in Afghanistan, the team operated all over the country, conducting missions that pitted them against Taliban and Al-Qaeda fighters. Karl and nine or ten others, sometimes fewer, worked alone in highly isolated and austere conditions.

“We went out four or five times a week to locations hours away by air, and were there as short as two hours and as long as 36 hours,” he says. “There were a lot of times I thought I was about to die.”

One night in October 2009, the team went to a storage depot nestled between two mountains in a valley in Daree-ye Bu, in the western province of Badghis, to destroy drugs, IEDs, and other weapons. The mission had been a success, but as the group was ready to depart via two Chinook helicopters, it came under fire. Karl recalls an RPG zooming above him, its velocity knocking him to the ground as it passed. It detonated against the mountain behind him.

Karl Holt - In the Field
Karl shared this photo of his unit . The person closest is Sgt. Keith Bishop, one of Karl's friends and brothers who was killed in the 2009 crash. Second is Sgt. Jeremy Valdez, the only other surviving Green Beret, who pulled Karl from the area amid the 'cooking off' of ammunition.

“Our small group was alone, and several hundred Taliban were amassing on our position and aiming to kill us," he says. “When the two helicopters arrived, we couldn’t see them. It was completely dark, blacked out with sand and smoke. Literally, we just held on to each other and ran toward the heat and the sound of the helicopters.”

It was 3:30 a.m. The helicopters were lifting off the ground as the last man ran inside. The first Chinook made it to the top of the mountain and cleared the cliff. Karl’s helicopter, meanwhile, in the confusion of war and while maneuvering away from incoming fire, nearly ran into the cliff. It lost control and fell 800 feet to the village below, crashing through a two-story compound. The helicopter broke in half on impact. Karl was sitting in the front; everyone immediately around him died.

Despite his severe injuries, Karl survived. He was, however, the only medic on board, and his aid bag had been destroyed in the crash. As he came to, he couldn’t breathe – too much wreckage was covering him. He struggled to remove the weight.

“There was nobody around,” he says. “We were completely isolated – alone basically.”

Karl Holt - Rotor
The rotor of the Chinook Karl Holt was riding in on that night in October 2009.

Once free, he realized he couldn’t stand. He had broken his back, and his left leg was “pretty much destroyed.” His face had been crushed and he’d lost several teeth. Bodies had been decapitated and limbs were strewn. Only five individuals who were on board were able to walk. "I started crawling," he says. Jeremy Valdez, the only surviving Green Beret, put his life on the line as ammunition "cooked off" amid the heat and yanked him out. 

“Once away from the crash site, we consolidated patients in a darkened room," Karl says. "I was the only medic, and I had 10 traumatic patients. Our weapons had been destroyed by the crash and we were preparing for the fight of our lives."

Karl began crawling from one patient to the next, stopping hemorrhages, applying tourniquets, splinting fractures, and trying to keep everyone conscious.

"That’s your job, no matter the circumstances – that’s what you do. You do everything possible and hope for the best.”

Healing

After several surgeries, Karl recalls waking up in Germany and piecing together what had happened. He has since seen footage of the crash, which was filmed by aircraft above. Today, he’s still not sure how he survived.

“I just feel really lucky,” he explains. “I guess I was sitting in the right spot.”

Since then, he has remained close to the families of some of those who died, and occasionally hears from his friends who made it home.

Karl Holt - Children
Karl celebrates earning his white coat with his children.

“I get texts throughout the year,” he says, “saying, ‘Hey, man, I hugged my kid this morning. Thank you.’ I’ve gotten emotional about that. That means a lot. I’m just so happy for them.”

As he returned home, despite feeling fortunate to have survived, he faced his own challenges, not only from the physical injuries he suffered but also from the psychological scars of his experiences and the difficulty of adjusting to life away from the battlefield.

Like so many members of Special Forces, long periods away from home had put a tremendous strain on his marriage, and he and his wife divorced upon his return. He quickly became a single father, with joint custody of his two children, Kendon and Kerrigan.

During that time, as a Special Operations medic instructor at the Joint Special Forces Medics Training Center (JSOMTC) at Fort Bragg, Karl met Eric Strand and Bruce Cairns, MD, the Fort Bragg and UNC Medical Center representatives, respectively, of the Advanced Medic Instructor Training (AMIT) program. Dr. Cairns, the director of the North Carolina Jaycee Burn Center, and others from UNC Medical Center had developed AMIT to further the medical training and education of JSOMTC medic instructors by inviting them to UNC Hospitals for rotations.

Strand, a former Green Beret medic, was vacating his position as the Fort Bragg point of contact for AMIT as he prepared to go to medical school at UNC. AMIT needed a replacement, and Karl had done rotations at UNC Medical Center through the program.

“There was never any doubt that he would do well as the AMIT lead at Fort Bragg,” says Strand, a third-year medical student at UNC today. “I chose him to run it because he had demonstrated such incredible drive, overcoming so much, since he returned from Afghanistan.”

Dr. Cairns recalls that period as critical in the development of AMIT.

"We absolutely needed someone who could help ensure that our great relationship with Fort Bragg would remain intact during this transition," Dr. Cairns says. "Karl was exactly the person to make this happen. He hit the ground running. Working with Eric and others, he helped expand AMIT while continuing to share with people why it was so important for us to help support veterans." 

Karl has been a wonderful advocate for veterans, a truly thoughtful, supportive voice for those in need and a great friend to many, including myself. I am very proud to know Karl; I am extremely grateful for his service and so appreciative of his accomplishments at UNC and am excited to see what he will accomplish in the future. --Bruce Cairns, MD, director, North Carolina Jaycee Burn Center

During that time, Karl also had begun to consider the possibility of going to medical school. In addition to teaching at the JSOMTC, working to recover from his injuries, and being a father, he decided to take his undergraduate prerequisites for medical school at Campbell University’s Fort Bragg campus.

Throughout that period, however, he noticed that something wasn’t right – beyond the physical injuries he had sustained, he wasn’t feeling himself. He became depressed easily, and sometimes was incapable of doing even the slightest amount of reading and studying.

“I was struggling,” he says. “I couldn’t read without getting nauseated. If I lost my place on the page, it took three or four minutes to return to it. My focus was nonexistent. I was constantly in a fog. It was so bad that I asked myself, ‘What kind of life am I going to be able to live?’”

Karl went to a neurologist, who discovered that during the helicopter accident, he had suffered a traumatic brain injury that had gone undiagnosed. He did almost two years of cognitive and occupational rehabilitation, using his eyes to track objects in his peripheral vision. During sessions, he rehabbed until he became nauseated, at which point he sat down for 30 minutes, letting the feeling subside, and then returned to the therapy.

“The elasticity of the brain is amazing,” he says. “It began making new connections and healing itself.”

A bridge for veterans

Karl took his medical school requirements in four-hour classes, four nights a week, after work. He began his medical school career at UNC this year.

He doesn’t often speak about his combat experiences unless it’s done in the context of helping others, whether talking to other veterans who have suffered from PTSD or to providers who care for veterans. Among the complications of adjusting to life back home was figuring out whether certain psychological challenges were from his undiagnosed traumatic brain injury or from PTSD, which he’d also been battling.

A few years ago, he spoke with the psychiatry residency program at UNC about his experiences. He has also given grand rounds to the Department of Surgery at UNC, at the request of Dr. Bruce Cairns, and spoken frequently on behalf of the new UNC School of Medicine Physician Assistant Program. The program, which launches in January, is designed to provide educational and career-development opportunities for nontraditional students, including veterans with medical experience, and to reduce North Carolina's healthcare workforce shortage in underserved areas.

UNC has opened their arms up and welcomed me from the beginning. This community is an inclusive environment for veterans and sees veterans as untapped resources in North Carolina who have a lot to contribute. --UNC medical student and former 18-Delta Karl Holt

“The PA program has been a phenomenal effort on behalf of veterans, specifically those from my brotherhood,” Karl says. “I’ve wanted to raise awareness that there’s a community of 18-Deltas out there that have a lot to give, have a lot of experience, and can have a very positive influence medically in their communities.”

He never forgets how he felt when he returned home and had to face not only the long recovery from his physical injuries and psychological and emotional problems, but also the dilemma of applying his skills in a civilian setting.

“People with our background have so much experience and training, but no civilian certification,” he says. “We enter civilian life, and none of what we’ve accomplished means anything. It’s a very difficult transition. I’ve found that it’s important to speak about this and help others – to try to serve as a bridge for people, talking to them about how they can transition. In so many ways, UNC has given me opportunities to be a resource for others, which has helped me through difficult times.”

A patient, a learner

It took almost five years for Karl to recover. During that time, he averaged a surgery every other month, including more than 30 on his face, where he had lost so much bone that doctors had to take bone from his hips and graft it in.

“It was touch and go,” he says. “But it gave me an immense amount of compassion and understanding for what patients go through: the ups and downs, not knowing how things are going to work out, hoping that you have the best care, being at the mercy of providers to be at the highest levels of professionalism.”

Karl Holt - Arlington National Cemetery
Two years ago, Karl traveled to Arlington National Cemetery with his fiancee to visit the grave of his friends SFC David E. Metzger and SSG Keith R. Bishop. A few years earlier, at their funeral in Arlington, Virginia, he was on his way home, driving back to North Carolina, when he realized that he could not overcome the psychological scars of his experiences by himself.
As he continues his medical school education and advances into his career, these experiences will help him develop relationships with his own patients, allowing him to relate to them, whether or not they’re aware of his personal experiences.

“It will come across in how I treat them,” he continues. “There’s a big picture to medicine that involves how you interact with patients.”

Throughout his treatments, he learned that words matter: what providers say to patients and how they say it can make a difference in how a patient handles his or her outcome. He recalls that physicians sometimes “thought out loud” in front of him during clinical visits, explaining what they believed they could do for him, without any reliable information to back it up.

“In my condition, wondering if I’d every be ‘normal’ again, I was hanging on every word, and I counted on what physicians said out loud in front of me,” he says. “When what they said didn’t work out – wasn’t even close to working out – it sent me on a roller-coaster ride, which could have been avoided. It taught me the importance of setting realistic expectations. It gave me an understanding of the fragile psychological state a patient may be in.”

A desire to serve

For now, though, Karl is focused on the educational opportunities that lie immediately before him and is grateful to UNC for its investment in him.

“You sit in a lecture, hear professors speak, and find out later that they’re the ones who discovered the finding they were just lecturing about,” he says. “It’s awesome. You pinch yourself and ask, ‘Is this really happening? Am I really supposed to be here?’ I am extremely grateful for the opportunity to study and train here, and I really feel like it’s home.”

Dr. Amelia Fischer Drake, executive associate dean of academic programs at the UNC School of Medicine and distinguished professor of Otolaryngology/Head and Neck Surgery, is among those he credits for that investment.

"She was instrumental in helping me on my journey to UNC," he says. "Individuals like Dr. Drake demonstrate UNC's commitment to veterans."

Dr. Drake believes that students like Karl make the UNC School of Medicine a stronger institution.

“Karl is a natural leader who is dedicated to service and to medicine,” says Dr. Drake. “I regard him as a gift to the UNC School of Medicine in regards to what he offers both students and faculty. His patriotism and his experience in caring for others will be strong assets as he advances through medical school.”

Eric Strand, meanwhile, considers the experiences Karl promises to bring to the medical profession invaluable. 

“It needs people who have come from those dark places to show patients what can be possible,” Strand says. “He left a comfortable, lucrative career to be a Green Beret based on his desire to serve at the highest level possible. He endured a horrific experience and years of recovery. He was still getting multiple surgeries, teaching long hours, and doing well in his night classes. Through all that, he managed to successfully get into medical school and do well. He embodies so much of what is good about UNC and about Special Forces. He is driven by pure passion in circumstances that would make ordinary people rot away.”

Karl Holt dedicates this story to the memory of his friends and brothers SFC David E. Metzter and SSG Keith R. Bishop who were killed in Operation Enduring Freedom in 2009. For more UNC Medical Center military news visit http://news.unchealthcare.org/military.

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