by Zach Read - firstname.lastname@example.org
In the years following the 9/11 attacks, Martin McCaffrey, MD, while at Naval Medical Center in San Diego (NMCSD), cared for many babies whose fathers were active duty, seeing combat in Afghanistan and Iraq. In certain cases, when a soldier’s baby was born with a life-threatening condition, the military would fly the father home directly from the battlefield to be with the mother and child in the Neonatal Intensive Care Unit (NICU).
“When I was in San Diego, I remember thinking, ‘What a great thing this is – bringing guys back, away from the fighting, to be with their family,’” says McCaffrey, Professor of Neonatal-Perinatal Medicine at the UNC School of Medicine and neonatologist in the Newborn Critical Care Center (NCCC) in the North Carolina Children’s Hospital.
NMCSD provided a relatively supportive transition for the soldier arriving from the battlefield to the NICU.
“These dads returning from war were surrounded by military people, including other families they talked to and bonded with,” says McCaffrey. “Invariably, they’d meet other dads and see people they knew from the NICU on the compound, around the hospital, or in the courtyard. These fathers were pretty well supported.”
McCaffrey, who did his fellowship at UNC from 1992 – 1995, returned to UNC in 2006, and he’s seen plenty of military families come through the NCCC at N.C. Children’s Hospital, including soldiers returning from combat in Afghanistan and Iraq. He’s been impressed by the thoughtful care provided to the families. He believes that the large number of UNC Hospitals' health care providers that have served makes for a strong culture of support for the military.
“We’ve been able to serve the military community here well because we have a cadre of military people working at UNC,” he says. “You can’t just wake up as an organization one day and say you understand the needs of the military and begin caring well for military families.”
While all NCCC families require special attention, McCaffrey has noticed that soldiers who return from the battlefield straight to the NCCC need an extra level of care, especially in a civilian hospital. One soldier, whose wife delivered prematurely, had been on an outpost in the Helmand Province. He was in between firefights with Taliban and Al-Qaeda forces when he was told that his baby was born not only early, but with gastroschisis, a condition in which the stomach and intestines are on the outside of the abdomen. The dad was sent back to UNC to be with his family and had an extremely difficult time with the adjustment.
“Picture this dad, sitting in a trench, in heavy fighting at a Forward Operating Base in Afghanistan,” says McCaffrey. “His lieutenant comes up to him and tells him during fighting that his wife just delivered and his baby was born with this serious problem. Someone tries to explain it to him but no one really knows exactly what the medical problem is. He’s told that he has to get back to the States … . Imagine the transition moving from the frontlines of a battle to being in a hospital for two or three months, powerless, surrounded by alarms, beeps going off all day, people periodically surrounding bedsides in the unit. I’ve gotten a small sense of how challenging an adjustment it must be.”
To help with these issues, McCaffrey has partnered with case managers, discharge planners, and chaplains to identify military families when they arrive and to try to help them through difficult times in unfamiliar hospital settings. One program they have been developing is called Operation Liberty Pass, a partnership with the Arrowhead Inn in Durham, N.C., to help military couples take a break from the NCCC for an overnight in a rejuvenating environment while their baby is undergoing a prolonged hospitalization.
“I think there are a few areas where we need to focus our support efforts for military families,” says McCaffrey, who met the owner of the Arrowhead Inn while on an anniversary getaway with his wife, Theresa. “We need to be more attuned to helping active duty dads who are called back home after a difficult birth. We need to offer relief opportunities for families whose infants are hospitalized long term. We also need to make certain military families are aware of the travel benefits and financial support they are entitled to when their children are hospitalized a distance from their duty station, and a family member is staying to attend to the child.”
A Path to the Navy
In the early 1970s, Life magazine journalist Thomas Thompson chronicled Houston doctors Michael DeBakey and Denton Cooley as they raced to transplant a human heart. More than 1,600 miles northeast of Houston, in Yonkers, the 12-year-old McCaffrey devoured all Thompson’s operating-room details.
“I remember reading a passage about DeBakey walking out of this incredibly involved heart surgery,” recalls McCaffrey. “He was in the OR for 12 hours, was exhausted, and refused to be spelled. When the case was over, he walked out, shed his gear, and yelled down an empty hallway, ‘Is there anyone else out there who needs an operation?’ From that moment forward, I wanted a life in medicine.”
McCaffrey became the first in his family to graduate from college. He completed his medical degree at Albany Medical College, his residency in pediatrics at NMCSD, and his fellowship in neonatal-perinatal medicine at UNC. Although certain he wanted to be a physician, neonatal-perinatal medicine wasn’t on his radar. As a medical student, he’d enjoyed pediatrics and the intensive aspects of trauma. His rotations in pediatrics at NMCSD, under the tutelage of Dr. Mitch Heroman, NICU director at the time, convinced him that his calling was in the NICU.
The very first delivery McCaffrey attended, during his first week of residency in San Diego, was supposed to be a routine C-section, which NICU teams regularly attended. At delivery, however, the baby was not at all a routine case. The infant was born with gastroschisis and was not breathing. McCaffrey took care of the baby’s critical needs by inserting a breathing tube in the child’s airway, then called Dr. Heroman, who further stabilized the baby and explained to McCaffrey that he did exactly what he was supposed to.
“Dr. Heroman embodies the core values of Navy medicine,” McCaffrey says of his mentor. “He was and is a model naval officer, demonstrating honor, commitment, and courage. He was an unbelievably skilled neonatologist with an incredible grasp of physiology. He could explain and teach. He had a profound impact on me.”
McCaffrey was sold. He finished his pediatrics residency, would serve his utilization tour as a general pediatrician, and figure out how to train as a neonatologist later.
After completing his residency in San Diego, McCaffrey spent three years as a general pediatrician at the U.S. Naval Hospital in Guam, where 50,000 military families were stationed. The service on Guam was part of his Navy scholarship obligation. He met Theresa, a NICU nurse, at NMCSD, and they PCS’d (permanent change of station) together.
McCaffrey joined three other pediatricians at the 50-bed hospital. When pediatric patients with complicated conditions required care in more advanced medical settings, they were sent by medevac to Clark Air Base in the Philippines, Tripler Army Medical Center in Hawaii, or even Okinawa. Occasionally, roles would be reversed and Guam would take patients from other Pacific islands. When Mount Pinatubo erupted in the Philippines in 1991, for example, refugees arrived in Guam, and McCaffrey was on duty for their care.
McCaffrey describes pediatrics in Guam as all-purpose, all the time.
“When you were on call, you’d do everything,” says McCaffrey. “You’d see clinic, have nursery duty, and visit sick kids in the ICU. You would be in clinic in the morning and rush to go intubate a newborn patient minutes later. It was ‘adrenalin-rush pediatrics.’”
As the on-call pediatrician, McCaffrey was part of the hospital code team. Whether it was an adult or child, everyone responded.
“Nowhere else would I have been the go-to person to perform surgical cutdowns to obtain IV access for general surgeons running adult trauma codes,” he says. “The experience taught me much about medicine and how to deliver care in difficult conditions.”All hands were on deck one night when a child with a severe heart condition and an infant born at 32 weeks with previously unknown esophageal atresia, a condition in which the esophagus was not connected to his stomach, arrived and were placed in beds beside each other. Both patients required complicated care to be stabilized. The heart patient required an improvised, lifesaving catheter procedure called a Rashkind procedure, which was performed in the Naval Hospital's two-bed stabilization nursery. Both babies would need to be medically evacuated to receive further care in Hawaii. As was customary for patients requiring a higher level of care than was possible on Guam, the Navy pediatric team would have to arrange transport on an Air Force plane, supply necessary equipment, and medically escort the patients themselves.
“The belly of a C-141 cargo plane is a horrible space to take care of a baby,” says McCaffrey. “These are not short flights. It’s hot and cold – there’s no consistency in temperature – it’s incredibly noisy, and the monitors inconsistently work.”
Delayed by torrential rains and failed power supplies en route to the plane, the team eventually got to Anderson Air Force Base the following morning, loaded the babies onto the plane, and hooked up the equipment that would keep the patients alive. The baby with the heart condition coded only once during the flight.
“We defibrillated with paddles and things were relatively smooth thereafter,” says McCaffrey. “There were four medical providers on that trip. There could not have been a better team.”
McCaffrey describes the Rashkind story as legendary within the Navy Pediatric community.
“Let’s just say that when we arrived in Hawaii, we somehow missed flights back to Guam for a couple days.”
In Good and Caring Hands
McCaffrey calls his decision to join the Navy one of the best career decisions he’s ever made.
“It grew into the most amazing experience,” says McCaffrey, who is retired from the Navy. “I miss it every day. Chapel Hill is incredible. I love being here and I love my division, department, and the services we work with, but the camaraderie you develop serving in the military is different. And the people you serve, who are volunteering and sacrificing, are remarkable.”McCaffrey will never forget one service member and his family. Shortly after the 9/11 attacks, McCaffrey was on call in his San Diego NICU. He admitted a baby who was born prematurely, at 34 weeks, with lung disease and a heart defect. The baby’s father, a Marine Corps pilot, flew F-18s and had been called to monitor the skies over southern California in the hours immediately following the 9/11 attacks. As his son was ready to be discharged, the father arrived at the hospital and handed McCaffrey a photograph. It was a picture of the father flying air cover over Los Angeles during that time. He’d written a caption on the photo: “All safe up here. Thanks for keeping it safe down there for [our son].”
“That’s what it’s about,” says McCaffrey. “As care providers here, we’re not taking bullets, and we fight in different types of trenches, but the men and women who are willing to give all for us here at home need to know that their families are in good and caring hands. They have to be comfortable in the knowledge that their loved ones are receiving the best possible medical care. This is what we do.”
UNC Health Care one of 15 recipients of the 2014 Secretary of Defense Employer Support Freedom Award
The Freedom Award is the Department of Defense’s highest recognition given to employers for exceptional support of Guard and Reserve employees. This year’s recipients were selected from 2,864 nominations received from Guardsmen and Reservists for going far beyond what the federal law requires to support their military employees. Read more about the Freedom Award. UNC Health Care has a tradition of physicians, staff, and students who have served or are currently serving in the military. Read about trauma surgeon Amy Rezak Alger, North Carolina Jaycee Burn Center director Bruce Cairns, transplant surgeon David Gerber, Surgical Intensive Care Unit director Sean Montgomery, medical student and former Green Beret medic Eric Strand, and pediatric surgeon Timothy Weiner.