Wednesday, January 6, 2021

A Matter of Honor


A few years ago, I went to my 40th West Point class reunion. I had a wonderful time especially renewing friendships with those with whom I lived, studied, and trained during those four arduous years. We truly were “a band of brothers”. 44 years later my time at West Point continues to significantly define who I am today.


While at the reunion, I was interviewed by West Point’s Center for Oral History as a result of my experiences while a cadet, in particular during the Honor Scandal of 1976. At the time, it was a huge event receiving national attention and threatening to destroy the very foundation that makes West Point great - it’s Honor Code. Though innocent, I was caught in the middle of it. I found myself in a battle to prove my innocence and defend my honor. Instead of being innocent until proven guilty, I was guilty until proven innocent. It was a terrible, transformative time.


The honor scandal involved an electrical engineering exam that my entire class took just before Spring Break my Junior year. This was a take-home test, yet, as was true with any work at West Point, you were honor bound to not ask for or received any help from anyone, no matter how minor. If you did, you were required to footnote the help you received and your grade was reduced accordingly. Many of my classmates, for reasons known only to them, chose to help each other and not footnote that help. Thus, they had violated the code. An investigation of epic proportions ensued.


In the months that followed, I and others under investigation, were moved to barracks separate from the rest of the Corps of Cadets; relieved of leadership responsibilities within the Corps for the summer; assigned a lawyer; and given a trial date. The first time I met my lawyer he told me I had a 20% chance of being found innocent! I was shocked to my core. I responded, “Sir, you’re telling me, someone who is completely innocent, that I have only a 20% chance of being found innocent?” He reminded me that up to that time, scores of my classmates had gone before the Honor Committee and all had been found guilty and dismissed. It was the lowest, darkest time of my life. To be accused of something you did not do is one the worst things that can happen to a person.


My lawyer came to believe in my innocence and so began a many - months fight to prove it. I won this battle, but at great emotional cost. I was extremely embittered toward West Point and all it represented. It was an institution that prided itself on over 200 years of unparalleled education, military, leadership, and character training. Yet I, and many other innocent classmates, were caught up in an investigation that became a witch hunt. Eventually, hundreds of us were investigated and over 150 found guilty and dismissed. It left a chasm within my class that to this day has not completely healed.


The day I graduated was bittersweet for me. I was happy beyond words to have survived the blood, sweat, and tears of my four years there. But I was also extremely bitter toward West Point. When I drove my car through Thayer gate into “freedom”, I intentionally flipped my rearview mirror up so I would not see a trace of it. I was so angry I refused to wear my class ring for years. I was not convinced that what I had been through had been worth it. Eventually, with time, bad memories begin to fade and my anger softened. With my acceptance to medical school, I realized the critical role West Point played in opening that door for me. I came to understand that all the pain and sacrifice had been worth it.


 I am a better person for having gone through that most difficult time. As a result, I have a strong sense of justice and a resolve to be a man of honor and integrity, living up to the West Point motto “Duty, Honor, Country”. As a leader, I continually seek to create a culture of respect that allows people to do what they  do best, better, and to reach their fullest potential!


Andy Lamb, MD

Tuesday, June 9, 2020

"Bugle Notes" - A Cry From My Heart - A Letter to a Journalist

Dear Sir,

I am not sure why I feel so compelled to write you. You probably will not even see this email but I still must do so. I am a 56 year - old Christian white male physician living in NC. I am a graduate of the United States Military academy at West Point and the University of Alabama School of Medicine. I was raised an "Army Brat" as my father was a career Infantry officer who served two combat tours in Vietnam. I am a veteran of the First Gulf War as well.

 I come from a conservative and deeply southern background. My mother's family was originally from the mountains of North Georgia and my father's family was from rural Mississippi. My ancestors fought for the Confederacy. I was raised by a loving and caring family but one very much part of the prejudices of the times, thus, I spent my earliest years exposed to an environment of racism. I am a product of the Jim Crow era.

I have read your column in the local newspaper for many years and, to be honest, I either cursed you for what you wrote or cried as I recognized the truth of your words. Many times, I did not want to read your articles because I knew they would only make me mad but I did. Why? Because your words pierce my heart as if they were a scapel surgically cutting out the residual hatred, racism, and prejudice that still laid deep within. So, I continue to read you and I read you, again, yesterday, and I knew I needed to write because.... I don't know how to put it, I just NEEDED to write you.

 Thank you for your honesty, as brutal and as hard as it is at times. Often, I want to throw the paper away after I read your articles but I do not because you make me think, you make me feel, you even make me cry as I better comprehend the hate, evil and, injustice of racism still present in this country, a country I  love and, once upon a time, swore to defend and would do so gladly even now. I wish I could say that the racism of the past was gone but I cannot. Are things better than during those terrible times of the Jim Crow era? I believe they are but are they where they should be, ought to be, must be? The answer is obvious and Dr. Martin Luther King’s dream remains distant.                

 Two experiences in my life changed me as a person. After spending many years in the Deep South, where most Infantry posts are located, my father was assigned to the Presidio of San Francisco in the summer of 1969. I was not yet 14 and for the first time in my life I came face to face with the realness of my own prejudices. Joey Robinson came into my life. He was one of the most popular kids in high school, a star athlete, and he was black. Despite the fact that I was a tall, skinny, shy, dorky-looking kid with glasses, big ears, and a thick Southern accent, Joey accepted me for who I was. We became close friends and, through him and other black classmates, I came to understand how wrong were the beliefs about ‘’colored people” that I had already learned in my then short life time.

 I will never forget the last time I saw Joey. It was the summer of 1972. I was moving the next day to Alabama as my father was given a new assignment. Joey and I went to a San Francisco Giants/Atlanta Braves baseball game. After the game we returned to my home and said goodbye. I never saw Joey again, though to this day I miss him. What I remember most about that day, though, was not the game but my mother saying goodbye to Joey. Joey had become part of our family. My mother hugged and kissed Joey as she tearfully said goodbye. After Joey left, my father looked at my mother and said, "I never thought I would see the day that you would kiss a black man." To her, to all of us, Joey was neither black nor white, he was "us" - he was me, I was him. (Where are you Joey Robinson?)

Months later, I am in my Senior year in high school - quite a culture shock going from California to Alabama! I am on the high school football team. The school is well integrated and relations between blacks and whites are good considering it is ALABAMA in 1972! The presence of a nearby Army post helped as black students from military families are very much the norm. Our team captain is an amazing young guy with the appropriate name of Speedy. He was our star half back, the Junior class President, and he was African- American. Everyone loved Speedy! Not only was he an amazing person, he was an excellent student, a true leader, and a friend to everyone.

 Early in the season, we were scheduled to play a team from a part of northern Alabama known for its racism and continued presence of the KKK at that time. The week of the game, my high school and the football team began receiving hate mail from the town where we were to play. The mail, as you would expect, spewed death threats and racial epitaphs - we were not to bring our “n…..” with us. Speedy, in particular, was targeted. We went anyway.

 It was early in the third quarter, we were winning, and Speedy was having a great game when it happened. Speedy runs a sweep to the right gaining 20 hard earned yards. He is knocked out of bounds within 10 yards of me (I played defense so I was on the sideline) and as he rolled on his back, well out of bounds, the played called dead by the referee, an opposing player comes running full speed, dives and spears Speedy with his helmet, head to head, helmet to helmet. It was a clearly late, intentional hit. Speedy laid motionless. He was taken by ambulance to the nearest hospital where we learned late that night he died from a massive brain injury and bleed! The next day at practice, we all gathered as the coaches played and replayed the film of the hit that killed Speedy! We all mourned his death. We were all forever changed by it.

 I share this because I am tired of the racism, covert and overt, that remains embedded in our culture and, yes, in our hearts. It will not disappear quickly. It will take the passing of those raised in such a way and the raising and education of the "next generation". I now recognize that my anger is not toward you. You make me think, you make me question, you make me look deep into my heart and, when I do, I see the racism that still exist. I am angry, but not at you, rather at myself, and it hurts, and I cry. I will continue to read you and, as I do, I pray God will continue to transform me into a person who simply desires to love God and others.


Andy Lamb

Author's Note: I wrote this in 2012 to Mr. Leonard Pitts, the Pulitzer Prize winning journalist with the Miami Herald, in response to one of his commentaries in the local paper.

Tuesday, May 26, 2020

"Bugle Notes" - The Bugler's Last Note


It will happen to all of us, some sooner than others. Sometimes it comes as a well-wrapped package, years in the making with celebration, affirmation, and anticipation. Other times, though, it’s not so well wrapped. Sometimes, it is unexpected, disheveled, leaving you confused, unsure, sad, hurt, angry a cauldron of emotions. It may be 30 years or more in coming but it will come, like the light at the end of that proverbial tunnel; the “not yet” of the future increasingly replaced by the “already been” of the past; the bugler’s last note waiting to be played. It’s the time when you leave the work that has, in many ways, defined who you are, for that “next stage” in life, however it may look. For some, one’s identity as a person is threatened and fear and uncertainty follow. For others, it is an unexplored path that veers off the main road disappearing into a forest, its ultimate destination unknown, a new adventure beckoning.

 As I look back on my life’s journey “to make a difference” in this world, there is an exact time and place at which I can say, “That was the start, the beginning, my reveille, my early morning bugle call.” It was July 2, 1973, the day I entered West Point. I was 17 years old and I knew, at least I thought I knew, what I wanted to do with my life. I was going to be “an Airborne, Ranger infantry officer and lead men in combat”. But God had other plans for me. Medicine was my calling and making a difference in the lives of people my passion. For over 42 years I have dedicated my life to serving both my country and others. All things, though, eventually come to an end. General Douglas MacArthur, in his farewell speech to Congress upon his “retirement” from the Army, eloquently said, “Old soldiers never die, they just slowly fade away”, and so it is with me. I do so, not so much with sadness, though it is there, rather with extreme gratitude that I have been able to do what I love to do most – care for and serve others and teach, encourage, and mentor those who follow me. I do so, standing at the beginning of that unexplored, untraveled path, poised to take that first step, my “next stage” waiting. It’s how it should be; how I want it to be.

It is with sadness, though, that this will be my last “Bugle Notes” to you. Thank you for allowing me to share them with you. I wrote them to encourage you, to support you, and to remind you that what you do is important; what you do makes a difference every day; and what you do it is still a privilege. I hope I succeeded in even a small way.  You are appreciated; you are valued; you are loved.

Andy Lamb, MD

Author's comment: This is the last "Bugle Notes" I wrote to the medical staff of the hospital system where I was the Vice President of Medical Affairs. Over a little more than 5 year period I wrote close to 100. I chose for this blog page the one's I felt best sent the message I wanted to convey and would be applicable to any health  care provider no matter where they were. I will continue to write my "Bugle Notes" and add them to this page. I hope you will continue to check back periodically for my latest! In the meantime, should you so choose, there are plenty "Bugle Notes" here to be read!

If any of these stories have had a special meaning to you in any way, I would love to hear about that! I write from my heart and I hope at least a few of these stories will touch yours.
                                                                                                                             AL May 2020

Monday, May 25, 2020

"Bugle Notes" - Sharing Their Stories

In the book "The Insanity of God", the writer had been an American missionary to Somalia during the late 1980's through early 90's. This was a time when there was no place on earth with greater needs, hardships, suffering, and dying. It truly was "Hell on earth". The missionary and his small team risked their lives with every trip into this most desolate of places where there was no order, no laws except those established by the two warring classes. It was a world of total chaos in which people - men, women, and children -were starving to death by the thousands or killed in the terrible war surrounding them.

This missionary had been increasingly frustrated with their inability to truly help these people in a meaningful way. He wrote, "The people I wanted to help were living in such horrible conditions that my natural response was to focus only on what they lacked." His typical encounter with people would sound something like this: "Do you need food? We have food. Is your baby sick? We have medicine. Do your children need clothes? We have clothes for them".

He goes on to write that eventually he realized those were not the most important questions. When he took the time to really listen to them, the people themselves told them what they needed most. He wrote, "One day, I said to a bent-over, shriveled-up woman, 'Tell me what you need most? What can I do for you first?' She looked ancient, but she may have only been in her forties. She began to share the following with me:

"I grew up in a village many days from here. My father was a nomad who sold camels and sheep. I married a camel herder who did the same things. He was a good man; together we had a good life and four children. The war came and the militia marched through our village, stealing or slaughtering most of our animals. When my husband tried to stop them from taking our last camel, they beat him, and they put a gun to his head (and tears began to trickle down her cheeks). I worked hard to care for my children but the drought came and despite everything I tried to do it wasn't enough. My oldest boy got sick and died. When the last of our food was almost gone, my children and I began walking. I hoped that life would be better here in the city. But it is not, it is harder. Men with guns everywhere. They raped and beat me. They took my older daughter. I only have the little one left."

This woman, as did countless others, desperately needed more than the help that this missionary team was prepared to give. The writer came to understand that what these people wanted even more was for someone, anyone, even a stranger, to sit for a while and let them share their stories. This is the power of human presence! It is never enough to merely feed, shelter, and medically treat people. Individuals who have witnessed profound evil, endured terrible hardships, and suffered heartbreak and loss, have also lost all sense of their own humanity.

He continued, "By listening to their stories, we are saying to them that they mattered. We are saying that they were important enough to be heard. Just by listening, we could restore a measure of humanity. Often that felt more important and more transforming than one more dose of life-saving medicine or another days' worth of physical nourishment."

 We are fortunate that we do not live in such a hellish nightmare. I believe that what this missionary came to understand is equally applicable to each of us. Our patients come to us sick, frightened, at times dying. They feel vulnerable and helpless.They are often totally dependent on others. Their life has become chaos. They, too, can feel as if their humanity has been loss in the maze of increasing technology and decreasing personal touch that is medicine today.

 Our patients have their own stories, too. They may not be as tragic as the one above but they are nevertheless just as meaningful. Our lives are made up of stories and stories are a powerful way to convey a message, to tell others who you are, what you need, what you fear, and what brings you joy. In the busyness of the day, when it seems that there is not enough time to do one more thing, or when you have done all you know to do, yet nothing has helped, may we take the time to sit down with them and "share their stories". In doing so, we can bring the human side back to medicine. Isn't that why we went into medicine?

Andy Lamb, MD

Sunday, May 24, 2020

"Bugle Notes"- What Are You Passionate About?

"What are you passionate about?" This is a question I often ask people when I meet them for the first time. Anytime I am around young people, as I am through medical missions, I always ask this question. I believe the answer to it is key to understanding the heart of that person.
We can be passionate about one thing or many things. I bet if asked, every one of you could quickly come up with an answer to this question. If you cannot, you should ask why not because one's passions, to a significant extent, reflect who they are as a person – emotionally and spiritually. Who wants to live a life devoid of passion? I cannot imagine doing so. To me, that would be a life without adventure, without purpose, without real significance – a boring life!
I have my passions. These passions define who I am as a person. Those who know me, know I am a fly fishing "nut"! I will fly fish any time, any place, under just about any condition. I also tie my own flies and build fly rods. I love it! When I am standing in a cold, crystal-clear stream with the mountains surrounding me, I am at complete peace. The only things I think about is catching the next trout and thanking God for allowing me to be in such a beautiful place. I can literally fly fish for hours and not once think of anything - not work, not all the demands on my life, not the latest trouble I may be experiencing - only the beauty, serenity, and peace of the moment and the trout!
As passionate as I am about fly- fishing, it does not compare to what really gets me excited - leading short- term medical missions around the world and investing, mentoring, and encouraging young people. I have had the privilege of leading over 40 medical missions to eight different countries on four different continents since 2004. I have served with hundreds of amazing people who have a passion to serve and love others. They want to live a life that counts, a life that makes a difference in the world. They are also our future and they want someone to mentor them, to invest in them, and help them through the ups- and- downs of life. That is what I do, that is about what I am passionate. My question again is, "What are you passionate about?" How do your passions affect your life priorities, who you are as a person, and even as a physician, or do they?
Every hospital must have a “Culture of Excellence”, a culture that is passionate about exceptional patient care. Anything less should not be acceptable. This is a passion worth having! The humbling thing is that each of you, whether in the hospital or outside the hospital, is doing this! What you do every day for your patients, your hospital, and your community makes a difference and is foundational for providing this exceptional care.
 As always, thank you for all you do every day on the front line of patient care. I know the hard work you do and will never forget that. You are making a difference - one life at a time!
Andy Lamb, MD

Saturday, May 23, 2020

"Bugle Notes" - The Helicopter

You are a 19 year old kid. You are critically wounded and dying in the jungle in the Central Highlands of Vietnam.  It’s November 14, 1965. Your unit is outnumbered 2:1 and the enemy fire is so intense from 100 yards away, that your commanding officer has ordered the Med Evac helicopters to stop coming in. You’re lying there, listening to the enemy machine guns and you know you are not going to get out. Your family is around the world, 12,000 miles away, and you will never see them again.

As the world starts to fade in and out, you know this is the day. Then over the machine gun noise you faintly hear the sound of a helicopter. You look up to see a Huey coming in. But…it doesn’t seem real because no Med Evac markings are on it. Captain Ed Freeman is coming in for you. He’s not a Med Evac, so it’s not his job, but he heard the radio call and decided he’s flying his Huey down into the machine gun fire anyway.

Even after the Med Evacs were ordered not to come, he’s still coming. He drops in and sits there in the machine gun fire, as they load 3 of you at a time on board. Then he flies you up and through the gunfire to the doctors and nurses and safety. And he keeps coming back, 13 more times. Until all the wounded were out. No one knew until the mission was over that he had been hit 4 times in the legs and the left arm. He took 29 of you and your buddies out that day. Some would not have made it without him and his Huey. For gallantry above and beyond the call of duty, Captain Ed “Too Tall” Freeman was awarded the nation’s highest honor, the Medal of Honor.

My father was an Airborne, Ranger Infantry Officer. He knew Ed Freeman. He too, like “Too Tall” Freeman, and all those involved in what was the first major battle of the Vietnam war, the battle of Ia Drang, were members of the 1st Cavalry Division. They deployed to Vietnam in the summer of 1965. This battle is immortalized in the book “We Were Soldiers Once and Young” and the movie years later. I remember the time well. I was 10 years old living in Ft. Benning, GA. During this time a new concept of battle was developed called air assault – bringing soldiers directly into combat by helicopter.

It was a hard time for my mother, alone with 4 children under the age of 12, the youngest less than 3 months. She cried often especially when she received word that the husband of another friend had been killed. In our neighborhood during 1965-66, there was not a man around. They were all in Vietnam. At the age of 10, all I knew was that my father was fighting a war in Vietnam. I never seriously thought he would be killed. Why should I? He was invincible in my eyes. Every night, as a family, we ate dinner on TV trays. We watched the iconic Walter Cronkite as he talked about the latest action in Vietnam, the black and white, days old film footage flashing before us. We watched, hoping beyond hope, for a glimpse of my father, our eyes glued to the screen. We thought we saw him once.

As I reflected on this story, I wonder if I could have done what “Too Tall” did? What caused him, or for that matter, anyone, to do such selfless acts of bravery at incredible risks to themselves? I began to see a connection between what he did and what each of you do as physicians. The connection is a special bond that exists between those who have experienced shared hardships in pursuit of a common purpose – in our case, years of arduous preparation in medical school, followed by more years of demanding residency training. There are few things that bond people more closely than shared hardships for a common cause. I experienced this at West Point, during my residency, and during the first Gulf War while deployed on the Iraqi border in support of the 101st Air Assault Division. This bond also results from being part of something bigger than yourself. For “Too Tall” and my father, it was the identity they had with the 1st Cav Division and the resulting sense of duty to their fellow soldiers and their country. There is an unwritten code among soldiers – NO ONE left behind! From these bonds, relationships are made, strengthened, and invariably trust grows.

 I believe the most important part of being a physician (or any health care provider) is not the clinical acumen possessed (as important as that is) rather the relationships developed and the surrounding influences and qualities produced by those relationships. A culture built on such relationships is one of trust, respect, and caring. This is a culture which allows the best in every person to be realized. In medicine, it translates to every patient getting the best care possible, every time. Thank you for being willing to be part of something bigger than yourself through which you can do even greater things and make a bigger difference.

Andy Lamb, MD

Friday, May 22, 2020

"Bugle Notes" - "This Is Water"

“There are these two young fish swimming along and they happen to meet an older fish swimming the other way, who nods at them and says, “Morning boys. How’s the water?”
And the two young fish swim on for a bit, and then eventually one of them looks over at the other and goes, “What the hell is water?”

 These are the opening lines of acclaimed author David Foster Wallace’s last book “This Is Water”. It was published shortly after his death in 2008. He posits the question to university graduates, “How do you measure the value of the education they received?” What followed was a thought - provoking examination of what he called “the capital-T Truth”. The challenge we all face he wrote, in understanding this “capital-T Truth”, is overcoming what he called “your default setting”. This is the place you go in response to life’s many challenges. It is the way you automatically and even subconsciously believe something is true even though you may be wrong. Why? Because we all believe, to one degree or another, that we are “the absolute center of the universe, the realest, most vivid, and important person in existence.” Anything else we reject or don’t recognize, just as the two young fish did not know what water was because their natural default setting did not recognize it as separate from themselves. Their world was all about themselves.

Wallace writes that our default setting of seeing things only as we see them and rejecting other possibilities has in our present culture yielded extraordinary wealth, comfort, and personal freedom - “The freedom to be lords of out tiny skull-sized kingdom, alone at the center of all activities.” He goes on to write, though, that the kind of freedom that is “most precious” we do not hear much about “…in the world of winning and achieving and displaying”. This freedom involves attention, awareness, discipline, effort, and being able to truly care about other people and to sacrifice for them, over and over. Isn’t this what we have all done, sacrificed for others over and over during the arduous years of schooling and training and even beyond?

Do you live in “your default setting” blinded to what is real and truly important (“What is water?” as the young fish asked)? Or do you choose to live a life with an awareness of what is so real and essential, yet so hidden in plain sight all around you, that you have to keep reminding yourself over and over, “This is water. This is water.”? In doing so, you can have that “precious freedom”- you can truly care about those entrusted to you. You can then do what you do best, better – making a difference in the lives of others and doing so with compassion and caring every day.

Life is precious, the work you do important, and the impact you have on others life-changing. May the busyness of medicine and its’ inherent frustrations, not cause you to lose sight of what is important, why you went into medicine, and the difference you make every day. What is my “capital-T Truth”? It is to live a life that counts, to make a difference in the lives of others every chance I get. What is yours?

Thank you for the privilege of serving you any way I can.

Andy Lamb, MD