Saturday, June 26, 2021

"The First 100 Yards"


You are 19 years old standing in the muck and mud that are the trenches of World War I. You are cold, hungry, filthy, emotionally, mentally, and physically exhausted; you stare straight ahead, eyes vacant not revealing deep inside you a visceral fear that defies description; a fear that only those who have faced the horror of combat know. You are an American soldier and this is your reality. You know what awaits when the order is given to “go over the top” – the withering rifle, machine gun, and artillery fire, a rain of deadly hot steel indiscriminately finding flesh and bone, mutilating and killing those around you and quite possibly you. Any sense of youthful immortality long erased by the nightmares you have already experienced.


The first 100 yards, survive the first 100 yards you keep telling yourself. If you can just make those 100 yards you know your chances of surviving the day increase significantly. Importantly, as well, gaining victory. A mere 100 yards…but it might as well be 1000. Knowing that many among your “band of brothers” will die, that you may die within the next few moments, you still do it. The order is given and you immediately go over the top, the fear replaced by a single thought, survive those 100 yards. How do you do it? Why do you do it? You cannot do otherwise. You cannot, you will not, let your buddies down, those with whom you have shared hardships and terrifying moments; those with whom you have a special bond that no one else can understand. You have to be there for them; you will be there for them no matter the cost.


The first 100 yards speaks directly to facing one’s fears, struggles, challenges; of persevering, of doing what has to be done despite the fear, however that may look. The war with COVID-19 has been, for those in the front - line trenches, so to speak, their own first 100 yards. Yet, despite the heartbreak – death, suffering, isolation, loneliness– and their own personal fears, they daily went “over the top” to cross those 100 yards and lovingly, compassionately care for those at their most terrifying and vulnerable time.  


History is replete with those willing to “go over the top” and dare to cross the “first 100 yards” to confront whatever the “enemy” was – the “Black Plague”, TB, Spanish Flu, Ebola, and now COVID-19. The risks were real; death was possible just as it was with the soldier in the trenches. Yet, time and again, they stepped up and said, “I will go. I will do it. Send me.” As a nation, we owe thanks to those who did just that. I for one am most thankful!


Andy Lamb, MD




  1. I read your "about me" profile attached to your blog. I was captured by two sentences; the first mentioning your senior executive position in a healthcare system and the second stating "Medicine is hard work and getting harder". I wonder, why do we accept that as a fact in this place and time. Why is it considered "normal" that satisfaction with a career in medicine must inexorably deteriorate over time? What are our leaders doing to address this fundamental reality that is poisoning our profession? I am a product of this malaise. Speaking out about it cost me dearly. I'd love to understand what our thought leaders envision as the medical career of the future and whether they believe we have any leverage over the conditions in which the coming generations of physicians will practice? How will we effect positive change? Do we have to become revolutionaries, mercenaries, use subversive means or practice civil disobedience to protect or improve the conditions under which we work? What will it take to avoid the soldier's mentality?

  2. Thank you for, first, reading my "Bugle Notes", and second, for taking the time to respond! You make some very important observations/questions. I completely understand your frustration as I have the same. I don't claim to have the answers but this is what I believe is a major contributor to "poisoning our profession" as you so accurately point out - the serious lack of good leadership in healthcare as well as the vast majority of organizations across the country, but especially medicine. Those in positions of authority and decision-making are increasingly non-medical and, thus, have no idea what it is like to be a physician, nor do most really even care. They, in my opinion, lack even a modicum of foundational leadership skills and, as a result, do not know nor understand the first and most important tenant of leadership - TAKE CARE OF YOUR PEOPLE! People are the most precious resource of any company/organization/team and their needs must come first. This was the first thing I learned at West Point. If you take care of your people they will take care of whatever the job/assignment/mission is AND they will take care of you! Too many in leadership, especially at the senior executive levels where I worked for 5 1/2 years, too often, don't care how the medical staff is doing. Rather they care about metrics, numbers, outcomes but not people. I could write a book on this (and might one day). This must change if we, as physicians, are going to see a culture change that eliminates the poisonous culture you alluded to!

    I believe we as physicians need to/have to take back our rightful positions of leadership so we can be actively involved on those decisions that directly affect us. We as a profession unfortunately abdicated this responsibility decades ago to the non-medical administrators who gladly accepted it! Physicians, especially our younger ones, need to be encouraged to become involved in leadership at all levels and then mentored and taught what good/great leadership looks like. If you want to know what I believe is the best way to lead, read my "Bugle Notes" "The Ten Commandments of a Servant Leader".

    This is long enough but I hope you get some idea of where I am coming from. Again, thank you for responding and most of all, thank you for all you do!

    1. I read your article that was posted on Kevin MD. Congratulations on your retirement though it is clear to me that you will continue to contribute to your profession and society. My heart breaks for essential workers, first responders, all medical professionals in all positions/levels. My only hope is that now that all ages are suffering from the delta variant that human beings will utilize the answer science provided. Recently, I became involved with new 501(c) in NH: NH Alliance for End of Life Options. Though Vermont and Maine have passed medical aid in dying legislation, NH has yet to do so. Best wishes as you continue to adjust to a new chapter in life.

    2. Nancy,
      Thank you for reading my story and especially for taking the time to write me. I cannot agree more with you! This is a most difficult time for those involved in patient care. They need and deserve our complete support and encouragement. They are truly on the front lines of this war on COVID. Thank you for what you are doing in NH with the 501(c). It sounds like very important work!