Page 62 - JSOM Fall 2023

The internal meaning of dynamism is displayed in SOST medic “When given orally, this particular antibiotic has great
practical performance as “the ability to navigate complex tran- blood/brain barrier penetration.” Then the surgeon said,
sitions,” as highlighted in the following quote: “If someone is severely injured, they’re not going to be
swallowing any medications. Certainly, not through a NG
Performing austere medicine can be a fight with time tube. If they’re in shock their gut is not going to perfuse.
whether it’s a slow or fast operational tempo. These There’s no way that orals are going to be good for the
changes are hard to navigate. When there are lots of mission we are planning to support.” When we come to-
catastrophic casualties it’s kind of chaotic. It’s easy to get gether as a team and make s**t happen, it’s a magical
sucked into the details of a specific casualty instead of feeling.
tracking the unfolding status of all the patients as well as
new ones that are or might be coming. When there are This quote pinpoints how the interrelated rhythmical, sche-
only a few minor casualties, SOST medics struggle with matic, and affective conceptual attributes support the func-
their purpose because they want to be in a position to tion of freedom of maneuver. The battle rhythms of practical
save lives. Getting the call to save-life is icing on the cake. performance created through medical and tactical training
That’s just luck of the draw and we may never have that develops predictive pattern recognition in SOST medics. The
opportunity. The actual job is to be ready when called rhythmical process of meaning-making impacts schema for-
upon. Navigating the various changes across time trig- mation by supporting the SOST medic’s ability to aggregate,
gers various idiosyncrasies in each SOST medic’s identity. integrate, and interpret diverse experiences to achieve the SOF
For overall survival and flourishing, individual personali- mission objectives. The rhythmical and schematic underpin-
ties have to learn to be interdependent, which means it’s nings of practical performance support SOST medics’ affec-
important to keep egos in check. The question is: “Can tive engagement with the intra- and interpersonal mood of the
their individual egos successfully survive together in an SOF mission. Taken together, these three conceptual attributes
austere environment?” We try to help people develop are essential to discerning how to achieve the right task, at
a healthy appreciation of this ego-system to ensure that the right time, in the right way, with the right people. As such,
different personalities successfully coexist and deliver our rhythm, schema, and affect formation are essential conditions
full range of medical capabilities. that strengthen or weaken the expression of unconventional
resilience.
This quote pinpoints how time, identity, and context are in-
terrelated conceptual attributes that support the function of The internal meaning of ambiguity is displayed in SOST medic
dynamism. SOST medic practical performance expresses the practical performance as “the ability to interpret expectational
quality of temporality. While combat performance occurs in uncertainty,” as highlighted in the following quote:
a specific time, the specific experiences associated with cata-
strophic injury exposure are understood and integrated across On our busiest days we would see 20 some trauma pa-
time. This temporal process of meaning-making impacts tients. I think we had 19 mass casualty events in a 7-week
identity formation as transition between various deployment period with just 6 of us working 24 hours a day out of a
tempos causes SOST medics to question the purpose of their house. We never got a full night of sleep. There were a
practical performance. If the context of SOST medic practical few times when mortar fire landed right next to our surgi-
performance fosters an interdependent ego-system, then com- cal compound. The enemy would put a couple of families
plex transitions are more fluidly navigated. As such, we take in a van and let them drive out of the city. As they were
temporality, identity, and context to be necessary conditions leaving the city the enemy would start shooting at them,
that strengthen or weaken the expression of unconventional so then the driver would slam on the gas trying to get
resilience. away. As the van came flying at the local forces’ lines, the
local forces would think it was a vehicle born IED. So, the
The internal meaning of freedom of maneuver is displayed in van would get shot up from the front. It’s just f…ing car-
SOST medic practical performance as “the ability to achieve nage. When we fix someone in a foreign country, we do
the right task, at the right time, in the right way, with the right the best we can at that moment, but then we send them
people,” as highlighted in the following quote: on to the level of care that exists in their local hospitals.
We’d patch them up, then the locals would put them in
SOST was at Fort Bragg drilling our medical knowledge their make shift ambulance, and the patient would disap-
with Operators, which helped them understand our bat- pear. Ultimately, we never knew the outcome of the peo-
tle rhythms. Then we started doing some CQB drills and ple we worked on. Spending a lot of time with the local
training on the gun range with them, which allowed us to forces provided consolation. The entire deployment they
understand the foundations of their battle rhythms. Work- slept and ate with us. They brought us food and medical
ing together stabilized our ability to fluidly move across resupply because ours was not established. They were our
the various tactical and medical experiences allowing us security too. The level of trust and interdependency that
to sync up our battle rhythms. Consequently, this type developed when we cared for local casualties was critical,
of training develops our ability to schematize the SOF even when catastrophic injury led to death. For instance,
mission and provide more accurate medical support. For there was a pediatric burn case in which a child had sus-
example, we were packing out to go on a mission that tained nonsurvivable injuries. We knew the child was
had a high likelihood of traumatic brain injury. Someone going to die. Making the decision to withdraw care was
said we should take oral antibiotics, but the ER doc said: rough, but we never knew when the next truck of casu-
“Why would we take oral antibiotics? We’re going out for alties was coming or how many people were in the back.
48 hours tops. The IV antibiotics will cover all the things So, we did all we could, extubated and a grieving parent
these orals can and more.” A third person responded, carried the child away. That image stays in the heart.

60 | JSOM Volume 22, Edition 3 / Fall 2023