University of Utah Physician Assistant Program

Donald M. Pedersen, PA-C, PhD
University of Utah Physician Assistant Program, Salt Lake City, Utah

The military cemetery at Fort Douglas in Salt Lake City, Utah provided the backdrop on a glorious July afternoon to recall the origins of the physician assistant profession. Nearly 200 individuals joined the faculty, staff, students, and alumni of the University of Utah's physician assistant program on this hallowed site to unveil a tribute to combat medics and corpsmen and the role they played in the birth of the physician assistant profession. I've narrated the ceremony in the following pages. It is my hope you enjoy it as much as all who were able to attend.

“Lifesavers Then—Caregivers Now”

With this article I hope to convey a sense of the ceremony held on July 11, 2003, to unveil the sculpture depicted above. Hopefully it will be a fitting tribute and serve as a constant reminder of the origins of a profession that continues to have “service to the underserved” as one of its basic tenets.

Newman Center Music Group

Music – From a Distance

From a distance, we all have enough,
And no one is in need.
There are no guns, no bombs, no diseases,
No hungry mouths to feed.
From a distance, we are instruments
Marching in a common band,
Playing songs of hope, playing songs of peace.
They're the songs of every man.

—Julie Gold

Combat medics and corpsmen serving in the Vietnam conflict were the genesis of the physician assistant (PA) profession. These veterans, who provided lifesaving medical care under the most harrowing of conditions, were the inspiration for and the first enrollees in PA educational programs across the country. Their skills would have, for the most part, gone to waste had it not been for the PA movement in the United States.

Combat medics and corpsmen, with their extensive practical experience and additional training in PA programs across the United States have significantly increased the availability of needed primary health care services in rural and inner city communities in this country and around the globe.
Speaking on behalf of the board, the staff, and all of the members of the AAPA, AAPA Executive Vice President Dr. Stephen Crane thanked those who made the afternoon a reality, and congratulated the Utah program on a job well done. Dr. Crane went on to say that AAPA was pleased to be a financial contributor to this most worthy of projects, and thanked everyone for the effort. Here are Dr. Crane's comments:

“While we are here today to celebrate the unveiling of a most beautiful statute, and to recognize a most important part of the origin of the PA profession as so eloquently stated by Don, we will accomplish more than just this task. In honoring medics and corpsmen and the PA profession, we are acknowledging once again the importance of courage in our work and in our lives. Corpsmen showed courage in their battlefield heroics in so many ways, whether it was from a foxhole, in a MASH unit behind the lines, on ships, or providing care to the population—all showed great courage. These individuals and others from the civilian sector also showed great courage in starting a new and most uncertain profession.
The battlefield of the health care in the 60's was strewn with failed attempts at new professions. But through persistence, capability, and an unwavering commitment to the concept of the PA, these people were successful in making this innovation in health care delivery a reality. This afternoon, we also are acknowledging the care, commitment, and compassion of all those who served in the medical branch of the military, and all individuals who play a role in delivering health care today as PAs.

Honor Guard—Presentation of the Colors
Ft. Douglas 328th Combat Support Hospital

Music – America the Beautiful

O beautiful for patriot dream That sees
beyond the years
Thine alabaster cities gleam, Undimmed by human tears!
America! America! God shed his grace on thee, and
Crown thy good with brotherhood, From sea to shining sea.

—Samuel Ward and Katharine Bates

It is not enough to cure—it is also necessary to care. Caring takes very special qualities in an individual, of which there is an abundance among PAs. These include: selflessness, self-sacrifice, empathy, and love. These qualities are expressed especially by those who provide service in underserved areas. One of the things that has impressed me most in my almost 30 years with the profession are the stories of those who serve in rural and inner city areas, or wherever medical care is hard to find. The Utah program has distinguished itself in preparing people for this service and I congratulate you on this. We also are acknowledging today, in this very special place, the importance of heroes and heroism. Quentin Crisp, a British writer of the 1980s, said and I quote: ‘To be a person of destiny is to arrive at a point in history when the only gift you have to offer has suddenly become relevant.'
Medics and corpsmen were heroes of their time, stepping forward to save countless lives and to minimize as much human suffering as they could, while giving of themselves totally. Their services were relevant for their time in Vietnam, just as the services of those who have followed them have been relevant in the middle east, in Africa, in the Caribbean, or wherever else our military and civilian forces have been sent. These truly were people of destiny at their time and place. But, thankfully for us, the corpsmen and medics of Vietnam became people of destiny in helping to establish a new profession that continues to help people in so many ways today. Truly these are heroes of our time.	*Stephen Crane, PhD*
It is only right that we thank them with the sculpture that will soon be presented to us. It is only right that we honor them in this way for their courage, their compassion, as well as their heroism. Once again on behalf of the AAPA, thank you for the honor to be with you this afternoon to bring you greetings from the Academy, but most importantly to celebrate medics, corpsmen, PAs, and the worlds of curing and caring that they represent.”

Keynote Address

Next at the podium was Elmo Taylor, my friend and PA classmate. Elmo has lived the motto “Lifesaver Then—Caregiver Now.” He was a medic with the 1st Infantry Division in Vietnam from 1968–1969. He later became a physician assistant and was in the eighth class of the Utah program. He subsequently practiced at the Wayne County Clinic in Bicknell, Utah, for a dozen years—living the mission of service to the underserved. Here are his words on that day:

“Throughout recorded history there has been conflict, resulting in pain and suffering—creating a need for the caregiver.
Accepting the call to serve, out of a sense of duty, patriotism, and a realization that the freedoms we enjoy in this land are not always free. The incredible journey of one Army medic. Life saver then—caregiver now— physician assistant.

Elmo Taylor, PA-C

After receiving military and medical training, this journey starts at the induction center of the 1st infantry division, in the jungles of Vietnam. The passing comment of a soldier out processing: “The 1st infantry division takes care of their men.” The duties of the platoon medic, responsible for the health care for approximately 30 men. With instructions that you are a rifleman first and medic second. Train to take lives before you are trained to save lives. You are respectfully referred to as “Doc.” In the heat of battle, the call is “medic.” This gives a new meaning to “medically underserved area” or “house call.”

The duty of the medic was to stabilize the patient for medivac to obtain more definitive care, oftentimes not knowing the outcome. Hoping the care was sufficient. Many paying the ultimate price. Time heals many wounds, both physical and mental. We try to remember the good times and forget the bad. As we meet this day to pay tribute to the military medic, the life saver, it is important to remember, both the good and bad.
   Remembering: the soldier giving buddy aid to his fallen comrade, by neatly applying a field dressing, with direct pressure to a very small wound on the anterior of his comrades chest. Concerned that his buddy is not responding. Not realizing that the exit wound in his back was larger then his fist. With a sympathetic pat on his shoulder, the medic moves on to help the next casualty. Having a fellow soldier not 3 feet from you, received a gunshot wound to his thigh. Dragging him to a safer location to stabilize a fractured femur and gunshot wound. You notice next to your location an unexplored artillery round. And you wonder “what am I doing? and what am I doing here?”
   Remembering: the platoon leader of a mechanized unit, waiting for his replacement, with orders in his hand to meet his wife in Hawaii. Volunteers for one last mission, to help rescue an infantry platoon that has taken numerous casualties and is pinned down by enemy fire. After the conflict, assessing his lifeless body, lying in the bottom of his armored personnel carrier. Try to make sense of it all. Realizing he had no obligation to be there. His assignment had been completed.
   To maintain any mental stability, was the knowledge that your primary mission was to save lives, and not just to take them. Trying to convince a very young new soldier, that you do not treat ringworm with mosquito repellent. The combat medic with his limited knowledge and resources, called to do extraordinary service to those in need. My first exposure to the Medex project was in our family doctor's waiting room. A brochure introducing this new health care professional. Describing an independent duty Navy Corpsman, and the additional training he had received as a Medex. And I thought, I've been there and I could do that. Thanks, Bob Jeleco, Utah Medex Class One. After years of preparation and additional medical training, and the infamous PA selection process, I found myself as a very proud member of Medex Class VIII. Following a very intense accelerated didactic phase, I was privileged to participate in an excellent preceptorship program, with a very pro-PA medical practice, in Fort Morgan, Colorado. After completion of the Medex program, and national certification, I continued employment in this setting for a few years.

The ceremony attendees enjoy the shade on the grounds of Ft. Douglas Cemetery on a warm summer day

   With a desire to return to Utah, I found myself employed by a rural satellite health clinic, in Bicknell, Utah. There I was! On independent medical duty — 60 miles from the closest hospital and my supervising physician. Scared to death, and expected to know what I was doing. It soon became apparent that I had received excellent training, and the realization that I had been trained and exposed to almost every medical condition I was called on to treat.
   Gaining acceptance with the local medical community, the volunteer EMT organization. Working with the state EMS, who had no provisions for a PA to ride on an ambulance. Going through the EMT training and becoming an instructor. Gaining the confidence and acceptance of all the community. Being on call 24/7. With the concern of “burnout.” With the reference of having been a combat medic, my current work load never did get that hard.
   Remembering: the first emergency childbirth, in the back of an ambulance, going way too fast, dodging livestock and deer … successfully delivering a breach baby … suture a laceration before 6 a.m. Christmas morning on my kitchen table … conducting a clinic tour on a Sunday afternoon for a vacationing physician, from the University of Utah, School of Medicine. An out-of-town hunter drives up with an injured person who was in a rollover. With the assistance of this physician, the stabilization and transport of a C-spine fracture. Thanks, Dr. Castle. The pain threshold of a corneal foreign body is approximately 3 a.m. … the one man “code” … I had been asked why I did not stay at this rural clinic. After 11 years I thought I had. Thanks to my wife and family for all of the missed holidays, birthdays, anniversaries, etc.
   On behalf of all combat medics, I thank you for the opportunity to say “Thanks for remembering.” As a PA, I say thanks to the national and state organizations, and all those who make this PA profession what it is today.”

Music – Turn, Turn, Turn

To everything, turn, turn, turn
There is a season, turn, turn, turn
And a time to every purpose under heaven
A time to be born, a time to die
A time to plant, a time to reap
A time to kill, a time to heal
A time to laugh, a time to weep

—Pete Seeger

Artist Remembrance

I didn't know John Prazen long, but he had a profound impact on me. About 2 years ago I went to John with the idea of a tribute to the combat medic. Being a former Navy corpsman he immediately seized on the idea and before I knew it—the clay sculpture was finished—and this was before we had raised one cent. That's how committed he was to this project.

John died while his magnificent work of art was being cast at the foundry. With his passing we lost a man who was an artistic treasure. I know he would have enjoyed the day his work was unveiled and I believe he was there with us celebrating this achievement. His son Adrian was there, and shared these words with us:

“Hello, my name is Adrian Prazen. I am the son of John Prazen, the sculptor of the piece being presented today. My father inspired my life, as well as the lives of everyone he met. Passing on the courage to follow your dreams and to live a life you love—everyday. He also instilled in his children that can't is not a word. He, on many occasions reminded me that “if you are unable to find a conventional way to do something, then find an unconventional way.” That statement shaped my life. I would now like to share a poem with you that was written by two of my brothers:

Life Story of a Dreamer

Life story of a dreamer is not always so well, I know this first hand as I'm a dreamer, can you tell.
A gift from my father, I will pass it to my son, a story never ending and has only just begun.
Life story of a dreamer and I'm a dreamer's son. My father's words, I hold dear. You can do this, son, he said so clear.
This gift from my father, I pass it on to you. The life story of a dreamer is one that's only true.
Life story of a dreamer and I'm a dreamer's son.

—Mark and Randy Prazen

Music – He Ain't Heavy-He's My Brother

The road is long,
With many a winding turn,
That leads us to who knows where,
Who knows where,
But I'm strong, strong enough to carry him,
He ain't heavy, he's my brother.

—Bobby Scott and Bob Russell

This project was one very close to my father's heart. As he was a corpsman himself serving aboard the USS Sperry. He had great admiration for those who serve our country. John Prazen, artist, father, mentor and friend. Thank you for the life you have given me and may the art you have given move, touch and inspire us all.”

Conclusion

Unfortunately our world continues to struggle over differences in ideologies and outright inhumanities continue to occur. When called upon, military medics and corpsmen continue their noble tradition of standing ready to save and to heal—placing themselves in harm's way. We will not forget the sacrifices they have made in the past and the sacrifices they continue to make on a daily basis around the world.
As a natural outgrowth of the attitudes and orientations of medics and corpsmen—today's physician assistants continue this tradition of service to the most vulnerable in our society.

Donald Pedersen, PA-C, PhD

Our PA profession is strong today, in large measure, due to our rich military heritage. This sculpture will serve as a constant reminder of the inextricable connection between the PA profession and our military forbears. This link should be continually celebrated with reverence and today, as a day of remembrance, will begin that process here in Utah.
I believe this work of art captures well the commitment to caring displayed by the medics and corpsmen of the past and of those presently serving our country. Thanks to the early students of PA programs, medics and corpsmen, who infused this caring attitude into our profession, the PA profession—a grand social experiment that began in the mid 1960s, with its origins firmly rooted in the military medical ethos—can only be viewed today, nearly 40 years later, as a resounding success.

Music – Battle Hymn of the Republic

Mine eyes have seen the glory of the coming of the Lord;
He is trampling out the vintage where the
grapes of wrath are stored;
He hath loosed the fateful lightning of his
terrible swift sword;
His truth is marching on.
Glory! Glory! Hallelujah! His truth is marching on.

—Julia Howe

The sculpture has a permanent home at the entry way of the Utah Physician Assistant Program at the University of Utah in Salt Lake City. A pictorial history of the Combat Medic/Corpsmen Memorial Sculpture Project can be viewed here.
All are welcome to view the sculpture when in Salt Lake City. Please come and visit any time.
The motto and trademark: “Lifesavers then—Caregivers now—Physician Assistants” has been used with permission of the Veteran's Caucus of the American Academy of Physician Assistants.

Clockwise from above: Mary Ettari, PA-C, MPH, president of the PA Foundation, addresses the attendees and reflects on the origins of the profession and the foundation. Sculpture unveiled by Don Pedersen and Adrian Prazen. Dr. William Wilson and Dr. Hilmon Castle, cofounders of the Utah (MEDEX) Physician Assistant Program, share their reflections of the beginning of the program and the profession. Combat medic sculpture as displayed today outside the Utah Physician Assistant Program building.

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