People often ask what inspired me to become a dermatologist. The answer is a convoluted story of serving as the U.S. Marine Corps First Reconnaissance Battalion Surgeon during two combat tours in Fallujah, Iraq. It was my responsibility to bring home every member of that battalion to their families, to uphold the oaths I had taken as an officer and a doctor, and to first do no harm. I remember one heart-wrenching moment at a pre-deployment picnic when a little girl said to me, “Bring my daddy home.” After having just one year of being a doctor to rely on, I had absolutely no idea how to be a good doctor let alone a good officer. No training could have prepared me for the reality of war. But I knew I had to bring the Marines home.
Being trained as a doctor in America is a privilege for which I am eternally grateful. In America we have access to all the latest and greatest diagnostic and therapeutic modalities. In Fallujah, we had precious few of these. All we had, all we could reasonably rely on, was our common sense and a spirit that would never give up.
Common sense + medical education + observation = what we had to offer with some degree of consistency.
It took one day of being in Fallujah that I realized the above. During the first mass casualty I experienced, it was readily apparent that the seasoned war doctors used every one of their five senses to diagnose and treat the patients. Rarely did they ask for any type of test or imaging. And one of the most important senses that they relied upon was their sixth sense or that of intuition which heightens perception.
After the mass casualty, I started relying upon my sixth sense more than everything else. And one of the things that helped me the most was paying attention to people’s skin. While I was not yet a dermatologist, I was partially able to determine the emotional state of those in my battalion by how their skin looked, how it changed, and when they came into sick call.
Think of the last time you were really stressed.
Did you eat well, sleep enough, take care of yourself appropriately, and have an emotional state that supported your goals? Everything in life takes a turn for the worse when we are stressed. And it is no surprise that your skin reflects everything else that is happening in your life, with your psyche, and to your body.
Stress increases inflammation in your body. Inflammation wreaks havoc on every organ system and manifests itself differently in each system.
- Cardiovascular – increased blood pressure and heart rate
- GI – gas, bloating, reflux
- Dermatology – increased acne, rashes, viral infections
Because the skin is the easiest of the organ systems to be examined, it became my go-to when needing to diagnose how the Marines were doing emotionally. And making sure that the Marines’ emotional needs were being met would allow them to keep their head in the game, stay focused while on missions, and keep them out of harm’s way. If someone started having an acne outbreak or a cold sore outbreak, or rashes they normally did not have, it usually meant there was a situation at home or a problem within the platoon or, … that needed to be addressed as well as the skin issue that was occurring. By paying attention to the skin, I was able to have some insight into their souls. With a lot of grace from above, that little girl’s daddy and every single member of the battalion was returned home to their families and I developed an interest in becoming a dermatologist.
So why am I writing this in Doctors Quarterly?
Because I’ve had the privilege of transferring the insights I learned in Iraq to treating patients here and perhaps this will serve as a reminder to pay attention and take care of yourselves during the good times and the bad. Perhaps it is a reminder to ask a friend if they are ok when your sixth sense starts to kick in and their skin starts to show signs of underlying turmoil.
When your skin starts to misbehave, by all means, please be seen by a healthcare provider. But I would also encourage you to ask yourself how your life is going, how are you eating, and how are you taking care of yourself. The skin is the biggest organ of the body and certainly things that will affect other organ systems will be noticeable in your own skin.