Book Review: Blood on China Beach

Rob Lawrence is a featured speaker at EMS World Expo, scheduled for September 8–12 in Las Vegas, NV, where he will discuss how to create and implement effective public safety campaigns.

No sooner had I got halfway through the prologue of Blood on China Beach by Paul Pitlyk than I realized I would not be able to put this soon-to-be classic down.

British General Rupert Smith said, “There is only one certain outcome of any plan, and that is casualties.” The U.S. operational plan for Vietnam was to dominate the ground, close with the enemy and kill them on “search and destroy” missions; the Viet Cong (VC) had similar war-fighting aims. And in accordance Smith’s axiom, casualties—by the helicopter load—filled the field hospitals, and the pages of Pitlyk’s book.

The opening paragraphs set the scene in Da Nang, 1965. They describe the arriving casualties and the explosive devices that caused them. Pitlyk’s power of description meant I not only read the words, but immediately saw and smelled the images of war in my mind’s eye. The “wamp” of the helicopter engines, the squelch of the South Vietnamese mud, the  urgency of the treatment required to ensure the golden hour produced a crystal clear outcome were all very vivid.

The story takes place over three parts, all equally compelling. Having endured medical school and a Mayo Clinic residency and qualification in neurosurgery, the 32-year-old Pitlyk set about finding a job, a sports car and the creation of his own private practice. His journey into military service was guided by family history—his father served in World War I and his older brothers in World War II. The subliminal urge to have his photo in military uniform above the mantle alongside his father and brothers was a driving force. It wasn’t until he had set himself up in practice, complete with a partner, girlfriend and car, that he made the leap into the maelstrom of Southeast Asia.

Enlistment consisted of reporting to Camp Pendleton, CA, where a two week (it should have been four, but he arrived late) Navy Medical Officer course was quickly completed. Thereafter, a draft was issued for a “safe” base hospital in Vietnam where his neurosurgery skills would inevitably be put to good use.

In war, however, the enemy is not bound to follow our plans, and as Pitlyk began his journey the VC overran and destroyed the base hospital. On arrival—and as an alternative—he was posted to a forward medical facility, within sight, sound and range of combat operations. His new frontline home, akin to a MASH unit, was simply called “Charlie Med.”

The forward proximity of such units, combined with the advent of the “Huey” evacuation helicopter, meant the time from when a soldier was wounded to evacuation to immediate and aggressive surgical resuscitation occurred in less than an hour. This was the birthplace of the “golden hour.” Never before had surgeons seen such “fresh” injuries—the speed of evacuation meant surgeons got patients on the table often before they bled out, or even lost consciousness.

The nature of VC munitions, tactics, ambushes and the ubiquitous “Bouncing Betty” (where the device is operated by trip wire and pops up to explode) mines caused more amputation, and head and traumatic brain injuries, than had been seen in other wars.

Pitlyk’s accidental deployment to the forward area provided a neurosurgical expertise for those who required immediate stabilization due to head injury. Patients would remain in the forward location for only six hours, just long enough to allow for intervention and stabilization.

Word of Pitlyk’s presence and treatment skills spread, and soon helicopters with head-wounded soldiers began overflying other facilities to deliver their patients to him. Alongside the traditional MASH setting, Pitlyk operated in tented facilities, standing on duckboards sloshing with blood and mud in equal measure. When both of the surgical theaters were full because of the high influx of wounded, Pitlyk’s patients frequently found themselves being placed on a picnic table for their life-saving procedures.

Midway into his year in hell, Pitlyk packed his sea bag and moved to the newly rebuilt China Beach facility, after its VC attack and destruction, on the outskirts of Da Nang.

The mud of the jungle was replaced by the sand of the coastal plain. As combat operations intensified, troop numbers on the ground increased and the influx of casualties grew. Despite being at the next—and more advanced—level of care within the chain of evacuation, equipment challenges remained an issue. Pitlyk—ever resourceful, and by now an established and credible combat surgeon—was able to manipulate the system to ensure the supplies kept rolling in.

A visiting U.S. Navy hospital ship saw Pitlyk convince his commanding officer to let him borrow a medevac Huey and “fly out to lunch,” returning with a cargo hold of essential supplies. A visit from a surgeon from the general hospital in Japan gave him the invite to reciprocate and once again he journeyed out on a foray to scavenge and “borrow.”

The nature of traumatic brain injuries provided Pitlyk with a daily challenge: operate on an area of the brain that would recover, or avoid surgery on parts of the traumatized brain that could cause further injury and ultimately reduce the soldier’s quality of life back home. Pitlyk was fully aware and troubled that he, from time to time, would have to make god-like decisions regarding mortally wounded soldiers. In his own words he says he had, “enough emotional swings to make a psychiatrist seasick.”

Pitlyk’s surgical memoir is also scattered with vignettes about life under combat conditions; the VC, not a signatory to the Geneva Convention, would regularly target medical installations and Pitlyk, caught in the open, narrowly escaped one such assault at China Beach.

But almost as soon as it began, his tour of duty came to an end. Pitlyk rotated out of country, alive, with a lifetime of neurosurgery experience and a vision of the hell war truly is.

Rob Lawrence is chief operating officer of the Richmond Ambulance Authority. Before coming to the USA three years ago to work with RAA, he held the same position with the English county of Suffolk as part of the East of England Ambulance Service. He is a graduate of the Royal Military Academy Sandhurst and served in the Royal Army Medical Corps. After a 22-year military career in many prehospital and evacuation leadership roles, Rob Joined the National Health Service, initially as the Commissioner of Ambulance Services in the East of England. He later served with the East Anglian Ambulance Service as director of operations. He is also a member of the EMS World editorial advisory board.