Army surgeon William C. Borden was devastated by the death of his patient after routine surgery. It would be his only patient to die after an appendectomy. But the outcome was expected: Peritonitis from a ruptured appendix was nearly always fatal in the pre-antibiotic era. To make things worse, the patient was his friend and colleague, Maj. Walter Reed.
After Reed’s death, Maj. Borden dedicated himself to building an institution in honor of his friend. A combination of hospital, research center and medical library, it was a novel concept in the early 20th century. “Borden’s Dream,” Walter Reed Army General Hospital, later Walter Reed Army Medical Center, opened on May 1, 1909. The hospital will close next month and merge with the National Naval Medical Center to form the new Walter Reed National Military Medical Center in Bethesda.
It will be sad to leave the Walter Reed campus. The old hospital in Building One received casualties from every conflict from World War I to Vietnam and has the refurbished suite of rooms where Gen. John Pershing and President Dwight D. Eisenhower spent their last days. From simple doughboys to heads of state, every patient got the best of care in the world’s preeminent military hospital. In 1977, Building Two became the new hospital and the site of the current valiant effort to treat the most severely injured casualties from Iraq and Afghanistan.
Closing the physical plant of Walter Reed will not change the spirit of Borden’s Dream. Hopefully, however, it will begin a new age in military medicine.
In 1998, the TriCare program was inaugurated to optimize military health care. The initial plan directed patients to military hospitals and clinics with the excess workload being referred to selected civilian providers. Over time, the rules changed, allowing many beneficiaries to opt out of care at military facilities and see their choice of civilian providers. Today those living in Maryland and Washington can choose Johns Hopkins as their site of medical care instead of a local military hospital. The overall result of these changes has been a steady erosion of the patient base for military hospitals in the Washington area.
A hundred years later, Maj. Borden can still show us how to energize a medical system. He saw beyond the parochial conditions of a peaceful, post Spanish-American War America and realized the potential for a vibrant medical institution that would meet and foresee the needs of the Army. The move to Bethesda will combine two medical staffs into an entity across the street from the National Institutes of Health. The military can take advantage of this fortunate confluence of resources and regain world-class status, but to do so we must learn from institutions that have made the grade, and that means the establishment of endowments. Clinical stability and excellence will be ensured by endowing professorships of major departments, such as surgery and medicine. Once those are established, the cream of the crop of military physicians should be recruited to the faculty.
Closer ties to NIH will promote the kind of military physician-researcher in the mold of Dr. Reed. Further endowments should be established by a strategic planning committee to support the hospital’s need to be at the cutting edge of medicine and meet the particular needs of the armed forces in such areas as trauma care, prosthetics and rehabilitation. Endow a federal institution? Absolutely. The service academies have done so for years, and those funds have helped raise their academic standing considerably. Millions of dollars have been collected by veteran-affiliated organizations for wounded warriors in the past 10 years, and there is every reason to believe that kind of support will continue for our men and women in uniform. Another lesson to be learned from the academies is the practice of promoting department chairmen to the rank of brigadier general and rear admiral on the day of their retirement. This would not change their retirement pay but would enhance the prestige of their positions and help retain key clinical leader-educators on active duty.
In this era of tight health-care dollars, the rationale for maintaining a separate military health-care system needs to be examined. The United States is among only a few major nations that have military hospitals. With TriCare providers accepting more care every day, retaining a redundant health-care system should be justified and the need for military hospitals in the domestic environment articulated. If it is still deemed to be a viable model, much of the workload lost to TriCare should be lured back into the military medical treatment system.
Inspired by Maj. Borden’s example, the new Walter Reed National Military Medical Center will be the right place to start.
The writer, a retired colonel in the Army Medical Corps, works as a contract physician at Walter Reed Army Medical Center.