Hektoen International

A Journal of Medical Humanities

The fall

Max Kutch
Hanover, New Hampshire


The author (face shown) with his team. From the author’s personal collection.

Gazing through my night vision goggles (NVGs) at the green outlines of my teammates, we began to silently enter our sniper hide. My breathing labored under the heavy weight of my battle gear and the thick, humid Iraqi air. As I scanned the path we had just patrolled, I was jarred forward by a devastating crash. Ten feet ahead of me, Erik was navigating a narrow rooftop path twenty feet above the ground. His depth perception, altered from the NVGs, resulted in a critical misstep and traumatic fall. All I could hear was groaning, inarticulate sounds as I rushed down towards Erik and began an assessment. Although I was the medic for my team, I wore that title loosely because of my lack of training, experience, and confidence.

Navigating the unfamiliar, dark building, I approached his facedown body and lifted his heavy rucksack, which had landed on top of him. My sweat dripped onto his body as I rolled him over and began to treat him to the best of my limited abilities. My mind was racing: the antagonistic ideas that I had no idea what I was doing and should not be the person treating Erik, juxtaposed with the hope that I could be of some benefit because there was no one else.

I completed my blood sweep and airway assessment, noting that he did not appear to have any broken bones and was not bleeding externally. But I could tell he was not in good shape. The blow had cracked Erik’s helmet, snapped off his NVGs, and bent his M-16 service rifle into a crooked semicircle; I could only imagine what other injuries it had caused. Wrestling with cognitive dissonance and concern that I did not know enough, I began to expose his chest and was immediately paralyzed in fear as I noticed his sternum. What I now know as pectus excavatum is a definitive sign of chest trauma. As I ran my fingers over his inverted chest, I did not notice any bruising, and the bones did not produce crepitus. I quieted my internal dialog, determined that I could not do anything about Erik’s chest at that time, and continued with my scan.

As he slowly regained consciousness, Erik’s words slurred as he claimed to have no memory of the fall. Trying to process all of the information that was flooding into my brain and quelling my anxious self-talk, I noticed his unequal, fixed-dilated pupils. Although I had no formal training on head injuries, I knew he needed a higher level of care as soon as possible. I flashed back to one of my football teammates in high school who presented similarly after a hard hit, learning later he had suffered a severe concussion. As the birds began chirping and the first rays of sunshine were peaking over the horizon, Erik started to vomit. I wrapped him in my emergency blanket, positioned him into a recovery position, and told one of my other teammates to watch him to make sure he did not aspirate his vomit.

This was the first time that I had ever taken charge and instructed someone else to do something. I had spent the first year and a half of my military career following orders as the lowest-ranking person. Not only was this my first deployment, but I was also the youngest member of a team full of people whom I looked up to. For better or worse, the military hierarchy is instilled into everyone from the earliest days of boot camp, and I had never before thought about being forthright with my opinions, let alone my directions. However, today was different. Knowing that if I did not speak up there would be serious consequences, I mustered up the courage to insist to the team leader that Erik needed evacuation to a higher level of care. I could tell that Robbie did not want to leave the hide site that we had spent all night getting to, but he heeded my advice and called in the emergency extraction for medical evacuation.

This critical moment in my life showed me firsthand how billet could overstep rank, and being the subject matter expert on the ground allowed me freedom of thought and action. It showed me the significance of preparation and being a well-versed medical provider, but also having the courage to step up and do what needs to be done. Erik’s fall was a pivotal crossroads in determining who I ultimately became as a person. I learned that regardless of rank or status I could take ownership, make change, and direct tasks for a common goal. Following Erik’s fall, I was determined to notice and conquer my inner voice of doubt, parsing it away from the voice that knows the “right thing” to do. In the words of Dale Carnegie: “Inaction breeds doubt and fear. Action breeds confidence and courage. If you want to conquer fear, do not sit home and think about it. Go out and get busy.”



MAXIMILLIAN VAUGHN KUTCH, BS, MD Candidate, Geisel School of Medicine at Dartmouth ’26, graduated from Texas A&M University in 2020 after serving twelve years in the United States Marine Corps as a Special Operations Scout Sniper. Max plans to go into emergency medicine following graduation from medical school. He currently lives in Bradford, Vermont with his wife Elizabeth and two children.


Submitted for the 2022–23 Medical Student Essay Contest

Winter 2023  |  Sections  |  War & Veterans

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