PATRICK TRIPP is a physician and an associate professor of radiation oncology at the University of Pennsylvania and the Philadelphia VA Medical Center.
In 1967 and ‘68, in the hills and valleys of Quang Tri Province, U.S. Marines established positions along the demilitarized zone that separated South Vietnam from the communist North. The Marines did not know the terrain— the jungles, ridges, and ravines of the Annamite Range, where the 60-foot tree canopy and dense undergrowth limited visibility to just a few yards. There, in the far north of South Vietnam, the cold, steady monsoon rains, called the crachin, from the French word for “drizzle,” continued for months. The land and climate were suited to the ancient military strategy of the Vietnamese, used in turning back the Mongols, the Ming, and the French: violent, close-quarters combat. Hundreds of Marines and thousands of their Vietnamese allies died in month after month of intense fighting. In the Situation Room in the White House basement, President Lyndon Johnson followed the Battle at Khe Sanh on a sand-table model. When the Marines finally withdrew in July 1968, the North Vietnamese, bloodied but still formidable, seized control of the area. Nothing had been achieved.
The medical oncologist at the VA called. “Mr. A is back in the hospital,” he said.
“They're calling recurrence, on the brain MRI, in the left temporal lobe, exactly where he was treated with radiation last year.”
That stinks,” I said. “We can see him.’
I could picture Mr. A in front of me, with his handlebar mustache, its tips twirled into points. He always wore a white T-shirt, a black leather vest, and an army-green “boonie” hat with the sides turned up to display three small enamel pins: one with the “M.I.A.” logo, white letters on a black shield; next to it, the eagle, anchor, and globe insignia of the Marines; and a miniature South Vietnamese flag, with its yellow and red horizontal stripes. He had a welcoming, wide-open grin that he flashed easily and often, and that made him less daunting to talk to, especially in those moments —we'd had many of them—when we discussed matters of life and death. Eight years earlier, he'd been operated on for an early-stage lung cancer. A year after that, he developed an inoperable recurrence, which was treated with radiation combined with chemotherapy. Since then, each of his surveillance CAT scans had looked alike—there was a small chance that he had been cured. After together reviewing the images from the five-year scan, I walked him and his wife out of the exam room.
We'll see you next year, with new scans,” I said.
“I'm blessed,” he replied. “Every day.” He nodded to his wife, who had continued walking
