On the sprawling grounds of Walter Reed National Military Medical Center is a wooded ravine with a surprising sense of seclusion. Not far from the roads that ribbon the 243-acre campus in Bethesda, Maryland, deer rustle in the brush and the rushing Stony Creek makes gentle music, pushing aside the noise of passing cars. Over the past year, this half-mile-long oasis has undergone subtle changes. Soon it will officially begin a new life as the Green Road, a healing garden for war veterans recovering at Walter Reed and their families.
For six years, Frederick Foote, AB’80, has worked to convince US Navy brass and potential donors of the recuperative properties of this tiny haven. Nature, Foote says, is a potent reminder to combat vets that “all is not trauma”: that “there’s rebirth and regeneration.” It’s a project the retired Navy doctor has pursued almost sleeplessly: gathering partners, organizing fundraisers, chipping in proceeds from his book sales, greasing the bureaucratic wheels. The Green Road will open September 26, boasting a restored streambed; pavilions for gatherings, small performances, and commemorations of fallen comrades; and a wheelchair-safe path that connects two facilities at Walter Reed where recovering veterans live with their families.
The Green Road and the access to nature it provides to those vets are part of a larger shift in health care for the war wounded. The hallmark harms suffered by servicemen and servicewomen in Iraq and Afghanistan—post-traumatic stress disorder and traumatic brain injury, in many cases from blast impacts—have recalcitrant, elusive effects on both body and psyche. Conventional medicine, Foote has long believed, is insufficient to address them.
Now, it appears, the armed services believe it too. The military has become, Foote says, “the nation’s biggest user of holistic medicine.” At Walter Reed, the nation’s largest military hospital, injured vets in the National Intrepid Center of Excellence (NICoE), a traumatic brain injury clinic, receive acupuncture to help with their pain alongside advanced brain imaging to diagnose their injuries. They take classes in art and music and writing in addition to physical therapy. Some live at Walter Reed together with family members. And soon they will have access to the Green Road and its solaces.
The integration of holistic approaches has been embraced not just at the NICoE but at other Department of Veterans Affairs facilities. These supplement rather than replace surgery and pharmaceuticals, the mainstays of traditional care. Holistic treatment is relatively cheap to provide and has been shown to improve medical outcomes in complex cases. Of the $1.4 million Foote raised for the Green Road, some $250,000 will support research through 2017 to quantify the effects of nature on the health of the battle wounded.
The opening of the Green Road next month will close this phase of Foote’s career—15 years studying the practice and effects of holistic care and the past 10 or so also doing the legwork and persuasion to get such care put into practice. After the ceremony, he’ll return full time to the vocation he once thought would be a lifetime pursuit: poetry.
Rangy and wired behind his thick mustache, Foote is an easy, riveting storyteller. He laughs a lot, not least at himself, and catches you up in it. About war and its casualties, he is sad and serious, resigned to the necessity of human conflict as a road to justice but hopeful the future will hold a different way of conducting it.
On and off for the past 40-plus years, Foote has been in and around the Navy—first as a medical corpsman, in recent years as an advocate for the war wounded and their needs, and in the long middle as a Medical Corps commander and neurologist who was deployed during Operation Iraqi Freedom. Through it all, Foote never stopped thinking about the line and verse and meter that still had the air of a true calling.
At 62 Foote published his first book of poems. Medic against Bomb: A Doctor’s Poetry of War (Grayson, 2014) was wrought from his experiences tending to US and Iraqi wounded in 2003 on the Navy hospital ship Comfort. Recognized with multiple awards, the book gave voice to Foote’s mixed emotions as a longtime Navy doctor and, increasingly, an outspoken pacifist. One poem, “The Hurt Fedayeen,” recalls treating an Iraqi soldier: “We shot him through the chest, and now we’re saving his life; / it seems absurd, but that’s what Americans do— / blow a place apart, then put it together again, / pretending it’s good as new.”
War medicine, Foote says and the poems make harrowingly clear, “is horrible.” And a paradox: “It grinds you down. You do brilliant work. You’re at your best. You do miracles you never thought you could do. But the tide of ruin is so great. It’s like you threw a cup of sand in the ocean.” An Army kid, Foote seized on Robert Frost at 12 or 13, after reading around for a year or two in his mother’s poetry anthologies. Dylan Thomas captured his imagination next, then T. S. Eliot: “That’s probably how poetry flamed up in me really loud, about age 15, 16.” Around the same time, he contracted appendicitis that turned dangerous after being misdiagnosed, and spent three shattering weeks at Bethesda’s National Naval Medical Center on a ward with “39 shot-to-pieces Marines.”
His “pity for wounded soldiers and the victims of war all started at that hospital, right on the ward, in 1967,” Foote says. “And it drove my whole medical career.”He went off to Middlebury for a year at 18 but left “to find myself.” He also swore off writing poetry, which dredged up intense emotions that felt connected to his identity crisis.
Foote worked in Ireland for 18 months, then, with his eye on going back to college later on the GI Bill, joined the Navy as a hospital corpsman. Stationed in Italy for four years, he immersed himself in ancient literature and philosophy. “That’s where a lot of this nature stuff comes from,” he says, and some of his interest in holistic medicine too, which he notes was used by the ancient Greeks. “I spent my weekends in Pompeii, and I was an intellectual sailor,” navigating the classics.
After four years of service, he enrolled at St. John’s College in Annapolis, Maryland. But the dream of being a doctor had taken hold, and the school’s inflexible great books curriculum wasn’t going to prepare him for that. So Foote transferred to the University of Chicago, chained himself to his books (“I lived in the Reg. … I had food caches there.”), and studied his way into Georgetown medical school.
Feeling the absence of writing in his life, he tested the waters during a leave of absence from Georgetown, but wound up writing prose instead. Years later when he was chief resident at Yale School of Medicine, “poetry just kicked in the door and took possession of my room and never left.” Foote returned to the Navy, planning to serve 10 years and then retire to write poetry full time. Instead—among other destinations—he ended up on Comfort.
Comfort and its sister ship, Mercy, were originally supertankers. The Navy purchased them and converted them into massive floating hospitals that launched in 1987 and 1986, respectively. They have 12 operating rooms and 1,000 beds each, including dozens for intensive and emergency care. “They were built to handle World War III, basically,” Foote says.
The ships have been used mostly for humanitarian relief in the wake of natural disasters like Hurricane Katrina and the 2010 Haiti earthquake. In September 2001 Comfort was deployed to Pier 92 in midtown Manhattan with the expectation it would treat people hurt in the attack on the World Trade Center. There were so few survivors that it was used instead to house out-of-town relief workers who had traveled to New York to help out.
In 2003 Foote was one of 1,000 Navy medics who were on Comfort in the Persian Gulf. “We were expecting American casualties,” he recalls. “Nobody had thought there would be any Iraqis.” But about 200 Iraqi men, women, and children were treated in addition to more than 450 US patients. “We weren’t prepared at all. We had one translator on the ship who knew Arabic, and we had one Koran on the whole ship.”
The Koran was a parallel Arabic and English text that Foote had brought to study on his own but gave to the ship’s Iraqis. Women and children had their own ward, and one part of Comfort housed wounded prisoners of war. “We were healing the enemy, and that was very difficult,” Foote says. “Emotionally you had to really get used to it.”
After 10 weeks, the Iraqi patients were transferred to more permanent camps and facilities. By then “it was really kind of an emotional farewell,” Foote recalls. “We’d all learned some Arabic, they’d learned some English, and they pretty much felt we had taken care of them like our own family.”
“Medics hate war,” he says. “It’s just shattering horrible destruction. On the other hand, we’re members of the military, and it’s our job to fight our nation’s wars. So for many of us what it comes down to is you hate the war, but you love the warrior.”
That love is palpable in Medic against Bomb, even as the poems lay bare the devastation Foote witnessed, in a style reviewers have compared to Homer, Kipling, and Tennyson. The first section, “Contact,” dwells on the efforts of American doctors and Iraqi patients to understand each other and on the human wreckage surrounding them. The poems in “Battle Fugue” recreate the chaotic immediacy and minute-to-minute sensory input of combat and triage.
“Ruins of Peace,” the closing section, turns to the aftermaths of war, psychic and bodily. It includes “Rock Creek PTSD,” in which a wounded vet regards a long-loved creek through new eyes. The poem begins: “Rock Creek tumbles as / daylight ends, its water pours / over straits and bends, / flinging its way through spouts and flumes, / as human fortune collides with doom. / Tumult issued in / roaring sounds / clears the mist as / the rush tilts down / to freezing deeps and / pernicious bogs, / bleakly featured with fallen logs. / You soothed my suffering mind before, / and how I wish / you were not transformed, / turned so fatal / in each detail, / your clean bright energy leached / and paled.”
“Rock Creek PTSD” is the photo negative of what Foote hopes the Green Road will represent for men and women like the poem’s speaker. Access to nature is just a small piece of what he’s helped the military do for them. It all began in 2001, when Foote formed the Epidaurus Project. The working group of five doctors, one chaplain, and one medical anthropologist studied how the US Military Health System could integrate holistic care. They wrote statements and pitched ideas to military leaders, some of whom listened. But money was short, and for the first few years their work was largely theoretical.
Then soldiers started coming home from the Middle East with new kinds of battle wounds. The Navy “learned that we couldn’t treat brain injury and PTSD with what we had,” Foote says. “We needed something, and it sort of smelled like some of this stuff we’d been talking about.” In 2005 a Pentagon commission recommended merging the badly deteriorating Walter Reed Army Medical Center with Foote’s workplace at the time, the National Naval Medical Center, to create today’s Walter Reed. A new community hospital 30 miles away in Fort Belvoir, Virginia, was part of the recommendation too. Foote was tapped as an adviser.
For the previous four years he and his Epidaurus colleagues had been studying how hospital structures themselves could contribute to recovery. “I just took all that. I stole it all and threw it at the Navy,” Foote says. Getting in at the planning stage meant he could advocate for “healing buildings”—with clean air and water, nontoxic materials, and pristinely quiet rooms, one per patient to lower the incidence of infections. The hospital should provide space for family members to sleep in the same room with patients. “And bring in art and nature,” Foote says, “because that really reduces stress and improves outcomes.”
When it opened in 2011, Foote says, Fort Belvoir Community Hospital was the most advanced example of evidence-based design in health care. The hospital’s generous windows let in a flood of light and look out on trees and sky. Its creative arts therapy program is supported by the National Endowment for the Arts, like that at the NICoE before it, which was started by Foote (informally at first, he says, “largely just with the nurses’ permission”).
When patients are discharged, the NICoE reports, the treatments they most want to continue include yoga, acupuncture, and mind-body skills. Those who have taken advantage of the holistic care options say they have more control of their pain, are able to decrease or stop their medications, and are less anxious, less irritable, more relaxed, and sleep better.
Foote is also behind the Maryland Network of Arts and Gardens for Veterans, which stems from the Green Road project but promises to serve a far wider population of vets in pursuit of full recovery. The Epidaurus Project continues as part of Baltimore’s Institute for Integrative Health, where Foote is a scholar. And to measure the effects of all this work on vets’ health, he helped develop a set of metrics that are in the midst of being applied, including 12 pilot research projects now under way at Walter Reed, he says.
Foote likes to set things in motion and leave them in capable hands, moving on to his next project. Right now that’s a second poetry book, “Coal Train Poems,” a satirical meditation on American history. After the Green Road opens, “I’m out of here,” he says. “And hopefully nobody ever even remembers my name.” Everything he’s done at Walter Reed and Fort Belvoir is in the name of the soldiers, of whom he writes in Medic against Bomb: “I have loved and honored them from my boyhood and always will.”