11/11/2013 08:45 am ET Updated Jan 23, 2014

For Veterans, Patient Protection and 'Accordable' Care Acts

The Daughters [and Sons] of Mars

A novel's tales of casualties, care and courage should be prescribed for those keen on putting boots on hostile ground.

Ninety-five years after 1918, the reader is left wondering if the survivors of conflict will remain featureless. Will they be largely "unrecognized" in the scheme of national awareness, concern and appreciation? Will they receive affordable care?

For many of my health-science students, the term "health exchanges" would signify the authorized sharing of notes from labs or clinicals. The term would also describe empathetic conversations with patients and patients' family members.

While those students competently register heart rate and blood pressure, Armistice Day doesn't register.

How to stock their intellectual medical cabinets with accounts of the dire bedside dilemmas that preceded and finally brought about the 11th hour of the 11th day of the 11th month of 1918?

Maybe it's best to work on -- make an assault on -- the sensibilities of those who have the authority to put boots on the ground -- on ground where those boots are not especially welcome.

The Daughters of Mars,Thomas Keneally's new novel, might be in the forefront of such an assault. And, for good pedagogic measure, the novel puts patient protection in the front line.

The novel's World War I heroics -- in front-line regimental aid posts, forward dressing stations, casualty-clearing-stations, resuscitation wards, thoracic wards and gas wards -- might just trigger the consciences of those whose policies and strategies have been responsible for turning so many soldiers and marines into patients.

While not, in the main, a political novel, Keneally's saga of two sisters who are nurses (and the emotional triages of their sister nurses) can detonate into discussions of how wounded warriors are attended to. The novel also gives us a feel for -- yes, a feel for -- the ravages of bullets, bombs and chemical weapons.

Under attack from German planes, nurses carry patients to the relative shelter and safety of trenches and dugouts. The heads and hearts of patients who cannot be moved are covered with tables, basins and pans: "It was a half-way rational idea to save those patients from shrapnel and it possessed for the nurses the comfort of acting to defy events."

The "events": German bombs seem to be aimed at ("intimately dedicated to") those already wounded soldiers and at their nurses (all of whom had been wounded emotionally and psychologically).

With field hospitals under attack, the reader is told of "the voices and the hearing that ceased" as if "absorbed into something vaster." The blasts and concussions throw the nurses backwards and down; a "ruthless force" has them "tumbling without dignity or hope -- taking breath in the middle of their flight" and having breath jolted out again as they crash to earth, "where time has been canceled."

In a crater, parts of unlucky stretcher bearers and patients are "scattered in goblets of flesh." Those momentarily spared try to find breathing air "amid a rain of grit" and the "terrible acidic stillness which wasn't like quiet at all but which assaulted the air and rang in the ears."

With an approximation of "all clear," nurses hasten to their wards to put out fires that water can't quench. Earth and sand and blankets, were needed to smother flames that seemed to be fed by ether; the "opiate" that will no longer be available to still the agonies of those still to be treated.

There is a haunting timeliness to the novel, as if news reports aren't sufficient to chronicle the horrors of chemical warfare: "Mustard gas burned all membranes. It burned the eyes, the face, the mucous membranes and the walls of the lungs... the oily vapors of the chemical yperite which had entered the victims' clothing could burn them through fabric."

How does even the most dedicated and empathetic of nurses comfort gas victims? Those who've been gassed believe themselves to be drowning in their own lung fluid: "It was as though acid-laced water was invading the patient's nasal sinuses and lungs, not once but continuously." Oxygen masks were placed over blistered faces and the gasping mouths.

As patients' hearts failed from tormented breathing and edema ("that inner drowning"), "nurses reached for syringefuls of reviving camphor and pituitarin." When hearts and lungs could not be reclaimed, terminal doses of chloroform and morphine were administered to ease the burning membranes and the ending panic.

With doctors overwhelmed with fractures, tracheotomies and amputations (when "bacteria had already beaten the surgeon's knife" and had invaded the patient's "reserves") nurses determined the doses and the applications; they determined what was needed, who needed them and how they were needed.

Nurses did what could be done to help the naked, blistered, gasping men to gargle out the poison, to wash it from their noses and eyes. But the bodies of the gassed themselves exuded poison, and, every quarter of an hour, nurses must go outside and take the fresh air and cough their throats clear of the communicated venom.

In describing the onslaughts of dysentery, typhoid, influenza and pneumonia, along with the disfigurements (bodies -- heads even -- missing pieces of ordinary anatomy) and mutilations (opened, gaping chests and abdomens), The Daughters of Mars gives us a sense of what those nurses saw and smelled and felt.

There was the "stench of acrid wounds" -- the "putrefaction" of "necrotic flesh," which they had to wash.

"Reeking uniform fragments" had to be removed along with "putrid bandages."

Grotesque mutilations of now fetid flesh had to be irrigated -- with the dexterous removing of embedded sinews of cloth, shards and slivers of metal, fragments of bone. The reader is given to know of the skill, resolve and fortitude it took to maneuver quickly and expertly in an unholy stew of "soured blood turning toward sepsis and gangrene." Once wounds were irrigated and shrapnel extracted, dressings had to be changed again and again.

In addition to medical crises, there was the cold and the damp punctuated by enemy air assaults. In other months and climates, flies and rodents.

To come through, "The sharpness of self" had to be "submerged, again and again, by busyness."

To carry on, somehow, the nurses had to compartmentalize their emotions, anesthetize their fears and sense of horror. They knew full well of graves being filled. They knew that limbs and facial features would remain "missing in action." They knew that many young faces would never be re-constructed; disfigurements could never be configured to their once fully-human form. And there were many strains of "invisible disablements" -- what now are aptly categorized as post-traumatic stress disorders. These "disablements" may still resist or even confound today's much advanced diagnoses and treatments.

The reader is hopeful that medical advancements -- reconstructive surgery and prosthetics -- allow for some (little enough) salvaging of anatomies and lives. But, even in this century, the reader is left wondering if the survivors of conflict will remain featureless. Will they be largely "unrecognized" in the scheme of national awareness, concern and appreciation? Will they receive affordable care?

Those keen on putting boots-on-the-ground, should be required to read The Daughter of Mars so that their own nostrils and skin, and digestive systems and minds' eyes get a taste of what can happen to those whose boots are put on hostile ground: Ground, where, 95 years after 1918, "malign inventiveness" re-creates "a dimension of barbarity" and "less contained savagery" on "a new continent of human bile."