My earliest memory of a trip to the doctor is a happy one. I was 6 or 7. I had hurt my arm, and, because I desperately wanted a cast and a sling, I insisted it was broken. I remember that the doctor was kind, and he gently let me know that my arm was only sprained. Nevertheless, he wrapped it in a tan elastic bandage, and prescribed a sling for me. One of the reasons I loved that sling was its brown color. It was an Army sling. Because we were a military family, the hospital where Mom had taken me was Walter Reed. For many years my associations with that complex of Georgian brick buildings in the far northwest of Washington were only positive. I grew up believing that military medicine is the best in the world, and that that was especially so in Washington. My father received comprehensive care in his last years at Malcolm Grow Medical Center at Andrews Air Force Base, and my elderly mother had a major operation at the Bethesda Naval Hospital. The recent revelations of shoddy care offered to soldiers wounded in Iraq and Afghanistan at Walter Reed were doubly shocking to me. Last week, a special commission reported that those failures were the result of bureaucratic mismanagement, but I wondered -- was something else at work in the way those soldiers were treated? Bethesda is the key. Around the time of my visit to Walter Reed, James Forrestal, recently retired secretary of Defense, was admitted to Bethesda as a patient, and I now understand his welfare was not the hospital's paramount concern. This was the spring of 1949, and tensions with the Soviet Union were running high. Forrestal had stoked those tensions, helping to put in place what might now be reckoned a paranoid foreign policy. That was why, when he had a psychological breakdown -- he was found catatonic in his Pentagon office, he was reported seen running through the streets in his pajamas crying "The Russians are coming!" -- the clinical paranoia of the secretary of Defense was treated as a national secret. When Forrestal was admitted to Bethesda, he was not assigned to the locked psychiatric ward on the first floor because of the questions that would raise. Instead, he was put in the unsupervised VIP suite on the 16th floor. May 22, he killed himself by jumping from the unbarred window of his bedroom. No one at the Navy hospital wished Forrestal ill, but keeping his condition secret was more important than keeping him safe. So-called national security trumped patient health, which resulted in unacknowledged pressures on diagnosis and treatment. "Operational fatigue" was the condition which Navy doctors ascribed to Forrestal, establishing appearances that all he needed was a little rest. This concern for public perception led directly to tragedy. In the culture of neglect at today's Walter Reed, the commitment may be defined as a contrary one , since the object of public perception is not appearances, but disappearances. War-broken soldiers must disappear. For reasons of national security -- namely, to shore up popular support for war policy -- the Defense Department has longed underplayed the tragic consequences of the conflicts in Iraq and Afghanistan. Returning corpses (soon to number 4,000) are shrouded in secrecy. The suffering of the wounded (more than 26,000) is kept out of the nation's awareness. It is not that the medical professionals at Walter Reed are callous or uncaring. It is that the entire system is geared to making the men and women who carry visible signs of the war's cost slide back into the general population unnoticed. An inhospitable hospital serves that purpose. Mold infested walls of the Walter Reed housing units are the functional equivalent of unbarred windows at Bethesda. Of all of the lies that the Bush administration has promoted, none is more egregious than that it "supports the troops." Unlike the others, that lie holds. In its name, Bush vetoed the war appropriations bill last week, as if the welfare of young and vulnerable soldiers is his chief concern. American soldiers are pawns in the game the president is playing with history. No longer capable of pretending that national security requires American presence in Iraq, Bush is simply refusing to acknowledge that what he did was wrong. He's like a child insisting that his arm is broken, when it isn't. In Bush's case, the fake dressing for which he longs are human lives.
James Carroll's column appears regularly in the Globe.
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