Photo by Hush Naidoo Jade Photography on Unsplash.

The healthcare landscape has changed remarkably in Connecticut.

You may have noticed some name changes, new signage, and that “opportunities” for care have increased to a level that rivals access to coffee. In this essay, I’m going to review this new landscape, and consider why it developed. My goal is to help the reader make sense of Connecticut’s new, and still evolving, hospitals roster.

I begin this review in Hartford, where healthcare system changes are really representative of the industry’s overall transformation. In addition, because I was a member of Saint Francis Hospital’s attending and management staff for 10 years in an earlier part of my life, I know the players.

In the mid-1970s, Hartford was well-served by three independent hospitals in, what appeared to be, a stable healthcare environment. The oldest, Hartford Hospital, was founded in 1854 by the local medical society, actually in response to an industrial accident — a steam boiler explosion. Saint Francis Hospital, which was established in 1897 by the “Sisters of Saint Joseph”, is now the largest Catholic hospital in New England. A third, smaller hospital, Mount Sinai, was founded in 1923 to provide a facility for Jewish doctors, who were unable to obtain staff privileges in the other two.

Then, an extraordinary makeover of that local system of independent hospitals began in1995 when Mount Sinai merged with Saint Francis, which was one of the first occasions in the United States of a formalized relationship between stand-alone Catholic and Jewish hospitals. The facilities that once housed Mount Sinai became the Mount Sinai Rehabilitation Hospital.

By 2015, Saint Francis had already become part of Trinity Health of New England, an “integrated health care delivery system”, with five hospitals; which, in turn, is a member of Trinity Health, a Catholic health system with 93 hospitals in 22 states! 

Drivers of Mergers and Affiliations:

Such deals are growing across the United States. Some of the motivation can be attributed to the hospital industry’s response to healthcare reform and managed care, both of which often involved negotiated reimbursement schemes and utilization review programs. Clearly, larger hospital groups are in a stronger position to negotiate compensation rates with payors and regulators. 

In addition, smaller independent hospitals may also consider some sort of affiliation with a larger organization to both improve their capacity to secure capital for programs and facilities, take advantage of resultant economies of scale; and to attract and retain, or simply get access to, physicians in some of the more arcane medical specialties.

Although I had knowledge of the events discussed below, as they occurred, reviewing them as a continuum is really stunning and demonstrates the great breadth and scope of the two major Connecticut hospital groups.

The Hartford Juggernaut: 

The front entrance of Hartford Hospital in Hartford, Connecticut, United States. Public Domain photo by Elipongo.

In 1994, Hartford Hospital began its transformation from local independent hospital into a “statewide, integrated health system”, when it merged the venerable Institute of Living — founded in 1822 as a private, residential psychiatric hospital — into the hospital’s Department of Psychiatry. The Institute had gained some international notoriety for its treatment of silent movie stars like Clara Bow, errant clerics, and an early adoption of a science-based model of care.

Further, in 1996, pediatric patients from Newington Children’s Hospital, the University of Connecticut Health Center, and Hartford Hospital were all relocated to the new Connecticut Children’s Medical Center, constructed contiguous to the Hartford Hospital campus. 

Planning for this new hospital had actually begun in 1986, when Newington and Hartford agreed to construct a new facility. Extraordinarily, this new alliance was designed to span care from infancy, through childhood, adolescence and young adulthood; and finally transitioning to adult care.

Last October, the Hartford Courant reported that the Hartford HealthCare system now, “… serves 185 towns and cities and is within 15 miles of every Connecticut resident.” It includes seven hospitals, roughly stretching diagonally across the state from Windham and Backus Hospitals in the northeast to St Vincent’s in the southwest.  The data are daunting: almost 30,000 employees, nearly 2,500 licensed beds, and operating revenue of $4.3 billion. 

The Yale Dreadnought:

Aerial view of the campus of Yale-New Haven Hospital in Connecticut, including Smilow Cancer Hospital at Yale-New Haven and Yale-New Haven Children’s Hospital. Photo taken in 2010 by YNHHEditor. This file is licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license.

Development of the “grandmother of all CT hospitals” began in 1826, when the Connecticut General Assembly authorized 10 incorporators to establish the General Hospital Society of Connecticut, which was chartered as the first Connecticut hospital in New Haven, and the fourth voluntary hospital in the United States. (i.e., a private nonprofit hospital.)

A new 13-bed hospital opened in 1833; and served as the primary teaching hospital for the Yale medical school, which was founded in 1810 as the Medical Institution of Yale College.

In 1884, the hospital’s name was changed to New Haven Hospital, reflecting the name that was commonly used at the time; and then, in 1945, Grace-New Haven Hospital, to acknowledge an affiliation with neighboring Grace Hospital. And finally, in 1965, as the relationship with the University became more formalized, Yale New Haven Hospital. 

Now moving forward, perhaps Al Jolson described it best in the 1927 film “The Jazz Singer” … “you ain’t heard nothing yet”. 

In 1996, the hospital began its transformation into the “Yale New Haven Health System” (YNHHS), when it entered into a partnership with Bridgeport Hospital; and further expanded in 1998, with the addition of Greenwich Hospital. 

In 2012, they acquired the assets of the Hospital of Saint Raphael, which was founded by the “Sisters of Charity of Saint Elizabeth” in 1907, and also located in New Haven. 

In 2016, ownership of New London’s Lawrence and Memorial Hospital was assumed by YNHHS, which also included L&M’s earlier acquisition of Westerly Hospital, consummated in 2013.

The Yale data are equally daunting: a year ago, YNHHS reported 2,681 licensed beds, 28,589 employees, and total assets of $6.5 billion. The system now includes five acute care hospitals, the Smilow Cancer Hospital, Yale New Haven Children’s, and Psychiatric Hospitals, and a multispecialty medical group with more than 1,000 physicians; yielding a sphere of medical influence along the shoreline from Westchester County to Westerly, RI. 

Independent Stand-Alone:

Middlesex Health, which is centered around Middlesex Hospital and an extensive network of community-based outpatient services, remains independent. Middlesex joined the Mayo Clinic Care Network in 2015, which enables their medical staff to easily consult with and take advantage of the broad expertise of the Mayo Clinic in diagnosing complex cases. The relationship with Mayo Clinic is not an acquisition or a merger, but an intellectual partnership (my words).  They are the first hospital in CT and only the second hospital in New England to join the network. 

Satellites:

Most patient encounters with these hospital systems will occur in outpatient settings outside the hospital campus. These can include urgent care centers, blood draw and diagnostic imaging centers, group practices; and more comprehensive sites like the Pequot Health Center (L&M/YNHHS) in Groton, which provides primary care services on a walk-in basis. diagnostic imaging, blood tests, and same day surgery (e.g., cataracts).

The growth of these outpatient sites has been facilitated by electronic medical records and digital radiographs. These records can be shared across different health care settings. via secure enterprise-wide information systems. This technology would also enable the type of relationship that Middlesex has with Mayo. 

I was surprised that Hartford Healthcare has opened eighteen “Go Health” urgent care centers from Montville to Torrington. Go Health Urgent Care is a national company headquartered in Atlanta; with nearly 200 urgent care centers in AK, CA, CT, DE, MO, NY, NC, OK, OR, and WA “through partnerships with market-leading health systems”.

Author’s Notes: Hospital mergers and acquisitions show no signs of slowing down in the United States., and, as economic, regulatory, and operational challenges continue, many community hospitals will consider whether or not they should remain independent, or affiliate with another hospital or health system. 

There are a range of affiliations that a hospital’s leadership can consider, from a fairly simple cooperation agreement among hospitals for group purchasing, to an acquisition of one facility by the other, in which all control is surrendered to the acquiring entity. In the above, I used news reports from the “Hartford Courant”, “New Haven Register”, the “Providence Journal”, and information published by the hospital group, to define the type of affiliation. 

In closing, there is an additional wrinkle to hospital transformation. This morning, while watching the News, Dr. James Cardon came on and did a commercial for CarePartners of Connecticut, a Medicare supplemental insurance company formed in 2018, by two leading organizations; Hartford Healthcare and Tufts Health Plan. “When doctors and a health plan work together, it simplifies patients getting the care they need. That’s what CarePartners of Connecticut is committed to.”

For me, this addition is beyond “stunning.”

Editor’s Note: This is the opinion of Thomas D. Gotowka.

About the author: Tom Gotowka’s entire adult career has been in healthcare. He’ will sit on the Navy side at the Army/Navy football game. He always sit on the crimson side at any Harvard/Yale contest. He enjoys reading historic speeches and considers himself a scholar of the period from FDR through JFK.

A child of AM Radio, he probably knows the lyrics of every rock and roll or folk song published since 1960. He hopes these experiences give readers a sense of what he believes “qualify” him to write this column.

Editor’s Note: This is the third column by Tom Gotowka under the heading, ‘Epic Poems of Folk and Rock.’ Find Part I  at this link and Part II at this one.

I continue the “epic poems” theme in this essay, but shift to the epic works of conflict; focusing on the rock and roll genre, as influenced by the Vietnam War.

In review, Part 1 presented several works of folk music that, I felt, were the natural successors of the epic poems of antiquity. In Part 2, I considered how America became entangled in the Vietnam War, as a prerequisite for this review of the music of that war.

Epics of the Vietnam War Era:

As noted last time, “Stars and Stripes” called Vietnam “the first rock and roll war”. I present, in the following, some of the music that supports that contention. I provide some context for each song, and include a sample of the lyrics, trying to ensure that the sample still conveys the original message.

Some of the lyrics are a little gritty, and the context may be troubling, but they’re included to fully illustrate the era, not to offend the reader. So, here’s the war in six songs.

“Fortunate Son”: Creedence Clearwater Revival (1969)

Photograph of Creedence Clearwater Revival (1968). L-R: Tom Fogerty, Doug Clifford, Stu Cook, and John Fogerty.

When John Fogerty wrote the song, draft deferments were undoubtedly on every teenaged American boy’s mind. His lyrics support the men who served in Vietnam, but condemn the “children of privilege” (i.e., “millionaire’s son”), who used that privilege to “dodge” the draft.

Pulitzer Prize winning Vietnam War correspondent, David Halberstam, reported that the ways in which draft-age men received deferments favored those who were wealthier and more educated. For example, able both to remain in college full-time, and then pursue advanced degrees after graduation; and thus, qualifying for student deferments. 

In addition, those same young men could obtain deferments for physical problems, even untreated bone spurs, more easily than could poor or working-class men; and, “rather than trying to convince a draft board that they were physically unable to serve in the military, they could just get a note from their family doctors”. 

“Some folks are born, made to wave the flag;
they’re red, white and blue.
And when the band plays “Hail to the Chief”,
they point the cannon at you, Lord!
Some folks are born, silver spoon in hand;
Lord, don’t they help themselves?
But when the taxman comes to the door,
the house looks like a rummage sale.
It ain’t me, it ain’t me;
I ain’t no millionaire’s son.
I ain’t no fortunate one”.

“Feel Like I’m Fixing’ To Die Rag”: Country Joe McDonald ​(1965)

In this dark parody of the war, Country Joe (and the Fish) demonstrate the hopelessness that many Americans felt toward the War. The artist touches on, albeit, sarcastically, several important war themes in the full seven verses: the government notion that going to war was in the country’s best economic interest; and, consequently, the support from Wall Street, weapons manufacturers, and an “overly aggressive” Pentagon. 

The song also has the distinction of having been performed twice at Woodstock, and I have corroboration from a very reliable eye witness, my wife, Christina, who was present at those “3 Days of Peace & Music” in the Catskills, in 1969.

“Well, come on all of you big strong men,
Uncle Sam needs your help again.
He’s got himself in a terrible jam, way down yonder in Vietnam.
So put down your books, and pick up a gun,
we’re going to have a whole lot of fun.
And come on mothers throughout this land, pack your boys off to Vietnam.
Come on pops, don’t hesitate, send them off before it’s too late.
And then, it’s one, two, three, what are we fighting for?
Don’t ask me, I don’t give a damn.
Next stop is Vietnam!
And it’s five, six, seven,
open up the pearly gates.
Well, there ain’t no time to wonder why,
Whoopee! we’re all going to die.”

“Revolution”: The Beatles (1968)

Trade ad for Beatles’ 1964 Grammys. Public Domain.

John Lennon and Paul McCartney wrote the song to demonstrate their strong objection to the increasingly violent protests that had occurred in response to the war.

To illustrate, in April, 1965, Students for a Democratic Society (SDS), held its first national protest march in Washington, DC. Co-sponsored by Women’s Strike for Peace, 25,000 attended.  After this peaceful protest march, SDS grew increasingly militant, and their tactics then included the occupation of college administration buildings on campuses across the country. The 1968 violence at Columbia University is covered in “The Strawberry Statement”, by James Kunen (both book and movie).

On Oct. 21, 1967, over 100,000 protesters gathered at the Lincoln Memorial; and later that same night, over 35,000 of the group marched on to the Pentagon for a second rally, where they sparked a violent confrontation with the soldiers and U.S. Marshals protecting the Pentagon complex. Nearly 700 demonstrators were arrested. 

Notably, the demonstrations produced the famous “flower power” photograph of a protester placing a flower in a paratrooper’s M14 rifle barrel. 

On March 17, 1968, 10,000 protesters demonstrated in Trafalgar Square against American action and British support in Vietnam. This was followed by 8,000 protesters marching to the American Embassy in Grosvenor Square; where a fierce battle with riot police and mounted officers ensued.

In August 1968, the Democratic National Convention in Chicago, bore witness to a series of riots, involving tens of thousands of Vietnam War protesters, both during and before the convention. Eight protest leaders were tried on charges of criminal conspiracy and incitement to riot. 

The eight eventually became the “Chicago Seven”, after convictions were overturned because of procedural errors and Judge Hoffman’s “overt hostility to the defendants”.

Tragically, on May 4, 1970, just four days after President Nixon announced the escalation of the war into Cambodia, four students at Kent State were shot by National Guardsmen during a protest.

“You say you want a revolution.
Well, we all want to change the world.

You say you got a real solution.
Well, we’d all love to see the plan
You ask me for a contribution.
Well, we’re all doing what we can; but, 

if you want money for people with minds that hate;
all I can tell you is, brother, you have to wait.
When you talk about destruction,
don’t you know that you can count me out?
But if you go carrying pictures of Chairman Mao;
you aren’t going to make it with anyone, anyhow.”

“Ballad of the Green Berets”: Barry Sadler (1965)

The United States Army Special Forces, the “Green Berets”, are the Army’s special operations group, whose mission extends well beyond conventional warfare. 

In May 2004, a plaque was dedicated at Fort Campbell, honoring the 695 Green Berets killed in action, and the 79 missing in action during Vietnam.  Of the MIA, only three soldiers have been recovered. 

“Ballad” is a patriotic tribute to our soldiers in Special Forces, and one of the few popular songs of the Vietnam War era that portrays the military in a positive manner. 

Sadler served as a medic with the 5th Special Forces Group (Airborne), and his song, written to boost morale among our troops in Vietnam, also served as the inspiration for the John Wayne movie, “The Green Berets”.

“Fighting soldiers from the sky, fearless men who jump and die.
Men who mean just what they say; the brave men of the Green Beret.
Silver wings upon their chest; these are men, America’s best.
One hundred men we’ll test today, but only three win the Green Beret.
Trained to live off nature’s land; trained in combat, hand-to-hand.
Men who fight by night and day, courage peak from the Green Beret.”

“I Ain’t Marching Anymore”: Phil Ochs (1965)

Ochs was the “iron man” of “protest” singers; and, in his career, performed, as a “regular” at anti-war, civil rights, organized labor, and women’s rights events. 

I believe that this is his best; or at least his best- known anti-Vietnam War song; and it became an “anthem” at rallies and protests. 

The song is really a treatise on the entirety of American conflict, and he casts himself as a tired soldier, who has fought in each American war, beginning with the battle of New Orleans in the War of 1812. And on through both world wars.

He performed the song in August 1968, during the violent protests outside the Chicago Democratic National Convention, and, it is claimed, inspired hundreds of young men to burn their draft cards (really). He later described it as the highlight of his career.

“Oh, I marched to the battle of New Orleans,
at the end of the early British wars;
the young land started growing, and
the young blood started flowing,
but, I ain’t marching anymore.

I’ve killed my share of Indians, in a thousand different fights.
I was there at the Little Big Horn;
I heard many men lying, I saw many more dying;
but, I ain’t marching anymore.

Chorus: It’s always the old who lead us to war;
it’s always the young to fall.
Now look at all we’ve won with the saber and the gun.
Tell me, is it worth it all?

I stole California from the Mexican land,
and fought in the bloody Civil War.
I even killed my brothers, and so many others;
but, I ain’t marching anymore.

I marched to the battles of the German trench,
in a war that was bound to end all wars. 

I must have killed a million men, and now they want me back again;
but, I ain’t marching anymore.

I flew the final mission in the Japanese skies, and
set off the mighty mushroom roar.
I saw the cities burning, and 

I knew that I was learning;
that I ain’t marching anymore

Call it peace or call it treason,
call it love or call it reason;
but I ain’t marching anymore.”

“Born in the USA”: Bruce Springsteen (1984)

Bruce Springsteen performing at Roskilde Festival 2012. Photo credit: Bill Ebbesen. This file is licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license.

I present “Born” as the anchor of the song list because Springsteen’s focus is on America’s poor treatment of returning Vietnam War veterans. The lyrics are an account of the disrespect those veterans faced on their return home to a society that was largely opposed to the war. 

This song may be one of the most misinterpreted songs in rock and roll history. Since its release, the song’s chorus has been omnipresent at political rallies; and heard as a celebration of American life. The anti–war message is rooted in the verses, and may have been lost early on, because the song was released about a decade after the war ended.

The song is consistent with what I noted last time in “Working-Class War”, by Christian Appy; who observed that the typical U.S. soldier in Vietnam was from a poor or working-class family; a large portion were from the inner cities and factory towns. 

In the first verse, Springsteen introduced the story of a young man, born into a failing American town, who was apparently abused by his family. In some trouble, he is ordered by the courts to enlist rather than serve time. His brother, or close friend, is killed in action. 

He returns home after the war, can’t find a job, and is treated with indifference by the V.A. The final verse describes his progression into despair.

“Born down in a dead man’s town; the first kick I took was when I hit the ground.
You end up like a dog that’s been beat too much,
until you spend half your life just covering up.
Got in a little hometown jam; so, they put a rifle in my hand.
Sent me off to a foreign land; to go and kill the yellow man.
I had a brother at Khe Sanh, fighting off the Viet Cong.
They’re still there, he’s all gone.
I came back home to the refinery; hiring man says “Son if it was up to me”.
I went down to see my V.A. man; he said “Son, what don’t you understand”?
In the shadow of the penitentiary; out by the gas fires of the refinery.
Nowhere to run, and nowhere to go.”

Author’s Notes:

Unlike Bruce Springsteen, I am not certain whether the courts can, or ever did, require enlistment in lieu of serving time for a criminal infraction.  If so, I can’t imagine that these individuals would be considered high value recruits. A large portion of the opposition to the war was the onus of the draft. I was not able to find reliable data on the portion of draftees, versus voluntary enlistees, in Vietnam, as opposed to prior, or subsequent (e.g., Afghanistan) wars.

I only included works that I could directly attribute to the writer’s reaction to the war. Clearly, there was a wealth of additional music that was popular at the time and was probably listened to regularly by soldiers in Vietnam.   For example, I included nothing by the Rolling Stones; and did not consider “We Gotta Get out of this Place”, by the British group, The Animals, although the song has been part of the sound tracks of many productions about the war. 

If you want to explore a very realistic production, I recommend “Hamburger Hill”, which is a highly accurate 1987 movie about the 1969 assault by the Army’s “Screaming Eagles” Battalion on a well-fortified enemy mountain position. The editors dramatically incorporated the music of the day into their soundtrack.

I was a “fortunate one” — the United States Navy and the military provided financial support and enabled deferments for over 10 years of advanced education. I had agreed, up front, to repay that support in service, which I’ve previously said was at a Naval Hospital.

My next “View” will be of the remarkable changes that have occurred in CT’s hospital and healthcare landscape I think that hospital advertisements on local newscasts now exceed those for replacement windows. 

Editor’s Note: This is the opinion of Thomas D. Gotowka.

About the author: Tom Gotowka’s entire adult career has been in healthcare. He’ will sit on the Navy side at the Army/Navy football game. He always sit on the crimson side at any Harvard/Yale contest. He enjoys reading historic speeches and considers himself a scholar of the period from FDR through JFK.

A child of AM Radio, he probably knows the lyrics of every rock and roll or folk song published since 1960. He hopes these experiences give readers a sense of what he believes “qualify” him to write this column.

In my previous essay, I discussed a few contemporary works of folk music, that, in my opinion, are natural successors to the epic poems of antiquity. I continue the “epic poems” theme in this essay, but shift to the epic works of conflict; focusing on the rock and roll genre, as influenced by the Vietnam War, which remains in my memory as a chaotic and tragic period of American foreign policy history. 

However, discussions regarding ending the war in Afghanistan, America’s longest war, are again underway; and so, it may be a good time to revisit how we ended what will, consequently, become “America’s Second Longest War”. 

Returning to the original theme, songs that were inspired by past conflicts include “Yankee Doodle” (mid-1700s); “When Johnny Comes Marching Home” (1863); “Over There” (1917); “We’ll Meet Again” (1939); and “Boogie Woogie Bugle Boy” (1941).

In advance of reviewing the songbook of the Vietnam War, I provide, in the following, an overview of how the United States became entangled in Vietnam. 

However, my goal is to present the War at the “boots on the ground” level; i.e., from the perspective of the “grunts and jarheads”. Note that these are not insulting terms. In Vietnam, ‘grunts’ were U.S. Army and Marine Corps infantrymen, or foot soldiers. ‘Jarheads’, on the other hand, are USMC personnel of any rank; and the term is an homage to the high and tight haircuts worn by Marines.

I don’t feel that you can appreciate the music without understanding the war.

Vietnam: The War formerly known as “America’s Longest” (1954 to 1975)

The war in Vietnam was extraordinarily unpopular with Americans. There was no “Pearl Harbor” or “Nine-Eleven” at its beginning; and most Americans probably had only limited knowledge of that part of Asia. Vietnam was the first truly televised war. Camera crews were on-site almost continually; and journalists often recorded their coverage right in the field. Thus, Americans had a very realistic view of the devastation and violence of the War. 

The Threat of Falling Dominoes:

This map shows the partition of French Indochina after partition under the 1954 Geneva Conference. This file by SnowFire is licensed under the Creative Commons Attribution-Share Alike 4.0 license.

After armed forces led by communist leader, Ho Chi Minh, defeated French colonial forces in 1954, and ended nearly 75 years of French colonial rule, world and regional leaders passed the Geneva Accords, which divided Vietnam into the communist North and a more democratic South. 

President Eisenhower warned that the situation in Vietnam was like, “a falling domino, whose loss would lead to rapid and widespread communist victories in neighboring countries.”

Ho Chi Minh then sought to unify the two Vietnams under his communist regime; and precipitated the conflict that placed North Vietnam, with its Viet Cong allies in the South, against South Vietnam and its principal ally, the United States. 

The United States provided funding, armaments, and training to South Vietnam’s government and its military. Unfortunately, tensions rapidly escalated into widespread armed conflict, and President Kennedy expanded our military aid and committed to deploy soldiers to the region.

In his 1961 inaugural address, Kennedy had stated his belief that “U.S. security may be lost piece to piece, country by country, as the result of the domino effect”.

After Kennedy’s death in 1963, his successor, Lyndon Baines Johnson, continued down the same path, and further increased troop deployments. 

“Domino” was then used by successive administrations to justify continued escalation of our involvement in Vietnam. Note that Congress never declared war, and never formally gave the President the authority to escalate our presence in Vietnam until early 1964; and only after the “Gulf of Tonkin Incident”, during which the North Vietnamese fired on two American ships in international waters. 

At the same time, the Soviet Union and China were pouring weapons and supplies into the North; and providing combat troops for North Vietnam’s campaign against the South. 

By 1969, more than 500,000 U.S. military personnel were stationed in Vietnam, and the bulging costs and casualties of the war finally proved too much for Americans to endure, and a poorly-conceived peace agreement was negotiated by the Nixon Administration’s national security advisor, Henry Kissinger, in 1972.

The Paris Peace Accords resulted in the withdrawal of all U.S. and allied forces, the release of Americans who were prisoners of war, and a very loose cease fire, which was almost immediately violated.

The end of the Vietnam War actually occurred on April 30, 1975, after the Saigon government surrendered to the North. Over the next 12 months, North and South were formally united under the control of North Vietnam’s communist government, becoming the Socialist Republic of Vietnam.

Vietnam has estimated that nearly 2 million civilians (i.e., both North and South) perished; and over a million North Vietnamese and Viet Cong fighters were killed. The U.S. military estimates that nearly 250,000 South Vietnamese soldiers died in the war.

The American Soldier in Vietnam:

Between 1964 and 1973, the U.S. military drafted 2.2 million American men from an eligible pool of about 27 million. Historian, Christian Appy, observes, in “Working-Class War”, that the average U.S. soldier was 19-years-old, and from a poor or working-class family, and had not attended college.

A large portion of U.S. troops were African-American men from the inner cities, boys from farming communities, and the sons of immigrants from factory towns. Many of these men enlisted or were drafted right out of high school. 

These young soldiers found themselves in a land of intense heat and humidity, flooded fields, and dense jungles. It could rain nonstop for days at a time during monsoon season. 

They were not welcomed by the local farmers and villagers, but viewed with distrust or hostility. To the Vietnamese, this was the “Resistance War Against America”. 

The fighting conditions in Vietnam were “dreadful” and strained our military tacticians. Unlike past conflicts, Vietnam combat was not “conventional”; rather, it was guerrilla warfare; and the jungles made this form of attack very effective. Tactics included ambushes, sabotage, “hit-and-run” raids on our supply operations, and booby traps. Some civilians, including women and children, actively assisted the Viet Cong guerillas.

A US “tunnel rat” soldier prepares to enter a Viet Cong tunnel. Public domain.

An additional problem was the extensive underground system of tunnels, which was used by the Viet Cong; and “tunnel rat” became an unofficial specialty for those who cleared and destroyed enemy tunnel complexes.

The final Vietnam War tally was 58,148 killed and 75,000 severely disabled. Of those killed, nearly two-thirds were younger than 21-years-old; and the Marines accounted for a third of all American casualties.

Many of our servicemen were exposed to the chemical defoliant, Agent Orange; and hundreds of thousands of Vietnam veterans have died from their exposure to dioxin, the deadly toxin in Agent Orange. Dioxin can cause multiple cancers, peripheral neuropathy, and has also been linked to an elevated risk for Parkinson’s Disease. 

Epics of the Vietnam War Era:

“Stars and Stripes”, the daily independent news source for the military, named Vietnam “the first rock and roll war”. It was the Sixties, these were young men, and the songbook was immense. 

In the next essay, I will review a series of songs from that era that provide some insight into how many Americans responded to the War and expressed their opposition. 

Editor’s Note: This is the opinion of Thomas D. Gotowka.

Author’s Notes: On April 25, 2021 the New York Times reported 571,753 COVID deaths in the United States; nearly a ten-fold increase over our Vietnam War combat deaths. I recall how intense our response was to Vietnam casualty reports, which were eventually updated almost daily on the then still-trusted evening news. I don’t believe that we’ve ever mourned COVID deaths with that same passion.

Anti-Vietnam War protests increased remarkably in the United States through the 1960s, and the draft became the focus of organized resistance. Despite our technological advantages, larger forces, and better weapons, the Viet Cong were able to hold us off and prevent the United States from achieving any sort of victory in Vietnam from winning.

The public was never really in support of the war.

Tragically, our returning soldiers were often treated with contempt. These servicemen usually did a one-year tour of duty. Men came back from Vietnam by themselves rather than with their units; and, as one soldier shipped out, another returned home.

I served during the Vietnam War era, but the entirety of my active duty was at the Naval Hospital at NAS Pax River, MD. My patients were primarily Naval Aviators, and their ground or flight deck support, returning from or going to the war zone.

At the very least, in 1982, the Vietnam Veterans Memorial was dedicated in Washington, D.C., inscribed with the names of 57,939 members of U.S. armed forces, who had died or were missing as a result of the war.

My close childhood friend was killed in action, and his name, Gary John Shea, is engraved on Panel 61E Line 2 of the Memorial. I have seen the engraving.

About the author: Tom Gotowka’s entire adult career has been in healthcare. He’ will sit on the Navy side at the Army/Navy football game. He always sit on the crimson side at any Harvard/Yale contest. He enjoys reading historic speeches and considers himself a scholar of the period from FDR through JFK.

A child of AM Radio, he probably knows the lyrics of every rock and roll or folk song published since 1960. He hopes these experiences give readers a sense of what he believes “qualify” him to write this column.