2010 Braceland Seminar Recap

First off I have to say that the venue and the food were stellar. Everything we were served was made on premises; all of the baked goods, the desserts, even the granola at breakfast. The day started off with breakfast and stunning views from the 41st floor of the New Orleans Marriott as the sun rose over the city. The highlight of breakfast was little plates of house-cured salmon accompanied by chopped egg, onions, capers and lemon. I couldn't believe that people weren't snapping these up, so when the rush died down, I had four.

CAPT Noel Howard led off with an update on the DoD/VA Disability Evaluation System merger. Medical boards from start to completion are taking considerably longer than the "legacy" process, which we know, but CAPT Howard took time to identify the common pitfalls that make the new process even longer. He also showed that the new process actually increased, not decreased, the workload at the PEB. Over the next year as more MTFs adopt the new process, the PEB workload will increase even more, which may lead to additional lengthening of the completion timeline. Really good to know, but not good news.

CAPT Kevin Moore gave an unclassified retelling of his involvement in drawing guidelines for interrogations of detainees. As he always does, CAPT Moore gave us the facts, then dissected the facts first from an ethical perspective, and then from a legal perspective. The question he did not answer for us was, when these two perspectives diverge, which do you choose? There was a sidebar about how easy, or uneasy, it is to tell a Marine General Officer no.

Then we had our morning Starbucks coffee break with hot, fresh beignets. The beignets were scrumptious, but we also had bite-sized fruit tarts, which were little tart shells filled with custard and topped with perfectly arranged sliced fresh fruit.

LCDR Will Sauvé reviewed humanitarian assistance following the earthquake in Haiti, drawing from both his experience aboard USS Bataan and that of CDR Jan Carlton aboard USNS Comfort. Jan had hoped to be with us in New Orleans, but she was not able to attend. We got a first person account of the chaos and logistical hurdles that accompany a major disaster, and how that impacts the ability to render care.

Because we had an unforeseen gap in the speaker's schedule, I stepped in with a short talk about the current debate about homosexuals serving openly in the military, and what happened in my practice on Okinawa the last time this debate took place 17 years ago. I focused on the impact the debate had on the patients I saw, with the idea that past experience may foretell current and future practice trends.

Lunch. There is no describing the spread the Marriott put out for lunch. The soup and bread alone you could have made a meal of. Roast Corn and Shrimp Chowder, it was wonderful. The chopped salad with bacon and blue cheese would have made another meal, and it was accompanied by sliced, marinated steak. The sliced steak and the bread would have made a third meal. Then there was the massive bowl of pasta jambalaya and a oversized chafing dish of chicken simmered in poblano butter sauce. There were three desserts to choose from, but I didn't get that far, because we had awards to present.

First we had door prizes. The Mardi Gras beads I had hoped would entice Devin Shoquist to attend the Braceland for the first time went to LT Liz Yoder, because she claimed them if no attending stepped forward. New Orleans snow globes went to CAPT Noel Howard for having attended the most Bracelands and to CAPT Kevin Moore for having traveled the furthest to attend the 2010 Braceland. CAPT Gail Manos presented the Hogan Award to LT Karis Stenback of San Diego for the best resident research paper.

CAPT Warren Klam accepted the Sears Award for outstanding contributions to Navy Psychiatry. CAPT Klam delivered remarks on many of the developments that impacted the community during his five years as Specialty Leader. It was a very touching moment as the community recognized CAPT Klam's service, his dedication to duty, and the personal integrity he brought to the job. Integrity, he reminded us, was not simply an internal ethic, but what one shares with others when together they confront difficult problems. He spoke about how difficult it was to ask people to deploy, while at the same time trying to balance the needs of each individual versus the demands on the community.

After lunch CAPT Manos gave us her unflinchingly candid talk on the state of manning in Navy Psychiatry. As usual, there was little good news in the short term. But I think that everyone took away the idea that CAPT Manos is the best person we have to protect and defend our interests amongst all the powerful competing interests.

Then we had the residents' presentations, which are always my favorites. LT Amy Canuso from San Diego spoke on a case of beriberi. LT Emad Daniel from Portsmouth gave a case report of catatonic illness. LT Kristine Muñoz from San Diego reported a case where non-native and native-language speakers reached different diagnostic conclusions, and thus different treatment recommendations. LT Karis Stenback from San Diego gave an abbreviated version of her Hogan Award paper, how bupropion improved firearms prowess, which touched off a discussion about the prohibition of carrying a weapon while taking medication. LCDR Paulette Tucciarone from Bethesda spoke on instituting a process to notify providers and encourage healing in the aftermath of patient suicide. I found LCDR Tucciarone's short talk about physicians taking care of physicians compelling because it showed not only the research she performed, often hitting brick walls, but also her resilient determination to craft a process in the absence of one, which is one of the definitions of leadership. LT Liz Yoder from Portsmouth took us out with a talk on HIPAA, giving a personal perspective and all she learned when she was accused of violating a federal law. It doesn't get better than this.

During the residents' presentations we were served more food, but we didn't take a formal break. We had these huge cookies, oatmeal raisin, chocolate chip and macadamia nut. There were dainty coconut and almond macaroons, organic fruit and assorted sodas.

I cannot end without acknowledging those who made the Braceland possible. LTs Emad Daniel and Mike Okasinski from Portsmouth provided their laptops and the projector to coordinate the presentations. Ms. Dottie Vexler at Portsmouth did untold and truly impressive work to provide us with CME credits. CAPT Gail Manos stoked the fire whenever it burned low.

The day was stunningly wonderful, made so by our event coordinator at the Marriott, Kristen Moody, and the Marriott staff and chefs who treated us with their immense talent and their utter dedication to service.

The beautiful sweet and savory taste of New Orleans is still fresh on our tongues, but now that it is over, we have to reluctantly turn our attention to next year. The Braceland will be in Honolulu next year, Friday the 13th May 2011, save the date.