Nicole Mitchell's 'Hope, Future and Destiny'

DATE July 11, 2005 ACCOUNT NUMBER N/A
TIME 12:00 Noon-1:00 PM AUDIENCE N/A
NETWORK NPR
PROGRAM Fresh Air

Interview: Dr. Francis Dufrayne talks about his recent experiences
in Iraq as a Naval Reserve physician
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

The war in Iraq has relied heavily on Reserve and National Guard members, who
make up about 35 percent of the troops in Iraq. But that share is expected to
drop to 30 percent by next year. The lead story in today's New York Times is
about the steep decline in Reserve and National Guard troops on domestic and
overseas missions. The main reason for this decline, according to military
personnel specialists, is that more and more of these troops are nearing their
maximum 24-month call-up limit.

We're going to hear the story of one Reservist who was called to Iraq, a
doctor I know named Dr. Francis DuFrayne. He's a captain in the Navy Reserve
and is in his mid-50s. His 28-year-old son, who's a captain in the Marine
Corps Reserve, was called to serve in Iraq at the same time. Dr. DuFrayne was
based in the Iraqi town of Ramadi for six months. He returned to the States
in early April but remained on active duty until early May. We invited Dr.
DuFrayne to talk with us about what it was like to leave his Philadelphia
gastroenterology practice to practice military medicine in a war zone. Dr.
DuFrayne is an assistant professor in medicine at the University of
Pennsylvania and is on the executive committee of Pennsylvania Hospital.

Dr. DuFrayne, were you surprised to be called up to actually go to Iraq?

Dr. FRANCIS DuFRAYNE (Gastroenterologist, Pennsylvania Hospital; Assistant
Professor in Medicine, University of Pennsylvania): No, actually, I wasn't
surprised, because I'm in a unit that is, in military terms, called an
operational unit. You know at some point you can be called to go back to
active duty and to go to different parts of the world. I've been in the
military and the Reserves--active duty in the Reserves for a long time. I
always knew that this was a possibility. I've pretty much stayed in
operational medicine my whole time in the military, so I knew more than likely
at some point I would be going overseas.

GROSS: What was your family's reaction?

Dr. DuFRAYNE: Very supportive. Luckily for me, I--my wife and I got married
while I was on active duty in the military. I had a...

GROSS: This was when you were in the Navy in the '70s.

Dr. DuFRAYNE: When I was in the Navy in the early '70s. And I had about a
12-year gap when I came out of the Navy. I had to go to college and medical
school, all my training, and at the end of my training, I said to my wife,
`You know, now that all this is done, I'd actually--would like to go back in
the--go into the Reserves.'

GROSS: Why did you want to go back into the Reserves?

Dr. DuFRAYNE: You know, I really benefited from my time in the service. I
was 18 when I went in the military. I really didn't know what I wanted to do.
I was basically given the assignment of being a corpsman, or a medic. In the
Navy, medics are called corpsmen. I had no interest in medicine whatsoever
before then and, in my time in active duty, really learned to love it, and it
really kind of pointed me in the direction. So having come out, I went to
college on the GI Bill, and when I was done everything, I thought, `You know,
now I'd really like to serve. I can really give back what I've learned.' And
that was really important to me.

GROSS: So when you were called up for active duty, you were sent to Ramadi in
Iraq?

Dr. DuFRAYNE: I was--the process of being called up is, the unit is
activated, and our unit goes anywhere from northern North Carolina to northern
Pennsylvania. We all are then sent to a training base, and our training base
was in Port Hueneme, California. From there--I spent about six or eight weeks
in Port Hueneme going through training, getting us sure everybody's medically
ready and physically ready and go through the training of what we do. And in
from there, we flew to Kuwait, stayed in Kuwait for about a week and then went
up into Iraq. And where I was stationed was in the town of Ramadi.

GROSS: And describe Ramadi and where it fits in in terms of the fighting...

Dr. DuFRAYNE: OK.

GROSS: ...and the insurgency in Iraq.

Dr. DuFRAYNE: Ramadi is in the western part of the Sunni triangle. It's
about 50 or 60 miles directly west of Baghdad. So if you draw a straight
line, you have Baghdad; about 20 miles outside of Baghdad you have Fallujah.
About 30 miles west of Fallujah is Ramadi. And they're all part of the Sunni
triangle.

GROSS: Were you in a hospital, in a clinic?

Dr. DuFRAYNE: No, we were on--I was on a base. The base itself was actually
called Camp Ramadi. It was a fairly large military complex. It was an old
Republican Guard base. And on that base there were eight or nine different
units, several Army units, several Marine Corps units and the one Navy unit,
and that's what comprised the whole base. There was no hospital there. There
was a small clinic run by the Army. It was a separate unit that the Army
brought in to help take care of the sick and wounded. But I was actually--I
stayed with my unit. I was the medical officer for the large Navy unit there.

GROSS: Were there times when you were dealing with combat injuries?

Dr. DuFRAYNE: Yes. While we were there--when we first got there in September
and October, the area we were in was fairly active. We would have rocket or
mortar attacks four or five times a week on the base. So if anybody was
injured in that, you would take care of them. And then outside of the base
itself in the town of Ramadi, there could be combat injuries at any time. And
they would bring those people back into the base where we would take care of
them, stabilize them, get them ready for transport to a surgical unit. And
that's how we took care of them.

GROSS: Did you have to treat a lot of stress-related illnesses? You know,
because I'm thinking some of the people there might not have seen combat
before and might have been really worried about it. I mean, just from reading
accounts of people in war, I know that there's a lot of stress-related--for
instance, gastrointestinal disorders, and that's your speciality. I mean,
you're a gastroenterologist. And, you know, one of the hazards of war--May I
say it bluntly on the air?--is diarrhea.

Dr. DuFRAYNE: Right.

GROSS: So, like, what was it like for you to be seeing that problem that's,
like, combat-stress-related as opposed to seeing patients in your practice in
Philadelphia?

Dr. DuFRAYNE: Right. The stress actually--there was a lot of stress,
obviously, you know. They're in a--and everybody's in a pretty harsh
environment. The stress really came out in several ways. First of all, when
we were in California, you could--and the closer we got to going, you could
start to see some stress issues come out, and everybody handles it
differently. And that's--one of the challenges is to figure out, is this a
real physical complaint, or is this someone who's really having a stress
reaction? And it's coming out, you know, in different ways or different
manifestations of it. So that part was a challenge. When we got there, early
on, believe it or not, a lot of the stress issues went away because people
were really focused. They were in a new environment; there were a lot of
things they had to learn; it could be very dangerous or hazardous at times.
As we really acclimated to that, then I started to see some of the stress
issues coming out again. And--but for the most part--I don't want to really
overstate it--people performed very well. And I would say while we were
there, the stress issues were really at a minimum.

GROSS: Did you have to play a therapist a little bit in order to figure out
what was stress-related and what was more of a physiological problem?

Dr. DuFRAYNE: Yes. Yes, I did. And that is really for me one of the
benefits of being with my unit for some time because I knew everybody fairly
well. So when they would come in and I would start to see you the second or
third time for a similar problem and I could really see that there was no
physiological basis for it, then we would really start to sit down and start
to talk about stress issues and how they're handling things--Are there worries
back home? Are there worries here?--and see if we could help people deal with
things.

GROSS: To which I'd say, `Of course there's worries back home and worries
there.'

Dr. DuFRAYNE: Of course. But...

GROSS: So, I mean, everybody was dealing with that, so it's not anything that
you can fix. And, I mean--and when you're dealing with your civilian
practice, you could probably tell your patients, `Well, I know this will be
hard, but try to work a few less hours a week.' But what are you going to
tell to somebody who's in Iraq about how to cut down on the stress in their
life?

Dr. DuFRAYNE: You really--you're right. You can't really tell them, you
know, everything's OK. Everything will be all right. Work less, take it
easy, you know, take Sunday off.

GROSS: Yeah, right.

Dr. DuFRAYNE: There were no off days.

GROSS: Yeah.

Dr. DuFRAYNE: But what you really try and do is help them to figure out
what's causing their stress and then hopefully come up with some mechanism
where they can deal with it a little bit better. You know, some people
weren't calling home enough. You could call home. And some people thought it
was better not to call home because they didn't want to worry their families.
But then they were getting stress on top of it from not hearing from their
families. So you start to look at what the issues are, and for everybody, the
issues are really--it's different with every person that came in.

GROSS: What are some of the other physical manifestations of stress that you
saw?

Dr. DuFRAYNE: I saw--for physical, I saw a number of people who had no
problems with hypertension before, high blood pressure. And all of a sudden
they were starting to show with high blood pressure. Some GI complaints,
stomach pains, those types of things, decrease in appetite. Started to deal
with some sleeplessness the longer the tour went on. So those were some of
the more common issues.

GROSS: Take sleeplessness. At what point do you prescribe a sleeping pill?

Dr. DuFRAYNE: While you're there you really try not to because in the middle
of the night if something happens, I really can't have you groggy in bed and
not reacting. So if it's related to some stress event that we can help you
deal with it, you know, that's fine. If not, sometimes I had to almost stand
a person down for a couple days. Let's relieve you of your duty. Let's have
you take it easy. You know, these are the things I want you to do. I want
you to go the gym. I want you to get some sleep. I want you to, you know,
you know, visit the dining hall, you know, more regularly than you have been.
And helping them really overcome that acute episode. But, no, we really
didn't prescribe sleeping pills or sleeping aids while we were there.

GROSS: This is a question that's it's going to be difficult to ask, not
because it's emotional, but because it's graphic. But--I've never been in a
war, but from the war literature--I mean, I know fiction and non-fiction. I
know about a lot of people, the first time they're in combat, they mess
themselves. And, I mean, as a gastroenterologist, that's like part of your
issue, you know, as a civilian doctor. If soldiers told you that that had
happened to them and it upset them or scared them, or embarrassed them, what
kind of advice could--or help could you give them?

Dr. DuFRAYNE: Basically, what I would tell them is, one, physically there's
nothing wrong with them, that it can be a fairly normal response to a very
stressful situation, that they're--you know, they're here talking to me about
it. What they don't realize is how many other people are also in talking to
be about it and that they're not in an abnormal situation or they're not
having an abnormal response, that it can be a fairly normal response to some
pretty intense emotions or reactions. So I really try and just reassure them
that, `You're normal. You're as normal as the rest of us.' And, you know,
just because it happened once doesn't mean it's going to keep happening. It's
not a chronic or a recurrent problem and that, you know, they're doing just
fine.

GROSS: And how would that go down?

Dr. DuFRAYNE: Most of the time really well. I--what Marines and soldiers
and sailors really worry about is, `Am I measuring up? Am I as good as the
next person? Am I letting my buddies down?' so to say--so to speak. So the
best thing you can do is reassure them that, `Your buddies are having the same
problems, that you're no different than anyone else. This is a really
stressful environment and things happen to all of us.' And just by letting
them know that they're not out of the norm, they really accept it very well
and handle it much better.

GROSS: Did you ever feel at sick call that a soldier was trying to play you
and to, like, act sicker than they were so they could be relieved of their
duty for a bit?

Dr. DuFRAYNE: Yes. I would say for all medical officers in every branch of
the military, there's always that small percentage that doesn't want to do
whatever that assigned task is for that day. So an easy out is to say, `I'm
not feeling so good.' So then you go and see the corpsman or the medical
officer, and they try and figure it out. And for the most part, you try and
give people the benefit of the doubt. It's when you start seeing the same
person over and over and you start--then you have to start questioning, `Why
am I seeing you three times a week for relatively minor things?' So then you
have--your degree of suspicion goes up a little bit and you pay attention to
it a little bit more.

GROSS: Did you have to deny people--do you have to call people on their
alleged illnesses?

Dr. DuFRAYNE: Yes, and I really tried to be straightforward with it. I
would, you know, start to say, `Hey, you know, I'm really seeing you more
often in sick call for really minor things. So it really, for me, kind of
raises the question in my mind is, is there something else going on that you
and I need to talk about? Is there--you know, are you having problems? Are
there--are you having a hard time adapting? Is, you know, something going on
in your work space that maybe I can help with?'

GROSS: My guest is Dr. Francis DuFrayne, a gastroenterologist who is also a
captain in the Navy Reserve. He recently returned home after serving six
months in the Iraqi town of Ramadi.

We'll talk more after a break. This is FRESH AIR.

(Soundbite of music)

GROSS: My guest is Dr. Francis DuFrayne. He's a gastroenterologist who's
based in Philadelphia. He's been in the Navy Reserves for years and was
called up and served six months in Iraq practicing as a doctor in Ramadi. He
recently returned home.

One of the things you had to decide is whether a soldier's wound was bad
enough to send them out or send them home. It's dangerous to fly in Iraq. I
mean, you could get shot down in a 'copter getting sent out to a better
medical facility. Did that figure into your decision about when to fly
somebody out?

Dr. DuFRAYNE: Yes. In a nutshell, yes, because, just like you said, it
is--particularly in the daylight hours it can be very risky. So if you're
wounded, if you come in, we have to decide right then and there, `Are you
stable? Is this a wound that can wait a couple hours and we can do a more
routine medical evacuation?' If you really have life-threatening or anywhere
close to life-threatening, they we'll medevac you at any time, and that was
really our approach to things.

For people who didn't have war-related wounds or, you know, you could fall
and twist your knee or--that part really was a little bit more difficult,
because we didn't really have the capability on my base to do anything
extensive. So you really had to decide, `Is this an injury that is going to
require more medical care and it's beyond what I'm capable of giving right
now?' and then try and make arrangements to medevac the patient.

Sometimes when people would come in and you really--you know, if you had an
injury, if you pulled a muscle, if you--I would frequently say, `You have to
let me know. Is this bad enough that I really need to make arrangements to
send you to Baghdad to have a specialist's care?' knowing that that's always
a possibility.

GROSS: How do you think the system could be improved? Does it need
improvement, the medical system?

Dr. DuFRAYNE: We actually talked about this amongst ourselves--all the
physicians--while we were there. I would say our biggest need for improvement
would be communication within the units. So if I am seeing you as a patient
and I need to send you down for further care, once I send you to the next
place, they really take over and rightfully so. They're now responsible, and
they could send you on to Germany or somewhere else, and I would not know
about that for a while. So it really was more of a communication in between
the units with the understanding that communication for a number of us was
difficult to begin with. You could communicate by e-mail a lot of times. The
phone service in between the military bases was adequate, but some bases were
really a little bit more isolated, and it was much harder to get them on the
phone.

GROSS: What were the scariest moments for you in Iraq?

Dr. DuFRAYNE: Probably several things: the rocket and mortar attacks on our
base, though they were short-lived because generally they would fire a couple
of rockets and then would leave the area where they were firing them pretty
quick. So it was nothing sustained, but it happened so quickly, you're not
prepared for it at all, and all of the sudden, it's there and it happens. So
that could be a pretty scary moment for everyone.

Flying also at times could be nerve-wracking in that you're really exposed.
So luckily for me, I really did no flying during the day. All my flying was
at night, which is a much safer period.

GROSS: Now you're back just a few weeks from Iraq. Are you still in the
Naval Reserves?

Dr. DuFRAYNE: Yes. I've been back now about six weeks. The tour of the
unit that I'm with--about every two or three years we change units. So I'm
actually at the end of that tour. So sometime in September I have to decide
whether or not to go to another unit, or is it time to retire? I've been in
the military now a total of about 24 years. So I can retire really when I
want.

GROSS: How are you going to decide whether to retire or not?

Dr. DuFRAYNE: It's actually been very tough. I've been thinking about it.
Is it, you know, time to retire? But I've always promised myself as long as I
enjoy what I'm doing, as long as I still have the desire to serve, then I'm
going to continue to do that. So I thought about it when I came back. It was
an active discussion. My wife has always been very supportive of both my son
and I; you know, my son's also in the military. And it really comes
down--it's always been her stance that it's really our decisions. It's what
we want to do. So I've had a lot of family support, and it's a tough
decision, but I think I'm going to continue to serve.

GROSS: Your son is in the Navy?

Dr. DuFRAYNE: My son is in the Marine Corps.

GROSS: In the Marine Corps, OK. So did you encourage him to join?

Dr. DuFRAYNE: Did not. It was actually--the way it came about was our son
was in college. He was about half-way through his second year and came home
on a weekend visit and started talking to my wife and I about--he would
actually like to think about going in the Marine Corps, which really took both
of us by surprise, because it was nothing he really ever discussed or pursued
before that. He wanted to know what our thoughts were and basically what we
told him was it really is his decision. Whatever he decides, he has our
support. So--but, no, it was not--it was just in medicine. I never
encouraged or discouraged my children from entering medicine. It's the same
for serving. If you feel that calling to serve, then by all means do it. But
if not, there's no pressure there to do it.

GROSS: Dr. Francis DuFrayne lives in Philadelphia. He's also a captain in
the Navy Reserve and served in Iraq for six months. He'll be back in the
second half of the show.

I'm Terry Gross, and this is FRESH AIR.

GROSS: This is FRESH AIR. I'm Terry Gross back with Dr. Francis DuFrayne, a
gastroenterologist in Philadelphia, who's also a captain in the Navy Reserve.
He was called to active duty in Iraq and spent six months practicing military
medicine in the town of Ramadi. His 28-year-old son is a captain in the
Marine Corps Reserve and was called to serve in Iraq at the same time. Dr.
DuFrayne returned to the States in early April but remained on active duty
until early May.

So you were in Iraq the same time your son was?

Dr. DuFRAYNE: I was. We both were mobilized within about two weeks of one
another, and it wasn't a surprise. We both knew; we both had a good six-week
notification. He left for Iraq about two weeks before I did, and we were both
there at the same time.

GROSS: Did you try to see each other?

Dr. DuFRAYNE: We did not. That's one promise we actually made--was that we
would not go out of our way--knowing the dangers of travel, that we would not
go out of our way to see one another. If we happened on one another, then
that would be a great thing, but we ended up not seeing each other.

GROSS: Until you returned home. Tell the story.

Dr. DuFRAYNE: Yeah, until I returned home. I was in--the way the Navy and
Marine Corps bring you out is they will bring you home--is they do it in
stages. So for me, my stage was I left Iraq, went to Kuwait, spent a little
bit of time in Kuwait kind of decompressing and starting to go through the
process. And in--the only way I could communicate with my son was by e-mail
because you didn't really have good phone service on his base. So I knew his
window of returning to the States, and it happened to overlap my being in
Kuwait getting ready to leave.

So, by chance, one day I happened to drive--it's about five miles away from
where I was--I drove down to the next base where I thought he would possibly
be coming out and was able to find him and found out, just in discussing him
that day after we were in--you know, with each other for an hour or so, that
just by chance we both happened to be leaving for home that night, and we were
both on the same plane.

GROSS: So did you sit next to each other?

Dr. DuFRAYNE: We did. It was actually funny. I--because of my rank, being a
Navy captain, it's a fairly senior rank for people who are serving, and I was
able to go on the plane in one of the first waves. So not only did I reserve
my seat; I reserved the seat next to me.

(Soundbite of laughter)

Dr. DuFRAYNE: So I went back to the door, and there was a young Marine
officer. And I said, `When the other Captain DuFrayne comes on board, could
you please send him up front?' So he came up and, you know, wanted to know
what was going on. I said, `Look, we got seats together.' So we actually
were able to spend the whole time, whole flight, coming home together.

GROSS: Did you allow yourself to think about his safety while you were there?

Dr. DuFRAYNE: I really tried not to think about what he was doing or what he
was involved with because I was not able to really be in communication or
contact with him. You really try and keep it in the back of your mind, so
that doesn't really overtake what you're trying to accomplish yourself.

GROSS: How many weeks have you been back from Iraq?

Dr. DuFRAYNE: About 10 weeks.

GROSS: Has it been hard for you to get yourself back into your civilian life
after having spent six months as a Navy captain practicing medicine in Ramadi?

Dr. DuFRAYNE: Yes. I don't think it really had to do so much with being in
Ramadi itself, but being away for a while, living at a level of intensity that
is much higher than what your normal lifestyle is. Yes, it actually was--it
took me a while to come back and start to feel like I'm fitting in.

GROSS: What was the hard part?

Dr. DuFRAYNE: Believe it or not, going back to work. My wife really set it up
so that when I came home--when I was home for a couple weeks, it was actually
very quiet; did a lot of things around the house. We took a little trip, did
those kind of things. But after a couple weeks when I went back to work, it
was a little bit more of an adjustment in that I was around a lot more people,
people I haven't seen in a long time, people who were really concerned about
me. So for the first week or so I really had to spend some time--and I really
planned it in my schedule coming back. I kept a very light schedule and spent
time speaking with people and kind of letting them know that, you know, I'm OK
and my family's OK. And so that part was a little tough. And then after
that, it's actually been fine. I've been back to work now for about three
weeks.

GROSS: Is seeing your patients different now because, you know, you have
patients dealing with--well, you deal with everything. You deal with cancer.

Dr. DuFRAYNE: Right.

GROSS: But you also deal with just, you know, like, nervous stomachs as we
might put it.

Dr. DuFRAYNE: Right.

GROSS: You deal with a--you know, as a gastroenterologist, who deal with a
whole range. And people get very caught up in their daily lives, but, you
know, we may be overwrought with daily life here, but we're not in a war
situation like Iraq. So do you ever feel like saying to your patients, `Oh,
you have it easy compared to what's in Iraq'? Or how do you see it?

Dr. DuFRAYNE: No. Actually, it's funny. My patients feel that way more than
I do. When I first started seeing patients again, a lot of times their first
comment was, `This is really nothing compared to what you were seeing.' And
what I really try to reassure them is even when I was in Iraq, I saw all
levels of illnesses and complaints and--just like I do in my daily practice.
So you really try and take each moment for what it is. You know, `I'm helping
you with your problem now, and when we're done, I'll move on to the next
problem, the next medical issue, which may be a lot more serious or a lot less
serious than yours.' But you really have to take each one individually. So I
actually think it was harder for my patients than it was for me.

GROSS: We've been reading a lot here about post-traumatic stress disorder
and, you know, a lot of people coming back from Iraq and having stress-related
problems, having a lot of trouble reorienting themselves to life here. And a
lot of people, you know, come back and they don't have a job, or their
business collapsed in their absence. And I'm wondering if you have friends
who were in the Reserves with you who had any problems like that.

Dr. DuFRAYNE: It turns out that the post-traumatic stress disorder--and
that's what they now call, you know, combat stress or combat fatigue--that
post-traumatic stress disorder is more common than you would think. There
have been studies, you know, showing that in the post-Vietnam era. And most
recently a study came out last summer in The New England Journal of Medicine
about post-traumatic stress disorder in people involved in fighting in Iraq
and Afghanistan. And it turns out it's probably in the order of 15 to 20
percent of individuals who are exposed to that.

GROSS: So do you have friends who've had to deal with it?

Dr. DuFRAYNE: Yes.

GROSS: What are some of the symptoms you're hearing about from friends?

Dr. DuFRAYNE: Well, it turns out, as being the unit medical officer, it's
really my responsibility for my unit...

GROSS: Ohh.

Dr. DuFRAYNE: ...to identify it and help people to deal with it.

GROSS: Even when they're home.

Dr. DuFRAYNE: Even when they're home. So...

GROSS: Ohh. So what do you do?

Dr. DuFRAYNE: ...the stress really doesn't necessarily come out while you're
over in Iraq or in Afghanistan. It--the peak of it probably comes within
three to six months--you can really start to identify it three to six months
after you leave the situation. So some people experience it while they're
there, but I would say the majority of people don't experience it until
they're out of that situation and finally get back into a normal life.

GROSS: So what are the symptoms that people are calling you about?

Dr. DuFRAYNE: Sleeplessness, irritability, signs and symptoms of depression,
nightmares. There are a whole host of things that we look for. You know,
flashbacks, inability to control kind of pervasive thoughts; you know, `I
don't want to think about that right now, but I can't stop thinking about it,'
that type of thing. And when you start to show or exhibit those signs or
symptoms, then we really try to help you deal with that.

GROSS: How?

Dr. DuFRAYNE: For Reservists--and I really deal with the Navy
Reservists--luckily for us, we're--the unit that we report to--I'm with the
battalion; the battalion always reports to a division. There's a senior
medical officer at our division, Dr. Bob Kaufman(ph), who, one, was one of
the authors of that study I was just telling you about, and, two, he's a
psychiatrist. And he really helps each individual unit, helps each medical
officer, for one--he's kind of the person who keeps an eye on me--and, also,
comes to our units. He'll be coming to our unit shortly, and we'll really
start that process of screening. We screen everyone who goes over. So we try
and screen and identify. And if we really think you're starting to exhibit
problems, we'll refer you to the Veterans Administration's post-traumatic
stress disorder clinic. The Veterans Administration really does a great job
with them ...(unintelligible).

GROSS: Are you having any symptoms?

Dr. DuFRAYNE: Luckily, no. So far I've been very good. It's--you know, only
been out of Iraq for about 10 to 12 weeks, but so far, no, I have no problems
with sleeping. I really have none of that. The thing I did have, which in
interviewing or speaking with the people in my unit--for the first couple
weeks I really had a feeling of indifference; that, you know, you're kind of
blase about things. Luckily for me, that passed pretty quickly.

GROSS: Did you find you were indifferent to things? Is that what you...

Dr. DuFRAYNE: I also found out I was indifferent to things.

GROSS: And did that upset you? Did there...

Dr. DuFRAYNE: It actually upset me. It's funny, you--as a physician, you look
at things more clinically, so it's like, `Those are the things that happen to
other people, and I'm here to help them deal with it.' And then all of a
sudden it's like, `Wow. Why is it happening to me?' So, yeah, it's a little
upsetting at times. So, luckily, though, that lasted for a couple weeks, and
then it really ended, and since then I've been fine.

GROSS: My guest is Dr. Francis DuFrayne, a gastroenterologist who's also a
captain in the Navy Reserve. He recently returned home after serving six
months in the Iraqi town of Ramadi. We'll talk more after a break. This is
FRESH AIR.

(Soundbite of music)

GROSS: My guest is Dr. Francis DuFrayne, a gastroenterologist who's also a
captain in the Navy Reserve. He recently returned home after serving six
months in Iraqi practicing medicine.

I don't think you'd really want to get into a discussion about the politics of
the war, and that's really not what we invited you to talk about. But I know
the issue for you in the military is service. And when you enroll for that
service, you don't know what kind of conflicts your country's going to get in
and what you're going to think of them. So is it, on some level, irrelevant
to you what this specific conflict is about in terms of the service that you
want to perform to the men and women who are fighting for, you know...

Dr. DuFRAYNE: To a degree, yes, in that if I so opposed the action that our
country was taking, if I really thought that what we were doing was immoral, I
always have the option to walk away, to resign or retire. So, on one level,
that possibility's always there, but the much stronger pull for me really is
the service--is--I watch what a lot of these young men and women do, and it's
truly phenomenal. And as a medical person, I really feel that, you know, a
lot of medical people really needed to be there to support them. So that pull
for me is much stronger than what the politics of any of this particular
situation or any particular situation is.

GROSS: The war in Iraq has been, in many ways, an unpopular war in the United
States. Is that something that affected you while you were serving, or is it
affecting you now that you're back? Do you feel like your work was
undermined, that people here were unappreciative of you and your fellow
Marines risking their lives?

Dr. DuFRAYNE: Actually, no. It's really been the opposite in that, for me,
having the benefit of being a Vietnam-era veteran; I didn't serve in Vietnam,
but I was in the Navy at that time. And almost anybody in uniform was, you
know, criticized fairly regularly. Having gone through that and now having
gone through this, for us, it's really been the opposite. The response of the
American people has really been phenomenal. Between mailing things over to
us--it got to the point that when the mail would come, we would just be
inundated with packages from people I know, people I don't know, concerned
people sending you over, you know, almost anything you could possibly think
of.

And now that I've been back, I can't tell you how many times people, either my
patients, family, friends, people who just really met me once or twice--I see
them again and they're like, `You were in my thoughts and prayers constantly.
We were really concerned about you. We were'--so, no, for me it's been the
opposite. And the same has been true--in speaking with my son and other
people, the response for them has also been the same; that the overall
feeling--even though there is some opposition, it's really they're opposed
more to policy than to the people who serve.

GROSS: Well, Dr. DuFrayne, it's good to have you back. Welcome back to
Philadelphia and the United States and glad that your health and well being
was good throughout the time you served. Thank you.

Dr. DuFRAYNE: Thanks, Terry. It was a pleasure.

GROSS: Dr. Francis DuFrayne is a captain in the Navy Reserve. He's an
associate professor of medicine at the University of Pennsylvania and is on
the executive committee of Pennsylvania Hospital. His son, Fran DuFrayne, is
a captain in the Marine Corps Reserve. The two DuFraynes were called to
active duty in Iraq at the same time. As Dr. DuFrayne described earlier,
they flew home on the same plane. We called his son, Fran DuFrayne, who is
now a research associate at the Center for Strategic and International
Studies.

What was your reaction when you knew that you and your father would be in Iraq
at the same time?

Captain FRAN DuFRAYNE (US Marine Corps Reserves; Research Associate, Center for
Strategic and International Studies): I was just glad I wasn't the one who
had to tell my mom.

GROSS: Right. Did that job fall to your father?

Capt. DuFRAYNE: Yes. I was actually activated first. And then right as I was
leaving to go do some additional training, about two weeks later he got
activated.

GROSS: When I asked your father if he ever thought about the possibility of
seeing you while you were both in Iraq, he said that that would have been a
really difficult thing to do; he didn't really think about that because travel
itself was so dangerous; that even if one of you could have gotten away to
make the trip, it really would have been too dangerous to think about. Did
you have the same kind of reaction?

Capt. DuFRAYNE: Yeah. I mean, number one, our operational tempo was very
high, so we didn't have a whole lot of time to really consider it. And even
if we had, the ground that we would have to cover to get from where I was to
where he was was fairly dangerous. So we had just decided that it wasn't
worth the additional risk and that if we just kind of ran into each other by
chance, that that would be great. But I think you're so preoccupied with the
job--and I had a platoon of Marines that I was responsible for, so I don't
really think--you know, you try not to think about it all the time.

GROSS: Would you describe the work that you were doing in Iraq, and tell us
where you were?

Capt. DuFRAYNE: We were in a town called Mahmudiyah, and I'm a combat engineer
platoon commander. And we were--my platoon was responsible for supporting an
infantry battalion and their operations in zone. My job really consisted of
working with my guys to provide whatever construction needs the battalion
needed but also to do weapons cache searches and destruction.

GROSS: What kind of construction work did you do?

Capt. DuFRAYNE: Mainly for us, it was establishing either forward operating
bases or checkpoints between forward operating bases.

GROSS: Some of those checkpoints have been very controversial. I mean, it's
mostly the--what happens at the checkpoints that's been controversial. I'm
sure you heard stories of people being shot going through checkpoints who were
Iraqi civilians who had no weapons and didn't intend any harm. Is that
something you were concerned about while building the checkpoints, or is that
really not your issue?

Capt. DuFRAYNE: Well, no. I mean, it's everyone issue, and, you know, we were
obviously concerned about it in building the checkpoints 'cause we didn't want
to do any harm to the civilians who, you know, were not really involved or the
ones that were cooperating with us. And, you know, the intention of the
checkpoint is to identify insurgents or people trying to harm innocent
civilians. So we're very careful to make sure that the checkpoint is easily
understandable and that--you know, put signs out, so people understand what's
going on and, you know, try to help ease the confusion a little bit.

GROSS: Is it dangerous building the checkpoints 'cause they're pretty
unpopular among a lot of people in Iraq?

Capt. DuFRAYNE: It is dangerous to a point because you're in a static position
at that point and you're somewhat exposed.

GROSS: Were you fired on while building them?

Capt. DuFRAYNE: Occasionally.

GROSS: Now your father told us that you ended up flying home together.

Capt. DuFRAYNE: Yes. It was actually a pretty funny coincidence. We hadn't
seen each other the whole time that we were over there, and he stopped by to
visit the tent that I was in when we were in Kuwait. And just through
conversation, we realized that we were on the same flight later on that day.
We hadn't actually spoken the whole time we were over there. We'd e-mailed a
couple of times, but we hadn't actually spoken. So it was nice to just kind
of sit down and compare experiences and just talk about, you know, family
matters and just enjoy the time together.

GROSS: Did your mother meet the plane?

Capt. DuFRAYNE: No. Actually, when we landed, we just left and had to go our
separate ways with our units, to go to different bases, to go on with our
deactivation process.

GROSS: Oh, so it wasn't this dramatic double homecoming.

Capt. DuFRAYNE: No, no, it's not like you see in the movies.

GROSS: No, it's not...

Capt. DuFRAYNE: We just kind of landed and hopped on the bus and went to our
bases and spent some more time deactivating and then, you know, eventually
headed back home.

GROSS: Thank you very much for talking with us.

Capt. DuFRAYNE: OK. Thank you for having me.

GROSS: Fran DuFrayne is a captain in the Marine Corps Reserve. He served in
Iraq at the same time as his father, Dr. Francis DuFrayne, who we heard from
earlier.

Coming up, jazz critic Kevin Whitehead reviews a new CD by flutist Nicole
Mitchell. This is FRESH AIR.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Review: Nicole Mitchell's "Hope, Future and Destiny"
TERRY GROSS, host:

Flutist, composer and singer Nicole Mitchell comes from Chicago, where she's
a member of the musicians' co-op the Association for the Advancement of
Creative Music. She's one of the few prominent women who've passed through
that organization. Jazz critic and former Chicagoan Kevin Whitehead says
Mitchell's a terrific flute player, but that's just the beginning.

(Soundbite of "Wondrous Birth")

KEVIN WHITEHEAD reporting:

Flutist Nicole Mitchell's tune "Wondrous Birth"--a tip of the hat to South
African kwela, a jazz style that evolved from street-corner pennywhistle
music. The mother cottoning is a touchstone for Mitchell. The previous album
by her Black Earth Ensemble was called "Afrika Rising." The music we're
hearing today comes from their latest CD, "Hope, Future and Destiny," where
she's doled as Nicole Margaret Mitchell. Her compositions are peppered with
references to musics of the African diaspora. There's a bit of reggae, gospel
and classic soul in the mix. And the ensemble's billowing polyrhythms may
echo drum choirs of the rain forests.

Like other Afrocentric musicians, she'll use stately bass vamps to suggest the
timeless wisdom of ancient cultures.

(Soundbite of music)

WHITEHEAD: Mitchell's rich blend of ensemble colors includes strings, reeds
and brass. And she places enough action over the top of those bass vamps to
suggest the bustle and upheaval of current events and cultural evolution.

(Soundbite of music)

WHITEHEAD: Other prominent Chicagoans here include trumpeter Corey Wilkes,
saxophonist David Boykin, bassist Josh Abrams and drummer Arveeayl Ra. At
best, Nicole Mitchell's complex writing recalls the late clarinetist John
Carter's colorful and multivectored "Roots and Folkore" series, itself a
meditation on African and African-American culture. Like Carter, Mitchell is
a virtuoso soloist. She's one of the very best jazz flute players, with a
sure-footed sense of swing and a forceful liquid tone that stands up to a
rowdy band.

(Soundbite of music)

WHITEHEAD: Nicole Mitchell wrote this music for a multidiscipline community
theater piece, a family saga called "Vision Quest." It also includes a few
songs, some with inspirational lyrics. On this concise tale of teen-age lust,
Mitchell's rich instrumental harmonies and intersecting lines are translated
to voices, her own included.

(Soundbite of song)

Unidentified Group: (Singing in unison) Life wants you to love. Mama wants
you to wait. How can you be beautiful when he is in your heart, when he is in
your heart?

Unidentified Choir: (Singing in unison) ...(Unintelligible) is a woman.

Unidentified Group: (Singing in unison) Life wants you to love. Mama wants
you to wait. How can you be beautiful when he is in your heart...

Unidentified Choir: (Singing in unison) But you're mine ...(unintelligible).

Unidentified Group: (Singing in unison) ...when he is in your heart? Life
wants you to love. Mama wants you to wait. How can you be beautiful when he
is in your heart, when he is in your heart?

WHITEHEAD: I'd be fibbing if I said everything on Nicole Mitchell's "Hope,
Future and Destiny" was to my taste. Even so, she does a lot of things very
well, and when she's really cooking, Mitchell combines exploratory and pop
sensibilities better than many jazz musicians who aim for that tricky mix.
Chicago knows how good she is, but Nicole Mitchell deserves more than just
hometown fame.

(Soundbite of music)

GROSS: Kevin Whitehead teaches English and American studies at the University
of Kansas, and he's a jazz columnist for EMusic.com. He reviewed "Hope,
Future and Destiny" featuring flutist Nicole Mitchell on the Dreamtime label.

(Credits)

GROSS: I'm Terry Gross.
Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.