"'The people I’m talking about didn’t die in combat… As if there weren’t many other people who suffered.'"

Two young doctors are drafted into military medical service during the Vietnam War. While both stay stateside, their time on base treating soldiers alerts them to the horrors of rampant drug use, addiction, racial bias, and the shipment overseas of sick and unfit soldiers. When the physicians try to treat the troubled men in their care, they face a corrupt and hostile chain of military leaders focused on populating ranks on the war front and denying treatment to the men suffering under their command. The book’s ultimate focus is on the case of one sad addict, a young soldier who receives his drugs from the very command chain that will eventually send him to fight overseas and who, thanks to the army’s focus on feeding the war rather than caring for its men, ultimately dies from his addiction and lack of care.

This is a story of the collateral damage of war. The title refers to the military operations and personnel back in the United States during the war. This is in contrast to “in-country,” which refers to the war locale itself or, in this case, Vietnam. The author suggests that beyond Vietnam’s documented horrors of battlefield deaths and post-war struggles were “out-of-country” victims—soldiers who suffered and died as a result of military bureaucracy, egos, lack of caring, and competing priorities.

The persuasive passion with which the author pleads his case on behalf of the men who suffered out-of-country is weakened only by its one-sided approach. Why were military leaders so quick to abuse men in their chain of command, and so slow to do the right thing? What pressures and compensations drove their blind fealty to war over citizens, and how can a populace mourning individual suffering reconcile these wartime actions? Exploring the competing demands on commanding officers might further sharpen the vision of this eye-opening narrative.

Any story of doctors in military service bucking the norms of the system naturally evokes comparisons to Richard Hooker’s novel MASH: A Novel About Three Army Doctors, which was famously adapted to a feature film and long-running television series about a mobile hospital unit in the Korean War. Perhaps doctors make good vessels to question war and satirize bureaucracy, as their life-saving mission is a worthy juxtaposition to the destructive mission of armed combat. While Hooker’s characters survived the surreal experience of healing in the midst of the carnage, this book’s doctors identify and expose stateside hypocrisy and abuses, pushing back when their oath to heal is directly contradicted by their military orders.

Exposed here is a dark corner of the military, illuminated as a sociopathic corporation fixed on delivering young men to war and blind to human elements and reasonable accommodations. In this moving reenactment, power is abused, men are dehumanized, and the demands on military leaders to populate war take primacy over reasonable care of suffering men. Out-of-country, there is no enemy combatant, yet the war these soldiers face is nevertheless deadly and requires battle strategies that are risky and creative. Sobering and thought-provoking, this is an effective glimpse into the unsolvable paradox of war and sending men to die.

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