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Being human Reflections on Life, Being Human, and Medicine

The Deeper Lessons from “Twelve O’Clock High”

Gregory Peck is in his prime playing the role of Brigadier General Savage. I talked about this in my blog post last week.

But later in the movie, General Savage becomes a casualty of war. He tries to climb into the aircraft to go on the bombing mission but his body – or perhaps more accurately – his mind – will not let him do so. He is finished. He has given all of his might and energy and he has finally collapsed.

Many of us push ourselves hard.  It may be the very long call weekend. It might be the moral strain of caring for a very ill patient population. Or it may be the stress of constant and unremitting demands on us regardless of what we do. We wonder if the day will come someday when we will have pushed too hard. Will we collapse? Will we too reach the point where our bodies or perhaps our minds will no longer be able to go forward? What will it take to get us to this point? What will it be like when we reach that point?

But I think we are asking the wrong questions.

In my previous blog post we referenced the 1949 movie, “Twelve O’Clock High.” This movie is a classic and continues to be used to this day to teach leadership skills in the military. In that post we looked at how Brigadier General Savage (Gregory Peck) assumed the role that he knew was needed to pull together a failing bomber squadron in World War 2. We learned the lesson of “putting on the uniform” of leadership.

But there is a much deeper and more subtle lesson within the movie. It is not one that I was taught. It is not one that I have heard discussed in this context before. I have been struggling to understand it and come to grips with it. I hope that together we can wrestle with it. I do not promise to have this fully developed and understood. I am a novice here and not an expert. 

But let us boldly try to figure it out together.

In the movie, the approach taken by General Savage worked. The squadron came together, and the men of the squadron regained confidence and the pride that they needed to be able to be successful. There were casualties. Aircraft and men were lost. But they did much better after he pushed them and made them find the strength they had within themselves.

Then the General becomes a casualty himself.

In the climax of the movie General Savage plans to go on the bombing mission. As he tries to climb into the airplane, his legs physically stop working. He is unable to go, and another pilot must step in to take his place. He then enters into a state of catatonia (unresponsive and staring into space.) This persists until the planes safely return home. He then gets up and lays down and goes to sleep.

When you first watch the movie, you see this as bravery and selfless sacrifice. In other words, General Savage was so committed to the mission that he too was willing to sacrifice himself. The result was severe psychological trauma to the point of a conversion disorder (physical symptoms as a result of psychological trauma) and even catatonia (inability to move or interact because of psychological trauma).

Is this ok?

In the setting of a life or death struggle in war we might think that this level of sacrifice is tolerable. We might even think that it is admirable. 

The problem is that we continue to do this even today. We put expectations on ourselves and others that result in similar degrees of psychologic trauma. One of the words that we use for this is “burnout.” We wonder if we will someday reach a breaking point. I have wondered this when the clock goes past midnight for another day in a row and I am still working on finishing charts before the next morning comes. I have wondered this when I feel the trauma of a poor patient outcome and I feel my heart breaking. I have wondered this when all of the pressure to keep up with everything just seems to be so persistent.

And so, the question is whether we have a breaking point. But I think we are asking the wrong question.

The deeper questions are two: (1) Are such casualties acceptable? And (2) If they are not, what do we do to prevent them?

Twelve O’Clock High is only a movie and as such can only help us think and reflect. But please let us indulge a bit more and think about it.

Are these casualties acceptable? I do not think so. I do not actually think they are necessary. Some casualties are necessary risks. The bombers had to fly through the flak and deal with the threats of enemy aircraft. But the commander perhaps has other protections that should have been better used.

And so, answering “no” to question 1 we move to question 2.

First, we must recognize the risks in “putting on the uniform” of leadership. Trying to take on a persona other than your own is admirable and sometimes necessary but is not long sustainable. One of the keys to sustainability and maturity is to learn about your own persona. Who are you? How do you best function? What motivates you and drives you? What happens when you are stressed and what is the best that could be expected from you when all is good? 

This may not sound as exciting as sacrificing yourself for a cause, but it is:

  • True
  • Real
  • Mature
  • Necessary.

If you read some of the experts who have recovered from burnout, it is also a key to their recovery. With the help of some good authors and my daughter, I have been reading and learning about the Enneagram. In it I can see parts of myself reflected. More than that, I learn what it means to make an honest appraisal of myself both good and bad. In that I learn about my strengths and weaknesses and limitations. It is once I begin to understand those that I then can begin to gain the strength to truly lead instead of just pretending to lead.

General Savage put on a personality. But he could only sustain it for a period of time. Better would have been for him to know his limitations and to know how he needed to transition to what was true and real. There he would have found more strength.

The other biggest limitation is isolation. He carried the burden alone. He put on the persona that was required of him. He carried the responsibility for everything that was happening. When his commanding general asked him to leave and give up the command of the squadron, he refused. It had become his mission and he was carrying the weight of the world on his shoulders alone. 

It is a classic fatal mistake. No one was asking him to do this. He was taking it on himself. And it is a very tempting and intoxicating thing to do. The elixir of pride makes this very tempting. It is pride that feels and tastes so good, but which is deceptive and destructive in the end.

I too recall days of this. I remember the middle of the night decisions. The risks and decisions that were so hard to make. I could feel my shoulders get broad as I would hoist the decisions upon them. It would be scary but also, I would feel inflated by the burden. It is a heavy burden and it is something that all of us can bear for awhile. But it is not the right way to do things.

At times I was told that I was wrong. I was wrong to be bearing these burdens alone. They would tell me that no one was asking me to do this. They would reassure me that they would always be there and that we should depend on each other. At first, I would disagree with this and perhaps even take offense at this. “They just do not understand.” Now I see their wisdom.

What am I saying?

Twelve O’Clock High shows us the epitome of leadership in both positive and negative ways. It is important that we be bold enough to step up and lead. The people around us need us – are depending on us to do so. But it also shows us the failings that we so often fall into.

  1. You do not have to lead like other people lead. You may need to take on a role uncomfortable to you for a season, but this is only for a period of time until you can shift to what your role truly ought to be. You must find a sustainable role for yourself.
  2. You must be brave enough to learn yourself. Use whatever tool you find most helpful. I favor the enneagram as one that opens up both your strengths and weaknesses. Whatever the tool it must do both sides. And you must be willing to accept both. From there you can understand what leading means for you in a manner that is sustainable for you.
  3. You must never be alone. We were never intended to go it alone. Figure out your network of support above – alongside – and below you. In this there is great strength. 

I hope this post makes sense? I struggle a bit because I think these lessons are deep and not easily understood. But I am still reading and learning and growing. 

Thanks for letting me think and wrestle with these thoughts with you.

Categories
Being human Medicine Reflections on Life, Being Human, and Medicine

Can You Be the Person that the Uniform Demands?

It was the fall of 1984. I was a sophomore in college and had just become the president of the InterVarsity Christian Fellowship (IVCF) chapter at Hope College. There was a student activities fair. All of the various student organizations that were a part of campus life were set up with a table. Most had a display and sign up sheets. The new students were walking past.

An extrovert was needed. You know the type – the smiling and outgoing person who would step from behind the table and great people and shake hands. We needed the confident type that would get people interested. The type that would look people in the face and talk to them and by so doing have them gain an interest in the organization.

I happen to be an introvert. I remember being a shy boy. I was always happy with just a few close friends. I never liked big groups. I was not the “bubbly” or “out there” type. 

But on that Autumn day we needed one. And no one else at the table was going to be that person. So, I stepped up and I pretended. I took on the persona that was needed for that day. I remember my friends looking at me in surprise as the evening went on. But it was what was needed. And it helped us to gain interest and regrow the organization that I loved being a part of.

The next scene is from my training in the military. It is about 4 years later. And as a part of our leadership training we had to watch the World War 2 movie, “Twelve O’Clock High”. Gregory Peck is playing the role of Brigadier General Frank Savage.  He has been ordered to take over command and “remake” the 918thBomb Group. They have been suffering heavy losses and have been nicknamed a “hard luck group.” 

Savage is casually riding in the front of the car beside his driver as they drive to the airbase. They chat as equals and friends, ignoring the large difference in rank between them. He has them stop along with road. They chat and smoke a cigarette. They both then straighten their uniforms and become much more official. When General Savage gets into the car, he gets into the back of the car. Instantly he is a different sort of general. He takes on a much stronger persona while the driver drives him to the airfield.

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The coming scenes show Savage taking on the role of the very strong and demanding commanding officer. He demotes the sentry at the gate into the airfield. He immediately closes the officers’ club. He holds a briefing and tells everyone to, “Consider themselves dead already,” for the sake of being effective in their mission. He demotes the “air exec” and puts him in charge of all of the failing aircrew in the squadron. He is tough and hard. People don’t like it. Most of them request transfer away from his strong leadership style.

The movie makes it clear that the persona that General Savage is displaying is not his real personality. He knows that in order for the group to have success they need a strong leader. They need someone who will push them. They need to be pushed so hard that they find strength within. In that strength they can then regain success and then confidence and pride. He has to be a harsh leader even though it is not who he is.

This is a principle that has followed me throughout my career. In the military I learned that when I put on a uniform, I must be the person that the uniform needs me to be. If it demands strength, then I need to be strong. If it demands that I be a commanding presence, then that I must be. Whatever the job is, it does not matter who I am underneath. It only matters who the person in the job needs to be. The uniform in a way both empowers and pushes me to be the person that it needs me to be.

The next example is from 1993.  It was just a year after finishing my internal medicine internship. I was a department head for a large Navy medical department. Suddenly I had a chief petty officer (CPO) and a dozen enlisted corpsman reporting to me. I started out as myself. My natural tendency is to be kind and a servant leader. I would work hard and expect them to work hard by following my example. 

What I discovered was that it didn’t work. 

There was disorder and chaos. Their job was to maintain the medical records of several thousand reserve military members. They were being lazy and sloppy. They did not have any internal drive to excellence. They were just marking time and not really caring about what they were doing.

I decided that it was time for me to actually fill the role of the uniform that I was wearing. 

In essence, I stopped alongside the road with my CPO. We had a nice and friendly chat. And then we got back into “the car” and I came into the office as the officer that the job needed me to be.  

Effective immediately all of the corpsmen were expected to be at work and ready at the time of my arrival. When I came into their space, they would call, “Attention on Deck!” I would then review them to make sure that they were in proper uniform and in good order. The CPO and I would lay out the expectations for the day. And then I would leave to go see my patients.

It worked.

They started thinking that this was not just a boring job. They began to take it all seriously. They became real sailors. They were not just assigned to managing reserve records. They were instead making sure that everything in those records was “shipshape” so that the squadrons we managed could deploy at a moments notice.

The man who came to work each day was not me. But it was the man that I needed to be. I continued it for some time before I later changed to a different job.

This pattern has repeated itself many times throughout my career. 

And so, the principle is clear. You can and must deliver the leadership skills that your job demands. You can do a lot more than what you might naturally do based on your personality. You should be able and indeed must be able to take on a different persona as the job demands. If you fail to do so, you are negligent. Even more than that you are unkind to the those who you are leading. They often need a strong leader in order to have success. It matters not whether you want to or not. They need for you to stand up, speak up, and deliver the leadership they need. If you just sit in the background and are silent you may be hurting the people you are supposed to be leading. “Man up” and do the job!

Did it work? In the movie I mean – did it work? I would encourage you to go watch it. But just to cut to the chase, the answer is that it did. The men became much stronger and more effective. They found that they had strength within them that they didn’t know they had. They just needed to be pushed a little bit to find it. In the end they believed in themselves again. Their results improved and their casualty rates when down.

What am I saying? 

  1. Do the job. Don’t just sit back silently when people need you to lead.
  2. Sometimes you have to become the person that the uniform is demanding that you be. It doesn’t matter if it isn’t “you”. If you accepted the job, then you need to be who the job needs you to be.
  3. If you can be strong in leadership, you can make those who you lead better. They can be more effective and frankly happier once they realize that they are capable of doing more. But they often need a strong leader to push them to this.
  4. Watch “Twelve O’Clock High.” It really is a great movie and you will be happy to have watched it.

Finally – there is an even deeper and more subtle lesson from “Twelve O’Clock High.” But I am going to save that for next week!