Over the last 18 months or so, I have had many people ask me what the advantages of being the oldest student in a physician assistant program might be. My reply? There really are not too many, except for maybe one—life—the 20-plus years of accumulated experiences that many of my classmates do not have. I can attest my brain is not nearly as pliable as theirs. I have honestly prayed that osmosis would be the answer to my educational obstacles, you know, laying your head on the text, closing your eyes, and “soaking it all in.” Regrettably, my utilization of scientific experimental principles has failed me thus far. Translation: I am grudgingly remanded to reading the text like everyone else.
All joking aside, starting P.A. school at 46 was the most daunting and arduous task I have undertaken thus far in my life; much harder than I ever thought. It did not help that I had to have emergency surgery to repair a central herniated disc halfway through the 15-month didactic phase of my program. My options were far from optimal—either suck it up, push through, and do whatever had to be done to complete the mission or wait six months to restart the class. Taking a leave of absence was not an option; neither was failure. At 7:30 a.m., on Monday, Nov. 20, 2017, I completed my physical diagnosis final practical exam, which took an hour; by 10:30, I was headed to the O.R. for a two-hour surgery. The next several months were physically and mentally taxing to say the least. Between sitting through eight hours of class daily and four months of physical therapy, the time I had to dedicate toward studying was significantly less than I had the first six months of school. Keeping the objective in the forefront, which was to graduate, I buckled down, focused, and took advantage of the time I did have to study. The crazy thing about it, my grades improved—go figure.
By the grace of God, I fumbled my way to the last week of August, the final week of our 15-month didactic phase. By then all my energies were spent, and I felt like Ahab chasing his white whale. By Thursday, I had completed all but one final exam, emergency medicine. After graduation, I intended on applying for an emergency medicine post-graduate fellowship, and the outcome of that final test had the potential to determine my future as a P.A. In hindsight, at that point in time, I truly had no prediction on how I was going to fare on the other side of that test; but in my head, I was giving it everything I had.
Somewhere around 5 p.m. on Thursday evening, I reached a mental wall. I was no longer able to keep my thoughts focused on the task at hand. I was physically and emotionally drained. The pain in my back and legs was at the point I needed something more than tramadol to take the edge off. To be honest, the worst part was, I no longer cared. That feeling of giving a damn was gone. My inner voice became my outer voice and I dropped the “F-bomb it” out loud. I stood up and walked away from my desk telling myself that whatever happened was clearly out of my hands at this point. To be frank, at that very moment, I was just searching for an excuse to give up. Reflecting on my life, there are only a handful of times that I have been as physically and mentally exhausted as I was that day. The one that always stands out is May 14, 1996, my 25th birthday, a day that was about to play a very significant role in the outcome of my test scores, more than I could or would have ever imagined.
I am not sure exactly why, other than the fact I needed to clear my head, despite the pain, I walked the quarter of a mile to our mailbox and back. Standing in the kitchen, I began to sort out the bills from the “vote for me” election fliers. The last envelope in the pile was from the Marine Corps Scholarship Foundation in Alexandria, Virginia. Usually, I deep-six letters from organizations like these, because sadly—being a P.A. student— I have nothing to give, at least till I graduate and find a paying J-O-B. I still don’t know what made me open that letter, other than there was truly something else guiding me. It read:
“Dear Mr. Gilpen:
I am pleased to share with you that Ms. Nancy West recently made a gift in your honor to the Marine Corps Scholarship Foundation. We are…”
It felt like a bolt of lightning hit me, jolting me immediately to my knees. I sat down on the floor of my kitchen as raw emotion overtook me. My 15-pound canine best friend Cookie licked the tears off my cheek as memories that I had not thought about in a long time began racing through my consciousness.
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Most people may not understand how a single sentence can knock a grown man to his knees. However, that letter took me back to the culmination of the worst four days of my life. Let me provide some insight. In my office is a 24” by 36” artist’s rendering of what I remember most about my 25th birthday. The picture is not so dissimilar from images we have seen in the media since 9/11—a row of helmets atop M-16s inverted with the bayonet stuck in the ground, pristine dog tags hanging, with an empty pair of combat boots at the base, and a grieving widow and a lost child placing a flower to honor their Marine—representing the 12 Marines, a Navy corpsman, and an Army staff sergeant who had died four days earlier on May 10 in a helicopter crash during Operation Purple Star at Camp Lejeune. I know the names of every last one of the men that picture represents because they were from my unit, the Battalion Landing Team 2/8, also known as “America’s Battalion,” and our sister unit HMM 266, the “Fighting Griffins,” both elements of the 24th Marine Expeditionary Unit—Special Operations Capable (MEU-SOC).
One of the inverted rifles captured in the original picture published in the June 1996 edition of Leatherneck magazine represented Corporal Erik “Kirk” Kirkland, U.S.M.C. Nancy West, the woman who had made a donation in my honor, was Kirk’s mother. The emotion I felt was not one of sadness or grief, rather quite the opposite. Kirk and I had come from very different backgrounds; his father was a college professor who had protested the Vietnam War at the Pentagon, mine a Marine who had served 15 months in the Republic of Vietnam with a medivac helicopter squadron. We were complete opposites; he was “East Coast refinement” and I was the “redneck cowboy” from Oklahoma. Had it not been for the Marine Corps, we would never have met, much less been friends. More than that, I had been one of the corpsmen who had treated the wounded and recovered the dead that night. I tried to save them all, but some things are beyond our control, despite our best efforts. It has taken me many years to come to terms with this fact.
Hanging next to the picture is a copy of the memorial speech given by Lieutenant General Charles E. Wilhelm, commander, U.S. Marine Forces Atlantic. Halfway through he said:
“On that day when your pack is the heaviest, when the sun is the hottest, when the brush is the thickest, and the path to the objective is the steepest, and you’re not sure if you’re going to be able to make it, you’re going to look over your shoulder. And when you do that, at the rear of the column, who are you going to see? We are going to see Lieutenant Colonel Mick Kuszewski and Lieutenant Art Schneider. We are going to see Staff Sergeant Sean Carroll, and he is going to be followed by Corporal Erik Kirkland; Britt Stacey will be right behind him. John Condello will be watching your left flank; Jackie Chidester will be watching the right. Jorge Malagon will be there where we always expected him to be; in the midst of the scrap, there to hold you up, there to encourage you. And bringing up the rear, the trusty Doc, old Brett Garmon. …
On a very, very dark night, when the waters are uncertain and the landing zone is very hard to find, you are going to find you have extra help in the aircraft. At the door, you’re going to have Brandon Tucker and Brian Collins keeping good watch to the left and the right. And in the cockpit, you’re going to have Scott Rice, and you’re going to have Joe Fandrey, and they’re going to steady your hands at the controls, and they are going to help you bring that aircraft safely to earth. …
Trust me, you haven’t seen the last of these Marines. When you need them most, they’ll be there. …”
To me, there is no doubt that letter was anything but divine intervention, reminding me that I was not alone. A reminder the men I served with were there holding me up, supporting me, reinforcing and encouraging me to lace my boots up tight, stand up, shoulder that ruck, lean in. Most of all, keep moving forward. That’s exactly what I did. I picked myself up off the floor, folded the letter, placed it back into its envelope, and walked back in to my office. I spent the next four hours focused on my exam material. Then I went to bed, got up at 4:30 a.m., drove the hour to school, and spent another two hours studying before the test. In the end, I made a 93; more importantly, I proved to myself that I had more to give than I realized. Lieutenant General Wilhelm was right. I had not seen the last of my friends. It was a reminder that they were and would always be with me.
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