Dr. James Walter, Colonel, USAF (ret) was a college fraternity brother of John Akin, one my closest high school friends, who also became a physician. Jimbo and I, along with two other men interviewed for this project, Stephan Moran, a trauma surgeon in Huntsville, Alabama, and John Hill, a regional bank communications officer in Birmingham, served as pallbearers at John Akin’s funeral not quite five years ago.
When we talked in 2010, less than two months before his 50th birthday, Jimbo was still on active duty as an emergency medicine physician for the Air Force in San Antonio, Texas. He has since rejoined his family in Montgomery, Alabama where he practices medicine, as a civilian, at Maxwell Air Force Base.
I was actually on the way to the Air Force Academy as a pilot and my vision—they don’t know what happened—but my vision went really bad very quickly, and so I wasn’t able to be a pilot. I wasn’t qualified anymore. So I had one day to decide what I wanted to do with my life, and I decided I would go into medicine.
I was crushed. My dad was a pilot and I worshipped planes growing up. That was my whole life. I would memorize training documents on planes and I could tell you anything about any plane in the world. And so I was just devastated. I mean, I’ve never really been suicidal but if I had been that would’ve been the closest I would’ve ever been, because my whole life had been geared to that. I mean, my entire room was full of planes and pictures of planes and I read every historical document about flying. It was crazy.
I had worked as a volunteer at the hospital at Maxwell Air Force Base during the summer. I would work in orthopedics because I thought surgery was fun, so I would go into surgery with the orthopedic surgeon. And he was a real good guy. My dad was a West Point graduate and he was like, “If the reason you’re going to the Academy is to fly, and now you can’t fly, then you won’t make it.” He said, “Don’t go to the Academy.”
And that’s where I was born. I was born at the Air Force Academy. So I had always had this feeling that was my destiny. So now I’m not going to the Academy. Now I’m not flying. And I tend to get bored really easy, and I thought, What’s the one thing I can do in my life that would not let me get bored? And I thought medicine was it.
I like being on my own with the stress of trauma and blood, and you’re the one that’s got to figure it out really quick. So just literally I was like, Well, I guess I’ll go be a doctor. I mean, I hate to say it that simply, but that’s really the way it was. And literally one day with my dad and the Academy advisor we just kind of sat down and I said, “Okay.”
I’m separated from my family for a year and a half, two years because of this job. And that sucks. That’s been really tough. It’s very weird being almost a bachelor again. You get back into some of your same old stupid things that you used to do, you know, and how you definitely need a wife to make you human. Because the guys that never get married always have some weird traits [laughs], and you realize why that happens and thank goodness you have a wife that straightens you out.
I sit around and I eat cereal and I eat pizza, and that’s pretty much my diet. So it’s weird being on your own, but it’s more being a slob, comes back very naturally and there’s nobody there to pick up after you. And washing my own clothes again. But really it’s the cereal and the pizza, which is all I ever ate. If you look at my house, that’s all I have.
When I was little I had bright red hair. I was very skinny, and so I always felt I had to prove myself to some extent because I was always being called Opie or Red. And when you’re a bright redheaded, skinny, albino-looking kid, they pick on you. So I always wanted to prove myself and sports did not come easily for me. I had to really work at sports, but I realized that was important.
When you’re a kid, sports are everything. Sports was the key. I always had to struggle and work hard. Having bright red hair and being white as a sheet when you’re a kid [laughs] doesn’t make it easy.
As a physician, my biggest fear is somehow making a mistake and a patient suffers for it. You know, every physician out there’s got coffins in the closet. And I can tell you the two cases that to this day will haunt me, not necessarily because I did something wrong, but that I could’ve done it better. And I still think about those patients, you know, probably weekly. And that’s always tough. Honestly that’s the biggest fear: the fear of somehow I don’t do absolutely the best job I can with a patient and they suffer.
When I was younger, when Akin and I went to medical school, they told us, “This is a lifestyle. Your family will suffer. Your marriage will suffer. Everything will suffer because your patients come first, you know. When a patient calls you, you go. You don’t have any choice. You’re gone.” And that was tough and it did affect our family because I’ve always put the patients first.
As a physician you’re held to a different standard and you should be.
I’m proud of the military and I’m serving in the military during a time of war, you know, and that’s part of my calling in life. I always wanted to be in the military. Somebody in our family has always been in the military.
Sometimes I’m just like, Wow, I can’t believe where I am right now in my life. Because I’m almost 50, but in some ways I feel like I’m still 25. I just don’t heal as well.
I’m supposed to be really mature and really grown up and a great role model, and there’s part of me, it’s like I’m still just a goofy kid in some ways. I’m still eating Lucky Charms.
I think of my father. I’m like, Gosh, my dad was 50. He was such a man, and what an amazing figure, you know. He worked for the Pentagon and for the Joint Chiefs of Staff. He used to talk to Congress and I’m like, Wow, you know. And I just don’t look at myself at 50 like that.
My dad had Alzheimer’s, and so the last years of his life, when I finally had moved back to the country, he was starting developing the dementia. And he died relatively young, you know. I would’ve loved to have talked to my dad now that I’m grown up.
It is a real fear. I do watch the research going on out there on it. My dad was brilliant, and watching him go through it crushed me and I don’t want to go through that. I told my wife, “If I get demented, you know, put me in a Porsche.” I’ve always wanted to have a Porsche. “Put me in a Porsche, put a brick on the accelerator and drive it off a cliff.” You know, I don’t want to go the way my dad went, which is that horrible end stage demented patient. I don’t want to do that. So I try to stay in shape, and I’m on a statin drug because they’ve shown that statins decrease Alzheimer’s. Because it is a fear. I just don’t dwell on it.
I’ve spent a lot of time overseas with the war, and I did get in one position in an African country that’s not very friendly to us and some things happened and I remember sitting there as we’re breaking out the machine guns, and I remember thinking, You know what? I may just die in this Godforsaken place. There’s like 22 of us here. They could kill all of us and all we would do is write a letter of protest. And for a couple of hours we were in a position where I was like, You know what? I might die. And I remember going, What the heck am I doing? Why am I here, halfway around the world, away from my family, sitting here with my M4, you know, looking through my night vision goggles to see if these guys are going to start shooting? And that was the first time, honestly. That’s the first time in my whole life I really thought, I may die right now. And I remember going, What a dumb place for me to be [laughs]. I want to die with my family.
The position I was in over there was the position I had allowed myself to be put into. It’s what I’m good at, you know. And I don’t want anybody else to be there. I mean, I don’t want somebody else to go in my place. But I didn’t have to be there. I had elected to do that job. You know, I’ve done this job for a few years and it involves going to different countries. And I’m a little bit of an adrenaline junkie. I like being challenged. But even being in Iraq and Afghanistan, I mean, yeah, you get mortared and whatever, but this is the first time I was looking at a barrel of a gun, really, and going, Wow. And these people hate our guts. Where I was, these people don’t like us and they have no qualms pulling that trigger or blowing up our plane or whatever.
And I put myself in that position and I didn’t have to be there, and that was the realization. I’ve been in a lot of crazy places, but that was the first time I was like, I’m going to die and my wife’s going to be pissed off at me [laughs].
I have a pretty strong faith, so I’m not scared of death. You know, I’m a Christian. I believe there’s another life for me after this. I see that patients who have a faith, whether it’s Christianity or whatever, tend to accept death better. Those who have nothing, that death is the end of everything to them, you know, I see them fight death so hard.
One of my two coffins [was a woman] in her mid-80s and [she] had had a heart attack in surgery and basically she’d gone into massive pulmonary edema. She was going to die no matter what, but I was intubating her. I had to delay my intubation with her because there was so much fluid coming out of her lungs, and I should’ve done a surgical airway on her faster than I did. She ended up dying and I would like to have done that surgical airway quicker.
Her family was very nice. It was the one time the family consoled the doctor, because I was devastated. My greatest skill is getting an airway. I would get called by people everywhere I’ve been to get airways. And here’s my greatest skill and I delayed getting the airway on her, you know. And she would’ve died probably in the next 12 hours anyway, but I definitely hastened her death and I have to live with that. And her family, you know, I called them and I told them. And I’m very honest. I told them what happened. You know, Fine. Sue me. I don’t care. I told them what happened in the O.R. It took me longer to get the airway than it should’ve.
And they said, “Do you know what my mother did?” And I said, “No.” And they said, “Well, she was a hospital chaplain, retired.” And they said, “We know where she’s going and it was her time to go. She would’ve had a tough life if she had survived anyway. She had a massive heart attack.” And they were very good to me, and I appreciated that, but I still think about her. I mean, I still think of her like it was yesterday. So I would’ve liked to have done that surgical airway quicker and moved faster, you know. To this day I don’t know why.
It was my best skill. I can do all kinds of crazy airways because of the military. I was brilliant at it. I mean, I still am. That’s still my best skill. Never lost an airway in my life. Never had a delay. People would call me screaming for help and I would always save the day. Part of me thinks, Jim, you were cocky. She was suffering no pain. She was totally unconscious, but I also look at myself and I think I was cocky. I was like, I’ve got this. I’ve done this a million times. I’m the best in the world at this. Look at me. I’m Super Doc, you know. And I truly believe that when you start getting cocky, somebody’s going to pull you back down to earth.
And, my God, as a physician you just can’t do that. You can’t get cocky. You can’t let your pride get in your way. And if she’d lived another twelve hours her family would’ve made it. They didn’t make it before she died, to get her see her. I’m real big on bringing families into the room when people are dying. I don’t know if she ever would’ve woken up. It was a massive heart attack. She had no pain, no nothing.
It was God calling me to the carpet, going, Hey, you’re not all that. And, Don’t be so cocky. And, This is how I’m going to teach you that lesson. And obviously I never forgot it. And it’s definitely affected my care, in a good way. I’m more careful. I’m more understanding of patients. Really, ever since then I have really made the focus of bringing families in. And some doctors don’t do that. And some of my staff and my nurses don’t get it either. But I’m like, “No, not until the family comes in here and holds her hand and whatever they’re going to do,” you know, “but they’re going to get that opportunity.” And some people don’t understand that.
My daughter was born in England. And I had to resuscitate her because the British doctors didn’t know what they were doing. So I had to intubate my own daughter and do CPR on her and everything like that. And twelve hours later, when I realized she was acting normally and everything was fine, that was a huge relief to me, you know, because I did not know what was going to happen with her.
Because it was a disaster. I mean, welcome to national health care. This is national health care at its worst. Untrained staff, didn’t recognize a problem. I was telling them we had a problem. I was dictating medical therapy to the British nurses and midwife that was there, and it was a big fight. I said, “My wife needs oxygen. This baby’s not doing well. We’ve got to get this baby out,” blah blah blah. Then of course she came out and, you know, she was as blue as blue and had no heartbeat and wasn’t breathing.
And they didn’t know what to do. They called the doctor. It was a young doctor who had no training in neo-natal or resuscitation, you know. She was clueless and almost did my daughter in. And so I literally knocked her across the room, took all the equipment and tubed her, put on the ventilator and did CPR. So twelve hours later, when I realized that she was fine, that was probably one of the greatest days of my life because I did not know what was going to happen to my daughter.
We didn’t have any more children after that because the experience was so traumatic for us. We were going to have three or four kids probably, and we have two. And that’s because of my daughter.
As physicians, because we deal with death all the time, we probably have a different look at it. We realize that life’s unfair and horrible things happen to people that should never happen to them.
The funny thing is, I’m the oldest of the group, you know, of all the friends, so I was supposed to die first, not Akin. He was supposed to go last. That’s the logical thing we always figured would happen would be everybody coming to my funeral and having a drink, and instead it’s the exact opposite. And I don’t get it. I don’t understand why God lets these things happen. You know, somebody with these three wonderful children and all this kind of stuff. Why do you take them then? I don’t get it. But it’s part of life. And, you know, that’s just unfortunately the way it is.
When you go into this field you realize that people are going to die, and they’re going to die on you a lot. And so you maybe develop a little bit of callousness, but you realize that this is what you’re intended to do and you have to handle it well. And because is death is around you cannot be overwhelmed by it.
Of course, you know, you have your moments. We all cry. We’re all human. We all go to the stairwell and just have our big cry, you know. And in a funny way the fact that Akin was a doctor was consoling to me, because John also knew how the cards are dealt sometimes. It doesn’t make sense and it’s unfair. But I know John knew that, because he dealt with it too because he was doing anesthesia on trauma patients. So, in a weird way, John probably understood it better than most people, that death happens, you know.
It doesn’t make any easier when it’s your friend. John’s my only real friend that’s died. He’s my only friend that’s died. Even in all the military stuff I have never had any close friends die. They’re all still alive, except for Akin. So, you know, it’s like, Wow. Thank goodness I’ve only had him. But, you know, it just sucks.
It’s not necessarily that life is unfair. I think life is life, and you just have to realize that lots of things are thrown at you and it’s kind of how you deal with it. And I see people all the time that, you know, there’s a death in the family, or a spouse or a child or a good friend like John, and they can never get past it. And somehow we have to get past these things. I think about John all the time. Every time I get to the lake the first thing I think of is John, because John was the lake, you know. For years and years John was the lake person. All my images of John—there are some in college, of course—but they have always been around Lake Martin. So now that we have a place on Lake Martin it’s always like John’s lake.
John lived a lot longer than most people do. When John got the diagnosis, when we talked, I mean, right off the bat I know what the statistics are for that. That ocular melanoma, by definition, is an advanced stage. And people with advanced melanoma don’t live very long. I’m sure Stephan did the exact same thing I did, immediately calculate the five-year survivability from ocular melanoma.
I was so excited that John had a really good first year, you know, because it doesn’t necessarily go that way. But he did great, and I was so happy for him. Because I’ve seen patients with ocular melanoma—I’ve only had a couple of them—but, you know, they’re advanced melanoma and they go very quickly sometimes. So his first year was great. And then the last year, you know, my regret with John was that I didn’t plead with him more to stop the chemotherapy. If I could go back I would tell John not to do chemo, because, you know, a lot of what got him was the chemo. Knowing that melanoma is terminal, that he’s not going to get past it, you know, I wish he had stopped it earlier. He might’ve lived a little bit longer. But he had a great first year and I’m so thankful for that.
John knew where it was going. He knew it was going to go to his bone. He knew it was going to go to his liver and he knew it was eventually probably going to go to his brain. He knew. And that’s the weird thing about being a doctor. There’s just that part of us that is very, [deep voice] Okay, well my five-year survivability is 18 months. I mean, there’s that weird part of us that we do to each other and I know he did it to himself.
I grew up very middle class. I have a handicapped brother. All my mom and dad’s money went to my brother. I’ve never, honestly, except maybe a couple times in my life, ever been really jealous of anybody. I’m happy. I have more than I thought I would ever have. I have a wonderful marriage. You know, I have good kids. My son challenges me, but he’s still a good kid. Never wanted to be a millionaire. Happy with what I have, you know. That makes it easy if you have that mentality of being in the military, because your buddies do. When I came out of my residency my income went up $15,000 a year. My friends that were in their residency that were civilians, their incomes went up $200,000 a year. And that was like, “Great. Good for you guys,” you know. But I was never jealous of them. I’ve been blessed with that.
I lost control of my son for a couple years, and so that was really tough. You know, his junior and senior year, and even his freshman in college, though it was better, were really difficult. Really his senior year was incredible. He just went crazy on us, you know. The ultimate adolescent.
He’s 19, almost 20, and doing a lot better. We have a relationship again. But pretty much his senior year in high school we did not have a relationship. He was just doing a lot better, but he was just the ultimate adolescent and really getting into some trouble, and getting into things that you never thought you’d have to deal with.
I worshipped my father, you know. My father was just an amazing person. He was brilliant. He fought in three wars. He was a fighter pilot. He was an infantry soldier. He went from being a private, you know, the lowest ranking person you can be, to a colonel, which is impressive for a kid that grew up on a dairy farm. And he had gone to West Point, yet he was the nicest good ol’ boy you ever met in your life. Had a great sense of humor. Real affectionate.
He was in the Battle of the Bulge. 75% of his unit was killed or wounded. You know, he was in Korea, he was in Vietnam, he flew 100 combat missions. And he came out with never a scratch. Actually in World War II he got shot. He was reconnaissance group and they came out when the Germans attacked at Ardennes. And my dad was a machine gunner, so he was the fourth in line, and they walked out from behind the hedgerow and the Germans attacked. They didn’t know the Germans were there. And the Germans opened up on them and killed the first three guys, and killed the guy behind my dad and shot my dad.
The World War II helmets, there’s a little silver rim around the helmet that had the liner on it. Well, he got shot in the silver rim. The bullet hit the rim, bounced upwards, split his helmet in half and knocked him out cold. The Germans thought he was dead. So my dad woke up later and there are dead guys around him and there’s a battle going on, and he’s in the middle of it, you know, trying to figure out what the hell’s going on. But not a scratch. And he got out of there and survived. He was 18 years old. And I’m like, Oh my gosh. How do you do this when you’re 18?
So an amazing man, you know. He was a great guy and he was kind of my hero. And the weird thing with my son is I look at my son when he looks at me, and I don’t think he thinks of me the way I thought of my father. And that’s tough, you know. My dad was everything to me. And when my son was younger, of course, I was everything. But once he got about 15 or 16 I became the enemy. And I know that’s what adolescents do. I get that. But it got really bad. And it kind of broke my heart.
There were times during his senior year in school I would just be crying, you know, and I would tell my wife, “I don’t know what to do. I give up.” And she’s like, “You can’t. You can’t ever give up.” You know, that’s the thing. That’s what they’re trying to do is make you give up. They want to prove to themselves that you’ll give up on them. And that was tough. You never think that your son, your child will do these things. You raise them well. You’re good role models for them and you have a stable marriage. My wife stopped working once we had children, to be with the kids. That was, you know, the way we thought it should be. And then to see a son rebel, like as bad as he did. I mean, it crushes you.
In my job in the Air Force, I do fly a lot as a flight surgeon. You know, I spend a lot of time in the air. I mean, I actually wear a flight suit to work. It’s actually my job. And the thing I’ve learned over the past 21 years in the military is that I definitely believe in divine intervention and I think God knew that I was not the world’s greatest pilot. I wanted to be a fighter pilot then, and if I hadn’t gotten to be fighter pilot and had to fly something else I don’t know if I’d have been happy. And I realize now that I probably was not cut out to be a fighter pilot. So I think, you know, from a divine intervention point, God was like, You know what? This is not the career for you. I’ve got something better for you.
I’m a much better doctor than I would be a pilot. I absolutely realize I would not have been a really good pilot like I would’ve wanted to be, because I like being really good at what I do. And it was definitely the right decision for me to do this. You know, I’m just better at this.
When I was younger I had a lot of disappointment. But looking back on it it’s absolutely the best thing that ever happened to me.