Disarming bombs and booby traps in Vietnam might better prepare a future
doctor for a career in neurosurgery rather than psychiatry, but it was less
the hand-eye coordination and more the ability to compartmentalize and set
aside anxiety while doing his job that led John Mateczun into his chosen
specialty and now guides him through the most challenging assignment of his
Rear Admiral John Mateczun, MC, heads the Joint Task Force of the
National Capitol Region Medical. He will need every bit of his training in
psychiatry, public health, and law as he shepherds the merger of Walter Reed
Army Medical Center and Bethesda National Naval Medical Center to completion
Credit: Aaron Levin
Today, Rear Adm. John Mateczun, M.D., M.P.H., J.D., commands the joint task
force overseeing the integration and expansion of major military medical
systems and facilities around Washington, D.C. The project will take four
years to complete, cost $1.2 billion, involve 13,000 people, and merge Walter
Reed Army Medical Center and Bethesda National Naval Medical
Center—"two institutions with very proud but different histories
and cultures"—into one "world-class" military medical
center, to be known as Walter Reed National Military Medical Center, he said.
In addition, a community hospital at Fort Belvoir, Va., will triple its
capacity and an Air Force hospital in Maryland will close.
The project is more than the largest military medical construction project
ever. The task force must develop an integrated, regional model of delivering
health care based on common clinical and business processes, he said.
At the same time, Mateczun must also ensure that mergers and construction
don't interrupt provision of medical services in the entire National Capital
Region, which includes Army, Navy, and Air Force facilities in Virginia,
Maryland, the District of Columbia, Pennsylvania, New Jersey, and West
"We have to make sure that we're still the nation's premier site for
casualty reception and for military families," he said.
Perhaps the fact that the leader of this effort has deep roots in both the
Army and the Navy will help him ride herd on the two services.
Mateczun dropped out of college and joined the Army in 1966, volunteering
for service as an ordnance disposal specialist.
"Like many things in our lives, there were rational and irrational
parts to that decision," he said in an interview in his office in
Bethesda, Md. "I was influenced by people I had known who had done the
same job and maybe also by the mystique of bomb disposal."
The mystique was powerful. After a voluntary second tour of duty in 1969-70
(and a Bronze Star), Mateczun returned to the University of New Mexico.
"Choosing medicine was an outgrowth of my combat experience,"
he recalled. "A lot of veterans reflect on what they've been through and
try to see its meaning. Surviving that experience leads many to be thankful
for that gift and wanting to be of service to others."
His choice of psychiatry was another step along the same path, part of
putting his experience in context, helped by a fellowship at the National
Institute of Mental Health during medical school researching biological models
of depression. He was commissioned as a Navy ensign in his senior year in
Residency at the Naval Regional Medical Center in Oakland followed,
accompanied by study for a master's in public health at the University of
California at Berkeley. That was not his last sojourn in the classroom,
While later stationed in Washington, D.C., Mateczun needed to take a course
in criminal law as part of board certification in forensic psychiatry.
Georgetown University wouldn't permit anyone but law students to take
individual courses, so he applied to and graduated from law school.
Law offered a new set of intellectual and cognitive skills and was
enjoyable, to boot, he said. "Lawyers and psychiatrists are both able to
deal with ambiguity."
Then, as chair of psychiatry at the Portsmouth (Va.) Naval Hospital, he
organized and led mental health teams supporting sailors and their families
following two naval tragedies, the downing of a civilian Iranian airliner
carrying 290 passengers by the USS Vincennes in 1988 and the accidental
explosion in a gun turret on the USS Iowa the following year that killed 47
Both these events highlighted the complexities of mental health care in
military settings. Men and women who fight wars—whether they are ground
troops, pilots, or ships' crewmembers—may be physically distant from
their opponents but have no emotional distance from the results of their
action, he said.
"All individuals fear for their own lives and struggle with what they
have to do to preserve it," he said, speaking of the Vincennes, whose
crew mistakenly believed it was about to be attacked. "In combat there
are many unspoken, private fears and anxieties that people think are not
reflective of the best in themselves."
The two events affected not just the sailors and officers on board each
ship but also their families, the communities where they lived, and the
readiness of the military unit each ship represented. All required time to
cope with the aftermath of tragedy.
Mateczun led teams of psychiatrists and psychologists who brought people
together to talk first about the facts of each incident and then, more
intensely, about the emotions related to the stress each produced. The teams
could help commanders assess the readiness to return to sea by offering
insight into the response to stress and trauma.
"Navy and Marine leaders are trained to make decisions," he
said. "We help them with advice."
The National Naval Medical Center will soon lie at the core of a much
expanded and integrated military medical center. The project will cost $1.2
billion and take four years to complete.
Credit: Aaron Levin
He next advised the Marine Corps on setting up and operating combat stress
centers in preparation for the Gulf War in 1991 and was subsequently named
director of medical services at the National Naval Medical Center in
He eventually served in a number of other administrative and policy roles,
at various times planning coordination of military health care services in the
northeastern United States, formulating policy for clinical services at the
Department of Defense, commanding the Charleston (S.C.) Naval Hospital, and
serving as the joint staff surgeon, the medical advisor to the Joint Chiefs of
While serving in the latter position, Mateczun was at the Pentagon on
September 11, 2001. He went to the building's clinic, working with burn
victims. Mateczun stayed at the Pentagon through the night of September 11 and
the next day, working with firefighters and others.
Part of his current task is a response to that day, preparing those under
his command to "think about the unimaginable and be prepared to adjust
and react when the worst happens."
Mateczun's own ability to adjust and react has been tested at every level
of military medicine from the stresses of the battlefield in Vietnam to
running Bethesda Naval Hospital. Now he will have to combine the steady nerves
of the bomb squad sergeant, the broad scope of public health, the clarity of
the legal mind, and the decisiveness of the administrator with the more
nuanced insights of the psychiatrist to guide the massive ship of regional
medical care toward a safe harbor.
"One of the maxims of management is that leaders fall back on their
core areas of competence in difficult moments," he said. "The
skills of psychiatry lie in using different models—whether
bio/psycho/social or public health—on a daily or even an hourly basis,
so you don't have to figure it out anew each time." ▪