The first time I realized how real the uniform I wore in the Air Force was was back in 1997. I was at a training course designed to help health care professionals understand how to operate in war zones. A fellow physician, a colleague of mine from an officer indoctrination course, gave a presentation on what happened after the bombing of the Khobar Towers. He had gone the route of being a flight surgeon and two years out of medical school was one of the first physicians on that horrific scene.

Most people remember where they were on 9/11/2001. The news hit me while I was on my way to Elmendorf AFB for work. It was a day that changed life in the Air Force.

It was surreal watching the planes crash into the World Trade Center again and again sitting in the Internal Medicine break room. Most of the talk on base was about the need to respond. The emotions ran from disbelief to sadness to anger.

For the next year I had to leave for work at least 30 minutes earlier than before. If I was called in for an emergency in the middle of the night it was a guaranteed car search. Patients were frequently late for appointments because of the extra security. Any medical technician with security experience was immediately recruited for other duties.

The deployment tempo went into high gear. The US invaded Afghanistan not long after and along with troops already in the Persian Gulf the strain was significant.

Then the decision was made to invade Iraq. This pushed the deployment patterns to the brink. I had friends around the country spending more time deployed than at home. It created some great stories but it was also taking a toll on the mental health of everybody.

Deployment can be detrimental to a young physician. A friend of mine was sent to Iraq fresh out of training and did not get to practice his specialty for a year. The Army had to send him for extra training when he got back just to get him back up to speed.

The lack of physicians taking TRICARE in Anchorage made my gastroenterology position on base irreplaceable. I was bounced out of readiness spots and others sent instead on two occasions. It created even more strain for the remaining internists who had to fill those spots.

In many ways despite the 24/7 endless call I was the luckiest gastroenterologist in the USAF.

The biggest aggravation for me was stop-loss. Stop-loss is a policy which prevents active duty members from separating if they are in a critical field. Many people may remember this policy was applied to Diane Benson's son. It was lifted for my field weeks before I separated in 2003.

It became inexplicable when I started asking questions. Air Force bigwigs actually told me they did not want to take reservists out of civilian jobs and that is why stop-loss was there. So, an officer who signed on the dotted line to be available would not be used while an officer who was supposed to be released was retained against his will. Reservists collect a paycheck and benefits for a reason.

The other ridiculous statement made was that they could use stop-loss to keep a gastroenterologist at Elmendorf. It turns out the USAF was critically short on the specialty. That's great, but stop-loss was there to fight a war not ensure screening colonoscopies.

That kind of bizarre and abusive thinking only compounds morale issues.

Between 9/11/2001 and 7/3/2003 when I left the USAF, there was a remarkable change in attitude. The same people who were once ready to fight were worn out. The desire to fight was being replaced with puzzled thoughts of what the mission truly was.

A lot of it started when the decision was made to invade Iraq. It was not that Saddam Hussein was not worth eliminating. But how do you invade Iraq and not be there for decades? And how many times can you ask people to deploy?

That is still an issue. It is unclear how this country would be able respond if it had to get involved in another major conflict tomorrow.

The story of Dr. Nidal Malik Hasan did not surprise me today. His outburst may be worse than many others but the mental breakdowns are popping up all over the country. The mental health of our young military members is deteriorating with every passing day.

Dr. Hasan has been reported to have gotten into arguments with other military members about the wars. Some may point to his Muslim faith as an issue but there are plenty of soldiers of all faiths who have lost it at home and abroad over the years.

Americans have become selfish. They no longer are willing to sacrifice for principles bigger then themselves. The going gets tough whether it is Vietnam, Afghanistan, or Iraq and the calls to cut and run grow loud.

This time though we are stretched thin. Iraq has always had unclear motives and goals. Iraq has also diverted resources and created murkiness in Afghanistan despite the fact that the goal there was initially clear.

Dirty Harry would say, "A man has got to know his limitations." So does a nation. We have gone beyond them in the last decade with the military. That does not excuse us from avoiding the consequences.

How do we lessen the burden? A draft? Call up every reservist permanently? Stop-loss everyone?

Do we just stop and give up? That is what some people want to do.

It would not be right to leave Iraq or Afghanistan in chaos. The unfortunate truth is we may have to still be there for decades. We still have bases that are left over from WWII so the idea is not that far-fetched.

One thing is certain. The US appears to no longer have the intestinal fortitude to stand by its convictions. That is something we need to get back whether the motives were correct or not. It remains our responsibility.

We have to deal with the consequences of our actions both correct and incorrect. We need to then learn and not make the same mistake again.

It is true for the individual as well as the nation. We will never be truly great again until everybody gets it.