Still, many have tried. After telling about killing someone during a battle in Vietnam ("I am pulling back the slide to put a round in the chamber. I must kill this man before he kills me. I must take his life away from him. My hand shakes. I will ask God to steady my hand. I will ask God to help me kill this man killing me."), Michael Norman puts it this way [1]:

I, too, of course, am dead. The bullet that killed Dong killed me. One shot, two souls. I am now a hollow man, empty and alone. My psyche has a cicatrix.

It can hardly be any wonder, therefore, that all wars create war syndromes, those constellations of nonspecific but disabling symptoms and signs whose ultimate explanation is still elusive but that seem in part to be a way for persons who have been in war to express things they've seen and done that are literally unspeakable [2]. In Norman's words:

War makes men like me, hollow men, men weighed down by memory, out of time and out of place, men who spend their lives trying to recover what has been lost, men haunted by the awful mystery that spared them, that left them alone, walking in the empty spaces.

As to the question of being healed of these maladies, Norman's response is: "Healed? You want me healed. Should I invoke Eliot? ‘Time is no healer because the patient is no longer here.’"

For physicians who are part of war, the experience is inevitably somewhat different; not better, different. So it was for Roger Bone, whose Perspective on immunologic dissonance appears in this issue [3]. Shipped off to Vietnam right out of a medical internship, Bone was assigned to be the chief of anesthesia at a field hospital in an area of heavy fighting. As the tells it, he found himself during his tour of duty caring for more than a thousand severely wounded soldiers. A great many of these young men died, and a distressingly high percentage died not directly of their wounds but of a peculiarly aggressive and unexplained form of respiratory failure that came to be known as "Da Nang lung." The experience of caring for these men was pivotal in Bone's choice of a career; he decided to become, in his words, "a thinking pulmonologist." His memory of so many men lost because they couldn't breathe—and of his inability to do anything about it because no one understood why it happened—led him to dedicate much of his subsequent professional life to finding out why.

Confronted directly now with his own death from cancer, Bone has recently given us several essays of extraordinary honesty and personal courage about the experience of his own dying [4-6]. He, like others before him, has tried to tell us what has really happened; judging from the number and intensity of the responses to his accounts, he has succeeded. But perhaps this is just what we'd expect from the man who, in a hot and sweaty field hospital in Vietnam, volunteered to remove a live grenade from the body of a wounded soldier. The soldier died 3 hours later; Bone's comment, looking back on this incident 20 years later, was "but at least I had given him a chance."

In this issue, Bone leaves us, as a final professional legacy, his Perspective on immunologic dissonance: a synthesis of what is known, and reflections on what is not known, about his old nemesis, Da Nang lung [3]. Although reframed now as part of a more general pathophysiologic process and dressed in the elegant language of clinical science, that is, the "systemic immune response syndrome" (SIRS) and the "multiple organ dysfunction syndrome" (MODS), Da Nang lung is still almost as mysterious and as frustrating to manage as it was in the field hospitals and jungles of Vietnam [7].

Is Bone right in his conjectures about immunologic dissonance? About complex, powerful biological defenses out of control? About defense and counterdefense out of balance? He may be or he may not. Either way, he is unique in his ability to hack his way through the jungle of tangled pathophysiologies that lie at the dark heart of multiorgan failure and to bring clinical science and bedside experience meaningfully together. It will be a long time before we reach the deep understanding of these syndromes that Bone and so many others have sought, the understanding that will lead to the therapeutic tools that were so grievously lacking in Vietnam and are lacking still. But Bone's many clinical contributions in this area over the years, as well as the orderly, thoughtful synthesis that he has extracted from the chaos of "immunologic dissonance," are likely to be seen as notable benchmarks along the way.

War's legacy is so bitter that it's hard to credit the idea that anything positive can grow out of it, yet Bone's career and his contributions say otherwise. The recent novel Birdsong by British journalist Stephen Faulks also reflects on the new life and purpose that can come forth from a war (in this case, World War I), although sometimes not until decades later [8]. Indeed, both Faulks's fiction and Bone's real-world contributions say much the same as the poem "Everyone Sang," written by World War I poet Siegfried Sassoon: that the possibilities for regrowth after a war are endless and are passed along, endlessly, in the very exultation of war's ending [9]:

Everyone suddenly burst out singing;

And I was filled with such delight

As prisoned birds must find in freedom,

Winging wildly across the white

Orchards and dark-green fields; on—on—and out of sight.

Everyone's voice was suddenly lifted;

And beauty came like the setting sun;

My heart was shaken with tears; and horror

Drifted away ... O, but Everyone

Was a bird; and the song was wordless; the singing will never be done.

Peace, Roger Bone.