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A Day in the Life: A Man on a Mission

December 30, 2021
Pierre Noel, MD
Medical Director of Military Medicine, Mayo Clinic, Phoenix, Arizona

In this edition, Pierre Noel, MD, walks us through a typical day in the atypical life of a hematologist and military medicine specialist.

Pierre Noel, MD

Mayo Clinic, Phoenix, AZ

Bone marrow transplantation, military medicine

Years practicing:

One might wonder how a born-and-raised Montrealer and practicing hematologist came to work with the U.S. Homeland and National Security Council and the U.S. Air Force 724th Special Tactics Group, and serve with several special mission units deployed to Iraq, Afghanistan, and other war-torn countries. To quote the Grateful Dead, "What a long, strange trip it's been."

The twists in the journey began in hematology at Mayo Clinic in Minnesota in 1988, where I was focusing on myeloid disorders and hematopoietic cell transplantation. When Mayo expanded to Florida and Arizona, I moved to Arizona to start a new bone marrow transplantation program.

My involvement with the military started shortly thereafter, when I was recruited as a volunteer medical instructor (in wilderness medicine, biologic and chemical warfare agents, etc.) at the Naval Special Warfare Group 1 in California. Not long after, I was "in the army now" – or, rather, in the U.S. Air Force Reserves. I was later recruited to the National Institutes of Health in Bethesda and joined the Air Force 724th Special Tactics Group in North Carolina.

Life changed for good following the events of September 11, 2001. Among many consequences of the attack, in subsequent years I worked with the White House, served on several federal disaster response and emergency preparedness working groups, and deployed with special mission units.

In 2010, I retired from the military. It was time to get back to normality and focus once more on the more relaxed and peaceful profession of hematopoietic cell transplantation. But "The best-laid schemes o' Mice an' Men / Gang aft agley" to quote a famous Scottish poet, and the military and national security were not done with me yet. With the support of Mayo Clinic and generous benefactors, I launched the Special Operations Tactical Medicine Training Program at Mayo in 2012. We now have trained more than 1,000 special operations personnel in combat trauma, prolonged field care, and critical care.

Given the success of the courses and my interest in the military, I was named director of Mayo Clinic's Center for Military Medicine in 2018.

Today, I have the privilege of being an appointed consultant in protective medicine for the White House Medical Unit, and I serve on the Defense Health Board, the Medical Technology Enterprise Consortium, and the Atlantic Council's Scowcroft Center for Strategy and Security.

How does a Montrealer and practicing hematologist come to work in national security? To quote the Grateful Dead, "What a long, strange trip it's been."

If you are wondering how I balance such disparate interests, I will note that my clinical practice is almost exclusively hospital-based; this permits me to juggle the requirements of a hybrid career. My experiences after 9/11 also give me a sense of perspective on the rougher academic days. Given my work in national security roles and in combat environments, I am consoled – and amused – by the famous saying often attributed to Henry Kissinger: "University politics are vicious precisely because the stakes are so small."

Here is how I spent a recent workday, which marked the first day of a military training course.

5:00 a.m. I exercise for one hour. I need to make myself believe I can still fly to a war zone at short notice.

7:00 a.m. I arrive at the military training laboratory. Our student body consists of seasoned special operations medical personnel with significant combat experience. Our faculty consists of multiple subspecialty surgeons, anesthesiologists, critical care specialists, respiratory therapists, and one misplaced hematologist (me).

The curriculum covers the skills necessary to support a critically injured service member in an austere combat environment for up to 72 hours without access to definitive surgical care. This morning, we are teaching point-of-care ultrasound and ultrasound-guided vascular access.

10:00 a.m. During a break, I check on results of transplant patients and discuss patients with the nurses. I call my administrative partner in military medicine to discuss research grants and Veterans Affairs/TRICARE issues.

10:30 a.m. I am back coordinating teaching stations. A neurosurgeon is guiding students through a decompressive craniectomy; a urologist demonstrates the placement of a suprapubic catheter; an ENT specialist is teaching cricothyroidotomies; and an anesthesiologist is coaching students on the fine points of managing a difficult airway.

1:00 p.m. Lunch break; it's also when I address patient care–related issues.

1:30 p.m. We start critical care simulations using actors and high-fidelity mannequins in mobile emergency rooms located adjacent to abandoned buildings, and in specially outfitted containers positioned in the desert.

5:00 p.m. I drive home and go for a run to reenergize myself. I am attending on the leukemia and allogenic transplantation service next week, so I try to figure out how I will get anything else accomplished.

I prepare dinner with my lovely wife, Sue; share news regarding our grown kids; and FaceTime with our two precious granddaughters.

A medical career is full of options and opportunities. I never dreamed a hematologist would be teaching trauma and critical care and deploying overseas with a special mission unit. The opportunity of advising the White House Medical Unit was a fantasy. I am fortunate to have the privilege of serving my adopted country, training the elite members of our military, and practicing a fascinating medical specialty with tremendous colleagues in fabulous medical institutions. I am blessed with a supportive and tolerant wife who encouraged me to push the boundaries and live the life I dreamed of.


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