Surgical care in combat is not graded on a curve. The test is simple and unforgiving: Could a wounded soldier be saved? If so, did we save him?
That standard is why the after-action review, or AAR, is so ingrained in military culture. Once an operation ended, everyone involved gathered to look back. Did we achieve the objective? Were the tactics sound? Did we make the right decisions? What mistakes were made, and by whom?
Participation is demanded of everyone, and the rules are simple. Leave your ego at the door, be willing to criticize the actions of others, and be willing to accept the same.
In a forward surgical unit, that process could be grueling. The sessions could be long, and the comments were raw. Your choices were dissected with all the compassion of a tax audit. Yet we welcomed it. When the next casualty arrived, we would be better because of what we had learned from the last one and our heroes would have higher chances of survival.
When I put away the uniform, I kept that commitment to self-examination and self-criticism. Mistakes in medicine rarely offer a do-over. Mistakes in public policy often do, if leaders can set aside their egos long enough to seize it.
On a rare day off this week, I watched the July 29 Senate hearing with Dr. Anthony Fauci in its entirety. Fauci repeatedly invoked the Fifth Amendment rather than answer the committee’s questions. With almost no substantive answers, it would be easy to dismiss the hearing as a waste of time. It wasn’t — as it should be seen as a cautionary tale about lack of accountability and the implications of refusing to learn from one’s mistakes.
What unfolded was a missed opportunity. Fauci had the chance to answer questions that have lingered for years. He declined while cowering in the cocoon of several high-priced attorneys.
Fauci had every constitutional right to remain silent, and invoking that right is not an admission of guilt. But the Fifth Amendment answers a legal question, not a question of leadership. Americans, especially the vilified, de-platformed, and the terminated, were still entitled to an explanation from one of the most powerful officials of the pandemic era.
The more than 1,000 pages of private journals released before the hearing show why the questions before the committee mattered. They pull back the curtain on a man who often spoke with far greater certainty than the evidence justified. They reveal a growing preoccupation with his public image and celebrity and a willingness to discredit highly qualified colleagues who questioned the prevailing view. Many of his recommendations may have been well-intentioned, but his own notes show that some rested on educated guesses and unproven hypotheses rather than the ironclad evidence his public posture suggested.
I have never been a Fauci hater. I believe in giving almost anyone the benefit of the doubt until the evidence no longer allows it. I will continue to extend grace for decisions made during the first months of COVID. It was terrifying, and it was deadly. I was there.
At my hospital, we converted two additional areas into intensive care units after the original ICU filled. We seriously considered turning a nearby college dormitory into a hospital. People were dying, and the medical community was scrambling to turn the tide.
Having said that, the journals and the timeline of what Fauci knew make it impossible to keep extending that benefit of the doubt. His own words also weaken the “noble lie” defense — the idea that misleading the public can be excused if it serves some greater good. There certainly were lies, but it is clear there was little nobility in them. At a minimum, they show that his public certainty often exceeded what the evidence could support.
The problem went beyond what Fauci said. His doctrinaire commitment to his original pronouncements, along with the silencing or punishment of those who questioned them, discouraged consideration of alternative treatments and hypotheses.
Anecdotal evidence is not proof, but it is often where medical progress begins. During an epidemic, treating physicians may try a different approach from the prevailing protocol and compare the results. If outcomes appear better, they share what they have seen and begin preparing more structured studies to test it. That is how an observation becomes evidence.
During COVID, however, outside-the-box thinking was too often discouraged or punished, and Fauci stood at the apex of the public health establishment that created that climate. An effective response to an epidemic must remain fluid, welcome competing ideas and investigate them honestly. In case you are wondering, that is the actual definition of science.
This week’s hearing could have begun a true after-action review of one of the deadliest and most divisive periods in our history. An honest AAR would be neither a political spectacle nor a blanket absolution. It would ask which measures worked and which failed. Which emergency decisions were reasonable at the time? Which persisted too long? When did officials turn uncertainty into certainty, and how did that damage public trust? And yes, accountability would either be self-imposed or forcibly delivered.
North Carolina’s hospitals, schools, businesses, nursing homes and families lived with these decisions. During the next emergency, state leaders will again make choices that affect lives and livelihoods. We should examine our own response with the same candor, preserve the reforms that helped, discard the policies that failed, and establish clearer limits before the next crisis arrives. It will require the same abandonment of ego and willingness to admit mistakes that have been absent in the years that followed, but it is no less necessary than a national scale review.
Fauci could have helped begin that reckoning. He could have told the country what officials knew, what they feared, where they were wrong, and what he would do differently. He chose to be evasive. He chose to be a coward.
Fauci’s legacy will be complicated. He did important work during his career, and his earliest pandemic efforts may well have been earnest. But leaders are measured not only by how they act in a crisis, but also by whether they will account for their actions afterward.
The country still needs an after-action review, with or without him. If we refuse to examine the last pandemic because the facts are politically inconvenient or reputations are fragile, the next outbreak will find us with the same blind spots and far less public trust.
