On December 10, 2023, Vice Adm. Michael L. Cowan, the 34th Surgeon General of the Navy died. He was 78.

Vice Adm. Cowan served in a wide-variety of clinical, operational, staff and leadership positions over the course of his 33-year career. His career culminated in 2001 with his selection as the 34th Surgeon General of the U.S. Navy and Chief of the Bureau of Medicine and Surgery (BUMED).

Cowans career legacy includes pioneering the concept of Force Health Protection, redefining deployable medicine in the 21st century, and serving as the Navy Surgeon General during the attacks on September 11th, 2001, and the start of the wars in Iraq and Afghanistan.

It could be stated that medicine was always in the sights of the Fort Morgan, Colorado native. Following pre-med at the University of Colorado at Boulder and after attending medical school at the Washington University School of Medicine, Cowan went to Temple University to study internal medicine and hematology under his mentor Dr. Sol Sherry (1907-1983). Sherry was already a medical giant whose research led to the development of clot-dissolving drugs to treat heart attacks. Cowan envisioned following in Sherrys footsteps and spending his career in academic medicine, but all that would change in 1971 when he was drafted into service.

At the time I was a free spirit, related Cowan. My hair was too long, and I could have put it into a ponytail. I had the attitude that most people had in 1971 about the militaryI was very anti-war, anti-military. I really knew nothing about the military, and everything I thought I knew was wrong.

Although he entered the Navy, as he later jokingly remarked, kicking and screaming, he was soon hooked. While serving as a general medical officer at Naval Hospital Camp Lejeune, N.C., Cowan learned the important role the Navy played in supporting the Marines. I particularly took pride that I was taking care of these young men and women who were serving their country, said Cowan. And it felt good as a physician to know that I didnt have to worry about their insurance. The phrase I always used was, I didnt have to ask them how sick they could afford to be. My job was just to take care of them to the best of my ability, and my paycheck didnt depend on anything else.

Camp Lejeune would remain a special place for Cowan throughout his career. Just over twenty years after entering the Navy, while serving as the Commanding Officer of Naval Hospital Camp Lejeune (1993-1996), he was selected for flag rank.

In 1972, Cowan continued his residency in internal medicine followed by a hematology/oncology fellowship at the National Naval Medical Center (NNMC) in Bethesda, Maryland. It was at Bethesda that his love for Navy Medicine was born, and his decision to stay in the Navy was made.

I was at a change of command ceremony at Bethesda, and as the band started playing the march, as the flags came in, I got a tingle, recalled Cowan. As we were standing at attention in front of the flags about to witness this time-honored, old military ceremony, the hair on the back of my neck went up and I thought, Okay, thats it, thats the answer to my friends question as to why I stay in. The hair on the back of my neck goes up and Im reminded of what this is all about.

Over the ensuing years, Cowans love for the Navy and his role as, he described it, a physician-leader continued to grow. He served as Chief, Internal Medicine, at Naval Hospital Rota, Spain (1975-1976), and Chief of Clinical Investigations for the Navy Malaria Vaccine Research Program at the Naval Medical Research Institute (forerunner of todays Naval Medical Research Command) (1979-1982).

In 1982, Cowan was selected by Dr. Jay Sanford (1928-1996), president of the Uniformed Services University of the Health Sciences (USUHS) in Bethesda, Maryland, to serve as the schools Deputy Director of Operational and Emergency Medicine in the Department of Military Medicine. In this position, Cowan taught the military medicine course and led fourth-year medical students through the Bushmaster exercise. It was a role that would leave an indelible mark on hundreds of future military physicians.

In Bushmaster, we wanted to push people to their limits in a controlled way, explained Cowan. It was a leadership lab that tested what people are really made of when they are really tired and frustrated and just dont think they can do it anymore. Over time we learned how to push people to grow, but in the early days we didnt know how far to push.

On one of his earliest Bushmasters, Cowan, Dr. Sanford, and his team of instructors, started a drill at eleven oclock at night after the students had had a long day. We simulated an attack on the camp with boomers and machinegun fire, recalled Cowan. They were supposed to respond, but they didnt come out.

Cowans team then threw several tear gas canisters around the tent. But still no response. Dr. Sanford slowly walked over, picked up the tent flap, kicked a tear gas canister under the tent flap and walked to the observation area. Still nothing. Cowan and Sanford then turned to each other and at that point knew they had overworked the students and called it a day. The students had just had it, so they had put their gas masks on, pulled their sleeping bags up over themselves the best they could, and just stayed there, recalled Cowan. They slept in their gas masks.

One of his students forever impacted by Cowan and the Bushmaster was Vice Adm. (ret.) C. Forrest Faison III, the 38th Surgeon General of the Navy and a USUHS graduate.

I dreaded this course all four years [at USUHS], recalled Faison. Over the next two weeks we started running back-to-back mass casualty, and combat scenarios. Youre doing this around the clock, and youre exhausted. Then comes the main event, which is a main mass casualty drill where they wrap it all together, and were so sleep deprived. Its hot, its muddy, and its just nasty. And we get through the scenario and were doing a hot wash, and Admiral Cowan gets up there and he goes, Youre cold, youre wet, youre tired, youre hungry. So why do you do it? You do it because that guy on the stretcher is depending on you to do it. And his family back home are depending on you to do it. And its the right thing to do.

Cowans time leading the Bushmaster would follow him throughout his career, even to distant places around the globe. While serving as Task Force Surgeon, Operation Restore Hope in Mogadishu, Somalia (1992-1993), Cowan recalled that many of his former students were serving as medical officers in Marine units and as command surgeons. I was able to delegate far more and had far more confidence in the abilities of these folks than I ever would have if they never had that field experience.

It was in Somalia that Cowan also recognized the unique values of each service, a piece of knowledge that would later serve him well as Joint Staff Surgeon (1997-1999); Chief of Staff, Office of Assistant Secretary of Defense for Health Affairs, The Pentagon (1999-2000); and Deputy Director and Chief Operating Officer, TRICARE Management Activity (2000-2001).

Cowan took the helm as the 34th Surgeon General of the Navy in August 2001. He was on the job for just 30 days when the attacks on September 11th occurred. Instantly, the world had changed, and Navy Medicines course would forever be altered to meet the new challenges ahead. He recalled, On September 11th, I walked to my desk about 10:30 in the morning and threw [my priorities] in the trash can. Priorities had just changed.

Within 24-hours of the attack Cowan updated the Navy Medicines motto from Standing by to assist to Steaming to assist and deployed the hospital ship USNS Comfort to New York City where it served as a relief valve for the rescue workers.

Primary care and physical therapy and messmen and general duty hospital corpsmen boarded he Comfort, and they steamed up to New York, related Cowan. While there they provided up to 1,000 people a day [with] hot meals, a shower, a berth, and laundry service. So, youd go aboard, theyd take your dirty laundry, feed you, put you to bed, give you a shower, wake you up, give you your clean clothes back, or new clothes, and send you back to work. We took criticism for that. There were people who thought that that was an undignified mission for a war ship of the United States Navy and I shouldnt have done that.

Yet, it had a positive impact.

A year later, while attending a reception for exercise BALTIC OPERATIONS (BALTOPS 22), he walked over to a group of Navy messman to congratulate them on doing a nice job. As we were talking and laughing, I said, By the way, how many of you were on the Comfort last year? And most of the hands went up, said Cowan. And this one kid, a 22-year old, kept trying to put his hand up and the others kept slapping him down, good naturedly. He said, I was on the Comfort in New York, but I wasnt crew. I was a New York City fireman. After seeing what the Navy did in New York I was so impressed that I joined the Navy under the condition that I become a messman assigned to the Comfort.

Admiral Cowan was a soft-spoken, caring, and impactful leader who always saw the bigger picture and thought outside the box, said Rear Adm. Darin Via, the 40th Navy Surgeon General. He was way ahead of his time and Navy Medicine is stronger because if him.

One of Vice Adm. Cowans greatest legacies was a humble leadership and his trust of others. This is captured when describing his philosophy of service:

I think a big part of my philosophy was formed by a phrase my dad used to use that I really glommed onto. He said, Your life finds you far more often than you find your life, stated Cowan. Had I not been drafted I never would have come into the military. I would have been an academic, probably stayed at Temple [University] . . . That would have been my life, and I would have been very happy. But this detour happened, and it became a better life, one that I would have never sought after and the direction of that detour I would have never sought out. My whole life found me almost against my will.

So, when people, young officers in particular, ask me, Can you give me some career advice? I say, I will, but its not going to be very good. What Im going to tell you youve got to take with a grain of salt. I tell them, Just dont worry about it. The one thing you must do in life is to do your job. No matter what job youve got, do the hell out of it and then position yourself to try to get jobs you enjoy doing. If you enjoy a job, youll do it well; if you dont enjoy your work, then life isnt worth living.

Admiral Cowan was predeceased by his wife of 60 years, Linda, and son Dr. Mark Cowan, both passing earlier this year.

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Remembering Vice Adm. Michael Cowan, the 34th Surgeon General of Navy Medicine (2001-2004) - American Military News