House Calls
The UVA Health System Takes Telemedicine into the 21st century
as published in albemarle Magazine's August 2015 issue
Dr. Karen Rheuban places her black flip phone on a glass-covered oval table at the University of Virginia (UVA) Center for Telehealth. The tiny device looks like a relic next to a high-def monitor and heavyweight camera at the head of the gray meeting room. That phone is about the only low-tech part of her job as the head of Pediatric Cardiology at UVA and the co-director of UVA’s 20-year-old Telemedicine program.
Every week, Dr. Rheuban sits down with about a dozen doctors, coordinators and analysts to discuss the latest developments. The telehealth team files into the room and two people appear on-screen to virtually join the meeting. Dr. Rheuban smiles under her purple-metallic glasses and hugs her coworkers as they fuel themselves with coffee from extra-large thermoses. A navy button-down shirt with rhinestones bedazzling the collar peeks out of Dr. Rheuban’s white doctor’s coat. She’s dressed to meet with the Virginia Senate, so today she’ll duck out of the meeting early.
“We’re busy. We’re really involved both in policy, in research, in clinical outreach, outcome-based training. We are here really to drive the missions of the health system. This is a dedicated, incredible team that makes it happen,” Dr. Rheuban said.
Dr. Rheuban taps her fingers on the table for emphasis as she speaks. Her hands stay busy rubbing together as she listens. She has to keep moving to stay on top of the ballooning telehealth program at UVA.
Its specialty medical services have doubled over the past four years. The center now connects 152 telemedicine partner sites across the Commonwealth to UVA Hospital. The technology has put UVA Hospital on the map as one of the country’s premier telehealth centers.
At today’s meeting, graphs and figures showing the lives saved thanks to UVA Telemedicine spices up talk of technical problems and installation successes. Almost 50,000 patients have been treated, and Virginians have travelled 16 million fewer miles for medical care—the equivalent of taking 1,300 cars off the road for a year in terms of CO2 emissions.
UVA Telemedicine mentors healthcare systems across the nation and abroad. It’s helped draft federal and state telemedicine legislation and regulations. Dr. Rheuban has testified seven times before US Congress.
When Dr. Rheuban graduated from Ohio State University College of Medicine in 1974, she didn’t set out to be one of the faces of telemedicine. At that time, female doctors usually stuck to traditional roles. Determined to carve her own path, Dr. Rheuban pursued Pediatric Cardiology. She moved to Charlottesville for her residency at UVA and rose to become the Associate Dean for Continuing Medical Education ten years later. She still lives in Charlottesville, but looks back to New York City, her hometown, for inspiration. Her favorite words to live by come from the famous Yankee’s catcher Yogi Berra: “When you come to a fork in the road, take it.”
Dr. Rheuban and other UVA doctors often hit the highway to treat patients outside of the Charlottesville area. The long trek to places across the state like Winchester and Bristol meant she could only see her patients a day or two every other month. Dr. Rheuban treats babies with heart problems, and they need care more often than that.
At a medical conference Dr. Rheuban heard Dr. Jay Sanders, the CEO of the Global Telemedicine Group, describe how telemedicine could solve her problem and connect her to patients instantaneously.
“I was totally enthralled and came back to UVA to tell our Dean, Dr. Robert Carey,” she said. So began the UVA Center for Telehealth in 1995. Heeding Berra’s advice, Dr. Rheuban started on her way to transform from Pediatric Cardiologist to one of the country’s most prominent telemedicine advocates.
In the beginning, there were many challenges. Telemedicine faced a sluggish dial-up internet technology that limited its applications. Broadband was also expensive. People didn’t understand how clinical care could be provided through these technologies. There was no reimbursement from insurance—telemedicine fell outside of mainstream healthcare.
Dr. Rheuban had to fight to convince policymakers that a video chat appointment is as good as a bricks-and-mortar visit. For example, she illustrated how utilizing telemedicine for diabetic eye exams can ultimately save money. Diabetics can be at risk for blindness, but many who live far away from a hospital often don’t get a yearly eye exam. Telemedicine can electronically transport doctors to patients in rural Virginia. A nurse can take a patient into a darkened room and capture an image of the retina. The nurse sends the image to a retinal specialist, who then looks at it on a smartphone and decides whether or not the patient should come to Charlottesville for a closer look. So far, over 2,000 patients have been treated this way. From an economics standpoint, it costs much more to cover the expenses of a visually impaired or blind diabetic than to pay for preventative care.
Telemedicine has also meant that bedridden patients don’t even have to change out of their pajamas to see a doctor. It limits burdensome travel time for patients managing chronic diseases and the elderly. Patients and caregivers don’t have to take time off work for follow up visits.
“(These patients’ alternative) choice is to get in the car and drive five hours to get to a clinic for a 20-minute appointment, so they’ve really embraced this,” said Dr. Rheuban.
Telemedicine services go beyond video consultations. In UVA’s remote monitoring program, patients leave the hospital with devices that will keep track of their health. They can step on a scale or strap on blood pressure monitor at home that sends readings to a team of nurses. If a patient has an abnormal reading, the patient’s primary care doctor gets an alert. The doctor can then call the patient to intervene if necessary. More preventative treatment and better access to doctors means less hospital admissions.
Telemedicine allows hospitals to pool their resources and personnel. It is now possible to consult a specialist doctor or surgeon in any hospital emergency department, intensive care unit or operating room with a wireless connection. For instance, when a patient has a stroke, a specific clot-busting medication, if taken within the first couple hours, can save some people from brain damage or death. But the drug can kill others, and only a stroke specialist can make that call. Some local hospitals don’t have a stroke neurologist on site, but thanks to telemedicine, they can connect to one at UVA.
But even with its advantages, bringing telemedicine into local practices wasn’t a foregone conclusion.
“Everything we do is governed by so much regulation and the need for technology and infrastructure support, collaboration,” said Dr. Rheuban.
Dr. Rheuban had to convince a group of methodical professionals, who were used to looking at a patient across their examining table, to reimagine a time-tested procedure. Physicians had to willingly disrupt the way they interact with patients and their referral system.
“She’s plowed through a lot of the obstructions, both institutional and regional and national. She had to deal with the cultural issues, the turf issues, the regulatory issues, the reimbursement issues,” said Dr. Neal Kassell, Distinguished Professor of Neurosurgery at UVA, who’s worked on medical committees with Dr. Rheuban throughout her career. “She has the perfect personality to resolve those problems. She’s a leader.”
Dr. Rheuban stepped up to become president of the American Telemedicine Association from 2009-2010. There she helped introduce legislation that requires insurance companies to pay for telemedicine. Virginia Medicaid has broadly covered it since 2003, but Dr. Rheuban still lobbies for better coverage nationally. Medicare only reimburses for “rural” patients. But its definition of rural doesn’t cover the grassy hills of Buckingham County, Floyd County, Washington County or Scott County.
“Our position on all of this is that we’re the University of Virginia. It’s not the University of Charlottesville,” said Dr. Rheuban. “Telemedicine is a team sport. We have transformed care delivery in Virginia and contributed nationwide as well.”
Dr. Rheuban’s filled up her bench with powerful allies to support her. Among them is Rick Goings, the Chairman and CEO of Tupperware Brands Corporation. Goings and his wife Susan’s pledged $100,000 to the UVA Telehealth Center. Aside from wanting to help an old friend—Goings met Dr. Rheuban in college—he believes telemedicine is the key to unlock equal access to healthcare worldwide.
Goings works from his equestrian estate outside of Charlottesville, home to his two Tennessee Walking horses and herd of miniature ponies. Eagle Hill Farm was designed to merge Rick and Susan’s business life with a personal sanctuary. Goings often flies in business associates and regularly hosts executive leadership teams at the farm. He feels where you are geographically shouldn’t prevent you from doing business, and that concept is the same with medicine.
“Think of telemedicine as how we’ve shrunk the world with technology. This is going to be able to help people with access,” said Goings.
Back at the UVA Center for Telehealth meeting room, framed pictures of UVA’s patients standing together from several developing nations line the wall. UVA reaches countries all over the world from Haiti to Rwanda to China.
Treatment is only as good as the technology allows it to be. Even during today’s meeting at the Center for Telehealth, a shaky Skype connection cuts off the videoconference three times.
Since UVA Telemedicine began 20 years ago the technology has leapt forward and continues to improve. Its scope and scale are growing exponentially, and it’s been Dr. Rheuban’s life work to make that happen. “I love helping others, and in whatever way I can do that in my career, it’s been my privilege,” she said.
Dr. Rheuban gathers her things as she hurries out of the office to get to the Virginia Senate. She may spend a lot of time with politicians, but doesn’t see a future for herself in politics. “Somebody once asked me if I’d ever run for public office, and I said, ‘Are you kidding me?’”
Her ultimate career goal is for virtual medicine to become part of everyday healthcare. As she closes the door, a trailing voice calls, “Bye, Governor Rheuban,” behind her. It seems she has a vote of confidence from her coworkers.
The UVA Health System Takes Telemedicine into the 21st century
as published in albemarle Magazine's August 2015 issue
Dr. Karen Rheuban places her black flip phone on a glass-covered oval table at the University of Virginia (UVA) Center for Telehealth. The tiny device looks like a relic next to a high-def monitor and heavyweight camera at the head of the gray meeting room. That phone is about the only low-tech part of her job as the head of Pediatric Cardiology at UVA and the co-director of UVA’s 20-year-old Telemedicine program.
Every week, Dr. Rheuban sits down with about a dozen doctors, coordinators and analysts to discuss the latest developments. The telehealth team files into the room and two people appear on-screen to virtually join the meeting. Dr. Rheuban smiles under her purple-metallic glasses and hugs her coworkers as they fuel themselves with coffee from extra-large thermoses. A navy button-down shirt with rhinestones bedazzling the collar peeks out of Dr. Rheuban’s white doctor’s coat. She’s dressed to meet with the Virginia Senate, so today she’ll duck out of the meeting early.
“We’re busy. We’re really involved both in policy, in research, in clinical outreach, outcome-based training. We are here really to drive the missions of the health system. This is a dedicated, incredible team that makes it happen,” Dr. Rheuban said.
Dr. Rheuban taps her fingers on the table for emphasis as she speaks. Her hands stay busy rubbing together as she listens. She has to keep moving to stay on top of the ballooning telehealth program at UVA.
Its specialty medical services have doubled over the past four years. The center now connects 152 telemedicine partner sites across the Commonwealth to UVA Hospital. The technology has put UVA Hospital on the map as one of the country’s premier telehealth centers.
At today’s meeting, graphs and figures showing the lives saved thanks to UVA Telemedicine spices up talk of technical problems and installation successes. Almost 50,000 patients have been treated, and Virginians have travelled 16 million fewer miles for medical care—the equivalent of taking 1,300 cars off the road for a year in terms of CO2 emissions.
UVA Telemedicine mentors healthcare systems across the nation and abroad. It’s helped draft federal and state telemedicine legislation and regulations. Dr. Rheuban has testified seven times before US Congress.
When Dr. Rheuban graduated from Ohio State University College of Medicine in 1974, she didn’t set out to be one of the faces of telemedicine. At that time, female doctors usually stuck to traditional roles. Determined to carve her own path, Dr. Rheuban pursued Pediatric Cardiology. She moved to Charlottesville for her residency at UVA and rose to become the Associate Dean for Continuing Medical Education ten years later. She still lives in Charlottesville, but looks back to New York City, her hometown, for inspiration. Her favorite words to live by come from the famous Yankee’s catcher Yogi Berra: “When you come to a fork in the road, take it.”
Dr. Rheuban and other UVA doctors often hit the highway to treat patients outside of the Charlottesville area. The long trek to places across the state like Winchester and Bristol meant she could only see her patients a day or two every other month. Dr. Rheuban treats babies with heart problems, and they need care more often than that.
At a medical conference Dr. Rheuban heard Dr. Jay Sanders, the CEO of the Global Telemedicine Group, describe how telemedicine could solve her problem and connect her to patients instantaneously.
“I was totally enthralled and came back to UVA to tell our Dean, Dr. Robert Carey,” she said. So began the UVA Center for Telehealth in 1995. Heeding Berra’s advice, Dr. Rheuban started on her way to transform from Pediatric Cardiologist to one of the country’s most prominent telemedicine advocates.
In the beginning, there were many challenges. Telemedicine faced a sluggish dial-up internet technology that limited its applications. Broadband was also expensive. People didn’t understand how clinical care could be provided through these technologies. There was no reimbursement from insurance—telemedicine fell outside of mainstream healthcare.
Dr. Rheuban had to fight to convince policymakers that a video chat appointment is as good as a bricks-and-mortar visit. For example, she illustrated how utilizing telemedicine for diabetic eye exams can ultimately save money. Diabetics can be at risk for blindness, but many who live far away from a hospital often don’t get a yearly eye exam. Telemedicine can electronically transport doctors to patients in rural Virginia. A nurse can take a patient into a darkened room and capture an image of the retina. The nurse sends the image to a retinal specialist, who then looks at it on a smartphone and decides whether or not the patient should come to Charlottesville for a closer look. So far, over 2,000 patients have been treated this way. From an economics standpoint, it costs much more to cover the expenses of a visually impaired or blind diabetic than to pay for preventative care.
Telemedicine has also meant that bedridden patients don’t even have to change out of their pajamas to see a doctor. It limits burdensome travel time for patients managing chronic diseases and the elderly. Patients and caregivers don’t have to take time off work for follow up visits.
“(These patients’ alternative) choice is to get in the car and drive five hours to get to a clinic for a 20-minute appointment, so they’ve really embraced this,” said Dr. Rheuban.
Telemedicine services go beyond video consultations. In UVA’s remote monitoring program, patients leave the hospital with devices that will keep track of their health. They can step on a scale or strap on blood pressure monitor at home that sends readings to a team of nurses. If a patient has an abnormal reading, the patient’s primary care doctor gets an alert. The doctor can then call the patient to intervene if necessary. More preventative treatment and better access to doctors means less hospital admissions.
Telemedicine allows hospitals to pool their resources and personnel. It is now possible to consult a specialist doctor or surgeon in any hospital emergency department, intensive care unit or operating room with a wireless connection. For instance, when a patient has a stroke, a specific clot-busting medication, if taken within the first couple hours, can save some people from brain damage or death. But the drug can kill others, and only a stroke specialist can make that call. Some local hospitals don’t have a stroke neurologist on site, but thanks to telemedicine, they can connect to one at UVA.
But even with its advantages, bringing telemedicine into local practices wasn’t a foregone conclusion.
“Everything we do is governed by so much regulation and the need for technology and infrastructure support, collaboration,” said Dr. Rheuban.
Dr. Rheuban had to convince a group of methodical professionals, who were used to looking at a patient across their examining table, to reimagine a time-tested procedure. Physicians had to willingly disrupt the way they interact with patients and their referral system.
“She’s plowed through a lot of the obstructions, both institutional and regional and national. She had to deal with the cultural issues, the turf issues, the regulatory issues, the reimbursement issues,” said Dr. Neal Kassell, Distinguished Professor of Neurosurgery at UVA, who’s worked on medical committees with Dr. Rheuban throughout her career. “She has the perfect personality to resolve those problems. She’s a leader.”
Dr. Rheuban stepped up to become president of the American Telemedicine Association from 2009-2010. There she helped introduce legislation that requires insurance companies to pay for telemedicine. Virginia Medicaid has broadly covered it since 2003, but Dr. Rheuban still lobbies for better coverage nationally. Medicare only reimburses for “rural” patients. But its definition of rural doesn’t cover the grassy hills of Buckingham County, Floyd County, Washington County or Scott County.
“Our position on all of this is that we’re the University of Virginia. It’s not the University of Charlottesville,” said Dr. Rheuban. “Telemedicine is a team sport. We have transformed care delivery in Virginia and contributed nationwide as well.”
Dr. Rheuban’s filled up her bench with powerful allies to support her. Among them is Rick Goings, the Chairman and CEO of Tupperware Brands Corporation. Goings and his wife Susan’s pledged $100,000 to the UVA Telehealth Center. Aside from wanting to help an old friend—Goings met Dr. Rheuban in college—he believes telemedicine is the key to unlock equal access to healthcare worldwide.
Goings works from his equestrian estate outside of Charlottesville, home to his two Tennessee Walking horses and herd of miniature ponies. Eagle Hill Farm was designed to merge Rick and Susan’s business life with a personal sanctuary. Goings often flies in business associates and regularly hosts executive leadership teams at the farm. He feels where you are geographically shouldn’t prevent you from doing business, and that concept is the same with medicine.
“Think of telemedicine as how we’ve shrunk the world with technology. This is going to be able to help people with access,” said Goings.
Back at the UVA Center for Telehealth meeting room, framed pictures of UVA’s patients standing together from several developing nations line the wall. UVA reaches countries all over the world from Haiti to Rwanda to China.
Treatment is only as good as the technology allows it to be. Even during today’s meeting at the Center for Telehealth, a shaky Skype connection cuts off the videoconference three times.
Since UVA Telemedicine began 20 years ago the technology has leapt forward and continues to improve. Its scope and scale are growing exponentially, and it’s been Dr. Rheuban’s life work to make that happen. “I love helping others, and in whatever way I can do that in my career, it’s been my privilege,” she said.
Dr. Rheuban gathers her things as she hurries out of the office to get to the Virginia Senate. She may spend a lot of time with politicians, but doesn’t see a future for herself in politics. “Somebody once asked me if I’d ever run for public office, and I said, ‘Are you kidding me?’”
Her ultimate career goal is for virtual medicine to become part of everyday healthcare. As she closes the door, a trailing voice calls, “Bye, Governor Rheuban,” behind her. It seems she has a vote of confidence from her coworkers.
Terry Dougherty in his Federalist cavalry uniform
Photo by: Katie Manning
Civil War Reenacting Behind the Lines: Spotsyvania gears up for the 150th Battle of the Wilderness
as published in Albemarle Magazine's April/May 2014 issue
Civil War reenactor Terry Dougherty marches across a former Civil War battleground in a crisp Confederate-soldier uniform, gripping his single-shot Whitworth rifle. He’s on a mission to convert a young boy into a soldier. He hones in on his target and asks the boy if he’d like to fire a musket.
Dougherty hands over the weapon. Close your eyes, he says. He points to an imaginary line of soldiers. They’re coming to pillage your property, ransack your home, eat your cow, and steal your horse.
“You’re going to do everything you can to protect your mother and your family. You’re going to take sight on that blue line, and you’re going to find you one, and you’re going to smite him, and send him to meet his maker,” he says.
And then the boy’s eyes open. He tucks the gun between his cheek and shoulder. He aims. He fires. Bam. He beams.
“I want to smite one,” a girl yells as she runs to Dougherty.
He steps back from retelling the war story and pauses for emphasis. He has a flair for the dramatic.
“For the people who come, we want them to learn from the heritage,” says Dougherty, who also curates the Spotsylvania Civil War museum. “You do it because you love history, and I feel very fortunate to live in an area like this that truly is a crossroads for the Civil War.”
Dougherty’s father began telling him Civil War stories in the 1960s.
“Having those stories, it shaped me for the future,” he says. Now he wants to pass on that enthusiasm to the next generation.
But given the controversial nature of the Civil War – specifically its ties to slavery – why try and pass down a tradition of trying to recreate it?
Stephen Cushman, an English Professor at the University of Virginia (UVA), wrote “Bloody Promenade,” which in part describes what motivates reenactors. He boils it down to three reasons: to instruct, to commemorate and to entertain.
Reenactors do what they do, so we don’t forget, to commemorate and keep knowledge alive, says Cushman. It’s a spectacle for the crowd and entertaining for the reenactors.
For many, relieving the Civil War is more than a hobby. Reenactors study specific characters to play. They sign up online for a unit that adheres to the Civil War’s military hierarchy. Newcomers start out at the bottom of the totem pole hoping to work their way up to become commanding officers. Each unit drives to up to 10 or even 20 battles a year in different locations, scattered across the southeastern region of the U.S.
Right now, they’re in the thick of the 150th anniversary of the Civil War, basically the Olympics of reenacting. There are more spectators. There’s more production.
Spotsylvania’s upcoming 150th Battle of the Wilderness reenactment is no exception. The county anticipates $80,000 in revenue from the event. With 16,000 spectators and participants expected to descend on 9019 Old Battlefield Boulevard on May 1-4, Spotsylvania could see its biggest battle since the original 150 years ago.
At the Wilderness, the Union Army’s General Ulysses S. Grant tangled with Confederate General Robert E. Lee for the first time. This started the Overland Campaign, which debuted a new kind of warfare.
“It’s not about march, march, march, down, fight and retreat. It’s about march, march, march, down, and fight, and fight, and fight,” says Cushman.
Grant had more soldiers to throw at the battle and better access to supplies. With these new tactics, Grant needed only to trudge on and whittle down the Confederate numbers to win the war.
Ask a Spotsylvania reenactor where his relatives were during this battle. He’ll likely tell you down to the unit. The area saw enough casualties to fill up UVA’s John Paul Jones Arena – twice. The battle is more than a landmark for the county.
“The people who do come from this area and trace their history back a long way, I think are deeply imprinted by the battle, particularly in the rural areas,” says Cushman.
Union Cavalry reenactor David Childs lives in Prince William County. Both of his great-great grandfathers from New York fought in the Civil War.
Childs worked for Homeland Security 28 years ago when he bought a complete set of shiny camping gear. Two weeks later he saw a reenactment. He was hooked.
“If you like to camp, try reenactment, you’ll never go back,” he says.
He cast aside his modern day equipment – it’s only been used twice to this day – opting instead for a Civil War uniform, a canvas tent, beds and gear made of natural fibers.
Civil War outfitting costs a few thousand dollars and up. Just renting a trained “war horse” for the weekend will set you back $400 dollars.
“It can get expensive. It’s like any hobby, but it’s a lot cheaper than fishing. You don’t have to buy a boat,” he says.
The proceeds from each reenactment usually go to museums, monuments and historical sites.
Although reenactors strive to preserve history, some say they miss the mark.
Frank Walker, author of “Remembering: A History of Orange County, Virginia,” sits in his sunroom, stationed nearby several Civil War battlegrounds. He says that while the guns and the smoke might spark an interest in the Civil War, reenactments provide a murky historical account.
“They (reenactors) really try to know the unit and the individual they’re portraying. When it comes to actually reproducing a particular scene, it never quite comes off,” says Walker. “After about your third reenactment, you realize you’re seeing the same reenactment again.”
Of course, spontaneity is inevitable when orchestrating thousands of people. Horses will spook, dumping their riders in the dirt. Bones break.
It’s rare, but even battle sequences can go awry. Dougherty remembers a reenactment when a man brought a 1855 collector’s item musket.
“You’re suppose to practice if you come in close and have any hand-to-hand combat or anything like that,” he says.
The musket ended up accidentally clubbing the man in the back of the head.
“It changed over from a prepared scenario to a fist fight, and it went on for about 20 minutes. and bodies flying and punches getting thrown,” Dougherty says.
The most glaring disparity between the real battle and the reproduction is the relative size of the armies. The Union troops outnumbered Confederates two to one at the Wilderness. At the reenactment, those numbers will be flipped. More reenactors prefer to play Confederate troops.
There’s no way to recreate the battle exactly as it was, but for Dougherty that’s not the point. He takes stock of what he can control. He mans the battle’s website. He’s digging up soil to create trenches. He even called the National Guard to get permission to shoot off smoke bombs to simulate the forest fires that happened during the battle.
“Basically you couldn’t see your hand from your face,” he says.
As the day approaches, Dougherty says he’ll plunge 70 hours a week into organizing the event. But capturing the feeling of the battle goes beyond logistical preparation and historical facts.
Dougherty studied his part in such detail that he can slip into an in-character conversation without missing a beat. It’s his idea of a good time. He does it often.
“Recreating history is just like going to the movies. You pick a character. You recreate it. I don’t care if it’s a Confederate soldier from 1864 or you’re a World War I fighter pilot,” he says.
Perhaps the greatest reason why reenactors reenact is simply that they enjoy doing it.
“Shooting the muskets fun. Everybody should do it once in awhile,” Dougherty says.
as published in Albemarle Magazine's April/May 2014 issue
Civil War reenactor Terry Dougherty marches across a former Civil War battleground in a crisp Confederate-soldier uniform, gripping his single-shot Whitworth rifle. He’s on a mission to convert a young boy into a soldier. He hones in on his target and asks the boy if he’d like to fire a musket.
Dougherty hands over the weapon. Close your eyes, he says. He points to an imaginary line of soldiers. They’re coming to pillage your property, ransack your home, eat your cow, and steal your horse.
“You’re going to do everything you can to protect your mother and your family. You’re going to take sight on that blue line, and you’re going to find you one, and you’re going to smite him, and send him to meet his maker,” he says.
And then the boy’s eyes open. He tucks the gun between his cheek and shoulder. He aims. He fires. Bam. He beams.
“I want to smite one,” a girl yells as she runs to Dougherty.
He steps back from retelling the war story and pauses for emphasis. He has a flair for the dramatic.
“For the people who come, we want them to learn from the heritage,” says Dougherty, who also curates the Spotsylvania Civil War museum. “You do it because you love history, and I feel very fortunate to live in an area like this that truly is a crossroads for the Civil War.”
Dougherty’s father began telling him Civil War stories in the 1960s.
“Having those stories, it shaped me for the future,” he says. Now he wants to pass on that enthusiasm to the next generation.
But given the controversial nature of the Civil War – specifically its ties to slavery – why try and pass down a tradition of trying to recreate it?
Stephen Cushman, an English Professor at the University of Virginia (UVA), wrote “Bloody Promenade,” which in part describes what motivates reenactors. He boils it down to three reasons: to instruct, to commemorate and to entertain.
Reenactors do what they do, so we don’t forget, to commemorate and keep knowledge alive, says Cushman. It’s a spectacle for the crowd and entertaining for the reenactors.
For many, relieving the Civil War is more than a hobby. Reenactors study specific characters to play. They sign up online for a unit that adheres to the Civil War’s military hierarchy. Newcomers start out at the bottom of the totem pole hoping to work their way up to become commanding officers. Each unit drives to up to 10 or even 20 battles a year in different locations, scattered across the southeastern region of the U.S.
Right now, they’re in the thick of the 150th anniversary of the Civil War, basically the Olympics of reenacting. There are more spectators. There’s more production.
Spotsylvania’s upcoming 150th Battle of the Wilderness reenactment is no exception. The county anticipates $80,000 in revenue from the event. With 16,000 spectators and participants expected to descend on 9019 Old Battlefield Boulevard on May 1-4, Spotsylvania could see its biggest battle since the original 150 years ago.
At the Wilderness, the Union Army’s General Ulysses S. Grant tangled with Confederate General Robert E. Lee for the first time. This started the Overland Campaign, which debuted a new kind of warfare.
“It’s not about march, march, march, down, fight and retreat. It’s about march, march, march, down, and fight, and fight, and fight,” says Cushman.
Grant had more soldiers to throw at the battle and better access to supplies. With these new tactics, Grant needed only to trudge on and whittle down the Confederate numbers to win the war.
Ask a Spotsylvania reenactor where his relatives were during this battle. He’ll likely tell you down to the unit. The area saw enough casualties to fill up UVA’s John Paul Jones Arena – twice. The battle is more than a landmark for the county.
“The people who do come from this area and trace their history back a long way, I think are deeply imprinted by the battle, particularly in the rural areas,” says Cushman.
Union Cavalry reenactor David Childs lives in Prince William County. Both of his great-great grandfathers from New York fought in the Civil War.
Childs worked for Homeland Security 28 years ago when he bought a complete set of shiny camping gear. Two weeks later he saw a reenactment. He was hooked.
“If you like to camp, try reenactment, you’ll never go back,” he says.
He cast aside his modern day equipment – it’s only been used twice to this day – opting instead for a Civil War uniform, a canvas tent, beds and gear made of natural fibers.
Civil War outfitting costs a few thousand dollars and up. Just renting a trained “war horse” for the weekend will set you back $400 dollars.
“It can get expensive. It’s like any hobby, but it’s a lot cheaper than fishing. You don’t have to buy a boat,” he says.
The proceeds from each reenactment usually go to museums, monuments and historical sites.
Although reenactors strive to preserve history, some say they miss the mark.
Frank Walker, author of “Remembering: A History of Orange County, Virginia,” sits in his sunroom, stationed nearby several Civil War battlegrounds. He says that while the guns and the smoke might spark an interest in the Civil War, reenactments provide a murky historical account.
“They (reenactors) really try to know the unit and the individual they’re portraying. When it comes to actually reproducing a particular scene, it never quite comes off,” says Walker. “After about your third reenactment, you realize you’re seeing the same reenactment again.”
Of course, spontaneity is inevitable when orchestrating thousands of people. Horses will spook, dumping their riders in the dirt. Bones break.
It’s rare, but even battle sequences can go awry. Dougherty remembers a reenactment when a man brought a 1855 collector’s item musket.
“You’re suppose to practice if you come in close and have any hand-to-hand combat or anything like that,” he says.
The musket ended up accidentally clubbing the man in the back of the head.
“It changed over from a prepared scenario to a fist fight, and it went on for about 20 minutes. and bodies flying and punches getting thrown,” Dougherty says.
The most glaring disparity between the real battle and the reproduction is the relative size of the armies. The Union troops outnumbered Confederates two to one at the Wilderness. At the reenactment, those numbers will be flipped. More reenactors prefer to play Confederate troops.
There’s no way to recreate the battle exactly as it was, but for Dougherty that’s not the point. He takes stock of what he can control. He mans the battle’s website. He’s digging up soil to create trenches. He even called the National Guard to get permission to shoot off smoke bombs to simulate the forest fires that happened during the battle.
“Basically you couldn’t see your hand from your face,” he says.
As the day approaches, Dougherty says he’ll plunge 70 hours a week into organizing the event. But capturing the feeling of the battle goes beyond logistical preparation and historical facts.
Dougherty studied his part in such detail that he can slip into an in-character conversation without missing a beat. It’s his idea of a good time. He does it often.
“Recreating history is just like going to the movies. You pick a character. You recreate it. I don’t care if it’s a Confederate soldier from 1864 or you’re a World War I fighter pilot,” he says.
Perhaps the greatest reason why reenactors reenact is simply that they enjoy doing it.
“Shooting the muskets fun. Everybody should do it once in awhile,” Dougherty says.