HONOLULU, Hawaii -- "It doesn't matter where you start. It's where you end up," said Lt. Gen. Nadja West, Army Surgeon General and Commanding General, U.S. Army Medical Command (MEDCOM), to an audience of military and civilian leaders at Fort Shafter, Hawaii, as part of her first official visit to the Pacific Region.

West's story is a testimony for what can be accomplished through hard work and perseverance. The youngest of 12 children, all adopted, West said, "If I can do it, anyone can. I was an orphan. I started with an uncertain future." Once adopted into a military family she had no thought of doing anything other than joining the military.

"It wasn't just the parents I had that started me on the right path," she said. "It's the inspiration and encouragement they provided."

Coming from a humble family, West's father joined the Army as a private when it was segregated, working his way through enlisted and then warrant officer ranks, where he retired as a chief warrant officer four. "He worked hard and believed in the Army as an institution because things were happening in the military that weren't happening in the civilian sector. The Army led the way," she said. "So he saw in the Army a way to better himself, better his family and must have loved it because he stayed in for 33 years."

As the youngest, West watched nine of her siblings join the military. With brothers in the Army, sisters in the Women's Army Corps (WAC), and a sister in each of the Navy and Women's Auxiliary Air Force (WAAF), the examples set by her siblings and parents paved the way for her military future.

West said being the youngest, she had some confidence issues growing up and was a bit fearful and not always sure of her abilities. But her parents constantly told her she could do anything she put her mind to and not to let anyone tell her not to strive for something and that it can't be done. "So, that's kind of how I live my life," she said.

When it came time to make a military enlistment decision, one of her brothers, who graduated from West Point, told her the service academy was opening to women and she should apply. "And so I did and got in and what a culture shock," she said. "I went from an all-girl catholic school to a predominately all-male military academy at age 17."

With perseverance and the support from classmates, West worked hard and graduated from West Point. Then she came to her next crossroads-medical school. Even though she'd graduated from West Point, medical school seemed daunting. "I had a lapse in confidence thinking 'I can't do that. I can't go to medical school. That's hard,'" she said.

She credits her parents encouraging her, but also outside people. She said a lesson learned is mentors come in all types and are people you encounter along the way that you don't even know are encouraging you and it's not someone that has to look like you.

"There was a physician at Walter Reed who happened to see me in my uniform. I was a cadet still, and I was visiting my dad. He was ill in the hospital," West said. "[The physician] found out I wanted to go to medical school but I'd given up on that dream because I thought I couldn't do it. His comment to me was, 'If you want to do it, apply. Worse they can do is say no and what have you lost? Nothing but the application fee and what you have lost if you don't try is knowing you might have had a chance and might have gotten that yes answer.'

"So I studied hard, took the tests, and I got in. That's a lesson learned I would tell anyone," she said. "Make sure you don't sell yourself short and make sure if you have a dream that you go for it and always look and realize there are people out there, mentors you might have, and people that encourage you along the way that you don't even know. So be aware and be on the lookout."

As a resident at Fort Benning, Georgia, West learned another lesson. "The battalion commander asked me, 'Can you fix broke Soldiers?' And the answer is, 'Yes sir, I can,'" she said.

"I was a resident going through my residency program, little did I know Desert Storm would happen and I would be called up," she said. "You have to be ready. Always strive to be the best you can be in your craft."

Throughout her career, West said she's had lots of people encouraging, helping and mentoring her to be the best she could, but sometimes luck comes into play. "Colin Powell always says luck equals opportunity plus preparation. I had a lucky day. Someone asked me if I was interested in interviewing to be the division surgeon for 1st Armored Division," she said. "As a medical corps person who graduated from West Point but didn't really spend a lot of time at operational units other than Desert Storm, the first thing I said was, 'I can't do that. I can't do Division Surgeon.' For a minute I had to say 'Stop.' Someone felt it was worth the ask to say 'Hey, do you want to interview?' So someone must have thought I had the skills. So instead of having that crisis in confidence again, I interviewed."

Here she learned the importance of preparation. While the Army Command and General Staff course was not required for military physicians, West said she always made sure to keep her military schools up-to-date. "I didn't just want to do what I had to do. I wanted to do the best I could do," she said. "As an Army officer I wanted to make sure I had all the training and education I could to make sure I was not just a competent physician but a competent Soldier."

She credits having attended the course with contributing to her interview for and selection of the 1st Armored Division, Division Surgeon. "The fact that I had done it provided me the opportunity and preparation to be able to take advantage of that opportunity," she said offering Soldiers the advice, "Be prepared in everything you can do. Your ORBs if you're officers. Your ERBs if you're enlisted. Make sure they're up-to-date. Make sure you do all the schoolings and courses you can to ensure you're prepared in case an opportunity comes up."

Had West not been prepared, she would have missed what she describes as one of the best career and leader developing and broadening positions in her career. "We deployed to Kosovo during that time so we prepared units medically," she said. "Working in that environment really taught me a lot."

While deployed, West said she learned the importance of being extremely competent in her craft so she was able to apply the best medical knowledge. "You never know who might be asking you a question," she said. "It's important to always keep yourself up-to-date and well informed in your craft and responsibility." She also reflected that had she given leadership incorrect information, it would have minimized her ability to be an effective advisor.

As a leader, she also learned the importance of being a good role model. "You always have someone looking up to you or watching you and maybe crafting their style of leadership after you," she said. "Make sure you're the example young Soldiers can see and learn good habits from and not bad."

Continuing her military education, West attended the National War College. She soon had to make another career choice. She was offered an opportunity to work alongside the Navy on their leadership staff as the two services integrated the former Walter Reed Army Medical Center and National Naval Medical Center, in Bethesda, Maryland, into one integrated health system that is now known as Walter Reed National Military Medical Center. She thought it could be a risky position because she wasn't sure what the expectations were. She talked to her husband, asking his thoughts. Should she take a sure thing or take an uncertain job?

"I ended up taking the job and that's probably one of the best jobs I ever had," she said. "They didn't see me as an Army officer. I was part of the team. I learned a lot from our Navy colleagues."

West said she's never had a bad assignment. Working with the Navy taught her to take any and every job as a learning opportunity and an opportunity to serve as an example. "Whatever job you're given, do it very well," she said. "You never know what job you're going to get, but the one you do get, do it to the utmost of your abilities. You never know the outcome.

"My journey is not something I mapped out," she said. "I didn't start out saying, 'Ok, I'm going to do this path and be the surgeon general someday. In fact, I still chuckle (in disbelief) when I think about it. I'm honored to have been selected and am going to do the best of my ability."

As West said, it doesn't matter where you start; it's where you end up. She may have started as an orphan with an uncertain future, but along her path, through hard work, determination and the help of positive role models, she blazed a trail of success. West became the first African-American female lieutenant general in the Army's active component and is the highest ranking woman to graduate from the United States Military Academy.