As 2012 began, I found myself facing an all-too-familiar challenge.  One of the veterans I serve needed medical attention, and if he were to go into the hospital over the course of a few days, he would recover well.  The problem?  Getting him there.  He finally did come in, and he finally is getting the care he needs.  But he reminded me of some of the challenges that most of us professionals face when we are working with combat veterans–especially younger, male combat veterans.

1.  He’s a guy.  Psychological research clearly indicates that men put off medical care (as well as other personal matters) far longer than they should, leading to increased complications–and, in medical situations, even to unnecessarily early death.

2.  He’s military.  I do try to urge the vets to consider that just because it feels as if boot camp changed everything about them, it does not follow that boot camp actually changed everything about them, e.g., their physiology, as un-tough as that reality might be.  Veterans get sick.  Veterans have to live with bodily changes over which they might have no control, such as permanent changes in the movement of their limbs or the firing of their neurons–or even the temporary proliferation of their white blood cells.  It’s a hard row to hoe:  you want to be respectful of their dignity, yet you don’t want to let them take that Ultra-Man malarkey too seriously.

3.  He has PTSD.

Combat trauma complicates everything:  yes, somewhat from the hypervigilance and the emotional ups-and-downs it engenders.  But even more, it complates everything via the shame it imprints into the soul of every man and woman who suffers from it.  They shouldn’t hurt like they do, they tell themselves.  They shouldn’t dream, they shouldn’t startle, they shouldn’t need to get away, dear God, just for a few minutes, just leave me alone, please, why don’t you?   Yes, my arm hurts, and, yes, I’m sick and tired of hurting in my arm and in my heart so much that I will not–I will not–cry, not a chance, but if you can’t count that pulse any quicker than that, Nurse, then I might just have to let you know in no uncertain terms that you need to take a refresher course, and not on my time, sister/brother, not on my time, are we clear?

God, and then one more time:  getting that look, from the nurse, from the attendant, trying to calm down, trying not to scream, sob, hit the wall, you name it, trying not to feel so rotten that once again I screwed up, I said something I shouldn’t have, something I meant but I didn’t really mean.  God, when will it ever end.

And we haven’t even got to the blood pressure yet.

I’m glad my patient is getting the help he needs.  I pray for a peaceful night.  For everybody.