Another detour (there’ll probably be a lot of these) . . .

I first met a certain young man at a time of his greatest pain, both of body and of soul.  He came from a family of some means, not exactly an everyday occurrence, at least at my VA.  He was anything but wanting to depend on the familial largesse, however.  While most of his peers went off to classy colleges with lots of ivy and lots of trees, he joined the military.  He had something to prove, more to himself than to anyone else:  he could make it on his own; he could physically challenge himself and succeed; he could shatter the stereotypes of the Abercrombie & Fitch rich kid.

He succeeded.  He became someone whom others could depend on.  He believed in himself.   He was about to be deployed.

Then he had an accident.  A bad one.

Surgeries ensued.  Rehabilitation.  More surgeries.  He accepted the emotional support of his family, but he refused to lean on their finances.  The more the surgeries, the more he hurt.  Pain meds became a problem–a big one.  The more he hurt, the more he demanded to be on his own, to do it himself.  His family bought him a place to live.  He finally recognized that he needed at least some of their help.  He lived in the house for a while, then not, for a while again, then not.  The more he struggled, the worse he felt.

For he believed that he should not be alive.

The man who replaced him in his duty was not as well-trained as he had been.  Eventually my patient’s two closest friends and that man died in an engagement.  My patient was convinced that had he been there, he might have been able to manage the situation successfully.  Or at least he would have gone down with his buddies, together.

Wracked with physical pain, tortured by emotional pain, he was hovering on the brink of suicide when we met.  He could not conceive of a future worth living.  He could not conceive of himself as being someone worthy of a future.  The only thread binding him to life was the thought of what his death would do to his mother (and when he was not angry at the man, his father).  That did bind him–but barely.

When we first met, we had some, shall we say, difficult discussions.  He was not at all happy with the rather limited options I offered him at one point.  Yet he lived, and I lived, and he’s better, and I’m glad.  His physical pain is better.  His addiction is not destroying him.  His depression has improved.  He has found a girlfriend, and they are working to figure out their lives a step at a time.  He still proudly lives on his own, with his own money (though, yes, he’ll accept an occasional airfare).  I wouldn’t say that he’s focused, but then neither would he.  He’s living with that uncertainty for the time.  So am I.  If he misses an appointment, he’ll call soon to check in.  The hard times are past.  We’re now always glad to see each other.

It’s good to have happier stories.  His is by no means over, mind you, but he’s moving forward from a much more stable place.  In a way, his case was “easier,” in that he only imagined the horrors of war, rather than having them imprinted indelibly onto his neurons.

But I stress in a way.  Remember that many veterans could not go to the combat theater (physical challenges, job requirements), while others were deployed in a capacity that made stress less constant (though never absent).  Never assume, however, that therefore they are, by definition, “lucky.”  Granted, some feel that way.  But by no means all.  For some, their lack of being “in the action” haunts them continually.

Yes, we could say that this is misplaced machismo–and I would never be one to say that such could never be the case.  High-energy veterans are looking for high-energy experiences.  Yet their pain often says less about them than it does about their ideas of what others are thinking and/or experiencing about them.  Many of these veterans, men and women, struggle with feeling like failures.  No, they didn’t want to die; they didn’t want to face the question of harming or killing others.  But they did want to be part of something bigger than themselves.  Their pain grows not out of failed individual accomplishment, but out of a sense of failed communal contribution.  They slacked off.  They didn’t do their part.  They got the easy way out, took the easy way out.  They dishonored those who died.

Yes, those who have not been in the military, who may hold values that differ from traditional military values:  such persons may find these statements nigh onto incomprehensible.  It has to be about individualism, they can only assume, or foolhardiness, or unconscious malevolence, for values such as “honor” and “loyalty” are merely prettified code words for institutionally-celebrated violence.

Perhaps they’re right.

But I can say that most veterans do deeply feel those words–as well as feel the call of the dead, reminding them of those words hour by hour.

Some people are surprised to hear veterans say that they’d go back to combat in an instant–even if the veterans are struggling with the worst symptoms of PTSD.  Some people even consider that bordering on crazy.

Yet not these veterans.  The siren call of combat (shades of Greek epic!) is not necessarily about patriotism, or about preservation of liberty, or about any other abstract idea that will play well in a political sound-byte.  In a way, yes, it is about all those things.  But most of all it’s about Jack, Trish, Gomez, Thompson, Wiley Coyote, Big Bubba, Sister Sue–and, no matter whether your politics allow you to believe it or not, about spouse, kids, parents, and neighbors back home.  It’s the human that draws them back, not the abstract.  It’s the human that grips them and makes them feel guilty, weak, stupid, less-than.

Life happens, friend.  Accidents happen.  My patient has so tried to blame himself for that accident, and certainly where there is a will, there can be a way.  At one time, he had himself pretty convinced.  But never forget what I learned in law school:  you can always find the conclusion you’re looking for if you search hard enough and ignore everything else enough.  Just because veterans can convince themselves of their weakness, their foolishness, their cowardice–that don’t make it so.

But as professionals, we have to be patient.  We have to understand that sometimes people can regret their circumstances excrutiatingly, so much so that they cannot even conceive of it as “good fortune” that allowed them to live, allowed them not to awaken at night screaming.  True, life happens.  But face it:  we’d all like it to to be otherwise.  Every last one of us.