Truth be told, he and I never should have met in the first place.

Working at a VA associated with a major university has its perks, the most glorious being–residents!  Believe you me:  I am more than thankful to have the opportunity to work with young psychiatrists-in-training, not only because of their energy, their intelligence, their curiosity–but also, yes, I admit it, because of their being on-call in the hospital every night.  We staff psychiatrists have it nice as a result, I do grant you.  Even though we’re on call for a week at a time, four to five times a year, it’s all by beeper.  The men and women slogging it out in the trenches at 2AM are half my age.  They might beep me at 3AM to discuss a case, but, hey:  I fall back asleep easily.  Hallelujah.  For residents and for sleep.

In the latter part of 2010, however, it was not always so.  For reasons too complicated to explain, the staff psychiatrists had to serve as the first-call person on the weekends.  Poor us, I know.  Still, another glorious perk of Med Center VA life?  Having  very competent social workers working through the night in our emergency department, triaging and making life livable for all.  Sweet.  Plus, since we are able to access our VA computer accounts via a secure website, we doctors were able to manage all other matters that fall from the quiet of our homes.  Sweet x 2.

I did, though, cover one particularly memorable weekend:  ten admisions to our inpatient service in the span of two days, with two discharges.  None of the admissions was easy.  None of the discharges was.  By late Sunday evening, both I and the very competent, always-faithful nursing staff had just about had enough, thank you.

It was about 9:30 that evening when the ER social worker called me.

She had interviewed a young man who was struggling with acute drug intoxication issues (among other quite complicated matters, it should be added).  This social worker is quite savvy, yet she was struggling to know what to recommend for the man.  Given his impulsivity, she was quite concerned for his safety.  Still, he had “a way” about him, she told me, that made her wonder whether it might not indeed be OK to release him that night to his family, with outpatient care to be scheduled within a day or so.  I remember her words well, listening to them as I was while sitting in an easy chair in our family’s spare bedroom:  “It’s times like these that I miss having the residents here.  Sometimes that was all it took:  having an MD sit with the patient and convince the guy face-to-face that he’d be better off if he’d just come into the hospital for a while and get himself settled down.”

She was right.  I knew that.  I too was not pleased with the thought of this guy’s just going home in the condition he was in.  I knew I was on solid ground to ask the social worker to contact hospital security and then tell the patient that he was going to have to stay, whether he wanted to or not.  I knew that our VA police, our ER staff, and our inpatient staff were all quite competent enough to make that happen with only the minimal Sturm und Drang.  Nevertheless, I also knew:  Sturm and Drang there would be.  The kid was “strong and wiry,” according to the worker, and “he wouldn’t go down without quite the fight.”   “Code Orange” is what we call such a melee in our neck of the woods.  No good comes from such high drama, for anybody, certainly not at 10PM on a Sunday night and certainly not with an already overworked nursing staff (two admitted patients were already on one-to-one nursing monitoring).  I knew that.

Still, I’ve got the initials behind my name.  All I had to do was to say the word, hang up, and go back to reading my Kindle.  The inpatient doctor would have had to have picked up the pieces in the morning.  Wouldn’t have been the first time.

“OK,” I finally said.  “I’ll be there in a half hour.”

I have colleagues who still roll their eyes on hearing that–and rightly so, I might add.  Their knowing half-smiles say it all:  only you, Rod.  Only you.

After arriving and then enduring the knowing half-smiles of the ER staff, I walked into the young man’s room.  He was lying on his side, facing the wall.  He barely turned his head to look at me.  He wasn’t hostile, but believe me, he wasn’t impressed either.  “I don’t know, man,” was about all he could say.  “I don’t know.”

He eventually did turn to face me.  It had been Afghanistan, I finally learned–that, and a quite, quite complicated life pre-deployment.  Bad, the whole scene, really bad.  He just couldn’t take it any more, the waking up screaming, the never-ending newsreel of blood and body parts in his head, the absolute certainty that it would never end, that it never should end, given what he’d seen, what he’d done, halfway around the world, just the other side of town.  He wasn’t going to kill himself, or at least not really.  He just didn’t care.  About anything.

His family had brought him in.  I sat with them for a good half-hour or so in a secluded corner of the waiting room.  I still can see his father, fighting back the tears that he was too worn out to hide:  “We just don’t know what to do.  I love him more than anything, but . . . we just don’t know what to do.”

When I went back to the patient and told him what his family had said, he looked genuinely shocked.  “You mean they’re still here?” he asked.

“Yes.  They’re worried.  Big time.”

Wiry and strong as he was, he dropped his head and began to cry.  “I’m so terrible to them,” he finally whispered.  “They love me so much.  I don’t deserve it.”  Slowly he raised his head.  “OK.  I’ll stay.”

By the time all the admission dog-and-pony show was over, it was about 1AM.  I was about to head out of our inpatient unit when I saw him sitting by himself in our day room, clad in the standard-issue hospital pj’s, staring at the floor, strong, wiry–and anything but.

All right.  I’ll confess it to the entire world.  Here it goes, ready?

Sometimes the Dad in me takes a gut punch whenever I look at these guys, see that far-off look in their eyes, watch their slow breathing, their mouths slightly opened, with just enough shortness of breath to remind both of us that it can all be so tiring, life.  Death.  These are the sons and daughters of my peers.  Each one of them could have been mine.

There.  I said it.

It’s called “countertransference” in the lingo of my trade, the all-too-human feelings that arise in us all-too-human treaters in our all-too-human work.  It can be a problem.  It’s not always, not by a long shot.  It just happens.  I’m no neophyte to this.

Still, it had been a long night.  For him.  Strong, wiry, lost–him.

I went over and sat across from him at the table.  He looked up, a bit confused, even.

“You don’t have to stay, you know,” he said.

“I know.”  We just looked at each other.

I launched into my spiel, the one about feeling so intensely, so deeply that a group of men can almost think the same thoughts simultaneously, not quite knowing where one of them ends and the other one picks up.  About love.  About having a part of your soul ripped out of you when you realize your brother of brother’s not there any more, not even in one piece any more, never again to laugh, cuss, get drunk, stare at a computer screen, reading an e-mail.

“Were you in the military?” he finally asked.

“No.”

Once again, he looked genuinely shocked.  “So how do you know all this?”

“You guys tell me.”

It was his first smile of the evening, skeptical though it was.  “You actually listen?”

I wasn’t quite sure what to say.  I suspect I smiled as well.  “Yeah, that’s sort of the point, you know,” is what I think I finally said, something like that.

The smile disappeared, yet replaced not with a frown, but rather with this look of puzzlement that had a sort of “well, who’d-a thought . . .” quality to it.

“Thanks, man,” he finally whispered.  We shook hands.  I went home.

It’s been a long road since then.  Really long.  Good stuff.  Not-so-good stuff.  He’s told me more than once:  “I think about that night a lot, you sitting there with me at that table.  I really do, man.  I really do.”

It had been a while since I’d seen him.  Stuff.  Not-so-good kind, at least recently.  He looked good, though, better than I’d seen him in a while.  He was so proud of himself, of all the work he’d been doing trying to get his life together, of his dreams to help other veterans.  He was wearing a well-worn Indiana University soccer outfit, still strong, still wiry.  He has one of those “Yeah, I know, I’ve been bad, but you still like me, don’t you?” smiles.

He’s right.  And he knows it.

He handed me a CD.  “Here, man.  I want you to have this.  It’s pictures, from Afghanistan, different stuff.  Just us mainly messing around, you know.  Not really any combat.  I just want you to have it.”

“Thanks.”  I took it.

After he was gone, after I’d written my encounter note, I opened up the D: drive of my laptop and pressed the CD down into it.  My photo program opened up the first picture.  He  was lying on a cot, shirtless, clearly just waking up, clearly not that impressed with the photographer.  I hit the slide show button.

My photo program eases one picture into another, like moseying along through the family album, giving you a few seconds to prepare yourself for the ridiculous look on whoever’s face is about the grace the screen, a sort of retrospective, “This Is Your Life” quality, know what I mean?

It was his smile.  Over and over.  He’s quite photogenic, actually.  Combat fatigues, physical training outfits, swimming trunks, goofy T-shirts, posing with local troops, robed men at fancy hotels, cute kids, even with President Bush, no lie.  There was this family wedding picture.  He was in a tux, holding what looked to be the ring-bearer, his hair slightly longer than Army-issue, sun-bleached just enough.  Went well with the smile.  The whole look.

I didn’t cry.  Yet there was something inside me, that Dad something again.  It’s a sincere smile, his is, one of those “you gotta love me” types, one of those that says–not shouts, mind you, just says–“Here I am, world.”  Here I am.

God, I wish he didn’t know what he knows.

Please, dear God.  Let him find peace.