A year ago, I started this blog, no fanfare, just a thought to share ideas with other professionals. 21,000 some hits later, here we are.

Odd, how Life takes its turns.

In a time of war, how does one mark a New Year? As more of the same? As something new? Perhaps both.

Life will indeed take its turns.

I often wonder how many, if any, of my VA colleagues, whether in Washington or scattered around the country, take the time to follow the blogs and the tweets and the Facebook posts of the combat veterans/families whom they serve.

I have found the postings that I have read to be invaluable. Unfortunately, I have also found some of them to be nearly unbearable.

Sunday morning, as I scrolled through my Facebook feed, I found the following entry on a Facebook page:

i sit .. i think ..
i wish
i could submerge my face beneath the water in the sink
my world stinks
smells of sulfur burning
flesh mangled and disfigured
i cant talk to no one
my family dont even know
about the mortar that didnt go off feet from me
or the one that did feet from me..
the room filled with dust and new cracks ..
some were awarded posthumous
some awarded alive
im home
drinking and going out
hard look at my kids
hey daddy .. this .. hey daddy that..
not to their knowing .. some guy i never met .. his kids are now fatherless.. his wife cant nag him ..
an american father of the young men lost at my side creeps in my head .. his strong sons are dead
no hey daddy for him as well
a letter and a flag with a check
he knows not i saw his son .. head severed from his neck ..
home now
the new blood in the unit dont know
the spouse dont know
my kids dont know
hell i dont know
the experts dont know
i see
the old war dogs
boozing .. doping .. wig’n out
room full of admin adverse separations
draw down time
thanks but you made a life mistake bye bye
so what you did the nasty things .. that allow the meek to sleep
like fighting pit bulls put to sleep
i sit alone .. unable to adjust .. anxiety high .. prone to violence.. my inner city upbringing .. used in combat .. now home .. i wish i didnt come back ..
there is nothing to understand .. nothing to judge.. ive got this scarlet letter on my soul .. and it will never budge

– battle scarred soldier

For one combat veteran, another year, more of the same.

He is not alone.

My patient ended up being the last one I saw at the VA in 2012. He’d called me earlier in the day, hoping that I was still going to be at the hospital later in the afternoon, as he hadn’t yet been sure he could convince a family member to drive him down. A detente must have been achieved, though: he gave me an ETA.

As always, he was right on time.

He looks pretty good, although, granted, “looking pretty good” for him does not quite equal “looking good” in the, what, colloquial sense of the word, shall we say. He still looks exhausted–which he is, physically, emotionally. Yet he’s gained some needed weight, and he can even flash the occasional hint of a smile, albeit one more along the lines of “see, I told you I could do it, now lay off, why don’t ya.”

One takes what one can get.

He is also much less depressed than he was just a few months ago. He’s responded well to medications, and fortunately they haven’t caused him any untoward side effects. While I’d never actually worried for his physical safety, I’m nevertheless quite happier now that he is happier.

I had to ask one question, though.

“So how are the nightmares?”

The smile withdrew a bit, although a glimpse remained. Funny, if there can be any warmth in sardonic, he can pull it off.

“Same.”

“That bad?”

“Up and down, I guess. Harder for a little while a couple weeks ago, when I thought my bosses were going to have to lay me off. But they brought me back on as soon as they could. It’s better now.”

“You and the girlfriend?”

“OK. The usual. She irritates me. I irritate her. But it’s been OK, all in all. Christmas wasn’t bad.”

“Those kids still adoring you?”

I got the warmth to triumph over the sardonic with that one. Three-pointer for the Doc.

“I guess you could say so.”

“They ever see their dad?”

He harumphed. “You kidding me? Loser.”

“So you’re still Pop, eh?”

Even though the smile remained relatively intact, the seriousness that has so often oozed out of him began wending its way around the corners of his lips. A slight tightening of the edges, that was all it was. Yet he was heading back to a place oh-so-familiar to him (and to me), a place where just a quick shift of the eyebrow is all it would take to announce oh-so-ever-so-not-so-subtly, “Watch it, pal.”

“I never want those kids to know what I’ve had to know.”

It was almost as if we were characters in a Harold Pinter play, truth be told, although our history together has been far too positive to merit the description “Pinter-esque.” Still, these staccato bursts of dialogue between us were not foreign to our previous conversations, either. A lot can be said with a few words, very few facial muscle movements–and the eyes.

Whether or not a Pinter stage had been set, I decided to play my part.

“It wasn’t like this before deployment, was it.”

We stared at each other, all smiles gone. No hostility. Just no smiles.

“Never.”

As I wasn’t quite sure what to say, I said nothing.

“I was never this angry before,” he finally said, in a whisper that was oddly deadpan. “I lose my cool all the time. I’m a jerk. I have to stay away from people. You don’t understand. When I took the drugs, I didn’t have to remember. I didn’t care. But I’m not going back there, the drugs. So that means my life is Hell. I just want to go to work and be left alone, do maintenance, that’s it. Work’s the only place where I don’t have to worry about everybody throwing their two cents in, making sure I do what it is they want me to do, yapping in my ear, blah, blah, blah. Those kids and my grandparents, they’re everything to me. The kids’ mom, yeah, I care about her, but she gets so on my nerves, always something. I used to be happy, you know. No more, though. Work, the kids, my grandma and grandpa, that’s it. Everything else is just a pain in the ass.”

In all that, he’d given me the one opening I’d never before had. I took it.

“When you took the drugs, you didn’t have to remember . . . what?”

We’d never before gotten within fifty kilometers of that question. He looked at me, no anger, no tears, nothing, just looked at me.

“Him.”

I wasn’t sure I was ready for what was coming. I swallowed. “Him, who?”

“Him,” it turns out, had been the same age as he had been. They’d met in their unit, no boot camp memories therefore having been shared. But that hadn’t mattered. They’d just hit it off. My patient had met “his” family. “He” had had a future ahead of him, apparently, college included, all mapped out. My patient deeply admired “him.”

“He” agreed to switch places with my patient–at my patient’s request, of course–so my patient ended up in the vehicle behind “him,” no big deal. It was for a boyish reason, to be sure, but certainly innocent, certainly something “he” hadn’t minded at all.

“He” ended up with burns over ninety percent of “his” body after the IED exploded directly under “him”, dying right in front of my patient after “he” had been pulled out of the spot in the vehicle that should have been my patient’s to occupy.

A silence worthy of Pinter at his zenith settled between us.

“You think about him a lot?” I finally asked.

“Every day. Every day.”

By this point he was simply staring past me, toward the far corner of my small office, as best as I could tell. He was staring and he wasn’t, truthfully. He was just, for lack of a better word, existing.

“I hate this,” he eventually said, more intensely than he had said anything previously. “I’ll have nightmares tonight because of this. You’ll see. It always happens after I think about him too much.”

Before I could even catch a breath to consider a response, he plowed forward, his intensity growing by the syllable.

“I took him away from his family, Doc, a family I had to look at when I got back. He was going to be somebody. I come from nothing. I ain’t worth nothing. I’ll never be more than a maintenance man. There’s no forgiveness for me. Don’t tell me there is. Don’t tell me about his not wanting me to feel this way. Don’t tell me that it wasn’t my fault. Everybody says all that. But you’re all wrong. I should have been in that vehicle. I was just thinking about myself. That’s the way they always did it: go after the vehicles in the middle, make everyone stop, then start shooting. That’s exactly what happened. Don’t tell me it wasn’t my fault. I’ve heard it all. It was my fault. I killed him.”

These are my hardest moments as a therapist. Bar none.

These moments are not about “reality” in the usual meaning of the word, after all. Unlike the man of my patient’s self-description, my real patient is sensitive and bright. He makes not one simple move in our cat-and-mouse encounters. He’s got my number as much as I have his.

He understands physics, therefore. He understands chance. He understands his buddy would never have wanted him to suffer as he is now suffering.

And as far as he’s concerned, that and five dollars will get us each a tall Breakfast Blend at Starbuck’s.

At these moments, there is nothing brilliant for me to say. Even though I refuse to join him in his self-condemnation, I accomplish nada by debating it. He and I both know that at this very moment, these days of his life, “facts” are irrelevant.

These are instead the facts, after all:

1. He should be dead.

2. He cannot love or be loved, because he should not be alive.

3. He is biding his time until it is his time.

4. Nothing will change any of this.

Another year for him as well, in other words. More of the same.

Perhaps.

You see, I have written of this man before. Twice.

I wrote of him in April, in One More Time, With Feeling. We had just reconnected after an unwanted break. Capsule summary: “Glad to see you, Doc, but no war talk.”

I then wrote of him again in July, in Not Yet, But Maybe . . . Capsule summary: Same girlfriend, similar family issues, incipient depression, the whole deal, but “no war talk, Doc, no . . . war . . . talk.

And even though he kept coming as the months progressed, he wasn’t going to talk about the war, no way, nohow, don’t even ask.

But then on Friday I did.

And he answered.

Something new.

He didn’t leave my office healed. The man who wrote the above Facebook entry isn’t healed either.

More of the same.

My patient did know, though, that I refuse to accept his self-characterization. I refuse to accept his self-condemnation and his self-sentencing. True, I’m not going to argue with him. After all, if my patient had been seated where he should have been seated that fateful day . . .

I’d have been talking to his buddy on Friday, instead.

But just because I am not going to argue with him (with words, that is), that doesn’t mean that my body, my emotional neurons, my soul, even, are not going to debate that man every time he dares cross the threshold of my office.

He may end up right, of course, i.e., that nothing will change, that every New Year will always be more of the same.

But one thing the man can be sure of: I’m not going to be helping him along the road to that alleged, final outcome. And since I am not going anywhere, he’s either going to have to keep confronting my hope-filled neurons and soul–or he’s going to have to stop seeing me.

So far, he’s not chosen the latter option,

There is no gun to the boy’s head. There are other Suboxone providers at my hospital.

So even though his head is telling him all is over, his feet are holding open the possibility that he might have made an error in calculation somewhere. Every time he walks into my office, he runs the risk that, well, if he’s not careful, something new might happen.

To the man whose post I quoted, I can only say this: whether you can find yourself believing so or not, your words betray a soul that, while apparently feeling lost now, is certainly not lost for good, a soul to whom it makes sense for a child to say, “Hey, daddy!” Whether or not I’m an expert–for I’ll readily admit that there is much that I can never know of the suffering combat veterans have endured–I do know that to survive is not to sin.

You can feel free to disagree. I’ll feel free to disagree with your disagreement.

And I hope, in whatever small way it can, my disagreement will provide you one thing new for the New Year.

To my patient, to the writer, to combat veterans in the United States, Canada, the United Kingdom, Australia, everywhere, I wish each of you a New Year that might have at least one spot of “something new” that might–just might–lead to a “Happy” that can be meaningful enough to keep open the hope that “more of the same” need not always be so.