By Bombs and Brainspotting Blindsided

“It’s finished, over. Everyone knows now. I’m a drunk, that’s it, face it, nothing more. I’ve lost everything.”

I can’t say this was the first time that I had heard such an opening line from a patient. Such regrets are pro forma among addicts who have, at least for the day, come to the end of the line. Sometimes everything changes with such statements, à la The Hallmark Channel, sometimes not. It’s the stuff 12-step meetings and skid rows are made of.

Granted, this particular soldier had “hit bottom” (as the AA folks are wont to say) in a particularly, shall we say, noteworthy way. He’d hidden his alcohol dependence well for years, even from those closest to him. He’d never done anything small his whole life, though, so why not expose oneself as grandly as one can? Would we still be talking of Icarus had he not taken that selfsame route?

Right around the time my patient and I met, the Irish actor Peter O’Toole died. His obituary in the New York Times was a fitting tribute to Life lived intensely and hard, a life in which one works hard to reframe regrets as opportunities—and woe to anyone who dares intimate they might be otherwise. It would be a stretch to claim that my patient resembled the man who made T.E. Lawrence alluring enough to fill a Cinerama screen for four hours, intermission notwithstanding. Yet in spirit, they could have been brothers: success, booze, the whole bit.

Who knows, perhaps I was thinking of the Shakespearean actor O’Toole as I was listening to the opening lines of my patient. To steal inelegantly from Queen Gertrude, I found myself musing, “The man doth confess too much, methinks.”

“You started out in the Marines, didn’t you?” I asked him.

“Yeah, but then I got out. When 9/11 hit, I had to get back in, but the Marines wouldn’t take me. The Army would, though. The rest is history.”

That much of history, I had already known, and thence my Hamlet-ian suspicion. For I had known that he had been involved in the initial fighting in Iraq, the “Shock and Awe” that did so much more than both for all those involved at that time, civilian or military.

You were in the initial invasion, correct?”

Still wrapped in his shame—not wallowing, mind you, just wrapped—he scarcely seemed to register the question.

“Yes.”

“Quite the time, eh?” I asked.

That, he registered. He looked directly at me, not with hostility, nor with anguish, but more with the detached empathy of a good 60 Minutes interview by Scott Pelley.

“It was hell,” he replied. “But we did what we had to. I don’t let it bother me that much.”

The Bard in me continued wondering.

“Did you drink this much before the War?”

For a couple seconds, he just stared at me, as if I’d just said something to him in Ukrainian, or Armenian, maybe. Then his eyes darted to the right, his head tilted ever so slightly, sort of like that puzzled dog you see looking at the gramophone in the old RCA Victor ads.

“Come to think of it,” he said as he looked back at me, “I guess not. I mean, I had my problems, but . . .”

“Nothing like that,” I filled in.

Another pause, his eyes apparently scanning the entire library of his frontal lobe one last time, just to make sure.

“No,” he answered, his eyes returning to mine empty-handed. “I guess not.”

I decided to go for it.

“So how do you know whether the War’s been bothering you or not? You basically haven’t been sober since you hit stateside some ten years or so ago.”

In a matter of seconds, that brought another eyes-darting, head-tilting to the right, not one this time of canine puzzlement, though, but rather one far more familiar to me from my past few years of working with combat veterans: the long look down a road marked “To Baghdad.”

“All I remember is a blast,” he said softly, to no one in particular, or so it seemed. “It was meant for me, you know. I was all hot-shot, gung-ho. I had the military experience, so my Command used me to help gather information from locals. I was always at the same spot, every day, and that day I just happened to turn back to check on something, wasn’t where I should have been, where I always was, right across from where that car bomb went off. I . . . I shouldn’t be here.”

He looked back at me, almost as if he were trying to refocus his eyes after having stared at the sun.

“God, so . . . so much happened.”

“You ain’t been soused all these years for nothing, eh?” I said, meaning it just as pointedly as I had said it.

As reality set in, he shook his head, just slightly.

“No one knew, my wife, my Command, nobody. I can’t believe I’ve hidden it all these years, the drinking. I . . . I just couldn’t take it any longer.”

I leaned forward. “It’s not just the drinking, you know. It’s the drinking and the War. You’ve got to face them both. No either-or here.”

For a few seconds, he didn’t even breathe, staring.  “How do I do that?” he finally said, quite genuinely, poised as if he dare not ask.

I looked  into his eyes. More often than not, the gaze of those who are coming off alcohol has a certain cloudiness to it, as if the entire brain behind it were stuck in a perpetual state of “Huh?” Not his, though: coordinated, focused, driven he still appeared, with the look that his Command must have seen so many years ago, the same look that somehow, through all the leftover remnants of the booze from the nights before, Command must still have been seeing day in, day out since.

“I want you to talk to my colleague tomorrow,” I answered. “She works with a form of treatment called Brainspotting. It’s an off-shoot of something they call EMDR, Eye Movement Desensitization and Reprocessing. You might have heard of that one. It’ll sound totally wacko, Brainspotting, I’ll warn you: it’s based on the idea of presenting the brain with alternating stimuli via hearing, touch, while having you find a spot in your visual field that, believe it or not, does seem to be almost a nodal point for the body’s experience of emotion. Most of the soldiers around here are skeptical as all get out about it—until after they’ve done it once. Give it a chance. With your detoxing, I’m not sure you’re ready for it, but we’ll see what she says.”

He gave me the smile of someone waiting for the punch line.

“This something like voodoo hypnosis?” he asked.

“Talk to her,” was all I replied. “See for yourself.”

When I spoke with him the next evening, after he had worked for a couple hours with my colleague, he had neither the clouded look of the alcoholic nor the steely look of the up-and-coming sergeant. It was a look well-familiar to me since I have been working here at the unit in Nashville: the look of someone who’s just ridden the park’s meanest roller coaster ten times and somehow, in some way is actually feeling . . . calm.  Exhausted. But calm.

“So how was it?” I asked, barely able to keep the “I told you so” off my face.

“My God,” he stage-whispered, just tired enough not to have the energy to slap that look off my face, just with-it enough to let me know how lucky I therefore was. “What was that? I mean, she had me dredge up stuff I hadn’t thought of in years, and . . .”

“And you’re OK enough with it,” I replied, well familiar with this conversation. “Not ‘OK’ in that you’re fine and dandy, but OK enough, exhausted, but OK.”

Apparently after my words had found their correct spots in his cortex, delayed a bit more than usual by some routing neurons that were still shaking their heads at each other and asking “What the hell . . .?” he simply said, “Yeah.”

I love that moment.

“You’re going to need to put together a solid recovery plan,” I said to him, “and you’re going to have to keep talking to her—and then keep talking to someone after you leave here. It’s both, not one or the other. You’re not ‘just an alcoholic.’  You’re not just another veteran with PTSD.  Don’t let anyone tell you otherwise, even though you’ll find a few who’ll try.”

After a few seconds, neurons apparently having decided to get back to work, he leaned forward. “So there’s hope?” he asked.

“Sounds as if your body is saying so,” I replied.

He half-smiled, half-grimaced. “My body is telling me to get some sleep.”

I love that moment as well.

“Sounds like a good idea,” was all I could say.

Techniques aside, established or controversial, we all now respect the brain for what it is: in the words of Dr. Samuel Wang from Princeton, it’s a “survival machine, not a computer.” It does what it needs to do in order to keep us doing what we hope to keep trying to do, day in, day out. It will lead us down one path of destruction if by doing so it senses that it can avoid what, to it, appears to be an even worse path. Our brains and our bodies are efficient, not necessarily wise. Sometimes we don’t know a good path until it’s laid out before us in neon chartreuse, long after we’ve exhausted every other, even blatantly ludicrous alternative.

Thank goodness we sometimes can be hit from our blind side, whether having been previously blinded by the light of an explosion or the darkness of an addiction.  Thank goodness that some Icarus’s can learn, can take the risk of flying just a bit lower than their energy might otherwise take them, for a while, for a purpose, until an AA sponsor can be found, until certain memories can be processed with words and without, until a body can find more internal order, until a life can create more external order, until such Icarus’s can land on a safer shore, only then to take off one more time, not as a desperate escape, but simply as a way to get to the next challenge. And the next.

JD/rjsd

To Err Is Human, To Forgive Is Gary Cooper

I’m not sure that even now he fully understands the impact of his presence, this soldier, notwithstanding our having discussed it several times. Of average height and very strong build, he, to be fair, would not necessarily stand out on an Army base filled with men of such description, if all you were to do were to view him in a still pose, standing or sitting.

It’s how he moves.

I’ll never forget first seeing him walk, sit down, lean forward, fold his hands, bend his head downward. He was not the first burdened soldier I’d met, not by a long shot. Yet there was something so measured about him, so willing to accept the load, no matter how heavy. It was as if Atlas had volunteered to Zeus to bear the weight of the heavens so that no one else would be so encumbered, no hint of martyrdom anywhere, simply duty and faithfulness.

Unfortunately for him, though, he had taken on weight that had been unfairly farmed out to the innocent, whether by the questionable decisions of superiors or by Life. As a veteran of four Middle East deployments, he had had more than his share of opportunities to do that.

Only then to return home and to discover that Life does not cease to provide such opportunities once you’ve hopped a plane back stateside.

More pertinent to this tale, moreover: true to form, to his character, he was even willing to bear such a weight for me.

It was probably our second, maybe third time speaking together. Already, in just those short encounters, I had come so to admire him, even as I had also come to feel so much sadness at his recurring assumption that if someone was going to have to take the “hit” for Life’s cruelties, it might as well be him.

The conversation that day took an innocent enough turn, in retrospect, a discussion of possible future options, as I recall, tossed out as one scenario among many.

I said what I said.

He didn’t respond as he could have. As I babbled on, he simply nodded his head in that most soldierly of manner, the ever-ready “Roger that, sir,” I’m sure, right there on his lips.

It was I who had to stop in mid-sentence, smacked in the psychic face by the import of the words I had just spoken to him.

You see, I had just “tossed out” an option that would have been impossible precisely because of something that had happened to him, something about which he had felt the greatest of blame, even though there had been none for him “realistically” to take on. For a moment, I had acted as if what had most rent his heart had never happened at all. I might as well have been talking to Atlas about that oversized beach ball on his shoulders.

This was not the first time this had happened to me, of course, although fortunately a mistake of this gravity is a rare one. Once I realized my mistake, I think I must have just sat there open-mouthed, wide-eyed, the whole bit. All I can remember is his face, a single swallow, a deep breath with his mouth closed, in and out, no change in countenance whatsoever, followed by that look of being willing to take the hit one more time and then to listen attentively to whatever my next words might have been.

“Oh, my God, I’m so sorry,” was all I could utter. I then spoke my mistake out loud.

“That’s all right,” he whispered, although the quick catch in his voice revealed that it had been anything but.

“No, it’s not,” I shot back, quite aware of my need to allow him, even urge him to put blame where blame was due. “You deserve better than your doctor even momentarily forgetting what I forgot.”

His discomfort was crescendoing. “Really, sir, it’s OK. I forget things all the time. No big deal, really.”

This was a hard decision point for me. On the one hand, I needn’t—and what’s more, shouldn’t—keep harping on something that a soldier has no desire to rehash. He or she has the right to request that we just let it go, already.

Yet somehow I knew that this was not one of those times.

For a few frantic microseconds, I dove inward, trying to interrogate every neuron I possibly could: “Why did I do that?”  Only one thought, more image than language, came to me: I was already experiencing him as the strong, good, fulfilled man that he could and can be.  I was, in other words, already experiencing him as having moved forward.

“You know,” I finally said. “I have no clue as to whether this will make things better or worse, but I do want you to know: I think at that moment I was experiencing you as the strong man you are, even though I realize that you’re feeling anything but that. Even though I know full well that you are struggling, I still think of you, feel you as the man who I know you want to become.”

For a few seconds, he stared at me, still not angry, but less anxious as well. He then looked down and even, for an instant, smiled, more out of recognition than out of anything approaching levity.

“You know, one of the other soldiers told me that exact thing, just yesterday, that I’m exactly the kind of guy he sees himself wanting to become. It . . . it helped.”

I leaned forward.

“You appear to be having no problem forgiving me for my blunder, am I right?”

He looked back at me. “Absolutely.”

“Then, maybe,” I replied, “could you see how all the rest of us, whether alive or not, would have no problem forgiving you—if in fact there were actually something to forgive? The hardest person on you is you.”

He dropped his head back down. “It’s always been that way.”

“Do you see, then,” I went on, “how because of what just happened, we proved together at least one instance of something that you’ve doubted much of your life: that words can make a difference, that trying to work something out is more than half the answer to whatever it is that comes between two people? All your life you’ve felt that words really don’t make a difference, so just soldier on. Sure, you’ve been to War four times: so you know that’s very often the case, the only case. But it’s not always the case, especially between two people who are trying to understand each other. Good intentions may not always lead to good results, but sometimes they’re all we have—and they really are at least better than silence.”

It took only him only a few seconds to look back at me with both that same “what do you know” smile and the words that I’d been expecting all along: “Roger that, sir. Roger that.”

Gary Cooper was certainly a complex man in real life, but on the silver screen he came to stand for all men of few words, yet of deep feeling. I’m not so sure that the sheriff in High Noon was ultimately that interested in forgiveness, truthfully. So I’m glad his counterpart in my life turned out to be more amenable to the notion.

The soldier has worked hard to understand himself, to give himself over to what cannot be changed, to begin to change what can. He’d have always been the type to live the Serenity Prayer more than say it, truth be told, though I’m sure he’d not be against it. Wise men, young ones included, are willing to give even the standardized a shot.

He’s still frustrated, no doubt of that, sad as well. But together we discovered that words can make at least the beginning of a difference when said sincerely by two persons trying to make Life better. The old analysts always said that there is no such thing as a “mistake.” It’s never random when we disappoint one another. I’m afraid they’re probably right.

Thank goodness that in spite of that, my Sergeant Cooper was willing to give voice to at a least a few more words than “yup,” “nope,” and “can’t rightly say.”

I am indeed most fortunate.

 

JD/rjsd

I’ll Fly Away

“My wife read your blog. She loved it.”

He surprised me, this handsome fly-boy, with his mentioning the blog. Since my move to Nashville earlier this summer, I’d been wondering how to proceed with it, given my new circumstances, i.e., an inpatient unit from which soldiers could be far more easily identified were I to write of them. It was not only my grief (strong word, but apt) over my leaving the VA that was blocking the writer, in other words, or perhaps taunting him, rather.

“Thank you,” I replied. “Coming from an English teacher, I take that as the highest compliment.”

He was looking at me quite expectantly, with a smile on his face both reserved and a mile-wide.

“How long have you been doing it?” he asked.

“Just under two years. It’s been a bit sparse this year, though, what with my move down here and all.”

He nodded quite amiably, like the good warrant officer he was, well seasoned in the fine art of making senior officers feel as if they’d just said something worth listening to.  I was half-expecting a “Roger, that” at any moment.

“It’d be fine if you wanted to write about me, you know. I wouldn’t mind,” he replied instead, without a hint of hesitation.

“A story you’d like to tell?”

Funny: his smile didn’t really change, yet there it appeared on his face, diffused throughout, the seriousness of all that had happened to him.

“Yes, sir.  Yes.”

I looked down to my left, to the floor next to his chair. A handsome German shepherd, appropriately decked out in his “working dog” attire, lay calmly there, at ease, both nodding off and aware, so aware. I was tempted to ask him, “Wirklich?  Should I?”, as if he actually were one of those menacing hounds on Hogan’s Heroes who used to gobble up those fine French delicacies out of the hands of Corporal LeBeau.

Had I done so, I suspect all the dog would have done would have been to shoot me a look that would simply have conveyed the already-obvious:  “Remember: I’m watching.”

How good it had been to see that smile that day, honestly. Only a few weeks before he’d first entered my office, then sans dog, looking for the world like some extra staggering behind Viggo Mortensen in The Road, post-apocalyptic smack-dab in the middle of Music City USA. He was on too many medications, to be sure. His treaters had known that. I knew that.

But that wasn’t just medications glazing those eyes. If only.

He’d started out his career as an enlisted man, impressing the bejeezus out of every senior soldier he ever encountered, yet completely oblivious thereof. After all, all his life he’d always assumed that he was never going to be good enough, that he was going to have to work twice as hard as everyone else to be half as good, that he would always be “almost . . .”

And assume that, he continued to do as he flew figuratively through the ranks into the position of warrant officer, flew so high that eventually he flew literally through Army flight school, rising, rising to the position of instructor, one deployment down, another, another . . .

Others whom he loved, though, his very own Band of Brothers traveling at the speed of sound, were not as fortunate as he, or so he assured me. They nosedived.  Literally.

He was lucky, he kept telling me. Remember, he was twice-as-hard/half-as-good. He got the long end of the chance-stick. That wasn’t fair. He shouldn’t be alive. They should.

Through all his grief, though, all his explanations, all relayed to me in a tone of desperation that made even me think that perhaps the bad guys were just outside my office door, poised, itching for a soon-to-be-relished opportunity, I could sense that he knew what he knew he knew, even though he was doing all in his power not to know it: that while some survivals were indeed dumb luck, others were anything but. He was good at what he did.

And, almost certainly, better, yes, than others had been.

Survivor guilt is hard enough when all you have to show for it is chance. When you’re also carrying competence, the burden grows exponentially.

But the smile did appear, though, thanks to some med changes (nothing spectacular, trust me), a colleague who has turned EMDR (eye movement desensitization and reprocessing therapy, a trauma-focused treatment) into a quiet, yet explosive tour de force, and—you ready?—Norman Vincent Peale.

How to Win Friends and Influence People. I’m serious here. All your fancy-dancy treatments?  Take that.

I’ll never forget his look when he showed me the life-changing passage, even though, for the life of me, I cannot recall what it said. All I know is that he practically did a 100m sprint to his room to fetch the book, the dog more-than-able to keep the pace, yet clearly unimpressed with the assignment. He beamed as he handed it to me, page dog-eared (sorry, don’t know how to avoid the pun). All I can remember is what he said to me as I looked back up at him after having read the crucial paragraph.

“It’s OK for me to be happy, isn’t it, Doc? It’s really OK.”

What else could I do but beam myself and chuckle?

“Yes, it is. Yes, it is.”

You go, Norm.

And so the day came for him and his fine friend to head back home. It’s such a different experience, this job. At the VA I saw men and women for months at a time, weekly, monthly, you name it. Here I see them daily for a brief while, sit with them at their most painful, work with them to calm at least somewhat the raging storms within them, enough so as to allow them to sleep, perchance not to dream, to find it easier to take the next hill, both literal and figurative.

He flew away. And he didn’t even have to die, hallelujah, by and by.  He could be happy. He could live.

And the dog and I parted friends. I think.

A few days after he left our hospital, I received a note from his wife. She wanted to share with me an essay that she’d written just before my fly-boy had entered our facility, one she’d written solely to put into the words the pain that was tearing her asunder, day after day:

He is a man in a bottle. He sits atop our refrigerator. My husband’s grandfather carved the little figure out of some light-colored wood, balsa maybe. The figurine is a tiny fisherman. Unfortunately, there are no little wooden fish in the bottle with him. He must fish for the pace of mind it brings him, not the thrill of the catch. I wish my husband could find the same peace of mind. He is also in a bottle.

He came home from deployment, but he came home changed. There is a barrier between us now. The glass bottle that shields him from the memories also shields him from life. Anytime he attempts to leave his confinement, he suffers. The memories press in on him, and he retreats again. I miss him; I miss him so much.

I wish I could help, that I could make him better, but it’s his battle to fight, a battle of memories, fear and anxiety, a battle that only he understands. Right now he’s battling it with bottles, the many bottles of medications that crowd his bathroom cabinet. Each bottle, a different form of ammunition against his monsters. To help him sleep, to combat nightmares, to minimize his depression, to bury the anger, to tackle the anxiety, forty pills a day, forty temporary bandaids that cover up the problem, but cannot heal it.

So there he sits, day after day, confined in his bottle . . . out of my reach.

The essay was placed inside a small card, written just the day before. In it, handwritten now, not typed, were the following words:

Thank you so much for all you’ve done for my husband. He’s starting to act like my husband again, and I sure did miss that guy. You helped him find his way back from that dark place, and I hope everything he’s learned from your program helps him stay out of it for good.

I hope so as well. And even though I appreciate the thanks, I do think both she and I need to give thanks where thanks is due: to the good Reverend from Manhattan who, across time and space, reached into the heart of a Nashville pilot and breathed into him the words, “Live, young man. Live.”

Amen to that, Pastor.

And fly away, fly-boy. Fly away.

JD/RJSD

(Note:  By typing these initials, “John/Jane Doe’s” and mine, I am signifying that the soldier about whom the essay is written has approved its content, received a copy, and given written permission for its publication on the blog.)

An IED on the Rocks, Please, With a Twist

It’s been a long month of starting new jobs, new high schools, new colleges, new furniture settings, along with Lord-alone-knows-what-new-else’s. My wife has sworn on all that is Holy that she will never again gaze upon, let alone touch a Banker’s Box. I have to concur. We’re just hoping against hope that 1-800-GOT-JUNK has a franchisee somewhere within fifty miles of us.

But the blog kept calling, thankfully. Even more, so did the memories of the men and women whom I’ve had the honor to serve.

We weren’t supposed to have met, for example, he and I.

As I was finishing my last couple weeks at the VA in Indianapolis, I had made a pact, I guess you could call it, with the nursing staff not to take on any new patients. It had seemed only fair, after all, given my then lame-duck status. All in all, I kept up my end of the bargain.

Except for this one time.

I’ll blame one of my other colleagues (and why not? I’m gone, you know). He was the one to knock on my door at about 1400h one day to tell me, “Doc, you’ve got to see this guy. I know you’re leaving, but it’s bad.”

When I walked out my door, I saw in the waiting room a young man sitting about twenty feet from me, his hands gripping the sides of his chair for dear life, staring off to his right, my left, God-knows-where, having clearly been doing so for God-knows-how-long, given the tone of his forearm musculature. His shaved head accentuated his angular features, his gymnast’s posture and physique. He was wearing the nondescript dark shirt and dark basketball shorts that so often these days are the “just rolled out of bed” uniform of choice for men his age.

That would, of course, have assumed that he’d slept at all the night before.

“Sure, I’ll see him,” I said.

It’s been a good couple months now since he and I met, so many details have faded in my aging brain. His life had been falling apart, though, pain pills, the usual. His wife had had it. His family had had it. He’d managed, however, to get hold of some Suboxone (the opioid substitution medication) on the street, and he knew that if he could just take it regularly, he wouldn’t wake up every day obsessed with finding the next pill, given that the “next high” had long before been a luxury that had, through the miracle of the body’s ability to adjust to the effects of opiates, faded into distant memory.

He had, in other words, become part of that elite group that uses opiates not for fun, but for survival.

He was doing all he could not to be irritable with me. I assured him I wasn’t offended by his periodic failures in that endeavor. Clearly he was dope sick. At times I could practically map the waves of nausea as they progressed from his gut, cell by excruciating cell, throughout his body.

What I can never forget, though, is one line of his story.

“They called me the ‘IED magnet,’” he told me. “Thing was: I was always the one who lived.”

Many others—and I mean many others—had not been so fortunate.

Neither can I forget his intensity as he told me his tale, an intensity only somewhat heightened by the strength of his withdrawal symptoms. He had the gaze that I’ve come to see so often in many young combat veterans: one both hollow and piercing, as if the ocular orbit out of which these veterans peer seems suddenly to project a rocket-propelled grenade of psyche straight toward my own eyes, no warning, no mercy.

But when I started to talk to him about combat trauma, he could only say, “Please. I’m sick. Can we just talk about that later?”

He agreed to come back a couple days later, although because he was having such difficulties getting along with his family, he was not sure he could find a ride.

But he did.

He returned in garb just as collegiate, but now more appropriate for a grueling one-on-one at the basketball court, rather than for a semi-stupor on the pull-out couch in the living room, sheets not included. His gaze had followed the lead of his garments: more lively, more suave, even.

“This stuff is amazing,” he said to me. “I feel like a human again.”

And, indeed, he was acting like one.

That was not, however, comforting me, I’m afraid.

For again, although the details fail me all these weeks later, the image does not: his sitting there in the chair in my office, one ankle calmly pivoting over the other knee, opining at length about whatever, his child, his failing marriage, the war.

Note: I didn’t just write The War. Just . . . the war.

Similarly, I also cannot forget my own experience at that moment, my sitting there, watching him, listening to him, wondering over and over and over, with his each calm explanation, his each pensive musing: “Wait a minute . . . was I . . . was he . . . am I missing something? Did I overreact the other day? What the . . .?”

Finally, I had to speak it.

“I’m sorry, but . . . I can’t help but notice that you seem to be talking about The War almost as if we were sitting over cocktails in smoking jackets, chatting in British accents about some ‘dreadful little incident, you know, old chap?’ I mean . . . if I hadn’t met you a couple days ago, right here, in this room, if I hadn’t sat in this very chair and felt you say those words—‘IED magnet’—why . . . well, I’d think, ‘This guy’s doing just fine.’ But . . . I know better.”

For a moment, he said nothing. I said nothing. His eyes, however—and I suspect mine as well—picked up all the conversational slack, for how long, I can’t tell you.

“And so do you,” I finally said right to him, intending it just as tersely as I’d said it.

Our eyes continued to speak to each other, although saying what, I couldn’t have told you.

“Am I right?” I eventually asked. “Or am I overblowing all this?”

Ever so slowly his ankle slid off the opposite knee, his leg just as slowly planting its foot back onto terra firma. Not a cell of the remainder of his body moved. Including his eyes.

“Yes,” he finally whispered. “You’re right.”

Another silence.

“You know,” I said (more like stammered), “when you’re like this, you really hide it, the pain that both you and I know is there. I mean, you’re good, really good at that. No one would ever suspect—unless they knew already, of course. But even then . . .”

He assayed a smile, though all other cells, again eyes included, remained motionless.

“I know,” he said. “But I don’t know how else to do it, to say it, whatever ‘it’ is, you know? I . . . I can see that people want to know that it’s all right, that I’m all right, that the past is the past, that it’s done. So . . . I give them what they want.”

“And then they blame you for being a loser drug addict, right?” I replied. “Since they’re assuming you’ve put all that War stuff behind you?”

Slowly the cells began to shift within him, easing him into a sadness that was only slightly perceptible, yet, for any who would dare look for it, readily discernible.

“You do what you have to do,” he finally said. “You protect them, even when they don’t know it. Goes along with the territory.”

I was not about to let him off that easily.

“Your good looks and your charm are your greatest asset and your worst enemy, you know that, don’t you?”

The semi-smile returned as he inched forward in his chair and then slowly stood up.

“You gave me something to think about today, Doc” he said as he offered me his hand. As soon as I’d shaken it, he turned to walk out the door, only to stop, turn back, grab me one more time with those eyes, and simply say, “Not bad, Doctor. Not bad at all.”

I can’t tell you the number of times I’ve thought about that man in the intervening weeks, how many times I’ve realized that I’ve met him many times before, in that veteran that one time, in that soldier now. So many civilians have no clue whatsoever how sharp, how perceptive many of these men and women are. So many assume that people go into today’s military to escape rotten childhoods, to find something to do with their lives that are going nowhere, to get three meals and a cot that they’d otherwise not be able to put together enough intelligence and common sense to provide for themselves in any reliable fashion.

How wrong, how utterly wrong they often are.

How often I also hear the “twenty per cent” number thrown around, the “official” estimate of the number of returning OEF/OIF veterans who are suffering from combat trauma/PTSD. Occasionally you’ll see a “thirty” pop up here and there, but just as often you’ll read of very smart people marveling that the “rate” isn’t higher than it is, thank Goodness.

Perhaps they’re right. I’m just a country psychiatrist trying to make a living, after all, as one of my former supervisors used to drawl.

I guess if one never asks to take a sip out of the drinks that others are pouring down their throats, though, one never has to know whether those burns making their way down those esophagi are stings of delight or, shall we say, stings of a much, much different toxicity.

Oh well, what you don’t know doesn’t hurt you, right?

I hope that somewhere tonight he is feeling more peaceful.

I wish I could be more hopeful in my hope.

God, be with him.

Lambs, Lions, Lights

I have settled into my new position as the Medical Director of the Warrior Wellness Unit at the TriStar Skyline Madison Campus Hospital in Nashville, Tennessee, and I am proud to be working with a group of professionals who are extremely dedicated to providing the best care possible for men and women serving in the active-duty military, especially those serving at Fort Campbell Army Base, up the road in Clarksville, Tennessee.

Given the nature of inpatient work, I cannot share my experiences with these men and women in the same way that I did when I was working at the VA. Yet I have begun meeting daily with the soldiers on my unit in “Doc’s Group,” in which we are sharing with each other ways that emotions, disappointments, and hopes can be expressed through the arts, including visual art, music, poetry, and essays. Some days I share items that I have collected. Some days the soldiers share items that have come to mean much to them or that they themselves have created.

Periodically I hope to share some of these soldier-created items, whether visual, musical, or literary. I will identify them generically as having been made by a “soldier” who, to maximize anonymity, will always be male. Each entry will have been shared directly with the soldier before it is posted, and he will have approved its publication.

For most of the soldiers, they wish to share their creations and their thoughts so that other active-duty military and veterans who have endured the traumas of combat might know that they are not alone, that there is hope that somehow what could never before be expressed might somehow, in some way find expression in a way that is meaningful and, at least to some extent, healing.

I am honored to work with these men and women, and I am glad to share their creations with you.

_________________________________________________________

“You mean you’d really put this stuff on your blog?” the soldier asked me.

“If you’d like, of course.”

For a few moments, he looked genuinely confused. Then, quietly, he lowered his head and whispered, “Thanks, Doc.”

After a few moments, he looked back up at me.

“I never thought this stuff was very good. I hope I don’t embarrass myself.”

************************

(Until lambs become lions)

Stay the flight of bullets
Blunt the hunters’ knives
Break the shepherds’ cudgels
For Earth belongs to the wolves at night.

He keeps this on the front of his writing notebook. He likes to remind himself that wolves can be both light and dark. Thus, although they are to be respected and even feared, they need not be feared because they are necessarily evil.

“Even wolves,” he told me, “can protect.”

“Furthermore,” he said,  “lions and lambs don’t just have to sit with each other in peace, like the Bible says. Lambs can try to become lions. They never really succeed, you know, but they try, not to become killers, but to become strong for others.”

*********************************

The Soliloquy

Lately I have felt so low
Weighed down by the sin sewn
Into my soul.

Swimming in a sea of lies this high,
Concentrations of bullshit burn my eyes.

Fire running through my veins engulfs my emotions.
I cannot fuckin’ think straight.

Crawling through a reality of broken glass,
If one is afraid to bleed,
One will never last.

Stones fall from the heavens atop my head.
Yet I walk without fear or dread.

For I’m not the only one
Who in this Hell found his faith.
For we are many rams now,
Instead of sheep.

“The stones, they’re like rain, you know?” he said to me. “But you just keep walking.”

*****************************************

Rain falls from the sky, yet the sun still shines.
The wind lightly blows, caressing my skin.
The water runs down my face slowly,
Trickling like a tear,
Rays from the sun warming my soul.

Nature has emotions just like me.
In this moment, I feel like I am one with everything.

“It was just a poem I wrote, Doc, no big deal.”

********************************************

The “Aperion”

There is a place I go from time to time.
It has no name.
Here there is no time.
Why I go, I do not know.

Maybe to be alone.
Think about shit.
Reflect on my life.

There’s no light,
Dark and void, no sound.
Deaf and blind, but conscious still.

Sometimes I walk
But this void is endless.

Questioning my sanity with every pace,
I begin to explore my emotions,
One at a time.
Hatred is always the last to manifest
For I know it the best.

Then I see it,
The unextinguishable flame,
From which all things came

It neither speaks nor listens.
It simply defies the darkness.
It illuminates the darkness of my soul.

I move closer and closer
Letting its warmth warm the numbness of my skin.

I reflect on my travel and trials
I have faced.

I administer my judgment of choices I have made.
I cast my verdict.
My sentence is set.
I need no jury,
For who are they to judge?

I’ve lived, loved, loathed, learned, and laughed.

I enter the fire willingly from whence I came.

May I arise from the ashes and wake again.
For I would carry the fire in me and see
The aperion of all things.

And bring a reality of serenity into being.

“The ‘aperion’ is absolute truth,” he told me, “the one that no one knows. Sometimes the world can feel so bad, I go to that dark place even when I don’t want to. But there is light there, Doc, I know it. Somewhere, there is light.”

_________________________________________________________________

I hope I don’t embarrass myself, Doc,” he had said to me.

Have no fear, soldier. You didn’t.

No way, nohow.

A Goede Hombre

I received the text earlier this week, at 1404h, Central Daylight Time, Tuesday, July 2, 2013, a picture.

He looked great, wearing what appeared to be a simple, black suit/tux, sporting with it a white, pointed-collar shirt, well-starched, and a formal black tie, half-Windsor knotted. I suspect the picture had originally been taken at his older brother’s wedding not long ago.  He had that certain “brother of the groom” air about him, after all: slightly annoyed to be all decked out on a day that wasn’t exactly his, yet pleased well enough all the same, knowing full well, of course, that he looked mighty fine in these trappings, if he did say so himself.

In the background was an American flag and the unmistakable emblem of the United States Marine Corps. He would, undoubtedly, have been far more proud of those than he would have of his handsome mugshot.

I have finally made the move to Nashville. I have finally found the time to sit quietly with my cup of Tazo Zen tea. I have finally found the courage to announce, again with the permission of his family, that on Friday, July 5, 2013, another fine young man whom I had the honor to serve was laid to rest.

He died early in the morning hours of my final day of service at the VA in Indianapolis. I learned of his passing late that afternoon. As had been Ethan’s death (Reporting for Duty, Sir), his had not appeared to have been self-inflicted, and it had come without warning. He had spoken to family and to his best friend mere hours before, in good spirits, looking forward to his and my final meeting together before my move, even more looking forward to plans for treatment and for a new chance at a life perhaps less pain-filled, definitely more hope-filled.

He was buried in a community far both from my former home and my new one. I had a couple chances to speak with his mother. I asked her to convey my sincerest condolences to his father, his brother, his grandfather, and all those whom he had loved and who had loved him.

I did not, therefore, hear “Taps” a third time in as many months. Yet as I sit here, watching the Cumberland River quietly drift by me, ferrying branches big and small toward destinations perhaps just around the bend, perhaps miles away, with the occasional speed boat barreling by, ferrying revelers trying to swig down one last Miller Lite before heading back to post-Fourth of July reality, I can so easily imagine a bugler standing on the shore opposite me, looking me directly in the eye, nodding, lifting his instrument to his lips to announce not only to me but to anyone else within earshot that another who tried the best he could to do the best he could has departed us, only then, after the fading of the last note, lowering that instrument, tucking it under his left arm, raising his right hand in that four-count salute rendered only to those who deserve it, holding it, lowering his arm in another four counts, then looking up at me, nodding, and finally with a sharp about-face, turning to walk away from the bank, into the trees, into the memory and the imagination from which he had come.

My patient—let’s call him “Kurt”—came from a successful family of international entrepreneurs, his father’s lineage Dutch, his mother’s, Hispanic. He’d attended the finest of schools as a boy, a teenager. Easily he could have attended the finest of universities after that. He was smart, multilingual, bearishly handsome, affable, after all: Cambridge, New Haven, New York, Princeton, all would have gladly welcomed him, no questions asked.

But this boy had an energy that only the Marines could handle.

He was so proud of his unit. He had given me a copy of its insignia, all ready to be mounted on my rear window should I have so desired (and with his full permission, I might add, implying that such would have been enough to get me through any subsequent interrogations by fellow Marines as to why I might have been claiming  the right to be lollying around town with such an honored accouterment).  He was a Marine’s Marine.

Thus, he never forgave himself for the training incident the week prior to his deployment, the one during which his right arm was so shattered, he finally had to lose one bone altogether in order to preserve whatever function allowed to him, the one after which he was separated  permanently from the other two men on his team whom he’d come to love more than Life itself . . .

From the other two men who—along with Kurt’s replacement, less prepared than Kurt had been—died only weeks later in an IED explosion that Kurt, to his final moments, I’m certain, believed with his every living cell that he could have avoided had he been there or, at the very least, he could have endured with his friends together, one final time.

From that point on, Kurt’s life was embedded within pain. He had to take pain medications at levels that still cause me to tremble at the very thought. He endured constant nightmares of a vicious home invasion he had survived as a youth—with night after night after night of such nightmares ending with his escaping (which, in real life, he had), while his Marine buddies, captured in the dream, were slaughtered by the intruders, over and over and over again.

Yet, there was not always pain between us.

The day had not started out well, almost two years ago, now. His pain had been  so acute, he was considering suicide. He refused to stay in the hospital. I refused to let him leave. It was tense, to say the least. Finally I had to call the VA Police to stand watch outside my office as I arranged the admission in the secretary’s office next door.

Then I heard it.

“Hey, Doc!” came the policeman’s voice, not exactly panicked, but not exactly calm either.

Good God, I could only think.

“What?”

“Uh, sir . . . I’m not quite sure how to tell you this, but your patient just jumped out your office window.”

I kid you not.

Now, fortunately, it was a first-floor office. Yet it was still a good six-foot drop.

I had barely turned around before seeing said policeman zoom around the corner, heading toward the front door of the building, the words he’d been  shouting into his walkie-talkie lingering behind him like an ether cloud, as sound apparently could not travel as fast as that man was moving. I’ll never forget walking up to my office, by this point all alone (since all others within fifty feet had made similar dashes around said corner), only to see my office window wide open.

I’d not even had a clue that the window could have been opened.

But that’s not the best part.

Within five minutes, Kurt marched right back in, now accompanied by three policemen and a host of other witnesses, with that same nonchalant look that, come to think of it, he’d shown in that picture from his brother’s wedding.

“What happened?” I asked (a stupid question, I know, but I couldn’t think of anything else to say).

“I needed a cigarette,” he told me, as calmly as all get-out. “The cop said I couldn’t go out to get one, and I knew I couldn’t smoke upstairs in the hospital, so I just decided I’d find me a way to get one more cigarette while I still could.”

I do so wish there had a been a picture of my face at the moment, given that my memory of his face was that he was still struggling to figure out what all the big deal was about.

“Are you kidding me?” was all I could say, standing there, as I was,  in front of a good half the Hospital’s police force, along with God and all Nature, to boot.

“He’s not,” the original policeman chimed in. “Really. By the time we got out there, he was just standing there, putting his lighter back in his pocket, taking a few puffs, asking us why we were all so upset.”

Kurt just smiled. “I told ’em I just wanted to smoke a cigarette. I guess they didn’t believe me.”

I repeat: kid you not.

I swear to God, also: by the next day I had so many environmental engineers swarming into that office, I’d have died hermetically-sealed in said room should any disaster have struck thereafter, nuclear or otherwise. I wonder if, now that I”m gone, Homeland Security is using it as a holding cell for those too dangerous for Gitmo.

One of my other patients, a former Marine officer, had heard the “Legend of the Jumping Marine” somewhere along the way (who hadn’t?), and I’ll never forget the smile as wide as the nearby White River when he spoke to me about said affaire mémorable.

“Now that’s a Marine, I tell you. You tell them to go take that hill, and they ask you ‘How many times, Sir?’ You gotta love ’em.”

Indeed, you do.

So I sit here, now sipping San Pellegrino, and I ask myself, “What can I say?” How can I honor him in the same way that phantom bugler did only a short time ago, disturbing the peacefulness of the river in my mind’s eye not so as to upset, but rather so as to remind, to call me to remember what it means for some men and women to choose to accept a life that they were not forced to accept, to choose to face risks that many of us would have preferred that they not have faced, whether for reasons of love or for those of ideology

I can only do so at this moment, I believe, by honoring his pain, honoring it so that others may know the depth of his suffering, honoring it so that others, perhaps, can begin to know something of the sufferings of many, many of his brothers and sisters who have served in combat, who entered War and left War with a capacity for emotional power that few had allowed themselves to realize before, let alone even to accept now.

With each passing day, with each troop or veteran I meet, I become more convinced that many, many civilians simply cannot begin to fathom the physicality of the warrior’s emotions, whether that warrior be a man or a woman. Granted, there are some civilians (more than a few, I might add) who are “warriors in spirit,” who can indeed find themselves caught up, sometimes quite frequently, in similar depths. Yet most civilians, I assert with solid confidence, must learn the following formula and apply it, whether they think they should have to or not:

Take whatever emotion you have ever felt in your life—joy, curiosity, grief, rage, anxiety, sensuality, shame, whatever—localize it in your body, and then imagine it now crashing down into your gut with a force that draws your every inner organ into it like some whirlpool out of Hell. Then repeat, shoving all of it down into that whirlpool even more deeply. Then repeat. Eight more times.

By the time you hit Whirlpool Ten, you’ll be close to the emotional experience of the Warrior. Not there. But close.

I have yet to meet a troop or a veteran who has not known, full well with bells on his/her toes, that he or she was going to have to “Move On” from his/her wounds of the extremities, of the brain, of the soul.  That’s never the issue, no matter how many times, no matter who adds the adverb just to that phrase, as if somehow the person uttering such nonsense were finally giving said troop or veteran the psychological equivalent of a reminder that s/he could have also had a V-8.

It’s never about “moving on.” It’s about what one has to drag along, from the very depths of one’s soul, whenever one does move on.

Everyone has experienced gut-wrenching emotions. Not everyone has had to experience such emotions every single time that door marked “Emotions” is opened, even when one is desperately, desperately hoping that the last five loads of psychic lumber with which you’d tried to nail that door shut will hold, please, dear God, please.

I sometimes read “pain experts” pontificate about the “psychological overlay” of pain as if they were finally giving us the news that we’d never considered and that will now finally open all of us to the Promised Land of the cognitive. I know about all the evidence. I know about all the good intentions of all who have so published in the journals, opined in the op-ed pieces, spoken to the cameras in the well-orchestrated segments of the latest news show, the latest radio spot.

Yet Kurt’s grief over his fallen buddies, his shame over his injuries, his anxiety over his future: they so Hurt with a capital H, so overran his biological pain receptors with the same ferocity, the same violence with which those intruders had once overran his boyhood home, he had to sweat with psychic blood every ounce of hope that he was able to earn. Hope, for him, was a hill that made Iwo Jima look like Kiddieland.

But he always asked me the same thing, every time, every time: “How many times do you want me to take it, Sir?”

How many times.

Until the day you have been able to imagine your whole body being wracked with an emotion so powerful that it brings you to your knees, always figuratively, often literally, with each sunrise; until the day you have been able to imagine the courage it takes to rise up, under such circumstances, and walk ten miles or, maybe, just take the dog out; until the day you can feel your most powerful emotion in your most painful of spots and can then say to yourself, “Oh, my God: do you mean it can feel worse than this?” and know that there are men and women out there in their teens, in their twenties, thirties, forties, fifties, sixties and beyond who can answer a resounding “Yes!” while trying not to relive, yet never to forget horrors and truths that, hopefully, you’ll never even have to imagine imagining—until then, please, please, please: never speak to a troop or a combat veteran the equivalent of the English words, “Move on.”

My title, of course, is a polyglot admixture, the Dutch goed with the Spanish hombre, the admixture of “A Good Man,”  the admixture that was Kurt, the admixture that could have taken a much easier road, but whohad refused to do so, the admixture who so many times had wanted to give up on that hill called Hope, so far from Bill Clinton’s Arkansas hometown of the same name, the admixture who had many, many times stumbled and fallen as he’d tried to take that hill, the admixture who had nevertheless kept trying, kept trying, semper fidelis to the end.

As with Porthos, as with Ethan, I have not earned the right to salute you, Kurt, my friend, as that bugler did in my mind mere minutes ago. So I can only give you what I gave them, unfortunately only in the Spanish of your lengua maternal and not also in the Dutch of your paternal tongue.

But do know that if  I could have spoken both languages, I would have. As always, Kurt. As always.

El dolor ha pasado, Kurt. Duerme siempre en paz.

The pain is over, Kurt, hallelujah. Rest in peace.

The Handshake

Finally, I’m back.

The movers have driven away. Much to the relief of our children, my wife and I have returned (somewhat) to the world of the living and semi-human. A very good thing.

Now . . .

First, my thanks. Second, the news. Then, the Marine.

The Thanks

I cannot begin to know how to express adequately my thanks to the editors of WordPress for having spoken well of the blog and specifically of my tribute to my veteran-patient, Ethan, in Reporting for Duty, Sir. Similarly, I’m in the same position thanking all those who have begun to follow the blog as a result. Your encouragement means a great deal to me, and I hope that I can continue to honor the men and women whom I’m privileged to serve through the blog and all those whom it reaches.

The News

With a great deal of mixed emotion, then, both excited and pained, I announce to my blog readers that as of June 28, 2013, I will be leaving my position at the Richard L. Roudebush VA Medical Center in Indianapolis.

First, the excitement.

On July 1 (or some time thereafter, the bureaucratic gods so willing), I will be taking up my new position as the Medical Director of the Warrior Wellness Unit at the TriStar Skyline Madison Campus in Nashville, Tennessee. TriStar Skyline Medical Center, a division of Hospital Corporation of America (HCA), has at its Madison Campus in northern Nashville put together a program for active-duty personnel and veterans that I can only describe as abso-stunning-lutely amazing, offering quite comprehensive behavioral health services for military persons, male and female, current and former. As a private facility, it does depend upon third-party reimbursement for the maintenance of these services, yet the Hospital Administration remains committed to monitoring the implementation of the Health Care Affordability Act over the coming years so that as many persons as possible who have sought honorably to serve in the military might be able to benefit from the Program’s high-level, acute care.

Many of the staff members (RN’s and Masters-Level Counselors) are themselves former military, and in just my few meetings with them so far, I’ve been far-more-than-impressed with their commitment to the highest quality care and treatment of any who are serving or who have served in the Armed Forces.

Nashville is a great town. This is a great job. My wife and I have found a great school for my youngest. We are actually moving into a great place that is reasonable in size and quiet in location. Great.

Now, the pain.

I had had no plans whatsoever to leave the VA system. In spite of my periodic gripes about some bureaucratic meshugaas or another, I have appreciated deeply my colleagues and, even more, have appreciated and cared deeply about the men and women whom I’ve had the opportunity to serve.

My wife and I made our decision to move based on personal, family factors that thankfully meshed well with the professional opportunity that the Warrior Wellness Unit offered. Yet I’m haunted by the feeling—never once validated by any veteran whom I’ve served, I might add—that I’m leaving all the veterans I’ve served behind on the battle field.

As is said colloquially, this is not my first rodeo, so I am quite aware that my haunting does not mean I actually deserve any spectral visitations, whether of the Patroklos kind, the Christmas kind, or any other kind.

And I am also quite aware that simply because the veterans whom I’ve served have not overtly validated those feelings, I cannot therefore blithely assume that there is not at least a part of each of those veterans that feels that I exactly deserve any ghostly chain that might be rattled at me.

Eventually almost all of them—sheepishly—will most likely ‘fess up to the latter. Good for them.

There is much to discuss over the coming days and weeks, not the least of which is how the blog will both change and not change. Yet just as my life with these brave men and women has progressed in the past months and years, so it will progress now: one encounter at a time.

Therefore . . .

The Marine

I haven’t written about him since last fall, when he went off to an intensive treatment program to help with his combat trauma and opiate dependence. To longer-time readers of the blog, however, he is no stranger:

1. Will the Real Me Please Stand Up?
2. Location, Location, Location . . .
3. Youth Remembered, Youth Blown Apart, Youth Renewed
4. 2K, 1 by 1
5. “The Ghost of My Innocence”

We began working together again a few months ago, after he had returned not “cured,” by any means, yet still much better, less tormented.

Until recently, the opiates had remained a problem—but that means, of course, that recently they have not been. Good for him. Very good.

He came in for a scheduled appointment just a couple days after I had published “Taps” and the Last Musketeer, the post in which I had described the funeral of my patient, Porthos, and my interactions with Athos, his battle buddy, the “last one standing.”

“I cried like a baby probably four different times while reading it,” my Marine told me. “One was especially bad.”

“And that one was?” I asked.

He looked both down and off, as if he were conjuring up the screen inside his head, perhaps much more.

“When Athos said to you that he didn’t want to let Porthos go,” he said quietly. “And then when he went over and saluted the casket. I . . . I don’t know. I just didn’t think I could take it, reading it.”

I gave him a few seconds, then “You never got to see their caskets, did you, Mike’s, Keith’s, the other guys’. You were struggling to stay alive after the blast and you didn’t even know they were gone, you in a coma, your body desperately clinging on to your arm, refusing to let it go, just surviving.”

He took his own few seconds, finally raising his head, slowly, looking me directly in the eye.

“You know, Doc, people tell me all the time how grateful I should be to be alive, to have my arm, to be able to use it. And I am. I really am. But somehow, when you’re the only one left, nobody can get it. I stayed alive so that they could stay alive. They stayed alive so that I could stay alive. Now I’m alive, and they’re not, and I . . . I . . .”

His deep sigh, his looking downward said it all.

“Failed?” I finally asked.

“You know,” he said, looking back at me, “I know that’s not true. In my head, I know it’s not. But in my heart? Those were my men, Doc, my men.”

His intensity, his sincerity: they made it both easy and hard to listen to him, take all of him in, his words, yes, but also his breathing, his cadence, his posture.

“In some ways,” I said, “it could be easier to imagine being in the coffin than outside it, couldn’t it, with him, flag-draped, the whole ordeal over, the War, Life, united with them again, somehow, maybe?”

His gaze drifted off. “I don’t know, Doc. I just don’t know.”

Athos and I have had similar conversations since Porthos’ death. The metaphor came quickly to me, so visual.

“It’s as if you’re either in the casket,” I finally said, “or you’re standing guard right next to it, as if it were your very own Tomb of the Unknown Soldier, keeping vigil 24/7, never leaving your man behind, faithful to the end, refusing to leave the casket’s side and live, not only to show your solidarity with all of them, with Mike, Keith, the others, but even more to promise them that you will always—always—hold them in your heart.”

“We knew everything about each other,” he whispered, still looking off. “Absolutely everything, and I . . .”

“And you,” I whispered, “are the last one left to hold them in your heart just as they were in War, with their fears, their bravery, their goofiness, their love, everything, when they were at the most real, in some ways their most alive, right?”

One more time he turned to look at me, without tears, though, as if his eyes, his lacrimal glands were telling me that they just no longer had it in them any more—that I should therefore just fill in the blanks, and I’d get the gist quite fine, thank you.

“You just can’t imagine what it’s like,” he said, “not to be able to punch on them, joke around with them, just . . . just see them there, right in front of me, laughing, cussing, you name it. I . . . I miss them so much.”

It was then that it finally hit me.

My Marine has known for a while that I will be moving. Like many of the men and women whom I serve, he knows my e-mail address, my text number. He knows that I have gladly offered to stay in touch, by Skype, by FaceTime, both of us knowing that even though I will no longer be able to be his “doctor,” I can still be an older friend, willing to listen, even willing to shed a tear or two of my own every now and then, living as we do in these times when The Jetsons is beginning more and more to look like a documentary

But pixilated image does not a body make.

“And now,” I finally said, as calmly as I could, “once again another man leaves you behind, not giving you any choice whatsoever in the matter, this one promising to stay in touch, sure, to go eye-to-eye if necessary, but still, not “there”-there, not . . . embraceable.”

This time the familiar tear returned, the familiar bite of the lip, the familiar look that shouts “I don’t want to deal with this now.”

“I know it’s going to be OK, Doc,” he spit out, scarcely audible. “I know that I’ll see you again, that you’ll only be a few hours away. It’s just . . .”

The swallow took too much effort, took too long to allow the thought to conclude.

“It’s just,” I added, “that it won’t be me, will it, the physical me. All you have to touch now of Mike, Keith, the others are their gravestones. Physically, they are gone, never to return. For me, all you’ll have to touch is a computer screen. Yes, you know that it’s a simple interstate that will separate us, nothing more, no bugles, no folded flags. We may both know that in our heads, but the heart . . . it’s not so sure, is it. It says that this whole ‘moving’ on my part smells an awful lot like another set of forced separations several years ago, ones that closed down any possible Skype connections for good.”

He looked at me for a good ten seconds or so. His question, when it came, was emotion-drenched, sincere, felt in the heart far more than the mere word heartfelt could ever even begin to describe.

“Are we going to make it, Doc?”

I leaned forward, as sure then of my answer as I am now typing it.

“Yes. Yes, we will. Your body will begin eventually to get it, that virtual presence can still be real presence, that the past is not doomed to repeat itself, that two people who care about each other and who work together toward growth will find a way to make it work— not just survive, but really work, finding-some-kind-of-meaning-in-this-crazy-world work.”

He smiled. It was good to see that. “I’ll hold you to that.”

“Roger that,” I replied.

It was only as he eventually got up to leave that I realized, however, that “making it work” was going to have to start right there, right then.

For often at the end of sessions, we have embraced, no big deal, but meaningful (yes, to both of us). Not exactly kosher in the view of many, I readily acknowledge, but for us, it has worked. (You’ll either believe that or you won’t, and I won’t hold either view for you or against you, promise.)

As I looked at him at that moment of imminent departure, though, all my training, all my supervisors’ admonitions began to mosey their way from my frontal lobe and its associational memory circuits down to my limbic system, my emotions, to the place whence all life arises as my day dawns, the place whither all life seems again to return after a solid day’s work.

I didn’t want to say what I knew I had to say. I’m human, after all.

But there you have it.

“You know,” I began, pressed forward by every clinical aphorism traipsing off my neuronal staircase, “given all we’ve talked about today, it probably makes sense . . . not to embrace now, like we often do. If we’re going to work together to learn that sight and sound alone can be enough to make a relationship work, after all, then, I think, well, we should probably start now. You know what I mean?”

So definitive, so decisive. I know. But again, there you have it.

I awaited his response, enduring in my head the countless “I told you so’s” from colleagues and mentors, present and past. Once again, as if on cue, his smile rescued me.

“I think you’re right about that, Doc,”he said, thankfully with at least a bit more definitiveness, more decisiveness than I’d been able to muster. “Why don’t we . . .

He offered me his right hand, a simple motion, forward.

“Why don’t we just shake on it?” he said.

Thank goodness that sometimes in therapy, our patients rescue us at our moments of greatest need.

“Sounds good,” I replied.

And so we did.

Life is full of decisions. Life is full of decisions thrust upon us. Life is full of events that force someone somewhere, perhaps us, perhaps not, to make decisions about something, sometimes again and again.

There was a time in my professional life—and not so long ago, I might add—when the last gesture I would have ever thought of offering a patient would have been, dare I even type the word, a hug. Believe you me, I would not have thought  that simply because of some unwritten rule somewhere, either. I would have thought the action unwise. I would probably still think it unwise.

Most of my veteran patients have been men far younger than I. As veterans who successfully completed their term of service with either an honorable discharge or its equivalent, they had learned to be respectful of older men, even when those men had yelled at them, taunted them, harassed them. They had even found a way to act respectful of the older men who had betrayed them.

They had learned to be deferential to men who had made decisions for them, who had transferred them to parts unknown without warning, who had ordered them to do what some of them had not been sure they ought to have done.

They certainly had learned that life is very, very often not fair, that they could not expect to get what they wanted, not only when they had wanted it, but perhaps ever. They had learned how to say, at the drop of a hat (to avoid the drop of a body to “do fifty”), “Yes, sir” and “No, sir” and “Thank you, sir.” As a result they had learned right down to their bone marrow the lesson that countless young soldiers and Marines have recited to me: it is what it is.

As an older male professional, therefore, I can get away with metaphoric murder with these veterans (and probably could count on them to help me cover up a literal one). I can give them a hug at session’s end and they won’t freak out (just as long as I follow their lead for how long it should be). They will say, “Thank you, sir.”

I can look them in the eye and say, “Sorry, I’m moving two states away in a matter of weeks.” They will say, “Good luck to you, sir.”

After all, many of them know what it is to have the best friend they could ever imagine die right in front of them. They will say, “It is what it is.”

“Sir.”

My job is to know—and to give them the permission both to know and to express directly to me—that it’s all a bit more complicated than that.

The old psychoanalysts did not warn therapists about the physical touching of patients just to be prudes. In fact, they did not warn us just to keep us away from “boundary violations” that can destroy our patients’ lives.

They warned us also because even gestures well-intentioned and well-received can nevertheless have consequences unforeseen, complications that all will have to address. And by “all,” they meant all.

I don’t know if I’ll ever forget that moment that my Marine and I looked at each other and offered each other a hand. In that moment, the ghosts of young men long-departed whispered to us both, reminding us that Life is not always fair, is never predictable, is always to be lived minute by minute. In that moment, two men had to understand both in action and in word that we all hope for a total rescue that nevertheless can only come in bits, can only be achieved imperfectly at best. And in that moment, we both expressed to each other that each of us was going to continue to keep trying to find a way, even when neither of us has a clue whether a way will be available, to acknowledge that it is what it is, to hope, against all hope, that—just maybe—it will be what it will be.

“Taps,” Déjà Vu

One week ago today, I again headed south of Indianapolis, seven weeks to the day after I had begun a similar trip for a similar purpose, all-too-sad, all-too-soon.

It was time to bury Ethan (Reporting for Duty, Sir).

Small-town funeral homes have a certain cross-similarity to them. Either they are restructured, early-twentieth century, Victorian-style homes far too small for their grand claims to shepherd one’s dearly departed to Glory, or they are unassuming, generic, one-story, brick-faced edifices that could pinch hit for a Knights of Columbus hall, if that ever were to turn out to be necessary.

Either way, you usually can’t miss them, GPS or no GPS.

As I did for Porthos’ funeral those weeks before (“Taps” and the Last Musketeer), I made my way into the parking lot, where I was properly tagged for the eventual procession (here, a rectangular, orange paper tag to hang on the rear-view mirror, sort of a souvenir, I guess you could say), and I then backed myself into the parking spot at the rear of the building, glad that my blue Volkswagen Beetle could be maneuvered thus without much worry for the mammoth SUV to my left.

I had arrived early, as I had not been able to come down for the viewing the night before. When I got inside, I eventually caught up with three colleagues who had already been there: Ethan’s two therapists and his Family Care Coordinator. After quick greetings that were regretted by all only because of their location, not their intention, I headed into the main salon.

There to my left was an open casket, flag-draped, Ethan’s body lying within, holding a Bible, oriented toward a long-before-taken family photo that was keeping vigil over him. To the right were two easels smothered in pictures of an always-smiling young man, sometimes goofily mugging before the camera, sometimes simply enjoying the very fact that this very person was taking a snapshot of him at that very moment.

On one easel he was clad in various, well-coordinated outfits of Army chic, accessorized with appropriate guns here and there. He was a few pounds lighter than I had known him, but not by much. Unlike many such pictures that I’ve seen through the years, his were never posed in the “Don’t Tread On Me” stance so common for the young and—yes, I’ll say it—the well-armed. His smile, his innocent, “Good morning to you, Sir” smile, was ubiquitous.

Next to it was another easel of more contemporary, always civilian pictures, same dizzying mixture of the goofy and the mundane, by himself, with others, eating, drinking, showing off, sitting.

Same smile, but . . .

Well, eyes have a way of outlining otherwise-genuine smiles to provide an onlooker with a clue that perhaps, just perhaps, this smile is having to work overtime to keep at bay other facial expressions far less pleasant, far less tranquil.

Then over to the left, on the other side of the casket, was a display of military memories. As I walked toward it, I could see his dress uniform from his Airborne division, a stunning oil portrait of him in that same uniform, his Purple Heart award . . .

. . . and his boots. It was the boots that brought me short, threatened me with more than a tear or two. Empty boots—ones with a gun propped up in them, helmet perched on gun’s end—are the “soldier’s memorial,” the makeshift tombstone, the one honor all military men and women can give to a fallen comrade in the field before all are returned home. A soldier’s boots (almost as much as his gun) keep him alive.

At that moment, I felt Ethan more intensely than I had in days.

It was then that I turned to see his mother and stepfather come into the room. I went up to them and (emboldened by the last funeral, I guess you could say) embraced them both. His stepfather then said, “The pastor would like to talk to you.”

I accompanied him to another room around the corner, where I met a man a good ten years older than I, with the smile and the build of a preacher who knows not only who the best cooks in his congregation are, but also where to find them, 24/7.

“Thank you, Doctor,” he said as he shook my hand. “Will that be OK with you?”

My face must have shown the obvious question with the word what inserted before the words be OK, for Ethan’s stepfather quickly stage-whispered to us both, “We were wondering, Doctor, if . . . if you’d be willing to read what you wrote about Ethan during the service.”

“In fact,” the pastor added, “I’ve got a copy of it. Right here.”

As he handed it to me, both the men smiled smiles that seemed to be assuring me that this really wasn’t quite the bombshell it appeared to be.

“Of course,” I replied. “I would be honored.”

Soon the room was full of folks of all ages, all dress, from the semi-formal to the tank-top and shorts. There were handshakes, a few backslaps, but overall everyone was settling into a quiet that was fully recognizing the loss that each was continuing to experience.

Then Robin came in, accompanied by her father, then joined by Ethan’s parents. She was dressed in a simple black dress, one for which, I’m certain, Ethan would have most readily complimented her. Her tears had apparently decided to take a break, but they’d more than left a residue that they could return to at a moment’s notice. She sat in a wingback chair on the front row, right in front of her husband’s body, slipping from view as she sank into the overstuffed cushion. Parents seated themselves on both sides, and then for a few moments, silence.

Then, over the speakers, the sound of a banjo.

It only took a few bars for the song to reveal itself: it was the old gospel hymn, “I’ll Fly Away,” sung in perfect Appalachian harmony, melody and tenor, almost as if taken note for note from the movie, O Brother Where Art Thou?

I don’t know what it is about that song. Perhaps it has its own, special neuronal bundle somewhere inside my noggin, ready to be tweaked and ignited at a moment’s notice to flood me with revival meetings of long ago, I don’t know. Yet something about it always makes me wish I could exchange my bass-baritone, if only briefly, for a nice, soft second tenor that can modulate from chord to chord, carrying me away, “by and by,” to “oh, Glory” and beyond.

Barely had the song ended and my smile begun to relax when other chords took their place, guitar, violin, cello. A gasp went through the audience,clearly far more acquainted with the standard repertoire of Nashville than I am.

It was Tim McGraw’s “If You’re Reading This,” a simple ballad, written as a letter from a soldier to his wife and family “just in case.” It’s a song of pride, of sorrow, a song of hope for peace, of hope for good lives for all those left behind, long after the soldier has given up his. It’s quintessential Country. Many tears were shed.

Soon Ethan’s best friend got up to speak, his voice breaking even as he stood firmly at the podium, proud of the man whom he’d loved more than any other, the man whose name his son bears as part of his. In their brevity, his words spoke volumes.

It was then my turn to take my place at the mike. I looked at the words before me. I was very glad that, this time, I no longer had to use pseudonyms. My own voice held firm itself until those final words: if anyone had the heart of an angel and the resolve of a guardian, it was Ethan. A few moments’ pause, and then when I was done, I turned to find myself face-to-face again with the oil painting—and with a smile that, depending on one’s theology, one can only hope has returned somewhere, by and by.

The service ended, folks began to pass before the casket. Strong, handsome young men, some in sunglasses that were almost certainly hiding a multitude of sins behind them, grabbed onto each other for dear life to stand before their buddy one last time. Old, young, they all passed by, we all passed by. I shook his father’s hand and thanked him for the honor of knowing his son. I embraced Robin as she thanked me for my words and for my commitment to Ethan. I embraced his mother, his stepfather, all of us knowing, without saying, that words only get in the way at moments such as these, only in the way.

The procession to the cemetery was long, car after car rolling past the respectful gazes of drivers who’d stopped their cars, persons peering out of downtown eateries and offices. We all scrambled to find parking somewhere near the graveside once we’d arrived at our destination. It looked as if it could begin pouring any minute.

The same strong, handsome young men who had gathered at that coffin in tearful embrace then, without a word, lined up, slowly slid their friend’s flag-draped coffin out of the hearse, steadied themselves, and in a unison that was felt, not commanded, carried their pal—even, in a way, quietly marched him—to his final place of rest.

The pastor said a few words, and then the VFW Honor Guard sprang to attention, guns cocked, fired, cocked, fired.

And then the bugle, a “Taps” perhaps even a bit more andante than had been Porthos’ those weeks before. Same clear tones, however, same perfect intervals, same call from across at least two hundred years of history.

After the last tone had faded, two soldiers took their places at the ends of the casket, just as their predecessors have done so many thousands of times before, and they ever so slowly, ever so precisely lifted, folded, folded, folded, until finally one saluted the other, after which that one handed the triangular flag over to the most senior soldier in attendance, who then gently lowered it into Robin’s lap, words whispered, salute rendered.

It was done.

As the family gathered together in embraces and tears, I bade farewell to my colleagues, who were hoping that they might miss the worst of the oncoming downpour. As I’d brought my umbrella, just in case, I decided to turn back to look at the casket. It was perhaps more “in state” than it had been up to that point, silent, a monument holding the remnants of a life that had suffered, a life that had loved, a life that had smiled.

As I walked up to it, I stood alone. Slowly I lowered my fingers to his coffin and remembered a similar touch only weeks earlier. I wondered about the appropriateness of repeating again the Latin phrase I’d spoken to Porthos. For a few moments it felt like a formality quite out of place with the guitar chords and gospel songs of rural Indiana.

Yet it was at that moment, believe it or not, that I thought of opera, an art form at which I suspect Ethan would have more giggled than to which he would have wasted any moments of life listening. But you know, really: opera, country music . . . worlds apart, yet the same world, no? Rodolfo crying out at the death of Mimi, Tosca tossing herself in grief-stricken rage off the heights of Rome, Butterfly contemplating that knife as Pinkerton stands nearby with his American bride, Rigoletto holding his dying daughter, Gilda, as she sings of joining her mother in a far-off Heaven: are any of their griefs, their words that different from the griefs, the words of songs sung far less loudly, yet no less sincerely, in quiet recording studios, at fairground amphitheaters big and small?

Perhaps at that moment Ethan and I met one last time. Like many of the men whom I serve, he was often in awe of my doctor-lawyer pedigree. He would have had no doubts whatsoever that I could be one of those types who gets into all that “fat lady singing” nonsense. Yet when we were working together, trying to hold between us unspeakable pain that was slowly allowing itself to be spoken, we were just two guys from Indiana, one a generation older than another, both trying to make Life work as best as we can.

War tried to destroy him. It made a good go of it. But as I contemplated that smile one last time at that grave, both Ethan and I knew better.

Yes, I did say the words: Cruciatus consumptus est, Ethan. Requiesce in pace. The torment is over, Ethan. Rest in peace.

Yet also I had to whisper just a few more words, ones that I suspect I could have taken the melody to Ethan’s tenor and we’d have both sounded just fine, thank you, sounded just fine.

Fly away . . . oh Glory, fly away.

Amen.

Reporting for Duty, Sir

With the permission of his family, I report, with much sadness, that another young veteran whom I have had the honor to serve died this past week. The cause of his death remains unclear, but all agree that it was not self-inflicted, and it does appear that he died suddenly and without suffering.

Ethan (not his real name) first came to my office a couple years ago. He was not in good shape. He had suffered a significant traumatic brain injury (TBI) from an IED (improvised explosive device) explosion while having served in the Middle East, and he had subsequently become hooked on opiates (painkillers). When I first met him, he was gaunt of body and of gaze. He had the distractibility that I have often seen in veterans who are struggling with the consequences of TBI, but his had a desperate edge to it, an irritation that appeared to be heading nowhere, targeting no one in particular.

How good it was, then, that he found Suboxone (an opiate-substitution medication) to be so hope-restoring for him. He filled out in body and in soul, and a smile took up permanent residence on the lower half of his much-less-lined face, a puckish one, I guess I’d say. Great word, puckish. Great smile.

He grew up in a semi-rural area south of Indianapolis. He once told me how to get there, and I realized that I had often passed the requisite landmark on Indiana State Road 37 during my many trips through the years down to Indiana University in Bloomington, where I had taught an undergraduate class. In fact, he was still in high school when I first began making that trek. It was a well familiar one to me, in other words, by the time his mother, who lived not far from that landmark, had already begun praying every morning, every night for his safe return home.

He did return home. But he was not whole. He knew it. His family knew it. Everyone knew it.

Ethan was working with two of our finest therapists at the Indianapolis VA when he came to see me, so he never had a need to share with me any of the worst aspects of his combat experiences. He did hint at them, though. I needed no more than that. His experiences of the War—both of what he saw and of what he had to do—haunted him daily.

Yet as time progressed—and even more, as he worked with his therapists—those haunting experiences receded in prominence, leaving in their wake the far-less-easy-to-treat symptoms of his TBI. Day-to-day detail often confused him far more readily than it had before deployment. Often he forgot where he was to be and when he was to be there—appointments, for example. Family did their best to help him keep track of everything, a challenge for them all. How many times did Ethan come into my office, once more apologizing for having forgotten something, sometimes an important something, sometimes not.

Then he met Robin.

Robin had had her shares of struggles also, but together they went on to make a life that, while not without its challenges, was nonetheless even more with its hopes, saturated with a love that kept a certain puppy-dog air about it, even as they faced together, head-on, all the Shakespearean “slings and arrows” that Life can bring any of us. They got married. They made plans to buy a home. Those plans fell through. They kept looking, envisioning for themselves a family that would be as safe as they could make it, as secure as they could love it.

Still, Ethan suffered, suffered from War like so many other thoughtful, good-hearted men and women with whom he had flown on that plane to Kuwait, with whom he had ridden into extremely-hot, extremely-volatile territories in vehicles that were, in spite of their advanced technology and their construction, still all-too vulnerable.

He knew that he suffered. Robin knew that. His family knew that. His therapists knew that. I knew that. Everyone knew that.

He continued to find Walmarts nerve-wracking. He still had to have a seat in full view of the door, wherever, whenever. He still had nightmares. He still had became leery of unseen powers in government, in society that could, at a moment’s notice—perhaps, just perhaps—take away from him all whom he loved, all that he had worked for.

Yet in spite of all that, recently he had been coming into my office with all the fervor of a country boy ready to start yapping away on a Saturday morning with a bunch of men, old and young, spread out in the back corner of the local McDonalds, solving the world’s problems over large cups of rapidly-cooling java.

It was his smile, though, puckish. Got me every time. It reminded me of the smile, the “I’m so tickled” demeanor of a fellow Hoosier from long before his time, one who had reigned over Tuesday nights on CBS at my house all my growing-up years: Red Skelton. Like Skelton, Ethan always looked as if he was just so taken with the punch line of the joke he was about to tell, he could barely contain his guffaws long enough to spit out the first words without being stopped by a string of giggles that would bring the audience—and even more, him—long past the verge of tear-stained laughter.

He was a good man, a young man. He had the heart of a Boy Scout rushing to walk the old lady across the street. He had the sense of honor, of duty of a soldier who, while still trying to be good, would learn how to harm, how to kill, if necessary, to protect those whom he loved, whether miles away or right next to him.

We had our regular appointment this past Wednesday. Without any notice, he, quite willingly, came and spoke to a group of my colleagues about his experiences as a patient at our VA. He was articulate. He was honest about his past struggles, his current memory problems, his hopes for a better future. My colleagues applauded him at the end of the discussion. After we had shaken hands after the meeting, he walked away with a smile about twice the size of the some of the country fields he must have run through when he was a boy.

He died the next day.

I had a chance to speak with his mother on Saturday. In her grief and complete disbelief that he was, indeed, gone, she still spoke of how excited Ethan had been becoming about Life, even as he had continued to struggle with the combat-related anxieties of the day-to-day. They had been planning for a family gathering on the day that he had died. In the preceding weeks and months, she had begun hearing in his voice a certain quality, a certain youthfulness that she had feared would never, ever return.

“So you were getting your boy back?” I said.

Her tears answered me.

Then she told me something quite extraordinary.

“You know,” she said. “Ethan had been telling Robin a lot recently that his dreams had been changing. He kept on having these dreams, these feelings that he was to become a guardian angel.”

You can’t make these things up.

Ethan was not an imposing man, yet neither was he a reticent one. Even as he displayed that puckish smile over and again, he also displayed a certain resolve, a certain protector-warrior sense, even if only in glimpses, that reminded us all—that reminded him—that he was still ready for duty, ready to assume a role that he loved, ready to face again, if necessary, a violence that would perhaps destroy him, but that would not—would not—destroy those whom he loved.

War, with its horrors and realities, did try to destroy his tender heart. It did leave its wound in that heart, its permanent reminder of what had been lost, of who had been lost. Yet along with a tender heart, War found a determined heart. That, War could not take away, in spite of the nightmares it had implanted in him, in spite of the memory and the focus it had robbed him of.

I leave it to everyone else to decide as to whether there is indeed some Heaven somewhere that serves as a place of further, dutiful service for one who had so faithfully tried to fulfill such service in this life. All I can say is this: if anyone—anyone—had the heart of an angel and the resolve of a guardian, it was Ethan. If he has indeed reported for duty, God has indeed already sent him out on his first of many, many missions.

May he rest in peace.

The Tattoo Graft

Even though I had promised to break my blog “fast” with reflections on the Boston Marathon bombing and its aftermath, Life led me elsewhere. Thankfully.

I have known him for a while now, this former Special Operations soldier. He had seen—and more, had experienced—more than his share of horrors in the Middle East, often accompanied only by a few men who eventually came to mean Life itself to him. “Brothers” finally took on a meaning that previously he’d only dreamed of.

There were those who didn’t make it back.

He struggled in the years afterwards, making some attempts at treatment, but finding none that he found that useful. Drugs, especially painkillers, became his constant companion. He knew he was wasting his life. Finally he faced a severe medical crisis. He came home to Indianapolis to seek the medical treatment he needed—and even more, to find a reason to keep on living.

The medical treatment, he received. The painkiller problem remained, however. And thus we met.

At first he was probably more eager for Suboxone (the opiate substitution medication) than I was. His medical treatment had taken a lot out of him, after all, and he had very real reasons to have very real pain. While Suboxone is sometimes useful as an analgesic, it has not been, in my experience, the best painkiller that has found its way onto the planet. I urged him to hold off, to have us work together first to keep his pain medications steady, on a schedule, controlled, until he could recover further.

During those initial weeks he laid out his story of War. Even when hurting, even when on pain medications, he was quick-minded, analytical to the max, a strategist par excellence, just as he had been in the military. Yet at the same time, in a way unusual for men as gung-ho as he, he was unafraid to acknowledge his more disturbing emotions, his fears of never getting better, his grief over buddies never to be seen again.

“I’ve played around with this too long, Doc,” he eventually told me. “I’ve just got to get my head together, my life. I can’t keep going like this.”

Indeed he couldn’t. I suspect he’d always been on the wiry side, but both his medical treatment and his drug usage had left him a bit less imposing that he certainly once had been. His curly hair was of a length far afield from the judicious cuts of his military days, no doubt: neat, clean, true, yet in a certain way more an afterthought, as if the rest of his body was having to work long past quitting time to keep the legions of locks on his head from tipping him over sideways.

Eventually he started the Suboxone. It was indeed helpful.

But nowhere near as helpful as the woman he met one fine day.

I walked out of my office one afternoon to find a man sitting in the waiting area whom I’d never met, his long, jeans-covered legs comfortably stretched out a good mile and a half into the center of the room as he sat askew in his chair, perusing some cheap magazine from off the table next to him, his hair cropped stylishly short, his entire musculature at parade-rest, I guess one could say, both at ease and yet, what, ready, just in case. The man looked up at me, smiled, and shot a quick wave.

It was he.

“Sorry,” I said once we’d made our way to my office. “I didn’t recognize . . . well, the hair!”

He grinned. “Oh, yeah: got tired of it hanging all over the place, I guess.”

“You better believe ‘I guess,’” I replied, impressed by how the cut made him look both older and younger simultaneously, more seasoned, yet more daring.

“I think my girlfriend likes it better like this,” he said as he folded his hands onto his lap, sliding himself down into a just-hanging-out-here slump that was anything but sloppy.

“So all’s going well with you guys?” I asked.

“Oh, yeah, real well,” he answered, as if that were so old-hat news he’d not even considered I might ask such a dumb question. “Her kids are great. I . . .”

Then he stopped, for moment staring right at me, but at the same time right through me, not in that way that gives one chills, but rather in a way that seemed to advise me that even if he were to speak further, our conversation would not be resuming any time soon.

“You know,” he finally whispered, “I . . . I was really afraid that I’d never find love, that I was too screwed up. I couldn’t ever get women to listen to me. But that’s what she does: listens. She doesn’t freak out. She just . . . listens. I feel so safe with her, steady, like I haven’t felt in I-don’t-know-how-long.”

After a few seconds, he returned his gaze back from wherever to me. If a smile can be calm, his was.

“What a good thing, eh?” I could only respond.

“Yes, sir,” he said. “Yes, it is.”

Sadly, in the world of modern combat veterans, calm smiles often last only so long.

It was a few weeks later that I received word that he was wanting to speak to me right away. Fortunately I was able to see him later that day.

The news was not good. His battle buddy, the man “closer than a brother “ to him, had just committed suicide.

“I . . . I had no idea,” he whispered to me, doing everything a good military man can do to maintain the composure that was anything but his. The two of them had been in continuous contact. They had spoken only a few hours earlier. There had been problems in the man’s life, true, but . . .

“We . . . we survived so much, he watching my back, I, his,” he continued. “ How . . . how?”

He went to the funeral, of course, faithfully watching over his buddy’s widow in the very way he knew the man would have done had the roles been reversed, had it been the ever-patient, ever-listening woman at his side who would have received the folded flag.

“I did OK, Doc,” he later told me. “Except when they played ‘Taps.’ I lost it. I just . . . lost it.”

The months passed by. He found a job. He had to in-out a few appointments, assuring me that he was doing OK, not great, but OK. Then recently he came in, collapsed in the chair by my desk, and gave me that look that I’ve seen from so many veterans with whom I’ve had the honor to work: the “yeah, Doc, the jig’s up” look.

Time to be gentle. Time to be real.

“Not good?” I asked.

He shook his head, his at-me/through-me look back. “I can’t sleep,” he replied. “Nightmares, constant thoughts about what we had to do, what we saw. I miss him like anything, yet I could just kill him if he weren’t dead! Is that a terrible thing to say?”

I had to smile. “It’s true, though, isn’t it? You’d like to smack him up the side of the wall, and yet you’d like to hold on to him as if there were no tomorrow, all at the same time, right?”

His smile in return was pained, no longer calm. Yet it was still a smile.

“You better believe it.” After a few moments, “Will this ever end?”

Again, the question I hear day after day after day.

“Will a certain sadness, a certain pain never end?” I reply. “Probably not. Probably shouldn’t. But it’s like I tell all the guys: the pain doesn’t have to hurt like this. Even though you know this all happened in the past, your brain is still experiencing everything as if it were happening right here, right now. You’re reliving it all, not remembering it. Once you can get from relive to remember, it does feel different, easier in a way—not easy, but easier, in a meaningful way.”

We talked about his various treatment options at the Clinic, both individual and group. He was certainly interested, yet his work schedule did make regular attendance at therapeutic sessions complicated. Still, he told me, “It helps to know I can get better. Thanks.”

Then came last week.

He’s gained some of his bulk back. In no way is he small. He’s more agile: not wound tight, ready to spring, but more ready to dart, stealthily, sort of like the Road Runner with good upper-body strength.

The calm smile was back.

“You look good,” I told him.

“Thanks,” he replied, almost shyly. “You know, I . . . I got a couple new tattoos a few weeks ago, and it’s like . . . well, I don’t know quite how to put it. It’s like . . . I’m better.”

“What happened?”

“Well, I had added two more, on my back. One has some initials, dates: for the guys we lost. But it was the one for my battle buddy, it . . . it changed everything. You know, it was like you said: I need to remember, not relive. I’ve joined this group of vets who get together and just talk. The leader of the group’s been great, got me to thinking, ‘what more could I have done?’ And like it hit me: nothing. I could have done nothing more. I would have done anything for him. He was more my brother than my real brother is. But I did all I could. I loved him like no one else. That’s . . . that’s it. That’s it.”

He said it all right to me. Gone was the right-through-me. Even after all the one-to-one we’d experienced together so far, this was five levels deeper. At least.

“You know,” I finally said, “if I could ask: what was it about the tattoo? How did it make the difference?”

The calm smile turned quizzical, not in a threatening way, more in a “now, isn’t that a question” way. He looked off for a bit, a few seconds only, then looked right back at me.

“You know, when he died, the moment he killed himself, he ripped a part of me right away, yanked it out. There was this big, gaping wound in my heart, my soul. You can’t know, Doc, you just can’t know how much he meant to me. He was hurting so badly, so badly, and I couldn’t save him. I don’t know what made me do it, but I just one day decided I needed to carry him on my back, the rest of my life. You know, it’s funny: it’s almost as if I needed to hurt to get him back, to feel the pain of the tattoo, to do it for him. And it’s weird: all of a sudden, when the guy was done making it, it was as if my buddy was sewn right back into me, filling that hole, like he’s going to be at my back, day in, day out. I walked out of that parlor and, I don’t know, it was as if a huge burden just rolled off me. I . . .”

He smiled again, not so much calm this time as, what, thankful. Tearfully thankful. His water-rimmed eyes ever slowly reached out and took mine in their grasp, not forcefully, but confidently. Sadly, but confidently.

“It’s like you said, Doc,” he whispered. “I don’t have to relive. I can just remember.”

The old psychoanalysts always talked about the psychic, emotional power of the skin, that millimeter-thick barrier that keeps us both whole and vulnerable, that both contains us and exposes us.

Yet for one wiry, analytical man who has finally found love, finally found the family who can accompany him into the future, his skin has also freed him, has put a past in its place, has grafted onto him a different, yet equally-powerful love that will link a well-loved past into a well-loved future and finally, as much as can be done after War, make him whole.

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