The War Within: Afterword

The following  is the text of my last post in the series The War Within (all essays being available via the drop-down menu above).  I do hope that some readers will find it within them to take the time to read all six essays–but even more, that when they do, then may some of them  go on to help me sharpen my ideas, clarify them, drop the ones that don’t fly,  use well the ones that do.

It remains an honor to serve the men and women who have served in combat, to care about them, about those whom they love, about all their futures–and, I hope, in doing so to prove wrong in our generation the words of the prophet Jeremiah in the Hebrew Bible, i.e., that it can indeed become possible in our lifetimes to “say Peace, peace” and, in the hearts of some, to have that in fact be true (or at least, true enough).

Afterword:  Broken Vases, Mending Lives

After our trilogy of “movies,” then, where do we find ourselves vis-a-vis combat veterans’ finding a way to make a life with–and even more importantly, a life beyond–The War Within.

Consider the following “parable,” presented by Dr. Salman Akhtar, a well-known psychoanalyst and poet from Philadelphia. Although he presents the story within a different context, I believe his is a tale that can speak volumes–one filled with both poetry and hope–to those combat veterans who continue to struggle against their Wars Within. In his book Broken Structures (1992), he writes:

The Parable of Two Flower Vases

[L]et us suppose that there are two flower vases made of fine china. Both are intricately carved and of comparable value, elegance, and beauty. Then a wind blows, and one of them falls from its stand and is broken into pieces.

An expert from a distant land is called. Painstakingly, step by step, the expert glues the pieces back together. Soon the broken vase is intact again, can hold water without leaking, is unblemished to all who see it.

Yet this vase is now different from the other one. The lines along which it had broken, a subtle reminder of yesterday, will always remain discernible to an experienced eye.

However, it will have a certain wisdom, since it knows something that the vase that has never been broken does not: it knows what it is to break and what it is to come together again.” (p. 375)

Just as no two combat veterans are alike, neither are their courses of restoration to more meaningful lives. In the previous essays, I have (in a way) portrayed extroversion and introversion with terms and examples that are often quite contrasting.  The Great Escape is a far cry, after all, from The Endless Return through The Well-Hinged Door. Without doubt, Life–and people who live–are for more complex than that.

Yet at the same time, even though many seem to relish to possibility of being “uncategorizable,” seeing their refusal to be pigeonholed as the ultimate expression of their autonomy as a breath-filled human being, we can often see how much energy such individuals expend simply to persuade us pigeonholing-types that they are, indeed, the proud members of the “uncategorizable” category.

None of us wishes to be black/white, yet most of us just feel better when we believe most everybody else is.

As Kurt Vonnegut so effectively put it: so it goes.

No matter whether you are a combat veteran, a loved one of a combat veteran, or a service provider for combat veterans, I would have you consider the utility of at least entertaining the notion that it might not only be helpful, but also hopeful to take seriously the idea that people “re-energize” in radically different “places.” While we all want to have the flexibility to find energy sources wherever we need, whether within or without, I still maintain that for each of us, one of those “places,” i.e., the inside or the outside, simply feels more “natural” in a way that while hard to define precisely, is nevertheless far less hard to experience usefully.

By understanding how differently the world can feel to people who, on the surface, appear to be so similar, one can go a long way toward reducing not only the misunderstanding of others, but also–and perhaps for many combat veterans, even more–the misunderstanding of oneself. Whether extroverted, introverted, or any combo in-between, combat veterans are some of the most self-demanding persons I know. And without self-understanding, self-demanding always ends up self-destructive.

Sadly, sadly, for many combat veterans, I cannot use that latter word solely as a figure of speech.

Different experts use differing techniques. Different vases lend themselves to differing techniques. Painstaking need not be an expression of time, but it is always an expression of intent, of taking on a project worth doing, a goal worth pursuing, a life worth living (and caring about, whether someone else’s or one’s own). By understanding our differences, we all can have patience when others misunderstand us. We can know how we’re strong. We can know how we’re challenged.

But fortunately, for combat veterans everywhere, even more, they can know this: that the right expert and the right vase can come together, can fool some of the people all the time, can fool all of the people some of the time, but ultimately can fool no one that indeed it is possible to know what it means to break apart, to see Chaos ravage the innocent over and over, to whisper goodbye to one’s best friend as one holds him or her in one’s arms, to swear that never again will anyone matter–and yet then, with faith, hard work, and a few A-list companions, to know what it is to come together again, to escape greatly, to return endlessly yet march back out through doors well-hinged, to mend, to keep on mending, to live, to love.

It is a knowledge that none of us wishes for, yet it is a knowledge that some of us, once endowed with it, can eventually find a way to use meaningfully, hopefully–and, lo and behold, without leaks.

“The Ghost of My Innocence”

This past Tuesday I took my eldest back to college, her sophomore return far more blasé than had been her long-awaited freshman arrival one year ago, the latter having been made even far more smashing by a goodly portion of the men’s soccer team’s having hustled her every belonging up to her fourth floor room, all in a grand welcome to the joy-filled communal life of Goshen College that was awaiting her.

This year, it was her boyfriend, she and I who trudged about twice as much stuff up the same four floors, with constant reminders from her to keep it moving so that a). she wouldn’t miss her first Ministry Leader’s meeting and b). the fish wouldn’t die.  Given the ungodly amount of cash she’d dropped at the pet store mere days earlier to make sure said fish would have a comfy home within which to reside (a fish, I might add, up to that point unnamed, lest such a christening turn out for naught, given the perils of the anticipated three-hour car ride),  I easily could understand her new-pet-mom solicitude.

Understand and appreciate, of course, being quite separate activities.

I joyfully report to you, dear Reader, that 1). said fish survived and is now most assuredly named, 2).  she and her boyfriend have been reunited, 3). Dad was released to his three-hour car ride back home with a heartfelt, albeit somewhat hastened farewell, and ergo 4). God is in His Heaven.

And I was exhausted.  I won’t even begin to tell you the number of patients I had to see the day before and the day after in order to make all this exhaustion possible (joyfully possible, of course).

My patient and I met again the day after The Great Return.  It had been almost a week since he and I had sat before that computer screen and watched in external reality that progression of images that daily form his internal one (2K, 1 by 1).  His spirits were better, given that we had made some progress in perhaps finding him a place in a residential treatment program.  We made plans to see each other again on Friday.

By Friday’s arrival, I had an even better appreciation of the scope of meaning inherent in the mere word exhaustion.

Fortunately, though, my patient always brings a certain reliable, appropriately-restrained “joyful” to my door every time he comes, his smiling “Hello, Doctor!” always reminding me of the young college grad ready to tackle another day of the boss’s to-do list with that can-do attitude that will take this young man far in life, I tell you, far, far.

His is a smile that can make an exhausting day less so.  His is also a smile–as he and I both well know–that usually belies a pain underneath that, in just a matter of minutes, both of us will be forced to confront.

We started our time together by my reading him the narrative I had written for his program application.  In it I had endeavored to convey both my respect and hope for him, while also my concerns which, like his, are not trivial.

“I guess that about says it, Doc,” he responded, followed by a few seconds of silence and then, “I hope it works.”

I’d be hard-pressed to say that he ever looks vulnerable in the usually understanding of that word.  At that moment he was more like cautiously expectant, with the look of someone who really does have something he’d like to say, but who’s not quite sure whether now’s a good time.

“How have you been?” I simply asked.

He shrugged, producing a faint semi-snicker with a faint semi-smile that was, apparently, his body’s forewarning to both of us that–get prepared, boys–now’s the time.

“OK, I guess,” his voice, his gaze already beginning to assume that just-the-other-side-of-Baghdad air that I have come to know so well.

He then began to speak, though not at all a monologue.  Instead it was an extended, open invitation to me to bear witness, to sit there, listen, to acknowledge that words were being produced by his vocal chords, that physics was doing its part to transmit sine waves through the atmosphere to my tympanic membranes, all with the hope that, please, I would allow those very sine waves to insinuate themselves into my own neuronal system, my circulating blood, my life.

He had actually suffered two injuries while on deployment.  The first, while significant, was managed relatively easily in the advanced medical world of the modern combat theater.  He had returned to his buddies as quickly as he could.  They needed him.  He needed them.

The second was another matter altogether.

Although I had known the basics of what had happened, he went on to tell me, detail after detail, what he remembered, what he had been told, what he surmised.  He gave me all that was necessary to visualize the truck, his position in it, the positions of so many others, their duties, their quirks, their unexpected companions . . .

The remains of all the above after the blast.

While I had known that he “really should not be alive,” up to that point, I had not really . . . known.

It is on days such as these that I am glad that I am as old as I am.  I would never have been ready for this as a younger man.  Honestly, I’m not ready for it now.  But at least I do know that silent witness can make all the difference–or more accurately, the silent permission to allow another to implant his pain into my body, my knowing all along that the pain is his, not mine, and that therefore my body need not react as his, but instead react as one who only has an inkling of his pain, but a genuine inkling, not a facsimile of it, but a meaningful portion of the real deal.

He looked directly at me.

“They don’t tell you about this, Doc, in the movies, at the recruiters office.  They don’t tell what it’s like to look into the body of another and see . . .”

I have no clue how long the next silence lasted.

“Have you ever seen my picture from afterwards?” he finally asked, sort of with a sardonic levity, I guess you could say.

“The one of you in the hospital?” I responded, remembering seeing somewhere the emaciated body of a young man (that much I could discern), appearing as perplexed and battle-worn as most folks do the minute they’re transferred to the floor from the ICU.

“No, my ID.”

I then remembered something about his having lost his ID in the explosion, about his having to have had another one made in order to get him to his next phase of stabilization in Germany.

“Here,” he said after pulling a piece of plastic out of his wallet, handing it to me.  “I still keep it with me.”

I took it.

Do you know what I thought of at that moment, that very first instant I saw that picture that, thankfully, was of a human, but not of one whom I’d ever met, not of one who should have to appear as that human appeared in that photo, that very first instant that stopped the flow of my thoughts, my feelings as if the needle of an old vinyl record player in my head had been savagely ripped across the grooves, bringing silence only after having first embedded a permanent scar of its skid?

His mom and dad.

Even at this very moment, sitting on my porch on a quiet, sunny, Midwestern morning, I hold back, with some effort, the tears as I wonder, in spite of my desperately not wanting to wonder: oh, my God, what if that had been my son?

I can actually begin to feel the beginnings of my blood pooling into my nether regions.  I’m actually glad I’m seated.  I can’t go there.  And I am doing just that, going there, right here, right now.

I suspect I did the same in front of my patient just hours ago.  But honestly, I can’t remember.

All I can remember is this: very softly he began to speak, no longer looking in my direction, but rather back toward the other side of the Earth.  He was in his own world–and he was in mine.  His eloquence was literally–and I do mean that word, literally as in literally–breathtaking.  He spoke of his exhaustion, one for which the word dwarfed cannot even begin to describe its comparison to the measly exhaustion I’d been experiencing up to that point.  He spoke of his fury, at the politicians who sent him there, even as he spoke of his love for the Nation’s people for whom he had served.  And he spoke of the ghosts that haunt him daily, the spirits of those men, some of whom he’d just tolerated, some of whom he’d loved more than life itself, all for whom he would have died in their stead.

And he spoke of the most terrifying ghost of all.

“It’s the ghost of my innocence, Doc,” he said, slowly, as if watching it at that very moment stalking him, having the gall to stand right there in front of him, looking him square in the eye, daring him to say one more word.  “I’ll never get it back.  But it’s like it won’t leave me.  It just follows me.  I can’t shake it, Doc.”

After a few moments of silence, he looked right at me, not furious, not confused.  Only exhausted.

“I just want it to end, Doc.  I want a life again.”

As we gazed at each other for the next few moments, therapy, like Life, took one of its odd turns.  When I was training as a child and adolescent psychiatrist in Boston, I learned a very important lesson: sometimes pain can be so overwhelming, its only relief is movement.  Literally.

At the very moment I remembered that, he said to me, “I’ve got to have a cigarette, Doc.”

I smiled.  “Want to go for a walk?”

Clearly he was surprised, but it took only moments for the yes-sir smile to return.  “Sure.”

It was the end of the day.  I only had paperwork ahead of me.  So together we made our way out to the parking lot, to his car with its Purple Heart license plate.  He lit up.  We chatted, about the Mennonite church, about my uncle who had died in World War II, about my complex relationship with War and with the men and women who must fight in it, who fight because that is what they have pledged their honor and their lives to do, whether or not any of the rest of us think they should have.  We talked about his parents, about his desire that I speak with them about the treatment options he and I are considering.  He finished his smoke.  We headed back to the office.  He grabbed his cap, squared it on his head.

There he was again, the recent college grad bidding adieu to the boss after a well-executed day, the smile the corporal must give the colonel when he’s taking leave to go back to the barracks after finishing his assigned tasks–and quite well, I might add, sir, don’t you agree?

“See you Tuesday, Doc,” he said.

“See you then.”

We shook hands, and he left.

And, yes, those ghosts left with him as well.  Yet for a while, they had haunted me that day, too.  And I can only hope that after having done so, when they return to this fine young man, so physically reconstructed by science that he goes back now to Mom and Dad looking just ever so slightly older than did that twenty-one year old who took his leave to fly to Kuwait all those years ago, those ghosts will find a way, gently, to remind him that they no longer wish to haunt him, but rather that they wish to solidify into the foundation upon which he can emotionally, spiritually be reconstructed as well, into a future that will be theirs precisely because it will be his.

And I’m quite sure:  the ghost of his innocence will gladly join them in that goal.

2K, 1 by 1

The past few days have been challenging ones, with many men and women having passed through my door, most of whom I know well.  Fortunately many are doing well.   Unfortunately some are not.

It’s the nature of my business.

Sadly, there is an additional factor in the nature of my business.  It’s called reality.

Reality, this week, has not been kind.  For as many readers may already know, this past week our Nation achieved–if one only could, without bitter irony, call it that–a milestone.

Two thousand service members have died in the conflicts in Iraq and Afghanistan.

The New York Times published a powerful memorial for these men and women.  In the print version, the pictures of all two thousand were laid out over the pages of the paper.  On the website, however, was a memorial that simply left me, what, sighing, deeply, closing my eyes, rubbing the back of my neck, dropping my head back, opening my eyes toward a ceiling (a Heaven?), taking in a deep breath, letting it out, looking back down at a laptop screen, silent, staring.

I do the very same now.

Before me on that screen is a picture of man, pixilated.  Two thousand pixels form his picture.  As I move my cursor over an individual pixel, a box appears with a name and a date.  If I click on that pixel, the overall picture changes.  It is now that man, that woman whose name was in that box.  Different pixel, different box, another click, different picture.  Two thousand times over.  The wonders of modern technology.

The title of the page is “The Faces of the Dead.”

You can search for an individual by name, by home state, by hometown.  Click on the name, and you’ll see the picture, some with faces smiling, some serious, some clad in T-shirts, some in full dress uniform.  You’ll see along the right-hand side of the screen the man’s, the woman’s name, date of death, home, service branch, age at death, theater in which they died.  They are in their twenties, thirties, forties–their teens.

Of course I eventually found the young lad I had memorialized in Dona Ei Requiem.  Yet for many of those about whom my patients talk, they are just first names to me, their dates of service and death somewhat of a blur.

But for one, I knew his home state.  So I typed it into the appropriate search box and hit the button.  It turns out that his home state has suffered relatively few deaths, all in all.  I scrolled down the list.  There was the first name, the date of death.  Yes, that was when it happened, when my patient died–but didn’t.

I clicked on the name.

There he was.

Just another name, I suppose, another face.

If only.

I knew that I would end up having to write about this experience.  But before I could even get enough breathing room to consider doing that, within hours of my having viewed that screen, I was sitting before my patient.

He is not doing well.

He is not suicidal.  He is not giving up.  But he is tired.  He wants to move forward in his life.  He wants at least some of it, the pain, the memories, please, God, to stop.

I debate whether to say anything to him.  He is distressed already, after all.  Yet I also wanted him to know that I had not forgotten, neither him nor the name of his best friend.

“Have you seen the pictures in The Times?” I asked.

He hadn’t.

“Would you like to?”

He looked at me, an odd mixture of blankly and knowingly.  That was such a dangerous move for a therapist.  I’d taken the risk that he’d say “yes” for my sake, not his.  I might have misstepped.

“Yes,” he finally said.

I believed he meant it.  I was tempted to check that out.  I kept my mouth shut, though.  What’s done was done.  He didn’t owe me any more assurance than that.

He scooted his chair next to mine, and we both turned to my Government-issued monitor.  Type, click, type, click.  Page found.  Search box clicked, state typed, menu appears.  I began scrolling down.  I saw the first name, but was that the last name?  I continued to scroll down quickly.  There, another with the same first name, but, no, I was sure that was not it.  Scroll.

“You just passed it,” he said quietly.

My eyes focused.  Indeed I had.  There it was.  I clicked.  A picture appeared on screen.

I looked at my patient.

He was staring, nodding every so slightly.  He was not smiling, yet he was not frowning, either.  He swallowed.  He looked at me.

“Yes, that’s him,” he whispered.  No smile, no tears, no distress, just acknowledgment.

His friend had not been the only one who had died that day, in that place.  I knew that.

So I turned to the screen, shifted the cursor one pixel to the right, to a new box, new name, same date.  I clicked.

He looked at the picture with the same expression on his face.  He nodded.

“Yes,” he whispered again.

I moved right another pixel.

More than one group of men perished that day.  They served in different branches.  Yet whenever I clicked on a pixel and saw the particular branch of my patient come up in the side bar, I looked at him.

When I did, I saw the same nod, heard perhaps a name whispered, watched a man watching a screen.  I would then turn back toward that screen and move the cursor over another pixel, creating another box.  A couple times he whispered the name before I clicked, then nodded at the picture, almost imperceptibly, yet with an ever-so-slight satisfaction that, yes, he’d been right.

Finally, I hit a box with an earlier date.  I stopped.

I turned to look at him.  He was still staring at the screen, not exactly lost, but not exactly there, either.

“You all right?” I asked.

He nodded, still looking at the screen.  Then he looked at me.

“Yes,” he said.  He was right there with me.  Or at least I guess you could say that.

“How was that for you, seeing all them?”

He shook his head ever so slightly.  For an instant, he even had the glimmer of a smile, more one of pity than anything.  Pity for me.

“Doc,” he whispered.  “I see them every day.”

That, I was not prepared for.

It took at least a second or so for it to hit me.  And I mean hit.  Funny, though, not in a sock-‘em way.  More like the kind of hit that stops your breath in mid-stream.  The kind that demands a tear in recompense.

I didn’t even try to hide it.

“I’m sorry,” I whispered back.  It was all I could say.

He smiled, still slightly, but now with a warmth that melted pity into a shared humanity.

“It’s OK, Doc,” he replied.  “Thank you.”

It’s now hours later.

I look at these pictures, in the middle of a night in which I can’t sleep, pixel by pixel by pixel, and two questions keep coming to me.

The first is why?  I do not, however, dwell long on that one.  I can’t afford to.  I have to leave it to others to debate the why’s, to extol, to excoriate.  The very men and women whom I see every day often ask the same, of themselves, of each other, of us as a society.  My personal call, however, is not to the why.  The political will have to be decided elsewhere.

The second, though, is when?  Of course the political infiltrates that word as well, can’t help but to.  Yet there is a yearning in that word–that demand for Time to provide an answer, damn it–that allows me to pull away as an individual from the communal, political aspect of the question, to ask simply as a man, a father: when?

When will the pixels end?

The song almost awakened me tonight, if you want to know the truth:  the song of yearning, asking, please.  I remember hearing it sung in a Boston theater over twenty years ago.  Jean Valjean, praying for Marius at the barricades.  Cameron Mackintosh’s Les Misérables.

God on high
Hear my prayer
In my need
You have always been there

He is young
He’s afraid
Let him rest
Heaven blessed.
Bring him home
Bring him home
Bring him home.

He’s like the son I might have known
If God had granted me a son.
The summers die
One by one
How soon they fly
On and on
And I am old
And will be gone.

Bring him peace
Bring him joy
He is young
He is only a boy

You can take
You can give
Let him be
Let him live

If I die, let me die
Let him live
Bring him home
Bring him home
Bring him home.

How many Valjeans, Fantines pray that song tonight, every night.  I am a father.  I understand.

Yet also tonight, for me, that song implores on behalf of another, a young man who sees the faces of the dead every day.

Together he and I are working to find him a place where he can stay for a while, remember as he has to, cry and rage as he must, finally to inhale the pictures of those faces and then pass them through his alveoli, into his bloodstream, to be transported artery after artery, arteriole after arteriole, until finally they find their true, final resting place, in neurons of memory that are mere holding stations for the soul, to be called upon in times of need for strength, for purpose, for thankful love.

Like so many of his brothers and sisters, a part of his soul is still over there in the desert, outside that town where he finally lost consciousness, where, without knowing it, he said his final goodbyes.

Bring him home, God.  Embed those pictures, those men into his heart, pixel by pixel, life by life.  And bring him home.

Hands and the Unfathomable

The consultation was an unusual one. A combat veteran was referred to me by another physician after the veteran had had some puzzling medical complications. The doctor was wondering whether “this gentleman’s problems might be related to his PTSD.”

Now, truthfully, if I’d just heard about this man’s symptoms in a case presentation, “PTSD” would not have been on the top of my list in (what we call in medical parlance) the differential diagnosis.

Apparently it was, though, for the veteran. For he had been the one to bring up the possibility.

When I first saw him, he appeared surprisingly chipper, given what he’d gone through medically only quite recently. He proceeded to tell me that although he was having problems remembering certain parts of his then-recent illness, he definitely recalled a time during it when he had felt “as if I were watching myself.”

“Has that every happened before?” I asked.

“Well, yes and no,” he replied. “Since I’ve been back from deployment, I’ve had some really strange experiences, but I have to say: nothing quite like this, certainly not during the day.”

“At night?”

“That’s been a different story, I’ll admit. Sometimes I’ve woken up and realized that I’d been wandering in some part of the house for who-knows-how-long, without a clue as to how I got there. And sometimes my wife says I start having these conversations with her in the middle of the night, going on and on about something or other dealing with The War, when I later can’t remember a thing.”

The man spoke with a certain assured air, if one could say such a thing about someone who was talking about being, at times, anything but assured about reality itself. He was a big guy, though in no way fat. True, he’d probably been a bit more toned, shall we say, in times gone by, but the adjective “husky” would have always been a mark of respect for him, never a euphemism. His dark hair was short, not in a military way, rather more like in the way of the decent guy next door who’d called to you over the fence some Friday evening to see if you and yours would like to join him and his for burgers and brats (and a bottle or two of Fat Tire).

“When were you over there?”

“2003, 2004. Flew over on my twenty-third birthday, flew back on my twenty-fourth.”

I looked at him and said nothing. He looked back and did the same.

I’m in fact never quite sure what to say when I find out a combat veteran took part in the initial invasion of Iraq. I only imagine, knowing that I can never begin to imagine, knowing, therefore, that anything I have to say will only be trivial, at best.

“Not good?”

He snorted, thankfully in a resigned way, rather than the disdainful way that question deserved.

“You could say that.”

“What was your MOS?” (i.e., his assignment)

“Medic.”

Once again, I’m never quite sure what to say.  As I’ve noted before (e.g., in Kilroy Wasn’t Here), when I hear that a veteran was a combat medic, I try not to react too blatantly to other imaginings of mine, imaginings of gunfire, explosions, screams, hands being held for the final time. Rarely am I successful, though.

Twenty-three, a combat medic, in Iraq.

I wasn’t successful this time either. He noticed.

“Where were you over there?” I finally asked.

“You name it.”

In spite of the relatively terse answers, he was not at all wary or distant. In a way, it was as if he’d already been through this drill many a time before, so no need to get all worked up about it, after all. But then neither was he cool nor nonchalant. Instead, he very much exuded this feel of “if you’re willing to ask, I’m willing to answer,” a certain, pleasant-enough quid pro quo, if you will–one straight out of Hell, of course.

“How many close to you did you lose?”

He looked down, again in that tired, even matter-of-fact way.

“Four I was really close to,” he replied, as if both steeling himself for inner pain, yet somehow at the same time planning to be bored by it.

“Were you with any of them when they died?”

He looked back up at me, again not indifferently, yet, what, wearily, as if one more damn trip down the back alley of unspeakable memories was simply too much to ask of him today, too much.

“One.” He sighed ever so slightly, with a been-there done-that look on his face that could only radiate to the world that he would never finish being-there, never be finished doing-that, never. “One.”

It had been an officer, a man he had deeply admired, deeply cared about. It was awful. There were plenty more awfuls, though. Over the next five, ten minutes, he recounted some of them. He spared not a detail.

Clearly he cared deeply, about everything. Clearly he was struggling to find another ounce of energy to care any more, about anything.

“I was twenty-three. I saw things no twenty-three year-old, no one should have to see. I had to put my hands where no one–twenty-three, no one–should have to put his hands.”

It was the latter image, of course, that grabbed hold of my lower spine and squeezed with a vengeance. It’s been years since I medically invaded a body, drew blood, inserted catheters, dropped a nasogastric tube. Yet the physicality of the hand inserted where no hand should go: my own body reminded me that once I had been more than close to pulsating organs–holding retractors only, of course, while others far more daring than I invaded, inserted themselves further, deeper. Yet I knew that I could imagine such a scenario–hands as strangers in a strange land–far more easily than I would like to know.

He had stopped talking. He did not appear ready to cry, to lose his composure, nothing of the kind. Yet, still, his tiredness as way of life: the façade was beginning to crack.

“What’s the greatest sadness in you?” I finally asked.

Honestly, I have no clue where that question came from. Clearly he had been expecting it as little as I had been planning it.

He cocked his head slightly, almost as if he were taking a moment to admire my chutzpah, practically radiating one of those “well, who’d a-thought” looks. After five seconds or so, he finally said:

“You know, there was once a time when a question like that would have sent me over the edge. I don’t know quite how to say this, but . . . that question makes sense to me now. You know what’s my greatest sadness? The fact that I’m never not sad, no matter how I might appear on the outside, no matter what I say, no matter that I love my family more than anything. Please understand: I have happiness. My wife, my kids, they’re wonderful, they keep me going. But it’s as if I know one truth more than any other, a truth I couldn’t get rid of even if I wanted to: although I’m happy, I’ll never be happy again.”

“I mean,” he continued, “I shouldn’t be alive. You’ve got to understand how crazy it is that I’m sitting here with you. Good men are dead, and here I am. Over there, it got to the point that I didn’t care, period, didn’t care. I’d walk into the middle of a fire fight, thinking ‘so what’? Dead, alive, it didn’t matter. If you want to know the truth, I’m still like that, basically. I don’t want to die. I’m not going to hurt myself. I want to be alive for my family. And yet I can honestly say to you: I don’t care if I’m alive or not.”

I could say that I made no effort to calm him in all this, but that would give quite a misleading impression. He was quite calm, in fact. Or rather, should I say, he was quite calm and he wasn’t even close to being so.

Yes. That’s it.  Not even close.

“You know what?” he finally asked. “I was so messed up when I got back from Iraq. I hadn’t even heard of the term “survivor guilt,” but that was all I was, survivor guilt, all day, all the time, wandering, trying to figure out how I could muster the courage to carry out the only decent act left for me to do: die. But I couldn’t even kill myself. One time I had everything in place to do just that. But in the only minutes I realistically had to carry out the plan, the means I’d chosen just wouldn’t work. I tried, and I tried, and I tried, but nothing. And then once the chance passed, the means suddenly started working again, but it was too late. It’s like I’m being kept alive, even when I don’t care one way or the other. Yet I do care. For my family, I want to live. But I don’t want to live, see? Yet at the same time, I can’t even care enough not to want to live. Is any of this even making sense?”

“Yes,” was all I could reply. For, in listening to him, it did.

“You still in the medical field?” I finally asked.

“God, no,” he answered. “I lived enough of that as it was. I can’t even imagine doing it again. No, I want to become a counselor. People say I’m a good listener. They lean on me. That’s what I want to do. Maybe that’s how all of it will make sense one day. I don’t know.”

For a few seconds I looked at him, husky, sporting his brat-and-burger haircut, his smile still discernable behind that look of indifferent confusion, confused indifference.

“You’ll be good, you know,” I told him. I meant that.

Clearly he’d not been expecting that response either.

“You speak clearly, candidly, straight from the heart,” I continued. “You’re willing to live with your own confusion. That’s key in this job, believe me. I’ll have to say one thing, though.”

With that latter statement, his indifference vanished. Only plain old-fashioned confusion remained to face the music.

“What’s that?” he asked.

“Well,” I said, “if you’re planning to make it possible for others to live better, then you’re going to have to live better yourself. Even if you think that you don’t care, that you’re really not that into living: sorry, reality check. You do and you are. Your hope, that goal of becoming a counselor who will listen to another combat vet no matter what is remembered, what is said: they betray you, the real you behind all the indifference towards the next sunrise, the next cup of coffee, the next diaper change. Hate to break the news to you, guy, but it ain’t just your family who’s keeping you alive. You are as well.”

For the first time, his eyes went into lock-down, obviously determined not to let any lacrimal material even consider escape into the light of day.

“You’re probably right,” he finally said, his every milligram of emotional fortitude on full alert.

Truth be told, though, he looked–at least to me–to be more on the relieved side than anything else. Guess it’s not so bad to be found out after all.

In the end, I told him I’d be glad to work with him. He smiled.

“You know, almost all the psychology types I met in the service were worthless, didn’t have a clue. They really thought they could slice open a huge scab on your heart, muck around there for an hour or so, and then expect you to go home and be just as fine as they were going to be that night, as if to say. ‘OK, now that you’re all ripped up and raw, see you next week and we’ll pick up where we left off.’ Nuts, totally nuts.”

I smiled back. “Me too?” I asked.

He sat back, with a smile perhaps not quite yet ready to make an offer, let alone accept one, but, at the same time, a smile not exactly ready to pack up and leave the negotiation table either.

“Maybe I should start talking with someone again,” he mused, eyes still riveted to mine, while in no way giving me the pleasure of being right about one darn thing. “Who knows? Maybe that’ll help.”

I gave him my card. He took it. We’ll see what comes of it.

I can’t remember anyone being quite so graphic with me as he’d been when describing his experiences. A reference he made to a scene near the end of Kubrick’s The Shining, as a prototype for the setting of one of his rescues, was more than apt. And if I may be so bold: the horror of Nicholson’s imitation of McMahon earlier in that film had nothing, not a thing on the horror this guy saw coming at him day after day after day.

In being so explicit, so raw, I don’t at all think that he was giving me some kind of test, as if to see how well I could “take it.” No, sadly, I fear all was just as it appeared: horror had become so commonplace for him, so sleight-of-invading-hand in its routine manifestations during combat, each of the stories was simply another day at the office, as far as he was concerned.

An unfathomable day at the office, perhaps. But he reminded me of a truth so well-known, tragically, to so many men and women who once saw what their twenty-three, nineteen, thirty-five year-old eyes should never have seen: one doesn’t to have to reach a fathom into a body, a soul to get to a horror that can leave a sadness in its wake that can become so intrinsic, one can narrate a c’est-la-vie assessment of it and almost–almost–get away with it.

No, for that, just a simple hand-length will do.

The Killing Floor

You’ve got to give credit where it’s due: I didn’t see this one coming, no way, no how.

The veteran and I had been “introduced” long before he’d known it.  I had been on back-up call for our service, and I had received a page from the resident on-call about a man whom she had just seen in our emergency room, a veteran a few years out of his last deployment who was “not doing too well” (his words).  She told me that he had been working closely with the Chief of our Chaplain Service, as well as with one of my colleagues who specializes in treating combat trauma.  According to the resident, both my colleagues had been urging the veteran to consider a brief hospitalization for stabilization.  Finally, that night, the veteran had decided he was in agreement.

The problem was: because of staffing issues, our inpatient service was “full,” and the veteran would have had to have been referred to another VA hospital in our area.  The resident doubted he would go for that–and I doubted that the referral would have been helpful in the least.  I know both his treaters well and trust their judgments implicitly: if they thought the veteran could benefit from an inpatient stay, he could benefit from an inpatient stay, period–but only at the one where these well-trusted treaters worked.

I won’t bore you with details.  Let’s just say that “full” can be a relative term, and although there was, shall we say, dissent within the ranks, the veteran was eventually admitted.

I have my ways.

And an M.D. behind my name.

Then what do you know: the next day there I was, minding my own business, when lo and behold, a new guy showed up in a group that I’m attending that is being run by the Chief Chaplain.  The group is geared for Iraq/Afghanistan veterans who are struggling with their spiritual identity and beliefs.  When he introduced himself, I knew exactly who he was.  After all, the embers of the controversy I’d sparked in his honor were still glowing on the other side of the hospital, as far as I knew.

He was strikingly handsome, in a certain, young Brad Pitt kind of way, although unlike Mr. Brangelina, his hair was dark and graying–albeit a very Pitt-esque graying, if you know what I mean.  He wore a baseball cap as if he’d been born with it, and his intensity marched right from the entry of our clinic into the entry of our group room like Caesar taking Gaul, all three parts.

And he was in pain.  A lot of it.  He couldn’t have hidden that had God come down and ordered him to.

Today, a week later, he came in and took his place around the table.  There was a bit of a riled edge to him, but nothing drastic, and without much effort he bantered with the other men of the group until the festivities began.  Soon after that beginning, however, he asked us all a question.

“Do you guys mind if I tell you the words of a song I’ve written?  I play the guitar, and it helps me cope, and, I, well . . . it’s been a bad week.  The worst, really.  Would you be willing to hear it?”

We all said yes, of course–out of curiosity, true, but also, admittedly, out of a certain kindhearted tolerance, you know how that goes.

So without skipping a beat, he recited the words to us, just a touch out of breath, yet slowly and clearly, with a cadence worthy of the meter, never sing-song, always with a distant gaze that seemed to place him somewhere between Indianapolis and Baghdad, if I had to take a guess.

I didn’t see it coming until it came.  His lyrics.  Him.

When he finished, the room was silent.  All I can remember is sitting there like a fool, my mouth hanging open, looking directly at the Chaplain, who was sitting there like a fool, his mouth hanging open, looking at me.  Our eyes spoke in unison to each other:  Oh, my God.

Oh my God.

He went on to talk a fair amount today.  He was a bit embarrassed at how much he spoke, yet never did he monopolize the group.  His heart was simply pouring forth his pain, his confusion, his anger at a world that should be far more reliable than it is.  The other guys nodded in agreement, murmured in assent, freely added their thoughts, their elaborations.

I don’t think any of them noticed the tear streaking down my right cheek.

When the group was over, I asked him if I could publish the lyrics in my blog.  I promised him that I would read him the text of the entry.  He seemed genuinely touched, excited even.

“I wrote it for the regular soldier, the guy trying to do the right thing, trying to stay alive.  I’d really like to make a video of it, you know?  Share it with other soldiers, like a gift, all of us trying to make sense of it all.”

I was about to give him my e-mail address when I realized that he was getting a piece of paper so that I could write down the lyrics as he dictated them to me.  Clearly he was wanting to speak the words to me again.

His delivery was a bit slower, in deference to my aging hearing, I suppose, yet just as intense, just as desirous of a listener–any listener–to get it, please, get it.  Please, sir.  Please.

The Killing Floor

Driving through the sand
In an 1114,
My men and I are true killing machines,
50 cal and a Mark 19.
We can take out anything.

Death is near,
I can feel it in my bones.
Contact right, coming over my headphones.
I look to the right, and what do I see?
I see this Iraqi man staring right back at me.
He raised his weapon, I had to blow him away.

I still think about him every day.

Was he a father, or was he a son?
I wonder if he’d ever even held a gun.

What are we fighting this war for?
It’s a one-man show on the killing floor.
The killing floor is what you need.
The killing floor is what you believe.

Have you ever heard a mother’s cry?
Have you ever seen a father’s tear?
Who are we kidding,
We’re killing children here.

Have you ever seen that father’s tear?
Or have you ever heard that mother’s cry?
That will tear you up from within.
Then I look at the killing floor again.

Beauty is within the selfless sacrifice.
Have you ever seen a dead soldier’s eyes?

What are we fighting this war for?
It’s a one-man show on the killing floor.
The killing floor is what you need.
The killing floor is what you believe.

He stopped, smiled sheepishly, just barely.  Then he started to pick up his things as if to make a quick exit.

In theory, I needed to go.  I had a private patient about to arrive soon.  But I just sat there.

He stopped again and looked at me.

“Do you . . . can you talk a bit more?”

I paused.

“Let’s go down to my office.”

I opened the door and asked him to take a seat while I made a call.  I left my private patient a voice mail and sent her a text.  “I need to stay at the VA.  There’s a guy I need to keep talking with.  I’m really sorry.  I’ll call you when I can.”

By the time I got back to my office and to him, I had my text reply.  “Don’t worry.  I’m glad you’re there for him.”  The woman’s a straight-shooter.  She says what she means.  I appreciated those words.  Still do.

We ended up speaking about fifteen minutes more.  It had indeed been a, what, eventful week for him, with a capital E.  He knew that he’d been the cause of a lot of his problems.  He was not shirking one microgram of responsibility.  But still, he was feeling betrayed.  He was wondering why he’d put his life on the line for this.  He was wondering why he had lost the men he loved for this.  He was wondering why there were Iraqis dead by his hand for this.  For life in the America of the marketing campaign, where your every move at Target is studied.

For this.

“You just can’t go to war, you know, as if you had nothing better to do.  We veterans have got to make people understand that.  We’ve got to communicate.  I thought combat was going to be some . . . well, I don’t know what.  I was gung-ho, though, all the way.  Then I saw the kids.  They were everywhere, asking for food, for candy.  There was this one girl.  I always gave her muffins.  It was like her whole world had been made by me, just for some muffins.  And then one day she never came back.”

He paused, his eyes tethered to the ground, as if trying to dig his way back to a doorway in the Middle East.

“I think about her every day.”

Slowly he looked up at me, his eyes moist.

“I’m a good man, really.  I never got into trouble in high school–oh yeah, maybe a cigarette here and there, every once in a while some weed.  But I made good grades, and I wanted to be a soldier.  I went to basic the summer before my senior year, while everybody else was just goofing off.  And then 9/11 came, and I knew: I had to go over there.  I had to.”

I could see him in my mind, the sophomore, the junior, playing baseball, knocking off home runs to impress the girls.  In rural Indiana, of all places.

“I was the only one to carry on the family name,” he barely whispered.  “Now I have a son to carry it on.  I take that stuff seriously, really seriously.  I want to be an honorable man.  Sometimes my morals and my orders crossed.  I . . . I just want my son to know that deep down, I was once a kind man.  I think I’m still good.  I think.  I hope I am.  For his sake–I hope I am.”

Good God, I can only think, even now: where did this guy come from?  A field somewhere east of town?  Seriously?

Yes.  Seriously.

You know what his favorite word is?  Perspective.  I kid you not.  Perspective.  He wants to understand, to “wrap his head around . . .”  Around what?

The killing floor.

And a name.  Borne faithfully from father to son.

The name of a good man.

%d bloggers like this: