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.”


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.


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.

“Taps” and the Last Musketeer

It’s time to get this written.

Spring has slowly been intimating its way into Indiana these past several days, although, admittedly, I’m being kind in giving it this much due. Still, the snow is gone, and temperatures are edging toward their becoming worthy of some notice beyond “scorn.” Yet while the thermometer has only been cooperating begrudgingly, the barometer has been anything but: beautiful, nearly cloudless skies have been ours to enjoy.

Funny, isn’t it, how the living prefer sunshine for funerals.

As I have noted in previous posts (Goodbye, My Friend and In Memoriam: Porthos, 1985-2013), my patient, Porthos, a combat veteran of two deployments to Iraq, age twenty-seven, died in an auto accident a little over a week ago. He had grown up in a town that had once had the decency to be out in the boondocks, but which has, over the years, become another bedroom community for Indianapolis. It’s quite a hike, nevertheless, from my house, so I headed out in plenty of time, ostensibly so that I could secure an adequate parking spot.

In reality, I was just needing the time to myself.

All the way down there, I couldn’t stop thinking about a topic so near and dear to so many therapists’ hearts, minds, and critiques: boundaries. Truly, I’m not sure what some therapists would do if they weren’t policing not only their own, but everyone else’s, twenty-four seven, usually with, if I may so say, a certain self-satisfied, ethical purity.

Yet in spite of my snarkiness, the topic is indeed a critically important one, signifying as it does the question of how much should the personal and the professional be allowed to co-mingle in a therapeutic relationship. Certain answers to that question are easy, of course: no sexual favors, no financial manipulation, for example. Others plague all young therapists and many older ones: when, if ever, does one accept a nominal gift from a client/patient? How much does one reveal about one’s personal life, one’s experiences, one’s disappointments?

Or . . .

Does one embrace a patient’s grieving father, his grieving mother, his grieving brother—his grieving best friend who also has medicine bottles in his bathroom cabinet that have printed upon them my name?

As the traffic thinned out, as the several lanes merged into two, I had to wonder: for whom was I going down there? For Porthos? His family? My other patient, his battle buddy through both deployments, Athos?

For me?

After thirty years in this business, I have come to the conclusion that the answer to all such questions is E, i.e., “all of the above.” I can live with that. I have learned that these things have a way of working themselves out.

I pulled into the lot of the funeral home with more than enough time to spare before the service, dutifully then backing into my parking spot as I was instructed, my purple “Funeral” flaglet well-perched on the roof above me.

Men and women were already there, though, even more dutifully standing guard along the sidewalk leading to the entry door, all clearly my senior, most dressed in leather, many with the familiar POW-MIA emblem from the Vietnam era emblazoned on their backs, holding the United States flags that so readily were flapping in the cool breeze, their Harleys parked only feet away, ready to be mounted, to be driven at the head of a procession to the cemetery, in a silence that not even the loudest of mufflers could pierce.

About ten minutes later, Athos and his fiancée arrived in their SUV. After backing the car in almost directly across from me, he turned off the engine and, in moments, was looking directly at me. The smile of recognition was there on his face, yet he knew it as well as I did: neither of us wanted to be seeing each other at that moment. He zipped an open palm past his face, once, in that muted “Hi” so often seen in old home movies when a person has that ridiculous light glaring into his or her face, hoping against hope that Uncle Maury will just move on to the next relative and leave me the heck alone.

I got out of my car first, only then to watch him somewhat pour himself out of his, almost as if he were maple sap reluctantly exiting through that spigot in the trunk of the tree during a sub-zero winter. Yet door shut, he turned to me in his suit, dark shirt, dark tie, a little too slender, true (as countless maternal types had reminded him at the viewing the night before), yet still ready for his Jos. A Bank’s photo shoot. He smiled again at me, adjusted his tie as he did his obligatory “look both ways,” so well learned in first grade, and then began to walk across the driveway toward me.

He marched right up to me, eyes refusing to let anything even approaching a tear to leak out, trying to maintain some semblance of a smile. His beard was well-trimmed. His hair was neatly cut, longer than military, definitely, yet still a certain “short chic.” Tobey Maguire’s Nick Carraway was back, in other words, at your service. Preparing to bury Leonardo DiCaprio’s Gatsby.

For a second or so, we just looked at each other.

“Thanks for coming, Doc,” he finally said, a certain hesitancy more than apparent.

This was it. I knew it. The boundary decision.

So I made it.

I opened my arms wide.

His eyes saw their chance, and for just a few seconds they forced his entire facial musculature to contract in response, both giving in to tears and refusing to do so, as he nearly fell into me, wrapping his arms around my upper body, his head in an instant buried at my neck, his body seeking my ballast to help steady those eyes and get those partners back in line, buddy-boy, and I mean, right now.

“I don’t know if I can get through this, Doc” he whispered, quickly, desperately, right into my ear.

“I know you don’t,” I whispered back into his. “You don’t have to think you will. You just will. You’ll do it, and you’ll have no clue how. For his family. For him.”

For a few seconds, nothing, then another whisper entered my ear. “Thank you, Doc.”

Just as quickly we separated and looked at each other. His smile was trying to weasel its way back into place.

“I’ve got to go in and see his folks. You’re coming to the cemetery, aren’t you?”

“Of course,” I replied.

He cleared his throat, adjusted his tie one more time, and then his sunglasses. “OK, great, I’ll . . . I guess I’ll see you inside?”

“Of course.”

The smile having reasserted itself, he was gone with the nod of a head.

Several minutes later I entered the funeral home myself, making my way to the large room where just the night before I’d walked in to see at the end a large wooden casket, carved and stained in such a way as to remind any onlooker of a life that had been honorably, even beautifully lived. A United States flag, well-folded into its triangular form, lay on top of one end of the casket, various pictures and a sports jersey on the other.

As I took my seat in the far back corner, by all the pictures that had been assembled and displayed along the back of the room, I looked down to see on the table next to me a five by seven of two very young-appearing men, stocky, I think, more because of all the outfit and combat gear each was sporting than because of any good, home-cooked meals out in the desert. Each had a “go ahead, cross me, I dare you” look chiseled on his face. I had both to smile and to bite my lip.

Porthos and Athos, bodies so proud, yet eyes already having begun to be transformed by War.

In Central Indiana, it usually seems as if all funeral homes are constantly jockeying for the title of “Most Gaudily Edwardian.” Fortunately, this one had bowed out of competition at a more respectable moment. I was quite glad, in fact, that as the music began to be piped in, it was not the usual, top-ten hits of nineteenth-century, Methodist hymns being played far too slowly and far too cheesily on a Hammond, draw-bar spinet.

Quite the contrary. It made me smile without any lip-biting.

It was Josh Groban.

All I could think: Porthos, a veteran of many a barroom scuffle brought on by some unsuspecting, churlish drunk who’d made the poor decision to “dis” or threaten one of Porthos’ buddies; Porthos, the guy who’d argue a point with you well into near-absurdity just to prove to you that you couldn’t run over him . . .

Porthos, the man who, after being awakened one more time by the terrors of nightmares that had left him drenched in sweat, would calm himself by watching Harry Potter movies, over and over again, so often that he could quote entire scenes by heart . . .

Of course, Josh Groban. Of course.

Soon the room was packed not just with the usual cadre of retired individuals who apparently plan their golf schedules around funeral services, but also—even mostly—with dozens of young men, still well-built as their hairlines were receding, and dozens of young women, still with sensuous smiles after having put on that extra pound or so after their last pregnancy. Some were dressed to the nines. Some were wearing T-shirts and jeans. All would embrace over and over, smiles radiating “It’s been too long,” yet voices soft enough not to remind any of them that one of their gang, though still in the room in body, was now quiet, quiet as he’d never been in high school, never in the Army, never in life.

At some point, Porthos’ mother saw me, came over, hugged me, and said “Thanks for coming.” My reply was as it had been to Athos: “Of course.” We looked briefly at each other, two parents of different children, yet both parents nonetheless. We both knew there was nothing more to say. We left it at that.

Eventually his older brother and his girlfriend made it toward the front of the room, then his younger brother and his husband. His younger brother, D’Artagnan, caught my eye. He smiled, waved sheepishly, as did I in return. Once more, we left it at that.

Finally, as Porthos’ mother took her place next to her youngest son, his heartbroken father walked in and took his place on her other side, the college professor dressed for a no-nonsense lecture, ready to see his son off with the honor the younger man deserved.

Athos and his fiancée were barely a few seats away from them.

As the service progressed, as the National Guard chaplain whom Porthos had so deeply admired spoke, as Indiana’s Adjutant General looked on, as both his father and his younger brother tearfully remembered him, admired him as their hero, as the quintet of friends apparently from high school sang in Appalachian open harmony, quite in tune, a song drenched in country-western fervor, yet universal in sentiment, I could only think: my God, what if I hadn’t come?

Boundaries, schmoundaries.

I have to wonder: if more of my VA colleagues across the nation were to attend just such services, feel the lives of the men and women we have served, absorb the sadness and the futility of lives cut off far too soon, whether in battle, in the accidents of those who had always imagined themselves indestructible, in the self-destructions of those who could no longer imagine a future without excruciating pain of body and soul—what then? Who would we be? To whom, to how many in this country could we then announce, scream, pontificate, plead to not forget, not abandon, not leave these same men and women worrying one more day about where their next meal will come from, about whether they will have a roof over their heads?

The service over, I was one of the first to be escorted up front. For a couple seconds, I stood before the casket, not even sure I was wanting to have the wherewithal to understand the import of the moment. Just as quickly I turned to meet the eyes of his younger brother, to embrace him and hear him say “Thank you,” to hear myself once again saying “Of course.” Then it was his mother, same.

Then it was his father.

For a moment we looked at each other, Dad to Dad. As we embraced, his voice broke ever so softly. “Thanks for helping him talk about what he needed to talk about.”

This time, my “Of course” served more as my defense against the breaking of my own voice.

I shook the hand of his older brother, and then I turned to see Athos sitting there, head down, quickly batting at his eye. He looked up at me, and then in an instant was standing, and one more time, boundaries were . . . well, I don’t know, they just were.

Another firm embrace. Another “Thank you” whispered into my ear. Another “Of course” whispered into his.

The cemetery was not that far from the funeral home, though it wasn’t a stone’s throw either. It was quite a line of cars making its way down the divided highway, led by the police car and a pack of very loud, very silent Harley-Davidsons. Interesting, I thought: out in this more rural area, cars were stopping as the procession went by, even when they were going the opposite direction on a divided highway. You’d never see that in Indianapolis.

We wound our way to the rear of the cemetery—to the burial ground of soldiers from all the way back to the Civil War. His was a beautiful spot, right next to an ancient tree. The family sat down in the tent. The rest of us gathered along the sides. Across from us were the two rows of marksmen (and women), standing at attention, ready. To the far right, a lone man stood, also at attention, a bugle tucked underneath his arm.

Men and women in uniform gathered to the left of us, all ages, each falling into a respectful parade-rest. Six men then came to full attention and, in well-orchestrated fashion, marched their way to the back of the hearse. With a series of precise, right-angle turns, one of them made his way to the door and opened it.

There he was, Porthos, casket draped in the flag that he had more than once told me that, in spite of all his suffering, he would serve under again and again.

Ever so precisely the men maneuvered the casket out of the hearse. Ever so precisely they carried it to the grave site. Ever so precisely they rolled it into place. Ever so precisely they stood back, turned, marched off.

The chaplain spoke a few words. The crowd recited the Lord’s Prayer. A few more words from the chaplain, and then another man in uniform precisely made his way to the casket, precisely and respectfully requested that all stand.

From across the way the commands were barked.

Rifles clicked. Fired.

Clicked. Fired.

To the right, men and women stood at full attention, their white-gloved right hands slowly making their way to a salute as the bugler slowly, precisely brought the instrument to his lips.

Ever so slowly, ever so precisely, ever so, dare I say, musically, he made his way up the major chord, each note clarion-like and yet not, both forceful, yet haunting.

He hit the final high sol easily, sustaining it just long enough, then made his way down the octave, perfect interval by perfect interval, until the final do filled the air, no vibrato, just tone, a good eight counts.

Porthos would have loved it.

As the guns were firing, the salutes lifting, the bugle playing, one uniformed soldier stood at the head of the casket, a second at its foot. As the final note of the song faded, the two men clicked into action, lifted the flag draping the casket, and ever so slowly, ever so precisely began to fold it, in half, in half again, then right triangle by right triangle.

Finally only one of the two men was left standing there, holding the folded flag, as Indiana’s highest-ranking National Guard officer walked slowly up to him. The man handed the General the flag, then saluted. He walked off.

And then it happened.

From behind the family, Athos stood and walked toward the General. At full attention, he put out his hands, and slowly the General lowered the flag into his, ending with a salute, older man to younger, both living and dead.

Athos then turned and made his way to stand in front of Porthos’ parents, to be met there by Porthos’ Uncle Jack, a Vietnam veteran whom Porthos had often spoken to me lovingly about, his inspiration for taking his energy, his mind, his body to serve, even knowing that death could result, by his hand, to his dearest friend, to himself.

Athos handed Jack the flag. And he saluted.

Jack nodded, turned, knelt down, and handed the folded flag finally to Porthos’ mother, his father right beside her.

Minutes later, the service was over.

People began to walk around, speak softly, hug. I looked over to see Athos embracing his fiancée, whom I’d only met for the first time the night before, a woman who’d been Porthos’ childhood buddy, the girl he’d taken to Prom “just because,” the woman who’d have never known Athos, whom Athos would have never known, would have never found comfort with, had it not been for that wisecracking charmer from Indiana.

Eventually I made my way over to him. He was standing next to Aramis’ brother-in-law: Aramis, the first of the Musketeers to die, in battle, the kid from the big family in Maryland, the man whose body Athos had lovingly guarded to his final resting place (Taking Him On Home).

Athos looked at me and swallowed. For a few seconds we stood there. The tear was trickling down his cheek. I think one was trickling down mine as well. I can’t quite remember.

Slowly he walked toward me, and once again boundaries evaporated. This time, though, I could feel the shaking of tears in his chest as he embraced me, not sobbing, just . . . tears.

“I’m not ready to let him go,” he finally whispered into my ear.

“I know,” I replied.

Slowly he pulled back. As we looked at each other, we both knew there was nothing left to say. He nodded, as did I. Then he turned away.

I wondered whether he was going to finish what he had to finish.

He did.

He’d told me the night before. “The last salute. That’s what’s going to be the hardest.”

I watched him as he went over to another man, his age, in full uniform. Briefly they spoke. Then, together, they walked up to the casket. People continued to walk around, speak softly, hug.

The two men assumed full attention. They looked down at the casket. Then, in a fashion just as the men and women had assumed at the sounding of “Taps,” just as the General had done to the flag and to him, Athos and his friend slowly began to raise their right hands to their foreheads, the entire journey from chest to brow extending over four, slow beats, at the end of which their hands stood still, as did Time, one last time.

Although not in heart, but at least in body, the last Musketeer had done it: had let his second brother go, had saluted him one last time at a casket, had taken his place, unwillingly, yet bravely, as the last one standing.

Slowly both men lowered their hands. Slowly they turned away—and then embraced.

About five minutes later, I turned to find him standing in front of me.

“You still in the hospital this week?” he asked.


“Maybe I could come by on Friday?”

“Of course.”

I think we both attempted something like a smile. That may be the best either of us can hope for. For a while.

Eventually it was time for me to go. I walked over to the casket and lowered the tips of the fingers of my right hand down onto it.

I, of course, had not earned to right to salute.

And so I thought what I needed to think, whispered what I needed to whisper.

Words that I now must write.

For I, too, don’t want to let Porthos go. And I, too, like Athos, must find a way to begin to do just that.

And so I type what I whispered to his body—perhaps, I hope, in some way even now whisper to him. Even though I could not salute him, I could say something, something that perhaps as his psychiatrist—and even more, as his somewhat boundary-bending friend—only I could say.

You see, I was by no means the only one to whom he bared the terrors and grief of his soul. He did to Athos. He did to his chaplain. He did to a few other buddies. Yet I do know that even with them, he’d only been able to graze against the guilt in his soul, the grief in his heart, the suffering in his mind.

With me, however, he had honored me enough with his trust to allow me to watch him begin to grasp those demons more firmly, to take the risk with him that everything could blow up, to have the faith that it wouldn’t, to feel together what never should have been felt by him in the first place.

Perhaps, then, there are words that only I can pronounce, not as some sort of blessing—far from it—but rather as a statement of fact, a “performative” utterance, as the literary critics are wont to say, words that by their very speaking both acknowledge what “is” and bring that “is”into being.

I have to laugh, actually. Porthos gave me no end of grief about being a “Harvard hot-shot.” He, more than anyone, would have enjoyed the ridiculousness of some Westside Indianapolis boy acting as if he could spout off some highfalutin’ Latin nonsense in the tradition of the Lux et Veritas so proudly displayed on anything Harvardian one can buy at the Coop in Cambridge.

Yet at the same time, sometimes I would wake up in the morning to find that he had texted me in the middle of the night to tell me that another nightmare had awakened him, shook him to the core, but that he was “going to be OK, Doc. I’m feeling a little better.” Why?

Because he’d watched a couple Harry Potter movies.

It was J. K. Rowling, of course, who helped make Latin fashionable again, with her spells, curses, and family names that hearken back to the language of Rome. How Porthos would have so appreciated, then, at least one word in the phrases, that wizarding word for a curse that could, if left unchecked, destroy both body and soul of any man or woman who had to endure it.

He knew something of that process, after all.

Yet, thankfully, he also knew of other processes as well. He knew, like Harry, that ultimately what saves us all is simply faithfulness and love.

I only hope that well within boundaries, yet well not constrained by them, he learned something of the latter two from me, enough so that I can say what I have to say, perhaps the only good I can see arising out the sadness sounded in that bugle’s call, in that beloved brother-in-arm’s salute.

And so one last time, now with fingertips touching wood only in spirit, I let you go, Porthos. As your doctor, I give you the final diagnosis to set you free.

Cruciatus consumptus est, Porthos. Requiesce in pace.

Indeed, the torment is over, Porthos. Rest in peace. Amen.


In Memoriam, Porthos, 1985-2013

With the permission of his family, and with much sadness, I let you all know that this week, as I said before, I lost not only a patient, but a friend: a man whom some of you have come to know as Porthos.

In the late afternoon of Monday, March 25, 2013, he died in an auto accident, leaving his parents, his brothers, his family and friends, me—and a brave, tired, bereft battle buddy, Athos—rich in memory, yet broken in heart. He will be buried with full military honors this coming week.

I first wrote of him over a year ago now, just after the shootings in the village near Kandahar, Afghanistan, in an entry entitled No Trouble At All:

Today I was in contact again with one of the veterans I work with, one who has struggled almost incessantly since coming home. He’s a dashing rake, by anybody’s measure. He comes from a well-educated family. He’s smart. He’s intense. He was once a bit of a bad-boy, but he’s working now to pull his life together, to find love, to find a place back in his family, back in this world.

In a matter of days after landing in the Middle East, this man’s dearest friend—his brother to the core—was dead. Others in his unit soon followed. He wakes up in the night screaming, sweating, panicked. Not a day goes by that he doesn’t think of his friend, often—usually—with tears. To this day, when he promises me something important, he does so on that man’s memory and on his grave. . .

He always apologizes when he contacts me. He’s so ashamed to do so. But he gets so desperate. And he hopes against hope that I won’t hold the contact against him, one more time, another, another.

Honestly, they’re indeed no trouble at all. He knows the drill: if I can get back with him, I will. If I don’t right away, he knows that I’m with family or with other patients. He knows I’ll get back to him eventually, even if it’s just a “hang in there.” He knows he’ll have his time later that week to come see me, to try somehow to find that devilish smile of his one more time, to remember when it was all easier, to borrow as hope what is my certainty: that he will find a better day. One day. Not today. Most likely not soon. But one day.

I can say that because he’s a warrior’s warrior, through and through. Behind that Abercrombie façade (albeit a brunette one), there’s a force of nature. He was a handful as a kid. He’s a handful now. He won’t give up. Never did. Never will.

All I can say is: good for him.

We took care of today’s matters in short order. He thanked me quite genuinely. “I’m sorry,” he said again, “to mess up your weekend.” I heard the break in his voice, quick, but definitely there.

“No trouble at all,” was my reply.

What else do we have, really, except time, a future.

He doubts he has a future, of course. My job—our job, as professionals—is to disabuse him and those like him of that notion one day at a time. No guarantees of any particular outcome. Just life, with its joys, its challenges, its months off, its back-to-works.

We’ll see each other tomorrow.

“What else do we have, really, except time, a future,” I asked, so confidently, so seemingly a lifetime ago. If only, if only.

He reappeared nine months later, in Merry Christmas, Reality Notwithstanding:

I’ve already spoken of [him] in “No Trouble At All.” He and I have struggled back and forth over what to do, when to do it, how to do it. He’s always respectful, quite engaging, the whole gamut from jocular to irritable (with an apology therefor immediately afterwards, I might add).

He comes from a professional family, several members of which are not, shall we say, reticent to express views that he’s not too thrilled to hear, his younger brother in particular. They’re an intriguing pair, these brothers: both quite physically striking in appearance, kinetic-energy extroverts par excellence. When they sit in the room together, they jockey for position as to who is going to make the next comment about whom—and have no fear, the younger one is not about to be the loser any more than fifty per cent of the time. One might be tempted to call each of them a “pretty boy”—but believe you me, you’d better not do so to their faces, and you’d better not count on the usual associations to that term if you were to get on their wrong sides. . .

Whenever. . . the rakish Porthos . . . had spoken of [his deceased battle buddy, [Aramis], he’d only been able to choke out a few words before telling me that he could say no more. I never could learn from him [his] buddy’s full name, simply because he could never bring himself to speak it without beginning quietly to sob. . .

Porthos returned to a family with whom he has cried, laughed, struggled. He returned to a younger brother who can outflank his every protestation, yet who can then quietly shed his own tears as he listens to his big brother’s overwhelming grief.

Again, with tears that younger brother called me Monday evening, just as I was texting him to express my concern and condolences. We spoke only briefly. There was little to say.

Yet as I thought about it that night, the night I wrote the previous entry, Goodbye, My Friend, I did realize there was indeed one more thing to say, to text to this handsome, younger brother, to this—perhaps?—D’Artagnan:

“I wanted you to know: when he and I met on Friday, he told me that he was worried about you and asked me to check on you. . . I know the two of you could go at it at times, but please do know that he loved you dearly and was proud to be your brother. That I know, and that I wanted you to know as well.”

I finally, then, wrote of him just last month, in To Remember, Not Relive:

Porthos and I have known each other for a while. Our relationship has always been warm–though, shall we say, complicated as well. As the middle of three strong-willed sons born to a strong-willed father, he knows how to make his wants and wishes known. Fear not that, I can assure you.

And I might add: I wouldn’t get into a scuffle with him. Some of the more foolhardy in his time have. They learned. Forthwith.

Yet can that boy pour on the charm, or what. His is a perfect mixture of the quite genuine and the quite consciously manipulative. He’s had more than his fair share of practice through the years.

He actually leaves me reeling much of the time, truth be told. I’m never quite sure whether I want to give him a warm rub on the top of his head or smack the living daylights out of him. Usually both.

Porthos, in other words, is one of those individuals about whom no one–and I mean, no one–can feel nonchalant.

Porthos is quite a handsome man. How we think the attractive never have to suffer, don’t we? How wrong we are. Anguish is just anguish, whether on the good-looking or on the plain.

He looked at me, with a face both steeled and tear-stained. He has all the gear in place for “Leading Man” status, yet I’m hard-pressed to come up with a modern exemplar for him, given that most A-list stars today are simply too “pretty.” Perhaps a young Mark Harmon as the surgeon on the “St. Elsewhere” of the 1980’s, even then oozing the “NCIS” Gibbs-attitude that would one day make him America’s favorite Marine, back then painfully walking down that hospital hall for the final time, his character well-aware that he might soon die of AIDS.

“I sometimes just don’t know if I can do this, Doc,” he finally whispered. “I’m not going to kill myself or anything, but sometimes I’m afraid I won’t make it. It just hurts so, her, Aramis, the War, everything. It just so, so . . . hurts.”

The final word had plopped out of him, as if it had been teetering on his lip all the while, not wanting to risk the reality that would result from its mental equivalent having found voice, sound, transmitted out to a world, to me, to . . . what?

And then it happened: in the middle of his anguish, he started to look as if he were ready to fall asleep, to look as I imagined he must have looked at the end of that twenty-four hours he and Athos had had to stand watch over the body of Aramis, waiting for the helicopter to arrive: too exhausted to run, too charged to collapse.

And I realized: he wasn’t with me. He was in Iraq.

“No one has any idea, do they?’ I finally asked, too exhausted, too charged myself. “You’re there, right now, aren’t you.”

He was staring off to the side, grudgingly allowing one tear at a time past the checkpoint, his eyelids in a bizarre, internal arm-wrestling, the upper halves determined to shut this show down, the lower halves determined not to give in ever, do you hear me, ever!

“I’m sorry, Doc,” he whispered, his tears, few as they were, so robust, so proud to be Army-strong, his eyes fixated miles away. “I’m trying, really I am. I hope you believe me. Please believe me, Doc. Please.”

“I do,” I answered, hoping perhaps that some information, meager as it was, would jar us both out of the grip of those tears. His energy, his intense drive, his inner push never to give up, never: there they were, torturing him, yet keeping him alive, simultaneously, right in front of me, with my every verbal reminder of the truth, the Truth.

It was horrible to watch.

All I could think at the moment was, “My God, this is what they all go through, isn’t it, all these men and women, the ones whose Facebook posts, whose blogs I read, who talk of being walloped back and forth through Time, through emotion, psychically miles away from the loved one before them, then within nanoseconds careening right into them, then back, then in, tethered to a yo-yo only Satan himself could have manufactured–with a smile.”

I had to stop. Had to.

“Will it ever get better, Doc?” he asked.

“Yes, it can,” I said as I leaned forward.

Still exhausted, but somewhere, unbelievably, still rakish, he closed his eyes, took in a deep breath, opened his eyes back up, looked into mine, and merely whispered, “If you say so, Doc. If you say so.”

I do say so. And I do believe so.

And I can at least say this, for the sake of his family, for the sake of Athos, for the sake of all combat veterans who have worried that, indeed, “hope” is an oxymoron: he was indeed getting better. He had a long ways to go. His road would have been a challenging one. But he was walking it. He would have continued to walk it.

The reliving was becoming remembering. In a way, he’d gone out on the road this past weekend to continue that very process. It was the process he was living when his time—like that of Aramis, also one to Live capitalized until the very end—came.

I can write no more now. Amazing what you can do with the Ctrl-C and the Ctrl-V commands. Copy and paste. Works like a charm.

I’m dreading next Wednesday. I’m dreading the guns. I’m dreading “Taps.”

And yet who am I, really? I did not raise him. I did not wrestle with him, argue with him, dream about the future with him, at five, fifteen, even twenty-five. I did not stand with him over the body of a dead comrade, sing with him at the top of our lungs Back Where I Come From, miles and miles away.

But he did permit me to feel his heart, to honor me with his pain, to trust me with his future.

I so wish there had been more of the latter, Porthos. I so, so wish.

He died at age twenty-seven, having seen so much death, having hurt so much pain, yet having also smiled so many smiles, having pulled so many pranks, having charmed his way out of so many tight squeezes, having watched so many episodes of The Vampire Diaries with his Dad, having known he could talk to his Mom about anything, having deeply enjoyed his brothers’ happiness with the loves of their lives, having texted one last time to Athos, the last Musketeer, just hours before his death, “Love you, bro.”

And he did, Athos. He did. That I know, and that I wanted you to know as well.

Goodbye, my friend. Goodbye.

Combat Veterans and “Closure”

A few days ago, Max Harris wrote the third of his blog posts (from Every Day Is a New Day) about his losing to death his therapist, Dr. Joseph Casagrande.  In my two previous posts, I shared Max’s frustrations and anger.  Today I share his grief, just he shared it with all of us:

I went out to the cemetery today.  I had learned late Thursday night that Doc does have a final resting place and it was less than a half hour from my house.  Needless to say, after spending Friday getting everything sorted out with the VA (that’s another post for another day), I was exhausted and couldn’t make it out to the cemetery yesterday.

So I went this morning.  Talk about surreal.  There I was, not a soul in sight anywhere.  I was standing in front of his grave marker, solemn and contemplative, head down.  No cars drove by the cemetery in that moment and the snow started to come down very heavily.  It felt like one of those moments you read about in books or in serious dramas.  Yet this was real life.  This was MY life and, for some reason, it just felt right that I should have solitude and quiet in that moment.

And then it passed and the emotional pain hit like someone ripping off a Band-Aid.  Intense, searing, yet short lived.  I was left with the dull throb of missing someone I would never see again, but being there – seeing Doc in his final resting place – gave me the closure I needed desperately to fully move on.  I didn’t realize how badly I needed it until that moment.  It made me wonder why I needed that closure, that finality, so keenly.

I thought about it on my walk back to the car, on the ride home and a good portion of the early afternoon.  And then, it hit me.  I needed this because I never got closure for all of the death and violence I experienced over in Iraq.  It made me think about all of the other veterans with PTSD that were suffering just like me and it made me realize:  If there is ONE THING that can trigger us and bring it all back into our consciousness, it’s having someone close to us die and not getting the closure we need to move on.

In retrospect, I recognize now that a lot of the anger I have felt for the past few days was not anger felt but, rather, anger remembered.  Grief.  Not felt, but remembered.  Helplessness, intensely remembered.  I recognize now that this event, the unfortunate circumstances surrounding Doc’s passing and the way in which I was informed, has been a blessing in disguise.  It may take it a while for me to fully accept that, but I know I eventually will.  What I have gained from this experience is how losing someone I care about will affect me in the future.  It also equips me to support my fellow veterans if they find themselves in the same position.

So take heed.  If it is in your power, do everything you can to provide adequate closure for veterans with PTSD.  Don’t blindside them.  Do what you can to be compassionate and try to leave them feeling like they are in control of the situation and how they choose to grieve.


The combat veterans whom I serve often ask me “When will it end? When will I be able to move on?” They—and I—often struggle to understand what, at any particular point, that “it” is: the emotional instability, the nightmares, the flashbacks, the guilt, the grief?  All the above?

If only the latter, if only.

There is a part of the brain called the hippocampus.  Among its various functions, it serves as the “cataloguer,” if you will, of our life’s experiences.  It is the part of the brain that allows us to remember an event and actually remember it, i.e., put it in the past, in a particular context, one that began and then ended, one which no longer abides with us today.  The hippocampus is our own personal scapbooker, of the good times, of the crummy times, one of the main producers of our episodic memory, the this/then-that/then-that of our existence.

For the most part, the hippocampus turns off when we experience trauma, when Reality overwhelms us with the fire and brimstone that ignite our emotions into a wildfire worthy of any California hillside.  No time to catalogue in such a situation: it’s time to move!

Unfortunately, as a result, such memories then hang around as vivid videos inside our heads, as if we’d been transformed into a smartphone that could transport us back to Hell with the mere tap of a finger.  They’re not downloaded off the phone, if you will, into our brain-laptops, into file folders marked “War” or “Attack” or “Earthquake,” with each segment named and stored as a WMV file, ready to be watched at any time, true, yet just as ready to be shut off by a click on the Play button.

Ready—and able—to be “closed.”

The “closure” of grief and the “closure” of trauma are not, in quite important ways, synonymous, even though both processes are ultimately about loss: the former of someone real, the latter of a fantasy, a hope-against-hope that “it will never happen to me.” It is precisely because the experiences are indeed both about loss, though, we can see how they often find their ways to plow together into our souls like the proverbial Mack truck.

Max, like so many combat veterans, is once again having to catalogue the world:  Dr. Casagrande is gone; his buddies and the Iraqi civilians are gone, whether they “left” a month ago or, as Max noted recently, ten years ago this month. There is a comfort in cataloguing, in filing a memory, an emotion into a neuronal cabinet so that it isn’t just sitting around ready to be stimulated at a moment’s notice.

Sadly, though, neither the cabinet drawers of “grief” or “trauma” have the common courtesy to stay closed.  They have this tendency to fly open at the most inopportune of times:  a song heard on Pandora, a film clip on the History Channel, a photo on page five of the local morning paper.

Once they have been downloaded and filed at some point, though (all metaphors wonderfully mixed), they can be filed back, even after they’ve popped out here and there.  There is comfort in that.  One doesn’t have to live in the mind-cinema from Hell, in other words, stuck on the front row, all that horror careening toward your senses, larger than life.

That theater at least can be closed, hallelujah.

I’m glad that you had that time in the cemetery, Max.  I’m glad that Dr. Casagrande can be “filed,” while never filed away.  May his “folder” pop open at all the right times, causing you to remember once again his warmth, his wisdom.  May he rest in peace in Pennsylvania, and may he continue to bring you peace wherever you might find yourself.

In Memoriam, Clay Warren Hunt, 1982-2011

I have been putting off this post for several days.

Fortunately, Life has been more than accommodating in this procrastination, given that it has certainly proceeded at a hectic pace recently, what with travel, snow, college visits, surgeries (my wife’s, and she’s fine, all things considered), and—hallelujah!—the book manuscript finally at the editors, ready to be sliced and diced.

But it’s time.

This past Sunday, as CBS’s 60 Minutes was airing, I was in the car with my eldest as she was driving us back to Goshen College after her (so-called) Spring Break. Our most pressing issues of the evening were, upon arrival, a). whether her fish was or was not pale and b). whether she and her boyfriend would have the leftover Costco chicken pot pie the next night or the night after that.

How lucky a father I am.

Only much later that evening, as I was checking my e-mails far too late in the night, did I learn from a Google news tracker that earlier that evening the CBS news show had aired a segment, presented by Byron Pitts, entitled “The Life and Death of Clay Hunt.” Given that it was well past midnight, I decided to check it out later.

On Monday, I did.

It is this picture that I cannot get off my mind, the one that greets the curious web surfer who happens upon the 60 Minutes site:


It’s his eyes. Pure and simple, the eyes.

God, how many times have I seen those eyes.

Not only am I a lucky father, I am also a lucky psychiatrist. On many a day as a Suboxone provider, I have had the privilege of helping men and women who have struggled with opiate (painkiller/heroin) dependence re-find their lives. For many—and, thankfully, I do mean many—relief from opiate addiction helps relieve them of much of whatever combat stresses they might have endured. Thank goodness, “return from combat” does not have to equal “PTSD.”

But then there are the days I see those eyes.

Uniformly, the men behind those eyes are, like Clay, quite handsome, sturdily-built, intense as all get-out. Whether in the waiting room or upon entry into my office, they sport that same smile Clay flashed so naturally, so alluringly as he struck that “hey, I’m just a cool guy” pose in the college video interview shown on the segment, straddling the table chair, forearms debonairly leaning against the chair’s back, looking, for the life of him, as if he were a screen-test finalist at the next Ryan Gosling look-alike contest.

Yet how much more than charm and magnetism do such eyes convey. Mirrors of the soul, they are, or so the proverb tells us. How sad it is to realize that, yes, the proverb knows whereof it speaks, painfully, wrenching-ly so.

I’ve said it before, I’ll say it again: how we’d like to believe that the attractive never suffer, that somehow good genetics and a few extra hours at the gym insulate someone from the truths that Life will simply not let most in this world avoid.

Even more, though, how we’d like to believe that the attractive never think deeply, never ponder, never see the images of the dead pass before them, daytime, nighttime, never feel their very souls being wadded up and flicked into some plastic-lined, psychic receptacle at the far end of the park downtown.

Clay was born a mere two weeks before I finished my last medical school rotation, Pediatric Neurology at the James Whitcomb Riley Hospital for Children in Indianapolis, over thirty years ago now. Seeing his eyes; seeing the effect he continues to exert two years later on the men and women he touched; seeing his battle buddy, Jake Wood, no slouch in the looks and intensity department himself, struggle to maintain his own cool-guy composure not just in front of a camera, but clearly, by his own admission, day after day after day, at his every thought of this man who, even as we speak, should have been preparing to get himself measured for a groomsman’s tuxedo—seeing all that, I’m glad that I have thirty years behind me, that I’m foolish enough still to believe that I can somehow hold within me another’s sadness that can never be fully held, that I’m self-forgiving enough to allow myself to keep trying to do just that long after a wiser man would have hightailed it out of town and not looked back.

“Survivor Guilt” is what they call it, of course, the progenitor of those eyes. Clay hauled it around as a rucksack heavier than any that a sadistic, higher-ranking chain-of-command could have ordered him to carry. Winston, my “correspondent” over the past several posts, has been doing the same, though still alive, thankfully, still hoping that one day it will no longer commandeer his dreams, hijack his all-too-brief moments of happiness.

How many times a day do I see it in the men and women whom I have the privilege of serving, the guilt, the sadness in those eyes? Sometimes they flash before me, those pains, much as they did in those moments in which Jake Wood was no longer the honcho from Team Rubicon, but rather was simply the grieving best friend of a good man. Sometimes, though, they camp out right there in front of me, in eyes that literally have seen too much and that now, somehow, are desperately trying figuratively to see again, uncertain whether they dare brighten again, uncertain whether they are worthy of even considering doing so.

To Clay’s parents, his family, to Jake Woods and all those who served with him, I can only say: I wish I could have known him. I wish I could have appreciated those eyes in much lighter, much more rascally days.

I am so glad that each of you had many of those very days with him.

May the memories of them sustain you always. And may he rest in peace.

Oprah and Monday-Morning Quarterbacking

“Doc, Monday was probably one of the worst days I’ve had in a long time. A long time.”

I’ve written about this combat veteran several times before, e.g., in Buddy, Got the Time? and Conical Combat Linkages. He’s older than many of the men and women I usually see, a veteran of an earlier conflict, smart, insightful. He’s been doing much better overall, so his statement took me by surprise.

“What happened?” I asked.

“I had some of the worst nightmares I’ve had in I-don’t-know-how-long,” he replied. “And it was as if I just couldn’t get the War out of my head all day, no matter what I tried to do to distract myself.”

“Any idea what brought all that on?”

A brief pause, then “I think some of it may have had to do with the Father’s homily on Sunday about good and evil; for some reason that got to me. But when I asked myself that question, believe it or not, the best answer I could come up with was that it was that Jeep commercial during the Super Bowl.”

Sidebar and true confession: I’m neither pro nor con American football. I was never that much of a fan growing up, and I know only enough about the game to keep myself from gross embarrassment when discussing the topic. Whenever the Indianapolis Colts are doing well, I do feel under a civic obligation to take reasonable notice, but otherwise football season is no different from pre-inventory shopping season at the local Walmart as far as my day-to-day life goes. (Although yes, I confess: as a former Bostonian, I do have to keep up with the New England Patriots every now and then, whether out of nostalgia for the old days or out of the national pastime of hating Tom Brady “just because,” I can’t quite tell.)

Ergo, given that I didn’t have much of a stake in either Baltimore or San Francisco, and given that I find Life moving forward fairly easily whether or not I take note of Beyonce in this world of ours, I was napping during THE Game.

I had seen something somewhere, however, about some commercial featuring Oprah having been THE Super Bowl commercial of 2013. I think it had even registered with me that it had had something to do with veterans.

The week’s news about combat veterans, however, whether mainstream, independent, or blogged, had been almost exclusively about the murder of OEF/OIF combat veteran and renowned sniper, Chris Kyle, by another combat veteran whom he had been trying to help. From the Right, the Left, the Pro, the Con, from all points in-between, it had been all-Texas-shooting, all-PTSD, all the time.

Not Oprah.

“I’m afraid I didn’t pay that much attention to the game,” I therefore confessed. “What was the commercial?”

“God, it was . . . I’m not really quite sure why it hit me like it did. It was a long commercial, heavy orchestration, the whole bit. It was all from the soldier’s perspective, coming home. But then–I don’t what it was, Doc–but at some point, one of those scenes, the music, everything: I wasn’t in my house. I literally was hearing my son’s footsteps, watching him running toward me, yelling, ‘Daddy, Daddy!’ Back then, when it originally happened, I was standing next to this guy, about my height. Our hair was short, his and mine, about the same color, and both of us were dressed in our fatigues. So for a moment, my son wasn’t quite sure which one of us was his Dad. But then he just grabbed me. Doc, I . . . they were his footsteps I was hearing. His.”

For a few seconds, both of us were silent.

“And then,” he continued, “this commercial started talking about how we’re all in this together, you know, for the veterans, yadda-yadda? And I almost got sick, literally. How many times have I heard that through the years, ‘we’re here for you,’ and then nothing, just talk. It was as if I were in two worlds at the same time, one back then, one now, feeling how important it all was, my son, the military, yet at the same time feeling how ridiculous all those empty promises can be, over and over, sending us off to War, expecting us to be fine afterwards, don’t complain, ‘thank you for your service,’ blah, blah.

“Then Sunday evening, in my own home, all of a sudden this women next to me brought me back to reality, asked me–I’m not kidding you–‘Where are you? You’re not here, are you?’ And I just turned to her, looked at her for a couple of seconds, and said, ‘No. I’m not.’ That was it. And then I was back. And then Monday came.”

He paused, and then he finally said, “I’m so glad that I’m feeling better, Doc. But this PTSD stuff is terrible. I don’t know how else to put it. Terrible.”

After we had finished speaking together, I Googled the commercial and watched it. He’d been right, of course, about the heavy orchestration, perfect for the setting: the violas and cellos leading the way, giving the whole couple minutes of film all the necessary lower-register depth, with the French horns making their entrances at the appropriate times, at least in three parts, sometimes four.

And Oprah was at her best as well, ever dramatic and ever genuinely so. I had no doubt that she spoke every word from her heart, trying to express for “all of us” how we want to be honest, yet hopeful; upbeat, even as we each know that we dare not be that too strongly, lest we dishonor, lest we, even worse, disavow.

I couldn’t help but think of another meeting with another combat veteran, only days earlier: with Porthos, about whom I’d written in my last entry, To Remember, Not Relive. As I always do, I had read with him the entry. About halfway through, he’d stopped me.

“Doc,” he’d said, quietly, yet, as always, intensely, “that’s OK. Really. I want you to publish it, but . . . but I think I’m going to need to read it by myself, later. I . . . I just can’t go back there now. I want you to put it out there, but . . . I need to come back to it later. Thank you. Is that OK?”

Of course it had been.

The next day, Porthos had then texted me: “It was a hard night. I hardly slept. It was your blog, Aramis, everything. Thank you so much for writing it, but it’s just so hard. Please don’t be upset. Thank you for understanding.”

A few days later, I learned from my “statistics guy” that I had, in the previous week, seen sixty-five patients within the course of five days. Thankfully, most of those men and women had been doing fairly well, moving on with their lives now that they are on Suboxone, the opiate substitution regimen.

Some had not been, though. Many had had to change scheduled appointments because their babysitter hadn’t shown up; or because their parent had had to work that day and couldn’t watch their child; or because their boss had changed his mind and had refused to let them off for their appointment, and they can’t afford to lose this job, understand, because it had been so hard to find; or because they had had to get to that job interview and hope that this one will work out, even if the pay is a pittance, because it’s at least something; or because the bus had broken down across town and now they’re going to be late for work if they have to wait for their sister or boyfriend to pick them up after the latter gets off work; or because . . .

But then there had been the guy who had claimed that his meds had been stolen. Now some programs have found it quite easy to manage such situations: if your meds are stolen, too bad, you signed an agreement when you started, and that’s the way it goes, so you’re just going to have to wait until your next scheduled time, so here are some side-effect medications, and be sure not to start using again because then we’ll have to re-look at your whole program, and don’t forget that we know those Suboxones are going for $20 a strip on the street, so how are we so sure that they were really stolen anyway, and . . .

But then, of course, there was also the fact that the guy probably shouldn’t have tried to get back together with his wife, since she had been sleeping with another guy, after all, the one who may in fact have been the father of “their” last child, but since that guy always did have a tendency to smack her around a bit if she stayed around him too long, my guy just couldn’t refuse to take her back, but then he’d had it that night and had put his bag outside the door of the apartment just as he stepped back into the apartment to give his older child a hug, but then his wife started yelling at him again and said the one thing that always sets him off and so he said the one thing always sets her off, and then she screamed for him to get out, but by the time he had turned around the bag was gone, but then why did they live in that junkhouse of an apartment building anyway, you know, right next to the stairs, so couldn’t he have just run after the culprit, like anyone would have who had an ounce of sense, but then she had grabbed his arm as he’d yelled at her to stop and the kid was crying and he knew that she’d call the cops if he tried to pull her off because that was what she was saying that she was going to do if he walked away, but then . . .

But, of course, that all could have been some big lie, because you know how these addicts are, and Suboxone is $20 a strip on the street, and . . . well, everyone knows that I’m too nice, you see. There are no dearth of people who are willing to tell me so, in fact. Sometimes right to my face. Only because they care. About appropriate patient care, of course.

But then, as had been reported to me just the day before, a quote from a psychiatrist in another state about working with military personnel and combat veterans: “they’re all just ‘entitled’ anyway, these guys, as if someone owes them something. So what do you expect?”

Monday-morning quarterbacking: how easily it comes for some. How devastatingly for others.

Sometimes I am amazed at how, even with the best of intentions, whether via stirring commercials, well-meaning blog posts, or anything else, we can both thrill and injure those whom we admire, encourage, care deeply about. Nothing is straightforward about War, of course: before, during, after, no matter who the victor, no matter what the spoils. Even as we remember that, we try to forget, and even as we try to forget, we remember.

I can say this, though, from my Monday-morning armchair, clueless as I am about football, even more clueless as I am about the destruction of property and soul that War brings: all men and women who believe they are called to protect others, even at those moments when it is unclear whether anyone is being protected or even wanting to be protected; all those who are both ready to die for the ones next to them, yet also ready to wonder whether they should hold off just a few more seconds, to make sure that car’s driver is not a “bad guy,” to make sure that what that kid’s pulling out of his pocket is just his hand, not an explosive device; all those who press two fingers to their lips and then press those very fingers onto a computer screen that transmits the images of those fingers across land and sea to a partner, a parent, a child who is doing the same, only in a room that, thankfully, will not be at risk of a mortar attack any time soon–all such men and women are “entitled,” period, end of story: to our respect, whether borne via Jeep or not; to a living wage at an honorable job; to a second chance to get it right, maybe even to a fourth or fifth.

When one has earned what one is due, one is not “entitled,” after all. One is “entitled to.”

Big difference.

Any quarterback can tell you that.

I suspect Ms. Winfrey and I easily–and unashamedly–agree.

To Remember, Not Relive

I have written about him before, most recently in the posts Merry Christmas, Reality Notwithstanding and Taking Him On Home. He’s Porthos, the fun-loving rake to the quieter, more relaxed Athos–and their deeply-loved, fallen comrade, Aramis.

Porthos and I have known each other for a while. Our relationship has always been warm–though, shall we say, complicated as well. As the middle of three strong-willed sons born to a strong-willed father, he knows how to make his wants and wishes known. Fear not that, I can assure you.

And I might add: I wouldn’t get into a scuffle with him. Some of the more foolhardy in his time have. They learned. Forthwith.

Yet can that boy pour on the charm, or what. His is a perfect mixture of the quite genuine and the quite consciously manipulative. He’s had more than his fair share of practice through the years.

He actually leaves me reeling much of the time, truth be told. I’m never quite sure whether I want to give him a warm rub on the top of his head or smack the living daylights out of him. Usually both.

Porthos, in other words, is one of those individuals about whom no one–and I mean, no one–can feel nonchalant.

I’ve taken my share of hits from VA colleagues about him. We’re a bit of a known pair, again, truth be told. Some have made it clear, for example, that they think that I “coddle” him. Many have intimated that I should be more “firm” with him, although none has been able to tell me exactly how such “firmness” should look.

Our struggles with each other have usually been around two subjects: medications, i.e., which kinds, how much, how often, etc., etc.; and psychotherapy, i.e., which kinds, how much, how often, etc., etc. Simple.

Although he and I have had our disagreements, he certainly has not been one merely to “demand” something and then pitch a fit if he were not to get what he’d wanted. Quite the contrary: he does his research, and our negotiations around various regimens have reached points of complexity that I can only call “admirable” on his part. Still, disagree, we have, and sometimes strongly. In the end, though, he has always acquiesced to the fact of life that ‘tis I, not he, who has the MD behind the name.

For example, about ten days ago.

Details are not relevant, but it had been one of our more intense, so-called discussions. He let me know in no uncertain terms that I had not started his weekend out on a pleasant footing. I let him know in similar terms that even though that had not been my intention, I could only be so upset thereabout.

We met the following Monday.

He had agreed to come in twice a week, at least for some focused, therapeutic contact, and he had agreed to hook himself up again with one of our intensive group programs. He had also agreed to two-week supplies of his medications, and he had agreed to the dosages I’d recommended.

But that was only a small part of the story.

He’d thought a lot during the weekend, about himself, his family, his sadness, his frustration over the physical limitations that have been plaguing him post-deployment. Of that, I had no doubt: when I opened the door to my office, he was standing there, with just enough of an impatient, “can we get going here, please?” edge to him to keep me on my toes, but with a countenance that more implored me to notice how worn-down he was, how very, very worn-down.

“Hey,” he said, most definitely without the exclamation point.


“Do you mind if I put my leg up?” he asked, eyes darting to his left, my right, to the second chair in the room which often does its part to relieve his lower back of the pressure that can gnaw at him whenever he sits for any length of time.

“Of course. No problem.”

Soon we were both situated. For a few moments we just sat there, looking at each other, the semi-grin, semi-skepticism on his face, I’m sure, only a mirror of the same on mine.

“We still on speaking terms?” I finally ask, my semi-grin having turned full.

He rolled his eyes.

“I understand,” he replied, full-smiled as well, although for only briefly. “I know I’ve got to do something about myself. I . . .”  Suddenly, he shifted forward.  “Please, Doc, you understand, don’t you? How hard it is without her?”

“Her,” of course, is the young woman to whom he’d deeded not only his heart and soul, but a goodly portion of his every quantum of thought as well. They’d talked of marriage, of having children together, but then finally she’d decided that she could not make it work.

“Dad tells me that I’ve got to move on, but . . . I just can’t get him to understand. It’s not that easy. I don’t want to move on. I know that if she just knew how hard I’m trying . . . But she won’t return my calls, texts, nothing. I’m not going to be a stalker-type. I’m not going to go over to her place. No one’s going to accuse me of that, no one. But if she could just see me, see how hard I’m trying, see how much she means to me–God, Doc, she’d understand, wouldn’t she? Wouldn’t she? I mean, Doc, am I wrong? Can you understand why I just can’t give up yet, why I just can’t move on? Please, tell me you understand, please!”

Porthos is quite a handsome man. How we think the attractive never have to suffer, don’t we? How wrong we are. Anguish is just anguish, whether on the good-looking or on the plain.

“Porthos, here’s what I would say: don’t give up until you’re ready to give up. When it’s time, if it’s ever time, you’ll know. What you’ll then have to do is live out what you will already know. That will be the hard part.”

He looked at me, with a face both steeled and tear-stained. He has all the gear in place for “Leading Man” status, yet I’m hard-pressed to come up with a modern exemplar for him, given that most A-list stars today are simply too “pretty.” Perhaps a young Mark Harmon as the surgeon on the St. Elsewhere of the 1980’s, even then oozing the NCIS Gibbs-attitude that would one day make him America’s favorite Marine, back then painfully walking down that hospital hall for the final time, his character well-aware that he might soon die of AIDS.

“I sometimes just don’t know if I can do this, Doc,” he finally whispered. “I’m not going to kill myself or anything, but sometimes I’m afraid I won’t make it. It just hurts so, her, Aramis, the War, everything. It just so, so . . . hurts.”

The final word had plopped out of him, as if it had been teetering on his lip all the while, not wanting to risk the reality that would result from its mental equivalent having found voice, sound, transmitted out to a world, to me, to . . . what?

And then it happened: in the middle of his anguish, he started to look as if he were ready to fall asleep, to look as I imagined he must have looked at the end of that twenty-four hours he and Athos had had to stand watch over the body of Aramis, waiting for the helicopter to arrive: too exhausted to run, too charged to collapse.

And I realized: he wasn’t with me. He was in Iraq.

“No one has any idea, do they?’ I finally asked, too exhausted, too charged myself. “You’re there, right now, aren’t you.”

He was staring off to the side, grudgingly allowing one tear at a time past the checkpoint, his eyelids in a bizarre, internal arm-wrestling, the upper halves determined to shut this show down, the lower halves determined not to give in ever, do you hear me, ever!

“I’m sorry, Doc,” he whispered, his tears, few as they were, so robust, so proud to be Army-strong, his eyes fixated miles away. “I’m trying, really I am. I hope you believe me. Please believe me, Doc. Please.”

“I do,” I answered, hoping perhaps that some information, meager as it was, would jar us both out of the grip of those tears. “Listen, this is neurologic, Porthos. You see, trauma separates the part of the brain that feels, sees, hears from the part that makes sense of events, of Time, of those very feelings.

“They then stay separated, physiologically. You can only ‘remember’ if the front part of your brain can pull the ‘you that’s you,’, that is, your experience of the trauma, of yourself–your ‘Self’–away from the trauma enough to get the whole brain on the same page, the page that says ‘OK, this has happened, but that was then, this is now.’ Until then, it’s as if your brain is experiencing the trauma in an eternal present. You’re reliving it, not remembering it.

“That’s where the nightmares come from, the flashbacks. When you hurt because your girlfriend’s gone, you’re hurting not only because she’s gone, but because Aramis is gone, because all your buddies who died in the convoy are gone, because you had to pick up what was left of them, all of them. It’s as if your brain is saying, “Oh, my God, here we go again! We’ll never escape!

“Even when the front part of your brain knows–knows without a doubt–that it’s today, not back then; that it’s about your girlfriend, not about Aramis; that you’re in Indianapolis, not the desert: even then, it cannot yet grab onto that other part of the brain that is still feeling, hearing, seeing, smelling, tasting the destruction, the confusion, the adrenaline. The death.”

Pretty good, eh?

One problem, though, a big one:  with each of those words, I knew that I was both helping and hurting him, both assuring him that he was not crazy, yet reminding him that he felt crazy even so. His energy, his intense drive, his inner push never to give up, never: there they were, torturing him, yet keeping him alive, simultaneously, right in front of me, with my every verbal reminder of the truth, the Truth.

It was horrible to watch.

All I could think at the moment was, “My God, this is what they all go through, isn’t it, all these men and women, the ones whose Facebook posts, whose blogs I read, who talk of being walloped back and forth through Time, through emotion, psychically miles away from the loved one before them, then within nanoseconds careening right into them, then back, then in, tethered to a yo-yo only Satan himself could have manufactured–with a smile.”

I had to stop. Had to.

I had learned in a new way what I had never wanted to know. I was Katniss at the end of The Hunger Games, wasn’t I, gazing down at Cato, her nemesis, he nearly devoured by unearthly hounds, begging her, with his eyes only, to end it all, now, please, please.

Like Cato, Porthos looked at me, fortunately not devoured, yet no longer charged. Just exhausted.

“Will it ever get better, Doc?” he asked.

Fortunately, I am not Katniss. I have more than arrows to work with.

“Yes, it can,” I said as I leaned forward. “I’m learning a technique, EMDR, that stands for ‘Eye Movement Desensitization and Reprocessing.’ I’ll give you a website to read about it. Check it out. Go ahead and read other stuff about it on Google, too. I’ll promise you: you’ll find a lot of hot-shot people with M.D. and Ph.D. degrees who’ll swear on a stack of Bibles that it’s hogwash and witchcraft. I once thought that myself. But I was wrong. The technique can help link that experiencing part of the brain with the contextualizing part, maybe not perfectly, but for many veterans, well enough to allow some real, meaningful healing to begin. You’d be one of the first that I try it out on, but I work with a smart teacher, and together, the three of us will find a way to discover how that powerful intensity inside you can save you, not destroy you.”

Still exhausted, but somewhere, unbelievably, still rakish, he closed his eyes, took in a deep breath, opened his eyes back up, looked into mine, and merely whispered, “If you say so, Doc. If you say so.”

I do say so. And I do believe so.

As best as I can determine, remember comes from a Latin root for memory. Yet there is something about the English word, re-member, as if member were a verb to mean “piecing together, putting the members of a body, a group back together.” Horror and grief without context are horror and grief eternal. When re-membered, though, sown back into the tapestry of Time, they hurt no less, but they need hurt no longer. Re-living can then become mere living. How good.

Yes, Porthos, how good.

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