Tag Archives: military experience

To Remember, Not Relive (Encore)

February 10, 2016 By in Living Life Tags: , , , , , , , , Leave a comment

Silhouette of a soldier against the sun.

As I continue to remember with you Porthos, Athos, and Aramis, the three Army Musketeers, now three years later, I find that a good way to distance myself from my emotional responses is to critique my writing—which is, I must say, quite worthy of critique. Less noble it is, I guess, yet how more pragmatic to edit rather than to wonder what should have been, might have been, or to shed a tear or two.

One of the privileges of aging is to find that one can condemn oneself and then grant clemency to the offender, all within the same breath. Or paragraph, at least.

So, editing is for another day. Today, it is instead 03 February, 2013, and I’ll take my post’s advice: 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.

“Hey.”

“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.

Until tomorrow, be well,

Doc

Merry Christmas, Reality Notwithstanding (Encore)

February 8, 2016 By in Living Life Tags: , , , , , , , , 1 Comment

Silhouette of a soldier against the sun.

 

Today, I continue to ask you to join me as I remember Three Musketeers: one whom I never met, one whom I’ll not meet again, one who still lives his life in the best memories of both.

Anniversaries are not the only times to remember. So are Holidays. So it was three years ago, in December.

From December 25, 2012 comes our next tale, Merry Christmas, Reality Nothwithstanding.

I’d say they came as a matched set, but since I knew one of them a year before the other, that’s not quite true.

That, of course, doesn’t mean that the second one was not quite aware of me that whole time.

I’ve already spoken of the first one before, 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.

Recently, though, even with all the Sturm und Drang in essentially every area of his life, my patient has primarily been grieving the loss of a deeply-loved girlfriend. As a man who has in all areas of his life been big in all the meanings possible in that italicized word, he has not given up this big pattern in his grief over love lost. He can only speak of her with me briefly before he visibly begins to shake, clutch his gut, and shed more than a few tears.

He has come to acknowledge the past, that what’s done is done, that there is nothing more he can do. Still…

My patient had always told me about his best friend, his battle buddy “who’s not doing much better than I am, Doc. I wish he’d come see you, but he can’t stand the VA.”

About two months ago, his friend finally did come.

_______________________________________

Borrowing from this coming year’s release of a new film version of The Great Gatsby, if my first patient is Leonardo DiCaprio’s Jay Gatsby, my second is Tobey Maguire’s Nick Carraway. Quite handsome himself, he is—though in that Maguire kind of way that made Peter Parker so alluring to Kirsten Dunst’s Mary Jane Watson.

When I walked out to meet him that first time, he was sitting quietly in his chair in the waiting room, eyes downcast, sporting a full beard that was neatly trimmed, dressed as if ready to head out for deer hunting just as soon as we were done—yet alone, most likely, with mixed feelings as to whether he would really want to shoot one of God’s creatures or not.

He looked up at me with a mixture of apprehension and deep sadness. I soon found out why.

His experiences at VA’s have not been particularly positive. He is from the South, where he grew up in a small, working-class family that has endured more than its fair share of tragedy, leaving him now the only living child of his parents. He moved up here to Indianapolis to live near my patient, and here he met a female friend of my patient (not the patient’s ex-girlfriend) who has become “my love, my rock, my everything.” They are planning on getting married as soon as they can afford to, and he is deeply happy.

About that.

Yet he too has struggled with intense symptoms of combat trauma/PTSD. He had once even come close to ending his life. He remembers his time in a VA hospital after that episode as one spent trying to avoid the angry, demented old veterans in wheelchairs, as well as the overtly psychotic, middle-aged ones who would suddenly start screaming for no apparent reason.

Then, in his recounting his most recent encounters with VA treaters, he told me that he was made to feel like a “drug abuser” and a “self-centered jerk, like someone unwilling to take responsibility for his life.”

He has been less-than-impressed, in other words, with the Veterans Health Administration.

As he spoke, I quickly glanced at some of the notes written from various providers from different VA’s. I have to say: it’s quite amazing what people will write down on a computer, leaving permanent, electronic traces, you know, for others to find no matter where, no matter when.

Consequently—and sadly—I have no trouble believing my patient on this one.

We talked for a while, about his symptoms, his treatment history, his relationship with my other patient. Then he just fell silent, head down.

“Is there something else?” I asked him, a bit taken aback by the sudden change.

Slowly he raised his head to look at me. He saw that I saw the tear streaming down his cheek.

“What’s the matter?” I whispered.

He swallowed and then quietly said, “I’m sorry, Doc. I’m a little distracted, I guess. You see, I got a phone call while I was driving down here. It was my mother. They found my father dead today.”

To be fair, it is not unusual for patients to talk for extended periods of time before finally, usually at the end of the hour, they muster the courage to tell me what has been weighing most heavily on their hearts.

Still, this was one for the books, I’ll grant you.

The details are of secondary importance here, except to say that his father’s death had been one more tragic chapter of a painful family tale. What was so strikingly clear, however, was how my patient had clearly entertained no thought whatsoever that I would take much interest in the fact of his father’s death or even consider trying to help him find a way to make it safely back to his home state, multiple hours away by car.

With tears now streaming down his face, he said to me quite calmly—and, I might add, without a hint of malice—“I just never thought that VA doctors would care that much to hear about something like my father dying.”

I’d like to say that I was stunned, horrified that a combat veteran could feel that way. I’d read those previous notes, however.

Fast forward two weeks, after he’d made it down there, made it through the funeral at which he’d played guitar with his father’s best friend because, when both he and his father had had one beer too many, his father had told him time and again that he had wanted the two of them to sing this one particular song at his funeral.

Should that day ever come.

I had to bring it up, of course, his guilt over his not being there for his father in his father’s time of need. There are ways, after all, to do that which are not too invasive. He didn’t seem to mind.

“He was always there for me, rooting for me, even when I did stupid things,” he said, now having no embarrassment over the tears, trickling as they were. “I miss him so much. I wish I could have been there for him. He knew he was dying. I just can’t believe I can’t pick up the phone and call him.”

We talked some more. He smiled through his tears, cried through his smiles. It does appear that he will one day come to acknowledge the past, that what’s done is done, that there is nothing more he can do. Still…

It is at moments such as these that I have to make the “therapist’s decision.” Links from the past to the present always present themselves, especially with combat veterans, yet brilliant interpretations can often be nothing more than cheap psycho-pyrotechnics if one is not careful, a therapist’s (i.e., my) momentary narcissistic gratification (“Look, supervisor-in-my-head, no hands!”) at the expense of a soul suffering in front of one.

Yet somehow, for both of these men, on different days, in different contexts, it felt right to say it, to one man grieving a lost love over which he had no control, to another grieving a lost father over whose suffering he had no control.

“It’s like TJ, you know. You couldn’t help him either. And he was everything to you.”

For you see, the Dynamic Duo had once been The Three Musketeers. Porthos and Athos had once had an Aramis.

Whenever my first patient of the two—the rakish Porthos, if you will—had spoken of TJ, 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 their buddy’s full name, simply because he could never bring himself to speak it without beginning quietly to sob.

My second patient, though—the fatherly Athos—had been able to speak more, tell me TJ’s full name, tell me about his large family, his Aramis-like youthfulness, his faithfulness to the religious faith of his family, his willingness to say whatever, to crack them both up over and over and over again.

He had been able describe his death in front of both of them, taking bullets that should have been either of theirs to absorb.

Both men realize that they will one day have to acknowledge the past, that what’s done is done, that there is nothing more either of them could have done. Still…

_______________________________________________________

So what does any of this have to do with Christmas?

At one point during our second conversation, the second veteran’s (Athos) phone began to ring. At the sound of the melodic ring tone, he smiled.

“That’s Porthos right there,” he said as he allowed the call to go to voice mail.

“What’s that song?” I asked him.

“Oh,” he replied with a smile both sad and relieved, “that’s Kenny Chesney’s song, “Back Where I Come From.”  Porthos and I used to sing it all the time when we were over there. It’s kind of how we kept each other going, you know? We’d sing about where we came from, where we hoped we could go back to. TJ died just days after we arrived in the theater. That’s how we coped.”

Chesney is an American country-western singer, and the song has become a semi-trademark of his. The words are as follows:

In the town where I was raised 
The clock ticks and the cattle graze 
Time passed with Amazing Grace 
Back where I come from

Now you can lie on a riverbank 
Paint your name on a water tank 
Or miscount all the beers you drank 
Back where I come from

Back where I come from 
Where I’ll be when it’s said and done 
I’m proud as anyone 
Back where I come from

We learned in Sunday school 
Who made the sun shine through 
I know who made the moonshine, too 
Back where I come from

Blue eyes on a Saturday night 
Tan legs in the broad day light 
TV’s, they were black and white 
Back where I come from

. . .

Some say it’s a backward place 
Narrow minds on a narrow way 
I make it a point to say 
That that’s where I come from

That’s where I come from 
Where I’ll be when it’s said and done 
I’m proud as anyone 
That’s where I come from

_________________________________________________________

Where we “come from” always remains a place to which to return whenever we find ourselves lost in life. For many combat veterans, thankfully, where one “came from” can be synonymous with a family who will always be there, even when they cannot be. Others are not that fortunate, yet still can find a “family” in the brothers and sisters who had once had their backs, with whom they had been, wherever they had been, when all indeed could have been said and done, with a single gunshot, a single IED.

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.

Athos returned to a family with whom he has cried, laughed, struggled. He made his father proud. Now he has laid the man to rest with overwhelming grief and a song.

Both men still fall silent at the memory of the funny kid who lost his opportunity to return to his own loud, ethnic family so that they could in fact return to theirs.

Combat veterans, like parents of children in Connecticut or spouses of firefighters in New York, know well how oxymoronic the words Merry and Christmas often seem together. Merry? You serious?

Yet if Holidays provide us memories of stockings overturned in a frenzy next to an artificial tree, or memories of Seder meals and who’s going to find the matzoh this year, or memories of the whole clan getting together on Memorial Day weekend to endure one more round of Uncle Harry’s high school football stories—or even memories of sitting in a godforsaken desert with once-total strangers who now mean the world to you, singing “Silent Night,” even if slightly off-key—they often, thankfully, also  remind many of us of one more thing:  we come from somewhere.

Relationships, Time, Life, all once mattered.

________________________________________

For my children, Christmas Eve will always bring memories of candlelight services at the only church they have ever known, at the end of which each person, with his or her own personal candle, files out into our large atrium, singing quite on-key, in four-part harmony, all verses of “Silent Night,” until finally all are present within the hall, illuminated by only a hundred or so candles, everyone humming a capella one more time the song that many Mennonites can still sing one verse of which in German.

It will then bring memories of our coming home to eat shrimp cocktail with cheese and crackers, after which they open up one present, only one, which is always pajamas, into which they change and then take turns hanging up the twelve tree bulbs which narrate Clement Clark Moore’s The Night Before Christmas.

One day they will have their own families, and it is from these memories that they will create their own, whether or not their mother and I will ever be able to join them.

I acknowledge that one day, Reality may make it such that we may have to cherish such memories without them. On such a day, I will be devastated. I will not be merry.  But I will have a place in my heart where I “come from.”

For that reason, as I blew out my candle in that atrium, I remembered TJ.

Perhaps that’s all that “Merry Christmas” is, especially for combat veterans: a reminder that there once was a place where they “came from,” even if such a place was miles from wherever they actually came from. Maybe it’s simply a reminder that Life can have meaning, a meaning which bring both smile and tear, a meaning which once was, and–perhaps–a meaning which, though never the same, can in some other form be again.

Perhaps.  It’s a lot to ask of two words. But it’s a start.

To the Porthos and his family, Merry Christmas. To Athos, his girlfriend, and his mother, Merry Christmas. To the family of Aramis, Merry Christmas.

To my wife, my children, my family, my friends and colleagues, to combat veterans everywhere and those whom they love . . .

Merry Christmas.

Until tomorrow, be well,

Doc

No Trouble at All (Encore)

February 7, 2016 By in Living Life Tags: , , , , , , , Leave a comment

Silhouette of a soldier against the sun.

 

Good to be back with you all.

A date is approaching, next month actually. Seasons move forward through the years, yet certain ones halt us, if only temporarily, reminding us again of what once was, of who was once.

It has almost been three years since I stood with my hand upon a young combat vet’s coffin. To this day, I cannot watch a Harry Potter movie without, at some point, feeling his presence. These next few days, I ask your leave to remember him again with you as well, from prologue to epilogue, with encores of blog posts from March 2012 through October 2013.

As a psychiatrist, I often come upon spots in my heart where certain patients have trod, some stealthily, some ploddingly. This one young former US Army soldier did both and more, through passageway after passageway, still now in memory leading me back to spots where we laughed together, even shed a tear together, always with that smile on his face that made me roll my eyes and smile as well.

There were once, you see, Three Musketeers: Porthos, Athos, and Aramis, united not in Dumas’s France this time, but in the United States Army, in a hot land far from home.

Two have since fallen. One is making the life he can. Here are the times we traveled together, in body and in spirit.

From March 11, 2012 comes the prologue, 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’s been trying to get back to school.  It’s been anything but a cakewalk, to say the least, though that says absolutely zero about his talents and his potential, both of which are quite abundant.  He endures the lectures that many of us remember in those 100-level courses, trying to stay focused, trying not to wonder what these kids around him are thinking about him, kids who are just about the age he was when he walked off that plane.

When he sent his buddy’s body back home.

He’s trying.  He’s trying his darndest.

It’s the courses with the papers, though.  They’re the ones that get him.  Too much time to sit in front of a computer.  And remember.

He tries not to overuse his medications.  He’s put his family in charge of them.  Yet there are the times that he wakes at night and can’t stop shaking, can barely move, barely swallow.  He knows a pill won’t save him.  But, God:  it’s so awful.  A war raging, smack dab in the middle of his bedroom.  In the middle of his soul.

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 facade (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.  I had a few minutes on the way to the Starbucks, after all.  I have a few minutes now on the porch, absorbing this quite pastoral Sunday afternoon for mid-March in Indiana.

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.

And so the story went on.

Until tomorrow, be well,

Doc

The Zombies’ Discharge Papers

January 27, 2016 By in Living Life Tags: , , , , , , , , Leave a comment

Silhouette of a soldier against the sun.

Vets. Zombies. Seriously

Today it’s vets and zombies.

I’m serious. Vets. Zombies. Vets and Zombies.

It’s a new world, folks. A new world.

For a conventional take, try Army Times´ “Trailer for Veteran-Made ‘Range 15’ to Debut During Sundance.” For a more in-your-face (or should I say, in-your brain?) take, try Broadly.’s “The Disabled Iraq Veteran Starring in a Military Zombie Film.”

Either way, get ready. They’re coming.

I know, I know: you thought this was all taken care of by Brad Pitt in World War Z, or if not, at least by Ms. Bennet and Mr. Darcy in everyone’s classic favorite, Pride and Prejudice and Zombies.

Nay, nay, ‘twas not the end.

Recently I talked about the veteran-run clothing marketer, Article 15, and especially its quite irreverent take on T-shirts and other items to reflect military humor. Capitalism and good military competition being what they are, though, the good folks at Article 15 are anything but alone. For example, another group, Ranger Up, provides similar apparel meant to be worn and, oh, yes, noticed and remembered.

Well, like any good service members, the vets of both companies carry competition only so far, and their joint identities as ex-military have brought them together to make a film that too is meant to be, you got it, noticed and remembered.

It’s called “Range 15,” and it’s being billed as a “zombie-comedy-action-thriller.”

I think that about covers it.

Maybe there’s a love story in there as well, who knows. I’m afraid to ask.

I’ve previously mentioned Matt Best of Article 15. He’s one of the producers. But so is Ranger Up’s founder, Nick Palmisciano, a former United States Army infantry officer. And Captain Kirk’s in it: really, William Shatner. And Marcus Luttrell.  And the trailer just appeared at the Sundance Film Festival.

And 2016 is just getting started.

And you’ve got to check out the Broadly. article that features the female lead, combat vet and former US Army Explosive Ordinance Disposal (EOD, i.e., bomb squad) technician, Mary Dague. Ms. Dague lost both her forearms in an explosion in Iraq. She’s quite proud of her “nubs,” as she calls them. I suspect the zombies find out in the film why she likes also to think of herself as a T-rex.

When I tell people that I work with combat vets, they often respond with a cross with between awe and pity, as if somehow both I and the vets I serve are lucky to leave our sessions with our souls intact, given what we go through together. That is, on some days, indeed the case.

Yet on other days, I can say that I have never laughed in a professional office as hard as I have laughed with many of these men and women. Of course the best comedy usually has knifing anger weaved into it. Aristotle himself told us, after all, that comedy is about foibles, and foibles always mean that someone somewhere is angry, ashamed, or both.

Yet what is the old cliché? “Either laugh or cry?” To laugh is to remember all the laughs that have gone on before, to remember those we have laughed with, whether or not we will laugh with them again. To remember them at some of their best moments: a stifled giggle when the officer passes by who ain’t gonna be too pleased when he sees what awaits him in his quarters, a body-shaking guffaw as she can’t honestly believe that you really fell for that and actually put that in your mouth!

All right, true: the psychoanalyst in me could have a heyday with the idea of zombies and veterans, together. But, you know, come to think of it: why?

They say that Freud said that “sometimes a cigar is a cigar.” Whether he did or not, sometimes a good laugh should just be that: a good laugh.

Just don’t laugh your head off.

If you do, have the mustard and Wonder bread handy. Some patrons take their burgers raw. And they don’t like waiting.

Until tomorrow, be well,

Doc

Desert Sands at 25 Years

January 25, 2016 By in Living Life Tags: , , , , , , , , Leave a comment

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Wars, Blogs, Lives

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Twenty-five years ago, on January 16, 1991 (US time), Operation Desert Storm began, with coalition forces initiating military activities that would eventually lead to the expulsion of Iraqi forces out of Kuwait. By the end of February, it was “over.”

If only.

Today I want to introduce you to a blog I recently discovered, a blog of a combat vet who would dispute any claim that War is over when it’s “over,” yet one who also appears determined never to forget that he has what it takes. Welcome to the blog, Stuck in the Sand: PTSD and College.

Even though the blog’s author gives links that easily lead to your finding his name, he writes the blog without name. He’s a college student, finishing up at the University of Wisconsin, heading out to California to find fame and fortune in the tech industry. By UW standards, he’d be an “older” student, but he doesn’t seem to mind. He loves to code.

Who doesn’t, these days.

Don’t for a moment think, though, that he writes as if hiding in some wretched corner of Madison. Quite the contrary: he openly writes his confusions, his hopes, his losses, his gains, the more painful parts of his life story, the more joy-filled parts. He is no great fan of the US Veterans Administration, especially its medical facilities, but neither does he rant about the VA incessantly. He’s been homeless. He’s been divorced. He’s been down-and-out, up-and-in, resentful, grateful, you name it.

He is simply living, trying to make sense of a life that arose out of a desperate childhood, only to find itself in the middle of a War that was somehow being touted as a video game writ large. All twenty-five years ago, all today.

I find the blogs of many combat vets quite compelling. Often entries appear haphazardly, written in crisis perhaps, or perhaps in a moment of unforeseen, but well-savored joy. The authors frequently excuse themselves as not being adequately articulate, adequately accurate, even adequately reliable. Stuck in the Sand’s author often deprecates himself so, even as he speaks his truth with both a poetry and a coarseness that leaves a reader with scenes easily imagined, emotions easily felt.

Like most other vet bloggers, Stuck in the Sand’s author makes no claim to universality. He readily acknowledges that others have perhaps suffered just as much as he has, likely more. Yet by the very act of writing he also acknowledges that his own pain is not nothing, is not no-big-deal. It is the pain that draws him to a computer screen somehow, keystroke by keystroke, to find a way to alleviate that suffering momentarily, reshape it, re-envision it.

Whether with thesaurus words or with F-bombs strategically placed for proper effect. And affect.

As I find blogs, I’ll let you know. If one grabs you, stick with it for a while, notice the rhythms of a life that has known War and is trying now to know peace, listen for the “what it takes” in the phrasing, see it in the sentence structure, feel it as it blasts and as it whispers.

Twenty-five years is a long time, especially for a War that was supposed to be one step beyond a weekend, Xbox marathon, just aim and shoot. Stuck in the Sand is doing what he can not to remain stuck so. I look forward to reading more. I wish him the best.

Perhaps some of you will as well.

Until tomorrow, be well,

Doc

One Brave Voice

January 23, 2016 By in Living Life Tags: , , , , , , , , Leave a comment

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Not Politics, But Truth

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In the January 23, 2016 New York Times, an op-ed appeared entitled “Sarah Palin, This Is What PTSD Is Really Like.”  While I do my best to avoid the political in this blog, the old truth remains: the personal is political. And the political is personal. Because of the piece’s context, I cannot help but speak politically. But because of its truth, I can admire it so much the more for the personal, for the person behind it, for the persons who live it daily.

Nathan Bethea served in the United States Army as an infantry officer for seven years, including a deployment to Afghanistan from 2009 to 2010.  As best as I can extrapolate from the op-ed piece, he must have been stationed in Alaska during Mrs. Palin’s run as a vice-presidential candidate for the 2008 United States presidential elections—and her then-term as governor of the state.

Mr. Bethea appears to be no grand fan of Mrs. Palin. I must say that I join him in less-than-enthusiastic appraisal of her. But for him—and for me—she’s more a foil, a bearer of ideas far-too-widely spread among civilians, ideas that Mr.Bethea confronts with quiet bravery and quiet conviction.

He wrote his piece in response to Mrs. Palin’s linkage of her son Track’s recent arrest for domestic violence with his experiences both in and after combat since having served in the United States Army.

I will let Mr. Bethea speak for himself:

“Mrs. Palin seemed to suggest that the policies of President Obama had somehow worsened her son’s condition. And by explaining away domestic violence as the “ramifications of PTSD,” she intimated that her son’s actions are logical consequences of what he experienced while deployed. This is, of course, a disingenuous argument from a career opportunist. However, in a roundabout way, Mrs. Palin reignited a valuable discussion of combat and its psychological effects. Her portrayal of her son’s condition seems aligned with enduring renditions of veterans as ticking time bombs, as damaged beings primed to harm.”

He then wrote:

“Within a week of my return in March 2010…I found myself in a hot, loud and crowded room full of aloof young strangers. In that moment, I felt a sudden burst of panic, something completely unexpected. I felt as if I was going to die. I had to leave the room, to return to the safety of my truck parked outside in the snow. Something was very wrong; something about me was clearly defective.”

Then:

“Later, I realized that many of my friends had experienced similar moments: extreme reactions to emotional stimuli, hours of fear, weeks of hyper-vigilance. The common thread was not a tendency toward violence but rather toward self-hate. There were no flashbacks of combat. There was instead a sinking feeling that I’d always be a downer, always on guard, never able to relax. It was the fear of being permanently broken.”

Mr. Bethea was both fortunate and brave: fortunate in that he was able to access adequate treatment and support for his challenges, brave in that he was and is willing to accept both in order to make his post-combat life as meaningful as possible, currently, among others, as a writing instructor for the New York City-based creative arts program, Voices from War. He confronted stigma while in the Army. He confronts possible stigma right now as he contemplates his literary career.

And he’s a combat vet. He has what it takes to do what needs to be done. He seeks out missions, connections, strives for them, lives for them. He’s even willing to sign his name to them, in one of the most high-profile media outlets in the world.

That’s both a political choice and a choice beyond the political, utterly personal, yet so bravely public. Whether or not one agrees with his words, one has to admire that he, like so many other war writers, is not willing to let War have the last word. Not by a long shot.

He ends his piece this way:

“I can function in society because I was able to seek care, and I want to make that care more accessible to people who need it.

“That process begins by speaking frankly. Facing up to destructive or abusive behavior comes next, along with the assertion that we are responsible for our actions, no matter what burdens we carry. Post-traumatic stress is no excuse for violence or abuse, nor should it be considered a default association. I’d like to hope that, beneath the bluster and the political talking points, Sarah Palin understands this. I hope even more that her son seeks care and finds peace.”

What more can an old, civilian psychiatrist say except this:

Mr Bethea, Mr. Palin: may you both never forget who you have been. May you both never give up on who you might become. May I and my colleagues never fail you. May you both find peace, now and always.

Until tomorrow, be well,

Doc

To learn more about Voices from War

click here.

Bird’s-Eye Extreme

January 22, 2016 By in Living Life Tags: , , , , , , , Leave a comment

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Look, Ma, I’ m Flying!

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I could say that today’s piece is about a project. It is. It’s also about a documentary. That too. In some ways, it’s about a movement, of sorts. All well and good.

But what most attracted me to this organization?

I’ll admit it:  energy and attitude. Lord, and how.

The organization is The Bird’s Eye View Project.

Get ready.

Ryan Parrott is a former US Navy SEAL, a veteran of three combat tours to Iraq, and survivor of a devastating IED blast in 2005.

And “Birdman,” as he’s called, has a mission: to use “extreme sports to connect people to the extreme needs of veterans and first-responders,” thereby helping “veterans and first-responders heal and lead fulfilling and productive lives.”

And when this man says extreme, he means it. Jumping off cliffs. Big cliffs. Snowboarding down mountains. Big mountains. As best as I can tell, his goal is eventually to do both at the same time. Big-ly.

And why? To promote fundraising for a variety of smaller charities that are committed to helping veterans and first-responders. His logic is straightforward: many groups are doing big things for veterans and first-responders, but with somewhat of a small voice. By pushing himself to extremes that play big, he can attract attention for them, through himself and not for himself.

He’s set up a project that is sort of like pay-per-view: by making donations that get distributed to the charities, you get a front-row cyber-seat to the ongoing documentary that follows Parrott’s efforts at training and then performing stunts that are guaranteed to leave you shaking your head, smiling, and, well, glad it’s him and not you.

Talk about a man putting all his excess energy to good use. The film on the website didn’t even make four minutes, and I was ready to take a breather.

Through the years I’ve had the honor of working with several former members of Special Operations forces. To a man, each has had an energy and an internal fire that has impressed me, challenged me, even, at times, exhausted me. They have seen War up close and personal. Their energy has been both their salvation and their curse. Where does one put all that energy after a career such as that?

Well, Birdman apparently has decided that he’s going to answer that question on a big stage, in a big way, for a big purpose. But he does so, of course, because he knows that the “small” things in life, the quiet things such as perseverance and courage and faithfulness are ultimately what make life worthwhile.

Still, a few steps off a cliff do get the old blood flowing in the morning. So much for coffee.

Until tomorrow, be well,

Doc

Guilt, Smiles, and In-Between

January 21, 2016 By in Living Life Tags: , , , , , , , , Leave a comment

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Living the Past’s Futures

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Today is about a video clip. I first saw it courtesy of the Task & Purpose website, in an article entitled “Vargas and Best of Article 15 Talk Survivor’s Guilt, Loss.” It is also available on a Facebook page.

I strongly urge you to check it out.

“Article 15” is shorthand for major disciplinary action taken against an active-duty, United States service member, a reference to a particular section of the Uniform Code of Military Justice (UCMJ). It also, though, is the name of an online clothing store, veteran-run, specializing in military-related apparel that appears meant to be, shall we say, worn in-your-face and with-a-smile.

See for yourself. You won’t forget it any time soon, I promise.

Just as you won’t forget the Facebook film.

Mr. Vargas and Mr. Best are closely associated with both.

Having now worked for several years with combat vets, I have, admittedly, often guffawed at the outrageous tall-tales and snappy one-liners that some young (and not-so-young) service members have shot my way, even if the more civilianly-correct part of me (forget politically-correct, for we’re not even in the general vicinity) might have advised said service members to be, let’s say, circumspect in how widely they might advertise their particular brand of humor.

Yet with every irreverence comes also a corresponding reverence: for decisions made under pressure, for risks taken, for lives gained, for lives lost.

Mr. Vargas and Mr. Best, the makers of T-shirts with such logos as “Keep Calm and Freedom On,” have also put together the short film. “Live for Those Who Can’t,” a memorial to US Army Staff Sergeant Richard Barrazo and Sergeant Dale Behm, both of whom were killed in Ramadi, Iraq on March 18, 2006.

I suspect both SSG Barrazo and SGT Behm would have loved the T-shirt. They also loved the men under their command. Some of those men are alive today precisely because the two of them are not. Vargas and Best have sworn not only never to forget them. They have sworn never to stop living in honor of them.

It takes bravery to laugh after War, really laugh, not just with rage-filled laughter, but with irony-filled, foible-filled laughter. Many service members whom I’ve served have come to me fearing that to laugh again would be to betray. “How can the world smile after the Sergeant is gone?” they wonder

How can it? Vargas and Best make that clear: in the same way the world smiled when Sergeant was around, sometimes with bravado, sometimes with subtlety, always with an edge that only a service member can truly appreciate.

You had what it took to laugh before death. Even after it, you still have what it takes to laugh again, perhaps now with a different edge, true, but nevertheless an edge that can be nothing more than just a buckle in the carpet, one you might trip over for a good sight gag, not an edge that you fall over, never to rise again.

Both Vargas and Best have sworn never to forget. Both have sworn to live in remembrance.

I suspect that both have sworn to laugh in remembrance as well.

I suspect both the Sergeants would have been pleased. And owned a couple shirts as well.

Until tomorrow, be well,

Doc

A Labyrinth for Healing

January 19, 2016 By in Living Life Tags: , , , , , , , , Leave a comment

Silhouette of a soldier against the sun.

Winding in the Right Direction

Today I want to tell you about a place. For those of you who might someday find yourselves in the Toronto, Ontario, Canada area, head about thirty minutes east of town, if you get a chance, and check out the town of Whitby, Ontario. Look around, and you should be able to find a park, the Park of Reflection.

Go to it, and meander.

Great word, meander, “poking around,” derived from the name of a wandering river in modern-day Turkey. Greek in origin it is, like labyrinth, the maze that ancient myth said housed the monster in Crete, the place where the young people of Athens went to be devoured every seven years or so.

The Park of Reflection is a labyrinth built to honor those Canadian service members who have become ill or injured in the line of duty. It’s not one of those fun-house kind of mazes, like the ones carved out of American cornfields around Halloween to spook middle-schoolers. It is rather a complex pattern in the ground of curves and straightaways, meant not to be rushed through, but meditated through.

Fancy ideas for a veterans’ memorial park, some might say.

Yet labyrinths, no matter how exotic they may look, have a very simple story that can be told about them. The average person of the Middle Ages could not make pilgrimages to holy sites. By slowly, thoughtfully moving along the paths of labyrinths that were in some churches, these people could spiritually accomplish what was physically impossible.

That is what makes the park so interesting. By slowly making one’s way along the path of the labyrinth-maze, a visitor is challenged to, in a way, take time with War, time that Canadian service members had no choice but to give. There is no physical danger in doing so. Only a peace-filled invitation to reflection.

Sponsored by Wounded Warriors Canada, an organization that itself grew out of a need to bring some normalcy to the lives of wounded Canadian service members, the park tries to make the abnormality of War into something that, through the abnormality (at least these days) of quiet reflection, reminds all of us of the normal lives of normal men and women who made a commitment to their society and who must now make a new normal for themselves.

If meandering through the park means nothing more than wandering, then the word accomplishes little. Another “thank you for your service” with some nice benches and some pretty, big flowers here and there, that’s all.

Yet if, like its river namesake, meandering means winding one’s way around curves that are metaphors for the complex decisions made and lives lived by service members, then the park is a place worth visiting indeed.

Kudos to Wounded Warriors Canada

Even more, thanks to Canada’s wounded warriors.

Until tomorrow, be well,

Doc

To learn more about Wounded Warriors Canada

click here.

Following the Blasts

January 18, 2016 By in Living Life Tags: , , , , , , , , Leave a comment

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New Directions, New Possibilities

Today we remember that the trauma after War is in no way easy to define and, even more, to locate. Neurons in the brain just don’t go around playing games of telephone, like two kids listening to tomato cans on opposite ends of a string. Our sensations (sight, sound, touch), our movements, and our emotions (automatic responses to push us toward or pull us away from something): all these experiences come together in complex ways inside our skulls. And when those skulls get rattled, they get rattled complexly. From Scientific American, today’s it’s “Veterans of Iraq, Afghanistan Show Brain Changes Related to Explosion Exposure.”

A group of researchers associated with the Veterans Administration Hospital (Puget Sound) in Seattle, Washington, USA, asked the question: if we look at the brain scans of service members who have been exposed to blasts such as those caused by improvised explosive devices (IED), will we see differences in how those scans appear when compared to those of similar individuals who have not experienced such blasts?

No surprise, the answer was yes. More of a surprise was the area that located the differences: the cerebellum.

canstockphoto8184814

The cerebellum (highlighted above) is a part of the brain that has long been associated with coordination of physical movement. In a way, it’s the home of your “muscle memory.”  Muscle memory, however, is not just about knowing how to pedal a bike after not having been on one for ten years. Many different functions come together in the cerebellum to allow responses to events to be as smooth and as correct as possible.

Even though service members are now, because of advanced protective coverings, far less likely to die from blasts, they are certainly still quite susceptible to the highly-pressurized air from those blasts. By affecting areas like the cerebellum, these blasts, especially when many in number, can pummel the brain enough to cause far-ranging changes.

This is the tip of the iceberg as far as traumatic brain injury (TBI) research. The cerebellum will almost certainly remain an important area of scientific interest, but likely other areas will also get their chances at the microphone. We’ll let the smart folks do what they do best.

What combat vets do best is, in a way, just as important.

Too many times we become fatalistic when we hear the letters “TBI,” as if it were something akin to Ebola infection.  Yes, for any service member who has been exposed to blast injuries, the longstanding effects of TBI must be investigated and documented. Yes, some challenges caused by TBI will not, at least with current medical technology, just disappear.

But that’s what combat vets do best: face challenges. Do what it takes, because they have what it takes. Short-term memory and attention might be affected. Mood shifts might have to be taken into account. But still there are missions and connections worth looking for, striving for, living for.

So you learn to avoid situations that only bring pain. You learn to apply skills in a new way.You don’t give up. That’s not what combat vets do. You didn’t then. You don’t and won’t now.

The investigators published their research in a journal of the American Academy for the Advancement of Science. That’s a big deal, a very big deal. People are taking this work seriously, and combat vets can count on that.

Living with TBI isn’t easy. Neither was coming back from War. That’s why the real healing will always be in the truth: combat vets still have what it takes to do what needs to be done.  We keep going, as we all keep learning, keep trying—and keep living.

Until tomorrow, be well,

Doc

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