“The Ghost of My Innocence”

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

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

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

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

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

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

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

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

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

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

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

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

“How have you been?” I simply asked.

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

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

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

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

The second was another matter altogether.

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

The remains of all the above after the blast.

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

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

He looked directly at me.

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

I have no clue how long the next silence lasted.

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

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

“No, my ID.”

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

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

I took it.

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

His mom and dad.

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

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

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

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

And he spoke of the most terrifying ghost of all.

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

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

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

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

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

I smiled.  “Want to go for a walk?”

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

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

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

“See you Tuesday, Doc,” he said.

“See you then.”

We shook hands, and he left.

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

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

2K, 1 by 1

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

It’s the nature of my business.

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

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

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

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

I do the very same now.

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

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

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

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

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

I clicked on the name.

There he was.

Just another name, I suppose, another face.

If only.

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

He is not doing well.

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

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

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

He hadn’t.

“Would you like to?”

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

“Yes,” he finally said.

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

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

“You just passed it,” he said quietly.

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

I looked at my patient.

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

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

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

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

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

“Yes,” he whispered again.

I moved right another pixel.

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

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

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

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

“You all right?” I asked.

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

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

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

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

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

That, I was not prepared for.

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

I didn’t even try to hide it.

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

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

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

It’s now hours later.

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

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

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

When will the pixels end?

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

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

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

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

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

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

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

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

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

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

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

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

Semper Fi (x 2)

You gotta hand it to Marines: they’re Marines.  Really, what else can you say?

With an amazing amount of accuracy, you should be able to spot one from about twenty feet down the hall.  No one quite walks like a Marine, let’s face it.  Yet worry not: if you miss said Marine at twenty feet, you won’t at five, given that every article of clothing he’s wearing (almost certainly including his boxers) has some permutation of “USMC” emblazoned somewhere thereupon.

And you had better show proper respect for each article thereof, too, if you know what’s good for you.

I met him just this past week.  While probably a bit stockier than he had been right out of San Diego, he was not so by much.  I would have said “Yes, sir” to this guy no matter what my rank.  Every muscle on his face was advertising “resolve” in luminescence just short of neon lights.  He walked into my office with resolve.  He sat down in his chair with resolve.

And it was taking every last bit of his resolve to hold on to his resolve.  For the boy had been jonesin’.  And I ain’t talkin’ a little bit.

He had just made the decision: it was time to stop the pain pills.  They weren’t helping that much anyway, and they were taking over his life.  He’d come too far to let that happen.

And far he had come: he had partipated in engagements that every single one of you who is reading this either a). heard of, or b). had to work really hard not to hear of.  Casualties were many.  He lost men he was so close to, he could finish their sentences.

When he came back home, it was hard, really hard, on his wife as much as on him.  Two girls were born during the time.  He struggled, the usual, the nightmares, the flashbacks, the emotional outburts, the whole bit.

He came to the VA the first time and ended up with a therapist he didn’t find that helpful.  Yet he hung in there.  He’s a Marine, after all, once a Marine, always a Marine, hang-in-there Marine.  She assured him, after all, that if he just stuck with this “prolonged exposure therapy,” he’d feel better.  She knew it.  She’d seen it happen.

Finally he’d had it.  He called it quits.

Soon, however, both he and his wife had had it with how he’d become after he’d “had it” that first time.  So being a Marine, he tried again.

This time it worked.

He has felt understood.  He has felt that he has been taken seriously.  He has felt that he doesn’t need to worry about falling apart every time he walks out of the Clinic door.

The therapist meets with him and his wife.  There have been some challenging encounters.  But he and his wife are together, working together.  He’s even doing more than his fair share of the childcare.

“And you know what?” he said to me.  “I’m not that bad at it.”

Of course not.  He’s a Marine.

True, I know: many will not associate “Marine” with “caretaker,” and they will be right (and often, quite painfully so).  Yet this man is a Marine’s caretaker: he has taken on his daughters as a mission.  He has looked hard at his behavior.  He’s “loosened up”–I won’t say “quite a bit,” but “a bit” isn’t fair either.  He is proud of himself.

He still has bad days.  Certain days of the year are harder than others.  He and his wife still have their struggles.  Nightmares can still come to haunt.  But by his report, he is doing much better.

Day One, he started on Suboxone, the opioid substitution medication.

Day Two, I had a chance to meet his wife and daughters.  His wife is a pleasant no-nonsense, armed with very appropriate questions for me about her husband’s care.  The older girl actually sniffled a bit and crawled into Mommy’s lap upon first meeting me, yet within a good ten minutes, she was–well, not exactly warming up, and not exactly flirting, but more like, what, letting me know that she might give me a chance, but on her timetable, thank you.

And the younger daughter?  If that girl ain’t a general in the Marines by the time she hits retirement, then clearly there is no justice in this world.  She marched into my office, chatting full force, headed straight to the Keurig carousel and demanded to know the difference between Tazo Zen tea and Starbucks French Roast, and right now, buddy, understood?  She then began to inspect my bookshelf.  She was not impressed.  Fortunately a pen, a pencil, and some paper spared me further dressing down à la Full Metal Jacket.

By Day Three, our Marine was feeling much better.  And the General?  She was pooped, so she stayed in her stroller.  But both Papa and I knew that we’d better get our business done and fast, lest the demand for freedom come now, I told you, NOW!

I am indeed coming to the conclusion that Semper Fi has its own nucleotide chain on at least one chromosome.

Semper fidelis, however, “always faithful,” need not apply just to Marines.

I would also like to honor a mulier semper fidelis, i.e., an always-faithful woman: our Marine’s therapist.

While one may complain about the VA ad infinitum, one matter is undisputed: we have a great (and I mean, great) electronic medical record system.  With a few pecks on a keypad, I can get access to a veteran’s medical records from VA’s across the country.  And that is useful because, in this case, our Marine does not usually get his care in Indianapolis.

When I went to his full record, I counted up the number of sessions that our Marine (and sometimes his wife) have had with our faithful therapist.

Over the course of the past year, twenty-seven.

That’s 2-7.

Why, pray tell, you might ask, am I making such a big deal of said number?

Well, the answer is in the therapist’s notes.  For you see, with each note the therapist was assuring me, the reader, that she was performing “evidence-based CPT,” i.e., cognitive processing therapy.  She applied evidence-based CPT at her last session.  She applied it at the session before that.  I can only assume that she will apply evidence-based CPT at her next session (next week), as well as the session after that and the session after that.  I have no reason to assume otherwise (either as to her documentation or as to the fact that she will be seeing him at least three more times).

Let’s have some fun, shall we?  Check out this for link for Wikipedia, that final answer for all matters human.  It is to the article for, you guessed it, Cognitive Processing Therapy.

Read said article now.

Did you notice anything?

Did you notice the number 12 appearing in several places?

Pray tell, to what did said number 12 refer to?

What, you say?  The number of sessions needed to complete a course of said Cognitive Processing Therapy?

Hmm.   12.  27.  Correct me if I’m wrong, but 27 is 2.25x 12.

Am I right?

Hmm.  But the studies say . . .

Ah, the studies.

Let’s have us a little chat about my world at the VA, shall we?

The VA is really into evidence-based therapies.  Really, really, really, really.  (So’s the Department of Defense)

Now, the evidence assures us that 12 sessions of CPT should be quite significant in reducing the symptoms of PTSD.  I do stress reduce, for as we know, there is always an escape clause in every application of a therapy study, i.e., it’s statistical and actual results may vary according to the clinical situation.

I love that.  I mean, as a lawyer, I really love that.  Really, really, really, really.

I mean, give me that clause, and I’m good to go.

Clearly, so is our faithful therapist.

For you see, if we were to be honest here, our therapist is misusing critical human resources in caring for our Marine.  Why, if she were truly following what the evidence shows, by this point she’d have sent two Marines into the world, filled to the brim with new schemata to counteract their maladaptive beliefs, thus allowing them to move forward, beyond their stuck points, now on their own, to apply their newly-formed coping skills to myriad newly-arising life situations.

And furthermore, a third Marine would, even as we speak, be preparing to leave mere psychoeducation to enter into a phase of practice and Socratic dialogue, his or her redemption being assured, naturellement, before Halloween.

OK, here’s where it gets really fun.

Let’s go back to our “clinical situation.”  OK, 27, twenty-seven.  All right, now all we’ve got to do is come up with why we’re still at 27–and counting!

Oh, let’s see, what could we say?  Our Marine did not fully incorporate his learning sufficiently during the first twelve sessions because, oh, what, he didn’t try hard enough?  Oh dear, no, that can’t be it.  He lacked the requisite cognitive capacities needed to do so?  Oh, ditto, shoot.  His clinical situation was more complicated than those who participated in said studies that produced said evidence for said evidence-basis?  What, more of his friends died?  He got knocked around more than the other participants?  His dad beat him senseless every third day as he was growing up?  (Oh, shoot, no, the initial assessment tells us that’s not the case, darn it.)

Well, how about . . . this:

How about, 1).  His therapist knows what to put in the chart to keep the honchos-who-know happy.  OK, check.

Now for 2):

His therapist takes him seriously.  She does help him learn to think more usefully before his emotions get away from him.  She sits with his tears, as long as he needs to cry, no shame whatsoever, knowing that, yes, one day the flow of the tears will slow, that then will be the time to think, and feel, and think, and feel, and maybe not say anything for a few minutes, and then feel, and then . . .

And she’ll do this week after week.  She’ll remind him of the progress he’s made so far.  She will assure him that setbacks are part of the game.  She won’t even think about when Session Eleven becomes Session Twelve becomes Session Thirteen, because at the end of each session he says that it’s been helpful to talk, to get new ideas, just to get all this sh** off his chest, and he looks forward to getting together in a couple of weeks, and then a couple weeks after that, and then after that, because each time they’ll talk, and he’ll get new ideas and will get all this sh**off his chest, and then . . .

Fidelis.  Faithful.  This resolute man, though still struggling, is proud that he has regained some of his resoluteness.  People can still irritate the you-know-what out of him.  He still really can’t handle Target or Wal-Mart, let alone a job in which he actually has to act as if this buffoon he’s working with truly knows his head from a hole in the ground.  But he can talk more with his wife about the “problems of daily living,” as many of my fellow mental health professionals so disdainfully spit out.  He can take some time before bed, pull himself together, and even sleep more nights than not without revisiting Hell one more glorious time.  And if he runs into problems, he’ll talk to his therapist about it in two weeks–wait, no, it’s this week, isn’t it?

Whew.

And he can even manage to take care of the General.  By himself.

Well, what do you know.

I have only one thing to say, to the therapist and to the General:

You go, girl.

The Onion Takes Manhattan, or A Tale of Two Essays

It is the best of times. It is the worst of times.

While I apologize to Mr. Dickens, I have to say, as a psychiatrist who works for the VA, that no truer words have e’er been spoken.

I have lived to see battlefield medicine reach a level from which many a man, many a woman, who otherwise might have become a name etched on a monument, has instead been able to return home to loved ones, to life.

And I have lived to see such men, such women struggle, claw their way, beg-borrow-steal to find a life worth returning to.

I have lived to see my profession, mental health, finally take seriously the long-term consequences of combat.

And I have lived to see some in my profession define “taking seriously” as prescribing pills as if there were no tomorrow; as manualizing protocols to get the job done in as few steps as possible, as if emotional healing were an advanced form of “Name That Tune” in three notes; as being oh-so-proud of itself for its evidence–its chi squares, p values, meta-analyses and all–while farming out the long-term emotional, the existential, the spiritual to the chaplains for them to clean up once the real work of psychological treatment is over.

The best, the worst.

If Dickens told us a tale of the London and Paris of old, then this week I had the opportunity (or the misfortune, rather) of reading tales from two publications that purport to represent (and proudly, I might add) less the best and the worst of today, but perhaps more the sublime and the ridiculous: The New York Times and The Onion.

Last Sunday, in the Sunday Review section, Nicholas Kristof wrote the essay, “War Wounds,” a devastating piece on the consequences of combat in the life of one man, Major Ben Richards, a 2000 honors graduate of West Point, who is, in Kristof’s words, “a brilliant man tracking his [own] cognitive deterioration.” Since having survived the explosion of two roadside bombs, Richards, fluent in Mandarin, who at one point pioneered cooperative work with Sunni Muslims in Iraq, has struggled to maintain enough adequate attentional focus to monitor the whereabouts of his toddler at his own home, let alone to write the papers in a Georgetown University graduate school class that he once would have breezed through without a second thought.

Kristof, who wrote earlier this year another excellent piece about which I commented in the blog, (In Memory of Ryan), pulls no punches as he sits down with this man and his wife, both only in their mid-thirties, in an Iowa home that became their refuge after Major Richards could no longer manage a teaching position at West Point:

[M]y take [says Kristof] is that whatever political leaders say in Washington, and whatever directives emerge from the Pentagon, not nearly enough is changing on the ground. Mental health still isn’t the priority it should be. Just about every soldier or veteran I’ve talked to finds that in practice the mental health system is clogged with demands, and soldiers and veterans are falling through the cracks. Returning soldiers aren’t adequately screened, diagnosis and treatment of traumatic brain injury are still haphazard, and there hasn’t been nearly enough effort to change the warrior culture so that getting help is smart rather than sissy.

The essay makes clear that both Richards and his wife have struggled with a dual obstacle course far more daunting than any that the good Major might have faced in his Army training maneuvers: the Department of Defense and the VA. Mrs. Richards struggled to find a kind word about anybody connected with either system, while, to his credit, Major Richards–Army loyal to the bitter end–tried to relate the best spin on his own tale that he could.

If Mrs. Richards somewhat held her tongue, however, other with whom Kristof spoke felt no compunction to follow suit.

“The V.A. certainly doesn’t care,” said Jim Strickland, who runs the V.A. Watchdog Web site. As he observes on the site’s home page, “This country is capable of drafting you, putting you in boot camp, teaching you to kill someone, and then putting you in a war zone within six months. So why can’t they process a claim that fast?”

What do I say after that?

Well, I did say something, the first time that I have ever commented on a Times article. I believe what moved me to do so was Kristof’s poignant one-,two-word descriptions of the Major’s struggle to maintain his composure as he related his disappointment over his injuries and his shortened military career. I wrote:

Sad to say, I can’t thank Mr. Kristof enough for his continued focus on the needs of our combat veterans. I’m sad to say precisely because I walk into a VA every day, trying not to lose hope, focusing day in and day out just on the man, the woman in front of me. Yes, we deserve a great deal of the calumny we get. Yet I’m still proud to work for Secretary Shinseki, for my Medical Center Director, for my Chiefs of Psychiatry and Mental Health Services. As a psychiatrist who sits with the tears, the rage, but also the hopes and the courage of these men and women, I’m honored to be allowed into their lives. And they keep coming,

We need your voice, Mr. Kristof, and the voice of brave men like Major Richards over and over. If not, the country will forget before it even has the decency to remember in the first place.

I agree with Mr. Kristof that the Major is anything but a failure. He’s still watching over his troops by refusing to live as if he were a failure. So many men and women have wept in my office because they had to give up a career that had finally given them meaning, all because of wounds that many would prefer to chalk up to some crazy notion of golddigging on the Government’s dime, as if men and women who volunteer in a time of war to do what they believe is right are the type who were really looking eventually for taxpayers to subsidize their cigarettes and bon-bons.

Keep calling all of us to task. Please.

So, all in all, one scrapbook-of-crummy-times essay should have sufficed for the week. But then came The Onion.

For any who might not know, The Onion is (allegedly) as far from The Times as mere mortals can travel. It’s an often-hilarious, always-irreverent newspaper spoof that has been skewering both the Right and the Left (although, admittedly, a bit more the Right) since 1988. Let’s just take a gander at a few of the “paper’s” lead stories this week to get a flavor of our publication here:

Putin Learns Putin is Behind the Plot to Assassinate Putin

Ugandan Powerball Jackpot Hits 31 Grains of Rice

Jennifer Aniston Engaged to a Guy Who Frankly Will Never Replace Brad

Need I say more?

However . . .

Another story also appeared in this week’s edition:

It Would Be an Honor to Serve My Country, Return With PTSD, Sit On a Mental Health Care Waiting List, Then Kill Myself

We ain’t in Kansas no more, Toto.

Purporting to be a “commentary” by an Army private who is about to be deployed to Afghanistan, it takes “black humor” to realms unknown. Some (e.g., Time magazine) found it tasteless and even vile. Far many more, however (e.g., persons posting comments on The Onion’s Facebook page), found it disturbing, satire at its most truth-filled, its most gut-wrenching, its most awful. Here are excerpts:

It’s a matter of principle, really [why I joined the Army]. From a young age I was taught that throughout our history, Americans have had to stand up and fight for the freedoms we enjoy. I always knew that when the time came, I would serve with honor and nobly suffer from post-traumatic stress disorder until my only recourse was to end my own life. So it’s with eager anticipation that I head off to the battlefield to defend, be ignored by, and then—left all alone, with my personal demons closing in—kill myself for the land I love so dearly.

I know no greater honor than relying on an agency [the Veterans Benefit Administration] with a backlog of more than half a million claims that can’t get its sh** together enough to transfer its paper files to a central computer.

And to see the look on my child’s face as he watches his own father, fresh off the battlefield, crying in a fetal position in the corner of his living room because he can’t get the help he needs, even though he’s been calling doctors for three straight months—tell me, is there any feeling greater than that? I don’t think there is.

So when I finally can’t take it any longer and decide to check into a hotel to end my own life, please know that I have but one simple request: My agonizing struggle and tragically preventable death should be the last thing on anyone’s mind. Because the only thing that’s important for someone like me, who will be dedicating his life to serving his country, is that my government lets me waste away until I become a shell of my former self.

That’s what being an American soldier is all about.

God, I wish I could laugh at this. I always gladly take laughter over nausea. Not my lucky day, though–or maybe more accurately, my lucky life.

I read this as I ended a week in which, happily, good has occurred: Will Do, Sir is sincerely trying to communicate more openly with his girlfriend. Buddy, Got the Time? is doing his best not to get into the same old Abbott and Costello routines from Hell with his young-adult son. Inside, Outside, Anywhere is trying to find ways to get his energy back into the world and into the lives of others. Maybe a Letter was proud to help out a good friend with some remodeling work. New Year, Old Challenges is also going to help a buddy remodel–at least two states away, much to my patient’s relief. The new guy from 525,600 Minutes has decided that perhaps he doesn’t have to be ashamed to admit that he’s depressed after all and therefore that he doesn’t have to freak out about trying an antidepressant.

But I read this as I ended a week in which, sadly, No Trouble At All revealed to me some truths–not about himself–that have been haunting him for weeks, more than explaining why his combat trauma symptoms have been skyrocketing. Quite the Handful struggled with several of us treaters over proper medications–and not at all pleasantly, I might add.

And I read this as I ended a week in which, even more sadly, three men entered my life within a matter of about six hours: a mortician whose traumas span a lifetime, culminating in body of a peer after body of a peer after body of a peer; a scout who lost, at one point, nearly a buddy a day, “hanging in there” until a natural disaster destroyed every thing in his life, finally forcing him to remember every one who had been swept away from him; and a chemical weapons man, so tolerant of alcohol that he hadn’t even felt that drunk when his blood alcohol content was over 300, desperate to hold his marriage together, hoping that some Librium would be all it would take to smooth everything over, so not wanting to admit to himself that he had not been drinking himself into oblivion solely for kicks, so not wanting to whisper to me, in answer to my “One day you’re going to face this,” a tear-embroidered “You’re probably right.”

The Muppets Take Manhattan is a fun, no-brainer little romp from the Eighties that used to keep my kids in stitches long enough for me to catch a good half-hour of shut-eye back in the day. Kermit, Miss Piggy, and the whole crew vow to take their college senior variety show to Broadway, with thrills and chills ensuing along the way, culminating in Miss Piggy’s clobbering Kermit into kingdom-come to restore his memories and, with a cast of hundreds of chickens, dogs, rats, etc., etc., to keep the show going on. Moral of the story? Dreams can come true–even, for Miss Piggy, ones of marriage to a certain, dashing young frog.

I’m not quite sure whether The Onion took Manhattan or vice versa, whether “all the news that’s fit to print” ended up in an op-ed piece or in a devastating–what, parody? Truth that no one dares speak in polite, conventional company?

I ended up, though, with a moral very different from Kermit’s and Piggy’s, one that I have to sit with every day of my working life, one that I have to feel, even occasionally embroider with my very own tears:

Dreams can be killed, by an IED, by an indifferent public who dares to harrumph and tut-tut a biting farce, all the while living out every word of that farce every day.

I am thankful that dreams can nevertheless be re-formed. I am glad that I have the honor every day of being part of that reformation process for the children of my peers. As a society, as Londoners, Parisians, New Yorkers, Hoosiers: we all should be doing nothing less than the same.

Mr. Kristof, editors of The Onion: never let us forget that–especially before many of us even have the decency to remember that in the first place.

Please.

Hands and the Unfathomable

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

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

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

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

“Has that every happened before?” I asked.

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

“At night?”

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

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

“When were you over there?”

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

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

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

“Not good?”

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

“You could say that.”

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

“Medic.”

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

Twenty-three, a combat medic, in Iraq.

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

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

“You name it.”

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

“How many close to you did you lose?”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Yes. That’s it.  Not even close.

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

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

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

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

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

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

Clearly he’d not been expecting that response either.

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

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

“What’s that?” he asked.

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

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

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

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

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

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

I smiled back. “Me too?” I asked.

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

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

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

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

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

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

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

Dona Ei Requiem

Late last week I received a call from our Emergency Department, directly to my office phone.

This is not usual.

“Doctor Deaton,” a voice greeted me, the edge therein more than a little palpable.  “This is the charge nurse in the ER.  One of the doctors has a question for you about Suboxone.  Can you speak with her?”

This too is not usual.

It turned out that a young man had appeared in our emergency room who was in great abdominal pain.  He had been on Suboxone through a private doctor in town, and when he became no longer able to afford the medication, he had to stop it, precipitating withdrawal symptoms.  The situation was even more unusual, though, in that the man had only been on a relatively small dose of Suboxone, yet was having quite serious abdominal symptoms.  By the time the doctor got to me on the phone, matters had become so difficult that, shall we say, help was rapidly needed in the ER to keep matters under control. (I heard the call for it over the hospital loudspeaker.  Never a good sign.)

The young man was hurting, and apparently he was not a happy camper.

Eventually he was admitted to a medical floor of the hospital, from which another doctor called to ask me to consult in a few days about the Suboxone.  When I did call those few days later, I learned from the young doctor caring for the man that “he’s got a lot more problems than just Suboxone.  His wife says that he’s really got problems from the war, and I’ll tell you:  he really looks like he’s suffering over here, too, especially at night.  I think he may need some time on the Psychiatry service.”

Fortunately by the time this young man had arrived at my office, much had improved.  He was back on a good dose of Suboxone.  He was taking medication both for his nightmares and for his mood swings.  He was living in a much calmer world.

Sitting there before me, in his late twenties, he was the paragon of the “good old country boy”: on the slim side, but still with a military man’s body, along with a respectable blotch of hair on his chin and a respectful grin on his face that would have made Andy Griffith proud.  Obviously, he was feeling much better.

“I’m back on the Suboxone dose I was on before,” he told me.  “It’s a lot better.  And the new medicines are helping, too, already.  I’ve slept better these last couple of days.”

Matters had been worsening for a while, long before he stepped into our hospital for the first time that previous week.  He is several years out of his last deployment.  Fortunately he has been able to work effectively, but he’s been just as fortunate to have understanding superiors who have genuinely liked him and appreciated his hard work.  Apparently he has not always been a pleasure to work around.

Similarly, he is fortunate beyond belief that he has had the family he does.  He married his high school sweetheart quite young, and their first child quickly followed. His wife has stuck with them through thick and thin.  His parents have been extremely supportive of the couple, and they remain so to this very day.

Still, he had had opiate problems long before his enlistment.  He did become clean for his first few years of service, but after an injury in the field, he returned to the medications, first as prescribed, but later, especially when he returned home, as a way to deal with all the demons that were haunting him.  He finally got himself to a Suboxone provider in the community, and matters changed for him.

Somewhat.

“What was your MOS?”  I asked him.   (MOS is, essentially, his job in the military).

“Infantry,” he told me, sheepishly, yet still pleasantly.  “But I spent most of my time on transport.  We were ‘outside the wire’ all the time.”

With that final sentence, his whole tone, his whole demeanor changed.  When a soldier or Marine is “outside the wire,” he or she is outside the (very, very relative) safety of the operating base and out in the world of curious kids begging for chocolate bars–oh, and IED’s (improvised explosive devices) ready to destroy everything in range, including you.

The change in him was dramatic.  I paused.  He suddenly looked about ten years younger, far more vulnerable, far less sanguine.  He was staring down at the carpet–or through a tunnel of time, I’m not sure.

“Bad?” I finally say.

He nodded, said nothing.

“How many did you lose?”  I asked, trying to keep my voice at a respectful quiet.

“Four,” he finally whispered.  “One . . . one was my best friend in the world.”

“Who was he?”

He told me his name.

“Where’d you guys meet?”

He looked back at me, a slight smile returning.

“We were in AIT together (Advanced Individual Training, where one goes after Basic Training to learn one’s job).  We just hit it off.  He was a farm boy like me, you know, just simple, no big deal.  He was so funny.  We’d laugh our heads off.  He . . .”

He looked back down, his smile suddenly retracted into his face with the breath he’d drawn in, held.  It appeared that his body was betting that if he just didn’t move, that tear at the end of his left eye wouldn’t dare move either.

I said nothing.

As he began breathing again, he looked back at me.  The tear had already headed points south.

“He was just twenty, Doc,” he barely whispered.  “He was a lot younger than me.  He was just twenty when he died.  He . . .”

Our eyes remained padlocked on each other’s.  Ever so slightly, he began to shake his head.  As he did, he bit his lower lip–but the tear in the other eye paid no heed.

“He never even lived, Doc.  He never even got a chance to live his life.”

This was not, of course, the first time I’d heard that sentiment.  Yet somehow, coming from him at that moment, so honestly, so sincerely, so achingly, almost as if Jim Nabors had transported his Gomer Pyle across time to sit right there in front of me, but this time with no “Howdy, Sergeant!”, no “Gollllllllllly!”, just a farm boy’s face, trying, begging to understand.

“What happened?” I finally asked.

“He was in the Humvee right ahead of me, inside.  Then all of a sudden, everything exploded.  The gunner on top just blew right off, the gun and everything, gun landed right on top of the guy in the hole that had just opened up.  I ran up, and . . . and my buddy still had a pulse in his leg, I could feel it, but they . . .  they Med-Evac’ed him but  . . . he never made it.”

We were staring at each other, but the padlock on our gaze had fallen off.  The chain connecting our eyes just hung there, limply.

“The NCO,” he continued, “we got a tourniquet on his leg in time.  He lost it later, but he made it.”

Neither of us said a word.

“Does anybody,” I finally whisper, “understand what’s going on inside you?”

Our interocular chain dropped, he briefly looked down, smiled, and then looked back.  “Yes,” he nodded.  “My wife.  She knew him, too.  He and I were stationed together.  He lived over in the barracks, and we had our own apartment, and he’d come over every weekend and stay with us, and . . .”

He stopped, pursed his lips, seemingly sending another telegram to the eyes to lay off.

Obviously they didn’t receive it.

A few seconds, nothing, then,

“She really loved him, too.  I was his big brother.  He was my little brother.  She . . . she knew he was dead before I did, heard it on the news.  She was freaking out.  She knew we were joined at the hip.  She . . .”

A tear was nestled in the bush of hair on his chin.  He was so sincere, so genuine.  Gomer himself never looked that genuine.

“He was only twenty, Doc.  Twenty.”

Silence.

“I don’t want to live like this any more, Doc.  I’m tired.  I can’t do it.”

Now it was my turn to smile, ever so slightly.

“You want to make it right for your family.  For his sake.  Your kids would have played with his kids.  Now you’ll just raise your kids right and remember him, in his honor.  True?”

Slowly the smile arose on his face.  It was still slight, but the eyes–they had brightened ever so slightly.

“Thank you,” he whispered.  “I’d never thought of it that way.  That helps.  Thank you.”

After he left, I decided to do it.  After all, I cannot remember the last time I had a full name.  I went to Google.  I found him, he who, unlike Harry Potter, was the boy who never lived.

I looked at his picture, smiling brightly, his beret just at the right angle to add a year or two to that face, that . . . young, so full-of-life face.

As I looked at that young man’s face, I saw the face of my daughter’s boyfriend, of her buddy beaming from the stage of his Rent production, of her boyfriend’s roommate who could win at least a silver medal in whatever “sardonic smiles” competition he might enter, of the young man across the street whom I’ve watched grow up since he was in kindergarten.

I couldn’t stop looking at it.  I couldn’t help but imagine the three of them, this young man in the beret, my patient, his wife, all laughing their heads off.

On the way home, it hit me, a memory of my own.

Twenty-five years ago, the minister and his wife of the church I was attending, the church at which I met my wife in the choir, lost their six-year-old daughter to cancer.  The congregation was devastated.  The funeral was huge, unforgettable.

From that time, what I can least forget is one song, the choir accompanying a duet of two sopranos, one the wife of one of my law school classmates, the other–my wife, a voice major from Michigan.   It was Andrew Lloyd Webber’s Pie Jesu, which at that time had just recently debuted.

Back in the present, when I got home, I grabbed my phone and headed straight to Spotify.  There I found it, the original recording of the song with Webber’s then-wife Sarah Brightman and the boy soprano, Paul Miles-Kingston.  I played it.

It was as I remembered it.

Pie Jesu means “kind Jesus,” and it forms part of the old Latin funeral, or Requiem, Mass.  Webber takes those words and combines them with another phrase of the Mass, the Agnus Dei, the “Lamb of God,” to create a seamless hymn of memorial:

Pie Jesu, pie Jesu
Kind Jesus, kind Jesus,

Qui tollis peccata mundi
Who takes away the sins of the world.

Dona eis requiem
Grant them rest.

Agnus Dei, agnus Dei
Lamb of God, Lamb of God

Qui tollis peccata mundi
Who takes away the sins of the world.

Dona eis requiem sempaeternum.
Grant them eternal rest.

To this day, it remains the song I recall immediately when contemplating the death of one who has died too soon, one who never even had the chance to live.  It is the song I recalled as I looked at that smiling face under that dapper beret.

We live in an odd world.  Here they are, two farm boys, both laughing their heads off as they make their dads proud when they go into the military, honorably, bravely.  The last thing on their minds would have ever been some high-falutin’ song sung in Latin, of all things, Latin.

Yet for centuries we have all mourned the loss of those who never had the chance to live, the Roman church through its Mass, the country Baptist church of this young man’s childhood through its hymnody, a group of Iraqi women who cry over their sons, their daughters who never wanted to harm anyone, who got caught in the crossfire, wrong place, wrong time, through the soft sounds, the wails of their songs.

All of us are united.

And today, the song weaves its way around two country boys.  To say goodbye to one of them.

Creator God, dona ei requiem.  Grant him rest.  Amen.

A Mennonite at the VA?

As some readers know, just this past week I enjoyed my one Warholian fifteen-minutes-of-fame:  one of my posts made it to WordPress’s home page, sort of my version of being “on the cover of the Rolling Stone,” if you know what I mean.  It was in that Warholian post, Conical Combat Linkages, that I revealed that I’m a “Mennonite by choice.”  According to my stats, more than a few people now know this about me.

Interestingly, also last week Anna Groff, an editor of one of our Church’s national periodicals, The Mennonite, contacted me about an article she’s putting together on Mennonites who work at the VA.  Apparently there is not a huge crew of us, surprise, surprise.

For readers who may not know: Mennonites are a Protestant group who were originally known as “Anabaptists” during the Reformation.  Originally from Switzerland, southern Germany, and Holland, many came over to the United States in the eighteenth century, first living in the Pennsylvania area, then moving to the Midwest, especially Indiana and Ohio, with later groups settling in Kansas and points West, or in the western regions of Canada.  There also is a large group who live in Central America and in Paraguay.

Don’t ask about the latter two.  It’s complicated.

(I did feel compelled to mention the latter, however, given that a group of one of our more distant, conservative cousins, the Beachy Amish Mennonites, living in Nicaragua, were described in a not-too-flattering front page article in the New York Times today.  For those who have read the piece, just rest assured: when I say distant, I mean distant.  I’ll leave it at that.)

Traditionally Mennonites, like the Quakers, have felt strongly that the Christian faith requires its adherents to avoid violence, seek peace, and refrain from participating in wars.  In other words, we are usually referred to as pacifists.

Ergo the title of this post.

Anna sent me a list of thought-provoking questions to answer for her article, and so I decided: well, since I’ve identified myself as Mennonite on the blog, I might as well answer her questions in a post.  After all, readers–and even more, patients–should know whom they are getting when they get me so that, well, they can decide whether they even want to get me at all.

Because this is such a complex issue that speaks so directly to many areas of my life about which I feel strongly and deeply, my essay in answer to her questions is quite long, even for me!  Also, it has a certain in-group-ness about it which may not be agreeable to many readers.  Moreover, for many readers a discussion of issues of faith itself might not be the way you’re wanting to while away your next more-than-several minutes of your life.

Given that, I have posted the essay separately, under the title Letter to a Mennonite Pastor, which can be accessed either through the link just provided or through the “Thoughts” menu above.  It may end up of interest only to fellow Mennonites.  (It may end up of interest to absolutely no one at all.)  Still, as I deal in it directly with my role as someone who is both a member of a particular faith community and as someone who serves combat veterans, I hope that others might find that the discussion in it will, at least in some way, prove enlightening.

Many thanks to all those who have visited the blog these past few days, and especially many thanks to those of you who “liked” the Conical Combat Veteran post and to those of you who have subscribed.  I hope that I continue to write posts that each of you will find worthy of the respect and caring every returning combat veteran deserves.

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