Beam Me Home, Scotty!: 01, Introduction

August 19, 2016 By Rod in "Beam Me Home Tags: combat trauma, hero, military, Posttraumatic stress disorder, PTSD, Star Trek, Story Grid, veteran 1 Comment

I promised myself I’d keep going, so here we are, the first segment of the presentation, Beam Me Home, Scotty!: How Star Trek Can Help Us Make Sense of the Brain, PTSD & Combat Trauma.

Yes, it’s hard to stay brief. But I’ll struggle on.

In the Hero’s Journey, the first two stages are The Ordinary World and The Call to Adventure. Here they are, all “four minutes” or so of them.

Keep me honest, folks.

So, why should we put Star Trek and combat trauma/PTSD together?

The brain itself tells a story, you know. Every morning, our bodies get up, face the obstacles of the day, and the brain—the organ in charge of our survival in this world,—asks us, our heart, our lungs, our muscles: So, my friend, will our hero make it today, or not? Now that’s a story’s end each of us wants to know.

So why shouldn’t we tell such a story with more familiar characters whose mission—to go boldly forward into life—is one that each of us would like to participate in?

Imagine, if you will, that you are now watching me lean onto a guardrail, looking out over Boston Harbor, over at Logan International Airport, the planes landing, taking off.

Now watch that scene change, as you see me making my way down the aisle of an airplane, the attendant’s voice overhead announcing the full, “red-eye”, overnight flight from Los Angeles to Boston. See me come upon the open middle seat, between a woman in her late thirties and a man not much older than I—acquaintances, clearly. Notice how they welcome me into their midst. Catch how I put my shoulder bag under the seat in front of me. See upon that bag the familiar logo, the initials “VA.” As you do, hear that someone else has noticed those initials as well.

“Oh, Lord, don’t let Joe see that!” the woman sitting at the window whispers, a smile tempering the warning.

“Too late,” the man on the aisle says, with a tempered smile as well. “That’s all right, sir. I’ll let you off easy—this time.”

As we prepare to taxi down the runway, I do tell them that yes, I have worked for the VA before. I’m a psychiatrist, heading to Boston for a training about combat-related PTSD.

It turns out that they are both combat veterans, former United States Army: the woman, Jane, a former 68 Whiskey (68W), a combat medic, two fourteen-month tours in Iraq early in the conflict, now an advanced practice nursing student in Atlanta—”sorry, Doc, not psych; critical care, probably, definitely not peds.”

The man, Joe, a former 35 Papa (35P), a Vietnamese language specialist who in an extended tour of duty during the Tet offensive found out that being picked out by the First Sergeant because you’re the best at what you do means that maybe you won’t in fact be sitting next to a radio all day translating messages, as they told you at Defense Language Institute; who, as a result, has been no stranger to VA mental health. He’s now a part-time English instructor at various community colleges in central Ohio because, well, you can periodically lose your cool and piss people off, and the Department Chair will still take you back. After all, “who else can you get to teach Composition 101 and actually read the crap those kids write?”

“We’re actually both advocates for veterans health care,” Jane says, “heading off to a planning meeting in Boston about mental health services. Joe’s not exactly a fan of VA’s psychiatric services, I have to tell you, but me? I’ve never been one much to talk to anybody about Iraq. Yet even with all my own training, I’ve always wondered: can PTSD ever get better?”

I smile. “Of course.”

Joe, still pleasant enough, yet clearly skeptical, rolls his eyes. “Well, that’s news to me, good sir. And just how do you make that happen?”

“Well, glad to tell you—but you’ll have to use your imagination.”

Jane laughs. “Like the kids shows on PBS? Hey, I’m game.”

Joe rolls his eyes even further. “Sure, I’ll do it just to prove to you both how wrong our good doctor is.”

“OK, then,” I say. “Let’s just sit back, close our eyes, take a few deep breaths, and see what happens.”

So we do.

And the scene changes.

Back to Work

August 15, 2016 By Rod in "Beam Me Home Tags: combat trauma, military, Posttraumatic stress disorder, PTSD, Star Trek, Story Grid, veteran 1 Comment

Well, finally made it to northern Indiana. All of us appear to be in one piece, even the cat and the chinchilla. After a move, one finds solace in whatever one can.

Lots of thoughts along the way, especially given that my two younger children, ages twenty-one and eighteen, both enjoyed long periods of iPhone listening on the way from Nashville to South Bend. Currently my goal is to get the presentation down to one hour; the original presentation at Fort Campbell was just over that.

Interesting, the differences between storytelling as a verbal art form and as a written art form, especially since Beam Me Home, Scotty! is not your usual “story.” I’d had some excerpts to share, or so I’d thought before the move. Now I’ve got work to do.

As all who have followed me over time know, brevity has ne’er been my strong suit. There are times for more words, times for fewer. “One hour” is certainly going to fit into the latter category.

I’d thought of looking at archetypes, but I believe it will be better if I simply get to work making excerpts. Let’s see what the coming days bring.

At least they will not be bringing endless trips to Lowe’s for moving supplies. “Brevity” will be more than an acceptable price to pay for that relief.

Fiction or Non?

June 19, 2016 By Rod in "Beam Me Home Tags: combat trauma, military, Posttraumatic stress disorder, PTSD, Star Trek, Story Grid, veteran Leave a comment

Shawn Coyne, whose work I’ll be referencing quite a bit, emphasizes over and again the question that every author needs to hear, yet dreads: “So, really, what kind of story is this you’re telling? A crime story? A love story? A young-adult thriller?”

In other words, what’s its genre?

Before I even can get to that, though, I have to ask an even more basic, more dreadful question of myself: Is this fiction or nonfiction?

As of today, this is my take on Beam Me Home, Scotty!: it’s “fictional non-fiction,” or rather, non-fiction that claims up front that fiction is the best way to make sense of it.

I’m in trouble. I know.

Actually, what I’m most afraid to admit is that I’m sailing into the waters of Allegory. I’m about ready to sink and drown in the Pilgrim’s Progress’s Slough of Despond, in other words. Good Lord, I can’t believe I just wrote that, but there you have it.

Any of you who who survives this mess: tell my family that I loved them.

What I am now going to do is ignore that I have written yon, two previous paragraphs, although. of truth, they will endure there in cyberspace, for me to revisit one day as I look back with chagrin and e’en amusement at this venture. Instead, grant me, O fellow traveler, a few more posts of self-delusion, meager scraps of Hope that this endeavor—yea, verily—will actually work, as I continue forthwith to humiliate myself before thee.

Back to fiction vs. non-fiction.

I do believe that I have to err on the side of non-fiction because, yes, I do have a “point” to make: that through the use of a fictional device, we can better understand a non-fictional reality that otherwise seems too confusing to grasp.

That, in Shawn’s words, is my “Big Idea”: specifically, by envisioning a story told on the USS Enterprise, we can better understand how the brain reacts to—and, more importantly, moves on from—traumatic experiences.

That brings us back to genre.

On his website, Shawn extends his Story Grid conceptualization from fiction (the subject of his book) to non-fiction, and he claims that there are four main “genres” of non-fiction: academic, how-to, narrative nonfiction, and Big Idea. He claims (I think, rightly) that all four genres benefit from storytelling, but especially the latter two.

Beam Me Home, Scotty isn’t narrative nonfiction, à la Laura Hillenbrand’s Seabiscuit or Unbroken. There is not (so far) a literal USS Enterprise, the story of which I can literately extol. Instead, it’s a Big Idea book, a very-distant cousin of Malcolm Gladwell’s The Tipping Point.

Shawn analyzes The Tipping Point on his website, using his Story Grid method. He stressed that, as a “story,” Big Idea nonfiction should look at a truth and find something surprising in it, much as how Gladwell noticed Hush Puppies’ suddenly becoming big in Soho and eventually, as a result, came up with a provocative theory about, among other things, mass hysteria.

I’m going to try to do the same with my claim that the “fiction” of Star Trek can help us understand more clearly some important truths—physical, mental, and spiritual—about life after the witnessing of and, sometimes, the participation in the world’s violence. I hope to surprise, at least a little, as well. Here’s to hoping.

Next, on to “narrative device.”

What if . . . ?

June 17, 2016 By Rod in "Beam Me Home Tags: combat trauma, military, Posttraumatic stress disorder, PTSD, Star Trek, veteran 8 Comments

In the world of writing (and especially screenwriting), it’s called the “high concept” or the “elevator pitch,” the latter always introduced by the same hypothetical: “Suppose you were on an elevator, and the door opens, and in walks Steven Spielberg. He pushes the button for an upper floor, and you’ve got that much time to interest him in your story. What would you say?”

Knowing me, I’d spend at least three-quarters of my time asking myself, “Is that really Steven Spielberg?” The other one-quarter, I’d be thinking, “Good Lord, we’re all getting older, aren’t we?”

No matter, it all boils down to this: what, many writing coaches ask, is your “what if?”

For now, how about:

What if the brain were set up like the Starship U.S.S. Enterprise? How would that better help us understand what happens to people after a traumatic event, and especially after the traumatic events of combat?

There it is, my elevator pitch, such as it is.

You know, come to think of it: what if the brain really were set up like the Starship Enterprise? What would it look like on the inside? Who would be manning it? Would Captain James T. Kirk still be in control? If not, who, then? And how would the ship respond to the next Romulan/traumatic vessel coming into view?

Those are the questions that I’m going to try to answer in this book.

On “Pantsers” vs. Plotters

In the writing world, a “pantser” is just that: someone who writes by the seat of his/her pants, typing whatever the Muse sings, wherever the Muse leads. I’ll leave you to figure out how “plotters” differ. Nature vs. nurture, briefs vs. boxers, pantsers vs. plotters: the debates go on.

Confession: in the late 2000’s, I wrote a first draft of a novel. It was about 1/4 plotter and 3/4 pantser.

I can now admit it: it was a flop. Details are unimportant. Trust me, it was.

So I’ve been, over the past many months, trying a different ratio: 3/4 plotter, 1/4 pantser. Together, let’s see what you think.

For now that we have my “what if,” let me begin to tell you about genre and theme. More next time.

On Minimizing and Making a Move

June 15, 2016 By Rod in "Beam Me Home Tags: combat trauma, military, neuroscience, Posttraumatic stress disorder, PTSD, veteran 2 Comments

To those of you still following—Many Thanks! Bless you!

Announcement One:

Life is changing for me again, i.e., yes, another big move. Hopefully, by this fall my family and I will be living in the Goshen-Elkhart-South Bend area of northern Indiana, just off the Michigan border, in the center of the state, about three hours north of Indianapolis and two hours east of Chicago.

The move is purely a personal one, as I have greatly enjoyed my work this past year with the United States Department of the Army at Fort Campbell, Kentucky. It does appear, though, that over the long haul our family will be settling into the northern Indiana area, so in spite of the Lake Michigan snow, Hoosiers we will once again be.

Yet fear not (as if you were): the good fight remains to be fought, and thus I have accepted a position again with the United States Veterans Health Administration, this time as a staff psychiatrist at the Community Based Outpatient Clinic in South Bend, just down the street from the ever-Irish University of Notre Dame.

This upcoming move has led me to realize, though (finally). that I might best be served by focusing on just one project at a time and go from there.

So, Announcement Two:

I’m going to write my book “on the blog,” i.e., Beam Me Home, Scotty: How Star Trek Can Help Us Make Sense of the Brain, PTSD, & Combat Trauma.

I’ve been doing a whole lot of thinking and (even) private writing on such a book over the past many months, while I’ve tried to use the blog and podcast for other purposes, i.e., getting out information about resources around the English-speaking world for struggling combat vets. The latter has been noble goal of which I’m proud, yes, but I’m afraid I have to face facts: I lack the requisite proper combo of youthful energy and sufficient time to fight a good fight on two fronts.

So here we go.

I’ve been struggling with the book for the past eighteen months, for reasons that I’ll outline in future posts, because the struggles do go to the issue of “what it is to write a book,” at least for me. During the struggles, the great Amazon “I’m tracking your clicks” Big Brother offered up an interesting suggestion one evening as I was sipping a venti soy latte at my then-local Starbucks: Shawn Coyne’s The Story Grid.

Coyne is an experienced book editor who has written, in my opinion, the best book, bar none, on how to write, in his words, a “story that works.” He’s opinionated, but warm-heartedly so, and speaking myself as a very inexperienced writer, yet an experienced shrink and reader, he’s, IMHO, as right-on as you can get. He’ll play a prominent role as I write my book before your eyes over the coming months.

So then…

Last fall, Shawn teamed up with another writer, Tim Grahl, to start a podcast based on the book, entitled The Story Grid Podcast. I had known of Grahl from a previous book that he had written, Your First 1000 Copies, a compact, well-written, and well-advised primer on book marketing. It turns out that Tim is also an ever-hopeful novelist, and he convinced Shawn to join him as he very publicly exposes his soul to write his first novel.

What has ensued is a great venue for would-be writers, with an atmosphere reminiscent of Click & Clack on NPR’s Car Talk, except here one “brother” is constantly reviewing the “engine” of the other. Again, good-heartedly, I might add.

But as Tim has found out, a good heart can be a pointed one as well.

Well, for good or for ill, I don’t have a good-hearted taskmaster over me, but thankfully I do have a good-hearted band of faithful few who occasionally check in on the blog, so I’m sure that here and there I will have good suggestions to consider and to use.

I had thought of trying to write the book for commercial distribution, but I’m simply too much of a small fry to get the attention of CBS for permission to use the ideas in a commercial venture. What’s more: I’ve used the ideas quite a bit with many of the combat vets I’ve been serving, and I’d like to have a place to send them for more detailed investigation—should they be so inclined to do so, of course! So the blog’s going to be the place.

And, thus, we’re off. I’ll be using Coyne’s approach, and thus will start out with my thinking about the overview of the book, and then will present my current ideas about its set-up—and then we’ll work on the first draft. (And I do mean we, truly. Any thoughts from anyone in cyberspace will be more than welcomed. Not necessarily implemented, mind you, but always welcomed!)

Onward!

“‘Taps’ and the Last Musketeer” (Encore)

April 7, 2016 By Rod in Living Life, Respect, Honor, Duty Tags: combat trauma, Grief Loss and Bereavement, military, Posttraumatic stress disorder, PTSD, survivor guilt, veteran Leave a comment

It has now been nearly two months since I last posted. So much for “until tomorrow.”

I’m more than glad to report that my life has, indeed, been busy, colorful, hectic, the usual mea culpa‘s for not having written. All are true.

And all are, of course, beside the point.

One of the occupational hazards of being a psychiatrist—certainly for those of us with a more psychotherapeutic bent to our trainings and practices—is that you can never quite take even your own excuses too seriously.

Another, again for those of us cursed to take listening as a task worth doing, is memory: memory not only of words and events, but of emotions and feelings that allow themselves expression only in the deepest, embodied repositories of experiences past.

Not that some things are necessarily that hard to remember, mind you. All things considered, modern psychiatry, especially as practiced in the United States, is relatively straightforward. Given the focus in my field on biologic interventions, I’m happy to report that, in spite of all the hope-filled research that keeps gushing out of our journals with the most esoteric of statistics therein dissolved, the formulary we have available to us to treat mental disorders is, practically speaking, not that hard to master and, therefore, not that taxing to the brain to apply.

Granted, one can lose oneself to one’s heart’s content in the symptomatic litanies of the DSM, arguing the finer nuances of serotonin versus dopamine for the most efficacious treatment of any particular syndromal consubstantiation of eternal, mental-health truths. Also, there are the endless, prescribed combos of this-‘n-that-medicines that would probably serve as bases for the next set of O.W.L. Potions exams in J.K. Rowling’s Harry Potter world. Everybody’s got his or her favorite, after all.

But there you have it.

After that, all you have are a few medical records, body, soul—and memory.

Three years it has been since Porthos died. I have heard “Taps” played since then. Sadly, I will almost certainly hear it one day again.

A mere cut and paste, and the embodied memories of 2013 become the entries of 2016. If only life could be as easily dispatched by a mere Control/Command C and V.

Procrastination in deed, procrastination in wordy preambles. To remember is to honor. To honor is to feel: sounds, images, words in Latin, words in English, death, life, and the connections that made—and make—it all worthwhile.

From 05 April 2013, just over three years to the day, comes “‘Taps’ and the Last Musketeer.”

It’s time to get this written.

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

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

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

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

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

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

Or . . .

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

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

For me?

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

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

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

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

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

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

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

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

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

So I made it.

I opened my arms wide.

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

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

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

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

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

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

“Of course,” I replied.

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

“Of course.”

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

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

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

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

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

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

It was Josh Groban.

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

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

Of course, Josh Groban. Of course.

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

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

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

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

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

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

Boundaries, schmoundaries.

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

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

Then it was his father.

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

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

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

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

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

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

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

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

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

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

From across the way the commands were barked.

Rifles clicked. Fired.

Clicked. Fired.

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

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

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

Porthos would have loved it.

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

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

And then it happened.

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

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

Athos handed Jack the flag. And he saluted.

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

Minutes later, the service was over.

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

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

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

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

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

“I know,” I replied.

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

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

He did.

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

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

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

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

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

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

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

“Yes.”

“Maybe I could come by on Friday?”

“Of course.”

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

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

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

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

Words that I now must write.

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

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

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

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

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

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

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

Because he’d watched a couple Harry Potter movies.

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

He knew something of that process, after all.

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

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

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

Cruciatus consumptus est, Porthos. Requiesce in pace.

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

Amen.

“Goodbye, My Friend” and “In Memoriam: Porthos, 1985-2013” (Encore)

February 11, 2016 By Rod in Living Life Tags: combat, post-traumatic growth, Posttraumatic stress disorder, PTSD, resilience, veteran, war Leave a comment

Silhouette of a soldier against the sun.

On the evening of Monday, March 25, 2013, I was leaving a dinner meeting w aith colleagues, a group with whom I had been meeting for just under twenty years, once a month during the school year, to eat together and to support each other in our work. We’d been through births, deaths, marriages, divorces, new practices, failing practices, the whole bit. We ate that night at the cafe at Nordstrom’s, up at the Fashion Mall on the north side of Indianapolis.

I had just stepped into my Chevy Traverse, in the free parking garage just north of the mall, third floor as I recall, easier to reach from the skybridge connecting store to parking facility. It must have been around 830 PM or so.

My phone rang. I recognized the number. It was Athos.

When I answered, I heard the only vocal inflection that one dreads more to speak than to hear.

“Doc, it’s me. I’m sorry to bother you at home, but…it’s about Porthos. He was in a car wreck this afternoon, coming back from Fort Brag. He’s…he’s dead.

At 2:16 AM, Tuesday, March 26, 2013, I published the following blog post, entitled Goodbye, My Friend:

Mere hours ago, one of my patients died, not by his own hand, but suddenly, unexpectedly, far too young, far too soon.

Words fail me. Yet at the same time, I cannot let this night pass without my having typed at least a few such words onto a screen, into cyberspace, for him, whose smile I will never again see.

My God, never again.

Goodbye, my friend. For indeed we were not just “doctor and patient,” were we? It matters not that in another few hours, in the very next daylight I will see, I will write my final note in your chart, does it, for you were never just another note, never just words under federal protection.

These very words that I type, at this very moment: God, I wish you could see them. I wish I could see you seeing them. I wish we could laugh about them. I wish I could hear you say, “Jesus, Doc, lighten up, why don’t you.”

I promise, my friend, that one day I will. The memory of your smile will help me do just that.

But for now, I have to ask you to give me a few hours, a few days, as long as it will take.

May somewhere, somehow, not just my memory of you, but you—you—know: it was never just a job.

At this very moment, you cannot know how glad I am that I can write that.

But then on second thought: maybe you always did know that.

Ergo, your smile.

Goodbye, my friend. Goodbye.

On Saturday morning, March 30, 2013, I then posted the following, under the title In Memoriam: Porthos, 1985-2013:

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

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

I then quoted extensively from the both No Trouble at All and Merry Christmas, Reality Notwithstanding, from the latter an excerpt that had spoken of Porthos’ younger brother.

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.

To that, I then added

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

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

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

I then added an excerpt from To Remember, Not Relive, ending it with the following quote from the blog post:

Still exhausted, but somewhere, unbelievably, still rakish, [Porthos] 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.

I concluded the post as follows:

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

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

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

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

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

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

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

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

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

Goodbye, my friend. Goodbye.

Three years. So much changes. So much does not.

Until tomorrow, be well,

Doc

To Remember, Not Relive (Encore)

February 10, 2016 By Rod in Living Life Tags: combat, Mental health, military experience, post-traumatic growth, Posttraumatic stress disorder, PTSD, trauma, veteran, war 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

Taking Him on Home (Encore)

February 9, 2016 By Rod in Living Life Tags: combat, post-traumatic growth, Posttraumatic stress disorder, PTSD, resilience, veteran, war Leave a comment

Silhouette of a soldier against the sun.

Thank you for continuing to join me in my remembering.

It was a new year, 2013. So much ended up changing over the coming months. But on January 10, 2013, there were new possibilities.

There still are, of course. Just different ones.

From that date, here is Taking Him on Home:

I met with Athos last week, one of the “Three Musketeers” whom I had described in an earlier post, Merry Christmas, Reality Notwithstanding. Athos is the second of the two men I have had the chance to work with, the quieter one, the Tobey Maguire/Nick Carraway to my first patient’s, Porthos’, Leonardo DiCaprio/Jay Gatsby, as you might recall.

The third musketeer, Aramis, was the man they each mourn to this day.

“I sent the link of your blog post to my Mom,” Athos told me before either of us had even had a chance to consider sitting down. “She wanted me to tell you ‘Thank you for taking care of my boy.’”

As he finally did begin to lower himself into his seat, he flashed a hint of the smile that, no doubt, keeps him his “Mom’s boy” even to this day. Even after all that has happened.

“Well, tell her ‘thank you’ as well,” I replied. “It remains my pleasure.”

“I haven’t sent it to Aramis’ folks yet, but I’m planning to,” he then said, a bit sheepishly, even though at the same time definitively, if such a combo could be possible.

“You stay in touch with them?”

“Oh, yes. I talk to them a lot. I’d spent time with them, gotten to know them. I mean, at his funeral, it was like I was there in his place, like a son, you know?”

“They let you come home for his funeral?” I asked. That’s not the usual practice, after all, not by a long shot, especially during the period of the conflict in which Aramis was killed.

Athos hesitated a bit, as if he hadn’t quite been expecting my query.

“Yes, I . . .” His swallow betrayed less an impending tear than more an impending dread, the dread of here we go, one more time, remember, one more time. “Yes, I came home with him.”

For a moment, I couldn’t quite place the scenes in my mind again, Aramis’ death, Athos’ and Porthos’ positions, their responses.

“You were there, weren’t you, when he died?”

“Yes, sir.” He swallowed again.

“Porthos too, right?”

“Yes, sir. We were both right there. We’d all gone by the spot earlier, and we were on our way back. Somehow we missed those guys the first time through. They must have just sat there as we walked past them that first time, I guess, I don’t know. But then they opened fire, just like that. I mean, man, I went down for cover, but Aramis just charged ahead, shooting right at them. They hit him five times, last one through the head, the one that killed him.”

I didn’t pause. I’m not sure whether I felt his momentum or dreaded it.

“You saw it all?”

“Yes, sir. I just started shooting. I’d never shot at anybody before. I just shot and shot and shot. Then I started to run out to him. I heard somebody shout at me to get back, and all I can remember doing was shouting back, ‘F*** you, I just lost my best friend.’ Then all of a sudden, I felt a hand on my shoulder, and I whirled around, and there was my sergeant. He just looked at me, only could have been seconds, and he just said, not yelled, ‘I know, but not now, not now,’ and he pulled me back.”

Now there was a pause.

“You know,” he continued, in his mind perched on some rock thousands of miles away, in heat so real to him even I could almost feel it, “we couldn’t get his body out for about twenty-four hours, so we just stayed with him, Porthos and I, we couldn’t leave him. It was hot, it was . . . it was bad. The medic had covered his face, you know? So that . . . we didn’t see it. I took his gun, all his stuff. His blood was still all over everything. When the helicopter came, I climbed in one side and Porthos climbed in the other, his body in between us, and we were off to get him on the Blackhawk to get him out of there.”

“But what was even more crazy,” he then said, “was that when I got out of the helicopter, I just started walking–I mean, I didn’t even know which way was up, you know what I’m saying?–and then out of the blue this airman leaps right on me and starts screaming at me that I’d about walked into the propeller. And you know what, Doc, you know what?”

I figured that he was going to say what he finally did say. And even though he saw that I had already had it figured, no matter: he said it anyway.

“I wouldn’t have cared if it had.”

He meant what he said, of course, yet I have to say this as well: there was something less definite about him that day we spoke, less miles-away, less certain, as if somehow futile was slowly easing its way out of the centerpoint of his vocabulary.

Then after a few seconds, “And it was right after that that the big guy pulled me aside and asked me.”

“Asked you what?”

He snorted, although hardly at all, truthfully, and certainly not at all one of contempt, but more like one of a person’s somehow still not quite believing that what happened actually happened. He looked right at me.

“He asked me if I wanted to take Aramis on home, back to the States, to his family. And I didn’t hesitate for a second, not a second. I just said, ‘Yes, sir.’” Slowly his gaze left mine, wandered past my head, toward the window, out. “Yes . . . sir,” he then whispered.

I’m sure the next silence was only seconds long, but with his looking through the window, he pushed me back a good six psychic inches from him, not too far, mind you, but far enough to privilege me only with the sharing of his story, but not with participating too closely in it. He was in a world that was his and Aramis’s, theirs alone.

“When they put him in the plane to take him back, I just crawled in and lay down next to him. I didn’t leave his side the whole way. We’d heard that the escorts sometimes would do s*** like putting their feet up on the bodies. No way, man. No way.”

Those last words were not spoken to me, were no mere descriptions of what was or was not going to happen. Those words were a vow, spoken to a best friend who, though not hearing, would nevertheless know that Athos had not only had his back, but finally also his whole body, to the end, the very end.

Then, all of a sudden, he smiled, just enough to bring us both back to my office, to each other and to each other’s gaze.

“You know, Doc: that’s when I found out what happens when you’re lying on the bottom of one of those planes as it’s coming in for a landing. I mean, the presssure?” He gave me a are-you-kidding-me look well worth the price of admission. “Not good, Doc, not good.”

Freed from the reverie of his final one-on-one trip with his “bestest buddy,” he returned to a more steady, though still thoughtful narrative pace. He talked of his time with Aramis’ family, the funeral, the motorcade to the national cemetery, the graveside service.

“But you know what I’ll never forget?” he then said. “I’d just gotten out of the limo, and I was like standing there, not even sure where I was, who I was, nothing. And so I look up, and there he was, the big guy, the senior man himself, looking right at me. It took me a few seconds, but then I saw what he was looking at: I had something hanging from my uniform. But before I could even react, all he did was walk toward me, take a pin off his own uniform, and then pin mine back together. He put his hand on my shoulder and just said, ‘There you go, son. There you go.’ And he squeezed my shoulder and walked on. I . . . I couldn’t believe it.”

We talked more, about Aramis still for a while, but soon we were talking about his own girlfriend and his (quite funny) memories of trying to keep Porthos in line while they were back in the military. By hour’s end, he had already stood up to leave, our plans for our next meeting having been made, when he paused and looked right at me.

“I don’t know if I’ve ever told anybody all that, Doc. But, you know: I made it through without crying. That’s . . . that’s a start, Doc. That’s a start.”

With that, he walked out.

A week later, the pictures in my mind that I cannot shake are two. One is the picture of a young man, barely into his twenties, lying on the bottom of a cargo plane next to a box, vowing to remain faithful until the landing at Dover, protecting another man’s honor that, in one way, was only a memory and that, in another way, was the only bit of Aramis that no one–no one–would ever take from him. No one.

The second is of a senior officer looking into the eyes of a young enlisted man, quietly saying, “There you go, son. There you go.”

There is no glory in War. Only days before that officer took Athos’ shoulder, a family over in the Middle East had buried another man, a man perhaps who had died with hatred and malice in his heart, a man perhaps who had, instead, merely died wanting only to get these armed strangers out of his country. I will never know.

I do know that Athos, Porthos, Aramis, each believed he was “born to protect.” Each believed that 9/11 was an Act of War. Each believed that their mission was part of a greater mission to assure that 9/11 would not happen again. What others believed or to this day believe about that mission, that never was the point. They believed honorably. They acted as men, real men capable of rage and love. Their commanders saw them as men, real men capable of respect and even worthy of the title “son.”

One of them did not come home alive.

He did not, however, come home alone.

For it was, to the end, as Alexandre Dumas put in the mouths of his famous trio, “One for all, all for one.”

All for one.

Until tomorrow, be well,

Doc

Merry Christmas, Reality Notwithstanding (Encore)

February 8, 2016 By Rod in Living Life Tags: combat, military experience, post-traumatic growth, Posttraumatic stress disorder, PTSD, resilience, survivor guilt, veteran, war 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

Listening to War

Reflections on Words Heard Only Askew

Tag Archives: Posttraumatic stress disorder

Beam Me Home, Scotty!: 01, Introduction

Back to Work

Fiction or Non?

What if . . . ?

On Minimizing and Making a Move

“‘Taps’ and the Last Musketeer” (Encore)

“Goodbye, My Friend” and “In Memoriam: Porthos, 1985-2013” (Encore)

To Remember, Not Relive (Encore)

Taking Him on Home (Encore)

Merry Christmas, Reality Notwithstanding (Encore)

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