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

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

Taking Him on Home (Encore)

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)

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

The Slide Show (Encore)

Silhouette of a soldier against the sun.

 

From January 2012 through August 2013, I blogged regularly about my experiences working with Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) combat vets at the Richard L. Roudebush Veterans Administration Medical Center in Indianapolis, Indiana, USA. Given the anonymity of the large setting, I was able to write, with the full permission of all the veterans profiled, openly about their experiences and about their impact on my experiences.

Since then I have worked in settings that are not as anonymous, and therefore I have not been able, at least on a regular basis, to write similar pieces. So given that it’s now been at least two years since many of those essays were written, periodically I will plan on sharing them with you.

I plan to label them “encore” pieces, and they will be longer than the usual daily musings, so you’ll know them when you see them. I will present them, for the most part, unchanged from the originals. Some of these veterans I still keep in touch with periodically. Others, I merely remember.

But all I remember with great respect and, I’ll say it, with great fondness.  Today’s piece speaks well of what it was like to watch these young vets suffer, grow, falter, pick up and try again, especially as an older man the age of their parents, watching what easily could have been, in an alternative life, my very own child.

Today, it is “The Slide Show,” originally posted on 06 April 2012.

Truth be told, he and I never should have met in the first place.

Working at a VA associated with a major university has its perks, the most glorious being–residents!  Believe you me:  I am more than thankful to have the opportunity to work with young psychiatrists-in-training, not only because of their energy, their intelligence, their curiosity–but also, yes, I admit it, because of their being on-call in the hospital every night.  We staff psychiatrists have it nice as a result, I do grant you.  Even though we’re on call for a week at a time, four to five times a year, it’s all by beeper.  The men and women slogging it out in the trenches at 2AM are half my age.  They might beep me at 3AM to discuss a case, but, hey:  I fall back asleep easily.  Hallelujah.  For residents and for sleep.

In the latter part of 2010, however, it was not always so.  For reasons too complicated to explain, the staff psychiatrists had to serve as the first-call person on the weekends.  Poor us, I know.  Still, another glorious perk of Med Center VA life?  Having  very competent social workers working through the night in our emergency department, triaging and making life livable for all.  Sweet.  Plus, since we are able to access our VA computer accounts via a secure website, we doctors were able to manage all other matters that fall from the quiet of our homes.  Sweet x 2.

I did, though, cover one particularly memorable weekend:  ten admisions to our inpatient service in the span of two days, with two discharges.  None of the admissions was easy.  None of the discharges was.  By late Sunday evening, both I and the very competent, always-faithful nursing staff had just about had enough, thank you.

It was about 9:30 that evening when the ER social worker called me.

She had interviewed a young man who was struggling with acute drug intoxication issues (among other quite complicated matters, it should be added).  This social worker is quite savvy, yet she was struggling to know what to recommend for the man.  Given his impulsivity, she was quite concerned for his safety.  Still, he had “a way” about him, she told me, that made her wonder whether it might not indeed be OK to release him that night to his family, with outpatient care to be scheduled within a day or so.  I remember her words well, listening to them as I was while sitting in an easy chair in our family’s spare bedroom:  “It’s times like these that I miss having the residents here.  Sometimes that was all it took:  having an MD sit with the patient and convince the guy face-to-face that he’d be better off if he’d just come into the hospital for a while and get himself settled down.”

She was right.  I knew that.  I too was not pleased with the thought of this guy’s just going home in the condition he was in.  I knew I was on solid ground to ask the social worker to contact hospital security and then tell the patient that he was going to have to stay, whether he wanted to or not.  I knew that our VA police, our ER staff, and our inpatient staff were all quite competent enough to make that happen with only the minimal Sturm und Drang.  Nevertheless, I also knew:  Sturm and Drang there would be.  The kid was “strong and wiry,” according to the worker, and “he wouldn’t go down without quite the fight.”   “Code Orange” is what we call such a melee in our neck of the woods.  No good comes from such high drama, for anybody, certainly not at 10PM on a Sunday night and certainly not with an already overworked nursing staff (two admitted patients were already on one-to-one nursing monitoring).  I knew that.

Still, I’ve got the initials behind my name.  All I had to do was to say the word, hang up, and go back to reading my Kindle.  The inpatient doctor would have had to have picked up the pieces in the morning.  Wouldn’t have been the first time.

“OK,” I finally said.  “I’ll be there in a half hour.”

I have colleagues who still roll their eyes on hearing that–and rightly so, I might add.  Their knowing half-smiles say it all:  only you, Rod.  Only you.

After arriving and then enduring the knowing half-smiles of the ER staff, I walked into the young man’s room.  He was lying on his side, facing the wall.  He barely turned his head to look at me.  He wasn’t hostile, but believe me, he wasn’t impressed either.  “I don’t know, man,” was about all he could say.  “I don’t know.”

He eventually did turn to face me.  It had been Afghanistan, I finally learned–that, and a quite, quite complicated life pre-deployment.  Bad, the whole scene, really bad.  He just couldn’t take it any more, the waking up screaming, the never-ending newsreel of blood and body parts in his head, the absolute certainty that it would never end, that it never should end, given what he’d seen, what he’d done, halfway around the world, just the other side of town.  He wasn’t going to kill himself, or at least not really.  He just didn’t care.  About anything.

His family had brought him in.  I sat with them for a good half-hour or so in a secluded corner of the waiting room.  I still can see his father, fighting back the tears that he was too worn out to hide:  “We just don’t know what to do.  I love him more than anything, but . . . we just don’t know what to do.”

When I went back to the patient and told him what his family had said, he looked genuinely shocked.  “You mean they’re still here?” he asked.

“Yes.  They’re worried.  Big time.”

Wiry and strong as he was, he dropped his head and began to cry.  “I’m so terrible to them,” he finally whispered.  “They love me so much.  I don’t deserve it.”  Slowly he raised his head.  “OK.  I’ll stay.”

By the time all the admission dog-and-pony show was over, it was about 1AM.  I was about to head out of our inpatient unit when I saw him sitting by himself in our day room, clad in the standard-issue hospital pj’s, staring at the floor, strong, wiry–and anything but.

All right.  I’ll confess it to the entire world.  Here it goes, ready?

Sometimes the Dad in me takes a gut punch whenever I look at these guys, see that far-off look in their eyes, watch their slow breathing, their mouths slightly opened, with just enough shortness of breath to remind both of us that it can all be so tiring, life.  Death.  These are the sons and daughters of my peers.  Each one of them could have been mine.

There.  I said it.

It’s called “countertransference” in the lingo of my trade, the all-too-human feelings that arise in us all-too-human treaters in our all-too-human work.  It can be a problem.  It’s not always, not by a long shot.  It just happens.  I’m no neophyte to this.

Still, it had been a long night.  For him.  Strong, wiry, lost–him.

I went over and sat across from him at the table.  He looked up, a bit confused, even.

“You don’t have to stay, you know,” he said.

“I know.”  We just looked at each other.

I launched into my spiel, the one about feeling so intensely, so deeply that a group of men can almost think the same thoughts simultaneously, not quite knowing where one of them ends and the other one picks up.  About love.  About having a part of your soul ripped out of you when you realize your brother of brother’s not there any more, not even in one piece any more, never again to laugh, cuss, get drunk, stare at a computer screen, reading an e-mail.

“Were you in the military?” he finally asked.

“No.”

Once again, he looked genuinely shocked.  “So how do you know all this?”

“You guys tell me.”

It was his first smile of the evening, skeptical though it was.  “You actually listen?”

I wasn’t quite sure what to say.  I suspect I smiled as well.  “Yeah, that’s sort of the point, you know,” is what I think I finally said, something like that.

The smile disappeared, yet replaced not with a frown, but rather with this look of puzzlement that had a sort of “well, who’d-a thought . . .” quality to it.

“Thanks, man,” he finally whispered.  We shook hands.  I went home.

It’s been a long road since then.  Really long.  Good stuff.  Not-so-good stuff.  He’s told me more than once:  “I think about that night a lot, you sitting there with me at that table.  I really do, man.  I really do.”

It had been a while since I’d seen him.  Stuff.  Not-so-good kind, at least recently.  He looked good, though, better than I’d seen him in a while.  He was so proud of himself, of all the work he’d been doing trying to get his life together, of his dreams to help other veterans.  He was wearing a well-worn Indiana University soccer outfit, still strong, still wiry.  He has one of those “Yeah, I know, I’ve been bad, but you still like me, don’t you?” smiles.

He’s right.  And he knows it.

He handed me a CD.  “Here, man.  I want you to have this.  It’s pictures, from Afghanistan, different stuff.  Just us mainly messing around, you know.  Not really any combat.  I just want you to have it.”

“Thanks.”  I took it.

After he was gone, after I’d written my encounter note, I opened up the D: drive of my laptop and pressed the CD down into it.  My photo program opened up the first picture.  He  was lying on a cot, shirtless, clearly just waking up, clearly not that impressed with the photographer.  I hit the slide show button.

My photo program eases one picture into another, like moseying along through the family album, giving you a few seconds to prepare yourself for the ridiculous look on whoever’s face is about the grace the screen, a sort of retrospective, “This Is Your Life” quality, know what I mean?

It was his smile.  Over and over.  He’s quite photogenic, actually.  Combat fatigues, physical training outfits, swimming trunks, goofy T-shirts, posing with local troops, robed men at fancy hotels, cute kids, even with President Bush, no lie.  There was this family wedding picture.  He was in a tux, holding what looked to be the ring-bearer, his hair slightly longer than Army-issue, sun-bleached just enough.  Went well with the smile.  The whole look.

I didn’t cry.  Yet there was something inside me, that Dad something again.  It’s a sincere smile, his is, one of those “you gotta love me” types, one of those that says–not shouts, mind you, just says–“Here I am, world.”  Here I am.

God, I wish he didn’t know what he knows.

Please, dear God.  Let him find peace.

Until tomorrow, be well,

Doc

Heroism and a Different Veteran

 

Doing What It Takes, In a Moment, In a Life

Today, I move away from combat veterans, but only in a literal sense. For in a more figurative sense, if we speak of those who are willing to serve through thick and thin, but even more who are willing to react to the unexpected horror of the world in ways that, without thought, move toward others rather than away from them: if we speak thus, then we’re not heading into new territory whatsoever.

Today I write in memory of a fallen hero, not in a far-off desert or mountain range, but in a suburban schoolyard

Today’s article is from The Washington Post, and it is entitled, “Talking About a Legend”: Indiana School Principal Dies Saving Children in Path of Bus.”

For twenty-two years, Susan Jordan was principal of Amy Beverland Elementary School, located on the far northeast side of Indianapolis, Indiana, USA. In those years she held together a faculty and a student body of diverse ethnicity and class, creating a community of “Amy Beverland Stars” that not only sheltered and empowered children through their pre-teen years, but well into their adulthoods and their own growth into parenthood and caretaking.

On Tuesday, January 26, 2016, mid-afternoon, at the end of another school day of announcements, lunch lines, and recesses, as students ages six through twelve were loading into buses or waiting for parents outside the building, Mrs. Jordan was where she always was, stewarding the hyper and the worn-out, the gabby and the sullen, all toward home, with a smile, a hug, a pat on the back, even an occasional high-five.

Suddenly a bus shifted into gear and lunged over the curb, toward a group of children. Mrs. Jordan lunged in response. In seconds she managed to push away all but two of the children out of the bus’s path. Those two children, ages 10, were seriously injured when struck, but are alive and will return one day to school.

For Mrs. Jordan, Tuesday became her last day of class.

The school district’s superintendent later that day called her “a legend.”

For my two younger children, now young adults, from the first day they stepped off a bus into the first grade until the last day they stepped onto one at the end of fifth grade, she was just “Mrs. J.”

From August 2001 until May 2008, I saw Susan Jordan at countless assemblies, concerts, fundraisers—and daily school pick-ups. A good ten years my senior, she had energy and enthusiasm that put me to shame. From the very beginning she knew my daughter and son by name. She even remembered regularly to ask about my eldest daughter, after she had, in 1999, steered us to send our first-born to another elementary school across the township because she knew “that would be the perfect place for her.”

We use the word “hero” so freely these days. Combat veterans are loathe to accept it. I have no doubt Mrs. Jordan would have felt similarly.

Yet in so many ways the heroic is heroic precisely because, when truly lived, it is so mundane. Hour by hour, day by day the future hero makes decisions as to how and where she will focus her attention, her energies. She scouts out what she values, whom she values, adjusting her gaze onto familiar patterns, attuning her ear to familiar sounds.

Then in that horrible moment, it happens. Connection happens. Love happens. No thought, just motion, motion toward a future for others, whether or not it ends the future for oneself.

I salute you, Mrs. Jordan. If I may be so bold, on behalf of all the combat veterans whom I have served and whom I will serve until my own time comes, I salute you again.

On September 11, 2001, you stood at the door of your school and reunited my worried wife with my confused, seven-year-old daughter. In the years since, you oversaw the education of hundreds of children who had to learn about writing and multiplication in a world that no longer was so easily ignorable by comfortable, suburban Americans. You guided children through the deaths of classmates, through the dissolution of their families, through their own medical illnesses. You created an atmosphere of warmth and rigor that supported my children’s teachers to become the finest that they were.

You were heroic, in the most commonplace of moments, in the most extraordinary.

From all of us who knew you, from all those who serve their fellow citizens in places of greatest danger precisely because of heroes like you, thank you.

From my family, from me, thank you.

Rest in peace.

Until tomorrow, be well,

Doc

One Brave Voice

Silhouette of a soldier against the sun.

Not Politics, But Truth

Listen to Podcast of Blog Entry:

 

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

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

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

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

I will let Mr. Bethea speak for himself:

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

He then wrote:

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

Then:

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

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

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

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

He ends his piece this way:

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

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

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

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

Until tomorrow, be well,

Doc

To learn more about Voices from War

click here.

Bird’s-Eye Extreme

Silhouette of a soldier against the sun.

Look, Ma, I’ m Flying!

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

But what most attracted me to this organization?

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

The organization is The Bird’s Eye View Project.

Get ready.

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

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

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

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

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

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

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

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

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

Until tomorrow, be well,

Doc

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