An IED on the Rocks, Please, With a Twist

It’s been a long month of starting new jobs, new high schools, new colleges, new furniture settings, along with Lord-alone-knows-what-new-else’s. My wife has sworn on all that is Holy that she will never again gaze upon, let alone touch a Banker’s Box. I have to concur. We’re just hoping against hope that 1-800-GOT-JUNK has a franchisee somewhere within fifty miles of us.

But the blog kept calling, thankfully. Even more, so did the memories of the men and women whom I’ve had the honor to serve.

We weren’t supposed to have met, for example, he and I.

As I was finishing my last couple weeks at the VA in Indianapolis, I had made a pact, I guess you could call it, with the nursing staff not to take on any new patients. It had seemed only fair, after all, given my then lame-duck status. All in all, I kept up my end of the bargain.

Except for this one time.

I’ll blame one of my other colleagues (and why not? I’m gone, you know). He was the one to knock on my door at about 1400h one day to tell me, “Doc, you’ve got to see this guy. I know you’re leaving, but it’s bad.”

When I walked out my door, I saw in the waiting room a young man sitting about twenty feet from me, his hands gripping the sides of his chair for dear life, staring off to his right, my left, God-knows-where, having clearly been doing so for God-knows-how-long, given the tone of his forearm musculature. His shaved head accentuated his angular features, his gymnast’s posture and physique. He was wearing the nondescript dark shirt and dark basketball shorts that so often these days are the “just rolled out of bed” uniform of choice for men his age.

That would, of course, have assumed that he’d slept at all the night before.

“Sure, I’ll see him,” I said.

It’s been a good couple months now since he and I met, so many details have faded in my aging brain. His life had been falling apart, though, pain pills, the usual. His wife had had it. His family had had it. He’d managed, however, to get hold of some Suboxone (the opioid substitution medication) on the street, and he knew that if he could just take it regularly, he wouldn’t wake up every day obsessed with finding the next pill, given that the “next high” had long before been a luxury that had, through the miracle of the body’s ability to adjust to the effects of opiates, faded into distant memory.

He had, in other words, become part of that elite group that uses opiates not for fun, but for survival.

He was doing all he could not to be irritable with me. I assured him I wasn’t offended by his periodic failures in that endeavor. Clearly he was dope sick. At times I could practically map the waves of nausea as they progressed from his gut, cell by excruciating cell, throughout his body.

What I can never forget, though, is one line of his story.

“They called me the ‘IED magnet,’” he told me. “Thing was: I was always the one who lived.”

Many others—and I mean many others—had not been so fortunate.

Neither can I forget his intensity as he told me his tale, an intensity only somewhat heightened by the strength of his withdrawal symptoms. He had the gaze that I’ve come to see so often in many young combat veterans: one both hollow and piercing, as if the ocular orbit out of which these veterans peer seems suddenly to project a rocket-propelled grenade of psyche straight toward my own eyes, no warning, no mercy.

But when I started to talk to him about combat trauma, he could only say, “Please. I’m sick. Can we just talk about that later?”

He agreed to come back a couple days later, although because he was having such difficulties getting along with his family, he was not sure he could find a ride.

But he did.

He returned in garb just as collegiate, but now more appropriate for a grueling one-on-one at the basketball court, rather than for a semi-stupor on the pull-out couch in the living room, sheets not included. His gaze had followed the lead of his garments: more lively, more suave, even.

“This stuff is amazing,” he said to me. “I feel like a human again.”

And, indeed, he was acting like one.

That was not, however, comforting me, I’m afraid.

For again, although the details fail me all these weeks later, the image does not: his sitting there in the chair in my office, one ankle calmly pivoting over the other knee, opining at length about whatever, his child, his failing marriage, the war.

Note: I didn’t just write The War. Just . . . the war.

Similarly, I also cannot forget my own experience at that moment, my sitting there, watching him, listening to him, wondering over and over and over, with his each calm explanation, his each pensive musing: “Wait a minute . . . was I . . . was he . . . am I missing something? Did I overreact the other day? What the . . .?”

Finally, I had to speak it.

“I’m sorry, but . . . I can’t help but notice that you seem to be talking about The War almost as if we were sitting over cocktails in smoking jackets, chatting in British accents about some ‘dreadful little incident, you know, old chap?’ I mean . . . if I hadn’t met you a couple days ago, right here, in this room, if I hadn’t sat in this very chair and felt you say those words—‘IED magnet’—why . . . well, I’d think, ‘This guy’s doing just fine.’ But . . . I know better.”

For a moment, he said nothing. I said nothing. His eyes, however—and I suspect mine as well—picked up all the conversational slack, for how long, I can’t tell you.

“And so do you,” I finally said right to him, intending it just as tersely as I’d said it.

Our eyes continued to speak to each other, although saying what, I couldn’t have told you.

“Am I right?” I eventually asked. “Or am I overblowing all this?”

Ever so slowly his ankle slid off the opposite knee, his leg just as slowly planting its foot back onto terra firma. Not a cell of the remainder of his body moved. Including his eyes.

“Yes,” he finally whispered. “You’re right.”

Another silence.

“You know,” I said (more like stammered), “when you’re like this, you really hide it, the pain that both you and I know is there. I mean, you’re good, really good at that. No one would ever suspect—unless they knew already, of course. But even then . . .”

He assayed a smile, though all other cells, again eyes included, remained motionless.

“I know,” he said. “But I don’t know how else to do it, to say it, whatever ‘it’ is, you know? I . . . I can see that people want to know that it’s all right, that I’m all right, that the past is the past, that it’s done. So . . . I give them what they want.”

“And then they blame you for being a loser drug addict, right?” I replied. “Since they’re assuming you’ve put all that War stuff behind you?”

Slowly the cells began to shift within him, easing him into a sadness that was only slightly perceptible, yet, for any who would dare look for it, readily discernible.

“You do what you have to do,” he finally said. “You protect them, even when they don’t know it. Goes along with the territory.”

I was not about to let him off that easily.

“Your good looks and your charm are your greatest asset and your worst enemy, you know that, don’t you?”

The semi-smile returned as he inched forward in his chair and then slowly stood up.

“You gave me something to think about today, Doc” he said as he offered me his hand. As soon as I’d shaken it, he turned to walk out the door, only to stop, turn back, grab me one more time with those eyes, and simply say, “Not bad, Doctor. Not bad at all.”

I can’t tell you the number of times I’ve thought about that man in the intervening weeks, how many times I’ve realized that I’ve met him many times before, in that veteran that one time, in that soldier now. So many civilians have no clue whatsoever how sharp, how perceptive many of these men and women are. So many assume that people go into today’s military to escape rotten childhoods, to find something to do with their lives that are going nowhere, to get three meals and a cot that they’d otherwise not be able to put together enough intelligence and common sense to provide for themselves in any reliable fashion.

How wrong, how utterly wrong they often are.

How often I also hear the “twenty per cent” number thrown around, the “official” estimate of the number of returning OEF/OIF veterans who are suffering from combat trauma/PTSD. Occasionally you’ll see a “thirty” pop up here and there, but just as often you’ll read of very smart people marveling that the “rate” isn’t higher than it is, thank Goodness.

Perhaps they’re right. I’m just a country psychiatrist trying to make a living, after all, as one of my former supervisors used to drawl.

I guess if one never asks to take a sip out of the drinks that others are pouring down their throats, though, one never has to know whether those burns making their way down those esophagi are stings of delight or, shall we say, stings of a much, much different toxicity.

Oh well, what you don’t know doesn’t hurt you, right?

I hope that somewhere tonight he is feeling more peaceful.

I wish I could be more hopeful in my hope.

God, be with him.

A Goede Hombre

I received the text earlier this week, at 1404h, Central Daylight Time, Tuesday, July 2, 2013, a picture.

He looked great, wearing what appeared to be a simple, black suit/tux, sporting with it a white, pointed-collar shirt, well-starched, and a formal black tie, half-Windsor knotted. I suspect the picture had originally been taken at his older brother’s wedding not long ago.  He had that certain “brother of the groom” air about him, after all: slightly annoyed to be all decked out on a day that wasn’t exactly his, yet pleased well enough all the same, knowing full well, of course, that he looked mighty fine in these trappings, if he did say so himself.

In the background was an American flag and the unmistakable emblem of the United States Marine Corps. He would, undoubtedly, have been far more proud of those than he would have of his handsome mugshot.

I have finally made the move to Nashville. I have finally found the time to sit quietly with my cup of Tazo Zen tea. I have finally found the courage to announce, again with the permission of his family, that on Friday, July 5, 2013, another fine young man whom I had the honor to serve was laid to rest.

He died early in the morning hours of my final day of service at the VA in Indianapolis. I learned of his passing late that afternoon. As had been Ethan’s death (Reporting for Duty, Sir), his had not appeared to have been self-inflicted, and it had come without warning. He had spoken to family and to his best friend mere hours before, in good spirits, looking forward to his and my final meeting together before my move, even more looking forward to plans for treatment and for a new chance at a life perhaps less pain-filled, definitely more hope-filled.

He was buried in a community far both from my former home and my new one. I had a couple chances to speak with his mother. I asked her to convey my sincerest condolences to his father, his brother, his grandfather, and all those whom he had loved and who had loved him.

I did not, therefore, hear “Taps” a third time in as many months. Yet as I sit here, watching the Cumberland River quietly drift by me, ferrying branches big and small toward destinations perhaps just around the bend, perhaps miles away, with the occasional speed boat barreling by, ferrying revelers trying to swig down one last Miller Lite before heading back to post-Fourth of July reality, I can so easily imagine a bugler standing on the shore opposite me, looking me directly in the eye, nodding, lifting his instrument to his lips to announce not only to me but to anyone else within earshot that another who tried the best he could to do the best he could has departed us, only then, after the fading of the last note, lowering that instrument, tucking it under his left arm, raising his right hand in that four-count salute rendered only to those who deserve it, holding it, lowering his arm in another four counts, then looking up at me, nodding, and finally with a sharp about-face, turning to walk away from the bank, into the trees, into the memory and the imagination from which he had come.

My patient—let’s call him “Kurt”—came from a successful family of international entrepreneurs, his father’s lineage Dutch, his mother’s, Hispanic. He’d attended the finest of schools as a boy, a teenager. Easily he could have attended the finest of universities after that. He was smart, multilingual, bearishly handsome, affable, after all: Cambridge, New Haven, New York, Princeton, all would have gladly welcomed him, no questions asked.

But this boy had an energy that only the Marines could handle.

He was so proud of his unit. He had given me a copy of its insignia, all ready to be mounted on my rear window should I have so desired (and with his full permission, I might add, implying that such would have been enough to get me through any subsequent interrogations by fellow Marines as to why I might have been claiming  the right to be lollying around town with such an honored accouterment).  He was a Marine’s Marine.

Thus, he never forgave himself for the training incident the week prior to his deployment, the one during which his right arm was so shattered, he finally had to lose one bone altogether in order to preserve whatever function allowed to him, the one after which he was separated  permanently from the other two men on his team whom he’d come to love more than Life itself . . .

From the other two men who—along with Kurt’s replacement, less prepared than Kurt had been—died only weeks later in an IED explosion that Kurt, to his final moments, I’m certain, believed with his every living cell that he could have avoided had he been there or, at the very least, he could have endured with his friends together, one final time.

From that point on, Kurt’s life was embedded within pain. He had to take pain medications at levels that still cause me to tremble at the very thought. He endured constant nightmares of a vicious home invasion he had survived as a youth—with night after night after night of such nightmares ending with his escaping (which, in real life, he had), while his Marine buddies, captured in the dream, were slaughtered by the intruders, over and over and over again.

Yet, there was not always pain between us.

The day had not started out well, almost two years ago, now. His pain had been  so acute, he was considering suicide. He refused to stay in the hospital. I refused to let him leave. It was tense, to say the least. Finally I had to call the VA Police to stand watch outside my office as I arranged the admission in the secretary’s office next door.

Then I heard it.

“Hey, Doc!” came the policeman’s voice, not exactly panicked, but not exactly calm either.

Good God, I could only think.

“What?”

“Uh, sir . . . I’m not quite sure how to tell you this, but your patient just jumped out your office window.”

I kid you not.

Now, fortunately, it was a first-floor office. Yet it was still a good six-foot drop.

I had barely turned around before seeing said policeman zoom around the corner, heading toward the front door of the building, the words he’d been  shouting into his walkie-talkie lingering behind him like an ether cloud, as sound apparently could not travel as fast as that man was moving. I’ll never forget walking up to my office, by this point all alone (since all others within fifty feet had made similar dashes around said corner), only to see my office window wide open.

I’d not even had a clue that the window could have been opened.

But that’s not the best part.

Within five minutes, Kurt marched right back in, now accompanied by three policemen and a host of other witnesses, with that same nonchalant look that, come to think of it, he’d shown in that picture from his brother’s wedding.

“What happened?” I asked (a stupid question, I know, but I couldn’t think of anything else to say).

“I needed a cigarette,” he told me, as calmly as all get-out. “The cop said I couldn’t go out to get one, and I knew I couldn’t smoke upstairs in the hospital, so I just decided I’d find me a way to get one more cigarette while I still could.”

I do so wish there had a been a picture of my face at the moment, given that my memory of his face was that he was still struggling to figure out what all the big deal was about.

“Are you kidding me?” was all I could say, standing there, as I was,  in front of a good half the Hospital’s police force, along with God and all Nature, to boot.

“He’s not,” the original policeman chimed in. “Really. By the time we got out there, he was just standing there, putting his lighter back in his pocket, taking a few puffs, asking us why we were all so upset.”

Kurt just smiled. “I told ’em I just wanted to smoke a cigarette. I guess they didn’t believe me.”

I repeat: kid you not.

I swear to God, also: by the next day I had so many environmental engineers swarming into that office, I’d have died hermetically-sealed in said room should any disaster have struck thereafter, nuclear or otherwise. I wonder if, now that I”m gone, Homeland Security is using it as a holding cell for those too dangerous for Gitmo.

One of my other patients, a former Marine officer, had heard the “Legend of the Jumping Marine” somewhere along the way (who hadn’t?), and I’ll never forget the smile as wide as the nearby White River when he spoke to me about said affaire mémorable.

“Now that’s a Marine, I tell you. You tell them to go take that hill, and they ask you ‘How many times, Sir?’ You gotta love ’em.”

Indeed, you do.

So I sit here, now sipping San Pellegrino, and I ask myself, “What can I say?” How can I honor him in the same way that phantom bugler did only a short time ago, disturbing the peacefulness of the river in my mind’s eye not so as to upset, but rather so as to remind, to call me to remember what it means for some men and women to choose to accept a life that they were not forced to accept, to choose to face risks that many of us would have preferred that they not have faced, whether for reasons of love or for those of ideology

I can only do so at this moment, I believe, by honoring his pain, honoring it so that others may know the depth of his suffering, honoring it so that others, perhaps, can begin to know something of the sufferings of many, many of his brothers and sisters who have served in combat, who entered War and left War with a capacity for emotional power that few had allowed themselves to realize before, let alone even to accept now.

With each passing day, with each troop or veteran I meet, I become more convinced that many, many civilians simply cannot begin to fathom the physicality of the warrior’s emotions, whether that warrior be a man or a woman. Granted, there are some civilians (more than a few, I might add) who are “warriors in spirit,” who can indeed find themselves caught up, sometimes quite frequently, in similar depths. Yet most civilians, I assert with solid confidence, must learn the following formula and apply it, whether they think they should have to or not:

Take whatever emotion you have ever felt in your life—joy, curiosity, grief, rage, anxiety, sensuality, shame, whatever—localize it in your body, and then imagine it now crashing down into your gut with a force that draws your every inner organ into it like some whirlpool out of Hell. Then repeat, shoving all of it down into that whirlpool even more deeply. Then repeat. Eight more times.

By the time you hit Whirlpool Ten, you’ll be close to the emotional experience of the Warrior. Not there. But close.

I have yet to meet a troop or a veteran who has not known, full well with bells on his/her toes, that he or she was going to have to “Move On” from his/her wounds of the extremities, of the brain, of the soul.  That’s never the issue, no matter how many times, no matter who adds the adverb just to that phrase, as if somehow the person uttering such nonsense were finally giving said troop or veteran the psychological equivalent of a reminder that s/he could have also had a V-8.

It’s never about “moving on.” It’s about what one has to drag along, from the very depths of one’s soul, whenever one does move on.

Everyone has experienced gut-wrenching emotions. Not everyone has had to experience such emotions every single time that door marked “Emotions” is opened, even when one is desperately, desperately hoping that the last five loads of psychic lumber with which you’d tried to nail that door shut will hold, please, dear God, please.

I sometimes read “pain experts” pontificate about the “psychological overlay” of pain as if they were finally giving us the news that we’d never considered and that will now finally open all of us to the Promised Land of the cognitive. I know about all the evidence. I know about all the good intentions of all who have so published in the journals, opined in the op-ed pieces, spoken to the cameras in the well-orchestrated segments of the latest news show, the latest radio spot.

Yet Kurt’s grief over his fallen buddies, his shame over his injuries, his anxiety over his future: they so Hurt with a capital H, so overran his biological pain receptors with the same ferocity, the same violence with which those intruders had once overran his boyhood home, he had to sweat with psychic blood every ounce of hope that he was able to earn. Hope, for him, was a hill that made Iwo Jima look like Kiddieland.

But he always asked me the same thing, every time, every time: “How many times do you want me to take it, Sir?”

How many times.

Until the day you have been able to imagine your whole body being wracked with an emotion so powerful that it brings you to your knees, always figuratively, often literally, with each sunrise; until the day you have been able to imagine the courage it takes to rise up, under such circumstances, and walk ten miles or, maybe, just take the dog out; until the day you can feel your most powerful emotion in your most painful of spots and can then say to yourself, “Oh, my God: do you mean it can feel worse than this?” and know that there are men and women out there in their teens, in their twenties, thirties, forties, fifties, sixties and beyond who can answer a resounding “Yes!” while trying not to relive, yet never to forget horrors and truths that, hopefully, you’ll never even have to imagine imagining—until then, please, please, please: never speak to a troop or a combat veteran the equivalent of the English words, “Move on.”

My title, of course, is a polyglot admixture, the Dutch goed with the Spanish hombre, the admixture of “A Good Man,”  the admixture that was Kurt, the admixture that could have taken a much easier road, but whohad refused to do so, the admixture who so many times had wanted to give up on that hill called Hope, so far from Bill Clinton’s Arkansas hometown of the same name, the admixture who had many, many times stumbled and fallen as he’d tried to take that hill, the admixture who had nevertheless kept trying, kept trying, semper fidelis to the end.

As with Porthos, as with Ethan, I have not earned the right to salute you, Kurt, my friend, as that bugler did in my mind mere minutes ago. So I can only give you what I gave them, unfortunately only in the Spanish of your lengua maternal and not also in the Dutch of your paternal tongue.

But do know that if  I could have spoken both languages, I would have. As always, Kurt. As always.

El dolor ha pasado, Kurt. Duerme siempre en paz.

The pain is over, Kurt, hallelujah. Rest in peace.

The Tattoo Graft

Even though I had promised to break my blog “fast” with reflections on the Boston Marathon bombing and its aftermath, Life led me elsewhere. Thankfully.

I have known him for a while now, this former Special Operations soldier. He had seen—and more, had experienced—more than his share of horrors in the Middle East, often accompanied only by a few men who eventually came to mean Life itself to him. “Brothers” finally took on a meaning that previously he’d only dreamed of.

There were those who didn’t make it back.

He struggled in the years afterwards, making some attempts at treatment, but finding none that he found that useful. Drugs, especially painkillers, became his constant companion. He knew he was wasting his life. Finally he faced a severe medical crisis. He came home to Indianapolis to seek the medical treatment he needed—and even more, to find a reason to keep on living.

The medical treatment, he received. The painkiller problem remained, however. And thus we met.

At first he was probably more eager for Suboxone (the opiate substitution medication) than I was. His medical treatment had taken a lot out of him, after all, and he had very real reasons to have very real pain. While Suboxone is sometimes useful as an analgesic, it has not been, in my experience, the best painkiller that has found its way onto the planet. I urged him to hold off, to have us work together first to keep his pain medications steady, on a schedule, controlled, until he could recover further.

During those initial weeks he laid out his story of War. Even when hurting, even when on pain medications, he was quick-minded, analytical to the max, a strategist par excellence, just as he had been in the military. Yet at the same time, in a way unusual for men as gung-ho as he, he was unafraid to acknowledge his more disturbing emotions, his fears of never getting better, his grief over buddies never to be seen again.

“I’ve played around with this too long, Doc,” he eventually told me. “I’ve just got to get my head together, my life. I can’t keep going like this.”

Indeed he couldn’t. I suspect he’d always been on the wiry side, but both his medical treatment and his drug usage had left him a bit less imposing that he certainly once had been. His curly hair was of a length far afield from the judicious cuts of his military days, no doubt: neat, clean, true, yet in a certain way more an afterthought, as if the rest of his body was having to work long past quitting time to keep the legions of locks on his head from tipping him over sideways.

Eventually he started the Suboxone. It was indeed helpful.

But nowhere near as helpful as the woman he met one fine day.

I walked out of my office one afternoon to find a man sitting in the waiting area whom I’d never met, his long, jeans-covered legs comfortably stretched out a good mile and a half into the center of the room as he sat askew in his chair, perusing some cheap magazine from off the table next to him, his hair cropped stylishly short, his entire musculature at parade-rest, I guess one could say, both at ease and yet, what, ready, just in case. The man looked up at me, smiled, and shot a quick wave.

It was he.

“Sorry,” I said once we’d made our way to my office. “I didn’t recognize . . . well, the hair!”

He grinned. “Oh, yeah: got tired of it hanging all over the place, I guess.”

“You better believe ‘I guess,’” I replied, impressed by how the cut made him look both older and younger simultaneously, more seasoned, yet more daring.

“I think my girlfriend likes it better like this,” he said as he folded his hands onto his lap, sliding himself down into a just-hanging-out-here slump that was anything but sloppy.

“So all’s going well with you guys?” I asked.

“Oh, yeah, real well,” he answered, as if that were so old-hat news he’d not even considered I might ask such a dumb question. “Her kids are great. I . . .”

Then he stopped, for moment staring right at me, but at the same time right through me, not in that way that gives one chills, but rather in a way that seemed to advise me that even if he were to speak further, our conversation would not be resuming any time soon.

“You know,” he finally whispered, “I . . . I was really afraid that I’d never find love, that I was too screwed up. I couldn’t ever get women to listen to me. But that’s what she does: listens. She doesn’t freak out. She just . . . listens. I feel so safe with her, steady, like I haven’t felt in I-don’t-know-how-long.”

After a few seconds, he returned his gaze back from wherever to me. If a smile can be calm, his was.

“What a good thing, eh?” I could only respond.

“Yes, sir,” he said. “Yes, it is.”

Sadly, in the world of modern combat veterans, calm smiles often last only so long.

It was a few weeks later that I received word that he was wanting to speak to me right away. Fortunately I was able to see him later that day.

The news was not good. His battle buddy, the man “closer than a brother “ to him, had just committed suicide.

“I . . . I had no idea,” he whispered to me, doing everything a good military man can do to maintain the composure that was anything but his. The two of them had been in continuous contact. They had spoken only a few hours earlier. There had been problems in the man’s life, true, but . . .

“We . . . we survived so much, he watching my back, I, his,” he continued. “ How . . . how?”

He went to the funeral, of course, faithfully watching over his buddy’s widow in the very way he knew the man would have done had the roles been reversed, had it been the ever-patient, ever-listening woman at his side who would have received the folded flag.

“I did OK, Doc,” he later told me. “Except when they played ‘Taps.’ I lost it. I just . . . lost it.”

The months passed by. He found a job. He had to in-out a few appointments, assuring me that he was doing OK, not great, but OK. Then recently he came in, collapsed in the chair by my desk, and gave me that look that I’ve seen from so many veterans with whom I’ve had the honor to work: the “yeah, Doc, the jig’s up” look.

Time to be gentle. Time to be real.

“Not good?” I asked.

He shook his head, his at-me/through-me look back. “I can’t sleep,” he replied. “Nightmares, constant thoughts about what we had to do, what we saw. I miss him like anything, yet I could just kill him if he weren’t dead! Is that a terrible thing to say?”

I had to smile. “It’s true, though, isn’t it? You’d like to smack him up the side of the wall, and yet you’d like to hold on to him as if there were no tomorrow, all at the same time, right?”

His smile in return was pained, no longer calm. Yet it was still a smile.

“You better believe it.” After a few moments, “Will this ever end?”

Again, the question I hear day after day after day.

“Will a certain sadness, a certain pain never end?” I reply. “Probably not. Probably shouldn’t. But it’s like I tell all the guys: the pain doesn’t have to hurt like this. Even though you know this all happened in the past, your brain is still experiencing everything as if it were happening right here, right now. You’re reliving it all, not remembering it. Once you can get from relive to remember, it does feel different, easier in a way—not easy, but easier, in a meaningful way.”

We talked about his various treatment options at the Clinic, both individual and group. He was certainly interested, yet his work schedule did make regular attendance at therapeutic sessions complicated. Still, he told me, “It helps to know I can get better. Thanks.”

Then came last week.

He’s gained some of his bulk back. In no way is he small. He’s more agile: not wound tight, ready to spring, but more ready to dart, stealthily, sort of like the Road Runner with good upper-body strength.

The calm smile was back.

“You look good,” I told him.

“Thanks,” he replied, almost shyly. “You know, I . . . I got a couple new tattoos a few weeks ago, and it’s like . . . well, I don’t know quite how to put it. It’s like . . . I’m better.”

“What happened?”

“Well, I had added two more, on my back. One has some initials, dates: for the guys we lost. But it was the one for my battle buddy, it . . . it changed everything. You know, it was like you said: I need to remember, not relive. I’ve joined this group of vets who get together and just talk. The leader of the group’s been great, got me to thinking, ‘what more could I have done?’ And like it hit me: nothing. I could have done nothing more. I would have done anything for him. He was more my brother than my real brother is. But I did all I could. I loved him like no one else. That’s . . . that’s it. That’s it.”

He said it all right to me. Gone was the right-through-me. Even after all the one-to-one we’d experienced together so far, this was five levels deeper. At least.

“You know,” I finally said, “if I could ask: what was it about the tattoo? How did it make the difference?”

The calm smile turned quizzical, not in a threatening way, more in a “now, isn’t that a question” way. He looked off for a bit, a few seconds only, then looked right back at me.

“You know, when he died, the moment he killed himself, he ripped a part of me right away, yanked it out. There was this big, gaping wound in my heart, my soul. You can’t know, Doc, you just can’t know how much he meant to me. He was hurting so badly, so badly, and I couldn’t save him. I don’t know what made me do it, but I just one day decided I needed to carry him on my back, the rest of my life. You know, it’s funny: it’s almost as if I needed to hurt to get him back, to feel the pain of the tattoo, to do it for him. And it’s weird: all of a sudden, when the guy was done making it, it was as if my buddy was sewn right back into me, filling that hole, like he’s going to be at my back, day in, day out. I walked out of that parlor and, I don’t know, it was as if a huge burden just rolled off me. I . . .”

He smiled again, not so much calm this time as, what, thankful. Tearfully thankful. His water-rimmed eyes ever slowly reached out and took mine in their grasp, not forcefully, but confidently. Sadly, but confidently.

“It’s like you said, Doc,” he whispered. “I don’t have to relive. I can just remember.”

The old psychoanalysts always talked about the psychic, emotional power of the skin, that millimeter-thick barrier that keeps us both whole and vulnerable, that both contains us and exposes us.

Yet for one wiry, analytical man who has finally found love, finally found the family who can accompany him into the future, his skin has also freed him, has put a past in its place, has grafted onto him a different, yet equally-powerful love that will link a well-loved past into a well-loved future and finally, as much as can be done after War, make him whole.

“Taps” and the Last Musketeer

It’s time to get this written.

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

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

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

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

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

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

Or . . .

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

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

For me?

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

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

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

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

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

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

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

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

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

So I made it.

I opened my arms wide.

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

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

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

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

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

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

“Of course,” I replied.

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

“Of course.”

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

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

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

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

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

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

It was Josh Groban.

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

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

Of course, Josh Groban. Of course.

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

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

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

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

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

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

Boundaries, schmoundaries.

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

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

Then it was his father.

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

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

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

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

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

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

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

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

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

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

From across the way the commands were barked.

Rifles clicked. Fired.

Clicked. Fired.

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

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

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

Porthos would have loved it.

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

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

And then it happened.

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

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

Athos handed Jack the flag. And he saluted.

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

Minutes later, the service was over.

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

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

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

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

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

“I know,” I replied.

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

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

He did.

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

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

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

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

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

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

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

“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.

In Memoriam, Porthos, 1985-2013

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

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

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

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

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

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

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

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

All I can say is: good for him.

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

“No trouble at all,” was my reply.

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

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

We’ll see each other tomorrow.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

It was horrible to watch.

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

I had to stop. Had to.

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

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

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

I do say so. And I do believe so.

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

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

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

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

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

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

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

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

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

Goodbye, my friend. Goodbye.

In Memoriam, Clay Warren Hunt, 1982-2011

I have been putting off this post for several days.

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

But it’s time.

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

How lucky a father I am.

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

On Monday, I did.

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

Hunt_Wide_620x350

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

God, how many times have I seen those eyes.

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

But then there are the days I see those eyes.

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

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

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

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

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

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

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

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

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

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

Dear Doc/Dear Winston, 03.03.13

Dear Doc,

Dear Mom and Dad,

Just another day in Iraq, waking up wondering if today is the day I get to meet the Maker at this fuckin’ place.

I put a bullet in clip with HOMIS written on the side of it. Was thinking about you guys today, wondering what you’re doing.

I couldn’t sleep last night. The mortars just wouldn’t stop. It’s almost comforting, hearing the outgoing rounds blast out of the 120 (120 mm mortar round HEDP) (High Explosive Dual Purpose).

I lay in my bed thinking about being a little kid again. Where did the days go? Life is different here. I would try to tell you how, but I wouldn’t know where to begin.

I miss my baby girl. I will kill them all to come home to that sweet, innocent little baby. My heart is so cold, and she is like a spark burning deep in my chest. How will I ever tell her what I did here? I tremble at the thought of holding her. She is the only thing that scares me in this world. My breaths shorten at the thought of her.

Please don’t hate me for what I have done. I had no choice. I wished and prayed they would just stop and give up. I think to myself every time I pull the trigger, “Why don’t you just stop. Please. Don’t make me shoot you.”

But after awhile it turns to hate; the thought of one bullet not going through his chest upsets me.

Hope all is well. Maybe I will get to come home soon.

Love,

Your Son

Winston

__________________________________________________________

Dear Winston,

I’m sorry that it has taken me a few days to get back to you: I have been traveling this week, and life got away from me (much thanks to Chicago’s O’Hare airport, I might add, the number one exemplar of “chaos theory in action”).

I have pondered this letter often, however. After four years of working with the men and women who, like you, once served in combat, I still find myself surprised at how unprepared—how reluctant, even—I can be to experience the dramatic shifts in thought and emotion that you and so many of your brothers and sisters experience, sometimes hour by hour.

To feel at one moment a love for a child, a nostalgia for a family time, then to feel at the next a hatred that can easily conceive of killing, only to be followed by a sincere, pain-filled desire for all the hatred, all the killing to end, all of this happening day after day after day, on a busy city street in an Iraqi city, at a quiet kitchen table at your home, enduring another sleepless night: I have no clue, Winston. I have no clue.

I do mean this: thank you for trying to give me a clue. I don’t like knowing what I have to know as a result of your having done so. I don’t like the gut shifts that occur within me as I read this letter, the psychic handball marked “raw emotion” that ricochets inside me, wall to wall to wall, the soul-imploding pain that I only dare to imagine to imagine as I consider, dear God, what if this were my son writing me this?

I’m sorry, Winston. I know that you volunteered to serve. But I, as a citizen of this nation, sent you to the Middle East with the promise that it would all make sense in the end. Nobody sent me to jail for refusing to pay the taxes that go to support the military.

I’m sorry that we, as a nation, are still not only struggling to make sense of it all, but, even worse, are struggling—why??—with the (what seems to me to be the obvious) notion, based on justice and mercy, that we owe you and your brothers and sisters. We asked you to give up your youth, give up the innocence that we still so easily cling to as we sip our morning, bad coffee and check out the local weather, all so that, indeed, we can make sure that we avoid the freeway jam to get to work, only then to pour ourselves another cup of even-worse coffee and gossip about the previous evening’s cable TV fare.

Thank you, Winston. I wish we all were living lives more worthy of the suffering that you and your brothers and sisters continue to endure, even last night, even now.

It continues to be an honor to work with you.

Doc

Dear Doc/Dear Winston, 02.25.13

Dear Doc,

I hate waking up and looking outside to see it gray and cold, rain setting in. It just feels like a day for a funeral.

I think about shit like that. When you have seen death like I have, it puts a damper on life, sometimes. You know that pain, the pain that hurts like hell, and you would do anything to take it all back or make it go away.

Well, after a while that goes away, but not mine. It stays and grows inside of me. It’s like I have hooks in my body and chains pulling at it all directions, and you can see fucking pain. You can see a little light at the end of a tunnel, but can never get close to it. And people keep telling you it’s all going to be okay, that they are praying for me and that they think about me and all that shit.

Well, I think about war, hate, life—why are we here? What is the purpose, or why do we continue to go on? You just keep going living in a life that is miserable. Why do I do it? I don’t know.

It’s hard when you want to live a life of war, filled with selfishness and anger. I now know why the Templars loved their lives, because they fought their whole lives and had God at the tip of their swords, striking down evil.

Winston

_____________________________________________

Dear Winston,

The writer Michael Howard wrote this comment on yesterday’s post:

“One of the real-life WWII characters I am writing about in my book survived Peleliu … In the early 60’s he would wake up his boy in the middle of the night to take him out on patrols. When I bounce the story off people who know nothing of PTSD, they tend to think it is fiction.”

Remember also what I wrote about you in Empty Chairs, Empty Tables: From Paris to Fallujah and Kandahar?:

“Yet also, had I not just spent the previous minutes with him, absorbing his words, not just hearing them, I could have looked at him and thought: grief that can’t be spoken? Seriously?”

In just these past two months, how our relationship has changed, hasn’t it? Gone is any distancing, defensiveness on your part. In its stead is the warmth, the humor that I know has always been you. True, if I pay close attention, I can notice still a hesitancy on your part, but quite easily I could chalk that up to the deference that a younger man can show an older man. Had I known nothing of you, I would have thought nothing of it.

Hence, my own words in that entry come back to smack me in the face:

“Just because a grief can’t be seen doesn’t mean that it can’t be spoken.”

Because of your willingness to speak your heart, Winston, I do so hope that at least a few more people can understand how the truism “Looks can be deceiving” can instead be a profound truth of combat trauma. Yes, a part of you wants to live a life of selfishness and anger, filled with righteous hate. Yet a part of you, night after night, searches for that little girl in your dreams, feels that pain of a father trying to heal the infected leg of a son, wants to understand why, why, why.

How appropriate perhaps it is, then, that you refer to the Knights Templar. Remember “Indiana Jones and the Last Crusade”? Remember the knight who stayed by the Holy Grail for seven hundred years, protecting it from those who would use it for their own glory and power?

The Knights were certainly no strangers to the atrocities of the Crusades, atrocities which continue to burn in the souls of Muslims and Jews to this very day. Yet somewhere there, within at least some of them, was a faithfulness, an honor, a duty that has lasted enough through the centuries to make a character in a fantasy-adventure film if not believable, then at least understandable.

I know that The War still can rage within you, filling you with all its annihilation, even its allure. And I know that you are there, perhaps, if I might say, a Templar in the best sense, one who has known all that War can do to a soul, one who wants to remain faithful to a vision that was good in its outset, even if complex and even destructive in its fulfillment, one who waits, hoping against hope.

That is the man whom I see.

Doc

Dear Doc/Dear Winston, 02.24.13

Dear Doc,

This pain that is inside of me will not go away.

I am so fucking tired. Some days I wish I would have just died alongside my brothers. I feel like they went the best way possible, killing the fucking assholes who caused this devil inside me.

It’s like a fire raging in my chest, and nobody can hear or see it. I ponder on the day I can walk into Hell and make those bastards’ lives even more miserable.

How do I continue to get up and live another day? Nothing makes sense anymore. The only thing I know has been taken from me, and now I’m left with scars and a constant state of paranoia and anger. I lay in my bed watching my trigger finger twitch, thinking of a way to make my heart pound like it used to.

I fear no evil. Death would be doing me a favor. HA!

And people . . . they are dust . . . people? Walking around with their faces stuck in computers and cell phones, playing their video games, talking about how they wanted to go to war, but couldn’t. Fucking pussies, if you ask me.

And people wonder why I stuck a needle in my arm and watched as the liquid went in and the pain . . . well, it just went away. The devil was at bay, and my mind at peace. WTF.

God sure has a plan for me . . . if You’re listening, come down and end this fucking pain.

Vibration from the 50 cal rattling through my arms. DIE, Mother fuckers, DIE! The smile of pure hatred pouring from my face. That’s living for those of you who know what I’m talking about.

Nothing ELSE matters?

Winston

_______________________________________________________

Dear Winston,

The power of punctuation.

It’s the question mark at the end, you.

We have no clue, do we, Winston, we civilians? It’s not only our computers, our cell phones, our video games that consume us, blind us. Our arguments, justifications, outrages: they do as well. We have so much to say about the War: “Support Our Troops!” “War Is Not the Answer!” “Thank You for Your Service!” We know why we should have gone to War. We know why we never should have gone to War.

We all want it to be so simple. “The Devil is on the outside: see what happens if we don’t go to War!” “The Devil ends up on the inside: see what happens if we go to War!”

You, your brothers and sisters: you are the ones who have had to face both Devils, one there, one here, both unrelenting, both demanding that you face a Reality right now—right NOW!—that the rest of us took a pass on, still take a pass on, whether with shame or with pride.

Dust. Yes, we all are, Winston: the brothers whom you lost; those who tried to kill you, who did kill them; the boy with the rotting leg; the father who risked a soldier’s ire to save his son; the soldier who writes late at night, hoping against hope that a doctor will not turn away from his rotting soul; the doctor who tries to reassure him, even as he has to cause that soldier some pain, that the rotten parts can indeed be debrided, that the living parts underneath can still become enlivened and enlivening once again.

Nothing ELSE matters? Question mark?

Thank you, Winston, that you are allowing me to find your answer to that question with you.

Doc

Dear Doc/Dear Winston, 02.23.13

Dear Doc,

It was just another day, waking up and getting ready to go on patrol, standing behind the truck, bullshitting with the guys, waiting on the op order. Early May in Iraq: it’s not too hot, not too cold, nice breeze blowing. The morning was great.

The lieutenant comes, giving us the brief. Time to mount up and get going.

My feet pressed against the bench, my body up out of the hatch, leaning back against the cases of ammo on the top of the truck. In front of me is the 240 Mounted, with the rounds fed into the chamber. It sits on a swivel, easy to maneuver and aim. I swing it around to my right side and leave it sitting tucked against my side.

Rolling down the road, dust flying, looking off into the distance, watching the road behind us, little kids run along the side of the road, hands in the air, yelling some bullshit you can’t understand. As we pull into the city, cars smash into each other, trying to get around us like they are in such a big hurry to go nowhere.

Watching the road behind me, there is a car that keeps getting closer and closer to the back of the truck. I wave the red flag and start yelling, but he doesn’t give a shit. I pull up my rifle and point it at his head, thinking he will get the picture. Nope, the dumbass just keeps creeping slowly up on us.

So I swing the 240 around, cock back the bolt, and get a round in the chamber. Leaning softly on the butt stock, pointing my sights at the front of his car, I squeeze the trigger and let a 10 round burst go into the hood of his car. He slams on his brakes as I lower the ramp.

Moving in formation, we come up on his car. I pull out my 9 mil and press the barrel to his fucking head and tell him “Etla oguf dishma ge inta to hal areid ah chic werack.” (Slowly get out of the car and come here. I want to talk to you.)

The man gets out and starts rambling on about how he needs to get his son to the doctor because he is sick. Well, I told him: get him out; my medic will take a look at him. The boy gets out; his flesh on his leg is hanging off the bone. Yellow puss seeps out of the burn. The flies cover it as they cut away at the flesh.

I have doc clean it up, cut away the dead tissue, and put creams on it. We give him antibiotics, bandages, cream, ibuprofen, and clean wraps. “Tell the man to bring his son by our base in 2 weeks, and we will take another look at it.”

He thanks us and invites us over for chai and dinner. We accept and arrange a day to come over. Just the simple choice to stop him instead of shoot him, and I became their hero.

But that’s just me. Thousands of soldiers make this choice every day, and they all aren’t heroes.

Winston

______________________________________________

Dear Winston,

I write this the morning after you and I have seen each other again, after you have talked of worrying about your grandmother’s health, of your plans for your daughter’s upcoming birthday. I am so glad that you have remained clean and that you and your wife feel more hopeful about your future.

I find myself thinking about you at the age you were when you were over there. I spent my early twenties in medical school. I was an emotional wreck, to be honest, although I did a fairly good job of hiding that from most folks around me (probably all, truth be told). I had a good intuitive feel for people and situations, but, honestly, that talent complicated my life as much as it eased it. I certainly saw my share of life-and-death situations, but I was always low on the decision-making totem pole, a well-educated orderly, for the most part. I did make some split-second, potentially-game-changing decisions, but I knew that within a few more seconds, someone older, someone at least slightly more experienced than I would be present to pick up the slack.

Odd, isn’t it, Winston: everyone from The New York Times to the Congress of the United States has—under quite the high-flying moral flag of “concern for others,” I might add—since then made darn certain that no other young twenty-something should have any such split-second moments in any hospital, any clinic, anywhere. Safeguards, safeguards, safeguards!

There are a lot of people, Winston, who are quite proud of themselves that they have succeeded in that endeavor.

But, of course, this is War, isn’t it, Winston? One panicked father gets the assurance that he’ll have an attending physician at the side of his son. Another gets the possibility that an unsupervised twenty-year-old will even allow him to exist with his son.

I have no clue whatsoever what I would have done at that age had I needed in that split-second not to decide whether a man’s breathing rate was worthy of calling a Code Team, but rather whether to fire a gun. Yes, I would have been trained well. Yes, I would have known the Rules of Engagement. Yes, I would have wanted to do the right thing, for my buddies, even for that man.

But I was so uncertain in life, so uncertain. I don’t know.

I can understand, though, why you might have mixed feelings about the word “hero.” I think I would have been with you on that one, Winston. No doubt.

Thank you again for your honesty. Thank you again that you force me one more time, one more day, to be honest with myself.

Doc

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