Following the Blasts

Silhouette of a soldier against the sun.

New Directions, New Possibilities

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

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

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

canstockphoto8184814

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

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

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

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

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

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

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

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

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

Until tomorrow, be well,

Doc

Two Kids in a Play Pool

Silhouette of a soldier against the sun.

And the Lives They Are Still Making

A blog post from the US:  meet Josh and Glenda Leary, from play pool until today. Meet reality. Check out “A Childhood Love Story Endures the Invisible Wounds of Combat.”

This is life in the world of combat veterans and their families.

Stories of young romance. Stories of “we thought it was going to be this, but it turned out to be that.” Stories of “Oh, by the way: you’re deploying. Get your gear.”

See you in a few months or so. Maybe.

Maybe not.

Stories of trying to make sense of it all afterwards. Stories of trying to live the non-sense of it all long afterwards.  Stories of both partners rediscovering what they have, at one level, known all along: that they both still have what it takes.

I wish Josh and Glenda well. They have learned something—or better, some things—about connecting in order to calm, engaging survival again and again, all to energize life.

And take care of the kids and the dogs. For another day.

Until tomorrow, be well,

Doc

To learn more about the blog’s sponsor, “Hope for the Warriors,”

An organization for veterans’ caregivers, click here.

Caring for Caregivers

Silhouette of a soldier against the sun.

Bravery in the Home

Out of Tampa, Florida, USA comes a piece about caregivers for wounded combat veterans, the ones who work to keep home places not only worth living, but thriving as well, “Patti Katter: Care for Caregivers.”

Simply put: my deepest admiration to all those who work to make the day-to-day lives of the combat veterans they love more meaningful and more worthwhile. Throughout the years that I have had the opportunity to work with wounded service members, far more than once have I had the opportunity to see in the eyes of those caregivers fatigue, fear–and yet enduring love/

Here’s to each of you

Until tomorrow, be well,

Doc

For further information about the Elizabeth Dole Foundation and its mission to “Caring for Military Families,” see this link.

Making Peace With Warriors (Abigail Deaton)

This morning my eldest, Abby, a rising junior at Goshen College, a Mennonite college in northern Indiana, requested that the following Gospel excerpt be read at our church, First Mennonite of Indianapolis.

The Gospel According to Saint Matthew, 8:5-13
King James Version, Authorized

And when Jesus was entered into Capernaum, there came unto him a centurion, beseeching him and saying, “Lord, my servant lieth at home sick of the palsy, grievously tormented.” And Jesus saith unto him, “I will come and heal him.”

The centurion answered and said, “Lord, I am not worthy that thou shouldest come under my roof: but speak the word only, and my servant shall be healed. For I am a man under authority, having soldiers under me: and I say to this man,’ Go’, and he goeth; and to another, ‘Come,’ and he cometh; and to my servant, ‘Do this,’ and he doeth it.”

When Jesus heard it, he marvelled, and said to them that followed, “Verily I say unto you, I have not found so great faith, no, not in Israel. And I say unto you that many shall come from the east and west, and shall sit down with Abraham, and Isaac, and Jacob in the kingdom of heaven. But the children of the kingdom shall be cast out into outer darkness: there shall be weeping and gnashing of teeth.”

And Jesus said unto the centurion, “Go thy way; and as thou hast believed, so be it done unto thee.”

And his servant was healed in the selfsame hour.

She then gave the sermon that follows below:

Average age is about twenty-one. Seventy-five percent are white; twenty-five percent are other minority groups. Most are middle to upper middle class. At some point in the term, they serve abroad, see things that they will never forget. They’ll come back with stories, with people, with memories forever in their hearts. And they never really come back the same.

That describes roughly the average student at Goshen College. But that also describes the average combat veteran returning from the recent wars in Afghanistan and Iraq. Granted, there are quite a few differences between a student at a pacifist college and a combat veteran. Our stories don’t tend to end with “And then I never saw him again,” for example. Our stories don’t tend to involve as much violence, as much death. Our stories don’t tend to leave us feeling as if our sense of peace and trust in humanity has been stripped from our very soul.

The number of veterans who will need to be treated for years because of the emotional scars of war has been labeled the major mental health crisis of our generation. More than 2.2 million service members have been deployed since the war in Afghanistan began. According to a study done by the not-for-profit organization RAND, twenty percent of those who have returned show signs of mental health problems. These mental and emotional scars ultimately lead to serious repercussions that forever change the lives of these warriors and their families.

If we are really called to be peacemakers, it is time for us to serve those in the service.

The most widely-known and commonly-diagnosed mental health issue among the military is posttraumatic stress disorder, or PTSD. In the past ten years there have been a total of 88,719 reported cases of PTSD in all branches of the military. The National Institute for Mental Health defines PTSD as “an anxiety disorder than can develop after exposure to a terrifying event in which grave physical harm occurred or was threatened.” The three common symptoms of PTSD are  “re-experiencing symptoms” such as intense flashbacks or night terrors; hyperarousal symptoms, which are essentially a heightened awareness of one’s environment; and avoidance symptoms. These symptoms come together to cause extreme anxiety. These men and women are having intense, horrific flashbacks and are also so aware of their environment that they can appear  paranoid. It causes them to become extremely anxious, angry, and fearful, and therefore they avoid people who don’t understand.

Other problems facing service members are traumatic brain injuries (TBI) and substance abuse. According to a Frontline report, over 400,000 cases of TBI have occurred during the recent war. TBI’s can cause an array of physical as well as mental and emotional problems such as lack of concentration and focus, self-control problems, and difficulty with mood changes, to name a few.

In the Time Magazine article “America’s Medicated Army,” Mark Thompson reported that over 20,000 troops are taking antidepressants and sleeping pills. Many times troops are obtaining psychotropic and/or pain medications without prescriptions. When they come home and are unable to obtain these prescription drugs, the withdrawal symptoms are so bad and the emotional pain so intense, they commonly self-medicate.

The wounds of war do not stay on the battlefield, but are often dragged home. In a recent study done by Dr. Steven Sayers and his colleagues, forty percent of veterans expressed feeling as if they were strangers in their own homes. Sayers also found that veterans with PTSD or depression are five times more likely than other veterans to have family issues. Combat experiences leads to a sixty-two percent higher likelihood of divorce. And according to a US Army report, over the past six years cases of child and spousal abuse have gone up 177 percent.

But the most shocking statistic is not of those wounded, but of those lost. The cover of Time Magazine for the week of July 23, 2012 was a picture of a soldier with the title, “One A Day” printed under it. According to the article inside, “The War on Suicide,” on average one soldier commits suicide every day. Since that article was published, 335 soldiers have committed suicide.

And those are only active duty soldiers.

Further on in the article, the author says that among veterans, a suicide happens every eight minutes. Since that article was published, therefore, the number of veterans who have taken their own lives has reached 6,030.

If every person attending the upcoming convention of the Mennonite Church-USA in Phoenix were to commit suicide twice, we would almost hit that number.

We have a crisis on our hands. As peacemakers, we are called to serve in times of crisis. So why are we just sitting here?

I understand that as pacifists, we are not always sure how to react to soldiers, those with whom we disagree on a fundamental level. But as peacemakers, we do not have the best record of being peaceful when it comes to dealing with warriors.

In 2008, Ernest Martin, a retired Mennonite pastor, wrote an article in The Mennonite [the church’s national periodical] entitled “Human Sacrifice.” The last paragraph of this article is as follows:

We hear of instances of soldiers intentionally falling on an explosive to save comrades. Risking life and losing life for the benefit of another follow the example of Jesus’ sacrificial love. But initiating, supporting and participating in human sacrifice for advancing personal, ideological, and economic goals is God-rejecting idolatry. Kyrie eleison.

For those of you who don’t know, kyrie eleison means “Lord, have mercy.” But my question is: why can we not show that same mercy? If a young veteran were to come up to you and say, “I saw my buddy die out there to save my life. Within split seconds I watched what was once a body, what was once a friend, a husband, a father, what was once a man turn into an unrecognizable pile of flesh and blood,”—I would hope your first response would not be “Sorry, but you know: it’s God-rejecting idolatry.”

Because if it is, you might as well be talking to Veteran Number 6,031.

It isn’t about them or us. It isn’t about patriotism or pacifism It isn’t about war or peace. It’s about people suffering and people serving. It’s about warriors and peacemakers. Take down those barriers and see the person on the other side.

My father is the inspiration for this speech. Four years ago my father started working as a psychiatrist at the Veteran’s Administration Hospital in Indianapolis. Day after day my father goes in to work to serve men and women no older than myself. And day after day he comes home with horror stories sketched in his mind, with tales he cannot tell us, with burdens to hold that were not his to bear. But he bears them—because he embodies the core value of being a compassionate peacemaker. On Goshen College’s website, it says that compassionate peacemakers “embrace ‘shalom’—the peace that God intends for humanity.” Day after day my father sees those who have lost their humanity and helps them find peace once more.

Jesus was approached by a soldier. But not only was he a soldier, he was a Roman. He was a Gentile. He was a warrior. The peacemaker and the warrior disagreed on fundamental levels.

The soldier came up to Jesus to serve his servant, to help his fallen comrade. And what did Jesus do in return? Did Jesus scorn the soldier? Did he ask him to leave the Army? Did he say, “I’ll give you grace, but only if you follow me?”

No. He looked at the man, amazed, and said, “Truly I tell you: I have not found anyone in Israel with such great faith.”

I’m not saying to go become a psychiatrist at a VA hospital. I’m not even asking anyone to go visit veterans at a hospital. What I am asking for is a change of heart.

I’ve been a nanny for two veterans. I’m a friend of several soldiers. And I’m a Mennonite for peace. I don’t think those contradict.

If you choose to befriend a soldier or welcome back a veteran, just remember to love with no strings attached. They aren’t asking you to change your views, so don’t go in trying to change theirs.

Eastern Mennonite University professor Lisa Schirch wrote:

When you start to love people you disagree with, everyone starts looking a lot more like a human being doing the best she can with what he knows and has experienced.

If you don’t feel comfortable doing any of that, then I ask just one thing: Stop seeing a military. Start seeing a person.

Kyrie eleison.

As a father, I admire my daughter, admire the woman she has become. I so look forward to the life that she is hoping to create. I am so thankful for every moment that I can have with her.

As a fellow Mennonite, however, my response can only be a direct, simple, and heartfelt one:

Amen, my sister. Kyrie Eleison. On all of us.

“Taps,” Déjà Vu

One week ago today, I again headed south of Indianapolis, seven weeks to the day after I had begun a similar trip for a similar purpose, all-too-sad, all-too-soon.

It was time to bury Ethan (Reporting for Duty, Sir).

Small-town funeral homes have a certain cross-similarity to them. Either they are restructured, early-twentieth century, Victorian-style homes far too small for their grand claims to shepherd one’s dearly departed to Glory, or they are unassuming, generic, one-story, brick-faced edifices that could pinch hit for a Knights of Columbus hall, if that ever were to turn out to be necessary.

Either way, you usually can’t miss them, GPS or no GPS.

As I did for Porthos’ funeral those weeks before (“Taps” and the Last Musketeer), I made my way into the parking lot, where I was properly tagged for the eventual procession (here, a rectangular, orange paper tag to hang on the rear-view mirror, sort of a souvenir, I guess you could say), and I then backed myself into the parking spot at the rear of the building, glad that my blue Volkswagen Beetle could be maneuvered thus without much worry for the mammoth SUV to my left.

I had arrived early, as I had not been able to come down for the viewing the night before. When I got inside, I eventually caught up with three colleagues who had already been there: Ethan’s two therapists and his Family Care Coordinator. After quick greetings that were regretted by all only because of their location, not their intention, I headed into the main salon.

There to my left was an open casket, flag-draped, Ethan’s body lying within, holding a Bible, oriented toward a long-before-taken family photo that was keeping vigil over him. To the right were two easels smothered in pictures of an always-smiling young man, sometimes goofily mugging before the camera, sometimes simply enjoying the very fact that this very person was taking a snapshot of him at that very moment.

On one easel he was clad in various, well-coordinated outfits of Army chic, accessorized with appropriate guns here and there. He was a few pounds lighter than I had known him, but not by much. Unlike many such pictures that I’ve seen through the years, his were never posed in the “Don’t Tread On Me” stance so common for the young and—yes, I’ll say it—the well-armed. His smile, his innocent, “Good morning to you, Sir” smile, was ubiquitous.

Next to it was another easel of more contemporary, always civilian pictures, same dizzying mixture of the goofy and the mundane, by himself, with others, eating, drinking, showing off, sitting.

Same smile, but . . .

Well, eyes have a way of outlining otherwise-genuine smiles to provide an onlooker with a clue that perhaps, just perhaps, this smile is having to work overtime to keep at bay other facial expressions far less pleasant, far less tranquil.

Then over to the left, on the other side of the casket, was a display of military memories. As I walked toward it, I could see his dress uniform from his Airborne division, a stunning oil portrait of him in that same uniform, his Purple Heart award . . .

. . . and his boots. It was the boots that brought me short, threatened me with more than a tear or two. Empty boots—ones with a gun propped up in them, helmet perched on gun’s end—are the “soldier’s memorial,” the makeshift tombstone, the one honor all military men and women can give to a fallen comrade in the field before all are returned home. A soldier’s boots (almost as much as his gun) keep him alive.

At that moment, I felt Ethan more intensely than I had in days.

It was then that I turned to see his mother and stepfather come into the room. I went up to them and (emboldened by the last funeral, I guess you could say) embraced them both. His stepfather then said, “The pastor would like to talk to you.”

I accompanied him to another room around the corner, where I met a man a good ten years older than I, with the smile and the build of a preacher who knows not only who the best cooks in his congregation are, but also where to find them, 24/7.

“Thank you, Doctor,” he said as he shook my hand. “Will that be OK with you?”

My face must have shown the obvious question with the word what inserted before the words be OK, for Ethan’s stepfather quickly stage-whispered to us both, “We were wondering, Doctor, if . . . if you’d be willing to read what you wrote about Ethan during the service.”

“In fact,” the pastor added, “I’ve got a copy of it. Right here.”

As he handed it to me, both the men smiled smiles that seemed to be assuring me that this really wasn’t quite the bombshell it appeared to be.

“Of course,” I replied. “I would be honored.”

Soon the room was full of folks of all ages, all dress, from the semi-formal to the tank-top and shorts. There were handshakes, a few backslaps, but overall everyone was settling into a quiet that was fully recognizing the loss that each was continuing to experience.

Then Robin came in, accompanied by her father, then joined by Ethan’s parents. She was dressed in a simple black dress, one for which, I’m certain, Ethan would have most readily complimented her. Her tears had apparently decided to take a break, but they’d more than left a residue that they could return to at a moment’s notice. She sat in a wingback chair on the front row, right in front of her husband’s body, slipping from view as she sank into the overstuffed cushion. Parents seated themselves on both sides, and then for a few moments, silence.

Then, over the speakers, the sound of a banjo.

It only took a few bars for the song to reveal itself: it was the old gospel hymn, “I’ll Fly Away,” sung in perfect Appalachian harmony, melody and tenor, almost as if taken note for note from the movie, O Brother Where Art Thou?

I don’t know what it is about that song. Perhaps it has its own, special neuronal bundle somewhere inside my noggin, ready to be tweaked and ignited at a moment’s notice to flood me with revival meetings of long ago, I don’t know. Yet something about it always makes me wish I could exchange my bass-baritone, if only briefly, for a nice, soft second tenor that can modulate from chord to chord, carrying me away, “by and by,” to “oh, Glory” and beyond.

Barely had the song ended and my smile begun to relax when other chords took their place, guitar, violin, cello. A gasp went through the audience,clearly far more acquainted with the standard repertoire of Nashville than I am.

It was Tim McGraw’s “If You’re Reading This,” a simple ballad, written as a letter from a soldier to his wife and family “just in case.” It’s a song of pride, of sorrow, a song of hope for peace, of hope for good lives for all those left behind, long after the soldier has given up his. It’s quintessential Country. Many tears were shed.

Soon Ethan’s best friend got up to speak, his voice breaking even as he stood firmly at the podium, proud of the man whom he’d loved more than any other, the man whose name his son bears as part of his. In their brevity, his words spoke volumes.

It was then my turn to take my place at the mike. I looked at the words before me. I was very glad that, this time, I no longer had to use pseudonyms. My own voice held firm itself until those final words: if anyone had the heart of an angel and the resolve of a guardian, it was Ethan. A few moments’ pause, and then when I was done, I turned to find myself face-to-face again with the oil painting—and with a smile that, depending on one’s theology, one can only hope has returned somewhere, by and by.

The service ended, folks began to pass before the casket. Strong, handsome young men, some in sunglasses that were almost certainly hiding a multitude of sins behind them, grabbed onto each other for dear life to stand before their buddy one last time. Old, young, they all passed by, we all passed by. I shook his father’s hand and thanked him for the honor of knowing his son. I embraced Robin as she thanked me for my words and for my commitment to Ethan. I embraced his mother, his stepfather, all of us knowing, without saying, that words only get in the way at moments such as these, only in the way.

The procession to the cemetery was long, car after car rolling past the respectful gazes of drivers who’d stopped their cars, persons peering out of downtown eateries and offices. We all scrambled to find parking somewhere near the graveside once we’d arrived at our destination. It looked as if it could begin pouring any minute.

The same strong, handsome young men who had gathered at that coffin in tearful embrace then, without a word, lined up, slowly slid their friend’s flag-draped coffin out of the hearse, steadied themselves, and in a unison that was felt, not commanded, carried their pal—even, in a way, quietly marched him—to his final place of rest.

The pastor said a few words, and then the VFW Honor Guard sprang to attention, guns cocked, fired, cocked, fired.

And then the bugle, a “Taps” perhaps even a bit more andante than had been Porthos’ those weeks before. Same clear tones, however, same perfect intervals, same call from across at least two hundred years of history.

After the last tone had faded, two soldiers took their places at the ends of the casket, just as their predecessors have done so many thousands of times before, and they ever so slowly, ever so precisely lifted, folded, folded, folded, until finally one saluted the other, after which that one handed the triangular flag over to the most senior soldier in attendance, who then gently lowered it into Robin’s lap, words whispered, salute rendered.

It was done.

As the family gathered together in embraces and tears, I bade farewell to my colleagues, who were hoping that they might miss the worst of the oncoming downpour. As I’d brought my umbrella, just in case, I decided to turn back to look at the casket. It was perhaps more “in state” than it had been up to that point, silent, a monument holding the remnants of a life that had suffered, a life that had loved, a life that had smiled.

As I walked up to it, I stood alone. Slowly I lowered my fingers to his coffin and remembered a similar touch only weeks earlier. I wondered about the appropriateness of repeating again the Latin phrase I’d spoken to Porthos. For a few moments it felt like a formality quite out of place with the guitar chords and gospel songs of rural Indiana.

Yet it was at that moment, believe it or not, that I thought of opera, an art form at which I suspect Ethan would have more giggled than to which he would have wasted any moments of life listening. But you know, really: opera, country music . . . worlds apart, yet the same world, no? Rodolfo crying out at the death of Mimi, Tosca tossing herself in grief-stricken rage off the heights of Rome, Butterfly contemplating that knife as Pinkerton stands nearby with his American bride, Rigoletto holding his dying daughter, Gilda, as she sings of joining her mother in a far-off Heaven: are any of their griefs, their words that different from the griefs, the words of songs sung far less loudly, yet no less sincerely, in quiet recording studios, at fairground amphitheaters big and small?

Perhaps at that moment Ethan and I met one last time. Like many of the men whom I serve, he was often in awe of my doctor-lawyer pedigree. He would have had no doubts whatsoever that I could be one of those types who gets into all that “fat lady singing” nonsense. Yet when we were working together, trying to hold between us unspeakable pain that was slowly allowing itself to be spoken, we were just two guys from Indiana, one a generation older than another, both trying to make Life work as best as we can.

War tried to destroy him. It made a good go of it. But as I contemplated that smile one last time at that grave, both Ethan and I knew better.

Yes, I did say the words: Cruciatus consumptus est, Ethan. Requiesce in pace. The torment is over, Ethan. Rest in peace.

Yet also I had to whisper just a few more words, ones that I suspect I could have taken the melody to Ethan’s tenor and we’d have both sounded just fine, thank you, sounded just fine.

Fly away . . . oh Glory, fly away.

Amen.

Reporting for Duty, Sir

With the permission of his family, I report, with much sadness, that another young veteran whom I have had the honor to serve died this past week. The cause of his death remains unclear, but all agree that it was not self-inflicted, and it does appear that he died suddenly and without suffering.

Ethan (not his real name) first came to my office a couple years ago. He was not in good shape. He had suffered a significant traumatic brain injury (TBI) from an IED (improvised explosive device) explosion while having served in the Middle East, and he had subsequently become hooked on opiates (painkillers). When I first met him, he was gaunt of body and of gaze. He had the distractibility that I have often seen in veterans who are struggling with the consequences of TBI, but his had a desperate edge to it, an irritation that appeared to be heading nowhere, targeting no one in particular.

How good it was, then, that he found Suboxone (an opiate-substitution medication) to be so hope-restoring for him. He filled out in body and in soul, and a smile took up permanent residence on the lower half of his much-less-lined face, a puckish one, I guess I’d say. Great word, puckish. Great smile.

He grew up in a semi-rural area south of Indianapolis. He once told me how to get there, and I realized that I had often passed the requisite landmark on Indiana State Road 37 during my many trips through the years down to Indiana University in Bloomington, where I had taught an undergraduate class. In fact, he was still in high school when I first began making that trek. It was a well familiar one to me, in other words, by the time his mother, who lived not far from that landmark, had already begun praying every morning, every night for his safe return home.

He did return home. But he was not whole. He knew it. His family knew it. Everyone knew it.

Ethan was working with two of our finest therapists at the Indianapolis VA when he came to see me, so he never had a need to share with me any of the worst aspects of his combat experiences. He did hint at them, though. I needed no more than that. His experiences of the War—both of what he saw and of what he had to do—haunted him daily.

Yet as time progressed—and even more, as he worked with his therapists—those haunting experiences receded in prominence, leaving in their wake the far-less-easy-to-treat symptoms of his TBI. Day-to-day detail often confused him far more readily than it had before deployment. Often he forgot where he was to be and when he was to be there—appointments, for example. Family did their best to help him keep track of everything, a challenge for them all. How many times did Ethan come into my office, once more apologizing for having forgotten something, sometimes an important something, sometimes not.

Then he met Robin.

Robin had had her shares of struggles also, but together they went on to make a life that, while not without its challenges, was nonetheless even more with its hopes, saturated with a love that kept a certain puppy-dog air about it, even as they faced together, head-on, all the Shakespearean “slings and arrows” that Life can bring any of us. They got married. They made plans to buy a home. Those plans fell through. They kept looking, envisioning for themselves a family that would be as safe as they could make it, as secure as they could love it.

Still, Ethan suffered, suffered from War like so many other thoughtful, good-hearted men and women with whom he had flown on that plane to Kuwait, with whom he had ridden into extremely-hot, extremely-volatile territories in vehicles that were, in spite of their advanced technology and their construction, still all-too vulnerable.

He knew that he suffered. Robin knew that. His family knew that. His therapists knew that. I knew that. Everyone knew that.

He continued to find Walmarts nerve-wracking. He still had to have a seat in full view of the door, wherever, whenever. He still had nightmares. He still had became leery of unseen powers in government, in society that could, at a moment’s notice—perhaps, just perhaps—take away from him all whom he loved, all that he had worked for.

Yet in spite of all that, recently he had been coming into my office with all the fervor of a country boy ready to start yapping away on a Saturday morning with a bunch of men, old and young, spread out in the back corner of the local McDonalds, solving the world’s problems over large cups of rapidly-cooling java.

It was his smile, though, puckish. Got me every time. It reminded me of the smile, the “I’m so tickled” demeanor of a fellow Hoosier from long before his time, one who had reigned over Tuesday nights on CBS at my house all my growing-up years: Red Skelton. Like Skelton, Ethan always looked as if he was just so taken with the punch line of the joke he was about to tell, he could barely contain his guffaws long enough to spit out the first words without being stopped by a string of giggles that would bring the audience—and even more, him—long past the verge of tear-stained laughter.

He was a good man, a young man. He had the heart of a Boy Scout rushing to walk the old lady across the street. He had the sense of honor, of duty of a soldier who, while still trying to be good, would learn how to harm, how to kill, if necessary, to protect those whom he loved, whether miles away or right next to him.

We had our regular appointment this past Wednesday. Without any notice, he, quite willingly, came and spoke to a group of my colleagues about his experiences as a patient at our VA. He was articulate. He was honest about his past struggles, his current memory problems, his hopes for a better future. My colleagues applauded him at the end of the discussion. After we had shaken hands after the meeting, he walked away with a smile about twice the size of the some of the country fields he must have run through when he was a boy.

He died the next day.

I had a chance to speak with his mother on Saturday. In her grief and complete disbelief that he was, indeed, gone, she still spoke of how excited Ethan had been becoming about Life, even as he had continued to struggle with the combat-related anxieties of the day-to-day. They had been planning for a family gathering on the day that he had died. In the preceding weeks and months, she had begun hearing in his voice a certain quality, a certain youthfulness that she had feared would never, ever return.

“So you were getting your boy back?” I said.

Her tears answered me.

Then she told me something quite extraordinary.

“You know,” she said. “Ethan had been telling Robin a lot recently that his dreams had been changing. He kept on having these dreams, these feelings that he was to become a guardian angel.”

You can’t make these things up.

Ethan was not an imposing man, yet neither was he a reticent one. Even as he displayed that puckish smile over and again, he also displayed a certain resolve, a certain protector-warrior sense, even if only in glimpses, that reminded us all—that reminded him—that he was still ready for duty, ready to assume a role that he loved, ready to face again, if necessary, a violence that would perhaps destroy him, but that would not—would not—destroy those whom he loved.

War, with its horrors and realities, did try to destroy his tender heart. It did leave its wound in that heart, its permanent reminder of what had been lost, of who had been lost. Yet along with a tender heart, War found a determined heart. That, War could not take away, in spite of the nightmares it had implanted in him, in spite of the memory and the focus it had robbed him of.

I leave it to everyone else to decide as to whether there is indeed some Heaven somewhere that serves as a place of further, dutiful service for one who had so faithfully tried to fulfill such service in this life. All I can say is this: if anyone—anyone—had the heart of an angel and the resolve of a guardian, it was Ethan. If he has indeed reported for duty, God has indeed already sent him out on his first of many, many missions.

May he rest in peace.

Facing Reality

It has been a challenging week.  From the more “trivial” standpoint, I moved my private office after just under seventeen years at my former location.  A good time to purge, I must say.  My wife was more than willing to counsel and exhort me in that endeavor.  Threaten is another word that comes to mind.

Also, we had another regulatory agency visit my VA this week.  All went well.  I’m happy.  My bosses are happy.  All God’s children are happy.

From a far more important standpoint, though, it has been a challenging week.

Earlier this week I had a series of contacts with a young veteran whom I know well–and about whom I care deeply.  For purposes of anonymity, I cannot go into detail about all our recent contacts.  Suffice it to say, however, that this week this man did not fare well.  He has struggled with significant symptoms, both physical and emotional, since the first wave of deployments.  He struggled with life before his military service.  He has struggled mightily with life since.

He did not have it easy coming up, not by anybody’s reckoning.  He is, however, very sharp, very warm-hearted–and very, very funny, in the driest of ways.  With a barely-muttered aside, he can crack me up to beat the band, no lie.   I crack him up by my being so cracked up.  We fit together quite nicely, thank you.

And he probably has one of the most severe cases of combat trauma that I have encountered to date.

He is doing so much better than he had in the past.  Gone are the periods of near-dissociative episodes, in which he felt himself split apart into “good” and “bad,” warring factions that threatened to pound his very sanity into nothingness.  In their place are far more extended periods of calm, of hope, of fun with his kids, of dreams for a future in which he can help other veterans find their greater stability as well.

Yet all can change in an instant for him.  That happened this week.  More than once.

He called me first in near-desperate panic, begging me to help him pull together, to tell him what to do now.  He listened to my thoughts.  I listened to his storms.  We found a way out, for that moment.

But there was another moment later in the week.  Same drill.  He, another colleague, and I worked through it all.  Another way out.

But then there was another moment.

Physically he is all right.  His family is all right.  Life has, however, become far more complicated, for all of them.

Less dramatically–but no less challengingly–I met this week with another veteran whom I’ve known for a long time–and whom I also care about deeply.  He is older, a veteran of a previous engagement.  He has suffered both from combat trauma and from the longstanding consequences of traumatic brain injury.

In spite of the latter, however, he has managed to complete a college degree in a science-related subject, and he is pursuing graduate work with success.  He has had to work hard–and I mean, hard.  Correlations and causations that had once come so easily to his understanding are now far more challenging to discern, at least with any rapidity.  He has to read and re-read what he used to skim.  He has to keep the reminders, the sticky notes, the periodic reviews far more at hand, far more routinely.

He had a disappointment this week, a major one.  He will move forward.  He will succeed.  Yet this one hurt.

And neither of us will forget it.

After a pause in his narrating his disappointment, he looked at me.  “You’re a smart guy, things come easily for you, right?”

I wasn’t quite sure what to say, but given that he was well-acquainted with my academic provenance, I could only be so self-effacing.

“I guess you could say that.”

“You know,” he continued, “things used to come easily for me as well.  In my training classes–big time ones, mind you, not just run-of-the-mill stuff–I was always top in my class.  Until the TBI.  It’s never been the same since.”

He paused again.  His eyes bore right into mine.

“You’d hate it more than anything, wouldn’t you, if your thoughts became as scrambled as mine can be, if you could remember all that you once could do, if every day you were reminded that you’ll never be able to go back there fully, that you’ll never again be top-of-your-game, that you’re lucky if you can just remember all the steps to heating up a can of soup.”

Silence between us.  You can bet that I was feeling those eyes smack down into the center of my peritoneum.  My gut.

“You can’t even let yourself imagine it, can you?” he finally said, softly–yes, accusingly as well, but only somewhat, truly only somewhat.  He was less interested in making a point.  He was more interested in seeing whether I’d try to imagine.

It’s an odd experience when one interacts with a patient while trying to remain aware of one’s own shortcomings, challenges–come out and say it, one’s ultimate fears.  Even though only a second or two might pass between me and a patient, time can seem to go on forever in my head, hours of self-confrontation, wondering whether what I might say is for the patient’s well-being–or for my own self-soothing.

“No,” I finally said, “I can’t.  I’m sorry.  I . . . I have no clue what you’ve gone through.  And . . . it’s hard to even consider the thought.”

He didn’t look self-satisfied.  He didn’t look accusatory.  He just looked at me, barely nodding his head.  He glanced down, as if somehow to say to himself, “OK.  Check.”  Then he started talking about another subject.  Soon we were laughing–a joint activity that we have only recently come to enjoy together.  Nothing more was said about scrambled thoughts and painful recollections.

People sometimes ask me, “How do you do it, listen to all this?”  Honestly, I don’t, for the most part, find it that hard.  More often than not, a painful series of moments will lead, at least eventually, to less painful ones, to “truths” that become less fixed, to possibilities that will lead, at least somewhat, to new realities.

Not all realities, however, as as forgiving.

I can indeed find myself speechless before certain realities: realities about illnesses that can still, in spite of one’s best efforts, overwhelm a man or woman and set back even the most determined of combat veterans; realities about neurologic capacities that will indeed grow–but only so much, and never back to a place of halcyon, intellectual ease; realities that force me to face men and women whom I care about and force me to acknowledge, even silently, that I have indeed been spared their suffering, that I have in abundance what they can only remember in sighs: an emotional stability that can keep the days from exploding at a moment’s notice; a logical ease, both inductive and deductive, that can waltz from point A to point B to conclusion C as gracefully as a modern-day Astaire.

Speechless does not mean incapacitated.  But it is speechless, nonetheless.  I dare not claim what I cannot deliver, an “understanding” that can never be anything even close.  Thankfully–truly, thankfully–the men and women I serve never hold my ignorance against me.  If anything, most of them appreciate that I don’t try to get it more than I can.

But that doesn’t necessarily make my gut feel better.  And that I have to face.  For them.  For me.

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