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.

The Monsters Are Here, So They Say

I am unabashed fan of the original Rod Serling series, Twilight Zone.  Deep in the recesses of my memory, I seem to recall my parents watching the show at least occasionally, although at most I could only have been five or six.  The opening music still draws me in, every time, and when I found out I could watch episodes on my iPhone via Netflix, life suddenly took on new meaning.  Seriously.

A few weeks ago I re-watched an old classic from the show’s first season, “The Monsters Are Due on Maple Street,” featuring a host of great character actors whom I remember playing roles in film and TV throughout my early and teen years.  The story is a simple one:  in the opening scene, a discus-shaped shadow passes over the street of an idyllic town of the late 1950’s.  Soon afterwards, nothing on the street works:  electricity, cars, even lawn mowers.  Then for some inexplicable reason, some people’s cars or lights begin to work, while everyone else’s do not.

The key word there is inexplicable, for the whole point of the episode is simply this:  people will not live without explanations, even if they have to come up with them based on the flimsiest of evidence.  A young boy tells the neighborhood that he has just read a story about how aliens send scouts ahead of them, in the form of humans, so that the eventual invasion will go more smoothly.  Soon the various people on the street begin to throw out recriminations left and right (“He’s the alien!  No, she’s the alien!”), until finally, in a fit of fear, one man ends up shooting another neighbor to death.  Within minutes the whole street devolves into a series of terrified accusations and attacks, with lights coming on in some houses, only to dim again, with lights then coming on in a house a few doors down, then off, then on in another house, then off, cars going on and off, lawn mowers going on and off.

The Twilight Zone kicker, of course, is at the end, when the camera fades back from the street that is now in a state of riot, upwards toward  a hill overlooking the scene, only to show an actual discus-shaped space ship with two very human-looking aliens looking over the destruction below them.  One of them marvels that it only takes a few tricks, and soon humans are more than willing to destroy themselves.  The other, apparently more experienced with our kind, assures his colleague that it always works that way with humans.  Always.

I could talk again about the Kandahar incident in this light, but instead I want to consider a much more mundane, much more insidious process, one that many combat veterans (both men and women) face every day.  It’s a simple proposition, really:  when anything goes wrong and a combat veteran is within blaming distance–blame the veteran.  For many of us civilians, it works every time.

An interesting story made the rounds of the VA recently, The “Dangerous” Veteran:  An Inaccurate Media Narrative Takes Hold, telling about efforts being made in the San Diego area to establish a treatment facility for combat veterans with both PTSD and traumatic brain injury (TBI)–and about the efforts of the locals to prevent this from occurring.  Behind their concern is their fear that the facility may be too close to a school–and, of course, who knows what might happen to innocent children, right?

If  you meet a combat veteran, in other words:  thank the veteran for his/her service–and then lock your doors.

I have had more than one very frank, very painful discussion with a combat veteran about how (usually) his energy and intensity will automatically place him as the number one “blame object” whenever anything goes wrong between him and another person.  It will matter not that the other person might have just texted him some vicious insult.  It will matter not that the clerk has an attitude as big as Montana.  If any voice is raised, if any withdrawal occurs, it will be the combat veteran who is the one at fault, the one who cannot cope, the one who cannot manage his emotions.

Remember:  we’re not talking about domestic violence here, although clearly that is a serious problem among certain combat veterans.  We’re talking about the lights and lawnmowers, if you will, of life:  the throwing of the cell phone against the wall, the cursing of the clerk.  For such veterans, provocation will never be considered by civil society as a two-way street.  The veteran, we are told, like the rest of us should be able to take whatever is dished out to him, smile, firmly assert his boundaries, and then leave well enough alone and move on.

Yup, that’s exactly what he was taught in boot camp.

These are complex situations.  One should be able to say that blame is not the point.  One could say that blame should not be the point.  But usually–it’s the point, pure and simple.  When warriors-in-spirit become combat veterans, they don’t always play nice in the sandbox.  I certainly am not arguing that we should carte blanche exonerate them.  Nevertheless, neither should we ride too high a moral high horse as we collect our reasons to fear and to judge them.

Remember:  one can be angry until the cows come home, and one will not necessarily–in fact, not even usually–explode simply out of the anger.  One explodes when one has been made to feel weak, one-down, unimportant (as compared to the speaker’s importance), whether man or woman.  That’s what leads to outbursts.  The guy who cuts off the veteran, saying essentially “my goals are more important than yours.”  The clerk who gets put out by the veteran’s impatience or sarcasm, saying essentially “my manners are better than yours.”

Serling was a master of his genre–and a master psychologist.  Seek and ye shall find, the Good Book says.  Works well when you’re seeking  monsters, the kind that invade homes in the middle of the night in far-off places or that hole up in cabins in the woods, ready to assault the innocent at a moment’s notice.  No such monsters in our neighborhood, so they say.  Thank goodness.

Woe to the man or woman with a warrior’s intensity who happens into that neighborhood.

Woe even more to him or her:  the neighborhood is probably his or her own.

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