Maybe a Letter

Before I continue with the subject of combat veterans and personality, a detour.

Today I met with a young man with whom I’ve been working for the past few months.  He saw quite a bit of combat action in Iraq, and he had to make some decisions which he finds himself still second-guessing.  He came from a family that was not the least bit supportive, and he had hoped that the military would give him the focus and self-esteem he needed.  Indeed it did do both, but his nightmares and emotional lability (up-and-downness) made it impossible for him to continue his military career–and have made it nigh-onto-impossible to find a way to make life work as a civilian.

Simply by the way he talks about his wife and kids, I can hear the soft, though definite chords of caring in his voice.  Yet his subjective experience of them is so distant.  He  sees their need for him and their love for him, but he honestly cannot fathom it.  In so many ways, he is typical of many combat veterans returning from the present conflict.

Two points, though:  first, it is indeed difficult to sit with this man, not because he is “difficult,” not because he feels so lost, but rather simply because he feels so disconnected–and yet desperately trying to connect with me all the same.  He comes to me voluntarily, and he is faithful in his attendance.  Yet I myself can indeed feel his disconnection–and feel my helplessness to “fix” that in any way except to make myself available to him emotionally, as much as he will let me.  If he were more obstinate, I think it’d be easier.   But it’s as if a river runs between us, wide, but not so wide that we cannot look each other in the eyes, that I cannot see in those eyes of his a desire to cross, yet also an acquiescence in some experience that says “cross the river, I never shall.”   It’s as if he is both at peace with that feeling and in a greater combat with it than he had ever imagined possible in a literal desert.

Working closely with combat veterans in any capacity is not for the fainthearted.  Yet neither is it for the eager-hearted as well.  I know that sitting with this man, being ready to be helpless myself, being ready to have not a clue how he should proceed forward, being unafraid to sit at the riverbank with him and try to smile, try to nod an encouragement to cross, go ahead, just give it a try–these are  exactly what he needs.  And although I suspect he could not articulate this, it is almost certainly exactly what he wants.  He wants to see if I have the stamina not just to have his back, but to have his front as well, to be able to take as long as necessary face-to-face to say week in, week out:  our muddling through and trying to get this?  It’s worth it.  You’re worth it.  Let’s keep going.  Keep going.

Yet it is here where the second point sidles up and pokes us both.  In the last year he lost a friend from the military.  On Christmas Day, he sat for about an hour in front of a blank sheet of paper, trying to imagine what he could possibly say to the man’s mother, wanting so desperately to articulate something, something about what they meant to each other, how they kept each other going, kept each other alive.  No words could come, only ache in the presence of stationery.

I asked him if he would be interested in our working together to come up with a letter, if I could help him find the words that failed him.  He swallowed.  I would say that he seemed to be fighting back a tear, but I’m not sure if that would say more about me and my hope than it would about him and his biology.  But he did say this:

“Yes.  I’d like that.”

We take each day as it comes, and we move forward.  These men and women do.  We professionals must as well.

New Year, Old Challenges

As 2012 began, I found myself facing an all-too-familiar challenge.  One of the veterans I serve needed medical attention, and if he were to go into the hospital over the course of a few days, he would recover well.  The problem?  Getting him there.  He finally did come in, and he finally is getting the care he needs.  But he reminded me of some of the challenges that most of us professionals face when we are working with combat veterans–especially younger, male combat veterans.

1.  He’s a guy.  Psychological research clearly indicates that men put off medical care (as well as other personal matters) far longer than they should, leading to increased complications–and, in medical situations, even to unnecessarily early death.

2.  He’s military.  I do try to urge the vets to consider that just because it feels as if boot camp changed everything about them, it does not follow that boot camp actually changed everything about them, e.g., their physiology, as un-tough as that reality might be.  Veterans get sick.  Veterans have to live with bodily changes over which they might have no control, such as permanent changes in the movement of their limbs or the firing of their neurons–or even the temporary proliferation of their white blood cells.  It’s a hard row to hoe:  you want to be respectful of their dignity, yet you don’t want to let them take that Ultra-Man malarkey too seriously.

3.  He has PTSD.

Combat trauma complicates everything:  yes, somewhat from the hypervigilance and the emotional ups-and-downs it engenders.  But even more, it complates everything via the shame it imprints into the soul of every man and woman who suffers from it.  They shouldn’t hurt like they do, they tell themselves.  They shouldn’t dream, they shouldn’t startle, they shouldn’t need to get away, dear God, just for a few minutes, just leave me alone, please, why don’t you?   Yes, my arm hurts, and, yes, I’m sick and tired of hurting in my arm and in my heart so much that I will not–I will not–cry, not a chance, but if you can’t count that pulse any quicker than that, Nurse, then I might just have to let you know in no uncertain terms that you need to take a refresher course, and not on my time, sister/brother, not on my time, are we clear?

God, and then one more time:  getting that look, from the nurse, from the attendant, trying to calm down, trying not to scream, sob, hit the wall, you name it, trying not to feel so rotten that once again I screwed up, I said something I shouldn’t have, something I meant but I didn’t really mean.  God, when will it ever end.

And we haven’t even got to the blood pressure yet.

I’m glad my patient is getting the help he needs.  I pray for a peaceful night.  For everybody.

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