This service member’s pain preceded her entrance into the room. From outside I could hear, “I am not going to do it.” The secretary called ahead and said the service member refused to complete the required paper work and asked if that would disqualify her for the visit? It usually does. I decided to proceed anyway.
A young woman with a disarming smile on her face appeared. Her presentation did not fit with the phone call. “My provider got reassigned. I am just here to get my medication renewal,” she said. As I reviewed her list of medicines I surmised she had some serious problems, probably PTSD.
We began talking about her history and none of the “preliminary hostility” was evident. She was pleasant and cooperative. Yet she recounted a more than ten year history of serious depression, anxiety, nightmares and social withdrawal and isolation. This history is frequently recited by someone injured during deployment.
She denied ever having been physically injured during a deployment. I asked nevertheless, more about the deployments. She listed several extended deployments to all the battle zones and wars established by the United States during the past fifteen years. “No physical injury,” she repeated. “But you must have seen a lot of trauma?” I hesitantly asked. “I sent a lot of soldiers home with a flag,” she responded. For a while I continued talking but my mind was trying to figure out why she gave them flags. Even after eight years of this work I can be a little slow to see death.
This soldier simply wanted her medication renewed. Nevertheless, I asked her what type of job provided her the opportunity to drape a flag over each dead soldier’s coffin. “Witnessing trauma,” she replied. “I assembled the body parts.” She talked about how she prepared for seeing death. She read books, and studied about it. She went to the operating rooms to witness trauma and trauma surgery. She prepared in every way she could imagine. “I forced myself to be part of the trauma,” she said. I asked, “If it helped?” “Not at all,” was her response.
“Intellectually one can prepare but emotionally it is another story.” She added, noting, that she had tried preparing to see trauma and death but had not prepared for the reaction of medical personnel to the process of dying. “What do you mean?” I asked. “Watching two and one-half hours of terminal labored breathing gets to people,” she said. She saw some irritated and overworked medics yell. “Stop breathing” at one dying patient so they could get on to the next dying person.
In retrospect she tried to evaluate each case to see what could have been done better. During the process she worked at trying to make herself numb. Her eventual solution was to give up on being compassionate. “If I had no compassion, dealing with death became easier.” As I listened the expression on her face suggested her mind had just left our room. I asked if she were back on the battlefield. “I can be right there in that moment, right now, right now,” said this soldier who gave up on compassion. One of the cardinal signs of PTSD is re-experiencing the past while living in the present. I could see her going back and forth while she tried to talk about it.
Knowing the importance of talking about these experiences I asked with whom she speaks. “I can talk with civilian friends,” she said, “but they do not understand. I can talk with my husband but he does not want to hear it.”
“What did you see?” I asked. She described bodies and parts destroyed beyond recognition. Her job was to identify them and bag them together but there was no way to know who they were. She described her promotion into this job because she could do it without compassion. All the male soldiers cried too much.
Before this initial interview was over I had to ask if she had ever attempted suicide. “Too many times to count” was her response. “It is always on my mind. But just the sissy stuff like over-dosing with pills and cutting wrists. Nothing serious.”
Before she left she said that she had been referred for a Medical Evaluation Board in which the military service determines if one has a particular diagnosis and if it is service connected. If so, one is entitled to a medical retirement with benefits. This soldier had recounted to me some of the worst trauma I have heard. She demonstrated involuntarily her PTSD symptoms right in front me. She said the Board had agreed that she had PTSD but the cause was childhood trauma.
NO MEDICAL BENEFITS. I said “That is ridiculous.” “That is what my other provider said also,” she responded.
I guess the U.S. Army has also given up on compassion
Ted Beal
Edward W. Beal, MD, Psychiatrist, Department of the Army,
Department of Tele-Health,
U. S. Army Medical Department Activity, Fort Meade
