Physicians generally like the people they treat. I have enjoyed most of the people with whom I have worked but not all. If you really do not like someone, it often becomes difficult to be helpful.

I have seen one soldier many times whom I did not like. While she was likable, I did not like the experience of working with her. It took me too long to figure out that she was not the problem so much as how I felt while treating her. So, I was not able to help her very much and that made me feel helpless. It was much later when I was able to piece together each of our parts in the medical relationship.

She had served more than one tour under difficult circumstances.

Her career was long and productive. Afterward, she had nightmares, depression, anxiety, panic attacks, and fainting spells. Mostly, however, she suffered from an overwhelming sense of helplessness under pressure. She just did not seem to be able to do anything about her situation. Nothing I did or offered improved her condition substantially. Most troubling was the fainting spells she experienced. She would pass out, lose consciousness under unpredictable circumstances. She had the appropriate medical and neurological workups and no cause could be found. She could no longer safely work or drive a car because she would pass out without warning.

Physicians always think there has to be a medical explanation. With panic attacks, physicians in-variably think that the patient must be thinking about uncomfortable things that prompt the anxiety, which then generalizes and be-comes out of control. More recently a whole body of know-ledge has shown that individuals have a biochemical storm that may account for their panic, and it may not be related to what they were thinking. Medications administered before or after the experience can alter the experience and calm them down. The experience does not have to stem from psychological causes. It may be stimulated by a real life event that the mind pairs with some past troubling experience. An event so simple—as driving down the Interstate under a bridge--can trigger a panic attack that reminds the mind automatically of a patrol while deployed in Iraq or Afghanistan.

I tried to help this solider examine her life and try to figure out what was happening in her mind before she passed out. In short we never got anywhere, and I did not like working with her because it went nowhere.

One day she came in and was excited, seemed relieved. She said she was beginning to think she knew what the cause was. She had never told anyone her story. Working as a medic on a medical evacuation helicopter can be stressful. On this day in question, she had worked on multiple evacuations from sun up to sun down under dangerous conditions. After the last evacuation, her exhausted crew lifted off for their home base. As they were returning home she saw a human figure pointing something at the helicopter and flashed several times. Assuming they were taking “hostile fire,” she urged evasive action.

The next morning, rested and reflecting, she suddenly realized the flash was from a device given to soldiers seeking help. The device was designed to emit a light only upward and not horizontally so that the surrounding enemy could not see it. The soldier she directed her helicopter crew to leave was not an enemy directing hostile fire. Rather, that soldier was a comrade seeking their help. The thought of having abandoned this soldier left her feeling completely helpless.

This story was like a big NEON SIGN in front of me flashing “helplessness.”

Maybe this was not so much a medical problem as a moral problem. She did the wrong thing—not through any fault of her own—but she made the wrong judgment or decision. Only in retrospect did her intellectual mind know that! The emotional mind does not work that way. Armed with new information it tends to hold us responsible—not for the facts as presented at the time—but for the facts as you know them now. That is a battle that cannot be won. Only forgiveness works.

Forgiveness … Pg. 2

A poetic rendition of Psalm 51 may be an appropriate reflection: “Speak to me in words that release me.” Medically I did not know how to do that for this soldier. Fortunately she went to a hospital specializing in PTSD. The hospitalization was helpful in terms of their treatment, but more help may have come from the experience of meeting some infantrymen in group therapy. She only saw
failure that “ate me alive.” They, however, saw a heroine who, on a particular day, had saved many lives. “We were deployed at different times but what we saw and felt was the same and so it became a shared experience,” she reported.

Finding a way to forgive oneself is the key, or finding someone else who will forgive you can be just as much of a key. This conundrum is more moral than medical. Veteran Thomas Gibbons-Neff reflected this idea when he wrote in the Washington Post:
               Recognizing moral injury isn’t so much about how the country understands its veterans; rather it is about how veterans understand themselves … and it‘s also about reconnecting with a moral community feeling connected to your fellow man. *

Since hearing her story, it is interesting how much my attitude toward this soldier has changed, how much I look forward to seeing her. She is feeling better, fainting less frequently. Maybe the change in me is due to what I now see that we have in common: the ability to forgive ourselves our own mistakes, for that is part of what it means to be human.

Ted Beal
Ted Beal, MD, a psychiatrist at the Walter Reed Medical Center is a member of the Georgetown Medical School faculty. He and his wife, Kathy, are long-time friends of CPF

*Gibbon-Neff, Thomas, “Can the Soul Recover From War?” The Washington Post, Outlook Section, Sunday, March 8, 2015, p. 4.

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