Tag Archives: combat operational stress management

Loose Thoughts: Can Somebody Tell Me What Sleep is and Why the Old Crap? Why not New Crap?

bean church 1 Mr Bean Trying to Stay Awake in Church.  I can Really Relate See the video at

http://video.google.com/videoplay?docid=-7178785146631188901&ei=UthpSvKcCpv-qAOCyJAd&q=mr+bean+in+church&hl=en

Tuesday and Wednesday were days where the old Crap both my own life and others kept rising to the top.  My current and crap, which in reality is my old crap move to the present are my PTSD related issues or maybe it’s the whole damned subscription.  My stuff came up, because as Elmer the Shrink says that they have been suppressed by my brain and get dredged up by stuff that triggers them.  Thus it is kind of involuntary, something that I hate.  I am a deliberate and logical person and I don’t like this stuff coming up and screwing with my life, which right now is pretty busy and stressful.

Tuesday night I had the “privilege” of getting two and a half hours of sleep after a great seminar on Caregiver Operational Stress management and intervention.  I was proud of myself.  I actually got through an entire daylong seminar without an immediate PTSD meltdown during the seminar.  That last three times I have attended classes or seminars dealing with things related to or that touch on my stuff it has been like a old pitcher who has seen better days getting chased from the mound at Yankee Stadium in the first inning giving up 7 runs without recording an out.   Tuesday it was hard but it was like getting a complete game and the win.  This was a big accomplishment for me as I have not been able to do this since before I went to Iraq.  However, the subject matter did kick up a bunch of my stuff from Iraq and getting to sleep was really; I mean really fun….not.   To use the old pitcher metaphor I may have got the win but my arm and body need some time to recover, only instead of the arm and body it is by pea-brain. So Tuesday I didn’t get to bed until 2:30 AM and was back up at 5:00 AM so I could come to work and take the duty for the house in addition to my regular duties.

Now I don’t mind having duty, especially at night when I get a chance to round through our hospital wards and spend time with staff, especially the folks in the various ICUs and units that are not part of my daily routine. Yesterday I had a couple of meetings today, a long one in the morning and a couple in the afternoon.  The last meeting was like one of those afternoon classes that I dreaded back in college and seminary;  the kind that I took because I was either working or wanted to sleep late, but which kicked my ass.  One time in seminary the “Z Monster” grabbed me after eating a big burger at lunch before going to class.  That afternoon in Philosophy of Religion the Professor, Dr. Yandall Woodfin, decided to enlighten us with a slide show of various art masterpieces and the religious and or philosophical meanings that could be ascribed to them, I think there were several slide trays of them as this was in the technological dark ages before Power Point poisoning.  I was sitting in the front row, my desk almost under Dr. Woodfin’s nose just slightly to the left of the slide carousel.  The lights were turned low so we could see the pictures better and the temperature was just warm enough in the classroom to  make me even more sleepy.  As all the blood in my body rushed from my brain to my burger locker I began to struggle to stay awake.  It was like Mr. Bean trying to stay awake in church http://video.google.com/videoplay?docid=-7178785146631188901&ei=UthpSvKcCpv-qAOCyJAd&q=mr+bean+in+church&hl=en I was fighting hard but the “Z Monster” won.  I was doing the “bob, jerk and sleep” for about 20 minutes when finally catastrophe hit.  I flipped my desk; it was a rollover accident without a roll bar, but it was amazing that I did not hurt myself and just how fast I recovered.  I had that desk righted and had my ass back in it before anyone knew what hit them. My fellow students tried to restrain their laughter as the unflappable Dr Woodfin kept the lecture going without missing a beat.  I don’t know if it was years of training or the fact that he was in his “teaching zone” but his focus was amazing as he showed absolutely no distraction by my roll over.

I had similar experiences in other academic and military settings, but while I may have fallen out of my seat I never again flipped a desk.    However today was tough.  I had been pumping myself with caffeine all day long and evidently it was not having the desired effect. I got to the NOD (Nurse of the Day) meeting where the on call people meet with representatives of the nursing units to get an idea what is going on in the hospital at large.  Today I took my seat and the “Z Monster” showed his well disguised face and zapped me.  Pretty soon I was fighting to stay awake.  I was pinching myself, shrugging my shoulders, sucking down my Coke Zero just to stay awake, a couple of times I caught myself about to fall forward in my chair, thankfully I didn’t snore…yes I have done that in meetings or classes too.  When the meeting ended I was more than happy.  I slowly rose from my chair, shook myself out and downed the last of my Coke Zero.  When I got back onto the ICU I got second wind and was good the rest of the evening, made all of my rounds and finally feeling that things were okay for the night trundled off to the chaplain call room to try to sleep.  I got in the bed, pulled the threadbare hospital sheets and too small blankets over me, arranged the flat pillows so they resembled a real pillow turned off the lights and close my eyes.  Unfortunately though my body was toast my brain did not want to turn off, it was like the brain had a mind of its own and was going to keep my body up even though my body was saying “Oh God let me sleep.”  I was so tired that I couldn’t even write myself to sleep like I normally do. Even my entreaties to the Deity Herself seemed to go unanswered, so a laid there, turned on the television and surfed the paltry selection of channels that Mordoc the Preventer of Information contracted to get finally flipping between late night talk show hosts on the major networks other than Conan O’Brien I didn’t know who the majority of these guys were, one of them who followed Conan started kissing the camera in the middle of his monologue.  I rapidly changed channel as that was frightening.  Finally about 2:30, which must be the new 11:30 for me, I drifted off to sleep to be awakened by the 0600 test of our Code Blue response pager.  I did my duty turnover, pumped myself full of caffeine checked on the ICU and PICU, visited some patients, consulted the staff, answered some hot e-mail and calls regarding our incoming Pastoral Care Residents and realized that my body was starting to tell me that I was done.  I trudged down to our main office, sat down with the boss who asked why I was still at work, discussed a couple of issues with him and got sent home where I kissed Judy, pet the dog and threw my ass in bed.  I feel slightly more human now and pray that the sleep I got this afternoon does not mess up going to sleep tonight.

bean church two

While thinking about how my old crap was exhumed by the class, something that Elmer the Shrink says that my brain has been suppressing, I got an e-mail from a pastor who has syndicated opinion column for a number of newspapers here in the USA.  The guy used to write some pretty good stuff that was encouraging, inspiring and occasionally thought provoking.  But something has changed and his articles have become often become almost venomous.  I guess that he’s really angry about something, probably Obama and the Democrats.  I understand that that is his right as a citizen, there are a lot of people unhappy with the President and Congress, my mother is one of them.  I talk to my mother almost daily almost and for eight years she bitched about Bush and the Republicans and now she is bitching about Obama and the Democrats, but she represents herself, she is not a pastor, she holds no church or public office and thus can do whatever she wants.

Anyway this pastor chose to write an article full of anger and poisonous invective, but not at anything happening now.  He chose to dig up old crap with no relevance to the Gospel, or to anything that is happening now.  He chose to write about a doctoral seminar that he attended several years ago. He discussed a situation where a non-US citizen pastor of an American church in a graduate program was criticizing the USA as a major source of the world’s problems.  Now I might take offense if someone did that, I would defend my country and I might depending on the situation confront him during or after the class.  However, this chose to drag this up when it seems totally irrelevant to anything going on now.  I really don’t think that anyone is concerned about how a foreign pastor pissed this minister off years ago. People are scarred spitless of the Commie North Koreans, Iranian nukes, Pakistani nukes, the expanding war in Afghanistan, the price of gas, the economy and a hundred other very real crisis’s.  But this pastor decided to tell how a long time ago he responded in a class to a guy who dared to criticize the USA.  But this wasn’t the worst of it, this guy ended the column with a particularly acidic comment that was like cup of “America Love it or Leave It” with a shot of Drano.  There was no redemptive point to the article; there was no humor, no spiritual lesson, just a very angry and bitter screed about something that happened in a classroom among a bunch of doctoral students which happened four years ago at the height of the insurgency in Iraq.  I did not think that the article was befitting of him and hope that his ministry is not filled with stuff like this as it is poison.  Like Drano it will clean you out, but it will leave you empty inside.  If this were an isolated occurrence with this pastor I would chalk it up to him having a bad day, but he is trending this way and I’m afraid that if he continues to do so he will hurt his church and the broader Christian church by becoming identified more with a political message than his faith.  In fairness I don’t know what caused him to write the article, maybe something triggered him and caused this to kick in.  I do want to be fair to him.  I do plan on discussing the matter with him because I actually do care.

Now I’m sure that there are people who think that I’m full of crap too, and I’m okay with that, because I know that I have issues and rough edges and sometimes push the envelope.  At the same time I do try to find a point of contact in the present and write, even when I am critical of a person or institution.  I do not believe that anyone or any institution is totally bad or good, even people that I disagree with are like broken clocks, they are right twice a day.

I hope to sleep tonight and I hope none of my old Crap or anyone else’s old Crap shows up tonight. Unfortunately Crap tedns to rise to the surface.

Peace, Steve+

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Filed under iraq,afghanistan, leadership, Loose thoughts and musings, philosophy, PTSD, Religion

Revisiting the Demons of PTSD: Returning to Iraq in Virginia a Year and a Half Later

Today I am attending a conference on Caregiver Operational Stress Control.  This brought out my “demons” as I was faced with the stories of others who had been to the same places that I have been in Iraq, and experienced similar things that I experienced on my return.  This is a re-posting of something that I wrote in March at the very beginning of this blog.  At that time I had very few readers.

I am glad to be at this training today.  I needed to take a Xanax when I arrived because I don’t do well with these kind of events anymore.  The intial session and a video of Dr Heidi Kraft talking about her expereinces at Al Taqaduum where I was based out of.  I was scheduled for another meeting but I knew that I needed to be here.  So I asked my Department Head who was going to the meeting if I could stay and he allowed me to do so. God bless him.

I received a note from a new friend in another country’s military, a physician with multiple tours in Afghanistan.  He is dealing with many of the things that I discuss in this essay and had a bad day that took him back to Afghanistan.  I am sure that he is not alone as I deal with many people in my Medical Center who have similar experiences.  Yesterday I was walking down a hallway near our Operating Room and I saw a pretty good sized blood spill on the floor. I was surprised at my reaction as I kept seeing it in my mind the rest of the day and flashbacks to Iraq and the TQ Shock Surgery Trauma platoon where I was pulled into a couple of the last major mass casualty events where 10-15 Marines or soldiers came in at a time. I began to see those wounder Marines on the tables and can visibly see those Marines, their wounds, even tattoos… I hope this helps break the code of silence.  I wrote this on a particularly rough day and will repost some of those early essays as they are still very relevant.  Peace, Steve+

964Trying not to Show my Stress and Exhaustion after 2 weeks out while in between flights at Al Asad

The feeling of abandonment and aloneness, separation and disconnection run deep for those returning from unpopular wars in which the majority of the citizens take no part.  The effects are devastating.  It is estimated that at least 100,000 Vietnam veterans have taken their lives in the years after that war.  Last year the Army had its highest number of active duty suicides ever recorded, January and February of 2009 have been banner months for Army suicides.  Of course as I noted in my previous post these numbers don’t include reservists and Guardsmen who have left active duty or veterans dischaged from the service.  Neither do they include the host of service men and women who died from causes undetermined.

Many veterans attempted to return to “normal life” and family following the war. Many only to have marriages fall apart, continue or leave untreated alcohol and drug addictions acquired in country which often follow them back destroying lives, families and careers.  Most felt cast aside and abandoned by the goverment and society. Many got through and return to life with few visible effects, but the scars live on.  My dad would never talk about his experience in the city of An Loc in 1972 where he as a Navy Chief Petty Officer was among a small group of Americans operating an emergency airstrip in the city which was besieged by the North Vietnamese and Viet Cong for 80 days.  I do know that it affected him, he wasn’t the same when he returned, he was a lot more tense and had some problems initially with alcohol.  He never talked about his time there.

I have seen the effects of this in so many lives,  I remember a Vietnam vet who attempted to kill himself with a shotgun blast to the chin in Dallas during my hospital residency.  He forgot to factor in recoil and blew off his face without hitting his brain or any major arteries.  He survived…talk about having something to be depressed about later.  I have seen the tears as veterans rejected by the country during and after than war begin to seek community with their wartime brothers, men who had experienced the same trauma followed by rejection and abandonment by the people that sent them to Southeast Asia.  One only has to talk to veterans of the Ia Drang, Khe Sahn, Hue City, the Central Highlands and Mekong Delta or read their stories to know what they have gone through.  LTG Hal Moore and Joseph Galloway in We Were Soldiers Once..and Young and We are Soldiers Still have deeply penatrating and soul searching views of Vietnam as does Bing West in The Village. Bernard Fall does the same from a French perspective in Hell in a Very Small Place and Street Without Joy. Alistair Horne’s book A Savage War of Peace discusses and tells the story of many French soldiers in Algeria, who fought a war, won it militarily and had their government abandon them, bringing out a mutiny and coup atempt by French Soldiers who had fought in Indochina, were almost immediately back in action in Algeria with little thanks or notice from thier countrymen.  Abandonment is an ever present reality and “demon” for many of us who have served regardless of our nationality, French, Canadien or American who have fought in wars that have not engaged the bulk of our fellow citizens. Go to the Vietnam Veterans Memorial in Washington DC and tocuh it, trace the outline of a name, look upon the makeshift memorials and tokens of remembrance left by comrades who came home and understand the sorrow and the sacrifice.

Unfortunately we would like to think that this is something out of history that we have learned from and applied the lessons and in doing so no longer have an issue.  Unfortunately this is not the case.  There are many, depending on the study anywhere from8-20 percent of returning Iraq and Afghanistan veterans who suffer from some type of PTSD, Combat Stress reaction or other psychological malady incurred during their tour. Similar numbers are reported by the Israeli Armed Forces in from the 1973 War forward.   The British are seeing the same now as their veterans return from war.  Canadian Forces assigned to the UN command during the Rwanda genocide suffer horribly from PTSD. The mission commander, LTG Romeo Dalliare now a Senator in the Canadian Parliament is a leading spokesman for those who suffer from PTSD. His book Shake Hands with the Devil is a study of how military professionals were exposed to atrocities that they either were forbidden to stop or lacked the combat power to do so even if they wanted to.  These men and women tell their story in a video put out by Canadian Armed Forces.

105Convoy along Route Uranium

I am not going to rehash stories that I have recounted in my other posts dealing with PTSD here, but both I and many men and women that I know are scarred by the unseen wounds of this war.  We gladly recognize, and rightfully so, those who suffer physical wounds.  At the same time those who are dying inside are often ignored by their commands or if they come out are shunted into programs designed to “fix” them.  In other words make them ready for the next deployment.  I am not saying here that there is an intentional neglect of our service men and women who suffer from PTSD and other issues.  I do not think that is the case, but it is a fact of life. The military is shorthanded and stretched to the breaking point. Many Army Soldiers and US Marines have made 3-5 deployments since 2003. The Navy has sent over 50,000 sailors, not including those assigned with the Marines into “Individual Augmentation” billets in support of operations in Iraq, Afghanistan, the Horn of Africa and other fronts in this war.  The Navy personnel, as well as Air Force personnel who perform similar missions often do not have the luxury of going to war and coming home with a particular unit.  We serve often in isolation and incredibly disconnected from our commands, our service is often misunderstood.  Now there are efforts by the services and some commands to do things better to support our sailors, some of these at my own hospital.  However as an institution the military has not fully made the adjustment yet.

Many sailors feel abandoned by the country and sometimes, especially when deployed by the Navy itself.  I have debriefed hundreds of these men and women.  Almost all report anger and use terms such as being abandon, cut off and thrown away by the service and the country.  Those from all services who work in unusual joint billets such as advisers to local military and police forces in Afghanistan and Iraq feel a sense of kinship with each other, often feel a connection to the Iraqis and Afghans but are often not promoted or advanced at the same rate as others who have served in conventional forces in traditional jobs.  There was a film called Go tell the Spartans staring Burt Lancaster about Army advisers in the early stages of Vietnam.  If you see it and have been to Iraq with our advisers you can see some of the same dynamics at work.

At this point we are still engaged in Iraq and Afghanistan.  These wars divided the nation and the veterans, though better treated and appreciated by society than most of thier Vietnam counterparts have no memorial.  Words of thanks uttered by politicans and punits abound, our Vietnam era and other fellow veterans in their latter years come to the airports that we fly in and out of to say thank you, but our numbers are rising, the war rages on both in country and in our minds and lives are being lost long after soldiers have left the battlefield.

not a happy camperNot Doing Well on Leave about 5 months After my Return from Iraq

We have to do a better job of ensuring that those who sacrifice so much do not feel that they have been cut off and abandoned while they are in theater and especially when they return. When it is time we need a memorial on the Capitol Mall for those who served in these wars.  I don’t know when that will be, but I do hope to see it in my day.  Sure it’s only symbolic, but symbols can be healing too, just look at the black granite wall rising up from the ground and going back down into it, filled with the names of those who gave their lives and made the supreme sacrifice in Southeast Asia.  Simply known by most as “the Wall” it has become a place of healing and rememberance.  A place to say thank you, goodbye and amen.

Peace and blessings, Steve+

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Filed under healthcare, iraq,afghanistan, Military, PTSD, Tour in Iraq, vietnam