Tag Archives: insomina

Emotional and Physical Recovery from a Traumatic Event

Pearls Before Swine Comic Strip for August 07, 2017

Comic, Pearls Before Swine, (c) 2017 by Stephan Pastis

Friends of Padre Steve’s World,

On Thursday afternoon my car was run off the road by an inattentive driver with a very loud exhaust system.

I honestly thought I would be better the next day, but late in the afternoon when Judy took me to get the car, I got in the driver seat and I felt sick to my stomach and was trembling. I got the car home and she drove us to Gordon Biersch where we had a nice night.

I didn’t sleep well, lots of nightmares and I didn’t leave bed, except to let the dogs out until about 1 PM. I knew I had to get a few groceries at Kroger and Wegmans so I made the trip. Until I got to the Kroger parking lot the trip went well. Then it seemed that every old lady was trying to crash by cutting me off or taking up most of a lane. I was doing into panic mode, but took a deep breath, regathered myself and instead of going directly to Wegmans I stopped by Gordon Biersch for a one and done to calm the nerves. Since I no longer take a specific anti anxiety medication, I stopped taking the minimal PRN dosage of Xanax a few years back because I was experiencing less anxiety.

The crash has re-triggered that anxiety, something I will talk to with my shrink on Tuesday and my psychiatric medicine manager Wednesday. But yesterday I needed to calm down. I texted Judy and posted my situation on Facebook. A good friend came over and spent some time with me at the bar. I then did a take out order since Judy told me that. Wegmans could wait.

Judy reminded me of the chemical chain reaction that trauma sends through the body, and how it takes time for that to play out. I am lucky to have her.

This morning we planned to go out to breakfast, but since neither of us were hungry we stayed in bed with the dogs. They have been very comforting, especially my girl Izzy. Judy is about to drive us to Biersch for dinner so we can get out of the house.

Tomorrow I am up really early for fat boy PT, then I have to drive to the Naval Medical Center for aquatic physical therapy and to get my antidepressant refilled  since I have gone without it 5 days and don’t want to crash and get suicidal. Then I will go in to work.

About the cartoon. That is how I have felt all weekend. The cartoon is Pearls Before Swine by Stephan Pastis. This particular cartoon ran in August of 2017. His comics can be accessed at GoComics.com, I hope that since I didn’t ask permission to run it that you will flood his site with hits and buy his books.

So until tomorrow, and hopefully better times,

Peace,

Padre Steve+

 

 

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Filed under Loose thoughts and musings, mental health, Military, PTSD

There Will be Nightmares: PTSD & Memories of War

Friends of Padre Steve’s World

I’m really very tired today so another short post. I haven’t slept well in several weeks, part of this of course was the worry I had regarding my wife Judy and her cancer diagnosis, surgery and recovery. As she has gotten better I have been dealing with stuff from my own closet of anxieties. Those who have been reading my articles here know that I deal with PTSD, Traumatic Brain Injury and moral injury from my time in Iraq, and my return home.

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Last year I went through a very difficult time dealing with the military mental health system that I never want to repeat again. I hope I don’t have to, but I may. My therapist who I have had since last summer took a new job thousands of miles away and now I am going to have to find another therapist. I am hoping the man I see for my medication management can get me referred to someone good, because I do not want to be thrust back into the system and take the luck of the draw. That scares me to death, and since I found out my therapist was leaving and that I will not see her again I have been trying to keep my anxiety under control and not to panic. Awake I do pretty well with this, but when I try to sleep, all my Iraq stuff, plus all the very real and bad experiences that I had with the military mental health system last year flood my psyche. The night terrors are back, the terrible dreams and fears. It is not fun waking up in the middle of the night in a state of terror. Last year, after dealing with a number of providers and administrators I was nearly suicidal. It took the intervention of a former commanding officer who had been recently selected for promotion to Admiral in the Medical Corps to get me listened to and to get me the help that I sought.

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But I know that I am not alone, I will get the professional help that I still need and I do have some friends I can talk to about these issues. Likewise I know many combat who veterans deal with similar issues related to their service, as well what happened to them when they returned home from Iraq or Afghanistan. The return from war is often worse than actually being over there, few people really understand, unless they too have been there.

Guy Sajer wrote in his book The Forgotten Soldier, “Only happy people have nightmares, from overeating. For those who live a nightmare reality, sleep is a black hole, lost in time, like death.” General Gouverneur Warren, a hero of many Civil War battles including Gettysburg wrote to his wife after the war “I wish I did not dream so much. They make me sometimes to dread to go to sleep. Scenes from the war, are so constantly recalled, with bitter feelings I wish never to experience again. Lies, vanity, treachery, and carnage.”

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I am a realist about this. I know that there is no magic wand which will make it all go away and I don’t expect any therapist, or even God to cure me. I can understand why Alexander Dumas in the Count of Monte Cristo wrote, “Moral wounds have this peculiarity – they may be hidden, but they never close; always painful, always ready to bleed when touched, they remain fresh and open in the heart.”

That is true and I know to some people that may sound like I have given up, especially because it runs counter to the snake oil salesmen who write self-help books which promise to heal you in whatever number of steps or exercises; especially the ones written by preachers. But that is not the case, despite everything I still have a love of life and lust for learning. Except that now I just have moved to a new level of understanding concerning my own dark places, and that pain that manifests at night as I try to sleep. Since nothing will take it away I need to live with it and realize that it won’t always be the first thing that I think about when I wake up in the morning. That my friends is the essence of hope. 

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One of my favorite actors, James Spader, plays a character named Raymond Reddington on the television show The Blacklist. During one episode he told another character something quite profound, something that if we actually embrace it can be somewhat comforting. “There is nothing that can take the pain away. But eventually, you will find a way to live with it. There will be nightmares. And every day when you wake up, it will be the first thing you think about. Until one day, it’s the second.”

I think that is why I can continue and at the same time seek to be available to those who suffer similar afflictions, and thankfully, I do still have those opportunities and as the late Henri Nouwen wrote, “Ministry means the ongoing attempt to put one’s own search for God, with all the moments of pain and joy, despair and hope, at the disposal of those who want to join this search but do not know how.”

Anyway, have a nice night.

Peace

Padre Steve+

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Filed under Loose thoughts and musings

The Long Strange Trip: Seven Years of PTSD, TBI & Moral Injury

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You’re sick of hangin’ around and you’d like to travel,
Get tired of travelin’ and you want to settle down.
I guess they can’t revoke your soul for tryin’,
Get out of the door and light out and look all around.

Sometimes the light’s all shinin’ on me,
Other times I can barely see.
Lately it occurs to me what a long, strange trip it’s been.

Truckin’, I’m a goin’ home. Whoa whoa baby, back where I belong,
Back home, sit down and patch my bones, and get back truckin’ on.

From Truckin’ by the Grateful Dead

It has been seven full years since I descended into the hell of the abyss that is PTSD. Back in the late spring and early summer of 2008 just a few months after my return from what I still consider my best tour of duty in over 30 years of military service with US advisors and Iraq Army and Security forces in Al Anbar Province in 2007-2008 I was in a state of emotional and spiritual collapse.

I really couldn’t believe then what was happening to me or they way that it would end up shaping my life to the present day. In retrospect my return from Iraq marked a beginning of a personal hell that for a number of years seemed like that it would never end. It was painful, it was isolating and it marked a profound change in the way that I saw God, faith, politics and social justice. It changed me in ways that I never could have imagined when I got on a bus heading for Fort Jackson South Carolina following the July 4th holiday of 2007.

Those brave souls that have followed me on this website as well as those that are still my friends despite occasional disagreements and misunderstandings, those that may not understand me but still are my friends have seen this.

So seven years later what is it like? I kind of feel like T.E. Lawrence when he penned this thought in a letter to a friend:

“You wonder what I am doing? Well, so do I, in truth. Days seem to dawn, suns to shine, evenings to follow, and then I sleep. What I have done, what I am doing, what I am going to do, puzzle and bewilder me. Have you ever been a leaf and fallen from your tree in autumn and been really puzzled about it? That’s the feeling.” T. E. Lawrence, Letter 1935

I still have terrible trouble sleeping. It got worse last summer when I had a complete relapse and major crash.  I don’t take heavy doses of sleep meds anymore, my new doctors are working to see what will work. I now take a mild dosage of an anti-anxiety medication and an anti-depressant, I also have a new medication to help reduce the severity and violence of my nightmares. This is far better of a combination than the heavy doses of medications that made me feel like I was hung over without that benefit of sharing too many drinks with friends at the local watering hole.

As opposed to the years immediately following my time in Iraq I have to say that I am no longer self medicating with alcohol. I remember in 2009 going out for dinner, having a few beers, then going to a ball game and drinking a few more and coming home with Krispy Kreme donuts and drinking more beer on a regular basis and usually taking a couple of shots or Jaegermeister or glasses of a  nice Spanish Brandy just to get to sleep so I could go back to facing life and death situations the next day in the ICUs that I then worked in. I don’t need that anymore, even though sleep can be problematic and dreams and nightmares rivaling anything I can watch on my HD TV. I can understand the words of Union General Gouverneur Warren after the Civil War:

“I wish I did not dream so much. They make me sometimes to dread to go to sleep. Scenes from the war, are so constantly recalled, with bitter feelings I wish never to experience again. Lies, vanity, treachery, and carnage.”

I still love to pony up to the bar and share a couple of steins with friends but I don’t need it to numb myself into feeling no pain. Talking with many other vets who have served in Iraq, Afghanistan or even Vietnam I know that I wasn’t alone in those dark days.

I have become a bit less hyper-vigilant than I was just in May of 2008. However, that being said I do notice that I am more on guard on the roads and that little things, sirens, emergency vehicles. Loud noises and traffic still set me off more than when I lived in rural North Carolina while stationed at Camp LeJeune from 2010 until August of 2013.

I absolutely hate air travel. I don’t like the crowds, the stress of security or the constant delays, changes and overcrowding. Truthfully I felt more comfortable flying the skies of Iraq on Marine, Army and Air Force fixed and rotor wing aircraft and on occasion being shot at in Iraq’s Al Anbar Province than I do on any airline today in this country.

I have become exceptionally sensitive to tragedy, death and suffering. The loss of friends or major incidents where military personnel are killed in combat, training missions or just doing their job hits me hard. The worst times are when friends, or others that I know die by their own hand. When they are veterans who suffer from PTSD, TBI or Moral Injury it is like a dagger plunging into me.

Whereas in 2008 through 2010 and even until 2011 I was exceptionally sensitive to criticism to the changes that were occurring in my life including my move to the “left” both theologically and politically I have gotten to the point that I realize that it is more important to be honest and authentic as to who I am and what I believe.

I have found that those that really matter to me don’t care so much about those things and that relationships maintained with people who don’t always agree with each other where all remain their personal integrity are far more rewarding than relationships that are first and foremost decided by allegiance to political or religious orthodoxy no matter what side of the spectrum it is from. I hate group think. Thus though I have to now consider me to be on the “liberal” side of the political and theological divide I still have to be considered a moderate simply because I refuse to make people my enemy simply because I disagree with them or they with me.

When I began this site in the spring of 2009 I named it Padre Steve’s World…Musings of a Passionate Moderate. I think I did that because it actually described me then, and now, even though I am pretty passionately liberal about some things and that doesn’t bother me in any way because it comes from my wrestling with God and faith and realizing that integrity matters more than about anything else. I changed the title of the site to Musings of a Passionately Progressive Moderate last year. I did this because I am a passionately progressive moderate; a liberal committed to a Christian faith that speaks up for the oppressed. I am willing to confront those that would use faith, political or economic power to oppress the weak or those different from us.

Since I returned from Iraq in 2008 I discovered what it was to really question faith and God. To become for a couple of years a man who was for all practical purposes an agnostic praying that God still existed and cared. I discovered that in doing so that faith returned, different but more real than I had ever experienced in a life spent in the Christian faith and ministry.

My agnostic period gave me an immense empathy and appreciation for those who have lost faith, struggle with faith or reject any concept of God. I value reason as much, maybe if not more than faith now, not that reason is infallible or perfect. However, reason does allow me to evaluate my faith, and appreciate the amazing mysteries of the universe that our science and technology continue to reveal in ever more complex detail.

That brought change because my rediscovered faith brought me into conflict with people in the church denomination and faith community where I had been ordained as a priest. I was asked to leave and found a new home church and denomination that fit my life, faith experience and where I could live and minister in complete integrity. In the church that took me in during the fall of 2010 I can be faithful to the Gospel and care for the lost, the least and the lonely. This is especially the case for those who have been abused by churches and ministries, who often contact me.

I am now in the process of more medical evaluation and testing to discover the extent of the Traumatic Brian Injury and how it is interacting with the PTSD.

It has been a long strange trip and it will probably continue to go on.

Peace

Padre Steve+

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Filed under faith, mental health, PTSD, Tour in Iraq

Living with Dark Places and Pain

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“There is nothing that can take the pain away. But eventually, you will find a way to live with it. There will be nightmares. And everyday when you wake up, it will be the first thing you think about. Until one day, it’s the second.” Raymond “Red Reddington (James Spader) The Blacklist

I am haunted by many things, unlike many people who have little self-awareness I might have just a bit too much. I have talked about the nightmares, night terrors and insomnia that I have many times following my return from Iraq. I used to believe, at least back in the first year or so after I returned that I thought that eventually I would get over it. I don’t believe that anymore, now I just believe that I will find a way to live with them.

I guess that is the secret to life. Instead of wishing that something would miraculously take way the pain, I guess that it is better to find a way to live with it because one day something  else will replace it.

Is that an ideal way to deal with life? Probably not, but I know that I am an idealist anymore. I used to be, but that was a while back. It took time, but war and the lies of men that I voted for, men who I trusted because they professed my faith, my love of country, and some who even shared my vocation as a priest and chaplain took that from me.

Experts call this “moral injury.” For me it is connected with my tour in Iraq, PTSD and what I experience when I came home from colleagues, and people in my former church. Betrayal and abandonment is a terrible thing, but I am learning to live with it. It is not pretty but I am learning with every passing night and morning. Alexander Dumas wrote in The Count of Monte Cristo:

“Moral wounds have this peculiarity – they may be hidden, but they never close; always painful, always ready to bleed when touched, they remain fresh and open in the heart.”

My life is full again, there is meaning and purpose, but it is tempered by realism and the expectation that every day I will wake up and still think about those painful memories until finally something else takes their place. 

I guess that the secret to living with darkness and pain is simply to live with it because the saying that “time heals all wounds” is a lie, it is the fabrication of people that don’t want to deal with the real world. God might heal, but then God may not. So I will live with it and in doing so I will continue on and in the process hopefully be there for others that also struggle with pain that does not want to go away and nightmares that never seem to end. As Henri Nouwen wrote:

“Ministry means the ongoing attempt to put one’s own search for God, with all the moments of pain and joy, despair and hope, at the disposal of those who want to join this search but do not know how.”

Peace

Padre Steve+

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Filed under christian life, faith, ministry, PTSD

Highs and Lows: Baseball versus Alzheimer’s and Mass Murder at Fort Hood

field_of_dreamsField of Dreams

This has been a weird week.  There was some great baseball in the World Series and I even nailed the prediction for it.  Just take a look back if you don’t believe me.  I have never gone public with a World Series prediction and I am pretty pleased that my predictions were pretty good considering that I am neither the Prophet nor the Son of the Prophet.  Neither am I infallible like the Pope being that I am just a miscreant Priest and member of the Church of Baseball, Harbor Park Parish where I have my season ticket in Section 102, Row B, Seat 2.

The Series was good for me, I really didn’t care who won, except that I predicted the Yankees in six based on match ups, statistics and numbers.  I’m a Giants, A’s and Orioles fan and as I sit here in my O’s hat and sweatshirt I can honestly say that I didn’t have a dog in the fight.  However to be right in analyzing the playoffs and World Series is pretty cool.  Maybe someday I will be a real sportswriter or broadcaster and get to sit opposite Jay Mariotti and Woody Paige on Around the Horn.

However, the series helped distract me in some ways for my trip home to see what I can do to help my brother with my parents.  I don’t look forward to the trip; the airports get to me now.  Thankfully I’m not going through Atlanta or Washington Dulles.  At least O’Hare has decent food and beer.  I guess the thing that gets me the most about going home this time is that my mom wants me to help go through possessions, not paperwork.  I’m thinking about years of memories that she has kept; family heirlooms and the just plain shit in some cases.  The stuff really doesn’t matter to me but it will be taxing.  Likewise the thought of seeing my dad again in his decrepit state, shrunken and mostly demented from Alzheimer’s disease is painful to think about.

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Yesterday morning after my on call shift I went up for my weigh in.  I gained 25 pounds since the spring, I knew that going in, I knew that I would not make the weight.  Most of the weigh came from stopping by Krispy Kreme on the way home from Harbor Park, picking up a dozen hot and fresh glazed and downing 3-4 or more with a beer before going to bed.  Of course the reason I did this was because I was emotionally spent, couldn’t sleep and couldn’t pull myself away from work.  Add stress, anxiety, no sleep, overwork, bad diet and little exercise  together and you get fat…well I get fat, I don’t know about you.  This is the first time in 28 years in the military that I have been officially fat.  I’ve always been close to the limit because the Deity Herself did not endue me with a couple of additional inches of height to help me as the military is run by the tall skinny mafia and the standards reflect that.   Until yesterday I had always made it sometimes by the skin of my teeth, but always made it.  When I was in better shape I would crush the physical fitness part of the assessment even if I was close to the weight limit.  Today after sleeping through my alarm and barely making it in to work I did the Physical Readiness Test and despite having only done 3 sessions of PT since the end of April I did better than a lot of young people, I passed, not to my usually standard of near perfection, but passing.  My diet has already been adjusted; my work schedule and duties have been rearranged to help me recover from Iraq and my return.  I’m doing more supervisory and administrative work vice the heavy clinical work in ICU.  This will give me the time that I need to do what I have not done since my return from Iraq that is to take care of me.  So I do have a sense of humor about this, I’m not going to stay fat and I am going to get my physical edge back.  I’m old but not done.  After the weigh in I thought about the episode of Third Rock from the Sun where Dick Solomon, played by John Lithglow gets fat and joins a weight loss organization called the Fat Losers. I have included the links to the episode on You Tube here:

http://www.youtube.com/watch?v=OgP2h1x2EZc

http://www.youtube.com/watch?v=-x0kzALQPU4

http://www.youtube.com/watch?v=Q2tYkwhqqxs

I will keep you abreast of my journey to take this off and turn myself into a bald version of Arnold.  If anyone wants to take that journey with me let me know.  We’ll be the real “Fat Losers” and kick some ass.

fort hood shootingsGrieving Soldiers at Fort Hood

The shooting at Fort Hood yesterday shook me and the Abbess pretty bad.  For me it hit my sense of safety and security was rocked as a Moslem Army Major brutally attacked and killed 12 soldiers and an Army civilian and wounded 30 more soldiers.  I’ve mentioned in my Fort Hood updates more about how it hit me so I won’t rehash that here except that I started emotionally melting down a bit as I watched the coverage which I could not let go of.  I thought of friends that I know there and my times about Fort Hood when I was in the Army, and the thought that an officer who swore the same oath that I have committed such an atrocity in the name of his religion really got me.  If he had been an enlisted man I think my reaction would have been different, somehow when I learned that it was an officer, a psychiatrist and a Moslem floored me.  Frankly in my world officers don’t do this.  Today I was able to get with Elmer the Shrink and talk. That helped. My boss and our deputy helped take care of me today and yesterday.  On the way home I stopped by Harbor Park to take in the view of the field and relax.  Thankfully the good folks in the office allow me to do this.  It helped a lot.

harbor park opening dayMy Field of Dreams: Harbor Park

After a nice dinner with the Abbess at Gordon Biersch I did what I almost always do after such a couple of days and retreated into the world of magic that is baseball.  I put on For the Love of the Game and Field of Dreams.  Somehow those help me.  The lead character played by Kevin Costner, Billy Chapel pitches a perfect game and reminisces about his life and career.  It reminds me of possibilities even for me and Field of Dreams reminds me of all that is good, even in spite of all the evil that the world.  The baseball season may be over, but the game reaches me when nothing else can.  I looked at the diamond surrounded by the cornfields and remember when I drove to Iowa and made the trip to Dyersville just to play catch on the Field of Dreams.  I hope that when I go home that somehow I can help ease my dad’s pain in some way, and maybe just maybe have him back for a few minutes.

Me and last last picMy last Visit with Dad in May

Thank you for your prayers and encouragement.  Please keep praying for the victims and all those affected at Fort Hood.  Pray that the violent and senseless act of Major Hasan will not beget more violence.

Peace,

Padre Steve+

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Filed under alzheimer's disease, Baseball, PTSD, traumatic national events

PTSD²: Learning to Live Together When Both of You Have PTSD

Judy and Steve[1]_edited-1The Abbess and Me

The Abbess and I have been married 26 years.  We have dealt with PTSD for all of that time. Now we did not always know this was the case, not until she received the diagnosis back in 1989 and even then we did not really appreciate the effect that it was having on her and us.  She has written a wonderful piece over at her place, the Abbey Normal Abbess’s Blog entitled “The Abbess talks about a household with PTSDwhich I have linked here:  http://abbeynormalabbess.wordpress.com/2009/09/18/the-abbess-talks-about-a-household-with-ptsd/

Any regular reader of this website knows that the host, Padre Steve deals with PTSD, a gift that he brought home with him from Iraq.  There are a decent number of articles here that reference my struggles in coming to grips with this, how it affects me and how I am working with Elmer the Shrink to figure this surreal, confusing, illogical and sometimes frightening mess out.

Now before I came home with PTSD and actually figured out what the hell was going on with me and why I was falling apart I had little understanding of what the Abbess was going through.  She suffers from childhood PTSD, abusive father, generally un-protective mother who probably had her own childhood abuse issues going on and a sister who physically abused her.  She also was traumatized when she was between two and three years old when a Doctor removed a cyst from her face without anesthesia, that is one of her earliest memories and for many years caused her to fear going to the doctor.  When we started dating the family was probably in one of their more peaceful states but there were plenty of times where I saw some scary shit going on.  At the same time the Judy that I knew was the confident young college student, gifted artist and President of the Delta College German Club with a vibrant faith.  There were hints back then that she was damaged by her family of origin but I just took it as something that she would simply grow out of.  I had read about PTSD in Vietnam veterans but kind of brushed that aside and had no idea that someone who had not been to war could suffer from PTSD.

After she was diagnosed with childhood PTSD neither of us really knew what to do with it and most of her therapists did not deal with it and instead focused on depression and one even tried to diagnose her and turn her into a sufferer of Dissociative Identity Disorder the diagnosis formerly known as Multiple Personality Disorder.  That was a fiasco brought on by “Christian” therapists who tried to find demons in everything.  Of course if there were demons involved or Satanic ritual abuse that made it easy, you didn’t need to deal with the PTSD or any of the psychological components to what was going on.  I think that these therapists, one of who is now famous for his diagnoses of former NFL star Hershel Walker did great harm to Judy and others in making a psychological diagnosis based on unsupportable “spiritual” causes.  These spiritual “causes” were not based on fact, but rather the therapist’s suppositions which were based on conspiracy theories   usually involving how police worked with satanic groups to conduct satanic rituals and then return the victims to their homes.  If we know what we had known now we would have made a malpractice suit against the therapists and pastoral counselor involved in Judy’s treatment at the time.

It was not until I was on active duty in the Navy that a therapist began to work with Judy’s PTSD.  Even still with her getting treatment I was still learning how to grapple with all the reactions that I had seen for years because to me they were still not logical.  I am a methodical and logical person and if you know anything about PTSD you quickly find that much of what happens to a person has nothing to do with logic, but what the brain and the nervous system are doing and not how a person is deciding to act at a given point.  So when Judy would startle or have some kind of meltdown I would try to counter with logic.  This to my surprise never worked and I was always left frustrated.  Over the years I became a bit more understanding but still would have trouble with the severe startle reflex as well as the occasional meltdowns which over the past couple of years have gotten to be less severe because of a conscious effort to help her work through her PTSD symptoms and become more aware of what was happening and triggers.

Doonesbury ptsd-pmsPMS -PTSD Judy’s Best friend said to me “You’re a girl now”

Then I went to Iraq and came back with PTSD with all the trimmings.  I think that she started figuring it before me so when I finally crashed on June 16th 2008, I do remember the date well, she was not surprised when I came back and told her that the doctors thought that I had PTSD and were referring me for treatment.  The good thing for me was that they did not refer to the Psychology or Psychiatry clinic but to the Deployment Health Office where I met and began to work with Elmer the Shrink.  My first visit to his office I got a copy of the Doonesbury book dealing with coming home from war and PTSD.  I laughed and cried all the way through the book.  Until I went to Iraq I had never been a big fan of Doonesbury but I really appreciate it now.  Military.com has a link to the Doonesbury at War series which I find quite nice to have.

http://www.military.com/warfighters

I appreciate the help and understanding of people that I work with.  That helps; I don’t have the sense of abandonment and isolation that I experienced the first 8 months that I was back from Iraq.  I think that my medications are getting managed a bit better as well.  One thing that is hard to understand when you first start getting treatment is that you are kind of an experiment in progress as the doctor’s figure out what works and what doesn’t work.  This I think can be very frustrating to people who want “fixed” right now.

doonesbury ptsd onsetSome of my dreams get pretty physical

Before I went to Iraq she was the more observant one of us.  Now I am the more observant. The one value of PTSD that I don’t really want to lose is my awareness of what it happening around me.  It has I’m sure been more help than hindrance getting me out of dangerous situations quickly because in many cases I sense things even before I see or hear them.  As I have pointed out in other posts this has come in handy especially in our nutty Hampton Roads traffic and the “kill or be killed” mindset that you have to have to survive on I-64 or I-264.  While I like the ability to do this the startle response that I have now is really annoying.  We have a phone in our house that the ringer sends me into orbit.  If I am sitting in the living room when it goes off it scares the absolute shit out of me as it does Judy.  It is interesting to see both of us almost jump through our asses when that damned thing goes off. Inevitably it is the damned Rite Aide Pharmacy automated line or a equally damned telemarketer that does this.  Other loud noises get me.  I was driving to work and there was a vintage Chevy Camaro just ahead of me and in the adjacent lane to my right. It was still in that morning twilight when the Camaro started backfiring out of its twin exhaust pipes.  The backfire sounded like a burst of semi automatic weapons fire close up and the flashes from the pipes looked like muzzle flashes.  Other unexpected loud noises get me as does the sound of helicopters, especially at night.  I don’t do crowds well unless they are at a baseball game.  I went to do the invocation yesterday at the Norfolk Naval Shipyard to kick off the annual Combined Federal Campaign.  I was expecting a small rather sedate event.  It was nothing of the sort.  There were at least a couple of hundred people in a relatively small auditorium, a band, reports and photographers, a color guard and drill team from a local ROTC unit even balloons and banners.  The noise and light, many moving pieces gave the event a pep rally feel which drove up my anxiety level pretty bad. I was able to keep from having a panic attack or a meltdown, but it took work not to fall apart especially with the week that I had had and the fact that in the previous 31 hours I had only 3.5 hours of sleep.  I don’t like my outbursts of anger which can border on rage depending on the sense of danger that I feel although some expressions that I have come up with in these events are pretty funny as I question the parentage and oedipal tendencies of some people.  Anxiety, tremors, muscle tension, insomnia and nightmares are no fun either.

I guess for me that the war is not over and I know that if I was to go back I would do just fine. I almost think that another deployment to either Iraq of Afghanistan would help me in some ways. I guess I might get another shot at it as things continue to develop over there.  Personally I think I need it to close the loop and one day when peace comes to Iraq to go back there to visit some of the Iraqis that I got to know while there.

Dundas at HitSomehow I was More Relaxed in Iraq than I am Here

So now I am much more understanding of what Judy has lived with since childhood.  She has been a help to me in understanding my struggle as well and what I have experienced has helped me have a lot more compassion and understanding for her.  The only one without PTSD is our little dog Molly so it does make for interesting living around our little household.

Peace,

Padre Steve+

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The Art and Science of Staying Awake and Going to Sleep When You Have PTSD

“The blood level in my caffeine is getting too high” Woody Paige on ESPN’s Around the Horn

opus coffeeToday: 3 24 Ounce Cups of Southern Pecan Coffee with French Vanilla Creamer and Splenda

Which came first the chicken or the Egg McMuffin?  That is the type of life I have when it comes to a little thing that you never notice until you can’t do it…something called sleep.  Today is one of those days where the inner Chinese kids, Yin and Yang are trying to get themselves into some kind of equilibrium, or maybe even equilibriumnumnum after a pretty rough week and a night on call at the medical center.  As usual my insomnia and anxiety have joined their ever loving hands together to ensure that I have had less than optimal sleep.  Yesterday’s on call duty and that of last night was fairly relaxed.  I had my new residents with me getting oriented to pulling duty and I have to say they are a fun bunch. We have two Americans and two Canadians all with great senses of humor and all who have had some kind of combat tour.   I actually like being around them which I cannot say of everyone that I have worked with in 28 plus years in the military.  They are a joy.  Likewise I love being around the hospital staff doing my rounds at night and to top things off there were no tragedies.

This being said I still could not get to sleep last night which kind of tops off a week of crappy or too little sleep.  Love them or leave them crappy or insufficient sleep over a long period of time beat the hell out of you.  I know, it has me and to make an astute observation it makes me tired.

My battles with insomnia began about a third of the way into my Iraq tour. When we came back from a mission I would go to my “Can” and just sit awake either reading, playing chess on my computer or going out and watching the Dustoff helicopters coming in and out of the Surgical Shock Trauma Platoon helipad or looking off to the perimeter to see illumination rounds lighting up the night sky and hearing occasional gunfire and explosions.  It was incredibly hard to get to sleep no matter how tired I was.  That continued the whole tour and got worse.  Part was the late night flights that we so often took, part the danger that we faced and part the conditions that we slept in. At one FOB in Ramadi we stayed in an old trailer that we could hear the rats chewing on the ceiling. When we had to stay in Al Asad to catch a morning flight after having flown in our tents were near the flight line and F-18s flying in and out all night do not make for a quiet and restful night’s rest.  In some of the more remote FOBs the isolation and vulnerability made it hard to rest.  I think that it was about two-thirds of the way through that the dreams and nightmares started.

Doonesbury-082108Too True I can Relate

Having talked to others with PTSD or other combat related injuries of the brain and nervous system I find that I am not alone and most of us are mid-grade to senior career officers.  It’s kind of weird because when you are young in the military you are taught just to “suck it up” and as you go through your career you tell others the same thing until it happens to you. Thus for us old guys I think PTSD is actually harder than for young people because it destroys our world view and our tough personas which most up us have cultivated over a long period of time.  My friends and I share the same or similar experience and we all are trying some way of managing it.  All of us have some drugs, the legal kind of course to help us with anxiety, panic, depression and insomnia.  However there are times when the drugs don’t work as well as they should, or they need to be adjusted or changed.  In those times you still have to find ways of getting to sleep and for the times where you can’t sleep ways of keeping sharp so you can stay in the game and not screw anything up.

bean church 1Staying Awake

Some guys I know have added to the mix other kinds of over the counter drugs and supplements.  I don’t do that, not that there’s anything wrong with it, but I guess I never grew up.  I like my medicine whenever possible to taste good.  Thus my self-medication is limited to caffeine and really good beer.   My choice in caffeine is coffee which I have been drinking since I was 12 and I believe that by my junior year of high school Navy Junior ROTC my index finger was beginning to mould itself into the shape of a coffee cup handle.  With caffeine there is little moderation because since I don’t sleep I need to stay awake.  My alcohol consumption is moderate and I don’t drink hard liquor.  I always try to maintain the Yin and Yang of the blood to medicine to caffeine and alcohol at some kind of balance so I can get to sleep and then not be exhausted the next day.  I make sure that I don’t mix alcohol with my meds since I don’t want to do the Karen Anne Quinlan thing and end up in a coma, and end up in a broccolitative or asperagative state (I don’t do just any vegetables thank you).  However I know guys who have a lot heavier load of meds than I do who have no problem ingesting them and alcohol close together and most of these guys don’t just drink limited amounts of beer.  I’m quite happy not to be there and mixing meds and alcohol.  So for me the equation looks like this.  Please note I am a historian and not a mathematician and that since this is a new field of study for me that it does not yet factor in sleep quality:

Drugs- caffeine² ± beer÷ “defensive factor” (anxiety+ hyper-vigilance) + normal work and life stress ÷ spirituality factor² = sleep

Now also since I am a Priest and Chaplain there is the spirituality factor which is hard to quantify but can be stated very simply “Please God let me sleep + have I been to a baseball game.”  This is hard to quantify but I have given it a numeric value for the sake of argument. Now I’m not a mathematician by any means but this seems to work somehow.

axieties and dreamsYep…Them Iraqi Snorklewackers Show up Often

Now back to me and the guys I know who struggle with this.  Pretty much to a man we all still manage to do our jobs.  In fact we all love what we are called to do which probably helps us as far as the management of our situation.  Many of the folks I know are like me and if we had the chance would go back to the fight.  You put us together with men and women who have similar experiences in combat and we are in our element, there is a shared brotherhood because of the real dangers that we faced.  However that is not necessarily true of others that we serve alongside who have not been, as is oft said “in the shit.” Within that category there are those who are people that help us and care for us, they are appreciated even if they have not been in our shoes.  The often exude a kindness and love that helps us make it when we have bad days.  But there are also those that don’t always seem to have our interests at heart or who would appear by their words and sometimes their actions to use our injury against us.

garfield show me the coffeeAmen!

So this whole deal gets weird when you can’t sleep due to anxiety or insomnia and have to maintain your ability to do your job.  Now this is where the art and science of self medication come together. You have to be able to figure out how things balance out. Medications are set by prescription unless you throw in a wild card of over the counter meds and supplements.  Thus for me they are a relatively stable factor.  Then you factor in the caffeine factor.  This may vary but in my case I drink 24-72 ounces a day of coffee which is usually spread over a 4-8 hour period, and maybe 12-24 ounces of Diet Coke, Coke Zero or Diet Dr Pepper later in the day.  My caffeine level is variable based on how tired I am. If I am well rested the amount consumed goes down.  Today I was maxing out the caffeine factor because my ass was whipped and it was all I could do to get through the day.  Today I was so wiped that I added in the Skittles factor to get the quickie sugar rush.  I hate skittles, when we were poor in seminary it was the only candy we got because the church food bank gave them out.  Skittles, Boston Baked Beans, Swee Tarts and Smarties are all great instant energy, the problem with them is that they are like lighting the afterburner; they are only good for short spurts.  Beer varies but if I am home I might have two beers at dinner.  I have stopped any late night drinks.  Then there is the “defensive factor” which for me includes my anxiety and hyper-arousal levels.  This is combined with normal life and stress and divided by the spirituality factor to get a night’s sleep.  That is the science.  The art is how to make the adjustments to the factors that are variable fit the current life situation and find those illusive Chinese kids, Yin and Yang.

pub1

So the week is coming to a close, I have now been up 36 of the last 40 hours and have worked every day since last Monday, though Saturday and Sunday were just a few hours each despite having the duty pagers. I am tired I had a decent meal complete with vegetables, several portions of fruit and other healthy things.   As soon as the Orioles game is over I plan on heading to bed and hoping my meds and my general sense of exhaustion will overcome any anxiety or insomnia that might join hands to interfere with me.  I think I have managed to bring old Yin and Yang into balance for the evening and if I didn’t I I do hope that the Deity Herself will assist this effort tonight.

Peace, Padre Steve+

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