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To Iraq and Back: Living Wills, Immunizations Gone Bad and More Sleepless Nights

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This is another installment of my To Iraq and Back series which tells of my deployment to Iraq with RP1 Nelson Lebron in 2007 and 2008.

One of the sobering things as you get ready to go to war are administrative issues that deal directly with your mortality. They are mundane actions when we do them in peacetime but chilling when you put them in context of going to war.

In our society in which people do all they can to push back even thinking about death discussing the issues that deal with your possible dismemberment, disability or your death are taboo. The month before I deployed  Iraq Judy had me take out an additional life insurance policy that doubled what the military would provide in the event of my demise.  At that point Iraq was a cauldron, hundreds of casualties each month and I was going to the heart of the action in Al Anbar province.

Part of our processing to go to combat was a will and power of attorney update.  We had not updated our wills since well before coming to the Hampton Roads area so I took advantage of this time to get it done.  The will itself was pretty easy since we have no children and have not been married to anyone else.  That was the easy part.

The next part was dealing with various powers of attorney, a general power of attorney and a medical power of attorney. The medical power of attorney is something that I routinely deal with at the hospital. I have dealt with them before in other places.  At the same time they become somewhat disconcerting when you are getting to go into a combat zone where there is heavy fighting going on. For most that is disconcerting enough, but chaplains go into action unarmed.

Sometimes when I fill out one of these I pray that I don’t end up like Karen Anne Quinlan or Terri Shaivo.  When I did it this time all I could think about was me being so badly wounded that it would be like the movie The Naked Gun.  I someone telling Judy “Doctors say that Dundas has a 50/50 chance of living, though there’s only a 10 percent chance of that.” While this is going on I could just see me unable to respond trying to say “give me one more at bat skip, just one more chance…please.”  This may not seem like the most spiritual thing for a Priest to be saying but I don’t want to be in the afterlife before my time. It would be bad form.

Legal matters finished we had to get our immunizations. When you deploy the military always ensures that you are vaccinated against about everything imaginable. These include typhoid, anthrax, smallpox, malaria, yellow fever, certain regional diseases and probably others that I have forgotten.

I had received many of these before at various times. This included my first Anthrax vaccine. On this second occasion something happened and ti had a reaction to it.  My bicep felt like someone had shoved a baseball in it and the sucker hurt like hell. By the next morning I knew that my reaction was not “normal” because the first one I had did not do this.

I thought back to the Anthrax scare right after September 11th 2001 and I didn’t want to take any chances regarding something that the media said could be dangerous. What if they had messed up and given me a bad batch of the vaccine. Hell, just because I’m paranoid doesn’t mean that they are not out to get me. Besides if I was going to die for my country I didn’t want it to be from a reaction to a vaccine and not something heroic.

So I went back to the immunization section. Like a typical officer I simply “excused” my way past the queue of sailors waiting to get PPDs read and went to the desk. I figured that I wasn’t going to wait in line behind people with routine stuff when things looked like they were getting sporty for me.I call it “self-triage.”

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The Corpsman at the desk was polite and asked what he could do.  I told him that “I think I’m having a reaction to the Anthrax vaccine.”  He gave me a funny look and asked which one in the series this shot was. It was the second and since I figured that the next question would be “did you have a reaction the first time?” I continued “This didn’t happen the first time.”

The Corpsman looked at my arm and said “Obviously sir the first time you had no antibodies to Anthrax so it had nothing to react to….”  I was thinking “no shit Sherlock” when the young man went to get his Chief. The Chief came in, looked at my arm and said: “Gee sir it looks like you are having a reaction to the shot.”

I was thinking well no shit but didn’t say it. So the Chief took me back to his office and started having me checked to make sure that I didn’t have a fever or a number of other things, like if I was dizzy or was having trouble breathing. No I was neither dizzy nor experiencing breathing difficulties but was simply in pain, a bit scared and really pissed.

After his battery of questions and a couple of phone calls asked me “do you think that you are safe to drive?”

At that point I would have said anything to get the hell out of there and get on with what I needed to do to make sure that I wasn’t going to die.  So I said “of course I am.”

He asked if I was sure and I reaffirmed this to him in a convincing enough manner for him to send me over to Portsmouth by ambulance.

Portsmouth Naval Medical has a small office manned by a couple of nurses whose job it is to report bad vaccine reactions up to the FDA and God only knows who else. These ladies were very pleasant and when they got a look at my arm they were impressed.  Once again I heard “Yes sir you are having a reaction.”

I got to answer yet another battery of questions and they took a couple of pictures of the baseball sized knot on my left bicep.  One of them made a couple of phone calls and a few minutes later I was told that I would be okay. The explanation was that the subcutaneous injection had caused the vaccine to be encapsulated in my arm rather than doing what it needed to be doing. I was told to inform whoever gave me my next shot in the series to make sure that they got in the muscle. I was told to take some Motrin for the pain and swelling and do a lot of push-ups, pull-ups and massage the bicep to help the swelling dissipate faster. My fears eased and I left the hospital and reported back to the processing site where all of my fellow sailors had already left for the day.

I spent another tense and sleepless night with Judy, the emotional distance still there.  We talked about various things but nothing serious. I don’t think that either of us was able to vocalize well what we were feeling.

Even Molly seemed differed, I’m sure that she sensed that something was going on as I had continued to pack and re-pack my gear from EOD. Molly does not like it when either of us pack as it usually means that one or both of us is leaving.

The next morning I repeated my “Groundhog Day” trek back to Norfolk Naval Station fighting the idiots driving to work on the I-264, I-64 and I-564 battle zone where matching wits with the witless I safely picked my way through traffic while drinking my black coffee.

This was our next to last day of processing and we checked and re-checked paperwork, received our signed wills, living wills and powers of attorney. That morning I met with Father Pat Finn a mobilized reservist and Episcopal Priest from South Carolina and we had a nice chat where we were joined by Fr Steve Powers a retired Navy Chaplain and Rector of St. Brides Episcopal Church in Chesapeake.

Following that I was asked to assist with a sailor who was having some personal difficulties getting ready for the deployment.  These tasks completed I went back to muster with the others and sat down next to Nelson. Following this we went out where the Storekeepers and other supply staff had our gear.

We gathered outside where we lined up and given a sea bag in which to put our issue.  There were boxes of stuff everywhere and a couple of civilians and sailors stood by to ensure that we got what we were going to get.  Uniforms with all of our name tapes rank insignia and qualification pins sewn on were there as well as more socks, t-shirts and other assorted gear.

Our stash was a bit lighter than the others as we already had much of what was being issued. When this was done and we were released. I told Nelson to go home as his family was coming into town from New York.  Taking the newly issued gear home I again went about packing and repacking and took Judy out to dinner after which we spent our time alone together pondering the future.

Peace,

Padre Steve+

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Filed under iraq,afghanistan, Military, ministry, to iraq and back, Tour in Iraq

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.

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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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Going to War: Wills, Living Wills, Immunizations Gone Bad and Christmas in July

This is part three in my “Going to War” series. Previous parts are noted here:

Part One:Going to War: Reflections on My Journey to Iraq and Back- Part One

Past Two: Going to War: Interlude July 4th 2007

One of the sobering things as you get ready to go to war is issues that deal with your possible dismemberment, disability or yes even your death.  In the month or so before going to Iraq Judy had me take out an additional life insurance policy that doubled what the military would provide in the event of my demise.  Part of our processing to go to combat was a will and power of attorney update.  We had not updated our wills since well before coming to the Hampton Roads area so I took advantage of this time to get it done.  The will itself was pretty easy since we have no children and have not been married to anyone else.  That was the easy part. The next part was dealing with power of attorney.  We did a couple of them, a General for most stuff and a couple of specific POAs for various things.  I also had to do a medical power of attorney.  The medical power of attorney is something that I routinely deal with at the hospital.  I have dealt with them before in other places.  At the same time they become somewhat disconcerting when you are getting to go into a combat zone where there is heavy fighting going on and that you know that you will be in places that the enemy likes to attack and by the way, you are as a chaplain unarmed.

When doing a Medical Power of Attorney I am always reminded of the episode of Seinfeld where Kramer sees part of a movie called The Other Side of Darkness which supposedly is about a lady who ends up in a coma.  Since Kramer doesn’t want to be in a coma he makes his own Power of Attorney for Jerry to be his representative.  Jerry refuses and Kramer gets Elaine to go to a lawyer played by Ben Stein to get his “living will” done.  Without going into too much detail the interview with the Ben Stein is funny as hell as in his monotone voice he asks Kramer what he would want to do if….and Kramer turns to Elaine and asks “what should I do?”  Of course after Kramer makes this out he sees the rest of the movie only to find out that the lady in the coma comes out of it.

I digress, but anyway sometimes when you fill one of these out you pray that you get it right so no one offs you before your time, but also so you don’t end up like Karen Anne Quinlan or Terri Shaivo.  All I could think of when doing this was me being so badly wounded that people were telling Judy that there was only a fifty- fifty chance of me living but only a ten percent chance of that and did she want to pull the plug.  While this is going on I could just see me unable to respond trying to say “give me one more at bat skip, just one more chance…please.”  This may not seem like the most spiritual thing for a Priest to be saying but I don’t want to be with Jesus or in Purgatory before my time.

Legal matters finished we had matters of health and preventive medicine to accomplish.  As always when you deploy the military ensures that you are vaccinated against about everything imaginable including typhoid, anthrax, smallpox, malaria, yellow fever, certain regional diseases and probably some that I have forgotten.  Many I had received at different times, including my first Anthrax vaccine which I  injection was done into my muscle. This time the corpsmen given the shot did it sub-cutaneous which means just below the skin.  Well something happened and the little reaction area became a big one that night.  My bicep felt like someone had shoved a baseball in it and the sucker hurt like hell.   By the next morning I knew that my reaction was not “normal” being that the first one I had did not do this. I thought back to the Anthrax scare right after September 11th 2001 and I didn’t want to take any chances regarding something that the media said could be dangerous.  Who knows, what if they had messed up and given me a bad batch or even a weaponized form of the vaccine.  Hell, just because I’m paranoid doesn’t mean that they are not out to get me.  If I was going to die for my country I didn’t want it to be from a reaction to a vaccine and not something heroic that would actually matter to someone and maybe even get a ship named after me.  So I went back to the immunization section, excusing my way past the queue of sailors waiting to get PPD’s read I went to the desk.  I figured that I wasn’t going to wait in line behind people with routine stuff when things looked like they were getting sporty for me. It’s called triage. The Corpsman at the desk was polite and asked what he could do.  I told him that “I think I’m having a reaction to the Anthrax vaccine.”  He gave me a funny look and asked whoch one in the series this shot was.  It was the second and I said.  “This didn’t happen the first time.”  He told e to show him my arm and then with a look of surprise on his face said: “Obviously sir the first time you had no antibodies to Anthrax so it had nothing to react to….”  I was thinking “no shit Sherlock” when the young man went to get his Chief.  The Chief came in, looked at my arm and said: “Gee sir it looks like you are having a reaction to the shot.” Wow, he could have floored me with that bit of news.  So he took me back to his office and started having me checked to make sure that I didn’t have a fever or a number of other things, like if I was dizzy or was having trouble breathing.   No I was neither dizzy nor experiencing breathing difficulties but was simply in pain, a bit scared and a lot pissed.   After his battery of questions and the phone calls asked me “do you think that you are safe to drive?”   At that point I would have said anything to get the hell out of there and get on with what I needed to do to make sure that I wasn’t going to die.  So I said “of course I am.”  He asked if I was sure and I reaffirmed this to him in a convincing enough manner for him to send me over to Portsmouth.  Now Portsmouth Naval Medical has a small office manned by a couple of nurses whose job it is to report bad vaccine reactions up to the FDA and God only knows who else.  These ladies were very pleasant and when they got a look at my arm they were impressed.  Once again I heard Yes sir you are having a reaction.”  Once and I got another battery of questions and they took a couple of pictures of the baseball sized knot on my left bicep.  Another couple of phone calls later I was told that I would be okay.  I was told by the ladies that he next shot of the series would have to go into the muscle as this batch had encapsulated itself in my arm instead of going to the rest of my body.  I was then told to take some Motrin for the pain and swelling and do a lot of push-ups, pull-ups and massage to help the area dissipate faster. My fears eased and I left the hospital and reported back to the processing site where all of my fellow sailors had already left for the day.

Another tense and sleepless night was spent with Judy and I with the emotional distance still there.  We talked about various things but nothing serious as I don’t think that either of us was able to vocalize well what we were feeling.  Even Molly seemed differed, I’m sure that she sensed that something was going on as I had continued to pack and re-pack my gear from EOD.  Molly does not like it when either of us pack as it usually means that one or both of us is leaving her employee for a time, we being the well treated and loved hired help.  So the next morning I repeated my “Groundhog Day” trek back to Norfolk Naval Station fighting the idiots driving to work on the I-264, I-64 and I-564 battle zone where matching wits with the witless I safely picked my way through traffic while drinking my black coffee.

Arriving for our next to last day of processing we checked and re-checked paperwork, received our signed wills, living wills and powers of attorney.  That morning I met with Father Pat Finn a mobilized reservist and Episcopal Priest from South Carolina and we had a nice chat where we were joined by Fr Steve Powers retired Navy Chaplain and Rector of St. Brides Episcopal Church in Chesapeake.   Following that I was asked to assist with a sailor who was having some personal difficulties getting ready for the deployment.  These tasks completed I went back to muster with the others and sat down next to Nelson my ever faithful assistant and body guard extraordinaire.  We were then told that we would collect the gear that we were being issued.  We gathered outside where we lined up and were given a sea bag in which to put our issue.  There were boxes of stuff everywhere and a couple of civilians and sailors stood by to ensure that we got what we were going to get.  Uniforms with all of our name tapes rank insignia and qualification pins sewn on as well as more socks, t-shirts and other assorted gear.  Our stash was a bit lighter than the others as we already had much of what was being issued and did not need the issue boots having already been issued non-issue boots courtesy of EOD.  When this was done and we were released I told Nelson to go home as his family was coming into town from New York.  Taking the newly issued gear home I again went to packing and repacking and took Judy out to dinner after which we spent our time alone together pondering the future.

Peace, Steve+

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