Story:"Me Too"

"Me Too"

This section comes from the book "A Doctors Journey;" it is about coming from the Israel and going to Alabama, to treat the PTSD Vietnam Veterans in a V.A. Hospital. A mission in life."ME Too" Part 1 My assistant in the group and a participating observer is Chaplain Mike Dills, the administrator of the PTSD program at the Tumpalega VA hospital. He is a pastoral counselor, a pilot, a Viet Nam veteran, and a colonel in the US Air Force active reserve. Mike started this morning's group as he usually does, by collecting the attendance forms from the 15 patients and signing them.He is a gentle man, in his late forties, slim build, pleasant of face; his wire-rimmed glasses set low on his nose are his most distinctive facial feature. He is polite in manner, graceful in movement and modest in his behavior. But - - from time to time he can be tough in his speech and behavior. He is that way now, as he signs the attendance form and talks about the rules of the program. He looks up occasionally to talk to them about maintaining discipline in the program. It is Friday morning and some of the patients had been complaining that they aren't allowed to leave for the weekend home visit before two p.m. Swinging his finger-pointed arm around the group and speaking crisply with his soft southern accent he says, "Listen up you guys. Friday is a therapy day and we don't want you to lose it, you hear? There's precious little enough time as it is, with only five weeks to the whole darn program." He signs the last of the forms and looks sternly around the group; frowning, he says, "And you all know you've not been policing up the room after groups. Dr. Bronsky and I don't want to go around picking up after you guys, cause you leave your coffee cups and soda cans behind you." I am sitting quietly, watching and thinking about how I will start the group. Mike is helping me in the difficult cultural transition because the American PTSD is different in some ways than the Israeli form of PTSD. In working with Israeli vets I found they never suffered the humiliation of being rejected and neglected after they fought for their country. They were not scapegoated for political reasons, they were given good psychiatric treatment very soon after they began to suffer from PTSD. There are significant cultural, religious and social differences between the southern American veteran and the Holocaust survivors and the Israeli soldiers. I am not really familiar with the culture of Alabama even though I did my pre-med studies at Tulane, in urban New Orleans, Louisiana . These vets grew up with an abundance of violent activities: hunting, fishing, sports, drinking, fighting. Many of them were frequently beaten as children. "My daddy made me go out and cut a big switch to bring him so he could beat my butt. If it wasn't big enough then he'd go out a get a really big one". Most of them were raised in strict Protestant (Southern Baptist) families; before they went to Viet Nam they attended church regularly and almost all of them went into the service believing in God. Suddenly, I am aware of the silence in the room, embedded in the loud thrumming of the air conditioning. Out of the corner of my eye I notice that one of the vets is nervously tapping his finger on the notebook sitting in his lap. Mike asks the vet, T.J., "Y'all ready to talk about your flashback?" Today is T.J.'s third session in the group and he has yet to speak of his PTSD symptoms. Yesterday afternoon he was on the back porch of the ward with the rest of the group, watching a cowboy picture on TV. When the shooting started he had a flashback, acting as if he was back in Nam, crying and in panic, hiding under the table, shouting "Incoming, incoming." The other vets calmed him down and took him to the nurse. She sent him to see me and I worked with him in an individual therapy session. Four days before I had seen him on admission: he was in his early forties, had been a pre-med student who quit a Georgia university more than twenty years ago to enlist in the marines so he could fight for his country. In the admissions interview he was anxious, cooperative but very reluctant to go into any details of the traumas he suffered in Nam. Now, in the group, T.J.'s hands are shaking and his body is very tense. He is a small man with big spectacles, a shaggy mustache that partially covers his mouth and a neatly trimmed Van Dyke beard. In a voice crackling with tension while rhythmically wringing his hands, he says, "Yes, I do Chaplain. I had a session with Dr. Bronsky yesterday and we talked about it." He pauses, takes a deep breath and lets it out slowly, putting the pen and notebook down on the floor besides his chair. He takes off his glasses, wipes them slowly with a crumpled, soiled handkerchief that he pulls out of his back pocket. Putting his glasses back on and clearing his throat quietly he says, "I saw how some of the guys got help when they talked about some of the stuff they're hung up on and I think it helped them. But I'm a little afraid."After a brief silence my voice sounds very loud as I say, "I know you're afraid because you're probably going to talk about something you kept bottled up in you for almost 25 years. It was only yesterday that you spoke to me about it. I don't think you'll have a flashback and if you do, you'll get plenty of support from Chaplain Dills and me. I'm sure the guys in the group will also be available 'to protect your back.' Besides, I believe you have too much strength to let it blow your mind." He nods his understanding and agreement, as does the Chaplain, along with most of the vets in the group. Raising my hand slightly off my lap in a 'stop sign' I say, "Before you start, I'd like to ask the guys here I have already worked with if they thought that sharing the experience of their traumas from Viet Nam was worthwhile." I look around the group and make eye contact with each patient who had taken the risk and talked about a traumatic experience in Viet Nam. Tim, sad-eyed, slow talking, clean-shaven and very neatly dressed, relived his experience of handling many hundreds of bodies, bagging them, tagging them, shipping them back to the U.S. He had mind-promised the bagged bodies that he would never forget them. Since returning home he has been obsessed with his promise that has became intrusive and obsessive thoughts. He describes them as being "like a like a broken record, going round and round in my mind, especially when I try to sleep." He visualizes the bodybags a number of times a day but if he feels threatened by someone, he imagines him dead and puts him in a bodybag. Tim sits very straight in his chair, clears his throat and says to T.J., "Do it man, I know it helped me." Bobby is small and thin with a high-pitched voice. In Nam he had been a 'tunnel rat': he had the job of exploring Viet Cong bunkers and tunnels. When he worked in the group he sweat profusely, often gulping for air. He relived the experience of being in the middle of a platoon, his two best friends, the lead man and the second man, walking point. They were ambushed and one of the point men was killed immediately, the other one seriously wounded. He was crying out to Bobby for help, but Bobby couldn't get to him because he was pinned down by the murderous crossfire. It would have been sure death for him if he had tried to get to his friend. After his platoon broke the ambush Bobby found his second friend, dead from a bleeding wound in his leg. If he had been able to get to him on time he could have saved him. He has been suffering from survivors guilt ever since. He barely raises his head to look at me and mumbles in a little voice, "You done said it for me, okay?" Kyle, obese, sweating, was a marine corpsman, as T.J. was. When he talked in group he cried, grimaced, walking around as he relived the trauma of losing his best buddy in a firefight. He was unable to help his friend because he was too far away to answer his cries of "Corpsman;" he was too busy caring for the many wounded around him. The next day he found his dead friend with bamboo sticks in his eyes and his genitals in his mouth. He looks toward T.J., then points with his head in my direction, "Trust the man. You're my brother. We were both there. We'll watch your back." Don is grey-haired, very big, muscular, and suspicious. His eyes usually are half-lidded and he glares aggressively at the person he is talking to. He describes himself as a "trained killer." He is very bright, a department manager in a big plant, but hides his intelligence by acting and saying, "I'm just a little old country boy." He didn't allow himself to cry when he shared his experience with the group. He raged and then crushed an empty soda can under his big foot before he stomped out of the room. But he was back in five minutes to finish up. He called his buddy "The Wildman," saying "We was both wildmen in them days. You better believe it. When we come off patrols we'd get drunk, fight, tear up whorehouses." His buddy was gravely wounded when he took a grenade hit that tore off his face, leaving a pulpy red mass, but his blond hair stayed clean and bright. Don had the same bright blond hair. "Shit T.J., you can trust this damn Yankee. Just a little, hear?" Lonny, tall, thin, chronic alcoholic, looked grim, spoke softly, his white-knuckled fist pounded rhythmically on the chair arm. He talked about his buddy on the navy river gunboat. After the war they were going to his friend's hometown, Chicago, to visit the Playboy Club. His friend was a member of the club and often told Lonny what they would do with the big-busted bunnies. The day his friend bought it, Lonny was at sick call because he had a fever. His friend, who was usually the after gunner, replaced him at his forward post on the fifty-millimeter gun. He took a direct hit with a rocket that neatly took off the top of his body and head. Since that time Lonny sees his friend in occasional flashbacks and recurrent nightmares. He points his finger at me and looks at T.J. "Dr. B. is okay. He's one of us. Go to it. It don't mean shit anyway." T.J. is different in his demeanor and speech than the others in the group. Almost all of them grew up poor in rural areas, didn't finish high school, and were driving farm vehicles, cars and motorcycles before they were sixteen years old. T.J. came from a large southern city; his father was a college graduate and a high level civil servant. He begins to speak tensely but clearly, telling the group that he had been a pre-med student but quit after two years to join the marines. "In those days I was a patriot and I joined up to serve my country." He met his friend Richard who joined around the same time and they became fast friends. T.J. took to calling him Dicky Lee, a private joke between them, christening his Boston catholic friend into the southern Baptist faith. In the individual session the day before, he spoke tearfully and lovingly of Dicky Lee, whom he described as "my best friend, like a brother, the best partner anyone can have in life. We went out barhopping, to whore houses. We had plans that after the war that we'd go to medical school together and open a private practice. We were going to be partners". He continues, "For two years we worked as medical corpsmen in navy hospitals. We were really good and got to be qualified operating room technicians. When we got our orders to go to Viet Nam we made a pact. If one of us got hit bad" - He stops speaking because he is choked up. He gulps, resettles his thick glasses on his nose and then he says, "Like if one of us loses a leg or something, then the other one won't let the dying man suffer. We had seen so many wounded marines, without arms, without legs, burned, blind." Very quietly he adds, "Neither of us believed we would have to use this euthanasia agreement." In Viet Nam the two buddies separated and corresponded regularly. They didn't see each other for almost a year. T.J. was stationed at a big field hospital that received helicopter loads of wounded and dying. Because there was a shortage of medical doctors his main job was to be at the helicopter-landing site when the wounded and dying came in. He did Triage. He explains this to the group, saying, "This is a fancy word we use in emergency situations where usually the doctor has to use his clinical judgment to decide what to do with the wounded, who is going to live and who is going to die. I did Triage. "There were three kinds of wounded: those you knew were going to die, no matter what. We eased their pain and we left them to die; the lightly wounded didn't need immediate care and were ignored." He pauses for a moment, looking up at the ceiling and then says bitterly, "It was the big in-between group we had to treat first so that we could get them back to the killing fields as quickly as possible." T.J.'s voice breaks and the tears come. There is some stirring to my left and I am handed the tissue box to pass on to T.J. When the box reaches him he pulls one out and with a shaking hand wipes his eyes without removing his glasses. He crumples the soggy tissue and carefully puts it into his lap. I ask him if he wants to stop and he responds by taking off his glasses, wiping them dry with a clean tissue, and says, "I'm going all the way." I speak in a voice that is slow, rhythmic and quiet, suggesting to him, "Why don't you take a deep breath...and then let go...slowly...as you breathe out." Yesterday I taught him a PASA relaxation exercise, (see Operating Principles.) He starts to do it but then says angrily, "I was playing God and I didn't want it, but what could I do. We had too many wounded and dying and not enough doctors. They said I had to do the triage so I had no choice." His anger is flooded away by deep sobbing. Some vets make a move to go to him but I shake my head no. They are angry with me but do nothing. When he is composed I tell him, "Time out." He looks up at me in surprise and then he nods in understanding. In the private session I taught him my meaning of a "Time out." You stop whatever you are thinking or doing, and you regulate your breathing to be slower and deeper. Then you relax any tense parts of the body you are able to. At that point you can choose to go on or to stop. There is no movement in the group and the silence in the room is almost perfect. Through the closed window behind T.J. I see a slow tractor lawnmower clumsily moving in and around the scattered trees, cutting the weedy lawns. I hear the distant hum of the air-conditioning, faintly intruding. T.J. begins to talk and cry, talk and wipe, choking up with anger and helplessness. Slowly and steadily he describes what happened. Three medivac choppers came in together bringing many wounded and some dead. T.J. is running from marine to marine, efficient and effective, smoothly triaging the wounded, and ignoring the dead. Then he trips over a squirming, moaning marine and he falls to the concrete. He begins to get up when he notices that it is a legless, dying Dicky Lee. A moan-wail is torn from T.J.'s mouth. The vets on either side of him reach out to him but he folds into himself, putting his head down, bringing his knees up a little, hugging them to his chest, rocking rhythmically. I fight back my tears, hesitating about intervening, and then l remember that T.J. wants to go all the way, and I decide that he can make it. I don't intervene. The group is restless, most of them tearful, some crying, none loudly. Mike is concerned and looks questioningly at me. I indicate that I am in control and he sits back in his seat, sighing. l wipe my wet eyes, look around the group. Most of them do not make eye contact with me. The intensity of T.J.'s reaction has waned. I speak quietly, emphatically. "T.J.? Can you look at me?" He does. I lean towards him and ask, slightly more emphatically, "Here? Now?" Slowly, he unfolds and looks up at me. I ask him if he knows who I am and what's happening. He nods, almost imperceptibly. "Do you want another time out?" He shakes his head, no. "Fine. By the way, we are all here, if you need us." I make a sweeping gesture that includes everyone in the room. There is a responsive, quiet chorus of yesses and heads nodding in support. "Why don't you finish the story," I say and then pause, "Here...now...you...us...All of us together." I take a deep breath, hold it for a second, and let the air out slowly. He takes a deep breath and lets out the air, loudly, into the heavy silence. He begins to speak, unmindful of the tears raining steadily down onto his shirtfront. "Dicky Lee was semi-conscious but he knew it was me. When I spoke to him he nodded. I put him against a mango tree and then I did what I had to. I gave him enough morphine to put him out of his misery and he relaxed right away. Then he stopped breathing." He looks at me with unseeing eyes, sobbing hysterically. Three patients go to him, one hugs him, and the other two put their hands on his shoulders. One of them whispers something to T.J. and he looks up, nodding his head, continuing to cry quietly. Then the three return to their seats. He stops crying and looks at me, indicating he wants to say something. I nod at him and he says, "I wrote to his parents that he died quietly in his sleep but I never told them the whole truth about the injection. Five times in the last twenty years I went to his home in Boston. Each time I got to the door but I couldn't ring the bell." I say, "I've got an idea I'd like to share with you." He nods almost imperceptibly and in a quiet, soft voice, says, "I'm with you. Go." "In my imagination I heard you speak about God to Dicky Lee, in three different ways. In the first way you said to him, 'Thank God I was able to keep my part of our pact.' In the second way you said, 'Thank God I was with you so you didn't die alone.' And the third way, 'Thank God you've gone to heaven and your suffering has stopped.'" In a little child's voice he says, "Do you really thinks so, Dr. Bronsky?" "You better believe that I do." Then I say aggressively, "And I'll tell you something else. I had a wild thought a few minutes ago and I'm going to show you what it is. I might get hurt but I'm going to do it anyway." I get up and whisper in the ear of the patient sitting on my right, "What I am going to do has nothing to do with you. I'm going to use you so be ready and above all don't feel guilty. I know exactly what I'm doing." I take a step in T.J.'s direction, and I purposely trip over the patient's foot and fall heavily to the floor. The rug cushions my fall and I roll onto my back, shaken up, momentarily confused, but unhurt. I sit up, take a deep breath and as I let it out I say, "I purposely made myself trip to illustrate a point. After the fall I know I can get up and I can stand on my own two feet." I pause for emphasis and then I say, "Dicky Lee, through no fault of his own, couldn't stand on his own two feet because his legs were gone. But you can." T.J. begins to cry and some of the group murmur about stopping but T.J. says, "No, no. Let him go on." I pause for a moment and then say, "Your legs are okay, and you can stand on your own two feet. I am asking you to use them to help me get up." He gets up, unsteady on his feet. Hands reach out to support him. I say loudly from my position on my back, "Let him stand on his own two feet." He sits down heavily in his chair. For a moment I have some conflicting thoughts about stopping but then I feel a big lump in my throat and my eyes flood with tears. With a voice near cracking, I say, "Choose to do it, T.J., or choose not to. Either way is okay with me." I am hinting that I need help from him to get up. There is a brief pause, then he gets up, swaying, and staggers towards me. I reach out my arm and he takes my hand in his. I use his support to sit up. For a moment I rest my head against his thick thigh. Then I look up at him and say, "Either you got the strength or you don't." He takes a step back and still firmly holding my hand in his he pulls up strongly. I am surprised by the ease with which he helps me to my feet. We hug, T.J. squeezing tight and patting me on the back. I hold him gently and stoop down a little to rest my head on his shoulder. Then I feel weak and begin to sway. He tightens his embrace and I stand more firmly. He says loudly, "Thank you, thank you, Dr. Bronsky." Tears choke me but I manage to say, "Thank you, T.J., thank you." After a few seconds we separate, he strongly squeezes my arm, then he goes back to his seat, walking steadily. I speak to his back, saying, "You're coming home, T.J. Welcome home." I sit down, bent forward from the waist, my head down, staring at a small imperfection in the carpet. My lips are quivering and the tears are filling my eyes but I can't let go. Don, big, muscular, ham-handed, gets up and walks towards T.J., saying, "You're a man, god-damn it. You sure are one hell of a man." He takes T.J.'s small hand in his huge one, pumps it up and down several times, shaking the dry-eyed T.J. They hug and rock, separate for a second and then hug and rock again. Don goes back to his seat and a number of veterans go to T.J. and shake his hand. He looks peaceful, breathing quietly. The tears in my eyes overflow and the chaplain asks me if there is something he or the group could do for me. I let go and burst into tears, deeply sobbing. I have wanted to cry like this for many years but was unable to let go. Sixteen years ago our first born, a son, almost eighteen years old, died of leukemia. Since then I've cried a number of times but I never let go as I do now. For a minute I have spasms of sobbing, and a growing sense of purging release. When I regain my composure I tell the group why I let go. Don gets up and hugs me. Then Tim comes to shake my hand, saying slowly, gently, "Doc, I got to hand it to you. You're okay. But don't you think you have to come home too?" The man on my left holds my hand. The man on my right puts his arm around my shoulder and I put my head on his shoulder and a new burst of wailing sobs rack my chest. After a minute I stop crying, feeling peaceful and sad. Chaplain Mike nods at me, says quietly that it is time to stop the group. Everyone gets up except me. Several patients come over to shake my hand, one tells me, "You're a man," another says, "Even though you ain't been to Nam you belong in the group." I look up, seeing that Mike is the only one left and he's standing a few feet away from me, waiting. I get up and we hug and I cry some more. Quietly I say, "Thanks, Mike." He says, "God bless you, sir." Later that afternoon after I finish my out-patient clinic I come out of my office and T.J. is sitting in the empty waiting room. I worry that something is wrong. "What're you doing here, T.J.? Are you all right?" He smiles softly, saying, "I'm fine. I came to see if you are all right." I sigh loudly, nod my head, tears in my eyes. I say, "I feel as if I've been walking around with a heavy weight on my shoulders and now it's not there anymore." He takes my arm, holding it gently and says, "Me and the other guys were talking about you. Like we were worried about you." We sit down in the waiting room and I tell him the details of my son's illness and death. I cry quietly and so does T.J. He offers me his hanky but I shake my head, wiping my eyes with the back of my hand. He takes my hand and wipes it with his hanky. He says, "I'm glad for you Doc. Another reason I came over was to tell you that I called Dicky Lee's parents, told them what happened and said I'll be coming to visit them after I get out of the hospital." He nods his head vigorously and says, " I feel much better. How about you?""Me too." T.J.'s written summary of his experience, twenty-four hours later. "Much of yesterday's group is unclear in my mind. I was mostly locked in on you and the pictures I was seeing in my mind. During the early part I was only vaguely conscious of the other people in the room. When you called a 'time out' and asked if I would help you was when the group came back into focus. When you fell to the floor and asked me if I would help you, I looked around the room. There were many with tears in their eyes and others with concern. There were a couple who showed anger but somehow I knew the anger was not directed at me. I felt caring and kinship and understanding. I wanted very much to help you up but I had a strong feeling that I wanted to run. I didn't know where I would go and something was telling me I had to stay and help you. I think it was then that Tim came to me and told me I should go to you, which I did. When I got you up I felt like I was going to fall myself and I held on to you. You hugged me and it seemed all of my strength left me for a moment. When I started back to my chair, Tim, and then you, told me I was "going home." I felt a release of tension and a strong feeling of support. After I returned to my chair, members of the group came to me and offered support and then I saw that you were broken up too and that the group was offering support to you as well. This created an even stronger feeling of belonging in me."