After passing through customs at Baltimore-Washington International Airport, returning military personnel are greeted by a large group of good hearted Americans. These folks are there to cheer and welcome us home. It can be an emotional moment. I received several cards from elementary school kids. I still have them. They are tucked away in a box for safe keeping. But, there is so much more to military life than what the service member endurs. Often, the struggles of the spouses, the kids, the parents, and the communities are even more difficult. We often hear about military families and the sacrifices that they make. But, just what is the experience of a military family?
As a family physician at Charleston Air Force Base, I see many examples of military life from the perspective of the family. One such example is an army wife that I have seen on many occasions in our clinic. (there is an army reserve unit in Charleston that come to our base for healthcare) She comes in not because her back hurts or that her allergies are acting up or that her blood pressure is high. All of those things may be true. But, this army wife comes in because she needs to talk. It is that simple. She needs to cry. She needs to laugh. She needs someone else to know outside her circle of friends that being an army wife is just plain hard. Things are better now that her husband is home from a year long deployment to Afghanistan. But, adjusting back to having a warm body next you to at night also is not exactly easy. The whole military wife experience is difficult. The least I can do is lend an ear.
Sometimes I can see that a family is falling apart slowly but surely. How can a young family be expected to survive when one of them is gone in a combat zone every other year? Many of them do not make it. One day I was told by one of my patients that he did not think his marriage would last another deployment. He is a young guy, his wife is even younger, and they have 2 toddlers. Going away to a dangerous place puts incredible stress on the family unit. The kids are affected probably more than we even understand. I just do not know how some of these families make it. And, this young family probably would not have made it intact much beyond 2011 except for a freak accident. My patient stepped out of a car and twisted his left knee. He was in quite a bit of pain when he came into the clinic. I examined him and then ordered a knee MRI (which I do not do very often). Several weeks later it was done. I have never been so happy to see that someone tore their anterior cruciate ligament! He needed surgery. He would not deploy again in 2011. His family suddenly had a much better chance to become stronger and to stay together.
The U.S. Military has bases all over the world. Essentially we have stayed in every place where war was waged with the exception of Vietnam. Places like Germany and Japan have a number of bases and thousands of Americans there. Entire families spend years living overseas. They live in places like Adana, Turkey or Weeting, England. Their kids go to Department of Defense schools. The women often travel to larger bases at the 34 week mark of their pregnancy to deliver the baby. These families also get to experience many unique things like climbing all over roman ruins in Turkey, swimming in the Mediterranean, visiting castles, taking in the new year in Edinburgh, or seeing live shows in the theatres of London. The kids make friends, and then move away multiple times. The family that I speak of here is that of my brother, Lieutenant Colonel Chris Hayes.
Others of us delay having a family or settling down because that it simply not in the cards for us. It can be better that way. But even those of us who are single in the military have families. When we deploy, many people are thinking of us. There are countless prayers from our parents, our siblings, our friends, and just about anyone who knows us. When the unthinkable happens, entire communities mourn the dead. So, we are all part of one family in the end... The Military Family.
Tuesday, March 22, 2011
Wednesday, March 16, 2011
PTSD Part 2
About 3 months after getting home from Afghanistan, the flashbacks from my deployment were persisting. It all seemed like a broken record. Why could I not just forget about it all? As a physician, it was clear to me that I was suffering from PTSD. I had learned about it in my training and had dealt with a number of military patients with PTSD. But, those of us in healthcare are not always good patients. I was in no hurry to seek counseling. Undoubtedly, it requires some humility to ask for help no matter what the situation. I certainly was not ashamed that 2 deployments had affected me. But, my pride was telling me that I was okay. It kind of goes without saying that we return at least a little different after an intense experience in a combat zone. But, would I allow my war experience to dominate my life? Absolutely not! I turned to Dr. K for help.
We are lucky to have Dr. K at Charleston Air Force Base. He is a civilian psychologist who moved to Charleston after many years as a police psychologist. He has specialized training in PTSD therapy. Dr. K has a reputation for being a bit unorthodox. I was curious to see what his therapy was all about. He started by showing me a video about Eye Movement Desensitization Reprocessing (EMDR). It involved a psychiatrist working with a veteran suffering from PTSD. The patient was taken back to the traumatic event by closing his eyes and visualizing in his mind's eye exactly what happened. Upon opening his eyes, he was asked to follow the hand the of the therapist as it was moved quickly back and forth through his vield of vision for a short period of time. The therapy is designed to "unlock" the memory that is causing the PTSD. Often, there are many "memories" that must be explored, visualized, and reprocessed. It is a powerful therapy that has shown to be quite effective in many veterans. Its efficacy is not fully proven, but a good number of patients have been helped by it.
So, there I was in Dr. K's office discussing my symptoms and my time in Afghanistan. I had recognized about a half dozen incidents that I had been thinking about frequently. We started by discussing something that occured in my first few weeks at Bagram. A load of trauma patients arrived in the middle of night. It was my first week on night call. The third patient through the door was my responsibility. He was a young marine who was injured by a roadside bomb. His left leg was badly broken. He was talking and seemed okay at first. Literally within seconds of moving him from the stretcher to the gurney, he went into hemorragic shock. The next 5 minutes seemed like an eternity. I called for help. He was intubated and put on a ventilator. The largest bore IV we had available was inserted into his subclavian vein, then 2 units of blood were literally pumped into him via a high speed pump. He went to the operating room STAT. I remember standing there in a state of shock after all this. It all happened so fast! I felt powerless. I felt inadequete. I was scared that someone was going to die because I was not a good enough physician. After all, I needed 2 other physicians, 2 nurses, and 3 technicians to help me save this marine, right?
Dr. K had me visualize this incident and quickly I felt like I was transported back to the trauma hot box at Bagram. I could practically feel the sweat beeding up on my forehead. It seemed like I could reach out and touch the patient. His leg was bleeding out. The extensive dressing was soaked through with blood. His eyes were open and he told me he was from Idaho. Then, he was unconscious. Controlled chaos ensued. I ran the code. Yes, that's correct. I was in charge. That is what really happened. His heart was racing and his blood pressure was dropping. I knew what he needed. We got him everything he needed right away. We could not wait even a moment. He needed life saving interventions NOW! The patient got them. He lived. The next day he was alive. In fact, he was awake and alert. He called his parents from Bagram to tell them he was okay... I opened my eyes and Dr. K moved his right hand back and forth. I concentrated deeply for the next minute only on his hand. I took a deep breath. My first experience with EMDR was now finished. I felt better. That night I slept better than I had in 100 days.
My therapy with Dr. K lasted just 4 sessions. EMDR was used to "unlock" some of my deepest and darkest memories. I could make sense of it all to a certain degree now. I realized that as a family physician I was simply one member of the medical team at Bagram. Every single one of us was needed there to provide the best health care possible for our very sick patients. We all did the best we could. There was little that could be said about some of the things we saw. A limbless soldier barely alive is just plain sad. Taking care of the enemy all shot up by our own troops is just insane. Working 5 months in a row without a day off is beyond exhausting. But, none of this was going to dominate my life any longer. It is all in past. Mankind will continue to kill one another. War is hell. But, I am okay. Yes, I am okay.
We are lucky to have Dr. K at Charleston Air Force Base. He is a civilian psychologist who moved to Charleston after many years as a police psychologist. He has specialized training in PTSD therapy. Dr. K has a reputation for being a bit unorthodox. I was curious to see what his therapy was all about. He started by showing me a video about Eye Movement Desensitization Reprocessing (EMDR). It involved a psychiatrist working with a veteran suffering from PTSD. The patient was taken back to the traumatic event by closing his eyes and visualizing in his mind's eye exactly what happened. Upon opening his eyes, he was asked to follow the hand the of the therapist as it was moved quickly back and forth through his vield of vision for a short period of time. The therapy is designed to "unlock" the memory that is causing the PTSD. Often, there are many "memories" that must be explored, visualized, and reprocessed. It is a powerful therapy that has shown to be quite effective in many veterans. Its efficacy is not fully proven, but a good number of patients have been helped by it.
So, there I was in Dr. K's office discussing my symptoms and my time in Afghanistan. I had recognized about a half dozen incidents that I had been thinking about frequently. We started by discussing something that occured in my first few weeks at Bagram. A load of trauma patients arrived in the middle of night. It was my first week on night call. The third patient through the door was my responsibility. He was a young marine who was injured by a roadside bomb. His left leg was badly broken. He was talking and seemed okay at first. Literally within seconds of moving him from the stretcher to the gurney, he went into hemorragic shock. The next 5 minutes seemed like an eternity. I called for help. He was intubated and put on a ventilator. The largest bore IV we had available was inserted into his subclavian vein, then 2 units of blood were literally pumped into him via a high speed pump. He went to the operating room STAT. I remember standing there in a state of shock after all this. It all happened so fast! I felt powerless. I felt inadequete. I was scared that someone was going to die because I was not a good enough physician. After all, I needed 2 other physicians, 2 nurses, and 3 technicians to help me save this marine, right?
Dr. K had me visualize this incident and quickly I felt like I was transported back to the trauma hot box at Bagram. I could practically feel the sweat beeding up on my forehead. It seemed like I could reach out and touch the patient. His leg was bleeding out. The extensive dressing was soaked through with blood. His eyes were open and he told me he was from Idaho. Then, he was unconscious. Controlled chaos ensued. I ran the code. Yes, that's correct. I was in charge. That is what really happened. His heart was racing and his blood pressure was dropping. I knew what he needed. We got him everything he needed right away. We could not wait even a moment. He needed life saving interventions NOW! The patient got them. He lived. The next day he was alive. In fact, he was awake and alert. He called his parents from Bagram to tell them he was okay... I opened my eyes and Dr. K moved his right hand back and forth. I concentrated deeply for the next minute only on his hand. I took a deep breath. My first experience with EMDR was now finished. I felt better. That night I slept better than I had in 100 days.
My therapy with Dr. K lasted just 4 sessions. EMDR was used to "unlock" some of my deepest and darkest memories. I could make sense of it all to a certain degree now. I realized that as a family physician I was simply one member of the medical team at Bagram. Every single one of us was needed there to provide the best health care possible for our very sick patients. We all did the best we could. There was little that could be said about some of the things we saw. A limbless soldier barely alive is just plain sad. Taking care of the enemy all shot up by our own troops is just insane. Working 5 months in a row without a day off is beyond exhausting. But, none of this was going to dominate my life any longer. It is all in past. Mankind will continue to kill one another. War is hell. But, I am okay. Yes, I am okay.
Friday, March 11, 2011
Gonna be a Gamecock
Today I was asked the question, "Do you want to go back to Afghanistan?" Are you kidding me? Absolutely not!!! The person who asked me just could not understand why I did not want to go back. Apparently, she had a "good" deployment to Iraq. She acted as if I was a little crazy to be taken aback by her question. It was kind of an uncomfortable exchange. But, it got me thinking about things... mainly life after deployment.
With this in mind, I am starting a new blog entitled "Life After Afghanistan". My blog while I was deployed to Bagram, Afghanistan in 2010 became quite popular. I was astounded by how many people read it. The feedback was overwhelmingly positive. People seemed enlightened to a certain degree about what it is like for a doctor in Afghanistan treating the wounded. Some people actually wanted more. One person told me that she was disappointed when I stopped writing. She felt like I left her hanging. Other people wanted me to get the blog published as a book. I thought about that long and hard. But, my heart never seemed to be into that idea. It would take a lot of time and effort to publish a book. It just did not seem right for me. Instead I decided today to just start writing again. Why? Because life goes on after the war. It has to go on and we have to move forward. This blog will not be as dramatic as "On Call in Afghanistan". But, it might be just as important for me. It might help me to make more sense of my experiences.
It seems like I have been decompressing ever since I landed back in the states on July 2nd, 2010. I had completed 2 difficult deployments of 6 months duration in a little over 2 years. It is a lot to process. Each day seems like I am just a little further away from the insanity of war. The images are still very real, but they are fading. As time goes on, I think about what happened over there just a little less with each day. This is normal. Other people that have been to Afghanistan tell me they have similar experiences. Some people never really face the demons that haunt them from war. I am not going to be like that. NO WAY! Life is too good to allow garbage from the past bring us down. I try each day to live in the moment. The present seems a little more important now that I have seen death and destruction up close and personal.
In the summer and fall of 2010, I began working on my life after the military. I decided on my way home from Afghanistan that I was going to apply for a fellowship in sports medicine. I have always been a sports fanatic. The opportunity to work with athletes and be involved with athletic teams really, really gets me excited. Fellowships in primary care sports medicine (the non surgical care of athletes) last one year. I interviewed at 5 places in the fall. During that time, I also decided 100% that my military career would be over when my committment expires on June 30th, 2011. I "dropped my papers" and was approved for what is called separating from the military. It seems a bit surreal, but in the not too distant future I will no longer be wearing a uniform. That actually sounds amazing!
What is even better is that in January I found out that I will be doing a fellowship at the University of South Carolina starting July 1st. GO GAMECOCKS! I am pumped! I will be part of the medical staff at a major university. I will be down on the field in front of 85,000 fans on football saturdays. I will be working with the 2010 national champs in baseball. The athletic department at the Univeristy of South Carolina is quite impressive... 500 student athletes, 19 teams, 24 athletic trainers, 26 million dollar budget just for football, etc. The facilities are excellent. Even better, the people are friendly and genuine. I immediately felt comfortable and at home there. It is going to be quite a year for me in Columbia, South Carolina.
What is even more important about all this is knowing that I am NOT going back to Afghanistan. Yeah, it is a struggle to make sense of the world and to achieve "normalcy" after some really intense experiences. But, I will get there. After all, I am GONNA BE A GAMECOCK! (at least for one year)
With this in mind, I am starting a new blog entitled "Life After Afghanistan". My blog while I was deployed to Bagram, Afghanistan in 2010 became quite popular. I was astounded by how many people read it. The feedback was overwhelmingly positive. People seemed enlightened to a certain degree about what it is like for a doctor in Afghanistan treating the wounded. Some people actually wanted more. One person told me that she was disappointed when I stopped writing. She felt like I left her hanging. Other people wanted me to get the blog published as a book. I thought about that long and hard. But, my heart never seemed to be into that idea. It would take a lot of time and effort to publish a book. It just did not seem right for me. Instead I decided today to just start writing again. Why? Because life goes on after the war. It has to go on and we have to move forward. This blog will not be as dramatic as "On Call in Afghanistan". But, it might be just as important for me. It might help me to make more sense of my experiences.
It seems like I have been decompressing ever since I landed back in the states on July 2nd, 2010. I had completed 2 difficult deployments of 6 months duration in a little over 2 years. It is a lot to process. Each day seems like I am just a little further away from the insanity of war. The images are still very real, but they are fading. As time goes on, I think about what happened over there just a little less with each day. This is normal. Other people that have been to Afghanistan tell me they have similar experiences. Some people never really face the demons that haunt them from war. I am not going to be like that. NO WAY! Life is too good to allow garbage from the past bring us down. I try each day to live in the moment. The present seems a little more important now that I have seen death and destruction up close and personal.
In the summer and fall of 2010, I began working on my life after the military. I decided on my way home from Afghanistan that I was going to apply for a fellowship in sports medicine. I have always been a sports fanatic. The opportunity to work with athletes and be involved with athletic teams really, really gets me excited. Fellowships in primary care sports medicine (the non surgical care of athletes) last one year. I interviewed at 5 places in the fall. During that time, I also decided 100% that my military career would be over when my committment expires on June 30th, 2011. I "dropped my papers" and was approved for what is called separating from the military. It seems a bit surreal, but in the not too distant future I will no longer be wearing a uniform. That actually sounds amazing!
What is even better is that in January I found out that I will be doing a fellowship at the University of South Carolina starting July 1st. GO GAMECOCKS! I am pumped! I will be part of the medical staff at a major university. I will be down on the field in front of 85,000 fans on football saturdays. I will be working with the 2010 national champs in baseball. The athletic department at the Univeristy of South Carolina is quite impressive... 500 student athletes, 19 teams, 24 athletic trainers, 26 million dollar budget just for football, etc. The facilities are excellent. Even better, the people are friendly and genuine. I immediately felt comfortable and at home there. It is going to be quite a year for me in Columbia, South Carolina.
What is even more important about all this is knowing that I am NOT going back to Afghanistan. Yeah, it is a struggle to make sense of the world and to achieve "normalcy" after some really intense experiences. But, I will get there. After all, I am GONNA BE A GAMECOCK! (at least for one year)
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