Wednesday, August 1, 2012

The Survivors

This week a ninety-year-old World War II veteran found his way into my exam chair. The first thing I noticed as he shuffled through the door was a small contusion on his left upper eyelid. It was so small that I almost considered it not worth mentioning. Little did I know that this slight bruise was the only visible manifestation of a much deeper wound—a wound that had been festering for nearly seventy years—a wound that no medicine can ever fully heal.

I initiated the visit with my usual questions: How have you been since your last visit to the clinic? Any changes in your vision? Any questions or concerns today? As I listened to his responses I did more than hear his words. I judged his speech, observed his eye movements, evaluated his vocabulary, and rapidly reached conclusions about his mental ability, education level, and yes, even socio-economic status. Though this sounds distant and clinical, it is a necessity. Without making such an assessment I would not know how to best communicate with my patients. But this clinical process drives a wedge between me and them. It takes away from the humanness of a conversation. It somehow prevents me from being able to look them directly in the eye and perhaps catch a glimpse of their soul.
And so as he answered away, I completed my secret evaluation: mental faculties fully intact, college educated, well groomed, still married, could probably survive without social security.
When he finished answering my opening questions he said, “So did you notice my black eye?”
“Yes. I was just about to ask you about that.”
 And only then did I finally really look into his eyes. They struck me as unnaturally dark.
“It’s the dreams. They won’t stop. I keep trying to bail out of my B-24. This time I made it out and hit my head on my nightstand. The worst one is where I am lying on the ground—I can see the wreckage of my plane and there is this line of gasoline stretching from it to me. I can see the fire coming, but I can’t move. After all these years it still has never managed to reach me, but it’s getting closer. Do you think there is any treatment that can make the dreams stop?”
It turns out he flew 36 combat missions in Europe and got shot down twice. The second time he was behind enemy lines and was the only one who managed to walk away from the wreckage. Somehow he survived. And it haunts him to this day.
I told him I was honored to meet him, that I consider him a hero. He doesn’t see it that way. He didn’t know what he was signing up for. He just did what he was told. And for better or for worse, he survived. But I don’t care what his intentions were. The fact is that he served. He sacrificed. And without the sacrifices he made, and continues to make, our world would be a different place.
I want to tread carefully here with what I am about to write, because the last thing I want to do is detract from those who have paid the ultimate price with their lives. But we must not forget the survivors and the hefty price they also pay. We often call death the “ultimate sacrifice,” and this may be so, but for some the cost of survival is a close second.
These wounded heroes from World War II are fast disappearing, but they are being rapidly replaced by another wave of walking sacrifices. A few months back one of these walked through my door. He was twenty-two years old. At first I thought he was seventeen. But not after I looked into his eyes. No, his eyes were much older.
When I pull up a patient’s electronic chart, every so often a banner will pop up on my screen. Sometimes they warn of a history of behavioral problems, or suicide risk, or other important need-to-know information. This particular fellow had a banner I had never seen before: “Warning, patient suffers from severe post-traumatic stress disorder triggered by images of dirt roads, or mention of dirt roads.” You see, on three separate occasions his armored vehicle had managed to find a roadside bomb. All three times his vehicle flipped, maiming or killing those inside. He walked away from two, but had to be carried away from the third, and somebody finally decided he had had enough.
We can read “Unbroken” or watch “Band of Brothers” or rent “Respeto” but most of us will never be able to fully comprehend the sacrifices our combat veterans make for us. I have only caught a glimpse, and it has left with me a deep appreciation. I hope I never forget.