Monday, January 31, 2011

Life After Afghanistan - PTSD

I have been conflicted a bit about my blog ever since I returned home. Part of me thought that it should end right after I got home. After all, I was home and everything was okay, right? Not the case. Life after Afghanistan has challenges as well. I have written a few entries in the past few months. I seem to be gaining some inspiration to write again. Today I was reminded vividly of a very important condition - Post Traumatic Stress Disorder (PTSD).



In the Charleston Air Force Base Clinic today, I saw a patient who was at Bagram Air Field on 19 May 2010. It was the night we were attacked by the Taliban. It was a complex attack at 3 in the morning that sent the base into chaos. I remember it vividly and probably will for the rest of my life. My patient from today is a member of security forces, a military cop essentially. He was in the middle of the firefight that night! 8 months later he has issues consistent with PTSD. This is not surprising in the least. But, he can and will get better. I assured him of that. How can I be confident of this? Well, it is because I also have PTSD.



PTSD has one major requirement. The person must have been involved in something outside of the normal human experience. Examples are a disfiguring accident, a motor vehicle crash, and rape. These are not normal events, and they should not be wished upon anyone. Of course, war is definitely outside the normal human experience! It is messed up to say the least. That is why it leads to a large amount of PTSD cases. There are 2 condtions which have become the signature medical problems of Iraq and Afghanistan - Traumatic Brain Injury from explosions and also PTSD from the insanity of war. Without a doubt, PTSD has been present in all wars from the beginning of time. It was previously called "shell shocked" or "combat stress". To have the "thousand yard stare" was definitely taboo. Heck, General Patton did notbelieve in it which is why he slapped a hospitalized soldier right in the face! He lost a star for that. Good riddance. The bottom line is that in the 21st century we have a much better understanding of PTSD, thus we can recognize and treat it.

PTSD is characterized by a number of symptoms. Flashbacks to the traumatic event are common. These flashbacks become intrusive. The person has difficulty functioning in normal society. Poor sleep, anger, poor concentration, irritability, substance abuse, depressed mood, and low energy are all symptoms of PTSD. Many other physical things can happen as well such as back pain, muscle aches, and gastrointestinal distress. In general, these people are a mess! One of my PTSD patients here in Charleston was at home taking care of his young kids. His wife was gone. He began thinking about his war experience as he did constantly. He then got in the car and drove down the street. At a traffic light, he realized that he was supposed to be at home taking care of his young kids. He turned around and went home. The kids were okay. Nothing bad happened. Nevertheless, these incidents are scary for everyone involved. He essentially was in a completely different world for about 10 minutes.

In my first three months back from Afghanistan in 2010, I noticed a lot of the symptoms listed above in myself. My sleep was quite poor. It just seemed like I could not sleep through the night. The silence here was deafening to me after sleeping through explosions all the time in Afghanistan. I kept thinking about certain incidents over and over trying to make sense of them which I never could. One day I left the gym after a workout and began thinking about one of my patients in Afghanistan. I opened the hatch to my Saturn VUE. I got in the car and drove 3 miles down a busy road at 50 mph with the hatch wide open. I pulled over and closed the hatch. No big deal, right? Nope! I could no longer deny that I did in fact have PTSD. I needed help before things worsened.

To be continued...

Sunday, January 9, 2011

Life After Afghanistan - A Long Haul

Today I realized that is has been exactly 3 years since my life as I knew it changed drastically. It was an ordinary Monday morning the second week of January 2008 when I received the news that I would be deploying to Afghanistan. The details were sketchy at that point. I was surprised because it had appeared that I would not deploy during that rotation cycle. I came to find out later that I was needed to replace a doctor who broke his leg during pre-deployment training. Regardless, it was an anxious time. I did not know what to expect and there were not many people to give me any definitive information. I remember being relieved to certain extent knowing that I would be going to Afghanistan and not Iraq. It seemed that Afghanistan was a "just war" given that Al Queda lived and trained there. We were going after the people that attacked us on 9/11 which seemed like a noble cause to me. I was naive at that point, but to this day I still believe that some good is being done in Afghanistan.

2008 was a long year for me. The first part was spent mentally preparing to go into a war zone. I was going to a dangerous place with a real possibility of a bad outcome like coming home in a body bag. I filled out my will and gave copies to my family. It was sobering. I thought about how I would like to be remembered. Crazy. Who thinks about these things at the age of 32? I then went to "Combat Skills Training" for 2 months at an Army base. I was no longer a doctor. Instead I was a member of the U.S. military making me a target at all times in Afghanistan. While deployed, I went on my fair share of trips off base in armored vehicles heavily armed. It was surreal. My mission there was to train Afghan doctors and medics which I did to the best of my ability. There was danger every day. I never was shot at and my life was never in imminent danger. I was lucky. On October 31st of 2008, I left Camp Alamo for a long convoy to Bagram Air Field. I remember arriving at Bagram and feeling like the weight of the world was lifted off my shoulders. Bagram is a heavily fortified base. I felt safe again. Safety is a good thing.

I returned to the United States a different person because I had seen a third world, war torn nation up close. The hypervigilance that you have in a dangerous place wore off in a few weeks. I was able to breathe a sigh of relief for a while. It was nice to see people and relate my experiences. I was proud of my service. Then, thoughts of another deployment came into focus. Notification came that I would be on the list to deploy in just 6 months. How could this be? For several weeks over the holidays I contemplated another deployment. But, this notification was a mistake, an apparent "clerical error". I was angry that such a mistake could be made, but it did not matter because I had been bitten by the deployment bug. Now I actually wanted to go back! Deep down I felt that going to Afghanistan one time was not enough. So many others had done more. I could do more. Specifically, I wanted to take care of the wounded. A call was made to higher headquarters. I volunteered to be sent to the hospital at Bagram during the next cycle. The Air Force was happy to grant me my wish.

So, it was July 2009 and I was facing another deployment. When a deployment is on the horizon, no matter how far away it is, your life basically goes on hold. Everything you do is in the context of this impending trip overseas. There was more training to attend this go round. But, it was purely medical training this time which was both exciting and nerve wracking. Little did I know that nothing could really prepare me for the experience at Bagram. I arrived on Christmas Eve 2009. On Christmas Day I had a knot in my stomach all day because I knew that this was going to be the hardest work of my career. The next 6 months were exhausting. The blog tells the story.

When I arrived home in early July, it was apparent to many that I had "been through the ringer". The second deployment was actually harder than the first. In fact, I hope it is the most difficult thing I ever have to do in my professional career. I have been adjusting back to life at home ever since. It seems like a never ending process. I think about my deployments every single day. The images seem to be fading, but the lessons learned are deeply engrained in my mind. As I reflect on all that has happened in the past 3 years, it is a bit overwhelming. It tugs at my emotions. One thing is undeniable. It has been a long haul.