A Student's Glimpse of PTSD and My Father

I was talking to my dad (a Vietnam vet) about a patient I saw recently at a local VA Hospital with PTSD. I was hoping to learn more about this patient and my father through our discussions (anonymously, of course). This young man was in the marines assigned to a special ops unit and had just returned from his third tour in Iraq. His PTSD was so severe that his wife had taken their children and left because she was frightened, angry and confused by him. He had checked himself into the inpatient ward at the VA because he was concerned about his actions and state of mind. I was doing a psych interview as a medical student and this was my first encounter with an acute, severe PTSD patient.

I am a 6'1" tall, 210lb and I have to admit that I have never really had too many moments when I have been truly concerned for MY safety with patients. What struck me was that during my interview with this patient I caught myself looking at his arms and sizing him up. I wondered where his weak spots might be. I was ruminating on the fact that this guy was trained in hand to hand combat (and had used it in real life) and I seriously wondered about whether or not I could take him down if he became suddenly violent. I was very surprised when I caught myself thinking this.

I was an EMT before medical school and have spent several nights working in a county ED. I have seen drunk, belligerent, drugged out patients from time to time and I have occasionally needed to restrain them, but I was never honestly ever worried about my safety. This time, it really entered my mind. I knew I was safe and although this guy was tweaking out, I did not think he would hurt me, but the thought entered my mind. It was sad and frightening at the same time when I learned about how many firearms he owns and how short a fuse he seemed to have. His flashbacks lasted for up to two hours at a time and he does not remember much at all during them.

I talked to my dad about this in hopes of understanding both of them a little better. My dad also suffers from PTSD and he has never really talked about Vietnam except on brief occasions. I don’t know how many vets his views may represent, but I liked his response to my email. I mentioned the patient with PTSD and how I saw his life turning out given the resources available to him and what some of my concerns were for his health and those around him. It was heartbreaking and frightening at the same time. This was the response my dad emailed me about what he thought was going on in this vet's head.

"The public, whether they support the current government or not, always count the casualties of war as the dead..... 58,000 in Vietnam, and the dead are to be honored. They were Americans, and whether they loved the current President and policy or not, he is the commander in chief. This is an important part of the separation of powers in government. When push comes to shove, the constitution allows a short cut. The president is the commander in chief of all military forces and can send them to war as he sees fit. And I think this is a prudent part of our constitution, even given that our current president has lost all touch with reality....... I used to say that the U.S. would be lucky to survive GWB, but now I am convinced that the world will be lucky to survive him.....

Anyway, that is politics, and not what I intended to write about.The real cost of war is those that survive. Those trained, exposed and then discharged with no help what so ever. The dead are to be honored; they did as they were ordered. The survivors, nearly to the last man, wish that they had not. It would have been so much easier and would have caused much less trouble to those that cared for them.

What your Marine probably feels is guilt. Guilt that he is alive, that he did not die with his comrades or just for the coffee he has in the morning. He sees the horrific harm that he has caused and all of his buddies that did not make it and at the end of the day realizes that it was all in vain. It was different in WWII. There were clear objectives, although there were thousands that came home with "battle fatigue" and got no treatment. One Pvt, Eddie Slovak, was even executed for trying to get out. (read more about Eddie Slovak here)

There is nothing that you can do for him except render him as harmless as non-invasive methods can. Medicate him to relieve the over whelming guilt and pain he feels, make him as comfortable and productive as he can be. Help him find employment at the local VA facility or elsewhere. Do not feel guilty if he just decides to die.

I slept with a loaded side arm for almost three years. It never gets better but the very, very lucky ones finally find a life that they can live with.......

Do not fear the Marine. He would never hurt you. He understands that you are the only small link he has between insanity and sanity. He may harm himself but rarely would he harm others."