Even as a 2nd-grader, I understood that 1) without a dead body, there would be no ritual of shared grief. No funeral, at a church or cemetery. And that 2) a grieving process inside me had nevertheless begun. The man who came home from the hospital only resembled the father we’d known.
Sometimes, as a 2nd-grader, I would look at him from across a room and see a kind of shimmer. A transparent overlay, the way the clear sheet with muscles covered the sheet of bones, in my atlas of the human body.
A transparency of my parent. Not quite aligned right. And now covered by a version of a man with different colors and shapes and noises and rage. Back from a war, all nervous muscle, without skin.
Today, President Biden spoke to reporters about the withdrawal of U.S. troops from Afghanistan, by 9/11/21. Twenty long years and 800,000 Americans who served there, and 2400 who died. Pretty sure news stories only count the ‘uniformed services’ (military personnel). Not the suit-and-tie diplomats, who serve in other ways. The way my father served, in Vietnam. (If I understand correctly, the State Department doesn’t share numbers of deployed personnel, for security’s sake.)
So 800,000 over the past 20 years in Afghanistan alone, of military people alone. Tip of an iceberg, for all of those who participated in war, some (many, most?) of whom came back different versions of themselves, to different versions of families, in turn.
My surgical director in the early 2000s was deployed to Bagram Air Force Base. He wrote us evocative emails about seeing first-hand “man’s inhumanity to man.” He thought he had seen everything as a trauma surgeon during the crack-epidemic in the ‘80s and ‘90s, at Washington Hospital Center in DC. But he couldn’t have imagined the trauma of children, he said, in the aftermath of an IED.
I remember a quiet med-student at that time, who seemed unable to accept or believe the encouraging feedback his standardized-patient, K., had just given him. In their conversation, all he wanted to hear was ‘What am I doing wrong?’ She couldn’t convince him that he had genuinely supported and partnered with her, with carefully chosen words, his gestures, posture, facial expression.
After the student left the exam room, a faculty preceptor came in; he had observed their conversation (remotely). K. told him she didn’t understand this student’s lack of faith in himself. The preceptor explained, “I know. We’re working on it, and thanks for doing your part.” Then he mentioned that the student had been a sniper in Iraq.
“Whoa.” (K. filled in much of this story for me afterward; I'd only observed part of it.)
“He was so good at it, they gave him all kinds of awards and recognition. The kid was Olympic-level sharpshooter, and under the pressure of a firefight?” Then he added, “But it got to him. He just couldn’t, hm, stomach the idea of being so good at killing people.” The doc let that settle.
“He put in for discharge. He was done. Almost done with, well, everything. And a very savvy commanding officer asked him, ‘What if you could turn that around, heal people, save lives?’”
To this day I feel, layer by layer, so grateful for that idea. I also felt a bit guilty for not imagining a military officer at war would think of it.
“So this student agreed to pivot to med-school. But.” Here he wagged his finger at no one and everything. “He hasn’t forgiven himself yet. He hasn’t started to see himself as a caring care-provider.” K. said, “Even though he is, already!” The preceptor agreed. “We’re working on it. Thanks again.”
More recently, one of my med-student advisees served in Iraq and Afghanistan; he's now a (civilian) resident in Boston. When I first met S., he described a ‘clean line’ between that past and his future (with his wife and now, two adorable little boys). He didn’t want a military scholarship, even for the free ride of med-school tuition. After multiple deployments, he had set his gear down as lightly as he could, and stepped onto a new path.
Just to think of the father and doctor he’s become, to think of his family, and all his patients, and his patients’ families? Heals me, every day. If S. came back with a transparent overlay, from the longest war in our history, which Biden is setting down as lightly as he can? I think his would be the layer of skin, that largest organ protecting all the other layers underneath. Somehow, from my perspective, he managed to walk through (or talk through) whatever post-trauma he endured, during and after those missions. One can only wish the same for the other 800,000, after 20 years.
The other night, my neighbor R. walked by with his Chihuahua, Lucky. I turned off my lawn-mower. He said he’d been gone for 3 weeks. Upstate New York, where his mother was dying. I told him I was sorry to hear the news, and he shrugged, one-handed, the other holding Lucky’s leash. “We should all be so lucky to go like she did.”
First he described the decisions she’d made, to stop dialysis, stop all her many treatments, which “even the docs said were doing her no good.” His mother put on her fanciest clothes, “did up her hair and face,” and he and his brothers and sisters all traveled to her facility to visit. Meanwhile, their father had been placed in a different assisted-living facility, but he’d fallen again and gashed open his leg, and needed the additional care of his wife’s facility. (Why they couldn’t just live in the same place, I still don’t understand, like I don’t much of healthcare in the U.S.) Anyway, they were all, serendipitously, together. Had a great visit.
“Then she told us to get out of her room. ‘Get out. I have to die now.’ She didn’t want none of us there. And we left. And pretty soon she died. On her own terms.”
What a gift. For all of them. I stood holding the handle of my mower, tears in my eyes. “I’m so happy for her, that she was able to die as she wanted. And, I’m so sorry your mother died, R.”
He nodded once.
This was already our longest conversation ever.
“But the thing is, here’s the thing.” Lucky sat down in the grass, then flattened, on his belly.
“I lost a mother but gained a father.” He looked at my face. I waited. He launched again.
“My dad was near suicidal after she died. He’s 88, can’t imagine being alive without her, even if they were in different facilities for the money and all. So he’s telling people out loud that he doesn’t want to live, so they send in some psychiatrist and we’re just hanging around waiting.”
R., I should add, is the neighbor whose truck includes a detachable plow, so when it snows a lot and the county takes days to reach us, he drives around pushing piles of snow off to the side. I’m usually trying to make a dent with my wobbly shovel when R. does this, so I can run inside and grab a pan of warm brownies. (I tend toward baking when it snows.) He always says it’s not necessary, and always looks glad to take the brownies.
“So this young psychiatrist comes out of his room and says, ‘You know he was a P.O.W. for 190 days?’ and we’re all just staring at him. ‘No way. We never even knew he was in a war.’ So the doc says yep, 190 days as a P.O.W. and down to 80 pounds or so when he was freed.
“He never said a word about it. To any of us. Anyways the doc gives him some kind of medication and says ‘in a few days he’ll be feeling much better.’ And darn if he wasn’t a completely different man, maybe two days later!”
What could I do but keep trying to absorb all this?
“From PTSD, I guess,” R. added, “which none of us knew he had. I mean he wasn’t mean to us, but he was always short with his answers, never had much patience with us, like that. And oh! Turns out he has these deep, long scars on his back, which he never let us see! He never took his shirt off, even at the beach or something. But I saw them, just last week.
“And he didn’t want me to enlist, as the only son. He fought and fought that. Which now I understand. But my mother wore him down and I went anyway.”
(Me with a hundred questions to triage.) “Do you think your mother knew he’d been a P.O.W.?” R. didn’t know, but he guessed not even she ever knew. “Do you know why he finally told this doctor?” He wasn’t sure, but probably all the talk about suicide had just got him talking in general. “What war would this have been?” Korea.
I tried to pace myself. “Do you know what medication they gave him?” Nope, only his sister got to hear “medical-privacy stuff.” “Did your brothers and sisters get to meet the ‘new man’ too?” Yep, they all didn’t believe R. when he tried to explain. But when they got there and talked to him, they couldn’t believe this guy was their same father.
“Wow, R. It’s like, you just met your Dad.”
He nodded again.
“What a trip you had. I’m so glad you got to meet your father. At 88.”
(Every now and then, over the years and with enough visits to my father’s various addresses, I'd feel like I met my dad. Once, on his lanai in Florida, he mentioned that the cafeteria in Saigon only played 3 songs. It got to the point where he was so sick of those songs he couldn’t eat there any more.
I asked him what were the 3 songs. Without a blink he said, “Don’t Sleep in the Subway, Darlin,” “Georgy Girl,” and “I’ll Be There.” Oh wow, I might have guessed the Petula Clark and The Seekers, but the Jackson 5? I started singing their “I’ll Be There” and my Dad said, “No … It went like this:” He started singing The Four Tops’ “Reach Out (I’ll Be There)”* like he’d just come from that cafeteria.)
(I’m so glad he told me something about the building where he worked. And that I asked him what songs. They’re like a leavening agent, for the few other memories he also shared, in glimpses and over time and much less musical.)
“Yep. Like I said, I lost a mother but gained a father.” R. finally moved a foot or two down the curb. Lucky jumped up. “All in all, a good trip. Okay Mary, have a good one!” And he was off.
Lucky pranced along and sniffed my lawn only briefly. He saw her! His crush!
The big, white floof on the next block was coming out of her house. Lucky loves that fluffy dog. He pulls and pulls on the leash so R. almost has to jog toward the house. But when Lucky gets close, he runs away. Sometimes he barks, running away.
All week I’ve been thinking about R.’s father, who held, underneath all that was visible, those unspeakable memories. No magic medication or trusty doctor to talk to. Been thinking about the millions, in American history alone, who came home with “shell-shock” or a “nervous breakdown,” as they called my father’s condition. Millions of families who didn’t or don’t know much about – or even the fact of – a family member’s traumatic episodes, and post-trauma stress.
The “end of a war” is hardly the end for anyone, especially the people whose towns and villages became battlegrounds. Just trying to live their lives, love their loves, walk their dogs, play the same songs over and over. I was relieved to hear President Biden say today that ‘the interpreters and their families’ would be brought to safety. Still, a whole lot of other people will remain, to face yet another version of warfare.
I’m not sure the “post” of post-trauma is even appropriate. It persists, present and pulsing and flexing, for decades, maybe generations, later.
At the same time, I’m grateful there are healers who can talk to an 88-year-old in upstate New York about a war he hadn’t mentioned in over 60 years. And grateful for medications now that could help him ‘free himself, to be himself’ as R. put it. My neighbor, gruff and generous, has a new father, his same father.
Very grateful to have meaningful work, in my small way, to help future healers become who they are, as long as they find doctoring a truly suitable path. This work path might be part of my own, decades-long grieving process, for a parent who didn’t die but never quite came home, and whom I had no hope of healing.
A parent finally free in late 2019, after the sound of Chopin eased the tremors in his muscles.
Thank you so much for reading.
Muffin
Here now are the Four Tops:
*https://www.youtube.com/watch?v=2EaflX0MWRo
Human body image:
https://www.britannica.com/science/human-body