“Have you seen ‘Saving Private Ryan’? What do you think about soldiers searching for a soldier to bring him home?” asked my patient. Of course, I’ve seen Saving Private Ryan. I told him that I couldn’t imagine what that war would have been like – the sights, the sounds and seeing the loss of lives. I also responded that any loving mother would want her children to be safe. “Even if lives of searchers are lost?” asked my patient. I responded that I hadn’t really thought of it that way. I didn’t really have a thought out response because I realized what he was really asking was whether it was worth it to risk the lives of others for the life of one.
We’ll call my patient George…. I’ve treated George off and on over the last 7 years. He’s a Vietnam War veteran who experiences back pain every day. I’ve never really been very helpful with assisting him with relieving his symptoms. He’s on high doses of narcotics and has been since his return from the war. He has always been quiet… every visit I try my best to somehow connect with him. I’ve failed miserably episode after episode.
This episode seems different. I’ll give my daughter the credit. This summer our daughter has been employed as my office manager. George definitely warmed up to her. The ice was broken and the connect changed one day a couple off weeks ago. He asked my daughter if she had a knife. My daughter looked at him and without missing a beat responded, “I have scissors which are 2 knives put together,” as she proceeded to hand them to him. That was the first time I ever saw him smile.
George’s long-term goals are to be no longer dependent on narcotics for pain control. This episode of care is for hip pain. His body language indicates hopelessness, lack of confidence and depression. He never looks me in my eyes. He’s got a lot on his mind about the future. He was recently diagnosed with Parkinson’s (related to his exposure to Agent Orange while in the Army during the Vietnam War). He owns a business in town and knows he needs to either close the doors or sell. He’s just not ready to do that yet.
After all these years George has begun opening up to me. Toward the end of his tour in Vietnam, he had a new “boss” giving orders. The boss demanded that the troops under his supervision needed to change their tactics and do everything by the book. I have no military background, so I don’t understand ranks or titles. George was supposed to lead his men through an area to clear some village. When the village was cleared, air support would be contacted. “Doing it by the book” meant that he would no longer be in the lead position as what had been common practice. He would be mid-pack next to someone with a communication device. The “lead” would be a young soldier. I could hear the anguish in George’s voice. He did not believe his boss was correct; he knew that for safety of all the men, he needed to lead the group through the grass. Seconds before disaster happened, George saw a flash of a line, but before he could do anything, the young leader triggered a trip wire which set up a chain of explosives. Everyone died except for George.
George was told that the fighting was intense. The helicopters above were ordered to leave… and all but one did. The team in one helicopter refused – that team was not leaving anyone behind. The team landed in monsoon like rain. The scene on the ground was horrible: body parts and boots. George was lying on the ground, face up. He remembers rain hitting his face. He couldn’t move or talk… and then, he remembers the dark: someone covered him with a tarp. That was the last he remembered. For some reason, he was not brought to safety at that time. A couple of days later, while under fire, a team was sent to rescue any soldiers still alive. He was told that it was by chance that someone uncovered him and actually assessed him. He was the only surviving soldier… and during the mission that rescued him, 5 soldiers died.
I believe George gave me the greatest gift: insight into him. I understand most of the pain science recommendations. George has seen many specialists. I don’t have the heart to “educate” him about pain… I think, now that I have a glimpse into who he is as a person, that there may be something far more important to tell him.
My impression: George has been living with guilt for a very long time. Every life he was responsible for that day died under his command. He knew his “boss” to be very wrong, yet he did as he was commanded to do. And then… after losing every soldier that day, 5 more lives were lost saving his life. I feel that in a way he’s been punishing himself. I plan on opening my heart next week… my messages: #1) God loves him. #2) forgive himself. I am hoping that George may find peace and as he does that his pain begins to subside.
Until next time,