Tag Archives: In vivo exposure

The Aftermath and #PTSD

Fourth of July is over, and with it comes recovery from a myriad of ailments.  Over eating BBQ, little sleep at night, and of course, recovering from fireworks and the memories I carry with them are the typical aftermath of this holiday weekend.  (my dad has a soft serve machine, it is impossible for me to resist helping myself to many ice cream cones…)

Quick reflections on July 4th

My neighbor behind my house must have a connection with Grucci because the fireworks display was spectacular.  It was a solid 40 minutes and a loud 40 minutes at that. My boys were in my lap and they asked to move from our behind glass indoor position to our back patio.  I obliged and we sat through the remainder on July 3rd outside.

It was intense.  They sound the same and bring the emotions right back.  I was overwhelmed at first, but remembered that the In Vivo only works if you remain immersed.  Plus, my son was firmly planted on my lap and he was not having me go back inside. I was able to talk with my wife and get through it.  By the end, I was proud that I succeeded in tackling my PTSD goal for the weekend.  It wiped me out, and I spent most of 4th on the couch, but I did it.  Which is my lead in to the title of this post: the aftermath.

What happens after?

I feel that the aftermath of traumatic events, and how they are handled and processed, both in groups and individually, is a critical step in lessening the severity and long term impact of the events.  Trouble is, in war, you are most definitely dealing with immediacy and not trying to get to far ahead of yourself.  If you look to far ahead, you get distracted, lose focus and miss an important mission.  If you dwell, you get bogged down and stuck in the mud.

You have to keep moving.  Moving keeps you alive.  We most often cannot take a timeout to review what just happened and explore our feelings. And that is exactly where the trouble starts.  It is a more exquisite form of a catch-22.  We must pay later to get through today.

It is my opinion that tempo has a lot to do with the lasting effects of PTSD.  The longer and harder the tempo, the less time to deal with what may be creeping up, the deeper it is ingrained.

Again, it is not the Armed forces job to completely manage the tempo.  The situations, dire and dangerous, dictate the pace.  But, I can assure the Army that the prolonged grind and staring into more deployments led to my exit, and I am sure it led to a few of my compatriots exit as well.

The Makeshift Field Hospital

In one particular instance, we did an out brief after a horrendous day.

The morning started with a car bomb vaporizing a dozen people and leaving hundreds more injured.  My unit housed the Forward Aid Station (FAS) and when the hospital in town was overflowing, we opened our gates to treat the wounded civilians.

They came in literally by the truck load.  Missing arms and legs, facing third degree burns, and quickly reaching our max capacity I spent that day doing triage assisting our stellar Medics.  It was so bad we pulled our line mechanics in to give IVs just so we could have more hands.  It is an understatement to say I am haunted by the children I saw that day, and unfortunately there are many.  We worked for hours upon hours calling in MEDEVAC choppers and treating the wounded.  When we were finished, we were left bleaching out all of the blood stains in the concrete at dusk still reeling from our impromptu hospital.

That night we sat with a counselor as a group and talked openly about our feelings and what happened.  I started with this, “Every time I walked past my room all I wanted to do was go sit on my cot in the corner, put my poncho liner over my head and cry.”

I didn’t.  I kept moving and stayed alive.  The aftermath is where you can get a lot of good work done, if the time permits.  I am grateful for that hour we spent talking that night.  It is a luxury in a combat zone that doesn’t come often.

The Aftermath has just begun

But, this just reinforces the need for our VA system to be stocked with staff eager to take us on.  The aftermath is still going on.  It will be for years.  We need the system that understands us and is sworn to continue our care to step up.  We need citizens to accept us as Veterans and embrace us on our road back to normalcy.

I can still vividly see a small boy who was burned down half his body and barely crying on a cot while we gave him an IV. The aftermath of these wars has only just begun.

The Obligatory “F-ing Fireworks!” and #PTSD 4th of July Post

Aptly Named Artillery Shells

Look at the pretty fireworks…

Last year was the first year since coming back from Iraq that I actually enjoyed watching fireworks.  Granted, it was from a distance, behind glass, with music playing while holding my kids on my lap, but hey, I will take whatever wins I can get.

My first deployment we received mortars steadily.  To put it bluntly, they suck.  In that deployment, our particular flavor of mortar attacks was even harder to swallow since we could not return fire.  Somehow, when you get to shoot back, you feel better because at least there is a remote chance of catching the bastard trying to send you the mortars.

At one point we were mortared every night for a week.  By the end we averaged an attack every three days.  Receiving mortars is one of the most helpless feelings you can have as a Soldier with the worse style coming when you lose a friend because of them.   The reason for this post is that those feelings come rushing back when you are caught off guard by some celebratory fireworks, and sometimes even when you prepare.

“INCOMING!”

When a mortar attack starts you hear, and sometimes see, the “flash”. Seconds later, with the “Bang”,  all hell is breaking loose in a whirl of screaming metal.  As I reviewed my journal from my first deployment I re-read entries about the mortar attacks, and having nightmares about mortars.  With fourth of July coming I have been trying to think of witty ways to approach and describe what it feels like to be mortared.  Unfortunately, I am at a loss.  It is, like love, something that needs to be experienced.  Once you have, you can stumble around for the rest of your life looking for the words.  You can read Shakespeare, but until you know love, you will not fully appreciate his words.  I can write about it.  You can read it.  But, full appreciation is not reached without experience.

I will say this, when you have been mortared and they land next to you, you can truly say you know what  terrified and helpless feels like.

An aside for a Charmin Moment..

(I can also add with with respect to mortars, they are most terrifying when you are trying to take a shit.  All of my journal entries exploring mortar attacks revolve around wanting to die with my boots on and my rifle in my hands.  And I quote, “I just don’t want to eat it with my pants around my ankles on the shitter.” We even had an Air Force guy in a neighboring camp get knocked out when a mortar landed two shitters down from him.   Most guys, for this reason, try to time their movements away from the mortar attack trends. But I digress…)

Still give me the shakes

I was riding my bike not a week ago and rode past, without seeing them, some people setting off fireworks.  When the unexpected fireworks go off, my first thought was and continues to be “Mother fucker!”.  (See, there is that anger again.).   If I know they are coming and I can prepare, I can tolerate the noise and the feelings.  Unfortunately, living in the burbs, there are not fireworks announcements or advertising like at a baseball game.

Look, I’m all about celebrating our nations’ Independence.  I love BBQs and sparklers.  I’m not going to bash, criticize or suggest that people are insensitive to Veteran’s when they start lighting those fireworks off.   It’s just that when the fireworks start going off,especially the mortar type, I would rather be inside.

Knowing this, I am going to take the time this year to embrace my avoidance of fireworks.  Hell, I may even go buy some.  I will count this as my In Vivo exposure for the weekend and report back later.

So, for all you fireworks fans out there, let’em fly!  (and I’ll be sure to try and schedule my “movements” during the day.)

Crowds, a baseball game and #PTSD

I am going to a baseball game tonight. Since coming back from Iraq, I have generally not had good times at baseball games and not because I am a New York Mets fan. I don’t like crowds and in general the traffic (public trains or the LIE) gets me anxious and I don’t have panic attacks so much as angry attacks.

(I have had exceptions, I saw Endy Chavez make the catch from Row V in Shea. Even though the Metsies lost that was a magical night and I was on a hell of a lot of meds..)

In any case, tonight is an opportunity for me to succeed. I recently completed Prolonged Exposure therapy at the Northport VA. PEt has two parts: imaginal exercises and in vivo exposures.

Imaginal Exposure: To summarize in my own words, you sit with your eyes closed and talk in the first person about really crappy traumatic experiences, record it, listen to it all week, then do it over and over. With each iteration the experience uncovers more thoughtful reflection as well as a greater perspective on the traumatic events. It sucks. Like all therapies related to PTSD, it gets harder before it gets easier.

In Vivo Exposure: Then there are homework assignments for in vivo exposure. This is the fun summary: pick out a mess of things you avoid like the plague, rate them from one (in bed about to fall asleep) to one hundred (In the shit bullets flying). Then go do them.

Avoiding public transit? Go ride the subway. Don’t like war movies anymore? Watch Restrepo… Twice. Hate crowds? Go to a Ballgame!

(When my wife heard that one she rolled her eyes, but I can assure you, this is legit.)

As I was immersed in each homework assignment, I was tasked with keeping tack my feelings and mood. It is sort of like embracing the mental suck. But, as advertised, things get easier and easier.

So, tonight is another opportunity to succeed. Let’s Go Mets!