Care of returning veterans: a story from the field

A physician reader of AFP's July 1, 2010 issue shared the following post.

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I read with keen nostalgia your insightful and excellent article, “Care of the Returning Veteran.” I retired from the Navy in October 2007 and currently serve as the Director of the Deployment Stress Management Program at the U.S. Department of State. On April 16, 2007, our 2nd Marines Logistics Group, 2nd Shock Trauma Platoon had been in Al Taqaddum, Iraq in the Anbar Province for 2 months out of an 8 month deployment. We flew from Camp LeJeune, North Carolina, to Scotland, then spent four days in Kuwait before entering Taqaddum, Iraq inside of a hot C-130 plane.

While serving as the Combat Stress psychiatrist in the Post-Anesthesia Care Unit, I remember attempting to move the remains of Lieutenant Jones (not his real name) from a torn and leaking body bag to a new body bag. The emergency and surgical physicians, nurses and hospital corpsmen were occupied with incoming wounded in the shock trauma bay down the hallway of our large wood and tin Quonset Hut-shaped building. A psychologist colleague came to assist, but did an abrupt about-face when she recognized Lieutenant Jones. As a company Commanding Officer, he had often telephoned or stopped by to refer one of his troops for emotional support or to assess fitness for duty. Lieutenant Jones had stepped on an explosive device that blew off his legs and ends of his arms. His face was charred and partially separated from his skull, suggesting that he had been killed immediately and felt no pain.

I remember being engulfed by nausea and a surreal emptiness. I felt as if Lieutenant Jones was spiritually nearby and not letting go of his previous life, waiting to see if I would "screw up" and move him somewhere against his desires. I briefly and intensely thought about his family. Finally, I moved forward and asked two corpsmen next to me to each take a corner of the leaking body bag and carefully and respectfully empty it into the new and recently opened bag. Lieutenant Jones's body slipped effortlessly inside. Additional personnel arrived shortly to ensure that his personal items were accounted for, then closed the new body bag. An ironed United States flag was unpacked, unfurled and placed gingerly across the body bag.

Many State Department employees share in today’s overlapping deployments with Department of Defense veterans, serving in forward operating bases in Iraq and other hazardous areas of the world. The Department of State's Mental Health Department evaluates and treats many returning employees for post-deployment stress reactions and disorders that include post-traumatic stress disorder and traumatic brain injury. These unheralded heroes of the backwaters who work in Provincial Reconstruction Team areas of Iraq, as well as other deployments, serve one to five year tours of duty often in the most austere conditions. We wish to remind AFP's readers of their service during these challenging times.

Christopher J. Kowalsky, MD
CAPT, MC, USN (Retired)
Director, Deployment Stress Management Program
U.S. Department of State

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The cover article of AFP's July 1 issue, "Care of the Returning Veteran," elicited several heartfelt responses from veterans and physicians who have provided care to military servicemen and women and their families. The next blog post will include an excerpt from one particularly moving response. If you are interested in writing for the AFP Community Blog, please contact me. In the meantime, welcome again!

Kenny Lin, MD
Associate Editor for AFP Online
American Family Physician
kwl4@georgetown.edu