He came in without an appointment, first to our Access Center, then directly to me.  It was time:  he had to get off the dope.  He couldn’t live like this any more.

When persons first come to me in my role as the doctor who provides Suboxone, the remarkable medication that helps many opiate addicts find a second chance at life, they are never in good shape.  To start on Suboxone, one needs to be in the early stages of opiate withdrawal, which is anything but a fun state:  gastrointestinal disturbances (nausea, diarrhea), temperature dysregulation (hot and cold flashes), severe muscle cramping–in short, a generalized state of ick.  None of my patients first encounter me with a bounce in their step–with the ill-temper of a bouncer, maybe, but never with a bounce.

He presented as quiet, even a bit timid.  I could still feel the Marine in him, though:  the occasional flash of the “can we get the point, please?”  The disgust of a drill sergeant with a new recruit (i.e., himself) who just can’t seem to get it.  But all things considered, he was respectful and cooperative.  He merely wanted all this crap over with.

Good news:  since then, a lot of the crap is over with.  He is feeling better.  Physically.

Also since then, I’ve heard from others that he has not always presented himself thus.  He has in the past had a far more confident air about him.  He has made an impact on people that has been quite lasting.

Eventually I asked him about this.

“You know,” he told me, “I’ve thought a lot about what you said in the beginning, about how a lot of guys feel as if a part of them died over there.  That’s what happened to me too.  Ever since I’ve been back, it’s as if I’ve been trying to create this new person for the world, somebody who people would like, somebody who doesn’t get all angry, who’s put together, confident, ready to take on the future. Lots of people think that’s who I am.  So I keep trying to make that guy–but it isn’t working.  The foundation just isn’t there.  I keep asking myself what I’m doing wrong, and I can’t come up with any answers.  I don’t know what to do.  I’m lost.”

“How has love been for you?”  I eventually ask.

He drops his head. “You wouldn’t believe the number of women I’ve dated since I’ve been back.  And I’ve just been awful.  I reach a point, and I  get bored, and I disappear–well, all except my current girlfriend, though.  She’s stuck with me through all this drug stuff, encouraged me.  She really loves me.  I say I love her, but I’m afraid I don’t.  I’m afraid I’m going to hurt her, really badly.  I don’t know if I’ll ever be normal.  All I want is a family, a house, a career–to help people.  That’s it.  But I’m so self-destructive.”

Fortunately he has not recently had any thoughts of suicide.  But he has indeed more than once contemplated swallowing a gun.  It’s serious.

His story is an all-too-familiar one.  His best friend in the world was blown up right next to him.  He shouldn’t be alive–literally.  In any previous war, he’d have become another name etched on a memorial.  His picture is right next to the dictionary entry for “survivor guilt.”

Yet that’s not all he is.  He is a guy, for example.  We guys are not that hot at closeness.  We know we want it, but we’d all prefer that we wouldn’t have to get all caught up in that mess, you know what I mean?  Come on, women in our lives:  you know the drill, don’t you?  I mean, we’re still here, right?  If we didn’t want to be, we wouldn’t be.  Right?

He’s also a guy on the verge of life.  A talented guy on the verge of life.  You know, I’ve been able to feed and clothe my family off the notion that somehow–don’t ask me how–intense, thoughtful men should be able to figure out where they can put their ambition, do so while also being confident but not obnoxious, while being a regular “guy” your buddies would want to hang out with, while also being a decent partner and dad who can be comfortable and supportive at home, at all times, all the while rising to become the top of their game–and doing all that easily and happily.

True confession:  I bought into that once myself.  I think my therapist was able to remodel a whole wing of his house as a result.

My therapist enjoys that wing, I’m sure.  Lucklily, in the process, he also–finally–got me to see that maybe I too could start getting real and yet enjoy life as well.

The point of today’s post is the same as the one over the past several posts:  never, never, never fall into the trap of believing a combat veteran when he or she tells you–no, believes with all his or her heart and mind and repeatedly, repeatedly tells you, if you’d only listen, numbskull–that he or she is all-PTSD, all-the-time.  Never.

For the guys, certainly:  never, never, never let them think that if only they’d not gone to war, they’d have breezed into love and work like all the other “normal” men around them.  (If ever LOL was to find its utter fulfillment, it would that last statement, believe you me.)  Never.

“Listen,” I eventually said.  “Did losing your best friend in the world and not even knowing it until long after he’d been in the ground, all because it took you that long to recover enough to open your eyes–did that change you forever?  Yes, it did.  Will love be hard because you never want to hurt like that again, never want to feel the pain of someone for whom you’d die in a heartbeat having the gall to die before you had a chance to prove that?  Yes, it will.  Are you lost because a big part of you believes down to your core that a loser like you, daring to breathe while others far better than you are mere memory, should never be allowed to find a way anywhere, ever?  Yes, you are.”

“But you’re more than that.  You don’t feel it, but your not feeling it doesn’t make it false.  Even if you’d never boarded that plane heading over the Atlantic, you’d still be terrified of closeness with a partner, uncertain whether you could ever make something of yourself, fret over which way to turn now, whom to trust, what to do next.  You think you’ve been creating this “actor” as if he were some figment of your imagination, smoke-and-mirrors out of whole cloth, the phony of phonies, hoping against hope that no one will catch you in the act?

“Wrong.

“You’re a guy.  You’re a guy who’s seen some really bad things.  You’re a guy who’s lived some really bad things.  You’re all that–and you’re not.  Our task ahead of us is not going to be an easy one, but we can’t shirk the mission:  you’ve got to become more able to tease apart what’s PTSD and what’s normal-guy-ridiculousness.  Every young buck has to be tamed, at least to a certain extent.  And you, my friend?  Let’s face it:  you’re quite the young buck.”

He did look away–very briefly–on that one.  Yet I caught that hint of a smile.  Good for him.  We’ve got something to work with.

The combat veterans we work with desperately need a narrative to add to the “I’m just War” story they tell themselves day in, day out.  Good news, folks:  there is one.  It’s called “human trying to make it in this world.”  Their PTSD will complicate that narrative–but it will not obliterate it.  Never, never, never let them go on thinking that.  Never.

Your reward?  The combat veteran’s “real me.”

It’s worth the effort.  For both of you.

I can hardly wait to see it in him.

It’s the smile.  Gets me every time.