Scanning, Zeroing In, and the Eyes of PTSD

I frustrate the nurses with whom I work. Greatly. In fact, I think I caused one of them to shake her head and roll her eyes at me so often, she simply had to retire, if not out of self-respect, then out of sheer exhaustion at least.

You see, they’re probably right: I probably do see too many patients.

Probably.

You now also probably see why she probably had to retire.

A complex dance often ensues, therefore, between the nurses in our clinic and the members of our OEF/OIF/OND staff (mental health practitioners who work with the combat veterans returning from the current controversies). The latter try to get direct access to me because they know I won’t say “No.” The former, knowing that I won’t say “No,” do all within their powers to intercept the access. This is actually easier than you might think, for I’m infamous for not returning voice mail messages. Consequently, sometimes the staff upstairs just give up and call the nurses directly, leading to negotiations for appointment times that make the NBA lockout look like another night of the boys snarfing down those hot wings at Hooters.

Ah, but OEF/OIF staff have discovered Microsoft Office Communicator! Furthermore, they have discovered that I have discovered it as well. They therefore have discovered that when that little green dot appears by my name on the dashboard, that’s their green light.

The nurses have discovered, therefore, that they might as well raise the white flag and simply pray that each day they can keep the waiting room from devolving into either a). a frat party, or b). a pack of seething wolves, each hound angling for the first strike whenever my door opens.

Thursday was no exception. Green light. Communicator message.

Yes, I eventually typed: have him come by at 1500h.

I think I’d just finished up with patient number thirteen or so when I walked out into the waiting area and noticed out of the corner of my eye a young man, average height, nondescript dress, watching the flat screen TV we have on our wall (one of those kooky “judge shows,” I think, or maybe Dr. Drew, who knows). I suspect that around patient nine I had forgotten about my morning conversation with my OEF/OIF/OND colleague, so as I headed back to my office, I had the dreaded “Oh, no, do I know him and have forgotten his name?”

I dashed to Communicator.

Deaton: Who is that young man out there? Do I know him?

Nurse: He’s the guy So-and-So sent down. From your call this morning.

Deaton: Oh. Yeah.

No reply. Surprise, surprise.

When I walked out to greet my patient, he turned from the TV to look at me. He’s in his late twenties, sharp facial features, sporting one of those stylish, five-o’clock shadows with attitude. He was built just like the gymnasts I remember from high school, as if at any moment he could have walked across the room, dusted his hands, and then raised his arm before grabbing the rings.

His brown eyes zeroed smack dab into mine as his every other facial feature seemed to be debating whether to follow suit. Odd, how relatively blank a face can appear, yet the eyes can jettison a gaze across an entire room that establishes for another set of eyes a demand that “no, you will not forget this moment, ever.”

“Good afternoon,” I said, quite aware of that demand yet, surprisingly, not at all intimidated by it.

He assayed a smile, genuine in intent, no doubt at all, yet, well, not exactly a 10.0 in execution. Not even a 6.0, to be truthful. Even from the American judge.

And just as suddenly as those eyes had asserted their demand, they dropped it.

This was supposed to have been a relatively straightforward consult. The man had had longstanding problems with an addiction to painkillers, and he’d already begun Suboxone, but couldn’t afford it in the private sector. He’d only recently learned about our program. The medication had been helpful, and he’d been pleased with the dosage he’d achieved.

“How have you been doing?” I asked.

He had been looking at me, but not. His eyes had been making the occasional dart around the room, but in a way that I’d never seen before. Not uncommonly do combat veterans scan my office as if scouting out simultaneously a). all exits and b). all blind spots that are going to have to be reconnoitered. This was different, though. He did not appear tense. Neither did he appear confused. For lack of a better term, he appeared to be fact-finding.

“OK enough,” he replied, certainly not annoyed–not as if I’d interrupted his completing his internal to-do list, in other words–but not exactly engaged, either. “Looking for a job.”

“What have you been looking for?”

“Something to use my degree in.”

“What’s your degree in?”

“Business management.”

“I see. From where?”

He told me.

“Where’s that?”

“Oh, I finished it online.” He then told me the school he had originally attended. It wasn’t a slouch of a school.

“How’d you end up finishing it online?”

That grabbed his attention, even if only for a few moments. He zeroed right in on me, probably only for about three seconds or so. But what a three seconds.

Then he looked away.

“I’d had x hours before I went into the military. After I got out, I tried to go back, but . . .”

His eyes shifted again, but somehow I suspected that the search had taken a turn inward. But I wasn’t sure.

“But I couldn’t do it. I had to do this presentation for a class, and . . . I just couldn’t do it. I would have done it fine before I went, but . . . I dropped out that day. Found Y school online soon afterwards. I finished my degree fine. Got a 3.9, actually. Would have even been higher, but . . . well, I messed up my last two classes. But I graduated.”

His gaze then returned to the room. Not with me. The  room. Whatever tension had briefly arisen, it was gone. Back to the to-do list.

Interestingly, though, my attention did not stay with his. I couldn’t help contemplating how Y school was not a stereotypical “online program,” but rather a division of a freestanding liberal arts school. He could not just have breezed through the curriculum, in other words, especially in business. A 3.9 could not have been a gift, a “thank you for your service” version of the old “Gentleman’s C.” He had worked for that.

Not being in a classroom apparently had made quite the difference.

“How did you end up in the military?”

That briefly brought his eyes back to mine. Same experience:  they seemed to be saying to me without any intimidation, but also without any hesitation: “Remember this moment. I’m taking you in. You take me in.”

Then again, they darted off.

“I was just . . . I don’t know, looking for something, I guess? For some reason for everything?”

“You find it?”

Without a hint of malice, but with the equal  intensity, his eyes beamed into mine, in a heartbeat, just as Sauron’s eye beamed onto Frodo whenever the latter had put the Ring on his finger. I felt no Ring Wraiths turning my way, fortunately. That isn’t to say, however, that I couldn’t have imagined some waiting in the wings if I were not to keep playing my cards right.

Then just as suddenly, he looked quite sad.

“I don’t know.”

“How many times were you deployed?”

“Twice.”

“When?”

He told me. “The second, it wasn’t . . . as bad. Piece of cake, really.”

“First time again, you were where?”

He told me. I remembered. Anyone who had been alive in the United States at the time would have remembered. It had been bad. Bad bad.

“How many did you lose?”

Off the eyes went, back inside, not Sauron-like,  but more Frodo-like, the Frodo who went back to the Shire after the Ring, looking, seeing that everything was the same. And not.  Never again.

“Injured, KIA?” he asked.

Yet as soon as he did so, the internal scan seemed to stop. For a few seconds he froze both of us in time, whether back then or now, I couldn’t tell you. He was just looking, somewhere. Then he looked back at me, in the way one does when one has to let another down as gently as possible.

“Total? I don’t know. I’d say, what, maybe forty percent? Maybe?”

A few seconds of silence. Eyes still connected to mine. Yet not.

“It never ended,” he continued. “Every day. It never ended.”

“Who’d you lose that you were closest to?” I tried to ask as gently as I could.

With that, his eyes ambled away, this time to some spot somewhere, far away from both of us.

He gave me a name.

“You with him when he died.”

At first he just nodded, his eyes apparently far too busy with a far-off scene.

“Truck in front of me,” he finally whispered. “Gone by the time I got there. He was the only one dead in the truck.”

Then Sauron returned, with his eyes instantly back on mine, yet still without malice, but rather with an intensity that only comes from traveling several thousand miles in a matter of moments.

“It was crazy when we got back. Suicides, accidents, jail, everything. We all . . . none of us were dealing with it. None of us.”

“You stay in touch with any of the guys?”

That brought a smile, sans continued gaze, however. He’d already wandered back to the to-do list.

“Yeah, one. Used to talk to him every day. Now it’s once or twice a week.” He chuckled. “We both had the highest score on . . . oh, what’s that test?”

“The ASVAB?” I asked, referring to a standardized military aptitude test.

“Yeah, the ASVAB. I think we both had the highest scores in the whole battalion, someone later told us.”

That piqued my interest.

“And you went straight infantry? That’s . . . not usual, is it? I mean, you had your pick of jobs, right?”

His eyes returned to me, along with a smile, too tired to be sardonic, too sardonic to be tired.

“Yeah.”

“So why infantry?”

Again he looked away, as if preparing to give himself a lecture he was well familiar with.

“I don’t know. I wanted to carry a gun, maybe, do what a serviceman is supposed to do, I guess? It sounded cool enough.”

He paused. His eyes slowly returned toward mine.

“They don’t tell you what it’s really going to be like.” Another pause. “I don’t know if they even can.”

And then the eyes were off, with a brief stop inward, then back to to-do.

We talked some more, about his opiate usage, about heroin. Painkillers had done the trick, that much I can say. So much so that he hadn’t had to feel when on them. When he’d been strung out, his gaze might still have been wandering in its endless site inspection, I don’t know. But if it had–he hadn’t cared.

On Suboxone, though, it was becoming a different matter.  Fewer cravings = more feelings.

I decided in the end to go for broke.

“You know, a part of you looks as if you’re  not at all engaged when we talk.  Yet it’s so obvious: that’s a ruse.  You’re deeply engaged. And you know it.  But it’s like, what . . . you’re not sure you want to come back out into the world?”

It was as if his eyes then turned on their heels, called away from whatever they’d been looking at, but turning slowly, even curiously. They paused, his eyes, and then it was as if they walked right up to mine.

Neither of us moved.

“Sounds about right,” was all he said.

I didn’t feel intimidated at all. But I did feel as if I had to watch my step. Why, I couldn’t have told you. But I had to watch my step.

“You have too much going for you, you know. You’re smart, intense, driven, attractive. You’ve got what it takes. But you’re not going to be able to use it, live it until you face the War inside you.”

Our eyes were toe-to-toe, if one could say that. He eyed my eyes, up. And down. Nothing else. Just my eyes, my gaze. Up. And down.

“I know,” he whispered, then, “I’m not sure I’m ready.”

I explained to him his various options, including the Prolonged Exposure Therapy and the Cognitive Processing Therapy that many of my colleagues offer. I told him that I worked in a way similar to how we had already been talking. I assured him that the former therapies can be quite effective for improving emotional regulation. I said that vets who feel a need to talk more had found it sometimes useful to talk to me, even if that might mean a slower pace. I stressed that the decision was up to him.

He looked curious, even a bit amused. “You mean you just don’t hand out Suboxone?”

I smiled. “I don’t have to–do just that, I mean.”

His eyes now literally eyed me head-toe.

“Maybe twice a month, maybe?” he finally asked, inspection apparently complete, assessment finished. “You think? I . . . I’m not ready for anything more. That . . . that OK with you?”

I had to smile. Fair enough, I thought. Fair enough.

“Absolutely,” I replied.

So we set up a time.

Neither of us is prepared, of course, for what lies ahead. We both know that. We’ll see.

But again, since it’s been about the eyes from the start–what else could we do?

3 responses

  1. You see, this is bigger than you. You have tremendous energy. If Undercover Boss came to your clinic with Eric Shinseki costumed as a patient, he’d pick you for the gold star. We have to change the mentality to more like yours. Thanks for your hard work … And please thank the nursing staff which looks out for you.

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